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Lawrence SM, Wynn JL, Gordon SM. Neonatal bacteremia and sepsis. REMINGTON AND KLEIN'S INFECTIOUS DISEASES OF THE FETUS AND NEWBORN INFANT 2025:183-232.e25. [DOI: 10.1016/b978-0-323-79525-8.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Roberts NJ, Sarria JC. Recognizing the roles of fever in host survival and in medical intervention in infectious diseases. Am J Med Sci 2024; 368:85-89. [PMID: 38795968 DOI: 10.1016/j.amjms.2024.05.013] [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: 12/13/2023] [Revised: 03/10/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
Fever has roles both in host defense against infectious challenges and in guidance of medical intervention. These roles remain insufficiently acknowledged and considered by both health care providers and patients and their families. This review cites reports in support of both roles and provides recommendations regarding the clinician's approach to fever, as well as points relevant for education of patients and their families.
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Affiliation(s)
- Norbert J Roberts
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA; Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Juan C Sarria
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
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3
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Sieghart D, Hana CA, Dürrschmid C, Heinz LX, Haslacher H, Zlesak M, Piccini G, Manenti A, Montomoli E, Jorda A, Fedrizzi C, Hasenoehrl T, Zdravkovic A, Anderle K, Wiedermann U, Drapalik S, Steinbrecher H, Bergmann F, Firbas C, Jordakieva G, Wagner B, Leonardi M, Pierleoni G, Ballini M, Benincasa L, Marchi S, Trombetta C, Perkmann T, Crevenna R, Zeitlinger M, Bonelli M, Aletaha D, Radner H. Immunogenicity and safety of COVID-19 booster vaccination: A population-based clinical trial to identify the best vaccination strategy. J Clin Virol 2024; 173:105661. [PMID: 38503118 DOI: 10.1016/j.jcv.2024.105661] [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: 03/09/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Various SARS-CoV-2 variants of concerns (VOCs) characterized by higher transmissibility and immune evasion have emerged. Despite reduced vaccine efficacy against VOCs, currently available vaccines provide protection. Population-based evidence on the humoral immune response after booster vaccination is crucial to guide future vaccination strategies and in preparation for imminent COVID-19 waves. METHODS This multicenter, population-based cohort study included 4697 individuals ≥18 years of age who received a booster vaccination. Antibody levels against SARS-CoV-2 receptor binding domain (RBD) and neutralizing antibodies against wild-type (WT) virus and Omicron variants were assessed at baseline (day of booster vaccination) and after four weeks. Safety was evaluated daily within the first week using a participant-completed electronic diary. Antibody levels were compared across different vaccination strategies, taking into account individual host factors. RESULTS Our main model including 3838 participants revealed that individuals who received a booster with mRNA-1273 compared to BNT162b2 vaccine had a significantly higher increase (95 %CI) in anti-RBD-antibody levels (37,707 BAU/mL [34,575-40,839] vs. 27,176 BAU/mL [26,265-28,087]), and of neutralization levels against WT (1,681 [1490-1872] vs. 1141 [1004-1278] and Omicron variant (422 [369-474] vs. 329 [284-374]). Neutralizing antibody titres highly correlated with anti-RBD antibodies, with neutralizing capacity 4.4 fold higher against WT compared to Omicron. No differences in safety were found between the two booster vaccines. CONCLUSION Our study underlines the superiority of a booster vaccination with mRNA-1273, independent of the primary vaccination and therefore provides guidance on the vaccination strategy.
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Affiliation(s)
- Daniela Sieghart
- Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Claudia A Hana
- Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Caroline Dürrschmid
- Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Leonhard X Heinz
- Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Austria
| | - Markus Zlesak
- Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | | | | | - Emanuele Montomoli
- Vismederi srl, Siena, Italy; Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Anselm Jorda
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Clemens Fedrizzi
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Timothy Hasenoehrl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University Vienna, Vienna, Austria
| | - Andrej Zdravkovic
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University Vienna, Vienna, Austria
| | - Karolina Anderle
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Ursula Wiedermann
- Center of Pathophysiology, Infectiology & Immunology, Institute of Specific Prophylaxis and Tropical Medicine, Medical University Vienna, Austria
| | | | | | - Felix Bergmann
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Christa Firbas
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University Vienna, Vienna, Austria
| | - Galateja Jordakieva
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University Vienna, Vienna, Austria
| | - Barbara Wagner
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University Vienna, Vienna, Austria
| | | | | | | | | | - Serena Marchi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Claudia Trombetta
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Michael Bonelli
- Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Daniel Aletaha
- Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria.
| | - Helga Radner
- Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria
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Aiba H, Funaki T, Yamada M, Miyake K, Ueno S, Tao C, Myojin S, Matsui T, Ogimi C, Kato H, Miyairi I, Shoji K. Association between use of antipyretics and antibody titers after two doses of the BNT162b2 SARS-CoV-2 vaccine in adolescents and young adults with underlying diseases. J Infect Chemother 2024; 30:176-178. [PMID: 37769991 DOI: 10.1016/j.jiac.2023.09.025] [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: 05/27/2023] [Revised: 08/29/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
There are few reports on the association between antipyretic use and antibody titers in adolescents and young adults following SARS-CoV-2 vaccination. Multivariable linear regression analyses were performed to examine the association between antipyretic use and antibody titers. The use of antipyretics was not associated with antibody titers (β coefficient [95% CI] = -0.107 [-0.438 to 0.224]).
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Affiliation(s)
- Hiroyuki Aiba
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Takanori Funaki
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Masaki Yamada
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department for Advanced Medicine for Viral Infections, National Center for Child Health and Development, Tokyo, Japan
| | - Kozue Miyake
- Department of Clinical Research Promotion, National Center for Child Health and Development, Tokyo, Japan
| | - Saki Ueno
- Department of Clinical Research Promotion, National Center for Child Health and Development, Tokyo, Japan
| | - Chiaki Tao
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Shota Myojin
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Toshihiro Matsui
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Chikara Ogimi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Hitoshi Kato
- National Center for Child Health and Development, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
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5
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Mera-Gallego R, León-Rodríguez L, Barreiro Juncal M, Pérez Molina L, Guisado Barral B, Busto Domínguez I, Andrés-Rodríguez NF, Fornos-Pérez JA. [Pharmacovigilance of vaccines against COVID-19 in community pharmacies. Results after the second dose and comparison between both]. FARMACEUTICOS COMUNITARIOS 2023; 15:5-16. [PMID: 39157697 PMCID: PMC11328522 DOI: 10.33620/fc.2173-9218.(2023).21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/10/2023] [Indexed: 08/20/2024]
Abstract
Aim Detection and tracing of suspicious adverse reactions (ARs) in community pharmacies after the second of COVID-19 vaccine dose. Comparison between doses. Methods Design: prospective observational study. Subjects Vaccinated against COVID-19, of legal age, who consent to participate. Variables Number and percentage of participants with ARs. Number, type and frequency of ARs. Impact on their daily life. Relations between variables.Approved by the Galician Ethical Committee of Research with medicines. Results 693 participants with the 2nd dose, 63.6% women. Age 56.8 years. 312 (45.0%) vaccinated, 49.4% women and 37.3% men (p<0.0001), reported at least one AR: 43.9% with Comirnaty®, 37.7% with Vaxzevria®, 63.0% with Spikevax®.There were 972 ARs, 75.2% in women and 24.8% in men (p<0.0001). Mean 1.4/vaccinated (maximum 11). The most prevalent AR: pain at injection site 197 (28.4%), tiredness/fatigue 141 (20.3%), myalgia 112 (16.2%), headache 95 (13.7%), fever 84 (12.1%).51 participants with ARs needed professional help: 10 from the doctor, 6 in the emergency room, 3 in hospitals (1 referral), 33 in the pharmacy. 70 (15.1%) were prevented from their daily activity. 201 Ars from vaccinated persons were reported.Number of people vaccinated with ARs and the number of ARs were less with the 2nd dose (p<0.05).Inverse relationship (p<0.05) between "age" and "number of vaccinated with ARs", "need for professional care" and "prevented daily activity". Conclusions The number of vaccinated participants with ARs and their number was also high with the second dose, although lower than with the first. Women and younger people are predictive of increased risk of AR after vaccination against COVID-19.
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Affiliation(s)
- Rocío Mera-Gallego
- Farmacéutica comunitaria en VigoEspaña
- Grupo Berbés de Investigación y DocenciaGrupo Berbés de Investigación y DocenciaEspaña
| | - Laura León-Rodríguez
- Grupo Berbés de Investigación y DocenciaGrupo Berbés de Investigación y DocenciaEspaña
- Doctora en Farmacia. Farmacéutica comunitaria en Ourense.España
| | - Miriam Barreiro Juncal
- Farmacéutica comunitaria en VigoEspaña
- Grupo Berbés de Investigación y DocenciaGrupo Berbés de Investigación y DocenciaEspaña
| | - Laura Pérez Molina
- Farmacéutica comunitaria en VigoEspaña
- Grupo Berbés de Investigación y DocenciaGrupo Berbés de Investigación y DocenciaEspaña
| | - Bibiana Guisado Barral
- Grupo Berbés de Investigación y DocenciaGrupo Berbés de Investigación y DocenciaEspaña
- Farmacéutica comunitaria en Crecente (Pontevedra).CEspaña
| | - Iván Busto Domínguez
- Grupo Berbés de Investigación y DocenciaGrupo Berbés de Investigación y DocenciaEspaña
- Departamento técnico del Colegio Oficial de Farmacéuticos de PontevedraColegio Oficial de Farmacéuticos de PontevedraEspaña
| | - N. Floro Andrés-Rodríguez
- Grupo Berbés de Investigación y DocenciaGrupo Berbés de Investigación y DocenciaEspaña
- Doctor en FarmaciaFarmaciaEspaña
| | - José A. Fornos-Pérez
- Grupo Berbés de Investigación y DocenciaGrupo Berbés de Investigación y DocenciaEspaña
- Doctor en Farmacia. Farmacéutico comunitario en Cangas do Morrazo (Pontevedra)España
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6
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Zempsky W, Bell J, Mossali VM, Kachroo P, Siddiqui K. Common Selfcare Indications of Pain Medications in Children. Paediatr Drugs 2023; 25:321-341. [PMID: 36928608 PMCID: PMC10019440 DOI: 10.1007/s40272-023-00562-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/17/2023]
Abstract
Pain has a multifaceted impact on individuals worldwide, affecting their physical functioning, emotional well-being, and quality of life. Children (age < 18 years) have a high prevalence of conditions associated with pain, such as toothache, headache, earache, sore throat, and respiratory tract infections, many of which may be accompanied by fever. Globally, the pharmacologic treatment of pain in pediatric patients is limited largely to nonopioid analgesics, and dosing must account for differences in age, weight, metabolism, and risk of adverse effects. This narrative review summarizes the findings of a literature search on the pediatric indications, dosing approaches, dosing guidelines, and pharmacokinetics of paracetamol and ibuprofen, which are common pain medications available globally for self-care use in children. The review also discusses the risks and benefits associated with these agents. The current roles of paracetamol and ibuprofen in the symptomatic management of coronavirus disease 2019 (COVID-19) infection and in the management of post-COVID-19 immunization symptoms in children are also discussed. Therefore, while a very large amount of data over several decades is available for paracetamol and ibuprofen, an urgent need exists for well-designed studies of these medications for the management of pain and fever in pediatric patients with COVID-19 to ensure optimal relief with minimal toxicity.
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Affiliation(s)
- William Zempsky
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, 06106, USA. .,University of Connecticut School of Medicine, Farmington, CT, USA.
| | - John Bell
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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7
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Lago-Deibe FI, Valladares-Cabaleiro M, Fernández-Domínguez MJ, Fernández-Fernández I, Clavería A, Rodríguez-Pastoriza S, Roca-Pardinas J, Martín-Miguel MV. Effectiveness and safety of tetanus vaccine administration by intramuscular vs. subcutaneous route in anticoagulated patients: Randomized clinical trial in primary care. Front Med (Lausanne) 2022; 9:1054988. [PMID: 36619617 PMCID: PMC9813590 DOI: 10.3389/fmed.2022.1054988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Design Prospective, double-blind clinical trial comparing tetanus-diphtheria vaccine administration routes, intramuscular (IM) vs. subcutaneous (SC) injection, in patients with oral anticoagulants. ISRCTN69942081. Study population Patients treated with oral anticoagulants, 15 health centers, Vigo (Spain). Sample size, 117 in each group. Outcome variables Safety analysis: systemic reactions and, at the vaccine administration site, erythematic, swelling, hematoma, granuloma, pain.Effectiveness analysis: differences in tetanus toxoid antibody titers.Independent variables: route, sex, age, baseline serology, number of doses administered. Analysis Following the CONSORT guidelines, we performed an intention-to-treat analysis. We conducted a descriptive study of the variables included in both groups (117 in each group) and a bivariate analysis. Fewer than 5% of missing values. Imputation in baseline and final serology with the median was performed. Lost values were assumed to be values missing at random. We conducted a descriptive study of the variables and compared routes. For safety, multivariate logistic regression was applied, with each safety criterion as outcome and the independent variables. Odds ratios (ORs) were calculated. For effectiveness, a generalized additive mixed model, with the difference between final and initial antibody titers as outcome. Due to the bimodal distribution of the outcome, the normal mixture fitting with gamlssMX was used. All statistical analyses were performed with the gamlss.mx and texreg packages of the R free software environment. Results A previously published protocol was used across the 6-year study period. The breakdown by sex and route showed: 102 women and 132 men; and 117 IM and 117 SC, with one dose administered in over 80% of participants. There were no differences between groups in any independent variable. The second and third doses administered were not analyzed, due to the low number of cases. In terms of safety, there were no severe general reactions. Locally, significant adjusted differences were observed: in pain, by sex (male, OR: 0.39) and route (SC, OR: 0.55); in erythema, by sex (male, OR: 0.34) and route (SC, OR: 5.21); and in swelling, by sex (male, OR: 0.37) and route (SC, OR: 2.75). In terms of effectiveness, the model selected was the one adjusted for baseline serology.
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Affiliation(s)
- Fernando Isidro Lago-Deibe
- Sárdoma Health Center, Vigo Health Area, Galician Health Service, Vigo, Spain
- South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), Vigo Health Area, Galician Health Service, Vigo, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
| | - Mercedes Valladares-Cabaleiro
- Moaña Primary Care Emergency Center (Punto de Atención Continuada), Vigo Health Area, Galician Health Service, Moaña, Spain
| | - María José Fernández-Domínguez
- South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), Vigo Health Area, Galician Health Service, Vigo, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
- Leiro Health Center, Ourense Health Area, Galician Health Service, Ourense, Spain
| | | | - Ana Clavería
- South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), Vigo Health Area, Galician Health Service, Vigo, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
| | - Sara Rodríguez-Pastoriza
- South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), Vigo Health Area, Galician Health Service, Vigo, Spain
| | - Javier Roca-Pardinas
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
- Department of Statistics and Operations Research, University of Vigo, Vigo, Spain
- Galician Research and Mathematical Technology Center (Centro de Investigación e Tecnoloxía Matemática de Galicia/CITMAga), Santiago de Compostela, Spain
| | - María Victoria Martín-Miguel
- South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), Vigo Health Area, Galician Health Service, Vigo, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
- Vigo Family and Community Medicine and Nursing Teaching Unit, Vigo Health Area, Galician Health Service, Vigo, Spain
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Tani N, Ikematsu H, Goto T, Gondo K, Yanagihara Y, Kurata Y, Oishi R, Minami J, Onozawa K, Nagano S, Kuwano H, Akashi K, Shimono N, Chong Y. No significant influence of pre-vaccination antipyretic use on specific antibody response to a BNT162b2 vaccine booster against COVID-19. Vaccine X 2022; 12:100224. [PMID: 36213591 PMCID: PMC9528015 DOI: 10.1016/j.jvacx.2022.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
The relation between pre-vaccination antipyretic use and antibody responses to SARS-CoV-2 vaccination has been unclear. We measured the pre- and post-BNT162b2 booster spike-specific IgG titers and recorded antipyretic use and adverse reactions for SARS-CoV-2-naive hospital healthcare workers. The data of 20 cases who used antipyretics within 24 h before vaccination were compared to that of 281 controls. The post-booster geometric mean IgG titers were 15,559 AU/mL (95 % CI, 11,474-21,203) for the cases and 16,850 AU/mL (95 % CI, 15,563-18,243) for the controls (p = 0.622). No significant reduction in the frequency or severity of any of the solicited adverse reactions was found for the cases. Similar results were obtained after adjustment with propensity-score matching for demographic characteristics, baseline IgG titer, and post-vaccination antipyretic use. Antipyretic use within 24 h before vaccination would not affect mRNA COVID-19 vaccine-induced specific antibody responses and that postponement of vaccination due to pre-vaccination antipyretic use would be unnecessary.
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Affiliation(s)
- Naoki Tani
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | | | - Takeyuki Goto
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kei Gondo
- Clinical Laboratory, Fukuoka City Hospital, Fukuoka, Japan
| | | | | | - Ryo Oishi
- Department of Infectious Diseases, Fukuoka City Hospital, Fukuoka, Japan
| | - Junya Minami
- Department of Infectious Diseases, Fukuoka City Hospital, Fukuoka, Japan
| | - Kyoko Onozawa
- Department of Infectious Diseases, Fukuoka City Hospital, Fukuoka, Japan
| | - Sukehisa Nagano
- Department of Neurology, Fukuoka City Hospital, Fukuoka, Japan
| | | | - Koichi Akashi
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Nobuyuki Shimono
- Center for the Study of Global Infection, Kyushu University Hospital, Fukuoka, Japan
| | - Yong Chong
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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9
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Najeebullah, Ali MA, Naveed R, Khatri G, Priya, Hasan MM. Acetaminophen: A hazard to immunotherapy. Ann Med Surg (Lond) 2022; 80:104272. [PMID: 36045804 PMCID: PMC9422271 DOI: 10.1016/j.amsu.2022.104272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
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10
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Use of analgesics/antipyretics in the management of symptoms associated with COVID-19 vaccination. NPJ Vaccines 2022; 7:31. [PMID: 35236842 PMCID: PMC8891349 DOI: 10.1038/s41541-022-00453-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/31/2022] [Indexed: 12/15/2022] Open
Abstract
COVID-19 vaccines are effective and important to control the ongoing pandemic, but vaccine reactogenicity may contribute to poor uptake. Analgesics or antipyretic medications are often used to alleviate vaccine side effects, but their effect on immunogenicity remains uncertain. Few studies have assessed the effect of analgesics/antipyretics on vaccine immunogenicity and reactogenicity. Some studies revealed changes in certain immune response parameters post-vaccination when analgesics/antipyretics were used either prophylactically or therapeutically. Still, there is no evidence that these changes impact vaccine efficacy. Specific data on the impact of analgesic/antipyretic medications on immunogenicity of COVID-19 vaccines are limited. However, available data from clinical trials of licensed vaccines, along with recommendations from public health bodies around the world, should provide reassurance to both healthcare professionals and vaccine recipients that short-term use of analgesics/antipyretics at non-prescription doses is unlikely to affect vaccine-induced immunity.
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11
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Bohn-Goldbaum E, Cross T, Leeb A, Peters I, Booy R, Edwards KM. Adverse events following influenza immunization: understanding the role of age and sex interactions. Expert Rev Vaccines 2022; 21:415-422. [PMID: 34937488 DOI: 10.1080/14760584.2022.2021075] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Reduction of adverse events following immunization (AEFI) could improve vaccine uptake. Evidence suggests sex and age affect AEFI rates but, with limited understanding of their interaction, groups at higher risk for adverse reaction cannot be identified. RESEARCH DESIGN AND METHODS Using deidentified data (n = 308,481) from Australians receiving influenza vaccinations in the 2020 calendar year, we analyzed the effects of independent predictors (i.e. age and sex), on experiencing an AEFI using logistic regression generalized additive modeling to capture any nonlinear relationships and adjusting for vaccine brand and concomitant vaccination. RESULTS The overall reaction rate was 5.5%. Modeling revealed significant effects of age (p < 0.001), sex (p < 0.001), and age × sex (p < 0.001). Females were more likely than males to experience AEFIs between 7.5 and 87.5 years of age and exhibited peak odds at about 53 years, while peak odds for males occurred in infancy. CONCLUSION The results suggest there is a need for targeting AEFI reduction in females, particularly in 30-70-year-olds, to improve the vaccination experience. The results further suggest that reducing concomitant vaccination and choosing less reactogenic vaccine brands could reduce risk of AEFI, however, retaining concomitant vaccination may optimize vaccine uptake.
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Affiliation(s)
- Erika Bohn-Goldbaum
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Troy Cross
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Alan Leeb
- Illawarra Medical Centre, Ballajura, Western Australia, Australia.,SmartVax, Perth, Western Australia, Australia
| | - Ian Peters
- SmartVax, Perth, Western Australia, Australia.,Datavation, Perth, Western Australia, Australia
| | - Robert Booy
- The Children's Hospital at Westmead, The University of Sydney, Sydney Medical School, Sydney, Australia
| | - Kate M Edwards
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, Australia
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12
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Jenetzky E, Schwarz S, Fingerhut I, Kerdar SH, Gwiasda M, Rathjens L, Kulikova O, Martin D. [The FeverApp Registry - A Way to Empower Parents through their Own Documentation to a Graduated Decision]. DAS GESUNDHEITSWESEN 2021; 83:S4-S11. [PMID: 34731887 DOI: 10.1055/a-1581-8155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM OF THE STUDY To demonstrate the feasibility and exemplarity of an app-based parent registry. METHODS The app as an elaborated interactive electronic case report form and the underlying data structure of the registry are presented. The initial recruitment efforts are illustrated and the temperature distribution, as well as the distribution of fever events in 2020, are analyzed. RESULTS The FeverApp successfully collects data into a central registry. Like every study, it also provides information on the current knowledge. The ecological momentary assessment can represent the illness situation at several levels (measurement, fever episode, individual, family, practice, country). Methods for data collection needed to be developed in a flexible manner due to pandemic conditions. The initial recruitment goal of 2400 fever phases in the first two years was met, with nationwide dissemination pending. It is shown that body temperature does not rise indefinitely; fevers reach an average of 39 degrees without antipyretics, although in rare cases temperatures beyond 41 degrees are reached without harm. Furthermore, a comparison with a reference practice shows that fever episodes can be recorded more comprehensively in the app, including infections that do not come to the presentation in a pediatrician's office. Thus, the FeverApp fulfills in a model-like fashion the use of registers in persons basically healthy and maps a multi-level diagnostics. CONCLUSION The FeverApp could basically establish itself as a supporting tool, the registry can reliably collect data with the method used and maps the current infection situation. In researching the question of how infections develop in the post-Covid period, the app could perform an important task.
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Affiliation(s)
- Ekkehart Jenetzky
- Department für Humanmedizin, Fakultät für Gesundheit Universität Witten/Herdecke, Witten, Deutschland.,Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, - und -psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Silke Schwarz
- Department für Humanmedizin, Fakultät für Gesundheit Universität Witten/Herdecke, Witten, Deutschland
| | - Ingo Fingerhut
- Department für Humanmedizin, Fakultät für Gesundheit Universität Witten/Herdecke, Witten, Deutschland.,Inhaber, Praxis Kleiner Piks, Bochum, Deutschland
| | - Sara Hamideh Kerdar
- Department für Humanmedizin, Fakultät für Gesundheit Universität Witten/Herdecke, Witten, Deutschland
| | - Moritz Gwiasda
- Department für Humanmedizin, Fakultät für Gesundheit Universität Witten/Herdecke, Witten, Deutschland
| | - Larisa Rathjens
- Department für Humanmedizin, Fakultät für Gesundheit Universität Witten/Herdecke, Witten, Deutschland
| | - Olga Kulikova
- Department für Humanmedizin, Fakultät für Gesundheit Universität Witten/Herdecke, Witten, Deutschland
| | - David Martin
- Department für Humanmedizin, Fakultät für Gesundheit Universität Witten/Herdecke, Witten, Deutschland.,Kinderklinik, Eberhard-Karls-Universität Tübingen Medizinische Fakultät, Tübingen, Deutschland
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13
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Klein NP, Zerbo O, Goddard K, Wang W, Fohner AE, Wiesner A, Shokoohi V, Coller J, Bok K, Gans HA. Genetic associations with a fever after measles-containing vaccines. Hum Vaccin Immunother 2021; 17:1763-1769. [PMID: 33351701 PMCID: PMC8115494 DOI: 10.1080/21645515.2020.1849520] [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: 12/03/2022] Open
Abstract
Children have elevated fever risk 1 to 2 weeks after the first dose of a measles-containing vaccine (MCV), which is likely affected by genetic, immunologic, and clinical factors. Fever after MCV is associated with febrile seizures, though may also be associated with higher measles antibody titers. This exploratory study investigated genetic and immunologic associations with a fever after MCV. Concurrent with a randomized Phase 3 clinical trial of 12–15-month-olds who received their first measles-mumps-rubella (MMR) vaccine in which parents recorded post-vaccination temperatures daily, we consented a subset to collect additional blood and performed human leukocyte antigens (HLA) typing. Association between fever 5–12 days after MMR (“MMR-associated”) and HLA type was assessed using logistic regression. We compared 42-day post-vaccination geometric mean titers (GMT) to measles between children who did and did not have fever using a t-test. We enrolled 86 children and performed HLA typing on 82; 13 (15.1%) had MMR-associated fever. Logistic regressions identified associations between MMR-associated fever and HLA Class I loci A-29:02 (P = .036), B-57:01 (P = .018), C-06:02 (P = .006), C-14:02 (P = .022), and Class II loci DRB1-15 (P = .045). However, Bonferroni's adjustment for multiple comparisons suggests that these associations could have been due to chance. Ninety-eight percent of children had protective antibody titers to measles; however, GMT was higher among those with fever compared with children without fever (P = .006). Fever after the measles vaccine correlated with genetic factors and higher immune response. This study suggests a possible genetic susceptibility to MMR-associated fever.
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Affiliation(s)
- Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Ousseny Zerbo
- Department of Epidemiology & Institute of Public Health Genetics, University of Washington, Seattle, WA, USA
| | | | - Weiqi Wang
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Alison E Fohner
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA.,Department of Epidemiology & Institute of Public Health Genetics, University of Washington, Seattle, WA, USA
| | - Amy Wiesner
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Vida Shokoohi
- School of Medicine, Stanford University, Stanford, CA, USA
| | - John Coller
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Karin Bok
- National Vaccine Program Office, US. Health and Human Services, Washington D.C., USA
| | - Hayley A Gans
- School of Medicine, Stanford University, Stanford, CA, USA
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14
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Green R, Webb D, Jeena PM, Wells M, Butt N, Hangoma JM, Moodley R(S, Maimin J, Wibbelink M, Mustafa F. Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa. Afr J Emerg Med 2021; 11:283-296. [PMID: 33912381 PMCID: PMC8063696 DOI: 10.1016/j.afjem.2020.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/08/2020] [Accepted: 11/15/2020] [Indexed: 12/24/2022] Open
Abstract
Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers. Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.
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Affiliation(s)
- Robin Green
- Department Paediatrics and Child Health, University of Pretoria, South Africa
| | - David Webb
- Houghton House Group, Johannesburg, South Africa
| | - Prakash Mohan Jeena
- Department of Paediatrics & Child Health, University of KwaZulu Natal, Durban, South Africa
| | - Mike Wells
- Division of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Jackie Maimin
- South African Pharmacy Council, Johannesburg, South Africa
| | | | - Fatima Mustafa
- Steve Biko Academic Hospital, Department of Paediatrics and Child Health, University of Pretoria, South Africa
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15
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Effect of prophylactic administration of antipyretics on the immune response to pneumococcal conjugate vaccines in children: a systematic review. Pneumonia (Nathan) 2021; 13:7. [PMID: 33894782 PMCID: PMC8070291 DOI: 10.1186/s41479-021-00085-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/29/2021] [Indexed: 02/01/2023] Open
Abstract
Background Prophylactic administration of antipyretics at the time of immunization seems to decrease some side effects, however reduced immune responses have been reported in some studies. This systematic review aimed to investigate the effect of prophylactic use of antipyretics on the immune response following administration of pneumococcal conjugate vaccines (PCVs). Methods A systematic review of randomized controlled trials and observational studies concerning the immune response to PCVs after antipyretic administration was performed up to November 2020 in the electronic databases of Pubmed and Scopus. Results Of the 3956 citations retrieved, a total of 5 randomized control trials including 2775 children were included in the review. Included studies were referred to PCV10 (3 studies), PCV7 and PCV13 (one study each). The prophylactic administration of paracetamol decreased the immune response to certain pneumococcal serotypes in all included studies. The effect was more evident following primary vaccination and with immediate administration of paracetamol. Despite the reductions in antibody geometric mean concentrations, a robust memory response was observed following the booster dose. Besides, antibody titers remained above protective levels in 88–100% of participants. The use of ibuprofen, that was evaluated in two studies, did not seem to affect the immunogenicity of PCVs . Conclusion Although the reviewed studies had significant heterogeneity in design, paracetamol administration seems to affect the immune response for certain serotypes. The clinical significance of reduced immunogenicity especially before booster dose needs further investigation.
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16
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Wrotek S, LeGrand EK, Dzialuk A, Alcock J. Let fever do its job: The meaning of fever in the pandemic era. Evol Med Public Health 2020; 9:26-35. [PMID: 33738101 PMCID: PMC7717216 DOI: 10.1093/emph/eoaa044] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
Although fever is one of the main presenting symptoms of COVID-19 infection, little public attention has been given to fever as an evolved defense. Fever, the regulated increase in the body temperature, is part of the evolved systemic reaction to infection known as the acute phase response. The heat of fever augments the performance of immune cells, induces stress on pathogens and infected cells directly, and combines with other stressors to provide a nonspecific immune defense. Observational trials in humans suggest a survival benefit from fever, and randomized trials published before COVID-19 do not support fever reduction in patients with infection. Like public health measures that seem burdensome and excessive, fevers involve costly trade-offs but they can prevent infection from getting out of control. For infections with novel SARS-CoV-2, the precautionary principle applies: unless evidence suggests otherwise, we advise that fever should be allowed to run its course. Lay summary: For COVID-19, many public health organizations have advised treating fever with medicines such as acetaminophen or ibuprofen. Even though this is a common practice, lowering body temperature has not improved survival in laboratory animals or in patients with infections. Blocking fever can be harmful because fever, along with other sickness symptoms, evolved as a defense against infection. Fever works by causing more damage to pathogens and infected cells than it does to healthy cells in the body. During pandemic COVID-19, the benefits of allowing fever to occur probably outweigh its harms, for individuals and for the public at large.
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Affiliation(s)
- Sylwia Wrotek
- Department of Immunology, Nicolaus Copernicus University, Torun, Poland
| | - Edmund K LeGrand
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee Knoxville, TN, USA
| | - Artur Dzialuk
- Department of Genetics, Kazimierz Wielki University, Bydgoszcz, Poland
| | - Joe Alcock
- Department of Emergency Medicine, University of New Mexico, Albuquerque, USA
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17
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Dolhain J, Janssens W, Dindore V, Mihalyi A. Infant vaccine co-administration: review of 18 years of experience with GSK's hexavalent vaccine co-administered with routine childhood vaccines. Expert Rev Vaccines 2020; 19:419-443. [PMID: 32419537 DOI: 10.1080/14760584.2020.1758560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The benefits of vaccine co-administration include improved vaccine acceptance and uptake resulting in an increased coverage and protection against multiple childhood diseases, with minimal medical visits. The diphtheria-tetanus-acellular pertussis-hepatitis B-poliomyelitis-Haemophilus influenzae type b vaccine (DTaP-HBV-IPV/Hib) has been available for more than 19 years and is recommended for co-administration with several other infant vaccines. AREAS COVERED This is a comprehensive review (34 studies, 21,000 participants) describing the immunogenicity and safety of DTaP-HBV-IPV/Hib when co-administered with 12 different vaccines in infants including pneumococcal, meningococcal, rotavirus or measles-mumps-rubella-varicella. EXPERT OPINION Interactions among co-administered vaccines are complex. Therefore, co-administration data are critical before a vaccination regimen can be recommended. Co-administration of DTaP-HBV-IPV/Hib with other routinely administered vaccines was associated with high percentages of children achieving seroprotection/vaccine response against DTaP-HBV-IPV/Hib antigens. In addition, co-administration was not associated with clinically significant interference in immune responses to co-administered vaccines and was well tolerated. Increased systemic reactions observed with some combinations (DTaP-HBV-IPV/Hib + pneumococcal conjugate or meningococcal serogroup B vaccines) were mitigated by prophylactic paracetamol administration. The data reported here, which represent the most frequently used co-administrations of DTaP-HBV-IPV/Hib worldwide, support the concomitant administration of DTaP-HBV-IPV/Hib with other routinely recommended infant vaccines.
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18
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Choe YJ, Blatt DB, Lee HJ, Choi EH. Associations between geographic region and immune response variations to pneumococcal conjugate vaccines in clinical trials: A systematic review and meta-analysis. Int J Infect Dis 2020; 92:261-268. [PMID: 32147023 DOI: 10.1016/j.ijid.2019.12.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Geographic region can be an important source of variation in the immune response to pneumococcal conjugate vaccines (PCV). The aim of this study was to collate data from available PCV clinical trials in order to characterize the differences in antibody responses in different countries. METHODS A systematic review and meta-analysis was conducted to examine the difference in antibody responses after primary series of PCVs in infants, associated with geographic regions, compared with each other and with the different PCVs using random-effects models. RESULTS A total of 69 trials were included. Studies conducted in the Western Pacific Region (WPR) showed higher geometric mean concentrations (GMC) compared to studies conducted in Europe. The pooled GMC for serotype 4 after three doses of PCV7 in the WPR was 5.19 μg/ml (95% confidence interval 4.85-5.53 μg/ml), while for studies conducted in Europe this was 2.01 μg/ml (95% confidence interval 1.88-2.14 μg/ml). The IgG GMC ratios among the WPR versus European regions ranged from 1.51 to 2.87 for PCV7, 1.69 to 3.22 for PCV10, and 1.49 to 3.08 for PCV13. CONCLUSIONS Studies conducted in the WPR generally showed greater antibody responses than the studies conducted in Europe. Indications of differences among geographic regions highlight the fact that further research is needed to compare the biological factors contributing to immune responses, which may affect vaccination schedules.
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Affiliation(s)
- Young June Choe
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea.
| | - Daniel B Blatt
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, United States.
| | - Hoan Jong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.
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19
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Comparison of Fever-reducing Effects in Self-reported Data from the Mobile App: Antipyretic Drugs in Pediatric Patients. Sci Rep 2020; 10:3879. [PMID: 32127557 PMCID: PMC7054323 DOI: 10.1038/s41598-020-60193-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 02/07/2020] [Indexed: 11/16/2022] Open
Abstract
We compared the fever-reducing efficacy of acetaminophen (AA), ibuprofen (IBU), and dexibuprofen (DEX) using data collected from the mobile healthcare application FeverCoach, which provides parents with guidelines for determining their child’s health condition, according to body temperature. Its dataset includes 4.4 million body temperature measurement records and 1.6 million antipyretics treatment records. Changes in body temperature over time were compared after taking one of three different antipyretics (AA, IBU, and DEX), using a one-way ANOVA followed by a post-hoc analysis. A multivariate linear model was used to further analyze the average body temperature differences, calibrating for the influences of age, weight, and sex. Children administered IBU had average body temperatures that were 0.18 °C (0.17–0.19 °C), 0.25 °C (0.24–0.26 °C), and 0.18 °C (0.17–0.20 °C) lower than those of children administered AA, at time intervals of 1–2 hours, 2–3 hours, and 3–4 hours, respectively. Similarly, children administered DEX had average body temperatures that were 0.24 °C (0.24–0.25 °C), 0.28 °C (0.27–0.29 °C), and 0.12 °C (0.10–0.13 °C) lower than those of children administered AA, at time intervals of 1–2, 2–3, and 3–4 hours, respectively. Although the data were collected from the application by non-professional parents, the analysis showed that IBU and DEX were more effective in reducing body temperature than AA was.
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20
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Lombardi N, Crescioli G, Bettiol A, Tuccori M, Rossi M, Bonaiuti R, Ravaldi C, Levi M, Mugelli A, Ricci S, Lippi F, Azzari C, Bonanni P, Vannacci A. Vaccines Safety in Children and in General Population: A Pharmacovigilance Study on Adverse Events Following Anti-Infective Vaccination in Italy. Front Pharmacol 2019; 10:948. [PMID: 31543816 PMCID: PMC6728926 DOI: 10.3389/fphar.2019.00948] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022] Open
Abstract
Background: The concern for adverse events following immunization (AEFI) and anti-vaccination movements that lacked scientific evidence-based supports may reduce vaccine uptake in the general population. Thus, the aims of the present study were to characterize AEFI in general population (all age groups), in terms of frequency, preventability, and seriousness and to define predictors of their seriousness in children. Methods: A retrospective study was performed on suspected AEFI reports for children and adults who received any form of vaccinations, collected in Tuscany, Italy, between 1 January and 31 December 2017. Patients’ characteristics, suspected vaccines, and AEFI description were collected. Causality and preventability were assessed using WHO and Schumock and Thornton algorithms, respectively. Logistic regression was used to estimate the reporting odds ratios of potential predictors of AEFI seriousness in children. Results: A total of 223 suspected AEFI reports were collected, and the majority of them were defined as non-serious (76.7%). Reports were mostly related to one vaccine, and to a median of two to five strains/toxoids. The total number of simultaneously administered strains/toxoids and the presence of allergens did not correlate with AEFI seriousness. Considering vaccines with a high number of administered doses (≥60,000 doses), the rates estimated for serious AEFI reports were always very low, ranging between 0.01 and 0.2/1,000 doses. Twenty-four vaccines (8,993 doses) were not related to any AEFI. Conclusion: Results of present study showed that AEFI were very rare; the vast majority of them was non-serious and, despite the claims of anti-vaccination movements, the simultaneous administration of vaccines was safe and did not influence the risk of reporting a serious AEFI, particularly in children.
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Affiliation(s)
- Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Alessandra Bettiol
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Marco Tuccori
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy.,Unit of Adverse Drug Reactions Monitoring, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Rossi
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy.,Centre of Pharmacovigilance, University Hospital of Siena, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Roberto Bonaiuti
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Claudia Ravaldi
- CiaoLapo, Charity for Healthy Pregnancy, Stillbirth and Perinatal Grief Support, Prato, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | - Miriam Levi
- Epidemiology Unit, Department of Prevention, Local Health Unit Tuscany Centre, Florence, Italy
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Silvia Ricci
- Department of Pediatric Immunology, University of Florence, Florence, Italy.,Meyer Children's Hospital, Florence, Italy
| | - Francesca Lippi
- Department of Pediatric Immunology, University of Florence, Florence, Italy.,Meyer Children's Hospital, Florence, Italy
| | - Chiara Azzari
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Pediatric Immunology, University of Florence, Florence, Italy.,Meyer Children's Hospital, Florence, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy.,Tuscan Regional Centre of Pharmacovigilance, Florence, Italy.,CiaoLapo, Charity for Healthy Pregnancy, Stillbirth and Perinatal Grief Support, Prato, Italy
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21
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Abstract
There is substantial variation between individuals in the immune response to vaccination. In this review, we provide an overview of the plethora of studies that have investigated factors that influence humoral and cellular vaccine responses in humans. These include intrinsic host factors (such as age, sex, genetics, and comorbidities), perinatal factors (such as gestational age, birth weight, feeding method, and maternal factors), and extrinsic factors (such as preexisting immunity, microbiota, infections, and antibiotics). Further, environmental factors (such as geographic location, season, family size, and toxins), behavioral factors (such as smoking, alcohol consumption, exercise, and sleep), and nutritional factors (such as body mass index, micronutrients, and enteropathy) also influence how individuals respond to vaccines. Moreover, vaccine factors (such as vaccine type, product, adjuvant, and dose) and administration factors (schedule, site, route, time of vaccination, and coadministered vaccines and other drugs) are also important. An understanding of all these factors and their impacts in the design of vaccine studies and decisions on vaccination schedules offers ways to improve vaccine immunogenicity and efficacy.
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22
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Weinkove R, Bowden E, Wood C, Campion V, Carter J, Hall R, Weatherall M, Beasley R, Young P. A randomized controlled feasibility trial of paracetamol during febrile neutropenia in hemato-oncology patients. Leuk Lymphoma 2019; 60:1540-1547. [PMID: 30656993 DOI: 10.1080/10428194.2018.1538512] [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: 10/27/2022]
Abstract
The efficacy of paracetamol (acetaminophen) as an antipyretic during febrile neutropenia (FN) has not previously been established. We conducted a randomized double-blind placebo-controlled feasibility trial: hemato-oncology patients at high FN risk were randomly assigned to six hourly oral paracetamol (1 g) or placebo during the first 42 hours of FN. Fifty-three participants were screened, thirty-seven enrolled; 22 developed FN and commenced treatment (13 paracetamol; 9 placebo); recruitment rates were below, and retention rates met, pre-defined feasibility criteria. During the first 24 hours of FN, paracetamol recipients had significantly lower peak temperature than placebo: mean 38.2 (standard deviation 0.8) °C versus 38.9 (0.4) °C; difference -0.78 °C (95% CI -1.38 to -0.18); p = .013. Bacterial load measurement was not informative. Paracetamol lowers body temperature during FN, and definitive trials to determine its impact on FN outcomes are needed. Australian New Zealand Clinical Trials Registry reference ACTRN12613000601730; funded by Health Research Council of New Zealand.
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Affiliation(s)
- Robert Weinkove
- a Wellington Blood and Cancer Centre, Capital and Coast DHB , Wellington , New Zealand.,b Malaghan Institute of Medical Research , Wellington , New Zealand.,c Department of Pathology and Molecular Medicine , University of Otago Wellington , Wellington , New Zealand
| | - Emily Bowden
- c Department of Pathology and Molecular Medicine , University of Otago Wellington , Wellington , New Zealand
| | - Catherine Wood
- a Wellington Blood and Cancer Centre, Capital and Coast DHB , Wellington , New Zealand.,b Malaghan Institute of Medical Research , Wellington , New Zealand
| | - Victoria Campion
- a Wellington Blood and Cancer Centre, Capital and Coast DHB , Wellington , New Zealand
| | - John Carter
- a Wellington Blood and Cancer Centre, Capital and Coast DHB , Wellington , New Zealand.,c Department of Pathology and Molecular Medicine , University of Otago Wellington , Wellington , New Zealand
| | - Richard Hall
- d Institute of Environmental Science and Research , Upper Hutt , New Zealand
| | - Mark Weatherall
- e Department of Medicine , University of Otago Wellington , Wellington , New Zealand
| | - Richard Beasley
- f Medical Research Institute of New Zealand , Wellington , New Zealand
| | - Paul Young
- f Medical Research Institute of New Zealand , Wellington , New Zealand.,g Intensive Care Unit, Capital and Coast District Health Board , Wellington , New Zealand
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23
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Scheifele D, Ward B. Fever prophylaxis can reduce vaccine responses: A caution. Paediatr Child Health 2018; 23:245-246. [PMID: 30038529 DOI: 10.1093/pch/pxy011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prophylactic administration of antipyretic/analgesic drugs, started at the time of immunization and repeated 6 and 12 hours later, is sometimes undertaken to reduce postimmunization fever and irritability in infants. Two recent studies showed that such prophylaxis can reduce immune responses to some infant vaccines, warranting judicious use. In contrast, implementing treatment 6 hours or more after immunization had no effect on vaccine responses and would reduce drug exposure of asymptomatic infants.
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Affiliation(s)
- David Scheifele
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia
- Canadian Association for Immunization Research and Evaluation, Vancouver, British Columbia
| | - Brian Ward
- Canadian Association for Immunization Research and Evaluation, Vancouver, British Columbia
- McGill Vaccine Studies Center, McGill University Health Center, Montreal, Québec
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Nainani V, Galal U, Buttery J, Snape MD. An increase in accident and emergency presentations for adverse events following immunisation after introduction of the group B meningococcal vaccine: an observational study. Arch Dis Child 2017; 102:958-962. [PMID: 28794096 DOI: 10.1136/archdischild-2017-312941] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether the introduction of the capsular group B meningococcal vaccine (4CMenB) in the UK has increased presentations of infants to emergency departments with adverse events following immunisation (AEFI). PARTICIPANTS, DESIGN AND SETTING A retrospective review of hospital records of infants aged 1-6 months presenting to Oxford University Hospitals NHS Trust's emergency departments from September 2013 to August 2016 with discharge diagnoses of vaccine reactions or non-specific conditions. Immunisation history was checked by reference to centralised immunisation records. MAIN OUTCOME MEASURES Presentation classifications were 'probable vaccine reaction' (ie, symptoms within 48 hours of immunisation; no alternative cause found), 'possible vaccine reaction' (symptoms within 48 hours of immunisation with a possible alternative cause) or 'not related' (clear alternative diagnosis or not immunised within previous 48 hours). RESULTS Prior to 4CMenB introduction (2013-15), an annual average of 12 infants presented with probable or possible AEFIs, increasing to 38 infants in the year following 4CMenB introduction (2015/2016). Rates of AEFIs per 1000 immunisation episodes increased post-4CMenB introduction from 1.03 to 3.4 (p<0.001) at 2 months and from 0.14 to 1.13 (p=0.005) at 4 months. At 3 months, when 4CMenB is not given, no increase was seen (p=0.380). 4CMenB introduction was also associated with increased AEFI-related hospital admissions, invasive investigations and intravenous antibiotic use. CONCLUSIONS The increase in emergency department attendances, investigations and antibiotic use for AEFIs following 4CMenB immunisation may influence the cost-effectiveness of the 4CMenB immunisation campaign.
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Affiliation(s)
- Viveka Nainani
- Department of Paediatrics, University of Oxford, Oxford, UK
- Department of Infection and Immunity, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Ushma Galal
- Nuffield Department of Primary Care Health Sciences, Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Jim Buttery
- Department of Infection and Immunity, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- SAFEVIC, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Monash Immunisation, Monash Health, Clayton, Victoria, Australia
| | - Matthew D Snape
- Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR, Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, UK
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