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Qualitative study by semi-structured interviews, conducted between October 2013 and March 2014 on the Rhône-Alpes region (France), with 24 GPs. Learning is missing in GPs' initial academic training. Contraindications and consent from the patient or its parents are expected. There are flaws in pre-vaccine checks because of the early delivery by the pharmacist. Overall, the 2013 recommendations are respected, hands hygiene by washing or the use of gloves are seen as unnecessary. Concerning the "reconstituted" vaccines, disinfection of the stopper of the lyophilisate is mentioned only once in two. Whatever the age and corpulence of the patient, reconstitution is mostly done with the 23G needle; the 25G needle, of smaller diameter, is used for injection. Forgetting the reconstitution is the most common mistake. The purge is carried out. Local disinfection is constant, the injection site widely respected except by a minority. Disposal of waste is properly done. Traceability is dual except for influenza vaccines. The adverse effect information is usually modest and made on demand. Postvaccination care rarely exceeds a few minutes. The analysis of the immunization practices of GPs shows the existence of choices, incidents, deliberate or involuntary errors or fault, consciously or unconsciously made. This process could be improved; a checklist could be used for the benefit of patients and vaccinators. [ABSTRACT FROM AUTHOR]

Summary: Vaccination against hepatitis B in infants has been recommended since 1994. However, the WHO target of eradicating the disease in Europe is compromised due to less than 50% coverage in France. A telephone survey conducted in the first quarter of 2009 on 300 general practitioners (GPs) randomly selected in 3 departments in eastern Île-de-France was used to study the knowledge, reported practices, and opinions on the vaccine in infants and the impact of the hexavalent vaccine''s reimbursement. Two hundred and nine GPs agreed to answer. Among those taking care of infants (180), 74.4% reported offering them the vaccine. The GPs who did not practice complementary and alternative medicine (CAM), who knew of the reimbursement of the hexavalent and the recommendations, and who practiced in the suburbs rather than in Paris offered to vaccinate infants more frequently. Among GPs taking care of infants, 40.5% reported they had changed their practice since the reimbursement of the hexavalent vaccine. More than a quarter of GPs (26.2%) were opposed to the vaccination against hepatitis B in infants. They were older, practiced CAM more frequently, and were less familiar with the recommendations. Among the respondents, 79% had encountered the fear of side effects from the parents and among them 17.7% did not insist or postponed the discussion. In conclusion, in 2009, over a quarter of GPs were refractory to the vaccination proposal in infants but the hexavalent vaccine seems to have a significant impact on practices. [Copyright &y& Elsevier]

Abstract: Pertussis is a potentially serious illness in very young infants. The growing number of cases encountered in the past few years is partly explained by the loss of immunity, either natural or post vaccinal. To prevent the occurrence of pertussis in newborns and very young infants, it is mandatory to ensure compliance with vaccination recommendations regarding the general population (vaccination of young adults likely to have a child, of fathers and siblings during pregnancies, of mothers soon after birth), as well as professionals in contact with infants too young to have received their three doses of primary vaccination (diphtheria-tetanus-polio-pertussis booster may be performed as soon as the latest is more than two years). Obstetricians, midwives and pediatricians are directly concerned by this vaccinal strategy, owing to their prominent place in both informing couples during pregnancy and after delivery, and performing maternal vaccines soon after birth. [Copyright &y& Elsevier]

Summary: There are few data examining the vaccine practices for 0- to 24-month-old premature infants born before 33 GW. The aim of the study was to examine the vaccine coverage in this population according to the French schedule at 6 and 24 months. Results: Eighty-seven infants were included in this regional prospective study. The immunization program began late and was initialized principally with DTPCoqHib (63%), usually after the 4th month. Fewer than one infant out of two (45%) had received three doses by 6 months of age. At 2 years of age, the coverage was 99% at 3 doses and decreased to 83% for 4 doses. For the MMR vaccine, the average age of administration was after 15 months, and 95% of infants had received one dose of MMR at 2 years of age. BCG coverage at 2 years of age was 94%, administered on average at 7 months. Forty-seven percent of the infants had received at least one dose of hepatitis B vaccine before 2 years of age, but only 31% had received two doses and a booster at 2 years of age. The adaptation of vaccination practices basically concerns the initial date of vaccination, but the immunization calendar is not recovered at 2 years of age. This should be taken into account for pertussis disease prevention in these young infants during the first 6 months of life, increasing the susceptibility period for this infectious disease. Discussion and conclusion: The vaccine practices do not follow the postnatal chronological age of the premature baby according to the schedule recommended for full-term infants and vaccination is begun late. Based on the CSHPF vaccination recommendations, nearly 7 premature infants out of 10 have an incomplete immunization status for DTPCoqHib, hepatitis B, and ROR at 2 years of age. According to the pertussis coverage observed in premature infants, the new recommendations on vaccination of the newborn''s care giver and family should be completed before the infant''s discharge from the hospital using a new acellular vaccine for adult immunization. The initiation of an immunization program during hospitalization would be beneficial for premature babies still hospitalized after 2 months of age. [Copyright &y& Elsevier]

Abstract: Respiratory tract infections are a major reason of antibiotic prescription. Some of these infections can be prevented by vaccination. In France, the main new data concerns the following vaccines: Haemophilus influenzae: besides the vaccine effectiveness H. influenzae b, that is a virulent capsulated strain, a polyvalent vaccine effective against non-capsulated strains, responsible for otitis media, is under development. Pneumococci: the conjugated heptavalent vaccine recommended for all infants in the USA since the year 2000 allowed a dramatic drop in the incidence of invasive infections and of otitis media due to pneumococci, with an indirect impact reducing the frequency of pneumonia in adults. Influenza: the vaccinal coverage remains insufficient in people targeted by recommendations, particularly in health care workers. New recommendations concern some travel agents, people living in close contact with infants at risk and women immediately after delivery of a newborn at risk. Pertussis: the vaccinal coverage of preadolescents is insufficient. Vaccination of adults is mainly recommended for people who are expected to be in close contact with newborns (health care workers, parents). Tuberculosis: BCG vaccination is no longer mandatory, but is now strongly recommended for all infants in the greater Paris area, French Guyana, and for all infants at risk, especially immigrants depending on their native country. Varicella: universal vaccination is not recommended. To prevent respiratory complications in adults, the vaccine is now recommended for all varicella naive teenagers. [Copyright &y& Elsevier]

Summary: Objective: Assessment of immunogenicity and reactogenicity of DTPa-IPV/Hib (Infanrixquinta®) and DTPa-IPV-HBV/Hib (Infanrixhexa®) combined vaccines coadministered in healthy infants with 7-valent pneumococcal conjugate vaccine (Prevenar®), according to the current French vaccine recommendations. Method: Multicenter, open label, non-controlled study performed in France. Each subject received 1 dose of DTPa-IPV-HBV/Hib combined vaccine at 2, 4 and 16–18 months of age, coadministered with conjugated pneumococcal vaccine and 1 dose of DTPa-IPV/Hib vaccine at 3 months of age coadministered with conjugated pneumococcal vaccine. Results: Among the 102 enrolled infants, 64 were analysed (10.09 weeks±1.22 of age; boys: 58%) in the According-To-Protocol (ATP) immunogenicity cohort. One month after the administration of the booster dose of DTPa-IPV-HBV/Hib vaccine, 93.8% of subjects had protective titres for anti-HBs antibody superior or equal to 10mIU/ml (primary objective). Seroprotection rate against Haemophilus influenzae type b component (anti-PRP antibody≥0.15μg/ml) was 98.4% and the immune response for the 7-valent pneumococcal serotypes (antipneumococcal antibody≥0,05μg/ml) was between 98.4 and 100%. Local reactogenicity increased with the number of doses administered, but was comparable between combined vaccines and conjugated pneumococcal vaccine. The incidence of fever increased between the primary vaccination and the booster. Conclusion: The immunogenicity and reactogenicity profile of DTPa-IPV-HBV/Hib and DTPa-IPV/Hib combined vaccines coadministered with conjugated pneumococcal vaccine according to the schedule recommended in the French vaccine calendar is acceptable and similar to previous reports. [Copyright &y& Elsevier]

Abstract: Universal vaccination of infants against pertussis has transformed the epidemiology of the disease. Pertussis has however become frequent, although not often diagnosed, in adolescents and adults and thus contributes to permanent transmission of Bordetella pertussis in France and contamination of young infants at risk of severe disease. Control of transmission of pertussis in France necessitates reinforcement of vaccination with late boosters in adolescents and adults and, in addition, education of physicians to recognize and treat early cases ofpertussis, especially in adolescents and adults with a persistant or chronic cough, and to take appropriate prophylactic measures (antibiotics and recall vaccination) of those in contact with confirmed cases. Effective treatment does little to reduce symptoms but it does reduce transmission. Macrolides are the recommended treatment for pertussis. [Copyright &y& Elsevier]

Abstract: Purpose. – Rare and unexpected adverse events following hepatitis B immunization have been reported. This article aims to illustrate the risk-benefit assessment of hepatitis B immunization strategies, using the available evidence in medical literature. Current events. – i) Hepatitis B vaccination efficacy is high in infants, children and adolescents. It may be lower in adults and at risk populations; ii) Hepatitis B descriptive epidemiological data in France are scarce, fragmental, unprecise and changing according to the studied population strata. The incidence of symptomatic cases in the general population is below 5 per 100,000 since the year 2000. In France, it is estimated that about 300,000 adults are carriers of HBs antigen, and thus able to transmit the disease; iii) The actual French pharmacovigilance signal and the epidemiological studies may suggest the hypothesis of an association between the occurrence of central nervous system demyelinating diseases and hepatitis B vaccination. If this association exists, the relative risk is probably of less than 3. Perspectives. – The lack of accuracy of risks estimates complicates the risk-benefit assessment of hepatitis B vaccination. Its perception is then influenced and distorted by subjective factors, underlying the need for research in communication about benefits and risks of immunizations. Although still debated, the hypothesis of a putative role of hepatitis B vaccine in the pathophysiology of demyelinating diseases should prompt to pursue experimental and epidemiological research to better understand the links between infectious environment and inflammatory chronic diseases. [Copyright &y& Elsevier]