title: [Vaccination coverage and socioeconomic determinants of BCG vaccination in children before 3 months: Results of the Elfe cohort study, 2011].
abstract: BACKGROUND
  In 2007, French authorities changed mandatory BCG vaccination for all children into a strong recommendation to vaccinate only children considered at high risk of tuberculosis. Vaccination coverage (VC) data are insufficient in France. We estimated VC at approximately two months of age and identified socioeconomic factors associated with BCG vaccination.
  
  
  METHODS
  The Elfe study (Étude Longitudinale Française depuis l'Enfance) included a random sample of about 18 000 children born in 2011 selected at birth from 320 maternity wards from mainland France. Information was collected through questionnaires and telephone interviews conducted approximately two months after delivery. Because BCG recommendations are different in the Paris region (Île-de-France [IDF]) and outside this region, VC was estimated separately in these two regions. We estimated VC for different levels of tuberculosis risk, approached by the geographical origin of the parents. Poisson regression was performed to analyze the association between socioeconomic factors and BCG vaccination status, and results expressed by prevalence ratios (PR).
  
  
  RESULTS
  CV was higher in IDF (59.5%) compared to at-risk children outside IDF (46.7%) (p<0.001). VC in children with two parents from a tuberculosis highly endemic country was 80.5% in IDF and 60.4% outside IDF. In the multivariable model, having one or two parents from a tuberculosis highly endemic country (PR around 1.40) or consulting a private pediatrician (PR around 1.15) or a maternal and child health (MCH) center (PR around 1.40) after leaving the maternity ward were associated with a higher VC, whereas a university educational level in mothers was associated with a lower VC (PR=0.80).
  
  
  CONCLUSIONS
  In France, BCG vaccination in infants is performed early after discharge from the maternity ward. A first consultation with a pediatrician or in a MCH center is associated with better vaccination coverage. Children at higher risk are probably well identified by physicians and better vaccinated.
authors.affiliation: Santé publique France, direction des maladies infectieuses, 12, rue du Val d'Osne, 94415 Saint-Maurice, France. Electronic address: jean-paul.guthmann@santepubliquefrance.fr.
authors.forename: J-P
authors.initials: JP
authors.lastname: Guthmann
authors.affiliation: Santé publique France, direction des maladies infectieuses, 12, rue du Val d'Osne, 94415 Saint-Maurice, France.
authors.forename: M
authors.initials: M
authors.lastname: Ragot
authors.affiliation: Santé publique France, direction des maladies infectieuses, 12, rue du Val d'Osne, 94415 Saint-Maurice, France.
authors.forename: M
authors.initials: M
authors.lastname: Ben Boutieb
authors.affiliation: Unité mixte Elfe Ined-Inserm-EFS, 94800 Villejuif, France; Service départemental de protection maternelle et infantile des Hauts-de-Seine, 92000 Nanterre, France.
authors.forename: C
authors.initials: C
authors.lastname: Bois
authors.affiliation: Unité mixte Elfe Ined-Inserm-EFS, 94800 Villejuif, France.
authors.forename: M-N
authors.initials: MN
authors.lastname: Dufourg
authors.affiliation: Santé publique France, direction des maladies infectieuses, 12, rue du Val d'Osne, 94415 Saint-Maurice, France.
authors.forename: D
authors.initials: D
authors.lastname: Lévy-Bruhl
mesh_terms: D000367:Age Factors; D001500:BCG Vaccine / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D011247:Pregnancy; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000517:prevention & control*; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D001500:BCG Vaccine
keywords: BCG; Couverture vaccinale; Déterminants socioéconomiques; France; Socioeconomic determinants; Vaccination coverage