Seropositivity to non-vaccine incorporated genotypes induced by the bivalent and quadrivalent HPV vaccines: A systematic review and meta-analysis

BackgroundHuman papillomavirus vaccines have demonstrated remarkable efficacy against persistent infection and disease associated with vaccine-incorporated genotypes and a degree of efficacy against some genetically related, non-vaccine-incorporated genotypes. The vaccines differ in the extent of cross-protection against these non-vaccine genotypes. Data supporting the role for neutralizing antibodies as a correlate or surrogate of cross-protection are lacking, as is a robust assessment of the seroconversion rates against these non-vaccine genotypes.MethodsWe performed a systematic review and meta-analysis of available data on vaccine-induced neutralizing antibody seropositivity to non-vaccine incorporated HPV genotypes.ResultsOf 304 articles screened, 9 were included in the analysis representing ca. 700 individuals. The pooled estimate for seropositivity against HPV31 for the bivalent vaccine (86%; 95%CI 78–91%) was higher than that for the quadrivalent vaccine (61%; 39–79%; p = 0.011). The pooled estimate for seropositivity against HPV45 for the bivalent vaccine (50%; 37–64%) was also higher than that for the quadrivalent vaccine (16%; 6–36%; p = 0.007). Seropositivity against HPV33, HPV52 and HPV58 were similar between the vaccines. Mean seropositivity rates across non-vaccine genotypes were positively associated with the corresponding vaccine efficacy data reported from vaccine trials.ConclusionsThese data improve our understanding of vaccine-induced functional antibody specificity against non-vaccine incorporated genotypes and may help to parameterize vaccine-impact models and improve patient management in a post-vaccine setting.     

Effects of domotics on cognitive,social and personal functioning in patients with chronic stroke: A pilot study

BackgroundStroke can cause severe brain lesions, leading to multiple cognitive, emotional and motor disorders. In fact, it is one of the main causes of death and disability worldwide, with a negative impact on quality of life for both patient and caregiver. Home automation (also known as domotics) could allow stroke patients to manage and improve their daily lives.ObjectiveThe aim of our pilot study was to evaluate the effects of domotics on cognitive functions and personal/social autonomy in patients with stroke.MethodsWe enrolled 40 patients affected by chronic stroke undergoing neurorehabilitation at IRCCS Centro Neurolesi (Messina, Italy), between June 2017 and March 2019. All of the patients were randomized into either the control group (undergoing traditional training based on face-to-face interaction between therapist and patient, and practical activities), or the experimental group (undergoing Home Automation training). Each participant was evaluated before and immediately after the training period. Each different training consisted of 3 sessions per week for eight weeks (i.e. a total of 24 sessions), each session lasting about 60 min. For both the conventional and experimental trainings, treatments were performed in groups, and all the patients were provided with the same amount of treatment.ResultsPatients in the experimental group showed a greater improvement in cognitive and social performance, as compared to the control group.ConclusionOur study shows that domotics could be effective in improving social and cognitive functioning, autonomy and functional recovery in patients affected by chronic stroke.     

我国新型冠状病毒肺炎疫情早期围堵策略概述

2019年12月,湖北武汉市发生新型冠状病毒肺炎疫情,并迅速向全国蔓延。在疫情发生初期,我国采用围堵策略,并围绕此策略要点实施一系列核心措施,包括社会动员、加强病例隔离和密切接触者追踪管理、封锁疫区和交通管控以减少人员流动、增加人际距离、环境卫生措施以及个人防护等,以期尽快将疫情控制在武汉等有限地区。本文对围堵策略实施的背景、主要内容、以及核心措施进行了概述,分析了我国现阶段实施的围堵策略及核心措施的公共卫生意义,并基于措施效果的全面评价与疫情发展的态势评估提出下一步考虑建议。     

Poverty,bridging between injecting drug users and the general population,and “interiorization” may explain the spread of HIV in southern Brazil

The aim of this paper is to study how structural determinants and the role of injecting drug users (IDUs) as a bridging population to the general population affected the AIDS subepidemic in southern Brazil during 1986–2000. Data from 288 southernmost Brazilian municipalities were analyzed. Using hierarchical modeling and inputs from a Geographic Information System, a multilevel model was constructed. The dependent variable was the logged AIDS standardized incidence rate (among the heterosexual population aged 15–69-years-old); independent variables included indicators for education, water provision, sewage, and garbage collection, per capita income, Gini coefficient (on income), Human Development Index, indicators of accessibility, and AIDS rate among IDUs. Significant predictors included AIDS rate among IDUs, distance from/to highways/railways, the Human Development Index and the ratio of residents who have access to sanitary installations. Poverty (as measured by socioeconomic indicators) and bridging from IDUs contribute to the spread of HIV/AIDS in Brazilian southern municipalities.     

Regional anesthesia and chronification of acute postoperative pain

Chronification of acute postoperative pain is the consequence of a number of factors; the article mentions different preemptive strategies that may put a limit to its development. Certain anesthetic and analgesic techniques have been assessed over the last years, and most articles highlight the usefulness of carrying out regional anesthesia techniques from the intraoperative period through several days into the postoperative period. Preventing the patients from suffering acute postoperative pain is one of the most appropriate tools for stopping the activation of the mechanisms involved in pain chronification. None of the regional techniques are equally valid and applicable to all surgical procedures.     

Rates of prevalent and new HIV diagnoses by race and ethnicity among men who have sex with men,U.S. states, 2013–2014

PurposeMen who have sex with men (MSM) bear a disproportionate burden of new and existing HIV infections in the United States, with black and Hispanic MSM facing the highest rates. A lack of data on MSM population sizes has precluded the understanding of state-level variations in these rates.MethodsUsing a recently developed model for estimating state-level population sizes of MSM by race that synthesizes data from the American Community Survey and the National Health and Nutrition Examination Survey, in conjunction with Centers for Disease Control and Prevention–based HIV diagnosis data, we estimated rates of living with an HIV diagnosis (2013) and new diagnosis among MSM (2014) by state and race.ResultsNationally, state-level median prevalence of living with an HIV diagnosis was 10.6%. White MSM had lower prevalence in all but five states; black MSM were higher in all but three. Hispanic MSM had highest concentrations in Northeast and Mississippi Delta states. Patterns were similar for new diagnoses rates.ConclusionsResults suggest that racial disparities in HIV infection among MSM are more prominent than geographic ones. Interventions should be differentially tailored to areas of high proportionate and absolute burden. Continued efforts to understand and address racial differences in HIV infection are needed.     

Defining the interval for monitoring potential adverse events following immunization (AEFIs) after receipt of live viral vectored vaccines

Live viral vectors that express heterologous antigens of the target pathogen are being investigated in the development of novel vaccines against serious infectious agents like HIV and Ebola. As some live recombinant vectored vaccines may be replication-competent, a key challenge is defining the length of time for monitoring potential adverse events following immunization (AEFI) in clinical trials and epidemiologic studies. This time period must be chosen with care and based on considerations of pre-clinical and clinical trials data, biological plausibility and practical feasibility. The available options include: (1) adapting from the current relevant regulatory guidelines; (2) convening a panel of experts to review the evidence from a systematic literature search to narrow down a list of likely potential or known AEFI and establish the optimal risk window(s); and (3) conducting “near real-time“ prospective monitoring for unknown clustering’s of AEFI in validated large linked vaccine safety databases using Rapid Cycle Analysis for pre-specified adverse events of special interest (AESI) and Treescan to identify previously unsuspected outcomes. The risk window established by any of these options could be used along with (4) establishing a registry of clinically validated pre-specified AESI to include in case-control studies. Depending on the infrastructure, human resources and databases available in different countries, the appropriate option or combination of options can be determined by regulatory agencies and investigators.     

Establishment of functional influenza virus-specific CD8+ T cell memory pools after intramuscular immunization

The emergence of the avian-origin influenza H7N9 virus and its pandemic potential has highlighted the ever-present need to develop vaccination approaches to induce cross-protective immunity. In this study, we examined the establishment of cross-reactive CD8⁺ T cell immunity in mice following immunization with live A/Puerto Rico/8/1934 (PR8; H1N1) influenza virus via two non-productive inoculation routes. We found that immunization via the intramuscular (IM) route established functional influenza-virus specific memory CD8⁺ T cell pools capable of cross-reactive recall responses. Epitope-specific primary, memory and recall CD8⁺ T-cell responses induced by the IM route, highly relevant to human influenza immunisations, were of comparable magnitude and quality to those elicited by the intraperitoneal (IP) priming, commonly used in mice. Furthermore, IM immunisation resulted in lower lung viral titres following heterologous challenge with A/Aichi/68 (X31; H3N2) compared to the IP route. Examining the ability of DCs from lymphoid organs to present viral antigen revealed that immune induction following IM immunization occurred in draining lymph nodes, while immunization via the IP route resulted in the priming of responses in distal lymphoid organs, indicative of a systemic distribution of antigen. No major differences in the pulmonary cytokine environment of immunized animals following X31 challenge were observed that could account for the improved heterologous protection induced by the IM route. However, while both routes induced similar levels of PR8-specific antibodies, higher levels of cross-reactive antibodies against X31 were induced following IM inoculation. Our data demonstrate how non-replicative routes of infection can induce efficient cross-reactive CD8⁺ T cell responses and strong strain-specific antibody responses, with the additional benefit from IM priming of enhanced heterosubtypic antibody production.