[BCG vaccine coverage in private medical practice: First data in children below two years old, seven months after the end of compulsory vaccination in France].
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Guthmann
J-P
JP
Unité des maladies à prévention vaccinale, département des maladies infectieuses, institut de veille sanitaire (InVS), 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France. jp.guthmann@invs.sante.fr
de La Rocque
F
F
Boucherat
M
M
van Cauteren
D
D
Fonteneau
L
L
Lécuyer
A
A
Cohen
R
R
Lévy-Bruhl
D
D
D001500:BCG Vaccine / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005602:France; D006291:Health Policy; D006801:Humans; D032541:Mass Vaccination / Q000331:legislation & jurisprudence*; D010349:Patient Compliance / Q000706:statistics & numerical data; D011331:Private Practice; D014376:Tuberculosis / Q000276:immunology
D001500:BCG Vaccine