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Forsyth KS, Jiwrajka N, Lovell CD, Toothacre NE, Anguera MC. The conneXion between sex and immune responses. Nat Rev Immunol 2024; 24:487-502. [PMID: 38383754 PMCID: PMC11216897 DOI: 10.1038/s41577-024-00996-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/23/2024]
Abstract
There are notable sex-based differences in immune responses to pathogens and self-antigens, with female individuals exhibiting increased susceptibility to various autoimmune diseases, and male individuals displaying preferential susceptibility to some viral, bacterial, parasitic and fungal infections. Although sex hormones clearly contribute to sex differences in immune cell composition and function, the presence of two X chromosomes in female individuals suggests that differential gene expression of numerous X chromosome-linked immune-related genes may also influence sex-biased innate and adaptive immune cell function in health and disease. Here, we review the sex differences in immune system composition and function, examining how hormones and genetics influence the immune system. We focus on the genetic and epigenetic contributions responsible for altered X chromosome-linked gene expression, and how this impacts sex-biased immune responses in the context of pathogen infection and systemic autoimmunity.
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Affiliation(s)
- Katherine S Forsyth
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nikhil Jiwrajka
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Claudia D Lovell
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Natalie E Toothacre
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Montserrat C Anguera
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Aamand T, Fisker AB, Correia C, Fernandes M, Clipet-Jensen C, Thysen SM. Do Pentavalent (DTwP-Hib-HBV) vaccines have sex-differential nonspecific effects? An observational study. Hum Vaccin Immunother 2023; 19:2288297. [PMID: 38054431 PMCID: PMC10732639 DOI: 10.1080/21645515.2023.2288297] [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: 09/06/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
Vaccines may alter the ability to combat infections unrelated to the target disease, i.e. have "nonspecific effects." The non-live Diphtheria-Tetanus-Pertussis vaccine (DTP) has been associated with increased child mortality, especially for females. In 2008, the DTP-containing Pentavalent vaccine replaced DTP vaccine in Guinea-Bissau. We investigate female relative to male mortality after Penta vaccination. In Guinea-Bissau, Bandim Health Project (BHP) registered children's vaccination and vital status at biannual village visits and provided vaccines. Among children Penta-vaccinated by BHP, we compared mortality of males and females in Cox proportional hazards models. Children aged 6 weeks to 8 months entered the analysis at the date of vaccination and were followed for up to 6 months. Between September 2008 and December 2017, 33,989 children aged 6 weeks to 8 months were under surveillance. Of these 12,753 (females: 6,363; males: 6,390) received Penta by the BHP and entered the study contributing with 19,667 observations. The mortality rate following Penta vaccination was 25.2 per 1,000 person years for females and 26.6 for males, resulting in an adjusted Female/Male mortality rate ratio of (F/M aMRR) 1.01 (0.82-1.25). The association between sex and mortality differed by timeliness of vaccination, F/M aMRR: 0.62 (0.41-0.93) for children vaccinated below median age, and F/M aMRR: 1.38 (0.90-2.13) for children vaccinated above median age. We did not find higher overall mortality in females than males after Penta vaccination. Our findings suggest that mortality differences between males and females following Penta vaccination may depend on timeliness of Penta vaccination.
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Affiliation(s)
- Thomas Aamand
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Ane Bærent Fisker
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense, Denmark
| | | | | | | | - Sanne Marie Thysen
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Gou Y, Li SM, Zhang JF, Hei XP, Lv BH, Feng K. 6084 Cases of Adult Tetanus from China: A Literature Analysis. Infect Drug Resist 2023; 16:2007-2018. [PMID: 37038478 PMCID: PMC10082574 DOI: 10.2147/idr.s404747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
Objective To describe the clinical characteristics, treatments, and outcomes of tetanus and determine the most appropriate focus for tetanus prevention and treatment to reduce morbidity and mortality in China. Methods Four databases, including the Chinese Bio-Medical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan-fang Data, were searched from 1 January, 2000 to 30 October, 2022. Results In total, 151 articles including 6084 tetanus patients met the inclusion criteria. Additionally, 5925 patients had their gender recorded in detail, among which 66.67% (3950/5925) were male, and 33.33% (1975/ 5925) were female. The average age in the detailed records was reported in 4773 cases, with an overall average age of 46.69. The number of patients' places of residence was 580. Those from rural areas comprised the highest percentage with 88.62% (514 / 580). The causes of injury were recorded in 1592 cases in total; injuries caused by metals, wood, and wooden spikes accounted for the highest percentage with 54.52% (868/1592). Patient outcomes were recorded in 4305 cases, with a mortality of 9.34% (402/4305). The leading causes of death included treatment terminated by family members, asphyxia due to persistent spasms, respiratory failure, and autonomic dysfunction, family automatic abandonment and asphyxia accounted for the highest percentage, both 24.00% (54/225). Conclusion The overall success rate of tetanus treatment in China has dramatically improved, but the prevention and control of non-neonatal tetanus is still challenging. Focus should be placed on the prevention of adult tetanus and standardizing the use of sedative and spasmolytic drugs. Additionally, medical professionals should popularize tetanus prevention and treatment knowledge among the people and strengthen training in grass-roots hospitals.
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Affiliation(s)
- Yi Gou
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Sheng-Ming Li
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Jun-Fei Zhang
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Xiao-Ping Hei
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Bo-Hui Lv
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Ke Feng
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- Correspondence: Ke Feng, Department of Emergency Medical, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, People’s Republic of China, Tel +86 18709676586, Email
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Aaby P, Nielsen S, Fisker AB, Pedersen LM, Welaga P, Hanifi SMA, Martins CL, Rodrigues A, Chumakov K, Benn CS. Stopping oral polio vaccine (OPV) after defeating poliomyelitis in low-and-middle-income countries: Harmful unintended consequences? Open Forum Infect Dis 2022; 9:ofac340. [PMID: 35937644 PMCID: PMC9348612 DOI: 10.1093/ofid/ofac340] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background The live vaccines bacille Calmette-Guérin (BCG) and measles vaccine have beneficial nonspecific effects (NSEs) reducing mortality, more than can be explained by prevention of tuberculosis or measles infection. Live oral polio vaccine (OPV) will be stopped after polio eradication; we therefore reviewed the potential NSEs of OPV. Methods OPV has been provided in 3 contexts: (1) coadministration of OPV and diphtheria-tetanus-pertussis (DTP) vaccine at 6, 10, and 14 weeks of age; (2) at birth (OPV0) with BCG; and (3) in OPV campaigns (C-OPVs) initiated to eradicate polio infection. We searched PubMed and Embase for studies of OPV with mortality as an outcome. We used meta-analysis to obtain the combined relative risk (RR) of mortality associated with different uses of OPV. Results First, in natural experiments when DTP was missing, OPV-only compared with DTP + OPV was associated with 3-fold lower mortality in community studies (RR, 0.33 [95% confidence interval {CI}, .14–.75]) and a hospital study (RR, 0.29 [95% CI, .11–.77]). Conversely, when OPV was missing, DTP-only was associated with 3-fold higher mortality than DTP + OPV (RR, 3.23 [95% CI, 1.27–8.21]). Second, in a randomized controlled trial, BCG + OPV0 vs BCG + no OPV0 was associated with 32% (95% CI, 0–55%) lower infant mortality. Beneficial NSEs were stronger with early use of OPV0. Third, in 5 population-based studies from Guinea-Bissau and Bangladesh, the mortality rate was 24% (95% CI, 17%–31%) lower after C-OPVs than before C-OPVs. Conclusions There have been few clinical polio cases reported in this century, and no confounding factors or bias would explain all these patterns. The only consistent interpretation is that OPV has beneficial NSEs, reducing nonpolio child mortality.
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Affiliation(s)
- Peter Aaby
- Bandim Health Project, Indepth Network , Apartado 861, Bissau, Guinea-Bissau
| | - Sebastian Nielsen
- Bandim Health Project, Indepth Network , Apartado 861, Bissau, Guinea-Bissau
- OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark , Denmark
| | - Ane B Fisker
- Bandim Health Project, Indepth Network , Apartado 861, Bissau, Guinea-Bissau
- OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark , Denmark
| | - Line M Pedersen
- Bandim Health Project, Indepth Network , Apartado 861, Bissau, Guinea-Bissau
- OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark , Denmark
| | - Paul Welaga
- Navrongo Health Research Centre , P. O. Box 114, Navrongo , Ghana
| | - Syed M A Hanifi
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research , Bangladesh (icddr, b)
| | - Cesario L Martins
- Bandim Health Project, Indepth Network , Apartado 861, Bissau, Guinea-Bissau
| | - Amabelia Rodrigues
- Bandim Health Project, Indepth Network , Apartado 861, Bissau, Guinea-Bissau
| | - Konstantin Chumakov
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring , MD , USA
| | - Christine S Benn
- OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark , Denmark
- Danish Institute of Advanced Science, Odense University Hospital/University of Southern Denmark , Denmark
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Fisker AB, Martins JSD, Jensen AM, Martins C, Aaby P, Thysen SM. Health effects of utilising hospital contacts to provide measles vaccination to children 9-59 months-a randomised controlled trial in Guinea-Bissau. Trials 2022; 23:349. [PMID: 35461287 PMCID: PMC9034539 DOI: 10.1186/s13063-022-06291-z] [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] [Received: 04/19/2021] [Accepted: 04/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measles vaccination coverage in Guinea-Bissau is low; fewer than 80% of children are currently measles vaccinated before 12 months of age. The low coverage hampers control of measles. Furthermore, accumulating evidence indicates that measles vaccine has beneficial non-specific effects, strengthening the resistance towards other infections. Thus, even if children are not exposed to measles virus, measles-unvaccinated children may be worse off. To increase vaccination coverage, WHO recommends that contacts with the health system for mild illness are utilised to vaccinate. Currently, in Guinea-Bissau, curative health system contacts are not utilised. METHODS Bandim Health Project registers out-patient consultations and admissions at the paediatric ward of the National Hospital in Guinea-Bissau. Measles-unvaccinated children aged 9-59 months consulting for milder illness or being discharged from the paediatric ward will be invited to participate in a randomised trial. Among 5400 children, randomised 1:1 to receive standard measles vaccine or a saline placebo, we will test the hypothesis that providing a measles vaccine at discharge lowers the risk of admission/mortality (composite outcome) during the subsequent 6 months by 25%. All enrolled children are followed through the Bandim Health Project registration system and through telephone follow-up. The first 1000 enrolled children are furthermore followed through interviews on days 2, 4, 7 and 14 after enrolment. DISCUSSION Utilising missed vaccination opportunities can increase vaccination coverage and may improve child health. However, without further evidence for the safety and potential benefits of measles vaccination, these curative contacts are unlikely to be used for vaccination in Guinea-Bissau. TRIAL REGISTRATION www. CLINICALTRIALS gov NCT04220671 . Registered on 5 January 2020.
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Affiliation(s)
- Ane B Fisker
- Bandim Health Project, Indepth Network, 1004, Bissau, Guinea-Bissau. .,Bandim Health Project, University of Southern Denmark, OPEN, 5000, Odense, Denmark.
| | | | - Andreas M Jensen
- Bandim Health Project, Indepth Network, 1004, Bissau, Guinea-Bissau.,Bandim Health Project, University of Southern Denmark, OPEN, 5000, Odense, Denmark
| | - Cesario Martins
- Bandim Health Project, Indepth Network, 1004, Bissau, Guinea-Bissau
| | - Peter Aaby
- Bandim Health Project, Indepth Network, 1004, Bissau, Guinea-Bissau.,Bandim Health Project, University of Southern Denmark, OPEN, 5000, Odense, Denmark
| | - Sanne M Thysen
- Bandim Health Project, Indepth Network, 1004, Bissau, Guinea-Bissau.,Bandim Health Project, University of Southern Denmark, OPEN, 5000, Odense, Denmark.,Center for Clinical Research and Prevention, Frederiksberg Hospital, 2000, Frederiksberg, Denmark
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Arega SM, Knobel DL, Toka FN, Conan A. Non-specific effects of veterinary vaccines: a systematic review. Vaccine 2021; 40:1655-1664. [PMID: 34815120 DOI: 10.1016/j.vaccine.2021.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022]
Abstract
The benefits of vaccines have been centred on their specific effects on subsequent infections by target pathogens. Recent studies, however, have opened up new insights into additional effects of vaccines known as non-specific effects (NSEs) or heterologous effects of vaccines. While several articles have reviewed epidemiological and immunological evidence for NSEs of vaccines in humans, similar works on veterinary vaccines are scarce. The objective of this paper was to review the findings of published studies on NSEs of vaccines developed or repurposed for use in animals. In total 8412 titles were retrieved from PubMed and CABI databases on the 30th of April 2021. After the final stage of screening, 45 eligible articles were included in the review. Data from these articles were summarised and presented here. In general, most of the vaccines studied in the reviewed articles have beneficial NSEs against multiple pathogens and disease conditions. There were, however, fewe studies reporting detrimental NSEs from both non-live and live vaccines which is in contrast to the currently existing evidence of beneficial NSEs of live vaccines and detrimental NSEs of non-live vaccines. This review may be used as a complement for future review of RCT studies of NSEs of vaccines in animals and provide a useful addition to the evolving understanding of the NSEs of vaccines.
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Affiliation(s)
- Sintayehu M Arega
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis.
| | - Darryn L Knobel
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis; Department of Veterinary Tropical Diseases, University of Pretoria, Pretoria, South Africa
| | - Felix N Toka
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
| | - Anne Conan
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis; Center for One Health Research and Policy Advice, City University of Hong Kong, Kowloon, Hong Kong Special Administrative Region
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Sørensen MK, Schaltz-Buchholzer F, Jensen AM, Nielsen S, Monteiro I, Aaby P, Benn CS. Retesting the hypothesis that early Diphtheria-Tetanus-Pertussis vaccination increases female mortality: An observational study within a randomised trial. Vaccine 2021; 40:1606-1616. [PMID: 34217570 DOI: 10.1016/j.vaccine.2021.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/25/2021] [Accepted: 06/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND There are worrying indications that diphtheria-tetanus-pertussis (DTP) vaccine has negative non-specific effects for females. We previously found, in a trial of early-Bacillus Calmette-Guérin (BCG) to low weight (LW) neonates, that receiving early-DTP (before 2 months of age), was associated with increased female mortality compared with no-DTP/delayed-DTP. Within a subsequent LW trial, we aimed to retest this observation. METHODS Between 2010 and 2014, in Guinea-Bissau, 2,398 infants were randomised 1:1 to early-BCG (intervention) or delayed-BCG (standard practice for LW neonates) and visited at 2, 6 and 12 months of age to assess nutritional and vaccination status. DTP is recommended at 6 weeks of age. We examined the effect of having "early-DTP" versus "no-DTP" at the time of the 2-month visit on all-cause mortality between the 2- and 6-month visits in Cox models stratified by sex and adjusted for BCG-group and 2-month-weight-for-age (z-scores) providing adjusted mortality rate ratios (aMRRs). We analysed to which extent conditions varied between the present and the previous LW trials and how that might have affected the overall result of comparing the early-DTP and the no-DTP groups. RESULTS At the time of the 2-month visit, 75% (1,795/2,398) had received DTP. Those vaccinated had better anthropometric indices than no-DTP infants at birth and by 2 months of age. Between the 2- and 6-month visits, 29 deaths occurred. The early-DTP/no-DTP aMRR was 1.09 (95% CI: 0.44-2.69); 1.19 (0.45-3.15) for females and 0.77 (0.14-4.19) for males. Compared to the previous study, the present study cohort had 56% (30-72%) lower overall mortality, fewer no-DTP infants, higher BCG vaccination coverage and several more oral polio vaccine campaigns. CONCLUSION We did not find that early-DTP was associated with increased female mortality as found in a previous study; differences in results may partly be due to a decline in overall mortality and changes in vaccination practices.
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Affiliation(s)
| | - Frederik Schaltz-Buchholzer
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Bandim Health Project, Institute of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Andreas Møller Jensen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Bandim Health Project, Institute of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Sebastian Nielsen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Bandim Health Project, Institute of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Ivan Monteiro
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Bandim Health Project, Institute of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark; Danish Institute of Advanced Science, Uni. Southern Denmark, Odense, Denmark.
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Juste RA, Geijo MV, Elguezabal N, Sevilla IA, Alonso-Hearn M, Garrido JM. Paratuberculosis vaccination specific and non-specific effects on cattle lifespan. Vaccine 2021; 39:1631-1641. [PMID: 33597115 DOI: 10.1016/j.vaccine.2021.01.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 12/25/2022]
Abstract
Records of cattle vaccination against paratuberculosis (PTB) have been analyzed to determine whether or not non-specific effect (NSE) on overall mortality similar to that observed in BCG vaccinated humans occurs in animals. The results of a previously reported slaughterhouse study on PTB prevalence were used as a reference on the age incidence of advanced patent (clinical) epidemio-pathogenic forms. In the proper vaccine study, cows in 30 cattle farms in the Basque Country, Spain were followed-up for between 1 and 13 years. Vaccinated groups were composed by 1008 (592 right-censored) animals younger than 3 months treated as calves and by 3761 (3160 right-censored) vaccinated at any older age. Controls were 339 (157 right-censored) and 4592 (2213 right-censored) age matched animals, respectively. Individual last year presence in the annual testing was considered age at culling or death. A survival analysis was carried out according age at vaccination of vaccinated versus non-vaccinated animals. PTB age incidence in the slaughterhouse study was subtracted from the difference between vaccinated and non-vaccinated animals at the same age in order to estimate PTB-specific and non-specific effects. The maximum difference was observed at the 2-3 years interval with a 33.9% mortality reduction in the calf vaccinated group. This corresponded also with the maximum NSE that was 24.5% for a PTB incidence of 9.5%. Overall, vaccination afforded to calves a 26.5% yearly mortality protection, split between 11.1% PTB-specific and 15.4% NSE. These results support a NSE on total mortality associated with PTB vaccination that appeared to persist for up to 6-7 years. This confirms for the first time in an animal field study the innate immune system memory predicted by the recently proposed trained immunity theory. Contrasting the literature, no deleterious effects of killed vaccines on females were observed. Mortality reduction would offset vaccination costs and could improve livestock systems efficiency and potentially reduce antibiotic use. Clinical trial registered with Spanish Agency for Drugs and Sanitary products (AEMPS) as 11/012/ECV.
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Affiliation(s)
- R A Juste
- Department of Animal Health, NEIKER-Basque Institute for Agricultural Research and Development, Basque Research and Technology Alliance (BRTA), Parque Tecnologico de Bizkaia, p-812, E-48160 Derio, Spain; SERIDA, Agrifood Regional Research and Development Service, 33300 Villaviciosa, Asturias, Spain.
| | - M V Geijo
- Department of Animal Health, NEIKER-Basque Institute for Agricultural Research and Development, Basque Research and Technology Alliance (BRTA), Parque Tecnologico de Bizkaia, p-812, E-48160 Derio, Spain
| | - N Elguezabal
- Department of Animal Health, NEIKER-Basque Institute for Agricultural Research and Development, Basque Research and Technology Alliance (BRTA), Parque Tecnologico de Bizkaia, p-812, E-48160 Derio, Spain
| | - I A Sevilla
- Department of Animal Health, NEIKER-Basque Institute for Agricultural Research and Development, Basque Research and Technology Alliance (BRTA), Parque Tecnologico de Bizkaia, p-812, E-48160 Derio, Spain
| | - M Alonso-Hearn
- Department of Animal Health, NEIKER-Basque Institute for Agricultural Research and Development, Basque Research and Technology Alliance (BRTA), Parque Tecnologico de Bizkaia, p-812, E-48160 Derio, Spain
| | - J M Garrido
- Department of Animal Health, NEIKER-Basque Institute for Agricultural Research and Development, Basque Research and Technology Alliance (BRTA), Parque Tecnologico de Bizkaia, p-812, E-48160 Derio, Spain
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Life expectancy of HIV-infected patients followed at the largest hospital in Guinea-Bissau is one-fourth of life expectancy of the background population. Infection 2021; 49:631-643. [PMID: 33528814 DOI: 10.1007/s15010-020-01574-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To estimate the life expectancy (LE) of HIV-infected patients in the West African country Guinea-Bissau and compare it with the background population. METHODS Using data from the largest HIV outpatient clinic at the Hospital Nacional Simão Mendes in the capital Bissau, a retrospective observational cohort study was performed. The study included patients attending the clinic between June 2005 and January 2018. A total of 8958 HIV-infected patients were included. In the analysis of the background population, a total of 109,191 people were included. LE incorporating loss to follow-up (LTFU) was estimated via Kaplan-Meier estimators using observational data on adult HIV-infected patients and background population. RESULTS The LE of 20-year-old HIV-infected patients was 9.8 years (95% CI 8.3-11.5), corresponding to 22.3% (95% CI 18.5-26.7%) of the LE of the background population. (LE for 20-year-olds in the background population was 44.0 years [95% CI 43.0-44.9].) Patients diagnosed with CD4 cell counts below 200 cells/µL had a LE of 5.7 years (95% CI 3.6-8.2). No increase in LE with later calendar period of diagnosis was observed. CONCLUSIONS LE was shown to be markedly lower among HIV-infected patients compared with the background population. While other settings have shown marked improvements in prognosis of HIV-infected patients in recent years, no improvement in Bissau was observed over time (9.8 years (95% CI 7.6-12.2) and 9.9 years (95% CI 7.6-12.1) for the periods 2005-2010 and 2014-2016, respectively).
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Vora KS, Sundararajan A, Saiyed S, Dhama K, Natesan S. Impact of COVID-19 on women and children and the need for a gendered approach in vaccine development. Hum Vaccin Immunother 2020; 16:2932-2937. [PMID: 33175602 PMCID: PMC8641604 DOI: 10.1080/21645515.2020.1826249] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/22/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has imposed unprecedented health and socioeconomic challenges on public health, disrupting it on a global scale. Given that women and children are widely considered the most vulnerable in the times of emergency, whether in war or during a pandemic, the current pandemic has also severely disrupted access to reproductive and child health services. Despite this, data on the effect of the pandemic on pregnant women and newborns remain scarce, and gender-disaggregated indicators of mortality and morbidity are not available. In this context, we suggest the implementation of a gendered approach to ensure the specific needs of women and their newborns are considered during the development of COVID-19 vaccines. Taking into account gender-based biological differences, the inclusion of pregnant and lactating mothers in clinical trials for the development of COVID-19 vaccines is of vital importance.
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Affiliation(s)
- Kranti Suresh Vora
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
- University of Canberra, Bruce, Australia
| | | | | | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, India
| | - Senthilkumar Natesan
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
- Biomac Life Sciences Pvt Ltd, Gandhinagar, India
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11
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Hanifi SMA, Fisker AB, Welaga P, Rieckmann A, Jensen AG, Benn CS, Aaby P. Diphtheria-Tetanus-Pertussis (DTP) Vaccine Is Associated With Increased female-Male Mortality. Studies of DTP administered before and after measles vaccine. J Infect Dis 2020; 223:1984-1991. [DOI: 10.1093/infdis/jiaa684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The third dose of diphtheria-tetanus-pertussis vaccine (DTP3) is used to monitor immunization programs. DTP has been associated with higher female mortality.
Methods
We updated previous literature searches for DTP studies of mortality by sex. We examined the female/male (F/M) mortality rate ratio (MRR) with increasing number of doses of DTP and for subsequent doses of measles vaccine (MV) after DTP and of DTP after MV.
Results
Eight studies had information on both DTP1 and DTP3. The F/M MRR was 1.17 (95% confidence interval [CI], .88–1.57) after DTP1 and increased to 1.66 (95% CI, 1.32–2.09) after DTP3. Following receipt of MV, the F/M MRR declined to 0.63 (95% CI, .42–.96). In 11 studies the F/M MRR increased to 1.73 (95% CI, 1.33–2.27) when DTP-containing vaccine was administered after MV.
Conclusions
F/M MRR increased with increasing doses of DTP. After MV, girls had lower mortality than boys. With DTP after MV, mortality increased again for girls relative to boys. No bias can explain these changes in F/M MRR. DTP does not improve male survival substantially in situations with herd immunity to pertussis and higher F/M MRR after DTP may therefore reflects an absolute increase in female mortality.
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Affiliation(s)
- Syed Manzoor Ahmed Hanifi
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institute, Copenhagen, Denmark
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ane Bærent Fisker
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institute, Copenhagen, Denmark
- Open Patient Explorative Network, Institute of Clinical Research, University of Southern Denmark, and Odense University Hospital, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Paul Welaga
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Navrongo Health Research Centre, Navrongo, Ghana
| | - Andreas Rieckmann
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institute, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Aksel Georg Jensen
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institute, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christine Stabell Benn
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institute, Copenhagen, Denmark
- Open Patient Explorative Network, Institute of Clinical Research, University of Southern Denmark, and Odense University Hospital, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Peter Aaby
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institute, Copenhagen, Denmark
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
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12
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Varma A, Jensen AKG, Thysen SM, Pedersen LM, Aaby P, Fisker AB. Research protocol of two concurrent cluster-randomized trials: Real-life Effect of a CAMPaign with Measles Vaccination (RECAMP-MV) and Real-life Effect of a CAMPaign with Oral Polio Vaccination (RECAMP-OPV) on mortality and morbidity among children in rural Guinea-Bissau. BMC Public Health 2019; 19:1506. [PMID: 31711464 PMCID: PMC6849174 DOI: 10.1186/s12889-019-7813-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measles and oral polio vaccinations may reduce child mortality to an extent that cannot be explained by prevention of measles and polio infections; these vaccines seem to have beneficial non-specific effects. In the last decades, billions of children worldwide have received measles vaccine (MV) and oral polio vaccine (OPV) through campaigns. Meanwhile the under-five child mortality has declined. Past MV and OPV campaigns may have contributed to this decline, even in the absence of measles and polio infections. However, cessation of these campaigns, once their targeted infections are eradicated, may reverse the decline in the under-five child mortality. No randomized trial has assessed the real-life effect of either campaign on child mortality and morbidity. We present the research protocol of two concurrent trials: RECAMP-MV and RECAMP-OPV. METHODS Both trials are cluster-randomized trials among children registered in Bandim Health Project's rural health and demographic surveillance system throughout Guinea-Bissau. RECAMP-MV is conducted among children aged 9-59 months and RECAMP-OPV is conducted among children aged 0-8 months. We randomized 222 geographical clusters to intervention or control clusters. In intervention clusters, children are offered MV or OPV (according to age at enrolment) and a health check-up. In control clusters, children are offered only a health check-up. Enrolments began in November 2016 (RECAMP-MV) and March 2017 (RECAMP-OPV). We plan 18,000 enrolments for RECAMP-MV with an average follow-up period of 18 months and 10,000 enrolments for RECAMP-OPV with an average follow-up period of 10 months. Data collection is ongoing. The primary outcome in both trials is non-accidental death or non-accidental first non-fatal hospitalization with overnight stay (composite outcome). Secondary outcomes are: non-accidental death, repeated non-fatal hospitalizations with overnight stay, cause-specific primary outcome, outpatient visit, and illness. We obtained ethical approval from Guinea-Bissau and consultative approval from Denmark. DISCUSSION Cluster randomization and minimum risk of loss to follow-up are strengths, and no placebo a limitation. Our trials challenge the understanding that MV and OPV only prevent measles and polio, and that once both infections are eradicated, campaigns with MV and OPV can be phased out without negative implications on child health and survival. TRIAL REGISTRATION NCT03460002.
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Affiliation(s)
- A Varma
- Department of Clinical Research, OPEN, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark. .,Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau. .,Research Center of Vitamins and Vaccines, Statens Serum Institut, Bandim Health Project, Artillerivej 5, 2300, Copenhagen, Denmark.
| | - A K G Jensen
- Department of Clinical Research, OPEN, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark.,Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - S M Thysen
- Department of Clinical Research, OPEN, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark.,Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau.,Department of Public Health, University of Aarhus, Bartholins Alle 2, 8000, Aarhus C, Denmark
| | - L M Pedersen
- Department of Clinical Research, OPEN, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark.,Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau
| | - P Aaby
- Department of Clinical Research, OPEN, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark.,Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau.,Research Center of Vitamins and Vaccines, Statens Serum Institut, Bandim Health Project, Artillerivej 5, 2300, Copenhagen, Denmark
| | - A B Fisker
- Department of Clinical Research, OPEN, University of Southern Denmark, Winsløwparken 19, 5000, Odense C, Denmark. .,Bandim Health Project, Indepth Network, Apartado 861, 1004, Bissau Codex, Guinea-Bissau. .,Research Center of Vitamins and Vaccines, Statens Serum Institut, Bandim Health Project, Artillerivej 5, 2300, Copenhagen, Denmark.
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13
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Fan Z, Zhao Y, Wang S, Zhang F, Zhuang C. Clinical features and outcomes of tetanus: a retrospective study. Infect Drug Resist 2019; 12:1289-1293. [PMID: 31190917 PMCID: PMC6529615 DOI: 10.2147/idr.s204650] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 03/29/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Tetanus is a serious disease resulting in muscle spasm, and even death. Methods: A retrospective, single-center study was conducted by analyzing demographic and clinical parameters. Results: The study included 12 males (70.6%) and 5 females (29.4%). The mean age of the patients was 56.71±9.05 years. Patient occupations included farming (47.0%), retired (23.5), homebound (23.5), and workers (6.0%). The causes of patient injuries were as follows: metal injury (52.9%), deep injury (29.4%), electrical injury (5.9%), maxillofacial region and knee injury (5.9%), and skin ulceration (5.9%). The disease duration ranged from 3 to 36 days, and the mean incubation period was 12.65±10.17 days. Four patients had co-morbidities. The infected patients were given tetanus antitoxin (TAT) and antibiotics treatment. One patient was given continuous renal replacement therapy (CRRT) and only one patient died. Conclusions: In our department, although tetanus is a serious disease, with effective treatment, patients have reasonable cure and low death rates.
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Affiliation(s)
- Zhe Fan
- Department of General Surgery, The Third People's Hospital of Dalian, Dalian Medical University, Dalian, People's Republic of China.,Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Yue Zhao
- Graduate School, Dalian Medical University, Dalian, People's Republic of China
| | - Shuang Wang
- Graduate School, Dalian Medical University, Dalian, People's Republic of China
| | - Feng Zhang
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Chengjun Zhuang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
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14
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Fischinger S, Boudreau CM, Butler AL, Streeck H, Alter G. Sex differences in vaccine-induced humoral immunity. Semin Immunopathol 2018; 41:239-249. [PMID: 30547182 PMCID: PMC6373179 DOI: 10.1007/s00281-018-0726-5] [Citation(s) in RCA: 242] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/15/2018] [Indexed: 02/06/2023]
Abstract
Vaccines are among the most impactful public health interventions, preventing millions of new infections and deaths annually worldwide. However, emerging data suggest that vaccines may not protect all populations equally. Specifically, studies analyzing variation in vaccine-induced immunity have pointed to the critical impact of genetics, the environment, nutrition, the microbiome, and sex in influencing vaccine responsiveness. The significant contribution of sex to modulating vaccine-induced immunity has gained attention over the last years. Specifically, females typically develop higher antibody responses and experience more adverse events following vaccination than males. This enhanced immune reactogenicity among females is thought to render females more resistant to infectious diseases, but conversely also contribute to higher incidence of autoimmunity among women. Dissection of mechanisms which underlie sex differences in vaccine-induced immunity has implicated hormonal, genetic, and microbiota differences across males and females. This review will highlight the importance of sex-dependent differences in vaccine-induced immunity and specifically will address the role of sex as a modulator of humoral immunity, key to long-term pathogen-specific protection.
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Affiliation(s)
- Stephanie Fischinger
- Ragon Institute of MGH, MIT, and Harvard, 400 Technology Square, Cambridge, MA, 02139, USA.,Institut für HIV Forschung, Universität Duisburg-Essen, Duisburg, Germany
| | - Carolyn M Boudreau
- Ragon Institute of MGH, MIT, and Harvard, 400 Technology Square, Cambridge, MA, 02139, USA
| | - Audrey L Butler
- Ragon Institute of MGH, MIT, and Harvard, 400 Technology Square, Cambridge, MA, 02139, USA
| | - Hendrik Streeck
- Institut für HIV Forschung, Universität Duisburg-Essen, Duisburg, Germany
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, 400 Technology Square, Cambridge, MA, 02139, USA.
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