Couverture vaccinale BCG en médecine libérale : premières données chez le nourrisson,sept mois après la levée de l’obligation vaccinale en France |
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| Authors: | J-P Guthmann F de La Rocque M Boucherat D van Cauteren L Fonteneau A Lécuyer R Cohen D Lévy-Bruhl |
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| Institution: | 1. Unité des maladies à prévention vaccinale, département des maladies infectieuses, institut de veille sanitaire (InVS), 12, rue du Val-d’Osne, 94415 Saint-Maurice cedex, France;2. Association clinique et thérapeutique infantile du Val-de-Marne (ACTIV), 27, rue d’Inkermann, 94100 Saint-Maur-des-Fossés, France;1. Unité des maladies à prévention vaccinale, département des maladies infectieuses, institut de veille sanitaire (InVS), 12, rue du Val-d’Osne, 94415 Saint-Maurice cedex, France;2. Inserm, UMRS 707, équipe DS3, 75012 Paris, France;3. Université Pierre-et-Marie-Curie, Paris 6, UMR-S 707, 75012 Paris, France;1. Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;2. Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;3. Department of Preventive Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;4. Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;5. Department of Occupational Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;6. Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan;7. Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;8. Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan;9. Department of Senior Citizen Service Management, Chia Nan University of Pharmacy & Science, Tainan, Taiwan;10. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;11. Faculty of Renal Care, School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan;12. Department of Medical Genetics, Kaohsiung Medical University, Kaohsiung, Taiwan;1. Department of Pharmacodynamics, Centre for Preclinical Research and Technology, Medical University of Warsaw, 1B Banacha Str., 02-097 Warsaw, Poland;2. Department of Neuropeptides, Medical Research Centre Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland;3. Laboratory of Pharmacology, Université Catholique de Louvain, Avenue Hippocrate 54, B-1200 Brussels, Belgium;4. Biological Research Centre, Hungarian Academy of Sciences, Temesvári krt 62, 6726 Szeged, Hungary;1. Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic de Barcelona, Instituto de Salud Global de Barcelona (ISGlobal), Centro de Investigación en Salud Internacional de Barcelona (CRESIB), Universitat de Barcelona, Barcelona, España;2. Servicio de Medicina Preventiva y Calidad Asistencial, Hospital General Universitario de Castellón, Castellón de la Plana, España;3. Servicio de Prevención de Riesgos Laborales, Hospital Clínic de Barcelona, Barcelona, España;1. Médecins du Monde, 62, rue Marcadet, 75018 Paris, France;2. Médecins du Monde, 4, avenue Rostand, 13003 Marseille, France |
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| Abstract: | ObjectivesIn July 2007, compulsory BCG vaccination for all children was replaced by a strong recommendation to vaccinate children at high risk of tuberculosis (children who live in Île-de-France IDF] or Guyana regions, who were born or whose parents were born in tuberculosis endemic countries, with a family history of tuberculosis or living in conditions defined as at risk by the doctor). In the absence of tools to detect an early decrease in vaccine coverage (VC) in this specific group, we conducted a survey with the main objective of measuring BCG VC in high risk children for which BCG is now recommended and who were born after the change in BCG vaccine policy.MethodsCross-sectional survey performed amongst physicians registered at “Infovac-France”, a network of general practitioners and paediatricians particularly aware of recent changes in the field of vaccinations. Each doctor was asked to recruit, during his medical consultation, between six and 12 children aged 2–7 months (born after the end of compulsory BCG vaccination in July 2007) and 8–23 months (born after the withdrawal from the market of the multipuncture form of BCG Monovax®] in January 2006 and before the end of compulsory BCG vaccination in July 2007). Doctors were asked to fill in a structured online questionnaire. Data were standardized and analysed with Stata 9.2.ResultsA total of 2536 children, recruited by 279 general practitioners and paediatricians (6.5% of all contacted doctors), were included. VC in the target group of high risk children for who BCG is still recommended and who were seen by doctors working in a private medical practice was: overall 68%; 58% in children born after the end of compulsory BCG vaccination (68% in IDF, 48% outside IDF); 77% in those born after the withdrawal of Monovax® from the market and before the end of compulsory BCG vaccination; 90% in children living in IDF born after the end of compulsory vaccination and considered as particularly at risk of tuberculosis (presence of vaccination criteria other than residing in IDF) and 60% in the same category of children whose sole criteria for vaccination was residing in IDF. Of doctors who worked in a private medical practice: 75% used to perform the BCG vaccination themselves and 58% had recommended or suggested vaccination to children at risk who were not yet vaccinated. Seventy-six percent of parents of children at risk of tuberculosis not yet vaccinated accepted BCG vaccination when recommended by their doctor.ConclusionOur survey showed, on the one hand, insufficient VC in children seen in a private medical practice and born after the end of compulsory vaccination for whom BCG is still recommended. This should encourage the Ministry of Health to reinforce its communication concerning this new policy. On the other hand, the survey showed encouraging results concerning both the coverage of children at particularly high risk in IDF and the adherence of doctors and families to the new vaccine policy. These results should be interpreted with caution, taking into account the methodological limitations of this survey. |
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