Factors and considerations for establishing and improving seasonal influenza vaccination of health workers: Report from a WHO meeting,January 16–17, Berlin,Germany

Health workers represent an important target group for seasonal influenza vaccination because of their increased risk of infection as well as the risk of transmitting infection to vulnerable patients in the health care setting. Moreover, seasonal vaccination of health workers contributes to pandemic preparedness. However, many countries, especially in Africa and Asia, do not have policies for health worker influenza vaccination. In countries where such policies exist, vaccination coverage is often low. The World Health Organization (WHO) is developing a manual to guide the introduction of seasonal influenza vaccination of health workers. An Independent External Advisory Group (IEAG) that is advising WHO on the content of the manual met to discuss issues that are relevant and often unique to health worker vaccination. This meeting report summarizes the main issues that were discussed and the outcomes of the discussion. The issues include policy considerations, including the evidence in support of health worker vaccination; categorization and prioritization of health workers; the choice of vaccination strategy; its integration into broader health worker vaccination and occupational health policies; planning and management of vaccination, particularly the approaches for communication and demand generation; and the challenges with monitoring and evaluation of health worker vaccination, especially in low and middle-income countries.     

1H nuclear magnetic resonance-based metabolic profiling of cerebrospinal fluid to identify metabolic features and markers for tuberculosis meningitis

BackgroundTuberculosis meningitis (TBM) is the most severe form of tuberculosis, and currently lacks efficient diagnostic approaches. Metabolomics has the potential to differentiate patients with TBM from those with other forms of meningitis and meningitis-negative individuals. However, no systemic metabolomics research has compared the cerebrospinal fluid (CSF) of these patients.Methods¹H nuclear magnetic resonance (NMR) was used for CSF metabolic profiling. Principal component analysis and orthogonal signal correction-partial least squares-discriminant analysis (OPLS-DA) were used to screen for important variables. The Human Metabolome Database was used to identify metabolites, and MetaboAnalyst 4.0 was used for pathway analysis and over-representation analysis.ResultsOPLS-DA modeling could distinguish TBM from other forms of meningitis, and several significantly changed metabolites were identified. Additionally, 23, 6, and 21 metabolites were able to differentiate TBM from viral meningitis, bacterial meningitis, and meningitis-negative groups, respectively. Pathway analysis indicated that these metabolites were mainly involved in carbohydrate and amino acid metabolism, and over-representation analysis indicated that some of these pathways were over-represented.ConclusionsThe metabolites identified have the potential to serve as biomarkers for TBM diagnosis, and carbohydrate and amino acid metabolism are perturbed in the CSF of patents with TBM. Metabolomics is a valuable approach for screening TBM biomarkers. With further investigation, the metabolites identified in this study could aid in TBM diagnosis.     

Rotavirus,vaccine failure or diagnostic error?

Immunochromatography (ICG) is highly used in clinical settings for rotavirus (RV) diagnosis. The specificity of the tests differs by brand type and is not 100%, therefore its use when the prevalence of the disease is low (i.e. in vaccinated children) may result in a proportion of false positive diagnoses.In some areas, vaccine effectiveness studies or surveillance is done using ICG. Our objective was to estimate the validity of ICG test in vaccinated children, and estimate the number of false positive results in the Valencian Region of Spain, where all RV infections are diagnosed using ICG and are not confirmed by PCR.Population based registries were used to identify all results from the RV antigen tests performed between January 2008 and June 2012 in children under 37 months. Hospitalization and vaccination status of the patients were obtained by linking different databases through a unique identification number. The Positive Predictive Value of the ICG test depending on the vaccination status of the child, hospitalization and the rotavirus season was estimated by a Bayesian model of latent classes.Of the 48,833 tests with valid results, 9429 were done in vaccinated children, and of those 3963 (42%) during the rotavirus season. The prevalence of positive results in vaccinated varied from 2.9 to 21.4% of the tests depending on the hospitalization and seasonality. The estimated PPV also varied from 27.1 to 84.6% when stratified by these two parameters. Globally it is calculated that approximately 267 out of the 520 (51.3%) positives in vaccinated children were false positive tests.The large percentage of false positives, due to an excessive number of tests in vaccinated and out of the RV season, if interpreted as vaccine failures, can cause a loss of confidence in the vaccine and lower the estimates of vaccine effectiveness.     

Boosting treatment stabilization in patients of amphetamine-type stimulant use disorder

BackgroundTo investigate boosting effects on treatment stabilization in the mandatory treatment modality for patients of amphetamine-type stimulant use disorder.MethodsThis is a retrospective follow-up study over a period from January 2013 to December 2018. We analyzed 425 patients of amphetamine-type stimulant use disorder under mandating treatments. Treatment stabilization for a given patient was defined once 4 negative urinalysis had been observed. We developed a dynamic monitoring model of boosting effects informed by the available data, specifically the number of negative urine samples required to reach stabilization, the sum of urinalyses done at the time when the given number of negative urine samples had been observed and who the patient was. To represent the simulated population, a Monte Carlo method was used to generate p-values from 1000 experiments conducted on a computer.ResultsIn the observed samples, the probability of 4 negative results in urinalysis from 4 outpatient visits was 75.5%. In comparison, the probability for achieving 4th negative results in urinalysis over 4 visits from negative binominal distribution was 57.3%, and from the computer simulation, 49.8%. The observed samples had significantly higher probability of achieving 4 negative results in urinalysis over 4 outpatient visits (p < 0.001).ConclusionsThe mandatory treatment modality boosted treatment stabilization for patients of amphetamine-type stimulant use disorder. The major benefit of using the monitoring model is the ability to monitor boosting effects of stabilization. Results supported the effectiveness of this mandatory treatment modality and can be implemented in deferred-prosecution based treatment modality.     

Pertussis in practice in 2007]

Universal vaccination of infants against pertussis has transformed the epidemiology of the disease. Pertussis has however become frequent, although not often diagnosed, in adolescents and adults and thus contributes to permanent transmission of Bordetella pertussis in France and contamination of young infants at risk of severe disease. Control of transmission of pertussis in France necessitates reinforcement of vaccination with late boosters in adolescents and adults and, in addition, education of physicians to recognize and treat early cases of pertussis, especially in adolescents and adults with a persistent or chronic cough, and to take appropriate prophylactic measures (antibiotics and recall vaccination) of those in contact with confirmed cases. Effective treatment does little to reduce symptoms but it does reduce transmission. Macrolides are the recommended treatment for pertussis.     

自然疫源性疾病流行因素分析及对策

目的总结和分析我国1991-2006年重点自然疫源性疾病的流行现状和分布情况,探讨新时期疫情的影响因素,提出加强自然疫源性疾病监测建议。方法收集1991-2006年全国鼠疫、肾综合征出血热(HFRS)、狂犬病、流行性乙型脑炎(乙脑)、钩端螺旋体病(钩体病)、布鲁氏菌病(布病)、登革热、疟疾等重点自然疫源性疾病的疫情监测资料并进行统计分析。结果1991-2006年全国鼠疫、HFRS、狂犬病、乙脑、钩体病、布病、登革热、疟疾等报告病例1 859 295例,死亡39 028例,发病比例由20世纪90年代初期的7%左右降至2%,下降近70%,死亡比例则由50%降至目前的40%左右,所占比重依然较大;疫情主要集中在我国南方温带和亚热带地区,呈现出南多北少的特点。全球气候变暖、媒介和宿主动物入侵与耐药性、生态环境变化以及畜牧养殖业和其相关产品加工产业的高速发展等因素是目前自然疫源性疾病疫情的影响因素。结论在监测工作中重点加强预警监测、免疫接种和防制策略的效果评价以及媒介生物和宿主动物综合治理等的研究。     

Comparative proteomic analysis of Vibrio cholerae O139, O22, O155 and El Tor biotype epidemic strains

Cholera ,as one of the most severe epidemic dis-eases inthe world,can occurin a short time ,andspread quicklyto a wide region.Until 1992 ,onlyV.choleraeserogroup O1 was recognized as thecause of epidemic cholera . However in October1992 ,a major outbreak of a cholera-like illnesscaused by a newserogroupstrain ofV.choleraee-mergedinIndia and Bangladesh.In contrast to allpreviously reported non-O1 strains , which induceonly sporadic cases of human diarrhea without epi-demic potential ,the new…