Negative perceptions of hepatitis B vaccination among attendees of an urban free testing center for sexually transmitted infections in France.

BACKGROUND: Official French health care policy recommends vaccinations against hepatitis B for all infants and at-risk adults. Attendees at our free testing center for sexually transmitted infections (FTC-STI) routinely express hepatitis B vaccine hesitancy. We aimed in this exposed population to explore the extent of knowledge concerning HBV infection, to quantify HBV vaccine refusal, and to identify the reasons for this refusal. METHODS: During a 3-month period in 2013, all attendees at the Grenoble FTC-STI were given an anonymous questionnaire exploring their knowledge of hepatitis B, perception of the hepatitis B vaccine, acceptance of free same-day hepatitis B vaccination, and reasons for refusing this offer (where applicable). RESULTS: The questionnaire was completed by 735 attendees (64.7% of those attending during the study period)(59.9% men; age 27.9 ± 9.2). Most respondents identified hepatitis B as a potentially severe, potentially lifelong illness existing in France. Concerning the hepatitis B vaccine, less than 50% totally or mostly agreed that it is safe; when asked whether the vaccine is dangerous, 44.2% answered "I don't know" and 14.0% agreed; when asked whether the vaccine is "not well characterized," 45.0%, answered "I don't know" and 26.5% agreed. When asked whether they mistrust the hepatitis B vaccine or all vaccines in general, 39.0% and 28.9% of those unvaccinated agreed, respectively. Two thirds refused to get vaccinated on the same day. When asked whether they were afraid of the adverse effects of this vaccine, only 18.7% disagreed. CONCLUSION: Negative perceptions of the hepatitis B vaccine are widespread in this at-risk population. Consequently, a successful communication strategy must reassure this at-risk population of the vaccine's innocuous nature.

[Method and participation in a preschool immunization survey in Isère (France) during the 2010-11 school year]. / Méthode et participation à une enquête en milieu scolaire sur la vaccination des enfants isérois (2010/2011).

INTRODUCTION: The Isère department has carried out a study on vaccination programmes and sites of vaccination among schoolchildren in Isère. The objective of this article is to present the original and robust method used in the study. We also describe the participation rate in the study. METHODS: A cross-sectional study was conducted among 4-year-old children in 2010/2011 during nursery school checkups. One hundred schools were randomly selected according to a complex sampling plan. The vaccination records of all children examined at checkups were photographed and data were cleared and adjusted. The participation of children in the study was investigated by distinguishing the reasons for exclusion from the study due to the mode of data collection and due to factors specific to the checkups. The factors studied concerned the intrinsic characteristics of the schools as well as data on organisation of the checkups. A total of 2,588 children from the 100 schools surveyed were included in the study, corresponding to a participation rate of 85.1%. RESULTS: 9.6% of the children selected were excluded for reasons specific to the checkups and 5.3% for reasons related to the study. Participation was higher for children examined by a team from the Maternal and Child Protection Unit (PMI: Protection maternelle et infantile), specialised in checkups. This was the only factor that appeared to impact the typical attendance of children at in nursery school health checkups. DISCUSSION: This result can probably be generalised to the other tasks of the PMI and provides important information for the future organisation of the PMI's activities.

[Adult vaccination coverage: surveys in four populations - Isère (France), 2002-2003]. / La couverture vaccinale des adultes : enquêtes dans quatre populations d'Isère (France), 2002-2003.

In order to assess their vaccination policy, the public health authorities in Isère (France) conducted several surveys to determine the vaccination coverage rate among adults. In France, the current state of knowledge in this area is limited. Four separate surveys were conducted in 2002-2003: (1) a telephone survey of 976 adults, 18% of whom had vaccination certificates; (2) a survey of 44 general practitioners (805 patients); (3) a survey of occupational health centers (82 practitioners and 1,119 employees); and (4) a survey of 1,214 patients vaccinated at the international vaccination center in Grenoble (France). The same data were recorded in all four surveys (last vaccination date, either declared by the patient or proven by a vaccination certificate). Based on certified evidence, vaccination coverage for tetanus, diphtheria, and poliomyelitis ranged from 31.6% to 83.9%, from 24.1% to 44.0%, and from 25.9% to 71.9%, respectively. Compared to general practitioners, vaccination coverage was higher among staff working at the occupational health center and lower in the general population. The four surveys covered only part of the adult population and provided only an estimate of vaccination coverage. The study found that tetanus vaccination coverage was the highest, but was still below expected levels. For the other vaccines, vaccination coverage among adults appears to be inadequate. The findings suggest that all health professionals involved in adult vaccination (occupational health doctors, general practitioners, hospital doctors, etc.) should be invited to participate in working groups on vaccination.

Occupational risk for cytomegalovirus, but not for parvovirus B19 in child-care personnel in France.

BACKGROUND: Studies assessing the risk of cytomegalovirus (CMV), parvovirus B19 (B19V), rubella and varicella infections in female child-care personnel may help define appropriate preventive strategies during pregnancy. METHODS: Serologic testing for all four viruses and a self-administered questionnaire to identify risk factors were conducted on child-care staff aged 20-50 years old and on a reference group of women. RESULTS: In 395 exposed and 382 reference women, CMV, B19V, rubella and varicella seroprevalence were 69.4, 79.4, 98.7, 100% for exposed women, and 41.1, 68.0, 98.2, 99.7% for reference women, respectively. For CMV, the adjusted seroprevalence ratio (PR) of exposed versus reference workers, (PR, 1.43 [95% IC, 1.22-1.69]) was observed as of the first year of exposure. The risk attributed to occupation was 30.1%. Identified risk factors included exposure duration, past employment in maternity hospital, and participation in cleaning tasks. The risk attributable to personal factors ranged from 14.5% to 32.4%. The adjusted B19V PR was not significant (PR, 1.05 [95% IC, 0.94-1.16]). CONCLUSIONS: French female child-care staff runs an occupational risk for CMV infection, but not for B19V infection. The fraction attributable to this CMV occupational risk was not higher than the risk associated with personal factors.

Outbreak of Q fever, Florac, Southern France, Spring 2007.

INTRODUCTION: In May 2007, five patients with Q fever-like symptoms were reported in an agricultural educational center in the rural southern French town of Florac. An investigation was undertaken to identify the outbreak source and risk factors for infection, and to implement control measures. MATERIALS AND METHODS: We undertook active case finding. Patients were defined as individuals with an unexplained fever of ≥38.5°C who lived in, worked in, or visited Florac between April 1 and June 30, 2007. Patients were confirmed by a positive Q fever serology test. A cross-sectional survey with a seroprevalence component was carried out in the educational center and surrounding area. A standardized questionnaire on known risk factors for the infection was used and serological testing was carried out on finger prick blood specimens from participants. The veterinary services investigated local herds within a 5-mile radius using polymerase chain reaction and serological tests. RESULTS: One hundred twenty-two people were included in the cross-sectional survey. Eighteen serologically confirmed acute cases were identified, of whom 12 were from the educational center. The statistical analysis showed an independent association between acute infection and living or working near an area where manure had been spread (p = 0.0.042) and male gender (p = 0.022). Frequenting the educational center's canteen was also associated with infection (p = 0.008) among staff and students. The veterinary investigations identified 11 of the 26 tested flocks of goats and sheep as seropositive for Coxiella burnetii, including 2 ovine flocks located northwest of Florac that had high shedding levels of the bacterium. DISCUSSION: The observed excess of cases of Q fever in Florac, an area endemic for this infection, in spring 2007 could be explained by an aerial transmission from infectious ovine flocks situated close to the town. All local herd owners were re-educated about the risks and prevention practices for Q fever.