A Lécuyer

Pierre and Marie Curie University - Paris 6, Lutetia Parisorum, Île-de-France, France

Are you A Lécuyer?

Claim your profile

Publications (38)49.54 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: In US, pneumococcal conjugate vaccine (PCV7) had reduced the burden of AOM and changed the profile of the disease. Prior to PCV7 implementation in France, AOM represented 8% of pediatricians visits and failure rate was 12%. The aim of this study is to describe the epidemiologic characteristics of AOM after PCV7 implementation. From 2007 to 2008, 30 pediatricians enrolled 3141 patients 3 to 36 months old with AOM. Standardized history and physical examination findings were recorded. Factors related to AOM failures were identified by multivariate logistic regression. AOM accounted for 5.8% of the 43 433 visits or 6.2 cases/week per pediatrician. Among 3141 evaluable AOM cases (mean age 16.7±8 months, peak incidence at 10 months), 99% had been vaccinated with PCV7 and 42.1% attended day care (DCC). Recurrent AOM comprised 24.5% of cases and 51% of children had received ATB in the last 3 months. At the time of diagnosis, 47.1% had fever≥38,5°C, 74.5% otalgia and 4.7% otorrhea. Febrile and painful AOM accounted for 29.5% of cases and cunjunctivitis-otitis syndrome for 18.2%. ATB was prescribed in 98.7% of cases (cefpodoxime proxetil, 59% and amoxicillin/clavulanate, 37%). The failure rate was 6.4% and failure risk was greater in children in DCC (OR=1.50, [1.10;2.05]), young age<18 months (OR=1.47, [1.06;2.04]) and history of recurrent AOM (OR=1.45, [1.02;2.06]). Despite PCV7 implementation, AOM remains a very frequent childhood infection and a major reason for ATB prescriptions.
    Archives de Pédiatrie 06/2011; 18(6):712-8. · 0.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Varicella, a widespread disease of childhood, is usually benign but may in some instances lead to complications and eventually death. The aim of this study was to assess whether varicella severity in infants below one year of age was associated with the level of anti-varicella zoster virus (VZV) maternal antibodies. Two different data sets were used. Data on varicella-associated complications were collected through a national surveillance network involving 175 hospital-based pediatric wards. Data on levels of maternal acquired antibodies according to infants' age were extracted from a cohort of 345 full term infants enrolled in a prospective multicenter study in seven pediatric wards and/or pediatric emergency units. Among infants hospitalized for varicella complications, the overall prevalence of complications increased regularly from 10.4% in infants below 1 month of age to over 72.4% at 5 months of age. Conversely, the mean antibody titre decreased from 536 mIU/mL in the [0-1 [month group to below the 150 mIU/mL threshold at 3-4 months [Pearson coefficient = -0.956 (p < 0.001)]. Based on large numbers of infants, our results show for the first time, a strong inverse correlation between the levels of circulating anti-VZV maternal antibodies in full term infants and occurrence of varicella complications below one year of age. Infant protection could be optimized by increasing herd immunity, reducing the susceptibility of women in childbearing age and lowering the age of routine vaccination to 9 months. Additional vaccination for unprotected persons in close contact with infants below 12 months of age could be promoted.
    Human vaccines 05/2011; 7(5):534-8. · 3.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Compliance with antibiotics is essential to ensure treatment efficacy and to prevent the emergence of bacterial resistant stains. In children who take oral form, the palatability and the frequency of administration seem to be factors important to good compliance. PATIENTS AND METHODS: This observational study was designed to assess the acceptability of oral antibiotics (including generics) commonly prescribed to children by primary care physicians in France. It was given to 50 pediatricians and 50GPs in private practice. For each patient, the physician and parents completed a questionnaire, and parents filled out a log for each drug intake. RESULTS: Between September 2006 and September 2007, 91 physicians enrolled 2400 children and 1482 patient records are fully assessable. The two factors that improve significantly compliance are administration in two doses by day (OR 2.2 [95% CI 1 6-3]) and acceptability ≥80% (OR 2.6, [95% CI 1.9-3.7]). The acceptability was better for amoxicillin-clavulanic acid 65.4% (95% CI [57.6 to 72.4]) than for cefpodoxime 47.1% (95% CI [43.8-50.4]) or cefuroxime axetil 26% (95% [CI 15.9-39.6]). Conversely, cefpodoxime proxetil obtained a better score for compliance 91.8% (95% CI [89.8 to 93.4) as amoxicillin-clavulanic acid 84.6% (95%CI 80.8 to 87.8) because of its mode of administration in two doses per day. There is no difference between the amoxicillin clavulanic acid reference product and its generics as a whole, however a large variability exists between generics. If, for antibiotics prescribed in two doses per day, the two administrations by day are roughly equidistant, it is not the same for those prescribed three times a day: indeed, while the doses taken are identical, only four hours separate the first intake of the morning from the second intake in mid-day and more than 12hours between the evening dose from the next morning intake. CONCLUSIONS: This study confirms the disparity in terms of acceptability among the different antibiotics prescribed for children even for the same drug, warranting evaluation for marketing of future generic drugs pediatric oral suspension. The disparity ranges for drugs three times daily asking consequences pharmacokinetics and dosage adjustment for a transition to two doses per day.
    Archives de Pédiatrie 03/2011; · 0.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In France, despite a high rate of pneumococcal conjugate vaccine coverage, the number of cases of pneumococcal meningitis in children did not decline significantly between 2001–2002 (n = 264) and 2007–2008 (n = 244). A decline was observed among children < 2 years old (185 [70.1%] to 134 [54.9%] cases; P = 0.0004), but was counterbalanced by an increase among children ≥ 2 years old (79 [29.9%] to 110 [45.1%] cases). Mean age increased significantly, from 2.3 (median 0.8) to 3.8 (median 1.5) years. After pneumococcal conjugate vaccine 7 implementation, a wide diversity of serotypes implicated in pneumococcalmeningitis was observed; serotypes 19A and 7F were the most frequent.
    The Pediatric Infectious Disease Journal 02/2011; 30(2):168-70. · 3.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Compliance with antibiotics is essential to ensure treatment efficacy and to prevent the emergence of bacterial resistant stains. In children who take oral form, the palatability and the frequency of administration seem to be factors important to good compliance.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2011; 18(5):611-616.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chickenpox is often considered more severe during the first year of life, but its course is usually mild during the first 3 months of life, presumably owing to the persistence of maternal antibodies. Hospitalization and intravenous acyclovir therapy are generally restricted to severe cases but also systematically recommended in newborns in France, irrespective of the clinical severity of the infection. This recommendation was launched in 1998 when Varicella zoster virus (VZV)-specific immunoglobulins were not available in the country and has remained unchanged since. The aim of this prospective observational study was to describe complications of varicella infection in a population of 745 children hospitalized for varicella before 1 year of age, with a specific focus on newborns. Complications occurred in 65% of cases. They were very rare before the age of 1 month (10%) but their incidence then increased progressively with age and probably the disappearance of maternal antibodies: 42% (1-2 months), 66% (3-5 months), 70% (6-8 months), and 79% (9-12 months). Conclusion Chickenpox is usually mild in newborns because most of them are protected by VZV maternal antibodies. Unless the absence of maternal VZV immunity is demonstrated, newborns with mild chickenpox should not require antiviral therapy.
    European Journal of Pediatrics 05/2010; 169(10):1293-7. · 1.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Neisseria meningitidis meningitis represents approximately one-half of the meningococcal cases in French children. To explore the contribution of bacterial typing in improving the management of cases, we aimed to describe clinical characteristics and mortality of meningococcal meningitis in children reported to the multicenter survey system, GPIP/ACTIV, in association with phenotypes/genotypes of bacterial isolates. From 2001 to 2005, 259 pediatric wards and 168 microbiology laboratories enrolled all children with bacterial meningitis. Risk factors, vaccination status, signs and symptoms, cerebrospinal fluid analysis, treatments and case fatality rate were recorded. A total of 962 cases of Neisseria meningitidis meningitis among a total of 2131 bacterial meningitis (45%) were recorded (mean age, 4.5 +/- 4.7 years). Serogroup distribution of the isolates was 62.3%, 33.7%, 2.9%, 0.6%, and 0.6% for serogroups B, C, W135, A and Y, respectively. The major clonal complexes were ST-41/44 (32.2%), ST-11 (21.9%), ST-32 (20.8%), ST-8 (8.2%), and ST-269 (4.9%). Despite global heterogeneity of the isolates, 2 phenotypes/genotypes were of interest. Isolates of the phenotype/genotype B:14:P1.7,16/ST-32 (56% clustered in the region of Haute Normandie) were observed in older children (8.6 years) and were associated with a higher case fatality rate (12%) than were other phenotypes of serogroup B. The phenotype/genotype C:2a:P1.5/ST-11 was found in 26.3% of serogroup C cases and was possibly associated with a higher mortality among serogroup C (9.9% for C and 5.9% for B, P = 0.04). This large survey provides data that could be important for implementation of future vaccines. Typing of meningococcal isolates could contribute to an understanding of prognosis in meningococcal meningitis.
    The Pediatric Infectious Disease Journal 02/2010; 29(7):618-23. · 3.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In a 12-month cohort follow-up study of 2435 children vaccinated in 2007 by Statens Serum Institute BCG strain (BCG SSI, 17.8% had an adverse event (AE): erythema 12.4%, induration 12.2%, abscesses 2.5%, ulceration 0.9%, lymphadenitis 0.1%. The factors associated with a lower risk of AE were: age at vaccination <1 year compared to age >1 year (OR=0.35 [0.2-0.6] for age <28 days, 0.29 [0.2-0.42] for age 29 days to 2 months, and 0.53 [0.37-0.74] for age 3-11 months), a visible papule (OR=0.48 [0.36-0.63]), and a low vaccine dose (OR=0.42 [0.31-0.58]). AE to BCG SSI vaccination were frequent but rarely severe.
    Vaccine 09/2009; 27(50):6967-73. · 3.77 Impact Factor
  • Archives de Pédiatrie 07/2009; 16(6):921-3. · 0.36 Impact Factor
  • Archives de Pédiatrie 07/2009; 16(6):924-5. · 0.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine whether the use of seven valent pneumococcal conjugate vaccine (PCV7) caused a shift in the Streptococcus pneumoniae serotypes distribution and whether it modified the resistance to antibiotics, 3291 nasopharyngeal swabs were obtained between 2001 and 2006, from children aged 6-24 months with acute otitis media. Following the implementation of PCV7, we observed a slight reduction in the overall pneumococcal carriage, a marked decrease of vaccine serotypes, an increase in non-vaccine serotypes carriage and a reduction in the carriage of penicillin non-susceptible strains. Most of the serotype 19A replacement was related to the clonal expansion of ST276 which was found to be the predominant ST among penicillin non-susceptible isolates.
    Vaccine 06/2009; 28(37):6114-21. · 3.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In July 2007, compulsory BCG vaccination for all children was replaced by a strong recommendation to vaccinate children at high risk of tuberculosis (children who live in Ile-de-France [IDF] or Guyana regions, who were born or whose parents were born in tuberculosis endemic countries, with a family history of tuberculosis or living in conditions defined as at risk by the doctor). In the absence of tools to detect an early decrease in vaccine coverage (VC) in this specific group, we conducted a survey with the main objective of measuring BCG VC in high risk children for which BCG is now recommended and who were born after the change in BCG vaccine policy. Cross-sectional survey performed amongst physicians registered at "Infovac-France", a network of general practitioners and paediatricians particularly aware of recent changes in the field of vaccinations. Each doctor was asked to recruit, during his medical consultation, between six and 12 children aged 2-7 months (born after the end of compulsory BCG vaccination in July 2007) and 8-23 months (born after the withdrawal from the market of the multipuncture form of BCG [Monovax] in January 2006 and before the end of compulsory BCG vaccination in July 2007). Doctors were asked to fill in a structured online questionnaire. Data were standardized and analysed with Stata 9.2. A total of 2536 children, recruited by 279 general practitioners and paediatricians (6.5% of all contacted doctors), were included. VC in the target group of high risk children for who BCG is still recommended and who were seen by doctors working in a private medical practice was: overall 68%; 58% in children born after the end of compulsory BCG vaccination (68% in IDF, 48% outside IDF); 77% in those born after the withdrawal of Monovax from the market and before the end of compulsory BCG vaccination; 90% in children living in IDF born after the end of compulsory vaccination and considered as particularly at risk of tuberculosis (presence of vaccination criteria other than residing in IDF) and 60% in the same category of children whose sole criteria for vaccination was residing in IDF. Of doctors who worked in a private medical practice: 75% used to perform the BCG vaccination themselves and 58% had recommended or suggested vaccination to children at risk who were not yet vaccinated. Seventy-six percent of parents of children at risk of tuberculosis not yet vaccinated accepted BCG vaccination when recommended by their doctor. Our survey showed, on the one hand, insufficient VC in children seen in a private medical practice and born after the end of compulsory vaccination for whom BCG is still recommended. This should encourage the Ministry of Health to reinforce its communication concerning this new policy. On the other hand, the survey showed encouraging results concerning both the coverage of children at particularly high risk in IDF and the adherence of doctors and families to the new vaccine policy. These results should be interpreted with caution, taking into account the methodological limitations of this survey.
    Archives de Pédiatrie 04/2009; 16(5):489-95. · 0.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The implementation of Haemophilus influenzae b (Hib) vaccination program in France in 1993 resulted in a rapid and dramatic decrease of the Hib meningitis incidence in children. The aim of our study was to describe the residual Haemophilus influenzae (Hi) meningitis in the French paediatric population between 2001 and 2006. The French Paediatric Infectious Diseases Group set up an active surveillance network to analyze the clinical and biological features of bacterial meningitis. We used these data to retrospectively study the risk factors, signs and symptoms, vaccination status, cerebrospinal fluid analysis, treatment and case fatality rate of Hi meningitis. Among the 2539 cases of bacterial meningitis reported in France between 2001 and 2006, 69 (2.7 %) were due to Hi. A mean number of 11.5 cases of Hi meningitis was reported annually (minimum 6, maximum 16). Among Hi meningitis cases, 36 strains were of serotype b, 8 were capsulated but not b (6 f, 1 e and 1 unknown serotype), 20 strains were not capsulated, and 5 were non studied. The mean age of the children was 30.3 months (median 13.8 months, range 3.3 months to 14.5 years). 41 % of children with Hib meningitis did not received any anti-Hib vaccine and 41 % did not followed the French recommendations for Hib vaccine. Hi meningitis still occurs, and more than half is due to the b serotype. Among Hib cases, 14 % did not recieved any anti-Hib vaccine and 15 % received an incomplete vaccination schedule. Increase of vaccine coverage and use of an earlier booster dose at the age of 12 months could further improve the epidemiology of Hib meningitis. The immunity of children with Hib meningitis should be systematically studied in order to improve the comprehension of the pathophysiology of vaccine failure.
    Archives de Pédiatrie 01/2009; 15 Suppl 3:S148-53. · 0.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Several studies have highlighted the assets of the influenza rapid diagnostic tests (IRDT) for the emergency department management of febrile children. The objective of this study was to determine in ambulatory pediatric setting impact of IRDT on the management of febrile children during an epidemic, especially on other diagnostic testing performed, antibiotic and antiviral treatments. During an influenza epidemic, 37 paediatricians in three different areas of France included all children presenting fever with respiratory illnesses; they performed IRDT (test QuickVue for Influenza A and B, Quidel). Data collected were antiflu vaccination, previous asthma, symptoms, clinical signs, other diagnostic testing performed, and a follow-up two weeks later. Between December, 2006 and April, 2007, 695 children entered the program. The average age of those children was 4.1 years old (SD 3.4), median 3.2 (0.07-17.5). In 41.6% of the cases, the tests proved positive. Among 13 symptoms of influenza, only five were significantly more present in the group IRDT+: shiver (68.1% versus 57.4%), asthenia (87% versus 79.9%), cough (87.5% versus 70.1%), rhinorrhea (93.4% versus 83.3%), and sleepiness (54.2% versus 43.4%). The number of laboratory tests and radiographs ordered were less frequent in group IRDT+ than in group IRDT-: respectively 0.7% versus 11.6%, and 0.7% versus 8.6% (p<0.0001). IRDT+ group received antibiotics in 7.6% of cases (22 patients, 20 for OMA) and antiviral in 64.7%. IRDT- group received respectively 18.5% antibiotics, and no antiviral (p<0.0001). This study confirms the difficulty of clinical influenza diagnosis, and suggests the assets of IRDT to diagnose influenza and to improve the management of influenza in ambulatory paediatric setting.
    Archives de Pédiatrie 01/2009; 16(3):288-93. · 0.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Listeriosis is a serious invasive disease which affects mainly pregnant women, newborns and immunocompromised adults. To analyze specifically the epidemiological and clinical data of the meningitis due to Listeria monocytogenes (Lm), from the French Network of Surveillance of Bacterial Meningitis in childhood. Patients were aged 0 to 18 years. The diagnosis was based on a combination of a feverish meningeal syndrome and a positive culture of cerebrospinal fluid (CSF) and/or a positive PCR in the CSF and/or positive blood culture associated with a pleiocytose. Among 2539 cases of bacterial meningitis recorded in 6 years (2001 to 2006), 18 cases were due to Lm (0.7 %) (sex ratio M / F : 0.8). The average of age was 2.5 years (median : 0.5 ; ext : 0-15.1). The serotype of Lm was 4B in half of the cases. Most cases have occured in summer and autumn. Two patients presented an acquired or congenital immunodeficiency. Fifty-six percent (n=10) were younger than 1 year, among them, 7 were newborns. The CSF direct microbiologic investigation was suggestive of Lm (Gram positive bacilli) only in two cases, but the culture of CSF was positive for 16 patients and the blood culture was positive for 2 other patients. Three of 18 patients died between 7 and 13 days after admittance : a premature baby of 25 weeks'gestational age, two full-term newborns of 2 days and 1.5 months old. The mortality rate was 16.7 % before the age of 1 year (no death after this age). Meningitis due to Lm remains a rare disease, including in neonatal period. The recent increase of cases in adults requires to maintain vigilance in children especially since direct examination of CSF can rarely allow the diagnosis.
    Archives de Pédiatrie 01/2009; 15 Suppl 3:S158-60. · 0.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In France, meningococcal meningitis account for 50% of bacterial meningitis in children. The GPIP/ACTIV (Groupe de Pathologie Infectieuse Pédiatrique and Association Clinique et Thérapeutique Infantile du Val de Marne) set up an active surveillance network to analyze the epidemiological, clinical and biological features of meningococcal meningitis. From 2001 to 2007, 252 French paediatric wards working with 166 microbiology laboratories enrolled all children (0-18 years old) with bacterial meningitis. Risk factors, signs and symptoms, vaccination status, cerebrospinal fluid analysis, treatments and case fatality rate were recorded. During the period of the study, 1344 meningococcal meningitis were reported among 2951 (45.5%) bacterial meningitis. Mean age was 4.4 years (+/-4.7, median 2.5) and 2/3 cases occurred in children under 5 years (68.5%). Serogroup B (59.1%) was preponderant following by serogroup C (28.9%). 25% of children had received an antibiotic treatment 24hours before lumbar puncture. A shock was reported in 31.3% of cases. Cerebrospinal fluid culture was positive in 73% of cases. All N. meningitidis isolates were susceptible to cefotaxime and ceftriaxone while 41.6% and 25.7% showed reduced susceptibility to penicillin and amoxicillin respectively. Two cases of meningitis due to isolates of serogroups C and B were reported in two children that were respectively vaccinated using A+C plain saccharide vaccine or two doses of MenBvac vaccine. All patients had received beta-lactamin. Global case fatality rate was 6.6% but was higher (9.9%) for serogroup C than for serogroup B (5.5%) (p=0,007). This study is among the largest series of microbiologically documented meningococcal meningitis to date (more than 1300 cases). In France, meningococal is responsible for 50 % of meningitis. Effective meningococcal serogroup B vaccine and serogroup C vaccination recommendation could lessen considerably the burden of meningococal meningitis.
    Archives de Pédiatrie 01/2009; 15 Suppl 3:S105-10. · 0.36 Impact Factor
  • Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2009; 16(6):921-923.
  • [Show abstract] [Hide abstract]
    ABSTRACT: This observational study was designed to evaluate the acceptability of oral antibiotics (including generics) commonly prescribed to children by community practitioners in France. Between February and July 2006, the parents of 953 children enrolled by 46 pediatricians completed a questionnaire, including a taste assessment based on representations of five facial expressions. The proportions of "satisfactory" taste judgments showed a significant difference between amoxicillin-clavulanate reference product and its generics (77.9% vs. 65%, p = 0.01). The amoxicillin-clavulanate generics were more likely than the reference product to be spat out at least once (28.7% vs. 19%, p = 0.05). The full treatment course was taken by 91.7% and 82.3% of children prescribed the amoxicillin-clavulanate reference product and its generics, respectively (p = 0.02). The proportions of "satisfactory" taste judgments showed no significant difference between amoxicillin reference product and generics (64.3% vs. 72.5%, p = 0.3). The amoxicillin generics were not different from the reference product to be spat out at least once (8.6% vs. 14.3%, p = 0.2). The full treatment course was taken by 90.7% and 94.6% of children prescribed the amoxicillin reference product and its generics, respectively (p = 0.3). This study suggests the role of the active substance in the taste, and calls for the evaluation of palatability of future drugs (generics and references) before granting of the marketing authorization, particularly for active substances of poor taste; this palatability plays a significant role in the compliance of the treatment, notably in children. Poor compliance increases the risk of therapeutic failures and the emergence of resistance.
    European Journal of Pediatrics 11/2008; 168(7):851-7. · 1.98 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To the Editor: In France, pertussis epidemiology has been extensively studied since 1993. Immunization of children with a highly efficacious pertussis whole-cell (Pw) vaccine (Sanofi Pasteur MSD, Lyon, France) for 40 years (since 1966) has reduced the incidence of pertussis. It has been demonstrated that infectious or vaccinal immunity to pertussis wanes with time and that pertussis is no longer a pediatric disease. Transmission now occurs predominantly from adolescents and adults to unvaccinated newborns.
    Emerging Infectious Diseases 08/2008; 14(7):1159-61. · 6.79 Impact Factor
  • Archives de Pédiatrie 07/2008; 15(5):543-4. · 0.36 Impact Factor