Trivalent and quadrivalent seasonal influenza vaccine in adults aged 60 and older: a systematic review and network meta-analysis

OBJECTIVES

To compare the efficacy of influenza vaccines of any valency for adults 60 years and older.

DESIGN AND SETTING

Systematic review with network meta-analysis (NMA) of randomised controlled trials (RCTs). MEDLINE, EMBASE, JBI Evidence-Based Practice (EBP) Database, PsycINFO, and Cochrane Evidence -Based Medicine database were searched from inception to 20 June 20, 2022. Two reviewers screened, abstracted, and appraised articles (Cochrane Risk of Bias (ROB) 2.0 tool) independently. We assessed certainty of findings using Confidence in Network Meta-Analysis and Grading of Recommendations, Assessment, Development and Evaluations approaches. We performed random-effects meta-analysis and network meta-analysis (NMA), and estimated odds ratios (ORs) for dichotomous outcomes and incidence rate ratios (IRRs) for count outcomes along with their corresponding 95% confidence intervals (CIs) and prediction intervals.

PARTICIPANTS

Older adults (≥60 years old) receiving an influenza vaccine licensed in Canada or the USA (vs placebo, no vaccine, or any other licensed vaccine), at any dose.

MAIN OUTCOME MEASURES

Laboratory-confirmed influenza (LCI) and influenza-like illness (ILI). Secondary outcomes were the number of vascular adverse events, hospitalisation for acute respiratory infection (ARI) and ILI, inpatient hospitalisation, emergency room (ER) visit for ILI, outpatient visit, and mortality, among others.

RESULTS

We included 41 RCTs and 15 companion reports comprising 8 vaccine types and 206 032 participants. Vaccines may prevent LCI compared with placebo, with high-dose trivalent inactivated influenza vaccine (IIV3-HD) (NMA: 9 RCTs, 52 202 participants, OR 0.23, 95% confidence interval (CI) (0.11 to 0.51), low certainty of evidence) and recombinant influenza vaccine (RIV) (OR 0.25, 95%CI (0.08 to 0.73), low certainty of evidence) among the most efficacious vaccines. Standard dose trivalent IIV3 (IIV3-SD) may prevent ILI compared with placebo, but the result was imprecise (meta-analysis: 2 RCTs, 854 participants, OR 0.39, 95%CI (0.15 to 1.02), low certainty of evidence). Any HD was associated with prevention of ILI compared with placebo (NMA: 9 RCTs, 65 658 participants, OR 0.38, 95%CI (0.15 to 0.93)). Adjuvanted quadrivalent IIV (IIV4-Adj) may be associated with the least vascular adverse events, but the results were very uncertain (NMA: eight 8 RCTs, 57 677 participants, IRR 0.18, 95%CI (0.07 to 0.43), very low certainty of evidence). RIV on all-cause mortality may be comparable to placebo (NMA: 20 RCTs, 140 577 participants, OR 1.01, 95%CI (0.23 to 4.49), low certainty of evidence).

CONCLUSIONS

This systematic review demonstrated efficacy associated with IIV3-HD and RIV vaccines in protecting older persons against LCI. RIV vaccine may reduce all-cause mortality when compared with other vaccines, but the evidence is uncertain. Differences in efficacy between influenza vaccines remain uncertain with very low to moderate certainty of evidence.

PROSPERO REGISTRATION NUMBER

CRD42020177357.

Differences and similarities between COVID-19 related-headache and COVID-19 vaccine related-headache. A case-control study

INTRODUCTION

Headache is a frequent symptom at the acute phase of coronavirus disease 2019 (COVID-19) and also one of the most frequent adverse effects following vaccination. In both cases, headache pathophysiology seems linked to the host immune response and could have similarities. We aimed to compare the clinical phenotype and the frequency and associated onset symptoms in patients with COVID-19 related-headache and COVID-19 vaccine related-headache.

SUBJECTS AND METHODS

A case-control study was conducted. Patients with confirmed COVID-19 infection and COVID-19-vaccine recipients who experienced new-onset headache were included. A standardised questionnaire was administered, including demographic variables, prior history of headaches, associated symptoms and headache-related variables. Both groups were matched for age, sex, and prior history of headache. A multivariate regression analysis was performed.

RESULTS

A total of 238 patients fulfilled eligibility criteria (143 patients with COVID-19 related-headache and 95 subjects experiencing COVID-19 vaccine related-headache). Patients with COVID-19 related-headache exhibited a higher frequency of arthralgia, diarrhoea, dyspnoea, chest pain, expectoration, anosmia, myalgia, odynophagia, rhinorrhoea, cough, and dysgeusia. Further, patients with COVID-19 related-headache had a more prolonged daily duration of headache and described the headache as the worst headache ever experienced. Patients with COVID-19 vaccine-related headache, experienced more frequently pain in the parietal region, phonophobia, and worsening of the headache by head movements or eye movements.

CONCLUSION

Headache caused by SARS-CoV-2 infection and COVID-19 vaccination related-headache have more similarities than differences, supporting a shared pathophysiology, and the activation of the innate immune response. The main differences were related to associated symptoms.

Bilateral absence of the deep brachial artery

The aim of the following study was to present and comprehensively describe a case of a bilateral absence of the deep brachial artery (DBA). Furthermore, its embryology and clinical significance will also be discussed. During routine dissection, a 71-year-old male cadaver with a bilateral abnormality in the DBA and its branches was found. The first branch of the brachial artery (BA) was found to be the radial collateral artery, which passed behind the radial nerve. Furthermore, the middle collateral artery originated distal to the radial collateral artery and gave off first a singular, minor muscular branch and then the superior ulnar collateral artery. Later, the preceding nutrient arteries of the humerus and the deltoid branch consecutively branched off from the middle collateral artery. Subsequently, the middle ulnar collateral artery, the inferior ulnar collateral artery, the deltoid artery, the radial artery, and the ulnar artery branched off from the BA, as adapted in the current knowledge regarding the anatomy of the upper extremity. Furthermore, detailed measurements of the distances between the mentioned arteries were carried out. In the present study, a bilateral absence of the DBA was demonstrated. Meta-analysis focusing on the anatomy of this artery has shown how variable its characteristics are. However, our case report is the first in the literature to present this extremely rare variation. Having adequate knowledge regarding the anatomy of the arteries of the proximal arm is of immense importance when performing orthopaedic and reconstructive surgeries in this area.

Fecal microbiota composition is related to brown adipose tissue 18F-fluorodeoxyglucose uptake in young adults

OBJECTIVE

Human brown adipose tissue (BAT) has gained considerable attention as a potential therapeutic target for obesity and its related cardiometabolic diseases; however, whether the gut microbiota might be an efficient stimulus to activate BAT metabolism remains to be ascertained. We aimed to investigate the association of fecal microbiota composition with BAT volume and activity and mean radiodensity in young adults.

METHODS

82 young adults (58 women, 21.8 ± 2.2 years old) participated in this cross-sectional study. DNA was extracted from fecal samples and 16S rRNA sequencing was performed to analyse the fecal microbiota composition. BAT was determined via a static ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography-computed tomography scan (PET/CT) after a 2 h personalized cooling protocol. ¹⁸F-FDG uptake was also quantified in white adipose tissue (WAT) and skeletal muscles.

RESULTS

The relative abundance of Akkermansia, Lachnospiraceae sp. and Ruminococcus genera was negatively correlated with BAT volume, BAT SUVmean and BAT SUVpeak (all rho ≤ - 0.232, P ≤ 0.027), whereas the relative abundance of Bifidobacterium genus was positively correlated with BAT SUVmean and BAT SUVpeak (all rho ≥ 0.262, P ≤ 0.012). On the other hand, the relative abundance of Sutterellaceae and Bifidobacteriaceae families was positively correlated with ¹⁸F-FDG uptake by WAT and skeletal muscles (all rho ≥ 0.213, P ≤ 0.042). All the analyses were adjusted for the PET/CT scan date as a proxy of seasonality.

CONCLUSION

Our results suggest that fecal microbiota composition is involved in the regulation of BAT and glucose uptake by other tissues in young adults. Further studies are needed to confirm these findings.

CLINICAL TRIAL INFORMATION

ClinicalTrials.gov no. NCT02365129 (registered 18 February 2015).

A systematic review of breast milk microbiota composition and the evidence for transfer to and colonisation of the infant gut

The intestinal microbiota plays a major role in infant health and development. However, the role of the breastmilk microbiota in infant gut colonisation remains unclear. A systematic review was performed to evaluate the composition of the breastmilk microbiota and evidence for transfer to/colonisation of the infant gut. Searches were performed using PUBMED, OVID, LILACS and PROQUEST from inception until 18th March 2020 with a PUBMED update to December 2021. 88 full texts were evaluated before final critique based on study power, sample contamination avoidance, storage, purification process, DNA extraction/analysis, and consideration of maternal health and other potential confounders. Risk of skin contamination was reduced mainly by breast cleaning and rejecting the first milk drops. Sample storage, DNA extraction and bioinformatics varied. Several studies stored samples under conditions that may selectively impact bacterial DNA preservation, others used preculture reducing reliability. Only 15 studies, with acceptable sample size, handling, extraction, and bacterial analysis, considered transfer of bacteria to the infant. Three reported bacterial transfer from infant to breastmilk. Despite consistent evidence for the breastmilk microbiota, and recent studies using improved methods to investigate factors affecting its composition, few studies adequately considered transfer to the infant gut providing very little evidence for effective impact on gut colonisation.

Summary of the National Advisory Committee on Immunization (NACI) Supplemental Statement on Recombinant Influenza Vaccines

Background

Recombinant protein technology is a novel platform for influenza vaccine manufacturing that differs significantly from existing egg-based and mammalian cell culture-based technologies. Supemtek™ is the first and, to date, the only recombinant quadrivalent influenza vaccine (RIV4) authorized for use in Canada in adults aged 18 years and older. The objective is to review the available evidence for efficacy, effectiveness, immunogenicity and safety of RIV4, and to summarize the National Advisory Committee on Immunization (NACI) recommendation regarding the use of Supemtek.

Methods

A systematic literature review and meta-analysis on the vaccine efficacy, effectiveness, immunogenicity and safety of RIV4 in adults was conducted according to methodology specified a priori in a written protocol. NACI evidence-based process was used to assess the available evidence and develop a recommendation regarding the use of Supemtek.

Results

Ten eligible studies were included in the evidence synthesis. One randomized controlled trial (RCT) in adults aged 50 years and older provided evidence that RIV4 may potentially offer improved protection against laboratory-confirmed influenza A infection compared to standard egg-based influenza vaccines. Data from eight RCTs assessing immunogenicity and five RCTs and one post-marketing surveillance study assessing safety indicated that Supemtek is a safe, well tolerated, and immunogenic alternative to conventional egg-based influenza vaccines for adults.

Conclusion

There is fair evidence that Supemtek is effective, safe, and has non-inferior immunogenicity to comparable vaccines, based on direct evidence in adults 18 years of age and older; thus, NACI recommends that Supemtek may be considered among the seasonal influenza vaccines offered to adults 18 years of age and older for their annual influenza vaccination.

Fatal drug poisonings in an industrial region of the Far North of Russia

Introduction

Drug poisonings is a continuous public health problem in Russia and worldwide.

Objectives

The objective of the study was to provide characteristics of lethal drug poisonings in a northern Russian region.

Methods

The data on deaths from drug poisoning that occurred between 2018 and September 2021, systematically collected by the Regional Center on the Organization of the Narcological and Psychiatric service of the Khanty-Mansi Autonomous Okrug of Russia, was analyzed.

Results

Among 220 cases of fatal drug poisoning the overwhelming majority (90.4%) occurred among males. The number of cases increased annually from 27 in 2018 to 71 in 2020. The average age of death increased from 33.6 years in 2018 to 38.2 years in 2021. Over two thirds of deceased (70.9%) had complete secondary or vocational secondary level of education, almost one third (30.0%) were skilled workers, and slightly less than half (44.1%) were unemployed. The most common causes of death were methadone poisoning (34.5%), poisoning with other opioids (21.8%), other synthetic drugs (17.3%), other unspecified drugs (11.8%), and psychostimulants (10.0%). Alcohol intoxication was identified as a concomitant cause of death in every fourth case (26.0%), of which 98% were among males. Most often, alcohol was present in the blood at a concentration of 120 mg/ml and above. Every fourth deceased (23.6%) was registered with narcology health service for drug addiction.

Conclusions

Fatal poisonings with narcotic drugs and psychotropic substances is a growing public health problem in a northern industrial region of Russia, which affects predominantly working-age males and requires comprehensive multisectoral response.

Disclosure

No significant relationships.

Factors associated with an increase in alcohol consumption among users of online social networks in Russia in the early months of the COVID-19 pandemic

Introduction

The various restrictions and physical distancing introduced inRussia in early months of COVID-19pandemic could have a particular impact on people who use alcohol and create new needs for prevention and treatment of associated disorders.

Objectives

The study was aimed at assessing changes in alcohol consumption among users of online social networks in Russia.

Methods

During June-September 2020,1518 adult users (18+) of the most popular social networks in Russia (Odnoklassniki, VKontakte,Facebook, Twitter), completed an anonymous online survey regarding alcohol use changes in the first months of COVID-19 pandemic. Binary logistic regression was used to estimate associations of increased alcohol consumption with socio-demographic and pandemic-related factors.

Results

35.4%of men and 25.6%of women increased their frequency of drinking; 24.9%of men and 17.7%of women increased their typical one-time volume of alcohol consumption,and 28.5% of men and 27.9% of women increased frequency of heavy episodic drinking in the early months of pandemic. After mutual adjustment of independent variables,age18-29 years(OR=1.710;95%CI 1.002-2.917), very strong restrictions of everyday life(3.127; 1.011-9.675)and severe negative consequences in relation to professional or financial situation due to spread ofSARS-CoV-2 (2.247; 1.131-4.465) were positively associated with increase in frequency of drinking. The odds of increase in frequency of heavy episodic drinking were more than twice higher(2.329; 1.001-5.428) among those who experienced severe negative consequences to their professional/financial situation.Higher typical frequency,larger one-time volume of alcohol use,and higher frequency of heavy episodic drinking before pandemic were positively associated with increase of alcohol consumption in early months of pandemic.

Conclusions

Timely monitoring of changes in alcohol consumption during pandemic can allow prevention of alcohol-related disorders, including mental disorders, among users of online social networks.

Disclosure

No significant relationships.

Changes in alcohol consumption in the Russian Federation during the first months of the COVID-19 pandemic

Introduction

Excessive alcohol consumption is a known risk factor for various mental health disorders and can exacerbate the already high burden of COVID-19 pandemic on mental health.On the other hand, the COVID-19 pandemic itself can adversely affect alcohol consumption and thus contribute to alcohol-related problems, including mental health problems.

Objectives

This study was aimed to assess changes in alcohol consumption that may have occurred as a result of the COVID-19pandemic and determine associated factors among population of Russian Federation.

Methods

By distributing a link to take part in an anonymous online survey,changes in volume and frequency of alcohol use,and frequency of heavy episodic drinking(6 or more servings of alcohol at a time)in the first months of COVID-19pandemic were assessed. 819respondents from Russia:321 men and 498women, submitted their responses during May-July,2020. Associations between changes in alcohol use were assessed in a univariate analysis with socio-demographic factors,alcohol use over the previous 12months,stress, individual perceptions of changes in daily and social life and other negative consequences of pandemic.The statistical significance of associations was assessed using the Pearson’sχ2 test.

Results

Individuals with initially higher alcohol consumption increased their alcohol use, while those who drank less, decreased alcohol use even more during pandemic (p<0.05). Severe restrictions of social/everyday life were associated with more frequent alcohol use and in larger volumes (p<0.001). Negative professional/financial consequences of pandemic and stress were associated with increase of typical drinking volume (p<0.001), more frequent alcohol use (p<0.001)and heavy episodic drinking (p<0.05).

Conclusions

The COVID-19 pandemic could have increased health inequalities in Russia through changes in alcohol consumption.

Disclosure

No significant relationships.

Application of birnessite-type solids prepared by sol-gel and oxidation methods in photocatalytic degradation of 4-nitrophenol

Potassium birnessites were prepared using two methods, sol-gel or oxidation. The solids were characterised by element chemical analysis, powder X-ray diffraction, FT-IR spectroscopy, thermal analyses, and nitrogen adsorption. The evolution of the properties as a function of the preparation method was discussed. The photocatalytic performance of these solids was preliminarily tested for the degradation of 4-nitrophenol. The degradation pathway and the nature of the by-products were investigated by mass spectrometry. The solids showed good catalytic behaviour, although their preparation must be improved, mainly concerning the calcination step involved in sol-gel synthesis, which led to the formation of Mn₂O₃ that worsened the catalytic behaviour.

Simulation of the Physiological Characteristics of Pillar and Modiolar Fibers of the Auditory Nerve

The study of the physiological characteristics of the auditory nerve fibers is fundamental to understand their capability to encode sounds. These characteristics include their spontaneous firing rate, their threshold, and their dynamic range. Although it is possible to perform in vitro recordings of these characteristics in different cell models, it is complicated to obtain in vivo measurements of them directly from the cochlea. For example, the apex of the cochlea since it is an unreachable region which is vulnerable to surgical trauma that could result in altered recordings. In this paper, the behavior of Pillar and Modiolar fibers of the auditory nerve were simulated in response to tone bursts of different frequencies and intensities. The proposed model allowed us to associate the basal firing rates with the physiological characteristics of the different auditory nerve fibers. This is especially important since some noise-associated hearing losses, such as acoustic trauma, have been explained as selective fiber damages.Clinical Relevance- Models that describe the properties of auditory nerve fibers are important to study specific aspects of maturation as well as the causes of sensorineural hearing loss in humans.

Anaerobic co-digestion of winery waste: comparative assessment of grape marc waste and lees derived from organic crops

Grapes are one the world's leading fruit crops, with close to 77 million tonnes harvested per year. Grapes are commonly used to produce wine; a process which generates different wastes such as grape mark waste (skins, seeds and stalks), lees and other residues. This study evaluates the treatment of winery waste derived from ecological cultivation by anaerobic digestion to produce energy in the form of methane. Grape marc waste, Verdejo and Pedro Ximenez (PX) wine lees were digested under stable conditions at mesophilic conditions. The PX lees showed the highest methane yield production (433 L_STP CH₄/kg VS) with a maximum OLR of 4.58 kg VS/m³·d. In the evaluated range the process was stable with a range of biodegradability of 51-79%. Due to different types of winery waste are generated at consecutive stages of the main production process, the sequential treatment of PX lees, Verdejo lees and grape marc waste in the same anaerobic digester could be an interesting option. This procedure would facilitate the management of the residual streams generated in wineries during the year and promotes the circular economy in the Montilla-Moriles Protected Designation of Origin.

[Vaccination against community acquired pneumonia in adults. Update 2021 of the position paper by Neumoexpertos en Prevención Group]

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the practical prevention guide for CAP through vaccination in Spain developed in 2016 and updated in 2018, based on available vaccines and evidence through bibliographic review and expert opinion. The arrival of COVID-19 as a new cause of CAP and the recent availability of safe and effective vaccines constitutes the most significant change. Vaccines against pneumococcus, influenza, pertussis and COVID-19 can help to reduce the burden of disease from CAP and its associated complications. The available evidence supports the priority indications established in this guide, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.

Computational evaluation of rebreathing and effective dead space on a helmet-like interface during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) is a potentially severe acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2. The potential for transmission of this disease has led to an important scarcity of health-care resources. Consequently, alternative solutions have been explored by many physicians and researchers. Non-invasive Ventilation has been revealed as one alternative for patients with associated acute respiratory distress syndrome. This technique is being used in combination with helmet-like interfaces because of their versatility and affordability. However, these interfaces could experience important problems of CO2 rebreathing, especially under low flow rate conditions. This work proposes a Computational Fluid Dynamics method to accurately characterize the fluid flow in a pre-design environment of helmet-like interfaces. Parameters as effective dead space, rebreathing, pressure, or temperature field distribution are quantified and analysed in detail in order to study the performance and feasibility of such devices to relieve the effects of respiratory infections.