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Objectives. COVID-19 vaccines have become the new hope for stemming the pandemic. We aimed to assess pre-launch vaccine acceptance among hospital workers in the Auvergne-Rhône-Alpes Administrative Region of France. Methods. We performed a cross sectional study involving all hospital workers in 11 Auvergne-Rhône-Alpes hospitals in December 2020. Univariate and multivariate analyses were performed to identify factors associated with vaccine hesitancy. Results. We analyzed completed questionnaires from 1,964 respondents (78% women, mean age 42 years, 21.5% physicians, 41% private care centers). A total of 1,048 (53%) hospital workers were in favor of COVID-19 vaccination. Vaccine hesitancy was associated with: female gender; young age; paramedical, technical, and administrative professions ( i.e., all non-medical professions); no prior flu vaccination; and employment in the private medical care sector ( p <0.05). Distrust of health authorities and pharmaceutical lobbying were the main obstacles to vaccination. Inversely, creating herd immunity and protecting patients and household members were the most frequently cited reasons in favor of vaccination. More than two-thirds of participants feared that the clinical and biological research was too rapid and worried about serious adverse effects. Most participants were interested in written information on the available vaccines, but the most vaccine-hesitant categories preferred oral information. Only 35% supported mandatory vaccination (Figure 1). Conclusions. Targeted written and oral information campaigns will be necessary to improve vaccination coverage among hospital workers who show a surprisingly high hesitancy rate. Imposing mandatory vaccination could be counterproductive.

Schnitzler syndrome is a rare condition defined by chronic urticaria and monoclonal IgM gammopathy. Malignant evolution to Waldenström disease (WD) has been reported in several cases. We report a 49-year-old man who developed a marginal zone B-cell lymphoma (MZL) 3 years after the beginning of Schnitzler syndrome. This is the first report of MZL in association with Schnitzler syndrome. IgM gammopathy is a clue for the diagnosis of Schnitzler syndrome. This condition needs to be closely monitored; it can precede the onset of an authentic lymphoproliferative disorder including WD and rarely MZL.

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Increased susceptibility to infections is among the main safety concerns raised by anti-TNF-α agents. We describe two cases of cutaneous actinomycosis in patients undergoing anti-TNF-α therapy: a 49-year-old female treated with etanercept for rheumatoid arthritis and a 57-year-old female treated with infliximab for psoriasis. Both patients had discharge with the intermittent presence of sulfur granules occurring at the site of previous surgical wounds. Bacteriological culture demonstrated Actinomyces. Since in both cases laboratory findings and medical imaging ruled out visceral actinomycosis, oral antibiotics were introduced without discontinuing anti-TNF-α. The first patient did not relapse after 2 years. The second one did and received a second course of antibiotics combined with transient interruption of the anti-TNF-α therapy. The risk of developing actinomycosis is reported to be similar in immunocompetent and immunocompromised patients, however cases of cutaneous actinomycosis occurring during anti-TNF-α therapy need to be recognized and may be under-reported.

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Background Most hospital organizations have had to face the burden of managing the ongoing COVID-19 outbreak. One of the challenges in overcoming the influx of COVID-19 patients is controlling patient-to-staff transmission. Measuring the specific extent of ICU caregiver exposure to the virus and identifying the associated risk factors are, therefore, critical issues. We prospectively studied SARS-CoV-2 seroprevalence in the staff of a hospital in Lyon, France, several weeks after a first epidemic wave. Risk factors for the presence of SARS-CoV-2 antibodies were identified using a questionnaire survey. Results The overall seroprevalence was 9% (87/971 subjects). Greater exposure was associated with higher seroprevalence, with a rate of 3.2% [95% CI 1.1–5.2%] among non-healthcare staff, 11.3% [8.9–13.7%] among all healthcare staff, and 16.3% [12.3–20.2%] among healthcare staff in COVID-19 units. The seroprevalence was dramatically lower (3.7% [1.0–6.7%]) in the COVID-19 ICU. Risk factors for seropositivity were contact with a COVID-19-confirmed household (odds ratio (OR), 3.7 [1.8–7.4]), working in a COVID-19 unit (OR, 3.5 [2.2–5.7], and contact with a confirmed COVID-19 coworker (OR, 1.9 [1.2–3.1]). Conversely, working in the COVID-19-ICU was negatively associated with seropositivity (OR, 0.33 [0.15–0.73]). Conclusions In this hospital, SARS-CoV-2 seroprevalence was higher among staff than in the general population. Seropositivity rates were particularly high for staff in contact with COVID-19 patients, especially those in the emergency department and in the COVID-19 unit, but were much lower in ICU staff. Clinical trial registration NCT04422977