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Argyropoulos CD, Leckler J, Salmanton-García J, Constantinou M, Alexandrou A, Themistocleous S, Noula E, Shiamakkides G, Nearchou A, Stewart FA, Albus K, Koniordou M, Kopsidas I, Spivak O, Hellemans M, Hendrickx G, Davis RJ, Azzini AM, Simon PV, Carcas AJ, Askling HH, Vene S, Prellezo JB, Álvarez-Barco E, Macken AJ, Di Marzo R, Luís C, Olesen OF, Frias Iniesta JA, Barta I, Tóth K, Akova M, Bonten MMJ, Cohen-Kandli M, Cox RJ, Součková L, Husa P, Jancoriene L, Launay O, Lundgren J, Mallon P, Mendonça MA, Marques L, Naucler P, Ochando J, Tacconelli E, van Damme P, Zaoutis T, Hofstraat S, Bruijning-Verhagen P, Zeitlinger M, Cornely OA, Pana ZD. Enhancing public health communication of vaccine trials: The pan-European VACCELERATE Toolkit. JMIR Public Health Surveill 2023; 9:e44491. [PMID: 36878478 PMCID: PMC10131613 DOI: 10.2196/44491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The pan-European VACCELERATE network aims to implement the first transnational harmonised and sustainable vaccine trial Volunteer Registry, serving as single entry-point for volunteers willing to participate in large scale vaccine clinical studies across the European region. The present work exhibits a set of harmonised vaccine trial educational and promotional tools for the general public, designed and disseminated by the pan-European VACCELERATE network. OBJECTIVE The main objectives of the present study are the design and creation of a standard toolkit to increase positive attitudes, and access to trustful information for better access and increased recruitment to vaccine trials for the public community. More specifically, the produced tools are focused on inclusiveness, equity, and they are targeting different population groups, including underserved ones, as potential volunteers for the VACCELERATE Volunteer Registry (elderly, migrants, children and adolescents). The promotion/education material is aligned with the main objectives of the Volunteer Registry, to increase public literacy and awareness regarding vaccine clinical research/trials and trial participation, such as informed consent and legal issues, side effects and frequently asked questions on vaccine trial design. METHODS The tools' development has followed the aims and principles of the VACCELERATE project, focusing on trial inclusiveness and equity and they are adjusted to the local country requirements to improve public health communication. The selection of the produced tools has been based on the cognitive theory, inclusiveness and equity of different aged and under-represented groups, and standardised material from several official trustful sources (e.g. COVAX, ECDC, EUPATI, GAVI and WHO). In addition, team of specialists from different fields (infectious diseases, vaccine research, medicine, education) edited and reviewed the subtitles and scripts for the educational videos, extended brochures, interactive cards and puzzles. Graph designers also selected the colour palette, audio settings and dubbing for the video story-tales and implementation of QR codes. RESULTS This study presents the first set of harmonised promotional and educational materials/tools (i.e. educational cards, educational and promotional videos, extended brochures, flyers, posters, and puzzles) for vaccine clinical research (e.g. COVID-19). The developed tools inform the public about possible benefits and disadvantages of trial participation, but also build the confidence of participants about the safety and efficacy for COVID-19 vaccines and healthcare system. The present material has been translated into several languages and meant to be freely and easily accessible to facilitate dissemination among the participating countries of the VACCELERATE network, as well as among the European and global scientific, industrial, and public community, in general. CONCLUSIONS The produced material could also be useful for filling knowledge gaps of healthcare personnel and providing the appropriate future patient education for vaccine trials, as well as to tackle vaccine hesitancy and parents' concerns for potential participation of children in vaccine trials.
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Affiliation(s)
| | - Janina Leckler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, DE.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, DE
| | - Jon Salmanton-García
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, DE.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, DE
| | | | | | | | - Evgenia Noula
- School of Medicine, European University Cyprus, 6 Diogenis Str., Nicosia, CY
| | - George Shiamakkides
- School of Medicine, European University Cyprus, 6 Diogenis Str., Nicosia, CY
| | - Andria Nearchou
- School of Medicine, European University Cyprus, 6 Diogenis Str., Nicosia, CY
| | - Fiona A Stewart
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, DE.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, DE
| | - Kerstin Albus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, DE.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, DE
| | - Markela Koniordou
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, GR
| | - Ioannis Kopsidas
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, GR
| | | | - Margot Hellemans
- Universiteit Antwerpen, Faculty of Medicine and Health Science, VAXINFECTIO, Centre of Evaluation of Vaccination, Antwerp, BE
| | - Greet Hendrickx
- Universiteit Antwerpen, Faculty of Medicine and Health Science, VAXINFECTIO, Centre of Evaluation of Vaccination, Antwerp, BE
| | - Ruth Joanna Davis
- University of Verona, Infectious Diseases, Department of Diagnostic and Public Health, Verona, IT
| | - Anna Maria Azzini
- University of Verona, Infectious Diseases, Department of Diagnostic and Public Health, Verona, IT
| | - Paula Valle Simon
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, ES.,Servicio Madrileño de Salud, Madrid, ES
| | - Antonio Javier Carcas
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, ES.,Servicio Madrileño de Salud, Madrid, ES
| | - Helena Hervius Askling
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, SE.,Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, SE
| | - Sirkka Vene
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, SE.,Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, SE
| | | | - Elena Álvarez-Barco
- Centre for Experimental Pathogen Host Research, University College Dublin School of Medicine, National University of Ireland, Dublin, IE
| | - Alan J Macken
- Centre for Experimental Pathogen Host Research, University College Dublin School of Medicine, National University of Ireland, Dublin, IE
| | | | | | - Ole F Olesen
- European Vaccine Initiative (EVI), Heidelberg, DE
| | - Jesus A Frias Iniesta
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, ES.,Servicio Madrileño de Salud, Madrid, ES
| | - Imre Barta
- National Koranyi Institute for Pulmonology, Budapest, HU
| | - Krisztina Tóth
- National Koranyi Institute for Pulmonology, Budapest, HU
| | | | - Marc M J Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, NL.,Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, NL
| | | | | | - Lenka Součková
- Masaryk University, Brno, Czech Republic, University Hospital Brno, Brno, CZ.,University Hospital Brno, Brno, CZ.,CZECRIN, Brno, CZ
| | - Petr Husa
- Masaryk University, Brno, Czech Republic, University Hospital Brno, Brno, CZ.,University Hospital Brno, Brno, CZ.,CZECRIN, Brno, CZ
| | - Ligita Jancoriene
- Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, LT.,Vilnius University Hospital Santaros klinikos, Medical Faculty, Vilnius University, Vilnius, LT
| | - Odile Launay
- Institut National de la Santé et de la Recherche Médicale-ANRS Maladies Infectieuses Émergentes, Paris, FR.,Université Paris Cité, Assistance Publique Hopitaux de Paris, Paris, FR
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, DK
| | - Patrick Mallon
- Centre for Experimental Pathogen Host Research, University College Dublin School of Medicine, National University of Ireland, Dublin, IE
| | | | | | - Pontus Naucler
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, SE.,Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, SE
| | - Jordi Ochando
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, ES
| | - Evelina Tacconelli
- University of Verona, Infectious Diseases, Department of Diagnostic and Public Health, Verona, IT
| | - Pierre van Damme
- Universiteit Antwerpen, Faculty of Medicine and Health Science, VAXINFECTIO, Centre of Evaluation of Vaccination, Antwerp, BE
| | - Theoklis Zaoutis
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, GR
| | - Sanne Hofstraat
- University Medical Centre Utrecht, Utrecht University, Utrecht, NL
| | | | | | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, DE.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, DE.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, DE.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne (CMMC), Cologne, DE.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, DE
| | - Zoi Dorothea Pana
- School of Medicine, European University Cyprus, 6 Diogenis Str., Nicosia, CY
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Hervius Askling H, Gisslén M. [Not Available]. Lakartidningen 2022; 119:22121. [PMID: 36178271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Helena Hervius Askling
- docent, överläkare, avd för infektionssjukdomar, institutionen för medi-cin Solna, Karolinska institutet; Akademiskt specialistcentrum, Region Stockholm
| | - Magnus Gisslén
- prof, överläkare, avd för infektionssjukdomar, Sahlgrenska akademin, Göteborgs universitet; infektionskliniken, Sahlgrenska universitetssjukhuset, Göteborg
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Wångdahl A, Sondén K, Wyss K, Stenström C, Björklund D, Zhang J, Hervius Askling H, Carlander C, Hellgren U, Färnert A. Relapse of Plasmodium vivax and Plasmodium ovale malaria with and without primaquine treatment in a non-endemic area. Clin Infect Dis 2021; 74:1199-1207. [PMID: 34216464 PMCID: PMC8994585 DOI: 10.1093/cid/ciab610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Indexed: 01/14/2023] Open
Abstract
Background The effect of primaquine in preventing Plasmodium vivax relapses from dormant stages is well established. For Plasmodium ovale, the relapse characteristics and the use of primaquine is not as well studied. We set to evaluate the relapsing properties of these 2 species, in relation to primaquine use among imported malaria cases in a nonendemic setting. Methods We performed a nationwide retrospective study of malaria diagnosed in Sweden 1995–2019, by reviewing medical records of 3254 cases. All episodes of P. vivax (n = 972) and P. ovale (n = 251) were selected for analysis. Results First time relapses were reported in 80/857 (9.3%) P. vivax and 9/220 (4.1%) P. ovale episodes, respectively (P < .01). Without primaquine, the risk for relapse was higher in P. vivax, 20/60 (33.3%), compared to 3/30 (10.0%) in P. ovale (hazard ratio [HR] 3.5, 95% confidence interval [CI] 1.0–12.0). In P. vivax, patients prescribed primaquine had a reduced risk of relapse compared to episodes without relapse preventing treatment, 7.1% vs 33.3% (HR 0.2, 95% CI .1–.3). In P. ovale, the effect of primaquine on the risk of relapse did not reach statistical significance, with relapses seen in 2.8% of the episodes compared to 10.0% in patients not receiving relapse preventing treatment (HR 0.3, 95% CI .1–1.1). Conclusions The risk of relapse was considerably lower in P. ovale than in P. vivax infections indicating different relapsing features between the two species. Primaquine was effective in preventing P. vivax relapse. In P. ovale, relapse episodes were few, and the supportive evidence for primaquine remains limited.
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Affiliation(s)
- Andreas Wångdahl
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Västerås Hospital, Västerås, Sweden
| | - Klara Sondén
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Katja Wyss
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Christine Stenström
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - David Björklund
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jessica Zhang
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helena Hervius Askling
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Carlander
- Department of Infectious Diseases, Västerås Hospital, Västerås, Sweden.,Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Urban Hellgren
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Anna Färnert
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Norman M, Navér L, Söderling J, Ahlberg M, Hervius Askling H, Aronsson B, Byström E, Jonsson J, Sengpiel V, Ludvigsson JF, Håkansson S, Stephansson O. Association of Maternal SARS-CoV-2 Infection in Pregnancy With Neonatal Outcomes. JAMA 2021; 325:2076-2086. [PMID: 33914014 PMCID: PMC8085767 DOI: 10.1001/jama.2021.5775] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The outcomes of newborn infants of women testing positive for SARS-CoV-2 in pregnancy is unclear. OBJECTIVE To evaluate neonatal outcomes in relation to maternal SARS-CoV-2 test positivity in pregnancy. DESIGN, SETTING, AND PARTICIPANTS Nationwide, prospective cohort study based on linkage of the Swedish Pregnancy Register, the Neonatal Quality Register, and the Register for Communicable Diseases. Ninety-two percent of all live births in Sweden between March 11, 2020, and January 31, 2021, were investigated for neonatal outcomes by March 8, 2021. Infants with malformations were excluded. Infants of women who tested positive for SARS-CoV-2 were matched, directly and using propensity scores, on maternal characteristics with up to 4 comparator infants. EXPOSURES Maternal test positivity for SARS-CoV-2 in pregnancy. MAIN OUTCOMES AND MEASURES In-hospital mortality; neonatal resuscitation; admission for neonatal care; respiratory, circulatory, neurologic, infectious, gastrointestinal, metabolic, and hematologic disorders and their treatments; length of hospital stay; breastfeeding; and infant test positivity for SARS-CoV-2. RESULTS Of 88 159 infants (49.0% girls), 2323 (1.6%) were delivered by mothers who tested positive for SARS-CoV-2. The mean gestational age of infants of SARS-CoV-2-positive mothers was 39.2 (SD, 2.2) weeks vs 39.6 (SD, 1.8) weeks for comparator infants, and the proportions of preterm infants (gestational age <37 weeks) were 205/2323 (8.8%) among infants of SARS-CoV-2-positive mothers and 4719/85 836 (5.5%) among comparator infants. After matching on maternal characteristics, maternal SARS-CoV-2 test positivity was significantly associated with admission for neonatal care (11.7% vs 8.4%; odds ratio [OR], 1.47; 95% CI, 1.26-1.70) and with neonatal morbidities such as respiratory distress syndrome (1.2% vs 0.5%; OR, 2.40; 95% CI, 1.50-3.84), any neonatal respiratory disorder (2.8% vs 2.0%; OR, 1.42; 95% CI, 1.07-1.90), and hyperbilirubinemia (3.6% vs 2.5%; OR, 1.47; 95% CI, 1.13-1.90). Mortality (0.30% vs 0.12%; OR, 2.55; 95% CI, 0.99-6.57), breastfeeding rates at discharge (94.4% vs 95.1%; OR, 0.84; 95% CI, 0.67-1.05), and length of stay in neonatal care (median, 6 days in both groups; difference, 0 days; 95% CI, -2 to 7 days) did not differ significantly between the groups. Twenty-one infants (0.90%) of SARS-CoV-2-positive mothers tested positive for SARS-CoV-2 in the neonatal period; 12 did not have neonatal morbidity, 9 had diagnoses with unclear relation to SARS-CoV-2, and none had congenital pneumonia. CONCLUSIONS AND RELEVANCE In a nationwide cohort of infants in Sweden, maternal SARS-CoV-2 infection in pregnancy was significantly associated with small increases in some neonatal morbidities. Given the small numbers of events for many of the outcomes and the large number of statistical comparisons, the findings should be interpreted as exploratory.
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MESH Headings
- Adult
- Breast Feeding/statistics & numerical data
- COVID-19/complications
- COVID-19/diagnosis
- COVID-19/epidemiology
- COVID-19/mortality
- Female
- Gestational Age
- Hospital Mortality
- Humans
- Hyperbilirubinemia/epidemiology
- Hyperbilirubinemia/etiology
- Infant, Extremely Premature
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/mortality
- Infant, Premature
- Length of Stay/statistics & numerical data
- Live Birth/epidemiology
- Male
- Outcome Assessment, Health Care
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Outcome
- Prenatal Care/statistics & numerical data
- Propensity Score
- Prospective Studies
- Respiratory Distress Syndrome, Newborn/epidemiology
- Respiratory Distress Syndrome, Newborn/etiology
- Resuscitation/statistics & numerical data
- SARS-CoV-2/isolation & purification
- Sweden/epidemiology
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Affiliation(s)
- Mikael Norman
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- The Swedish Neonatal Quality Register, Stockholm, Sweden
| | - Lars Navér
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mia Ahlberg
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Hervius Askling
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Emma Byström
- The Public Health Agency of Sweden, Stockholm, Sweden
| | | | - Verena Sengpiel
- Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonas F. Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Stellan Håkansson
- The Swedish Neonatal Quality Register, Stockholm, Sweden
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Karolinska University Hospital, Stockholm, Sweden
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Stefansson M, Askling HH, Rombo L. A single booster dose of diphtheria vaccine is effective for travelers regardless of time interval since previous doses. J Travel Med 2018; 25:5042126. [PMID: 29931363 DOI: 10.1093/jtm/tay041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/22/2018] [Indexed: 01/19/2023]
Abstract
Our study showed the immune response before and after a booster against diphtheria given within the 20-year interval recommended in Sweden or after a prolonged interval. Of 40 travellers, 10/13 in recommended interval group were immune before booster and 19/27 with a delayed interval. After booster, 13/13 versus 26/27 were protected. One booster was sufficient to achieve immunity regardless of the interval.
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Affiliation(s)
- M Stefansson
- Centre for Clinical Research Sormland County Council and Uppsala University, Kungsgatan 41, Eskilstuna, Sweden
| | - H H Askling
- Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - L Rombo
- Department Infectious Diseases, Mälarsjukhuset, Eskilstuna, Sweden
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Abstract
To estimate the tick borne encephalitis (TBE)-vaccination coverage in the greater Stockholm region, we sent a questionnaire to a randomized sample of 8000 individuals in 2013. Fifty-three percent of all respondents (n=4307) reported being vaccinated against TBE at least once. Reasons for not vaccinating included: no perceived risk (28.6%), too expensive (25.6%), did not have the time or opportunity (23%) and worried about vaccine side-effects (20.5%). Multiple logistic regression revealed that the probability of being vaccinated was higher among those who reported ≥2 weeks outdoor exposure in a known high risk area (OR 4.13 95% CI 3.54-4.81) and in individuals ≥60 years of age compared to all other age groups (OR 0.67 95% CI 0.55-0.81). A high net household income was associated with a higher probability of being vaccinated (OR 2.10 95% CI 1.6-2.73). Being born outside Europe was negatively correlated (OR 0.57 95% CI 0.39-0.83). Based on our findings the estimated TBE-incidence in the unvaccinated regional population was 8.5-12/100,000 which is comparable with high endemic areas as the Baltic region and Central Europe. We suggest targeted vaccination and reimbursement strategies in high-endemic areas of Sweden. Our results indicate a need for improved public information about TBE.
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Affiliation(s)
- Helena Hervius Askling
- Department of Communicable Diseases Control and Prevention (Smittskydd Stockholm), Box 1753, SE 11891 Stockholm, Sweden; Department of Medicine/Unit for Infectious Diseases/Solna/Karolinska Institutet, 17176 Stockholm, Sweden.
| | - Mona Insulander
- Department of Communicable Diseases Control and Prevention (Smittskydd Stockholm), Box 1753, SE 11891 Stockholm, Sweden; Department of Medicine/Unit for Infectious Diseases/Solna/Karolinska Institutet, 17176 Stockholm, Sweden.
| | - Maria-Pia Hergens
- Department of Communicable Diseases Control and Prevention (Smittskydd Stockholm), Box 1753, SE 11891 Stockholm, Sweden; Department of Medicine/Unit for Infectious Diseases/Solna/Karolinska Institutet, 17176 Stockholm, Sweden.
| | - Amy Leval
- Department of Communicable Diseases Control and Prevention (Smittskydd Stockholm), Box 1753, SE 11891 Stockholm, Sweden; Department of Medicine/Unit for Infectious Diseases/Solna/Karolinska Institutet, 17176 Stockholm, Sweden.
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Askling HH. Pre-travel advice to the most immunocompromised; Trying to guide where evidence is scarce. Travel Med Infect Dis 2015; 13:6-7. [DOI: 10.1016/j.tmaid.2014.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 12/26/2014] [Indexed: 11/29/2022]
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Erra EO, Askling HH, Yoksan S, Rombo L, Riutta J, Vene S, Lindquist L, Vapalahti O, Kantele A. Cross-protection elicited by primary and booster vaccinations against Japanese encephalitis: a two-year follow-up study. Vaccine 2013; 32:119-23. [PMID: 24176496 DOI: 10.1016/j.vaccine.2013.10.055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/05/2013] [Accepted: 10/16/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The inactivated Vero cell-derived vaccine (JE-VC, IXIARO) has replaced the traditional mouse brain-derived preparations (JE-MB) in travelers' vaccinations against Japanese encephalitis. We showed recently that a single JE-VC dose efficiently boosts immunity in JE-MB-primed vaccinees, and that JE-VC elicits cross-protective immunity against non-vaccine genotypes, including the emerging genotype I. While these studies only provided short-term data, the present investigation evaluates the longevity of seroprotection in the same volunteers. METHODS The study comprised 48 travelers who had received (1) JE-VC primary series, (2) JE-MB primary series followed by a single JE-VC booster dose, or (3) JE-MB primary series and a single JE-MB booster dose. Serum samples were collected two years after the last vaccine dose, and evaluated with the plaque-reduction neutralization test against seven Japanese encephalitis virus strains representing genotypes I-IV. PRNT50 titers ≥ 10 were considered protective. RESULTS Two years after the primary series with JE-VC, 87-93% of the vaccinees proved to be cross-protected against test strains representing genotypes II-IV and 73% against those of genotype I. After a single homologous or heterologous booster dose to JE-MB-primed subjects, the two-year seroprotection rates against genotype I-IV strains were 89-100%. CONCLUSIONS After JE-VC primary series, seroprotection appeared to wane first against genotype I. The first booster should not be delayed beyond two years. In JE-MB-primed subjects, a single JE-VC booster provided cross-protective immunity against genotype I-IV strains in almost all vaccinees, suggesting an interval of two years or even longer for the second booster. These data further support the use of a single JE-VC dose for boosting JE-MB immunity.
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Affiliation(s)
- Elina O Erra
- Haartman Institute, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Helena Hervius Askling
- Karolinska Institutet, Department of Medicine/Solna, Unit for Infectious Diseases, Stockholm, Sweden
| | - Sutee Yoksan
- Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Lars Rombo
- Karolinska Institutet, Department of Medicine/Solna, Unit for Infectious Diseases, Stockholm, Sweden; Centre for Clinical Research, Sörmland County Council, Eskilstuna, Sweden
| | - Jukka Riutta
- Aava Travel Clinic, Aava Medical Centre, Helsinki, Finland
| | - Sirkka Vene
- Swedish Institute for Communicable Disease Control, Solna, Sweden
| | - Lars Lindquist
- Karolinska Institutet, Department of Medicine/Huddinge, Unit for Infectious Diseases, Stockholm, Sweden
| | - Olli Vapalahti
- Haartman Institute, Faculty of Medicine, University of Helsinki, Helsinki, Finland; HUSLAB, Division of Virology and Immunology, Helsinki University Central Hospital, Helsinki, Finland; Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
| | - Anu Kantele
- Haartman Institute, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Aava Travel Clinic, Aava Medical Centre, Helsinki, Finland; Department of Medicine, University of Helsinki, Helsinki, Finland.
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Erra EO, Askling HH, Yoksan S, Rombo L, Riutta J, Vene S, Lindquist L, Vapalahti O, Kantele A. Cross-protective capacity of Japanese encephalitis (JE) vaccines against circulating heterologous JE virus genotypes. Clin Infect Dis 2012; 56:267-70. [PMID: 23074319 PMCID: PMC3526254 DOI: 10.1093/cid/cis883] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Current Japanese encephalitis vaccines are derived from strains of genotype III, yet heterologous genotypes are emerging in endemic areas. Inactivated vaccines given to European travelers were found to elicit protective levels of neutralizing antibodies against heterologous strains of genotypes I-IV.
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Affiliation(s)
- Elina O Erra
- Haartman Institute, University of Helsinki, Finland
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Erra EO, Askling HH, Rombo L, Riutta J, Vene S, Yoksan S, Lindquist L, Pakkanen SH, Huhtamo E, Vapalahti O, Kantele A. A single dose of vero cell-derived Japanese encephalitis (JE) vaccine (Ixiaro) effectively boosts immunity in travelers primed with mouse brain-derived JE vaccines. Clin Infect Dis 2012; 55:825-34. [PMID: 22696017 PMCID: PMC3423932 DOI: 10.1093/cid/cis542] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The new Japanese encephalitis vaccine (JE-VC, Ixiaro) has replaced mouse brain–derived vaccines (JE-MB) associated with serious safety concerns. A single dose of JE-VC effectively boosted immunity in JE-MB–primed travelers. Current recommendations for booster vaccination should be reevaluated. Background. A significant part of the world population lives in areas with endemic Japanese encephalitis (JE). For travelers from nonendemic countries, Vero cell–derived vaccine (JE-VC; Ixiaro) has replaced traditional mouse brain–derived vaccines (JE-MB) associated with safety concerns. The 2 vaccines are derived from different viral strains: JE-VC from the SA14-14-2 strain and JE-MB from the Nakayama strain. No data exist regarding whether JE-VC can be used to boost immunity after a primary series of JE-MB; therefore, a primary series of JE-VC has been recommended to all travelers regardless of previous vaccination history. Methods. One hundred twenty travelers were divided into 4 groups: Volunteers with no prior JE vaccination received primary immunization with (group 1) JE-MB or (group 2) JE-VC, and those primed with JE-MB received a single booster dose of (group 3) JE-MB or (group 4) JE-VC. Immune responses were tested before and 4–8 weeks after vaccination using plaque reduction neutralization test (PRNT) against both vaccine strains. Results. In vaccine-naive travelers, the vaccination response rate for test strains Nakayama and SA14-14-2 was 100% and 87% after primary vaccination with JE-MB and 87% and 94% after JE-VC, respectively. Antibody levels depended on the target virus, with higher titers against homologous than heterologous PRNT50 target strain (P < .001). In travelers primed with JE-MB, vaccination response rates were 91% and 91%, and 98% and 95% after a booster dose of JE-MB or JE-VC, respectively. Subgroup analysis revealed that a higher proportion of primed (98%/95%) than nonprimed (39%/42%) volunteers responded to a single dose of JE-VC (P < .001). Conclusions. A single dose of JE-VC effectively boosted immunity in JE-MB–primed travelers. Current recommendations should be reevaluated. Clinical Trials Registration. NCT01386827.
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Affiliation(s)
- Elina O Erra
- Haartman Institute, Faculty of Medicine, University of Helsinki, Finland
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Askling HH, Rydgård C, Ostlund MR, Vene S. [TBE in an elderly vaccinated couple. Don't forget booster doses to the elderly!]. Lakartidningen 2011; 108:1441-1442. [PMID: 21853731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Askling HH, Ekdahl K, Janzon R, Henric Braconier J, Bronner U, Hellgren U, Rombo L, Tegnell A. Travellers returning to Sweden with falciparum malaria: Pre-travel advice, behaviour, chemoprophylaxis and diagnostic delay. ACTA ACUST UNITED AC 2009; 37:760-5. [PMID: 16191897 DOI: 10.1080/00365540510044120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We have investigated pre-travel advice, behaviour, chemoprophylaxis and diagnostic delay in travellers returning to Sweden with falciparum malaria. Questionnaires were distributed to patients having been notified with falciparum malaria from 1994 to 2001. Of 408 notified patients, 237 (58%) returned the questionnaires; 62% were males and 43% above the age of 45 y. Africa was the travel destination in 90% of the cases, and 27% had travelled to Kenya. 69% had spent more than 1 night in the countryside, and 6% had stayed in modern urban areas only. 40% took an adequate dose of chemoprophylaxis, although this proportion decreased from 55% to 12% during the study period. Nine per cent used both bed nets and mosquito repellents regularly. The median time from onset of symptoms to contact with health care professionals was 2 d, and from that contact to start of malaria treatment the median time was less than 24 h.
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Affiliation(s)
- Helena Hervius Askling
- From the Department of Epidemiology, Swedish Institute for Infectious Disease Control (SMI), Stockholm, Sweden
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Abstract
Imported malaria has been an increasing problem in several Western countries in the last 2 decades. To calculate the risk factors of age, sex, and travel destination in Swedish travelers, we used data from the routine reporting system for malaria (mixture of patients with and without adequate prophylaxis), a database on travel patterns, and in-flight or visa data on Swedish travelers of 1997 to 2003. The crude risk for travelers varied from 1 per 100,000 travelers to Central America and the Caribbean to 357 per 100,000 in central Africa. Travelers to East Africa had the highest adjusted odds ratio (OR = 341, 95% confidence intervals [CI] 134-886) for being reported with malaria, closely followed by travelers to central Africa and West Africa. Male travelers as well as children <1-6 years of age had a higher risk of being reported with malaria (OR = 1.7, 95% CI 1.3-2.3 and OR = 4.8, 95% CI 1.5-14.8) than women and other age groups.
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Affiliation(s)
- Helena Hervius Askling
- Swedish Institute for Infectious Disease Control, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - Jenny Nilsson
- Swedish Institute for Infectious Disease Control, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - Anders Tegnell
- Swedish Institute for Infectious Disease Control, Stockholm, Sweden
| | - Ragnhild Janzon
- Swedish Institute for Infectious Disease Control, Stockholm, Sweden
| | - Karl Ekdahl
- Swedish Institute for Infectious Disease Control, Stockholm, Sweden
- Karolinska Institute, Stockholm, Sweden
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