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Espeche WG, Marin M, Romero C, Renna N, Vissani S, Blanco G, Pantalena SP, Cesario D, Diez E, Grasso C, Garzon E, Barochiner J, Ruise M, Minetto J, Mazzei N, Ramirez E, Rojas M, Carrera Ramos P, Gimenez MS, Rivarola M, Rada N, Deffacci A, Leiva Sisnieguez BC, Vissani J, Bercovsky R, Tenuta MA, Martinez C, Cerri G, Salazar R, Graziani L, Cornavaca T, Salazar MR. [Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study]. Hipertens Riesgo Vasc 2024; 41:78-86. [PMID: 38418299 DOI: 10.1016/j.hipert.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/24/2023] [Accepted: 02/04/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access. METHODS A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes. RESULTS A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence. Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy. CONCLUSION The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations. Inadequate use of combination therapy was observed. This study underscores the urgent need for targeted interventions addressing cardiovascular risk factors in poor areas to mitigate the burden of CVD.
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Affiliation(s)
- W G Espeche
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina
| | - M Marin
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Sección de Hipertensión, Hospital Italiano de San Justo, Buenos Aires, Argentina
| | - C Romero
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; School of Medicine, Emory University School of Medicine, Atlanta, EE. UU
| | - N Renna
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Departamento de Cardiología, Hospital Español de Mendoza, Mendoza, Argentina
| | - S Vissani
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Centro de Especialidades Neurológicas y Rehabilitación (CENYR) San Luis, San Luis, Argentina
| | - G Blanco
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Consultorios, Instituto Médico Prometeo, Mar del Plata, Buenos Aires, Argentina
| | - S P Pantalena
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Servicio de Cardiología, Centro Modelo en Cardiología, San Miguel de Tucumán, Tucumán, Argentina
| | - D Cesario
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Servicio de Cardiología, Hospital Villa Constitución, Santa Fe, Argentina
| | - E Diez
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Instituto de Medicina y Biología Experimental de Cuyo - UNCuyo - CONICET, Mendoza, Argentina
| | - C Grasso
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina
| | - E Garzon
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Servicio de Cardiología, Hospital Privado de Córdoba, Córdoba, Argentina
| | - J Barochiner
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Sección de Hipertensión arterial, Hospital Italiano de Buenos Aires, CABA, Buenos Aires, Argentina
| | - M Ruise
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Servicio de Cardiología CCV, Clínica Yunes, Santiago del Estero, Argentina
| | - J Minetto
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina.
| | - N Mazzei
- Universidad Maimónides, Buenos Aires, Argentina
| | - E Ramirez
- Departamento de Cardiología, Hospital Español de Mendoza, Mendoza, Argentina
| | - M Rojas
- Centro de Especialidades Neurológicas y Rehabilitación (CENYR) San Luis, San Luis, Argentina
| | - P Carrera Ramos
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina
| | - M S Gimenez
- Departamento de Cardiología, Hospital Español de Mendoza, Mendoza, Argentina
| | - M Rivarola
- Consultorios, Instituto Médico Prometeo, Mar del Plata, Buenos Aires, Argentina
| | - N Rada
- Consultorios, Instituto Médico Prometeo, Mar del Plata, Buenos Aires, Argentina
| | - A Deffacci
- Núcleo de Innovación y Desarrollo de Oportunidades, Municipalidad de Mendoza, Mendoza, Argentina
| | - B C Leiva Sisnieguez
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina
| | - J Vissani
- Centro de Especialidades Neurológicas y Rehabilitación (CENYR) San Luis, San Luis, Argentina
| | - R Bercovsky
- Consultorios, Instituto Médico Prometeo, Mar del Plata, Buenos Aires, Argentina
| | - M A Tenuta
- Departamento de Cardiología, Hospital Español de Mendoza, Mendoza, Argentina
| | - C Martinez
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina
| | - G Cerri
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina
| | - R Salazar
- Departamento de Cardiología, Hospital Español de Mendoza, Mendoza, Argentina
| | - L Graziani
- Departamento de Cardiología, Hospital Español de Mendoza, Mendoza, Argentina
| | - T Cornavaca
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Servicio de Cardiología, Hospital Privado de Córdoba, Córdoba, Argentina
| | - M R Salazar
- Sociedad Argentina de Hipertensión Arterial, CABA, Argentina; Unidad de Enfermedades Cardiometabólicas, Hospital San Martín de La Plata, Buenos Aires, Argentina
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Ruprecht A, Marin M, Strain AK, Harry K, Kenyon C. Notes from the Field: Expanded Laboratory Testing for Varicella - Minnesota, 2016-2023. MMWR Morb Mortal Wkly Rep 2024; 73:245-246. [PMID: 38512771 PMCID: PMC10794063 DOI: 10.15585/mmwr.mm7311a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
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Alonge OD, Marin M, Hickman CJ, Sowers SB, Chen MH, Hao L, Mercader S, El-Badry E, McClure DL, Icenogle JP, Sugerman DE, Crooke SN, Nguyen HQ. Long-term Neutralizing Antibody Levels Against Measles and Rubella Viruses Among Adults With 3 Doses of Measles-Mumps-Rubella Vaccine. Open Forum Infect Dis 2024; 11:ofad700. [PMID: 38213634 PMCID: PMC10783245 DOI: 10.1093/ofid/ofad700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024] Open
Abstract
Background A third dose of measles-mumps-rubella vaccine (MMR) may be administered for various reasons, but data on long-term immunity are limited. We assessed neutralizing antibody levels against measles and rubella among adults up to 11 years after receipt of a third MMR dose. Methods In this longitudinal study, healthy adults who received a third MMR dose as young adults (ages 18-28 years) were recalled around 5 years and 9-11 years after the third dose. Measles and rubella antibody levels were assessed by plaque-reduction and immunocolorimetric neutralization assays, respectively. Antibody concentrations <120 mIU/mL and <10 U/mL were considered potentially susceptible to measles and rubella, respectively. Geometric mean concentrations (GMCs) and 95% confidence intervals (CIs) over time were estimated from generalized estimating equation models. Results Approximately 5 and 9-11 years after receipt of the third dose, 405 and 304 adults were assessed, respectively. Measles GMC was 428 mIU/mL (95% CI, 392-468 mIU/mL) 5 years postvaccination, declining to 381 mIU/mL (95% CI, 339-428 mIU/mL) 11 years postvaccination. At the last follow-up visit (9-11 years postvaccination), 10% of participants were potentially susceptible to measles infection. Rubella GMCs were stable throughout the follow-up period (63 U/mL to 65 U/mL); none of the participants was susceptible to rubella at the last follow-up visit. Conclusions Eleven years after receiving a third MMR dose, measles and rubella neutralizing antibody levels remained high in adults. However, on the basis of waning antibody levels, some adults may become susceptible to measles infection over time despite receipt of 3 vaccine doses.
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Affiliation(s)
- Oluwakemi D Alonge
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carole J Hickman
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sun B Sowers
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min-hsin Chen
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lijuan Hao
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara Mercader
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elina El-Badry
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David L McClure
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Joseph P Icenogle
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David E Sugerman
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen N Crooke
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Huong Q Nguyen
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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Guo A, Leung J, Ayers T, Fields VS, Safi H, Waters C, Curns AT, Routh JA, Haselow DT, Marlow MA, Marin M. Mumps vaccine effectiveness of a 3rd dose of measles, mumps, rubella vaccine in school settings during a mumps outbreak -- Arkansas, 2016-2017. Public Health Pract (Oxf) 2023; 6:100404. [PMID: 38099088 PMCID: PMC10719407 DOI: 10.1016/j.puhip.2023.100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/05/2023] [Indexed: 12/17/2023] Open
Abstract
Objectives The largest mumps outbreak in the United States since 2006 occurred in Arkansas during the 2016-17 school year. An additional dose (third dose) of measles-mumps-rubella vaccine (MMR3) was offered to school children. We evaluated the vaccine effectiveness (VE) of MMR3 compared with two doses of MMR for preventing mumps among school-aged children during the outbreak. Study design A generalized linear mixed effects model was used to estimate the incremental vaccine effectiveness (VE) of a third dose of MMR compared with two doses of MMR for preventing mumps. Methods We obtained school enrollment, immunization status and mumps case status from school registries, Arkansas's immunization registry, and Arkansas's mumps surveillance system, respectively. We included students who previously received 2 doses of MMR in schools with ≥1 mumps case after the MMR3 clinic. We used a generalized linear mixed model to estimate VE of MMR3 compared with two doses of MMR. Results Sixteen schools with 9272 students were included in the analysis. Incremental VE of MMR3 versus a two-dose MMR regimen was 52.7% (95% confidence interval [CI]: -3.6%‒78.4%) overall and in 8 schools with high mumps transmission it was 64.0% (95% CI: 1.2%‒86.9%). MMR3 VE was higher among middle compared with elementary school students (68.5% [95% CI: -30.2%‒92.4%] vs 37.6% [95% CI: -62.5%‒76.1%]); these differences were not statistically significant. Conclusion Our findings suggest MMR3 provided additional protection from mumps compared with two MMR doses in elementary and middle school settings during a mumps outbreak.
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Affiliation(s)
- Angela Guo
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Jessica Leung
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Tracy Ayers
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Virgie S. Fields
- Arkansas Department of Health, 4815 W Markham St, Little Rock, AR, 72205, USA
- Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship, 2635 Century Pkwy NE #700, Atlanta, GA, 30345, USA
| | - Haytham Safi
- Arkansas Department of Health, 4815 W Markham St, Little Rock, AR, 72205, USA
| | - Catherine Waters
- Arkansas Department of Health, 4815 W Markham St, Little Rock, AR, 72205, USA
| | - Aaron T. Curns
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Janell A. Routh
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Dirk T. Haselow
- Arkansas Department of Health, 4815 W Markham St, Little Rock, AR, 72205, USA
| | - Mariel A. Marlow
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Mona Marin
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
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Abouelregal AE, Askar SS, Marin M, Mohamed B. The theory of thermoelasticity with a memory-dependent dynamic response for a thermo-piezoelectric functionally graded rotating rod. Sci Rep 2023; 13:9052. [PMID: 37270575 DOI: 10.1038/s41598-023-36371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/02/2023] [Indexed: 06/05/2023] Open
Abstract
By laminating piezoelectric and flexible materials during the manufacturing process, we can improve the performance of electronic devices. In smart structure design, it is also important to understand how the functionally graded piezoelectric (FGP) structure changes over time when thermoelasticity is assumed. This is because these structures are often exposed to both moving and still heat sources during many manufacturing processes. Therefore, it is necessary to conduct theoretical and experimental studies of the electrical and mechanical characteristics of multilayer piezoelectric materials when they are subjected to electromechanical loads and heat sources. Since the infinite speed of heat wave propagation is a challenge that classical thermoelasticity cannot address, other models based on extended thermoelasticity have been introduced. For this reason, the effects of an axial heat supply on the thermomechanical behavior of an FGP rod using a modified Lord-Shulman model with the concept of a memory-dependent derivative (MDD) will be explored in this study. The exponential change of physical properties in the direction of the axis of the flexible rod will be taken into account. It was also assumed that there is no electric potential between the two ends of the rod while it is fixed at both ends and thermally isolated. Applying the Laplace transform method, the distributions of the physical fields under investigation were calculated. The obtained results were compared to those in the corresponding literature with varying heterogeneity values, kernel functions, delay times, and heat supply speeds. It was discovered that the studied physical fields and the dynamic behavior of the electric potential are weakened by increasing the inhomogeneity index.
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Affiliation(s)
- Ahmed E Abouelregal
- Department of Mathematics, Faculty of Science, Mansoura University, Mansoura, 35516, Egypt
| | - S S Askar
- Department of Statistics and Operations Research, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia.
| | - M Marin
- Department of Mathematics and Computer Science, Transilvania University of Brasov, Brasov, Romania
| | - Badahiould Mohamed
- Faculty of Sciences and Technology, University of Nouakchott, Nouakchott, Mauritania
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Hanson KE, Marin M, Daley MF, Groom HC, Jackson LA, Sy LS, Klein NP, DeSilva MB, Panagiotakopoulos L, Weintraub E, Belongia EA, McLean HQ. Safety of measles, mumps, and rubella vaccine in adolescents and adults in the vaccine safety Datalink. Vaccine X 2023; 13:100268. [PMID: 36814595 PMCID: PMC9939709 DOI: 10.1016/j.jvacx.2023.100268] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/13/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Background Measles, mumps, and rubella vaccine (MMR) is routinely administered to children; however, adolescents and adults may receive MMR for various reasons. Safety studies in adolescents and adults are limited. We report on safety of MMR in this age group in the Vaccine Safety Datalink. Methods We included adolescents (aged 9-17 years) and adults (aged ≥ 18 years) who received ≥ 1 dose of MMR from January 1, 2010-December 31, 2018. Pre-specified outcomes were identified by diagnosis codes. Clinically serious outcomes included anaphylaxis, encephalitis/myelitis, Guillain-Barré syndrome, immune thrombocytopenia, meningitis, and seizure. Non-serious outcomes were allergic reaction, arthropathy, fever, injection site reaction, lymphadenopathy, non-specific reaction, parotitis, rash, and syncope. All serious outcomes underwent medical record review. Outcome-specific incidence was calculated in pre-defined post-vaccination windows. A self-controlled risk interval design was used to determine the relative risk of each outcome in a risk window after vaccination compared to a more distal control window. Results During the study period, 276,327 MMR doses were administered to adolescents and adults. Mean age of vaccinees was 34.8 years; 65.8 % were female; 53.2 % of doses were administered simultaneously with ≥ 1 other vaccine. Serious outcomes were rare, with incidence ≤ 6 per 100,000 doses for each outcome assessed, and none had a significant elevation in incidence during the risk window compared to the control window. Incidence of non-serious outcomes per 100,000 doses ranged from 3.4 for parotitis to 263.0 for arthropathy. Other common outcomes included injection site reaction and rash (157.0 and 112.9 per 100,000 doses, respectively). Significantly more outcomes were observed during the risk window compared to the control window for all non-serious outcomes except parotitis. Some variability was observed by sex and age group. Conclusion Serious outcomes after MMR are rare in adolescents and adults, but vaccinees should be counseled regarding anticipated local and systemic non-serious adverse events.
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Key Words
- ACIP, Advisory Committee on Immunization Practices
- Adolescents
- Adults
- CDC, Centers for Disease Control and Prevention
- CI, confidence interval
- ED, emergency department
- GBS, Guillain-Barré syndrome
- ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification
- ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification
- IQR, interquartile range
- ITP, immune thrombocytopenia
- MMR
- MMR, measles, mumps, and rubella vaccine
- MMRV, measles, mumps, rubella, and varicella vaccine
- RR, relative risk
- SCRI, self-controlled risk interval
- Safety
- VAERS, Vaccine Adverse Event Reporting System
- VSD, Vaccine Safety Datalink
- Vaccine
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Affiliation(s)
- Kayla E. Hanson
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 N Oak Ave, ML2, Marshfield, WI 54449, United States,Corresponding author at: Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue, ML2, Marshfield, WI 54449, United States.
| | - Mona Marin
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-5, Atlanta, GA 30333, United States
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Suite 200, Aurora, CO 80014, United States
| | - Holly C. Groom
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, United States
| | - Lisa A. Jackson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States
| | - Lina S. Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, United States
| | - Nicola P. Klein
- Vaccine Study Center, Kaiser Permanente Northern California, 1 Kaiser Plaza, Oakland, CA 94612, United States
| | - Malini B. DeSilva
- HealthPartners Institute, 8170 33 Ave S, Bloomington, MN 55425, United States
| | - Lakshmi Panagiotakopoulos
- Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS V18-4, Atlanta, GA 30333, United States
| | - Eric Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS V18-4, Atlanta, GA 30333, United States
| | - Edward A. Belongia
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 N Oak Ave, ML2, Marshfield, WI 54449, United States
| | - Huong Q. McLean
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 N Oak Ave, ML2, Marshfield, WI 54449, United States
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Ciacchini B, Di Nardo G, Marin M, Borali E, Caraccia M, Mogni R, Cairello F, Rabbone I, Ferrero GB, Pini Prato A, Felici E. Case report: Gastroenterological management in a case of cardio-facio-cutaneous syndrome. Front Pediatr 2023; 11:1160147. [PMID: 37138575 PMCID: PMC10149741 DOI: 10.3389/fped.2023.1160147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Background cardio-facio-cutaneous syndrome is a rare genetic disorder affecting less than 900 people in the world. It is mainly characterized by craniofacial, dermatologic and cardiac defects, but also gastroenterological symptoms may be present, ranging from feeding difficulties to gastroesophageal reflux and constipation.In this report we describe a case of this syndrome characterized by severe feeding and growth difficulties, with a particular focus on the management of gastroenterological complications. Case presentation the patient was a caucasian male affected by Cardio-Facio-Cutaneous syndrome who presented feeding difficulties already a few hours after birth. These symptoms worsened in the following months and lead to a complete growth arrest and malnutrition. He was first treated with a nasogastric tube placement. Subsequently, a laparoscopic Nissen fundoplication and a laparoscopic Stamm gastrostomy were performed. The child was fed with nocturnal enteral nutrition and diurnal oral and enteral nutrition. Eventually the patient resumed feeding validly and regained adequate growth. Conclusion this paper aims to bring to light a complex rare syndrome that infrequently comes to the attention of the pediatricians and whose diagnosis is not always straightforward. We also highlight the possible complications under a gastroenterologic point of view. Our contribution can be helpful to the pediatrician in the first diagnostic suspect of this syndrome. In particular, it is worth highlighting that -in an infant with Noonan-like features- symptoms like suction or swallowing problems, vomiting and feeding difficulties should orient towards the diagnosis of a Cardio-facio-cutaneous syndrome. It is also important to stress that its related gastroenterological issues may lead to severe growth failure and therefore the role of the gastroenterologist is key to manage supplemental feeding and to establish whether a nasogastric or gastrostomic tube placement is necessary.
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Affiliation(s)
- B. Ciacchini
- Division of Pediatrics, Department of Health Science, University of Piemonte Orientale, Novara, Italy
| | - G. Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - M. Marin
- Pediatric and Pediatric Emergency Unit, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - E. Borali
- Pediatric and Pediatric Emergency Unit, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - M. Caraccia
- Pediatric Surgery, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - R. Mogni
- Pediatric and Pediatric Emergency Unit, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - F. Cairello
- Pediatric and Pediatric Emergency Unit, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - I. Rabbone
- Division of Pediatrics, Department of Health Science, University of Piemonte Orientale, Novara, Italy
| | - G. B Ferrero
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - A. Pini Prato
- Pediatric Surgery, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - E. Felici
- Pediatric and Pediatric Emergency Unit, “U. Bosio” Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
- Correspondence: E. Felici
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Marin M, Leung JW, Lopez AS, Melgar M, Anderson TC, Curns AT, Dooling KL. 801. IDSA Featured Oral Abstract: 25 Years of Varicella Vaccination Program in the United States: Health Impact during 1995–2019. Open Forum Infect Dis 2022. [PMCID: PMC9752897 DOI: 10.1093/ofid/ofac492.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background In 1995, the United States was the first country to introduce universal childhood varicella vaccination. High vaccine coverage was attained among young children, ≥ 90% since 2007. In 2007, the policy was changed from 1-dose to a 2-dose program. We describe the impact of 25 years of the U.S. varicella vaccination program on varicella disease nationally. Methods We reviewed published data and analyzed overall and age-specific trends for rates from the pre-vaccine period (1990–1994) through 2019 for varicella incidence using National Notifiable Diseases Surveillance System data, hospitalizations using National Inpatient Sample data, and deaths using National Center for Health Statistics data. We present trends in persons aged < 50 years, which captures most varicella burden and avoids misclassified herpes zoster in older people. Outbreak (≥ 5 varicella cases epidemiologically linked) characteristics were assessed for 1995–2019 and were informed by published data and analysis of surveillance data reported to CDC. Results Within the 10 years of the 1-dose program, varicella incidence, hospitalization, and mortality rates declined dramatically (71%–90%) vs. pre-vaccine. However, limited transmission continued in school settings which informed the change to a 2-dose policy. By 2019, declines reached > 97% for incidence and 94% and 97% for hospitalizations and deaths, respectively. The greatest decline occurred among persons aged < 20 years, born during the varicella vaccination program, with 99%, 97%, and > 99% reduction in incidence, hospitalizations, and deaths, respectively. The 2-dose program further reduced the number, size, and duration of outbreaks vs. the 1-dose program; over the entire program, the proportion of outbreaks with < 10 cases increased from 28% to 73%. Conclusion The varicella vaccination program significantly reduced varicella morbidity and mortality in the U.S. Twenty-five years into the program, pediatric varicella hospitalization has become a rare event and varicella deaths in persons aged < 20 years are practically eliminated in the U.S. Annually, > 3.8 million cases, 10,500 hospitalizations, and 100 deaths from varicella are now prevented in the United States due to the varicella vaccination program. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
- Mona Marin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica W Leung
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Michael Melgar
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tara C Anderson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aaron T Curns
- Centers for Disease Control and Prevention, Atlanta, Georgia
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9
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Leung JW, Dooling KL, Marin M, Anderson TC, Harpaz R. 1461. The Impact of Universal Varicella Vaccination on Herpes Zoster Incidence in the United States. Open Forum Infect Dis 2022. [PMCID: PMC9752792 DOI: 10.1093/ofid/ofac492.1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The varicella vaccination program was implemented in the United States in 1995 and has resulted in large reductions in varicella disease burden. At the start of the varicella vaccination program, impacts on herpes zoster (HZ) epidemiology were unknown. We used a large claims database to examine national HZ incidence during 1998–2019 in cohorts of persons born before and after varicella vaccine introduction. Methods Medical claims data were obtained from 1998–2019 IBM® MarketScan® Research Databases. We identified HZ based on first outpatient service with an HZ ICD-9/10 code (053.xx/B02.xx) and calculated age-specific incidence for persons aged ≥30 years (all born pre-vaccine) and persons aged 1–29 years (includes persons born post-vaccine). Results Among persons aged ≥30 years, HZ incidence increased with age and calendar time (Fig. 1); incidence in the two oldest age groups (60–69 and ≥70 years) started to decelerate in 2007. Among persons aged 1–29 years, HZ incidence increased early in the study period for the oldest age groups (born pre-vaccine, i.e., born after 1990), but later declined once each age group was comprised of persons born in the post-vaccine period (children and adolescents) (Fig 2); the peak incidence occurred in progressively-earlier calendar years among progressively younger age groups.
![]() ![]() Conclusion HZ incidence in persons aged ≥30 years increased early in the study period for all age groups followed by declines starting with the oldest cohorts. The U.S. data do not support previous modelled predictions that reduced VZV exposure would result in increased HZ incidence among adults. The patterns of decline in HZ incidence in persons aged 1–29 years can likely be explained by the success of the U.S. varicella vaccination program and increasingly uncommon latent infection with wild type varicella-zoster virus. These data suggest that continued declines in age-specific HZ incidence are likely as varicella vaccinated cohorts age. The reduction of HZ resulting from the varicella vaccination program, should ultimately extend to the entire U.S. population over time. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
- Jessica W Leung
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Mona Marin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tara C Anderson
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Murdoch N, Stott AE, Gillier M, Hueso R, Lemmon M, Martinez G, Apéstigue V, Toledo D, Lorenz RD, Chide B, Munguira A, Sánchez-Lavega A, Vicente-Retortillo A, Newman CE, Maurice S, de la Torre Juárez M, Bertrand T, Banfield D, Navarro S, Marin M, Torres J, Gomez-Elvira J, Jacob X, Cadu A, Sournac A, Rodriguez-Manfredi JA, Wiens RC, Mimoun D. The sound of a Martian dust devil. Nat Commun 2022; 13:7505. [PMID: 36513637 PMCID: PMC9747922 DOI: 10.1038/s41467-022-35100-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Dust devils (convective vortices loaded with dust) are common at the surface of Mars, particularly at Jezero crater, the landing site of the Perseverance rover. They are indicators of atmospheric turbulence and are an important lifting mechanism for the Martian dust cycle. Improving our understanding of dust lifting and atmospheric transport is key for accurate simulation of the dust cycle and for the prediction of dust storms, in addition to being important for future space exploration as grain impacts are implicated in the degradation of hardware on the surface of Mars. Here we describe the sound of a Martian dust devil as recorded by the SuperCam instrument on the Perseverance rover. The dust devil encounter was also simultaneously imaged by the Perseverance rover's Navigation Camera and observed by several sensors in the Mars Environmental Dynamics Analyzer instrument. Combining these unique multi-sensorial data with modelling, we show that the dust devil was around 25 m large, at least 118 m tall, and passed directly over the rover travelling at approximately 5 m s-1. Acoustic signals of grain impacts recorded during the vortex encounter provide quantitative information about the number density of particles in the vortex. The sound of a Martian dust devil was inaccessible until SuperCam microphone recordings. This chance dust devil encounter demonstrates the potential of acoustic data for resolving the rapid wind structure of the Martian atmosphere and for directly quantifying wind-blown grain fluxes on Mars.
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Affiliation(s)
- N. Murdoch
- grid.508721.9Institut Supérieur de l’Aéronautique et de l’Espace (ISAE-SUPAERO), Université de Toulouse, Toulouse, France
| | - A. E. Stott
- grid.508721.9Institut Supérieur de l’Aéronautique et de l’Espace (ISAE-SUPAERO), Université de Toulouse, Toulouse, France
| | - M. Gillier
- grid.508721.9Institut Supérieur de l’Aéronautique et de l’Espace (ISAE-SUPAERO), Université de Toulouse, Toulouse, France
| | - R. Hueso
- grid.11480.3c0000000121671098Física Aplicada, Escuela de Ingeniería de Bilbao, Universidad del País Vasco (UPV/EHU), Bilbao, Spain
| | - M. Lemmon
- grid.296797.40000 0004 6023 5450Space Science Institute, Boulder, CO 80301 USA
| | - G. Martinez
- grid.410493.b0000 0000 8634 1877Lunar and Planetary Institute, Universities Space Research Association, Houston, TX USA ,grid.214458.e0000000086837370Department of Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI USA
| | - V. Apéstigue
- grid.15312.340000 0004 1794 1528Instituto Nacional de Técnica Aeroespacial, Madrid, Spain
| | - D. Toledo
- grid.15312.340000 0004 1794 1528Instituto Nacional de Técnica Aeroespacial, Madrid, Spain
| | - R. D. Lorenz
- grid.474430.00000 0004 0630 1170Space Exploration Sector, Johns Hopkins Applied Physics Laboratory, Laurel, MD USA
| | - B. Chide
- grid.148313.c0000 0004 0428 3079Space and Planetary Exploration Team, Los Alamos National Laboratory, Los Alamos, NM USA
| | - A. Munguira
- grid.11480.3c0000000121671098Física Aplicada, Escuela de Ingeniería de Bilbao, Universidad del País Vasco (UPV/EHU), Bilbao, Spain
| | - A. Sánchez-Lavega
- grid.11480.3c0000000121671098Física Aplicada, Escuela de Ingeniería de Bilbao, Universidad del País Vasco (UPV/EHU), Bilbao, Spain
| | | | | | - S. Maurice
- grid.15781.3a0000 0001 0723 035XInstitut de Recherche en Astrophysique et Planétologie, Université de Toulouse 3 Paul Sabatier, CNRS, CNES, Toulouse, France
| | - M. de la Torre Juárez
- grid.20861.3d0000000107068890Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA USA
| | - T. Bertrand
- grid.482824.00000 0004 0370 8434Laboratoire d’Etudes Spatiales et d’Instrumentation en Astrophysique (LESIA), Observatoire de Paris, Université PSL, CNRS, Sorbonne Université, Univ. Paris Diderot, Sorbonne Paris Cité, 5 place Jules Janssen, 92195 Meudon, France
| | - D. Banfield
- grid.5386.8000000041936877XCornell University, Ithaca, NY USA ,grid.419075.e0000 0001 1955 7990NASA AMES Research Center, Moffett Field, CA USA
| | - S. Navarro
- grid.462011.00000 0001 2199 0769Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | - M. Marin
- grid.462011.00000 0001 2199 0769Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | - J. Torres
- grid.462011.00000 0001 2199 0769Centro de Astrobiología (INTA-CSIC), Madrid, Spain
| | - J. Gomez-Elvira
- grid.15312.340000 0004 1794 1528Instituto Nacional de Técnica Aeroespacial, Madrid, Spain
| | - X. Jacob
- grid.15781.3a0000 0001 0723 035XInstitut de Mécanique des Fluides, Université de Toulouse III Paul Sabatier, INP, CNRS, Toulouse, France
| | - A. Cadu
- grid.508721.9Institut Supérieur de l’Aéronautique et de l’Espace (ISAE-SUPAERO), Université de Toulouse, Toulouse, France
| | - A. Sournac
- grid.508721.9Institut Supérieur de l’Aéronautique et de l’Espace (ISAE-SUPAERO), Université de Toulouse, Toulouse, France
| | | | - R. C. Wiens
- grid.169077.e0000 0004 1937 2197Earth, Atmospheric, and Planetary Sciences, Purdue University, West Lafayette, IN USA
| | - D. Mimoun
- grid.508721.9Institut Supérieur de l’Aéronautique et de l’Espace (ISAE-SUPAERO), Université de Toulouse, Toulouse, France
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Krow-Lucal E, Marin M, Shepersky L, Bahta L, Loehr J, Dooling K. Measles, Mumps, Rubella Vaccine (PRIORIX): Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1465-1470. [PMID: 36395065 PMCID: PMC9707358 DOI: 10.15585/mmwr.mm7146a1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Vaccination is the main means for preventing measles, mumps, and rubella virus infections and their related complications (1,2). Achieving and maintaining high 2-dose measles, mumps, and rubella vaccination coverage in the United States has led to elimination of endemic measles in 2000, rubella and congenital rubella syndrome in 2004, and a sharp decrease in mumps cases. However, measles and rubella remain endemic in many countries, leading to importations of cases and occasional local transmission within the United States (3). Reported U.S. mumps cases declined >99% from the prevaccine period (4); however, mumps is endemic worldwide, and since 2006, the number of mumps cases and mumps outbreaks has increased in the United States, with wider geographic spread since 2016 (4). Given the risk for importation of measles and rubella and the resurgence of mumps, maintaining high measles, mumps, and rubella (MMR) vaccination coverage is important. Since 1978, only one MMR vaccine, M-M-R II (Merck and Co., Inc.), has been available in the United States. On June 6, 2022, the Food and Drug Administration approved a second MMR vaccine, PRIORIX (GlaxoSmithKline Biologicals), for the prevention of measles, mumps, and rubella in persons aged ≥12 months. The three live attenuated viruses contained in PRIORIX are genetically similar or identical to the corresponding components in M-M-R II (Table) (5-7). On June 23, 2022, the Advisory Committee on Immunization Practices (ACIP) unanimously recommended PRIORIX as an option to prevent measles, mumps, and rubella according to the existing recommended schedules and for off-label uses (i.e., indications not included in the package insert)* (1,2). ACIP considered PRIORIX to be safe, immunogenic, and noninferior to M-M-R II. Both PRIORIX and M-M-R II are fully interchangeable for all indications for which MMR vaccination is recommended. This report contains ACIP recommendations specific to PRIORIX and supplements the existing ACIP recommendations for MMR use (1,2).
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12
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Leung J, Dooling K, Marin M, Anderson TC, Harpaz R. The Impact of Universal Varicella Vaccination on Herpes Zoster Incidence in the United States: Comparison of Birth Cohorts Preceding and Following Varicella Vaccination Program Launch. J Infect Dis 2022; 226:S470-S477. [PMID: 36265856 DOI: 10.1093/infdis/jiac255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
When the US varicella vaccination program was introduced in 1995, its impacts on the epidemiology of herpes zoster (HZ) were not precisely known. We used a large claims database to examine HZ incidence in the US during 1998-2019 among persons aged ≥30 years (the prevaccine cohort, born before 1990), and aged 1-29 years (includes the postvaccine cohort, born since 1990). We defined incident HZ as the first instance of an outpatient or emergency department (ED) claim with an HZ diagnostic code. Additionally, we examined the proportion of HZ visits among all ED visits as a complementary method to assess for healthcare-seeking artifacts in the findings. In persons aged ≥30 years (prevaccine cohort), we observed age-specific increases in HZ incidence during the earlier study years, with decelerations in later years, starting in 2007 with oldest age groups. Similar patterns were seen when we examined HZ visits as a proportion of all ED visits. For persons aged 1-29 years, age-specific HZ incidence increased early in the study period for the oldest age groups who were born prevaccine, but later declined in a stepwise pattern once each age group was comprised of persons born in the postvaccine period. Our results, corroborated with previously published studies, do not support prior modeling predictions that the varicella vaccination program would increase HZ incidence among adult cohorts who previously experienced varicella. Our findings also suggest that continued declines in age-specific HZ incidence as varicella-vaccinated cohorts age are likely.
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Affiliation(s)
- Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathleen Dooling
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tara C Anderson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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13
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Marin M, Seward JF, Gershon AA. 25 Years of Varicella Vaccination in the United States. J Infect Dis 2022; 226:S375-S379. [PMID: 36265845 DOI: 10.1093/infdis/jiac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/16/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jane F Seward
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,ASRT, Inc, Contractor, Smyrna, Georgia, USA
| | - Anne A Gershon
- Columbia University College of Physicians and Surgeons, New York, New York, USA
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14
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Marin M, Leung J, Anderson TC, Lopez AS. Monitoring Varicella Vaccine Impact on Varicella Incidence in the United States: Surveillance Challenges and Changing Epidemiology, 1995-2019. J Infect Dis 2022; 226:S392-S399. [PMID: 36265855 DOI: 10.1093/infdis/jiac221] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Surveillance is critical for monitoring vaccine impact. Varicella surveillance challenges predated varicella vaccine US licensure in 1995. Several interim steps were needed before case-based surveillance could be established in most states, and both active and passive surveillance was needed to document the vaccination program's impact on varicella incidence. By the end of the 1-dose program in 2005, incidence had declined 90% in the active surveillance areas, with significant declines occurring in all age groups within 5 years of program implementation. Additional declines occurred during the 2-dose program leading to >97% decline in incidence over the 25 years of program implementation through 2019, based on data from 4 states with continuous passive reporting. Surveillance showed that declines were highest among children and adolescents covered by the routine vaccination recommendations but occurred in all age groups. Although surveillance systems changed and were adapted to reflect evolving epidemiology, data consistently demonstrated decreasing varicella incidence following the vaccination program implementation. The vaccination program dramatically decreased virus circulation and increased community protection. Continued and improved varicella surveillance is needed to accurately monitor disease epidemiology and further guide prevention efforts.
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Affiliation(s)
- Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tara C Anderson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adriana S Lopez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abstract
We describe the changing epidemiology of varicella outbreaks informed by past and current active and passive surveillance in the United States by reviewing data published during 1995-2015 and analyzing new data from 2016 to 2019. Varicella outbreaks were defined as ≥5 varicella cases within 1 setting and ≥1 incubation period. During the 1-dose varicella vaccination program (1995‒2006), the number of varicella outbreaks declined by 80% (2003-2006 vs 1995-1998) in 1 active surveillance area where vaccination coverage reached 90.5% in 2006. During the 2-dose program, in 7 states with consistent reporting to the Centers for Disease Control and Prevention, the number of outbreaks declined by 82% (2016-2019 vs 2005-2006). Over the entire program (1995-2019), outbreak size and duration declined from a median of 15 cases/outbreak and 45 days duration to 7 cases and 30 days duration. The proportion of outbreaks with <10 cases increased from 28% to 73%. During 2016‒2019, most (79%) outbreak cases occurred among unvaccinated or partially vaccinated persons eligible for second-dose vaccination, highlighting the potential for further varicella control.
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Affiliation(s)
- Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Adriana S. Lopez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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16
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Dollard S, Chen MH, Lindstrom S, Marin M, Rota PA. Diagnostic and Immunologic Testing for Varicella in the Era of High-Impact Varicella Vaccination: An Evolving Problem. J Infect Dis 2022; 226:S450-S455. [PMID: 36265850 DOI: 10.1093/infdis/jiac363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The clinical presentation of varicella in unvaccinated persons, with skin vesicles and scabs, has facilitated the use of rapid diagnostic methods for confirming disease. Polymerase chain reaction (PCR) assays are the diagnostic method of choice. The sharp decline in unmodified cases of varicella due to the US varicella vaccination program has led to fewer healthcare providers being familiar with varicella presentation and an increased reliance on laboratory diagnosis to confirm suspected cases. The mild, atypical presentation of the disease in vaccinated persons (fewer skin lesions, mostly maculopapular) has made it more challenging for providers to recognize and also to collect samples to detect the virus. Nonetheless, PCR is highly sensitive and specific in confirming modified disease if adequate samples are provided. While a positive PCR result is confirmatory, interpreting a negative result can prove to be more challenging in determining whether suspected varicella is falsely negative or attributable to other causes. Enhanced education of healthcare providers is critical for adequate specimen collection from modified varicella cases. In addition, more sensitive commercial serologic assays are needed in the United States for varicella immunity testing in the vaccine era.
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Affiliation(s)
- Sheila Dollard
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Min-Hsin Chen
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen Lindstrom
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul A Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Moro PL, Leung J, Marquez P, Kim Y, Wei S, Su JR, Marin M. Safety Surveillance of Varicella Vaccines in the Vaccine Adverse Event Reporting System, United States, 2006-2020. J Infect Dis 2022; 226:S431-S440. [PMID: 36265846 DOI: 10.1093/infdis/jiac306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND . The Vaccine Adverse Event Reporting System (VAERS) is the United States national passive vaccine safety surveillance system. We updated the data on the safety of single-antigen varicella vaccine (VAR) and assessed the safety of combination measles, mumps, rubella, and varicella vaccine (MMRV) licensed in the United States using VAERS data. METHODS US VAERS reports received after administration of VAR and MMRV during 2006-2020 were identified. Reports were analyzed by vaccine type, age, seriousness, most common adverse events (AEs), and concomitant vaccines. We reviewed medical records of selected reports of AEs of special interest and conducted empirical Bayesian data mining to identify disproportionally reported AEs. RESULTS During 2006-2020, approximately 132.8 million VAR doses were distributed; 40 684 reports were received in VAERS (30.6/100 000 doses distributed), with 4.1% classified as serious (1.3/100 000 doses distributed). Approximately 35.5 million MMRV doses were distributed; 13 325 reports were received (37.6/100 000 doses distributed) with 3.3% classified as serious (1.3/100 000 doses distributed). The most common adverse health events after both VAR and MMRV were injection site reactions (31% and 27%), rash (28% and 20%), and fever (12% and 14%), respectively. Vaccination errors accounted for 23% of reports after VAR administration and 41% after MMRV administration, but ≥95% of them did not describe an adverse health event. AEs associated with evidence of vaccine strain varicella-zoster virus (vVZV) infection included meningitis, encephalitis, herpes zoster, and 6 deaths (all in immunocompromised persons with contraindications for vaccination). No new or unexpected AE was disproportionally reported. CONCLUSIONS No new or unexpected safety findings were detected for VAR and MMRV given as recommended, reinforcing the favorable safety profiles of these vaccines. Providers should obtain specimens for viral testing and strain-typing for serious AEs if they consider vVZV as the possible causative agent.
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Affiliation(s)
- Pedro L Moro
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paige Marquez
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yeowon Kim
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Shaokui Wei
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - John R Su
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Elam-Evans LD, Valier MR, Fredua B, Zell E, Murthy BP, Sterrett N, Harris LQ, Leung J, Singleton JA, Marin M. Celebrating 25 Years of Varicella Vaccination Coverage for Children and Adolescents in the United States: A Success Story. J Infect Dis 2022; 226:S416-S424. [PMID: 36265848 PMCID: PMC10065045 DOI: 10.1093/infdis/jiac337] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Indexed: 11/12/2022] Open
Abstract
Tracking vaccination coverage is a critical component of monitoring a vaccine program. Three different surveillance systems were used to examine trends in varicella vaccination coverage during the United States vaccination program: National Immunization Survey-Child, National Immunization Survey-Teen, and immunization information systems (IISs). The relationship of these trends to school requirements and disease decline was also examined. Among children aged 19-35 months, ≥1 dose of varicella vaccine increased from 16.0% in 1996 to 89.2% by the end of the 1-dose program in 2006, stabilizing around at least 90.0% thereafter. The uptake of the second dose was rapid after the 2007 recommendation. Two-dose coverage among children aged 7 years at 6 high-performing IIS sites increased from 2.6%-5.5% in 2006 to 86.0%-100.0% in 2020. Among adolescents aged 13-17 years, ≥2-dose coverage increased from 4.1% in 2006 to 91.9% in 2020. The proportion of adolescents with history of varicella disease declined from 69.9% in 2006 to 8.4% in 2020. In 2006, 92% of states and the District of Columbia (DC) had 1-dose daycare or school entry requirements; 88% of states and DC had 2-dose school entry requirements in the 2020-2021 school year. The successes in attaining and maintaining high vaccine coverage were paramount in the dramatic reduction of the varicella burden in the United States over the 25 years of the vaccination program, but opportunities remain to further increase coverage and decrease varicella morbidity and mortality.
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Affiliation(s)
- Laurie D. Elam-Evans
- Immunization Services Division, National Center for
Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA
| | - Madeleine R. Valier
- Immunization Services Division, National Center for
Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge,
Tennessee, USA
| | - Benjamin Fredua
- Immunization Services Division, National Center for
Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA
- Leidos Health, Inc, Atlanta, Georgia, USA
| | - Elizabeth Zell
- Immunization Services Division, National Center for
Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA
| | - Bhavini P. Murthy
- Immunization Services Division, National Center for
Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA
| | - Natalie Sterrett
- Immunization Services Division, National Center for
Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge,
Tennessee, USA
| | - LaTreace Q. Harris
- Immunization Services Division, National Center for
Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA
| | - Jessica Leung
- Division of Viral Diseases, National Center for
Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA
| | - James A. Singleton
- Immunization Services Division, National Center for
Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for
Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA
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Zhou F, Leung J, Marin M, Dooling KL, Anderson TC, Ortega-Sanchez IR. Health and Economic Impact of the United States Varicella Vaccination Program, 1996-2020. J Infect Dis 2022; 226:S463-S469. [PMID: 36265847 PMCID: PMC10941259 DOI: 10.1093/infdis/jiac271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the health and economic impact of the varicella vaccination program on varicella disease in the United States (US), 1996-2020. METHODS Analysis was conducted using the Centers for Disease Control and Prevention or published annual population-based varicella incidence, and varicella-associated hospitalization, outpatient visit, and mortality rates in the US population aged 0-49 years during 1996-2020 (range, 199.5-214.2 million persons) compared to before vaccination (1990-1994). Disease costs were estimated using the societal perspective. Vaccination program costs included costs of vaccine, administration, postvaccination adverse events, and travel and work time lost to obtain vaccination. All costs were adjusted to 2020 US dollars using a 3% annual discount rate. The main outcome measures were the number of varicella-associated cases, hospitalizations, hospitalization days, and premature deaths prevented; life-years saved; and net societal savings from the US varicella vaccination program. RESULTS Among US persons aged 0-49 years, during 1996-2020, it is estimated that more than 91 million varicella cases, 238 000 hospitalizations, 1.1 million hospitalization days, and almost 2000 deaths were prevented and 118 000 life-years were saved by the varicella vaccination program, at net societal savings of $23.4 billion. CONCLUSIONS Varicella vaccination has resulted in substantial disease prevention and societal savings for the US over 25 years of program implementation.
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Affiliation(s)
- Fangjun Zhou
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen L. Dooling
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tara C. Anderson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ismael R. Ortega-Sanchez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Shapiro ED, Marin M. The Effectiveness of Varicella Vaccine: 25 Years of Postlicensure Experience in the United States. J Infect Dis 2022; 226:S425-S430. [PMID: 36265844 DOI: 10.1093/infdis/jiac299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We summarize studies of varicella vaccine's effectiveness for prevention of varicella and lessons learned during the first 25 years of the varicella vaccination program in the United States. One dose of varicella vaccine provided moderate protection (82%-85%) against varicella of any severity and high protection (100%) against severe varicella, with some waning of protection over time. The 1-dose program (1995-2006) had a substantial impact on the incidence both of varicella and of severe outcomes (71%-90% decrease) although it did not prevent low-level community transmission and some outbreaks continued to occur in highly vaccinated populations. Two doses of varicella vaccine improved the vaccine's effectiveness by at least 10% against varicella of any severity, with further declines in the incidence both of varicella and of severe outcomes as well as in both number and size of outbreaks. There is no evidence for waning of the effectiveness of 2 doses of the vaccine.
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Affiliation(s)
- Eugene D Shapiro
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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21
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Marin M, Lopez AS, Melgar M, Dooling K, Curns AT, Leung J. Decline in Severe Varicella Disease During the United States Varicella Vaccination Program: Hospitalizations and Deaths, 1990-2019. J Infect Dis 2022; 226:S407-S415. [PMID: 36265852 PMCID: PMC10406340 DOI: 10.1093/infdis/jiac242] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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] [Indexed: 11/14/2022] Open
Abstract
To describe the impact of the US varicella vaccination program on severe varicella outcomes, we analyzed varicella hospitalizations using the National Inpatient Sample 1993-2019 and varicella deaths using the National Center for Health Statistics data 1990-2019. Over 25 years of vaccination program (1995-2019), varicella hospitalizations, and deaths declined 94% and 97%, respectively, among persons aged <50 years. Most of the decline (∼90%) occurred during the 1-dose period (through 2006/2007) by attaining and maintaining high vaccination coverage; additional declines occurred during the 2-dose period, especially in the age groups covered by the 2-dose recommendation. The greatest decline for both hospitalizations and deaths (97% and >99%, respectively) was among persons aged <20 years, born during the varicella vaccination program. In the <20 age group, varicella hospitalization has become a rare event, and varicella deaths have been practically eliminated in the United States. A total of >10 500 varicella hospitalizations and 100 varicella deaths are now prevented annually in the United States as a direct result of vaccination and reduction in varicella-zoster virus circulation.
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Affiliation(s)
- Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adriana S Lopez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Melgar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathleen Dooling
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron T Curns
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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22
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Willis ED, Marko AM, Rasmussen SA, McGee M, Broder KR, Marin M. Merck/Centers for Disease Control and Prevention Varicella Vaccine Pregnancy Registry: 19-Year Summary of Data From Inception Through Closure, 1995-2013. J Infect Dis 2022; 226:S441-S449. [PMID: 36265854 DOI: 10.1093/infdis/jiac277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The VARIVAX® Pregnancy Registry was established in 1995 to monitor pregnancy outcomes of women who received varicella vaccine (ie, VARIVAX) inadvertently while pregnant. METHODS Health care providers and consumers sent voluntary reports about women who received VARIVAX 3 months before or during pregnancy. Follow-up occurred to evaluate pregnancy outcomes for birth defects. Outcomes from prospectively reported pregnancy exposures (ie, reports received before the outcome of the pregnancy was known) among varicella-zoster virus (VZV)-seronegative women were used to calculate rates and 95% confidence intervals (CIs). RESULTS From 17 March 1995 through 16 October 2013, 1601 women were enrolled-966 prospectively-among whom there were 819 live births. Among 164 infants born to women who were VZV seronegative at the time of vaccination, no cases of congenital varicella syndrome (CVS) were identified (rate, 0 per 100, 95% CI, 0.0-2.2) and the birth prevalence of major birth defects was 4.3 per 100 liveborn infants (95% CI 1.7-8.6) with no pattern suggestive of CVS. No defects consistent with CVS were identified in any registry reports. CONCLUSIONS Data collected through the VARIVAX pregnancy registry do not support a relationship between the occurrence of CVS or major birth defects and varicella vaccine exposure during pregnancy, although the small numbers of exposures cannot rule out a low risk. VARIVAX remains contraindicated during pregnancy.
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Affiliation(s)
| | | | - Sonja A Rasmussen
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Karen R Broder
- Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Dooling K, Marin M, Gershon AA. Clinical Manifestations of Varicella: Disease Is Largely Forgotten, but It's Not Gone. J Infect Dis 2022; 226:S380-S384. [PMID: 36265857 DOI: 10.1093/infdis/jiac390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
After 25 years of varicella vaccination in the United States, classic varicella and its complications have become an uncommon occurrence. The clinical manifestation of varicella among vaccinated persons is usually modified, with fewer skin lesions, mostly maculopapular, and milder presentation. However, the potential for severe manifestations from varicella still exists among both vaccinated and unvaccinated persons, and thus healthcare providers should keep varicella in the differential diagnosis of a maculopapular or vesicular rash. The prompt recognition and diagnosis of varicella is important because when confirmed, clinical and public health measures need to be taken swiftly.
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Affiliation(s)
- Kathleen Dooling
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anne A Gershon
- Columbia University College of Physicians and Surgeons, New York, New York, USA
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Caballero R, Dago M, Camara-Checa A, Crespo-Garcia T, Rubio-Alarcon M, Rapun J, Marin M, Tamargo J, Delpon E. Empagliflozin and dapagliflozin increase Na current in human cardiomyocytes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2885] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Empagliflozin (EMPA) and dapagliflozin (DAPA) are sodium-glucose cotransporter 2 inhibitors (SGLT2i) used for the treatment of type 2 Diabetes Mellitus (T2DM). Both drugs reduce morbidity and mortality in heart failure (HF) patients with reduced or preserved ejection fraction, even in the absence of T2DM. Moreover, these drugs decrease ventricular arrhythmias and sudden cardiac death in HF patients. The sodium current (INa), carried by Nav1.5 channels, is responsible for cardiac action potential (AP) depolarization and determines excitability and conduction velocity. In HF patients, the expression of Nav1.5 channels is reduced, leading to a decrease of ventricular excitability that enhances the arrhythmic risk.
Purpose
We aimed to determine the effects of EMPA and DAPA on human cardiac INa and AP characteristics.
Methods
Peak INa and ventricular-like APs were recorded in cardiomyocytes derived from human induced pluripotent stem cells (hiPSC-CM) using patch-clamp techniques. INa was also recorded in CHO cells transiently transfected with human Nav1.5+Navβ1 channels. In all cases, EMPA or DAPA (1 μM) were added to culture media and incubated for 24-h.
Results
APs recorded in hiPSC-CMs exhibited automatic activity and incubation with EMPA or DAPA did not modify spontaneous beating frequency (0.39±0.04 Hz; P>0.05, n≥16). In cells driven at 1 Hz, none of the drugs modified resting membrane potential (−76.7±1.4 mV; P>0.05, n≥11), but significantly increased AP amplitude from 98.6±3.6 to 105±2.2 (DAPA) and 107±2.3 mV (EMPA) (P<0.05). Interestingly, only EMPA lengthened AP duration measured at 20%, 50%, and 90% (from 605.6±31.3 to 760.5±59.0 ms, P<0.05) of repolarization. In hiPSC-CMs EMPA increased maximum INa density by 64% (from −156.0±28.0 to −256.4±28.1 pA/pF, P<0.05, n≥7) and shifted the midpoint (Vh) of the inactivation curve to more hyperpolarized potentials (from −97.3±4.5 to −108.6±4.4 mV, P<0.05, n≥7). In turn, DAPA increased maximum INa density by 24% (to −193.8±26.6 pA/pF) and shifted the Vh of the activation curve to more negative potentials (from −47.2±1.6 mV to −55.5±2.8 mV, P<0.05), an effect that would increase the INa at negative potentials coinciding with channel opening. None of the drugs modified the time course of current activation or inactivation. In CHO cells, EMPA and DAPA effects on INa were identical to those observed on hiPSC-CM. These results suggest that both SGLT2i increase INa by enhancing Nav1.5 expression into the cell membrane, by a direct gating effect on the channel, or by a combination of both.
Conclusions
In human cardiomyocytes, EMPA and DAPA increase INa and the AP amplitude. Moreover, EMPA, but not DAPA, prolonged AP duration. We propose that EMPA and DAPA exhibit a unique mechanism that increases cardiac excitability and conduction velocity and could contribute to the prevention of arrhythmic events in HF patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministerio de Ciencia e innovaciόnInstituto de de Salud Carlos III
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Affiliation(s)
- R Caballero
- Complutense University of Madrid , Madrid , Spain
| | - M Dago
- Complutense University of Madrid , Madrid , Spain
| | | | | | | | - J Rapun
- Complutense University of Madrid , Madrid , Spain
| | - M Marin
- Complutense University of Madrid , Madrid , Spain
| | - J Tamargo
- Complutense University of Madrid , Madrid , Spain
| | - E Delpon
- Complutense University of Madrid , Madrid , Spain
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Guarneri V, Dieci M, Griguolo G, Pare Brunet L, Marin M, Miglietta F, Bottosso M, Giorgi C, Blasco P, Castillo O, Galván P, Jares P, Puig-butille J, Vivancos A, Villagrasa Gonzalez P, Parker J, Perou C, Conte P, Prat A. 140MO HER2DX genomic test in HER2-positive/hormone receptor-positive (HER2+/HR+) breast cancer (BC) treated with neoadjuvant trastuzumab (T) and pertuzumab (P): A correlative analysis from the PerELISA trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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26
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Conte P, Pare Brunet L, Brasó-Maristany F, Chic N, Martinez Saez O, Dieci M, Marin M, Guarneri V, Vivancos A, Villagrasa Gonzalez P, Parker J, Perou C, Prat A. 153P HER2DX risk-score in the context of the PREDICT online-tool: A correlative analysis of the Short-HER clinical trial in early-stage HER2-positive (HER2+) breast cancer (BC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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27
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Marin M, Hallett PD, Feeney DS, Brown LK, Naveed M, Koebernick N, Ruiz S, Bengough AG, Roose T, George TS. Impact of root hairs on microscale soil physical properties in the field. Plant Soil 2022; 476:491-509. [PMID: 35992246 PMCID: PMC9381483 DOI: 10.1007/s11104-022-05530-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
AIMS Recent laboratory studies revealed that root hairs may alter soil physical behaviour, influencing soil porosity and water retention on the small scale. However, the results are not consistent, and it is not known if structural changes at the small-scale have impacts at larger scales. Therefore, we evaluated the potential effects of root hairs on soil hydro-mechanical properties in the field using rhizosphere-scale physical measurements. METHODS Changes in soil water retention properties as well as mechanical and hydraulic characteristics were monitored in both silt loam and sandy loam soils. Measurements were taken from plant establishment to harvesting in field trials, comparing three barley genotypes representing distinct phenotypic categories in relation to root hair length. Soil hardness and elasticity were measured using a 3-mm-diameter spherical indenter, while water sorptivity and repellency were measured using a miniaturized infiltrometer with a 0.4-mm tip radius. RESULTS Over the growing season, plants induced changes in the soil water retention properties, with the plant available water increasing by 21%. Both soil hardness (P = 0.031) and elasticity (P = 0.048) decreased significantly in the presence of root hairs in silt loam soil, by 50% and 36%, respectively. Root hairs also led to significantly smaller water repellency (P = 0.007) in sandy loam soil vegetated with the hairy genotype (-49%) compared to the hairless mutant. CONCLUSIONS Breeding of cash crops for improved soil conditions could be achieved by selecting root phenotypes that ameliorate soil physical properties and therefore contribute to increased soil health. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11104-022-05530-1.
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Affiliation(s)
- M. Marin
- School of Biological Sciences, University of Aberdeen, Aberdeen, AB24 3UU UK
- The James Hutton Institute, Invergowrie, Dundee, DD2 5DA UK
| | - P. D. Hallett
- School of Biological Sciences, University of Aberdeen, Aberdeen, AB24 3UU UK
| | - D. S. Feeney
- The James Hutton Institute, Invergowrie, Dundee, DD2 5DA UK
- School of Science and Engineering, University of Dundee, Dundee, DD1 4HN UK
| | - L. K. Brown
- The James Hutton Institute, Invergowrie, Dundee, DD2 5DA UK
| | - M. Naveed
- School of Biological Sciences, University of Aberdeen, Aberdeen, AB24 3UU UK
- Present Address: School of Computing and Engineering, University of West London, London, W5 5RF UK
| | - N. Koebernick
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ UK
- Present Address: Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, 06108 Halle (Saale), Germany
| | - S. Ruiz
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ UK
| | - A. G. Bengough
- The James Hutton Institute, Invergowrie, Dundee, DD2 5DA UK
- School of Science and Engineering, University of Dundee, Dundee, DD1 4HN UK
| | - T. Roose
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, SO17 1BJ UK
| | - T. S. George
- The James Hutton Institute, Invergowrie, Dundee, DD2 5DA UK
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Masters NB, Mathis AD, Leung J, Raines K, Clemmons NS, Miele K, Balajee SA, Lanzieri TM, Marin M, Christensen DL, Clarke KR, Cruz MA, Gallagher K, Gearhart S, Gertz AM, Grady-Erickson O, Habrun CA, Kim G, Kinzer MH, Miko S, Oberste MS, Petras JK, Pieracci EG, Pray IW, Rosenblum HG, Ross JM, Rothney EE, Segaloff HE, Shepersky LV, Skrobarcek KA, Stadelman AM, Sumner KM, Waltenburg MA, Weinberg M, Worrell MC, Bessette NE, Peake LR, Vogt MP, Robinson M, Westergaard RP, Griesser RH, Icenogle JP, Crooke SN, Bankamp B, Stanley SE, Friedrichs PA, Fletcher LD, Zapata IA, Wolfe HO, Gandhi PH, Charles JY, Brown CM, Cetron MS, Pesik N, Knight NW, Alvarado-Ramy F, Bell M, Talley LE, Rotz LD, Rota PA, Sugerman DE, Gastañaduy PA, Ahluwalia IB, Akinkugbe OA, Aranas A, Arons M, Atherstone C, Bampoe V, Bessler P, Bligh L, Bonner K, Bowen VB, Broadwater K, Brunette GW, Brunkard JM, Burns DA, Cantrell M, Christensen BE, Cope JR, Cory J, Crawford NE, Daigle D, Daly SM, Dejonge P, Dualeh M, Dunn KH, Eidex RB, Elgethun K, Fajardo G, Fonseca-Ford M, Franc K, Gaines J, George N, Goodson J, Green C, Grober AJ, Hailu K, Hammond DR, Harcourt BH, Hess A, Hesse E, Hirst DV, Hornsby-Myers J, Humrighouse B, Ishaq M, Ishii K, James A, Jayapaul-Philip B, Jentes ES, Johnson L, Johnston M, Jolley CD, Kacha-Ochana A, Kaur H, Keaveney M, Kelly HC, Krishnasamy V, Kumar GS, Larkin M, Layde M, LeBouf RF, Lee D, Lira RC, Lopez R, Lozier MJ, Macler A, Mainzer H, Malden D, Malenfant J, Marano N, Marsh Z, Mayer O, McDonald R, Mehta N, Menon AN, Meyer E, Miles ST, Minhaj F, Mirza S, Moller KM, Morris SB, Neu DT, Oakley LP, Ocasio DV, Osborne T, Ou AC, Peck M, Person M, Posey D, Pullia A, Qi C, Raziano AJ, Richmond-Crum M, Roohi S, Saindon JM, Sami S, Sanchez-Gonzalez L, Schweitzer R, Schwitters AM, Shamout M, Shockey CE, Shragai T, Singler KB, Sison EJ, Smith D, Smith M, Sood NJ, Sunshine BJ, Trujillo A, Vallabhaneni S, Wickson A, Yoder JS, Zambuto LR, Cozzarelli T, Rice M, Ricks M, Birchfield JS, Nambiar A, Avrakatos A, Ballard TP, Dennis E, Gambino-Shirley K, Huston AE, Jennings MG, Oldham DM, Rabener MJ, Fandre MN, Jablonka RJ, Love A, Peduzzi OL, Snow K, Greer JA, Hughes CA, Humphreys MA, Korduba AB, Neamand-Cheney KA, Pritchard NL, Smith AM, Whelpley JL, Adekoya S, Alexander V, Davis M, Falk J, Kurkjian K, McCarty E, Moss J, Myrick-West A, Patel C, Pruitt R, Saady D, Sockwell D, Touma A, Wheawill S, Woolard D, Young A, Griffin-Thomas L, Kelly S, McLeod J, Lambert MC, Danz TL, Davis T, Guenther K, Hanson E. Public Health Actions to Control Measles Among Afghan Evacuees During Operation Allies Welcome - United States, September-November 2021. MMWR Morb Mortal Wkly Rep 2022; 71:592-596. [PMID: 35482557 PMCID: PMC9098237 DOI: 10.15585/mmwr.mm7117a2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
On August 29, 2021, the United States government oversaw the emergent establishment of Operation Allies Welcome (OAW), led by the U.S. Department of Homeland Security (DHS) and implemented by the U.S. Department of Defense (DoD) and U.S. Department of State (DoS), to safely resettle U.S. citizens and Afghan nationals from Afghanistan to the United States. Evacuees were temporarily housed at several overseas locations in Europe and Asia* before being transported via military and charter flights through two U.S. international airports, and onward to eight U.S. military bases,† with hotel A used for isolation and quarantine of persons with or exposed to certain infectious diseases.§ On August 30, CDC issued an Epi-X notice encouraging public health officials to maintain vigilance for measles among Afghan evacuees because of an ongoing measles outbreak in Afghanistan (25,988 clinical cases reported nationwide during January-November 2021) (1) and low routine measles vaccination coverage (66% and 43% for the first and second doses, respectively, in 2020) (2).
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Leung J, Reid HD, Morgan J, Kadyk H, Havener G, Marin M. Notes from the Field: Congenital Varicella Syndrome Case — Illinois, 2021. MMWR Morb Mortal Wkly Rep 2022; 71:390-392. [PMID: 35271562 PMCID: PMC8911996 DOI: 10.15585/mmwr.mm7110a5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
BACKGROUND Despite a >99% reduction in US mumps cases after the introduction of mumps vaccine in 1967, outbreaks have occurred in schools and other settings involving vaccinated children and adolescents since 2006. METHODS We analyzed mumps cases reported by US health departments to the National Notifiable Diseases Surveillance System. We present the incidence and vaccination status of pediatric cases (age <18 years) during 2007-2019 and describe demographic, clinical, and vaccination characteristics of pediatric cases reported during the most recent resurgence in 2015-2019. RESULTS During 2007-2019, 9172 pediatric cases were reported, accounting for a median of 32% of all cases reported each year (range: 13%-59%). A median of 87% (range: 81%-94%) of pediatric patients each year had previously received ≥1 measles, mumps, and rubella (MMR) vaccine dose. During 2015-2019, of 5461 pediatric cases reported, only 2% of those with known import status (74%) were associated with international travel. One percent of patients had complications and 2% were hospitalized. Among patients aged ≥1 year with known vaccination status (72%), 74% of 1- to 4-year-olds had received ≥1 MMR dose and 86% of 5- to 17-year-olds had received ≥2 MMR doses. Since 2016, pediatric mumps cases have been reported in most US states each year (range: 38-45 states). CONCLUSIONS Since 2007, one-third of US reported mumps cases occurred in children and adolescents, the majority of whom were vaccinated. Clinicians should suspect mumps in patients with parotitis or mumps complications, regardless of age, travel history, and vaccination status.
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Affiliation(s)
- Leah Shepersky
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Zhang
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Huong Pham
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mariel A Marlow
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Marin M, Feeney DS, Brown LK, Naveed M, Ruiz S, Koebernick N, Bengough AG, Hallett PD, Roose T, Puértolas J, Dodd IC, George TS. Significance of root hairs for plant performance under contrasting field conditions and water deficit. Ann Bot 2021; 128:1-16. [PMID: 33038211 PMCID: PMC8318266 DOI: 10.1093/aob/mcaa181] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND AND AIMS Previous laboratory studies have suggested selection for root hair traits in future crop breeding to improve resource use efficiency and stress tolerance. However, data on the interplay between root hairs and open-field systems, under contrasting soils and climate conditions, are limited. As such, this study aims to experimentally elucidate some of the impacts that root hairs have on plant performance on a field scale. METHODS A field experiment was set up in Scotland for two consecutive years, under contrasting climate conditions and different soil textures (i.e. clay loam vs. sandy loam). Five barley (Hordeum vulgare) genotypes exhibiting variation in root hair length and density were used in the study. Root hair length, density and rhizosheath weight were measured at several growth stages, as well as shoot biomass, plant water status, shoot phosphorus (P) accumulation and grain yield. KEY RESULTS Measurements of root hair density, length and its correlation with rhizosheath weight highlighted trait robustness in the field under variable environmental conditions, although significant variations were found between soil textures as the growing season progressed. Root hairs did not confer a notable advantage to barley under optimal conditions, but under soil water deficit root hairs enhanced plant water status and stress tolerance resulting in a less negative leaf water potential and lower leaf abscisic acid concentration, while promoting shoot P accumulation. Furthermore, the presence of root hairs did not decrease yield under optimal conditions, while root hairs enhanced yield stability under drought. CONCLUSIONS Selecting for beneficial root hair traits can enhance yield stability without diminishing yield potential, overcoming the breeder's dilemma of trying to simultaneously enhance both productivity and resilience. Therefore, the maintenance or enhancement of root hairs can represent a key trait for breeding the next generation of crops for improved drought tolerance in relation to climate change.
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Affiliation(s)
- M Marin
- School of Biological Sciences, University of Aberdeen, Aberdeen, UK
- The James Hutton Institute, Invergowrie, Dundee, UK
| | - D S Feeney
- The James Hutton Institute, Invergowrie, Dundee, UK
- School of Science and Engineering, University of Dundee, Dundee, UK
| | - L K Brown
- The James Hutton Institute, Invergowrie, Dundee, UK
| | - M Naveed
- School of Biological Sciences, University of Aberdeen, Aberdeen, UK
- School of Computing and Engineering, University of West London, London, UK
| | - S Ruiz
- School of Engineering, University of Southampton, Southampton, UK
| | - N Koebernick
- School of Engineering, University of Southampton, Southampton, UK
- Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - A G Bengough
- The James Hutton Institute, Invergowrie, Dundee, UK
- School of Science and Engineering, University of Dundee, Dundee, UK
| | - P D Hallett
- School of Biological Sciences, University of Aberdeen, Aberdeen, UK
| | - T Roose
- School of Engineering, University of Southampton, Southampton, UK
| | - J Puértolas
- The Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - I C Dodd
- The Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - T S George
- The James Hutton Institute, Invergowrie, Dundee, UK
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Bressan M, Brunetti R, Casellato S, Fava G, Giro P, Marin M, Negrisolo P, Tallandini L, Thomann S, Tosoni L, Turchetto M, Campesan G. Effects of Linear Alkylbenzene Sulfonate (LAS) on Benthic Organisms. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1989-260218] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Moreno-González G, Mussetti A, Albasanz-Puig A, Salvador I, Sureda A, Gudiol C, Salazar R, Marin M, Garcia M, Navarro V, de la Haba Vaca I, Coma E, Sanz-Linares G, Dura X, Fontanals S, Serrano G, Cruz C, Mañez R. A Phase I/II Clinical Trial to evaluate the efficacy of baricitinib to prevent respiratory insufficiency progression in onco-hematological patients affected with COVID19: A structured summary of a study protocol for a randomised controlled trial. Trials 2021; 22:116. [PMID: 33546739 PMCID: PMC7862837 DOI: 10.1186/s13063-021-05072-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Baricitinib is supposed to have a double effect on SARS-CoV2 infection. Firstly, it reduces the inflammatory response through the inhibition of the Januse-Kinase signalling transducer and activator of transcription (JAK-STAT) pathway. Moreover, it reduces the receptor mediated viral endocytosis by AP2-associated protein kinase 1 (AAK1) inhibition. We propose the use of baricinitib to prevent the progression of the respiratory insufficiency in SARS-CoV2 pneumonia in onco-haematological patients. In this phase Ib/II study, the primary objective in the safety cohort is to describe the incidence of severe adverse events associated with baricitinib administration. The primary objective of the randomized phase (baricitinib cohort versus standard of care cohort) is to evaluate the number of patients who did not require mechanical oxygen support since start of therapy until day +14 or discharge (whichever it comes first). The secondary objectives of the study (only randomized phase of the study) are represented by the comparison between the two arms of the study in terms of mortality and toxicity at day+30. Moreover, a description of the immunological related changes between the two arms of the study will be reported. TRIAL DESIGN The trial is a phase I/II study with a safety run-in cohort (phase 1) followed by an open label phase II randomized controlled trial with an experimental arm compared to a standard of care arm. PARTICIPANTS The study will be performed at the Institut Català d'Oncologia, a tertiary level oncological referral center in the Catalonia region (Spain). The eligibility criteria are: patients > 18 years affected by oncological diseases; ECOG performance status < 2 (Karnofsky score > 60%); a laboratory confirmed infection with SARS-CoV-2 by means of real -time PCR; radiological signs of low respiratory tract disease; absence of organ dysfunction (a total bilirubin within normal institutional limits, AST/ALT≤2.5 X institutional upper limit of normal, alkaline phosphatase ≤2.5 X institutional upper limit of normal, coagulation within normal institutional limits, creatinine clearance >30 mL/min/1.73 m2 for patients with creatinine levels above institutional normal); absence of HIV infection; no active or latent HBV or HCV infection. The exclusion criteria are: patients with oncological diseases who are not candidates to receive any active oncological treatment; hemodynamic instability at time of study enrollment; impossibility to receive oral medication; medical history of recent or active pulmonary embolism or deep venous thrombosis or patients at high-risk of suffering them (surgical intervention, immobilization); multi organ failure, rapid worsening of respiratory function with requirement of fraction of inspired oxygen (FiO2) > 50% or high-flow nasal cannula before initiation of study treatment; uncontrolled intercurrent illness (ongoing or severe active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements); allergy to one or more of study treatments; pregnant or breastfeeding women; positive pregnancy test in a pre-dose examination. Patients should have the ability to understand, and the willingness to sign, a written informed consent document; the willingness to accept randomization to any assigned treatment arm; and must agree not to enroll in another study of an investigational agent prior to completion of Day +28 of study. An electronic Case Report Form in the Research Electronic Data Capture (REDCap) platform will be used to collect the data of the trial. Removal from the study will apply in case of unacceptable adverse event(s), development of an intercurrent illness, condition or procedural complication, which could interfere with the patient's continued participation and voluntary patient withdrawal from study treatment (all patients are free to withdraw from participation in this study at any time, for any reasons, specified or unspecified, and without prejudice). INTERVENTION AND COMPARATOR Treatment will be administered on an inpatient basis. We will compare the experimental treatment with baricitinib plus the institutional standard of care compared with the standard of care alone. During the phase I, we will define the dose-limiting toxicity of baricitinib and the dose to be used in the phase 2 part of the study. The starting baricitinib dose will be an oral tablet 4 mg-once daily which can be reduced to 2 mg depending on the observed toxicity. The minimum duration of therapy will be 5 days and it can be extended to 7 days. The standard of care will include the following therapies. Antibiotics will be individualized based on clinical suspicion, including the management of febrile neutropenia. Prophylaxis of thromboembolic disease will be administered to all participants. Remdesivir administration will be considered only in patients with severe pneumonia (SatO2 <94%) with less than 7 days of onset of symptoms and with supplemental oxygen requirements but not using high-flow nasal cannula, non-invasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO). In the randomized phase, tocilizumab or interferon will not be allowed in the experimental arm. Tocilizumab can be used in patients in the standard of care arm at the discretion of the investigator. If it is prescribed it will be used according to the following criteria: patients who, according to his baseline clinical condition, would be an ICU tributary, interstitial pneumonia with severe respiratory failure, patients who are not on mechanical ventilation or ECMO and who are still progressing with corticoid treatment or if they are not candidates for corticosteroids. Mild ARDS (PAFI <300 mmHg) with radiological or blood gases deterioration that meets at least one of the following criteria: CRP >100mg/L D-Dimer >1,000μg/L LDH >400U/L Ferritin >700ng/ml Interleukin 6 ≥40ng/L. The use of tocilizumab is not recommended if there are AST/ALT values greater than 10 times the upper limit of normal, neutrophils <500 cells/mm3, sepsis due to other pathogens other than SARS-CoV-2, presence of comorbidity that can lead to a poor prognosis, complicated diverticulitis or intestinal perforation, ongoing skin infection. The dose will be that recommended by the Spanish Medicine Agency in patients ≥75Kg: 600mg dose whereas in patients <75kg: 400mg dose. Exceptionally, a second infusion can be assessed 12 hours after the first in those patients who experience a worsening of laboratory parameters after a first favourable response. The use of corticosteroids will be recommended in patients who have had symptoms for more than 7 days and who meet all the following criteria: need for oxygen support, non-invasive or invasive mechanical ventilation, acute respiratory failure or rapid deterioration of gas exchange, appearance or worsening of bilateral alveolar-interstitial infiltrates at the radiological level. In case of indication, it is recommended: dexamethasone 6mg/d p.o. or iv for 10 days or methylprednisolone 32mg/d orally or 30mg iv for 10 days or prednisone 40mg day p.o. for 10 days. MAIN OUTCOMES Phase 1 part: to describe the toxicity profile of baricitinib in COVID19 oncological patients during the 5-7 day treatment period and until day +14 or discharge (whichever it comes first). Phase 2 part: to describe the number of patients in the experimental arm that will not require mechanical oxygen support compared to the standard of care arm until day +14 or discharge (whichever it comes first). RANDOMISATION For the phase 2 of the study, the allocation ratio will be 1:1. Randomization process will be carried out electronically through the REDcap platform ( https://www.project-redcap.org/ ) BLINDING (MASKING): This is an open label study. No blinding will be performed. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) The first part of the study (safety run-in cohort) will consist in the enrollment of 6 to 12 patients. In this population, we will test the toxicity of the experimental treatment. An incidence of severe adverse events grade 3-4 (graded by Common Terminology Criteria for Adverse Events v.5.0) inferior than 33% will be considered sufficient to follow with the next part of the study. The second part of the study we will perform an interim analysis of efficacy at first 64 assessed patients and a definitive one will analyze 128 assessed patients. Interim and definitive tests will be performed considering in both cases an alpha error of 0.05. We consider for the control arm this rate is expected to be 0.60 and for the experimental arm of 0.80. Considering this data, a superiority test to prove a difference of 0.20 with an overall alpha error of 0.10 and a beta error of 0.2 will be performed. Considering a 5% of dropout rate, it is expected that a total of 136 patients, 68 for each study arm, will be required to complete study accrual. TRIAL STATUS Version 5.0. 14th October 2020 Recruitment started on the 16th of December 2020. Expected end of recruitment is June 2021. TRIAL REGISTRATION AEMPs: 20-0356 EudraCT: 2020-001789-12, https://www.clinicaltrialsregister.eu/ctr-search/search (Not publically available as Phase I trial) Clinical trials: BARCOVID19, https://www.clinicaltrials.gov/ (In progress) FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol."
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Affiliation(s)
- G Moreno-González
- Intensive Care Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain. .,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.
| | - A Mussetti
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Hematology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - A Albasanz-Puig
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Infectious Disease Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain.,Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - I Salvador
- Immunology Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain
| | - A Sureda
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Hematology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain.,Barcelona University, Barcelona, Spain
| | - C Gudiol
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Infectious Disease Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain.,Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Madrid, Spain.,Barcelona University, Barcelona, Spain
| | - R Salazar
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Oncology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - M Marin
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Oncology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - M Garcia
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Trials Unit, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - V Navarro
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Trials Unit, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - I de la Haba Vaca
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Oncology Emergency Unit, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - E Coma
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Oncology Emergency Unit, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - G Sanz-Linares
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Clinical Hematology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - X Dura
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Infectious Disease Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain
| | - S Fontanals
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Pharmacology Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - G Serrano
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Palliative Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - C Cruz
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain.,Palliative Department, Institut Català d' Oncologia, L'Hospitalet de LL., Barcelona, Spain
| | - R Mañez
- Intensive Care Department, Hospital Universitari de Bellvitge, L'Hospitalet de LL., Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LL., Barcelona, Spain
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Marlow M, Even S, Hoban MT, Moore K, Patel M, Marin M. Universities' experience with mumps outbreak response and use of a third dose of MMR vaccine. J Am Coll Health 2021; 69:53-58. [PMID: 31478806 DOI: 10.1080/07448481.2019.1651730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/19/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
During January 2016-June 2017, 75 mumps outbreaks occurred in US universities, despite high vaccine coverage among students. We evaluated universities' experiences with mumps outbreaks to inform policy deliberations on use of a third dose of MMR vaccine and CDC guidance. Participants: American College Health Association members in September 2017. Methods: Online survey assessing mumps outbreak characteristics and response measures distributed to 980 members. Results: Administrators from 251 (26%) universities from 47 states responded. Seventy-nine (31%) universities had mumps cases on campus during August 2014-August 2017; 17 (22%) recommended a third MMR dose. The main challenges reported in outbreak response were exclusion of persons without presumptive immunity and isolation of students with mumps. Universities' advice on addressing challenges is described. Conclusion: We identified common challenges faced by universities during mumps outbreaks, and lessons learned. These findings informed the October 2017 recommendation for use of a third MMR dose.
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Affiliation(s)
- Mariel Marlow
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan Even
- American College Health Association, Hanover, Maryland, USA
- University of Missouri Student Health Center, Columbia, Missouri, USA
| | | | - Kelly Moore
- Department of Health Policy, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Manisha Patel
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Oliver SE, Gargano JW, Marin M, Wallace M, Curran KG, Chamberland M, McClung N, Campos-Outcalt D, Morgan RL, Mbaeyi S, Romero JR, Talbot HK, Lee GM, Bell BP, Dooling K. The Advisory Committee on Immunization Practices' Interim Recommendation for Use of Moderna COVID-19 Vaccine - United States, December 2020. MMWR Morb Mortal Wkly Rep 2021; 69:1653-1656. [PMID: 33382675 PMCID: PMC9191904 DOI: 10.15585/mmwr.mm695152e1] [Citation(s) in RCA: 194] [Impact Index Per Article: 64.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Dooling K, Marin M, Wallace M, McClung N, Chamberland M, Lee GM, Talbot HK, Romero JR, Bell BP, Oliver SE. The Advisory Committee on Immunization Practices’ Updated Interim Recommendation for Allocation of COVID-19 Vaccine — United States, December 2020. MMWR Morb Mortal Wkly Rep 2021; 69:1657-1660. [PMID: 33382671 PMCID: PMC9191902 DOI: 10.15585/mmwr.mm695152e2] [Citation(s) in RCA: 266] [Impact Index Per Article: 88.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Oliver SE, Gargano JW, Marin M, Wallace M, Curran KG, Chamberland M, McClung N, Campos-Outcalt D, Morgan RL, Mbaeyi S, Romero JR, Talbot HK, Lee GM, Bell BP, Dooling K. The Advisory Committee on Immunization Practices' Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine - United States, December 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1922-1924. [PMID: 33332292 PMCID: PMC7745957 DOI: 10.15585/mmwr.mm6950e2] [Citation(s) in RCA: 365] [Impact Index Per Article: 91.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Poveda Pinedo I, Marco Clement I, Gonzalez O, Ponz I, Iniesta A, Pena L, Rodriguez M, Hernandez M, Arranz H, Araujo A, Marin M, Espinosa S, Dalmau R, Castro A, Lopez Sendon J. PETCO2 gradient: a novel prognostic parameter in cardiopulmonary exercise testing. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous parameters such as peak VO2, VE/VCO2 slope and OUES have been described to be prognostic in heart failure (HF). The aim of this study was to identify further prognostic factors of cardiopulmonary exercise testing (CPET) in HF patients.
Methods
A retrospective analysis of HF patients who underwent CPET from January to November 2019 in a single centre was performed. PETCO2 gradient was defined by the difference between final PETCO2 and baseline PETCO2. HF events were defined as decompensated HF requiring hospital admission or IV diuretics, or decompensated HF resulting in death.
Results
A total of 64 HF patients were assessed by CPET, HF events occurred in 8 (12.5%) patients. Baseline characteristics are shown in table 1. Patients having HF events had a negative PETCO2 gradient while patients not having events showed a positive PETCO2 gradient (−1.5 [IQR −4.8, 2.3] vs 3 [IQR 1, 5] mmHg; p=0.004). A multivariate Cox proportional-hazards regression analysis revealed that PETCO2 gradient was an independent predictor of HF events (HR 0.74, 95% CI [0.61–0.89]; p=0.002). Kaplan-Meier curves showed a significantly higher incidence of HF events in patients having negative gradients, p=0.002 (figure 1).
Conclusion
PETCO2 gradient was demonstrated to be a prognostic parameter of CPET in HF patients in our study. Patients having negative gradients had worse outcomes by having more HF events.
Time to first event, decompensated heart
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | - O Gonzalez
- University Hospital La Paz, Madrid, Spain
| | - I Ponz
- University Hospital La Paz, Madrid, Spain
| | | | - L Pena
- University Hospital La Paz, Madrid, Spain
| | | | | | - H Arranz
- University Hospital La Paz, Madrid, Spain
| | - A Araujo
- University Hospital La Paz, Madrid, Spain
| | - M Marin
- University Hospital La Paz, Madrid, Spain
| | - S Espinosa
- University Hospital La Paz, Madrid, Spain
| | - R Dalmau
- University Hospital La Paz, Madrid, Spain
| | - A Castro
- University Hospital La Paz, Madrid, Spain
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Marin M, Fiebelkorn AP, Bi D, Coleman LA, Routh J, Curns AT, McLean HQ. Adverse Events Among Young Adults Following a Third Dose of Measles-Mumps-Rubella Vaccine. Clin Infect Dis 2020; 73:e1546-e1553. [PMID: 32766827 DOI: 10.1093/cid/ciaa1090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/11/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A third measles-mumps-rubella vaccine (MMR) dose (MMR3) is recommended in the United States for persons at increased risk for mumps during outbreaks. MMR3 is also likely given to persons who might have received 2 doses of MMR but lack documentation. Since MMR3 safety data are limited, we describe adverse events in persons receiving MMR3 in a nonoutbreak setting. METHODS Young adults with 2 documented MMR doses were administered MMR3. From 2 weeks before until 4 weeks after MMR3 receipt, participants reported daily on 11 solicited, common symptoms potentially associated with MMR. Weekly rate differences in post- vs prevaccination (baseline) were evaluated by Poisson regression. Baseline rates were subtracted from postvaccination rates of significantly different symptoms to estimate the number and percentage of participants with excess risk for symptoms post-MMR3. Descriptive analyses were performed for 3 postvaccination injection-site symptoms. RESULTS The 662 participants were aged 18-28 years (median = 20 years); 56% were women. Headache, joint problems, diarrhea, and lymphadenopathy rates were significantly higher postvaccination vs baseline. We estimate that 119 participants (18%) reported more symptoms after MMR3 than prevaccination. By symptom, 13%, 10%, 8%, and 6% experienced increased symptoms of headache, joint problems, diarrhea, and lymphadenopathy, respectively, after MMR3. The median onset was Days 3-6 postvaccination; the median duration was 1-2 days. One healthcare visit for a potential vaccination-related symptom (urticaria) was reported. Injection-site symptoms were reported by 163 participants (25%); the median duration was 1-2 days. CONCLUSIONS Reported systemic and local events were mild and transient. MMR3 is safe and tolerable among young adults.
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Affiliation(s)
- Mona Marin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy Parker Fiebelkorn
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daoling Bi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura A Coleman
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Janell Routh
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron T Curns
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Huong Q McLean
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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Weinmann S, Irving SA, Koppolu P, Naleway AL, Belongia EA, Hambidge SJ, Jackson ML, Klein NP, Lewin B, Liles E, Marin M, Smith N, Weintraub E, Chun C. Incidence of herpes zoster among varicella-vaccinated children, by number of vaccine doses and simultaneous administration of measles, mumps, and rubella vaccine. Vaccine 2020; 38:5880-5884. [PMID: 32444193 DOI: 10.1016/j.vaccine.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Children may receive measles-mumps-rubella (MMR) and varicella (VAR) vaccines separately or as measles-mumps-rubella-varicella (MMRV). We examined whether pediatric herpes zoster (HZ) incidence varied by pattern of varicella vaccine administration. METHODS In six integrated health systems, we examined HZ incidence among children turning 12 months old during 2003-2008. All received varicella and MMR vaccines on recommended schedules. Cases were identified through 2014 using ICD-9 codes. Incidence was examined by number of varicella vaccine doses and same-day MMR. RESULTS Among 199,797 children, overall HZ incidence was 18.6/100,000 person-years in the first-dose MMR + VAR group, 17.9/100,000 person-years in the MMRV group, and 7.5/100,000 person-years in the VAR-alone group. HZ incidence was lower following the second dose than before the second dose in all first-dose groups. CONCLUSIONS HZ incidence was not meaningfully different between the MMRV and MMR + VAR first-dose groups. Overall and within first-dose groups, HZ incidence was lower among children receiving two varicella vaccine doses.
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Affiliation(s)
- Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA.
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA
| | - Padma Koppolu
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA
| | - Edward A Belongia
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue (ML2), Marshfield, WI 54449, USA
| | - Simon J Hambidge
- Denver Community Health Services, Denver Health, Mailcode 0278, 777 Bannock Street, Denver, CO 80204, USA; Institute for Health Research, Kaiser Permanente Colorado, 2550 South Parker Road, Suite 200, Denver, CO 80014, USA
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA
| | - Nicola P Klein
- Vaccine Study Center, Division of Research, Northern California Kaiser Permanente, 1 Kaiser Plaza, 16th Floor, Oakland, CA 94612, USA
| | - Bruno Lewin
- Department of Research and Evaluation, Southern California Kaiser Permanente, 100 S Los Robles Avenue, Second Floor, Pasadena, CA 91101, USA
| | - Elizabeth Liles
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA
| | - Mona Marin
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS V18-4, Atlanta, GA 30333, USA
| | - Ning Smith
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA
| | - Eric Weintraub
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS V18-4, Atlanta, GA 30333, USA
| | - Colleen Chun
- Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227, USA
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Marin M, Othman MIA, Seadawy AR, Carstea C. A domain of influence in the Moore–Gibson–Thompson theory of dipolar bodies. Journal of Taibah University for Science 2020. [DOI: 10.1080/16583655.2020.1763664] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M. Marin
- Department of Mathematics and Computer Science, Transilvania University of Brasov, Brasov, Romania
| | - M. I. A. Othman
- Department of Mathematics, Faculty of Science, Zagazig University, Zagazig, Egypt
| | - A. R. Seadawy
- Mathematics Department, Faculty of Science, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia
| | - C. Carstea
- Department of Air Surveillance and Defense, “Henry Coanda” Air Force Academy, Brasov, Romania
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Palese A, Decaro A, Bressan V, Marin M, Achil I, Hayter M, Watson R. Measuring the therapeutic properties of nursing home environments in the Italian context: findings from a validation and cross-sectional study design. Ann Ig 2020; 32:117-131. [PMID: 31944207 DOI: 10.7416/ai.2020.2236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The social and the physical features of the nursing home (NH) environment can offer a therapeutic support capable of maximising residents' physical and cognitive functions. A total of 23 instruments evaluating the therapeutic properties of a NH has been documented to date; among them, the most recent and widely used is the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH) composed of 13 domains and 84 items: higher scores in each domain indicate a higher presence of therapeutic principles. Validating the Italian version of TESS-NH tool and describing the therapeutic properties of Italian NH environments were the aims of this study. STUDY DESIGN A validation and a cross-sectional study design, undertaken in 2017. METHODS After having ensured the cross-cultural and the conceptual equivalence, together with the face and the content validation, 13 NHs accounting for 1,161 beds and articulated in 31 units have been evaluated with the TESS-NH tool via direct observation by trained researchers. Inter-rater reliability, test-retest, criterion validity, inter-dimension correlations and internal consistency were measured. Descriptive statistics was also calculated. RESULTS The inter-rater reliability was Pearson (r) >0.917 for continuous variables and weighted kappa statistics (k) of > 0.779 for non-continuous variables; the test-retest reliability was r > 0.848 and k of > 0.778, respectively. The criterion validity was r > 0.500 between each dimension and the single TESS-NH global item; moreover, correlations among the domains varied from not significant to significantly strong, while the internal consistency resulted in all evaluable dimensions in Cronbach alpha > 0.600. In the involved NH units, the TESS-NH total score was on average 122.19 out of the possible score from 0 to 149 (confidence interval (CI) 95%, 115.89-128.49). 25% of the units (=7) reported a total score of ≤ 113, and another 25% reported scores ≥ 133, thus from poor to excellent therapeutic properties. CONCLUSION The TESS-NH tool can be used in Italian facilities to support managers and researchers in evaluating the therapeutic properties of NH environments. Furthermore, the tool can support the evaluation of the effectiveness of interventional studies or quality improvement projects aimed at improving the NH's environment.
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Affiliation(s)
- A Palese
- Department of Medical Sciences, University of Udine, Italy
| | - A Decaro
- Department of Medical Sciences, University of Udine, Italy
| | - V Bressan
- Department of Medical Sciences, University of Udine, Italy
| | - M Marin
- Local Health Care Trust, Bassa Friulana-Isontina, Gorizia, Italy
| | - I Achil
- Department of Medical Sciences, University of Udine, Italy
| | - M Hayter
- Hull University, Hull, HU6 7RX, United Kingdom
| | - R Watson
- Hull University, Hull, HU6 7RX, United Kingdom
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Pike J, Marin M, Guo A, Haselow D, Safi H, Zhou F. 2016-2017 Arkansas mumps outbreak in a close-knit community: Assessment of the economic impact and response strategies. Vaccine 2019; 38:1481-1485. [PMID: 31818532 DOI: 10.1016/j.vaccine.2019.11.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 07/14/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022]
Abstract
On August 8, 2016, a confirmed case of mumps was reported to the Arkansas Department of Health (ADH) in an adult resident of Springdale, Arkansas. By July 2017, nearly 3,000 cases of mumps were reported to ADH from 37 of the 75 counties in Arkansas. Over 50% of cases were in the Arkansas Marshallese community, a close-knit community characterized by large, and extended families sharing the same living space and communal activities. In a statewide effort, ADH collaborated with CDC, the Republic of the Marshall Island's (RMI) Ministry of Health, and the Arkansas Department of Education (ADE) to rapidly respond to and contain the outbreak. We assessed the economic burden to ADH of the outbreak response in terms of containment and vaccination costs, as well as response costs incurred by CDC, RMI, and ADE. The 2016-2017 Arkansas mumps outbreak was the second largest US mumps outbreak in over 30 years and was unique in size, spread, and population affected. Total public health response costs as a result of the outbreak were over $2.1 million, approximately $725 per case. The costs incurred to control this outbreak reflect the response strategies tailored to the affected populations, including consideration of social, cultural, and political factors in controlling transmission and requirements of distinctive strategies for public health outreach. Aside from the burden these outbreaks have on the affected population, we demonstrate the potential for high economic burden of these outbreaks to public health.
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Affiliation(s)
- Jamison Pike
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease, Immunization Services Division, Atlanta, GA, USA.
| | - Mona Marin
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease, Immunization Services Division, Atlanta, GA, USA
| | - Angela Guo
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease, Immunization Services Division, Atlanta, GA, USA
| | - Dirk Haselow
- Arkansas Department of Health, Little Rock, AR, USA
| | - Haytham Safi
- Arkansas Department of Health, Little Rock, AR, USA
| | - Fangjun Zhou
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease, Immunization Services Division, Atlanta, GA, USA
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Ruiz S, Koebernick N, Duncan S, Fletcher DM, Scotson C, Boghi A, Marin M, Bengough AG, George TS, Brown LK, Hallett PD, Roose T. Significance of root hairs at the field scale - modelling root water and phosphorus uptake under different field conditions. Plant Soil 2019; 447:281-304. [PMID: 32214504 PMCID: PMC7062663 DOI: 10.1007/s11104-019-04308-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/13/2019] [Indexed: 05/22/2023]
Abstract
ABSTRACT BACKGROUND AND AIMS Root hairs play a significant role in phosphorus (P) extraction at the pore scale. However, their importance at the field scale remains poorly understood. METHODS This study uses a continuum model to explore the impact of root hairs on the large-scale uptake of P, comparing root hair influence under different agricultural scenarios. High vs low and constant vs decaying P concentrations down the soil profile are considered, along with early vs late precipitation scenarios. RESULTS Simulation results suggest root hairs accounted for 50% of total P uptake by plants. Furthermore, a delayed initiation time of precipitation potentially limits the P uptake rate by over 50% depending on the growth period. Despite the large differences in the uptake rate, changes in the soil P concentration in the domain due to root solute uptake remains marginal when considering a single growth season. However, over the duration of 6 years, simulation results showed that noticeable differences arise over time. CONCLUSION Root hairs are critical to P capture, with uptake efficiency potentially enhanced by coordinating irrigation with P application during earlier growth stages of crops.
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Affiliation(s)
- S Ruiz
- 1Bioengineering Science Research Group, Department of Mechanical Engineering, School of Engineering, Faculty of Engineering and Physical Science, University of Southampton, Southampton, SO17 1BJ UK
| | - N Koebernick
- 1Bioengineering Science Research Group, Department of Mechanical Engineering, School of Engineering, Faculty of Engineering and Physical Science, University of Southampton, Southampton, SO17 1BJ UK
- 5Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Universitaetplatz 10, 06108 Halle (Saale), Germany
| | - S Duncan
- 1Bioengineering Science Research Group, Department of Mechanical Engineering, School of Engineering, Faculty of Engineering and Physical Science, University of Southampton, Southampton, SO17 1BJ UK
| | - D McKay Fletcher
- 1Bioengineering Science Research Group, Department of Mechanical Engineering, School of Engineering, Faculty of Engineering and Physical Science, University of Southampton, Southampton, SO17 1BJ UK
| | - C Scotson
- 1Bioengineering Science Research Group, Department of Mechanical Engineering, School of Engineering, Faculty of Engineering and Physical Science, University of Southampton, Southampton, SO17 1BJ UK
| | - A Boghi
- 1Bioengineering Science Research Group, Department of Mechanical Engineering, School of Engineering, Faculty of Engineering and Physical Science, University of Southampton, Southampton, SO17 1BJ UK
| | - M Marin
- 2School of Biological Sciences, University of Aberdeen, Aberdeen, AB24 3UU UK
| | - A G Bengough
- 3Ecological Sciences Group, The James Hutton Institute, Invergowrie, Dundee, DD2 5DA UK
- 4School of Science and Engineering, University of Dundee, Dundee, DD1 4HN UK
| | - T S George
- 3Ecological Sciences Group, The James Hutton Institute, Invergowrie, Dundee, DD2 5DA UK
| | - L K Brown
- 3Ecological Sciences Group, The James Hutton Institute, Invergowrie, Dundee, DD2 5DA UK
| | - P D Hallett
- 2School of Biological Sciences, University of Aberdeen, Aberdeen, AB24 3UU UK
| | - T Roose
- 1Bioengineering Science Research Group, Department of Mechanical Engineering, School of Engineering, Faculty of Engineering and Physical Science, University of Southampton, Southampton, SO17 1BJ UK
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Merino L, Edberg U, Fuchs G, Åman P, Corbari G, Dahlberg L, Da-Riz V, Eerola S, Gerard R, Grancher D, Jensen S, Kangro A, Kjolby A, Lundberg L, Marin M, Meland S, Muriel B, Nicolas M, Ravn T, Tuhkanen M, Vartiala T, Zieprath G. Liquid Chromatographic Determination of Residual Nitrite/Nitrate in Foods: NMKL Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/83.2.365] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Nitrite and nitrate are used as additives in the food industry to provide color and taste and to control undesirable gas and flavor production by anaerobic bacteria by virtue of their antimicrobial properties. The analytical method that has been widely used to determine nitrite and nitrate involves the use of toxic cadmium. In response to a request from the Nordic Committee on Food Analysis, a study was performed to obtain an alternative chromatographic method to determine residual nitrite and nitrate in meat products. The study was done in 3 stages: (1) comparative evaluation of the performance of 3 liquid chromatographic methods, (2) internal validation of the selected ion chromatographic method, and (3) a collaborative study in which 17 laboratories from European countries participated. Furthermore, the applicability of the method to matrixes other than meat and meat products was demonstrated. The results of the collaborative study show that the European Prestandard prENV 12014-4 is well suited for the determination of nitrite and nitrate in different foods (e.g., meat products, vegetables, baby food, and cheese). The limits of detection for nitrite and nitrate ions are 1 and 10 mg/kg, respectively. Recoveries of residual nitrite/nitrate ranged from 96 to 108%. Repeatability and reproducibility were satisfactory.
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Affiliation(s)
- Leonardo Merino
- National Food Administration, Chemistry Division 2, PO Box 622, S-751 26 Uppsala, Sweden
| | - Ulla Edberg
- National Food Administration, Chemistry Division 2, PO Box 622, S-751 26 Uppsala, Sweden
| | - Georg Fuchs
- National Food Administration, Chemistry Division 2, PO Box 622, S-751 26 Uppsala, Sweden
| | - Per Åman
- Swedish University of Agricultural Sciences, Box 7051, S-750 07 Uppsala, Sweden
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Hanson KE, McLean H, Marin M, Panagiotakopoulos L, Weintraub E, Daley MF, Groom H, Jackson L, Jacobsen SJ, Klein N, Nordin JD, Belongia E. 2763. Uptake and Safety of Measles-Mumps-Rubella (MMR) Vaccine in Adolescents and Adults in the Vaccine Safety Datalink. Open Forum Infect Dis 2019. [PMCID: PMC6809901 DOI: 10.1093/ofid/ofz360.2440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
MMR vaccine is given routinely to young children but may be given at other ages. We described MMR use in adolescent and adult populations in the Vaccine Safety Datalink (VSD) and estimated the incidence of medically-attended outcomes after MMR to inform future studies estimating vaccine-associated risk.
Methods
The study population included adolescents (9–17 years) and adults (≥18 years) in VSD who received at least one MMR vaccine from 2010 through 2016. Outcomes were pre-specified based on previous vaccine safety studies and categorized as clinically serious (anaphylaxis, encephalitis/myelitis, GBS, meningitis, seizure) or non-serious (allergic reaction, arthropathy, fever, injection site reaction, lymphadenopathy, nonspecific reaction, parotitis, rash, syncope). Outcomes were identified by searching for ICD-9 and ICD-10 diagnosis codes in post-vaccination exposure windows. Medical records were reviewed for all serious outcomes to verify incident diagnoses. Incidence and 95% confidence intervals were calculated for validated serious and all non-serious outcomes.
Results
146,503 adolescents and adults received 162,992 MMR vaccines during the study period. The mean age at vaccination was 33.7 years, 65% were female, and 53% received at least one other vaccine simultaneously. Demographic and vaccination characteristics varied across age groups (Table 1). The analysis of post-vaccination outcomes included 162,053 MMR vaccinations. The incidence of validated serious outcomes was low, ranging from 0 to 6.8 per 100,000 vaccinations. Only one serious outcome (anaphylaxis) was noted to be vaccine-associated in the medical record. Incidence of clinically non-serious outcomes varied from 0.4 to 56.0 per 10,000 vaccinations. Injection site reactions were more common among adolescents (118.1 per 10,000 vaccinations), who also had a higher frequency of simultaneous vaccination (80%).
Conclusion
Clinically serious outcomes were rare following MMR vaccination. Rates of clinically non-serious outcomes varied but were similar to or lower than previous reports in children. This descriptive analysis did not evaluate the association between MMR and adverse events. Future analysis with an appropriate comparison group is needed for risk estimation.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Kayla E Hanson
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Huong McLean
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Mona Marin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Eric Weintraub
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Holly Groom
- Kaiser Permanente Northwest, Portland, Oregon
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Nicola Klein
- Kaiser Permanente Northern California, Oakland, California
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Weinmann S, Irving S, Koppolu P, Naleway A, Belongia E, Hambidge S, Jackson ML, Klein N, Lewin B, Liles E, Marin M, Smith N, Weintraub E, Chun C. 2767. Variation in Incidence of Pediatric Herpes Zoster by First- and Second-Dose Varicella Vaccine Formulations. Open Forum Infect Dis 2019. [PMCID: PMC6809746 DOI: 10.1093/ofid/ofz360.2444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Varicella (VAR) and measles-mumps-rubella (MMR) vaccines are recommended for children at ages 12–15 months and 4–6 years. These are administered as separate MMR and VAR vaccines (MMR+VAR) or as combined measles-mumps-rubella-varicella (MMRV) vaccine. Herpes zoster (HZ), caused by wild-type or vaccine-strain varicella-zoster virus, can occur in children after varicella vaccination. It is unknown whether HZ incidence after varicella vaccination varies by vaccine formulation or simultaneous receipt of MMR.
Methods
Using data from six integrated health systems, we examined HZ incidence among children who turned 12 months old during 2003–2008 and received varicella and MMR vaccines according to routine recommendations. All HZ cases ≥ 21 days after first varicella vaccination were identified using ICD-9 codes from inpatient, outpatient, emergency room encounters, and claims data, through 2014. HZ incidence was examined by vaccine formulation (MMR+VAR, MMRV, or VAR without same-day MMR) and doses received and compared using incidence rate ratios (IRR).
Results
Among 199,797 children, we identified 601 HZ cases. Crude HZ incidence after first-dose MMR+VAR (18.6 [95% CI 11.1–29.2] cases/100,000 person-years) was similar to the rate after first-dose MMRV (17.9 [95% CI 10.6–28.3] cases/100,000 person-years), but approximately double the rate among those with first-dose VAR without same-day MMR (7.5 [95% CI 3.1–15.0] cases/100,000 person-years); see Table 1. The IRR for HZ after first-dose MMR+VAR or MMRV, compared with VAR, was 2.5 (95% CI 1.4–4.4; P = 0.002). When examining any first or second dose formulation, crude HZ incidence was lower after the second varicella vaccine dose (13.9 cases/100,000 person-years), than in the period before the second dose (i.e., between first and second doses or after the first dose in children with only one dose; 21.8 cases/100,000 person-years, P < 0.0001). HZ incidence was also lower after two varicella vaccine doses in each of the three first-dose formulation groups.
Conclusion
HZ incidence among children varied by first-dose varicella vaccine formulation and number of varicella vaccine doses. Regardless of the first-dose varicella vaccine formulation, children who received two vaccine doses had lower HZ incidence after the second dose.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Sheila Weinmann
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | - Padma Koppolu
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Allison Naleway
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | | | | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Nicola Klein
- Kaiser Permanente Northern California, Oakland, California
| | - Bruno Lewin
- Kaiser Permanente Department of Research and Evaluation, Pasadena, California
| | - Elizabeth Liles
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Mona Marin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ning Smith
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Eric Weintraub
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Colleen Chun
- Kaiser Permanente Center for Health Research, Portland, Oregon
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Abstract
Background Numerous mumps outbreaks occurred in the United States over the last decade, with outbreaks affecting young adults on college campuses being among the largest and most widely publicized. However, at least half of mumps cases and outbreaks occurred in other age-groups and settings. We describe reported mumps cases among children and adolescents during 2015 through 2017. Methods The Centers for Disease Control and Prevention (CDC) analyzed reports of confirmed and probable mumps cases in persons aged ≤18 years (defined here as pediatric mumps) transmitted electronically through the Nationally Notifiable Diseases Surveillance System (NNDSS) by the 52 reporting jurisdictions. Results Between January 1, 2015 and December 31, 2017, 49 jurisdictions reported 4,886 pediatric mumps cases (35% of all US reported cases, 13,807); 8 jurisdictions reported >100 cases each, representing 82% of all pediatric cases. Overall, 29 (1%) cases were in infants <1 yr, 406 (8%) were in children aged 1–4 years, 1,408 (29%) in children aged 5–10 years, 1,365 (28%) in adolescents aged 11–14 years, and 1,678 (34%) in adolescents aged 15–18 years. Most (3,548, 73%) cases did not travel outside the state during their exposure period; only 37 (1%) traveled outside the country. Cases in patients aged 1–4 years were more frequently non-outbreak associated (38%) than those in patients <1 years and 5–18 years (24% and 9%, respectively). Among 3,309 (68%) patients with known number of MMR doses received, 81% of those 5–18 years had ≥2 MMR doses, while 67% of those 1–4 years had ≥1 dose. Median time since last MMR dose for patients with 2 doses was 8 years (IQR: 4, 11 years). Four patients had meningitis and 1 had encephalitis; all were ≥10 years old and previously received 2 MMR doses. Of male mumps patients older than 10 years of age (2,113), 46 (2%) reported having orchitis; of these, 33 (72%) had 2 MMR doses. Sixty-four patients were hospitalized and there were no deaths. Conclusion About one-third of cases reported during the recent US mumps resurgence were in children and adolescents. The low rate of mumps complications compared with previous studies suggests mumps complications may not be adequately captured in national surveillance or identified by providers. Providers should remain vigilant that mumps can still occur among fully vaccinated pediatric patients, even those recently vaccinated. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Mariel Marlow
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Zhang
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Mona Marin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manisha Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manisha Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
CONTEXT Live vaccines usually provide robust immunity but can transmit the vaccine virus. OBJECTIVE To assess the characteristics of secondary transmission of the vaccine-strain varicella-zoster virus (Oka strain; vOka) on the basis of the published experience with use of live varicella and zoster vaccines. DATA SOURCES Systematic review of Medline, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases for articles published through 2018. STUDY SELECTION Articles that reported original data on vOka transmission from persons who received vaccines containing the live attenuated varicella-zoster virus. DATA EXTRACTION We abstracted data to describe vOka transmission by index patient's immune status, type (varicella or herpes zoster) and severity of illness, and whether transmission was laboratory confirmed. RESULTS Twenty articles were included. We identified 13 patients with vOka varicella after transmission from 11 immunocompetent varicella vaccine recipients. In all instances, the vaccine recipient had a rash: 6 varicella-like and 5 herpes zoster. Transmission occurred mostly to household contacts. One additional case was not considered direct transmission from a vaccine recipient, but the mechanism was uncertain. Transmission from vaccinated immunocompromised children also occurred only if the vaccine recipient developed a rash postvaccination. Secondary cases of varicella caused by vOka were mild. LIMITATIONS It is likely that other vOka transmission cases remain unpublished. CONCLUSIONS Healthy, vaccinated persons have minimal risk for transmitting vOka to contacts and only if a rash is present. Our findings support the existing recommendations for routine varicella vaccination and the guidance that persons with vaccine-related rash avoid contact with susceptible persons at high risk for severe varicella complications.
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Affiliation(s)
- Mona Marin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Jessica Leung
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anne A. Gershon
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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Leung J, Elson D, Sanders K, Marin M, Leos G, Cloud B, McNall RJ, Hickman CJ, Marlow M. Notes from the Field: Mumps in Detention Facilities that House Detained Migrants - United States, September 2018-August 2019. MMWR Morb Mortal Wkly Rep 2019; 68:749-750. [PMID: 31465321 PMCID: PMC6715258 DOI: 10.15585/mmwr.mm6834a4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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