Objective. - A recent measles epidemic in France incited us to report and describe measles cases requiring hospitalization, to raise the awareness of health professionals on under-diagnosis and frequent complications of this viral disease.Design. - We carried out a retrospective and epidemiologic study of measles cases recorded in the Nantes Teaching Hospital between August 2008 and September 2009. All these cases where confirmed by biological diagnosis and recorded by the Teaching Hospital virological laboratory.Results. - Thirteen cases of measles (11 adults and two children) were recorded during the study period. Adults were young (mean age 21.4 years); the oldest was 35 years old. We noted two severe cases with viral pneumonia and hypoxemia and one case with bacterial pneumonia. Two female patients were pregnant; one delivered prematurely, in the acute phase of measles, with no complication for the newborn. Two cases occurred in the nursing staff by documented nosocomial transmission. Sixty-nine percent of the patients were not vaccinated whereas the vaccinal status was not documented for 31%.Conclusions. - These cases underline the potential severity of this infection and the difficulty to diagnose measles at the early phase because of lack of awareness of medical staff. It will be necessary to reinforce prevention messages and promote measles vaccination in children as well as in young people and health workers. (C) 2010 Elsevier Masson SAS. All rights reserved.

Background. - With the recent pertussis vaccine trials, the efficacy of acellular vaccines is now well known, estimated at 85% for multicomponent vaccines. On the other hand, the estimates of whole cell vaccines efficacy varies from 36% to 98% with the different vaccines used. We evaluated the field effectiveness of the French whole cell pertussis vaccine during outbreaks in schools and centers for disabled children.Methods. - Four limited outbreaks between 1993 and 1995 were investigated using a retrospective cohort study design. Vaccine effectiveness (VE) was assessed for the following case definition: clinical pertussis, laboratory-confirmed pertussis, epidemiologically confirmed pertussis (documented contact with a laboratory confirmed case). Immunization history was obtained by reviewing the child health record book. Effectiveness of a whole vaccination (four injections) and of a partial vaccination (one to three injections) were estimated as 1-(attack rare among vaccinated/attack rate among non-vaccinated).Results. - A whole immunization conferred good protection against pertussis with an estimated VE higher than 92% in three surveys, lower in the fourth sun ey (84%) in which antibiotic prophylaxis was set up very rapidly. A partial immunization conferred a mild protection (median: 60%).Conclusions. - These results are consistent with a previous report about the effectiveness of this whole cell vaccine using the screening method in a hospital network survey in France. In the same way, a large efficacy trial in Senegal comparing if with an acellular bivalent vaccine estimated its efficacy at 96%. This high efficacy together with a satisfactory vaccine coverage leads to the current epidemiological profile of pertussis in childhood in France: majority of cases occurring before 6 months of age, limited outbreaks in school children, many of whom being unvaccinated or partially vaccinated.

Contexte et objectifs. — Grâce aux récents essais cliniques, l’efficacité des vaccins coquelucheux acelluiaires est connue, de l’ordre de 85 % pour les vaccins multicomposés. Les vaccins à germes entiers ont en revanche une efficacité variable, de 36 à 98 % selon les vaccins. L’efficacité du vaccin à germes entiers utilisé en France (EV) a pu être estimée en situation épidémique.

BACKGROUND:With the recent pertussis vaccine trials, the efficacy of acellular vaccines is now well known, estimated at 85% for multicomponent vaccines. On the other hand, the estimates of whole cell vaccines efficacy varies from 36% to 98% with the different vaccines used. We evaluated the field effectiveness of the French whole cell pertussis vaccine during outbreaks in schools and centers for disabled children.METHODS:Four limited outbreaks between 1993 and 1995 were investigated using a retrospective cohort study design. Vaccine effectiveness (VE) was assessed for the following case definition: clinical pertussis, laboratory-confirmed pertussis, epidemiologically confirmed pertussis (documented contact with a laboratory confirmed case). Immunization history was obtained by reviewing the child health record book. Effectiveness of a whole vaccination (four injections) and of a partial vaccination (one to three injections) were estimated as 1-(attack rate among vaccinated/attack rate among non-vaccinated).RESULTS:A whole immunization conferred good protection against pertussis with an estimated VE higher than 92% in three surveys, lower in the fourth survey (84%) in which antibiotic prophylaxis was set up very rapidly. A partial immunization conferred a mild protection (median: 60%).CONCLUSIONS:These results are consistent with a previous report about the effectiveness of this whole cell vaccine using the screening method in a hospital network survey in France. In the same way, a large efficacy trial in Senegal comparing it with an acellular bivalent vaccine estimated its efficacy at 96%. This high efficacy together with a satisfactory vaccine coverage leads to the current epidemiological profile of pertussis in childhood in France: majority of cases occurring before 6 months of age, limited outbreaks in school children, many of whom being unvaccinated or partially vaccinated.

The purpose of this study was to determine the efficiency of semi-nested PCR in detecting hepatitis A virus (HAV) RNA. During a 2-year period (1990-1991), HAV RNA was searched for in shellfish from the French Brittany coasts using cRNA and vRNA probes. In January 1992, at the time of a hepatitis A outbreak, 28 stool samples were collected from infected patients (18 adults, 10 children) with anti-HAV IgM. Four samples from subjects with negative HAV serology were used as negative controls. Nucleic acid amplification (reverse-transcription-semi-nested PCR) was performed to detect HAV in stool. HAV RNA was purified by phenol-chloroform extraction and converted to cDNA using reverse transcriptase (Mu-MLV). After amplification, PCR products were visualized on an ethidium-bromide-stained gel and confirmed by hybridization with a specific digoxigenin-labelled oligoprobe. Samples were also studied by molecular hybridization with cRNA and vRNA probes. After onset of the illness, HAV RNA was detected over a longer time period by semi-nested PCR (16/28) than by hybridization (0/28). Even though biological diagnosis of hepatitis A will continue to rely on the detection of anti-HAV IgM, PCR should be useful in certain clinical cases (diagnosis of relapse) and for epidemiological and environmental monitoring of viruses.

Les troubles de la marche de l’enfant sont un motif fréquent de consultation. L’âge de l’acquisition de la marche est variable de 10 à 18 mois ; on considère un retard chez un enfant qui n’a pas acquis de marche autonome au-delà de l’âge de 2 ans. Certains troubles de la marche sont transitoires et banals : retard simple, troubles de la statique ; d’autres peuvent révéler une pathologie neurologique acquise ou progressive affectant l’équilibre, la force ou la coordination. Une démarche clinique rigoureuse est indispensable afin de confirmer la normalité du développement ou de repérer les signes évoquant une affection neurologique.Gait disorders are common. The age of independently walking varies from 10 to 18 months, and therefore a walking delay is said to occur after 2 years. Some gait disorders are common and transient but others may reveal congenital neurologic impairment or a serious degenerative situation responsible for a balance disorder, muscle weakness, or coordination disorders. Complete neurological examination is necessary to ascertain normal psychomotor development or to diagnose neurological disease.

Drug use was assessed in a prospective 6-month study carried out in the Department of General Medicine V and Rheumatology of the Nantes Regional Hospital Center. An attempt was made to evaluate consumption as realistically as possible, and a judgment was made based on the consensus of the medical team as to whether the prescription was justified or not. The mean number of drugs consumed by each patient was 2.8; 60% being prescribed for cardiovascular and neuropsychiatric purposes. As 33% of the prescriptions were considered unnecessary, it would appear that use was excessive in these hospitalized patients.

The role of drug use in iatrogenic pathology was studied prospectively in a hospital department. It wa s found that patients received an average of 2.8 drugs and that 30% of the prescriptions were unnecessary. During this six-month study of all patients admitted to a general medicine and rheumatology department, there were 67 iatrogenic accidents affecting 12.3% of the population: 41.8% of the accidents were directly responsible for hospitalization, 35.4% were due to therapy initiated during hospitalization and 32.8% occurred during the hospital stay but were the result of earlier treatment. Moreover, 26% of the accidents were related to what was considered to be unnecessary therapeutics. This study shows that elevated iatrogenic pathology was due to excessive drug use. However, the degree of severity of the adverse effects varied considerably, and some could have been easily avoided.

Statistical analysis of eosinophilia of 331 patients at the onset of hospitalisation define a logarithmic standard population of 327 patients whose eosinophilia rates stand between 0 and 810/mm3, among them 24 lies between 500 and 810, and 4 whose eosinophilia rise over 1,000/mm3. These 4 patients had transient hypereosinophilia whose etiology was defined only in 2 cases. The 24 patients with eosinophilia between 500 and 810/mm3 were significantly more frequently men, with rheumatoid disease (specially sciatica) and users of non steroidal antiinflammatory drugs (NSAID) than the general population. It suggest that NSAID may rise eosinophilia rates inside normal limits.

La comparaison avec les donnees de la litterature retrouve une concordance sur la particuliere frequence de ces affections dans l'Ouest de la France