Vaccination of children: France is a good student
In a context of declining vaccination coverage for children around the world, France continues to protect its children. There is still progress to be made.
Historic decline in child vaccination around the world: last July, the World Health Organization (WHO) and the United Nations Children’s Fund (Unicef) issued the alert in the face of a 5-point drop in two years of the percentage of children having received a reference vaccine. Specialists are already noting a resurgence of epidemics of measles or poliomyelitis and expect new epidemic outbreaks.
After a decade of progress in vaccination coverage, the Covid-19 crisis has dealt a major blow to childhood immunization by disrupting health services, but also by increasing distrust of vaccination. Low- and middle-income countries are the most affected, but Europe is not spared.
In this context, France is rather a good student: the vaccination of children continues to progress there. “The first confinement did indeed lead to a drop in injections, but these effects have been caught up and we have not observed a decrease in vaccination coverage following the pandemic”indicates epidemiologist Laure Fonteneau, co-author of a study published last April by Public Health France, presenting updated French data for 2021.
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Ten injections during infancy
Although vaccination has largely proven its effectiveness in preventing serious infections, minimum coverage rates are necessary to achieve collective protection and avoid the reappearance of epidemics. Hence the extension of the vaccination obligation for children under two years of age: in 2018, it was extended to eight additional vaccines (pertussis, Haemophilus influenzae b, hepatitis B, meningococcus C, pneumococcus, measles, mumps, rubella) in addition to vaccines against diphtheria, tetanus and poliomyelitis.
Concretely, the vaccination schedule provides for ten injections during early childhood as well as reminders in children and adolescents. Vaccination against human papillomavirus (HPV) infections, involved in cancers of the cervix, is also recommended for young girls from the age of 11, but also for young boys – involved in their transmission – since January 2021.
According to Laure Fonteneau, “vaccination coverage has increased in children affected by the vaccination obligation since 2018, but also in older children”. It is generally higher in the north than in the south of the country, with the overseas departments lagging behind. Surveys show an overall increase in adherence to vaccination: during the Covid-19 crisis, “antivax” movements would have had less impact than information on the usefulness of vaccines. Vaccination coverage is stabilizing at very high rates for vaccines traditionally well accepted in France (DTP, whooping cough, etc.), some 99% of infants born in 2021 having received their first dose.
On the other hand, despite an increase in the use of vaccination between 2019 and 2021, the objective of 95% complete vaccination schedule against measles, mumps and rubella (MMR) at 33 months has still not been achieved. Once considered benign, these diseases are nevertheless likely to lead to serious complications, with measles even remaining a major cause of mortality worldwide. Vaccination rates against meningococcal C, which causes sepsis and meningitis, and against the human papillomavirus also remain insufficient despite notable progress.
Between 2019 and 2021, global childhood immunization coverage, assessed by the number of doses of diphtheria, tetanus and pertussis (DTP) vaccines administered, increased from 86% to 81%. In 2021, one or more doses of these basic vaccines were thus missed by 25 million children. In addition, nearly 40 million children have not received their first or second dose of measles vaccine.
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