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PubMed | ACTIV Association clinique et therapeutique infantile du Val de Marne, University Paris Diderot and Nice University Hospital Center
Type: | Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie | Year: 2014

Group A streptococcal (GAS) meningitis in children are rare. The aim of this study was to analyze the clinical, biological and outcome data on GAS meningitis recorded in the Bacterial Meningitis (BM) French Surveillance Network (GPIP/ACTIV). From 2001 through 2012, 4,564 children suffering from proven bacterial meningitis were recorded in the data base. Among them, 0.7 % were GAS infections. The median age was 5.6 years. A history of community acquired infection before the onset of GAS meningitis was frequent. Apart from the identification of the bacterial species, GAS meningitis were clinically and biologically indistinguishable from meningitis caused by other pathogens notably S. pneumoniae. Case fatality rate was 8 %.


PubMed | AFPA Association francaise de pediatrie ambulatoire, ACTIV Association clinique et therapeutique infantile du Val de Marne, French Institute of Health and Medical Research and University Paris Diderot
Type: | Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie | Year: 2014

The purpose of this study was to assess the performances of the group A streptococcus (GAS) rapid antigen diagnostic tests (RADTs) in extra-pharyngeal infections. Between October 2009 and June 2014, 368 patients (median age: 48 months) were enrolled. The pathologies involved were : 160 perineal infections (44 %), 69 blistering distal dactylitis (19 %), 55 cervical lymphadenitis (15 %), 31 crusty or bleeding rhinitis (8 %), and 53 other diseases (14 %). The sensitivity of GAS-RADT used was 96 % (95 % CI: 92-99 %), the specificity 81 % (95 % CI: 75- 86 %), the negative predictive value 97 % (CI 95 %: 93-99 %), and the positive predictive value 79 % (95 % CI: 73-85 %). Finally, positive and negative likelihood ratio were 5 (95 % CI: 4-7) and 0.05 (95 % CI: 0.02-0.11) respectively. The GAS-RADTs developed for pharyngitis have comparable performances in these settings and therefore can be used.


PubMed | ACTIV Association clinique et therapeutique infantile du Val de Marne, French Institute of Health and Medical Research and University Paris Diderot
Type: | Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie | Year: 2014

Blistering distal dactylitis is a distinct clinical entity, generally due to S. pyogenes, unfrequently reported. Characteristically, blistering distal dactylitis is described as a localized infection involving the distal phalanx of the digits, and it usually presents as a fluid-filled blister. Between October 2009 and June 2014, 69 children (median age: 60 months, extremes: 0,6-176) were enrolled. The sensitivity of GAS rapid antigen detection test was 97 % (CI 95 %: 83-100 %), the specificity was 76 % (CI 95 %: 60-89 %), the negative predictive value was 97 % (CI 95 %: 83-100 %), and the positive predictive value 76 % (CI 95 %: 60-89 %). All patients with a positive GAS rapid antigen test were treated with antibiotics (amoxicillin essentially) and cured without surgery.


PubMed | ACTIV Association clinique et therapeutique infantile du Val de Marne and University Paris Diderot
Type: | Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie | Year: 2014

Perineal diseases in children are usually caused by group A streptococcus (GAS). If the natural course of untreated cases is not known, it is well known that symptoms do not resolve spontaneously and can persist often for many months, until appropriate diagnosis and effective treatment are instituted. Furthermore, failures and recurrences after penicillin treatment are frequent. From 2009 to 2014, 165 perineal infections (median age: 48 months, extremes: 0.4-139) were enrolled by 15 pediatricians: 4 balanitis, 29 vulvo-vaginal diseases and 132 perianal infections. Painful defecation, anal fissures and macroscopic blood in stools were significantly more frequent in GAS perianal infections than negative GAS infections (p<0.01). The performance of GAS-rapid antigen test compared to the GAS culture was : sensitivity 97 % [CI 95 %: 89-100 %], specificity 76 % [CI 95 %: 66-84 %], negative predictive value 97 % [CI 95 %: 91-100 %], positive predictive value 71 % [CI 95 %: 60-80 %].


PubMed | ACTIV Association clinique et therapeutique infantile du Val de Marne and University Paris Est Creteil
Type: Journal Article | Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie | Year: 2016

In December 2013, the French public health authorities recommended the use of Bexsero (meningococcus B vaccine) in areas with endemic risk and for patients at risk for invasive meningococcal B disease. In this context, InfoVac-France performed a national survey a few months after the implementation of the vaccine to evaluate physicians perceptions and experiences with this new vaccine.This survey was proposed by email in April 2014 to the InfoVac network. An initial email explained the purpose of this study and proposed an online questionnaire.Between April 29 and May 16, 2014, 1502 physicians answered online: 502 GPs (33%), 939 pediatricians (63%), and 61 other specialists (4%). In response, 91% of physicians would like to use this vaccine and 87% of pediatricians versus 50% of GPs knew that the vaccine was marketed. Physicians had been informed of the vaccine mostly via the InfoVac network (61%). The immunization schedules for all ages were slightly known by physicians (9% for GPs and 43% of pediatricians). This vaccination was still rarely proposed (18%) more often because it was not reimbursed to patients (62%). Although 39% of physicians were planning to propose the vaccine to their patients, 54% remained undecided. A total of 9% of pediatricians and 2% of GPs had already used this vaccination.This InfoVac-France survey shows that physicians would support the implementation of this vaccine, but questions persist as to its effectiveness, impact on carriage, and duration of protection.


Levy C.,SFP Societe Francaise de Pediatrie | Varon E.,SFP Societe Francaise de Pediatrie | Varon E.,Center National Of Reference Des Pneumocoques | Bingen E.,SFP Societe Francaise de Pediatrie | And 5 more authors.
Pediatric Infectious Disease Journal | Year: 2011

In France, despite a high rate of pneumococcal conjugate vaccine coverage, the number of cases of pneumococcal meningitis in children did not decline significantly between 2001-2002 (n = 264) and 2007-2008 (n = 244). A decline was observed among children <2 years old (185 [70.1%] to 134 [54.9%] cases; P = 0.0004), but was counterbalanced by an increase among children 2 years old (79 [29.9%] to 110 [45.1%] cases). Mean age increased significantly, from 2.3 (median 0.8) to 3.8 (median 1.5) years. After pneumococcal conjugate vaccine 7 implementation, a wide diversity of serotypes implicated in pneumococcal meningitis was observed; serotypes 19A and 7F were the most frequent. Copyright © 2011 by Lippincott Williams & Wilkins.


Cohen R.,ACTIV Association clinique et therapeutique infantile du Val de Marne | Cohen R.,Center Hospitalier Intercommunal Of Creteil | Levy C.,ACTIV Association clinique et therapeutique infantile du Val de Marne | Levy C.,Center Hospitalier Intercommunal Of Creteil | And 4 more authors.
Archives de Pediatrie | Year: 2012

Background: To assess the acceptability of a vaccine against meningococcus B by pediatricians and GP and to analyze how the vaccine could be implemented in France, InfoVac-France has set up a national survey. Methods: An email explained the purpose of this study and the practitioners of InfoVac-France network answered an online questionnaire (e-CRF). Results: Of the 6905 pediatricians and GP who saw the mail sent by InfoVac-France between 11 and 24 January, 2012, 1351 (13.5 %) completed the e-CERF: 361 GP (26.7%), 797 pediatricians (59%) and 193 other doctors (14.3%). The majority of practitioners (96.1%) believe that is important to implement a vaccine against meningococcus B in the French immunization schedule. In 80.5% of cases, practitioners do not want to vaccine three times routinely during a single consultation and more than half (53.5%) would prefer to use this vaccine alone. The best schedule of primary vaccination (80.6%) is the injection at 3, 5 and 6. months. The arguments considered likely to encourage parents to accept the vaccination would be the incidence of the disease, severity of meningitis (82.1%) and the rapid mortality (82.8%). Conclusion: This survey by InfoVac-France shows that the practitioners know the epidemiology of meningococcal B invasive disease in children. They would support the implementation of this vaccine for children under 2. years with a primary vaccination at 3, 5 and 6. months. © 2012 Elsevier Masson SAS.


Cohen R.,ACTIV Association Clinique et Therapeutique Infantile du Val de Marne | Cohen R.,SFP Societe Francaise de Pediatrie | Cohen R.,Center Hospitalier Intercommunal Of Creteil | Levy C.,ACTIV Association Clinique et Therapeutique Infantile du Val de Marne | Levy C.,SFP Societe Francaise de Pediatrie
Archives de Pediatrie | Year: 2012

Vaccines against the polysaccharide meningococcal capsule lead to the prevention of invasive meningococcal diseases due to serotypes A, C, Y, W135. Polysaccharide vaccines, according to their immunological characteristics, could be used only to protect during a risk period relatively short: travel in endemic areas, epidemics and index cases. The dramatic success of the implementation of meningococcal C conjugate vaccines in England, and in several European countries has opened new perspectives. Three ACYW135 conjugate vaccines are or will soon be available. Meningococcal conjugate vaccines may be used for the same indications than polysaccharides vaccines, but also for long term individual protection (both for patient at high risk or without risk factor) and in national immunization programs. They must replace polysaccharide vaccines notably because of the risk of immunologic hypo-responsiveness. © 2012 Elsevier Masson SAS.


Couloigner V.,University of Paris Descartes | Levy C.,ACTIV Association Clinique et Therapeutique Infantile du Val de Marne | Francois M.,University Paris Diderot | Bidet P.,University Paris Diderot | And 10 more authors.
Pediatric Infectious Disease Journal | Year: 2012

Background: Before 7-valent pneumococcal conjugate vaccine (PCV7) implementation in France, several studies had described the microbiology of acute otitis media (AOM) treatment failures. The causative pathogens were Streptococcus pneumoniae (Sp) followed by nontypable Haemophilus influenzae (NTHi). The aim of this study was to describe the epidemiology of pathogens involved in AOM treatment failures or recurrences. Methods: This French multicentric prospective study enrolled 143 children with AOM treatment failure between 2007 and 2009 observed by 8 ear, nose, and throat specialists. Failure was defined as the persistence of AOM symptoms after at least 48 hours of antibiotic therapy or their recurrence within 4 days after the end of treatment. Standardized history and physical examination findings were recorded, and culture of middle ear fluid (MEF) was obtained. Results: Mean age was 16.9 ± 9.9 months (median, 13.7). Eighty-eight percent of children had received more than 1 dose of PCV7, and 70.6% attended day care. The most common antibiotic used at the time of treatment failure or recurrence was a combination of amoxicillin and clavulanate (51.1%). Bacteriologic sampling demonstrated that in 35% of cases (n = 50), no otopathogen was cultured at the time of treatment failure or recurrence. Similar proportions of Sp and NTHi were observed in the 86 patients (60.1%) from whom only a single species was recovered from MEF (46.5% for Sp, n = 40 and 45.3% for NTHi, n = 39). Among Sp strains, 4.4% were penicillin susceptible, 77.8% were penicillin intermediate, and 17.8% were fully penicillin resistant, and serotype 19A represented 84.5% of all serotypes detected. Among NTHi isolates, 15.5% (n = 7) were β-lactamase-producing strains (including 2 strains with only this mechanism of resistance), and strains with reduced susceptibility by changes in protein binding to penicillin (β-lactamase-negative ampicillin resistant strains) represented 35.5% of cases. Among the 50 sterile MEF samples, polymerase chain reaction was performed in 32, of which 4 were positive for HI, 3 for Sp, and 3 for both. Conclusions: Among children with AOM treatment failures in France, Sp and NTHi were equally distributed; 19A was the main Sp serotype, and the main resistance mechanism for NTHi was β-lactamase-negative ampicillin resistance. Copyright © 2012 by Lippincott Williams & Wilkins.


Cohen R.,ACTIV Association Clinique et Therapeutique Infantile du Val de Marne | Cohen R.,Center Hospitalier Intercommunal Of Creteil | Levy C.,ACTIV Association Clinique et Therapeutique Infantile du Val de Marne | Bingen E.,University Paris Diderot | And 3 more authors.
Pediatric Infectious Disease Journal | Year: 2012

BACKGROUND: 13-valent pneumococcal conjugate vaccine (PCV13) licensure was based on the immune response (enzyme-linked immunosorbent assay and opsonophagocytic assay) compared with PCV7. National surveillance program of pneumococcal nasopharyngeal (PNP) carriage in children with acute otitis media (AOM) was set up in 2001 when PCV7 was introduced in France and continues to the present. This program was used in 2010-2011 to assess the effect of the implementation of PCV13 on PNP carriage in young children with AOM. METHODS: Between October 2010 and March 2011, 58 pediatricians obtained 943 nasopharyngeal swabs from children (6 to 24 months of age) with AOM. The swabs were sent for analysis to the French National Reference Centre for Pneumococci. Demographics, medical history, and physical examination findings were recorded. RESULTS: Among 943 children enrolled (mean age, 13.4 months), 651 had received at least 1 dose of PCV13 and 285 received PCV7 only. Among PCV13-vaccinated children, overall PNP carriage and carriage of serotypes not in PCV7 were significantly lower as compared with children exclusively vaccinated with PCV7 (53.9% vs. 64.6%, P = 0.002 and 9.5% vs. 20.7%, P < 0.0001, respectively). For serotypes 19A, 7F, and 6C, the carriage rates were also significantly lower in PCV13-vaccinated patients than in patients only vaccinated by PCV7: 7.5% versus 15.4%, P < 0.001, 0.5% versus 2.8%, P = 0.002, and 3.7% versus 8.4%, P = 0.003, respectively. CONCLUSION: In young children (<2 years) with AOM, this study suggests that PCV13 has an impact on overall PNP carriage, as well as on serotypes 19A, 7F, and 6C. Copyright © 2012 by Lippincott Williams & Wilkins.

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