[Evaluation of imported pediatric malaria management in northern France]. / Évaluation des pratiques dans la prise en charge du paludisme d'importation de l'enfant dans la région Nord--Pas-de-Calais.

OBJECTIVES: The study's objective was to evaluate the adequacy of treatment to recommendations, for the management of pediatric malaria. METHODS: A descriptive, retrospective, multicentre cohort study was conducted over a 7-year period (2000-2006) in 18 pediatric and infectious diseases units in northern France. All children, under 18 years of age, having consulted in one of these hospitals and for whom the diagnosis of malaria has been made by blood smear and/or thick drop examination, were included. RESULTS: One hundred and thirty-three cases of imported malaria were reported. Among the 120 available files, 23 documented severe malaria. Treatment documentation was available for 115 patients. This treatment was initiated orally in 47 cases and intravenously in 68 cases. Intravenous quinine was the first-line treatment in 58% of cases. Halofantrine was the first-line oral treatment. No change was observed along the 6 years. Only 32% of management was in adequacy with recommendations. Five therapeutic failures were recorded. The optimal application of recommendations would have saved 117 days in terms of hospital stay, corresponding to 54,000 €. CONCLUSIONS: The French Infectious Disease Society (SPILF) recommendations were not well observed. This inappropriate management was responsible for treatment failures and increased costs.

Rebound in the incidence of pneumococcal meningitis in northern France: effect of serotype replacement.

AIM: To determine whether the recent emergence of nonvaccine pneumococcal serotypes has affected the incidence of pneumococcal meningitis in children a few years after the introduction of the heptavalent pneumococcal conjugate vaccine. METHODS: We conducted a multicentre retrospective cohort study from 2005 to 2008 in all hospitals with paediatric units in northern France. It included all patients < 18 years of age who were admitted for laboratory-confirmed pneumococcal meningitis during the study period. Data were collected from medical files and laboratory records at each hospital and compared with the regional hospital discharge codes. We assessed global and age-specific incidence rates of pneumococcal meningitis from 2005 through 2008, compared them with those from the prevaccine era (2000-2002) and evaluated pneumococcal serotypes. RESULTS: In all, 41 cases were found during the study period. The incidence rate of pneumococcal meningitis varied from 0.8/100,000 children < 18 years in 2005 to 1.8/100,000 children in 2008 (2.2-fold increase, p = 0.06); and from 1.8 to 11.9/100,000 children < 2 years (6.5-fold increase, p = 0.004). This increase was caused by nonvaccine pneumococcal serotypes. CONCLUSION: The incidence of pneumococcal meningitis in infants has rebounded in northern France during the pneumococcal conjugate vaccine programme, with the emergence of nonvaccine pneumococcal serotypes.

[Incidence of invasive meningococcal diseases in children in Northern France: usefulness and limits of the discharge code database for correcting compulsory notification data]. / Incidence des infections invasives à méningocoque de l'enfant dans le Nord-Pas-de-Calais : intérêt et limites du programme de médicalisation des systèmes d'information (PMSI) pour la correction des données des déclarations obligatoires.

UNLABELLED: Surveillance of invasive meningococcal diseases (IMD) is based on mandatory reporting. Evaluation of the exhaustivity of the surveillance with capture-recapture analysis can correct for underreporting. AIM: To evaluate IMD incidence in children in Northern France from 2 databases and to determine the usefulness of the regional hospital reporting database for correcting mandatory reported data. PATIENTS AND METHODS: Regional study of IMD incidence in children under 18 years of age, between the years 2002 and 2005, by a secondary analysis of 2 databases: the regional hospital reporting database administered by the Department of Medical Information (DIM) and the mandatory reporting health authorities database (DDASS). The corrected incidence of IMD was determined using a capture-recapture method. RESULTS: Three hundred and eleven cases of IMD were reported in at least 1 database. Of the 233 patients identified in the DIM database, 23 were not reported in the DDASS database, but 78 retrieved in the DDASS database were missed by the DIM. Database exhaustivity varied between years from 70 to 75% for the DIM and from 83 to 99% for the DDASS database. The corrected incidence of IMD varied from 6.9 to 9.4/100,000 children between 2002 and 2005. IMD incidence of children less than 1 year of age reached 44.5/100,000 in 2005. IMD attributable to serogroup B were predominant (56%). CONCLUSION: In this study, the DIM database provided a useful independent correction of mandatory reporting, although it remained insufficient. A high IMD incidence in children was identified in Northern France, especially in children less than 1 year of age.

Decline in pneumococcal meningitis after the introduction of the heptavalent-pneumococcal conjugate vaccine in northern France.

BACKGROUND: The impact of the heptavalent-pneumococcal conjugate vaccine on the incidence of pneumococcal meningitis in Europe has not yet been assessed. OBJECTIVE: To determine whether heptavalent-pneumococcal conjugate vaccine implementation in northern France has resulted in a decrease in the incidence of pneumococcal meningitis in children. DESIGN: Multicentre retrospective cohort study from 2000 through 2005. SETTINGS: All paediatric departments of the 18 hospitals in northern France. PATIENTS: Patients <18 years of age, admitted for laboratory-confirmed pneumococcal meningitis during the study period, were included. INTERVENTIONS: Data were collected from medical files and the microbiological laboratories of each hospital and compared with the regional hospital discharge codes, using a capture-recapture method. MAIN OUTCOME MEASURES: The study assessed and compared global and age-related incidence rates of pneumococcal meningitis in 2001 (pre-vaccine era) and 2005. RESULTS: 77 cases were found through the capture-recapture method. The incidence rate of pneumococcal meningitis varied from 1.65/100,000 children <18 years in 2001 to 0.80/100,000 children in 2005 (53% reduction, 95% CI 31 to 74; p = 0.08). This has so far been significant only for children <2 years of age (8.9/100,000 in 2001 to 1.8/100,000 in 2005; 82% reduction, 95% CI 52 to 95; p = 0.03). CONCLUSION: A decline in pneumococcal meningitis has been observed in infants since heptavalent-pneumococcal conjugate vaccination began in our area.