A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), associated with severe respiratory illness emerged in Wuhan, China, in late 2019 (1). Epidemiologic data indicate that the virus can cause a wide spectrum of clinical disease (mild-to-severe illness), including death (2-4), and spreads through direct contact and droplets.Estimates are 5-6 days (range 2-14 days) for the incubation period and 2.2-3.6 for the reproduction rate; this rate is higher than those for seasonal and pandemic influenza (5,6). Extensive control efforts are now in place as part of a global containment strategy to minimize exportation from China and rapidly identify and stop international spread.In the World Health Organization European Region, Rome, Paris, London, Istanbul, and Moscow have direct flights to Wuhan, China, and the risk for importation was considered high (7). SARS-CoV-2 was reported to have been introduced into Europe by a person from France who had traveled to Wuhan, China, for work, became ill on January 16, and returned ill to France on January 22 (8). We report a cluster of illness in a tour group from Wuhan that predates this case detection and led to subsequent transmission in Europe. The StudyA 55-year-old woman (Taiwanese tour guide) who resided in Wuhan came to airport health authorities in Taipei on January 25, 2020, complaining of a cough since January 22. She was transported to a designated hospital and showed a PCR-positive result for SARS-CoV-2 on January 26. She indicated that she had led a group of tourists from Wuhan to Europe on January 16-24. Further interviews with her and discussions with the rest of the group through social media yielded detailed information.A group of 30 persons departed Wuhan on January 16, 2020, for a 9-day tour in Italy, Switzerland, and France (Table; Figure). During the flight on January 16 from Wuhan to Rome, 1 tour member was mildly ill and coughing. Her daughter became ill during the tour on January 21.On January 23, while in Paris, the mother and daughter decided to seek medical care. They called the Chinese embassy, who told them to call the emergency hotline (at SAMU Centre 15 Hospital, Paris, France) dedicated to evaluation of suspected 2019 novel coronavirus disease (COVID-19) cases in France (8). The emergency hotline routed the call to the 24-hour ambulatory service, but no information about suspicion of COVID-19 was given. A physician came to their hotel room and gave them a diagnosis of the common cold. The interaction lasted »20 min, including a 15-minute face-to-face examination, without protective masks for

Background Vaccination policy in France was previously characterised by the coexistence of eight recommended and three mandatory vaccinations for children younger than 2 years old. These 11 vaccines are now mandatory for all children born after 1 January 2018. Aim To study the French population’s opinion about this new policy and to assess factors associated with a positive opinion during this changing phase. Methods A cross-sectional survey about vaccination was conducted from 16 November–19 December 2017 among the GrippeNet.fr cohort. Data were weighted for age, sex and education according to the French population. Univariate and multivariate analyses were performed to identify factors associated with a favourable opinion on mandatory vaccines’ extension and defined in the ‘3Cs’ model by the World Health Organization Strategic Advisory Group of Experts working group on vaccine hesitancy. Results Of the 3,222 participants (response rate 50.5%) and after adjustment, 64.5% agreed with the extension of mandatory vaccines. It was considered a necessary step by 68.7% of the study population, while 33.8% considered it unsafe for children and 56.9% saw it as authoritarian. Factors associated with a positive opinion about the extension of mandatory vaccines were components of the confidence, complacency and convenience dimensions of the ‘3Cs’ model. Conclusions In our sample, two thirds of the French population was in favour of the extension of mandatory vaccines for children. Perception of vaccine safety and benefits were major predictors for positive and negative opinions about this new policy.

Objectives: To describe the prevalence, clinical features and complications of human metapneumovirus (hMPV) infections in a population of adults hospitalized with influenza-like illness (ILI). Methods: This was a retrospective, observational, multicenter cohort study using prospectively collected data from adult patients hospitalized during influenza virus circulation, for at least 24 h, for communityacquired ILI (with symptom onset <7 days). Data were collected from five French teaching hospitals over six consecutive winters (2012e2018). Respiratory viruses were identified by multiplex reverse transcription polymerase chain reaction (RT-PCR) on nasopharyngeal specimens. hMPV þ patients were compared with hMPVe patients, influenzaþ and respiratory syncytial virus (RSV)þ patients using multivariate logistic regressions. Primary outcome was the prevalence of hMPV in patients hospitalized for ILI. Results: Among the 3148 patients included (1449 (46%) women, 1988 (63%) aged 65 and over; 2508 (80%) with chronic disease), at least one respiratory virus was detected in 1604 (51%, 95% confidence interval (CI) 49e53), including 100 cases of hMPV (100/3148, 3% 95% CI 3e4), of which 10 (10%) were viral coinfection. In the hMPV þ patients, mean length of stay was 7 days, 62% (56/90) developed a complication, 21% (14/68) were admitted to intensive care unit and 4% (4/90) died during hospitalization. In comparison with influenza þ patients, hMPV þ patients were more frequently >65 years old (adjusted odds ratio (aOR) ¼ 3.3, 95% CI 1.9e6.3) and presented more acute heart failure during hospitalization (aOR ¼ 1.8, 95% CI 1.0e2.9). Compared with RSV þ patients, hMPV þ patients had less cancer (aOR ¼ 0.4, 95% CI 0.2e0.9) and were less likely to smoke (aOR ¼ 0.5, 95% CI 0.2e0.9) but had similar outcomes, especially high rates of respiratory and cardiovascular complications.