Hospital admissions as a function of temperature,other weather phenomena and pollution levels in an urban setting in China

Objective

To explore the relationship between weather phenomena and pollution levels and daily hospital admissions (as an approximation to morbidity patterns) in Hong Kong Special Administrative Region (SAR), China, in 1998–2009.

Methods

Generalized additive models and lag models were constructed with data from official sources on hospital admissions and on mean daily temperature, mean daily wind speed, mean relative humidity, daily total global solar radiation, total daily rainfall and daily pollution levels.

Findings

During the hot season, admissions increased by 4.5% for every increase of 1 °C above 29 °C; during the cold season, admissions increased by 1.4% for every decrease of 1 °C within the 8.2–26.9 °C range. In subgroup analyses, admissions for respiratory and infectious diseases increased during extreme heat and cold, but cardiovascular disease admissions increased only during cold temperatures. For every increase of 1 °C above 29 °C, admissions for unintentional injuries increased by 1.9%. During the cold season, for every decrease of 1 °C within the 8.2–26.9 °C range, admissions for cardiovascular diseases and intentional injuries rose by 2.1% and 2.4%, respectively. Admission patterns were not sensitive to sex. Admissions for respiratory diseases rose during hot and cold temperatures among children but only during cold temperatures among the elderly. In people aged 75 years or older, admissions for infectious diseases rose during both temperature extremes.

Conclusion

In Hong Kong SAR, hospitalizations rise during extreme temperatures. Public health interventions should be developed to protect children, the elderly and other vulnerable groups from excessive heat and cold.     

The short-term influence of temperature on daily mortality in the temperate climate of Montreal, Canada

The purpose of this study was to determine whether short-term changes in ambient temperature were associated with daily mortality among persons who lived in Montreal, Canada, and who died in the urban area between 1984 and 2007. We made use of newly developed distributed lag non-linear Poisson models, constrained to a 30 day lag period, and we adjusted for temporal trends and nitrogen dioxide and ozone. We found a strong non-linear association with high daily maximum temperatures showing an apparent threshold at about 27 °C; this association persisted until about lag 5 days. For example, we found across all lag periods that daily non-accidental mortality increased by 28.4% (95% confidence interval: 13.8–44.9%) when temperatures increased from 22.5 to 31.8 °C (75–99th percentiles). This association was essentially invariant to different smoothers for time. Cold temperatures were not found to be associated with daily mortality over 30 days, although there was some evidence of a modest increased risk from 2 to 5 days. The adverse association with colder temperatures was sensitive to the smoother for time. For cardio-respiratory mortality we found increased risks for higher temperatures of a similar magnitude to that of non-accidental mortality but no effects at cold temperatures.     

Extreme air pollution events from bushfires and dust storms and their association with mortality in Sydney, Australia 1994-2007

Introduction

Extreme air pollution events due to bushfire smoke and dust storms are expected to increase as a consequence of climate change, yet little has been published about their population health impacts. We examined the association between air pollution events and mortality in Sydney from 1997 to 2004.

Methods

Events were defined as days for which the 24 h city-wide concentration of PM₁₀ exceeded the 99th percentile. All events were researched and categorised as being caused by either smoke or dust. We used a time-stratified case-crossover design with conditional logistic regression modelling adjusted for influenza epidemics, same day and lagged temperature and humidity. Reported odds ratios (OR) and 95% confidence intervals are for mortality on event days compared with non-event days. The contribution of elevated average temperatures to mortality during smoke events was explored.

Results

There were 52 event days, 48 attributable to bushfire smoke, six to dust and two affected by both. Smoke events were associated with a 5% increase in non-accidental mortality at a lag of 1 day OR (95% confidence interval (CI)) 1.05 (95%CI: 1.00–1.10). When same day temperature was removed from the model, additional same day associations were observed with non-accidental mortality OR 1.05 (95%CI: 1.00–1.09), and with cardiovascular mortality OR (95%CI) 1.10 (95%CI: 1.00–1.20). Dust events were associated with a 15% increase in non-accidental mortality at a lag of 3 days, OR (95%CI) 1.16 (95%CI: 1.03–1.30).

Conclusions

The magnitude and temporal patterns of association with mortality were different for smoke and dust events. Public health advisories during bushfire smoke pollution episodes should include advice about hot weather in addition to air pollution.     

Outdoor temperature is associated with serum HDL and LDL

Background

While exposures to high and low air temperatures are associated with cardiovascular mortality, the underlying mechanisms are poorly understood. The risk factors for cardiovascular disease include high levels of total cholesterol and low-density lipoprotein (LDL), and low levels of high-density lipoprotein (HDL). We investigated whether temperature was associated with changes in circulating lipid levels, and whether this might explain part of the association with increased cardiovascular events.

Methods

The study cohort consisted of 478 men in the greater Boston area with a mean age of 74.2 years. They visited the clinic every 3–5 years between 1995 and 2008 for physical examination and to complete questionnaires. We excluded from analyses all men taking statin medication and all days with missing data, resulting in a total of 862 visits. Associations between three temperature variables (ambient, apparent, and dew point temperature) and serum lipid levels (total cholesterol, HDL, LDL, and triglycerides) were studied with linear mixed models that included possible confounders such as air pollution and a random intercept for each subject.

Results

We found that HDL decreased −1.76% (95% CI: from −3.17 to −0.32, lag 2 days), and −5.58% (95% CI: from −8.87 to −2.16, moving average of 4 weeks) for each 5 °C increase in mean ambient temperature. For the same increase in mean ambient temperature, LDL increased by 1.74% (95% CI: 0.07–3.44, lag 1 day) and 1.87% (95% CI: 0.14–3.63, lag 2 days). These results were also similar for apparent and dew point temperatures. No changes were found in total cholesterol or triglycerides in relation to temperature increase.

Conclusions

Changes in HDL and LDL levels associated with an increase in ambient temperature may be among the underlying mechanisms of temperature-related cardiovascular mortality.     

J-shaped association between plasma glucose concentration and cardiovascular disease mortality over a follow-up of 32 years

Objective

We aimed at examining the association between plasma glucose (PG) concentration and cardiovascular mortality in a population sample from Switzerland over a follow-up time of 32 years.

Methods

We analyzed 7984 men and women enrolled in the first National Research Program (NRP1A, 1977–1979) and followed up for survival until 2008. Mortality hazard ratios (HR) were calculated using adjusted Cox regression models. PG was measured in fasting state or randomly with known fasting time. Models were adjusted for age, sex, socio-demographic, lifestyle and cardiovascular risk factors.

Results

PG concentrations ≥ 6.1 mmol/L were associated with increased risk of cardiovascular disease (CVD) and all-cause mortality. Compared to normal PG (3.8–4.9 mmol/L) the adjusted HR (95% CI) for CVD mortality was 1.26 (1.01–1.58) for PG ≥ 6.1–6.9 mmol/L, 1.56 (1.18–2.06) for PG ≥ 7 mmol/L, 1.67 (1.22–2.30) for known diabetes. All-cause mortality essentially showed the same patterns. All-cause mortality was increased [1.35 (1.01–1.80)] also for PG < 3.8 mmol/L.

Conclusion

Plasma glucose remained significantly and independently associated with CVD mortality even after full follow-up. The relationship was J-shaped. In order to prevent premature death, persons with abnormal PG concentrations on both extremes should be screened and counseled for other CVD risk factors.     

Temperature, temperature extremes, and mortality: a study of acclimatisation and effect modification in 50 US cities

Objectives

The authors examined the increase in mortality associated with hot and cold temperature in different locations, the determinants of the variability in effect estimates, and its implications for adaptation.

Methods

The authors conducted a case-crossover study in 50 US cities. They used daily mortality and weather data for 6 513 330 deaths occurring during 1989–2000. Exposure was assessed using two approaches. First, the authors determined exposure to extreme temperatures using city-specific indicator variables based on the local temperature distribution. Secondly, they used piecewise linear variables to assess exposure to temperature on a continuous scale above/below a threshold. Effects of hot and cold temperature were examined in season-specific models. In a meta-analysis of the city-specific results, the authors examined several city characteristics as effect modifiers.

Results

Mortality increases associated with both extreme cold (2-day cumulative increase 1.59% (95% CI 0.56 to 2.63)) and extreme heat (5.74% (95% CI 3.38 to 8.15)) were found, the former being especially marked for myocardial infarction and cardiac arrest deaths. The increase in mortality was less marked at less extreme temperatures. The effect of extreme cold (defined as a percentile) was homogeneous across cities with different climates, suggesting that only the unusualness of the cold temperature (and not its absolute value) had a substantial impact on mortality (that is, acclimatisation to cold). Conversely, heat effects were quite heterogeneous, with the largest effects observed in cities with milder summers, less air conditioning and higher population density. Adjustment for ozone led to similar results, but some residual confounding could be present due to other uncontrolled pollutants.

Conclusions

The authors confirmed in a large sample of cities that both cold and hot temperatures increase mortality risk. These findings suggest that increases in heat-related mortality due to global warming are unlikely to be compensated for by decreases in cold-related mortality and that population acclimatisation to heat is still incomplete.Determining the potential health impacts of climate change is a complex issue. Both direct physical impacts from weather changes (for example, temperature increase, severe storms) and indirect impacts from changes in other factors (for example, vector-borne diseases, food production, population dislocation, etc) are expected to occur and should be taken into account when assessing the global impact of climate change.¹ This paper focuses exclusively on the direct health effects of changes in temperature, and particularly on the impact on mortality. Climate change is predicted not only to increase the average temperature of the planet by between 1.7 and 4.9°C by 2100,^2,3 but also to change the frequency of extreme weather events increasing extremely hot days and decreasing extremely cold days.¹ Because variations in morbidity and mortality rates have been associated with temperature changes,^4,5,6,7 controversy exists regarding what the overall effect of climate change will be. Some authors have suggested that increases in heat-related mortality will be so dramatic that they will not be compensated for by drops in cold-related mortality,⁸ while others believe that human populations will adjust to warmer temperatures and any small increases in heat-related mortality will be outweighed by larger declines in cold-related mortality.⁹Increases in mortality during the cold months have been widely reported in the literature, often referred to as excess winter mortality, and an important proportion of these deaths have been attributed to cardiovascular diseases.⁷ Similarly, the effect of elevated temperatures on mortality, especially those occurring during heat waves, have also been described in several studies where cardiovascular and respiratory diseases were reported as the most common mortality causes.^4,6 Fewer studies have looked at the association between more specific cardiovascular causes of death and temperature. A recent study in 12 US cities showed moderate increases in myocardial infarction deaths associated with both cold and hot temperatures.¹⁰ Consistently, in a previous study looking at susceptibility to temperature extremes in 50 US cities, we identified myocardial infarction and cardiac arrest as the primary causes of death that experienced the largest relative increases during extremely cold days.¹¹Estimates of the magnitude of the temperature effect on mortality have differed substantially across different regions, but few studies have investigated which factors account for this variability. In the Eurowinter study, the cold effects were milder in cities with cooler winters, where protective measures against cold were more effective.¹² A study in the US found that cities with a greater variability in temperature showed stronger temperature effects, while use of air conditioning reduced the heat mortality.⁵ Another US study found differing shapes of the mortality–temperature relation for northern and southern cities, and reported as modifiers of the heat effect use of air conditioning and some demographic characteristics of the population.¹³Recognising the determinants of regional variability in the impact of temperature on mortality and understanding the role of adaptive mechanisms in modifying that impact is key to better ascertain the potential public health consequences of global warming. We therefore conducted a large multicity study in 50 US cities to evaluate the effect of cold and hot temperatures on both all-cause and cause-specific mortality and to determine how several city characteristics may influence the impact of temperature on mortality.     

Effect of the interaction between outdoor air pollution and extreme temperature on daily mortality in Shanghai, China

Background

Both outdoor air pollution and extreme temperature have been associated with daily mortality; however, the effect of their interaction is not known.

Methods

This time-series analysis examined the effect of the interaction between outdoor air pollutants and extreme temperature on daily mortality in Shanghai, China. A generalized additive model (GAM) with penalized splines was used to analyze mortality, air pollution, temperature, and covariate data. The effects of air pollutants were stratified by temperature stratum to examine the interaction effect of air pollutants and extreme temperature.

Results

We found a statistically significant interaction between PM₁₀/O₃ and extreme low temperatures for both total nonaccidental and cause-specific mortality. On days with “normal” temperatures (15th–85th percentile), a 10-µg/m³ increment in PM₁₀ corresponded to a 0.17% (95% CI: 0.03%, 0.32%) increase in total mortality, a 0.23% (0.02%, 0.44%) increase in cardiovascular mortality, and a 0.26% (−0.07%, 0.60%) increase in respiratory mortality. On low-temperature days (<15th percentile), the estimates changed to 0.40% (0.21%, 0.58%) for total mortality, 0.49% (0.13%, 0.86%) for cardiovascular mortality, and 0.24% (−0.33%, 0.82%) for respiratory mortality. The interaction pattern of O₃ with lower temperature was similar. The interaction between PM₁₀/O₃ and lower temperature remained robust when alternative cut-points were used for temperature strata.

Conclusions

The acute health effects of air pollution might vary by temperature level.Key words: air pollution, climate change, extreme temperature, interaction, time-series     

Sociogeographic Variation in the Effects of Heat and Cold on Daily Mortality in Japan

Background

Ambient temperature affects mortality in susceptible populations, but regional differences in this association remain unclear in Japan. We conducted a time-series study to examine the variation in the effects of ambient temperature on daily mortality across Japan.

Methods

A total of 731 558 all-age non-accidental deaths in 6 cities during 2002–2007 were analyzed. The association between daily mortality and ambient temperature was examined using distributed lag nonlinear models with Poisson distribution. City-specific estimates were combined using random-effects meta-analysis. Bivariate random-effects meta-regressions were used to examine the moderating effect of city characteristics.

Results

The effect of heat generally persisted for 1 to 2 days. In warmer communities, the effect of cold weather lasted for approximately 1 week. The combined increases in mortality risk due to heat (99th vs 90th percentile of city-specific temperature) and cold (first vs 10th percentile) were 2.21% (95% CI, 1.38%–3.04%) and 3.47% (1.75%–5.21%), respectively. City-specific effects based on absolute temperature changes were more heterogeneous than estimates based on relative changes, which suggests some degree of acclimatization. Northern populations with a cool climate appeared acclimatized to low temperature but were still vulnerable to extreme cold weather. Population density, average income, cost of property rental, and number of nurses appeared to influence variation in heat effect across cities.

Conclusions

We noted clear regional variation in temperature-related increases in mortality risk, which should be considered when planning preventive measures.Key words: heat, cold, mortality, time-series, distributed lag     

Quantifying the health impacts of future changes in temperature in California

Background

Several epidemiological studies demonstrate associations between high summer temperatures and increased mortality. However, the quantitative implications of projected future increases in temperature have not been well characterized.

Objective

This study quantifies the effects of projected future temperatures on both mortality and morbidity in California, including the potential effects of mitigation.

Data and methods

We first estimated the association between temperature and mortality for populations close to weather stations throughout the state. These dose–response estimates for mortality were then combined with local measures of current and projected changes in population, and projected changes in temperature, using a baseline of average temperatures from 1961 to 1990, for the years 2025 and 2050. The latter were based on two greenhouse gas emissions scenarios (A2 and B1) developed for the Intergovernmental Panel on Climate Change. In addition, we assessed the impacts of future adaptation through use of air conditioners. Several sensitivity analyses were conducted to determine the likely range of estimates.

Results

These analyses indicate that for the high emissions scenario, the central estimate of annual premature mortality ranges from 2100 to 4300 for the year 2025 and from 6700 to 11,300 for 2050. The highest estimates are from the models that use age-specific dose–response functions, while the low estimates are from the models that adjust for ozone. Estimates using the low emissions scenario are roughly half of these estimates. Mitigation based on our estimates of the effects of 10% and 20% increase in air conditioner use would generate reductions of 16% and 33% in the years 2025 and 2050, respectively.

Conclusion

Our estimates suggest significant public health impacts associated with future projected increases in temperature.     

The risk of dying on days of higher air pollution among the socially disadvantaged elderly

Rationale

The estimated mortality rate associated with ambient air pollution based on general population studies may not be applicable to certain subgroups.

Objective

The objective of the present study was to determine the influence of age, education, employment status and income on the risk of mortality associated with ambient air pollution.

Methods

Daily time-series analyses tested the association between daily air pollution and daily mortality in seven Chilean urban centers during the period January 1997–December 2007. Results were adjusted for long-term trends, day-of-the week and humidex.

Results

Interquartile increases in particulate matter (PM₁₀ and PM_2.5), sulphur dioxide, nitrogen dioxide, carbon monoxide, and elemental and organic carbon were associated with a 4–7% increase in mortality among those who did not complete primary school (p<0.05) vs. 0.5–1.5% among university graduates (p>0.05). Among those at least 85 years of age respective estimates were 2–7%. However, among the elderly who did not complete primary school, respective estimates were 11–19% (p<0.05). The degree of effect modification was less for income and employment status than education, and sex did not modify the results.

Conclusion

The socially disadvantaged, especially if elderly appear to be especially susceptible to dying on days of higher air pollution. Concentrations deemed acceptable for the general population would not appear to protect this susceptible subgroup.     

Nutritional screening and mortality in newly institutionalised elderly: a comparison between the geriatric nutritional risk index and the mini nutritional assessment

Background & aims

Several tools are available for nutritional screening. We evaluated the risk of mortality associated with the Geriatric Nutritional Risk Index (GNRI) and the Mini Nutritional Assessment (MNA) in newly institutionalised elderly.

Methods

A prospective observational study involving 358 elderly newly admitted to a long-term care setting. Hazard ratios (HR) for mortality among GNRI categories and MNA classes were estimated by multivariable Cox’s model.

Results

At baseline, 32.4% and 37.4% of the patients were classified as being malnourished (MNA <17) and at severe nutritional risk (GNRI <92), respectively, whereas 57.5% and 35.2%, respectively, were classified as being at risk for malnutrition (MNA 17–23.5) and having low nutritional risk (GNRI 92–98). During a median follow-up of 6.5 years [25th–75th percentile, 5.9–8.6], 297 elderly died. Risk for all-cause mortality was significantly associated with nutritional risk by the GNRI tool (GNRI<92 HR = 1.99 [95%CI, 1.38–2.88]; GNRI 92–98 HR = 1.51 [95%CI, 1.04–2.18]) but not with nutritional status by the MNA. A significant association was also found with cardiovascular mortality (GNRI <92 HR = 1.79 [95%CI, 1.23–2.61]).

Conclusions

Nutritional risk by GNRI but not nutritional status by MNA was associated with higher mortality risk. Present data suggest that in the nutritional screening of newly institutionalised elderly the use of the GNRI should be preferred to that of the MNA.     

Smoking and air pollution exposure and lung cancer mortality in Zhaoyuan County

Background

Simultaneous exposure to high levels of air pollution and high tobacco consumption at the same place is rare. The aim of the present study was to evaluate the impact of the two factors on the risk of developing lung cancer.

Methods

Data on the number of deaths due to lung cancer and on population from 1970 to 2009 were obtained from Zhaoyuan County. Data on the smoking populations were obtained at random sampling survey during the time in Zhaoyuan. Data on the components of atmospheric surveillance were obtained from the local environmental protection offices. Logarithmic linear regression and general log-linear Poisson age-period-cohort (APC) models were used to estimate age, period, cohort, gender, smoking, and air pollution effects on the risk of lung cancer mortality.

Results

The standardized mortality rates of lung cancer drastically increased from 8.43 in per 100 000 individuals in the 1970–1974 to 25.67 in per 100 000 individuals in the 2005–2009 death survey. The annual change of lung cancer mortality was 3.20%. In the log linear regression model, the age, proportion of smokers, gender, period, and air pollution are significantly associated with lung cancer mortality. The APC analysis shows that the relative risks (RRs) of gender, smoking, and air pollution are 2.29 (95% confidence interval (CI): 2.16–2.43), 3.05 (95% CI = 2.76–3.36), and 1.42 (95% CI = 1.19–1.69), respectively. Compared with the period 1970–1974, high RRs were found during 1995–2009. Compared with the birth cohort 1950–1954, the RRs increased in the birth cohorts of 1910 to the 1940. Compared the aged 35–59 and 60–84 in the1980–1984 death survey (not exposed to air pollution) with that in the 2005–2009 death survey (exposed to air pollution), The two age groups exposed to air pollution, 25 years later, had an increased mortality rates for lung cancer by 2.27 and 3.55 times for males and by 1.47 and 3.35 times for females.

Conclusion

The mortality rates of lung cancer drastically increased in the past 35 years. The trend of lung cancer mortality may be in a great extent possibly due to the effects of combined smoking and air pollution exposure.     

Insufficient and excessive amounts of sleep increase the risk of premature death from cardiovascular and other diseases: The Multiethnic Cohort Study

Objective

To explore an independent association between self-reported sleep duration and cause-specific mortality.

Methods

Data were obtained from the Multiethnic Cohort Study conducted in Los Angeles and Hawaii.

Results

Among 61,936 men and 73,749 women with no history of cancer, heart attack or stroke, 19,335 deaths occurred during an average 12.9 year follow-up. Shorter (≤ 5 h/day) and longer (≥ 9 h/day) sleepers of both sexes (vs. 7 h/day) had an increased risk of all-cause and cardiovascular disease (CVD) mortality, but not of cancer mortality. Multivariable hazard ratios for CVD mortality were 1.13 (95% CI 1.00–1.28) for ≤ 5 h/day and 1.22 (95% CI 1.09–1.35) for ≥ 9 h/day among men; and 1.20 (95% CI 1.05–1.36) for ≤ 5 h/day and 1.29 (95% CI 1.13–1.47) for ≥ 9 h/day among women. This risk pattern was not heterogeneous across specific causes of CVD death among men (P_hetero 0.53) or among women (P_hetero 0.72). The U-shape association for all-cause and CVD mortality was observed in all five ethnic groups included in the study and by subgroups of age, smoking status, and body mass index.

Conclusion

Insufficient or excessive amounts of sleep were associated with increased risk of mortality from CVD and other diseases in a multiethnic population.     

Mortality and temperature in Sofia and London

STUDY OBJECTIVE: Heat and cold have been associated with increased mortality, independently of seasonal trends, but details are little known. This study explores associations between mortality and temperature in two European capitals-Sofia and London-using four years of daily deaths, air pollution, and weather data. DESIGN: Generalised additive models were used to permit non-linear modelling of confounders such as season and humidity, and to show the shape of mortality-temperature relations-using both two day and two week average temperatures separately. Models with linear terms for heat and cold were used to estimate lags of effect, linear effects, and attributable fractions. PARTICIPANTS: 44701 all age all cause deaths in Sofia (1996-1999) and 256464 in London (1993-1996). Main results: In London, for each degree of extreme cold (below the 10th centile of the two week mean temperature), mortality increased by 4.2% (95% CI 3.4 to 5.1), and in Sofia by 1.8% (0.6 to 3.9). For each degree rise above the 95th centile of the two day mean, mortality increased by 1.9% (1.4 to 2.4) in London, and 3.5% (2.2 to 4.8) in Sofia. Cold effects appeared after lags of around three days and lasted-particularly in London-at least two weeks. Main heat effects occurred more promptly. There were inverse associations at later lags for heat and cold in Sofia. CONCLUSIONS: Average temperatures over short periods do not adequately model cold, and may be inadequate for heat if they ignore harvesting effects. Cold temperatures in London, particularly, seem to harm the general population and the effects are not concentrated among persons close to death.     

Long-term response rates of successful hepatitis B vaccination in HIV-infected patients

Background

Data on long-term response rates after successful primary hepatitis B (HBV) vaccination in HIV-infected patients are scarce.

Objective

To evaluate the durability of an effective anti-HBs titer up to 5 years after primary vaccination in a cohort of 155 HIV-infected adults.

Methods

From a previous multicenter HBV vaccination trial we selected patients with an anti-HBs titer of ≥10 IU/l 28 weeks after the first vaccination. The anti-HBs titer was measured in annually stored plasma samples up to 5 years after vaccination. Patients with decreasing anti-HBs titers <10 IU/I were defined as transient responders (TR*) and with persistent anti-HBs titers ≥10 IU/I as long-term responders (LTR^).

Results

We included 155 patients, 87 were TR and 68 LTR. Mean age, percentage of female participants and duration of HAART use at primary vaccination were similar in LTR and TR. Anti-HBs level after primary vaccination was the strongest predictor for the durability of anti-HBs. Anti-HBs >100–1000 IU/I and >1000 resulted in an OR 8.3, 95% CI 3.38–20.16; p < 0.0001 and OR 75.6, 95% CI 13.41–426.45; p < 0.0001 versus anti-HBs titer of 10–100 IU/I after primary vaccination respectively. The mean time to loss of an effective anti-HBs titer was 2.0, 3.7 and 4.4 years respectively, for patients with an anti-HBs titer of 10–100 IU/I, >100–1000 IU/I and >1000 IU/I at primary vaccination. An undetectable HIV-RNA load and use of HAART during vaccination and at follow-up were, though not significantly, associated a higher long-term persistence of an effective antibody titer.

Conclusion

The durability of an effective anti-HBs level appears to be significantly related to the height of the antibody titers after the primary immunization procedure. Schedules to improve the vaccination response in HIV-infected patients therefore seem to be justified. Whether a HBV booster is indicated remains to be elucidated.     

Modelling of Temperature-Attributable Mortality among the Elderly in Lisbon Metropolitan Area,Portugal: A Contribution to Local Strategy for Effective Prevention Plans

Epidemiological studies on the impact of determining environmental factors on human health have proved that temperature extremes and variability constitute mortality risk factors. However, few studies focus specifically on susceptible individuals living in Portuguese urban areas. This study aimed to estimate and assess the health burden of temperature-attributable mortality among age groups (0–64 years; 65–74 years; 75–84 years; and 85+ years) in Lisbon Metropolitan Area, from 1986–2015. Non-linear and delayed exposure–lag–response relationships between temperature and mortality were fitted with a distributed lag non-linear model (DLNM). In general, the adverse effects of cold and hot temperatures on mortality were greater in the older age groups, presenting a higher risk during the winter season. We found that, for all ages, 10.7% (95% CI: 9.3–12.1%) deaths were attributed to cold temperatures in the winter, and mostly due to moderately cold temperatures, 7.0% (95% CI: 6.2–7.8%), against extremely cold temperatures, 1.4% (95% CI: 0.9–1.8%). When stratified by age, people aged 85+ years were more burdened by cold temperatures (13.8%, 95% CI: 11.5–16.0%). However, for all ages, 5.6% of deaths (95% CI: 2.7–8.4%) can be attributed to hot temperatures. It was observed that the proportion of deaths attributed to exposure to extreme heat is higher than moderate heat. As with cold temperatures, people aged 85+ years are the most vulnerable age group to heat, 8.4% (95% CI: 3.9%, 2.7%), and mostly due to extreme heat, 1.3% (95% CI: 0.8–1.8%). These results provide new evidence on the health burdens associated with alert thresholds, and they can be used in early warning systems and adaptation plans.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-021-00536-z.     

Irregular tick-borne encephalitis vaccination schedules: The effect of a single catch-up vaccination with FSME-IMMUN. A prospective non-interventional study

Background

Intervals longer than recommended are frequently encountered between doses of tick borne encephalitis virus (TBE) vaccines in both residents of and travelers to endemic regions. In clinical practice the management of individuals with lapsed TBE vaccination schedules varies widely and has in common that the underlying immunological evidence is scarce.

Study purpose and methods

The aim of this study was to generate data reliable enough to derive practical recommendations on how to continue vaccination with FSME-IMMUN in subjects with an irregular TBE vaccination history. Antibody response to a single catch-up dose of FSME-IMMUN was assessed in 1115 adults (age ≥16 years) and 125 children (age 6–15 years) with irregular TBE vaccination histories.

Results

Subjects of all age groups developed a substantial increase in geometric mean antibody concentration after a single catch-up TBE vaccination which was consistently lower in subjects with only one previous TBE vaccination compared to subjects with two or more vaccinations. Overall, >94% of young adults and children, and >93% of elderly subjects with an irregular TBE vaccination history achieved antibody levels ≥25 U/ml irrespective of the number of previous TBE vaccinations.

Conclusion

We conclude that TBE vaccination of subjects with irregular vaccination histories should be continued as if the previous vaccinations had been administered in a regular manner, with the stage of the vaccination schedule being determined by the number of previous vaccinations. Although lapsed vaccination schedules may leave subjects temporarily with inadequate protection against TBE infection, adequate protection can quickly be re-established in >93% of the subjects by a single catch-up dose of FSME-IMMUN, irrespective of age, number of previous vaccinations, and time interval since the last vaccination.     

Body mass index and weight-for-length ratio references for infants born at 33-42 weeks gestation: a new tool for anthropometric assessment

Background & aims

The risk of childhood obesity, an increasingly prevalent problem worldwide, might be predictable by early body mass index measurements. This study sought to develop body mass index and weight-for-length ratio references for infants born at 33–42 weeks gestation and to validate these data against the growth curves of the World Health Organization Multicenter Growth Reference Study.

Methods

Data were collected from the Neonatal Registry of Rabin Medical Center for all healthy singleton babies born live at 33–42 weeks gestation. Crude and smoothed reference tables and graphs for body mass index and weight-for-length ratio by gestational age were created for males and females, separately.

Results

Birth weight, length, and body mass index percentiles for full-term neonates were similar to the World Health Organization study, reinforcing the generalizability of our reference charts for infants born at 33–42 weeks. Cutoff values for small for date (<5th, <10th percentile) and large for date (>85th, >95th percentile) infants differed across gestational ages in both pre-term and full-term infants.

Conclusions

As body proportionality indexes provide an assessment of body mass and fatness relative to length, we suggest that BMI and Wt/L ratio percentiles be added to weight and length growth curves as a routine intrauterine growth assessment at birth.     

Immunogenicity and safety of a booster dose of diphtheria,tetanus, acellular pertussis and inactivated poliomyelitis vaccine (Tdap-IPV; Repevax) administered concomitantly versus non-concomitantly with an influenza vaccine (Vaxigrip) to adults aged ≥60 years: An open-label,randomised trial

Background

Annual influenza vaccination provides an opportunity to administer a booster dose of diphtheria, tetanus, acellular pertussis and inactivated poliomyelitis vaccine (Tdap-IPV) to the elderly. This study evaluated immune responses to and safety of the two vaccines administered concomitantly or sequentially to elderly individuals in France and Germany.

Methods

Individuals aged ≥60 years who had received a diphtheria/tetanus booster within 5–15 years were randomised (1:1) to receive either Tdap-IPV and an inactivated influenza vaccine concomitantly (Group 1) or inactivated influenza vaccine then Tdap-IPV 28–35 days later (Group 2). Antibody titres were measured before and 28–35 days after each vaccination.

Results

The mean age of randomised individuals (n = 954) was 68.8 years. Post-vaccination seroprotection rates (≥0.1 IU/mL for diphtheria/tetanus and ≥8 1/dilution for polio) for Group 1 were non-inferior to Group 2 for diphtheria (85.4% vs. 87.5%), tetanus (both 100%), polio type 1 (99.8% vs. 100%), polio type 2 (both 100%) and polio type 3 (99.3% vs. 99.8%). Similarly, percentages of individuals with pertussis antibodies ≥5 EU/mL for Group 1 were non-inferior to Group 2: pertussis toxin (94.3% vs. 98.1%), filamentous haemagglutinin (99.8% vs. 100%), pertactin (97.3% vs. 96.0%), fimbriae 2 and 3 (91.7% vs. 89.5%). Post-vaccination geometric mean titres of anti-influenza haemagglutinin antibodies for Group 1 were non-inferior to Group 2. Adverse events following administration of Tdap-IPV were similar in both study groups, with no vaccine-related serious adverse events.

Conclusion

Tdap-IPV and inactivated influenza vaccine can be administered concomitantly in the elderly without impairing tolerability or the immune response to either vaccine.     

Immunity to tetanus and diphtheria in the UK in 2009

Introduction

This study aimed to estimate the immunity of the UK population to tetanus and diphtheria, including the potential impact of new glycoconjugatate vaccines, and the addition of diphtheria to the school leaver booster in 1994.

Methods

Residual sera (n = 2697) collected in England in 2009/10 were selected from 18 age groups and tested for tetanus and diphtheria antibody. Results were standardised by testing a panel of sera (n = 150) to enable comparison with a previously (1996) published serosurvey. Data were then standardised to the UK population.

Results

In 2009, 83% of the UK population were protected (≥0.1 IU/mL) against tetanus compared to 76% in 1996 (p = 0.079), and 75% had at least basic protection against diphtheria (≥0.01 IU/mL) in 2009 compared to 60% in 1996 (p < 0.001). Higher antibody levels were observed in those aged 1–3 years in 2009 compared to 1996 for both tetanus and diphtheria. Higher diphtheria immunity was observed in those aged 16–34 years in 2009 compared to 1996 (geometric mean concentration [GMC] 0.15 IU/mL vs. 0.03 IU/mL, p < 0.001). Age groups with the largest proportion of susceptible individuals to both tetanus and diphtheria in 2009 were <1 year old (>29% susceptible), 45–69 years (>20% susceptible) and 70+ years (>32% susceptible). Low immunity was observed in those aged 10–11 years (>19% susceptible), between the scheduled preschool and school leaver booster administration.

Discussion

The current schedule appears to induce protective levels; increases in the proportions protected/GMCs were observed for the ages receiving vaccinations according to UK policy. Glycoconjugate vaccines appear to have increased immunity, in particular for diphtheria, in preschool age groups. Diphtheria immunity in teenagers and young adults has increased as a result of the addition of diphtheria to the school leaver booster. However, currently older adults remain susceptible, without any further opportunities for immunisations planned according to the present schedule.