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Between January 2003 and June 2005, an outbreak of meningococcal disease occured in the department of Seine-Maritime in northern France. Eighty six cases were notified, giving an average annual incidence of 2.7 cases per 100 000 inhabitants, compared with 1.6 in France. An especially affected area was defined as the city of Dieppe and its surrounding area (26 cases, giving an annual incidence of 12 cases per 100 000). This outbreak was due to N. meningitidis phenotype B:14:P1.7,16 belonging to the clonal complex ST-32/ET-5. Over the 31 B14:P1.7,16 cases confirmed by phenotyping methods at the national reference centre for meningococci (CNR, Centre National de Référence des méningocoques) the case-fatality rate (19%) and the proportion of purpura fulminans (42%) were especially high. Teenagers aged between 15 and 19 years and children aged 1 to 9 years were the most affected. In 2003, health authorities put in place enhanced epidemiological surveillance and informed practitioners and population about the disease. In 2004, the national vaccination advisory board studied the opportunity of using a non licensed outer membrane vesicle vaccine developed in Norway which may be effective against the B14:P1.7,16 strain. The Ministry of health decided in 2006 to offer vaccination with this vaccine to people aged 1 to 19 years in Seine- Maritime.

In the pre-vaccination era, rubella was regarded as only a mild exanthematous acute viral infection of children. The devastating effects of the disease were first identified in the early 1940s by an Australian ophthalmologist, and further confirmed during the 1962-65 rubella pandemic in Europe and the United States. They result from the transmission of the virus by infected pregnant women to their fetus. The resulting congenital rubella syndrome (CRS) comprises a lengthy list of abnormalities. The most common ones are deafness, ocular and cardiac defects and mental retardation. The objective of rubella vaccination, to which France has subscribed, is the elimination of CRS [1].

International audience; OBJECTIVES:This work aimed to describe the epidemiology of invasive meningococcal disease (IMD) in France, 2006-2015, including group- and genotype-specific disease burden, incidence trends before and after introduction of meningococcal C conjugate vaccines (MCCV) in 2010, and factors influencing the case fatality rate.METHODS:Mandatory notification data on incidence and IMD case characteristics were used. Genotyping of invasive strains and whole genome sequencing were performed by the French National Reference Center. Vaccination coverage was estimated from the National Health Insurance Information System's reimbursement data.RESULTS:The decrease in annual IMD incidence rates (per 100,000 inhabitants) from 1.23 in 2006 to 0.78 in 2016 was mainly related to the decrease in group B IMD. Group C incidence decreased from 0.29 in 2006 to 0.13 in 2010 but increased thereafter in age groups not targeted by MCCV. From 2010 onwards, MCCV coverage gradually increased but remained below 25% in 15-19 year-olds in 2015. Age, clinical presentation and, to a lesser extent, clonal complex 11 were the most significant factors determining mortality.CONCLUSIONS:The limited impact of vaccination on group C IMD incidence may be explained by the emergence of a new epidemic cycle in 2011 and the low vaccination coverage rates among adolescents and young adults.

In France, human papillomavirus (HPV) vaccination coverage among adolescents and young women is low and decreasing. We analysed data from the 2012 Health, Health Care and Insurance Survey with the aim of identifying factors associated with this vaccination. We also compared the socioeconomic profile of unvaccinated young women to that of women who do not undergo cervical cancer screening (CCS).Data were collected through interviews and self-administered questionnaires completed by a randomised sample of Health insurance beneficiaries. Two analyses were performed using Poisson regression: one to investigate the determinants of CCS uptake in women aged 25-65 years old (n=4508), the other to investigate the determinants of HPV vaccination in young women aged 16-24 years old (n=899). A sub-analysis was performed in 685 "daughter-mother" couples from the same household in order to analyse the association between participation to CCS in mothers and HPV vaccination in daughters.Factors significantly associated both to a lower CCS uptake and to an insufficient HPV vaccination were the lack of a complementary private health insurance (P=0.023 and P=0.037, respectively) and living in a family with a low household income (P0.001 and P=0.005, respectively). A low education level was associated to a lower CCS uptake (P0.001). The absence of CCS uptake in the last three years in mothers was associated to a lower level of HPV vaccination in their daughter (P=0.014).Women who do not undergo CCS and HPV unvaccinated young women tend to be of modest socioeconomic status. Unvaccinated young females tend to have mothers who do not undergo CCS and are therefore at risk of benefiting from none of the two cervical cancer preventive measures. The current implementation strategy concerning HPV vaccination in France may therefore increase inequalities regarding cervical cancer prevention.

Objectives To evaluate the proportion of pregnant women agreeing to cytomegalovirus (CMV) serologic screening. To collect data on CMV infection during pregnancy. Design Prospective study. Setting During two years, all pregnant women were informed on CMV infection. If the patient agreed, serological testing was performed around 12 weeks of gestation (WG) and, if negative, redone around 36 WG. Population Four thousand two hundred and eighty-seven pregnant women followed from 12 weeks to delivery. Methods If the first CMV serologic test was negative, detailed hygiene information was given to the parents. Diagnosis of primary infection was based on the detection of CMV-G, CMV-M and low CMV-G avidity index. When maternal infection was confirmed, diagnosis of CMV congenital infection was done in the newborns by urine culture within the three days following birth. Crude infection-rate data consisted of the number of CMV infection cases and person-time units for both exposed to hygiene CMV information (12 to 36 WG) and unexposed pregnant women (first 12 WG). Main outcome measures Rate of CMV seropositive and seronegative women. Rate of women agreeing for screening. Rate of primary infection. Rate of seroconversion. Number of CMV-infected newborns. Results Among the 4287 women followed, 3792 were either seronegative or with an unknown immune status. 96.7% out of them agreed for screening. 53.2% were initially CMV-specific IgG negative. Primary infection was detected in nine women between 0 and 12 WG (0.46%) and seroconversion was diagnosed in five women between 12 and 36 WG (0.26%) (mid P = 0.02, 95% CI [1.07–13.6]). Conclusions If clear information on CMV infection during pregnancy is given, patients frequently agree to screening. The rate of seroconversion after information, observed in this study, is low after counselling.

Resume But de l'etude. – Evaluer la valeur diagnostique de la RT-PCR sur liquide amniotique dans le cadre du diagnostic antenatal de l'infection rubeolique congenitale. Materiel et methodes. – La RT-PCR sur le liquide amniotique a ete comparee a la detection des IgM specifiques dans le sang fœtal et/ou du nouveau-ne chez 45 femmes ayant presente une primo-infection rubeolique certaine au cours de leur grossesse. Resultats. – La specificite de la RT-PCR s'est averee excellente (100 %) et la sensibilite du meme ordre que celle trouvee pour d'autres infections maternofœtales (83 a 95 %). Conclusion. – la RT-PCR sur liquide amniotique pourrait etre recommandee pour le diagnostic antenatal de l'infection rubeolique congenitale.

In April 2012, a cluster of two cases of meningococcal disease caused by rifampicin-resistant C meningococci was reported in the Champagne-Ardenne region, France. The two cases occurred in a student population living in the same town but studying at different schools. Bacteriological and epidemiological investigations of cases have shown that the isolates of both cases were non-differentiable.

From January to April 2012, 16 cases of W135 invasive meningococcal infection were reported in France. Of these, eight were linked to a recent travel history to Sub-Saharan Africa. These cases were reported in France concomitantly with the meningitis epidemic season in Sub-Saharan Africa. Considering the high number of travellers between France and West-African countries belonging to the so-called meningitis belt, the French recommendations for travellers stress the importance of vaccination before travelling to these countries.

Since the beginning of the outbreak in 2008 and through the national early warning system [3], the French Institute for Public Health Surveillance (InVS) received a total of 42 notifications of nosocomial transmission events (three in 2008, 10 in 2009 and 29 since January 2010). Among the notified events, 30 involved at least one HCW, and 44 of 61 cases (72%) were HCWs. Two of the three nosocomial transmission events in 2008 occurred in spite of a low prevalence of measles susceptibility in HCWs [4-7].

Between December 2008 and September 2009, 11 cases of invasive meningococcal disease (IMD) group B were reported in a 20 km diameter area in the Departement Landes, France. Two of them presented with purpura fulminans and one of them died. The strain responsible for this community outbreak was of the clonal complex ST-269.The incidence rate for IMD group B was 3 per 100,000 inhabitants in Landes from week 40 in 2008 to week 40 in 2009; it was the highest in France during that period. The number of cases observed was significantly higher than expected, especially in young adults (standardised incidence ratio: 23.5, p

Since early 2008, France has been experiencing a measles outbreak with almost 5,000 notified cases as of 30 June 2010, including three measles-related deaths. The proportion of cases 20 years or older reached 38% during the first half of 2010. This situation is the consequence of insufficient vaccine coverage (90% at age 24 months in 2007) that led to the accumulation of susceptibles over the last years. It underlines the need for additional measures targeting susceptible children and young adults.

Since the beginning of 2008, France has been experiencing a resurgence of measles. It started in a religious traditionalist group with low coverage and secondarily spread to the general population. This situation is the consequence of the insufficient vaccine coverage (less than 90 % at 24 months of age) which had led to the accumulation of susceptibles over the last years. More than 550 cases have been notified in 2008, the vast majority being unvaccinated. One measles-related death has occurred early 2009. Efforts to enhance communication to the general public and the health professionals on measles vaccination and control measures around cases are ongoing.

To date, 110 cases of measles have been identified by local health authorities in the Bourgogne and Nord-Pas-de-Calais regions of France, with onset of symptoms between 3 May and 19 July. The first three cases were reported on 25 June by a general practitioner to the French national institute of health (Institut de Veille Sanitaire, InVS) regional office in Bourgogne, in the centre of France. The three unvaccinated cases were students at a private religious school for girls located in Bourgogne and had onset of rash between mid-May and 23 June. On the same day, another general practitioner in Nord-Pas-de-Calais reported a case of measles in an unvaccinated 14 year-old boy attending a private religious boarding school for boys. The boy had developed a rash on 19 June and happened to live in the same place in Bourgogne where the above-mentioned girls' school was located. The two schools have elementary to secondary students. Both are private religious boarding schools. Most of the students come from the surrounding areas, some resident pupils are from other French regions, and some from abroad. All students returned home on 26 June for summer holidays.

Summary The recent emergence of Neisseria meningitidis W135 as a cause of epidemic bacterial meningitis and the availability of a trivalent ACW135 vaccine have created a need for accurate and timely meningococcal serogroup determination for organization of epidemic vaccine response. The sensitivity and specificity of the Pastorex® meningitis kit (Bio-Rad) to identify serogroups A and W135 in the African meningitis belt was assessed using PCR testing as the gold standard. The sensitivity and specificity for serogroups A and W135 were 87 and 85%, respectively, while the specificities were 93 and 97%. The positive and negative likelihood ratios for A were 12 and 0.14 and for W135 were 33 and 0.16. The positive and negative predictive values, computed to simulate an epidemic of meningococcal meningitis with an estimated 70% prevalence of N. meningitidis among suspected cases, were 97% and 75% for A and 99% and 73% for W135. In remote locations of the African meningitis belt, latex agglutination is the only currently available test that can rapidly determine meningococcal serogroup. This study showed that latex agglutination performs well and could be used during the epidemic season to determine appropriate vaccine response.

At the end of May 2003, the Marseilles Hospital Centre’s virology laboratory informed the French public heath institute of 5 cases of confirmed measles among young adults living in Marseilles. An investigation was conducted, consulting different community and hospital health services, to determine the virus circulation in the Provence-Alpes-Côte d’Azur (PACA) region by the southern interregional epidemiological cell. The investigation identified 259 cases: 183 clinical, 74 serologically confirmed and 2 epidemiologically linked cases. The first cases were identified during the first six months of 2003, with a peak in April. This outbreak of measles in the PACA region was favoured by poor vaccination coverage, which created groups of susceptible population. The real number of cases was probably higher than the number identified. This investigation has outlined the limitations of the measles surveillance system in France: the sentinel network had not detected any case for this period. France needs to reach the WHO objective of measles elimination by 2010 and the surveillance tools used must be those already used in the most countries that are furthest advanced in the elimination process. To reach this goal, the Direction Générale de la Santé has nominated a working group to be in charge of proposing a national plan to interrupt indigenous measles transmission in France.

Epidemic meningococcal disease has occurred in Africa for approximately 100 years and has been recognized as a particular problem in sub-Saharan Africa, “the meningitis belt,” since 1963. Despite intervention with plain polysaccharide vaccines, thousands of cases and deaths continue to occur. The circumstances that have driven these epidemics of disease remain poorly understood, but a number of factors are likely to be important, including crowded living conditions, population movements, seasonal factors, and the characteristics of the meningococci circulating at a given time. During the latter half of the 20th century, serogroup A meningococci have been responsible for most epidemic disease in Africa; however, as with other regions of the world, cases caused by serogroup B, C, Y, W135, and X meningococci have been occasionally responsible for epidemics. Some epidemic disease outbreaks have been associated with the annual Hajj pilgrimage (e.g., the spread of serogroup A meningococci during the late 1980s and the spread of W135 meningococci from 2000 onwards). Mass vaccination with serogroup A/C plain polysaccharide vaccines has been used to control outbreaks, once they have been identified, in a number of African countries. However, the efficacy of this reactive approach has been questioned, and the recent occurrence of W135 epidemics, combined with a global shortage of the polysaccharide vaccines, creates renewed urgency for a rational and universal preventive program. This workshop explored the scientific issues behind the design and implementation of a vaccine strategy for the meningitis belt of Africa focusing on the epidemiology of meningococcal isolates. Epidemiologic studies have provided an increasingly detailed knowledge of meningococcal disease in Africa. This knowledge has led to the identification of three distinct clonal complexes responsible for serogroup A disease in Africa (ST-1 complex, ST-4 complex, and ST-5 complex) with successive large-scale epidemics caused by ST-1 and ST-5 complex. Recent epidemiologic findings have shown that serogroup A meningococci belonging to the ST-5 complex (ST-5 and ST-7) were still responsible for most cases and outbreaks of disease in 2000, 2001, and 2002, with the W135 epidemics caused by bacteria belonging to the ST-11 complex. This complex has previously been associated with serogroup C disease. However, while knowledge of the clonal complexes has provided important information on meningococcal disease in Africa, more detailed isolate characterization has shown that important diversity is overlooked by relying solely on sequence type. Despite the availability of a number of meningococcal typing strategies (including pulsed-field gel electrophoresis, multilocus enzyme electrophoresis, and 16s rRNA typing), to date, no portable method is broadly accepted for identifying subvariants below the level of clonal complex. Funding for fundamental research to improve methods of analysis of diversity and dynamics of these populations is an urgent requirement. Since 2000, serogroup W135 meningococci (ST-11) have been isolated from sporadic cases in Algeria, Cameroon, Chad, Senegal, Niger, and Central African Republic and at the end of a serogroup A outbreak in 2001 and during a large outbreak during 2002 in Burkina Faso. Carriage studies demonstrated a high rate of carriage of W135 in some affected communities in Burkina Faso. Serogroup X has also been widespread in Africa (1970–2000) from studies in Mali, Niger, Burkina Faso, and Ghana. Serogroup X has been primarily found in healthy carriers but also in occasional epidemics. These studies highlight the importance of supporting enhanced laboratory surveillance throughout the region to monitor the spread of nonserogroup A meningococci. Polymerase chain reaction may increase case ascertainment, but basic microbiologic testing on a large scale is required. Several studies have been performed on carriage isolates from pilgrims returning from the Hajj. Since 2000 and the introduction of ST-11 complex, W135 meningococci among carried isolates in North Africa (Sudan, Morocco) was documented. By contrast, despite a small increase in cases associated with the Hajj, rates of disease caused by ST-11 W135 meningococci in Europe remained low since 2000, with some evidence that most activity was limited to the Muslim communities. One study found that the minority (8%) of W135 (case and carrier) isolates are O-acetylated (Oac+) in the United Kingdom and that the currently available tetravalent polysaccharide vaccine evokes bactericidal activity against both Oac+ and Oac- W135 and Y isolates. The relevance of O-acetylation to vaccine development remains uncertain. To plan intervention strategies in Africa, changes in the major vaccine antigen (the capsular polysaccharide) present among epidemic disease isolates should be closely monitored. Fundamental research to understand diversity and dynamics of these important bacterial populations is required. The recent epidemic of W135 and substantial numbers of cases caused by other non-A serogroups (X and C particularly) provide uncertainty about the future epidemiology of capsule expression during epidemics. Epidemic meningococcal disease in Africa might no longer be thought of as a peculiarity of serogroup A meningococci. The central idea from the workshop was that a comprehensive vaccine (i.e., a multivalent-conjugate) was the optimal approach to controlling epidemic disease in the meningitis belt of Africa. Even this approach may fail, given the remarkable adaptability of this variable organism. Further outbreaks of W135, as well as serogroup A, might occur in the region, and contingency planning for control of W135 outbreaks is required. A sustainable vaccine program for Africa is needed to prevent future epidemics. Conjugate vaccines provide the possibility of generating protective immunity from infancy and ending epidemic disease. Such vaccines have now been developed by pharmaceutical companies in industrialized nations. However, the challenge is the delivery of effective and affordable vaccines in sub-Saharan Africa, which has not so far been possible in collaboration with major pharmaceutical manufacturers. Practical and economic difficulties exist in delivering an affordable tetravalent ACYW conjugate vaccine for Africa, which, as outlined above, is an important objective. The Meningitis Vaccine Project will support the development of an affordable monovalent serogroup A conjugate polysaccharide vaccine in partnership with a developing country manufacturer. In the long term, this approach allows the possibility of sustainable prevention of epidemics in the region and is of great importance. This workshop concluded that a monovalent serogroup A strategy could leave the population exposed to the risk for further non-A epidemics and that strategies that include other serogroups, particularly W135, need to be put in place as soon as is possible. Development of an affordable vaccine for Africa cannot be achieved quickly. Discussion of the urgent issue of vaccines for control of epidemics of meningococcal disease in the next few years was not possible during the workshop. The current polysaccharide vaccine shortages raise the possibility that epidemic meningococcal disease continue with no intervention available. ACYW-conjugate vaccines are in development by several major vaccine manufacturers; however, without a market to drive production of millions of doses for sub-Saharan Africa, many more people might die before an affordable vaccine can be delivered by the Meningitis Vaccine Project.