[Influenza vaccine among the aged].
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Aged↗
Biomedical subjects
F Carrat
Publications and source records attributed to F Carrat.
[Anti-influenza vaccine. Bibliographic review].
A large number of papers are regularly published about anti-flu vaccine with discordant results regarding their efficacy. Through a recent review the efficacy of the vaccine has been evaluated both in terms of the immune response, the protection against clinical disease, but also as regards the impact from an epidemiological and economic point of view. In the majority of papers in which the immune response was studied before and after vaccination a 60 to 100% case of protection was obtained serologically by measuring the protective antibodies. These levels varied as a function of the type of the vaccination (inactive or living) and also of the immune state of the subject. In subjects of more than 60 years of age the immune response was 1.5 to 2 times less that in the young adult. The protection against clinical disease in children and adults is of the order of 40 to 70%, according to whether the infection is confirmed or not. On the other hand the vaccine is less effective in the elderly subjects, but gives a protection of the order of 75% protection against complications or of mortality linked to influenza. Finally there are a certain number of epidemiological and economic arguments which would justify the vaccine use on a large scale.
Adolescent↗
Epidemiologic mapping using the "kriging" method: application to an influenza-like illness epidemic in France.
This paper presents the application of a technique from the earth sciences, the "kriging" method, to the field of geographic epidemiology. Both the principles of the method and the basic equations are given. A key advantage of the method is that it relies on an analysis of the spatial variability of the data and allows the representation of the variable under study as a continuous process throughout a country. Application of the kriging method to the geographic distribution of an epidemic of influenza-like illness in France is discussed.
Epidemiologic Methods↗
Early detection of epidemic influenza.
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Diagnosis, Computer-Assisted↗
Effect of maternal and fetal characteristics on diagnosis of intrauterine growth retardation.
We studied the fetal and maternal characteristics that affect the diagnosis of intrauterine growth retardation and lead to variations in the sensitivity, specificity and predictive values. The population comprised the 18,166 women who consulted and delivered in two teaching hospitals in Paris from 1978 to 1983. Specificity was lower when a child was born before 37 weeks, with a small weight-for-gestational age, and when the mother had experienced complications during either her obstetric history or current pregnancy. Conversely, sensitivity was higher when these maternal and fetal characteristics were present. Positive predictive values rose in the presence of a risk factor for small-for-dates, but the rise was smaller than would have been expected if sensitivity and specificity had remained at the levels observed in the low-risk group.
Birth Weight↗
Field investigation of influenza vaccine effectiveness on morbidity.
Our objective was to evaluate influenza vaccine effectiveness during an influenza epidemic by means of a matched case-control study. The study was performed by 35 general practitioners who collected specimens for influenza virus testing from 610 patients who consulted for infectious syndrome: 168 (28%) were influenza-positive. Two designs were used for selecting controls to take into account the high incidence-rate of influenza-like illness and the various possible protective effects of the vaccine. A first disease-free control matched for age and sex was selected during the same week as the case. A second control matched for age and sex was selected at the end of the epidemic period, irrespective of disease history during the epidemic period. Upper and lower bounds of vaccine effectiveness can be derived from these case-control designs. After adjustment for chronic conditions and exposure to an index case, analysis of the matched-pairs whose case was influenza-positive showed, with the first group of controls, an influenza vaccine effectiveness of 68% (95% CI, 10% to 88%) and, in the second group, 53% (95% CI, -19% to 82%). Among the pairs whose case was negative for influenza, vaccine effectiveness was, respectively, 31% (95% CI, -17% to 59%) and 12% (95% CI, -47% to 47%). Vaccine effectiveness was highest for the H3N2 subtype whose vaccine strain was identical to that of the wild-type strain. The results suggest that influenza vaccine is effective in the field in preventing influenza morbidity.
Adolescent↗
Consequences of misdiagnosis of intrauterine growth retardation for preterm elective cesarean section.
We studied the consequences of misdiagnosis of intrauterine growth retardation (IUGR) for preterm elective cesarean section among live singleton newborns in two teaching hospitals in Paris between 1978 and 1983. The population studied comprised the 16,540 babies who were normal for date, according to the 10th percentile of the reference curve established in this population. For 118 of these infants, IUGR had been diagnosed during pregnancy. The preterm elective cesarean section rate was 12.7% among newborns for whom IUGR was erroneously diagnosed, compared to 1.2% among those for whom IUGR was not diagnosed. The relationship between preterm cesarean section and misdiagnosis of IUGR still existed (odds ratio: 5.2, 95% CI: 2.1-12.9) after taking into account obstetric history and hypertension during pregnancy. Our results show that after diagnosis of IUGR, supplementary tests are essential to confirm fetal distress and consequently avoid unnecessary interventions.
Cesarean Section↗
[Colonic involvement in ileal Crohn's disease].
OBJECTIVES: To determine the risk and predictive factors for colonic extension in patients with ileal Crohn's disease. METHODS: One hundred and fifty patients with ileal Crohn's disease and no specific colonic lesions on initial colonoscopy were studied retrospectively (median follow-up: 51 months). RESULTS: Twelve patients (8%) developed colonic lesions. Ten-year cumulated risks (95% confidence interval) for colonic extension were 17.2% (range: 5.8-28.6) in the whole group, and 22.4% (range: 8.7-36.1) in the group of 86 patients with repeated colonoscopy. Young age at diagnosis was the only factor predicting colonic extension. Seven patients with colonic extension required immunosuppressive therapy but none underwent surgery. CONCLUSION: Ileal Crohn's disease has a low tendency for colonic extension. Colonic extension has no major prognostic implications.
Adolescent↗