“I-MOVE” towards monitoring seasonal and pandemic influenza vaccine effectiveness: lessons learnt from a pilot multi-centric case-control study in Europe, 2008-9

Within I-MOVE (European programme to monitor seasonal and pandemic influenza vaccine effectiveness (IVE)) five countries conducted IVE pilot case-control studies in 2008-9. One hundred and sixty sentinel general practitioners (GP) swabbed all elderly consulting for influenza-like illness (ILI). Influenza confirmed cases were compared to influenza negative controls. We conducted a pooled analysis to obtain a summary IVE in the age group of ≥65 years. We measured IVE in each study and assessed heterogeneity between studies qualitatively and using the I2 index. We used a one-stage pooled model with study as a fixed effect. We adjusted estimates for age-group, sex, chronic diseases, smoking, functional status, previous influenza vaccinations and previous hospitalisations. The pooled analysis included 138 cases and 189 test-negative controls. There was no statistical heterogeneity (I2=0) between studies but ILI case definition, previous hospitalisations and functional status were slightly different. The adjusted IVE was 59.1% (95% CI: 15.3-80.3%). IVE was 65.4% (95% CI: 15.6-85.8%) in the 65-74, 59.6% (95% CI: -72.6 -90.6%) in the age group of ≥75 and 56.4% (95% CI: -0.2-81.3%) for A(H3). Pooled analysis is feasible among European studies. The variables definitions need further standardisation. Larger sample sizes are needed to achieve greater precision for subgroup analysis. For 2009-10, I-MOVE will extend the study to obtain early IVE estimates in groups targeted for pandemic H1N1 influenza vaccination.

"I-MOVE" towards monitoring seasonal and pandemic influenza vaccine effectiveness: lessons learnt from a pilot multi-centric case-control study in Europe, 2008-9

Within I-MOVE (European programme to monitor seasonal and pandemic influenza vaccine effectiveness (IVE)) five countries conducted IVE pilot case-control studies in 2008-9. One hundred and sixty sentinel general practitioners (GP) swabbed all elderly consulting for influenza-like illness (ILI). Influenza confirmed cases were compared to influenza negative controls. We conducted a pooled analysis to obtain a summary IVE in the age group of >or=65 years. We measured IVE in each study and assessed heterogeneity between studies qualitatively and using the I2 index. We used a one-stage pooled model with study as a fixed effect. We adjusted estimates for age-group, sex, chronic diseases, smoking, functional status, previous influenza vaccinations and previous hospitalisations. The pooled analysis included 138 cases and 189 test-negative controls. There was no statistical heterogeneity (I2=0) between studies but ILI case definition, previous hospitalisations and functional status were slightly different. The adjusted IVE was 59.1% (95% CI: 15.3-80.3%). IVE was 65.4% (95% CI: 15.6-85.8%) in the 65-74, 59.6% (95% CI: -72.6 -90.6%) in the age group of >or=75 and 56.4% (95% CI: -0.2-81.3%) for A(H3). Pooled analysis is feasible among European studies. The variables definitions need further standardisation. Larger sample sizes are needed to achieve greater precision for subgroup analysis. For 2009-10, I-MOVE will extend the study to obtain early IVE estimates in groups targeted for pandemic H1N1 influenza vaccination.

Characterisation of swabbing for virological analysis in the Spanish Influenza Sentinel Surveillance System during four influenza seasons in the period 2002-2006

This study sought to characterise the swabbing pattern in the Spanish Influenza Sentinel Surveillance System (SISSS) and ascertain to what extent the system meets the guidelines currently being drafted by The European Influenza Surveillance Scheme (EISS). Data on seasons 2002/2003 to 2005/2006 were drawn from SISSS. The study analysed collection and dispatch of swab specimens for virological analysis by reference to variables relating to patient sex, age group, vaccination status, specimen collection period, period of influenza activity, time of swabbing and epidemiological season. SISSS adapts to EISS recommendations with respect to the specimen collection period and period of influenza activity, but there is a tendency to collect fewer specimens than recommended as the age of patients increases, and in the case of elderly patients (65 years and older), frequency of collection is clearly insufficient. Furthermore, sentinel physicians collect a higher percentage of specimens in cases where patients have received the influenza vaccine.

A surveillance network for meningococcal disease in Europe

Between 1999 and 2004, the European Union Invasive Bacterial Infections Surveillance Network (EU-IBIS) received c. 50,000 reports of meningococcal disease from 27 participating countries. Analysis has demonstrated a major decline in the incidence of invasive disease in those countries that have introduced routine vaccination against serogroup C infection. The establishment of rapid reporting of W135 and B2a/B2b strains has been able to provide early reassurance that these strains are not emerging as major public health problems in Europe. Between September 2001 and February 2005, the EU-MenNet project offered further opportunities for enhancing this data resource. Collaborative projects included: improving the EU-IBIS website; reviewing case ascertainment in Europe; reviewing cost-effectiveness studies for meningococcal serogroup C conjugate (MCC) vaccination; international comparisons of MCC vaccine efficacy; and mathematical modelling studies. In addition, linking of data from the European Meningococcal Multi-locus Sequence Type Centre to epidemiological data was performed. Particular clonal complexes were found to be preferentially associated with certain serogroups. Case fatality was also found to vary with clonal complex, suggesting that genotype can be a marker for hypervirulence. The importance of close collaboration between networks of epidemiologists, microbiologists, and the wider scientific and public health community is demonstrated.

[Influenza surveillance. New solutions to an old problem]

The pandemic potential of influenza has made this disease the principal target of both national and international surveillance systems. The intrinsic characteristics of sentinel networks enable them to integrate epidemiological and virological information of a high incidence disease such as influenza, so helping in the early detection and characterization of the circulating influenza viruses and in evaluating their spread capacity in the population. A sentinel network, which covers 75% of the population, was created in Spain more than ten years ago. This provides a new approach to human influenza surveillance based on the individualized reporting of each case and the linkage of clinical, epidemiological and virological data. This system has contributed to a more accurate evaluation of influenza activity in Spain. In spite of the limitations of this sentinel system, which mainly derive from the lack of representativeness that any surveillance system based on population samples can encounter, it provides data which have proved useful for the follow-up and control of influenza. Rapid information transmission is one of the main advantages of the system, allowing its integration in the international disease surveillance networks and improving the timeliness of both information spread and formulation of recommendations.

Impact and effectiveness of meningococcal C conjugate vaccine following its introduction in Spain

This study describes the epidemiological impact of meningococcal C conjugate vaccine on age groups targeted by this vaccination programme in Spain, and estimates high short-term vaccine effectiveness values under field conditions in the 4 years following its introduction. Meningococcal C conjugate vaccine has led to a substantial reduction in incidence of meningococcal serogroup C disease in Spain among age groups targeted for intervention nationwide. Disease surveillance in the 4 years since the vaccine was introduced has enabled vaccine effectiveness (VE) to be estimated. The vaccine registered high short-term VE values but there has been some loss of VE with time. Four years after vaccination, vaccine protection levels exceeded 94% in cohorts immunised during the campaign. Among children vaccinated in routine childhood immunisation programmes, however, long-term VE loss was greater. Accordingly, there is a need for ongoing re-evaluation of VE and ascertainment of long-term vaccine protection. The findings reported would allow to decide on the advisability of revising current vaccination guidelines.

Increased influenza activity in Spain from mid-December 2004

Influenza activity was low in Spain between October and early December 2004, but has risen sharply since mid-December.

Impact of the meningococcal C conjugate vaccine in Spain: an epidemiological and microbiological decision

The new meningococcal C conjugate vaccine became available in Spain and was included in the infant vaccination schedule in 2000. A catch-up campaign was carried out in children under six years of age. As a consequence, the incidence of meningococcal disease caused by serogroup C has fallen sharply during the last three epidemiological years in Spain. The risk of contracting serogroup C disease in 2002/2003 fell by 58% when compared with the season before the conjugate vaccine was introduced. There was also an important decrease in mortality. Three deaths due to serogroup C occurred in the age groups targeted for vaccination in 2002/2003, compared with 30 deaths in the same age groups in the season before the launch of the vaccine campaign. In the catch-up campaign the vaccine coverage reached values above 92%. For the 2001, 2002 and 2003 routine childhood immunisation programme coverage values ranged from 90% to 95%. During the past three years a total of 111 cases of serogroup C disease have been reported in patients in the vaccine target group. Most of the vaccination failures occurred during the epidemiological year 2002/2003. Eight (53%) vaccine failures occurred in children who had been routinely immunised in infancy, and could be related to a lost of protection with time since vaccination. The isolation of several B:2a:P1.5 strains (ST-11 lineage) is noteworthy. These may have their origin in C:2a:P1.5 strains which, after undergoing genetic recombination at the capsular operon level, express serogroup B. These strains could have relevant epidemic potential.

Impact of the meningococcal C conjugate vaccine in Spain: an epidemiological and microbiological decision

The new meningococcal C conjugate vaccine became available in Spain and was included in the infant vaccination schedule in 2000. A catch-up campaign was carried out in children under six years of age. As a consequence, the incidence of meningococcal disease caused by serogroup C has fallen sharply during the last three epidemiological years in Spain. The risk of contracting serogroup C disease in 2002/2003 fell by 58% when compared with the season before the conjugate vaccine was introduced. There was also an important decrease in mortality. Three deaths due to serogroup C occurred in the age groups targeted for vaccination in 2002/2003, compared with 30 deaths in the same age groups in the season before the launch of the vaccine campaign. In the catch-up campaign the vaccine coverage reached values above 92%. For the 2001, 2002 and 2003 routine childhood immunisation programme coverage values ranged from 90% to 95%. During the past three years a total of 111 cases of serogroup C disease have been reported in patients in the vaccine target group. Most of the vaccination failures occurred during the epidemiological year 2002/2003. Eight (53%) vaccine failures occurred in children who had been routinely immunised in infancy, and could be related to a lost of protection with time since vaccination. The isolation of several B:2a:P1.5 strains (ST-11 lineage) is noteworthy. These may have their origin in C:2a:P1.5 strains which, after undergoing genetic recombination at the capsular operon level, express serogroup B. These strains could have relevant epidemic potential.

Influenza coverages in Spain and vaccination-related factors in the subgroup aged 50-64 years

This study sought to describe influenza vaccination coverages for different Spanish population subgroups, stressing the analysis of vaccination-related factors in subjects aged 50-64 years and estimating the possible beneficial effect of extending universal vaccination to this age group. A total of 6,400 surveys, targeting subjects over the age of 16 years and drawn from the 1997 Spanish National Health Survey, were used for study purposes. Influenza coverage was observed to rise significantly with age, and the reason cited by most subjects for seeking vaccination was medical indication. Coverage of the 50-64 age group was 21.6% (95% CI 19.4-23.8) and the variables associated with a greater probability of being vaccination were: residence in towns or cities with <10,000 inhabitants (OR 1.45); monthly income of less than 600 (OR 1.71); and presence of associated chronic disease (OR 3.07.) It is estimated that in Spain, 524,514 (40.7%) persons aged 50-64 years with associated chronic disease receive and 764,218 persons aged 50-64 years with associated chronic disease do not receive influenza vaccine. We conclude that the extremely high number of subjects in the 50-64 age range susceptible to influenza-related complications each year constitutes good grounds for universal vaccination being extended to said age group.

Biotransformation of a somatostatin analogue in precision-cut liver and kidney slices from rat, dog and man

1. Cleavage of the glucopyranosyl moiety of the somatostatin analogue SDZ CO 611 results in the formation of the major metabolite, SDZ CO 610, in liver and kidney slices of rat, dog and man, as well as in liver S9 and cytosol of rat and man. 2. The rates of SDZ CO 610 formation (nmol/h/mg slice protein) for all three species were determined in liver slices for 24 h and the relative order was: rat (0.12) > dog (0.096) = man (0.095). The rates of SDZ CO 610 formation (nmol/h/mg slice protein) for all three species in kidney were determined, and the relative order was: rat (0.29) > dog (0.16) > man (0.10). 3. SDZ CO 610 was rapidly formed by rat gut contents in the absence of NADPH, possibly by disaccharide-splitting enzymes. 4. Biotransformation of SDZ CO 611 to SDZ CO 610 in human and rat liver S9 and cytosol was similar to that found in liver slices cultures indicating that cleavage of the glucopyranosyl moiety of SDZ CO 611 could occur in the presence and in the absence of cytochrome P450, possibly by glucosidases in liver cytosol. 5. Rat intestinal homogenate also formed SDZ CO 610 but metabolism was dependent upon NADPH, suggestive of a cytochrome P450-dependent reaction.

The biotransformation of the ergot derivative CQA 206-291 in human, dog, and rat liver slice cultures and prediction of in vivo plasma clearance

Liver slice cultures from humans, dogs, and rats were used to investigate the biotransformation of the dopaminergic ergot agonist CQA 206-291 and to predict pharmacokinetic values for hepatic intrinsic clearance and plasma clearance. CQA 206-291 was extensively metabolized in the liver slice cultures and in vivo. The HPLC metabolite patterns from the liver slice cultures were similar for all three species, indicating the occurrence of the same metabolic pathways for CQA 206-291 biotransformation. The rate of formation of CQ 32-084, a pharmacologically active N-deethylated metabolite, exceeded that of metabolite d, a primary metabolite, by 1.4 fold in human liver slices, and by 1.7 fold in rat liver slices. In dog liver slice cultures, metabolite d formation exceeded CQ 32-084 formation by 1.3 fold and was formed at a statistically significantly greater rate (3 fold) than in either human or rat liver slices. The metabolism of ergots like CQA 206-291 by human fetal liver was also demonstrated in this study. However, the prominent metabolite from fetal and adult human liver microsomes was metabolite d with minor amounts of CQ 32-089 being formed. A major route of excretion for the metabolites of CQA 206-291 is the kidney, yet the kidney does not contribute to the metabolism of CQA 206-291. Kidney slices derived from humans, rats, and dogs did not metabolize CQA 206-291 within 24 hr. CQA 206-291 intrinsic clearance was derived from the half-life of parent drug disappearance in the liver slice and hepatocyte cultures, and from the ratio of Vmax/Km of human and rat liver microsomes.(ABSTRACT TRUNCATED AT 250 WORDS)

S-adenosyl-L-methionine reverses the cholestatic effect of ethinylestradiol in rat hepatocytes by increasing its catabolism

In this study, ethinylestradiol inhibited the uptake of taurocholate by cultured rat hepatocytes, increasing the Km while leaving the Vmax unchanged. S-Adenosyl-L-methionine (SAMe) had no effect on taurocholate uptake or release, but was able to reverse the competitive inhibition induced by ethinylestradiol. S-Adenosyl-L-homocysteine did not reverse this inhibition, which suggests that the methyl group of SAMe affects its activity. Several possible mechanisms for the action of SAMe were investigated. The methylation of cell membrane phospholipids was eliminated as a possible mechanism. The presence of SAMe greatly increased the catabolism of ethinylestradiol by hepatocytes and reduced its covalent binding to hepatocyte macromolecules. In culture supernatants, both highly polar (conjugated) and non-conjugated metabolites could be detected. Moreover, most of the metabolites were methylated. This suggests that SAMe may revert the effects of ethinylestradiol of taurocholate uptake by increasing its catabolic rate by hepatocytes.

Culture of human hepatocytes from small surgical liver biopsies. Biochemical characterization and comparison with in vivo

High yields of human hepatocytes (up to 23 X 10(6) viable cells/g) were obtained from small surgical liver biopsies (1 to 3 g) by a two-step collagenase microperfusion method. Cell viability was about 95%, attachment efficiency of hepatocytes seeded on fibronectin-coated plates was 80% within 1 h after plating, and cells survived for about 2 wk in serum-free Ham's F12 containing 0.2% bovine serum albumin, 10(-8) M insulin, and 10(-8) M dexamethasone. To evaluate the metabolism of human hepatocytes in serum-free conditions, we measured their most characteristic biochemical functions and compared them to those reported for human liver. After 24 h in culture, glycogen content was 1250 +/- 177 nmol glucose/mg cell protein and remained stable for several days. Gluconeogenesis from lactate in hormone-free media was (3.50 +/- 0.17 nmol glucose.mg-1.min-1) similar to that reported for human liver. Insulin at 10(-8) M activated glycolysis (X1.40) and glycogenesis (X1.34), and glucagon at 10(-9) M stimulated gluconeogenesis (X1.35) and glycogenolysis (X2.18). Human hepatocytes synthesized albumin, transferrin, fibrinogen, alpha 1-antitrypsin, alpha 1-antichymotrypsin, alpha 1-acid glycoprotein, haptoglobin, alpha 2-macroglobulin, and plasma fibronectin and excreted them to the culture medium. Maximum protein synthesis was stimulated by 10(-9) M dexamethasone. Basal urea synthesis oscillated between 2.5 and 3.5 nmol.mg-1 cell protein.min-1, about 5 times the value estimated for human liver. Cytochrome P-450 decreased in culture but it was still 20% of freshly isolated hepatocytes by Day 5 in culture. In addition, ethoxycumarin-O-deethylase and aryl hydrocarbon hydroxylase could be induced in vitro by treatment with methyl cholanthrene. Glutathione levels were similar to those reported for human liver (35 nmol.mg-1). The results of our work show that adult human hepatocytes obtained from small surgical biopsies and cultured in chemically defined conditions express their most important metabolic functions to an extent that is similar to that reported for adult human liver.

A study of the relative hepatotoxicity in vitro of the non-steroidal anti-inflammatory drugs ibuprofen, flurbiprofen and butibufen

1. The cytotoxic and metabolic effects of ibuprofen, flurbiprofen and butibufen have been studied in primary cultured hepatocytes. Toxic effects were observed for all three drugs at 10 times the therapeutic plasma concentration. 2. None of the drugs affected cell survival after 48 h of continuous exposure at their therapeutic plasma concentration, although significant increases of LDH leakage were detected. 3. Ibuprofen and butibufen were the most active in impairing gluconeogenesis from lactate (88% and 76% inhibition respectively) after 6 h exposure at therapeutic plasma concentrations. 4. At 5 times therapeutic plasma concentrations, albumin synthesis was inhibited 40% (ibuprofen), 35% (flurbiprofen) and 100% (butibufen) after 6 h exposure and significant effects were also observed after 24 h exposure. 5. Urea synthesis was inhibited 11% by butibufen at its therapeutic plasma concentration but only at higher concentrations by the other drugs. 6. Butibufen was potentially the most hepatotoxic drug as it has the highest therapeutic plasma concentration and had the lowest margin between therapeutic and toxic concentrations.

The potential use of cultured hepatocytes in predicting the hepatotoxicity of xenobiotics

1. A protocol is proposed for screening for hepatotoxicity of xenobiotics in vitro in which hepatocytes exposed to the compounds are evaluated for both cytotoxic and metabolic effects. Four established hepatotoxins have been studied. 2. alpha-Amanitin at 1.5 pg/mg cell protein inhibited RNA synthesis by 93% and reduced albumin synthesis to 56% of the control after 13 h treatment. 3. D-Galactosamine at 40 microM inhibited glycogen synthesis by 31%, glucuronidation of p-nitrophenol by 13% and albumin synthesis by 10%, and produced an increase in cytosolic enzyme leakage. 4. Thioacetamide decreased ureogenesis after 24 h of treatment at 230 microM (31% inhibition) and after 48 h at 2.3 microM (25% inhibition). 5. Ultrastructural alterations of hepatocytes were found after 48 h exposure to 1 mM acetaminophen and were preceded by extensive leakage of the enzymes GOT and LDH. Membrane damage was observed after 24 h exposure to 0.1 mM acetaminophen.

A cytochemical stain for glutathione in rat hepatocytes cultured on plastic

Thiol groups of glutathione react with the organomercurial azo dye mercury orange at a faster rate than with -SH groups of proteins. This property makes possible visualization of glutathione in cells without appreciable interference from other -SH groups. To render this method useful for cytochemical localization of glutathione in plastic cultured cells, it was necessary to adapt this reaction to the specific characteristics of the biological samples to be assayed. First, the choice of a solvent that would allow a convenient solubility of the dye and at the same time be compatible with the plastic culture plate was crucial. Second, to avoid diffusion of glutathione out of the cell the procedure for staining cells was also important. Satisfactory results were obtained after 30-40 sec reaction with 50 microM mercury orange in acetone/water 9:1, v/v, at room temperature. Glutathione-mercury orange complexes exhibited orange fluorescence on excitation with blue light. No diffusion of glutathione out of the cells was observed, and the hepatocytes stained with the dye showed orange fluorescence which paralleled their glutathione content.

Effects of benorylate and impacina on the metabolism of cultured hepatocytes

To directly evaluate the effects of benorylate and impacina on liver metabolism, we have adapted the use of cultured adult rat hepatocytes as a biological model. Cells were exposed to sub-toxic levels of the xenobiotic which were incorporated into the culture media. This was followed by the evaluation in treated cultures of some biochemical functions typical of the liver, namely, gluconeogenesis, glycogen metabolism, synthesis of plasma proteins and ureogenesis, and a comparison made with non-treated controls. Benorylate impaired glucose release by hepatocytes to the medium and net accumulation of glycogen was detected. Urea production also diminished (20%) in benorylate-treated cells. Impacina significantly increased the synthesis of albumin and tranferrin when added at therapeutic levels into the culture medium and did not alter other biochemical functions of the hepatocytes.