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Summary: Background: No study has compared the virological and immunological status of young people with perinatally-acquired HIV infection (P-HIV) with that of people with HIV adulthood (A-HIV) having a similar duration of infection. Methods: 5 French cohorts of P-HIV and A-HIV patients with a known date of HIV-infection and receiving antiretroviral treatment (ART), were used to compare the following proportions of: virological failure (VF) defined as plasma HIV RNA ≥ 50 copies/mL, CD4 cell percentages and CD4:CD8 ratios, at the time of the most recent visit since 2012. The analysis was stratified on time since infection, and multivariate models were adjusted for demographics and treatment history. Findings: 310 P-HIV were compared to 1515 A-HIV (median current ages 20.9 [IQR:14.4–25.5] and 45.9 [IQR:37.9–53.5] respectively). VF at the time of the most recent evaluation was significantly higher among P-HIV (22.6%, 69/306) than A-HIV (3.3%, 50/1514); p ≤ 0.0001. The risk of VF was particularly high among the youngest children (2–5 years), adolescents (13–17 years) and young adults (18–24 years), compared to A-HIV with a similar duration of infection: adjusted Odds-Ratio (aOR) 7.0 [95% CI: 1.7; 30.0], 11.4 [4.2; 31.2] and 3.3 [1.0; 10.8] respectively. The level of CD4 cell percentages did not differ between P-HIV and A-HIV. P-HIV aged 6–12 and 13–17 were more likely than A-HIV to have a CD4:CD8 ratio ≥ 1: 84.1% vs. 58.8% (aOR = 3.5 [1.5; 8.3]), and 60.9% vs. 54.7% (aOR = 1.9 [0.9; 4.2]) respectively. Interpretation: P-HIV were at a higher risk of VF than A-HIV with a similar duration of infection, even after adjusting for treatment history, whereas they were not at a higher risk of immunological impairment. Exposure to viral replication among young patients living with HIV since birth or a very early age, probably because of lower adherence, could have an impact on health, raising major concerns about the selection of resistance mutations and the risk of HIV transmission. Funding: Inserm - ANRS MIE.

In France, international adoption includes around to 90,000 children since 1980 and near 300,000 immigrant children were counted in 2008. This population is heterogeneous, according to age and country of origin, and its large number. It is not easy to completely and surely assess the vaccine status of the child. Due to a great variability of individual situations, it is not possible to have systematic and unchangeable rules. This article aims to give an update of catch-up vaccination of internationally adopted or refugee or migrant children in France. The vaccination status of a child who recently arrived in France is complex and has to be adapted to his country of origin. Some of them were never vaccinated whereas the vaccine status of others is uncertain or unknown. Three parameters have to be considered: the age of the child, the country of origin, and sometimes serology in the case of doubts of his vaccine status. Catch-up vaccination of foreign children has to be adapted to French vaccine recommendations, as a reference, and to vaccines already administered to the child., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Introduction: The yellow-fever vaccination center of the Tourcoing Hospital (France) has been accessible to Belgian travelers since its opening in 1994., Method: The authors reported the specificities of these consultations during the year 2010, by retrospectively analyzing electronic medical records., Results: Some medical issues encountered during the consultation were due to differences in vaccination schedules: for the polio vaccine, since the last dose is administered between 5 and 7 years of age in Belgium; and for the measles vaccine since a late two-dose schedule (second dose between 12 and 13 years of age) is recommended in this country. Moreover, some specific vaccines are available only in Belgium: a diphtheria-tetanus bivalent vaccine, and a live attenuated oral typhoid vaccine., Discussion: The specificities of the Belgian border traveler consultation in our French yellow-fever center are due to a difference in European vaccination schedules; the physician must be aware of these., Conclusion: The physician has to propose updates on vaccination schedules, and be aware of yellow-fever vaccine compatibility with vaccines recently administered in Belgium., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Unlabelled: In France, since 2003, all new HIV infection must be reported. Data collected with the declaration system is not exhaustive and only concerns epidemiological data., Objective: The authors' aim was to study the epidemiologic evolution of new HIV cases between January 1, 2000 and December 31, 2007 in North and East of France, to compare them with national and local data, to complete them, and to identify local specificities., Method: A retrospective observational study was made, with a standardized questionnaire completed by any volunteer HIV care center in the North and the East of France., Results: Three thousand and thirty questionnaires were analyzed. The main trends over these eight years were similar to those observed in the rest of France: a decreasing number of women and patients of foreign origin, a decreasing number of patients with a late diagnosis, an increasing number of primary infections, and a higher CD4 count on initiation of antiretroviral treatment. However, local specificities appeared, such as: increasing proportion of men having sex with men and a less important proportion of co-infected patients with hepatitis B and/or C than on the national level. The therapeutic regimen is adequate according to expert recommendations, with, however, a marked "center effect" concerning prescription habits., Discussion: Such a local epidemiological study, even if it confirms observed trends in the rest of France, allows detailing them and suggesting prevention measures more specifically adapted to local settings., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Objective: A literature review was made to answer the following question: are there differences in immunogenicity and safety of vaccines according to the administration route (intramuscular or subcutaneous) and the length of needles used for injection?, Design: The search strategy included electronic searching (Medline database via PubMed) and cross-references. Articles were selected by reading abstracts, guided by the clinical question. A total of 18 articles were selected and analyzed; 13 answered the question., Results: Nine articles compared the immunogenicity and/or the safety of a given vaccine administered via both intramuscular and subcutaneous routes. All the results showed that immunogenicity and systemic safety of the intramuscular route was at least as good as that of the subcutaneous route. Local tolerance was usually better via intramuscular route (lower risk of developing erythema or edema). Four articles compared the immunogenicity and the safety of vaccines administered with short (16mm) and long (25mm) needles in children. Long needles induced fewer local reactions, probably because they can reach more vascularized muscle, especially in overweight and obese patients., Conclusions: Immunogenicity and safety results are in favor of intramuscular vaccination. The appropriate needle length must to be adapted according to the morphological aspects (subcutaneous tissue and muscle thickness).

Hepatitis B is the most known viral hepatitis, and often turns into a media event in France. Its prevalence and incidence depend on countries, regions, and their inhabitants. The virus is highly infectious with a high genomic variability. Its immune reaction and pathology seem complex, but the latest consensus conferences gave a practical management. If Papillomavirus vaccine is ready and coming soon as the second STD vaccine, hepatitis B vaccine is available since 1982, and used with a real success. Fighting hepatitis B is to continue all together to immunize children and babies born from infected mothers, to adopt universal health workers precautions, to educate and modify high risk behaviours, to treat and prevent hepatitis B complications and superinfections, and finally to monitor and detect any resistant hepatitis B strain.

The ParaSight F is a new diagnostic test for Plasmodium falciparum infections and is based on the detection of a trophozoite-derived antigen, the histidine rich protein II (HRP-II). To assess the usefulness of this test, we conducted a prospective study and analyzed 62 blood specimens from 38 patients, using thin blood films, thick blood films and the ParaSight F test. Compared to thick blood film, on samples taken before and during treatment, the ParaSight F test had 86.4% sensitivity and 100% specificity. In 31.5% of P. falciparum infected patients, parasitemia was lower than 1 parasite/1000 red blood cells, with all specimens being positive by the ParaSight F test. In 15 cases, specimens were negative by thin blood film, but were positive by thick blood film and by the ParaSight F test. Two patients had, after their treatment was started, positive results by ParaSight F and negative results by thick blood film. Cross-reactivity occurred neither with other Plasmodium species, nor in cases of severe inflammatory syndrome. Persistence of antigenemia was monitored in 14 patients receiving quinine. At day five of treatment, antigenemia persisted in seven patients. In conclusion, the ParaSight F test does not allow following up the efficacy of treatment, identifying other Plasmodium species, or assessing parasitemia. However, because this test is easy to perform and has good sensitivity and specificity, it is a useful tool in emergent context, in cases of parasitemia lower than the thin blood film threshold, and in cases morphologically difficult to decipher.

Production of cytokines by immunocompetent cells in vitro may be assessed after stimulation with polyclonal activators. Because it mimics the natural environment, diluted whole blood (WB) culture may be the most appropriate milieu in which to study cytokine production in vitro. We tested TNF alpha production by small volume of whole blood (25 microliters) from HIV-1 positive patients by using a one-step procedure that combines WB stimulation with LPS and PHA and cytokine measurement. We studied 30 patients without secondary infection or at distance of secondary infection staged according to the classification proposed by the CDC and 12 healthy seronegative subjects. The mean values of TNF alpha from patients were not statistically different from those from normal controls however in certain patients at different stages of the disease higher values than the mean +2 SD of controls and lower values than the mean -2 SD of controls were obtained. Heparinized blood from 5 control subjects had been collected sequentially during a period of 5 months. The individual variation of TNF alpha production were limited for all these individuals. For each of 6 HIV-1 patients, whole blood samples were collected sequentially during a period of 5 months and in most of patients large variations of levels of TNF alpha were observed from one sample to another one. Our method can detect abnormal cytokine production in HIV-1 positive individuals and can become a useful tool to investigate the role of cytokines in the outcome of HIV-1 infection.

We report five cases of varicella pneumonia among ten otherwise healthy pregnant women who were admitted in our hospital between 1986 and 1991 with chickenpox. The precise frequency of this rare complication is not well known actually but analysis of the literature shows that the mortality rate is about 20%. Beside the problem of the fetal varicella syndrome, the other complication is the severe varicella of the neonate which can appear when varicella occurs in the mother within 5 days before, and 2 days after delivery. When primary varicella infection occurs during pregnancy clinical examination must be repeated for a week after occurring of the exanthema to find elements of severity significance. Acyclovir is the drug of choice (10 to 15 mg/kg every 8 hours) for 7 days when pneumonia is present. Varicella-zoster immunoglobulin is useful for prophylaxis and for neonates with high risk of severe varicella.

Malaria is an old but still current parasitosis. Transmitted by the bite of the female anopheles, it can be revealed by more or less serious symptoms according to the species of Plasmodium. Plasmodium falciparum is responsible for the serious forms. It is the most frequent species, resistant to 4 amino-quinolein and sulfamides in some areas. P. vivax and P. ovale, usually harmless, are not so widely geographically spread as P. falciparum; and apparently are not drug resistant but they expose patients to the risk of relapses. During pregnancy, the choice of a curative and prophylactic therapy must take into account the supposed or confirmed species, the place of the stay and the duration of the exposure. On this case the authors call to mind the epidemiological criteria necessary for early diagnosis, the antimalarial drugs that can be used in pregnant women and draw attention to immuno-allergic and the classical secondary effects of quinine, which can also occur with chloroquine.

For the empiric management of community-acquired pneumonia, ciprofloxacin (750 mg b.i.d.) was compared with two antibiotics frequently used in this indication, i.e., amoxicillin + clavulanic acid and erythromycin. One hundred and forty-two patients were randomized in this prospective study. Among them, the 63 patients with bacteriologically documented disease were evaluated. Clinical recovery was achieved in 73.3% of patients in the ciprofloxacin group (22/30) versus 81.8% of patients in the amoxicillin + clavulanic acid or erythromycin group (27/33) (non-significant difference). Clinical failures seen with ciprofloxacin were found to be correlated with recovery of Streptococcus pneumoniae. Ciprofloxacin is effective in pneumonia but should be used only in cases where Streptococcus pneumoniae can be excluded as the causative agent.