Vertebral osteomyelitis (VO) is a rare event. To estimate the incidence of VO in France for 2002-2003, national hospital-discharge data were used. Hospital stays were categorized as definite, probable or possible VO. Unique patient identification numbers allowed the investigators to link patients with multiple hospital stays and to analyse data for individual patients. A sample of medical records was reviewed to assess the specificity of the VO case definition. In 2002-2003, 1977 and 2036 hospital stays corresponding to 1422 and 1425 patients (median age 59 years, male:female ratio 1.5) were classified as definite (64%), probable (24%) and possible (12%) VO. The overall incidence of VO was 2.4/100,000. Incidence increased with age: 0.3/100,000 (70 years). The main infectious agents reported were Staphylococcus spp. (38%) and Mycobacterium tuberculosis (31%). The most frequent comorbidities were septicaemia (27%) and endocarditis (9%). Three percent of patients died. A review of 90 medical records confirmed the diagnosis of VO in 94% of cases. Using a hospital database and a specific case definition, nationwide surveillance of VO is possible.

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SUMMARYHigh titres of pertussis toxin (PT) antibody have been shown to be predictive of recent infection with Bordetella pertussis. The seroprevalence of standardized anti-PT antibody was determined in six Western European countries between 1994 and 1998 and related to historical surveillance and vaccine programme data. Standardized anti-PT titres were calculated for a series of whole-cell and acellular pertussis vaccine trials. For the serological surveys, high-titre sera (>125 units/ml) were distributed throughout all age groups in both high-(>90 %) and low-coverage (<90 %) countries. High-titre sera were more likely in infants in countries using high-titre-producing vaccines in their primary programme (Italy, 11 . 5% ; Western Germany, 13 . 3 % ; France, 4 . 3% ; Eastern Germany, 4 . 0%) compared to other countries (The Netherlands, 0 . 5 %; Finland, 0 %). Recent infection was significantly more likely in adolescents (10-19 years old) and adults in high-coverage countries (Finland, The Netherlands, France, East Germany), whereas infection was more likely in children (3-9 years old) than adolescents in low-coverage (<90% ; Italy, West Germany, United Kingdom) countries. The impact and role of programmatic changes introduced after these surveys aimed at protecting infants from severe disease by accelerating the primary schedule or vaccinating older children and adolescents with booster doses can be evaluated with this approach.

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