Vaccination of teenagers in France over a 10-year period (2012-2021).

OBJECTIVES: The objectives were to assess trends over the past 10 years in vaccination coverage rates (VCR) among adolescents in France aged 14-15 years, factors influencing decisions to vaccinate, and mothers' opinions on adolescent vaccination. PATIENTS AND METHODS: The 'Vaccinoscopie' internet survey is completed each year by mothers of adolescents, with questions about vaccinations received by their children, and their attitudes and barriers to vaccination. The 2012 to 2021 surveys were analyzed in this study, including data from 1500 adolescents in 2012 and 1000 adolescents each year from 2013 to 2021. RESULTS: None of the adolescent VCR targets were met, despite significant increases since 2012 for vaccines with the lowest coverage rates and vaccines with high but insufficient coverage i.e., meningococcal C (28.7% to 60.8%), HPV in girls (14.2% to 40.8%), hepatitis B (31.6% to 47.3%) and pertussis (76.3% to 91.0%). Physicians remained the primary source of vaccination information for 90.4% of mothers, and their advice had a real impact on improving VCRs. Adolescents were increasingly involved (40.1%) in decisions about vaccination. Depending on the vaccine, over 80% of mothers currently consider adolescent vaccination as useful or essential. Since 2017, they also feel better informed. CONCLUSIONS: Low and under-target VCRs put adolescents at risk of severe disease, and do not enable herd immunity or reduced transmission to other vulnerable age groups to be accomplished. Healthcare professionals must take every opportunity to check adolescents' vaccination status and recommend catch-up vaccines where applicable. Vaccination in schools should be considered.

SPILF update on bacterial arthritis in adults and children.

In 2020 the French Society of Rhumatology (SFR) published an update of the 1990 recommendations for management of bacterial arthritis in adults. While we (French ID Society, SPILF) totally endorse this update, we wished to provide further information about specific antibiotic treatments. The present update focuses on antibiotics with good distribution in bone and joint. It is important to monitor their dosage, which should be maximized according to PK/PD parameters. Dosages proposed in this update are high, with the optimized mode of administration for intravenous betalactams (continuous or intermittent infusion). We give tools for the best dosage adaptation to conditions such as obesity or renal insufficiency. In case of enterobacter infection, with an antibiogram result "susceptible for high dosage", we recommend the requesting of specialized advice from an ID physician. More often than not, it is possible to prescribe antibiotics via the oral route as soon as blood cultures are sterile and clinical have symptoms shown improvement. Duration of antibiotic treatment is 6 weeks for Staphylococcus aureus, and 4 weeks for the other bacteria (except for Neisseria: 7 days).

Quality of antibiotic prescribing to children through the coronavirus disease 2019 (COVID-19) pandemic.

Objective: To describe pediatric outpatient visits and antibiotic prescribing during the coronavirus disease 2019 (COVID-19) pandemic. Design: An observational, retrospective control study from January 2019 to October 2021. Setting: Outpatient clinics, including 27 family medicine clinics, 27 pediatric clinics, and 26 urgent or prompt care clinics. Patients: Children aged 0-19 years receiving care in an outpatient setting. Methods: Data were extracted from the electronic health record. The COVID-19 era was defined as April 1, 2020, to October 31, 2021. Virtual visits were identified by coded encounter or visit type variables. Visit diagnoses were assigned using a 3-tier classification system based on appropriateness of antibiotic prescribing and a subanalysis of respiratory visits was performed to compare changes in the COVID-19 era compared to baseline. Results: Through October 2021, we detected an overall sustained reduction of 18.2% in antibiotic prescribing to children. Disproportionate changes occurred in the percentages of antibiotic visits in respiratory visits for children by age, race or ethnicity, practice setting, and prescriber type. Virtual visits were minimal during the study period but did not result in higher rates of antibiotic visits or in-person follow-up visits. Conclusions: These findings suggest that reductions in antibiotic prescribing have been sustained despite increases in outpatient visits. However, additional studies are warranted to better understand disproportionate rates of antibiotic visits.

The impact of apraxia and neglect on early rehabilitation outcome after stroke.

BACKGROUND: This study aims to characterize the impact of apraxia and visuospatial neglect on stroke patients' cognitive and functional outcomes during early rehabilitation. Prior work implies an unfavorable effect of visuospatial neglect on rehabilitation; however, previous findings remain ambiguous and primarily considered long-term effects. Even less is known about the impact of apraxia on rehabilitation outcomes. Although clinicians agree on the significance of the first few weeks after stroke for the course of rehabilitation, studies exploring the impact of neglect and apraxia in this early rehabilitation period remain scarce. METHODS: Based on a screening of 515 hospitalized stroke patients from an early rehabilitation ward, 150 stroke patients (75 left-hemispheric strokes, 75 right hemispheric strokes) fulfilled the inclusion criteria and were enrolled in this observational, longitudinal study. The patients' cognitive and functional statuses were documented at admission to the early rehabilitation ward and discharge. Also, detailed apraxia and neglect assessments were performed at midterm. The predictive values of age and apraxia and neglect severity (as reflected in two components from a principal component analysis of the neglect and apraxia assessments) for cognitive and functional outcomes at discharge were evaluated by multiple regression analyses. RESULTS: Besides the expected influence of the respective variables at admission, we observed a significant effect of apraxia severity on the cognitive outcome at discharge. Moreover, neglect severity predicted the Early Rehabilitation Barthel Index (Frühreha-Barthel-Index) at discharge. Supplementary moderator analysis revealed a differential effect of neglect severity on the cognitive outcome depending on the affected hemisphere. CONCLUSION: Data indicate a strong association between apraxia and visuospatial neglect and early rehabilitation outcomes after stroke.

Changing profile of encephalitis: Results of a 4-year study in France.

CONTEXT: In 2007, we performed a nationwide prospective study to assess the epidemiology of encephalitis in France. We aimed to evaluate epidemiological changes 10years later. METHODS: We performed a 4-year prospective cohort study in France (ENCEIF) from 2016 to 2019. Medical history, comorbidities, as well as clinical, biological, imaging, and demographic data were collected. For the comparison analysis, we selected similar data from adult patients enrolled in the 2007 study. We used Stata statistical software, version 15 (Stata Corp). Indicative variable distributions were compared using Pearson's Chi2 test, and means were compared using Student's t-test for continuous variables. RESULTS: We analyzed 494 cases from 62 hospitals. A causative agent was identified in 65.7% of cases. Viruses represented 81.8% of causative agents, Herpesviridae being the most frequent (63.6%). Arboviruses accounted for 10.8%. Bacteria and parasites were responsible for respectively 14.8% and 1.2% of documented cases. Zoonotic infections represented 21% of cases. When comparing ENCEIF with the 2007 cohort (222 adults patients from 59 hospitals), a higher proportion of etiologies were obtained in 2016-2019 (66% vs. 53%). Between 2007 and 2016-2019, the proportions of Herpes simplex virus and Listeria encephalitis cases remained similar, but the proportion of tuberculosis cases decreased (P=0.0001), while tick-borne encephalitis virus (P=0.01) and VZV cases (P=0.03) increased. In the 2016-2019 study, 32 causative agents were identified, whereas only 17 were identified in the 2007 study. CONCLUSION: Our results emphasize the need to regularly perform such studies to monitor the evolution of infectious encephalitis and to adapt guidelines.

Protocol for DexEnceph: a randomised controlled trial of dexamethasone therapy in adults with herpes simplex virus encephalitis.

INTRODUCTION: Herpes simplex virus (HSV) encephalitis is a rare severe form of brain inflammation that commonly leaves survivors and their families with devastating long-term consequences. The virus particularly targets the temporal lobe of the brain causing debilitating problems in memory, especially verbal memory. It is postulated that immunomodulation with the corticosteroid, dexamethasone, could improve outcomes by reducing brain swelling. However, there are concerns (so far not observed) that such immunosuppression might facilitate increased viral replication with resultant worsening of disease. A previous trail closed early because of slow recruitment. METHOD: DexEnceph is a pragmatic multicentre, randomised, controlled, open-label, observer-blind trial to determine whether adults with HSV encephalitis who receive dexamethasone alongside standard antiviral treatment with aciclovir for have improved clinical outcomes compared with those who receive standard treatment alone. Overall, 90 patients with HSV encephalitis are being recruited from a target of 45 recruiting sites; patients are randomised 1:1 to the dexamethasone or control arms of the study. The primary outcome measured is verbal memory as assessed by the Weschler Memory Scale fourth edition Auditory Memory Index at 26 weeks after randomisation. Secondary outcomes are measured up to 72 weeks include additional neuropsychological, clinical and functional outcomes as well as comparison of neuroimaging findings. Patient safety monitoring occurs throughout and includes the detection of HSV DNA in cerebrospinal fluid 2 weeks after randomisation, which is indicative of ongoing viral replication. Innovative methods are being used to ensure recrutiment targets are met for this rare disease. DISCUSSION: DexEnceph aims to be the first completed randomised controlled trial of corticosteroid therapy in HSV encephalitis. The results will provide evidence for future practice in managing adults with the condition and has the potential to improve outcomes . ETHICS AND DISSEMINATION: The trial has ethical approval from the UK National Research Ethics Committee (Liverpool Central, REF: 15/NW/0545, 10 August 2015). Protocol V.2.1, July 2019. The results will be published and presented as soon as possible on completion. TRIAL REGISTRATION NUMBERS: ISRCTN11774734, EUDRACT 2015-001609-16.

Evolution between 2008 and 2018 of mothers' perception regarding vaccination and infant vaccine coverage in France.

OBJECTIVE: Monitoring of vaccination coverage rates (VCRs) is essential to assess the implementation of a country's vaccine policy and its effectiveness. Through the French Vaccinoscopy study, we measured the evolution of VCRs as well as mothers' opinion towards vaccination between 2008 and 2018, before and after implementation of infant mandatory vaccination extension. METHODS: This is a study based on an internet-standardised questionnaire. In 2018, a representative sample of 3000 mothers of infants 0 to 35 months of age answered on their opinion on vaccination and reported all vaccinations recorded in their child's health record. RESULTS: On the period considered, infant VCRs were stable and high for diphtheria, tetanus, poliomyelitis, pertussis and pneumococcus components and progressed for measles, mumps rubella, 2 doses at 24 months of age from 45.3% in 2008 to 81.0% in 2018, hepatitis B (HepB) complete primovaccination at 6 months of age from 45.9% in 2008 to 86.3% in 2017 and 95.5% in 2018, and meningococcus C (MenC) 1 dose at 6 months of age from 43.0% in 2017 to 74.2% in 2018. In 2018, 69.0% of mothers were in favour of vaccination while this rate dropped from 80.2% in 2012 to 64.0% in 2017, and 80.8 to 89.6% perceived HepB, MenC measles and pertussis vaccinations as useful/essential, percentages in progress versus 2017. CONCLUSION: Following the implementation of infant mandatory vaccination in 2018, proportion of mothers in favour of vaccination increased significantly. HepB and MenC VCRs significantly progressed between 2017 and 2018.

[Prevention of postoperative or associated of care pelvic inflammatory diseases. Is there a need for antibiotic prophylaxis for first trimester surgical-induced abortion to prevent pelvic inflammatory diseases? CNGOF good practice points]. / Prévention des infections génitales hautes postopératoires ou associées aux soins. Faut-il proposer une antibioprophylaxie lors des interruptions volontaires de grossesse chirurgicales pour prévenir les infections génitales hautes ? Conseils de bonne pratique du CNGOF.

Antibiotic prophylaxis is not recommended during surgical induced abortions. Systematic screening for Chlamydia trachomatis and Neisseria gonorrheae infection by polymerase chain reaction (PCR) on a vaginal sample is recommended before any surgical abortion. Moreover, the bacteriological result should be available before the abortion so that antibiotic treatment effective against the identified bacteria, if any, can be proposed before the procedure. The absence of bacteriological result on the day of the abortion must not, however, delay the procedure. If screening is positive for a sexually transmitted infection (STI), and the bacteriological result is only available after the abortion, it is recommended that antibiotic treatment start as soon as possible. The first-line antibiotic treatment is ceftriaxone 500mg in a single dose by the intramuscular route for N. gonorrheae, doxycycline 200mg per day orally for 7 days for C. trachomatis and azithromycin 500mg the first day (D1) then 250mg per day from D2 to D4 orally if Mycoplasma genitalium is detected by multiplex PCR. In case of positive screening, antibiotic treatment of the woman's partner(s) is recommended, adapted to the STI agent(s).

Infant mandatory vaccinations: Confirmation of a positive impact.

OBJECTIVE: Infant vaccines protecting against 11 diseases have changed from recommended to mandatory status in France for all children born from first of January 2018. Through Vaccinoscopie survey, we measured for the second consecutive year the impact of this new policy on vaccine coverage rates (VCRs) and mothers' perception regarding vaccination. METHODS: Web-based survey on a representative sample of 1500 mothers of 0 to 17-month-old infants. RESULTS: Non-optimal VCRs continued to increase in 2019 versus 2017 (according to age, +7 to 8 points VCR for Hepatitis B and +36 to 68 points for Meningococcus C). After a progressive decrease between 2012 and 2017, the rate of favorable mothers' opinion towards vaccination continued to progress in 2018 and 2019. CONCLUSION: These results confirmed the positive impact of this new law on infant VCRs and mothers' favorable opinion regarding vaccination.

Extended Magnetic Dome Induced by Low Pressures in Superconducting FeSe_{1-x}S_{x}.

We report muon spin rotation and magnetization measurements under pressure on Fe_{1+δ}Se_{1-x}S_{x} with x≈0.11. Above p≈0.6 GPa we find a microscopic coexistence of superconductivity with an extended dome of long range magnetic order that spans a pressure range between previously reported separated magnetic phases. The magnetism initially competes on an atomic scale with the coexisting superconductivity leading to a local maximum and minimum of the superconducting T_{c}(p). The maximum of T_{c} corresponds to the onset of magnetism while the minimum coincides with the pressure of strongest competition. A shift of the maximum of T_{c}(p) for a series of single crystals with x up to 0.14 roughly extrapolates to a putative magnetic and superconducting state at ambient pressure for x≥0.2.

Update on HSV and VZV infections of the brain.

HSV and VZV are the most frequently identified pathogen in encephalitis cases in France. Recent guidelines were provided by some scientific societies, for the management of encephalitis. PCR is the gold standard for the diagnosis, and the first-line imaging tool is MRI. Sequels are important and there is an absolute need for a better evaluation and management in the future to reduce the short- and long-term consequences, beyond reducing the case fatality rate. A better management of sequels is important. Autoimmune encephalitis triggered by HSV is a recent syndrome, which leads to consider it as a major issue in the management of patients. The final point is the importance of inflammation in explaining disorders and severity, meaning that anti-inflammatory treatments of whatever nature have to be validated.

Guidelines of the French Society of Otorhinolaryngology (SFORL): Nonsteroidal anti-inflammatory drugs (NSAIDs) and pediatric ENT infections. Short version.

OBJECTIVES: To present the guidelines of the French Society of Otolaryngology-Head and Neck Surgery concerning the use of non-steroidal anti-inflammatory drugs (NSAIDs) in pediatric ENT infections. METHODS: Based on a critical analysis of the medical literature up to November 2016, a multidisciplinary workgroup of 11 practitioners wrote clinical practice guidelines. Levels of evidence were classified according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system: GRADE A, B, C or "expert opinion". The first version of the text was reworked by the workgroup following comments by the 22 members of the reading group. RESULTS: The main recommendations are: NSAIDs are indicated at analgesic doses (e.g. 20-30 mg/kg/day for ibuprofen) in combination with paracetamol (acetaminophen) in uncomplicated pediatric ENT infections (acute otitis media, tonsillitis, upper respiratory infections, and maxillary sinusitis) if: o pain is of medium intensity (visual analogue scale (VAS) score 3-5 or "Evaluation Enfant Douleur" (EVENDOL) child pain score 4-7) and insufficiently relieved by first-line paracetamol (residual VAS≥3 or EVENDOL≥4); o pain is moderate to intense (VAS 5-7 or EVENDOL 7-10). When combined, paracetamol and ibuprofen are ideally taken simultaneously every 6h. It is recommended: (1) o not to prescribe NSAIDs in severe or complicated pediatric ENT infections; (2) o to suspend NSAIDs treatment in case of unusual clinical presentation of the infection (duration or symptoms); (3) o not to prescribe NSAIDs for more than 72h.

Management of infectious encephalitis in adults: Highlights from the French guidelines (short version).

The article highlights the French clinical guidelines for the management of adult patients with acute infectious encephalitis.