En France, le calendrier vaccinal a beaucoup evolue au cours des dernieres annees. Nous rapportons une etude de la couverture vaccinale des enfants consultant en centre de bilan de sante. L'analyse est realisee pour trois groupes d'age (10 mois, 2 et 4 ans) selon le mode de garde et le suivi medical. Patients et methodes. - L'etude transversale porte sur un echantillon de 900 enfants, venus entre avril et juin 1997, a partir des donnees figurant sur le carnet de sante et de l'entretien avec les parents. Resultats. - A 10 mois, 98 % des enfants sont vaccines contre la diphterie, le tetanos, la polio et la coqueluche (DTPC), 96 % contre Haemophilus et 1,7 % contre la rougeole; 42 % sont vaccines ou en cours de vaccination contre l'hepatite B et 94 % ont eu le BCG. Parmi les enfants de 2 ans, 90 % ont recu leur rappel DTPC. Plus de 90 % ont ete vaccines contre la rougeole et 50 % ont recu au moins une injection contre l'hepatite B. A l'age de 4 ans, 99 % des enfants sont a jour pour la vaccination DTPC; 78 % sont vaccines contre Haemophilus, 98 % contre la rougeole et 48 % contre l'hepatite B. Tous ont eu le BCG, controle pour 98 % d'entre eux (intradermoreaction a la tuberculine dans 22 % des cas). Les taux de vaccination les plus eleves sont observes chez les enfants suivis en protection maternelle et infantile. Le mode de garde influence peu la vaccination, sauf pour les enfants de 2 ans suivis en pediatrie liberale chez qui il existe une meilleure vaccination contre la rougeole si l'enfant est garde en collectivite. Conclusion. - Les couvertures vaccinales chez les enfants consultant en bilan de sante sont relativement satisfaisantes. Le retard a la vaccination contre la rougeole et la couverture encore faible contre l'hepatite B temoignent des difficultes a mobilser le corps medical et les familles pour ces vaccinations.
In France, the vaccination program has changed through the last years. We report a study on immunization rates of children who underwent a complete health checkup at a Well Child Clinic in Paris. We studied three groups of children (children at the ages of 10 months, 2 years and 4 years) regarding types of daycare and medical care. Patients and methods. - Nine hundred children who underwent a health checkup between April and June 1997 were included in the study. Data were collected from immunization records and parents' interviews. Results. - In 10-month-old children, prevalence rates of immunization against diphtheria, tetanus, poliomyelitis and pertussis (DTPP) and immunization against Haemophilus influenzae type b (Hib) disease were 98% and 96%, respectively. Only 1.7% were immunized against measles. Forty-two percent of children had complete or ongoing immunization against hepatitis B. The vaccination coverage for BCG was 94%. In two-year-old children, boostering for DTPP vaccine had been performed by 90%, more than 90% were immunized against measles and 50% had received at least one shot to prevent hepatitis B. At the age of 4 years, 99% were immunized against DTPP, 78% were immunized against Hib disease, 98% against measles and 48% for hepatitis B. All children were immunized with BCG, and 98% were BCG-controlled (22% had tuberculin intradermal reaction). The highest immunization rates were observed in children who had preventive care in 'Maternal and Infantile Protection Centres.' Immunization rates were not influenced by the type of daycare, except for measles in two-year-old children managed by private pediatricians. Conclusion. - We observed high immunization rates of children who underwent health checkups. Late immunization against measles and low immunization rates against hepatitis B reflect the difficulties encountered in mobilising physicians and families for these vaccinations.