France

Physicians

Factors associated with vaccination for hepatitis B, pertussis, seasonal and pandemic influenza among French general practitioners: a 2010 survey. 2013, Pulcini, Vaccine

27% of general practitioners were not vaccinated against hepatitis B, 36% were not vaccinated against whooping cough, 23% were not vaccinated against influenza. (France)

Physicians

Knowledge, attitudes, beliefs and practices of general practitioners towards measles and MMR vaccination in southeastern France in 2012. 2014, Pulcini, Clin Microbiol Infect

13% of general practitioners do not consider measles a dangerous disease. 12% of general practitioners consider the second dose of MMR to be useless.
33% of general practitioners do not believe that MMR vaccination should be mandatory for children under 2 years of age. (France)

Meningococcal

Increased Risk for Meningococcal Disease Among Men Who Have Sex With Men in the United States, 2012-2015. 2017, Folaranmi, Clin Infect Dis

The risk of meningococcal infection in homosexuals in 4 times higher, than in heterosexual people. HIV positive homosexuals suffer from meningococcal disease 10 times more often, than HIV negative ones. 45% of meningococcus patients reported multiple partners and participation in anonymous sex.
Among homosexuals, 32% smoke (as compared to 18% among adults in the USA), and 48% are drug users (as compared to an average of 10%).
In New York and Southern California, the risk of meningococcal infection among homosexuals was 50 times higher, than in general; in Germany, it was 13 times higher; and in Paris – 10 times higher.
24% of homosexuals are carriers of meningococcus, as compared to 6% of heterosexual women. Among homosexuals, who have had oral-anal contact recently, 43% were carriers.
Meningococcus was also found in the anal canal in 4.5% of homosexuals.
A new strain of meningococcus that can be transmitted sexually was discovered in 2016.
CDC reports that in 2016, 57% of men over 16 years of age infected with meningococcus, reported homosexual relations. More: [1] [2] [3].

Meningococcal

Meningitec (conjugate, against serogroup C) vaccine is used in France. At least 680 children were harmed by this vaccine. They sued the company, and their lawyer ordered a laboratory test of the vaccine. It turned out that it contains nanoparticles of heavy metals, such as titanium, lead and zirconium.

Tuberculosis

Environmental risk factors in paediatric inflammatory bowel diseases: a population based case control study. 2005, Baron, Gut

Patients with Crohn's disease are vaccinated with BCG 3.6 times more often than healthy individuals.

Hepatitis A

Hepatitis A outbreak in HIV-infected MSM and in PrEP-using MSM despite the high level of immunity, Lyon, France, January to June 2017. 2017, Charre, Euro Surveill

Hepatitis A outbreak in Leon in the first half of 2017. 46 cases, 38 of them men, 33 homosexuals, and 15 HIV positive. Most of them have been vaccinated or had antibodies.
According to the existing model, 70% of those with immunity would be enough to prevent hepatitis A infection among homosexuals. The authors conclude that 70% is not enough.
It is also reported that since contracting hepatitis A is also possible from needle sharing, slamming (intravenous drug use during anal contact), a practice that is gaining popularity among certain homosexual groups, can also increase the risk of infection. More: [1], [2].

Rotavirus

Rotavirus vaccines in France: because of the three infant deaths and too many serious side effects vaccines are no longer recommended for routine children immunization. 2015, Michal-Teitelbaum, BMJ

After the introduction of rotavirus vaccination in France, 508 side effects have been registered (201 of them serious), and 47 cases of intussusception. 2 infants died of intussusception, and another one died of necrotizing enterocolitis. In the five years preceding the vaccination, only one lethal case of intussusception has been reported. Therefore, rotavirus vaccine has not been included into the national immunization schedule and is not financed by the government.
Clinical studies of the vaccine did not determine that the vaccine reduced overall mortality neither in developed, nor in developing countries.

Pneumococcal

After the beginning of pneumococcal vaccination in France, the number of cases of pneumococcal meningitis increased by 34% (from 0.93 to 1.25/100,000).

Pneumococcal

Rebound in the incidence of pneumococcal meningitis in northern France: effect of serotype replacement. 2010, Alexandre, Acta Paediatr

The incidence of pneumococcal meningitis among children under the age of 18 increased 2.2 times between 2005 and 2008. The incidence rate among children under the age of 2 increased 6.5 times, and the coverage of vaccination increased from 56% to 90% during this time.
In 2008, the incidence of pneumococcal meningitis compared to the pre-vaccination era (Northern France)

Mumps

Waning immunity against mumps in vaccinated young adults, France 2013. 2016, Vygen, Euro Surveill

In 2013, 15 mumps outbreaks were registered in France. 72% of the cases had been vaccinated twice. The effectiveness of the vaccine was 49% for one dose and 55% for two doses.
Among those who had been vaccinated once, the risk of getting mumps increased by 7% for every year that had passed since the vaccination.
Among those who had been vaccinated twice, the risk of getting mumps increased by 10% for every year that had passed after the second dose.
Orchitis was observed in five men. One of them was unvaccinated, two had been vaccinated with one dose, and another two had been vaccinated twice.
Mumps is a mild disease, which passes on its own, but sometimes it can cause severe complications, such as orchitis, meningitis, pancreatitis or encephalitis, especially in adults. Complications from mumps are observed more often in adults and they are more severe than in children, especially among the unvaccinated.
In other countries, mumps outbreaks are also observed among the vaccinated. The reason for this is the decreasing effectiveness of the vaccine and the lack of natural boosters. Other reasons for the outbreaks could be the initial overestimation of the vaccine effectiveness, insufficient vaccination coverage, or existence of a strain that is not covered by the vaccine.
Outbreaks occurring among the vaccinated and the decreasing effectiveness, both lead to thoughts about a third dose of the vaccine. This kind of an experiment was conducted in the US during the outbreaks in 2009 and 2010. Both times the outbreak subsided a few weeks after the administration of the vaccine. However, the outbreaks always subside at some point, so it was unclear whether it had anything to do with the vaccination. Nonetheless, this and other experiments hint that a third dose of the vaccine might not be a bad idea. Moreover, during the vaccination campaigns in the US, the third dose had few side effects.
They wanted to introduce a third dose of MMR into the national immunization schedule in Netherlands, but changed their mind, since mumps rarely causes complications, and the vaccination coverage among adults is unlikely to be satisfactory.
Mumps outbreaks among the vaccinated, along with this study, led the Ministry of Health of France to recommend a third dose of MMR at times of outbreaks. Even though it is unknown whether the vaccine is effective for those already infected with the virus, it is quite possible that the vaccine will cause a decrease in the contagious period of the vaccinated patients.
The Dutch study determined that two thirds of cases during outbreaks are asymptomatic. The role of asymptomatic patients in the transmission of the disease remains unknown.
Future observations in France, and possibly other countries that would adopt the same recommendation, will help determine whether the third dose of MMR is effective during outbreaks.

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