Pourquoi des recommandations de vaccination généralisée contre le méningocoque C en France ?

In 2009, the French authorities have recommended the immunization against meningococcus C (MenC) of all infants between 1 and 2 years of age with a catch-up in children, adolescents and adults up to 24 years of age. The rationale of this decision relies on four major considerations: (1) after a peak in 2002, the incidence of invasive MenC disease remains stable at 0.3/100,000 in France and is henceforth, among the highest in Europe; (2) the recent evolution of circulating MenC strains shows the implantation of an hypervirulent strain C:2a:P1.7,1 belonging to the clonal complex E15/ST11; (3) meningococcal C conjugate vaccines are available and have demonstrated a good immunogenicity and tolerance in infants, children and adults; (4) some European countries have successfully experienced the implementation of universal MenC immunization targeting infants with an extensive catch-up program covering children and young adults. The choice of the strategy have been oriented by the results of a medico-economical study with modelisation and targets the infant between 1 and 2 years of age with transient extension to children, adolescents and adults up to 24 years of age. The success of such strategy is tightly linked to the ability to obtain rapidly high vaccination coverage levels in the whole target.     

Prise en charge des méningites postopératoires

Postoperative meningitis are rare but severe complications of neurosurgery. Their incidence varies from 0.3 to 1.5% after craniotomy. Aseptic meningitis are twice as more frequent than bacterial meningitis and have a constantly favorable outcome without antibiotic treatment. Physiopathology of aseptic meningitis remains debated between a bacterial origin with a low inoculum or a local inflammatory reaction to blood breakdown products, sutures, tissue breakdown products, etc. Clinical presentation and characteristics of cerebrospinal fluid (CSF) are similar between the two entities. Only negative CSF direct examination and CSF culture in the absence of antibiotic exposure previous to lumbar puncture allows the diagnostic of septic meningitis. There now is a consensus to systematically treat with antibiotics according to local ecology any patient with symptoms suggestive of postoperative meningitis with a CSF yielding more than 100 leukocytes/mm³. Antibiotic should be stop after 72 hours if CSF cultures remain sterile; if culture is positive, empirical treatment should be adapted accordingly. The efficiency of this approach was demonstrated in a prospective study and allowed a significant reduction in the duration of antibiotic treatment in patients with postoperative meningitis with a favorable clinical outcome.