Comparison of hepatitis E virus genotypes from rabbits and pigs in the same geographic area: No evidence of natural cross-species transmission between the two animals

Domesticated pigs have been shown to be a reservoir of genotypes 3 and 4 hepatitis E virus (HEV). Farmed rabbits were recently recognized as the host of a novel virus, rabbit HEV. In order to determine whether HEV is transmitted naturally between rabbits and pigs, a survey on HEV infections was conducted in rabbits and pigs aged 2–4 months from rabbit and pig farms located near to each other in nine villages in three counties of Hebei Province, China. The overall anti-HEV antibody positivity rates in serum samples of swine and rabbits were 61.7% (58/94) and 23.2% (67/289), and the positive rates for HEV RNA were 23.4% (22/94) and 10% (29/289), respectively. In addition, 37 of 125 swine fecal samples (29.6%) were HEV RNA positive. The nucleotide sequences of a 304 bp region within HEV ORF2 have identity ranging from 84.5% to 100% among the rabbit isolates and from 82.3% to 100% among the swine isolates. In contrast, the nucleotide identity between the two species groups was only 72–76.6%. Consequently, the two groups were clearly separated in the phylogenetic tree that showed all of the rabbit isolates are closely related to the rabbit HEV reported recently and the swine isolates belong to genotype 4, including subgenotypes 4a, 4c and 4d. The results showed that HEV is highly prevalent in farmed rabbits and pigs in these areas. However, genotype 4 HEV and rabbit HEV are circulating separately in pigs and rabbits in the same area. In conclusion, there was no evidence of cross-species transmission of HEV between pigs and rabbits. The frequency of HEV transmission events between these two animal species is likely low in commercial farms.     

Seroprevalence and distribution of hepatitis E virus in various ethnic groups in Gansu province,China

Gansu province is located in northwestern China and is home to 45 ethnic groups including Han, Hui, Zang and others. Different ethnic groups have varying involvement with livestock and meat consumption, especially pork. To investigate the prevalence of hepatitis E virus (HEV) infection and the distribution of HEV genotypes among the major ethnic groups in Gansu province, 2090 serum samples were collected from individuals from four regions and three ethnic groups, the Han, Hui and Zang. All serum samples were tested for anti-HEV IgG and IgM antibodies, as well as HEV antigen, and selected samples were then tested for HEV RNA. The data showed that the seroprevalence of anti-HEV IgG in the Hui, Han and Zang ethnic groups from the four regions was 8.9%, 18.7% and 32.9%, respectively, and these differed significantly (P < 0.05). The seroprevalence of anti-HEV antibody for each ethnic group varied among the different regions. In general, within the same region, the three ethnic groups also show differences. Genomic analysis indicated that HEV isolated from humans belonged to genotype 4, and resembled closely swine HEV isolates from Gansu province. The seroprevalence of anti-HEV antibodies was in accordance with the amount of contact with pigs in the different regions. Pigs are the primary host for HEV, so people in frequent contact with pigs may be at risk of zoonotic infection. However, populations that have rare contact with pigs are more likely to be susceptible to HEV when exposed, suggesting that should be the target of vaccination.     

Phylogenetic analysis of Hepatitis E virus strains isolated from slaughter-age pigs in Colombia

Hepatitis E virus (HEV) is a zoonotic virus that causes acute hepatitis in humans, and can be transmitted via the fecal–oral route. Pigs are considered to be a reservoir for this infection—mainly where the disease is not endemic. In a previous study conducted in Antioquia, which is a region in Colombia where the production and consumption of pork meat is higher than in the rest of the country, the presence of anti-HEV IgG-type antibodies was reported in slaughter-age pigs. Aiming to identify the HEV genotype circulating in swine, animal liver, and feces samples from five swine cattle slaughterhouses located in six different sub-regions of Antioquia were collected. A nested RT-PCR (nRT-PCR) was used in order to amplify the HEV ORF-1 (170 bp) and ORF-2 (348, and 958 bp). The amplicons yielded in this study were sequenced, and a molecular phylogeny analysis based on the maximum likelihood method, including HEV sequences reported in several countries, was performed. Phylogeny analysis revealed that HEV amplification fragments from Antioquia's pigs were grouped in three clades within the sub-genotype 3a without a specific geographical structure, and were also genetically related to Japanese and American HEV sequences. This analysis provides the first approach on the genetic diversity and circulation dynamics of HEV in Colombian herds.     

Social security status and mortality in Belgian and Spanish male workers

ObjectiveTo assess differences in mortality rates between social security statuses in two independent samples of Belgian and Spanish male workers.MethodsStudy of two retrospective cohorts (Belgium, n = 23,607; Spain, n = 44,385) of 50–60 year old male employees with 4 years of follow-up. Mortality rate ratios (MRR) were estimated using Poisson regression models.ResultsMortality for subjects with permanent disability was higher than for the employed, for both Belgium [MRR = 4.56 (95% CI: 2.88–7.21)] and Spain [MRR = 7.15 (95% CI: 5.37–9.51)]. For the unemployed/early retirees, mortality was higher in Spain [MRR = 1.64 (95% CI: 1.24–2.17)] than in Belgium [MRR = 0.88 (95% CI: 0.46–1.71)].ConclusionMRR differences between Belgium and Spain for unemployed workers could be partly explained because of differences between the two social security systems. Future studies should further explore mortality differences between countries with different social security systems.     

Bluetongue virus surveillance in the Islamic Republic of Mauritania: Is serotype 26 circulating among cattle and dromedaries?

In March 2013, EDTA-blood and serum samples were collected from 119 cattle and 159 dromedaries at the slaughterhouse of Nouakchott, the capital city of the Islamic Republic of Mauritania. Serum samples were screened for the presence of Bluetongue (BT) antibodies by competitive ELISA (cELISA). Positive samples were then tested by serum-neutralization (SN) to determine BTV serotype. RNA from blood samples was first tested by a genus-specific quantitative RT-PCR assay which is able to detect all 27 existing BTV serotypes (RT-qPCR_1–27). Positive samples were further screened by a RT-qPCR assay which, instead, is able to detect the classical 24 BTV serotypes only (RT-qPCR_1–24). Of the 278 serum samples tested, 177 (mean = 63.7%; 95% CI: 57.9%–69.1%) resulted positive by cELISA. Of these, 69 were from cattle (mean = 58.0%; 95% CI: 49.0%–66.5%) and 108 from dromedaries (mean = 67.9%; 95% CI: 60.3%–74.7%). BTV-26 neutralizing antibodies were by far the most frequently found as they were detected in 146 animals with titres ranging from 1:10 to 1:80. Out of 278 blood samples, 25 (mean = 9.0%; 95% CI: 6.2%–12.9%) were found positive for BTV by RT-qPCR_1–27, 20 (mean = 16.8%; 95% CI: 11.2%–24.6%) were from cattle and 5 (mean = 3.1%; 95% CI: 1.4%–7.1%) from dromedaries. When tested by RT-qPCR_1–24 the 25 BTV positive samples were negative. Unfortunately, no genetic information by molecular typing or by next generation sequencing has been obtained as for the very low levels of RNA in the blood samples.     

Antigenic composition and immunoreactivity differences between HEV recombinant capsid proteins generated from different genotypes

Appreciable variability has been observed in hepatitis E virus (HEV) serological diagnostics. Four recombinant proteins (p166s) were generated from position 452 to 617 aa of ORF2 of different HEV genotypes and used in an indirect ELISA to detect anti-HEV IgMs and IgGs in serially diluted sera of patients infected with different HEV genotypes (genotype 1, n = 15; genotype 3, n = 12; genotype 4, n = 17). To evaluate the differences at a conformational level, 3D-structure models of p166s were predicted, and different bioinformatics tools were used to analyze the antigenic composition. With both anti-HEV IgMs and IgGs antibodies, there was a considerable variability between the four antigens immunoreactivities. In silico results revealed the region 483–533 aa with the highest antigenic potential and contains six key aa at positions 488, 489, 512, 533, 483 and 530. This immunoreactivity variation could affect diagnosis results and seroprevalence estimations and the identification in silico of a region highly antigenic would guide the development of efficient serological assays and epitope-based vaccines.     

Risk factors for tuberculosis among health care workers in South India: a nested case–control study

ObjectiveThe epidemiology of tuberculosis (TB) among health care workers (HCWs) in India remains under-researched. This study is a nested case–control design assessing the risk factors for acquiring TB among HCWs in India.Study Design and SettingsIt is a nested case–control study conducted at a tertiary teaching hospital in India. Cases (n = 101) were HCWs with active TB. Controls (n = 101) were HCWs who did not have TB, randomly selected from the 6,003 subjects employed at the facility. Cases and controls were compared with respect to clinical and demographic variables.ResultsThe cases and controls were of similar age. Logistic regression analysis showed that body mass index (BMI) <19 kg/m² (odds ratio [OR]: 2.96, 95% confidence interval [CI]: 1.49–5.87), having frequent contact with patients (OR: 2.83, 95% CI: 1.47–5.45) and being employed in medical wards (OR: 12.37, 95% CI: 1.38–110.17) or microbiology laboratories (OR: 5.65, 95% CI: 1.74–18.36) were independently associated with increased risk of acquiring TB.ConclusionHCWs with frequent patient contact and those with BMI <19 kg/m² were at high risk of acquiring active TB. Nosocomial transmission of TB was pronounced in locations, such as medical wards and microbiology laboratories. Surveillance of high-risk HCWs and appropriate infrastructure modifications may be important to prevent interpersonal TB transmission in health care facilities.     

Impact of the national targeted Hepatitis A immunisation program in Australia: 2000–2014

In November 2005, hepatitis A vaccine was funded under the Australian National Immunisation Program for Aboriginal and Torres Strait Islander (Indigenous) children aged 12–24 months in the targeted jurisdictions of Queensland, South Australia, Western Australia and the Northern Territory.We reviewed the epidemiology of hepatitis A from 2000 to 2014 using data from the Australian National Notifiable Diseases Surveillance System, the National Hospital Morbidity Database, and Australian Bureau of Statistics causes-of-death data. The impact of the national hepatitis A immunisation program was assessed by comparison of pre-vaccine (2000–2005) and post-vaccine time periods (2006–2014), by age group, Indigenous status and jurisdiction using incidence rate ratios (IRR) per 100,000 population and 95% confidence intervals (CI).The national pre-vaccine notification rate in Indigenous people was four times higher than the non-Indigenous rate, and declined from 8.41 per 100,000 (95% CI 5.03–11.79) pre-vaccine to 0.85 per 100,000 (95% CI 0.00–1.99) post-vaccine, becoming similar to the non-Indigenous rate. Notification and hospitalisation rates in Indigenous children aged <5 years from targeted jurisdictions declined in the post-vaccine period when compared to the pre-vaccine period (notifications: IRR = 0.07; 95% CI 0.04–0.13; hospitalisations: IRR = 0.04; 95% CI 0.01–0.16). As did notification rates in Indigenous people aged 5–19 (IRR = 0.08; 95% CI 0.05–0.13) and 20–49 years (IRR = 0.06; 95% CI 0.02–0.15) in targeted jurisdictions. For non-Indigenous people from targeted jurisdictions, notification rates decreased significantly in children aged <5 years (IRR 0.47; 95% CI 0.31–0.71), and significantly more overall (IRR = 0.43; 95% CI 0.39–0.47) compared to non-Indigenous people from non-targeted jurisdictions (IRR = 0.60; 95% CI 0.56–0.64).The national hepatitis A immunisation program has had a significant impact in the targeted population with relatively modest vaccine coverage, with evidence suggestive of substantial herd protection effects.     

Invitation strategies for colorectal cancer screening programmes: The impact of an advance notification letter

AimTo estimate the impact of an advance notification letter on participation in sigmoidoscopy (FS) and fecal immunochemical test (FIT) screening.MethodsEligible subjects, invited in 3 Italian population based programmes using FS and in 5 using FIT, were randomised (1:1:1), within GP, to: A) standard invitation letter; B) advance notification followed after 1 month by the standard invitation; and C) B + indication to contact the general practitioner (GP) to get advice about the decision to be screened. We calculated the 9-month attendance and the incremental cost of each strategy. We conducted a phone survey to assess GP's utilization and predictors of participation.ResultsThe advance notification was associated with a 20% increase in the attendance among 15,655 people invited for FS (B vs A — RR: 1.17, 95% CI: 1.10–1.25; C vs A — RR: 1.19, 95% CI: 1.12–1.27); the incremental cost ranged between 10 and 9 Euros. Participation in FIT screening (N = 23,543) was increased only with simple pre-notification (B vs A — RR: 1.06, 95% CI: 1.02–1.10); the incremental cost was 22.5 Euros. GP consultation rate was not increased in group C.ConclusionsAn advance notification represents a cost-effective strategy to increase participation in FS screening; its impact on the response to FIT screening was limited.     

Specific memory B cell response and participation of CD4+ central and effector memory T cells in mice immunized with liposome encapsulated recombinant NE protein based Hepatitis E vaccine candidate

BackgroundLiposome encapsulated neutralizing epitope protein of Hepatitis E virus (HEV), rNEp, our Hepatitis E vaccine candidate, was shown to be immunogenic and safe in pregnant and non-pregnant mice and yielded sterilizing immunity in rhesus monkeys.MethodsThe current study in Balb/c mice assessed the levels and persistence of anti-HEV IgG antibodies by ELISA, frequencies of B, memory B, T and memory T cells by flow cytometry and HEV-specific IgG secreting memory B cells by ELISPOT till 420 days post immunization (PI) with 5 μg rNEp encapsulated in liposome based adjuvant (2 doses, 4 weeks apart). Mice immunized with a lower dose (1 μg) were assessed only for anamnestic response post booster dose.ResultsVaccine candidate immunized mice (5 μg dose) elicited strong anti-HEV IgG response that was estimated to persist for lifetime. At day 120 PI, frequency of memory B cells was higher in immunized mice than those receiving adjuvant alone. Anti-HEV IgG titers were lower in mice immunized with 1 μg dose. A booster dose yielded a heightened antibody response in mice with both high (>800 GMT, 5 μg) and low (⩽100 GMT, 1 μg) anti-HEV IgG titers. At day 6th post booster dose, HEV-specific antibody secreting plasma cells (ASCs) were detected in 100% and 50% of mice with high and low anti-HEV IgG titers, respectively, whereas the frequencies of CD4⁺ central and effector memory T cells were high in mice with high anti-HEV IgG titers only.ConclusionsTaken together, the vaccine candidate effectively generates persistent and anamnestic antibody response, elicits participation of CD4⁺ memory T cells and triggers memory B cells to differentiate into ASCs upon boosting. This approach of assessing the immunogenicity of vaccine candidate could be useful to explore the longevity of HEV-specific memory response in future HEV vaccine trials in human.     

Predictors of death in Malaysian HIV-infected patients on anti-retroviral therapy

ObjectiveTo determine the predictors of death in Malaysian HIV-infected patients undergoing antiretroviral therapy (ART).MethodsData from 845 HIV-infected patients aged ≥ 20 years on ART in a large teaching hospital in Malaysia from 1989 to 2009 were analyzed using Kaplan–Meier and Cox regression analyses.Results72.7% of the patients survived. Multivariate Cox regression showed that significant predictors of death were age ≥ 50 years (HR 1.76; 95% CI 1.18–2.64), secondary education (HR 3.57; 95% CI 1.12–11.37), tertiary education (HR 3.57; 95% CI 1.09–11.70), being unemployed (HR 1.49; 95% CI 1.07–2.09), AIDS on initial presentation (HR 5.75; 95% CI 3.29–10.07), single-drug ART (HR 1.84; 95% CI 1.27, 2.66), double-drug ART (HR 1.63; 95% CI 1.19–2.25) and inability to achieve viral load ≤ 50 copies/ml (HR 10.22; 95% CI 7.26–14.37).ConclusionEvery effort needs to be made to ensure that all HIV patients have access to triple drug ART, to lower viral load to ≤ 50 copies/ml and to treat HIV patients before they progress to AIDS as these are significant modifiable predictors of death in Malaysian HIV patients.     

Validity of the estimates of oral cholera vaccine effectiveness derived from the test-negative design

BackgroundThe test-negative design (TND) has emerged as a simple method for evaluating vaccine effectiveness (VE). Its utility for evaluating oral cholera vaccine (OCV) effectiveness is unknown. We examined this method's validity in assessing OCV effectiveness by comparing the results of TND analyses with those of conventional cohort analyses.MethodsRandomized controlled trials of OCV were conducted in Matlab (Bangladesh) and Kolkata (India), and an observational cohort design was used in Zanzibar (Tanzania). For all three studies, VE using the TND was estimated from the odds ratio (OR) relating vaccination status to fecal test status (Vibrio cholerae O1 positive or negative) among diarrheal patients enrolled during surveillance (VE =  (1 − OR)×100%). In cohort analyses of these studies, we employed the Cox proportional hazard model for estimating VE (=1 − hazard ratio)×100%).ResultsOCV effectiveness estimates obtained using the TND (Matlab: 51%, 95% CI:37–62%; Kolkata: 67%, 95% CI:57–75%) were similar to the cohort analyses of these RCTs (Matlab: 52%, 95% CI:43–60% and Kolkata: 66%, 95% CI:55–74%). The TND VE estimate for the Zanzibar data was 94% (95% CI:84–98%) compared with 82% (95% CI:58–93%) in the cohort analysis. After adjusting for residual confounding in the cohort analysis of the Zanzibar study, using a bias indicator condition, we observed almost no difference in the two estimates.ConclusionOur findings suggest that the TND is a valid approach for evaluating OCV effectiveness in routine vaccination programs.     

A molecular phylogenetics-based approach for identifying recent hepatitis C virus transmission events

Improved surveillance methods are needed to better understand the current hepatitis C virus (HCV) disease burden and to monitor the impact of prevention and treatment interventions on HCV transmission dynamics. Sanger sequencing (HCV NS5B, HVR1 and Core-E1-HVR1) and phylogenetics were applied to samples from individuals diagnosed with HCV in British Columbia, Canada in 2011. This included individuals with two or three sequential samples collected <1 year apart. Patristic distances between sequential samples were used to set cutoffs to identify recent transmission clusters. Factors associated with transmission clustering were analyzed using logistic regression. From 618 individuals, 646 sequences were obtained. Depending on the cutoff used, 63 (10%) to 92 (15%) unique individuals were identified within transmission clusters of predicted recent origin. Clustered individuals were more likely to be <40 years old (Adjusted Odds Ratio (AOR) 2.12, 95% CI 1.21–3.73), infected with genotype 1a (AOR 6.60, 95% CI 1.98–41.0), and to be seroconverters with estimated infection duration of <1 year (AOR 3.13, 95% CI 1.29–7.36) or >1 year (AOR 2.19, 95% CI 1.22–3.97).Conclusion: Systematic application of molecular phylogenetics may be used to enhance traditional surveillance methods through identification of recent transmission clusters.     

Connaissance et couverture vaccinale contre l’hépatite virale B (HVB) : étude transversale parmi les étudiants de l’université de Cocody,Côte d’Ivoire

BackgroundTo evaluate knowledge about hepatitis B and vaccination coverage among students at Cocody's University, Ivory Coast.Materials and methodsA cross-sectional study was conducted during the academic year 2005–2006 (2557 students). Parameters were collected by interview using a survey chart. Factors influencing knowledge and vaccination against hepatitis B were analyzed by logistic regression.ResultsThe majority of students (n = 1174, 69.4% [95% CI 68–71]) knew about hepatitis B. Only 17.5% and 26.1% of students respectively were aware of sexual and blood transmission. None of the students were aware of maternal-fetal transmission. Factors associated with knowledge of hepatitis B were enrollment in health sciences (Odds Ratio = 24.19 [95% CI 8.65–76.63]) and having a scholarship (Odds Ratio = 2.34 [95% CI 1.54–3.56]). Vaccination coverage against hepatitis B was low (Odds Ratio = 3.7% [95% CI 3–4]). Factors associated with vaccination were: knowledge of hepatitis B (Odds Ratio = 6.83 [95% CI 4.57–10.27]), enrollment in health sciences (Odds Ratio = 3.59 [95% CI 2.60–4.96]), marriage (Odds Ratio = 2.04 [95% CI 1.13–3.64]) and having a scholarship (Odds Ratio = 1.60 [95% CI 1.09–2.35]).ConclusionKnowledge and vaccination coverage against hepatitis B among students at Cocody's University is low. Students should be given information about hepatitis B and access to free vaccination. Students enrolled in health sciences should be vaccinated before admission because of specific risks of contamination, for themselves and for their patients.     

Hepatitis E vaccine immunization for rabbits to prevent animal HEV infection and zoonotic transmission

Hepatitis E virus (HEV) infection has become a significant global public health concern as increasing cases of acute and chronic hepatitis E are reported. HEV of animal origin was proved to be a possible source of human infection and a previous study showed that the recent licensed HEV 239 vaccine can serve as a candidate vaccine to manage animal sources of HEV infection. However, previous immunization strategy for rabbits was the same as that for human, which is too costly to conduct large-scale animal vaccination. In an effort to reduce the costs, three vaccination schemes were assessed in the present study. Forty specific pathogen-free (SPF) rabbits were divided randomly into five groups with eight animals for each and inoculated intramuscularly with different doses of HEV 239 and placebo, respectively. All animals were challenged intravenously with swine HEV-4 and rabbit HEV of different titers 7 weeks after the initial immunization and then fecal virus excretion was monitored for 10 weeks. The results indicated that immunizing rabbits with two 10 μg doses of the vaccine is superior to vaccination with two 20 μg doses or a single 30 μg dose, which can protect rabbits against homologous and heterologous HEV infection. These findings could enable implementation of large-scale animal vaccination to prevent rabbit HEV infection and zoonotic transmission.     

Poliovirus seroprevalence before and after interruption of poliovirus transmission in Kano State,Nigeria

IntroductionIn September 2015, Nigeria was removed from the list of polio-endemic countries after more than 12 months had passed since the detection of last wild poliovirus case in the country on 24 July 2014. We are presenting here a report of two polio seroprevalence surveys conducted in September 2013 and October 2014, respectively, in the Kano state of northern Nigeria.MethodsHealth facility based seroprevalence surveys were undertaken at Murtala Mohammad Specialist Hospital, Kano. Parents or guardians of children aged 6–9 months, 36–47 months, 5–9 years and 10–14 years in 2013 and 6–9 months and 19–22 months (corresponding to 6–9 months range at the time of 2013 survey) in 2014 presenting to the outpatient department, were approached for participation, screened for eligibility and asked to provide informed consent. A questionnaire was administered and a blood sample collected for polio neutralization assay.ResultsAmong subjects aged 6–9 months in the 2013 survey, seroprevalence was 58% (95% confidence interval [CI] 51–66%) to poliovirus type 1, 42% (95% CI 34–50%) to poliovirus type 2, and 52% (95% CI 44–60%) to poliovirus type 3. Among children 36–47 months and older, seroprevalence was 85% or higher for all three serotypes. In 2014, seroprevalence in 6–9 month infants was 72% (95% CI 65–79%) for type 1, 59% (95% CI 52–66%) for type 2, and 65% (95% CI 57–72%) for type 3 and in 19–22 months, 80% (95% CI 74–85%), 57% (49–63%) and 78% (71–83%) respectively. Seroprevalence was positively associated with history of increasing oral poliovirus vaccine doses.ConclusionsThere was significant improvement in seroprevalence in 2014 over the 2013 levels indicating a positive impact of recent programmatic interventions. However the continued low seroprevalence in 6–9 month age is a concern and calls for improved immunization efforts to sustain the polio-free Nigeria.     

Combined tetanus-diphtheria and pertussis vaccine during pregnancy: transfer of maternal pertussis antibodies to the newborn

Background and objectivesPertussis is currently an emerging public health concern in some countries with high vaccination coverage. It is expected that maternal pertussis immunization could provide newborn protection. We compared pertussis toxin antibody (anti-PT) levels in women during pregnancy (pre- and post-vaccination) with respect to levels in the newborn at delivery in women vaccinated during pregnancy. We also estimated anti-PT titers at primary infant vaccination.MethodsObservational study of pregnant women vaccinated with Tdap (≥20 weeks gestation) and their newborns between May 2012 and August 2013. Anti-PT levels were determined by ELISA in maternal (pre- and post-vaccination) and newborn blood.ResultsPre-vaccination, post-vaccination maternal and newborn samples were available in 132 subjects. Mean maternal age was 34.2 (SD 4.3) years. Median weeks of gestation at vaccination were 27.2 (Q1–Q3 21.7–30.8). Anti-PT (≥10 IU/ml) levels were found in 37.1% of maternal pre-vaccination samples (geometric mean titer (GMT) 7.9 IU/ml (95% CI 6.8–9.2)), 90.2% of post-vaccination samples (GMT 31.1 IU/ml (95% CI 26.6–36.3)) and 94.7% of newborns (GMT 37.8 IU/ml (95% CI 32.3–44.1)). The Lin concordance index between post-vaccination maternal and newborn samples was 0.8 (95% CI 0.8–0.9). Transplacental transfer ratio was 146.6%. At two months of age, 66% of newborns had estimated anti-PT levels ≥10 IU/ml.ConclusionsThere was a high correlation between anti-PT levels in mothers and newborns, with higher levels in newborns, which should be sufficient to provide protection against pertussis during the first months of life. Vaccination of pregnant women seems to be an immunogenic strategy to protect newborns until primary infant immunization.     

Seroprevalence of hepatitis B and factors potentially associated in a population-based study in Medellin,Colombia

The seroprevalence of hepatitis B (HB) and of potentially associated factors in Medellin, Colombia, were investigated 17 years after the start of universal vaccination. Biological and sociodemographic data from a population survey with a multistage random sampling were analyzed in 6–64 year old individuals. HB surface antigen, total HB core antibodies and HB surface antibodies, and in some cases IgM antibodies to HB core antigen, were tested in 2077 samples. Factors potentially associated with and natural, and vaccine immunity relative to susceptibility (absence of any marker) were analyzed using a multinomial logistic regression. The prevalence of serological patterns was: chronic infection 0.20% (95% CI 0.11–0.71), vaccine immunity 25.10% (95% CI 21.72–28.83) and natural immunity 2.60% (95% CI 1.80–3.74). No markers were detected in 71.30% (95% CI 67.70–74.83) of the individuals and evidence of recent infection was not detected. Relative to the absence of markers, natural immunity was potentially associated with age (6–17 years and 41–64 years) and sleeping less than 6 hours, while vaccine immunity was associated with age (6–17 years), reporting vaccination against HB, belonging to high socioeconomic strata, home ownership and being obese, after adjusting for other variables. These results may be a population effect of mass vaccination. It is recommended to complete the vaccination schedule and to study in detail, persistence of antibodies and the role of obesity and socioeconomic strata in the vaccine immunity.     

Influence of provider discussion and specific recommendation on colorectal cancer screening uptake among U.S. adults

ObjectivesIt is unclear if provider recommendations regarding colorectal cancer (CRC) screening modalities affect patient compliance. We evaluated provider–patient communications about CRC screening with and without a specific screening modality recommendation on patient compliance with screening guidelines.MethodsWe used the 2007 Health Information National Trends Survey (HINTS) and identified 4283 respondents who were at least 50 years of age and answered questions about their communication with their care providers and CRC screening uptake. We defined being compliant with CRC screening as the use of fecal occult blood testing (FOBT) within 1 year, sigmoidoscopy within 5 years, or colonoscopy within 10 years. We used survey weights in all analyses.ResultsCRC screening discussions occurred with 3320 (76.2%) respondents. Approximately 95% of these discussions were with physicians. Overall, 2793 (62.6%) respondents were current with CRC screening regardless of the screening modality. Discussion about screening (odds ratio (OR) = 8.83; 95% confidence interval (CI): 7.20–10.84) and providers making a specific recommendation about screening modality rather than leaving it to the patient to decide (OR = 2.04; 95% CI: 1.54–2.68) were associated with patient compliance with CRC screening guidelines.ConclusionCompliance with CRC screening guidelines is improved when providers discuss options and make specific screening test recommendations.     

Release from drinking-age restrictions is associated with increases in alcohol-related motor vehicle collisions among young drivers in Canada

BackgroundAlcohol-related motor vehicle collisions (MVCs) are a key concern in current international debates about the effectiveness of minimum legal drinking age (MLDA) laws, but the majority of this literature is based on natural experiments involving MLDA changes occurring 2–4 decades ago.MethodsA regression-discontinuity approach was used to estimate the relation between Canadian drinking-age laws and population-based alcohol-related MVCs (n = 50,233) among drivers aged 15–23 years in Canada.ResultsIn comparison to male drivers slightly younger than the MLDA, those just older had immediate and abrupt increases in alcohol-related MVCs of 40.6% (95% CI 25.1%–56.6%; P < 0.001) in Ontario; 90.2% (95% CI 7.3%–171.2%; P = 0.033) in Manitoba; 21.6% (95% CI 8.5%–35.0%; P = 0.001) in British Columbia; and 27.3% (95% CI 10.9%–44.5%; P = 0.001) in Alberta; but also an unexpected significant decrease in the Northwest Territories of − 102.2% (95% CI − 120.7%–74.9%; P < 0.001). For females, release from MLDA restrictions was associated with increases in alcohol-related MVCs in Ontario [34.2% (95% CI 0.9%–68.0%; P = 0.044)] and Alberta [82.2% (95% CI 41.1%–125.1%; P < 0.001)]. Nationally, in comparison to male drivers slightly younger than the legislated MLDA, male drivers just older had significant increases immediately following the MLDA in alcohol-related severe MVCs [27.0% (95% CI 12.6%–41.7%, P < 0.001)] and alcohol-related fatal MVCs [53.4% (95% CI 2.4%–102.9%, P = 0.04)].ConclusionsRelease from Canadian drinking-age restrictions appears to be associated with immediate increases in alcohol-related fatal and non-fatal MVCs, especially among male drivers.