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Sukumaran L, Radhakrishnan M. Effect of frozen storage on the inhibition of microbial population, chemical and sensory characteristics of coconut neera. J Appl Microbiol 2021; 131:1830-1839. [PMID: 33721389 DOI: 10.1111/jam.15068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/07/2021] [Accepted: 03/09/2021] [Indexed: 11/27/2022]
Abstract
AIM In this study, the effect of frozen storage on the inhibition of microbial population in coconut neera for shelf life extension was analysed. METHODS AND RESULTS The aliquots of fresh neera were frozen at -6 and -20°C. The microbial reduction and chemical qualities were analysed during storage days, and were compared with the control. The highest reduction in microbes was obtained at -20°C for lactic acid bacteria, yeast and total viable count. Moreover, the fluorescence cell staining and cell density analysis exhibited a decline at -20°C, however it showed higher at -6°C. At the end of 28 days, neera exhibited a pH of 5·37, total soluble solid of 14·0 °Brix and total acidity of 0·82 mg l-1 at -20°C. Besides, color, viscosity, total protein and ethanol showed a less difference with control and better sensory attribute up to 21 days at -20°C. CONCLUSIONS Frozen storage at -20°C resulted in a better inhibition of lactic acid bacteria, which preserves neera from the metabolic conversion. The physicochemical qualities of neera were preserved for a longer period when stored at -20°C than at atmospheric storage. SIGNIFICANCE AND IMPACT OF THE STUDY Frozen storage reduced microbial population and preserves the chemical properties with acceptable sensory attributes and increases the shelf life of coconut neera, making it fit for consumption.
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Affiliation(s)
- L Sukumaran
- Centre of Excellence in Nonthermal Processing, Indian Institute of Food Processing Technology, Ministry of Food Processing Industries, Government of India, Thanjavur, Tamil Nadu, India.,Affiliated to Bharathidasan University, Palkalaiperur, Tiruchirappalli, Tamil Nadu, India
| | - M Radhakrishnan
- Centre of Excellence in Nonthermal Processing, Indian Institute of Food Processing Technology, Ministry of Food Processing Industries, Government of India, Thanjavur, Tamil Nadu, India
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Myers T, Weintraub E, McNeil M, Sukumaran L, Duffy J, Baxter R, Klein NP, Daley MF, Donahue J, Tseng HF, Irving S, Jackson ML, Omer S. 2461. Safety of Quadrivalent Meningococcal Polysaccharide Diphtheria Toxoid-Conjugate Vaccine in Adolescents. Open Forum Infect Dis 2018. [PMCID: PMC6254304 DOI: 10.1093/ofid/ofy210.2114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The first quadrivalent meningococcal conjugate vaccine (MenACWY-D) was recommended for use in adolescents in 2005. Soon after, case reports of Guillain-Barre syndrome (GBS) following vaccination prompted subsequent studies, with a meta-analysis concluding that the attributable risk of GBS after MenACWY-D is unlikely to exceed 1 case per million vaccinations. We conducted a retrospective cohort study in the Vaccine Safety Datalink to assess the risk of 10 outcomes, including GBS, following MenACWY-D. Methods We included adolescents (aged 11–18 years) vaccinated with MenACWY-D during the years 2005–2014. We identified pre-specified outcomes using ICD-9 (International Classification of Disease, version 9) codes. We used automated data only for Bell’s palsy, fever, seizure and syncope, and we confirmed incident cases by medical record review for acute disseminated encephalomyelitis (ADEM), acute transverse myelitis (ATM), anaphylaxis, chronic inflammatory demyelinating polyneuropathy (CIDP), GBS and Henoch-Schönlein purpura (HSP). We used a self-controlled risk interval design to estimate relative risk (RR). Results Following 1.4 million doses of MenACWY-D, we detected increased risks for fever in the 1–6 days following vaccination (RR 1.5, 95% confidence interval [CI] 1.3–1.7) and syncope on the day of vaccination (RR 5.8, 95% CI 4.1–8.3), but not for seizures (RR 1.1, 95% CI 0.7–1.9) or Bell’s palsy (RR 1.1, 95% CI 0.8–1.5). We detected no cases in the post-vaccination risk intervals for CIDP, ADEM or ATM. We detected few cases of the other outcomes resulting in relatively unstable RR estimates: anaphylaxis (RR 1.9, 95% CI 0.5–7.1), GBS (RR 2.5, 95% CI 0.6–10.0) and HSP (RR 1.6, 95% CI 0.7–3.3). We estimated that the attributable risk of GBS was 1.5 cases per million vaccinations (upper bound of one-sided 95% CI, 4.9). Conclusion In a large retrospective cohort, we detected increased risks for syncope and fever, but not seizures or Bell’s palsy, following vaccination with MenACWY-D. Other outcomes were rare. Our findings, consistent with previous studies, suggest that the increased risk of GBS, if any, is likely small (<5 excess cases of GBS per million vaccinations). Disclosures N. P. Klein, Sanofi Pasteur: Investigator, Research grant. Merck: Investigator, Research grant. GSK: Investigator, Research grant. Pfizer: Investigator, Research support. Protein Science: Investigator, Research grant. MedImmune: Investigator, Research grant. Dynavax: Research Contractor, Grant recipient. M. L. Jackson, Novartis: Grant Investigator, Research support.
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Affiliation(s)
- Tanya Myers
- Centers for Disease Control & Prevention, Atlanta, Georgia
| | - Eric Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Roger Baxter
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - James Donahue
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Hung Fu Tseng
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | | | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Saad Omer
- Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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3
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Groom HC, Irving SA, Koppolu P, Smith N, Vazquez-Benitez G, Kharbanda EO, Daley MF, Donahue JG, Getahun D, Jackson LA, Tse Kawai A, Klein NP, McCarthy NL, Nordin JD, Sukumaran L, Naleway AL. Uptake and safety of Hepatitis B vaccination during pregnancy: A Vaccine Safety Datalink study. Vaccine 2018; 36:6111-6116. [PMID: 30194002 DOI: 10.1016/j.vaccine.2018.08.074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/16/2018] [Accepted: 08/29/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Hepatitis B virus (HBV) infection acquired during pregnancy can pose a risk to the infant at birth that can lead to significant and lifelong morbidity. Hepatitis B vaccine (HepB) is recommended for anyone at increased risk for contracting HBV infection, including pregnant women. Limited data are available on the safety of HepB administration during pregnancy. OBJECTIVES To assess the frequency of maternal HepB receipt among pregnant women and evaluate the potential association between maternal vaccination and pre-specified maternal and infant safety outcomes. METHODS We examined a retrospective cohort of pregnancies in the Vaccine Safety Datalink (VSD) resulting in live birth outcomes from 2004 through 2015. Eligible pregnancies in women aged 12-55 years who were continuously enrolled from 6 months pre-pregnancy to 6 weeks postpartum in VSD integrated health systems were included. We compared pregnancies with HepB exposure to those with other vaccine exposures, and to those with no vaccine exposures. High-risk conditions for contracting HBV infection were identified up to one-year prior to or during the pregnancy using ICD-9 codes. Maternal and fetal adverse events were also evaluated according to maternal HepB exposure status. RESULTS Among over 650,000 pregnancies in the study period, HepB was administered at a rate of 2.1 per 1000 pregnancies (n = 1399), commonly within the first 5 weeks of pregnancy. Less than 3% of the HepB-exposed group had a high-risk ICD-9 code indicating need for HepB; this was similar to the rate among HepB unvaccinated groups. There were no significant associations between HepB exposure during pregnancy and gestational hypertension, gestational diabetes, pre-eclampsia/eclampsia, cesarean delivery, pre-term delivery, low birthweight or small for gestational age infants. CONCLUSIONS Most women who received maternal HepB did not have high-risk indications for vaccination. No increased risk for the adverse events that were examined were observed among women who received maternal HepB or their offspring.
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Affiliation(s)
- Holly C Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States.
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Padma Koppolu
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Ning Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | | | | | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States
| | - James G Donahue
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Darios Getahun
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Alison Tse Kawai
- Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Natalie L McCarthy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - James D Nordin
- HealthPartners Institute, Minneapolis, MN, United States
| | - Lakshmi Sukumaran
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
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4
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Moro PL, Cragan J, Lewis P, Sukumaran L. Major Birth Defects after Vaccination Reported to the Vaccine Adverse Event Reporting System (VAERS), 1990 to 2014. Birth Defects Res 2018; 109:1057-1062. [PMID: 28762675 DOI: 10.1002/bdr2.23622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/18/2016] [Accepted: 12/19/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Major birth defects are important infant outcomes that have not been well studied in the postmarketing surveillance of vaccines given to pregnant women. We assessed the presence of major birth defects following vaccination in the Vaccine Adverse Event Reporting System (VAERS), a national spontaneous reporting system used to monitor the safety of vaccines in the United States. METHODS We searched VAERS for reports of major birth defects during January 1, 1990, through December 31, 2014. We excluded birth defects from vaccines that had been studied in pregnancy registries or other epidemiological studies (e.g., human papilloma virus, varicella, measles/mumps/rubella, and anthrax vaccines). Birth defects were categorized into trimester of vaccination and classified based on the organs and/or systems affected. If several birth defects affecting different systems were described, we classified those as multiple body systems. Empirical Bayesian data mining was used to assess for disproportionate reporting. RESULTS We identified 50 reports of major birth defects; in 28 reports, the vaccine was given during the first trimester; 25 were reports with single vaccines administered. Birth defects accounted for 0.03% of all reports received by VAERS during the study period and 3.2% of pregnancy reports; reported defects affected predominately the musculoskeletal (N = 10) or nervous (N = 10) systems. No unusual clusters or specific birth defects were identified. CONCLUSION This review of the VAERS database found that major birth defects were infrequently reported, with no particular condition reported disproportionally. Birth defects after routine maternal vaccination will continue to be monitored in VAERS for signals to prompt future studies. Birth Defects Research 109:1057-1062, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Pedro L Moro
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Janet Cragan
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Paige Lewis
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Lakshmi Sukumaran
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Sukumaran L, McCarthy NL, Kharbanda EO, Vazquez-Benitez G, Lipkind HS, Jackson L, Klein NP, Naleway AL, McClure DL, Hechter RC, Kawai AT, Glanz JM, Weintraub ES. Infant Hospitalizations and Mortality After Maternal Vaccination. Pediatrics 2018; 141:peds.2017-3310. [PMID: 29463582 PMCID: PMC6586222 DOI: 10.1542/peds.2017-3310] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The Advisory Committee on Immunization Practices currently recommends pregnant women receive influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines. There are limited studies of the long-term safety in infants for vaccines administered during pregnancy. We evaluate whether maternal receipt of influenza and Tdap vaccines increases the risk of infant hospitalization or death in the first 6 months of life. METHODS We included singleton, live birth pregnancies in the Vaccine Safety Datalink between 2004 and 2014. Outcomes were infant hospitalizations and mortality in the first 6 months of life. We performed a case-control study matching case patients and controls 1:1 and used conditional logistic regression to estimate odds ratios for maternal exposure to influenza and/or Tdap vaccines in pregnancy. RESULTS There were 413 034 live births in our population. Of these, 25 222 infants had hospitalizations and 157 infants died in the first 6 months of life. We found no association between infant hospitalization and maternal influenza (adjusted odds ratio: 1.00; 95% confidence interval [CI]: 0.96-1.04) or Tdap (adjusted odds ratio: 0.94; 95% CI: 0.88-1.01) vaccinations. We found no association between infant mortality and maternal influenza (adjusted odds ratio: 0.96; 95% CI: 0.54-1.69) or Tdap (adjusted odds ratio: 0.44; 95% CI: 0.17-1.13) vaccinations. CONCLUSIONS We found no association between vaccination during pregnancy and risk of infant hospitalization or death in the first 6 months of life. These findings support the safety of current recommendations for influenza and Tdap vaccination during pregnancy.
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Affiliation(s)
- Lakshmi Sukumaran
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia;
| | - Natalie L. McCarthy
- lmmunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Heather S. Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Nicola P. Klein
- Division of Research, Kaiser Permanente of Northern California, Oakland, California
| | - Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Rulin C. Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Alison T. Kawai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Eric S. Weintraub
- lmmunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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Gee J, Sukumaran L, Weintraub E. Risk of Guillain-Barré Syndrome following quadrivalent human papillomavirus vaccine in the Vaccine Safety Datalink. Vaccine 2017; 35:5756-5758. [PMID: 28935469 DOI: 10.1016/j.vaccine.2017.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Describe the Vaccine Safety Datalink's (VSD) Guillain Barré Syndrome (GBS) surveillance following quadrivalent HPV vaccine (4vHPV) from 2006 through 2015. METHODS Among 4vHPV vaccinated persons aged 9-26, ICD-9 coded GBS was identified in VSD's electronic data. Medical records were reviewed and adjudicated to confirm GBS. We calculated incidence rates of confirmed GBS within 1-42days following 4vHPV with a one-sided 95% confidence interval. RESULTS Following 2,773,185 4vHPV doses, we confirmed 1 case of GBS in a male and no cases among females. The incidence rate of medical record confirmed GBS within 42days following 4vHPV vaccine was 0.36 cases per million 4vHPV doses administered (1-sided 95% CI 1.71), which was less than the background rate. CONCLUSION We found no evidence of an increased risk of GBS following 4vHPV. With an upper 95% confidence limit, we estimate that, if an increased risk exists, we would expect at most 1.08 additional cases of GBS per million people vaccinated with 4vHPV.
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Affiliation(s)
- Julianne Gee
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Lakshmi Sukumaran
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eric Weintraub
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Moro PL, Sukumaran L. Cholera vaccination: pregnant women excluded no more. Lancet Infect Dis 2017; 17:469-470. [PMID: 28161571 DOI: 10.1016/s1473-3099(17)30055-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Pedro L Moro
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | - Lakshmi Sukumaran
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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8
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Vazquez-Benitez G, Kharbanda EO, Naleway AL, Lipkind H, Sukumaran L, McCarthy NL, Omer SB, Qian L, Xu S, Jackson ML, Vijayadev V, Klein NP, Nordin JD. Risk of Preterm or Small-for-Gestational-Age Birth After Influenza Vaccination During Pregnancy: Caveats When Conducting Retrospective Observational Studies. Am J Epidemiol 2016; 184:176-86. [PMID: 27449414 DOI: 10.1093/aje/kww043] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 02/19/2016] [Indexed: 12/11/2022] Open
Abstract
Vaccines are increasingly targeted toward women of reproductive age, and vaccines to prevent influenza and pertussis are recommended during pregnancy. Prelicensure clinical trials typically have not included pregnant women, and when they are included, trials cannot detect rare events. Thus, postmarketing vaccine safety assessments are necessary. However, analysis of observational data requires detailed assessment of potential biases. Using data from 8 Vaccine Safety Datalink sites in the United States, we analyzed the association of monovalent H1N1 influenza vaccine (MIV) during pregnancy with preterm birth (<37 weeks) and small-for-gestational-age birth (birth weight < 10th percentile). The cohort included 46,549 pregnancies during 2009-2010 (40% of participants received the MIV). We found potential biases in the vaccine-birth outcome association that might occur due to variable access to vaccines, the time-dependent nature of exposure to vaccination within pregnancy (immortal time bias), and confounding from baseline differences between vaccinated and unvaccinated women. We found a strong protective effect of vaccination on preterm birth (relative risk = 0.79, 95% confidence interval: 0.74, 0.85) when we ignored potential biases and no effect when accounted for them (relative risk = 0.91; 95% confidence interval: 0.83, 1.0). In contrast, we found no important biases in the association of MIV with small-for-gestational-age birth. Investigators conducting studies to evaluate birth outcomes after maternal vaccination should use statistical approaches to minimize potential biases.
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MESH Headings
- Adult
- Bias
- Comorbidity
- Databases, Factual
- Female
- Humans
- Infant, Newborn
- Infant, Small for Gestational Age
- Influenza A Virus, H1N1 Subtype/drug effects
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/adverse effects
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Maternal Age
- Observational Studies as Topic/methods
- Observational Studies as Topic/standards
- Pregnancy
- Pregnancy Complications, Infectious/immunology
- Pregnancy Complications, Infectious/prevention & control
- Pregnancy Complications, Infectious/virology
- Pregnancy Outcome/epidemiology
- Pregnancy Trimesters/drug effects
- Pregnancy Trimesters/immunology
- Premature Birth/epidemiology
- Premature Birth/immunology
- Prevalence
- Product Surveillance, Postmarketing/methods
- Product Surveillance, Postmarketing/statistics & numerical data
- Propensity Score
- Retrospective Studies
- Risk Assessment
- Time Factors
- United States/epidemiology
- Young Adult
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9
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Gee J, Weinbaum C, Sukumaran L, Markowitz LE. Quadrivalent HPV vaccine safety review and safety monitoring plans for nine-valent HPV vaccine in the United States. Hum Vaccin Immunother 2016; 12:1406-17. [PMID: 27029786 PMCID: PMC4964727 DOI: 10.1080/21645515.2016.1168952] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Quadrivalent human papillomavirus (4vHPV) vaccine was licensed for use in the United States in 2006 and through 2015 was the predominate HPV vaccine used. With the exception of syncope, a known preventable adverse event after any injected vaccination, both pre-licensure and post-licensure 4vHPV safety data have been reassuring with no confirmed safety signals identified. Nine-valent HPV vaccine (9vHPV) was licensed in 2014. This review includes post-licensure 4vHPV safety findings published to date that have informed the US vaccination program; these data will inform US safety monitoring and evaluation for 9vHPV.
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Affiliation(s)
- Julianne Gee
- a Division of Healthcare and Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Cindy Weinbaum
- a Division of Healthcare and Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Lakshmi Sukumaran
- a Division of Healthcare and Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Lauri E Markowitz
- b Division of Viral Diseases, National Center Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
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10
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Affiliation(s)
- Lakshmi Sukumaran
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Saad B Omer
- Hubert Department of Global Health, Emory University, Atlanta, Georgia
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11
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McNeil MM, Weintraub ES, Duffy J, Sukumaran L, Jacobsen SJ, Klein NP, Hambidge SJ, Lee GM, Jackson LA, Irving SA, King JP, Kharbanda EO, Bednarczyk RA, DeStefano F. Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol 2016; 137:868-78. [PMID: 26452420 PMCID: PMC4783279 DOI: 10.1016/j.jaci.2015.07.048] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/31/2015] [Accepted: 07/31/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Anaphylaxis is a potentially life-threatening allergic reaction. The risk of anaphylaxis after vaccination has not been well described in adults or with newer vaccines in children. OBJECTIVE We sought to estimate the incidence of anaphylaxis after vaccines and describe the demographic and clinical characteristics of confirmed cases of anaphylaxis. METHODS Using health care data from the Vaccine Safety Datalink, we determined rates of anaphylaxis after vaccination in children and adults. We first identified all patients with a vaccination record from January 2009 through December 2011 and used diagnostic and procedure codes to identify potential anaphylaxis cases. Medical records of potential cases were reviewed. Confirmed cases met the Brighton Collaboration definition for anaphylaxis and had to be determined to be vaccine triggered. We calculated the incidence of anaphylaxis after all vaccines combined and for selected individual vaccines. RESULTS We identified 33 confirmed vaccine-triggered anaphylaxis cases that occurred after 25,173,965 vaccine doses. The rate of anaphylaxis was 1.31 (95% CI, 0.90-1.84) per million vaccine doses. The incidence did not vary significantly by age, and there was a nonsignificant female predominance. Vaccine-specific rates included 1.35 (95% CI, 0.65-2.47) per million doses for inactivated trivalent influenza vaccine (10 cases, 7,434,628 doses given alone) and 1.83 (95% CI, 0.22-6.63) per million doses for inactivated monovalent influenza vaccine (2 cases, 1,090,279 doses given alone). The onset of symptoms among cases was within 30 minutes (8 cases), 30 to less than 120 minutes (8 cases), 2 to less than 4 hours (10 cases), 4 to 8 hours (2 cases), the next day (1 case), and not documented (4 cases). CONCLUSION Anaphylaxis after vaccination is rare in all age groups. Despite its rarity, anaphylaxis is a potentially life-threatening medical emergency that vaccine providers need to be prepared to treat.
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Affiliation(s)
- Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga.
| | - Eric S Weintraub
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Jonathan Duffy
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Lakshmi Sukumaran
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | | | | | | | - Grace M Lee
- Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, Mass
| | | | | | | | - Elyse O Kharbanda
- HealthPartners Institute for Education and Research, Minneapolis, Minn
| | - Robert A Bednarczyk
- Kaiser Permanente Center for Health Research, and the Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Frank DeStefano
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
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McCarthy NL, Gee J, Sukumaran L, Weintraub E, Duffy J, Kharbanda EO, Baxter R, Irving S, King J, Daley MF, Hechter R, McNeil MM. Vaccination and 30-Day Mortality Risk in Children, Adolescents, and Young Adults. Pediatrics 2016; 137:e20152970. [PMID: 26908690 PMCID: PMC6511986 DOI: 10.1542/peds.2015-2970] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE This study evaluates the potential association of vaccination and death in the Vaccine Safety Datalink (VSD). METHODS The study cohort included individuals ages 9 to 26 years with deaths between January 1, 2005, and December 31, 2011. We implemented a case-centered method to estimate a relative risk (RR) for death in days 0 to 30 after vaccination.Deaths due to external causes (accidents, homicides, and suicides) were excluded from the primary analysis. In a secondary analysis, we included all deaths regardless of cause. A team of physicians reviewed available medical records and coroner's reports to confirm cause of death and assess the causal relationship between death and vaccination. RESULTS Of the 1100 deaths identified during the study period, 76 (7%) occurred 0 to 30 days after vaccination. The relative risks for deaths after any vaccination and influenza vaccination were significantly lower for deaths due to nonexternal causes (RR 0.57, 95% confidence interval [CI] 0.38-0.83, and RR 0.44, 95% CI 0.24-0.80, respectively) and deaths due to all causes (RR 0.72, 95% CI 0.56-0.91, and RR 0.44, 95% CI 0.28-0.65). No other individual vaccines were significantly associated with death. Among deaths reviewed, 1 cause of death was unknown, 25 deaths were due to nonexternal causes, and 34 deaths were due to external causes. The causality assessment found no evidence of a causal association between vaccination and death. CONCLUSIONS Risk of death was not increased during the 30 days after vaccination, and no deaths were found to be causally associated with vaccination.
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Affiliation(s)
- Natalie L. McCarthy
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Address correspondence to Natalie L. McCarthy, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-D26, Atlanta, GA 30333. E-mail:
| | - Julianne Gee
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lakshmi Sukumaran
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Eric Weintraub
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Duffy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elyse O. Kharbanda
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota
| | - Roger Baxter
- Kaiser Permanente of Northern California, Oakland, California
| | | | - Jennifer King
- Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; and
| | - Rulin Hechter
- Kaiser Permanente Southern California, Pasadena, California
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Glanz JM, Newcomer SR, Jackson ML, Omer SB, Bednarczyk RA, Shoup JA, DeStefano F, Daley MF, Goddard K, Panneton M, Groom H, Plotkin SA, Orenstein WA, Marcuse EK, Brookhart MA, Kulldorff M, Shimabukuro T, McNeil M, Gee J, Weintraub E, Sukumaran L. White Paper on studying the safety of the childhood immunization schedule in the Vaccine Safety Datalink. Vaccine 2016; 34 Suppl 1:A1-A29. [DOI: 10.1016/j.vaccine.2015.10.082] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
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Sukumaran L, McCarthy NL, Kharbanda EO, McNeil MM, Naleway AL, Klein NP, Jackson ML, Hambidge SJ, Lugg MM, Li R, Weintraub ES, Bednarczyk RA, King JP, DeStefano F, Orenstein WA, Omer SB. Association of Tdap Vaccination With Acute Events and Adverse Birth Outcomes Among Pregnant Women With Prior Tetanus-Containing Immunizations. JAMA 2015; 314:1581-7. [PMID: 26501534 PMCID: PMC6586223 DOI: 10.1001/jama.2015.12790] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The Advisory Committee on Immunization Practices (ACIP) recommends the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine for pregnant women during each pregnancy, regardless of prior immunization status. However, safety data on repeated Tdap vaccination in pregnancy is lacking. OBJECTIVE To determine whether receipt of Tdap vaccine during pregnancy administered in close intervals from prior tetanus-containing vaccinations is associated with acute adverse events in mothers and adverse birth outcomes in neonates. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study in 29,155 pregnant women aged 14 through 49 years from January 1, 2007, through November 15, 2013, using data from 7 Vaccine Safety Datalink sites in California, Colorado, Minnesota, Oregon, Washington, and Wisconsin. EXPOSURES Women who received Tdap in pregnancy following a prior tetanus-containing vaccine less than 2 years before, 2 to 5 years before, and more than 5 years before. MAIN OUTCOMES AND MEASURES Acute adverse events (fever, allergy, and local reactions) and adverse birth outcomes (small for gestational age, preterm delivery, and low birth weight) were evaluated. Women who were vaccinated with Tdap in pregnancy and had a prior tetanus-containing vaccine more than 5 years before served as controls. RESULTS There were no statistically significant differences in rates of medically attended acute adverse events or adverse birth outcomes related to timing since prior tetanus-containing vaccination. [table: see text]. CONCLUSIONS AND RELEVANCE Among women who received Tdap vaccination during pregnancy, there was no increased risk of acute adverse events or adverse birth outcomes for those who had been previously vaccinated less than 2 years before or 2 to 5 years before compared with those who had been vaccinated more than 5 years before. These findings suggest that relatively recent receipt of a prior tetanus-containing vaccination does not increase risk after Tdap vaccination in pregnancy.
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Affiliation(s)
- Lakshmi Sukumaran
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia2Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Natalie L McCarthy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elyse O Kharbanda
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota
| | - Michael M McNeil
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison L Naleway
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | | | - Simon J Hambidge
- Department of Ambulatory Care Services, Denver Health, Denver, Colorado 8Institute for Health Research, Kaiser Permanente Colorado, Denver9Department of Pediatrics, University of Colorado, Denver
| | - Marlene M Lugg
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Rongxia Li
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric S Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jennifer P King
- Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Frank DeStefano
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Saad B Omer
- Rollins School of Public Health, Emory University, Atlanta, Georgia13Emory Vaccine Center, Emory University, Atlanta, Georgia
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Moro PL, McNeil MM, Sukumaran L, Broder KR. The Centers for Disease Control and Prevention's public health response to monitoring Tdap safety in pregnant women in the United States. Hum Vaccin Immunother 2015; 11:2872-9. [PMID: 26378718 PMCID: PMC5054779 DOI: 10.1080/21645515.2015.1072664] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 06/24/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022] Open
Abstract
In 2010, in response to a widespread pertussis outbreak and neonatal deaths, California became the first state to recommend routine administration of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy. In 2011, the Advisory Committee on Immunization Practices (ACIP) followed with a similar recommendation for Tdap vaccination during pregnancy for previously unvaccinated women. In 2012, this recommendation was expanded to include Tdap vaccination of every pregnant woman during each pregnancy. These recommendations were based on urgent public health needs and available evidence on the safety of other inactivated vaccines during pregnancy. However, there were limited data on the safety of Tdap during pregnancy. In response to the new ACIP recommendations, the Centers for Disease Control and Prevention (CDC) implemented ongoing collaborative studies to evaluate whether vaccination with Tdap during pregnancy adversely affects the health of mothers and their offspring and provide the committee with regular updates. The current commentary describes the public health actions taken by CDC to respond to the ACIP recommendation to study and monitor the safety of Tdap vaccines in pregnant women and describes the current state of knowledge on the safety of Tdap vaccines in pregnant women. Data from the various monitoring activities support the safety of Tdap use during pregnancy.
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Affiliation(s)
- Pedro L Moro
- Immunization Safety Office; Division of Healthcare Quality Promotion; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Michael M McNeil
- Immunization Safety Office; Division of Healthcare Quality Promotion; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Lakshmi Sukumaran
- Immunization Safety Office; Division of Healthcare Quality Promotion; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Karen R Broder
- Immunization Safety Office; Division of Healthcare Quality Promotion; Centers for Disease Control and Prevention; Atlanta, GA USA
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Sukumaran L, McNeil MM, Moro PL, Lewis PW, Winiecki SK, Shimabukuro TT. Adverse Events Following Measles, Mumps, and Rubella Vaccine in Adults Reported to the Vaccine Adverse Event Reporting System (VAERS), 2003-2013. Clin Infect Dis 2015; 60:e58-65. [PMID: 25637587 DOI: 10.1093/cid/civ061] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/21/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Limited data exist on the safety of the measles, mumps, and rubella (MMR) vaccine in adults. We reviewed reports of adverse events (AEs) to the Vaccine Adverse Event Reporting System (VAERS) to assess safety in this previously understudied group. METHODS VAERS is the national spontaneous vaccine safety surveillance system coadministered by the Centers for Disease Control and Prevention and the US Food and Drug Administration. We searched the VAERS database for US reports of adults aged ≥19 years who received the MMR vaccine from 1 January 2003 to 31 July 2013. We clinically reviewed reports and available medical records for serious AEs, pregnancy reports, and reports for selected prespecified outcomes. RESULTS During this period, VAERS received 3175 US reports after MMR vaccine in adults. Of these, 168 (5%) were classified as serious, including 7 reports of death. Females accounted for 77% of reports. The most common signs and symptoms for all reports were pyrexia (19%), rash (17%), pain (13%), and arthralgia (13%). We did not detect any new safety findings in empirical Bayesian data mining. We identified 131 reports of MMR vaccine administered to a pregnant woman; the majority of these vaccinations were in the first trimester and in 83 (62%), no AE was reported. CONCLUSIONS In our review of VAERS data, we did not detect any new or unexpected safety concerns for MMR vaccination in adults. We identified reports of pregnant women exposed to MMR, which is a group in whom the vaccine is contraindicated, suggesting the need for continued provider education on vaccine recommendations and screening.
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Affiliation(s)
- Lakshmi Sukumaran
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention Emory University School of Medicine, Atlanta, Georgia
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention
| | - Pedro L Moro
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention
| | - Paige W Lewis
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention
| | - Scott K Winiecki
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Tom T Shimabukuro
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention
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Sukumaran L, Mcneil M, Lewis P, Moro P, Shimabukuro T. 1077Adverse events following measles, mumps, and rubella (MMR) vaccine in adults reported to the Vaccine Adverse Event Reporting System, 2003-2013. Open Forum Infect Dis 2014. [PMCID: PMC5782074 DOI: 10.1093/ofid/ofu052.785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lakshmi Sukumaran
- Immunization Safety Office, CDC, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
| | | | - Paige Lewis
- Immunization Safety Office, CDC, Atlanta, GA
| | - Pedro Moro
- Immunization Safety Office, CDC, Atlanta, GA
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