Archive for September, 2017

Specific Biomarkers Associated With Neurological Complications and Congenital Central Nervous System Abnormalities From Zika Virus–Infected Patients in Brazil

Journal of Infectious Diseases July 15, 2017 V.216 N.2 P.172–181

Yiu-Wing Kam; Juliana Almeida Leite; Fok-Moon Lum; Jeslin J L Tan; Bernett Lee …

Background

Zika virus (ZIKV) infections have been linked to different levels of clinical outcomes, ranging from mild rash and fever to severe neurological complications and congenital malformations.

Methods

We investigated the clinical and immunological response, focusing on the immune mediators profile in 95 acute ZIKV-infected adult patients from Campinas, Brazil. These patients included 6 pregnant women who later delivered during the course of this study. Clinical observations were recorded during hospitalization. Levels of 45 immune mediators were quantified using multiplex microbead-based immunoassays.

Results

Whereas 11.6% of patients had neurological complications, 88.4% displayed mild disease of rash and fever. Several immune mediators were specifically higher in ZIKV-infected patients, and levels of interleukin 10, interferon gamma-induced protein 10 (IP-10), and hepatocyte growth factor differentiated between patients with or without neurological complications. Interestingly, higher levels of interleukin 22, monocyte chemoattractant protein 1, TNF-α, and IP-10 were observed in ZIKV-infected pregnant women carrying fetuses with fetal growth–associated malformations. Notably, infants with congenital central nervous system deformities had significantly higher levels of interleukin 18 and IP-10 but lower levels of hepatocyte growth factor than those without such abnormalities born to ZIKV-infected mothers.

Conclusions

This study identified several key markers for the control of ZIKV pathogenesis. This will allow a better understanding of the molecular mechanisms of ZIKV infection in patients.

PDF

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September 27, 2017 at 8:50 am

Sustained Immunogenicity of 2-dose Human Papillomavirus 16/18 AS04-adjuvanted Vaccine Schedules in Girls Aged 9–14 Years: A Randomized Trial

Journal of Infectious Diseases June 1, 2017 V.215 N.11 P.1711–1719

Li-Min Huang; Thanyawee Puthanakit; Chiu Cheng-Hsun; Tang Ren-Bin; Tino Schwarz …

Background.

We previously reported the noninferiority 1 month after the last dose of 2-dose human papillomavirus 16/18 AS04-adjuvanted (AS04-HPV-16/18) vaccine schedules at months 0 and 6 (2D_M0,6) and months 0 and 12 (2D_M0,12) in girls aged 9–14 years compared with a 3-dose schedule at months 0, 1, and 6 (3D_M0,1,6) in women aged 15–25 years. Here, we report the results at study end (month 36 [M36]).

Methods.

Girls were randomized 1:1 and received 2 vaccine doses either 6 months (2D_M0,6) or 12 months apart (2D_M0,12); women received 3 doses at months 0, 1, and 6 (3D_M0,1,6). Endpoints included noninferiority of HPV-16/18 antibodies for 2D_M0,6 versus 3D_M0,1,6; 2D_M0,12 versus 3D_M0,1,6; and 2D_M0,12 versus 2D_M0,6; and assessment of neutralizing antibodies, T cells, B cells, and safety.

Results.

At M36, the 2D_M0,6 and 2D_M0,12 schedules remained noninferior to the 3D_M0,1,6 schedule in terms of seroconversion rates and 3D/2D geometric mean titers for anti-HPV-16 and anti-HPV-18. All schedules elicited sustained immune responses up to M36.

Conclusions.

Both 2-dose schedules in young girls remained noninferior to the 3-dose schedule in women up to study conclusion at M36. The AS04-HPV-16/18 vaccine administered as a 2-dose schedule was immunogenic and well tolerated in young girls.

PDF

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September 27, 2017 at 8:48 am

Preventing Methicillin-Resistant Staphylococcus aureus (MRSA) Disease in Urban US Hospitals—Now for the Hard Part: More Evidence Pointing to the Community as the Source of MRSA Acquisition

Journal of Infectious Diseases June 1, 2017 V.215 N.11 P.1631–1633

EDITOR’S CHOICE

Susan M. Ray

Methicillin-resistant Staphylococcus aureus (MRSA) first emerged in the 1960s, shortly after the introduction of methicillin for therapeutic use [1].

Over the next 4 decades, MRSA spread worldwide and became endemic in hospitals in many countries [2]. In the 1990s, community- associated MRSA emerged as an epidemic of skin and soft-tissue infections in patients without any prior healthcare contact and was associated with serious morbidity and mortality [3, 4].

Although the earliest reports of community-associated MRSA disease in the United States were due to both USA400 and USA300, it was soon clear that USA300 was the epidemic community-associated MRSA clone of greatest importance in the United States, and it has persisted for well over a decade [5, 6].

By the mid-2000s, USA300 was noted to cause healthcare-associated disease [7], and in some urban centers it now accounts for up to 50% of nosocomial MRSA bacteremias [8] and a high proportion of cases of MRSA disease and colonization in long-term-care facilities [9, 10]….

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September 27, 2017 at 8:47 am

Antimicrobial Drug Prescription and Neisseria gonorrhoeae Susceptibility, United States, 2005–2013

Emerging Infectious Diseases October 2017 V.23 N.10

D. Kirkcaldy et al.

Centers for Disease Control and Prevention, Atlanta, Georgia, USA (R.D. Kirkcaldy, M.G. Bartoces, J.R. Papp, L.A. Hicks); University of Washington, Seattle, Washington, USA (O.O. Soge); Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (S. Riedel); Texas Department of State Health Services, Austin, Texas, USA (G. Kubin); Emory University, Atlanta (C. Del Rio); University of Alabama at Birmingham, Birmingham, Alabama, USA (E.W. Hook III)

We investigated whether outpatient antimicrobial drug prescribing is associated with Neisseria gonorrhoeae antimicrobial drug susceptibility in the United States. Using susceptibility data from the Gonococcal Isolate Surveillance Project during 2005–2013 and QuintilesIMS data on outpatient cephalosporin, macrolide, and fluoroquinolone prescribing, we constructed multivariable linear mixed models for each antimicrobial agent with 1-year lagged annual prescribing per 1,000 persons as the exposure and geometric mean MIC as the outcome of interest. Multivariable models did not demonstrate associations between antimicrobial drug prescribing and N. gonorrhoeae susceptibility for any of the studied antimicrobial drugs during 2005–2013. Elucidation of epidemiologic factors contributing to resistance, including further investigation of the potential role of antimicrobial drug use, is needed.

PDF

https://wwwnc.cdc.gov/eid/article/23/10/pdfs/17-0488.pdf

September 26, 2017 at 7:53 am

Risk of Recurrence of Adverse Events Following Immunization: A Systematic Review

Pediatrics September 2017 V.140 N.3

Joseline Guetsop Zafack, Gaston De Serres, Marilou Kiely, Marie-Claude Gariépy, Isabelle Rouleau, Karina Anne-Marie Top, for the Canadian Immunization Research Network

Abstract

CONTEXT

Reimmunizing patients who had an adverse event following immunization (AEFI) is sometimes a challenge because there are limited data on the risk and severity of AEFI recurrence.

OBJECTIVE

To summarize the literature on the risk of AEFI recurrence.

DATA SOURCES

PubMed, Embase, and Cochrane library.

STUDY SELECTION

We included articles in English or French published before September 30, 2016. Articles were selected if they estimated the risk of AEFI recurrence in at least 5 individuals. Studies with experimental vaccines were excluded.

DATA EXTRACTION

Data on study design, setting, population, vaccines, and AEFI recurrence were extracted.

RESULTS

Twenty-nine articles were included. Among patients with a history of hypotonic hyporesponsive episode (n = 398), anaphylaxis (n = 133), or seizures (n = 60) who were reimmunized, events recurred in 0% to 0.8%. Allergic-like events recurred in 30 of 594 reimmunized patients. Fever recurred in 0% to 84% of 836 reimmunized patients, depending on the vaccine and dose number. Among children with extensive limb swelling after the fourth dose of diphtheria-tetanus-acellular pertussis vaccine, recurrence was higher when the fifth dose was given withthe full-antigen formulation (78%) compared with the reduced-antigen formulation (53%, P = .02)

LIMITATIONS

Many studies, included few patients, and those with severe AEFIs were often not reimmunized.

CONCLUSIONS

Despite vaccines being administered to millions of people annually, there are few studies in which researchers evaluated AEFI recurrence. Published studies suggest that reimmunization is usually safe. However in these studies, severe cases were often not reimmunized.

FULL TEXT

http://pediatrics.aappublications.org/content/140/3/e20163707

PDF

http://pediatrics.aappublications.org/content/pediatrics/140/3/e20163707.full.pdf

September 25, 2017 at 8:22 am

The road to elimination of hepatitis C: analysis of cures versus new infections in 91 countries

Journal of Virus Eradication July 2017

Andrew M Hill1* , Sanjay Nath2 , Bryony Simmons2

1 Department of Translational Medicine, University of Liverpool, UK

2 Faculty of Medicine, Imperial College London, UK

Abstract

Background

Hepatitis C (HCV) can only be eradicated if annual rates of cure (SVR) are consistently and significantly higher than new HCV infections, across many countries. In 2016, the WHO called for a 90% reduction in new HCV infection by 2030. Direct-acting antivirals (DAA) can cure the majority of those treated, at around 90% in most populations, at potentially very low prices. We compared the net annual change in epidemic size across 91 countries using data on SVR, new HCV infections, and deaths. In a further 109 countries, we projected this figure using regional averages of epidemic size.

Methods

Epidemiological data for 2016 were extracted from national reports, publications and the Polaris Observatory. There were 91/210 countries with data on SVR, HCV-related deaths and new infections available for analysis; 109 countries had net change in epidemic size projected from the regional prevalence of HCV, extrapolated to their population size. ‘Net cure’ was defined as the number of people with SVR, minus new HCV infections, plus HCV-related deaths in 2016.

Results

For the 91 countries analysed, there were 57.3 million people with chronic HCV infection in 2016. In the remaining 109 countries, the projected epidemic size was 12.2 million, giving a global epidemic size of 69.6 million. Across the 91 countries, there was a fall from 57.3 to 56.9 million people in 2017, a 0.7% reduction. The projected global net change was from 69.6 to 69.3 million, a 0.4% reduction. Ten countries had at least five times more people reaching SVR than new HCV infections, including Egypt and USA. In 47/91 countries, there were more HCV infections than SVR in 2016.

Conclusion

Very few countries are on target to achieve elimination of HCV as a public health problem by 2030. While the North American, North African/Middle East and Western European regions have shown small declines in prevalence, the epidemic is growing in sub-Saharan Africa and Eastern Europe. Far higher rates of DAA treatment are required for worldwide elimination of HCV.

FULL TEXT

http://viruseradication.com/journal-details/The_road_to_elimination_of_hepatitis_C:_analysis_of_cures_versus_new_infections_in_91_countries/

September 25, 2017 at 8:21 am

Recommendations for prevention of surgical site infection in adult elective arthroplasty.

Medicina (B Aires). 2017;77(2):143-157.

[Article in Spanish]

Chuluyán JC1, Vila A2, Chattás AL3, Montero M3, Pensotti C4, Tosello C5, Sánchez M6, Vera Ocampo C7, Kremer G8, Quirós R8, Benchetrit GA9, Pérez CF10, Terusi AL11, Nacinovich F12.

Author information

1 Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. álvarez, Argentina. E-mail: jcchulu@gmail.com

2 Servicio de Infectología, Hospital Italiano de Mendoza, Mendoza, Argentina.

3 Hospital General de Agudos Dr. Pirovano, Argentina.

4 Clínica Monte Grande, Buenos Aires, Argentina.

5 Hospital de Clínicas José de San Martín, UBA, Buenos Aires, Argentina.

6 Hospital Italiano de Buenos Aires, Argentina.

7 Sanatorio Dupuytren, Argentina.

8 Hospital Universitario Austral, Argentina.

9 Instituto de Investigaciones Médicas A. Lanari, UBA, Buenos Aires, Argentina.

10 Policlínico del Docente-Centro Médico Huésped, Argentina.

11 Instituto César Milstein, Argentina.

12 Instituto Cardiovascular de Buenos Aires, Centros Médicos Dr. Stamboulian, Argentina.

Abstract

Surgical site infections complicating orthopedic implant surgeries prolong hospital stay and increase risk of readmission, hospitalization costs and mortality.

These recommendations are aimed at:

(i) optimizing compliance and incorporating habits in all surgery phases by detecting risk factors for surgical site infections which are potentially correctable or modifiable; and

(ii) optimizing preoperative antibiotic prophylaxis as well as intraoperative and postoperative care.

PDF

http://www.medicinabuenosaires.com/PMID/28463223.pdf

September 25, 2017 at 7:35 am

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