Does seasonal vaccination affect the clinical presentation of influenza among the elderly? A cross-sectional analysis in the outpatient setting in France, 2003-2014.
Identifieur interne : 000135 ( Main/Exploration ); précédent : 000134; suivant : 000136Does seasonal vaccination affect the clinical presentation of influenza among the elderly? A cross-sectional analysis in the outpatient setting in France, 2003-2014.
Auteurs : Anne Mosnier [France] ; Isabelle Daviaud [France] ; Saverio Caini [France] ; Hervé Berche [France] ; Jean-Michel Mansuy [France] ; Sylvie Van Der Werf [France] ; Jean Marie Cohen [France] ; Bruno Lina [France]Source :
- Vaccine [ 1873-2518 ] ; 2017.
Descripteurs français
- KwdFr :
- Femelle (MeSH), France (épidémiologie), Grippe humaine (anatomopathologie), Grippe humaine (prévention et contrôle), Grippe humaine (épidémiologie), Humains (MeSH), Mâle (MeSH), Orthomyxoviridae (classification), Orthomyxoviridae (isolement et purification), Patients en consultation externe (MeSH), Sujet âgé (MeSH), Sujet âgé de 80 ans ou plus (MeSH), Vaccins antigrippaux (administration et posologie), Études transversales (MeSH).
- MESH :
- administration et posologie : Vaccins antigrippaux.
- anatomopathologie : Grippe humaine.
- isolement et purification : Orthomyxoviridae.
- prévention et contrôle : Grippe humaine.
- épidémiologie : France, Grippe humaine.
- classification : Femelle, Humains, Mâle, Orthomyxoviridae, Patients en consultation externe, Sujet âgé, Sujet âgé de 80 ans ou plus, Études transversales.
English descriptors
- KwdEn :
- Aged (MeSH), Aged, 80 and over (MeSH), Cross-Sectional Studies (MeSH), Female (MeSH), France (epidemiology), Humans (MeSH), Influenza Vaccines (administration & dosage), Influenza, Human (epidemiology), Influenza, Human (pathology), Influenza, Human (prevention & control), Male (MeSH), Orthomyxoviridae (classification), Orthomyxoviridae (isolation & purification), Outpatients (MeSH).
- MESH :
- chemical , administration & dosage : Influenza Vaccines.
- classification : Orthomyxoviridae.
- epidemiology : France, Influenza, Human.
- isolation & purification : Orthomyxoviridae.
- pathology : Influenza, Human.
- prevention & control : Influenza, Human.
- Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Male, Outpatients.
Abstract
Vaccine-induced protection against influenza is not optimal, however it has been suggested that the vaccine may reduce the severity of symptoms among those who develop illness despite being vaccinated. We tested this hypothesis within a countrywide, sentinel general practitioners-based surveillance system in France. We included 2277 individuals aged 65years or older (of whom 1293 had been vaccinated against influenza, 56.8%) who consulted a general practitioner because of an acute respiratory infection (ARI) during 2003-2014. All patients were taken a nasopharyngeal swab, and information was collected on demographic characteristics and symptoms at disease onset. All specimens were tested for respiratory viruses and, if positive for influenza, the virus type and subtype were determined. We compared the average maximum temperature and the frequency of each symptom, between non-vaccinated and vaccinated influenza patients. We then used logistic regression models to calculate the odds of presenting with each symptom between vaccinated vs. non-vaccinated patients, adjusting by age group, virus (sub)type and season. Overall, 675 ARI patients (29.6%) tested positive for influenza. The A(H3) virus caused the majority of cases (55.1%), followed by influenza B (22.9%), A not-subtyped (11.7%), and A(H1) (10.3%) viruses. Compared to non-vaccinated influenza patients, those who had been vaccinated had a slightly reduced maximum temperature and presented less frequently with myalgia, shivering and headache. In stratified analyses, the observed effect was limited to patients infected with A(H3) or type B viruses. After adjusting by age group, virus (sub)type and season, the difference remained statistically significant only for headache, which was less frequent among vaccinated individuals (odds ratio 0.69, 95% confidence intervals 0.48-0.98). In conclusion, the vaccine was found to be modestly associated with less severe clinical presentation of influenza among the elderly. Our findings reinforce the need for influenza vaccines providing better protection.
DOI: 10.1016/j.vaccine.2017.02.067
PubMed: 28291646
Affiliations:
- France
- Auvergne-Rhône-Alpes, Midi-Pyrénées, Occitanie (région administrative), Rhône-Alpes, Île-de-France
- Lyon, Paris, Toulouse
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A cross-sectional analysis in the outpatient setting in France, 2003-2014.</title><author><name sortKey="Mosnier, Anne" sort="Mosnier, Anne" uniqKey="Mosnier A" first="Anne" last="Mosnier">Anne Mosnier</name><affiliation wicri:level="3"><nlm:affiliation>Open Rome (Organize and Promote Epidemiological Network), Paris, France; Réseau des GROG, Paris, France. 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Electronic address: mansuy.jm@chu-toulouse.fr.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire de Virologie, Centre Hospitalier Universitaire de Toulouse, Toulouse</wicri:regionArea><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Midi-Pyrénées</region><settlement type="city">Toulouse</settlement></placeName></affiliation></author><author><name sortKey="Van Der Werf, Sylvie" sort="Van Der Werf, Sylvie" uniqKey="Van Der Werf S" first="Sylvie" last="Van Der Werf">Sylvie Van Der Werf</name><affiliation wicri:level="3"><nlm:affiliation>Centre National de Référence des virus influenzae, Unité de Génétique moléculaire des virus à ARN, CNRS UMR3569, Université Paris Diderot Sorbonne Paris Cité, Institut Pasteur, Paris, France. Electronic address: sylvie.van-der-werf@pasteur.fr.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Centre National de Référence des virus influenzae, Unité de Génétique moléculaire des virus à ARN, CNRS UMR3569, Université Paris Diderot Sorbonne Paris Cité, Institut Pasteur, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Cohen, Jean Marie" sort="Cohen, Jean Marie" uniqKey="Cohen J" first="Jean Marie" last="Cohen">Jean Marie Cohen</name><affiliation wicri:level="3"><nlm:affiliation>Open Rome (Organize and Promote Epidemiological Network), Paris, France; Réseau des GROG, Paris, France. Electronic address: jmcoco@openrome.org.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Open Rome (Organize and Promote Epidemiological Network), Paris, France; Réseau des GROG, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Lina, Bruno" sort="Lina, Bruno" uniqKey="Lina B" first="Bruno" last="Lina">Bruno Lina</name><affiliation wicri:level="3"><nlm:affiliation>Centre National de Référence des virus influenzae, CBPE, Hospices Civils de Lyon et Virpath, Université Claude Bernard Lyon, Lyon, France. Electronic address: bruno.lina@univ-lyon1.fr.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Centre National de Référence des virus influenzae, CBPE, Hospices Civils de Lyon et Virpath, Université Claude Bernard Lyon, Lyon</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation></author></analytic><series><title level="j">Vaccine</title><idno type="eISSN">1873-2518</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Cross-Sectional Studies (MeSH)</term><term>Female (MeSH)</term><term>France (epidemiology)</term><term>Humans (MeSH)</term><term>Influenza Vaccines (administration & dosage)</term><term>Influenza, Human (epidemiology)</term><term>Influenza, Human (pathology)</term><term>Influenza, Human (prevention & control)</term><term>Male (MeSH)</term><term>Orthomyxoviridae (classification)</term><term>Orthomyxoviridae (isolation & purification)</term><term>Outpatients (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Femelle (MeSH)</term><term>France (épidémiologie)</term><term>Grippe humaine (anatomopathologie)</term><term>Grippe humaine (prévention et contrôle)</term><term>Grippe humaine (épidémiologie)</term><term>Humains (MeSH)</term><term>Mâle (MeSH)</term><term>Orthomyxoviridae (classification)</term><term>Orthomyxoviridae (isolement et purification)</term><term>Patients en consultation externe (MeSH)</term><term>Sujet âgé (MeSH)</term><term>Sujet âgé de 80 ans ou plus (MeSH)</term><term>Vaccins antigrippaux (administration et posologie)</term><term>Études transversales (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Influenza Vaccines</term></keywords><keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Vaccins antigrippaux</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Grippe humaine</term></keywords><keywords scheme="MESH" qualifier="classification" xml:lang="en"><term>Orthomyxoviridae</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>France</term><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>Orthomyxoviridae</term></keywords><keywords scheme="MESH" qualifier="isolement et purification" xml:lang="fr"><term>Orthomyxoviridae</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="prévention et contrôle" xml:lang="fr"><term>Grippe humaine</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>France</term><term>Grippe humaine</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Cross-Sectional Studies</term><term>Female</term><term>Humans</term><term>Male</term><term>Outpatients</term></keywords><keywords scheme="MESH" qualifier="classification" xml:lang="fr"><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Orthomyxoviridae</term><term>Patients en consultation externe</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Études transversales</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Vaccine-induced protection against influenza is not optimal, however it has been suggested that the vaccine may reduce the severity of symptoms among those who develop illness despite being vaccinated. We tested this hypothesis within a countrywide, sentinel general practitioners-based surveillance system in France. We included 2277 individuals aged 65years or older (of whom 1293 had been vaccinated against influenza, 56.8%) who consulted a general practitioner because of an acute respiratory infection (ARI) during 2003-2014. All patients were taken a nasopharyngeal swab, and information was collected on demographic characteristics and symptoms at disease onset. All specimens were tested for respiratory viruses and, if positive for influenza, the virus type and subtype were determined. We compared the average maximum temperature and the frequency of each symptom, between non-vaccinated and vaccinated influenza patients. We then used logistic regression models to calculate the odds of presenting with each symptom between vaccinated vs. non-vaccinated patients, adjusting by age group, virus (sub)type and season. Overall, 675 ARI patients (29.6%) tested positive for influenza. The A(H3) virus caused the majority of cases (55.1%), followed by influenza B (22.9%), A not-subtyped (11.7%), and A(H1) (10.3%) viruses. Compared to non-vaccinated influenza patients, those who had been vaccinated had a slightly reduced maximum temperature and presented less frequently with myalgia, shivering and headache. In stratified analyses, the observed effect was limited to patients infected with A(H3) or type B viruses. After adjusting by age group, virus (sub)type and season, the difference remained statistically significant only for headache, which was less frequent among vaccinated individuals (odds ratio 0.69, 95% confidence intervals 0.48-0.98). In conclusion, the vaccine was found to be modestly associated with less severe clinical presentation of influenza among the elderly. Our findings reinforce the need for influenza vaccines providing better protection.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">28291646</PMID><DateCompleted><Year>2017</Year><Month>12</Month><Day>19</Day></DateCompleted><DateRevised><Year>2018</Year><Month>02</Month><Day>06</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1873-2518</ISSN><JournalIssue CitedMedium="Internet"><Volume>35</Volume><Issue>16</Issue><PubDate><Year>2017</Year><Month>04</Month><Day>11</Day></PubDate></JournalIssue><Title>Vaccine</Title><ISOAbbreviation>Vaccine</ISOAbbreviation></Journal><ArticleTitle>Does seasonal vaccination affect the clinical presentation of influenza among the elderly? A cross-sectional analysis in the outpatient setting in France, 2003-2014.</ArticleTitle><Pagination><MedlinePgn>2076-2083</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0264-410X(17)30292-X</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.vaccine.2017.02.067</ELocationID><Abstract><AbstractText>Vaccine-induced protection against influenza is not optimal, however it has been suggested that the vaccine may reduce the severity of symptoms among those who develop illness despite being vaccinated. We tested this hypothesis within a countrywide, sentinel general practitioners-based surveillance system in France. We included 2277 individuals aged 65years or older (of whom 1293 had been vaccinated against influenza, 56.8%) who consulted a general practitioner because of an acute respiratory infection (ARI) during 2003-2014. All patients were taken a nasopharyngeal swab, and information was collected on demographic characteristics and symptoms at disease onset. All specimens were tested for respiratory viruses and, if positive for influenza, the virus type and subtype were determined. We compared the average maximum temperature and the frequency of each symptom, between non-vaccinated and vaccinated influenza patients. We then used logistic regression models to calculate the odds of presenting with each symptom between vaccinated vs. non-vaccinated patients, adjusting by age group, virus (sub)type and season. Overall, 675 ARI patients (29.6%) tested positive for influenza. The A(H3) virus caused the majority of cases (55.1%), followed by influenza B (22.9%), A not-subtyped (11.7%), and A(H1) (10.3%) viruses. Compared to non-vaccinated influenza patients, those who had been vaccinated had a slightly reduced maximum temperature and presented less frequently with myalgia, shivering and headache. In stratified analyses, the observed effect was limited to patients infected with A(H3) or type B viruses. After adjusting by age group, virus (sub)type and season, the difference remained statistically significant only for headache, which was less frequent among vaccinated individuals (odds ratio 0.69, 95% confidence intervals 0.48-0.98). In conclusion, the vaccine was found to be modestly associated with less severe clinical presentation of influenza among the elderly. Our findings reinforce the need for influenza vaccines providing better protection.</AbstractText><CopyrightInformation>Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Mosnier</LastName><ForeName>Anne</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Open Rome (Organize and Promote Epidemiological Network), Paris, France; Réseau des GROG, Paris, France. Electronic address: amos@openrome.org.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Daviaud</LastName><ForeName>Isabelle</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>Open Rome (Organize and Promote Epidemiological Network), Paris, France; Réseau des GROG, Paris, France. Electronic address: idaviaud@openrome.org.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Caini</LastName><ForeName>Saverio</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Open Rome (Organize and Promote Epidemiological Network), Paris, France. Electronic address: saverio.caini@gmail.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Berche</LastName><ForeName>Hervé</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Réseau des GROG, Paris, France. Electronic address: dr.herve.berche@wanadoo.fr.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mansuy</LastName><ForeName>Jean-Michel</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Laboratoire de Virologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France. Electronic address: mansuy.jm@chu-toulouse.fr.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>van der Werf</LastName><ForeName>Sylvie</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Centre National de Référence des virus influenzae, Unité de Génétique moléculaire des virus à ARN, CNRS UMR3569, Université Paris Diderot Sorbonne Paris Cité, Institut Pasteur, Paris, France. Electronic address: sylvie.van-der-werf@pasteur.fr.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cohen</LastName><ForeName>Jean Marie</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Open Rome (Organize and Promote Epidemiological Network), Paris, France; Réseau des GROG, Paris, France. Electronic address: jmcoco@openrome.org.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lina</LastName><ForeName>Bruno</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Centre National de Référence des virus influenzae, CBPE, Hospices Civils de Lyon et Virpath, Université Claude Bernard Lyon, Lyon, France. Electronic address: bruno.lina@univ-lyon1.fr.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><CollectiveName>GROG network</CollectiveName></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2017</Year><Month>03</Month><Day>11</Day></ArticleDate></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>Vaccine</MedlineTA><NlmUniqueID>8406899</NlmUniqueID><ISSNLinking>0264-410X</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007252">Influenza Vaccines</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003430" MajorTopicYN="N">Cross-Sectional Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005602" MajorTopicYN="N">France</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007252" MajorTopicYN="N">Influenza Vaccines</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="Y">administration & dosage</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007251" MajorTopicYN="N">Influenza, Human</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009975" MajorTopicYN="N">Orthomyxoviridae</DescriptorName><QualifierName UI="Q000145" MajorTopicYN="N">classification</QualifierName><QualifierName UI="Q000302" MajorTopicYN="N">isolation & purification</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D010045" MajorTopicYN="N">Outpatients</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">Elderly</Keyword><Keyword MajorTopicYN="Y">Illness severity</Keyword><Keyword MajorTopicYN="Y">Influenza</Keyword><Keyword MajorTopicYN="Y">Influenza vaccine</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2016</Year><Month>12</Month><Day>25</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2017</Year><Month>02</Month><Day>17</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2017</Year><Month>02</Month><Day>23</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2017</Year><Month>3</Month><Day>16</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2017</Year><Month>12</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2017</Year><Month>3</Month><Day>15</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">28291646</ArticleId><ArticleId IdType="pii">S0264-410X(17)30292-X</ArticleId><ArticleId IdType="doi">10.1016/j.vaccine.2017.02.067</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>France</li></country><region><li>Auvergne-Rhône-Alpes</li><li>Midi-Pyrénées</li><li>Occitanie (région administrative)</li><li>Rhône-Alpes</li><li>Île-de-France</li></region><settlement><li>Lyon</li><li>Paris</li><li>Toulouse</li></settlement></list><tree><country name="France"><region name="Île-de-France"><name sortKey="Mosnier, Anne" sort="Mosnier, Anne" uniqKey="Mosnier A" first="Anne" last="Mosnier">Anne Mosnier</name></region><name sortKey="Berche, Herve" sort="Berche, Herve" uniqKey="Berche H" first="Hervé" last="Berche">Hervé Berche</name><name sortKey="Caini, Saverio" sort="Caini, Saverio" uniqKey="Caini S" first="Saverio" last="Caini">Saverio Caini</name><name sortKey="Cohen, Jean Marie" sort="Cohen, Jean Marie" uniqKey="Cohen J" first="Jean Marie" last="Cohen">Jean Marie Cohen</name><name sortKey="Daviaud, Isabelle" sort="Daviaud, Isabelle" uniqKey="Daviaud I" first="Isabelle" last="Daviaud">Isabelle Daviaud</name><name sortKey="Lina, Bruno" sort="Lina, Bruno" uniqKey="Lina B" first="Bruno" last="Lina">Bruno Lina</name><name sortKey="Mansuy, Jean Michel" sort="Mansuy, Jean Michel" uniqKey="Mansuy J" first="Jean-Michel" last="Mansuy">Jean-Michel Mansuy</name><name sortKey="Van Der Werf, Sylvie" sort="Van Der Werf, Sylvie" uniqKey="Van Der Werf S" first="Sylvie" last="Van Der Werf">Sylvie Van Der Werf</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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