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Holdefer AA, Pizarro J, Saunders-Hastings P, Beers J, Sang A, Hettinger AZ, Blumenthal J, Martinez E, Jones LD, Deady M, Ezzeldin H, Anderson SA. Development of Interoperable Computable Phenotype Algorithms for Adverse Events of Special Interest to Be Used for Biologics Safety Surveillance: Validation Study. JMIR Public Health Surveill 2024; 10:e49811. [PMID: 39008361 PMCID: PMC11287092 DOI: 10.2196/49811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 02/24/2024] [Accepted: 05/26/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Adverse events associated with vaccination have been evaluated by epidemiological studies and more recently have gained additional attention with the emergency use authorization of several COVID-19 vaccines. As part of its responsibility to conduct postmarket surveillance, the US Food and Drug Administration continues to monitor several adverse events of special interest (AESIs) to ensure vaccine safety, including for COVID-19. OBJECTIVE This study is part of the Biologics Effectiveness and Safety Initiative, which aims to improve the Food and Drug Administration's postmarket surveillance capabilities while minimizing public burden. This study aimed to enhance active surveillance efforts through a rules-based, computable phenotype algorithm to identify 5 AESIs being monitored by the Center for Disease Control and Prevention for COVID-19 or other vaccines: anaphylaxis, Guillain-Barré syndrome, myocarditis/pericarditis, thrombosis with thrombocytopenia syndrome, and febrile seizure. This study examined whether these phenotypes have sufficiently high positive predictive value (PPV) to ensure that the cases selected for surveillance are reasonably likely to be a postbiologic adverse event. This allows patient privacy, and security concerns for the data sharing of patients who had nonadverse events can be properly accounted for when evaluating the cost-benefit aspect of our approach. METHODS AESI phenotype algorithms were developed to apply to electronic health record data at health provider organizations across the country by querying for standard and interoperable codes. The codes queried in the rules represent symptoms, diagnoses, or treatments of the AESI sourced from published case definitions and input from clinicians. To validate the performance of the algorithms, we applied them to electronic health record data from a US academic health system and provided a sample of cases for clinicians to evaluate. Performance was assessed using PPV. RESULTS With a PPV of 93.3%, our anaphylaxis algorithm performed the best. The PPVs for our febrile seizure, myocarditis/pericarditis, thrombocytopenia syndrome, and Guillain-Barré syndrome algorithms were 89%, 83.5%, 70.2%, and 47.2%, respectively. CONCLUSIONS Given our algorithm design and performance, our results support continued research into using interoperable algorithms for widespread AESI postmarket detection.
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Affiliation(s)
| | | | | | | | | | - Aaron Zachary Hettinger
- Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, Columbia, MD, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Joseph Blumenthal
- Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, Columbia, MD, United States
| | | | | | | | - Hussein Ezzeldin
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, United States
| | - Steven A Anderson
- Center for Biologics Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, United States
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Turnbull A, Putnam H, Sesay I, Bangura A, Bailey E, Dubbink JH, Grobusch MP. So, what's best? Accuracy and acceptance of thermometers in triage and inpatients in a low-resource tropical setting - The MaTe study. Heliyon 2024; 10:e25806. [PMID: 38371989 PMCID: PMC10873737 DOI: 10.1016/j.heliyon.2024.e25806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/20/2024] Open
Abstract
Objectives We searched for the most-suitable thermometry method in the low-resource, tropical setting of Sierra Leone, both in terms of accuracy and also patient and user acceptance. Methods We conducted a prospective comparative study of different methods of body temperature measurement. Each participant had their temperature taken by four different methods: non-contact infrared temperature (NCIT), axillary, tympanic membrane and rectal measurements. Rectal temperature was considered clinical gold standard. Primary outcome was predicted sensitivity and specificity of thermometry methods in detecting fever (rectal temperature ≥38.0 °C). Questionnaires were used to explore patient and healthcare worker attitudes towards different methods of temperature-taking. Results 824 rectal body temperature readings were taken from 562 participants. The mean rectal temperature was 37.4 °C (IQR 37 °C to 37.7 °C), with a minimum reading of 35.2 °C and maximum of 41.0 °C. Tympanic membrane thermometry showed the highest sensitivity of fever detection using the Genius3 TM thermometer (sensitivity 70.8 %, 95 % CI 60.2%-79.9 %; specificity 97.2 %, 95 % CI 95.5-98.4 %); and Braun TM (sensitivity 51.5 %, 95 % CI 42.6%-62.0 %; specificity 98.8 %, 95 % CI 97.7-99.5). NCIT thermometry sensitivity was low (36.8 %-41.4 % for the two devices used). Axillary thermometry sensitivity was 40.6 %. Participants ranked NCIT as the most and rectal as the least preferred method. Questionnaires from 32 participating nurses showed agreeability to using NCIT, TM and axillary methods routinely, but less so for rectal thermometry. Conclusions When combining the accuracy of different thermometry methods in detecting fever with user and patient acceptability, tympanic membrane thermometry appears most suitable but also has limitations.
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Affiliation(s)
| | - Harry Putnam
- Masanga Medical Research Unit (MMRU) and Masanga Hospital, Sierra Leone
| | - Issa Sesay
- Masanga Medical Research Unit (MMRU) and Masanga Hospital, Sierra Leone
| | - Aminata Bangura
- Masanga Medical Research Unit (MMRU) and Masanga Hospital, Sierra Leone
| | - Emily Bailey
- Masanga Medical Research Unit (MMRU) and Masanga Hospital, Sierra Leone
| | - Jan Henk Dubbink
- Masanga Medical Research Unit (MMRU) and Masanga Hospital, Sierra Leone
| | - Martin P. Grobusch
- Masanga Medical Research Unit (MMRU) and Masanga Hospital, Sierra Leone
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centresthe Netherlands
- Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Institut für Tropenmedizin, University of Tübingen, and German Centre for Infection Research (DZIF), Tübingen, Germany
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Heininger U, Buttery J, Kochhar S. Harmonized case definitions for endpoints in vaccine efficacy trials are needed. Vaccine 2023; 41:3947. [PMID: 36496284 DOI: 10.1016/j.vaccine.2022.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Affiliation(s)
| | - Jim Buttery
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Sonali Kochhar
- Department of Global Health, University of Washington, Seattle, USA; Global Healthcare Consulting, India
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Cheuvart B, Spiessens B, van Heesbeen R, Hung D, Andrade C, Korejwo-Peyramond J, Tavares-Da-Silva F. Harmonizing the collection of solicited adverse events in prophylactic vaccine clinical trials. Expert Rev Vaccines 2023; 22:849-859. [PMID: 37750613 DOI: 10.1080/14760584.2023.2262571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION During the clinical development of a vaccine, study participants are monitored for the occurrence of adverse events (AEs) over a defined period post-vaccination to assess the safety of prophylactic vaccines. Among the safety data collected, a standard practice in prophylactic vaccine clinical trials involves collecting reactogenicity data through daily AE solicitation of pre-defined sets of symptoms (i.e. solicited AEs). AREAS COVERED This paper aims to propose recommendations to improve and harmonize the collection of active AE solicitation in prophylactic vaccine clinical trials. EXPERT OPINION We recommend using limited lists of solicited AEs adapted to the vaccine technology and target population. While the US Food and Drug Administration toxicity grading scale is commonly used in adolescents/adults, harmonizing grading criteria in infants/children would facilitate the comparison of vaccines' safety profiles. Solicited systemic AEs should not systematically be considered causally related to vaccination. Collection of solicited AEs should occur in cohorts of a maximum of 1,000 vaccinated participants, as larger cohort sizes do not improve substantially the precision of AE incidence. The incidence of daily solicited AEs should be compared with a control group for improved interpretations of their clinical relevance. These suggestions would improve the characterization of safety profiles of vaccines.
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Affiliation(s)
| | - Bart Spiessens
- Statistics and Decision Sciences, Janssen Research & Development, Beerse, Belgium
| | - Roy van Heesbeen
- Clinical Development, Janssen Vaccines & Prevention, Leiden, Netherlands
| | | | | | | | - Fernanda Tavares-Da-Silva
- Clinical Research and Development, GSK, Wavre, Belgium
- Global Pharmacovigilance and Safety Science department, Organon, Brussels, Belgium
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Hu Y, Pan X, Chen F, Wang Y, Liang H, Shen L, Chen Y, Lv H. Surveillance of adverse events following immunization of 13-valent pneumococcal conjugate vaccine among infants, in Zhejiang province, China. Hum Vaccin Immunother 2022; 18:2035141. [PMID: 35240930 PMCID: PMC9009923 DOI: 10.1080/21645515.2022.2035141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the safety of 13-valent pneumococcal conjugate vaccine (PCV13) after its licensure. METHODS Review and describe the AEFI reported to national adverse event following immunization surveillance system (NAEFISS) in Zhejiang province from 2017 to 2020. Reporting rates of AEFI were calculated by age, city, severity of AEFI, categories of AEFI, and reaction categories. The data mining algorithm used in this study was reporting odds ratio (ROR). A value of ROR-1.96SE >1 (standard error [SE]) was considered as the positive signal. RESULTS NAEFISS received 3332 AEFI cases following PCV13, with a reporting rate of 17.58/10000 doses. Of the reported AEFI, 652 were serious AEFI cases and the reporting rate was 3.44 for serious AEFI. The reporting rate of fever was the highest among all the clinical diagnosis (7.39/10000 doses). The positive signals were obtained for injection site reaction (ROR-1.96SE: 1.55), hypotonic hyporesponsive episode (HHE) (ROR-1.96SE: 1.62) and febrile seizure (ROR-1.96SE: 1.52). CONCLUSION The present results supported previous observations that the PCV13 administered as the four-dose schedule was generally well tolerated in Chinese infants as we did not identify any new/unexpected safety concern from the NAEFISS during a four-year time period.
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Affiliation(s)
- Yu Hu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Xuejiao Pan
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Fuxing Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Hui Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Linzhi Shen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Yaping Chen
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Huakun Lv
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
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Cho S, Chang T, Yu T, Lee CH. Smart Electronic Textiles for Wearable Sensing and Display. BIOSENSORS 2022; 12:bios12040222. [PMID: 35448282 PMCID: PMC9029731 DOI: 10.3390/bios12040222] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 05/13/2023]
Abstract
Increasing demand of using everyday clothing in wearable sensing and display has synergistically advanced the field of electronic textiles, or e-textiles. A variety of types of e-textiles have been formed into stretchy fabrics in a manner that can maintain their intrinsic properties of stretchability, breathability, and wearability to fit comfortably across different sizes and shapes of the human body. These unique features have been leveraged to ensure accuracy in capturing physical, chemical, and electrophysiological signals from the skin under ambulatory conditions, while also displaying the sensing data or other immediate information in daily life. Here, we review the emerging trends and recent advances in e-textiles in wearable sensing and display, with a focus on their materials, constructions, and implementations. We also describe perspectives on the remaining challenges of e-textiles to guide future research directions toward wider adoption in practice.
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Affiliation(s)
- Seungse Cho
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA;
| | - Taehoo Chang
- School of Materials Engineering, Purdue University, West Lafayette, IN 47907, USA;
| | - Tianhao Yu
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA;
| | - Chi Hwan Lee
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA;
- School of Materials Engineering, Purdue University, West Lafayette, IN 47907, USA;
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA;
- Center for Implantable Devices, Purdue University, West Lafayette, IN 47907, USA
- Correspondence:
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Totterdell JA, Chacon GP, Estcourt MJ, Jones M, Richmond P, Snelling TL, Marsh JA. Statistical analysis plan for the OPTIMUM study: optimising immunisation using mixed schedules, an adaptive randomised controlled trial of a mixed whole-cell/acellular pertussis vaccine schedule. Trials 2022; 23:121. [PMID: 35130946 PMCID: PMC8819850 DOI: 10.1186/s13063-021-05874-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Objective The purpose of this double-blind, randomised, controlled trial is to compare allergic outcomes in children following vaccination with acellular pertussis (aP) antigen (standard of care in Australia) given at 2 months of age versus whole cell pertussis (wP) in the infant vaccine schedule. Participants Up to 3000 Australian infants 6 to <12 weeks of age born ≥32 weeks gestation. Interventions The intervention is a wP containing vaccine as the first scheduled pertussis vaccine dose instead of an aP containing vaccine. Outcomes The primary outcome is a binary indicator of history of IgE-mediated food allergy at the age of 12 months confirmed, where necessary, with an oral food challenge before 18 months of age. Secondary outcomes include (1) history of parent-reported clinician-diagnosed new onset of atopic dermatitis by 6 or 12 months of age with a positive skin prick test to any allergen before 12 months of age, (2) geometric mean concentration in pertussis toxin-specific IgG before and 21 to 35 days after a booster dose of aP at 18 months of age, and (3) sensitisation to at least one allergen by 12 months of age. Results Operating characteristics of trial decision rules were evaluated by trial simulation. The selected rules for success and futility approximately maintain type I error of 0.05 and achieved power 0.85 for a reduction in the primary outcome from 10% in the control group to 7% in the intervention group. Discussion A detailed, prospective statistical analysis plan (SAP) is presented for this Bayesian adaptive design. The plan was written by the trial statistician and details the study design, pre-specified adaptive elements, decision thresholds, statistical methods, and the simulations used to evaluate the operating characteristics of the trial. Application of this SAP will minimise bias and supports transparent and reproducible research. Trial registration Australia & New Zealand Clinical Trials Registry, ACTRN12617000065392. Registered on 12 January 2017 Study protocol
10.1136/bmjopen-2020-042838
Supplementary Information The online version contains supplementary material available at (10.1186/s13063-021-05874-6).
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Affiliation(s)
| | - Gladymar Perez Chacon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.,School of Population Health, Curtin University, Bentley, Australia
| | - Marie J Estcourt
- School of Public Health, University of Sydney, Camperdown, Australia
| | - Mark Jones
- School of Public Health, University of Sydney, Camperdown, Australia
| | - Peter Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Thomas L Snelling
- School of Public Health, University of Sydney, Camperdown, Australia
| | - Julie A Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
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Mahabala C, Dakappa PH, Gupta AR. A novel method for measuring sublingual temperature using conventional non-contact forehead thermometer. F1000Res 2022; 11:13. [PMID: 36071710 PMCID: PMC9396079 DOI: 10.12688/f1000research.74876.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 09/04/2024] Open
Abstract
Background: Sublingual temperature measurement is a quick and accurate representation of oral temperature and corresponds closely with core temperature. Sub-lingual temperature measurement using non-contact infrared thermometers has not been studied for this purpose and if accurate they would be a reliable and convenient way of recording temperature of a patient very quickly. The aim of the study was to evaluate the utility of recording sublingual temperature using an infrared non-contact thermometer and establish its accuracy by comparing the readings with tympanic thermometer recordings. Methods: This cross-sectional study was carried out in 29 patients (328 paired recordings from sublingual and tympanic sites simultaneously). Subjects were requested to keep their mouth closed for five minutes before recording the temperature. Sublingual recordings were performed for each patient at different times of the day using an infrared thermometer. The infrared thermometer was quickly brought 1cm away from the sublingual part of the tongue and the recordings were then done immediately. Readings were compared with the corresponding tympanic temperature. Results: The non-contact sublingual temperature correlated very closely with tympanic temperature (r=0.86, p<0.001). The mean difference between the infrared sublingual and tympanic temperature was 0.21°C (standard deviation [SD]:0.48°C, 95% confidence interval [CI] of 0.16-0.27). The intra-class correlation co-efficient (ICC) between core and sublingual temperatures was 0.830 (95% CI: 0.794 to 0.861) p<0.001. The sensitivity of sublingual IR (infrared) temperature of 37.65°C was 90% and specificity was 89% for core temperature >38°C. Conclusions: This innovative modification of using the forehead infrared thermometer to measure the sublingual temperature offers an accurate, rapid and non-contact estimation of core temperature.
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Affiliation(s)
- Chakrapani Mahabala
- Department of Internal Medicine, Kasturba Medical College,Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 575001, India
| | - Pradeepa H. Dakappa
- Department of Pharmacology, Nanjappa Hospitals, Durgigudi, Shivamogga, Karnataka, 577201, India
| | - Arjun R. Gupta
- Department of Internal Medicine, Kasturba Medical College,Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 575001, India
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Mahabala C, Dakappa PH, Gupta AR. A novel method for measuring sublingual temperature using conventional non-contact forehead thermometer. F1000Res 2022; 11:13. [PMID: 36071710 PMCID: PMC9396079 DOI: 10.12688/f1000research.74876.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 09/04/2024] Open
Abstract
Background: Sublingual temperature measurement is a quick and accurate representation of oral temperature and corresponds closely with core temperature. Sub-lingual temperature measurement using non-contact infrared thermometers has not been studied for this purpose and if accurate they would be a reliable and convenient way of recording temperature of a patient very quickly. The aim of the study was to evaluate the utility of recording sublingual temperature using an infrared non-contact thermometer and establish its accuracy by comparing the readings with tympanic thermometer recordings. Methods: This cross-sectional study was carried out in 29 patients (328 paired recordings from sublingual and tympanic sites simultaneously). Subjects were requested to keep their mouth closed for five minutes before recording the temperature. Sublingual recordings were performed for each patient at different times of the day using an infrared thermometer. The infrared thermometer was quickly brought 1cm away from the sublingual part of the tongue and the recordings were then done immediately. Readings were compared with the corresponding tympanic temperature. Results: The non-contact sublingual temperature correlated very closely with tympanic temperature (r=0.86, p<0.001). The mean difference between the infrared sublingual and tympanic temperature was 0.21°C (standard deviation [SD]:0.48°C, 95% confidence interval [CI] of 0.16-0.27). The intra-class correlation co-efficient (ICC) between core and sublingual temperatures was 0.830 (95% CI: 0.794 to 0.861) p<0.001. The sensitivity of sublingual IR (infrared) temperature of 37.65°C was 90% and specificity was 89% for core temperature >38°C. Conclusions: This innovative modification of using the forehead infrared thermometer to measure the sublingual temperature offers an accurate, rapid and non-contact estimation of core temperature.
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Affiliation(s)
- Chakrapani Mahabala
- Department of Internal Medicine, Kasturba Medical College,Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 575001, India
| | - Pradeepa H. Dakappa
- Department of Pharmacology, Nanjappa Hospitals, Durgigudi, Shivamogga, Karnataka, 577201, India
| | - Arjun R. Gupta
- Department of Internal Medicine, Kasturba Medical College,Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 575001, India
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Mahabala C, Dakappa PH, Gupta AR. A novel method for measuring sublingual temperature using conventional non-contact forehead thermometer. F1000Res 2022; 11:13. [PMID: 36071710 PMCID: PMC9396079 DOI: 10.12688/f1000research.74876.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Sublingual temperature measurement is a quick and accurate representation of oral temperature and corresponds closely with core temperature. Sub-lingual temperature measurement using non-contact infrared thermometers has not been studied for this purpose and if accurate they would be a reliable and convenient way of recording temperature of a patient very quickly. The aim of the study was to evaluate the utility of recording sublingual temperature using an infrared non-contact thermometer and establish its accuracy by comparing the readings with tympanic thermometer recordings. Methods: This cross-sectional study was carried out in 29 patients (328 paired recordings from sublingual and tympanic sites simultaneously). Subjects were requested to keep their mouth closed for five minutes before recording the temperature. Sublingual recordings were performed for each patient at different times of the day using an infrared thermometer. The infrared thermometer was quickly brought 1cm away from the sublingual part of the tongue and the recordings were then done immediately. Readings were compared with the corresponding tympanic temperature. Results: The non-contact sublingual temperature correlated very closely with tympanic temperature (r=0.86, p<0.001). The mean difference between the infrared sublingual and tympanic temperature was 0.21°C (standard deviation [SD]:0.48°C, 95% confidence interval [CI] of 0.16-0.27). The intra-class correlation co-efficient (ICC) between core and sublingual temperatures was 0.830 (95% CI: 0.794 to 0.861) p<0.001. The sensitivity of sublingual IR (infrared) temperature of 37.65°C was 90% and specificity was 89% for core temperature >38°C. Conclusions: This innovative modification of using the forehead infrared thermometer to measure the sublingual temperature offers an accurate, rapid and non-contact estimation of core temperature.
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Affiliation(s)
- Chakrapani Mahabala
- Department of Internal Medicine, Kasturba Medical College,Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 575001, India
| | - Pradeepa H. Dakappa
- Department of Pharmacology, Nanjappa Hospitals, Durgigudi, Shivamogga, Karnataka, 577201, India
| | - Arjun R. Gupta
- Department of Internal Medicine, Kasturba Medical College,Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 575001, India
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Xu L, Li N, Zhang L, Ma R, Fang T, Liu Z, Zhan S. Febrile Seizures and Measles-Containing Vaccines in China: A Self-Controlled Case Series Study. Vaccines (Basel) 2021; 9:vaccines9101073. [PMID: 34696181 PMCID: PMC8541362 DOI: 10.3390/vaccines9101073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 01/25/2023] Open
Abstract
Little is known about the risk of febrile seizures (FS) after vaccination with measles-containing vaccines (MCVs) in middle- and low-income countries. This self-controlled case series study aimed to evaluate the risk of FSs in Chinese children using data from the Ningbo Regional Health Information Platform. The observation period was 0-12 and 13-24 months of age for the MR and MMR vaccines, respectively. The relative incidences (RIs) within 0-6 days, 7-13 days, 14-27 days, and 28-42 days after vaccination with MCVs were estimated. The remaining observation period was the control period. The RIs within 0-6 days, 7-13 days, 14-27 days, and 28-42 days after MR vaccination were 1.11 [95% confidence interval (CI) 0.33 to 3.70], 0.80 (95% CI 0.23 to 2.86), 1.67 (95% CI 0.81 to 3.42), and 1.02 (95% CI 0.49 to 2.14), respectively. The corresponding RIs after MMR vaccination were 0.99 (95% CI 0.56 to 1.75), 1.17 (95% CI 0.68 to 2.01), 0.87 (95% CI 0.54 to 1.39), and 0.85 (95% CI 0.54 to 1.34), respectively. This study suggests that China's vaccination schedule for MCVs, as suggested by the World Health Organization (WHO) for countries with a high risk of measles mortality and ongoing transmission, does not increase the risk of FSs.
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Affiliation(s)
- Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (L.X.); (Z.L.)
| | - Ning Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China; (N.L.); (L.Z.); (R.M.); (T.F.)
| | - Liang Zhang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China; (N.L.); (L.Z.); (R.M.); (T.F.)
| | - Rui Ma
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China; (N.L.); (L.Z.); (R.M.); (T.F.)
| | - Ting Fang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, China; (N.L.); (L.Z.); (R.M.); (T.F.)
| | - Zhike Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (L.X.); (Z.L.)
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (L.X.); (Z.L.)
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing 100191, China
- Correspondence:
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Wennberg-Capellades L, Feijoo-Cid M, Llaurado-Serra M, Portell M. Feeling Informed Versus Being Informed: Mixed-Methods Analysis of Family Perceptions and Behavior Following a Pediatric Emergency Department Visit. J Pediatr Nurs 2021; 60:e87-e95. [PMID: 33840567 DOI: 10.1016/j.pedn.2021.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine perceptions of family-centered care, satisfaction, and quality of communication with health professionals during a pediatric emergency department visit, and to evaluate the perceived usefulness of the information received and whether provider treatment recommendations were followed after discharge. DESIGN Embedded mixed methods design with two concurrent phases. Participants in phase 1 were 385 adult relatives of children (age 6 days-17 years, mean 5.0 years, SD 4.5) seen in a pediatric emergency department. On the day of the visit, relatives completed questionnaires exploring perceptions of family-centered care, satisfaction (CSQ-8), and quality of communication with professionals (ad hoc instrument). For phase 2, we conducted daily structured telephone interviews with 37 of these parents over the six consecutive days following the emergency visit. RESULTS Satisfaction with the visit was significantly related to the perception of family-centered care (B = 0.25; 95% CI [0.20, 0.29]; p < .001). Follow-up interviews revealed that 45.9% (n = 17) of families did not follow the prescribed treatment and 32.4% (n = 12) made a further appointment with their primary care pediatrician. Qualitative analysis suggested that families lacked certain information from care providers. CONCLUSIONS Elements of a family-centered approach were rated positively and families believed that the information they received was useful. Importantly, more than half of the families who were followed up by telephone had doubts about provider treatment recommendations. PRACTICE IMPLICATIONS Family-centered care in the pediatric emergency department could enhance communication and help to ensure that treatment recommendations are followed at home.
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Affiliation(s)
- Laia Wennberg-Capellades
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Spain
| | - Maria Feijoo-Cid
- Nursing Department, Faculty of Medicine, Universitat Autonoma de Barcelona, Spain; Grup de REcerca Multidisciplinar en SAlut i Societat (GREMSAS), (2017 SGR 917), Spain.
| | - Mireia Llaurado-Serra
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Spain
| | - Mariona Portell
- Department of Psychobiology and Methodology of Health Sciences, Faculty of Psychology, Universitat Autònoma de Barcelona, Spain
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13
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Lindgren AL, Austin AH, Welsh KM. COVID Arm: Delayed Hypersensitivity Reactions to SARS-CoV-2 Vaccines Misdiagnosed as Cellulitis. J Prim Care Community Health 2021; 12:21501327211024431. [PMID: 34120504 PMCID: PMC8202256 DOI: 10.1177/21501327211024431] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The term “COVID arm” has been coined to describe a harmless delayed hypersensitivity reaction occurring approximately a week after administration of the novel SARS-CoV-2 mRNA vaccine. It appears as a red, warm, pruritic, indurated, or swollen area in the vicinity of the vaccine site. These reactions, especially if accompanied by systemic symptoms, have been mistaken for cellulitis. We report 3 cases of COVID arm, 2 of which were mistaken for cellulitis. Distinguishing features of COVID arm from cellulitis include pruritus as a common finding, occurrence approximately a week after vaccination, a lack of progression of symptoms, rapid response to topical steroids, and/or spontaneous resolution usually over 4 to 5 days. Practice Points: • Patients receiving SARS-CoV-2 vaccines may experience delayed hypersensitivity reactions characterized by erythema, swelling, and itching occurring near the vaccination site (COVID arm), approximately a week after vaccination. • Clinicians can distinguish SARS-CoV-2 vaccine reactions from cellulitis by the time of onset (approximately a week vs 5 days), by the lack of progression of symptoms, and resolution over 4 to 5 days. • Severe cases of COVID arm may be treated with topical steroids.
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14
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Buttery JP. Developing standard safety outcomes for COVID-19 vaccines. Vaccine 2021; 39:3025-3027. [PMID: 33888324 PMCID: PMC7953438 DOI: 10.1016/j.vaccine.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Jim P Buttery
- Centre for Health Informatics, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Murdoch Childrens Research Institute, Flemington Rd, Parkville 3052, Victoria, Australia.
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15
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Perez Chacon G, Estcourt MJ, Totterdell J, Campbell DE, Perrett KP, Marsh JA, Richmond PC, Wood N, Gold MS, Holt PG, Waddington CS, Snelling TL. OPTIMUM study protocol: an adaptive randomised controlled trial of a mixed whole-cell/acellular pertussis vaccine schedule. BMJ Open 2020; 10:e042838. [PMID: 33334840 PMCID: PMC7747585 DOI: 10.1136/bmjopen-2020-042838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Combination vaccines containing whole-cell pertussis antigens were phased out from the Australian national immunisation programme between 1997 and 1999 and replaced by the less reactogenic acellular pertussis (aP) antigens. In a large case-control study of Australian children born during the transition period, those with allergist diagnosed IgE-mediated food allergy were less likely to have received whole-cell vaccine in early infancy than matched population controls (OR: 0.77 (95% CI, 0.62 to 0.95)). We hypothesise that a single dose of whole-cell vaccine in early infancy is protective against IgE-mediated food allergy. METHODS AND ANALYSIS This adaptive double-blind randomised controlled trial is investigating whether a mixed whole-cell/aP vaccine schedule prevents allergic disease in the first year of life. The primary outcome is IgE-mediated food allergy by 12 months of age. Secondary outcomes include new onset of atopic dermatitis by 6 or 12 months of age; sensitisation to at least one allergen by 12 months of age; seroconversion in anti-pertussis toxin IgG titres after vaccination with aP booster at 18 months of age; and solicited systemic and local adverse events following immunisation with pertussis-containing vaccines. Analyses will be performed using a Bayesian group sequential design. ETHICS AND DISSEMINATION This study has been approved by the Child and Adolescent Health Service Human Research Ethics Committee, Perth, Western Australia (RGS 00019). The investigators will ensure that this trial is conducted in accordance with the principles of the Declaration of Helsinki and with the International Conference on Harmonisation Guidelines for Good Clinical Practice. Individual consent will be requested. Parents will be reimbursed reasonable travel and parking costs to attend the study visits. The dissemination of these research findings will follow the National Health and Medical Research Council of Australia Open Access Policy. TRIAL REGISTRATION NUMBER ACTRN12617000065392p.
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Affiliation(s)
- Gladymar Perez Chacon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Marie J Estcourt
- Health and Clinical Analytics Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - James Totterdell
- Health and Clinical Analytics Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dianne E Campbell
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten P Perrett
- Royal Children's Hospital, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie A Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Division of Paediatrics, School of Medicine, Perth Children's Hospital, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Nicholas Wood
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Michael S Gold
- Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Patrick G Holt
- The University of Western Australia, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Claire S Waddington
- Department of Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Thomas L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
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16
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Liu Y, Liu C, Gao M, Wang Y, Bai Y, Xu R, Gong R. Evaluation of a wearable wireless device with artificial intelligence, iThermonitor WT705, for continuous temperature monitoring for patients in surgical wards: a prospective comparative study. BMJ Open 2020; 10:e039474. [PMID: 33208327 PMCID: PMC7677341 DOI: 10.1136/bmjopen-2020-039474] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To evaluate a new-generation, non-invasive, wireless axillary thermometer with artificial intelligence, iThermonitor (WT705, Raiing Medical, Beijing, China), and to ascertain its feasibility for perioperative continuous body temperature monitoring in surgical patients. SETTING Departments of Biliary Surgery and Operating Room and the post-anaesthesia care unit of a university teaching hospital in Chengdu, China. PARTICIPANTS A total of 526 adult surgical patients were consecutively enrolled. DESIGN This was a prospective observational study. Axillary temperatures were continuously recorded with iThermonitor throughout the whole perioperative period. The temperatures of the contralateral armpit were measured with mercury thermometers at 8:00, 12:00, 16:00 and 20:00 every day and were used as references. OUTCOME MEASURES The outcomes were the accuracy and precision of the temperatures measured with iThermonitor, the validity to detect fever and the feasibility of continuous wear. Pairs of temperatures were evaluated with Student's t-test, Pearson's correlation and repeated-measures Bland-Altman plot. RESULTS A total of 3621 pairs of body temperatures were obtained. The temperatures measured with iThermonitor agreed with those measured with the mercury thermometers overall, with a mean difference of 0.03°C±0.35°C and a moderate correlation (r=0.755, p<0.001). The 95% limits of agreement (LoA) ranged from -0.63°C to 0.73°C, with 5.11% of the differences outside the 95% LoA. The intraclass correlation coefficient was 0.753. Continuous temperature monitoring captured more fevers than intermittent observation (117/526 vs 91/526, p<0.001), detected fever up to 4.35 hours earlier, and captured a higher peak temperature (0.29°C±0.27°C, 95% CI: 0.26-0.31). All subjects felt that wearing iThermonitor was more or less comfortable and did not affect their daily activities. CONCLUSIONS iThermonitor is promising for continuous remote temperature monitoring in surgical patients. However, further developments are still needed to improve the precision of this device, especially for temperature detection in underweight patients and those with lower body temperature. TRIAL REGISTRATION NUMBER ChiCTR1900024549; Results (registered on 5 July 2019).
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Affiliation(s)
- Yuwei Liu
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, P.R.China
| | - Changqing Liu
- Operating Room of Anesthesia Surgery Center, West China Hospital of Sichuan University, Chengdu, P.R.China
| | - Min Gao
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Wang
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yangjing Bai
- Department of Cardiac and Macrovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Ruihua Xu
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Renrong Gong
- West China School of Nursing, Sichuan University, Chengdu, P.R.China
- Department of Surgery, West China Hospital of Sichuan University, Chengdu, P.R.China
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17
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Valente Pinto M, Davis K, Andrews N, Goldblatt D, Borrow R, Southern J, Nordgren IK, Vipond C, Plested E, Miller E, Snape MD. Understanding the reactogenicity of 4CMenB vaccine: Comparison of a novel and conventional method of assessing post-immunisation fever and correlation with pre-release in vitro pyrogen testing. Vaccine 2020; 38:7834-7841. [PMID: 33109390 DOI: 10.1016/j.vaccine.2020.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Better understanding of vaccine reactogenicity is crucial given its potential impact upon vaccine safety and acceptance. Here we report a comparison between conventional and novel (continuous) methods of monitoring temperature and evaluate any association between reactogenicity and the monocyte activation test (MAT) employed for testing four-component capsular group B meningococcal vaccine (4CMenB) batches prior to release for clinical use in Europe. METHODS Healthy 7-12-week-old infants were randomised in two groups: group PCV13 2 + 1 (received pneumococcal conjugate vaccine 13 valent (PCV13) at 2, 4 and 12 months) and group PCV13 1 + 1 (received reduced schedule at 3 and 12 months). In both, infants received the remaining immunisations as per UK national schedule (including 4CMenB at 2, 4 and 12 months of age). Fever was measured for the first 24 h after immunisations using an axillary thermometer and with a wireless continuous temperature monitoring device (iButton®). To measure the relative pyrogenicity of individual 4CMenB batches, MAT was performed according to Ph. Eu. chapter 2.6.30 method C using PBMCs with IL-6 readout. RESULTS Fever rates detected by the iButton® ranged from 28.7% to 76.5% and from 46.6% to 71.1% in group PCV13 2 + 1 and PCV13 1 + 1 respectively, across all study visits. The iButton® recorded a higher number of fever episodes when compared with axillary measurements in both groups (range of axillary temperature fevers; group PCV13 2 + 1: 6.7%-38%; group PCV13 1 + 1: 11.4%-37.1%). An agreement between the two methods was between 0.39 and 0.36 (p < 0.001) at 8 h' time-point post primary immunisations. No correlation was found between MAT scores and fever rates, or other reported adverse events. CONCLUSIONS It is likely that conventional, intermittent, fever measurements underestimates fever rates following immunisation. 4CMenB MAT scores didn't predict reactogenicity, providing reassurance that vaccine batches with the highest acceptable pyrogen level are not associated with an increase in adverse events. Clinicaltrials.gov identifier: NCT02482636.
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Affiliation(s)
- Marta Valente Pinto
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, NIHR Oxford Biomedical Research Centre, United Kingdom.
| | - Kimberly Davis
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, NIHR Oxford Biomedical Research Centre, United Kingdom
| | - Nick Andrews
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - David Goldblatt
- Immunobiology Unit, UCL, Great Ormond Street Institute of Child Health, Biomedical Research Centre, London, United Kingdom
| | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester, United Kingdom
| | - Jo Southern
- Immunisation, Hepatitis and Blood Safety Department, National Infection Service, Public Health England, London, United Kingdom
| | - Ida Karin Nordgren
- Division of Biotherapeutics, The National Institute for Biological Standards and Control, United Kingdom
| | - Caroline Vipond
- Division of Bacteriology, The National Institute for Biological Standards and Control, United Kingdom
| | - Emma Plested
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, NIHR Oxford Biomedical Research Centre, United Kingdom
| | - Elizabeth Miller
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, NIHR Oxford Biomedical Research Centre, United Kingdom
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18
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Cowling BJ, Thompson MG, Ng TWY, Fang VJ, Perera RAPM, Leung NHL, Chen Y, So HC, Ip DKM, Iuliano AD. Comparative Reactogenicity of Enhanced Influenza Vaccines in Older Adults. J Infect Dis 2020; 222:1383-1391. [PMID: 32407535 DOI: 10.1093/infdis/jiaa255] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/07/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We analyzed data from a randomized controlled trial on the reactogenicity of 3 enhanced influenza vaccines compared with standard-dose (SD) inactivated influenza vaccine. METHODS We enrolled community-dwelling older adults in Hong Kong, and we randomly allocated them to receive 2017-2018 northern hemisphere formulations of SD vaccine (FluQuadri; Sanofi Pasteur), MF59-adjuvanted vaccine (FLUAD; Seqirus), high-dose (HD) vaccine (Fluzone High-Dose; Sanofi Pasteur), or recombinant hemagglutinin vaccine (Flublok; Sanofi Pasteur). Local and systemic reactions were evaluated at days 1, 3, 7, and 14 after vaccination. RESULTS Reported reactions were generally mild and short-lived. Systemic reactions occurred in similar proportions of participants by vaccine. Some local reactions were slightly more frequently reported among recipients of the MF59-adjuvanted and HD vaccines than among SD vaccine recipients. Participants reporting feverishness 1 day after vaccination had mean fold rises in postvaccination hemagglutination inhibition titers that were 1.85-fold higher (95% confidence interval, 1.01-3.38) for A(H1N1) than in those who did not report feverishness. CONCLUSIONS Some acute local reactions were more frequent after vaccination with MF59-adjuvanted and HD influenza vaccines, compared with SD inactivated influenza vaccine, whereas systemic symptoms occurred at similar frequencies in all groups. The association between feverishness and immunogenicity should be further investigated in a larger population. CLINICAL TRIALS REGISTRATION NCT03330132.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Female
- Hemagglutination Inhibition Tests
- Hong Kong/epidemiology
- Humans
- Influenza A virus/immunology
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/adverse effects
- Influenza Vaccines/immunology
- Influenza, Human/epidemiology
- Influenza, Human/prevention & control
- Betainfluenzavirus/immunology
- Male
- Vaccines, Inactivated/administration & dosage
- Vaccines, Inactivated/adverse effects
- Vaccines, Inactivated/immunology
- Vaccines, Synthetic/administration & dosage
- Vaccines, Synthetic/adverse effects
- Vaccines, Synthetic/immunology
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Affiliation(s)
- Benjamin J Cowling
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tiffany W Y Ng
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vicky J Fang
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ranawaka A P M Perera
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Nancy H L Leung
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yuyun Chen
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hau Chi So
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dennis K M Ip
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - A Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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19
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Marin M, Fiebelkorn AP, Bi D, Coleman LA, Routh J, Curns AT, McLean HQ. Adverse Events Among Young Adults Following a Third Dose of Measles-Mumps-Rubella Vaccine. Clin Infect Dis 2020; 73:e1546-e1553. [PMID: 32766827 DOI: 10.1093/cid/ciaa1090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A third measles-mumps-rubella vaccine (MMR) dose (MMR3) is recommended in the United States for persons at increased risk for mumps during outbreaks. MMR3 is also likely given to persons who might have received 2 doses of MMR but lack documentation. Since MMR3 safety data are limited, we describe adverse events in persons receiving MMR3 in a nonoutbreak setting. METHODS Young adults with 2 documented MMR doses were administered MMR3. From 2 weeks before until 4 weeks after MMR3 receipt, participants reported daily on 11 solicited, common symptoms potentially associated with MMR. Weekly rate differences in post- vs prevaccination (baseline) were evaluated by Poisson regression. Baseline rates were subtracted from postvaccination rates of significantly different symptoms to estimate the number and percentage of participants with excess risk for symptoms post-MMR3. Descriptive analyses were performed for 3 postvaccination injection-site symptoms. RESULTS The 662 participants were aged 18-28 years (median = 20 years); 56% were women. Headache, joint problems, diarrhea, and lymphadenopathy rates were significantly higher postvaccination vs baseline. We estimate that 119 participants (18%) reported more symptoms after MMR3 than prevaccination. By symptom, 13%, 10%, 8%, and 6% experienced increased symptoms of headache, joint problems, diarrhea, and lymphadenopathy, respectively, after MMR3. The median onset was Days 3-6 postvaccination; the median duration was 1-2 days. One healthcare visit for a potential vaccination-related symptom (urticaria) was reported. Injection-site symptoms were reported by 163 participants (25%); the median duration was 1-2 days. CONCLUSIONS Reported systemic and local events were mild and transient. MMR3 is safe and tolerable among young adults.
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Affiliation(s)
- Mona Marin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy Parker Fiebelkorn
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daoling Bi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura A Coleman
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Janell Routh
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron T Curns
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Huong Q McLean
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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20
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Valente Pinto M, O'Connor D, Galal U, Clutterbuck EA, Robinson H, Plested E, Bibi S, Camara Pellisso S, Hughes H, Kerridge S, Mujadidi YF, Findlow H, Borrow R, Snape MD, Pollard AJ. Immunogenicity and Reactogenicity of a Reduced Schedule of a 4-component Capsular Group B Meningococcal Vaccine: A Randomized Controlled Trial in Infants. Open Forum Infect Dis 2020; 7:ofaa143. [PMID: 32494580 DOI: 10.1093/ofid/ofaa143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background The 4-component capsular group B meningococcal vaccine (4CMenB) was licensed as a 4-dose infant schedule but introduced into the United Kingdom as 3 doses at 2, 4, and 12 months of age. We describe the immunogenicity and reactogenicity of the 2 + 1 schedule in infants. Methods Infants were randomized to receive 4CMenB with routine immunizations (test group) at 2, 4, and 12 months or 4CMenB alone at 6, 8, and 13 months of age (control group). Serum bactericidal antibody (SBA) assay against a serogroup B meningococcal reference strain (44/76-SL), memory B-cell responses to factor H binding protein, Neisseria adhesion protein A, Neisseria heparin binding antigen, Porin A (PorA), and reactogenicity was measured. Results One hundred eighty-seven infants were randomized (test group: 94; control group: 93). In the test group, 4CMenB induced SBA titers above the putative protective threshold (1:4) after primary and booster doses in 97% of participants. Postbooster, the SBA GMT (72.1; 95% confidence interval [CI], 51.7-100.4) was numerically higher than the serum bactericidal antibody geometric mean titre (SBA GMT) determined post-primary vaccination (48.6; 95% CI, 37.2-63.4). After primary immunizations, memory B-cell responses did not change when compared with baseline controls, but frequencies significantly increased after booster. Higher frequency of local and systemic adverse reactions was associated with 4CMenB. Conclusions A reduced schedule of 4CMenB was immunogenic and established immunological memory after booster.
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Affiliation(s)
- Marta Valente Pinto
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Daniel O'Connor
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Ushma Galal
- Nuffield Department of Primary Care Health Sciences, Clinical Trials Unit, University of Oxford, Oxford, United Kingdom
| | - Elizabeth A Clutterbuck
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Emma Plested
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Sagida Bibi
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Susana Camara Pellisso
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Harri Hughes
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Simon Kerridge
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Yama F Mujadidi
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Helen Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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21
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Satari HI, Puspita M, Sundoro J, Andrijono, Syafriyal, Sari RM, Bachtiar NS, Hadinegoro SR. Safety profile of Td vaccination in Indonesian pregnant women: a post-marketing surveillance study. MEDICAL JOURNAL OF INDONESIA 2019. [DOI: 10.13181/mji.v28i4.3321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The Indonesian Expanded Program of Immunization has implemented tetanus and diphtheria (Td) vaccination to replace the tetanus toxoid vaccine in pregnant women since the year 2016. Td vaccine is administered to protect against diphtheria and tetanus to the mother and her baby as well. This prospective study was conducted to assess the adverse reactions after Td immunization; besides, a retrospective study was conducted to observe the presence of severe local reaction (Arthus reaction), premature birth, and low birth weight history in the medical records of pregnant women who had received Td immunization in the past year.
METHODS A prospective observational study was conducted in 200 pregnant women. Local reactions and systemic events occurring within 28 days after immunization were recorded in the diary card and were confirmed by the health worker in the follow-up visit. A retrospective study was also conducted to evaluate 750 medical records of pregnant women who had received Td immunization. The study was conducted fromSeptember 2017 to January 2018. The study has been registered at ClinicalTrials.gov ID: NCT03383653.
RESULTS In 185 pregnant women who completed the study, the most common local reaction was pain, occurring in 33.5% of subjects within 24 hours after vaccination. Fever, other systemic reactions, and serious adverse events were not reported during the observation. In the retrospective study, 647 medical records were validated. No Arthus reaction was observed. The prevalence of premature birth was 1.24%, and that of low birth weight was 2.63%, which were below the normal rates.
CONCLUSIONS Td vaccination in pregnant women was safe and well-tolerated.
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Kachikis A, Eckert LO, Walker C, Bardají A, Varricchio F, Lipkind HS, Diouf K, Huang WT, Mataya R, Bittaye M, Cutland C, Boghossian NS, Mallett Moore T, McCall R, King J, Mundle S, Munoz FM, Rouse C, Gravett M, Katikaneni L, Ault K, Klein NP, Roberts DJ, Kochhar S, Chescheir N. Chorioamnionitis: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2019; 37:7610-7622. [PMID: 31783982 PMCID: PMC6891229 DOI: 10.1016/j.vaccine.2019.05.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/09/2019] [Indexed: 12/26/2022]
Affiliation(s)
| | | | | | - Azucena Bardají
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | | | - Khady Diouf
- Brigham and Women's Hospital, Boston, MA, USA
| | | | - Ronald Mataya
- Loma Linda University, Loma Linda, CA, USA; University of Malawi College of Medicine, Malawi
| | - Mustapha Bittaye
- Edward Francis Small Teaching Hospital, Banjul, The Gambia; Medical Research Council - The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia; University of The Gambia School of Medicine & Allied Health Sciences, The Gambia
| | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa; Department of Science and Technology National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nansi S Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | | | | | | | | | | | - Caroline Rouse
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Kevin Ault
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Centre, Oakland, CA, USA
| | | | - Sonali Kochhar
- Global Healthcare Consulting, India; Erasmus University Medical Center, Rotterdam, the Netherlands; University of Washington, Seattle, WA, USA
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Rouse CE, Eckert LO, Muñoz FM, Stringer JSA, Kochhar S, Bartlett L, Sanicas M, Dudley DJ, Harper DM, Bittaye M, Meller L, Jehan F, Maltezou HC, Šubelj M, Bardaji A, Kachikis A, Beigi R, Gravett MG. Postpartum endometritis and infection following incomplete or complete abortion: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 2019; 37:7585-7595. [PMID: 31783980 PMCID: PMC6891249 DOI: 10.1016/j.vaccine.2019.09.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 12/16/2022]
Affiliation(s)
- C E Rouse
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA
| | - L O Eckert
- Departments of Obstetrics and Gynecology and Global Health, University of Washington, Seattle, WA, USA
| | - F M Muñoz
- Department of Pediatrics, Section on Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - J S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - S Kochhar
- Global Healthcare Consulting; University of Washington, Seattle, USA; Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - L Bartlett
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - M Sanicas
- Sanofi Pasteur, Asia and JPAC Region, Singapore
| | - D J Dudley
- University of Virginia, Department of Obstetrics and Gynecology, Charlottesville, VA, USA
| | - D M Harper
- University of Michigan, Departments of Family Medicine and Obstetrics and Gynecology, Department of Epidemiology, Ann Arbor, MI, USA
| | - M Bittaye
- Edward Francis Small Teaching Hospital/University of The Gambia and Medical Research Council, The Gambia at London School of Hygiene and Tropical Medicine, USA
| | - L Meller
- Safety & Pharmacovigilance, Syneos Health, Raleigh, NC, USA
| | - F Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - H C Maltezou
- Department for Interventions in Healthcare Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - M Šubelj
- National Institute of Public Health, Ljubljana, Slovenia
| | - A Bardaji
- Barcelona Institute for Global Health, Barcelona, Spain
| | - A Kachikis
- Department of Obstetrics and Gynecology and Global Health, University of Washington, Seattle, WA, USA
| | - R Beigi
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M G Gravett
- Departments of Obstetrics and Gynecology and Global Health, University of Washington, Seattle, WA, USA.
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Safety of the rVSV ZEBOV vaccine against Ebola Zaire among frontline workers in Guinea. Vaccine 2019; 37:7171-7177. [DOI: 10.1016/j.vaccine.2018.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/28/2018] [Accepted: 09/06/2018] [Indexed: 11/20/2022]
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ADVANCE system testing: Can safety studies be conducted using electronic healthcare data? An example using pertussis vaccination. Vaccine 2019; 38 Suppl 2:B38-B46. [PMID: 31677946 DOI: 10.1016/j.vaccine.2019.06.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/02/2019] [Accepted: 06/17/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The Accelerated Development of Vaccine benefit-risk Collaboration in Europe (ADVANCE) public-private collaboration, aimed to develop and test a system for rapid benefit-risk monitoring of vaccines using healthcare databases in Europe. The objective of this proof-of-concept (POC) study was to test the feasibility of the ADVANCE system to generate incidence rates (IRs) per 1000 person-years and incidence rate ratios (IRRs) for risks associated with whole cell- (wP) and acellular- (aP) pertussis vaccines, occurring in event-specific risk windows in children prior to their pre-school-entry booster. METHODS The study population comprised almost 5.1 million children aged 1 month to <6 years vaccinated with wP or aP vaccines during the study period from 1 January 1990 to 31 December 2015. Data from two Danish hospital (H) databases (AUH and SSI) and five primary care (PC) databases from, UK (THIN and RCGP RSC), Spain (SIDIAP and BIFAP) and Italy (Pedianet) were analysed. Database-specific IRRs between risk vs. non-risk periods were estimated in a self-controlled case series study and pooled using random-effects meta-analyses. RESULTS The overall IRs were: fever, 58.2 (95% CI: 58.1; 58.3), 96.9 (96.7; 97.1) for PC DBs and 8.56 (8.5; 8.6) for H DBs; convulsions, 7.6 (95% CI: 7.6; 7.7), 3.55 (3.5; 3.6) for PC and 12.87 (12.8; 13) for H; persistent crying, 3.9 (95% CI: 3.8; 3.9) for PC, injection-site reactions, 2.2 (95% CI 2.1; 2.2) for PC, hypotonic hypo-responsive episode (HHE), 0.4 (95% CI: 0.4; 0.4), 0.6 (0.6; 0.6) for PC and 0.2 (0.2; 0.3) for H; and somnolence: 0.3 (95% CI: 0.3; 0.3) for PC. The pooled IRRs for persistent crying, fever, and ISR, adjusted for age and healthy vaccinee period were higher after wP vs. aP vaccination, and lower for convulsions, for all doses. The IRR for HHE was slightly lower for wP than aP, while wP was associated with somnolence only for dose 1 and dose 3 compared with aP. CONCLUSIONS The estimated IRs and IRRs were comparable with published data, therefore demonstrating that the ADVANCE system was able to combine several European healthcare databases to assess vaccine safety data for wP and aP vaccination.
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Woerner A, Pourmalek F, Panozzo C, Pileggi G, Hudson M, Caric A, Abraham S, Varricchio F, Velasco C, Oleske J, Bauwens J, Bonhoeffer J. Acute aseptic arthritis: Case definition & guidelines for data collection, analysis, and presentation of immunisation safety data. Vaccine 2018; 37:384-391. [PMID: 30342899 DOI: 10.1016/j.vaccine.2017.08.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Andreas Woerner
- University of Basel Children's Hospital, Basel, Switzerland.
| | | | - Catherine Panozzo
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Gecilmara Pileggi
- School of Medicine of Ribeirão Preto, University of São Paulo, Brazil; School of Medicine, University Federal of São Carlos, Brazil
| | | | | | - Sonya Abraham
- Imperial National Institute of Health Research/Wellcome CRF, Imperial College, London, United Kingdom
| | | | - Cesar Velasco
- Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | | | | | - Jan Bonhoeffer
- University of Basel Children's Hospital, Basel, Switzerland; Brighton Collaboration Foundation, Basel, Switzerland
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Abstract
BACKGROUND Comparing postvaccination fever rates in pediatric influenza vaccine clinical trials is difficult due to variability in how fever is reported. The impact of vaccine-related fever and antipyretic use on trivalent influenza vaccine immunogenicity in children is also unclear. METHODS In this pilot study, we used individual-level data provided by GlaxoSmithKline from 3 pediatric clinical trials of GlaxoSmithKline versus comparator trivalent influenza vaccine. We explored a primary study (NCT00764790), the largest trial involving young children (6-35 months, n = 3317), and further explored key findings in the 2 other trials (3-17 years, NCT00980005; 6 months to 17 years, NCT00383123). We analyzed postvaccination fever and antipyretic use, and their association with immunogenicity through use of multivariable regression. RESULTS Postvaccination fever data were reanalyzed from the primary study using the Brighton Collaboration standardized definition (vaccine-related fever ≥38°C, measured by any route, reported after each dose). Rates were substantially lower after first (2.7%-3.4%) and second doses (3.3%-4.1%), than those published (6.2%-6.6%; combined dose data, any causality). A pooled immunogenicity analysis combining the 3 studies (n = 5902) revealed children with postvaccination fever had significantly higher adjusted geometric mean titers than those without fever (ratio, 1.21-1.39; P ≤ 0.01). Conversely those with antipyretic use had significantly lower adjusted geometric mean titers (ratio, 0.80-0.87; P < 0.0006), dependent on virus strain. CONCLUSIONS Varying analyses and reporting methods can result in substantially different reported fever rates in studies. Standardized reporting of fever is needed to facilitate comparison between studies. Fever and antipyretic use may have important associations with influenza vaccine immunogenicity in children and need further prospective investigation.
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Abstract
Fever is a common symptom in children. Some children may present to their primary care physician with undifferentiated fever; that is, fever for which there is no obvious source from the history or physical examination. Undifferentiated fevers may be prolonged or recurrent. Distinguishing between the two is helpful for narrowing the differential diagnosis, which can be broad and include infections and inflammatory diseases and, rarely, malignancies and autoinflammatory disorders. The evaluation of such children requires a step-wise approach. Taking a detailed history, performing a thorough physical examination, and reviewing a fever and symptom diary is crucial in recognizing clues that may ultimately lead to a diagnosis. Some children who look good and whose fever disappears may never have a diagnosis, whereas referral to a specialist may be prudent for others. [Pediatr Ann. 2018;47(9):e347-e353.].
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Pantell RH, Roberts KB, Greenhow TL, Pantell MS. Advances in the Diagnosis and Management of Febrile Infants: Challenging Tradition. Adv Pediatr 2018; 65:173-208. [PMID: 30053923 DOI: 10.1016/j.yapd.2018.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Robert H Pantell
- Kapi'olani Medical Center for Women and Children, 1319 Punahou Street, Honolulu, HI 96824, USA.
| | | | - Tara L Greenhow
- Kaiser Permanente, Northern California, 2200 O'Farrell St, San Francisco, CA 94115, USA
| | - Matthew S Pantell
- University of California San Francisco, Suite 465, 3333 California Street, San Francisco, CA 94118, USA
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Effect of Tdap upon antibody response to meningococcal polysaccharide when administered before, with or after the quadrivalent meningococcal TT-conjugate vaccine (coadministered with the 13-valent pneumococcal CRM197-conjugate vaccine) in adult Hajj pilgrims: A randomised controlled trial. Vaccine 2018; 36:4375-4382. [PMID: 29880243 DOI: 10.1016/j.vaccine.2018.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/12/2018] [Indexed: 11/23/2022]
Abstract
Hajj pilgrims are susceptible to several serious infections and are required to receive multiple vaccinations. Polysaccharide-protein conjugate vaccines contain carrier proteins such as tetanus toxoid (TT), diphtheria toxoid or a mutant of diphtheria toxoid (CRM197). These carrier proteins may interact with other conjugate or combination vaccines containing tetanus or diphtheria on concurrent or sequential administration. We examined the immune interaction of separate and concomitant administration of a tetanus/diphtheria/acellular pertussis (Tdap) vaccine with a TT-conjugated quadrivalent meningococcal vaccine (MCV4) (coadministered with 13-valent pneumococcal CRM197-conjugate vaccine [PCV13]) in adult Australian pilgrims before attending Hajj in 2015. We randomly assigned each participant to one of three vaccination schedules. Group 1 received Tdap 3-4 weeks before receiving MCV4 coadministered with PCV13. Group 2 received all three vaccines concomitantly. Group 3 received MCV4 and PCV13 3-4 weeks before Tdap. Blood samples were collected at baseline, at each vaccination visit and 3-4 weeks after vaccination and tested for response to meningococcal serogroups C, W and Y using a serum bactericidal antibody (rSBA) assay with baby rabbit complement, and to diphtheria and tetanus toxoid, measuring IgG antibodies by ELISA. Participants completed symptom diaries after each vaccination. A total of 166 participants aged 18-64 (median 42) years were recruited, of whom 160 completed the study. Compared to the other groups, Group 1 (given Tdap first) had significantly lower proportion of subjects achieving a ≥4-fold rise in rSBA for serogroup W. No difference was detected across the three groups in achieving protection threshold (rSBA ≥8 post vaccination) or SBA geometric mean titre (GMT) post vaccination. Group 3, which was given MCV4/PCV13 first, had high levels of antibody against diphtheria and tetanus than the other groups, when tested prior to receipt of Tdap; Only the anti-tetanus responses remained significantly higher after Tdap administration. No serious adverse events were reported. In conclusion, when multiple vaccination is required for Hajj pilgrims, administering Tdap concurrently with MCV4/PCV13 produces adequate immune responses, and avoids meningococcal immune interference, in the convenience of a single consultation. However, giving Tdap 3-4 weeks after MCV4/PCV13 has the advantage of an enhanced tetanus toxoid response. The trial is Trials Registry (ANZCTR): ACTRN12613000536763.
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Harel L, Hashkes PJ, Lapidus S, Edwards KM, Padeh S, Gattorno M, Marshall GS. The First International Conference on Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis Syndrome. J Pediatr 2018; 193:265-274.e3. [PMID: 29246466 DOI: 10.1016/j.jpeds.2017.10.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Liora Harel
- Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tiva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Philip J Hashkes
- Pediatric Rheumatology Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Hadassah Hebrew University School of Medicine, Jerusalem, Israel
| | - Sivia Lapidus
- Pediatric Rheumatology Division, Department of Pediatrics, Goryeb Children's Hospital, Morristown, NJ; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Kathryn M Edwards
- Department of Pediatrics and Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, TN; Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Shai Padeh
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Italy
| | - Marco Gattorno
- Rheumatology Unit, Department of Pediatrics G, Gaslini Scientific Institute for Children, Genoa, Italy; University of Genoa, Genoa, Italy
| | - Gary S Marshall
- Divison of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, KY
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Hoppe C, Obermeier P, Muehlhans S, Alchikh M, Seeber L, Tief F, Karsch K, Chen X, Boettcher S, Diedrich S, Conrad T, Kisler B, Rath B. Innovative Digital Tools and Surveillance Systems for the Timely Detection of Adverse Events at the Point of Care: A Proof-of-Concept Study. Drug Saf 2017; 39:977-88. [PMID: 27350063 DOI: 10.1007/s40264-016-0437-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND OBJECTIVE Regulatory authorities often receive poorly structured safety reports requiring considerable effort to investigate potential adverse events post hoc. Automated question-and-answer systems may help to improve the overall quality of safety information transmitted to pharmacovigilance agencies. This paper explores the use of the VACC-Tool (ViVI Automated Case Classification Tool) 2.0, a mobile application enabling physicians to classify clinical cases according to 14 pre-defined case definitions for neuroinflammatory adverse events (NIAE) and in full compliance with data standards issued by the Clinical Data Interchange Standards Consortium. METHODS The validation of the VACC-Tool 2.0 (beta-version) was conducted in the context of a unique quality management program for children with suspected NIAE in collaboration with the Robert Koch Institute in Berlin, Germany. The VACC-Tool was used for instant case classification and for longitudinal follow-up throughout the course of hospitalization. Results were compared to International Classification of Diseases , Tenth Revision (ICD-10) codes assigned in the emergency department (ED). RESULTS From 07/2013 to 10/2014, a total of 34,368 patients were seen in the ED, and 5243 patients were hospitalized; 243 of these were admitted for suspected NIAE (mean age: 8.5 years), thus participating in the quality management program. Using the VACC-Tool in the ED, 209 cases were classified successfully, 69 % of which had been missed or miscoded in the ED reports. Longitudinal follow-up with the VACC-Tool identified additional NIAE. CONCLUSION Mobile applications are taking data standards to the point of care, enabling clinicians to ascertain potential adverse events in the ED setting and during inpatient follow-up. Compliance with Clinical Data Interchange Standards Consortium (CDISC) data standards facilitates data interoperability according to regulatory requirements.
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Affiliation(s)
- Christian Hoppe
- Department of Pediatrics, Charité University Medical Center Berlin, Berlin, Germany
- Vienna Vaccine Safety Initiative, Berlin, Germany
| | - Patrick Obermeier
- Department of Pediatrics, Charité University Medical Center Berlin, Berlin, Germany
- Vienna Vaccine Safety Initiative, Berlin, Germany
| | - Susann Muehlhans
- Department of Pediatrics, Charité University Medical Center Berlin, Berlin, Germany
- Vienna Vaccine Safety Initiative, Berlin, Germany
| | - Maren Alchikh
- Department of Pediatrics, Charité University Medical Center Berlin, Berlin, Germany
- Vienna Vaccine Safety Initiative, Berlin, Germany
| | - Lea Seeber
- Department of Pediatrics, Charité University Medical Center Berlin, Berlin, Germany
- Vienna Vaccine Safety Initiative, Berlin, Germany
| | - Franziska Tief
- Department of Pediatrics, Charité University Medical Center Berlin, Berlin, Germany
- Vienna Vaccine Safety Initiative, Berlin, Germany
| | - Katharina Karsch
- Department of Pediatrics, Charité University Medical Center Berlin, Berlin, Germany
- Vienna Vaccine Safety Initiative, Berlin, Germany
| | - Xi Chen
- Department of Pediatrics, Charité University Medical Center Berlin, Berlin, Germany
- Vienna Vaccine Safety Initiative, Berlin, Germany
| | - Sindy Boettcher
- National Reference Centre for Poliomyelitis and Enteroviruses, Robert Koch Institute, Berlin, Germany
| | - Sabine Diedrich
- National Reference Centre for Poliomyelitis and Enteroviruses, Robert Koch Institute, Berlin, Germany
| | - Tim Conrad
- Department of Mathematics and Computer Sciences, Freie Universität Berlin, Berlin, Germany
| | - Bron Kisler
- Vienna Vaccine Safety Initiative, Berlin, Germany
- Clinical Data Interchange Standards Consortium, Austin, TX, USA
| | - Barbara Rath
- Department of Pediatrics, Charité University Medical Center Berlin, Berlin, Germany.
- Vienna Vaccine Safety Initiative, Berlin, Germany.
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Mohanty L, Sharma S, Behera B, Panwar S, Paliwal C, Singh A, Gupta A, Chilkoti DC. A randomized, open-label clinical trial to evaluate immunogenicity and safety of an indigenously developed DTwP-Hib tetravalent combination vaccine (Easyfour®-TT) with Quadrovax® in Indian infants. Hum Vaccin Immunother 2017; 13:2025-2031. [PMID: 28700282 DOI: 10.1080/21645515.2017.1342020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
An open-label, randomized, multi-center trial was conducted to compare the immunogenicity and safety of an indigenously developed tetravalent DTwP-Hib vaccine, Easyfour®-TT with a commercially available vaccine, Quadrovax®. A total of 244 infants in good health, aged 6-10 weeks, were randomized in a 1:1 allocation to receive three doses of the test or comparator vaccine. Immunogenicity of the vaccines was determined by measuring the baseline and post-vaccination antibody response against the vaccine antigens; safety was evaluated in terms of local and systemic reactions (solicited and unsolicited) reported during the trial. Similar levels of seroprotection/seroresponse were achieved, 4 weeks after receiving 3 doses of Easyfour®-TT and Quadrovax®, and the antibody response of Easyfour®-TT was found non-inferior to Quadrovax®, against all four vaccine antigens. Both vaccines were well tolerated and had similar reactogenicity profiles, with a significantly lower occurrence of local (redness at injection site) and systemic reactions (irritability post-vaccination) with Easyfour®-TT vaccine as compared to Quadrovax® (p < 0.05). All adverse events resolved completely with no sequelae. All through the study, only one serious adverse event was observed that completely resolved upon treatment and was deemed unrelated to the vaccine administered. This study demonstrated that Easyfour®-TT vaccine was safe and immunogenic. CLINICAL TRIAL REGISTRATION NUMBER CTRI/2014/12/005326 (registered with the Clinical Trial Registry of India (CTRI)).
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Affiliation(s)
- Lalitendu Mohanty
- a Clinical Research Department , Panacea Biotec Ltd. , G-3, B-1 Extn/ Mohan Co-op, New Delhi , Delhi , India
| | - Sunil Sharma
- a Clinical Research Department , Panacea Biotec Ltd. , G-3, B-1 Extn/ Mohan Co-op, New Delhi , Delhi , India
| | - Beauty Behera
- a Clinical Research Department , Panacea Biotec Ltd. , G-3, B-1 Extn/ Mohan Co-op, New Delhi , Delhi , India
| | - Sachin Panwar
- a Clinical Research Department , Panacea Biotec Ltd. , G-3, B-1 Extn/ Mohan Co-op, New Delhi , Delhi , India
| | - Charu Paliwal
- a Clinical Research Department , Panacea Biotec Ltd. , G-3, B-1 Extn/ Mohan Co-op, New Delhi , Delhi , India
| | - Anit Singh
- a Clinical Research Department , Panacea Biotec Ltd. , G-3, B-1 Extn/ Mohan Co-op, New Delhi , Delhi , India
| | - Anu Gupta
- a Clinical Research Department , Panacea Biotec Ltd. , G-3, B-1 Extn/ Mohan Co-op, New Delhi , Delhi , India
| | - Deepak Chandra Chilkoti
- a Clinical Research Department , Panacea Biotec Ltd. , G-3, B-1 Extn/ Mohan Co-op, New Delhi , Delhi , India
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Kemmeren JM, van der Maas NA, de Melker HE. Comparison of the tolerability of newly introduced childhood vaccines in the Netherlands. Eur J Pediatr 2017; 176:757-768. [PMID: 28429115 DOI: 10.1007/s00431-017-2901-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED In 2011, the 7-valent conjugated pneumococcal vaccine (PCV7) was replaced by the 10-valent vaccine (PCV10) and universal hepatitis B vaccination has been introduced in the Netherlands. A questionnaire study was conducted to assess the tolerability of DTaP-IPV-Hib + PCV7 (PCV7-cohort), DTaP-IPV-Hib + PCV10 (PCV10-cohort), and DTaP-IPV-Hib-HepB + PCV10 (HepB-cohort). Parents were asked to report in questionnaires local reactions and systemic adverse events (AEs) before and after vaccination of their infant at 2, 3, 4, and 11 months of age. For 29.0 and 29.4% infants of the PCV7-cohort, at least one local reaction was reported in the week after the first dose of DTaP-IPV (left leg) and PCV-7 vaccination (right leg). Significantly more infants from the PCV10-cohort (45.1%, p < 0.001 and 44.6%, p < 0.001) and HepB-cohort (42.6%, p < 0.001 and 41.9%, p < 0.001) reported at least one local reaction. This effect was less pronounced after the successive doses. Most of the infants experienced at least one systemic AE, and after dose 4, this was higher for infants in the PCV10-cohort (65.9%, p = 0.047) and HepB-cohort (70.6%, p = 0.000) compared to the PCV7-cohort (62.3%). CONCLUSION Addition of antigens to a vaccine resulted in a higher reactogenicity, but the AEs were in general mild and transient. What is Known: • Assessment of adverse events is crucial for achieving the highest safety in immunization programs, in order to inform public health actions and maintain public confidence in immunization programs. What is New: • Newly introduced vaccines DTaP-IPV-Hib-HepB and PCV10 are generally safe and well tolerated in infants. • These results are useful for information purposes and for monitoring variations in rates of AEs in the general population or in the target group over time.
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Affiliation(s)
- Jeanet M Kemmeren
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Nicoline At van der Maas
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Hester E de Melker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
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Rath B, Conrad T, Myles P, Alchikh M, Ma X, Hoppe C, Tief F, Chen X, Obermeier P, Kisler B, Schweiger B. Influenza and other respiratory viruses: standardizing disease severity in surveillance and clinical trials. Expert Rev Anti Infect Ther 2017; 15:545-568. [PMID: 28277820 PMCID: PMC7103706 DOI: 10.1080/14787210.2017.1295847] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Influenza-Like Illness is a leading cause of hospitalization in children. Disease burden due to influenza and other respiratory viral infections is reported on a population level, but clinical scores measuring individual changes in disease severity are urgently needed. Areas covered: We present a composite clinical score allowing individual patient data analyses of disease severity based on systematic literature review and WHO-criteria for uncomplicated and complicated disease. The 22-item ViVI Disease Severity Score showed a normal distribution in a pediatric cohort of 6073 children aged 0-18 years (mean age 3.13; S.D. 3.89; range: 0 to 18.79). Expert commentary: The ViVI Score was correlated with risk of antibiotic use as well as need for hospitalization and intensive care. The ViVI Score was used to track children with influenza, respiratory syncytial virus, human metapneumovirus, human rhinovirus, and adenovirus infections and is fully compliant with regulatory data standards. The ViVI Disease Severity Score mobile application allows physicians to measure disease severity at the point-of care thereby taking clinical trials to the next level.
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Affiliation(s)
- Barbara Rath
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany.,c Division of Epidemiology and Public Health , University of Nottingham , Nottingham , UK
| | - Tim Conrad
- d Department of Mathematics and Computer Science , Freie Universität Berlin , Berlin , Germany
| | - Puja Myles
- c Division of Epidemiology and Public Health , University of Nottingham , Nottingham , UK
| | - Maren Alchikh
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Xiaolin Ma
- b Department of Pediatrics , Charité University Medical Center , Berlin , Germany.,e National Reference Centre for Influenza and Other Respiratory Viruses , Robert Koch Institute , Berlin , Germany
| | - Christian Hoppe
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,d Department of Mathematics and Computer Science , Freie Universität Berlin , Berlin , Germany
| | - Franziska Tief
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Xi Chen
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Patrick Obermeier
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Bron Kisler
- f Clinical Data Standards Interchange Consortium (CDISC) , Austin , TX , USA
| | - Brunhilde Schweiger
- e National Reference Centre for Influenza and Other Respiratory Viruses , Robert Koch Institute , Berlin , Germany
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36
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Dai Q, Liang Q, Hu Y, Meng F, Li J, Hou L, Zhou H, Chu K, Hu X, Tang R, Wang W, Hu J, Huang H, Li Z, Yang S, Zhu F. The early-onset febrile reaction following vaccination and associated factors: An exploratory sub-study based on the Ebola vaccine clinical trial. Hum Vaccin Immunother 2017; 13:1-6. [PMID: 28362208 DOI: 10.1080/21645515.2017.1288328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
A phase-1 clinical trial aimed to assess the safety and immunogenicity of the type-5 adenovirus vector based Ebola vaccine (Ad5-EBOV) was conducted in China. To provide more evidence for the safety evaluation and dose-selection, an exploratory sub-study using a wireless automatic temperature measuring platform was done based on the phase-1 clinical trial. The main aim of the sub-study was to obtain more information about the occurrence of fever and detect the potential associated factors, second was to assess the feasibility of the temperature measuring platform in vaccine clinical trials. Temperature data of 3 treatment groups all presented a rising tendency during the first 6 hours after vaccination, the incidence of elevated temperature and possible associated factors were analyzed. For the incidence of elevated temperature, no marked dose-response relationship was found in 6 hours with wireless thermometers; the information from mercury thermometers showed that the grade-1 fever proportion peaked at 6 hours and there was no difference between groups, while grade-2 fever proportion peaked at 24 hours and was significantly higher in high-dose group than those in the other 2 groups. Significant differences were found between sex groups (males vs. female, incidence rate ratios (IRR) = 2.93 and 7.62 for any-grade, grade-2 fever respectively, P<0.001); a decline in grade-2 fever incidence was found with the increasing age groups (IRR = 0.78, P = 0.003) and body mass index (BMI, IRR = 0.67, P<0.001) .Our findings show that the dose-dependent manner between fever and the dose of Ad5-EBOV in this study might emerge after 6 hours, and which is slight and transient. Wireless thermometers secured on the skin surface are not suitable for a long time (longer than 6 hours) measurement, new methods for temperature monitoring, like ear temperature measurement, should be tested in the further research.
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Affiliation(s)
- Qigang Dai
- a Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Qi Liang
- a Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Yuemei Hu
- a Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Fanyue Meng
- a Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Jingxin Li
- a Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Lihua Hou
- b Beijing Institute of Biotechnology , Beijing , China
| | | | - Kai Chu
- a Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Xiaokui Hu
- d Taixing Center for Disease Control and Prevention , Taizhou , China
| | - Rong Tang
- a Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Wenjuan Wang
- a Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Jialei Hu
- a Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Haodi Huang
- a Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Zhen Li
- a Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Shuqi Yang
- a Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Fengcai Zhu
- a Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
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Vigo A, Costagliola G, Ferrero E, Noce S. Hypotonic-hyporesponsive episodes after administration of hexavalent DTP-based combination vaccine: A description of 12 cases. Hum Vaccin Immunother 2017; 13:1-4. [PMID: 28301267 DOI: 10.1080/21645515.2017.1287642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Hypotonic-hyporesponsive (HHE) episodes are known and recognized phenomena, which typically occur within 48 hours of immunisation..Our aim is to describe 12 cases of HHE brought to the Center of Pediatric Sleep Medicine, with attention to the clinical features of the episode and their follow-up. Medical charts of infants visited between 2005-2015 were reviewed. Twelve infants showed a HHE using HHE using Brighton Collaboration Criteria. All infants received a Hexavalent diphtheria -tetanus -pertussis acellular component -hepatitis B-,inactivated poliovirus- Haemophilus influenzae type-b conjugate vaccine. Five out of 12 were brought to Emergency Department, where 2 were symptomatic (one was hyporeactive, the other had fever). No infant died during the episode, or the follow-up, nor developed neurological disease after subsequent vaccinations. HHE are confirmed as benign events, even after administration of hexavalent vaccination, devoid of negative neuropsychomotor outcome.
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Affiliation(s)
- Alessandro Vigo
- a Department of Paediatrics , Center for Pediatric Sleep Medicine and SIDS, Regina Margherita Children's Hospital, Città della Salute e della Scienza , Turin , Italy
| | - Giulia Costagliola
- a Department of Paediatrics , Center for Pediatric Sleep Medicine and SIDS, Regina Margherita Children's Hospital, Città della Salute e della Scienza , Turin , Italy
| | - Elisa Ferrero
- a Department of Paediatrics , Center for Pediatric Sleep Medicine and SIDS, Regina Margherita Children's Hospital, Città della Salute e della Scienza , Turin , Italy
| | - Silvia Noce
- a Department of Paediatrics , Center for Pediatric Sleep Medicine and SIDS, Regina Margherita Children's Hospital, Città della Salute e della Scienza , Turin , Italy
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38
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Meng FY, Sun Y, Shen YG, Pan HF, Tang JH, Wang BB, Wu CH, Ye DQ. Safety of measles-containing vaccines in post-marketing surveillance in Anhui, China. PLoS One 2017; 12:e0172108. [PMID: 28192490 PMCID: PMC5305249 DOI: 10.1371/journal.pone.0172108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 01/31/2017] [Indexed: 12/04/2022] Open
Abstract
The safety of measles vaccination is of great interest and importance to public health practice and the general society. We have analyzed the adverse events following immunization (AEFIs) of currently used measles-containing vaccines (including live attenuated measles vaccine, live attenuated measles and rubella combined vaccine, live attenuated measles and mumps combined vaccine, live attenuated Measles, Mumps and Rubella Combined Vaccine) in Anhui Province, China. From 2009 to 2014, 9.9 million doses of measles-containing vaccines were administrated and 1893 AEFIs were found (191.4 per million doses), of which, 33 serious AEFIs (3.3 per million vaccine doses) were reported. 59.4% (1124 cases) were male cases, and 85.1% (1611 cases) occurred in persons aged < 1 year. 93.3% (1766 cases) occurred at the first dose of vaccination and 95.9% (1815 cases) were found within 3 days after vaccination. This study presents up-to-date data and suggests that the measles-containing vaccines used in Anhui Province of China are safe.
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Affiliation(s)
- Fan-Ya Meng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Province, Hefei, Anhui, China
- Department of Immunization and Prevention, Anhui Center for Disease Control and Prevention, Hefei, Anhui, China
| | - Yong Sun
- Department of Immunization and Prevention, Anhui Center for Disease Control and Prevention, Hefei, Anhui, China
| | - Yong-Gang Shen
- Department of Immunization and Prevention, Anhui Center for Disease Control and Prevention, Hefei, Anhui, China
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Province, Hefei, Anhui, China
| | - Ji-Hai Tang
- Department of Immunization and Prevention, Anhui Center for Disease Control and Prevention, Hefei, Anhui, China
| | - Bin-Bing Wang
- Department of Immunization and Prevention, Anhui Center for Disease Control and Prevention, Hefei, Anhui, China
| | - Chang-Hao Wu
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Dong-Qing Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Province, Hefei, Anhui, China
- * E-mail:
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Li-Kim-Moy JP, Yin JK, Heron L, Leask J, Lambert SB, Nissen M, Sloots T, Booy R. Influenza vaccine efficacy in young children attending childcare: A randomised controlled trial. J Paediatr Child Health 2017; 53:47-54. [PMID: 27592696 DOI: 10.1111/jpc.13313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 04/02/2016] [Accepted: 06/19/2016] [Indexed: 12/12/2022]
Abstract
AIM Influenza causes a substantial burden in young children. Vaccine efficacy (VE) data are limited in this age group. We examined trivalent influenza vaccine (TIV) efficacy and safety in young children attending childcare. METHODS A double-blind, randomised controlled trial in children aged 6 to <48 months was conducted with recruitment from Sydney childcare centres in 2011. Children were randomised to receive two doses of TIV or control hepatitis A vaccine. Efficacy was evaluated against polymerase chain reaction-confirmed influenza using parent-collected nose/throat swabs during influenza-like-illness. Safety outcomes were assessed during 6 months of follow-up. RESULTS Fifty-seven children were allocated to influenza vaccine and 67 to control; all completed the study. The influenza attack rate was 1.8 vs 13.4% in the TIV and control groups, respectively; VE 87% (95%CI: 0-98%). For children aged 24 to <48 months, 0 vs 8 (18.6%) influenza infections occurred in the TIV and control groups respectively, giving a VE of 100% (16-100%). Efficacy was not shown in children 6 to <24 months, probably due to insufficient power. Injection site and systemic adverse events were mostly mild to moderate with no significant differences, apart from more mild diarrhoea following dose 2 in TIV recipients (11.8 vs 0%). CONCLUSIONS Influenza vaccine appeared efficacious in the subgroup of children aged 24 to <48 months, although caution is required due to the small number of participants. There were no serious adverse events and most parents would vaccinate again. Influenza vaccination in a childcare setting could be valuable and a larger confirmatory study would be helpful.
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Affiliation(s)
- Jean P Li-Kim-Moy
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jiehui K Yin
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Leon Heron
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Julie Leask
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen B Lambert
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Michael Nissen
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia.,Lady Cilento Children's Hospital, The University of Queensland, Brisbane, Queensland, Australia.,Department of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Theo Sloots
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Microbiology and Infectious Diseases, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
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40
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Tashani M, Alfelali M, Barasheed O, Alqahtani AS, Heron L, Wong M, Rashid H, Booy R. Effect of Tdap when administered before, with or after the 13-valent pneumococcal conjugate vaccine (coadministered with the quadrivalent meningococcal conjugate vaccine) in adults: A randomised controlled trial. Vaccine 2016; 34:5929-5937. [PMID: 27780630 DOI: 10.1016/j.vaccine.2016.10.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/05/2016] [Accepted: 10/06/2016] [Indexed: 01/07/2023]
Abstract
Sequential or co-administration of vaccines has potential to alter the immune response to any of the antigens. Existing literature suggests that prior immunisation of tetanus/diphtheria-containing vaccines can either enhance or suppress immune response to conjugate pneumococcal or meningococcal vaccines. We examined this interaction among adult Australian travellers before attending the Hajj pilgrimage 2014. We also investigated tolerability of these vaccines separately and concomitantly. We randomly assigned each participant to one of three vaccination schedules. Group A received adult tetanus, diphtheria and acellular pertussis vaccine (Tdap) 3-4weeks before receiving CRM197-conjugated 13-valent pneumococcal vaccine (PCV13) and CRM197-conjugated quadrivalent meningococcal vaccine (MCV4). Group B received all three vaccines on one day. Group C received PCV13 and MCV4 3-4weeks before Tdap. Blood samples collected at baseline, each vaccination visit and 3-4weeks after vaccination were tested using the pneumococcal opsonophagocytic assay (OPA) and by ELISA for diphtheria and tetanus antibodies. Funding for meningococcal serology was not available. Participants completed symptom diaries after each vaccination. A total of 111 participants aged 18-64 (median 40) years were recruited. No statistically significant difference was detected across the three groups in achieving OPA titre ⩾1:8 post vaccination. However, compared to other groups, Group A had a statistically significant lower number of subjects achieving ⩾4-fold rise in serotype 3, and also significantly lower geometric mean titres (GMTs) to six (of 13) pneumococcal serotypes (3, 5, 18C, 4, 19A and 9V). Group C (given prior PCV13 and MVC4) had statistically significant higher pre-Tdap geometric mean concentration (GMC) of anti-diphtheria IgG; however, there was no difference across the three groups following Tdap. Anti-tetanus IgG GMCs were similar across the groups before and after Tdap. No serious adverse events were reported. In conclusion, Tdap vaccination 3-4weeks before concomitant administration of PCV13 and MCV4 significantly reduced the antibody response to six of the 13 pneumococcal serotypes in adults. The trial is registered at the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000536763.
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Affiliation(s)
- M Tashani
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, NSW, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - M Alfelali
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, NSW, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - O Barasheed
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, NSW, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia; The Executive Administration of Research, King Abdullah Medical City (KAMC), Makkah, Saudi Arabia
| | - A S Alqahtani
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - L Heron
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Kids Research Institute, The Children's Hospital at Westmead, NSW, Australia
| | - M Wong
- Immunology Department, The Children's Hospital at Westmead, Westmead 2145, NSW, Australia
| | - H Rashid
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, NSW, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Sydney, NSW 2145, Australia
| | - R Booy
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, NSW, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Sydney, NSW 2145, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide 5001, Australia
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Halsey NA, Talaat KR, Greenbaum A, Mensah E, Dudley MZ, Proveaux T, Salmon DA. The safety of influenza vaccines in children: An Institute for Vaccine Safety white paper. Vaccine 2016; 33 Suppl 5:F1-F67. [PMID: 26822822 DOI: 10.1016/j.vaccine.2015.10.080] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 01/19/2023]
Abstract
Most influenza vaccines are generally safe, but influenza vaccines can cause rare serious adverse events. Some adverse events, such as fever and febrile seizures, are more common in children than adults. There can be differences in the safety of vaccines in different populations due to underlying differences in genetic predisposition to the adverse event. Live attenuated vaccines have not been studied adequately in children under 2 years of age to determine the risks of adverse events; more studies are needed to address this and several other priority safety issues with all influenza vaccines in children. All vaccines intended for use in children require safety testing in the target age group, especially in young children. Safety of one influenza vaccine in children should not be extrapolated to assumed safety of all influenza vaccines in children. The low rates of adverse events from influenza vaccines should not be a deterrent to the use of influenza vaccines because of the overwhelming evidence of the burden of disease due to influenza in children.
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Affiliation(s)
- Neal A Halsey
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Kawsar R Talaat
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Center for Immunization Research, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adena Greenbaum
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Eric Mensah
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tina Proveaux
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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42
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Statler VA, Marshall GS. Characteristics of Patients Referred to a Pediatric Infectious Diseases Clinic With Unexplained Fever. J Pediatric Infect Dis Soc 2016; 5:249-56. [PMID: 26407248 DOI: 10.1093/jpids/piv008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/03/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Older case series established diagnostic considerations for children meeting a priori definitions of fever of unknown origin (FUO). No recent study has examined the final diagnoses of children referred for unexplained fever. METHODS This study was conducted with a retrospective chart review of patients referred to a pediatric infectious diseases clinic from 2008 to 2012 for unexplained fever. RESULTS Sixty-nine of 221 patients were referred for "prolonged" unexplained fever. Ten of these were not actually having fever, and 11 had diagnoses that were readily apparent at the initial visit. The remaining 48 were classified as having FUO. The median duration of reported fever for these patients was 30 days; 15 had a diagnosis made, 5 of which were serious. None of the serious FUO diagnoses were infections. Of 152 patients with "recurrent" unexplained fever, 92 had an "intermittent" fever pattern, and most of these had sequential, self-limited viral illnesses or no definitive diagnosis made. Twenty of the 60 patients with a "periodic" fever pattern were diagnosed with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome. Overall, 166 patients either were not having fever, had self-limited illnesses, or ultimately had no cause of fever discovered. Only 12 had a serious illness, 2 of which were infections (malaria and typhoid fever). CONCLUSIONS Most children referred with unexplained fever had either self-limited illnesses or no specific diagnosis established. Serious diagnoses were unusual, suggesting that these diagnoses rarely present with unexplained fever alone, or that, when they do, the diagnoses are made by primary care providers or other subspecialists.
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Affiliation(s)
- Victoria A Statler
- Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, Kentucky
| | - Gary S Marshall
- Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, Kentucky
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Neonatal infections: Case definition and guidelines for data collection, analysis, and presentation of immunisation safety data. Vaccine 2016; 34:6038-6046. [PMID: 27491687 PMCID: PMC5139809 DOI: 10.1016/j.vaccine.2016.03.046] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 11/24/2022]
Abstract
Maternal vaccination is an important area of research and requires appropriate and internationally comparable definitions and safety standards. The GAIA group, part of the Brighton Collaboration was created with the mandate of proposing standardised definitions applicable to maternal vaccine research. This study proposes international definitions for neonatal infections. The neonatal infections GAIA working group performed a literature review using Medline, EMBASE and the Cochrane collaboration and collected definitions in use in neonatal and public health networks. The common criteria derived from the extensive search formed the basis for a consensus process that resulted in three separate definitions for neonatal blood stream infections (BSI), meningitis and lower respiratory tract infections (LRTI). For each definition three levels of evidence are proposed to ensure the applicability of the definitions to different settings. Recommendations about data collection, analysis and presentation are presented and harmonized with the Brighton Collaboration and GAIA format and other existing international standards for study reporting.
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Abstract
OBJECTIVES Actively recruit and intensively follow pregnant women receiving a dose of acellular pertussis vaccine for 4 weeks after vaccination. DESIGN AND SETTINGS A prospective observational study conducted in 2 New Zealand regions. PARTICIPANTS Women in their 28th-38th week of pregnancy, recruited from primary care and antenatal clinics at the time of Tdap administration. Telephone interviews were conducted at 48 h and 4 weeks postvaccination. MAIN OUTCOMES MEASURES Outcomes were injection site reactions, systemic symptoms and serious adverse events (SAEs). Where available, data have been classified and reported according to Brighton Collaboration definitions. RESULTS 793 women participated with 27.9% receiving trivalent inactivated influenza vaccine concomitantly. 79% of participants reported mild or moderate pain and 2.6% severe pain. Any swelling was reported by 7.6%, induration by 12.0% (collected from 1 site only, n=326), and erythema by 5.8% of participants. Fever was reported by 17 (2.1%) participants, 14 of these occurred within 24 h. Headache, dizziness, nausea, myalgia or arthralgia was reported by <4% of participants, respectively, and fatigue by 8.4%. During the study period, there were 115 adverse events in 113 participants, most of which were minor. At the end of the reporting period, 31 events were classified as serious (eg, obstetric bleeding, hypertension, infection, tachycardia, preterm labour, exacerbation of pre-existing condition and pre-eclampsia). All had variable onset time from vaccination. There were two perinatal deaths. Clinician assessment of all SAEs found none likely to be vaccine related. CONCLUSIONS Vaccination with Tdap in pregnant women was well tolerated with no SAE likely to be caused by the vaccine. TRIAL REGISTRATION NUMBER ACTRN12613001045707.
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Affiliation(s)
- Helen Petousis-Harris
- Department of General Practice and Primary Health Care, Immunisation Advisory Centre, The University of Auckland, Auckland, New Zealand
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Donna Watson
- Department of General Practice and Primary Health Care, Immunisation Advisory Centre, The University of Auckland, Auckland, New Zealand
| | - Janine Paynter
- Department of General Practice and Primary Health Care, Immunisation Advisory Centre, The University of Auckland, Auckland, New Zealand
| | | | - Nikki Turner
- Department of General Practice and Primary Health Care, Immunisation Advisory Centre, The University of Auckland, Auckland, New Zealand
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van der Maas NAT, Woudenberg T, Hahné SJM, de Melker HE. Tolerability of Early Measles-Mumps-Rubella Vaccination in Infants Aged 6-14 Months During a Measles Outbreak in The Netherlands in 2013-2014. J Infect Dis 2015; 213:1466-71. [PMID: 26690343 PMCID: PMC4813742 DOI: 10.1093/infdis/jiv756] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/14/2015] [Indexed: 12/12/2022] Open
Abstract
Background. In 2013–2014, a measles outbreak spread through the Netherlands. To protect young infants, measles-mumps-rubella (MMR) vaccination was offered to those aged 6–14 months in municipalities with routine first-dose MMR vaccine coverage of <90%. We assessed the tolerability of this early administration of MMR vaccine. Methods. After study entry (n = 1866), parents of eligible infants (n = 10 097) completed a questionnaire (n = 1304). For infants who received an early MMR vaccine dose (n = 962), we asked for information about adverse events (AEs) associated with the dose. AE frequencies were compared between infants aged 6–8, 9–11, and 12–14 months. Using multivariable logistic regression, we assessed the association between the risk of AEs and age at early MMR vaccination. Results. The response rate was 13%. Parents of 59 infants (6.1%) and 350 infants (36.4%) who received early MMR vaccination reported local and systemic AEs, respectively. Parents of infants vaccinated at 6–8 months of age reported systemic AEs less frequently (32%) than parents of children vaccinated at 9–11 months (45%) and 12–14 months (43%) of age (P = <.001). For local AEs, there were no differences (5%, 7%, and 10%, respectively; P = .08). Compared with vaccination at 6 months, all older infants except those aged 14 months showed an increased risk for any AE and for systemic AEs starting 5–12 days after vaccination. Conclusions. Early MMR vaccination is well tolerated, with the lowest AE frequencies found in infants aged 6–8 months. It is a safe intervention for protecting young infants against measles.
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Affiliation(s)
- Nicoline A T van der Maas
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - T Woudenberg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - S J M Hahné
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - H E de Melker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Rusmil K, Gunardi H, Fadlyana E, Soedjatmiko, Dhamayanti M, Sekartini R, Satari HI, Risan NA, Prasetio D, Tarigan R, Garheni R, Milanti M, Hadinegoro SR, Tanuwidjaja S, Bachtiar NS, Sari RM. The immunogenicity, safety, and consistency of an Indonesia combined DTP-HB-Hib vaccine in expanded program on immunization schedule. BMC Pediatr 2015; 15:219. [PMID: 26686508 PMCID: PMC4684926 DOI: 10.1186/s12887-015-0525-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 12/09/2015] [Indexed: 11/17/2022] Open
Abstract
Background WHO recommended incorporation of Haemophilus influenzae type b (Hib) vaccination into immunization program. Indonesia would adopt Hib as a National Immunization Program in 2013. We aimed at analyzing immunogenicity, safety, and consistency of a new combined DTP-HB-Hib (diphtheria-tetanus-pertussis-Hepatitis B-Haemophilus influenza B) vaccine. Methods A prospective, randomized, double blind, multicenter, phase III study of Bio Farma DTP-HB-Hib vaccine conducted in Jakarta and Bandung, August 2012 - January 2013. Subjects were divided into three groups with different batch number. Healthy infants 6–11 weeks of age at enrollment were immunized with 3 doses of DTP-HB-Hib vaccine with interval of 4 weeks, after birth dose of hepatitis B vaccine. Blood samples obtained prior to vaccination and 28 days after the third dose. Safety measures recorded until 28 days after each dose. Results Of 600 subjects, 575 (96 %) completed study protocol. After 3 doses, 100.0 and 96.0 % had anti-PRP concentration ≥0.15 and ≥1.0 μg/ml. Anti-diphtheria and anti-tetanus concentration ≥0.01 IU/ml detected in 99.7 and 100.0 %; while concentration ≥0.1 IU/ml achieved in 84.0 and 97.4 %. Protective anti-HBs found in 99.3 %. The pertussis vaccine response rate was 84.9 %. None Serious Adverse events (SAEs) considered related to study vaccine or procedure. Conclusions The 3-dose of DTP-HB-Hib was immunogenic, well tolerated and suitable for replacement of licensed-equivalent vaccines based on immunologic and safety profiles. Trial registration NCT01986335 – October 30th 2013.
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Affiliation(s)
- Kusnandi Rusmil
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia.
| | - Hartono Gunardi
- Child Health Department, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Eddy Fadlyana
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Soedjatmiko
- Child Health Department, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Meita Dhamayanti
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Rini Sekartini
- Child Health Department, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Hindra Irawan Satari
- Child Health Department, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nelly Amalia Risan
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Dwi Prasetio
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Rodman Tarigan
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Reni Garheni
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Mia Milanti
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Sri Rezeki Hadinegoro
- Child Health Department, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Suganda Tanuwidjaja
- Child Health Department, Faculty of Medicine, Padjadjaran University / Dr. Hasan Sadikin Hospital, Bandung, Indonesia
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Li-Kim-Moy J, Yin JK, Rashid H, Khandaker G, King C, Wood N, Macartney KK, Jones C, Booy R. Systematic review of fever, febrile convulsions and serious adverse events following administration of inactivated trivalent influenza vaccines in children. ACTA ACUST UNITED AC 2015; 20. [PMID: 26111238 DOI: 10.2807/1560-7917.es2015.20.24.21159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In 2010, increased febrile convulsions (FC) occurred after administration of inactivated trivalent influenza vaccine (TIV) in Australia. We systematically reviewed the rates of fever, FC and serious adverse events (SAEs) after TIV, focussing on published and unpublished clinical trial data from 2005 to 2012, and performed meta-analysis of fever rates. From 4,372 records in electronic databases, 18 randomised controlled trials (RCTs), 14 non-randomised clinical trials, six observational studies and 12 registered trials (five RCTs and seven non-randomised) were identified. In published RCTs, fever ≥ 38 °C rates after first dose of non-adjuvanted TIV were 6.7% and 6.9% for children aged 6–35 months and ≥ 3 years, respectively. Analysis of RCTs by vaccine manufacturer showed pooled fever estimates up to 5.1% with Sanofi or GlaxoSmithKline vaccines; bioCSL vaccines were used in two non-randomised clinical trials and one unpublished RCT and were associated with fever in 22.5–37.1% for children aged 6–35 months. In RCTs, FCs occurred at a rate of 1.1 per 1,000 vaccinated children. While most TIVs induced acceptably low fever rates, bioCSL influenza vaccines were associated with much higher rates of fever in young children. Future standardised study methodology and access to individual level data would be illuminating.
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Affiliation(s)
- J Li-Kim-Moy
- National Centre for Immunisation Research and Surveillance, The Children s Hospital at Westmead, New South Wales, Australia
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Abstract
Public health vaccination guidelines cannot be easily transferred to elite athletes. An enhanced benefit from preventing even mild diseases is obvious but stronger interference from otherwise minor side effects has to be considered as well. Thus, special vaccination guidelines for adult elite athletes are required. In most of them, protection should be strived for against tetanus, diphtheria, pertussis, influenza, hepatitis A, hepatitis B, measles, mumps and varicella. When living or traveling to endemic areas, the athletes should be immune against tick-borne encephalitis, yellow fever, Japanese encephalitis, poliomyelitis, typhoid fever, and meningococcal disease. Vaccination against pneumococci and Haemophilus influenzae type b is only relevant in athletes with certain underlying disorders. Rubella and papillomavirus vaccination might be considered after an individual risk–benefit analysis. Other vaccinations such as cholera, rabies, herpes zoster, and Bacille Calmette–Guérin (BCG) cannot be universally recommended for athletes at present. Only for a very few diseases, a determination of antibody titers is reasonable to avoid unnecessary vaccinations or to control efficacy of an individual’s vaccination (especially for measles, mumps, rubella, varicella, hepatitis B and, partly, hepatitis A). Vaccinations should be scheduled in a way that possible side effects are least likely to occur in periods of competition. Typically, vaccinations are well tolerated by elite athletes, and resulting antibody titers are not different from the general population. Side effects might be reduced by an optimal selection of vaccines and an appropriate technique of administration. Very few discipline-specific considerations apply to an athlete’s vaccination schedule mainly from the competition and training pattern as well as from the typical geographical distribution of competitive sites.
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Affiliation(s)
- Barbara C Gärtner
- Institute for Microbiology and Hygiene, Saarland University, Faculty of Medicine and Medical Center, Building 43, 66421, Homburg/Saar, Germany,
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Kwon HJ, Lee SY, Kim KH, Kim DS, Cha SH, Jo DS, Kang JH. The Immunogenicity and Safety of the Live-attenuated SA 14-14-2 Japanese Encephalitis Vaccine Given with a Two-dose Primary Schedule in Children. J Korean Med Sci 2015; 30:612-6. [PMID: 25931793 PMCID: PMC4414646 DOI: 10.3346/jkms.2015.30.5.612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 12/10/2014] [Indexed: 11/25/2022] Open
Abstract
Effective and tolerable vaccination is an essential strategy to prevent Japanese encephalitis (JE) in endemic areas. Although the live attenuated SA 14-14-2 JE vaccine (LAJEV) has been widely used since its introduction, the systemic data of LAJEV was very rarely available in Korea. We conducted the open-label, prospective cohort study to assess the immunogenicity and safety of this vaccine. Ninety subjects were enrolled, and LAJEV in a 2-dose primary series was given with a 12-month interval. Neutralizing antibody titers were measured before and after each vaccination, and active monitoring for adverse events was performed. After the first dose, 91.1% of subjects had seroprotection with a geometric mean titer (GMT) of 40.9. Seroprotection rate after the second dose was 97%, and GMT showed an increase of 6.5-fold. Most adverse events following immunization were self-limited, and no serious adverse events were reported until 42 days after each dose. The 2-dose administration of LAJEV in the primary immunization schedule appeared to be highly immunogenic and safe.
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Affiliation(s)
- Hyo Jin Kwon
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soo Young Lee
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ki Hwan Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Soo Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ho Cha
- Department of Pediatrics, Kyunghee University College of Medicine, Seoul, Korea
| | - Dae Sun Jo
- Department of Pediatrics, Chonbuk National University College of Medicine, Jeonju, Korea
| | - Jin Han Kang
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
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50
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Walther K, Burckhardt MA, Erb T, Heininger U. Implementation of pertussis immunization in health-care personnel. Vaccine 2015; 33:2009-14. [DOI: 10.1016/j.vaccine.2015.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/04/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
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