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The objective of this study was to estimate the impact of infestation pressures on the abundance of the parasitic sea louse, Lepeophtheirus salmonis, in the Bay of Fundy, New Brunswick (NB), Canada, using the Fish-iTrends database for the years 2009-2018. Infestation pressures were calculated as time-lagged weighted averages of the abundance of adult female (AF) sea lice within a site (internal infestation pressure: IIP) and among sites (external infestation pressure: EIP). The EIP weights were calculated from seaway distances among sites and a Gaussian kernel density for bandwidths of 5 to 60 km. The EIP with a bandwidth of 10 km had the best fit, as determined with Akaike's information criterion, and historical AF sea lice abundance. This estimated dispersal distance of 10 km was similar to previous studies in Norway, Scotland and in New Brunswick. The infestation pressures estimated from empirical AF sea lice abundance within and among sites significantly increased the abundance of AF sea lice (p

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

To assess the diagnostic value of RT-PCR on amniotic fluid (AF) for prenatal diagnosis of congenital rubella infection.RT-PCR on AF was compared to specific IgM antibody detection in foetuses and/or newborns in 45 pregnant women with confirmed primary infection.specificity of RT-PCR was 100% and sensitivity ranged between 83 and 95%.RT PCR may be considered as a valuable tool for prenatal diagnosis of foetal rubella infection.

Meningococcal meningitis occur as large epidemics in the "African meningitis belt" described by L. Lapeyssonnie. Neisseria meningitidis serogroup A, clone III-I, was involved in recent epidemics and immunization with A and C vaccine was therefore adequate. However, we report here the emergence of a new clone of N. meningitidis of serogroup W135 during the 2001 epidemics in Niger and in Burkina Faso and discuss the implications of this new epidemiological feature for future surveillance and vaccine strategies.

Introduction – objectifs Parmi les infections invasives a meningocoque (IIM), le serogroupe B est predominant en France et certains clones peuvent conduire a des epidemies prolongees. Une epidemie d’IIM B:14:P1.7,16 a ete detectee en 2012 dans les Pyrenees Atlantiques (PA) et a conduit a la mise en œuvre d’une campagne de vaccination par le vaccin MenBvac ® . Materiels et methodes La surveillance des IIM repose sur la declaration obligatoire et la caracterisation des souches par le Centre national de reference (CNR). Le suivi du taux d’adhesion a la vaccination de la population a repose sur l’analyse d’un fichier des personnes domiciliees, travaillant ou etudiant sur la zone et complete pour chaque personne ayant debute sa vaccination. Resultats Entre juillet et septembre 2012, quatre cas d’IIM B:14:P1.7,16 (un deces) ont ete declares autour de Lagor (PA), avec une incidence sur cette zone de 14 cas pour 100 000 habitants. Deux nouveaux cas ont ete declares en avril 2013 sur cette meme zone. Les lecons tirees de l’experience de la Seine Maritime ont conduit le Haut conseil de sante publique (HCSP) a recommander une vaccination des contacts puis la vaccination des 2 mois-24 ans par le MenBvac en juillet 2013. Fin 2013, la couverture vaccinale tous âges etait de 18,9 % pour la premiere dose en population generale. Tous les contacts des cas etaient vaccines. Conclusion La detection de cette epidemie a permis de mettre en place rapidement une campagne de vaccination aupres de la population concernee. Aucun nouveau cas d’IIM B:14:P1.7,16 n’a ete recense depuis avril 2013 suite aux vaccinations realisees aupres de tous les contacts des cas puis en population generale malgre une faible adhesion actuelle. Les regroupements temporo-spatiaux d’IIM B ont ete pris en compte par le HCSP dans les recommandations d’utilisation du nouveau vaccin Bexsero ® .

Introduction – objectifs Le vaccin Bexsero® a obtenu une AMM europeenne debut 2013 pour la prevention des infections invasives a meningocoque (IIM) B. Le Haut Conseil de la Sante Publique n’a pas recommande la vaccination en routine ni la vaccination des sujets contacts d’un cas sporadique. Une analyse des regroupements temporo-spatiaux d’IIM B identifies en France au cours des 15 dernieres annees a permis de definir des criteres d’alerte ou d’intervention vaccinale. Materiels et methodes Les grappes de cas survenues en collectivite entre 1998 et 2012, les epidemies et les foyers d’hyperendemie recenses entre 2003 et 2012 ont ete inclus dans l’analyse. Des criteres d’intervention ont ete identifies a posteriori en termes de sensibilite ou d’impact attendu en tenant compte de l’efficacite vaccinale et de la couverture des souches par le vaccin. Resultats La vaccination autour des cas sporadiques d’IIM B ou au sein d’une collectivite ou seraient survenues deux IIM B, aurait evite au mieux 1 cas secondaire par an en moyenne. La vaccination au sein d’une communaute ou les criteres d’alerte epidemique (incidence de 10/100 000 sur 3 mois avec au moins 3 cas lies a un meme clone) sont remplis et si la souche est couverte par le vaccin apparait justifiee. Des criteres d’alerte pour la detection de foyers d’hyperendemie (taux d’incidence ≥ a 3/100 000 sur 52 semaines, avec 4 cas, rattachables a des souches identiques) auraient permis d’identifier plus precocement 4 des 8 foyers identifies depuis 2003. Conclusion Certaines situations comme les grappes de cas en collectivite ou les epidemies justifient une intervention vaccinale. Des criteres conduisant a mettre en œuvre une expertise multidisciplinaire, lors de foyers hyperendemiques afin d’evaluer la pertinence d’une intervention vaccinale, ont ete proposes.

As previously reported, a C-type retrovirus, referred to as retrovirus X was isolated from HIV infected cells. In order to further characterize this virus, the proviral DNA was cloned and sequenced. The organization of the genome (8379 bp) appeared to be typical of the mammalian type C retroviruses. The virus was shown to be closely related to the gibbon ape leukaemia virus (GALV) with 87% similarity when the sequence was compared with the published genome of the Seato strain of GALV. At the level of the long terminal repeat where comparison was possible with other strains, the closest relationship was found with the San Francisco strain of GALV and with the simian sarcoma virus. These results suggest that the isolate should be considered as a strain of GALV.

A new needleless jet-injector, Mini-Imojet, was developed that administers liquid vaccines from a single-use, pre-filled cartridge named Imule, which avoids the risk of cross-contamination. We conducted clinical trials in several settings in France and West Africa to compare the immunogenicity and tolerance of five vaccines (influenza vaccine, Vi capsular polysaccharide typhoid vaccine, tetanus toxoid vaccine, diphtheria-tetanus-whole cell pertussis vaccine, and inactivated hepatitis A vaccine) administered with the Imule system vs standard syringe technique. In each vaccine study, all subjects of either group were tested for serum antibody titres to calculate the geometrical mean titres and seroconversion rates after complete vaccination. Immediate local-reactions were noted after each injection, and local and general reactions were evaluated during a predetermined period of follow-up. When delivered by the Imule technique, all the administered vaccines were of equivalent or superior immunogenicity, compared to the syringe technique. The tolerance to vaccines injected by the Imule system was acceptable in all studies. The most frequently observed reactions were mild (e.g. minor bleeding, superficial papules, erythema and induration) and could be considered to be inherent to the injection technique. The technical and safety advantages of the Mini-Imojet/Imule system, compared to sterilizable, standard disposable or autodestruct syringes and to classical multi-dose vial jet-injectors, reinforces the interest of this new injection technique for collective immunizations.

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

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

An epidemiological study was conducted during 1 year (1989) in a French department (Ille et Vilaine) on children under 6 years of age reported by local medico-social services as being at risk of child abuse or neglect. This involved 786 children, ie an incidence of 1/80 children under 6. Among these children, 282 (35.9%) presented with clinical signs possibly related to abuse; only nine were hospitalized after being reported, showing the limits of the hospital to detect child abuse or neglect. The psycho-social characteristics of the families, the sources and motives of the reports, the criteria used to assess the risks run by the children, the care and protection measures were investigated through multifactor statistical analysis. Alcoholism, violence and parental immaturity were the most worrying factors. Social workers were at the origin of most reports and referrals (78%); most often they were alerted by socio-economic problems and parental immaturity. Physicians were in a better position to signal physical abuse, but they overlooked the situations of neglect. These were 388 children referred to the judiciary; 91 were removed from their families. Removal was ordered by courts in the presence of alcoholism, familial violence, disabled parents, offence records, insanitary housing, physical abuse or neglect, repeated hospitalizations. The perception of the risks was found to be a subjective notion depending upon the assessor's experience and tolerance thresholds, but also the quality of the professionals training and the organization of the services.

The Sickness Impact Profile is a quality of life scale developed in the United States which is now widely used in clinical trials in chronic conditions such as chronic obstructive lung disease, angina, rheumatoid arthritis, chronic pain, psoriasis, inflammatory bowel disease and cancer. Validated generic scales permit cross cultural comparisons within disease processes in clinical trials. As a simple, direct translation of a scale is inadequate, we have created a French version of the original US version of the Sickness Impact Profile. The first phase was qualitative. A first French translation of the original US version was back translated into English by three independent translators. A second French version resulted from a consensus reached by a panel of lay subjects and health professionals after comparing the original US version, the first French version and the three back translations. This second version was tested with a group of 40 healthy volunteers. This qualitative phase resulted in a French Test Version with content and face validity. The quantitative phase assessed the equivalence of the rank order of each item, by sub scale, in the US version with that of the French Test Version, ie the rank of the French item was comparable (+/- 2) to the rank of the corresponding US item. The French Test Version was tested with 47 healthy subjects. Of the 136 items of the Sickness Impact Profile, 13 were retranslated to create a final French version. This was similarly tested on ten healthy subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Situation La Seine-Maritime connait depuis 2003 une hyperendemie d’infections invasives a meningocoque (IIM) dominee par l’expansion du clone B14 : P1-7,16. Methode Etude visant a quantifier le portage dans la population et ses facteurs de risque. Le protocole a ete valide par un comite de pilotage incluant l’InVS et le CNR. L’etude s’est focalisait sur les sujets les plus exposes aux IIM : les 1-25 ans de la zone de Dieppe, soit 27 000 personnes dont 8 600 etaient tirees au sort. Pour obtenir 3 500 a 5 000 adhesions (taux de 40 a 60 %), de nombreuses actions etaient menees : lettres personnalisees, information aux professionnels de sante, actions dans les etablissements scolaires, mediatisation… Du fait de la saisonnalite, l’investigation s’est deroulee sur 12 semaines (1T08). Ceci a necessite une chaine pouvant accueillir 100 sujets/j au CHG de Dieppe : 30 professionnels ont ete recrutes pour l’accueil (5’), le consentement (5’), un questionnaire sur l’etat de sante et le mode de vie (15’), et le prelevement de gorge (5’). L’ecouvillon etait ensemence extemporanement sur gelose immediatement placee a l’etuve. Apres 48 h d’incubation, les geloses etaient transportees au CHU de Rouen pour isolement des meningocoques parmi la flore pharyngee, identification et genogroupage (par PCR). Tous les meningocoques ont fait ensuite l’objet de typages complementaires au CNR. Une chimioprophylaxie etait proposee aux porteurs d’un meningocoque serogroupable. Au 16 fevrier 2008, 1 953 sujets ont ete inclus, confirmant la forte attente de la population. Les taux de portage de meningocoque (B14 : P1-7,16 et autres clones) et leurs facteurs de risques seront analyses apres le 29/3/8, date de fin des inclusions. Des resultats detailles pourront etre presentes aux JNI. Remerciements aux volontaires participants a l’enquete et a tous les personnels mobilises. Etude financee par le PHRC.

In November 2014, French public health authorities renewed the recommendation to target for vaccination against invasive meningococcal disease men who have sex with men (MSM) and all individuals ≥25 years attending social venues associated with the gay community. This policy was extended beyond the Paris region as a reaction to the continuing spread of serogroup C isolates belonging to a new lineage within clonal complex cc11 since the recommendation was first issued in July 2013.