It is the adults especially that are concerned by the novelties of the vaccinal calendar 2004, published by the weekly epidemiological Newsletter . He recommends vaccination against the whooping cough of the future parents and that against the chicken pox of the professionals of health and in contact with small childhood (on the other hand, he does not keep the vaccination generalised from 12 months). The revaccination by BCG is left.

Every year the vaccinal calendar is seen again by the experts in function of the evolution of the epidemiology of diseases, of the actualisation of knowledge on effectiveness and tolerance of vaccines, recommendations issued in other countries and in the bet on the market of new vaccines . " The weekly epidemiological Newsletter " (n 28/29, June 29th) publishes the calendar 2004 at the same time as the opinions of the great council of public hygiene of France which motivate modifications.

Babies polluted by their parents

The revision of recommendations on whooping cough was desired by of many m demis. Recent pid t ologiques studies assess every year around 800 on average number cases of whooping cough thez the new-born babies of less than 5 months, with a 1,7 % fatality. In more than a third of cases and perhaps even the half, the babies was polluted by their parents. Epidemics also happened at hospital personnels taking care of small childhood, with a risk of pollution nosocomiale. Where from recommendation to vaccinate the professionals of health and social in the contact with the babies and the adults likely to become parents in months or coming years (at the child, the length of vaccinal protection is of a dozen years, at the adult there are not data).

In case of pregnancy, they will vaccinate that the father and the children who are not up to date for this vaccination during the pregnancy of the mother and this last as early as possible after delivery. Looking forward to the bet on the market of a monovalent vaccine, it is recommended to use vaccine TDCAPOLIO on the occasion of the ten-year dipht rie-t tanos-polio recall or the t tanospolio which the vaccinal calendar envisages for the adults. No more than a dose and under any circumstances during the pregnancy will be given. If there is not information over delay to be respected in comparison with a tetanic vaccination, they dipht rique or they poliomy litique, no data of literature were found as for strict noxious effects if he is ten-year-old inferior.

Chicken pox

Not in generalised vaccination. As regards chicken pox, while two vaccines have AMM since December, 2003, the experts wondered about interest to generalise the vaccination of the children from 12 months, as wish it some pediatricians in view of complications which illness can draw away. They note that the chicken poxes of the child beyond 1 year are most often benign. The number of strict complications is assessed in literature between 0,6 and 26,7/10 000 cases (the impact of chicken pox is 600 000 cases a year, among which 90 % happen at the child's between 1 and 14 years).

The number of deceases turns around 20, two thirds happening at one more than 15 years. Chicken pox is especially dangerous for the pregnant woman, because of risk of foetal complications (they take a census around 500 chicken poxes pergravides a year, leading from 10 to 14 foetopathies), and for the persons immunod prim es. The risk of nosocomiales infections also is to take into consideration since from 1 to 2 % personnels of health am not immunised and is therefore possible contract serious forms.

To exclude the vaccination generalised at the child, the experts also took extrapolations into account: at best, the vaccination of a cohort would have avoided, when cohort would attain the age of 80 years, 52 000 cases, 487 hospitalisations, 73 strict complications and 7 deceases; more than 15 years of vaccination of the 11-year-old children would be necessary before avoiding on average a decease, 30 strict complications and 30 000 cases in year.

In terms of public health, it seems therefore more reasonable to recommend the vaccination of the adults not having antecedents of chicken pox in following cases: after an exhibition to a patient with eruption (in 3 days); at the beginning of medical and paramedical studies; for the personnels of health in appointment or, in defect and first and foremost, in services welcoming persons at risk of serious chicken pox; for the professionals in contact with small childhood; for the persons in narrow contact with immunod prim s. It is underlined that any vaccination against chicken pox at a young woman in age to procreate must be preceded of a negative test of pregnancy. New recommendations also concern vaccinations against hepatitis A and against influenza. Vaccination counters hepatitis

In is recommended from now on also to the bearing patients of a chronic illness of the liver before d compensation. That against influenza to the flight personnel of the boats of cruise and of planes and to the personnel of the industry of trips accompanying the groups of passengers.

The revaccination by BCG left. Finally, the new vaccinal calendar takes note of the abolition of the revaccination by BCG in general population and at the professionals displayed to tuberculosis (the decree is in authority of publication). France was the only country of the European Union to make it. The intradermo-reaction to the tuberculine in 5 Units will not be any more practiced in systematic title but only in following cases: to prove the absence of tuberculosis before firstly - vaccination (safe for the newborn babies); in the inquiry around a case of tuberculosis; as assistant to diagnosis; as reference test for the surveillance of professions at risks.

For whooping cough

Firstly - vaccination must be preferably practiced with vaccine with whole germs; vaccine acellulaire can however be used. The recall in 16-18 months can be indifferently practiced with vaccine with whole germs or vaccine acellulaire. A recall is recommended, since 1998, between 11 and 13 years and must be accomplished with a vaccine acellulaire, at the same time as the third recall diphtheria, tetanus and poliomyelitis.

Between 3 and 6 years, a second vaccination linking measles, mumps, rubella is recommended for all children because of risk mattering from happening of epidemics of measles, particularly at the teenagers. For the children of more than 6 years, it is necessary to be sure that they were once vaccinated at least against three diseases; otherwise, a dose of triple linked vaccine will be managed between 11 and 13 years. At the teenagers and the not vaccinated young women, the vaccination against rubella is recommended, for example during a consultation of contraception or premarital.

Firemen and BCG

The firemen must be registered on the list of professions subjected to vaccinal obligation by BCG. For 1990s, raise the experts, their exits for help to victim are numerous more and more, representing from now on near the half of interventions. And it is these interventions which display them most to the contagion. They are so often the first to intercede with precarious populations, to which the rates of impact of tuberculosis are particularly high.