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Resume Le Conseil national de protection de l’enfance (CNPE) a ete cree en France par la Loi de mars 2016. Cinq missions lui ont ete confiees, dont la principale est de « proposer au gouvernement les orientations nationales de la politique de protection de l’enfance dans le but de construire une strategie nationale. » Il est forme de 82 membres d’horizons differents dont trois pediatres. Les membres sont repartis en cinq commissions : Adoption et Suppleances longues, Adaptation des interventions en Protection de l’Enfance aux besoins de l’enfant, Prevention et reperage precoce, Connaissance en protection de l’enfance (PE) et Recherche, Formation. Le CNPE a donne de nombreux avis depuis sa mise en place et pris position sur de nombreux sujets. Les auteurs qui participent a ce conseil abordent les aspects positifs de sa creation, en particulier le regroupement de nombreux acteurs de la protection de l’enfance au sein d’une meme structure. Ils constatent aussi les difficultes de fonctionnement en particulier le manque de moyens et le besoin de clarification du role du CNPE par rapport au caractere decentralise des strategies de protection. L’epidemiologie reste mal connue mais le nombre tres important des enfants entrant dans ce cadre (protection de l’enfance et maltraitance) rend essentiel le role et la presence des pediatres au sein de ce conseil.

THE TIRED CHILD. Child fatigue is difficult to define and evaluate. This is a common reason for parental concern and consultation. The expressions of fatigue are variable according to age. An organic origin must be sought. It is rarely found when the symptom is isolated. Most often the origin of child and adolescent fatigue is environmental, related to living conditions. The analysis should focus on family constraints, sleep conditions, use of screens, school and activities. A psychological origin must be sought especially a depressive syndrome.L’ENFANT FATIGUÉ. La fatigue de l’enfant est difficile à définir et évaluer. C’est un motif fréquent d’inquiétude parentale et de consultation. Les expressions de la fatigue sont variables selon les âges. Une origine organique doit être recherchée. Elle est rarement retrouvée lorsque le symptôme est isolé. Le plus souvent, l’origine de la fatigue de l’enfant et de l’adolescent est environnementale, liée aux conditions de vie. L’analyse doit porter sur les contraintes familiales, les conditions de sommeil, l’utilisation des écrans, les activités scolaires et extrascolaires. Une origine psychologique doit être recherchée, particulièrement un syndrome dépressif.

Resume Introduction Les adolescents admis dans les services d’accueil des urgences pediatriques (SAUP) pour agitation sont de plus en plus nombreux. Leur agitation, multifactorielle, survient dans un parcours souvent « complexe ». Ils mettent en difficulte les structures hospitalieres d’accueil parfois inadaptees et depassees par ces moments de crises. L’objectif de cette etude etait de recenser et decrire la population admise dans un centre hospitalier universitaire (CHU) pour agitation au cours d’une annee, et de discuter la problematique de leur prise en charge. Materiel et methodes Etude retrospective de tous les adolescents admis pour agitation, au SAUP du CHU de Nantes, en 2015. Resultats Quatre-vingt-dix-neuf adolescents avaient consulte 182 fois pour agitation. Parmi eux, 85 % avaient des antecedents d’agitation, 70 % avaient un suivi psychologique en cours et 56 %, suivis par l’aide sociale a l’enfance, avaient un parcours « complexe ». La majorite des crises etait survenue au domicile parental et etait de type hetero-agressif. A l’arrivee au SAUP, 90 % etaient calmes. La duree moyenne de sejour au SAUP avait ete de 3 h 42 minutes et par la suite 31 % avaient ete hospitalises en pediatrie generale, 14 % en pedopsychiatrie et 8 % en psychiatrie pour adultes. Conclusion La proportion de parcours complexes parmi les adolescents admis aux SAUP etait importante. Ces adolescents en souffrance, au parcours complexe, illustrent le lien entre violences subies et violences agies. Le developpement d’unites d’hospitalisation de courte duree semble une solution pertinente pour permettre une mise a distance et une evaluation pluridisciplinaire, somatique, psychique et sociale de ces patients vulnerables.

Self-cutting in adolescents: when to worry?. Self-cutting, the most part of the nonsuicidal self-harming behaviours, seems becoming quite common among adolescents. Nevertheless, assessment and follow up are always required with at least three aims: to assess globally the adolescent' situation, and his or her to psychological distress - to look for a passed trauma (i.e sexual abuse) behind the self- harm behaviour - to recognize psychiatric disorders beside self-harming and to recognize patients to refer to the mental health services.Les scarifications chez l’adolescent : quand s’inquiéter ?. Les scarifications semblent aujourd’hui devenues banales chez l’adolescent. Elles doivent cependant toujours susciter une inquiétude médicale et conduire à une évaluation globale et à une proposition de suivi, en raison du mal-être dont elles témoignent et des éventuels antécédents traumatiques (par exemple des abus sexuels) qu’elles peuvent révéler. Cette évaluation permet également d’identifier les situations plus rares dans lesquelles les scarifications ne sont qu’un élément de troubles psychiatriques plus graves nécessitant d’emblée une expertise et une prise en charge en santé mentale.

All forms of abuse are observed in teenagers: physical, sexual, psychological, and neglect. The reader will find some topics more specific to adolescence, such as maltreatment and ICT (information and communication technology) as well as so-called indirect warning signs. Understanding the indirect signs is fundamental to recognizing abuse in teenagers. These include suicide attempts, running away, malaise, eating disorders, and acts of violence.

Background Adolescent vaccination coverage tends to be suboptimal, leading to resurgent infectious pathologies and vulnerability to various pathogens. The low frequency of medical consultations and missed opportunities for vaccination are often used to explain the low rate of vaccination. The aim of this study was to assess if the vaccination coverage rate is higher in chronically ill adolescents (CIA) who require a close pediatric specialized follow-up versus the rate in healthy adolescents (HA). Methods A monocentric cross-sectional study was conducted in the Nantes University Hospital. We included 114 CIA and 266 HA. The vaccination coverage rate and the up-to-date immunization status were compared between ill versus healthy adolescents for each of the following vaccines: diphtheria, tetanus, acellular pertussis, inactivated poliovirus (DTaP/IPV), measles-mumps-rubella (MMR), hepatitis B (HepB), meningococcal C conjugate (MnC), human papillomavirus (HPV) and composite combinations (e.g. DTaP/IPV-MMR-HepB-MnC). Results The overall immunization rate for DTaP/IPV-MMR-HepB-MnC was very low, with no significant difference between CIA and HA (9.6% versus 13.5%; p = 0.28). Most of the investigated vaccines exhibited similar immunization patterns for the two groups: DTaP/IPV (77.2 vs. 76.7%; p = 0.97), MMR (92.1 vs. 95.9%; p = 0.14), HepB (51.8 vs. 48.5%; p = 0.51) with the exception of the MnC (18.4 vs. 27.8%; p = 0.05) and HPV (28.6 vs. 16.1%; p = 0.04). Conclusion Despite undergoing specialized and close medical follow-up, we found that the vaccination coverage rate for the CIA remained suboptimal. This indicates that pediatricians need to check the vaccination status and, when required, ensure that the vaccination schedules for these fragile patients are up-to-date.

L’evolution des modalites de soins des enfants porteurs de maladies chroniques a ete marquee essentiellement par l’amelioration globale des pronostics liee aux ameliorations techniques. Nous avons evolue sur beaucoup de points. Les definitions et l’epidemiologie se sont modifiees avec l’apparition de nouvelles maladies et surtout l’augmentation globale du nombre d’enfants porteurs de maladies chroniques. Les situations se sont diversifiees selon, en particulier, les modes de revelation. Nous avons individualise de grandes etapes comme l’annonce, les phases evolutives, les transitions. La guerison est possible chez l’enfant. L’organisation des soins doit repondre a la question « A quoi tenons-nous ? » : poursuivre les progres techniques, associer prise en charge et accompagnement, associer les familles, integrer soma-psyche... Deux evolutions de modalites de soins paraissent remarquables : l’interdisciplinarite et l’education therapeutique.

Resume Objectifs La pratique pediatrique est un exercice difficile ou il faut apprendre a distinguer parmi une multitude de recours pour des motifs benins des situations cliniques rares mais potentiellement graves. Notre but etait d’evaluer les connaissances des etudiants entrant en 3e cycle de medecine generale sur ces situations. Methodes Cent trois etudiants ont ete evalues sur les « feux tricolores » sous forme de 103 questions a choix multiple (QCM) a 2 modalites (vrai/faux). Ces feux tricolores avaient ete definis par des praticiens pediatriques du centre hospitalier universitaire (CHU) et des enseignants de medecine generale de Nantes comme des fondamentaux de la pediatrie : situations pieges, diagnostiques ou therapeutiques a ne pas manquer. Le degre d’urgence etait defini par la couleur, le rouge correspondant aux urgences vitales immediates. Resultats Trente-six pour cent des QCM (n = 103) ont eu un taux de bonnes reponses inferieur a 75 %. Trente-deux pour cent des QCM concernant des situations avec urgence vitale (« feux rouges ») (n = 37) ont eu un taux de bonnes reponses inferieur a 75 %. Quinze pour cent des questions (n = 103) ont eu un taux de bonnes reponses inferieur a 50 %, la moitie concernant des « feux rouges » (meningite, decouverte de diabete, choc). Les questions concernant les nourrissons (n = 24) ont eu significativement moins de bonnes reponses (taux de bonnes reponses inferieur a 50 % de 29 % versus 10 %, p = 0,047) Conclusions Certaines situations d’urgence ou concernant les nourrissons ne sont pas maitrisees par la majorite des etudiants. Il est donc indispensable de mener une reflexion sur l’optimisation de l’enseignement de la pediatrie au second cycle.

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

Resume Objectif Etablir un protocole interregional actualise de prise en charge de la bronchiolite aigue du nourrisson de moins de 1 an. Methode Un groupe de travail compose de pediatres et d’urgentistes des hopitaux universitaires du Grand Ouest (HUGO) s’est reuni autour de l’analyse des donnees recentes de la litterature. Les recommandations issues de ce travail ont ensuite ete soumises et validees par les pediatres des HUGO. Resultats Apres avoir etabli des criteres permettant de distinguer un asthme debutant du nourrisson d’une bronchiolite aigue virale, les indications d’examens complementaires ainsi que les prescriptions d’antibiotiques et de kinesitherapie respiratoire ont ete precisees et reservees a des situations tres limitees. De meme, des modalites de prescription de l’oxygenotherapie et du support nutritionnel ont ete proposees. Enfin, d’autres therapeutiques comme les nebulisations de serum sale hypertonique ont ete jugees prometteuses mais leur place dans la prise en charge de la bronchiolite aigue du nourrisson reste encore a preciser. Conclusion Alors que la prise en charge de la bronchiolite aigue du nourrisson en France est actuellement guidee par la conference de consensus de la Haute Autorite de sante (HAS) qui date de 2000 et que nos confreres europeens et nord-americains ont recemment mis a jour leurs recommandations, ce travail a permis d’actualiser les modalites de prise en charge de cette affection et d’homogeneiser les pratiques au sein des HUGO.

International audience; The objective of this study was to investigate whether acute pain in abused children was under recognized by doctors and nurses compared to children evaluated for accidental injuries. We hypothesize that an abused child's reaction to physical pain could be an additional symptom of this challenging diagnosis. For the observational prospective case control study in an emergency department, children were eligible when: younger than six years old, the reported trauma occurred within the previous seven days, the trauma comprised a bone injury or burn, and the child was able to express his or her pain. The case group comprised children for whom the medical team reported their abuse suspicions and supporting information to a court, and whose cases of abuse were subsequently confirmed. The control group consisted of children with a plausible cause for their injury and no obvious signs of abuse. The children were matched according to their age and type of trauma. The pain was assessed by doctors and nurses before analgesic administration using a certified pain scale. Among the 78 included children, pain was significantly less recognized in the abused children vs. the controls (relative risk=0.63; 95% CI: 0.402-0.986; p=0.04). We observed a discrepancy between the nurses' and doctors' scores for the pain assessments (Kappa coefficient=0.59, 95% CI: 0.40-0.77). Our results demonstrate that pain expression in abused children is under recognized by medical staff. They also suggest that abused children may have reduced pain expression after a traumatic event. Paying particular attention to the pain of abused children may also optimize the analgesic treatment.

ResumeL’orientation d’un adolescent vers un lieu specifique de soin n’est jamais simple. Les Maisons des Adolescents possedent des atouts qui sont developpes a travers les modalites meme du travail mene par les accompagnants sociaux. Nous proposons de souligner ici la maniere dont ces derniers, dans leur accueil, appellent a un transfert tant sur l’institution que sur ses membres. L’accent est egalement mis sur un temps institutionnel fort, celui de la reunion clinique, qui permet la co-elaboration de l’experience clinique originale de ces professionnels, ainsi que la mise au travail de chacun des membres de l’equipe aupres des adolescents accueillis.Adolescence, 2012, 30, 2, 349-357.

Resume La reunion annuelle de la Societe americaine d’infectiologie (Infectious Disease Society of America [IDSA]), qui a reuni pres de 5000 congressistes de plus de 80 pays a Vancouver, Canada du 21 au 24 octobre 2010, a permis de faire le bilan de la pandemie de grippe A(H1N1) 2009 en Amerique du Nord, d’evaluer les programmes de vaccination, et de presenter les nouveaux vaccins en cours de developpement. Avec 12 500 deces aux Etats-Unis en 2009–2010, la grippe pandemique a ete moins meurtriere que la grippe saisonniere. Mais elle a frappe essentiellement des jeunes, et le bilan calcule en nombre d’annees de vie perdues est eleve. Les differents vaccins monovalents (vivants attenues, inactives avec ou sans adjuvants) ont ete bien toleres, chez les enfants comme chez les adultes et les femmes enceintes. La protection des tres jeunes nourrissons contre la coqueluche passe par le renforcement des rappels vaccinaux de son entourage familial. L’introduction du vaccin pneumococcique conjugue 13-valent au debut de l’annee 2010 pourrait resoudre – mais pour combien de temps? – le probleme de remplacement des serotypes, responsable d’une recrudescence des infections invasives a pneumocoques observee dans les pays qui avaient introduit le vaccin conjugue 7-valent. L’efficacite du vaccin rotavirus se confirme, avec une diminution des hospitalisations aux Etats-Unis et une diminution des deces dus aux gastroenterites au Mexique. Aux Etats-Unis, la vaccination des preadolescentes contre le papillomavirus humain (HPV) n’a pas entraine d’effet indesirable particulier. La vaccination de routine contre la varicelle, recommandee depuis 1995, n’a eu aucun impact sur l’evolution de l’incidence du zona. Quant au vaccin contre le zona, recommande pour les sujets de 60 ans et plus aux Etats-Unis, son efficacite sur le terrain serait de 55 %, d’apres une etude de cohorte (Kaiser Permanente de Californie du Sud). Si certains proposent l’elaboration de vaccins a la carte, en fonction des caracteristiques genetiques individuelles, la priorite reste l’augmentation de la couverture vaccinale, non seulement chez les enfants, mais aussi chez les adultes et les personnes âgees. Il convient de proposer un calendrier vaccinal etale sur toute la vie, la vaccination a l’âge adulte et chez les seniors etant determinante pour une bonne sante a tous les âges de la vie.

Age of first drink in France and Western countries is early. National and international surveys confirm this early onset. Drunkenness, which is the most obvious drinking outcome, seems to rise amongst young adolescents. Consequences of this precocity are considerable. At short-term, drunk teenagers are more frequently victims of accidents. In addition, they are more vulnerable to sexual abuses, as victims but also as perpetrators. At medium- and long-terms, the early development of alcohol use is linked to higher levels of later drinking dependence. Three explanatory ways for this precocity are developed: family's influence, role of advertising and media, and role of peers. When alcohol meets adolescence, it is sometimes a real storm. Prevention is uneasy because of the very commonplace of alcohol at home. It can concern family level or society level. As for tobacco, society intervention is needed to delay age of first drink and limit teenager alcohol use but this should not involved adolescents condemnation.

The optimal age for measles vaccination is an important health issue, since maternal antibodies may neutralize the vaccine antigen before a specific immune response develops, while delaying vaccination may increase the risk of complicated diseases in infants. However, measles vaccination impacts the duration of protection afforded by transplacental transfer of maternal antibodies: vaccination-induced maternal antibodies disappear faster than disease-induced antibodies. In order to maintain protection against measles in infants, it is important to monitor the dynamics of this phenomenon in vaccinated populations. To assess the current situation in France, a multicenter, prospective seroepidemiological study was conducted in seven French hospitals between October 2005 and January 2007. Maternal measles antibody concentrations from 348 infants 0 to 15 months old were measured using the plaque reduction neutralization assay. Geometric mean concentrations and the percentage of infants with maternal measles antibody concentrations above the protection threshold (≥120 mIU/ml) were assessed according to age. Results show that after more than 20 years of routine measles vaccination in France, maternal measles-neutralizing antibodies decrease dramatically in French infants by 6 months of age, from 1,740 mIU/ml for infants 0 to 1 month old to 223 mIU/ml for infants 5 to 6 months old, and that 90% of infants are not protected against measles after 6 months of age. Infant protection against measles could be optimized both by increasing herd immunity through an increased vaccine coverage and by lowering the age of routine vaccination from 12 to 9 months.

Resume La couverture vaccinale (CV) contre la rougeole a augmente de facon significative en France des 1983 (annee de la recommandation officielle). La majorite des femmes nees apres 1983 serait donc davantage immunisee par la vaccination plutot que par la maladie. Les anticorps antirougeole (AcR) maternels transmis pendant la grossesse protegent les nourrissons pendant les premiers mois de vie. Objectif Comparer les titres d’AcR neutralisants en fonction de l’âge chez les femmes de 12 a 40 ans, nees avant et apres 1983. Methodes Etude seroepidemiologique multicentrique realisee en France (octobre 2005–mai 2006). Au total, 210 femmes hospitalisees ou consultant a l’hopital ont ete inclues et reparties en 4 groupes d’âge (12–18 ; 19–22 ; 23–30 et 31–40 ans). Mesure des titres d’AcR par le test de reference de neutralisation par reduction de plages (seuil de protection > 120 mUI/ml). Resultats La moyenne geometrique des titres (MGT) d’AcR etait significativement superieure chez les femmes nees avant 1983 versus apres 1983 (MGT : 1358 versus 731 mUI/ml [ p p re fois en France, nous montrons que chez les femmes en âge de procreer les titres moyens des AcR neutralisants sont en 2005–2006 largement au-dessus du seuil de protection, quel que soit l’âge et que les femmes les plus jeunes (CV elevee) ont des titres significativement plus bas. La duree de protection conferee par les AcR transmis a leurs nourrissons pourrait ainsi etre reduite.

Study background: There is currently no data available regarding overall health and vulnerability factors for minors (i.e. those aged under 18) who have been placed in police custody in France. The purpose of this study was to define the sociodemographic characteristics of this population. We hypothesized that most of these teenagers can be deemed as being abused or neglected. Methods: We carried out a prospective study that included minors of 13 to 18 years of age who had been placed in custody at the Central Police Station of Nantes (France), from October 2012 to May 2013. The sociodemographic characteristics, scores for quality of life, and the data collected from the social and judiciary services were analysed to identify abused or neglected teenagers. Results: Ninety-nine cases were included. The identified population was mostly comprised of males, most commonly 16 years of age, who had been placed in custody for robbery. Their scores for quality of life were not statistically different from those of the general population. While 50% had already been identified by child protection services, our study shows that 84.8% of this population should nonetheless be considered as being abused or neglected. Conclusion: Compulsory health screening could provide an opportunity to detect abused or neglected teenagers, and consequently to provide them with access to appropriate care, as well as their referral to the relevant social and judiciary services so that the need for deploying specific protection to them can be assessed.

Child abuse is a major public health problem. The consequences including death, but also physical injuries and psychological troubles. To know and recognize the possibility of child abuse is essential for all doctors. This diagnostic hypothesis must be considered alongside all pathologies in varied clinical presentations. The practitioner must keep in mind that an unusual location, incoherent mechanism, a health seeking delay, no painful expression are warning signs and particularly a traumatic injury unexplained in an infant who does not move. To overcome the denial that surrounds these situations, the health professional should emphasize teamwork and not hesitate in doubt to be hospitalized children or at least contact a specialized team.

L’auteur (pediatre) analyse les fonctionnements de la liaison pediatrie-psychiatrie autour de la prise en charge des enfants malades et de leur famille. Les maladies somatiques de l’enfant sont accompagnees d’une « effraction psychique ». Les maladies psychiatriques ont un retentissement ou une presentation somatique. L’idee est qu’il existe un lien indissociable entre psyche et soma tout particulierement chez l’enfant. Ce lien doit amener a une « mede cine du troisieme type » qui integre la psychiatrie au travail pediatrique sans abandon des specificites. Plusieurs exemples sont donnes : annonce du diagnostic, prise en charge des maladies chroniques, anorexie mentale, etc. Des obstacles a ce travail integre existent et sont decrits. Le facteur de « liaison » principal est l’enfant qui nous oblige a depasser nos fonc tionnements dogmatiques.

We conducted a prospective study in 215 children, 3 to 36 months of age, presenting with fever > or = 39 degrees C without obvious origin, in order to evaluate the diagnostic value of procalcitonin (PCT) in detection of occult bacteraemia. PCT associated with white blood cell count constitutes an efficient screening method with sensitivity 100%, specificity 61.9% and positive and negative likelihoods ratios of 2.62 and 0, respectively.

International audience; Every year, the National Foundation for Infectious Diseases brings together more than 300 participants to review progress in vaccine research and development and identify the most promising avenues of research. These conferences are among the most important scientific meetings entirely dedicated to vaccine research for both humans and animals, and provide a mix of plenary sessions with invited presentations by acknowledged international experts, parallel sessions, poster sessions, and informal exchanges between experts and young researchers. During the Fifteenth Conference that took place in Baltimore in May 2012, various topics were addressed, including the scientific basis for vaccinology; exploration of the immune response; novel vaccine design; new adjuvants; evaluation of the impact of newly introduced vaccines (such as rotavirus, HPV vaccines); vaccine safety; and immunization strategies. The new techniques of systems biology allow for a more comprehensive approach to the study of immune responses in order to identify correlates of protection and to design novel vaccines against chronic diseases such as AIDS or malaria, against which natural immunity is incomplete.

A diagnosis of sexual abuse in children is being made increasingly in France and in all Western countries. Sexual abuses in France represent a third of all cases of maltreatment 1. In children less than 10 years of age, discovery of the circumstances varies according to the situations experienced by the adolescents. Stories can involve silence or a revelation by indirect signs or consequences of abuses. To approach this diagnosis, we will successively address three aspects: the usual circumstances of the revelation or evocation of this diagnosis, a speech and behavioral side, and a clinical examination and its difficulties.

Juvenile idiopathic arthritis is an inflammatory disease with various onset-forms which can sometimes be difficult to distinguish from genetic inflammatory/rheumatoid-like osteoarthropathies. In this report, we describe two boys with severe chronic arthralgia, stiffness and swelling of joints, motor weakness and joints contractures evolving despite immunosuppressive treatments and for whom all biological and molecular exams failed to identify a prompt diagnosis. Some findings also overlap with pseudorheumatoid dysplasia but WISP3 gene molecular analysis failed to identify any mutation for both patients. Therefore, we propose that these boys show a clinical entity distinct from the actually known genetic inflammatory/rheumatoid-like osteoarthropathies.

It is difficult to diagnose child abuse. Any injury to a child should raise the essential question as to its plausibility. Any incompatibility between the nature of the lesion and the child's age, or the explanations given, should suggest intentional injury. The presence of a bruise on an infant too young to move about is a serious warning sign. Any fractures before the infant is able to walk should raise the suspicion of intentional injury. Regardless of the type of abuse noted for an infant, it must be hospitalized. Supplementary examinations, in association with a psychosocial evaluation, will enable exploration for other lesions and the elimination of differential diagnoses. This allows the child to be protected, while including the family in the treatment process.

In 1999 the WHO alerted on vaccination coverage of adolescents in the world. In France, the vaccination coverage is low in this age. One third of teenagers has received all the recommended vaccines. The situation is particularly worrying for pertussis, measles mumps and rubella vaccines, and for the vaccine against hepatitis B. French coverage is considerably lower than figures published in the USA and Belgium. Vaccine strategies are specific to adolescence with regard to the location of vaccines, the vaccination decision, the vaccinator. The GP is the principal actor in the vaccine. Teenagers have largely favorable opinion about vaccination. The schedule is simple in adolescence. Recent innovations are: introduction of the vaccine HPV (Human Papillomavirus), generalization of the vaccine against meningococcal group C and simplification of the vaccination against hepatitis B. Six recommendations are proposed to improve vaccination of adolescents.

The objective of this study was to report the use of Mycophenolate Mofetil (MMF) in Juvenile Dermatomyositis (JDM). A retrospective chart review of children diagnosed with JDM having received MMF was performed. Response was evaluated 3 months after the onset of MMF by comparing muscle strength and steroid dosage before and after treatment. A good response was defined by global improvement concerning weakness and fatigability as evaluated subjectively by the physician along with a gain of at least 4 points on each of 2 muscle testings (Manual Muscle Testing, MMT and Childhood Myositis Assessment Score, CMAS) and/or a decrease of >15% of the corticosteroid dosage. Eight patients were identified. Except for one, all had received MMF secondary to an initial therapy of conventional immunosuppressants. Six patients showed good response by our predefined criteria. Changes of muscle testing scores ranged between +0 to +21 points (mean = +10.6) for the MMT and between +3 and +11 (mean = +7) for the CMAS. Corticosteroid tapering varied from 0 to 50%, with a mean of 18%. In most cases, follow-up was available for many months (up to 26); overall, we observed only one complication: a transient neutropenia in a patient concurrently receiving another immunosuppressant. This small series is the first published report on the use of MMF in JDM and suggests it is safe. Prospective larger studies are required to further elucidate the use of MMF in JDM.

Varicella is a widespread disease of childhood resulting from primary infection with varicella-zoster virus (VZV). The objective of this study was to determine the kinetics of the decline of maternal anti-VZV antibodies in French infants between birth and the age of 15 months in order to estimate the duration of passively acquired maternal anti-VZV immunoglobulin G (IgG). This prospective multicenter study was conducted between October 2005 and January 2007 in the pediatric wards and/or pediatric emergency units of seven French hospitals scattered throughout the country. The level of anti-VZV IgG antibodies in serum was measured by a time-resolved fluorescence immunoassay (TRFIA) (the threshold considered positive is 150 mIU/ml). A total of 345 infants were included. Seventy-seven percent of mothers reported a history of varicella. A rapid decline in the prevalence of anti-VZV antibodies was observed during the first few months of life, with the mean antibody titer decreasing from 536 mIU/ml at birth and through 1 month to below the 150-mIU/ml threshold at 3 to 4 months. The half-life of passively acquired maternal immunoglobulins was around 6 weeks. Based on a large number of subjects, this study clearly demonstrated, for the first time in France, high levels of passively acquired maternal antibodies during the neonatal period, and it allowed us to estimate the duration of passively acquired maternal anti-VZV IgG in French infants. After 4 to 5 months, infants had very low levels of maternal anti-VZV IgG, below the 150-mIU/ml cutoff of the VZV IgG TRFIA.

Measles antibody titers were measured in 210 French women. Ninety-four percent had protective values (>120 mIU/mL). Geometric mean titers were significantly different (P < 0.001) between women born before and after 1983, when measles vaccination was recommended (731 and 1358 mIU/mL, respectively). geometric mean titers in 4 age cohorts decreased significantly (P < 0.001) with increasing birth year. These data may help identify the appropriate age for infant vaccination.

We report the case of a 29-day-old baby girl in whom Escherichia coli meningitis led to the diagnosis of Currarino syndrome (CS) (OMIM 176450), an autosomal-dominant genetic disorder associated with sacral agenesis, anorectal malformation, presacral masses and spinal cord malformations. Her condition improved with antibiotics and early surgical treatment. A familial study identified other genetically related individuals with similar symptoms.