Publications by authors named "Pierre Verger"

138 Publications

French General Practitioners Frequently See Patients with Long-COVID.

J Am Board Fam Med 2021 Sep-Oct;34(5):1010-1013

From the Observatoire Régional de la Santé (ORS) Provence-Alpes-Côte d'Azur, 27 boulevard Jean Moulin, 13005 Marseille, France (BD-C, RL, DS, VG, PV).

A second epidemic has appeared among some patients infected with COVID-19 persistent disorders, commonly called "long COVID syndrome." Our study sought to identify the proportion of French GPs dealing with patients with potential long COVID syndrome and their symptoms in an online cross-sectional questionnaire-based survey among a representative national panel of GPs. The majority (53.8%) reported at least 1 patient with COVID-19 and persistent symptoms, and 33% 2 or more such patients. Their most frequent symptoms were respiratory difficulties (60.6%), psychological distress (42.8%), and anosmia-dysgeusia (40.8%). Long COVID syndrome's recognition, management, and rehabilitation are priorities requiring effective coordination between primary and secondary care.
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http://dx.doi.org/10.3122/jabfm.2021.05.210142DOI Listing
September 2021

Prevalence and Determinants of Vaccine Hesitancy and Vaccines Recommendation Discrepancies among General Practitioners in French-Speaking Parts of Belgium.

Vaccines (Basel) 2021 Jul 10;9(7). Epub 2021 Jul 10.

Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Bruxelles, Belgium.

General practitioners (GPs) play a critical role in patient acceptance of vaccination. Vaccine hesitancy (VH) is a growing phenomenon in the general population but also affects GPs. Few data exist on VH among GPs. The objectives of this analysis of a population of GPs in the Belgian Wallonia-Brussels Federation (WBF) were to: (1) determine the prevalence and the features of VH, (2) identify the correlates, and (3) estimate the discrepancy in vaccination's behaviors between the GPs' children and the recommendations made to their patients. An online survey was carried out among the population of general practitioners practicing in the WBF between 7 January and 18 March 2020. A hierarchical cluster analysis was carried out based on various dimensions of vaccine hesitancy: perception of the risks and the usefulness of vaccines as well as vaccine recommendations for their patients. A total of 251 GPs answered the survey. The average percentage of moderate to high vaccine hesitancy was 50.6%. Three factors were independently associated with increased risk of vaccine hesitancy: an age <50 years old, having no children, and having no contact with selected vaccine-preventable disease (measles, complicated influenza, chronic hepatitis B (HBV), bacterial meningitis, or cervical cancer) in the past 5 years. VH was associated with controversies on vaccines' safety. GPs who had vaccinated their children against six diseases (MMR, meningococcus C (MenC), HBV, and HPV) tended not to recommend the same vaccines to their patients. Among GPs with all children vaccinated against HBV, only 37.5% recommended catch-up HBV immunization to their patients. In this small cohort of GP, moderate to high VH was associated with controversies on vaccines' safety and with specific personal characteristics (age <50, no children, and no recent experience with a serious VPD). As previously reported, GPs have different vaccine prescription attitude toward their patients and children. These findings should be confirmed in larger cohorts.
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http://dx.doi.org/10.3390/vaccines9070771DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8310255PMC
July 2021

Intention to get vaccinated against COVID-19 among the general population in France: Associated factors and gender disparities.

Hum Vaccin Immunother 2021 10 22;17(10):3421-3432. Epub 2021 Jul 22.

Southeastern Health Regional Observatory (ORS Paca), Faculté De Médecine, Marseille Cedex 5, France.

As the coronavirus disease 2019 (COVID-19) spreads across the world, the rapid distribution of an effective vaccine and its acceptability among the population constitute priorities for health authorities. This study aimed to document attitudes of the general population toward a future vaccine against COVID-19. We used the national COCONEL surveys conducted during the lockdown to identify factors associated with vaccine refusal, in the whole population, and separately among men and women. We investigate the role of socioeconomic and demographic factors as well as exposure to COVID-19. Among the 5,018 participants, 24.0% reported their intention to refuse the vaccine. Thinking this vaccine would not be safe, being against vaccination in general, and perceiving COVID-19 to be harmless were the three main reasons given to explain vaccine refusal. Women were more likely to refuse the vaccine, especially due to a reluctance toward vaccination in general or the perception that a COVID-19 vaccine would not be safe. Some factors associated with the intention to refuse the vaccine were the same among men and women such as a lack of prior vaccination against influenza, and concern over being infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while others differed slightly according to gender such as age, and high prevalence of COVID-19 in their region of residence. Authorities should therefore guarantee that all the necessary precautions are taken before marketing the vaccine and communicate transparently on the process of its development, and on the coverage rate required to reach herd immunity.: EHI: Equivalized Household Income per month; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2.
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http://dx.doi.org/10.1080/21645515.2021.1893069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437523PMC
October 2021

Changes in general practitioners' attitudes toward COVID-19 vaccination after first interim results: a longitudinal approach in France.

Hum Vaccin Immunother 2021 10 13;17(10):3408-3412. Epub 2021 Jul 13.

Faculty of Medicine, ORS PACA (Southeastern Health Regional Observatory), Marseille, France.

We assessed whether the a priori acceptance by French general practitioners (GPs) of COVID-19 vaccines changed after the announcements about them in November 2020. In all, between two surveys in October-November and in November-December 2020, acceptance of COVID-19 vaccines increased among 16.9% of GPs and decreased among 23.0%. Among those with high acceptance in October-November (52.5%), 11.6% became hesitant-reluctant in November-December; in those with initial hesitancy-reluctance (24.6%), 15.2% showed high acceptance. Deteriorating acceptance was significantly associated with GPs' distrust in the Ministry of Health and a priori concerns about the safety of vaccines developed during an epidemic; the reverse was found for improving acceptance. In addition, better acceptance was more likely among GPs who perceived the medical severity of COVID-19 to be high and was less common among women. During a severe pandemic, GPs' trust in health institutions and perception of safety issues remain important predictors of their attitudes toward new vaccines. Vigilance is needed regarding health professionals' reactions to events that may cast doubt on the safety or efficacy of certain COVID-19 vaccines. Personalized approaches should be considered and tested to address their concerns as the situation and knowledge evolve.
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http://dx.doi.org/10.1080/21645515.2021.1943990DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437498PMC
October 2021

Vaccine hesitancy among hospital staff physicians: A cross-sectional survey in France in 2019.

Vaccine 2021 07 29;39(32):4481-4488. Epub 2021 Jun 29.

Inserm, F-CRIN, Innovative Clinical Research Network in VACcinology (I-REIVAC), Paris, France; Université de Paris, Faculté de médecine Paris Descartes; Inserm, CIC 1417, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France.

Background: Healthcare professionals, because they recommend vaccines to their patients, answer their questions, and vaccinate them, are the cornerstone of vaccination in France. They can nonetheless be affected by vaccine hesitancy (VH).

Aims: We sought to study the opinions, practices, and perceptions of French hospital staff physicians (HSPs) toward vaccination and the prevalence and correlates of VH among them.

Methods: We conducted a cross-sectional survey in 14 public hospitals in France from September 2018 to October 2019. HSPs completed a standardized questionnaire -most of the time face-to-face - about their vaccine-related attitudes and practices. Data were weighted for age and sex. An agglomerative hierarchical cluster analysis of the HSPs' perceptions and opinions toward vaccination allowed us to identify vaccine-hesitant HSPs, and multiple Poisson regression with robust standard errors let us study the factors associated with VH.

Results: The study included 1,795 HSPs (participation rate: 86%). Almost all (93.7%) were strongly favorable to vaccination, even though 42.2% (95CI = 39.8-44.6) showed moderate VH. VH prevalence was lowest among infectious disease specialists (12.3%; 95CI = 6.7-21.3) and pediatricians (27.7%; 95CI = 21.4-35.2). Hesitant HSPs were less trustful of vaccination information sources and doubted the safety of vaccines more often than HSPs with almost no VH. Compared with non-hesitant HSPs, those with higher VH had less often taken a medical course about vaccination and were less likely to be vaccinated against seasonal influenza, to recommend vaccines to their patients and to try to convince vaccine-hesitant patients to be vaccinated.

Conclusions: Strong favorability to vaccination does not prevent VH, which was observed in most specialties. Interventions are required to help hesitant HSPs to adopt more proactive vaccination practices.
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http://dx.doi.org/10.1016/j.vaccine.2021.06.053DOI Listing
July 2021

Online study of health professionals about their vaccination attitudes and behavior in the COVID-19 era: addressing participation bias.

Hum Vaccin Immunother 2021 09 28;17(9):2934-2939. Epub 2021 May 28.

ORS PACA (Southeastern Health Regional Observatory), Faculty of Medicine, Marseille, France.

Online surveys of health professionals have become increasingly popular during the COVID-19 crisis because of their ease, speed of implementation, and low cost. This article leverages an online survey of general practitioners' (GPs') attitudes toward the soon-to-be-available COVID-19 vaccines, implemented in October-November 2020 (before the COVID-19 vaccines were authorized in France), to study the evolution of the distribution of their demographic and professional characteristics and opinions about these vaccines, as the survey fieldwork progressed, as reminders were sent out to encourage them to participate. Focusing on the analysis of the potential determinants of COVID-19 vaccine acceptance, we also tested if factors related to survey participation biased the association estimates. Our results show that online surveys of health professionals may be subject to significant selection bias that can have a significant impact on estimates of the prevalence of some of these professionals' behavioral, opinion, or attitude variables. Our results also highlight the effectiveness of reminder strategies in reaching hard-to-reach professionals and reducing these biases. Finally, they indicate that weighting for nonparticipation remains indispensable and that methods exist for testing (and correcting) selection biases.
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http://dx.doi.org/10.1080/21645515.2021.1921523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381780PMC
September 2021

Psychological support in general population during the COVID-19 lockdown in France: Needs and access.

PLoS One 2021 20;16(5):e0251707. Epub 2021 May 20.

Southeastern Health Regional Observatory (ORS Paca), Marseille, France.

Introduction: With France one of the European countries most strongly affected by COVID-19 in the spring of 2020, French authorities imposed a nationwide lockdown for 8 weeks (March 17-May 10). This study explored the perception of the adult population about the need for-and access to-psychological support from health care professionals (HCP) in response to concerns about the psychological needs during lockdown.

Material And Method: This online cross-sectional survey of a representative sample of the adult general population of mainland France (N = 2,003) took place during the last four days of the French lockdown (May 7-10, 2020).

Results: One in eight respondents (12.2%) perceived a need for psychological support from an HCP during the lockdown; most had symptoms of depression and/or anxiety of at least moderate intensity. Only a third (29.8%, 3.6% of the entire sample) actually obtained this support. Factors associated with this perceived need included: age under 35, economic difficulties due to lockdown, pre-lockdown use of psychological support, infection with COVID-19, serious worries about becoming infected, and heavy media use to obtain information about the disease. Among those who perceived a need for psychological support, the elderly were the most likely not to consult an HCP. People aged 35-64, those with high income, and those seriously worried about developing COVID-19 were the most likely to forgo seeking access to care because of their fear of infection by the coronavirus-2019.

Conclusion: The perceived need for psychological support from an HCP and access to it appeared to be strongly associated with COVID-19 exposure factor. More research about this association is needed to improve the health authorities' understanding of the population's psychological needs in this situation and to enhance HCPs' abilities to meet them. In particular, further research of its specific impact on youth is necessary.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251707PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136662PMC
June 2021

Willingness to get a COVID-19 vaccine among critical care non-medical healthcare workers and impact of a vaccine information session.

Anaesth Crit Care Pain Med 2021 06 3;40(3):100860. Epub 2021 Apr 3.

Aix Marseille Université, IRD, AP-HM,SSA, VITROME, IHU Méditerranée Infection, 19-21 bd Jean Moulin, 13005, Marseille, France; Southeastern Health Regional Observatory (ORS PACA), Marseille, France. Electronic address:

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http://dx.doi.org/10.1016/j.accpm.2021.100860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019251PMC
June 2021

Vaccine Hesitancy, Acceptance, and Anti-Vaccination: Trends and Future Prospects for Public Health.

Annu Rev Public Health 2021 04;42:175-191

Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia B3K 6R8, Canada; email:

An often-stated public health comment is that "vaccination is a victim of its own success." While the scientific and medical consensus on the benefits of vaccination is clear and unambiguous, an increasing number of people are perceiving vaccines as unsafe and unnecessary. The World Health Organization identified "the reluctance or refusal to vaccinate despite availability of vaccines" as one of the 10 threats to global health in 2019. The negative influence of anti-vaccination movements is often named as a cause of increasing vaccine resistance in the public. In this review, we give an overview of the current literature on the topic, beginning by agreeing on terminology and concepts before looking at potential causes, consequences, and impacts of resistance to vaccination.
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http://dx.doi.org/10.1146/annurev-publhealth-090419-102240DOI Listing
April 2021

Attitudes of hospital physicians toward childhood mandatory vaccines in France: A cross-sectional survey.

Hum Vaccin Immunother 2021 Feb 22:1-8. Epub 2021 Feb 22.

INSERM, F-CRIN, Innovative Clinical Research Network in VACcinology (I-REIVAC), Paris, France.

: Due to a decades-long crisis of confidence in vaccination, in 2017 France extended the number of mandatory early childhood vaccines from 3 to 11.: To describe the opinions of hospital staff physicians (HSPs) regarding this measure, quantify the proportion who would have preferred measures based on education, and study the factors associated with the latter opinion.: Cross-sectional nationwide survey with a standardized questionnaire in 2018-2019 among HSPs in 14 French public hospitals. The factors associated with HSPs' preference for education and persuasion over mandatory vaccination were analyzed with simple and multiple Poisson regressions.: The analyses included 1,795 HSPs (participation rate of 86%). Among them, 84% considered the extension of mandatory childhood vaccination essential given the epidemiological context at the time; in a later question, 40% would have preferred education and persuasion. Multiple regressions showed that the latter tended to be younger and less trustful of sources of information about vaccination. They were more likely to think that information on the rationale behind the national vaccination policy lacked clarity and that the extension of mandatory vaccines was not essential, even in the current epidemiologic situation.: Although most HSPs agreed that the extension of mandatory childhood vaccines was essential, some were ambivalent about its coercive philosophy. Further research is necessary to better understand the reasons of this ambivalence. A fraction did not understand the French vaccination strategy well. Efforts to explain its details to HSPs and an overhaul of their initial training on vaccination are still needed.
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http://dx.doi.org/10.1080/21645515.2020.1870393DOI Listing
February 2021

The hydroxychloroquine debate: a therapeutic dilemma for general practitioners.

Eur J Public Health 2021 04;31(2):283-285

ORS PACA, Southeastern Health Regional Observatory (Observatoire régional de la santé Provence-Alpes-Côte d'Azur), Marseille, France.

France has been at the epicenter of the worldwide debate about hydroxychloroquine, as the main advocacy for its use to treat COVID-19 comes from a research unit led by Didier Raoult in Marseille. Among a national panel of 2940 general practitioners, we found that physicians in the areas most strongly affected by the epidemic or closest to the epicenter of the controversy reported that the hydroxychloroquine debate had made it difficult for them to deal with patients' treatment requests. Their adherence to official recommendations was also lower. It will be necessary to examine the conditions producing so strong a conflict.
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http://dx.doi.org/10.1093/eurpub/ckab002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928868PMC
April 2021

Understanding the determinants of acceptance of COVID-19 vaccines: a challenge in a fast-moving situation.

Lancet Public Health 2021 04 6;6(4):e195-e196. Epub 2021 Feb 6.

Faculté des sciences médicales et paramédicales, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille 13 385, France; UMR Vitrome, Mediterrannean Infection Institute, Aix-Marseille University, IRD.

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http://dx.doi.org/10.1016/S2468-2667(21)00029-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864794PMC
April 2021

Attitudes of healthcare workers towards COVID-19 vaccination: a survey in France and French-speaking parts of Belgium and Canada, 2020.

Euro Surveill 2021 01;26(3)

Anthropology Department, Laval University, Quebec City, Canada.

In October and November 2020, we conducted a survey of 2,678 healthcare workers (HCWs) involved in general population immunisation in France, French-speaking Belgium and Quebec, Canada to assess acceptance of future COVID-19 vaccines (i.e. willingness to receive or recommend these) and its determinants. Of the HCWs, 48.6% (n = 1,302) showed high acceptance, 23.0% (n = 616) moderate acceptance and 28.4% (n = 760) hesitancy/reluctance. Hesitancy was mostly driven by vaccine safety concerns. These must be addressed before/during upcoming vaccination campaigns.
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http://dx.doi.org/10.2807/1560-7917.ES.2021.26.3.2002047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848677PMC
January 2021

Acceptability of a Novel Telemedication Review for Older Adults in Nursing Homes in France: A Qualitative Study.

Clin Interv Aging 2021 7;16:19-34. Epub 2021 Jan 7.

ORS PACA, Southeastern Health Regional Observatory, Marseille, France.

Purpose: In France, polypharmacy among older people living in nursing homes (NH) is a major public health concern. In this context, the randomized controlled trial TEM-EHPAD was recently launched in various NH in southern France to evaluate the impact of implementing a novel telemedication review (TMR) on hospital admission rates of NH residents at high risk of iatrogenic disease. A qualitative study was integrated into the main trial study to assess general practitioners' (GP) and other NH healthcare professionals' (HP) acceptability of the proposed TMR before its implementation.

Material And Methods: A qualitative study using face-to-face semi-structured interviews was conducted with 16 HP before the beginning of the intervention. A manual thematic analysis was performed on the transcribed interviews.

Results: Four main themes emerged from the thematic analysis: HP perceptions of the TMR, difficulties related to medication management for NH residents, HP perceptions of the roles of different professionals, and facilitators of good practices. Most participants were favorable to the TMR, but some GP expressed fears about loss of control over their prescription writing.

Conclusion: This study fulfilled its objective to assess pre-intervention acceptability by GP and other HP. Results provided important information about how to adapt the TMR intervention to make it more acceptable to HP who will be involved in TEM-EHPAD. One of the main recommendations is the importance of providing participating GP with the opportunity to take part in the process of reviewing prescriptions.
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http://dx.doi.org/10.2147/CIA.S283496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7800438PMC
April 2021

Would we recover better sleep at the end of Covid-19? A relative improvement observed at the population level with the end of the lockdown in France.

Sleep Med 2021 02 8;78:115-119. Epub 2020 Dec 8.

AMU, UMR Vitrome, IHU Méditerrannée, IRD, France.

Background: The outbreak of the Covid-19 pandemic and the accompanying lockdown measures have had a major impact on societies around the world, leading to sleep problems for a large part of the population. In order to assess the sustainability of sleeping troubles related to the sanitary crisis, it was crucial to measure its prevalence after the end of the Covid-19 confinement.

Methods: As part of an epidemiological survey on Covid and Confinement (COCONEL), we enquired on sleep disorders using two items in 4 repetitive cross-sectional surveys. The first took place during the first week of the French confinement (March 31 to April 2; N = 1005 participants). The second took place in the middle of this period (April 15-17; N = 1005). The two last surveys were held at the end of the confinement (May 7-10; N = 2003) and one month after the end (June 10-12; N = 1736). Using a random constant, the mixed model took into account the longitudinal character of the last two waves (intra-individual correlations for individuals surveyed in waves 3 and 4).

Results: The prevalence of sleep problems significantly decreased during the last weeks of the confinement, and this trend was confirmed one month after the end of confinement. One quarter of the population reported that their sleep was better one month after the end of the confinement. Sleep improvement was reported more often by women and people aged less than 65. Such improvement was less frequent among those who were still highly exposed to the pandemic's media coverage after the end of the confinement.

Conclusion: The possibility of recovering a good sleep largely depends on the type of sleep disorder. The decrease in sleep problems occurred mainly among people with mild sleep problems during the confinement. Further research is needed to assess the long-term effects of the Covid-19 pandemic and its confinement period on sleep quality in the general population.
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http://dx.doi.org/10.1016/j.sleep.2020.11.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722490PMC
February 2021

The French general population's attitudes toward lockdown against COVID-19: a fragile consensus.

BMC Public Health 2020 Dec 18;20(1):1920. Epub 2020 Dec 18.

Inserm CIC 1417, Faculté de Médecine Paris Descartes, Univ Paris, AP-HP, Hôpital Cochin, Paris, France.

Background: In March 2020, as the coronavirus disease 2019 (COVID- 19) pandemic was spreading across the globe, many countries have implemented unprecedented lockdown measures. But how populations did react to these measures? We examined the case of France. Our aims were threefold: assessing some aspects of their impact on French's daily living conditions; investigating their attitudes toward the lockdown; investigating the factors associated with these attitudes.

Methods: A cross-sectional online survey was carried out 10 days after the nationwide lockdown (from March 27th to March 29th 2020), among a representative sample of the mainland French population aged 18 and over. A quota sampling method was applied to achieve a sample of 1012 respondents. We used a cluster analysis to obtain contrasted attitudinal profiles, and logistic regressions to investigated which factors were associated to these profiles.

Results: After 10 days of lockdown, there were already significant consequences regarding respondents' living conditions and mental health. Most respondents supported the current lockdown. However, it appeared as a stopgap measure due to a lack of alternatives, and a large majority acknowledged its heavy drawbacks. We found three contrasted attitudinal profiles: full support (38%), strong but critical support (31%), limited support (31%). Regarding respondents' SES, low-income and low-education respondents were more likely to display critical or limited support to the lockdown, as well as those who reported deteriorated living conditions or psychological distress.

Conclusions: In France, the large public support to the lockdown was fragile. First, it was a critical consensus anchored in current controversies and recent social struggles. Second, it was weaker among people with a lows SES, especially since the lockdown have exacerbated preexisting social inequalities.
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http://dx.doi.org/10.1186/s12889-020-10048-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746918PMC
December 2020

Physicians' decision processes about the HPV vaccine: A qualitative study.

Vaccine 2021 01 13;39(3):521-528. Epub 2020 Dec 13.

ORS PACA, Southeastern Health Regional Observatory, 27 Bd. Jean Moulin, 13385 Marseille Cedex 5, France. Electronic address:

Background: The contemporary crisis of trust in vaccines has severely impaired acceptance of the HPV vaccine, especially in France, where its uptake culminated at 23.7% in 2018 (complete course at age 16). Physicians' recommendations strongly influence its acceptance/refusal. Our study sought to understand the decision processes leading physicians to recommend this vaccine (or not).

Methods: Qualitative interviews of French physicians (general practitioners, gynecologists, and pediatricians). We first randomly selected doctors in a national register of medical professionals and then resorted to snowballing to build a convenience sample. We coded the interviews in a thematic analysis built both inductively and deductively from our research questions and data.

Results: Two thirds of the participants (19/28) were favorable to HPV vaccination, some (4) opposed it, while the others were hesitant about recommending it. In explaining their opinions, most participants mentioned that they trusted the stakeholders within the vaccination system: the less trust they had, the more critical they were of the vaccine and the more importance they attributed to patients' opinions. We identified three different ways they interacted with patients on this topic: informing and convincing; adapting to patients' opinions; refusing compromise about vaccination. Crossing these various themes, we found 5 types of physicians: dissidents (mistrustful of the healthcare system and HPV vaccine), hesitant (finding it difficult to make up their minds about this vaccination), laissez-faire (letting patients decide by themselves, but very favorable to HPV vaccination), educator (very favorable), and uncompromising vaccinators (refusing debate). Pediatricians were overrepresented among the latter two types.

Conclusions: Physicians' judgment was influenced by their trust in the stakeholders involved in designing and implementing the HPV vaccination strategy. In this sense, doctors did not differ substantially from laypeople. They were, nonetheless, strongly influenced by their professional style and ethos.
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http://dx.doi.org/10.1016/j.vaccine.2020.12.019DOI Listing
January 2021

Attitudes about COVID-19 Lockdown among General Population, France, March 2020.

Emerg Infect Dis 2021 01 12;27(1). Epub 2020 Nov 12.

Because the effectiveness of a coronavirus disease lockdown in curbing coronavirus disease spread depends on public support, acquiring real-time information about the way populations reacted to the lockdown is crucial. In France, such public support remained fragile among low-income persons, probably because the lockdown exacerbated preexisting social inequalities and conflicts.
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http://dx.doi.org/10.3201/eid2701.201377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774552PMC
January 2021

Anxiety, depression and sleep problems: a second wave of COVID-19.

Gen Psychiatr 2020 22;33(5):e100299. Epub 2020 Sep 22.

ORS PACA, Marseille, Provence-Alpes-Côte d'Azur, France.

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http://dx.doi.org/10.1136/gpsych-2020-100299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513629PMC
September 2020

Restoring confidence in vaccines in the COVID-19 era.

Expert Rev Vaccines 2020 11 8;19(11):991-993. Epub 2020 Oct 8.

Institut de santé publique du Québec, Centre de recherche du CHU de Québec - Université Laval , D'Estimauville, QC, Canada.

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http://dx.doi.org/10.1080/14760584.2020.1825945DOI Listing
November 2020

Covid-19 health crisis and lockdown associated with high level of sleep complaints and hypnotic uptake at the population level.

J Sleep Res 2021 02 28;30(1):e13119. Epub 2020 Jun 28.

Southeastern Health Regional Observatory (ORS Paca), Marseille, France.

The Covid-19 pandemic has disrupted the habits of billions of people around the world. Lockdown at home is mandatory, forcing many families, each member with their own sleep-wake habits, to spend 24 hr a day together, continuously. Sleep is crucial for maintaining immune systems and contributes deeply to physical and psychological health. To assess sleep problems and use of sleeping pills, we conducted a cross-sectional study of a representative sample of the general population in France. The self-reported sleep complaint items, which covered the previous 8 days, have been used in the 2017 French Health Barometer Survey, a cross-sectional survey on various public health issues. After 2 weeks of confinement, 74% of the participants (1,005 subjects) reported trouble sleeping compared with a prevalence rate of 49% in the last general population survey. Women reported more sleeping problems than men, with greater frequency or severity: 31% vs. 16%. Unusually, young people (aged 18-34 years) reported sleep problems slightly more frequently than elderly people (79% vs. 72% among those aged 35 or older), with 60% of the younger group reporting that these problems increased with confinement (vs. 51% of their elders). Finally, 16% of participants reported they had taken sleeping pills during the last 12 months, and 41% of them reported using these drugs since the lockdown started. These results suggest that the COVID crisis is associated with severe sleep disorders among the French population, especially young people.
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http://dx.doi.org/10.1111/jsr.13119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361195PMC
February 2021

[Vaccine hesitancy in France: prevalence and association with parents' socioeconomic status].

Med Sci (Paris) 2020 May 26;36(5):461-464. Epub 2020 May 26.

Aix-Marseille Université, IRD, AP-HM, Service de Santé des Armées (SSA), Vecteurs -Infections Tropicales et Méditeranéennes (VITROME), Marseille, France. - Institut hospitalo-universitaire Méditerranée infection, 19-21 boulevard Jean Moulin, 13385 Marseille Cedex 05, France - Observatoire régional de la santé Provence-Alpes-Côte d'Azur (ORS PACA), Marseille, France - Inserm, French Clinical Research Infrastructure Network (F-CRIN), Innovative clinical research network in vaccinology (I-REIVAC), Paris, France.

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http://dx.doi.org/10.1051/medsci/2020076DOI Listing
May 2020

Vaccine hesitancy among general practitioners in Southern France and their reluctant trust in the health authorities.

Int J Qual Stud Health Well-being 2020 Dec;15(1):1757336

ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.

Vaccine hesitancy is common in France, including among general practitioners (GPs).  We aimed to understand vaccine hesitant GPs' views towards vaccines. : We conducted in-depth interviews that were thematically analysed. We found that, facilitated by health scandals and vaccine controversies-that according to participants were not effectively handled by health authorities-the implicit contract existing between health authorities and GPs has been ruptured. This contract implies that health authorities support GPs in making vaccine recommendations by addressing GPs' own concerns, providing them with adequate and up-to-date information and advice, and involving them in vaccine decision-making. In turn, GPs encourage vaccination to reach vaccine coverage targets. The rupture of this implicit contract has led to a breach in trust in the health authorities and the vaccines that they recommend.
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http://dx.doi.org/10.1080/17482631.2020.1757336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269038PMC
December 2020

Long-term risk of hip or forearm fractures in older occasional users of benzodiazepines.

Br J Clin Pharmacol 2020 11 10;86(11):2155-2164. Epub 2020 May 10.

Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.

Aims: This article sought to study the association between patterns of benzodiazepine (BZD) use and the risk of hip and forearm fractures in people aged 50 and 75 years or more.

Methods: In a representative cohort of the French National Health Insurance Fund of individuals aged 50 years or older (n = 106 437), we followed up BZD dispensing (reflecting their patterns of use) and the most frequent fall-related fractures (hip and forearm) for 8 years. We used joint latent class models to simultaneously identify BZD dispensing trajectories and the risk of fractures in the entire cohort and in those 75 years or older). We used a survival model to estimate the adjusted hazard ratios (aHRs) between these trajectories and the risk of fractures.

Results: In the entire cohort, we identified 5 BZD trajectories: non-users (76.7% of the cohort); occasional users (15.2%); decreasing users (2.6%); late increasing users (3.0%); and early increasing users (2.4%). Compared with non-users, fracture risk was not increased in either occasional users (aHR = 0.99, 95% confidence interval [CI] 0.99-1.00) or in decreasing users (aHR = 0.90, 95% CI 0.74-1.08). It was significantly higher in early increasing users (aHR = 1.86, 95% CI 1.62-2.14) and in late increasing users (aHR = 1.39, 95% CI 1.15-1.60). We observed similar trajectories and risk levels in the people older than 75 years.

Conclusion: Occasional BZD use, which is compatible with current recommendations, was not associated with an excess risk of the most frequent fall-related fractures in people older than 50 or 75 years.
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http://dx.doi.org/10.1111/bcp.14307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576621PMC
November 2020

Vaccine hesitancy and self-vaccination behaviors among nurses in southeastern France.

Vaccine 2020 01 3;38(5):1144-1151. Epub 2019 Dec 3.

ORS PACA, Southeastern Health Regional Observatory, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France. Electronic address:

Background: Health care worker vaccine uptake rates are below official targets, and studies demonstrate some are vaccine hesitant. We assessed self-vaccination behavior, vaccine hesitancy (VH), and associated factors in a representative sample of nurses.

Methods: Cross-sectional questionnaire survey in 2017-18 in southeastern France (5 million inhabitants): community nurses were randomly selected from a list provided by the Inter-Regional Nurses' Council (stratified by gender and district of practice) and interviewed by telephone. Because no such list exists for hospital nurses (74% of all nurses in southeastern France), we randomly selected hospitals, taking their size into account and stratifying by district. Hospital nurses practicing in medicine, surgery, obstetrics, and gynecology departments and present at the time of the survey were included and interviewed face-to face. We measured VH according to the WHO definition (refusal, delay, or acceptance with doubts about at least one vaccine). Interviewers administered the questionnaires. We used multivariable logistic regression to analyze potential associations between VH, vaccine risk perceptions and trust in health authorities.

Results: Interviews were completed with 1539 nurses (response rate: 85%). Self-reported vaccine coverage ranged from 27% (seasonal influenza vaccine, recommended, 2016/17 season) to 96% (Bacillus Calmette-Guérin vaccine, mandatory). The VH prevalence rate was 44% (95% confidence interval: 38.7-48.4) and most often concerned seasonal influenza or A(H1N1) vaccines (54%) and the hepatitis B vaccine (18%). VH was significantly more frequent among nurses with low trust in health authorities or high vaccine risk perceptions.

Conclusion: Nurses in southeastern France have low levels of self-vaccination acceptance for most recommended vaccines. In addition, they have a high VH prevalence focused on the same vaccines as among the general population. These are important findings given that nurses are in regular contact with patients vulnerable to vaccine-preventable diseases and their VH could negatively influence patients' vaccination acceptance.
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http://dx.doi.org/10.1016/j.vaccine.2019.11.018DOI Listing
January 2020

Image of the new vaccination obligation through the media.

Vaccine 2020 01 8;38(3):498-511. Epub 2019 Nov 8.

IHU-Méditerranée Infection, Marseille, France; Aix Marseille Université, IRD, AP-HM, SSA, VITROME, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.

Introduction: Vaccination campaigns always go hand by hand with controversies about their safety and usefulness. The widespread perception of vaccines as dangerous induces a decrease in the population immunization coverage, which led The French Ministry of Health to add 8 new mandatory vaccines to the 3 existing ones. The objective of this study is to analyze the information conveyed by the media and received by the French population about this new legislation.

Method: The newspaper articles and television and radio programs were selected from the media with the highest audience rate from January 2016 to May 2018. They were analyzed according to the grounded theory, up to data saturation, with double coding.

Results: The qualitative analysis included 38 written press articles, 18 radio programs and 18 television programs. After coding, several themes emerged. Discussions about the usefulness of vaccination, trust in vaccines, vaccination coverage, and the cost of measure were controversial in the media. Questions about ethics were also mentioned. The description of anti-vaccines by journalists and some doctors conveyed a negative image while reminding their strong mobilization through social media. The law and its implementation details were frequently reminded across the different media.

Discussion-conclusion: Traditional media give opposing views on immunization obligations. Vaccination is supported by a majority of doctors. Parents share their fears and concerns about vaccination and its adverse effects. An effort regarding public communication seems necessary in order to reassure the population. The study of other media, such as the Internet, could help to deepen this study.
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http://dx.doi.org/10.1016/j.vaccine.2019.10.069DOI Listing
January 2020

Attitudes, knowledge, and willingness to be vaccinated against seasonal influenza among patients hospitalized with influenza-like-illness: impact of diagnostic testing.

Hum Vaccin Immunother 2020 04 2;16(4):851-857. Epub 2020 Mar 2.

Inserm CIC1425 Bichat, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.

Influenza vaccine adherence remains low. Communication of virological diagnosis to adults hospitalized with influenza-like illness (ILI) could improve their willingness to be subsequently vaccinated. We prospectively assessed, in adults hospitalized with ILI in six French university hospitals, their willingness to be vaccinated against influenza in the subsequent season, both before and after the communication of RT-PCR Influenza laboratory result; we identified then the determinants associated with the willingness to be vaccinated.A total of 309 patients were included during the 2012-2013 and 2013-2014 influenza seasons; 43.8% reported being vaccinated against influenza for the current season; before communication of influenza laboratory results, 65.1% reported willingness to be vaccinated during the subsequent season. Influenza was virologically confirmed in 103 patients (33.3%). The rate of vaccine willingness increased to 70.4% ( = .02) after communication of influenza laboratory results. Factors independently associated with the willingness to be vaccinated were the perception of influenza vaccine benefits (adjusted relative risk (aRR): 1.06, 95%CI 1.02-1.10), cues to action (aRR: 1.08, 95%CI 1.03-1.12), current season influenza vaccination (aRR: 1.38, 95%CI 1.20-1.59) and communication of a positive influenza laboratory result (aRR: 1.18, 95%CI 1.03-1.34). This last was associated with the willingness to be vaccinated only in the subpopulation of patients not vaccinated (aRR: 1.53, 95%CI 1.19-1.96).In patients hospitalized with ILI, communication of a positive influenza diagnostic led to a better appreciation of the disease's severity and increased the willingness to be vaccinated. This approach might be particularly beneficial in patients who do not have a history of influenza vaccination.
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http://dx.doi.org/10.1080/21645515.2019.1674598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227674PMC
April 2020

Vaccine hesitancy and coercion: all eyes on France.

Nat Immunol 2019 10;20(10):1257-1259

Aix Marseille Université, IRD, AP-HM, SSA, VITROME, Marseille, France.

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http://dx.doi.org/10.1038/s41590-019-0488-9DOI Listing
October 2019

Trajectories of seasonal influenza vaccine uptake among French people with diabetes: a nationwide retrospective cohort study, 2006-2015.

BMC Public Health 2019 Jul 9;19(1):918. Epub 2019 Jul 9.

Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.

Background: Annual seasonal influenza vaccination (SIV) is recommended for people with diabetes, but their SIV rates remain far below public health targets. We aimed to identify temporal trajectories of SIV uptake over a 10-year period among French people with diabetes and describe their clinical characteristics.

Methods: We identified patients with diabetes in 2006 among a permanent, representative sample of beneficiaries of the French National Health Insurance Fund. We followed them up over 10 seasons (2005/06-2015/16), using SIV reimbursement claims and group-based trajectory modelling to identify SIV trajectories and to study sociodemographic, clinical, and healthcare utilization characteristics associated with the trajectories.

Results: We identified six trajectories. Of the 15,766 patients included in the model, 4344 (28%) belonged to the "continuously vaccinated" trajectory and 4728 (30%) to the "never vaccinated" one. Two other trajectories showed a "progressive decrease" (2832, 18%) or sharp "postpandemic decrease" (1627, 10%) in uptake. The last two trajectories (totalling 2235 patients, 14%) showed an early or delayed "increase" in uptake. Compared to "continuously vaccinated" patients, those in the "progressively decreasing" trajectory were older and those in all other trajectories were younger with fewer comorbidities at inclusion. Worsening diabetes and comorbidities during follow-up were associated with the "increasing" trajectories.

Conclusions: Most patients with diabetes had been continuously vaccinated or never vaccinated and thus had stable SIV behaviours. Others adopted or abandoned SIV. These behaviour shifts might be due to increasing age, health events, or contextual factors (e.g., controversies about vaccine safety or efficacy). Healthcare professionals and stakeholders should develop tailored strategies that take each group's specificities into account.
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http://dx.doi.org/10.1186/s12889-019-7209-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617633PMC
July 2019
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