Fetal central nervous system anomalies: When should we offer exome sequencing?

OBJECTIVE

To investigate the detection of pathogenic variants using exome sequencing in an international cohort of fetuses with central nervous system (CNS) anomalies.

METHODS

We reviewed trio exome sequencing (ES) results for two previously reported unselected cohorts (Prenatal Assessment of Genomes and Exomes (PAGE) and CUIMC) to identify fetuses with CNS anomalies with unremarkable karyotypes and chromosomal microarrays. Variants were classified according to ACMG guidelines and association of pathogenic variants with specific types of CNS anomalies explored.

RESULTS

ES was performed in 268 pregnancies with a CNS anomaly identified using prenatal ultrasound . Of those with an isolated, single, CNS anomaly, 7/97 (7.2%) had a likely pathogenic/pathogenic (LP/P) variant. This includes 3/23 (13%) fetuses with isolated mild ventriculomegaly and 3/10 (30%) fetuses with isolated agenesis of the corpus callosum. Where there were multiple anomalies within the CNS, 12/63 (19%) had LP/P variants. Of the 108 cases with CNS and other organ system anomalies, 18 (16.7%) had LP/P findings.

CONCLUSION

ES is an important tool in the prenatal evaluation of fetuses with any CNS anomaly. The rate of LP/P variants tends to be highest in fetuses with multiple CNS anomalies and multisystem anomalies, however, ES may also be of benefit for isolated CNS anomalies.

Burden of herpes zoster: the direct and comorbidity costs of herpes zoster events in hospitalized patients over 50 years in France

Background

The objectives of this study were to describe hospital stays related to HZ and to evaluate the direct and indirect cost of hospitalizations due to HZ among patients aged over 50 years.

Methods

The hospitalizations of people aged over 50 years were selected from the French national hospital 2011 database (PMSI) using ICD-10 diagnosis codes for HZ.

Firstly, stays with HZ as principal or related diagnostic were described through the patient characteristics, type of hospitalization and the related costs. Secondly, a retrospective case–control analysis was performed on stays with HZ as comorbidity in 5 main hospitalizations causes (circulatory, respiratory, osteo-articular, digestive systems and diabetes) to assess the impact of HZ as co-morbidity on the length of stay, mortality rate and costs.

Results

In the first analysis, 2,571 hospital stays were collected (60 % of women, mean age: 76.3 years and mean LOS: 9.5 days). The total health assurance costs were 10,8 M€. Mean cost per hospital stay was 4,206€. In the second analysis, a significant difference in LOS and costs was shown when HZ was associated as comorbidity in other hospitalization’s causes.

Conclusions

HZ directly impacts on the hospital cost. When present as comorbidity for other medical reasons, HZ significantly increases the length of hospital stay with subsequent economic burden for the French Health System.

A comparative public health and budget impact analysis of pneumococcal vaccines: The French case

In 2002, a pneumococcal conjugate vaccine (PCV) was introduced to French infants and toddlers. A change has been witnessed in the incidence of pneumococcal diseases in adults: the incidence of invasive pneumococcal disease (IPD) of serotypes covered by PCV decreased, and serotypes not covered by PCV increased. This study aimed to quantify the public health and budget impact of pneumococcal vaccination strategies in at-risk adults in France over 5 years. A previously published population-based Markov model was adapted to the French situation. At-risk adults received either PPV23 (pneumococcal polysaccharide vaccine; for the immunocompetent) or PCV13 (for the immunosuppressed). The strategy was compared to PCV13 alone. Uncertainty was addressed using extreme scenario analyses. Between 2014 and 2018, vaccination with PPV23/PCV13 led to a higher reduction in terms of IPD and non-bacteremic pneumococcal pneumonia cases avoided in most scenarios analyzed when compared to PCV13 alone. For budget impact, none of the scenarios was in favor of PCV13. Under conservative coverage assumptions, the total incremental budget impact ranged from € 39.8 million to € 69.3 million if PCV13 were to replace PPV23 in the immunocompetent. With the epidemiological changes of pneumococcal diseases and the broader serotype coverage of PPV23, the current program remains an optimal strategy from public health perspective. Given the additional budget required for the use of PCV13 alone and its uncertain public health benefits, vaccination with PPV23 remains the preferred strategy.

[Activity and cost related to hospital management of herpes zoster in France: focus on ophthalmic herpes zoster]

OBJECTIVES

Herpes zoster secondary to reactivation and replication of the varicella zoster virus (VZV) caused a painful disease which impact the quality of life. Among the complications, herpes zoster ophtalmicus was responsible to post-herpetic neuralgia and lesions of the ocular globus. The aim of this study is to evaluated the burden and cost of herpes zoster in secondary care in France with focus on herpes zoster ophtalmicus (HZO).

METHODS

This retrospective analysis was performed using data extracted from the French medical information system during the year 2012. The diagnosis are coded using the international classification of diseases as primary, related or significant associated diagnosis.

RESULTS

During the year 2012, 2,509 patients 50 years old and more were admitted secondary to HZ. Among them, 495 were admitted with an HZO (19.7%). The mean age of patients hospitalized were 77 years. The average cost per stay varied between 3,370 euros and 9,191 euros respectively for zoster without complications and for encephalitis. The overall total hospitalization due to HZ and its complications was around 10.2 million euros in France in 2012, 18% of these costs were attributable to hospitalizations for HZO.

CONCLUSION

This study evaluated the cost of hospitalization due to zoster for the French health insurance. This total costs were probably underestimate because the non-exhaustiveness of CIM coding. This study shows the burden of zoster and his cost particularly heavy when ophtalmicus or neurological complications were associated to HZ.

[Catch-up vaccination of worldwide newcoming (adopted, refugee or migrant) children in France]

In France, international adoption includes around to 90,000 children since 1980 and near 300,000 immigrant children were counted in 2008. This population is heterogeneous, according to age and country of origin, and its large number. It is not easy to completely and surely assess the vaccine status of the child. Due to a great variability of individual situations, it is not possible to have systematic and unchangeable rules. This article aims to give an update of catch-up vaccination of internationally adopted or refugee or migrant children in France. The vaccination status of a child who recently arrived in France is complex and has to be adapted to his country of origin. Some of them were never vaccinated whereas the vaccine status of others is uncertain or unknown. Three parameters have to be considered: the age of the child, the country of origin, and sometimes serology in the case of doubts of his vaccine status. Catch-up vaccination of foreign children has to be adapted to French vaccine recommendations, as a reference, and to vaccines already administered to the child.

Assessment of individual vaccine status in a vaccinology experts' group

RATIONALE

Worldwide, experts in vaccinology have promoted the broad annual coverage of health care workers with the influenza vaccine. Furthermore, pertussis vaccination is now recommended for young adults and health care workers working with newborns.

AIM

To analyse the compliance with these guidelines among experts responsible for the development or dissemination of national immunization schedules.

METHOD

A cross-sectional survey was conducted in a vaccinology workshop group of French experts, using a self-administered questionnaire.

RESULTS

Among 44 experts, the average rate of influenza vaccination was 69.5% (95% confidence interval, 61.6% to 77.3%) between the 2003/04 and 2005/06 flu seasons, whereas the rate of pertussis vaccination during this period was only 30%. The main reasons that the experts gave for not being vaccinated were a lack of time or simply not remembering to do so.

CONCLUSION

Experts had low coverage rates for influenza and pertussis vaccination. To improve these rates, a multifaceted intervention combining audit and feedback strategy with a vaccine day is planned.

[Attitude of adults at work towards influenza vaccination]

OBJECTIVES

The authors had for aim to describe the main motivations of adults at work who spontaneously request influenza vaccine and the clinical profile of those vaccinated after the physician's suggestion.

METHODS

A national cross-sectional survey was made in primary care practice. The physicians filled out a questionnaire describing their opinion on their vaccine practice and described the 7 first vaccinated adults between 18 and 64 years of age.

RESULTS

1,456 physicians included 9,163 patients 46+/-12 years of age. Two thirds (64.8%) of them were vaccinated against influenza after spontaneously requesting it. The arguments justifying these spontaneous requests were the professional consequences of influenza (45.7%), its familial consequences (42.0%), the discomfort induced by the disease (41.7%), financial consequences (20.3%), the risk for the home environment (19.6%) and the family, and professional pressure (17.2%). The physicians preferentially suggested vaccination to patients presenting respiratory risk factors and in particular prone to frequent respiratory infections (75.2%), with a history of bronchitis (69.2%) or asthma (68.3%). Less than one physician out of two suggested it systematically to smokers (43.1%) or patients having presented with influenza on the previous year (41.1%).

CONCLUSION

Among the adults at work vaccinated against influenza, two thirds spontaneously requested it, essentially for socioprofessional reasons, whilst its proposal by medical practitioners still remained limited to patients presenting a medical status likely to be worsened by influenza.