Search

In response to the COVID-19 pandemic caused by SARS-CoV-2, governments have adopted a wide range of non-pharmaceutical interventions (NPI). These include stringent measures such as strict lockdowns, closing schools, bars and restaurants, curfews, and barrier gestures such as mask-wearing and social distancing. Deciphering the effectiveness of each NPI is critical to responding to future waves and outbreaks. To this end, we first develop a dynamic model of the French COVID-19 epidemics over a one-year period. We rely on a global extended Susceptible-Infectious-Recovered (SIR) mechanistic model of infection that includes a dynamic transmission rate over time. Multilevel data across French regions are integrated using random effects on the parameters of the mechanistic model, boosting statistical power by multiplying integrated observation series. We estimate the parameters using a new population-based statistical approach based on a Kalman filter, used for the first time in analysing real-world data. We then fit the estimated time-varying transmission rate using a regression model that depends on the NPIs while accounting for vaccination coverage, the occurrence of variants of concern (VoC), and seasonal weather conditions. We show that all NPIs considered have an independent significant association with transmission rates. In addition, we show a strong association between weather conditions that reduces transmission in summer, and we also estimate increased transmissibility of VoC. [ABSTRACT FROM AUTHOR]

The vaccine coverage against human papillomavirus (HPV) vaccination remains low in France. The objective of this study was to study adolescent perceptions by comparing boys and girls, in order to build effective school-based interventions. This paper presents a cross-sectional study in French middle school pupils. They completed online questionnaires on their knowledge and attitudes toward the HPV vaccine, HPV vaccination status, their intention, reasons to vaccinate or not to vaccinate, and psychological antecedents of vaccination. A structural equation modeling (SEM) analysis was used to test the hypothesized model. The participants are 818 pupils aged from 12 to 16 years (M age = 13.78). Most pupils were in the pre-contemplative stage (62.7 % of boys and 40.8 % of girls). SEM analysis indicated that the relationship between the level of HPV knowledge, the representations of vaccines in general, and vaccine intention was mediated by attitudes towards the HPV vaccine among both boys and girls. These findings reveal a high percentage of boys who do not feel concerned by the HPV vaccine and highlight the need to consider the psychological antecedents of vaccination in general in addition to the specific attitudes to the HPV vaccine. [ABSTRACT FROM AUTHOR]

• Gaps in knowledge about the role of HPV in head and neck cancers and anal cancers, • Most of health students would recommend the HPV vaccine to friends and relatives. • Positive attitudes were more frequent in medical/pharmacy versus nursing students. • After adjustment, educational health program didn't remain associated with attitudes. Despite documented effectiveness in preventing several cancers, genital warts and safety of Human Papillomavirus (HPV) vaccine, immunization coverage among French adolescents remains far from the 80 % target. University health students (HS) in France may promote HPV vaccine through a national service (Service Sanitaire des Etudiants en Santé). We aimed to evaluate intentions to recommend the HPV vaccine to friends and relatives, to receive HPV vaccine, and to identify factors associated with these attitudes. We conducted a cross-sectional survey in five French Universities from October 2019 to February 2020, using a self-administered online questionnaire. We used bivariable and multivariable logistic regression models to identify determinants of behavior around HPV vaccine: (i) individual intention for vaccination, and (ii) vaccine recommendation to friends and relatives. Among the 732 respondents (180 men, 552 women), 305 (41.7%) reported previous HPV vaccination (54.5 % among women), 504 (68.9%) would recommend the HPV vaccine to friends and relatives, 532 (72.7%) respondents would be vaccinated today if it was recommended for them. Intentions to recommend or to receive the HPV vaccine were less frequent in nursing students compared to medical and pharmacy students. After adjustment for demographical factors, HPV vaccine knowledge was associated with intention [aOR 1.30 (95%-confidence interval, 1.15–1.47)] and recommendation [1.26 (1.10–1.45)], respectively. Additionally, adjusting for knowledge about HPV infections, and confidence in vaccines in general was associated with vaccine intention [1.55, (1.30–1.84)] and recommendation [1.52 (1.24–1.86)]. HPV-vaccinated HS were more prone to recommend the HPV vaccine to friends and relatives [10.9 (6.6–17.9)]. A majority of HS would accept and/or recommend HPV vaccines. HS with greater knowledge about the HPV vaccine were more prone to recommend it. Strengthening knowledge about HPV and its vaccination is probably necessary before their Involvement in a HPV immunization program. [ABSTRACT FROM AUTHOR]

Background The incidence of certain vaccine-preventative diseases, such as influenza, herpes zoster and pneumococcal infection, continues to be high despite the availability of vaccines, resulting in a substantial health and economic burden on society, particularly among older adults aged ≥65 years. Methods A cost calculator was developed to assess the cost of illness of influenza, herpes zoster and pneumococcal disease in France. Direct medical costs related to diagnosis and treatment in the older adult population in both inpatient and outpatient settings were modelled over a 1-year time horizon. Scenario analyses were conducted to determine the impact of hospitalizations on the results by considering only influenza-attributed diagnoses. Results In France, influenza has the highest incidence, followed by herpes zoster and pneumococcal disease. Similarly, influenza poses the greatest cost burden among all older adults, while pneumococcal disease poses the greatest cost burden among those aged 65–74 years. When considering only influenza-attributed diagnoses, the number of inpatient visits and associated costs was reduced by 63% in the overall older adult population. In the low-incidence season, the number of inpatient visits and associated costs were reduced by 69%, while in the high-incidence season, the number of inpatient visits and associated costs increased by 63%. Conclusion Influenza remains a leading vaccine-preventable disease among older adults in France, resulting in a substantial economic burden that could be prevented by increasing vaccine uptake. [ABSTRACT FROM AUTHOR]

Background: In France, human papillomavirus (HPV) vaccination coverage is low, with 30.7% of 17-year-old girls having received a complete HPV vaccination schedule in 2020. Aim: To determine the perspective and behaviors of general practitioners (GPs) regarding HPV vaccination with their patients and if a reluctance is observed. Design and setting: A qualitative study based on semi-directed individual interviews was conducted between December 2019 and December 2020. A representative sample of GPs with various profiles were included in 4 French regions. Method: A purposive sampling was used and interviews were continued until data saturation was reached. The analysis was based on the grounded theory. Results: Twenty-six GPs aged 29–66 years were interviewed. The measures taken by the French health authorities (lowering the target age, reimbursing the vaccine, extending the target population to boys) were perceived as facilitators. The reported barriers were organizational, due to low attendance of adolescents, and relational, mainly due to parental vaccine hesitancy. Physicians had to deal with fears about the perceived risks and concerns about sexuality conveyed by HPV vaccination and linked to the socio-cultural characteristics of the families. Physicians developed strategies, including scientific knowledge mobilization, empowerment of families by promoting health through prevention, repetition of the vaccination proposals, personal experience and relationship. Different practices were identified according to three GP typologies: effective, convinced but unpersuasive, and reluctant physicians. Conclusion: Based on these results, specific interventions, including communication techniques, especially for hesitant or unpersuasive physicians, are needed to enable GPs to become more effective. [ABSTRACT FROM AUTHOR]

Background The poor health status of underserved populations is compounded by low vaccination uptake, leading to a greater risk of epidemics. On October 2017, a measles outbreak started in the southwest of France among under-vaccinated social groups, including Travellers. We aimed to describe the health status, healthcare use and child measles–mumps–rubella (MMR) vaccination coverage in Travellers according to their environmental and living conditions. Methods A cross-sectional study with a three-stage random sample design was conducted between October 2019 and March 2022 in the Nouvelle-Aquitaine region in France. Trained social workers administered face-to-face questionnaires to collect data on adults and children. Anthropometric measurements, vaccination records and data using an environmental exposure questionnaire were also collected. Results The participation rate was high (73.6%), with 1030 adults and 337 children included. Concerning the adults, 36.6% had obesity, 14.4% reported diabetes, 24.7% hypertension and 14.4% major depression. The prevalence of major depression was significantly higher in adults living in precarious and unauthorized housing than in those with adequate housing (19.8 vs. 14.7%, P  = 0.03). With regard to children, 45.3% had full (i.e. 2-dose) MMR vaccination coverage at 24 months and 17.9% had obesity. Finally, 74.5% of the households experienced housing insecurity, and 22.2% did not have a supply of drinking water. Conclusion Traveller children and adults faced deleterious environmental and living conditions potentially affecting their health, healthcare use and vaccination coverage. These results demonstrate the need for urgent interventions for underserved populations which take into account their specific needs. [ABSTRACT FROM AUTHOR]

In May 2019, a measles outbreak occurred in the French subregion of Loire‐Atlantique, particularly affecting Roma settlements. Various obstacles hindered the implementation of postexposure measures among Roma population, resulting in the spread of the cases to other settlements. Suspected cases of measles were immediately investigated and concerned settlements were visited for measles–mumps–rubella (MMR) vaccination. From July 1 to September 3, 2019, a first and then a second Health Reserve team helped for vaccination on the affected and then also the measles‐free settlements. Vaccination uptake was monitored with the use of the department's vaccination center immunization registry. Genotyping of selected samples was performed for comparison with viruses circulating at the same time in France and Romania. As of September 16 2019, 109 cases of measles were confirmed among Roma population, including 99 (91%) children under 15 years. Of the 85 people eligible for vaccination, 60 (71%) had not been vaccinated and 23 (27%) had an unknown vaccination status. Sequence comparison revealed that 28/29 sequenced D8 strains were 100% identical to the strain responsible for a large number of cases throughout France in 2019, and to two sequences reported in Romania among sporadic cases. The vaccination campaign resulted in 1136 people on 35 settlements receiving at least one dose of MMR vaccine and in the increase of one‐dose MMR vaccine coverage at 24 months from 43% (23/53) to 91% (48/53). With measles transmission continuing in Europe, efforts must be made to meet immunization coverage targets, particularly in hard‐to‐reach communities where outbreaks may be difficult to control. [ABSTRACT FROM AUTHOR]

Background: Given the widespread implementation of COVID-19 vaccination to mitigate the pandemic from the end of 2020, it is important to retrospectively evaluate its impact, in particular by quantifying the number of severe outcomes prevented through vaccination. Methods: We estimated the number of hospitalizations, intensive care unit (ICU) admissions and deaths directly averted by vaccination in France, in people aged ≥ 50 years, from December 2020 to March 2022, based on (1) the number of observed events, (2) vaccination coverage, and (3) vaccine effectiveness. We accounted for the effect of primary vaccination and the first booster dose, the circulating variants, the age groups, and the waning of vaccine-induced protection over time. Results: An estimated 480,150 (95% CI: 260,072–582,516) hospitalizations, 132,156 (50,409–157,767) ICU admissions and 125,376 (53,792–152,037) deaths were directly averted by vaccination in people aged ≥ 50 years, which corresponds to a reduction of 63.2% (48.2–67.6), 68.7% (45.6–72.4) and 62.7% (41.9–67.1) respectively, compared to what would have been expected without vaccination over the study period. An estimated 5852 (2285–6853) deaths were directly averted among the 50–59 years old, 16,837 (6568–19,473) among the 60–69 years old, 32,136 (13,651–36,758) among the 70–79 years old and 70,551 (31,288–88,953) among the ≥ 80 years old. Conclusions: The vaccination campaign in France considerably reduced COVID-19 morbidity and mortality, as well as stress on the healthcare system. [ABSTRACT FROM AUTHOR]

Introduction: Despite various efforts to improve human papillomavirus (HPV) vaccine coverage in France, it has always been lower than in most other high‐income countries. The health authorities launched in 2018 the national PrevHPV research programme to (1) co‐develop with stakeholders and (2) evaluate the impact of a multicomponent complex intervention aimed at improving HPV vaccine coverage amongst French adolescents. Objective: To describe the development process of the PrevHPV intervention using the GUIDance for rEporting of intervention Development framework as a guide. Methods: To develop the intervention, we used findings from (1) published evidence on effective strategies to improve vaccination uptake and on theoretical frameworks of health behaviour change; (2) primary data on target populations' knowledge, beliefs, attitudes, preferences, behaviours and practices as well as the facilitators and barriers to HPV vaccination collected as part of the PrevHPV Programme and (3) the advice of working groups involving stakeholders in a participatory approach. We paid attention to developing an intervention that would maximise reach, adoption, implementation and maintenance in real‐world contexts. Results: We co‐developed three components: (1) adolescents' and parents' education and motivation using eHealth tools (web conferences, videos, and a serious video game) and participatory learning at school; (2) general practitioners' e‐learning training on HPV using motivational interviewing techniques and provision of a decision aid tool and (3) easier access to vaccination through vaccination days organised on participating middle schools' premises to propose free of charge initiation of the HPV vaccination. Conclusion: We co‐developed a multicomponent intervention that addresses a range of barriers and enablers of HPV vaccination. The next step is to build on the results of its evaluation to refine it before scaling it up if proven efficient. If so, it will add to the small number of multicomponent interventions aimed at improving HPV vaccination worldwide. Patient or Public Contribution: The public (adolescents, their parents, school staff and health professionals) participated in the needs assessment using a mixed methods approach. The public was also involved in the components' development process to generate ideas about potential activities/tools, critically revise the successive versions of the tools and provide advice about the intervention practicalities, feasibility and maintenance. [ABSTRACT FROM AUTHOR]

• The proportion of fully vaccinated measles cases increases with age, reflecting higher vaccination coverage. • Vaccine effectiveness (VE) for two-dose measles vaccine is high in all ages. • Considering natural immunity absent, two-dose measles vaccine VE in the 26–31 age group is 91%, lower than in younger groups. • Accounting for natural immunity, two-dose measles VE is 96.8 % in 26–31 age group. • Two-dose measles VE decreases at a yearly rate of 0.22% after early life vaccination. From 2008 to 2019, France has experienced a resurgence of measles epidemics. Surveillance data have shown that the proportion of cases vaccinated with two doses of measles-containing vaccine (MCV) increased with age, raising concerns about the duration of vaccine protection. Our objectives were to investigate age-stratified vaccine effectiveness (VE) for the second dose of MCV (MCV2) and to quantify protection levels over time. We analyzed data on measles cases aged 2–31 years, reported via mandatory notification to the French measles surveillance system from October 2017 to September 2019. We estimated an age-stratified VE for MCV2 using the screening method, which compares the vaccination status of cases with that of the general population. We improved this method by accounting for natural immunity, exploring four scenarios with four possible levels of natural immunity in the population. In addition, we quantified the decay rate of protection over time, by fitting an exponential decay model among individuals vaccinated in early life. In the baseline analysis (absence of natural immunity), VE estimates were high in all age groups and decreased with age, from 99.6 % (95 % confidence interval: 99.3–99.8) in 2–5 years old to 91.4 % (85.1–95.0) in 26–31 years old. Accounting for natural immunity increased VE in the older age group to 93.2–99.2 % depending on the scenario. We estimated that VE was slowly decreasing over time, with an exponential decay rate of 0.0022/year (0.0017–0.0028), leading to VE of 96.7 % (96.0–97.4) 16 years after MCV2 vaccination. This decline was most compatible with scenario 2, a scenario of 4.4 % naturally immunized, non-vaccinated individuals in the 26–31 years old. Our study confirms the continued high effectiveness of two doses of MCV with only slight degradation, decades after immunization. These findings support the importance of achieving a very high vaccination coverage with 2 doses of MCV. [ABSTRACT FROM AUTHOR]

The struggle against influenza, and more recently against Coronavirus Disease 2019 (COVID-19), relies mostly on protective measures and vaccines. In France, COVID-19 vaccination campaigns include children over 5 years of age, whereas the influenza vaccine is reserved for children and infants older than 6 months with severe chronic disease. The final decision to vaccinate ultimately rests with the parents. This study aimed to explore the opinions of parents regarding COVID-19 and influenza vaccinations, and which factors are likely to influence their decision in order to improve prevention approaches, and thus obtain better vaccination coverage among children. In this trans -sectional multicenter survey, self-administered questionnaires were sent to parents of children attending 14 childcare institutions over a period of 2 months, December 2021-February 2022. The questionnaire consisted of three sections: the first collected general, social and professional data, the second addressed perceived parental acceptability regarding influenza and COVID-19 vaccinations in healthy children, while the last section explored the main sources of information consulted by the parents regarding vaccinations. Subject's characteristics were described using number and percentages, as they are all categorical variables. Description of answers regarding both influenza and COVID-19 sources of information data were performed. Characteristics of patients answers were described and compared according to intention of vaccine groups. Among the 343 questionnaires collected, 41.7 % of respondents stated they were supportive of vaccination of their children against influenza and 37 % against COVID-19. Media (Internet, TV and radio) were the most cited sources of information. Incentive factors for both vaccination against influenza and COVID-19 were individual, and collective protection. Limiting factors were fear of side effect and Age of the child. Media was the sole source of information, concerning vaccination against influenza for 59 % non-graduates and 28 % of participants having a higher education level, and respectively 49 % and 19 % for vaccination against COVID-19. The acceptability rate was influenced by the level of education and the sources of information. About 40 % of the parents were supportive of children's vaccinations against COVID-19 and influenza respectively (37 % and 42 %) in order to protect the vulnerable people around them. The media influences the decision to vaccinate especially when the level of education is low. [ABSTRACT FROM AUTHOR]

Background: Vaccination schedules differ from country to country. In France, the diphtheria, tetanus, pertussis, poliomyelitis (dTcaP) booster vaccine coverage for adults aged 25 has been lower than those recommended. We evaluated the impact of an awareness campaign undertaken by the French national health insurance system in 2021. Methods: A randomized, controlled study with adults residing in the Ardennes region was conducted to evaluate the effect on vaccine coverage of the booster vaccine reminder campaign carried out via letter and/or email and/or SMS. The randomization unit was the municipal administrative area (canton). Ten cantons were grouped into the intervention group (INT) and nine were the control group (CON). Outcomes were the booster vaccine delivery and the consultation of a general practitioner (GP) within 12 months (since the French national health insurance running the campaign suggested patients to consult their GP). Results: A total of 1,975 adults were included (INT: 67.3% vs. CON: 32.7%). Of them, 331 received a booster vaccine (INT: 17.4% vs. CON: 15.5%; p = 0.29), and 1,442 consulted a GP (INT: 73.7% vs. CON: 76.8%; p = 0.14). Those who consulted a GP had more frequent vaccine delivery (INT: 19.1% vs. CON: 10.5%; p < 0.0001). Conclusions: This study found that the awareness campaign run by the French national health insurance did not improve the uptake of the dTcaP booster and that there was a low rate of vaccinated adults aged 25 years. A GP consultation was associated with dTcaP booster vaccine delivery which may show that there is a need of involving GPs in vaccination follow-ups. Patients recognize GPs as providers of credible information and they may play a key role in individualized preventive healthcare actions. Systematic consultations with GPs for follow-up could be proposed to insured adults aged 25 years in the future. [ABSTRACT FROM AUTHOR]

Background: The highest incidence of invasive meningococcal disease (IMD) is observed in infants. However, its prevalence in neonates (≤28 days of age) and the characteristics of the corresponding isolates are less described. This report aimed to analyze meningococcal isolates from neonates. Methods: We first screened the database of the national reference center for meningococci in France for confirmed neonatal IMD cases between 1999 and 2019. We then performed whole-genome sequencing on all cultured isolates, and we evaluated their virulence in a mouse model. Results: Fifty-three neonatal cases of IMD (mainly bacteremia) were identified (50 culture-confirmed cases and 3 PCR-confirmed cases) of a total of 10,149 cases (0.5%) but represented 11% of cases among infants of under 1 year of age. Nine cases (17%) occurred among neonates of 3 days of age and younger (early onset). The neonate isolates were often of serogroup B (73.6%) and belonged to the clonal complex CC41/44 (29.4%) with at least 68.5% of coverage by vaccines against serogroup B isolates. The neonatal isolates were able to infect mice although to variable levels. Conclusion: IMD in neonates is not rare and can be of early or late onsets suggesting that anti-meningococcal vaccination can target women planning to have a baby. [ABSTRACT FROM AUTHOR]

• France has one of the lowest HPV vaccination coverage rates in Europe. • There is no literature concerning school staff's point of view on HPV issues. • No studies have been conducted since the vaccination was recommended for boys in France. • Parents and school staff, including school nurses, experience a lack of knowledge about HPV. • If information is a necessary element to get the capability to get vaccinated, motivation and opportunity are factors cited by parents and school staff. It has been proven that vaccination is effective against Human Papillomavirus (HPV) infections, genital warts, and pre-cancerous and cancerous cervical lesions. Nevertheless, the HPV vaccine coverage of 37.4 % in 2021 in France is one of the lowest in Europe. To explore and understand the reason why French population is so late compared to its neighbours, we carried out focus groups with mothers and with National Education school staff. We aimed to identify knowledge and perceptions of HPV in both study populations, as well as factors influencing HPV vaccination. Between January 2020 and March 2021, we performed a qualitative study using an inductive approach with a thematic content analysis (TCA). We conducted semi-structured focus groups with 29 people including 15 mothers of adolescents in middle schools and 14 school staff from the national education system. Different factors influenced the decision-making process of parents and school staff: knowledge and perceptions of HPV and its vaccine, sources of information about HPV and vaccination. Mothers' discourses differed from those of school staff. They mentioned the importance of gynaecological monitoring and the negative image of pharmaceutical companies, and questioned internet as a reliable source of information. For their part, school staff mentioned cultural and/or religious affiliation, municipalities' role to inform the population, and ethical dilemma or logistical challenges regarding HPV vaccination in schools. The results of these focus groups provided information on which elements may harm or help HPV vaccination. Identified perceptions, beliefs, knowledge, barriers, and facilitators will help us to build an intervention program focus on general practitioners (GP), school staff, parents, and adolescents. [ABSTRACT FROM AUTHOR]

• Hospital-acquired influenza (HAI) can lead to significant morbidity and mortality. • Knowledge on the impact of vaccination on HAI in hospitalized patients is limited. • The study reported 60 % reduction in the risk of HAI in vaccinated patients. • HAI can be better controlled by vaccinating patients at risk of hospitalization. Literature is limited on the impact of patient vaccination on the risk of hospital-acquired influenza (HAI). This test negative case-control study nested in a surveillance program aimed at evaluating the effectiveness of influenza vaccination in reducing the risk of HAI in hospitalized patients during 15 influenza seasons (2004–05 to 2019–20). HAI cases were those who developed influenza like illness (ILI) symptoms at least 72 h after hospitalization and had a positive reverse transcriptase-polymerase chain reaction (RT-PCR). Controls were those with ILI symptoms and a negative RT-PCR test. A nasal swab as well as socio-demographic, clinical data and information on influenza vaccination were collected. Of the 296 patients included, 67 were confirmed HAI cases. Influenza vaccine coverage was significantly higher among controls compared to HAI cases (p = 0.002). The risk of HAI was reduced by almost 60 % in vaccinated patients. A better control of HAI can be achieved by vaccinating hospitalized patients. [ABSTRACT FROM AUTHOR]

Pneumococcal immunization is recommended in dialysis patients. We aimed to estimate pneumococcal vaccination coverage among patients who initiate dialysis in France, and its association with mortality. Data were extracted from two prospective national databases, merged using a deterministic linkage method: renal epidemiology and information network (REIN) registry, which includes all patients on dialysis and kidney transplants recipients in France, and the national health insurance information system (SNIIRAM) which collects individual data on health expenditure reimbursement, including vaccines. We enrolled all patients who initiated chronic dialysis in 2015. Data on health status at dialysis initiation, dialysis modalities, and pneumococcal vaccine prescribed from 2 years before to 1 year after dialysis start were collected. Univariate and multivariate Cox proportional hazard models were used to assess one-year all-cause mortality. Among the 8,294 incident patients included, 1,849 (22.3 %) received at least one pneumococcal vaccine before (n = 542, 6.5 %), or after (n = 1,307, 15.8 %) dialysis start, as follows: 13-valent pneumococcal conjugated vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23), n = 938 (50.7 %); only PPSV23, n = 650 (35.1 %); or only PCV13, n = 261 (14.1 %). Vaccinated patients were younger (mean, 66.5 ± 14.8 years vs. 69.0 ± 14.9 years, P ≤ 0.001), more likely to suffer from glomerulonephritis (17.0 % vs. 11.0 %, P ≤ 0.001), and less likely to start dialysis in emergency (27.2 % vs. 31.1 %, P = 0.001). On multivariate analysis, patients who received PCV13 and PPSV23, or only PCV13 were less likely to die (respectively, HR = 0.37; 95 %CI 0.28–0.51, and HR = 0.35; 95 %CI 0.19–0.65). Pneumococcal immunization with PCV13 followed by PPSV23, or with PCV13 alone, but not with PPSV23 alone, is independently associated with decreased one year-mortality in patients who start dialysis. [ABSTRACT FROM AUTHOR]

Bluetongue (BT) causes an economic loss of $3 billion every year in the world. After two serious occurrences of BT (bluetongue virus [BTV] occurrence in 2006 and 2015), France has been controlling for decades, but it has not been eradicated. As the largest live cattle export market in the world, France is also one of the major exporters of breeding animals and genetic materials in the world. The biosafety of its exported cattle and products has always been a concern. The scenario tree quantitative model was used to analyze the risk of BTV release from French exported live cattle and bovine semen. The results showed that with the increase in vaccination coverage rates, the risk decreased. If the vaccine coverage is 0%, the areas with the highest average risk probability of BTV‐4 and BTV‐8 release from exported live cattle were Haute‐Savoie and Puy‐de‐Dôme, and the risk was 2.96 × 10–4 and 4.25 × 10–4, respectively. When the vaccine coverage was 90%, the risk probability of BTV‐4 and BTV‐8 release from exported live cattle was 2.96 × 10–5 and 4.24 × 10–5, respectively. The average probability of BTV‐8 release from bovine semen was 1.09 × 10–10. Sensitivity analysis showed that the probability of false negative polymerase chain reaction (PCR) test and the probability of BT infection in the bull breeding station had an impact on the model. The identification of high‐risk areas and the discovery of key control measures provide a reference for decision makers to assess the risk of French exports of live cattle and bovine semen. [ABSTRACT FROM AUTHOR]

France was the first European country to confirm cases of COVID-19, being one of the most affected by the pandemic in the first wave. This case study analyzed the measures adopted by the country in the fight against COVID-19 in 2020 and 2021, correlating it to the characteristics of its health and surveillance system. As a welfare state, it relied on compensatory policies and protection of the economy, as well as increased investments in health. There were weaknesses in the preparation and delay in the implementation of the coping plan. The response was coordinated by the national executive power, adopting strict lockdowns in the first two waves, mitigating restrictive measures in the other waves, after the increase in vaccination coverage and in the face of population resistance. The country faced problems with testing, case and contact surveillance and patient care, especially in the first wave. It was necessary to modify the health insurance rules to expand coverage, access and better articulation of surveillance actions. It indicates lessons learned about the limits of its social security system, but also the potential of a government with a strong response capacity in the financing of public policies and regulation of other sectors to face the crisis. [ABSTRACT FROM AUTHOR]

Background: Multiple factors shape the temporal dynamics of the COVID-19 pandemic. Quantifying their relative contributions is key to guide future control strategies. Our objective was to disentangle the individual effects of non-pharmaceutical interventions (NPIs), weather, vaccination, and variants of concern (VOC) on local SARS-CoV-2 transmission. Methods: We developed a log-linear model for the weekly reproduction number (R) of hospital admissions in 92 French metropolitan departments. We leveraged (i) the homogeneity in data collection and NPI definitions across departments, (ii) the spatial heterogeneity in the timing of NPIs, and (iii) an extensive observation period (14 months) covering different weather conditions, VOC proportions, and vaccine coverage levels. Findings: Three lockdowns reduced R by 72.7% (95% CI 71.3–74.1), 70.4% (69.2–71.6) and 60.7% (56.4–64.5), respectively. Curfews implemented at 6/7 pm and 8/9 pm reduced R by 34.3% (27.9–40.2) and 18.9% (12.04–25.3), respectively. School closures reduced R by only 4.9% (2.0–7.8). We estimated that vaccination of the entire population would have reduced R by 71.7% (56.4–81.6), whereas the emergence of VOC (mainly Alpha during the study period) increased transmission by 44.6% (36.1–53.6) compared with the historical variant. Winter weather conditions (lower temperature and absolute humidity) increased R by 42.2% (37.3–47.3) compared to summer weather conditions. Additionally, we explored counterfactual scenarios (absence of VOC or vaccination) to assess their impact on hospital admissions. Interpretation: Our study demonstrates the strong effectiveness of NPIs and vaccination and quantifies the role of weather while adjusting for other confounders. It highlights the importance of retrospective evaluation of interventions to inform future decision-making. [ABSTRACT FROM AUTHOR]

Background: HPV vaccine coverage in France remained lower than in most other high-income countries. Within the diagnostic phase of the national PrevHPV program, we carried out a mixed methods study among school staff to assess their knowledge, beliefs and attitudes regarding HPV, HPV vaccine and vaccination in general, and regarding schools' role in promoting HPV vaccination. Methods: Middle school nurses, teachers and support staff from four French regions participated between January 2020 and May 2021. We combined: (i) quantitative data from self-administered online questionnaires (n = 301), analysed using descriptive statistics; and (ii) qualitative data from three focus groups (n = 14), thematically analysed. Results: Less than half of respondents knew that HPV can cause genital warts or oral cancers and only 18% that no antiviral treatment exists. Almost 90% of the respondents knew the existence of the HPV vaccine but some misunderstood why it is recommended before the first sexual relationships and for boys; 56% doubted about its safety, especially because they think there is not enough information on this topic. Schools nurses had greater knowledge than other professionals and claimed that educating pupils about HPV was fully part of their job roles; however, they rarely address this topic due to a lack of knowledge/tools. Professionals (school nurses, teachers and support staff) who participated in the focus groups were unfavourable to offering vaccination at school because of parents' negative reactions, lack of resources, and perceived uselessness. Conclusions: These results highlight the need to improve school staff knowledge on HPV. Parents should be involved in intervention promoting HPV vaccination to prevent their potential negative reactions, as feared by school staff. Several barriers should also be addressed before organizing school vaccination programs in France. [ABSTRACT FROM AUTHOR]

Background: Long-term care facilities (LTCFs) experienced severe burden from the Coronavirus 2019 (COVID-19), and vaccination against SARS-CoV-2 is a major issue for their residents. Objective: The objective of this study was to estimate the vaccination coverage rate among the residents of French LTCFs. Method: Participants and settings: 53 medical coordinators surveyed 73 LTCFs during the first-dose vaccination campaign using the BNT162b2 vaccine, conducted by health authorities in January and early February 2021. Measurements: in all the residents being in the LTCF at the beginning of the campaign, investigators recorded age, sex, history of clinical or asymptomatic COVID-19, serology for SARS-CoV-2 or severe allergy, current end-of-life situation, infectious or acute disease, refusal of vaccination by the resident or by the representative person of vaccine, and the final status, vaccinated or not. Results: Among the 4,808 residents, the average coverage rate for COVID-19 vaccination was 69%, and 46% of the LTCFs had a coverage rate <70%. Among unvaccinated residents, we observed more frequently a history of COVID-19 or a positive serology for SARS-CoV-2 (44.6 vs. 11.2% among vaccinated residents, p < 0.001), a history of severe allergy (3.7 vs. 0.1%, p < 0.001), end-of-life situation (4.9 vs. 0.3%, p < 0.001), current infectious or acute illness (19.6 vs. 0.3%, p < 0.001), and refusal of vaccination by residents or representative persons (38.9 vs. 0.4%, p < 0.001). Conclusions: About 3 out of 10 residents remained unvaccinated, and half of the LTCFs had a coverage rate <70%. This suggests that COVID-19 will remain a threat to many LTCFs after the vaccination campaigns. [ABSTRACT FROM AUTHOR]

[Display omitted] • 4.5% out of 4.0 million adults at risk were vaccinated against pneumococcus. • 92% of adults at risk visited a GP and 36% visited an outpatient specialist. • From 10.3% in 2014 up to 18.8% in 2018 of immunocompromised patients were vaccinated against pneumococcus. • From 12.9% in 2014 down to 2.9% in 2018 of people with a chronic medical condition were vaccinated. • 43.6% of adults at risk of pneumococcal disease were vaccinated against influenza. The risk of developing pneumococcal infections increases with certain chronic conditions and in immunocompromised patients. We aimed to monitor pneumococcal vaccination coverage in at-risk patients and to examine factors associated with pneumococcal vaccination in France. In this annual cross-sectional study, at-risk patients were extracted between 2014 and 2018 from the National Health Insurance's (NHI) General scheme's claims database with their vaccine reimbursements. Descriptive analyses and a logistic model were performed to assess the influence of healthcare use and medical and demographic factors on pneumococcal vaccination. In 2018, 4.5% of 4,045,021 at-risk adults were up to date with their pneumococcal vaccination. During the study period, the number of patients with chronic medical conditions (86% of 4,045,021) increased by 10.1%, but vaccination coverage decreased from 12.9% to 2.9%. The population with immunocompromised status (14% of 4,045,021) increased by 16.2% and vaccination coverage from 10.3% to 18.8%. Influenza vaccination coverage was much higher and stable (around 45.0%). Factors associated with pneumococcal vaccination were: immunocompromised status vs. having a chronic medical condition (odds ratio [OR] 4.72), influenza vaccination (OR 2.36–3.42), hepatitis B vaccination (OR 2.82), DTPolio vaccination (OR 1.52), ≥5 specialist physicians' visits (OR 1.17), and age above 74 (OR 1.12). Pneumococcal vaccine dispensing was extremely low (median of 9 per GP,1 per specialist over 9 years) despite frequent healthcare visits. Pneumococcal and influenza vaccination coverage of adults at risk of pneumococcal disease fell well below public health expectations. Invitations for pneumococcal vaccination should be sent by the NHI to high-risk patients. Patient management protocols should include pneumococcal vaccination. Patients with multiple comorbidities are a high-priority population given the large potential health gains offered by pneumococcal vaccination. Commitment of both scientific societies and health authorities is urgently needed to increase vaccination coverage in at-risk populations. [ABSTRACT FROM AUTHOR]

Since January 2018, mandatory vaccination against meningococci serogroup C has been implemented in France for children <2 years with a recommended catch-up vaccination until the age of 24 years. We aimed to analyse the impact of mandatory vaccination on populations not targeted by it (2–24 years old). We used the database of the national reference centre for meningococci to collect the number of invasive meningococcal disease (IMD) cases before (2016–2017) and after (2018–2019) the mandatory vaccination. The cultured isolates were sequenced and submitted for genomic comparison. The total number of cases was 1706, including 376 cases of IMD serogroup C. Mandatory vaccination correlated with a significant decrease among the <2 years old and a decreasing trend among the 2–14 years old group but not among 15–25 years of age. This observation may be explained by the vaccine coverage that is still low among adolescents and young adults. Moreover, the genomic analysis revealed the co-circulation of two major genotypes belonging to the clonal complex ST-11 whose distribution differed across the age groups in accord with cyclic variations of genotypes. It is important to increase specific knowledge on meningococcal epidemiology and vaccination to involve them in establishing the vaccination strategy. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess vaccination perception and the prevalence of the overall vaccination coverage (VC) and associated factors among university students. An online study was conducted among students of a university in Rouen (Normandy), France, in January 2021, with questions about the VC and perception of the vaccines. The convenience sample included 3089 students (response rate of 10.3%), with a mean age of 20.3 (SD = 1.9). The overall VC was 27.8% (39.2% for the healthcare students (HCS) and 21.3% for the non-HCS; p < 0.0001). Confidence (efficacy and security) was lower than the conviction of usefulness. The characteristics associated with VC were having the intention to be vaccinated against COVID-19, high perceptions of usefulness for their own health, having confidence in the vaccines' efficacy and security, and a high estimated level of knowledge about vaccination. Education about the general interest and mechanism of action of vaccines could improve the perception of vaccines. Then, it is relevant to improve vaccination literacy and confidence in university students, who, as future adults and parents, will vaccinate themselves and their children; as well as healthcare students who are future healthcare workers and, therefore, will vaccinate and counsel their patients. [ABSTRACT FROM AUTHOR]

Background: The burden of influenza morbidity and mortality in nursing homes (NH) is high. Vaccination of residents and professionals working in NH is the main prevention strategy. Despite recommendations, vaccination coverage among professionals is generally low.Methods: We performed a nationwide cross-sectional survey of NH using a single-stage stratified random sampling design to estimate influenza vaccination coverage in NH healthcare workers (HCW) and non-medical professionals in France during the 2018-2019 season, and to identify measures likely to increase it. For each NH, a questionnaire was completed with aggregated data by one member of the management team. A multivariate analysis was performed using a negative binomial regression.Results: Five-hundred and eighty nine NH filled in the study questionnaire (response rate: 49.5%). When considering all professionals (i.e., HCW and non-medical professionals), overall vaccination coverage was 30.6% (95%CI [28.2-33.0], range: 1.6-96.2). Overall influenza vaccination coverage in HCW was 31.9% [29.7-34.1]. It varied according to occupational category: 75.5% [69.3-81.7] for physicians, 42.9% [39.4-46.4] for nurses, 26.7% [24.5-29.0] for nursing assistants, and 34.0% [30.1-38.0] for other paramedical personnel. Vaccination coverage was higher i) in private nursing homes (RRa: 1.3, [1.1-1.5]), ii) in small nursing homes (0.9 [0.8-0.9]), iii) when vaccination was offered free of charge (1.4, [1.1-1.8]), iv) when vaccination promotion for professionals included individual (1.6 [1.1-2.1]) or collective (1.3 [1.1-1.5]) information sessions, videos or games (1.4 [1.2-1.6], v) when information on influenza vaccines was provided (1.2 [1.0-1.3], and finally, vi) when a vaccination point of contact-defined as an HCW who could provide reliable information on vaccination-was nominated within the nursing home (1.7 [1.3-2.2]).Conclusions: Urgent and innovative actions are required to increase coverage in HCW. Vaccination programmes should include free on-site vaccination and education campaigns, and particularly target nursing assistants. The results of this nationwide study provide keys for improving influenza vaccination coverage in HCW. Programmes should ensure that information on influenza vaccines is provided by a vaccination point of contact in NH using attractive media. Combining the different prevention measures proposed could increase coverage in NH nationwide by over 50%. [ABSTRACT FROM AUTHOR]

• COVID-19 complete vaccination is mandatory for healthcare workers (HCWs) • Incidence density of infections increases with time from full vaccination in HCWs. • Median time from vaccine completion to SARS-CoV-2 infection was 5.5 months. • Using Fitted mixed Cox model, vaccines were not associated with SARS-CoV-2 infection. Healthcare workers (HCWs), at increased risk of coronavirus disease 2019 (COVID-19) were among the primary targets for vaccination, which became mandatory for them on September 15th, 2021 in France. In November they were confronted to the fifth COVID-19 wave despite excellent vaccine coverage. We aimed to estimate the incidence of SARS-CoV-2 infection after complete vaccination among HCWs with different vaccination schemes, and its determinants. We enrolled all HCWs in the university hospital of Rennes, France who had received complete vaccination (two doses of COVID-19 vaccine). The delay from last vaccination dose to SARS-CoV-2 infection was computed. Fitted mixed Cox survival model with a random effect applied to exposure risk periods to account for epidemic variation was used to estimate the determinants of SARS-CoV-2 infection after complete vaccination. Of the 6674 (82%) HCWs who received complete vaccination (36% BNT162b2, 29% mRNA-1273, and 34% mixed with ChAdOx1 nCoV-19) and were prospectively followed-up for a median of 7.0 [6.3–8.0] months, 160 (2.4%) tested positive for SARS-CoV-2 by RT-PCR. Incidence density of SARS-CoV-2 infection after complete vaccination was 3.39 [2.89–3.96] infections per 1000 person-month. Median time from vaccine completion to SARS-CoV-2 infection was 5.5 [3.2–6.6] months. Using fitted mixed Cox regression with the delay as a time-dependent variable and random effect applied to exposure risk periods, age (P < 0.001) was independently associated with the incidence of SARS-CoV-2 infection. Vaccine schemes were not associated with SARS-CoV-2 infection (P = 0.068). A period effect was significantly associated with the incidence of SARS-CoV-2 infection (P < 0.001). In this real-world study, incidence of SARS-CoV-2 infection increases with time in fully vaccinated HCWs with no differences according to the vaccination scheme. The short delay between complete vaccination and incident SARS-CoV-2 infection highlights the need for sustained barrier measures even in fully vaccinated HCWs. [ABSTRACT FROM AUTHOR]

Pregnant women have a high risk of severe influenza, associated with obstetrical complications. The World Health Organization (WHO) has recommended influenza vaccination for all pregnant women since 2012. The vaccination coverage remains low worldwide, and in Europe, due to a lack of proposition from the health care providers, and a high refusal rate from the women. The primary aim of this study was to estimate the influenza vaccination coverage (IVC) in a population of pregnant women in France, and to analyse its evolution from 2009 to 2018. The secondary objective was to describe the vaccinated population and to find determinants associated with the vaccination. This retrospective cohort study is based on the EGB French health care database, a representative sample of the French population containing data from the health insurance system. All pregnant women who delivered medically or spontaneously over the 2009–2018 period were included. In the 2009–2018 period, only 1.2% pregnant women were vaccinated against influenza (n = 875/72,207; 95% CI 1.14–1.30). The IVC slightly increased after the 2012 WHO recommendation, from 0.33 to 1.79% (p < 0.001) but remained extremely low (4.1% in 2018). Women younger than 25 years old had a low coverage (0.6%) whereas women over 35 years old were more likely to get the influenza vaccine (1.7%; OR: 2.82, 95% CI 2.14–3.71). The vaccination behavior was not influenced by multifetal pregnancy or parity, but socio-economically deprived women were less likely to be vaccinated (OR: 0.81, 95% CI: 0.67–0.98). Women with pre-existing medical conditions had an overall higher vaccination rate (2.5%; OR: 2.32, 95% CI: 1.94–2.77). The vaccine was mainly prescribed by family physicians (58%). Influenza vaccination in pregnant women in France remains very low, particularly in younger, healthy women, and measures such as information campaigns towards pregnant women and studies of the knowledge, attitudes, and practices of the health care professionals need to be undertaken to improve the coverage. [ABSTRACT FROM AUTHOR]

In 2014–2015, we conducted a randomized controlled trial (RCT) assessing the effect of an advertising campaign for influenza vaccination using posters and pamphlets in general practitioner (GP) waiting rooms. No effect of the intervention could be demonstrated, but the immunization uptake increased in both arms of the study. In 2019, we deepened the investigations explaining the increased uptake conducting a registry-based 4/2/1 cluster RCT designed by Zelen with two extra years of follow-up of the study cohort. The study population included 23,024 patients eligible to be vaccinated who were registered with 175 GPs. The main outcome remained the number of vaccination units delivered per study group. Data were extracted from the SNIIRAM warehouse claim database for the Lille-Douai district (northern France). No difference in vaccination uptake was found in the Zelen versus the control group of the initial RCT. Overall, the proportion of vaccinated patients increased in the cohort from 51.4% to 70.4% over the three years. Being vaccinated the previous year was a strong predictor of being vaccinated in a subsequent year. The increase in vaccination uptake, especially among people older than 65, can be explained by a cohort effect. Health promotion and the promotion of primary health care may play an important role in this increase. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of catch-up human papillomavirus (HPV) vaccination on conization rates in France in a large population-based study. Methods: We conducted a retrospective real-life cohort study on data collected prospectively by French National Health Insurance. Echantillon généralistes des bénéficiaires (EGB) is a database composed of demographic and health care utilization data for a 1/97th sample of the French population. We extracted data about all women born between 1983 and 1991, corresponding to the catch-up population (vaccination after 14 years old) at the time of implementation of HPV vaccination. The primary outcome was the occurrence of conization (all types of procedures) compared between vaccinated and non-vaccinated women. Results: The cohort consisted of 42,452 women. Vaccination coverage (at least one dose) was low (9.8%, n = 4,129), but increased with time from vaccine implementation, from 0% in the 1983 cohort to 31% in the 1991 cohort. The conization rate was 1% for the overall population. The risk of conization for women between the ages of 19 and 30 years was reduced in the vaccinated group with a Hazard Ratio (HR) of 0.59 (95% CI[0.39–0.90]; p = 0.043). Conclusions: With a 10-year follow-up, catch-up HPV vaccination is associated with risk reduction of conization between the ages of 19 and 30. [ABSTRACT FROM AUTHOR]

Background: Subnational heterogeneity in immunity to measles can create pockets of susceptibility and result in long-lasting outbreaks despite high levels of national vaccine coverage. The elimination status defined by the World Health Organization aims to identify countries where the virus is no longer circulating and can be verified after 36 months of interrupted transmission. However, since 2018, numerous countries have lost their elimination status soon after reaching it, showing that the indicators defining elimination may not be associated with lower risks of outbreaks. Methods: We quantified the impact of local vaccine coverage and recent levels of incidence on the dynamics of measles in each French department between 2009 and 2018, using mathematical models based on the "Endemic-Epidemic" regression framework. After fitting the models using daily case counts, we simulated the effect of variations in the vaccine coverage and recent incidence on future transmission. Results: High values of local vaccine coverage were associated with fewer imported cases and lower risks of local transmissions, but regions that had recently reported high levels of incidence were also at a lower risk of local transmission. This may be due to additional immunity accumulated during recent outbreaks. Therefore, the risk of local transmission was not lower in areas fulfilling the elimination criteria. A decrease of 3% in the 3-year average vaccine uptake led to a fivefold increase in the average annual number of cases in simulated outbreaks. Conclusions: Local vaccine uptake was a reliable indicator of the intensity of transmission in France, even if it only describes yearly coverage in a given age group, and ignores population movements. Therefore, spatiotemporal variations in vaccine coverage, caused by disruptions in routine immunisation programmes, or lower trust in vaccines, can lead to large increases in both local and cross-regional transmission. The incidence indicator used to define the elimination status was not associated with a lower number of local transmissions in France, and may not illustrate the risks of imminent outbreaks. More detailed models of local immunity levels or subnational seroprevalence studies may yield better estimates of local risk of measles outbreaks. [ABSTRACT FROM AUTHOR]

Background: Several countries are implementing COVID-19 booster vaccination campaigns. The objective of this study was to model the impact of different primary and booster vaccination strategies. Methods: We used a compartmental model fitted to hospital admission data in France to analyze the impact of primary and booster vaccination strategies on morbidity and mortality, assuming waning of immunity and various levels of virus transmissibility during winter. Results: Strategies prioritizing primary vaccinations were systematically more effective than strategies prioritizing boosters. Regarding booster strategies targeting different age groups, their effectiveness varied with immunity and virus transmissibility levels. If the waning of immunity affects all adults, people aged 30 to 49 years should be boosted in priority, even for low transmissibility levels. Conclusions: Increasing the primary vaccination coverage should remain a priority. If a plateau has been reached, boosting the immunity of younger adults could be the most effective strategy, especially if SARS-CoV-2 transmissibility is high. [ABSTRACT FROM AUTHOR]

Background: Vaccination is expected to change the epidemiology and management of SARS-CoV-2 epidemics.Methods: We used an age-stratified compartmental model calibrated to French data to anticipate these changes and determine implications for the control of an autumn epidemic. We assumed vaccines reduce the risk of hospitalization, infection, and transmission if infected by 95%, 60%, and 50%, respectively.Results: In our baseline scenario characterized by basic reproduction number R0=5 and a vaccine coverage of 70-80-90% among 12-17, 18-59, and ≥ 60 years old, important stress on healthcare is expected in the absence of measures. Unvaccinated adults ≥60 years old represent 3% of the population but 43% of hospitalizations. Given limited vaccine coverage, children aged 0-17 years old represent a third of infections and are responsible for almost half of transmissions. Unvaccinated individuals have a disproportionate contribution to transmission so that measures targeting them may help maximize epidemic control while minimizing costs for society compared to non-targeted approaches. Of all the interventions considered including repeated testing and non-pharmaceutical measures, vaccination of the unvaccinated is the most effective.Conclusions: With the Delta variant, vaccinated individuals are well protected against hospitalization but remain at risk of infection and should therefore apply protective behaviors (e.g., mask-wearing). Targeting non-vaccinated individuals may maximize epidemic control while minimizing costs for society. Vaccinating children protects them from the deleterious effects of non-pharmaceutical measures. Control strategies should account for the changing SARS-CoV-2 epidemiology. [ABSTRACT FROM AUTHOR]

Nearly two-thirds of geriatric short-stay patients were eligible for pneumococcal vaccination. Among patients eligible for vaccination, less than 5 % had received at least one injection of pneumococcal vaccine on admission. We found no modifiable factors associated with vaccination status, but several avenues for improving vaccination coverage., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Vaccine hesitancy in healthcare workers has been increasing especially in France while they are the cornerstone of vaccination programs. Greater understanding of healthcare students (HCS) vaccine knowledge, attitudes and beliefs is necessary to provide an adequate vaccination education to better equip them to promote vaccination in their future careers. The aim of this study was to assess vaccination perception (VP) (perception of benefits and risks of vaccines) and its impact on vaccination coverage (VC) for mandatory and recommended vaccines among HCS. Methods: A standardized, anonymous self-reporting electronic questionnaire was prospectively sent to HCS (medicine, nursing, pharmacy, midwifery, physiotherapy students and 1st year of health sciences students) of Normandy University in France between 18/03/2019 and 8/04/2019. VP was evaluated with questions regarding vaccination hesitancy, safety of vaccine and the benefit/risk balance of vaccination. Global VC (GVC) was defined as being vaccinated according to the mandatory and/or recommended vaccination schedule by national French law in 2018. Results: 542 HCS took part in this survey. VC was high for mandatory (diphtheriae, poliomyelitis, tetanus 93.5%, hepatitis B virus 88.6%) and even most of recommended vaccinations (measles 95%, pertussis 88.2%). Global VC (40.4%) was not statistically different between HCS except for 1st year health sciences students who were less vaccinated (25.6%). Regarding VP, 97.8% of HCS thought that vaccine are effective. When vaccine safety and level of vaccine hesitancy were assessed (on a 0–10 scale, 0: not safe or not hesitant and 10: completely safe and strongly hesitant for vaccine), 91% of respondents stated that vaccine safety is ≥7 and in 80% the vaccine hesitancy was < 3. There was no difference among student categories. 80.6% of HCS recommended all vaccines but only 52% agreed that flu vaccination should be mandatory for HCS. In the multivariate analysis, being a 1st year health care sciences student was associated with a lower GVC (OR 95% CI = 2 [1.2–3.3], p = 0.004) than being a medical student. Conclusion: HCS perceived vaccine as effective and secure. Despite the good perception of vaccines, less than half HCS are well vaccinated. [ABSTRACT FROM AUTHOR]

• The size of populations targeted by influenza vaccine recommendations was estimated, based on data from the French health insurance, at 17.6, 17.8, and 18.0 million for influenza seasons 2012–13, 2013–14, and 2014–15, respectively. • Vaccine coverage rates in these target populations were 32.1%, 31.9%, and 32.1%; i.e. 44.2%, 43.1%, and 42.7% for people aged 65 years and above, and 12.9%, 13.2%, and 13.7% for those aged below 65 years presenting a risk justifying vaccination. • The rate of influenza vaccination in France is far below the 75% objective set by the World Health Organization. To estimate the size of the populations targeted by the French recommendations of the High Council for Public Health (French acronym HCSP) regarding vaccination against seasonal flu and to estimate vaccination coverage rates in these populations. The analysis was conducted on a representative sample of patients retrieved from the French Health Insurance databases during three influenza seasons (2012–2013, 2013–2014, 2014–2015). Patients targeted by the influenza vaccination recommendations were identified based on their sociodemographic characteristics and disease identification algorithms during each season. Vaccine coverage rates were estimated based on reimbursed influenza vaccines. Results were extrapolated using indirect standardization to the overall French population. Populations targeted by the recommendations were estimated after extrapolation to 17.6, 17.8, and 18.0 million for the 2012–13, 2013–14, and 2014–15 influenza seasons, respectively. The vaccination coverage rates in these target populations were respectively estimated at 32.1%, 31.9%, and 32.1%; i.e. 44.2%, 43.1%, and 42.7% for individuals aged ≥ 65 years and 12.9%, 13.2%, and 13.7% for individuals ˂ 65 years of age presenting a risk justifying vaccination. Immunization coverage against influenza in France remains well below the target of 75% set by the World Health Organization. Multiple strategies combining communication, education, access program, and professional engagement could be implemented to improve this situation. [ABSTRACT FROM AUTHOR]

• Infant vaccines protecting against 11 diseases have changed from recommended to mandatory status in France for all children born from first of January 2018. • Vaccinoscopie is an annual French web-based survey targeting mothers, monitoring vaccine coverages (VCRs) in children as well as mothers' opinion regarding vaccination. • This study shows a positive impact of mandatory vaccination extension on VCRs and opinion of infants' mothers for the second consecutive year. • Among infants born after mandatory vaccination extension, VCRs for vaccines that did not achieve Public Health objectives increased further in 2018 and 2019 (especially MenC and HepB VCRs). Infant vaccines protecting against 11 diseases have changed from recommended to mandatory status in France for all children born from first of January 2018. Through Vaccinoscopie survey, we measured for the second consecutive year the impact of this new policy on vaccine coverage rates (VCRs) and mothers' perception regarding vaccination. Web-based survey on a representative sample of 1500 mothers of 0 to 17-month-old infants. Non-optimal VCRs continued to increase in 2019 versus 2017 (according to age, + 7 to 8 points VCR for Hepatitis B and + 36 to 68 points for Meningococcus C). After a progressive decrease between 2012 and 2017, the rate of favorable mothers' opinion towards vaccination continued to progress in 2018 and 2019. These results confirmed the positive impact of this new law on infant VCRs and mothers' favorable opinion regarding vaccination. [ABSTRACT FROM AUTHOR]

Background: Seasonal influenza vaccination coverage levels remain too low in many countries., Objectives: This study aimed to evaluate the impact of a reminder letter from their general practitioner (GP) on patients' influenza vaccination., Methods: Eligible patients for this controlled non-randomised study were the vulnerable categories targeted by the 2019-2020 national health insurance fund (NHIF) vaccination campaign, on the lists of 14 GPs from three practices in Paris (France) and unvaccinated on January 2, 2020 (mid-campaign). The choice of practices and assigning five GPs to the intervention arm were made for convenience. At mid-campaign, GPs in the intervention arm sent a standardised letter reminding each eligible patient to be vaccinated. In the control arm, GPs worked as usual. The intervention effect, calculated from the NHIF databases, was estimated by the difference between the groups in their vaccination coverage at the end of the campaign, with a linear mixed model adjusted for age, sex, chronic disease (at the patient level) and medical practice (at the GP level)., Results: The vaccination coverage at the end of the campaign was 14.7% in the intervention group ( n  = 317) and 1.7% in the control group ( n  = 493): a difference of 13.1% points (95% confidence interval [9.0-17.2], number needed to send 7.7). At the campaign's end, vaccination coverage among patients from the lists of GPs in the intervention arm was 62.7%, and 46.2% among patients from the control-arm GP lists., Conclusion: Reminder letters could help increase influenza vaccination coverage.

• Insufficient vaccinal uptake in HCWs may impact influenza outbreaks in health care settings in France. • Vaccination coverage in HCWs is dependent on HCWs' status, age, and practice. • Acceptance of mandatory influenza vaccination for HCWs is related to status, age and having received seasonal vaccination. Influenza is recognized as a public health threat. However, vaccine hesitancy and poor vaccine uptake have been seen in French healthcare workers (HCWs). As a result, authorities have considered implementing mandatory influenza vaccination for HCWs. This study aimed to describe factors associated with influenza vaccine adherence or non-adherence in French HCWs and to collect their perception about mandatory influenza vaccination. In February 2017, during the influenza season, a standardized questionnaire was sent electronically to the professional email addresses of French HCWs. Analyses were performed having collected 3000 responses. Between February 1 and 16, 2017, a 14-question survey was sent to HCWs professional email addresses. After a two week period had elaspsed, 3000 answers were collected for analysis. Overall, 45.7% of responders reported they had received influenza vaccination in 2016–2017, with statistical differences relating to professional status, age and practice. In addition, 92.2% reported caring for at-risk patients and 62.9% had a community-based practice. Finally, accepting mandatory influenza vaccination was statistically associated with higher age, a higher socio-professional category, and seasonal influenza vaccine uptake, but not with management of at-risk patients. Electronically submitted questionnaires are a rapid and easy tool that can be used to describe factors associated with influenza vaccine uptake in HCWs. In our study, differences in receiving influenza vaccination related to age, practice and professional categories, and provided an insight into potential adherence to mandatory influenza vaccination in HCWs. If repeated, these surveys may also monitor the evolution of vaccine uptake by professional categories. [ABSTRACT FROM AUTHOR]

Introduction: Vaccination is a crucial tool for the primary prevention of infectious diseases. Thanks to widespread vaccination, in the last century smallpox has been eradicated, and the Americas and Europe have become polio-free. Areas covered: The aim of our study was to assess vaccination coverage in childhood up to booster preschool age in order to update the analysis on European trends of immunization coverage in the last nine years (2009–2017) and to assess the impact of different national policies on vaccine uptake. Expert opinion: Despite the good results, several EU countries are going through unprecedented outbreaks of vaccine-preventable diseases due to insufficient coverage. The increase of vaccine hesitancy has made it difficult to reach and maintain high rates of vaccination coverage. Enforcing mandatory vaccinations is one of the strategies adopted by some countries, like Italy and France, to increase coverage. However, each country should find the most suitable way to keep up with vaccination coverages according to own cultural and organizational background. [ABSTRACT FROM AUTHOR]

Highlights • Meningitis C is a rare disease, with a high case fatality. Existing vaccines greatly contributed to controlling this disease in countries with high vaccine coverage. • Vaccinoscopie is an annual French web-based survey targeted at mothers and monitoring vaccine coverage of several diseases in children as well as the opinion of mothers regarding vaccination. • This study shows that MenC vaccination coverage is insufficient, especially in 14-15-year-old adolescents. In 2017 only one in two teenagers was vaccinated. • More than 25% of surveyed mothers think their teenager is protected by the vaccination whereas he/she is not. • The main concerns expressed by surveyed mothers considering MenC vaccination not very useful or useless are adverse effects, the rarity of the disease, and the lack of vaccine information. • Raising awareness and communicating evidence-based information on the importance of MenC vaccination by health players is essential to stop the spread of MenC in Franc. Abstract Objectives Meningococcal C (MenC) vaccination was introduced in the French vaccination calendar in 2010 to reduce the incidence of invasive meningococcal C disease (IMD C), mainly through herd immunity. The Vaccinoscopie survey helps follow vaccination coverage rates (VCRs) of children. Methods This annual survey is based on a self-administered online questionnaire. In 2017, 4500 mothers of children completed the questionnaire and reported all vaccinations recorded in their child's health record. Results MenC vaccination was deemed indispensable or useful by 77% to 84% of mothers. The main barrier mentioned by mothers considering the vaccination useless/not very useful, was fear of adverse effects. VCR was estimated at 77% among 24-35-month-old infants, 79% among 6-year-old children, and 50% among 14-15-year-old adolescents. VCR strongly varied depending on the physician's advice for vaccination and on the type of follow-up. Six months after publication of the new French vaccine calendar in April 2017, with a MenC vaccine recommendation for all 5-month-old infants, 43% of infants had received a dose at 6 months of age. Conclusions VCRs are insufficient to reach herd immunity. Between 2011 and 2017 more than 100 deaths could have been avoided in France if optimal VCRs had been achieved. Faced with this vaccine strategy failure, the new vaccine recommendation at 5 months of age seems well-accepted. This recommendation and the implementation of infant mandatory vaccination in 2018 should have a major impact on IMD C incidence in this age group. [ABSTRACT FROM AUTHOR]

Highlights • In France the vaccination of all infants born on or after January 1, 2018 against 11 diseases has changed from a recommended to a mandatory status. • Vaccinoscopie is an annual French web-based survey targeting mothers, monitoring vaccine coverage rates (VCRs) in children as well as mothers' opinion regarding vaccination. • This study reports the positive impact of mandatory vaccination extension on VCRs and on the opinion of mothers of infants. • Among infants born after the extension of mandatory vaccination, VCRs for at least one dose at six months of age greatly increased for vaccines that previously did not meet Public Health objectives (MenC and HepB). Abstract Objective In France infant vaccines protecting against 11 diseases have changed from a recommended to a mandatory status for all children born on or after January 1, 2018. Using the Vaccinoscopie survey, we measured the impact of this new vaccination policy on vaccine coverage rates (VCRs) and on mothers' perception of vaccination. Methods Online survey with 1000 mothers of 0- to 11-month-old infants. Results VCRs for at least one dose at the age of 6 months strongly progressed for diseases that previously did not meet Public Health objectives (+8 points for Hepatitis B and +31 points for meningococcal C vaccines). Mothers were more favorable to mandatory vaccination and better informed in 2018 than in 2017. Conclusion These first results showed a positive impact of the extension of mandatory vaccination on mothers' opinion regarding vaccination and on infant VCRs. [ABSTRACT FROM AUTHOR]

Highlights This study showed insufficient vaccine coverage among adolescents aged 16–18 years who participated in the National Defense Preparation Day in 2013 in the Aquitaine region and the benefit of using the electronic immunization record available from MesVaccins.net. Our findings suggest that the electronic immunization record is useful to collect vaccination data and that the National Defense Preparation Day organized in France is a good opportunity to collect health data among adolescents aged 16–18 years. To our knowledge, in 2013, our study was the first based on electronic immunization records in Europe. Abstract Objectives To measure vaccine coverage among adolescents aged 16–18 years who participated in the National Defense Preparation Day in the Aquitaine region using the free electronic immunization record. Patients and methods We considered adolescents aged 16–18 years who participated in the National Defense Preparation Day in the Aquitaine region from April to October 2013. All participants received a letter explaining how to create an electronic immunization record. Those records were then validated by checking data against the copies of the vaccination cards brought by participants on the day they attended. Vaccination coverage was estimated for eight vaccinations according to the cumulative number of doses registered and vaccines recommended during childhood. Results Among the 18,714 participants, 9636 agreed to create an electronic immunization record of which 2781 were validated. Vaccination coverage was ˃ 90% for tuberculosis, diphtheria-tetanus-poliomyelitis, measles-mumps-rubella, and Haemophilus influenzae type B, and ˂ 90% for pertussis, hepatitis B, meningococcal C disease, and human papillomavirus. These coverage rates were close to those reported in other available sources. Conclusion Our study calls attention to the insufficient vaccination of adolescents for pertussis, HBV, meningococcal C disease, and HPV. The absence of a system that routinely provides the vaccination status of this population is a major public health issue in France. The use of an electronic immunization record was innovative, but this tool is not extensively used in the general population and has been evaluated by Santé publique France (the French national public health agency). [ABSTRACT FROM AUTHOR]

Objectives Vaccinations are the main pillar of primary prevention for infectious diseases. To guide and prioritize public health interventions, the Regional Health Agency has asked the Prevention, Vaccination, and Screening Center of the Sarthe department to assess vaccination coverage (VC) at the sub-departmental level. The main objective was to measure the VC among school children aged 14–15 years in Sarthe at the sub-departmental level. Patients and methods We conducted a VC evaluation survey at the administrative district level among school children aged 14–15 years in the Sarthe department during the first quarter of the 2015–2016 school year. Results Among 2384 randomly selected school children, 1171 were included in the study. At the departmental level, 85% of children were up to date for DTP, 72% for pertussis, 45% for hepatitis B, 31% for meningococcus C, 93% for measles, and 18% of girls had received at least one dose of the HPV vaccine. Vaccination coverage varied by administrative districts. Conclusion At the departmental level, all VC were below national goals. Territorial disparities could be explained by sociodemographic differences or differences in medical practices. This survey allowed us to identify areas and population groups where the CV rate justified public health actions. [ABSTRACT FROM AUTHOR]

Background: Influenza-associated deaths is an important risk for the elderly in nursing homes (NHs) worldwide. Vaccination coverage among residents is high but poorly effective due to immunosenescence. Hence, vaccination of personnel is an efficient way to protect residents. Our objective was to quantify the seasonal influenza vaccination (IV) coverage among NH for elderly workers and identify its determinants in France.Methods: We conducted a cross-sectional study in March 2016 in a randomized sample of NHs of the Ille-et-Vilaine department of Brittany, in western France. A standardized questionnaire was administered to a randomized sample of NH workers for face-to-face interviews. General data about the establishment was also collected.Results: Among the 33 NHs surveyed, IV coverage for the 2015-2016 season among permanent workers was estimated at 20% (95% Confidence Interval (CI) 15.3%-26.4%) ranging from 0% to 69% depending on the establishments surveyed. Moreover, IV was associated with having previously experienced a "severe" influenza episode in the past (Prevalence Ratio 1.48, 95% CI 1.01-2.17), and varied by professional categories (p < 0.004) with better coverage among administrative staff. Better knowledge about influenza prevention tools was also correlated (p < 0.001) with a higher IV coverage. Individual perceptions of vaccination benefits had a significant influence on the IV coverage (p < 0.001). Although IV coverage did not reach a high rate, our study showed that personnel considered themselves sufficiently informed about IV.Conclusions: IV coverage remains low in the NH worker population in Ille-et-Vilaine and also possibly in France. Strong variations of IV coverage among NHs suggest that management and working environment play an important role. To overcome vaccine "hesitancy", specific communication tools may be required to be adapted to the various NH professionals to improve influenza prevention. [ABSTRACT FROM AUTHOR]

Objectives: To establish an overview of vaccination amongst health students in Lyon 1 University and to evaluate the implementation of a new verification system of immunization obligations with an electronic vaccination card (EVC) from the &#8220;MesVaccins.net&#8221; website., Methods: A questionnaire was sent by the Lyon 1 University Student Health Service (SHS) to the first-year health studies students over the age of 18 in Lyon in 2020-2021 who shared their EVC; exploitation of these EVCs&#8217; data., Results: Amongst all students, 67.4% transmitted their information to the SHS. They reported organizational difficulties in updating (33.3%) and certifying their EVC with a healthcare professional (55.9%). Global satisfaction of the students was 78.0%. This study highlighted many differences between Lyon Est and Lyon Sud campuses, especially about general knowledge of the SHS, visibility of the promotion campaign, rate of students who transmitted their information to the SHS and rate of up-to-date students. Regarding mandatory immunization, 83.4% of the students were up-to-date with diphtheria-tetanus-poliomyelitis, 56.8% with hepatitis B, and 64.7% had done a tuberculin intradermal test; 43.4% of the students were simultaneously up-to-date with these three immunizations., Conclusion: The rate of up-to-date students is insufficient. This study stresses the necessity of an early campaign of immunizations promotion, with better access to healthcare professionals able to certify EVCs.

Objectives The cocoon strategy against pertussis has been recommended in France since 2004 to indirectly protect young infants who are not yet vaccinated. We aimed to measure vaccination coverage among French parents of infants. Methods A representative sample of 300 mothers and 200 fathers of infants aged < 12 months completed a self-administered online questionnaire. They all provided their own vaccination records. Results Overall, 87% of mothers believed vaccination against pertussis to be important; 83% reported being immunized against pertussis but their vaccination records showed that a third of them was wrong (34%). On the basis of our sample, the 2009–2014 vaccination coverage against pertussis among mothers increased from 22 to 61% ( P < 0.005); over the same period of time, vaccination coverage against diphtheria, tetanus, and polio remained stable (80%). Vaccination coverage against pertussis among fathers increased from 21 to 42% between 2010 and 2013 ( P = 0.009). In 2013, one couple out of four (26%) was adequately immunized against pertussis. Conclusion The cocoon strategy was implemented 10 years ago in France but vaccination coverage remains suboptimal among parents of young infants. Healthcare professionals must recommend vaccination against pertussis to young adults and check that their vaccination status is up to date. [ABSTRACT FROM AUTHOR]

Highlights: [•] Data on 6275 residents from 175 nursing homes (NH) in France showed high vaccination coverage for seasonal influenza. [•] Vaccination coverage against pneumococcus was low and variable across NHs. [•] NH structure and internal organisation aspects were associated with vaccination coverage, particularly against pneumococcus. [Copyright &y& Elsevier]

In 2009–2011, 113 adult in- and outpatients with measles were referred to the University Hospital of Clermont-Ferrand (centre of France): 71 (62.8 %) needed hospitalisation, 31 had pneumonia, 29 diarrhoea, 47 liver enzymes elevation, 38 thrombopaenia, one encephalitis and there were no deaths. Nineteen cases occurred among healthcare workers and five of them were hospital-acquired. There were 92 unvaccinated patients. The 2011 peak of that measles re-emerging epidemic occurred when non-immunised adults were affected. [ABSTRACT FROM AUTHOR]

Abstract: Immunization against meningococcus C has been recommended in France since 2009 (infants from 12 to 24 months of age, and catch up vaccination up to 25 years of age). It has been reimbursed since January 2010. We had for aim to assess the vaccine coverage in 2011. Method: The study population included mothers of children targeted by the recommendation. They were recruited using Internet data (quotas based on the French National Institute of Statistics (INSEE) data based on a census made in 2007) based on the Institut des Mamans panel and its partners. The mothers had completed a standardized questionnaire and reported all vaccinations mentioned in their child's health-record. Results: We included 3000 mothers of children, 0 to 35 months of age, (1000 for each of the following age range: 0–11 months, 12–23 months, 24–35 months), and 2250 mothers of teenagers, 14 to 16 years of age. Vaccination was deemed “essential/useful” for respectively 90.2% (CI 95%: 89.2–91.3) and 87.8% (CI 95%: 86.4–89.2) of mothers. Vaccine coverage levels were 32.3% (12–23 months), 57.3% (24–35 months), and 21.3% (14–16 years). Comments: Two years after the Ministry of Health's decision to reimburse this vaccine, vaccine coverage levels were much lower than they should have been, to expect effectiveness of the vaccination policy. Only 21.3% of teenagers had been vaccinated, and 32.3% of infants during the second year of life. [Copyright &y& Elsevier]