Biomedical subjects

Daniel Lévy-Bruhl

Publications and source records attributed to Daniel Lévy-Bruhl.

4 recordsLinked to original sources

PubMed2006

[BCG Today].

Until recently, French BCG vaccination policy required BCG vaccination before entry into day-care centers or school and the revaccination of tuberculin-negative children. Recent reassessment of this policy led in 2004 to the discontinuation of all revaccinations and of postvaccination tuberculin tests except those performed as part of tuberculosis diagnosis or in the monitoring of healthcare and social workers, for whom BCG vaccination remains mandatory. After an epidemiologic assessment of the effect of either selective vaccination of high-risk children or discontinuation of all BCG vaccination and analysis of balance of risks and benefits of each option, the High Council of Public Hygiene (Infectious diseases section) approved the principle of selective vaccination of children. As a prerequisite to this implementation of this strategy, however, the council advised the Ministry of Health that other control measures to decrease the risk of tuberculosis in children should be reinforced. This issue is made more complex by the withdrawal in 2006 of the multipuncture vaccine, used in France in more than 90% of primary BCG vaccinations.

Adolescent↗

PubMed2006

Influenza pandemic preparedness in France: modelling the impact of interventions.

BACKGROUND: Influenza pandemics result in excess mortality and social disruption. To assist health authorities update the French pandemic plan, the authors estimated the number of health events (cases, hospitalisations, and deaths) in a pandemic and compared interventions in terms of impact and efficiency. METHOD: A Monte Carlo simulation model, incorporating probability distributions of key variables, provided estimates of health events (HE) by age and risk group. Input variables were set after literature and expert consultation. The impact of targeted influenza vaccination and antiviral prophylaxis/treatment (oseltamivir) in high risk groups (elderly, chronic diseases), priority (essential professionals), and total populations was compared. Outcome measures were HE avoided, number of doses needed, and direct cost per HE avoided. RESULTS: Without intervention, an influenza pandemic could result in 14.9 million cases, 0.12 million deaths, and 0.6 million hospitalisations in France. Twenty four per cent of deaths and 40% of hospitalisations would be among high risk groups. With a 25% attack rate, 2000-86,000 deaths could be avoided, depending on population targeted and intervention. If available initially, vaccination of the total population is preferred. If not, for priority populations, seasonal prophylaxis seems the best strategy. For high risk groups, antiviral treatment, although less effective, seems more feasible and cost effective than prophylaxis (respectively 29% deaths avoided; 1800 doses/death avoided and 56% deaths avoided; 18,500 doses/death avoided) and should be chosen, especially if limited drug availability. CONCLUSION: The results suggest a strong role for antivirals in an influenza pandemic. While this model can compare the impact of different intervention strategies, there remains uncertainty surrounding key variables.

Adolescent↗

PubMed2004

[Should France continue to use BCG?].

In the context of the decrease of tuberculosis incidence, a re-assessment of the French BCG vaccination policy has been undertaken. The synthesis of the data available, done by the National Institute for Public Health Surveillance (InVS) has led to the conclusion of the absence of justification of the current policy of re-vaccinating children with a negative tuberculin skin test. Data from studies and from the results of the experiences from several countries having discontinued primovaccination confirm the effectiveness of BCG vaccination on childhood tuberculosis, mainly on extra-pulmonary cases. Base on these data and on the estimation carried out by InVS of the impact of the discontinuation in France of BCG re-vaccination and primovaccination, it was decided to discontinue the policy of re-vaccination and of routine tuberculin testing. A multidisciplinary expertise aimed at studying the relevancy, the feasibility and the acceptability of various options of reducing the target-population of primovaccination is on-going.

Adult↗

PubMed2002

Central demyelinating disorders and hepatitis B vaccination: a risk-benefit approach for pre-adolescent vaccination in France.

The objective of the study was to provide immunization policy decision makers with a risk-benefit analysis for pre-adolescents vaccination, for various scenarios regarding the existence and the strength of an association between hepatitis B vaccination and the occurrence of first episode of central demyelinating (FECD) disease. The risks were assessed as the attributable risks of FECD for various time intervals between vaccination and onset of FECD and the benefits as the number of acute fulminant hepatitis B and cirrhosis prevented in a vaccinated annual cohort. Even in the worst-case considered, the number of complications prevented by the vaccination outweighs quantitatively the potential risks. Even if both sides of the balance are of different medical and sociological nature, this result is in favor of reinforcing the pre-adolescent vaccination strategy in France.

Adolescent↗