France is grappling with questions surrounding mandatory vaccination policies for meningococcal disease, particularly following recent extensions to recommended vaccination ages for serogroups ACWY and B. The influx of inquiries prompted InfoVac, a French vaccine information service, to publish a detailed analysis, co-authored with legal counsel, to clarify the evolving guidelines.
The updated recommendations mandate a tetravalent vaccine for infants against serogroups A, C, W and Y, replacing the previous focus on serogroup C. The vaccination schedule consists of a primary dose at six months of age, followed by a booster at twelve months, a policy implemented nationwide from January 1, 2025. For children who began vaccination with a meningococcal C vaccine before that date, a second dose with an ACWY vaccine is now required to ensure full protection. A catch-up vaccination program is also recommended for children up to four years old for both meningococcal B and ACWY vaccines.
Entry into collective settings, such as schools and daycare centers, will require proof of compliance with the vaccination schedule, allowing authorities to verify adherence to the new regulations. However, InfoVac acknowledges that the wording of the guidelines has led to interpretation challenges for both healthcare professionals and families.
Alongside the policy clarifications, a firm warning has been issued against the practice of mixing different vaccines within the same syringe. France’s National Agency for the Safety of Medicines and Health Products (ANSM) recently reported two instances of physicians combining vaccines to reduce the number of injections. InfoVac stresses that this practice is “formally prohibited,” citing potential increases in local or systemic reactions and, crucially, a risk of diminished immune response for each vaccine component. Any such injections are considered invalid, and all doses must be repeated.
Regarding winter epidemics, health officials indicate that the peak of respiratory syncytial virus (RSV) and influenza seasons is subsiding. Initiating vaccination against these viruses at this stage is deemed ineffective. Data from the French National Network for Sentinel Surveillance (PARI) and Public Health France show that the RSV epidemic’s intensity was comparable to the previous year, despite increased maternal vaccination coverage. However, analysis of the EPIPHARE study suggests that the effectiveness of maternal RSV vaccination, when administered between 32 and 36 weeks of gestation and beginning September 1st, was lower than observed in clinical trials.
Recent studies conducted in the United Kingdom and Australia indicate that initiating RSV vaccination at 28 weeks of gestation, with sufficient time between vaccination and the start of the epidemic season, significantly improves efficacy, exceeding 80%. These findings, corroborated by ongoing French research, are expected to influence future public health recommendations. Maintaining the current vaccination strategy would be “unreasonable” in light of this new data, according to InfoVac.
The influenza season was dominated by the A(H3N2) clade K subtype, with limited cases of influenza B and A(H1N1) pdm09. Despite increased vaccination coverage, the epidemic arrived early and was relatively intense, though less severe than the previous year. Vaccine efficacy against this strain was modest, a common occurrence with certain H3N2 variants.
Preliminary data from England and France reveal varying vaccine effectiveness. In France, vaccine efficacy against ambulatory consultations ranged from 57% for children under 18 to 28% for those over 65. In England, efficacy against emergency room visits was higher, reaching 74.8% for children aged 2-17, but declined to 34.7% for those over 65. The higher efficacy observed in England for children is attributed to the use of a nasal vaccine, compared to the injectable vaccine used in France. The potential for increased vaccination rates with the availability of a nasal vaccine is also noted.