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D Floret

Publications and source records attributed to D Floret.

At least 19 recordsLinked to original sources
PubMed2006

[French survey about intradermal BCG SSI adverse events in children under 6 years of age].

During April 2006, 579 physicians took part in a survey about intradermal BCG SSI adverse events (AE) in children less than 6 years old, managed by InfoVac France. Since January 2006, 68% physicians (paediatricians: 73% and general practitioners [GP]: 60%) have vaccinated at least one child. The site of injection is mainly the extern side of the shoulder (72%), according to the recommendations. Systematic vaccination is continued by 54% GP and 26% paediatricians. Others indications are: admission in day care center (33%), admission in day care center associated with risk factors (24%), or only risks factors (8%). Half physicians observed AE and 6% of them reported them at pharmacovigilance centers or pharmaceutical company. AE were mainly inflammations or indurations over 1 cm (for 75% of physicians who observed AE), oozing (73%). Abscesses are notified by 54%, ulcers by 39%, lymphadenopathies over 1 cm by 20%, suppurative lymphadenopathies by 3% and keloid scares by 17% of them, several AE may coexist for some children. Our aim is to start a prospective follow-up of BCG-SSI vaccination and its AE; 58% physicians who answered this investigation agreed to participate.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

[ENVOL study on the medical management of varicella and its complications in French ambulatory care].

OBJECTIVE: The authors had for aim to describe the management of varicella and its complications in French ambulatory care. METHODS: A descriptive prospective national survey was carried out in France on patients visiting a random sample of French GPs and pediatricians (investigators) having diagnosed varicella. During an inclusion period of 4 months, the investigators enrolled all patients (adults-children) who presented with varicella or varicella related complications, and who had not previously visited the investigator for this episode. Three questionnaires were used to record the data. RESULTS: One thousand two hundred patients were enrolled by 393 physicians 75% of whom were GPs. Ninety-four percent of patients were children under 13 years of age (group I). The sex ratio (M/F) was 1.1. The mean age was 3.5 years in group I and 23.8 years in patients over 13 years of age (group II). The mean length of the varicella episode was about 10.7 days. Most patients were given a pharmaceutical prescription on inclusion, 1% were also prescribed medical procedures, 0.3% were given local treatment, and 0.09% underwent physical therapy sessions. A proportion of 12.6% of patients visited their physician twice or more for the same episode. Six group I children were hospitalized. Eighty-seven patients presented with at least one complication i.e. 7.8% (95%CI=6.3-9.3) of all episodes, mainly bacterial superinfections. CONCLUSIONS: The rate of complications associated with varicella infection was higher than usually reported in France but in the same order of magnitude as in other developed countries. Bacterial superinfections were found to be the most frequent complications of varicella.

Ambulatory Care↗
PubMed2006

Are restrained children under 15 years of age in cars as effectively protected as adults?

AIM: To compare the injury distribution between children and adults, injured as restrained car passengers. METHODS: Population based study of data from a French road trauma registry in 1996-2002. Children under 15 years old were compared with adult casualties according to the distribution of serious injuries in three distinct body regions (head, chest, and abdomen) when they were restrained car passengers. A multivariate logistic regression was performed to quantify the risk of AIS2+ injury (Abbreviated Injury Scale of 2 or more). RESULTS: Among the 7568 casualties who were injured as restrained car passengers in car accidents, 1033 were less than 15 years old. Overall, 35.4% of children and 25.2% of adults were unrestrained. For children and adults, the risk of fatality was significantly reduced when they were restrained, but the percentages of children with Injury Severity Score (ISS) > or =16, were not significantly different between restrained and not restrained casualties. Compared to adults, restrained children aged 5-9 were 2.7 times (OR 2.74; 95% CI 1.17 to 6.43) as likely to sustain an AIS2+ abdominal injury, and tended to be more at risk of AIS2+ head injuries, but were less at risk of AIS2+ chest injuries. CONCLUSIONS: Children aged 5-9 years injured in road accidents as restrained car passengers were more likely to sustain an AIS2+ abdominal injury than adults. This emphasises the need to reinforce educational campaigns aimed not only at getting children into restraint systems, but also insisting on their correct use.

Abbreviated Injury Scale↗
PubMed2005

[Treatment of exacerbation of asthma: what are today's issues?].

During past decades, major progress has been accomplished in the management of acute asthma. Most recent recommendations include evidence-based rationale. The improved quality of clinical guidelines makes them efficient models for medical education. The pediatric pharmacopoeia provides a great variety of choices of drugs as well as for asthma medical devices. These innovations dramatically facilitated the medical management of asthmatic children, but they did not solve all problems. Physicians now use higher doses of salbutamol, but the early prescription of systemic glucocorticoids for moderate exacerbation of asthma is still underused, given the most recent clinical guidelines and meta-analysis. Furthermore, repeated emergency department visits to the wards and lack of primary care physician should systematically be appraised when evaluating severity, as they are both major risk factors for severe exacerbations, even though they are not considered in acute asthma severity scores. Finally, initiating (or reinforcing) patient education at the time of exacerbation also presents important challenges, as emergency visits are a favorable moment to commence the therapeutic education of the child and his family. Indeed, framing the controller medications and educating families about how to manage the disease and to improve their domestic environment are the genuine tools available for the prevention of asthma exacerbations, and particularly those most severe.

Acute Disease↗
PubMed2005

[Action to be taken when facing one or more cases of whooping-cough].

The evolution of the epidemiology of pertussis, new licensed macrolides and vaccines, new recommendations for vaccination among adolescents and adults need an update of the French guidelines for prevention of the disease around one or grouped cases of the disease. A particular attention should be raised to the diagnosis of whooping cough in adults who are presently the main reservoir of Bordetella pertussis. Whooping cough in adults presents as an unexplained prolonged cough with nocturnal exacerbation witch accounts for most of the contaminations of young infants. A bacteriological confirmation of pertussis should be provided before implementation of preventive measures: culture and PCR are presently the gold standard for the diagnosis of pertussis in infants, children and even adults who have been coughing for less than 20 days. Later on, serology (Elisa, immuno-empreinte) is the only technique available, but cannot be interpreted if the patient has been vaccinated less than one year ago. Infants under three months should be admitted to hospital and every case submitted to respiratory isolation. Eviction from the community should be pronounced within the five first days following the onset of an effective antibiotic treatment. New macrolides should be favoured: clarithromycin for seven days or azithromycin for five days. Household contacts should be given the same prophylactic antibiotic treatment: children and adolescent not correctly immunized, parents of the index case as adults parents of not or not completely immunized infants. The vaccination program of the household should be updated. The same measures should be applied in case of grouped cases (at least two contemporary or consecutive cases in the same area). In that case, the Public Health System doctors should be involved in the investigation and the classification of the cases. The close contacts not or not completely immunized should be prescribed and antibiotic prophylaxis and an update of their vaccination program. Among the occasional contacts, high-risk people only should be treated. In the day care centres an antibiotic prophylaxis should be given to children who have received less than four vaccine shots against pertussis and to the personnel contact to the cases as well. In the schools, the antibiotic prophylaxis should be prescribed to all children of the classroom(s) not completely vaccinated and to the teacher(s) as well. In the boarding schools and institutions with handicapped children, antibiotic prophylaxis could be applied to every member if the pertussis vaccine coverage is at less than 50%. In hospitals, coughing personnel should wear masks and investigations towards pertussis should be performed in people with a more than seven day unexplained cough. Preventive measures should be applied in case of confirmation of pertussis.

Adult↗
PubMed2005

[Varicella-zoster virus seroprevalence in nursery and day-care workers in Lyon (France)].

OBJECTIVE: Varicella is a potential occupational hazard for susceptible individuals working in pediatric institutions because infected adults run a greater risk of severe or even fatal varicella and because the disease is so common in children and so contagious. The seroprevalence of varicella-zoster virus (VZV) was examined in a sample of day-care workers in Lyon (France) to determine whether a targeted vaccination policy was needed. METHODS: Two hundred forty-one sera were sampled and analysed with an Elisa test between March and May 2001. Histories of past VZV infection were collected via questionnaires documented either before or after consultation of medical records or other sources of information. RESULTS: The overall VZV seroprevalence was 99.6%. The positive predictive values of past varicella histories (documented or not) were>99% showing that a history of previous varicella in day-care workers was reliable. However, only 68 to 71% of these with serologically confirmed varicella reported a prior history of varicella. All subjects reporting a non-positive history of varicella were seropositive. CONCLUSIONS: Virtually all day-care workers enrolled in this study presented serological evidence of VZV so that sub-populations at risk for varicella infection for which VZV vaccination may be effective could not be identified. However, the VZV seroprevalence of the workers in pediatric institutions being presumably higher than that of the general adult population (94-96.3%), vaccination of susceptible young recruits before any exposure to the VZV, or even vaccination of students willing to work in a pediatric institution, may be positive.

Adult↗
PubMed2004

[Influenza in pediatric intensive cure unit].

OBJECTIVES: The purpose was to identify clinical presentation leading to admission to PICU of children affected by influenza, to describe predisposing factors and outcome and to propose preventive measures. METHODS: Ten years (1989-1999) retrospective study carried out in the ten beds PICU. Every child in PICU with an influenza positive culture was enrolled. RESULTS: Twenty four cases collected, aged two weeks-15 years (m =43 months), 19 males. Acute respiratory failure (16/24 =67%) was the first manifestation: pneumonia (13), bronchiolitis (2), status asthmaticus (1). Eleven children had underlying diseases including five immunocompromized. Thirteen patients required mechanical ventilation (mean duration: 22 days), seven developed ARDS (4 immunocompromized) and three died. Central nervous system was the second system affected (8 cases). Four exhibited a chronical cerebral disease and five presented afebrile status epilepticus which required i.v. barbiturates and mechanical ventilation (mean duration: 22 hours). One presented encephalitis, one an apparent life-threatening event, both had a favorable outcome. One child exhibited severe hyperpyrexia and died from multiorgan failure. CONCLUSION: Severe forms of influenza are rare in children but may lead to life-threatening conditions and death(16.5%). Most occur in children with underlying disease, particularly immunocompromized who may exhibit ARDS.

Adolescent↗
PubMed2004

[Clinical effectiveness of seven-valent pneumococcal conjugate vaccine (Prevenar) against invasive pneumococcal diseases: prospects for children in France].

A seven-valent pneumococcal polysaccharide-CRM197 carrier protein conjugate vaccine (PNC7V; Prevenar, Wyeth, Paris) targets the serotypes (belonging to serogroups 14, 6, 19, 18, 23, 9, and 4) most often responsible for invasive pneumococcal disease (IPD) among children. A randomized, controlled, double-masked study among 37,868 children in northern California (Northern California Kaiser Permanente, USA) provided a per protocol vaccine efficacy value of 97.7% against invasive pediatric IPD due to the vaccine serotypes. The PNC7V vaccine was registered by the European Agency for the Evaluation of Medicinal Products (EMEA) in October 2000; a favorable "Community Marketing Decision" under the Centralized Procedure was granted in February 2001. PNC7V was recommended for most infants by the Conseil Supérieur d'Hygiène Publique de France in March 2002, on the advice of the Comité Technique des Vaccinations, as S. pneumoniae in children less than 2 years of age is the primary cause of bacterial meningitis and of mortality associated with community-acquired bacterial infections. The theoretical coverage of the vaccine towards pneumococcal invasive disease in France is about 80%, which represents one of the best serotype coverage estimates in Europe, and vaccines serotypes account for 90% of penicillin-nonsusceptible strains. Distinctive characteristics in France in terms of epidemiology, life style, and therapeutic attitudes justify a precise follow up of the consequences of the vaccination on a national level during the coming years. Hence, surveillance programs have been established: (i) to ascertain the future impact of large-scale PNC7V vaccination on invasive pneumococcal disease incidence, (ii) to follow the evolution of carriage and ecology of the pneumococcus, and (iii) to establish an active "vaccinovigilance".

Female↗
PubMed2004

[Mortality in pediatric renal transplants: 15 years' experience].

UNLABELLED: The aim of the study was to analyse retrospectively the patient survival and mortality risk factors in renal transplant children at Edouard-Herriot hospital, Lyon. PATIENTS AND METHODS: One hundred and ninety four patients 0 to less than 18 years of age received a renal transplant between April 1987 and January 2002. We collected data concerning the age at transplantation, the mean duration of dialysis prior to transplantation, the type of donor (living related: LRD, or cadaver: CAD) as well as long term follow-up of all the patients. Eleven patients died during the study period and we collected mortality and morbidity factors. RESULTS: Mean age at transplantation was 9.5 years (range: 0.6-17.9 years); 16 children were transplanted before 2 years of age. Eighty six percent received a first graft, 10% a second graft, and 3% a third graft. One third of the patients had preemptive transplantation. The graft was carried out respectively from a LRD in 18% and from CAD in 82% of the cases. Eleven patients (5.7%) died during this period; four of them were transplanted twice. Death occurred within 2.4 years after transplantation (range: 2 days-6.3 years). Five of these deceased children developed an acute rejection episode treated with methylprednisolone pulses and OKT3 monoclonal antibodies. Four had a cytomegalovirus (CMV) infection and three required repeated surgery. The causes of death were bacterial infections (4/11), CMV infection (2/11), neurological involvement (2/11), Burkitt lymphoma (1/11) and unexplained sudden death (2/11). CONCLUSION: The main causes of deaths in renal transplant children are bacterial infections. The improvement in patient survival probably will come from both better preventive approach to nosocomial infections and a less aggressive immunosuppression.

Actuarial Analysis↗
PubMed2004

[Human rabies in France in 2004: update and management].

Twenty people died of rabies in France between 1970 and 2003 (compared to 55,000 yearly worldwide), 80% on returning from Africa. Dogs were the contaminating animals in 90% of the cases and children were the most common victims. The last instance of rabies in a native French animal was reported in 1998. However the illegal importation of animals still poses a risk. The disease is transmitted by saliva, even before the appearance of clinical symptoms, through a bite, scratch, or licks of mucous membranes or broken skin. Person-to-person transmission has only been observed in cases of grafts (cornea). The mean incubation time of 1 to 3 months is long enough to allow passive immunization and vaccination. After its onset, the disease presents as encephalitis or a paralytic syndrome the outcome of which is always fatal. Clinical diagnosis may be difficult in the early stages of the disease. If rabies is suspected, the National Reference Centre is responsible for the sampling and proper transportation of these samples so as to ensure assessment results within 5 days. If stringent hygiene rules are complied to, there is no risk of contamination for those in close contact. Vaccination, which is performed in official rabies centers, is only performed after a diagnosis based on laboratory evidence, and solely for exposed persons or those for whom a reliable history cannot be established (children under 6 years). Prevention is based on information. People traveling abroad, particularly to Africa, are warned not to approach unknown animals (especially dogs) nor to try to import them, and are advised to comply with vaccinal recommendations for travelers, particularly for toddlers.

Adolescent↗
PubMed2004

[Nosocomial infections due to adenovirus in a paediatric unit].

OBJECTIVE: We carried out a retrospective analysis of an outbreak of adenovirus (AdV) infections in a paediatric unit. The aim of the study was to analyse cases, determine the route of transmission and to evaluate the efficacy of the prevention measures. PATIENTS AND METHODS: The study was performed by recollection of AdV infection cases during a period of 1 year and the results were compared with the list of clinical cases recorded during the epidemic. The clinical files of children with a positive specimen were retrospectively analysed. During that period, five members of the medical staff showed clinical signs and symptoms of AdV infection. A throat swab was collected from a subset of the staff. RESULTS: Among nine patients with positive AdV detection, six were infected with an Adv type 2. Six were nosocomially-acquired, the other two were only probable nosocomial infections. The index case was a child presenting a febrile diarrhoea 48 h prior to being admitted to the hospital. Nosocomial transmission was associated with the prolonged shedding of the virus with faeces of the infected cases. The specimens collected from the staff remained negative. The outcome was favourable for all children. CONCLUSIONS: Prevention measures, implemented when the epidemic was characterised, allowed the control of the nosocomial outbreak.

Adenovirus Infections, Human↗