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8 novembre 2023
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La prévention des infections respiratoires de l’hiver, c’est MAINTENANT !
Messages clés.
Après l’expérience de la triple épidémie (grippe-COVID-19 et VRS) de la saison 2022-2023, nos 24 structures ont souhaité se regrouper pour rappeler à chacun la nécessité de renforcer la lutte contre les infections respiratoires hivernales.
Les professionnels de santé habilités à vacciner sont maintenant plus nombreux, permettant d’espérer une meilleure application de tous les moyens de prévention :
- renforcer la couverture vaccinale grippe et COVID-19 pour protéger les plus fragiles et éviter un engorgement
des structures de soins ; - s’appuyer sur la possibilité de vacciner en même temps contre grippe et la COVID-19 ;
- utiliser au mieux les stratégies de prévention des infections par le VRS du nourrisson ;
- agir pour rendre disponible rapidement les vaccins contre le VRS chez les adultes ;
- promouvoir sans relâche les gestes barrières pour tous et tout au long de l’hiver.
Les infections respiratoires virales de l’hiver :
un impact difficilement soutenable pour notre système de soins
Depuis 3 années, la circulation des SARS-CoV-2, responsables de la COVID-19, a modifié l’épidémiologie des virus respiratoires saisonniers. La saison dernière 2022-2023 a vu le retour en force des virus de la grippe et du virus respiratoire syncytial (VRS), entraînant une « triple épidémie » grippe/COVID-19/VRS difficilement soutenable pour notre système de soins.
La circulation des variants SARS-CoV-2 est active : revaccinons sans attendre les plus fragiles
En France métropolitaine, de nombreux cas confirmés de COVID-19 ont été signalés depuis début septembre et les virus circulants ont évolué depuis le printemps dernier, rendant nécessaire un accès à la vaccination contre la COVID-19 pour les populations les plus fragiles, dès maintenant, avec les vaccins actualisés disponibles [1]. Ce rappel permet un bon niveau de protection contre les variants circulant actuellement.
La campagne de vaccination contre la grippe est lancée :
protégeons les personnes ciblées et celles et ceux qui les prennent en charge
Au-delà de la COVID-19, il est encore nécessaire de rappeler que les infections liées aux virus saisonniers plus « classiques » peuvent aussi être graves pour les personnes vulnérables.
En France, chaque année, l’épidémie de grippe saisonnière est responsable de, en moyenne, 31 000 hospitalisations respiratoires, dont 90% chez les personnes âgées de 65 ans et plus, avec 11 jours d’hospitalisation en moyenne dans cette population, et des conséquences chroniques telles que la dépendance [2]. Ce sont aussi plusieurs milliers de décès, essentiellement chez les personnes de âgées de 65 ans et plus [3]. La grippe peut également favoriser la survenue d’événements cardiovasculaires, avec un risque d’infarctus multiplié par 10 dans la semaine suivant l’épisode grippal [4].
C’est pourquoi la vaccination contre la grippe est recommandée et prise en charge pour les personnes âgées de 65 ans et plus, mais aussi pour les personnes plus jeunes, fragilisées par certaines maladies chroniques, et les femmes enceintes (protection de la maman et du nouveau-né pendant les premiers mois de vie).
Depuis cette année, elle peut également être proposée et remboursée à tous les enfants âgés de 2 à 17 ans révolus afin de les protéger de cette infection fréquente et de limiter la diffusion et l’impact de la grippe dans leur entourage familial et dans la population [5, 6].
Enfin, pour rappel, plusieurs travaux de recherche confirment le rôle des soignants dans la transmission des virus grippaux aux personnes à risque de forme grave, notamment en milieu hospitalier, et l’importance de la vaccination des professionnels de santé pour éviter la contamination des plus fragiles [7].
La campagne de vaccination contre la grippe a été lancée le 17 octobre 2023. Une administration concomitante des vaccins contre la COVID-19 et contre la grippe saisonnière peut être proposée [8, 9].
La campagne de vaccination contre la grippe a pour objectif une couverture vaccinale d’au moins 75% des personnes ciblées [5], avec, en France, des résultats TOUJOURS très en deçà de cet objectif [10]. Malgré cette couverture vaccinale sub-optimale, l’impact de santé publique de la vaccination est déjà important, avec environ 2 000 décès évités chaque hiver.
Les vaccins disponibles contre la grippe cette année protègent contre 4 virus grippaux, dont une souche nouvelle par rapport à l’an passé. A côté des vaccins antigrippaux tétravalents « classiques » utilisés depuis plusieurs années, un vaccin haute dose (HD) est disponible, autorisé (autorisation de mise sur le marché) chez les personnes âgées de 60 ans et plus, et pris en charge chez celles de 65 ans et plus. Ce vaccin inactivé, injectable, contient les mêmes souches que les vaccins classiques, à une dose quatre fois plus importante en antigènes ; il a démontré être plus efficace pour prévenir la grippe et ses complications chez la personne de 60 ans et plus, tout en restant bien toléré. Ce vaccin n’est pas soumis à une prescription médicale : il peut, dans le cadre de la campagne de vaccination, comme les autres vaccins contre la grippe, être proposé aux personnes de âgées de 65 ans et plus par tous les professionnels de santé habilités à vacciner [9, 11].
De nouveaux moyens de prévention contre le VRS arrivent
L’impact du VRS est également important chez les personnes âgées. Le VRS induit des épidémies saisonnières variables et pourrait être responsable de plus de 20 000 hospitalisations chez les personnes âgées de 65 ans et plus [14], avec des conséquences majeures [15]. L’ajout au calendrier vaccinal de deux vaccins contre le VRS (l’un pour les personnes âgées de 60 ans et plus, l’autre pour les femmes enceintes afin de protéger le nouveau-né) est actuellement à l’étude et devrait venir compléter la panoplie de prévention des infections par le VRS.
Au-delà des virus, n’oublions pas les pneumocoques
Les infections à pneumocoque, en particulier après infection virale, participent aussi aux infections respiratoires sévères de l’hiver. Le vaccin pneumococcique permet de réduire ce risque, mais la couverture vaccinale des populations à risque de forme grave (hors nourrissons) reste inférieure à 10% [16].
Enfin, rappelons l’importance des mesures barrières, un outil considérable qui reste mal utilisé
Contre toutes ces infections respiratoires, les mesures d’hygiène sont efficaces et trop souvent négligées par la population, METTONS-LES EN OEUVRE !
La santé de tous est notre priorité. Evitons ce qui est évitable en utilisant au mieux les outils de prévention disponibles : MOTIVONS CHACUN, VACCINONS ET FAISONS-NOUS VACCINER SANS TARDER !
Coordonnées des 24 structures signataires
Académie des Sciences Infirmières (ASI) – contact@academie-sciences-infirmieres
Association Française de Pédiatrie Ambulatoire (AFPA) – pediatres@afpa.org
Association nationale des médecins coordonnateurs et du secteur médico-social (MCOOR) – https://www.mcoor.fr
Collège de Médecine Générale (CMG) – 01 47 45 13 55
Collège Infirmier Français (CIF) – contact@college-infirmier.fr
Collège national des gynécologues et obstétriciens français – cngof@cngof.fr
Collège National des Sages-femmes de France (CNSF) – contact@cnsf.asso.fr
Conseil national professionnel de gériatrie – contact@cnpgeriatrie.fr
Fédération Française des Associations de Médecins Coordonnateurs en EHPAD (FFAMCO) – contact@ffamco-ehpad.org
Groupe de Pathologie Infectieuse Pédiatrique (GPIP) – sfp@sf-pediatrie.com
Groupe de recherche sur les infections pendant la grossesse (GRIG)- recherche.infection.grossesse@gmail.com
INFOVAC-FRANCE – infovac@infovac.fr
Société de Pathologie Infectieuse de Langue Française (SPILF) – spilf@infectiologie.com
Société de Pneumologie de Langue Française (SPLF) – 01 46 34 03 87
Société Française de Cardiologie (SFC) – stephanie.faucher@sfcardio.fr
Société Française de Gériatrie et de Gérontologie (SFGG) – caroline.pastorelli@sfgg.org
Société Française de Microbiologie (SFM) – secretariat@sfm-microbiologie.org
Société Française de Pédiatrie (SFP) – sfp@sf-pediatrie.comSociété Française de Recherche des Infirmiers en Pratique Avancée (SoFRIPA) – president.sofripa@gmail.comSociété Française de Santé Publique – accueil@sfsp.fr
Société Française des Sciences Pharmaceutiques et de l’Officine (SFSPO) – contact@sfspo.org
Société Française du Cancer – 06 17 44 70 76
Société Francophone de Néphrologie, Dialyse et Transplantation – i.bourdeau@sfndt.org
Société Francophone du Diabète (SFD) – l.blaise@ljcom.net
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