L'athérosclérose est une maladie cardio-vasculaire immuno-inflammatoire se développant sur un terrain de dyslipidémie. De nombreuses composantes de la réponse immunitaire sont capables de moduler le développement des plaques d'athérome. Notamment, les lymphocytes T (LTs) CD4+ dont le rôle dans le processus athérogène dépend de la voie de polarisation. Le mécanisme de polarisation des LTs CD4+ est sous le contrôle des cellules dendritiques conventionnelles (cDCs) CD11b+. Ainsi, moduler ces cDCs et orienter la réponse adaptative vers une polarisation anti-athérogène pourraient représenter une potentielle cible thérapeutique dans la pathologie. Dans cette perspective, nous avons évalué le rôle des cDCs CD11b+ dans le développement de l'athérosclérose qui à ce jour reste totalement inexploré. Nous avons montré que la baisse du nombre des cDCs CD11b+ n'a pas d'impact sur le développement des lésions d'athérome. Cependant, nous montrons que l'absence du facteur de transcription IRF4 nécessaire au développement des cDCs CD11b+ altère le rôle anti-athérogène reconnu de l'adjuvant vaccinal à base d'aluminium (Alum). Nos données suggèrent que les cDCs CD11b+ n'ont pas d'impact direct sur le développement de l'athérosclérose, cependant, elles contrôlent l'effet athéroprotecteur de l'Alum. / Atherosclerosis is a disease characterized by arterial blood vessel thickening due to the accumulation of inflammatory cells in the arterial intima in response to cholesterol deposition. Several components of the immune response are able to modulate the development of atheromatous plaques. In particular, the role of conventional of CD4+ lymphocytes in the atherogenic process depends on their polarization pathway. The polarization mechanism of CD4+ T cells is under the control of conventional CD11b+ dendritic cells (cDCs). Thus, modulating these cDCs and orienting the adaptive response towards anti-atherogenic polarization could represent a potential therapeutic target in pathology. In this context, we evaluated the role of CD11b+ cDCs in the development of atherosclerosis which still remains totally unexplored. We have demonstrated that the decrease of the number of CD11b+ cDCs has no impact on the development of atheroma lesions. However, we show that the deletion of IRF4, the transcription factor necessary for the development of CD11b+ cDCs alters the recognized anti-atherogenic role of the aluminum-based vaccine adjuvant (Alum). However our data suggest that CD11b+ cDCs have no direct impact on the development of atherosclerosis but can control the atheroprotective effect of Alum adjuvant.

Two epidemiological studies, designed to expand our knowledge of morbidity and mortality indicators concerning malaria and Bacillus Calmette-Guerin vaccination in the Hospital Albert Schweitzer health district located in Central Haiti's Artibonite Valley, are presented. The hospital serves a rural population of 190,000 in its 610 square mile district. A large proportion of the rural population still relies on traditional healers in times of illness. Consequently, accurate morbidity and mortality data from individuals and communities in the district are scarce. The first study investigated an outbreak of axillary lymphadenitis and abscesses after Bacillus Calmette-Guerin vaccination among rural Haitian children treated at Hospital Albert Schweitzer from January 1986 through March 1991. Seventy-seven cases of vaccine-related complications were identified, all among children immunized before the age of 1 year. The proportions of children with complications were 0.017% for 1986 through 1989, 0.91% for 1990, and 2.2% for January through March 1991. The probable explanation for the increase is a change in the BCG strain or in the reactogenicity of the Pasteur strain. / Graduation date: 1994

<p>Although monophosphoryl lipid A was recently approved by the Food and Drug Administration, more vaccine adjuvants are needed to meet the demand for vaccines against new, emerging, and re-emerging diseases. Additionally, characterizing the mechanisms of action of potent vaccine adjuvants is important for moving toward more rational vaccine design based on the careful selection of antigens and adjuvants to stimulate only the desired immune responses. Two experimental vaccine adjuvants, compound 48/80 (C48/80) and IL-1, were evaluated in these studies. The safety and efficacy of the mast cell activator C48/80 was evaluated when used as an adjuvant delivered intradermally (ID) with recombinant anthrax protective antigen (rPA) in comparison with two well-known adjuvants. Mice were vaccinated in the ear pinnae with rPA or rPA + C48/80, CpG oligodeoxynucleotides (CpG), or cholera toxin (CT). All adjuvants induced similar increases in serum anti-rPA IgG and lethal toxin-neutralizing antibodies. C48/80 induced balanced cytokine production (Th1/Th2/Th17) by antigen-restimulated splenocytes, minimal injection site inflammation, and no antigen-specific IgE. Our data demonstrate that C48/80 is a safe and effective adjuvant, when used by the intradermal route, to induce protective antibody and balanced Th1/Th2/Th17 responses. Histological analysis demonstrated that vaccination with C48/80 reduced the number of resident mast cells and induced an injection-site neutrophil influx within 24 hours. Nonetheless, rPA + C48/80 significantly increased antigen-specific IgG titers in mast cell-deficient mice compared to antigen alone, suggesting that C48/80 has mast cell-dependent and mast cell-independent mechanisms of action.</p><p>IL-1alpha and beta have been shown to have strong mucosal adjuvant activities, but little is known about their mechanism of action. Bone marrow chimeric mice were intranasally vaccinated with Bacillus anthracis lethal factor (LF) with or without 4 µg IL-1alpha or a control adjuvant (cholera toxin) to determine if IL-1R1 expression on stromal cells or hematopoietic cells was sufficient for the maximal adjuvant activity of nasally delivered IL-1alpha. IL-1alpha was not active in IL-1R1-deficient (<italic>Il1r1</italic>-/-) mice given <italic>Il1r1</italic>-/- bone marrow, demonstrating that the adjuvant activity of IL-1 was due to the presence of IL-1R1 and not contaminants. Cytokine and chemokine responses induced by vaccination with IL-1alpha were predominantly derived from the stromal cell compartment and included G-CSF, IL-6, IL-13, MCP-1, and KC. Nasal vaccination of <italic>Il1r1</italic>-/- mice given wild-type bone marrow (WT-->KO) and WT-->WT mice with LF + IL-1alpha induced maximal adaptive immune responses, while vaccination of wild-type mice given <italic>Il1r1</italic>-/- bone marrow (KO-->WT) mice resulted in significantly decreased production of LF-specific serum IgG, IgG subclasses, lethal toxin-neutralizing antibodies, and mucosal IgA compared to WT-->KO and WT-->WT mice (p < 0.05). Our results suggest that IL-1R1 expression in the hematopoietic compartment is sufficient for the maximal induction of antigen-specific adaptive immunity after nasal vaccination adjuvanted with IL-1alpha and that while stromal cells are required for maximal adjuvant-induced cytokine production, the adjuvant-induced stromal cell cytokine responses are not required for effective induction of adaptive immunity.</p> / Dissertation

Att bli vaccinerad kan för skolbarnet vara en jobbig upplevelse. Om barnet dessutom ärstickrädd blir situationen ännu jobbigare. Skolsköterskan ger en del av vaccinationerna somingår i det nationella vaccinationsprogrammet som Socialstyrelsen (2004) tagit fram. I den härstudien belyses de åtgärder som skolsköterskan gör för att underlätta vaccinationssituationenså långt det är möjligt. Genom att genomföra intervjuer med sex skolsköterskor och därav fåfram ett datamaterial som sedan analyserades enligt kvalitativ innehållsanalys, kunde dettaämne belysas. Resultatet som framkom var att skolsköterskorna gav skolbarnen stöd ochtrygghet genom motivationsarbete. Information var en stor del av skolsköterskornas åtgärder.Enskilda samtal och att ge extra mycket tid till barn med särskild stickrädsla var också enåtgärd. Genom omvårdnad som kunde ges genom lekande och lärande kunde skolsköterskange den trygghet som krävdes för vaccinationstillfället. För att stickrädsla hos skolbarn skakunna förebyggas måste skolsköterskan få den tid som krävs för dessa förebyggande åtgärder.Detta förebyggande arbete kan förhindra att skolbarnen blir stickrädda om de behöversjukvård senare som barn eller vuxen. / Having a vaccination can, for the child, be a difficult experience. In case of the child having afear of needles the experience becomes even more difficult. The school nurse gives some ofthe vaccinations included in the national program of vaccinations as the National board ofhealth and welfare (2004) have established. In this study, the measures made by school nursesto facilitate the vaccination situation as far as possible, are illuminated. To implementinterviews with six school nurses and thereby receiving interview material, later analysedaccording to qualitative content analysis, could this subject be illuminated. The resultreceived, was school nurses giving schoolchildren support and security through motivationalwork. Information was a significant part of the measures made by the school nurses.Individual conversations and the providing of extra time for children with a particular needlephobia was a measure aswell. Through care that could be given through playing and learning,school nurses could provide safety which was crucial at the time of the vaccination. Toprevent fear of needles, a school nurse has to be given the time required for these preventingmeasures. This preventing work will reduce the risk that the schoolchildren will have a fear ofneedles if care is needed later on as children or as adults.

Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2006. / Titre provenant de l'écran-titre. Bibliogr. f. 80-85.

This paper examines the correlates of seasonal flu vaccination in Canada between 2000 and 2011. In terms of the socio-economic characteristics of the population that relate to higher take-up, my findings are consistent with the previous literature. Specifically, the most important predictors of vaccination are the risk factors: age and chronic conditions. My results also suggest that both novel respiratory disease outbreaks and provincial immunization program design are important determinants of the seasonal flu vaccine take-up. The absence of a separate vaccine intended to protect from a novel virus during its epidemic could increase the seasonal flu vaccine take-up. In cases when a separate vaccine is offered, the seasonal flu vaccine take-up depends on the timing of vaccines’ delivery and the extent of prior influenza immunization coverage for a specific population subgroup in a province.

Vaccination av typiska barnsjukdomar världen över, har som enskild innovation räddat miljoner människor de senaste 200 åren. Trots detta är anti-vaccin rörelsen ett växande fenomen. Syftet med föreliggande litteraturöversikt var att kartlägga faktorer som påverkar föräldrar i deras beslut om att vaccinera sina barn. 18 vetenskapliga artiklar analyserades och utgjorde grunden för resultatet. Med stöd av Rogers teori (1995) om spridning av innovationer kategoriserades resultatet i tre teman: Innovationens karaktär, Kommunikationskanalen och Det sociala systemet. Några av de vanligaste orsakerna till att föräldrar valde att vaccinera sina barn var att de följde normen och/eller kände en rädsla för de vaccinpreventivbara sjukdomarna. Framträdande faktorer till att föräldrar valde att avstå barnvaccination var rädsla för biverkningar och bestående men, samt att barnet ansågs för litet och hade ett alltför sårbart immunsystem. En informationsaspekt genomsyrade samtliga studier och det främsta problemet bedömdes vara bristfällig- och opålitlig information från myndigheter och vårdpersonal. Som sjuksköterska behöver man därför vara öppen för att ta del av de faktorer som ligger bakom föräldrars tankar om barnvaccinationer för att på så sätt kunna hjälpa dem ta adekvata beslut. / Vaccination of typical childhood diseases in the world has as an intervention itself saved millions of people the last 200 years. Despite this the anti-vaccine movement is a growing phenomenon. The aim of this review was to map out the different factors affecting parents in their decision-making regarding childhood vaccination. 18 peer reviewed articles were analyzed and constituted the basis for the result. From this three themes emerged, all of them with inspiration from Rogers (1995) Diffusion of Innovation theory. The themes are: The Innovation, Communication Channels and A Social System. Some of the reasons for why parent choose to vaccinate their children were following a tradition/norm and/or a fear of the vaccine preventable diseases. The most prominent factors to why parents chose to refrain from childhood vaccinations were a fear of side effects and permanent disability as well as the belief that an infant is too young and its immune system is too vulnerable. An information aspect permeated all studies and the primary problem seemed to be inadequate and unreliable information from authorities and health care providers. Therefore, as a nurse, there is a need to be open to take part of the factors behind parents’ childhood vaccination beliefs to be able to help them make an adequate decision.

Hensikt: Hensikten med studien var å undersøke om Nasjonal vaksinasjonskalender for Russland følges i de to kommunene Montsjegorsk og Kirovsk på Kola når det gjelder vaksinering av barn i alderen 0-2 år Metode: Studien er en retrospektiv kohortstudie av vaksinerte barn i alderen 0-2 århenholdsvis Montsjegorsk kommune (2007 og 2008) samt Kirovsk kommune (2006, 2007,2008 og 2009). Resultat: Denne studien viser ingen signifikant forskjell på antall vaksinerte barn i Montsjegorsk og Kirovsk, der vi har fått tilgang til vaksinasjonskortene, og dekningsgrad forøvrig barnevaksinering i Russland. Det har ikke vært mulig å få fatt i populasjonsdata foraldersgruppen 0-2 år verken i Montsjegorsk eller Kirovsk for de årskullene undersøkelsenomfatter. Resultatene baserer seg derfor på vaksinasjonskortene vi har fått tilgang til. Konklusjon: Barn født i Montsjegorsk i 2007 og 2008, samt barn født i Kirovsk i 2006,2007, 2008 og 2009, og som det var vaksinasjonskort tilgjengelige for, ble vaksinert sombestemt i den nasjonale vaksinasjonskalenderen for Den Russiske Føderasjon / Aim: This study aimed to investigate adherence to Russia’s National Vaccination Calendarin two municipalities, Monchegorsk and Kirovsk, regarding vaccination of children 0-2years of age, and also determine who was registered for vaccination. Method: This is a retrospective cohort study of vaccinated children up to two years of age in Monchegorsk municipality during 2007–2008 and Kirovsk municipality during 2006–2009. Results: We were unable to obtain population data regarding 0-2 year ols children in Monchegorsk and Kirovsk. However, accessable vaccination cards shoved no significant differnece in the number of vaccinated children in these municipalities compared with general coverage for child vaccination in Russia. Conclusion: Vaccination cards for children born in Monchegorsk during 2007–2008 or Kirovsk during 2006–2009 suggest that vaccination occurred as prescribed by the National Vaccination Calendar of the Russian Federation / <p>ISBN 978-91-982282-5-0</p>

Bakgrund: Vaccinationstäckning är ett av de viktigaste och mest kostnadseffektiva sättet att förbättra den globala folkhälsan. Trots det uppfattas vacciner som osäkert och onödigt av allt fler individer. Försämrad vaccinationstäckning påverkar flockimmuniteten med ökad risk för nya sjukdomsutbrott och epidemier. Syfte: Syftet var att undersöka och sammanställa den vetenskapliga litteraturen om vilka faktorer som påverkar vårdnadshavarnas beslut att vaccinera eller inte vaccinera sina barn mot mässling-påssjuka-röda hund (MPR). Metod: Systematisk litteraturöversikt där totalt tio vetenskapliga artiklar ligger till grund för resultatet. The Health Belief Model har använts som teoretisk utgångspunkt. Resultat: Flera faktorer var viktiga för föräldrars beslut om vaccination. Fem faktorer identifierades som påverkar föräldrar att inte vaccinera sina barn: att föredra naturlig immunisering, rädsla för biverkningar, rädsla för vaccinet, misstro till myndigheter och förebygga sjukdom genom livsstil. Fyra faktorer som påverkar föräldrar att låta vaccinera sina barn identifierades: att undvika sjukdom, värna om flockimmunitet, fördelar överväger nackdelar samt kunskap och information om sjukdomarna och vaccinet. I resultatet identifierades också ett bifynd, att låta barnets immunsystem mogna innan vaccination. Både föräldrar som vaccinerade och inte vaccinerade sina barn tyckte att det fanns för lite information om vaccinet och dess biverkningar. Slutsats: Flera faktorer påverkar föräldrars beslut om vaccination för sina barn mot MPR. Både föräldrar som vaccinerar och inte vaccinerar sina barn tycker informationen om vaccin och dess biverkningar är för knapphändig och svårtillgänglig. Det är viktigt som sjuksköterska att ha kunskap om vilka faktorer som påverkar föräldrars beslut för att kunna bemöta föräldrars oro och bistå med adekvat och evidensbaserad information. / Background: Vaccination coverage is one of the most important and cost-effective ways to improve global health. Despite this more and more people feel uncertain about vaccinations. Impaired vaccination coverage affects the herd immunity and leads to an increased risk of disease outbreaks and epidemics. Aim: The aim of this study was to examine which factors influence parents’ decisions regarding vaccination of their children against measles-mumps-rubella (MMR). Method: A systematic review where the result is based on ten scientific articles. The Health Belief Model was used as theoretical framework. Results: Several factors were important for the decision to vaccinate or not. Five factors were identified among parents not vaccinating: to prefer natural immunization, fear of side effects, fear of the vaccine, mistrust in the authorities and prevent disease through lifestyle. While four factors were identified among parents vaccinating: to prevent disease, to protect the herd immunity, the advantages outweigh disadvantages, and knowledge and information about the disease and the vaccine. In addition, the finding, to let the child's immune system mature before vaccination was identified. Both parents who accept vaccination and parents who decline vaccination of their children considered the information about the vaccine inadequate. Conclusion: Several factors influence parents’ decision regarding vaccination of their children against MMR. Both parents who accept vaccination and parents who decline vaccination of their children consider the information about the vaccine and its side effects too scant and difficult to access. It's important that nurses have knowledge about factors that influence parents' decisions in order to respond to their concerns and provide appropriate and evidence-based information.

Entre 2008 et 2011, plus de 22 000 cas de rougeole ont été signalés en France. Comment la résurgence de cette « maladie du passé » peut-elle s’expliquer ? Un vaccin efficace existe pour s’en prémunir, mais il apparaît que de plus en plus de Français se méfient de cette méthode jugée dangereuse, inutile et/ou contre-nature. La résistance et l’hésitation face aux vaccinations ont gagné de nombreux pays occidentaux. La territorialisation de récentes épidémies de rougeole en Europe et en France donne à voir les espaces de sous-vaccination, corrélés à l’implantation de populations réfractaires aux vaccins. Comprendre l’inscription géographique du vaccino-scepticisme implique donc de relier les pratiques vaccinales aux contextes socio-territoriaux dans lesquels elles prennent place. L’analyse multiscalaire proposée dans ce travail permet ainsi d’articuler les modalités locales du refus vaccinal avec une approche plus globale du système de santé. Enfin, l’étude des représentations des différents acteurs (patients-citoyens, professionnels de santé, médias, experts et décideurs politiques) montre que la politique vaccinale est devenue plus qu’un investissement de santé publique, un enjeu de société. / Between 2008 and 2011, more than 22 000 cases of measles were reported in France. How can the resurgence of this “disease from the past” be explained? The existing vaccine is effective, yet it seems that more and more French people are wary of this method of protection which they consider dangerous, useless and/or unnatural.The reluctance and hostility to vaccination have spread across numerous western countries. The study of the territories affected by recent epidemics of measles in France and Europe points out spaces of sub-vaccination, correlated to vaccination-resisting populations. To understand the geographical localisation of this resistance, it is therefore necessary to connect the vaccinal practices with the social and territorial contexts of the skeptical populations. A multi-level analysis allows to articulate the local modes of vaccinal refusal with a more global approach to public health policy. Finally, a close study of the perceptions of the different actors involved (patients-citizens, healthcare professionals, media, experts and political decision makers) shows that vaccinal policy has become more than an investment of public health and is now a real societal challenge.