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Affiliation(s)
- Jessica May Franklin
- Edward Via College of Osteopathic Medicine, Virginia Campus, Blacksburg, Virginia
| | - Paul Hahn
- Andrew Rader United States Army Health Clinic, Fort Myer, Virginia
| | - Eric Fillman
- Clinical Pathology Associates, San Antonio, Texas
| | - Wendi Wohltmann
- San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
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2
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Lehman JS, Sokumbi O, Peters MS, Bridges AG, Comfere NI, Gibson LE, Wieland CN. Histopathologic features of noninfectious granulomatous disorders involving the skin. Hum Pathol 2020; 103:127-145. [PMID: 32544405 DOI: 10.1016/j.humpath.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/31/2020] [Indexed: 11/17/2022]
Abstract
Granulomatous dermatoses may represent primary skin inflammation or can serve as the harbinger of a multitude of underlying systemic disorders or drug reactions. Taken together with clinical findings, the microscopic features from skin biopsy can allow recognition of various patterns and facilitate a precise diagnosis. Accurate classification of entities in this category of inflammatory dermatoses may prompt clinicians to investigate for underlying systemic problems, thereby allowing the pathologist to add considerable value in the care of affected patients. This review article categorizes clinical and microscopic features of common and uncommon causes of noninfectious dermal and subcutaneous granulomatous inflammation.
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Affiliation(s)
- Julia S Lehman
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Margot S Peters
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Alina G Bridges
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nneka I Comfere
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Lawrence E Gibson
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
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3
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Choi YH, Perez-Cuevas MB, Kodani M, Zhang X, Prausnitz MR, Kamili S, O’Connor SM. Feasibility of Hepatitis B Vaccination by Microneedle Patch: Cellular and Humoral Immunity Studies in Rhesus Macaques. J Infect Dis 2019; 220:1926-1934. [PMID: 31408163 PMCID: PMC6834072 DOI: 10.1093/infdis/jiz399] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study evaluated dissolvable microneedle patch (dMNP) delivery of hepatitis B vaccine in rhesus macaques and provides evidence that dMNP delivery elicits seroprotective anti-HBs levels comparable with human seroprotection, potentially useful for hepatitis B birth dose vaccination in resource-constrained regions. METHODS Sixteen macaques were each vaccinated twice; they were treated in 4 groups, with dMNP delivery of AFV at 24 ± 8 µg (n = 4) or 48 ± 14 µg (n = 4), intramuscular injection of AFV (10 µg; n = 4), or intramuscular injection of AAV (10 µg; n = 4). Levels of antibody to hepatitis B surface antigen (HBsAg) (anti-HBs) and HBsAg-specific T-cell responses were analyzed. RESULTS Six of 8 animals with dMNP delivery of AFV had anti-HBs levels ≥10 mIU/mL after the first vaccine dose. After dMNP delivery of AFV, interferon γ, interleukin 2, and interleukin 4 production by HBsAg-specific T cells was detected. A statistically significant positive correlation was detected between anti-HBs levels and cells producing HBsAg-specific interferon γ and interleukin 2 (T-helper 1-type cytokine) and interleukin 4 (T-helper 2-type cytokine) in all anti-HBs-positive animals. CONCLUSIONS dMNP delivery of AFV can elicit seroprotective anti-HBs levels in rhesus macaques that are correlated with human seroprotection, and it could be particularly promising for birth dose delivery of hepatitis B vaccine in resource-constrained regions.
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Affiliation(s)
- Youkyung H Choi
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Monica B Perez-Cuevas
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Maja Kodani
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Xiugen Zhang
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Mark R Prausnitz
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Saleem Kamili
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Siobhan M O’Connor
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA
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4
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Adams JR, Senapati S, Haughney SL, Wannemuehler MJ, Narasimhan B, Mallapragada SK. Safety and biocompatibility of injectable vaccine adjuvants composed of thermogelling block copolymer gels. J Biomed Mater Res A 2019; 107:1754-1762. [PMID: 30972906 DOI: 10.1002/jbm.a.36691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 02/25/2019] [Accepted: 03/22/2019] [Indexed: 11/08/2022]
Abstract
Injectable thermogelling polymers have been recently investigated as novel adjuvants and delivery systems for next generation vaccines. As research into natural and synthetic biocompatible polymers progresses, the safety and biocompatibility of these compounds is of paramount importance. We have developed cationic pentablock copolymer (PBC) vaccine adjuvants based on Pluronic F127, a thermogelling triblock copolymer that has been approved by the FDA for multiple applications, and methacrylated poly(diethyl amino)ethyl methacrylate outer blocks. These novel materials have been demonstrated to effectively create an antigen depot, minimally impact antigen stability, and enhance the immune response to antigens (i.e., adjuvanticity) in mice. In this work, we investigated the safety and biocompatibility of the parent triblock Pluronic gels and the cationic PBC gels in mice. Histological analysis showed no injection site reactions and no damage to the liver or kidneys was observed upon administering the block copolymer formulations. However, the subcutaneous injection of a thermogelling Pluronic solution induced increased levels of lipids in the blood, with no further deleterious effects observed from the addition of the cationic outer blocks. This hyperlipidemia resolved within 30 days after the administration of the Pluronic formulation. To mitigate this adverse effect, the vaccine adjuvant formulations were modified by adding poly(vinyl alcohol), which allowed gelation, while reducing the amount of Pluronic in the formulation. This modified formulation abrogated the observed hyperlipidemia and no adverse effects were observed in the serum through biomarker analysis or at the injection site (i.e., inflammation) in comparison to the responses induced by administration of saline or incomplete Freund's adjuvant. These studies provide a foundation to developing these gels as adjuvants for next generation vaccines. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 1754-1762, 2019.
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Affiliation(s)
- Justin R Adams
- Department of Chemical and Biological Engineering, Iowa State University, Ames, Iowa, 50011
| | - Sujata Senapati
- Department of Chemical and Biological Engineering, Iowa State University, Ames, Iowa, 50011
| | - Shannon L Haughney
- Department of Chemical and Biological Engineering, Iowa State University, Ames, Iowa, 50011
| | - Michael J Wannemuehler
- Department of Veterinary Microbiology and Preventive Medicine, Iowa State University, Ames, Iowa, 50011
| | - Balaji Narasimhan
- Department of Chemical and Biological Engineering, Iowa State University, Ames, Iowa, 50011
| | - Surya K Mallapragada
- Department of Chemical and Biological Engineering, Iowa State University, Ames, Iowa, 50011
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5
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Abstract
Pigmented deposits can occur in the skin due to many and varied causes. Some of them are systemic conditions accompanied by involvement of internal organs. Others have serious prognostic implications, and early diagnosis can help in the correct and adequate management of the diseases. In addition, some of them are quite innocuous and the correct diagnosis avoids unnecessary treatments. In this article, we review the morphologic features of some of the most common and some of the less usual pigmented deposits in skin other than tattoos.
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Maurelli M, Colato C, Girolomoni G, Gisondi P. Severe cutaneous aluminum reaction to quadrivalent human papillomavirus vaccine treated with cyclosporin. J Dermatol 2017; 44:e332-e333. [PMID: 28868752 DOI: 10.1111/1346-8138.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Chiara Colato
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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7
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Gowring LE, Kobayashi TT, Lewin-Smith MR. Localized chrysiasis, aluminum salt deposition and dystrophic calcification a decade after gold injections. J Cutan Pathol 2015; 42:568-73. [PMID: 25950356 DOI: 10.1111/cup.12506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 03/04/2015] [Accepted: 03/22/2015] [Indexed: 11/28/2022]
Abstract
Localized chrysiasis is rare and can occur in two settings: after localized or traumatic implantation of elemental gold or gold salts or after localized laser or light therapy in someone who has been previously exposed to systemic gold therapy. We report a unique case of localized chrysiasis with associated aluminum salt deposition and sclerosing lipogranulomas because of previous injections of aurothioglucose (Solganal®). The unique histopathologic findings seen in this case have not been previously reported.
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Affiliation(s)
- Lena E Gowring
- Department of Dermatology, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Todd T Kobayashi
- Department of Dermatology, San Antonio Military Medical Center, San Antonio, TX, USA
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8
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The mechanisms of action of vaccines containing aluminum adjuvants: an in vitro vs in vivo paradigm. SPRINGERPLUS 2015; 4:181. [PMID: 25932368 PMCID: PMC4406982 DOI: 10.1186/s40064-015-0972-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/08/2015] [Indexed: 12/23/2022]
Abstract
Adjuvants such as the aluminum compounds (alum) have been dominantly used in many vaccines due to their immunopotentiation and safety records since 1920s. However, how these mineral agents influence the immune response to vaccination remains elusive. Many hypotheses exist as to the mode of action of these adjuvants, such as depot formation, antigen (Ag) targeting, and the induction of inflammation. These hypotheses are based on many in vitro and few in vivo studies. Understanding how cells interact with adjuvants in vivo will be crucial to fully understanding the mechanisms of action of these adjuvants. Interestingly, how alum influences the target cell at both the cellular and molecular level, and the consequent innate and adaptive responses, will be critical in the rational design of effective vaccines against many diseases. Thus, in this review, mechanisms of action of alum have been discussed based on available in vitro vs in vivo evidences to date.
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Needle-Free Dermal Delivery of a Diphtheria Toxin CRM197 Mutant on Potassium-Doped Hydroxyapatite Microparticles. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:586-92. [PMID: 25809632 DOI: 10.1128/cvi.00121-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/21/2015] [Indexed: 11/20/2022]
Abstract
Injections with a hypodermic needle and syringe (HNS) are the current standard of care globally, but the use of needles is not without limitation. While a plethora of needle-free injection devices exist, vaccine reformulation is costly and presents a barrier to their widespread clinical application. To provide a simple, needle-free, and broad-spectrum protein antigen delivery platform, we developed novel potassium-doped hydroxyapatite (K-Hap) microparticles with improved protein loading capabilities that can provide sustained local antigen presentation and release. K-Hap showed increased protein adsorption over regular hydroxyapatite (P < 0.001), good structural retention of the model antigen (CRM197) with 1% decrease in α-helix content and no change in β-sheet content upon adsorption, and sustained release in vitro. Needle-free intradermal powder inoculation with K-Hap-CRM197 induced significantly higher IgG1 geometric mean titers (GMTs) than IgG2a GMTs in a BALB/c mouse model (P < 0.001) and induced IgG titer levels that were not different from the current clinical standard (P > 0.05), namely, alum-adsorbed CRM197 by intramuscular (i.m.) delivery. The presented results suggest that K-Hap microparticles may be used as a novel needle-free delivery vehicle for some protein antigens.
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Abstract
Counseling messages for tobacco cessation, condom use, circumcision, and selective choice in the number of sexual partners can help reduce the risk of cervical cancer. Other sexual behavioral and reproductive risk factors for cervical cancer are a younger age at first intercourse and at first full-term pregnancy as well as increasing duration of combined hormonal oral contraceptive use. Micronutrients and supplements can reduce the risk of human papillomavirus infection, persistence, progression, and regression. Some human papillomavirus infections can be prevented by vaccination. Cervical cancer is best prevented by screening.
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Bergfors E, Hermansson G, Nyström Kronander U, Falk L, Valter L, Trollfors B. How common are long-lasting, intensely itching vaccination granulomas and contact allergy to aluminium induced by currently used pediatric vaccines? A prospective cohort study. Eur J Pediatr 2014; 173:1297-307. [PMID: 24752308 DOI: 10.1007/s00431-014-2318-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED The frequency of long-lasting, intensely itching subcutaneous nodules at the injection site for aluminium (Al)-adsorbed vaccines (vaccination granulomas) was investigated in a prospective cohort study comprising 4,758 children who received either a diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine (Infanrix®, Pentavac®) alone or concomitant with a pneumococcal conjugate (Prevenar). Both vaccines were adsorbed to an Al adjuvant. Altogether 38 children (0.83 %) with itching granulomas were identified, epicutaneously tested for Al sensitisation and followed yearly. Contact allergy to Al was verified in 85 %. The median duration of symptoms was 22 months in those hitherto recovered. The frequency of granulomas induced by Infanrix® was >0.66 % and by Prevenar >0.35 %. The risk for granulomas increased from 0.63 to 1.18 % when a second Al-adsorbed vaccine was added to the schedule. CONCLUSION Long-lasting itching vaccination granulomas are poorly understood but more frequent than previously known after infant vaccination with commonly used diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b and pneumococcal conjugate vaccines. The risk increases with the number of vaccines given. Most children with itching granulomas become contact allergic to aluminium. Itching vaccination granulomas are benign but may be troublesome and should be recognised early in primary health care to avoid unnecessary investigations, anxiety and mistrust.
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Affiliation(s)
- Elisabet Bergfors
- Department of Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, PO Box 454, 40530, Gothenburg, Sweden,
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12
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Subcutaneous granuloma annulare following influenza vaccination in a patient with diabetes mellitus. DERMATOL SIN 2014. [DOI: 10.1016/j.dsi.2013.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Weissmueller NT, Schiffter HA, Pollard AJ. Intradermal powder immunization with protein-containing vaccines. Expert Rev Vaccines 2013; 12:687-702. [PMID: 23750797 DOI: 10.1586/erv.13.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The central importance for global public health policy of delivering life-saving vaccines for all children makes the development of efficacious and safe needle-free alternatives to hypodermic needles, preferably in a thermostable form, a matter of pressing urgency. This paper comprehensively reviews past in vivo studies on intradermal powder immunization with vaccine formulations that do not require refrigeration. Particular emphasis is given to the immune response in relation to antigen adjuvantation. While needle-free intradermal delivery of vaccines induces a predominantly Th2-type immune response, adjuvants powerfully enhance and modulate the magnitude and nature of the elicited immune response at various effector sites.
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Affiliation(s)
- Nikolas T Weissmueller
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford and NIHR Oxford Biomedical Research Centre, Oxford, UK
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Gente Lidholm A, Bergfors E, Inerot A, Blomgren U, Gillstedt M, Trollfors B. Unexpected loss of contact allergy to aluminium induced by vaccine. Contact Dermatitis 2013; 68:286-92. [PMID: 23601064 PMCID: PMC3734622 DOI: 10.1111/cod.12053] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background In studies in Gothenburg, Sweden, in the 1990s of an aluminium hydroxide-adsorbed pertussis toxoid vaccine, 745 of ∼76 000 vaccinated children developed long-lasting itchy subcutaneous nodules at the vaccination site. Of 495 children with itchy nodules patch tested for aluminium allergy, 376 (76%) were positive. Objectives To study the prognosis of the vaccine-induced aluminium allergy. Patients and methods Two hundred and forty-one children with demonstrated aluminium allergy in the previous study were patch tested again 5–9 years after the initial test, with the same procedure as used previously. Results Contact allergy to aluminium was no longer demonstrable in 186 of the retested 241 children (77%). A negative test result was more common in children who no longer had itching at the vaccination site; it was also related to the age of the child, the time after the first aluminium-adsorbed vaccine dose, and the strength of the reaction in the first test. Conclusions Patch test reactivity to aluminium seems to disappear or weaken with time.
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Affiliation(s)
- Anette Gente Lidholm
- Department of Dermatology and Venereology, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden.
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Macartney KK, Chiu C, Georgousakis M, Brotherton JML. Safety of Human Papillomavirus Vaccines: A Review. Drug Saf 2013; 36:393-412. [DOI: 10.1007/s40264-013-0039-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hypersensitivity reactions to vaccine constituents: a case series and review of the literature. Dermatitis 2013; 23:102-9. [PMID: 22653170 DOI: 10.1097/der.0b013e31825228cf] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vaccines are composed of immunogens, preservatives, adjuvants, antibiotics, and manufacturing by-products. Components of vaccines may rarely elicit adverse reactions in susceptible individuals, thus raising concerns regarding vaccine safety. In this report, we add to the medical literature 3 cases of cutaneous delayed-type hypersensitivity to the vaccine preservative aluminum. We provide a review of major constituents in vaccines that have elicited immediate-type or delayed-type hypersensitivity reactions and describe their clinical manifestations. We include a table of the Food and Drug Administration-approved vaccines, which lists the quantities of major components including ovalbumin (egg protein), gelatin, aluminum, neomycin, 2-phenoxyethanol, thimerosal, and formaldehyde. Our goals were to inform physicians on the variety of hypersensitivity reactions to common vaccines and to provide information on the choice of vaccines in patients with suspected hypersensitivity.
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Bergfors E, Trollfors B. Sixty-four children with persistent itching nodules and contact allergy to aluminium after vaccination with aluminium-adsorbed vaccines-prognosis and outcome after booster vaccination. Eur J Pediatr 2013; 172:171-7. [PMID: 23052615 DOI: 10.1007/s00431-012-1841-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED Persistent itching subcutaneous nodules and aluminium (Al) allergy have been described after vaccination with Al-adsorbed vaccines but are considered rare. Little is known about the prognosis. Sixty-four children with itching nodules following vaccination with diphtheria-tetanus-pertussis (DTP) vaccines currently used in Sweden (Infanrix® and Pentavac®) were spontaneously reported to the authors from 1999 and followed for up to 12 years. The median duration of itching was 5 years in the 44 children who were free or almost free from symptoms at the latest follow-up. Typical findings were a long interval between vaccination and onset of symptoms (months or years) and intensified itching during intercurrent infections. Contact allergy to aluminium was demonstrated in 60/63 children (95 %). Neither the incidence nor differences between the two vaccines can be estimated from this study, but vaccine-induced itching nodules are probably more common than hitherto realised. The median interval between onset of symptoms and diagnosis was 8 months in a region where nurses were educated to recognise the condition compared to 2 years in other regions. Booster vaccination with DTP-polio was postponed or declined by 15/40 families in fear for new problems. Out of 25 children who received a booster dose, only two had new itching nodules. CONCLUSION Intensely itching subcutaneous nodules (vaccination granulomas) and contact allergy to aluminium may occur after primary vaccination with the two most commonly used DTP vaccines in Europe. The condition is probably underreported. Symptoms may last for at least 4-5 years but eventually seem to subside.
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Affiliation(s)
- Elisabet Bergfors
- The Research and Development Unit in Local Health Care, County of Östergötland, St Larsgatan 9D, 58185, Linköping, Sweden.
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Bergfors E, Lundmark K, Nyström Kronander U. A child with a long-standing, intensely itching subcutaneous nodule on a thigh: an uncommon (?) reaction to commonly used vaccines. BMJ Case Rep 2013; 2013:bcr-2012-007779. [PMID: 23354861 DOI: 10.1136/bcr-2012-007779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 2-year-old girl presented with an intensely itching subcutaneous nodule on the front of a thigh. The nodule persisted for 10 months until it was excised. Subsequent investigation for malignancy and systemic disease showed no pathological findings. The diagnosis, persistent itching vaccination granuloma, was revealed by hazard almost 2 years after the onset of symptoms. Persistent itching subcutaneous nodules at the injection site for aluminium containing vaccines (mostly diphtheria-tetanus-pertussis combination vaccines for primary immunisation of infants) may appear with a long delay after the vaccination (months), cause prolonged itching (years) and are often associated with contact allergy to aluminium. The condition is poorly recognised in Health Care which may lead to prolonged symptoms and unnecessary investigations.
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Affiliation(s)
- Elisabet Bergfors
- Research and Development Unit in Local Health Care, County of Östergötland, Linköping, Sweden.
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Milpied B, Ezzedine K, Ohayon-Courtès C, Genillier-Foin N, Peyromat M, Taieb A, Léauté-Labrèze C. Are post-vaccinal persistent itching nodules related to the use of local anaesthetic patches? A hypothesis to be confirmed. Contact Dermatitis 2012; 66:343-4. [DOI: 10.1111/j.1600-0536.2012.02013.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Beveridge MG, Polcari IC, Burns JL, Adler A, Hendrickson B, Stein SL. Local vaccine site reactions and contact allergy to aluminum. Pediatr Dermatol 2012; 29:68-72. [PMID: 21854416 DOI: 10.1111/j.1525-1470.2011.01541.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Childhood vaccines are a routine part of pediatric care in the United States; clinicians must be able to recognize and interpret associated localized adverse reactions. Redness and induration at the site of injection are commonly reported and are considered to be the result of local inflammation or hematoma formation, although other atypical reactions can occur. We report the case of a 6-month-old infant who developed subcutaneous nodules at the sites of his 4- and 6-month Pentacel (DTaP/Hib/IPV, diphtheria, tetanus, acellular pertussis, Haemophilus b conjugate, and inactivated poliovirus vaccine) and 6-month Prevnar (heptavalent pneumococcal vaccine) injections. Infectious disease and immunodeficiency examinations were unremarkable. Aluminum contact allergy was considered, and contact allergy testing confirmed sensitivity to aluminum. Although rare, aluminum contact allergy after routine immunization can occur and should be considered in the differential diagnosis of persistent subcutaneous nodules after vaccination.
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Affiliation(s)
- Mara G Beveridge
- Section of Dermatology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois 60637, USA
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21
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Morrison WB. Inflammation and cancer: a comparative view. J Vet Intern Med 2011; 26:18-31. [PMID: 22151229 DOI: 10.1111/j.1939-1676.2011.00836.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 09/22/2011] [Accepted: 10/05/2011] [Indexed: 12/11/2022] Open
Abstract
Rudolph Virchow first speculated on a relationship between inflammation and cancer more than 150 years ago. Subsequently, chronic inflammation and associated reactive free radical overload and some types of bacterial, viral, and parasite infections that cause inflammation were recognized as important risk factors for cancer development and account for one in four of all human cancers worldwide. Even viruses that do not directly cause inflammation can cause cancer when they act in conjunction with proinflammatory cofactors or when they initiate or promote cancer via the same signaling pathways utilized in inflammation. Whatever its origin, inflammation in the tumor microenvironment has many cancer-promoting effects and aids in the proliferation and survival of malignant cells and promotes angiogenesis and metastasis. Mediators of inflammation such as cytokines, free radicals, prostaglandins, and growth factors can induce DNA damage in tumor suppressor genes and post-translational modifications of proteins involved in essential cellular processes including apoptosis, DNA repair, and cell cycle checkpoints that can lead to initiation and progression of cancer.
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Affiliation(s)
- Wallace B Morrison
- Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, IN, USA.
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Gionfriddo JP, Denicola AJ, Miller LA, Fagerstone KA. Health effects of GnRH immunocontraception of wild white-tailed deer in New Jersey. WILDLIFE SOC B 2011. [DOI: 10.1002/wsb.17] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
PURPOSE OF REVIEW Studies of the human papillomavirus (HPV) vaccines, Cervarix and Gardasil provide strong evidence for the recommendation that HPV vaccines may minimize the incidence of cervical cancer over time. RECENT FINDINGS Both Cervarix and Gardasil provided more than 90% efficacy in preventing cervical intraepithelial neoplasia grade 2+ (CIN 2+) disease caused by HPV 16 and 18 in women 16-26 years who were seronegative and PCR-negative for HPV 16 and 18 at baseline. Cervarix provides more than 75% efficacy in independent cross-protection against persistent HPV 31 and 45, and 47% efficacy against HPV 33; whereas Gardasil offers 50% efficacy only against persistent HPV 31. A reduction in excisional therapies for CIN 2+ is nearly 70% for Cervarix, and 40% for Gardasil. Cervarix efficacy is documented to 6.4 years; Gardasil's to 5 years. Immunologically, Cervarix induces three to nine-fold higher peak-neutralizing antibody titers to HPV 16/18 than Gardasil, has significantly higher cervicovaginal mucus-neutralizing antibody presence than Gardasil, and significantly higher B memory cell response than Gardasil. Safety reports indicate injection site reactions for both Cervarix and Gardasil. Rare serious adverse events have been reported.
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Abstract
Cervarix and Gardasil are two prophylactic HPV vaccines designed primarily for cervical cancer prevention. Cervarix is effective against HPV-16, -18, -31, -33 and -45, the five most common cancer-causing types, including most causes of adenocarcinoma for which we cannot screen adequately. Gardasil is effective against HPV-16, 18 and 31, three common squamous cell cancer-causing types. In addition, Gardasil is effective against HPV-6 and -11, causes of genital warts and respiratory papillomatosis. The most important determinant of vaccine impact to reduce cervical cancer is its duration of efficacy. To date, Cervarix's efficacy is proven for 6.4 years and Gardasil's for 5 years.
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Affiliation(s)
- Diane M Harper
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, 7900 Lee's Summit Road, Kansas City, MO 64139, USA.
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Current world literature. Curr Opin Obstet Gynecol 2010; 21:541-9. [PMID: 20072097 DOI: 10.1097/gco.0b013e3283339a65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Human papillomavirus (HPV) is necessary for the development of cervical cancer. Cervical cancer is the second most common cancer in women worldwide but 80% occurs in developing countries, not countries with Pap screening programs. Pap screening programs in industrialized countries have reduced the incidence of cervical cancer to 4-8/100,000 women. HPV vaccines may be a promising strategy for cervical cancer in women without access to screening programs. In industrialized countries, the benefit of HPV vaccines focuses on individual abnormal Pap test reduction not cancer prevention. The focus of this review is to cover the side effects of Gardasil in perspective with the limited population benefit cervical cancer reduction in countries with organized Pap screening programs. In addition, information about Gardasil benefits, risks and unknowns for individual patient decision making for vaccination is presented. Gardasil offers protection against CIN 2+ lesions caused by HPV 16/18 and against genital warts caused by HPV 6/11 for at least 5 years. Combining Gardasil with repeated cytology screenings may reduce the proportion of abnormal cytology screens and hence reduce the associated morbidity with the subsequent colposcopies and excisional procedures.
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Affiliation(s)
- Diane M Harper
- Professor of Medicine, Director, Center of Excellence in Women's Health, University of Missouri-Kansas City School of Medicine, Departments of Biomedical and Health Informatics, Obstetrics and Gynecology and Community and Family Medicine
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Safety of human papillomavirus (HPV) vaccines: A review of the international experience so far. Vaccine 2009; 27:7270-81. [DOI: 10.1016/j.vaccine.2009.09.097] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 09/04/2009] [Accepted: 09/22/2009] [Indexed: 01/05/2023]
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