Does being a “SunSmart School” influence hat-wearing compliance? An ecological study of hat-wearing rates at Australian primary schools in a region of high sun exposure

BackgroundChildhood sun exposure is an important risk factor for skin cancer. Anecdotal evidence suggests that hats are under-utilized by Australian primary school students.MethodsThe proportion of students and adult role-models wearing hats was observed at 36 primary schools (63.9% SunSmart schools [SSS]) in Townsville (latitude 19.3°S; high to extreme maximum daily UV-index year round), Queensland, Australia, from 2009 to 2011.ResultsOverall, 52.2% of 28,775 students and 47.9% of 2954 adults were observed wearing a hat. Hat use (all styles) among SSS and non-SunSmart school (NSSS) students was similar before (24.2% vs 20.5%; p = 0.701), after (25.4% vs 21.7%; p = 0.775) and during school-hours (93.0% vs 89.2%; p = 0.649) except SSS students wore gold-standard (broad-brim/bucket/legionnaire) hats during school play-breaks more often in the warmer months (October–March) than NSSS students (54.7% vs 37.4%; p = 0.02). Although the proportion of adults who wore hats (all styles) was similar at SSS and NSSS (48.2% vs 46.8%; p = 0.974), fewer adults at SSS wore them before school (3.7% vs 10.2%; p = 0.035).ConclusionsSunSmart status is not consistently associated with better hat-wearing behavior. The protective nature of hats and the proportion of school students and adult role-models wearing them could be improved, possibly by offering incentives to schools that promote sun-safety.     

Weight and health-related quality of life: The moderating role of weight discrimination and internalized weight bias

ObjectivesObesity is an increasingly prevalent public health concern, with associated medical comorbidities and impairment in health-related quality of life (HRQoL). Obese women are frequently victims of weight-related discrimination. The HRQoL impairments among obese people could be related to this discrimination and to internalized weight bias.DesignWe examined the potential moderating role of discrimination (from others) and self-directed (internalized) weight-based discrimination in the association between body mass index (BMI) and HRQoL.MethodsEighty-one women (mean age = 41.1 years; mean BMI = 43.40 kg/m², 97% Caucasian) completed valid and reliable measures of weight bias internalization (weight bias internalization scale), perceived discrimination by others (everyday discrimination scale) and both physical and mental HRQoL (SF-36 Health Survey). Multiple regression analysis was used to test whether internalized weight bias or discrimination moderated the association between BMI and the summary scores for physical and mental HRQoL, controlling for age.ResultsSignificant associations were found between BMI and discrimination (r = .36, p = .002), between internalized weight bias and both mental (r = .61, p < .001) and physical HRQoL (r = .45, p < .001), and between discrimination and physical HRQoL (r = .29, p = .014). A statistically significant interaction was found between BMI and internalized weight bias (b = − .21, SE = .10, p < 0.05) in accounting for the variance in physical HRQoL.ConclusionsThe association between higher BMI and poorer physical HRQoL was found only in individuals reporting high levels of internalized weight bias. Self-discrimination among overweight individuals may be a critical factor in their physical health impairment.     

Antimicrobial resistance in community-acquired urinary tract infections in Paris in 2015

Background

Urinary tract infection (UTI) is one of the most frequent community-acquired infection. Escherichia coli resistance has been on the rise since 2000s.

Smoking and mortality among persons aged 75–94

ObjectivesExamine the effect of current level of smoking and lifetime tobacco consumption on mortality in persons 75–94 years of age.MethodsData were from a representative sample of older Jewish persons in Israel, which included 1,200 self-respondent participants aged 75–94 (Mean = 83.1, SD = 5.3) from the Cross-Sectional and Longitudinal Aging Study (CALAS). Data collection took place during 1989–1992. Mortality data on 95.1% of the sample at 20-year follow up were recorded from the Israeli National Population Registry.ResultsThe following variables adversely affected mortality for the whole sample: Smoking 11–20 cigarettes daily (HR = 1.276, p < .05), smoking over 20 cigarettes daily (HR = 1.328, p < .05), total tobacco consumption (HR = 1.002, p < .01), and heavy lifetime tobacco consumption (HR = 1.270, p < .01). Results were similar for persons aged 75–84, but the effect of smoking seems to decrease or disappear for ages 85 and above.ConclusionThis is the first report of all-cause mortality risk in both genders of a representative population aged 75 and over. Increased mortality risk is related to high daily quantity of current smoking, and to cumulative amount of lifetime smoking. The effect of smoking may disappear for ages 85 and above, and should be studied in larger oldest–old samples.     

Factors affecting physicians’ perception of the overuse of antibiotics

ObjectiveWe aimed to determine the reasons for irrational antibiotic use, to evaluate knowledge, attitudes, and behaviors of physicians regarding such use, to find factors affecting knowledge of physicians, and to explore precautions that need to be taken to stop irrational antibiotic use.Material and methodsWe performed the study between January 2014 and June 2014. We included 202 physicians who answered a questionnaire with 22 multiple-choice questions about knowledge (eight questions), behavior and attitudes of physicians (nine questions), and recommendations for reducing antibiotic consumption (five questions). Answers to all questions were assessed according to the physician's age, educational status, metropolitan areas, and healthcare facilities.ResultsThe effects of parents’ expectations and satisfaction (7.4%–40.0%) (P < 0.0001) and socioeconomical status of families (33%–62%) (P = 0.007) increased as the participants’ age decreased. Participants working at public hospitals (42.6%) considered expectations and satisfaction of parents more important than other participants (10.5%–26.9%; P = 0.002). Rapid recovery of patients was not an essential determinant for administering antibiotics for pediatricians (25.7%) and pediatric assistants (26.9%). However, it was important for emergency physicians (55.6%) and family physicians (60%, P = 0.016). Physicians working at university hospitals did not consider this determinant as important as physicians working in other healthcare facilities (P = 0.001).ConclusionTo determine the obstacles associated with promoting rational antibiotic usage, every country should assess the attitudes, behavior, and knowledge of physicians related to such use. The present study is one of the few in Turkey to address the problems associated with irrational antibiotic use.     

SFRP1 variations influence susceptibility and immune response to Mycobacterium tuberculosis in a Chinese Han population

ObjectivesSFRP1 acts as a well-established inhibitory regulator of the Wnt signaling pathway, whose polymorphisms have been demonstrated to be associated with the risk of inflammation, infection as well as cancer. We verified the hypothesis that single nucleotide polymorphisms (SNPs) within SFRP1 gene are associated with susceptibility and clinical characteristics of tuberculosis disease in a Chinese Han population.MethodsSix candidate SNPs were genotyped using MassARRAY method in a case–control design (260 tuberculosis patients and 252 healthy controls). A comprehensive analysis of single locus including the genotypic, allelic frequencies and the genetic models, haplotypic construction as well as gene–gene interaction was conducted to investigate the relationships between SNPs and TB. Significant SNPs were further interrogated in relation to TB clinical features and host inflammatory status.ResultsGenotype frequencies of rs4736958 and rs7832767 within SFRP1 gene were significantly different (p = 0.011, p = 0.008, respectively) between tuberculosis group and control group. Subjects carrying C allele for rs4736958 showed a decreased tuberculosis risk (OR = 0.66, 95% CI = 0.51–0.87, p = 0.003), whereas individuals carrying rs7832767 T allele had a significant increased risk in tuberculosis susceptibility (OR = 1.32, 95% CI = 1.01–1.74, p = 0.046). Genetic model analysis revealed that dominant, co-dominant and recessive models of rs4736958 were associated with decreased susceptibility to tuberculosis (p all < 0.05), while the recessive and co-dominant models of rs7832767 were related to significantly increased risk for tuberculosis (p all < 0.05). There was a reduced tuberculosis risk in association with the haplotype CC (representing rs3242 and rs4736958) of SFRP1 (OR = 0.73, 95% CI = 0.56–0.96, p = 0.026). Further stratification analysis indicated that TB patients with genotype CT for rs4736958 were associated with higher CRP concentrations, and heterozygous patients (CT genotype) of rs7832767 trended towards greater ESR levels.ConclusionSNPs rs4736958 and rs7832767 of SFRP1 gene were significantly associated with tuberculosis susceptibility and might influence the expression levels of inflammatory markers of tuberculosis patients in a Chinese Han population.     

Implementing classroom physical activity breaks: Associations with student physical activity and classroom behavior

ObjectiveTo investigate the relation of classroom physical activity breaks to students' physical activity and classroom behavior.MethodsSix elementary-school districts in California implemented classroom physical activity interventions in 2013–2014. Students' (N = 1322) accelerometer-measured moderate-to-vigorous physical activity (MVPA) during school and teachers' (N = 397) reports of implementation and classroom behavior were assessed in 24 schools at two time points (both post-intervention). Mixed-effects models accounted for nested data.ResultsMinutes/day of activity breaks was positively associated with students' MVPA (βs = .07–.14; ps = .012–.016). Students in classrooms with activity breaks were more likely to obtain 30 min/day of MVPA during school (OR = 1.75; p = .002). Implementation was negatively associated with students having a lack of effort in class (β = − .17; p = .042), and student MVPA was negatively associated with students being off task or inattentive in the classroom (β = − .17; p = .042). Students provided with 3–4 physical activity opportunities (classroom breaks, recess, PE, dedicated PE teacher) had ≈ 5 more min/day of school MVPA than students with no opportunities (B = 1.53 min/opportunity; p = .002).ConclusionsImplementing classroom physical activity breaks can improve student physical activity during school and behavior in the classroom. Comprehensive school physical activity programs that include classroom-based activity are likely needed to meet the 30 min/day school physical activity guideline.     

Correlates of Early versus Later Initiation into Sex Work in Two Mexico–U.S. Border Cities

PurposeTo examine correlates of early initiation into sex work in two Mexico–U.S. border cities.MethodsFemale sex workers (FSWs) ≥18 years without known HIV infection living in Tijuana and Ciudad Juarez who had recent unprotected sex with clients underwent baseline interviews. Correlates of initiation into sex work before age 18 were identified with logistic regression.ResultsOf 920 FSWs interviewed in Tijuana (N = 474) and Ciudad Juarez (N = 446), 9.8% (N = 90) were early initiators (<18 years) into sex work. Median age of entry into sex work was 26 years (range: 6–58). After adjusting for age, compared to older initiators, early initiators were more likely to use inhalants (21.1% vs. 9.6%, p = .002), initiate sex work to pay for alcohol (36.7% vs. 18.4%, p < .001), report abuse as a child (42.2% vs. 18.7%, p < .0001), and they were less likely to be migrants (47.8% vs. 62.3%, p = .02). Factors independently associated with early initiation included inhalant use (adjOR = 2.39), initiating sex work to pay for alcohol (adjOR = 1.88) and history of child abuse (adjOR = 2.92). Factors associated with later initiation included less education (adjOR = 0.43 per 5-year increase), migration (adjOR = 0.47), and initiating sex work for better pay (adjOR = 0.44) or to support children (adjOR = 0.03).ConclusionsDifferent pathways for entering sex work are apparent among younger versus older females in the Mexico–U.S. border region. Among girls, interventions are needed to prevent inhalant use and child abuse and to offer coping skills; among older initiators, income-generating strategies, childcare, and services for migrants may help to delay or prevent entry into sex work.     

Phenolic compounds and antioxidant activity of Spanish commercial grape juices

Evaluation of the antioxidant activity of components of the diet is important in order to establish healthy consumption patterns. Data are reported here on the antioxidant activity (FRAP and ABTS), of 20 commercial grape juices and 10 typical Spanish wines and on their content of total phenolic compounds, anthocyanins, flavonoids and 10 individual phenolic compounds (flavanols, benzoic acids and cinnamic acids, measured by HPLC-UV). Red grape juices had a significantly higher (p < 0.05) concentration of total phenols (1177 vs. 744 mg gallic acid/L), flavonoids (98 vs. 63 mg catechin/L) and a higher antioxidant activity (9.16 vs. 2.83 meq Trolox/L) in comparison to white grape juices. In comparison to the white wines, white grape juices contained more total phenols (744 vs. 286 mg gallic acid/L) and flavonoids (63 vs. 29 mg catechin/L) and evidenced higher antioxidant activity (p < 0.05). In comparison to the red wines, a lower content of total phenols (286 vs. 2358 mg gallic acid/L) and flavonoids (228 vs. 29 mg catechin/L) and an absence of anthocyanins were observed in the white wines, which are therefore less antioxidant. Although a two-fold higher concentration of antioxidant compounds was found in red wines than in red grape juices, the latter may be a good option for all age groups because of the absence of alcohol and the potentially beneficial health effects of their phenolic composition and elevated antioxidant activity.     

Impact of the 13-valent pneumococcal conjugate vaccine on Streptococcus pneumoniae multiple serotype carriage

IntroductionPneumococcal multiple serotype carriage is important for evolution of the species and to understand how the pneumococcal population is changing with vaccination. We aimed to determine the impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on multiple serotype carriage.Methods and materialsNasopharyngeal samples from fully vaccinated pneumococcal carriers (4 doses of PCV13, n = 141, aged 18–72 months) or from non-vaccinated pneumococcal carriers (0 doses of any PCV, n = 140, same age group) were analyzed. Multiple serotype carriage was evaluated by DNA hybridization with a molecular serotyping microarray that detects all known serotypes.ResultsVaccinated children had a lower prevalence of multiple serotype carriage than the non-vaccinated group (20.6% vs 29.3%, p = 0.097), and a significantly lower proportion of PCV13 serotypes (6.4% vs 38.5%, p = 0.0001). PCV13 serotypes found among vaccinated children were mostly detected as a minor serotype in co-colonization with a more abundant non-vaccine serotype. Vaccinated children were colonized by a significantly higher proportion of commensal non-pneumococcal Streptococcus spp. (58.2% vs 42.8%, p = 0.012). In vaccinated children there were significantly less non-vaccine type (NVT) co-colonization events than expected based on the distribution of these serotypes in non-vaccinated children.ConclusionsThe results suggest that vaccinated children have lower pneumococcal multiple serotype carriage prevalence due to higher competitive abilities of non-vaccine serotypes expanding after PCV13 use. This might represent an additional benefit of PCV13, as decreased co-colonization rates translate into decreased opportunities for horizontal gene transfer and might have implications for the evolution and virulence of pneumococci.     

Association of PvuII and XbaI polymorphisms in estrogen receptor alpha gene with the risk of hepatitis B virus infection in the Guangxi Zhuang population

Background and objectiveAvailable evidence has suggested that estrogen receptor alpha (ESR1) is implicated in the pathogenic process of hepatitis B infection. Therefore, we evaluated the association of PvuII (rs2234693) and XbaI (rs9340799) in ESR1 and HBV infection in Guangxi Zhuang populations.MethodsA total of 389 subjects were divided into four groups: 112 patients with chronic hepatitis B (CHB), 65 patients with hepatitis B virus (HBV)-related liver cirrhosis (LC), 107 patients with HBV-related hepatocellular carcinoma (HCC), and 105 healthy controls. The polymerase chain reaction–restriction fragment length polymorphism strategy was used to detect ESR1 gene PvuII and XbaI polymorphisms.ResultsCompared with healthy controls, binary logistic regression analyses show that the CC genotype of PvuII was associated with a significantly increased susceptibility to CHB compared with the TT genotype (OR = 1.760, 95% CI 1.316–2.831; p = 0.044). The PvuII CC genotype was also associated with significantly increased risk of HBV-related LC (OR = 1.921, 95% CI 1.342–2.478; p = 0.043). Similarly, the subjects bearing the homozygous CC genotype of PvuII polymorphism also had more than a 1.7-fold increased risk for development of HCC (OR = 1.748, 95% CI 1.313–2.787; p = 0.010) compared with those bearing the TT genotype. Furthermore, the AC haplotype was associated with a significantly increased risk of HCC with an OR of 1.456 (p = 0.003). In contrast, there were no significant differences in the genotype and allele of XbaI polymorphisms in the ESR1 gene between the groups of patients and healthy controls. In addition, ESR1 polymorphisms were not significantly associated with susceptibility to HBV-related HCC when using CHB and LC patients as references.ConclusionWe conclude that the CC genotype of PvuII in ESR1 is associated with an increased risk of CHB, HBV-related LC and HCC in Guangxi Zhuang populations.     

Measuring the effects of pneumococcal conjugate vaccine (PCV7) on Streptococcus pneumoniae carriage and antibiotic resistance: The Palestinian-Israeli Collaborative Research (PICR)

BackgroundThe Palestinian-Israeli Collaborative Research (PICR) cross-conflict setting provided a unique opportunity to study overall and indirect effects of pneumococcal conjugate vaccine (PCV7), in two closely related Palestinian populations governed by two distinct health authorities with distinct vaccination policies. Here, PCV7 effects on pneumococcal carriage, serotype distribution and antibiotic resistance are reported.MethodsAnnual cross-sectional surveys of pneumococcal carriage were performed during 2009–2011 among Palestinian children (≤5 years) (a) under Palestinian-Authority (PA) health policy (Ramallah, Nablus and Bethlehem), where PCV7 was unlicensed (b) under Israeli health policy (East-Jerusalem (EJ)) where PCV7 was rapidly implemented from July 2009. Clinical data were collected, pneumococci identified and characterized for antibiotic susceptibilities and serotype. Analyses included multivariate logistic models with an interaction term for PCV7-effect.ResultsAltogether, 2755 children from PA (n = 1772) and EJ (n = 983) were enrolled, of which ∼30% were pneumococcal carriers. While overall carriage was not affected by vaccination policy, carriage of vaccine-type (VT7) strains decreased from 52% to 22% (p < 0.001) in EJ, where PCV was implemented, but not in PA. This was accompanied by an increase in non-VT13 strains from 34% to 65% (p < 0.001) in EJ, but not in PA. Furthermore, within two years post-PCV7 introduction, proportion of multi-drug resistant strains, which was initially 23% in both populations, decreased significantly in EJ, to 10%, while simultaneously it increased in PA to 33% (p < 0.001). Similar trends were observed for resistance to most antibiotic groups. The proportion of resistant isolates among non-VT13 strains did not change during the study period.ConclusionsThe unique study design distinguishes secular and seasonal effects from true vaccine effects. While PCV7 did not affect overall pneumococcal carriage rate, VT7 strains, many of which were antibiotic resistant decreased and were replaced by non-VT13 strains, which were mostly not antibiotic resistant, resulting in a net decrease in antibiotic resistance.     

Élaboration d’un score pédiatrique tunisien de risque de dénutrition hospitalière : étude de cohorte prospective

AimThe aim of our study was to develop a Tunisian risk score for pediatric hospital undernutrition.Patients and methodsWe conducted a prospective study, including all children aged over 30 days hospitalized for more than 48 hours in pediatric department, over a six-month period. Hospital undernutrition was defined as a decrease of at least 25% in z-score of weight-for-height or BMI compared to admission. We developed a risk score for pediatric hospital undernutrition.ResultsWe followed 294 children with mean age of 43.6 months. The prevalence of undernutrition at admission was 25.5%. This prevalence increased at the end of the stay to 34%. The prevalence of hospital undernutrition was 28.6%. The risk factors for hospital undernutrition were: age ≤ 15 months (p = 0.007), chronic disease (p = 0.011), no breastfeeding (p = 0.048), presence of fever on admission (p = 0.040), food intake < 50% (p = 0.008), and mother–child separation (p = 0.029). A score of six items ranging from 0 to 20 was developed by assigning each risk factor its standardized coefficient. The threshold value was 4. This score was reliable (Cronbach's α = 0.9) and had a specificity of 80% and a sensitivity of 83%.ConclusionOur score had good psychometric properties and must be validated prospectively.     

Rapid impact of rotavirus vaccine introduction to the National Immunization Plan in Southern Israel: Comparison between 2 distinct populations

BackgroundRotavirus vaccines were licensed in Israel in 2007, and in 2011 the pentavalent-vaccine (RV5) was introduced into the Israeli National Immunization plan.AimTo determine the effect of rotavirus-vaccines on the incidence of hospital visits due to rotavirus gastroenteritis (RVGE) and all-cause diarrhea in Jewish and Bedouin children <5 year residing in southern Israel.MethodsWe conducted a population-based, prospective, observational study. Data from 2006 through 2013 were analyzed. Our hospital is the only medical center in the region, enabling age-specific incidences calculation.ResultsIn the pre-vaccine period, the overall RVGE hospital visits rates per 1000 in children <12, 12–23 and 24–59 m were 16.1, 18.6 and 1.4 in Jewish children, respectively. The respective rates in Bedouin children were 26.4, 12.5 and 0.7 (P < 0.001 for <12 m).Hospitalization rates were higher among Bedouin than among Jewish children (60.0% vs. 39.7%, P < 0.001). Vaccine uptake was faster in the Jewish vs. the Bedouin population.In the year following RV5 introduction, RVGE hospital visits rates declined by 82%, 70% (P < 0.001 both) and 36% (P = 0.092) in Jewish children <12, 12–23 and 24–59 m, respectively. In Bedouin children, the respective RVGE rates declined by 70% (P < 0.001), 21% (P = ns) and 14% (P = ns).Throughout the study, RVGE rates declined significantly in children <12, and 12–23 m by 80% and 88% in Jewish children, respectively, and by 62 and 75% in Bedouin children, respectively (P < 0.001 for all declines). In children 24–59 m, RVGE rates declined by 46% (P = 0.025) in Jewish children, but no reduction was observed in Bedouin children. The dynamics of all-cause diarrhea rates were similar to that of RVGE.ConclusionsSignificant reductions of RVGE rates were observed, following Rota-vaccine introduction in southern Israel in both Jewish and Bedouin children. However, the impact was faster and more profound in Jewish children, probably related to higher vaccine uptake and possibly to lifestyle differences.     

Linezolid versus vancomycin cost in the treatment of staphylococcal pneumonia

ObjectiveStaphylococcus aureus is involved in around 20% of nosocomial pneumonia cases. Vancomycin used to be the reference antibiotic in this indication, but new molecules have been commercialized, such as linezolid. Previous studies comparing vancomycin and linezolid were based on models. Comparing their real costs from a hospital perspective was needed.MethodsWe performed a bicentric retrospective analysis with a cost-minimization analysis. The hospital antibiotic acquisition costs were used, as well as the laboratory test and administration costs from the health insurance cost scale. The cost of each hospital stay was evaluated using the national cost scale per diagnosis related group (DRG), and was then weighted by the stay duration.ResultsFifty-eight patients were included. All bacteria identified in pulmonary samples were S. aureus. The cost of nursing care per stay with linezolid was €234.10 (SD = 91.50) vs. €381.70 (SD = 184.70) with vancomycin (P = 0.0029). The cost of laboratory tests for linezolid was €172.30 (SD = 128.90) per stay vs. €330.70 (SD = 198.40) for vancomycin (P = 0.0005). The acquisition cost of linezolid per stay was not different from vancomycin based on the price of the generic drug (€54.92 [SD = 20.54] vs. €40.30 [SD = 22.70]). After weighting by the duration of stay observed, the mean cost per hospital stay was €47,411.50 for linezolid and €57,694.0 for vancomycin (NSD).ConclusionThese results, in favor of linezolid, support other former pharmacoeconomic study based on models. The mean cost per hospitalization stay was not statistically different between the two study groups, but a trend in favor of linezolid is emerging.     

Is there an association between the coverage of immunisation boosters by the age of 5 and deprivation? An ecological study

ObjectiveTo determine whether there was an association between the coverage of booster immunisation of Diphtheria, Tetanus, acellular Pertussis and Polio (DTaP/IPV) and second Measles, Mumps and Rubella (MMR) dose by age 5 in accordance with the English national immunisation schedule by area-level socioeconomic deprivation and whether this changed between 2007/08 and 2010/11.DesignEcological study.DataRoutinely collected national Cover of Vaccination Evaluated Rapidly data on immunisation coverage for DTaP/IPV booster and second MMR dose by age 5 and the Index of Multiple Deprivation (IMD).SettingPrimary Care Trust (PCT) areas in England between 2007/08 and 2010/11.Outcome MeasuresPopulation coverage (%) of DTaP/IPV booster and second MMR immunisation by age 5.ResultsOver the 4 years among the 9,457,600 children there was an increase in the mean proportion of children being immunised for DTaP/IPV booster and second MMR across England, increasing from 79% (standard deviation (SD12%)) to 86% (SD8%) for DTaP/IPV and 75% (SD10%) to 84% (SD6%) for second MMR between 2007/08 and 2010/11. In 2007/08 the area with lowest DTaP/IPV booster coverage was 31% compared to 54.4% in 2010/11 and for the second MMR in 2007/08 was 39% compared to 64.8% in 2010/11. A weak negative correlation was observed between average IMD score and immunisation coverage for the DTaP/IPV booster which reduced but remained statistically significant over the study period (r = −0.298, p < 0.001 in 2007/08 and r = −0.179, p = 0.028 in 2010/11). This was similar for the second MMR in 2007/08 (r = −0.225, p = 0.008) and 2008/09 (r = −0.216, p = 0.008) but there was no statistically significant correlation in 2009/10 (r = −0.108, p = 0.186) or 2010/11 (r = −0.078, p = 0.343).ConclusionLower immunisation coverage of DTaP/IPV booster and second MMR dose was associated with higher area-level socioeconomic deprivation, although this inequality reduced between 2007/08 and 2010/11 as proportions of children being immunised increased at PCT level, particularly for the most deprived areas. However, coverage is still below the World Health Organisation recommended 95% threshold for Europe.     

The impact of a pneumococcal conjugate vaccination program on the nasopharyngeal carriage,serotype distribution and antimicrobial resistance of Streptococcus pneumoniae among healthy children in Turkey

BackgroundThe 7-valent conjugate pneumococcal vaccine (PCV7) was introduced by the Turkey National Immunization Program in 2008 and replaced by the PCV13 in 2011. We assessed the impact of PCV vaccination on the nasopharyngeal (NP) carriage, serotype distribution and antimicrobial resistance of Streptococcus pneumoniae (SP) among healthy Turkish children.MethodsA prospective surveillance study was performed between September 2011 and September 2013 in Istanbul, Turkey. NP swabs, demographic data, and vaccination statuses were obtained from 2165 healthy children aged 0–18 years. Pneumococcal carriage was defined by a positive culture; serotyping was performed via multiplex conventional PCR, and the antibiotic susceptibilities of the isolates were determined based on the minimum inhibitory concentration (MIC) values of the Clinical Laboratory Standards Institute (CLSI).ResultsThe prevalence of pneumococcal carriage was 6.4%. The carriage rates were 8%, 7%, and 5% in the following age groups: 0–24 months, 25–60 months, and >60 months, respectively. The carriage rate was significantly higher in the 0–24 month age group than in the >60 months age group (p = 0.03). Sixty percent of the children were not vaccinated with any PCV; 4%, 2%, and 4% received at least 1, 2 or 3 doses and 30% children received the full schedule (4 doses) of either PCV7 or PCV13. Among the isolated S. pneumoniae strains, 45% were of the non-vaccine type (NVT) and 55% were of the vaccine type (VT). The children who received at least a single PCV dose had significantly lower odds of colonization via VT serotypes than the non-vaccinated children [odds ratio: 0.61 (95% confidence interval = 0.41–0.91), p = 0.01]. The percentages of the serotypes covered by PCV7 and PCV13 were 51% and 56%, respectively. The most frequently isolated serotypes were 6A/B/C (n = 22, 16.5%), 19F (n = 18, 13.5%), 23F (n = 15, 11.2%), serotype 9V/A (n = 10, 7.5%), 12F (n = 5, 4.5%), 15A/F (n = 7, 4.5%) and 22 A/F (n = 6, 4.5%). Using the meningitis criteria and the MIC, 62% of the isolates were resistant to penicillin and 13% were non-sensitive to ceftriaxone. Erythromycin and clindamycin resistance were 43% and 31%, respectively.ConclusionWe shown that following nation-wide PCV vaccination, S. pneumoniae NP carriage was decreased.