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The impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on the incidence of pneumococcal meningitis (PM) in children is unknown. To determine this impact, a descriptive multicentre retrospective cohort study was conducted from 2008 to 2013 in northern France. All laboratory-confirmed PM in children aged <18 years in all hospitals of the area with paediatric units were included. Two independent databases were used for exhaustive identification of cases: medical plus laboratory records at each hospital and discharge codes. The corrected incidence of PM was determined by a capture-recapture analysis using these two databases. Sixty-two cases were found over the 6-year period. A decrease of the PM corrected incidence was observed in the global population (P = 0·07), significant only for children aged <2 years, from 11·9/100 000 in 2008 in 1·9/100 000 in 2013 [6·4 fold-decrease, 95% confidence interval (CI) 1·4-41, P = 0·01] between years 2008 and 2013. When comparing the pre- and post-PCV13 periods, this decrease was still statistically significant for children aged <2 years [7·32/100 000 (95% CI 4·39-10·25) to 2·78/100 000 (95% CI 0·96-4·60), P = 0·01]. Only three (5%) cases of PM caused by vaccine serotypes could have been prevented. After the introduction of the PCV13 vaccine, a decrease in the incidence of PM cases in children in northern France was observed.

To the Editor, Intramuscular adrenaline injection is the first-line treatment of anaphylaxis. 1 More serious and even fatal or biphasic reactions may occur if there is a delay in administering it. 1 Adrenaline injection for anaphylaxis that occurs outside of a healthcare setting should be immediately followed by a call to emergency medical services (EMSs) ('911' in North America, '112' in Europe). 1 Before discharge from the emergency care unit (ECU), an adrenaline autoinjector (AAI) should be prescribed with clearly written instructions for its use and safety recommendations. 1 Despite international guidelines and education about the treatment of anaphylaxis, adrenaline is underused by caregivers and healthcare professionals. This study aimed to understand the factors associated with the underuse of adrenaline in children experiencing anaphylaxis. Preliminary results of this study focusing on the clinical outcome of the anaphylaxis manifestations have been previously reported. 2 All children (≤15 years) admitted for anaphylaxis (2015-2017) to one of 18 paediatric ECUs in the Nord-Pas-de-Calais region of France were prospectively included. Diagnosis of anaphylaxis was based on the criteria proposed by the National Institute of Allergy and Infectious Disease (NIAID)/Food Allergy and Anaphylaxis Network symposium. 3 All medical records were reviewed by an

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