Monitoring the safety of influenza A/H1N1 pandemic and seasonal vaccines in Morocco

Background:

A vaccination campaign against pandemic influenza A/H1N1 was implemented in Morocco between November 2009 and April 2010. Overall, 705,883 subjects were vaccinated by Pandemrix, Arepanrix, and Panenza. The adverse events following immunization (AEFIs) data comparison was made with the 2014/2015 seasonal influenza vaccination campaign that was specifically investigated.

Aim:

To evaluate the safety of the 2009 pandemic influenza A/H1N1 vaccine and to compare it to that of 2014 seasonal influenza vaccine.

Methods:

During the pandemic vaccination campaign, the Morocco Pharmacovigilance Centre reinforced passive AEFI surveillance with an active and prospective monitoring programme of 1000 immunized people over 6 months at 10 randomly selected vaccination centres. For the 2014/2015 seasonal vaccination campaign, AEFI data were collected from spontaneous notifications.

Results:

Active monitoring of 2009 pandemic collected 771 AEFI reports, corresponding to an AEFI incidence rate of 77.1% with vaccination by either Pandemrix or Arepanrix vaccine in 95% of cases. Reported AEFI were most frequently local (37.7%), general (29.5%), and neurological reactions (20.3%). Most of the AEFI (95.5%) were observed during the first 48 hours after vaccination, and the remainder within 2 weeks. None of the reported AEFI were serious case. The highest rate of notification was documented for health professionals, followed by patients with diabetes or chronic respiratory diseases. Concerning passive surveillance, the AEFI notification rate was significantly higher for the 2009/2010 pandemic vaccine (3.1 vs 1.2 per 10,000). However, there was no significant difference between pandemic and seasonal vaccination with regards to the serious adverse events (SAE) notification rate (0.3 vs 0.2 per 10,000).

Conclusion:

Data analysis indicates that the vaccines used against 2009 pandemic influenza in Morocco have a satisfactory safety profile, similar to the seasonal influenza vaccine with the exception of local reactions as observed previously in other countries.

Characterization and phylogenetic diversity of Allorhizobium vitis isolated from grapevine in Morocco

AIMS

Crown gall, a phytobacteriosis characterized by the formation of tumours on plant roots was observed in recently planted vineyards of the Meknes region (Morocco). The objective of this research was to analyse the diversity of pathogenic agrobacteria isolated from grapevine in Morocco.

METHODS AND RESULTS

Eighty-two isolates from 11 affected vineyards were characterized by recA sequencing and were found to belong to Agrobacterium tumefaciens genomospecies G1, G4 or G7, Rhizobium rhizogenes, and to Allorhizobium vitis. Only the All. vitis isolates appeared to be pathogenic on tomato and multilocus sequence analysis phylogenetic analyses revealed a weak genetic diversity, with the definition of only four genomic groups. Definition of the All. vitis genomic groups correlated with specific pathogenic traits: indeed, genomic groups differed with respect to the severity of hypersensitive response symptoms on tobacco leaves, the intensity of necrotic response on grapevine explants and opine profiles. Both vitopine and octopine were detected by UHPLC in tumours induced by isolates of three genomic groups, an opine signature scarcely ever reported.

CONCLUSIONS

Allorhizobium vitis is the only causative agent of crown gall on grape in Morocco, pathogenic isolates can be separated into four genomic groups.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study of recently crown-gall-infested vineyards demonstrated that All. vitis is the only causative agent and revealed the presence of nonpathogenic Agrobacterium strain within tumours. Moreover, as the genetic diversity of the All. vitis isolates is relatively narrow, this study lays the basis for further analyses on the evolution of the disease, on the dissemination of the pTi and more globally on the fate of the different genomic groups in this newly colonized environment.

Assessment of a new instrument for detecting preventable adverse drug reactions

BACKGROUND

Pharmacovigilance centres (PVCs) in the World Health Organization (WHO) Programme for International Drug Monitoring have demonstrated their ability to detect preventable adverse drug reactions (ADRs) in their databases. In this field, there is no gold-standard method for detecting medication errors and evaluating ADR preventability. Therefore, we developed, from existing tools, a preventability assessment method: the 'P Method' (PM).

OBJECTIVE

To present the PM and to evaluate its inter-rater reliability.

METHODS

The PM includes 20 explicit criteria for assessing ADR preventability. This approach is based on identification of any potentially preventable risk factor that increases the likelihood of ADR occurrence. The outcome of the preventability assessment results in one of three possible scores: 'preventable', 'non-preventable' or 'not assessable'. The PM was tested in a multicentre study involving nine national PVCs. Two experienced reviewers at each participating PVC independently analysed the preventability of 183 ADRs, applying the PM.

RESULTS

The overall agreement between all reviewers for assessment of ADR preventability was 'fair', with a kappa value of 0.27 [95 % confidence interval (CI) 0.21-0.40]. The level of agreement between reviewer pairs ranged from 'slight', with a kappa value of 0.12 (95 % CI -0.03 to 0.27), to 'substantial', with a kappa value of 0.69 (95 % CI 0.48-0.89).

CONCLUSION

The analysis of the agreements and disagreements between reviewers highlighted where improvements might be made. Given that no standard assessment tool exists in the WHO Programme, the transparency of the assessment process in this method provides a substantial basis for further development and for support in signalling possible preventability.

The involvement of Pharmacovigilance Centres in medication errors detection: a questionnaire-based analysis

OBJECTIVES

This study assesses the ability of Pharmacovigilance Centres (PVCs) to detect medication errors (ME) and to proceed to building Patient Safety (PS) via their information networks and to underline the limits for this challenge.

METHODS

This was an exploratory study conducted in PVCs members of the World Health Organization International Drug Monitoring network. A questionnaire specifically designed for the needs of the study was sent to a network via a confidential email system. The questionnaire asked for information, progress and improvement made by PVCs in PS and ME.

RESULTS

Among the 88 countries, 21 answered. Reporting of Adverse Drug Reactions (ADRs) by health care professionals (HCP) is mandatory for 42% of PVCs. 100% of countries receive reports from HCP, 66% from patients and 24% from PCCs. ADRs reports are received by all communications means. There is an heterogeneity between countries regarding PVCs and PS activities. Among them, 4 PVCs have the prime activity of PS organization.

CONCLUSION

PVCs are able to detect and analyze ME. There is a need to coordinate efforts between countries to optimize ME detection, and its analysis. Bridges need to be built linking PVCs, PCCs and PS organizations in order to avoid duplication of workload.

Prevalence and preventability of adverse drug events in a teaching hospital: a cross-sectional study

We determined the prevalence of adverse drug events (ADEs) in a general teaching hospital in Rabat, Morocco. We performed a 5-day cross-sectional study of hospital departments recruiting inpatients and outpatients. Among the 1390 patients surveyed, 59 (4.2%) experienced at least 1 ADE and for 20 patients (1.4%) the ADE was responsible for hospitalization or prolongation of hospitalization. The ADE was classified as serious in 28 patients. Of the total of 76 ADEs, 10 (13.2%) were categorized as preventable; 6 of these occurred during the treatment monitoring phase. Patients who experienced an ADE were more likely to be women, to be younger (< 30 years) and to be hospitalized in medical departments.

[Serious gastrointestinal effects of nonsteroidal anti-inflammatory drugs (NSAIDS) in a prospective study in Morocco]

In Morocco, the need for post-marketing surveillance of selective Cox2 inhibitors (coxibs) prompted a study to assess the serious gastrointestinal effects of NSAIDs and to compare gastrointestinal tolerance of conventional NSAIDs and coxibs. A prospective study was conducted from April 2001 through May 2002 among hospital-staff gastroenterologists in the public and private sector as well as emergency surgical units. Over this period, 123 patients were reported to have serious NSAID-related gastrointestinal effects, and 63% of them were admitted for bleeding or perforated ulcers. Endoscopy most often identified the lesion as a gastric ulcer (45%). Emergency rooms reported that aspirin was the most common causal agent and that NSAIDs accounted for 8.7% of bleeding and 9.3% of the perforated ulcers. Our findings indicate that men and youth are most vulnerable to serious gastrointestinal effects from these drugs. Several risk factors from the literature were confirmed in our population: history of gastrointestinal disorders and joint disease, occurrence within less than 1 month of beginning the drug; association of NSAIDs and aspirin, diabetes and hypertension. No conclusion could be drawn about the comparative gastrointestinal tolerance of conventional NSAIDs and coxibs, however, since the latter account for only 3% of the NSAID market.

[Acute intoxication by redoul (Coriaria myrtifolia L.). Three observations]

INTRODUCTION

Coriaria myrtifolla L. (Redoul) is a shrub of the Mediterranean area. Poisoning with this plant is often accidental, following ingestion of the plant's fruit that are often mistaken for blackberries.

OBSERVATIONS

Having eaten Coriaria myrtifolla L. berries, three sisters suffered from acute poisoning. One died.

COMMENTS

Toxic effects are characterized by digestive (nausea, vomiting, abdominal pain), neurological (obnubilation, convulsions and their complications), and respiratory disorders (polypnea, respiratory problems, apnea, short and superficial respiration) together with myositis of the pupils. Treatment of this poisoning is purely symptomatic. In the case of convulsions, rapid resuscitation in an intensive care unit in necessary.

Non-linear analysis of the arterial pulsatile flow: assessment of a model allowing a non-invasive ultrasonic functional exploration

Ultrasonic measurements and modelling of blood flow in large vessels allows non-invasive evaluation of clinically interesting hemodynamic variables. To this aim, a non-linear mathematical model for the pulsatile arterial flow is proposed using the approximation of "local flow" theory. The model requires only measurements of instantaneous radius and centre-line blood velocity, and the knowledge of the tube distensibility to calculate blood velocity profiles, pressure gradient and wall shear stress. Evaluation of the proposed model using experimental data obtained from the literature proved that it can provide reliable results. In addition, as shown by assessing significance of various non-linear terms, results did not significantly change when a linear pressure-radius relationship was used instead of a non-linear relationship. Also, the model was found to be moderately sensitive to arterial tapering. Thus, the proposed model is suitable for a non-invasive clinical arterial exploration since it only requires three measurements which can be easily and precisely obtained in vivo using ultrasonic methods: the instantaneous radius, the centre-line velocity and the mean pulse wave velocity, this last variable characterizing the tube distensibility when assuming a linear pressure-radius relationship.

Immunochemical characterization of an IgG-binding protein of Streptococcus suis

Several bacterial species express surface proteins with affinity for the constant region (Fc) of immunoglobulin (Ig) of different animal species. Previous studies from our group have reported the presence of an IgG-binding protein in various serotypes of Streptococcus suis. This molecule was also shown to bind in a non-immune fashion chicken IgY and to our knowledge this characteristic is unique. In the present study, by dot-blotting, we showed that the native protein, obtained by affinity chromatography, reacted more strongly with IgG from various animal species than the denatured material. Using a competitive enzyme-linked immunosorbent assay the affinity of the native 60-kDa protein (previously identified as a 52-kDa protein) towards IgG of various animal species was compared to pig IgG. Bovine, goat and human IgG were able to compete effectively with pig IgG whereas chicken IgY constituted a poor competitor. Peptide mapping analysis using denatured protein indicated that pig and bovine IgG recognized the same proteolytic fragment whereas chicken IgY did not. The smallest proteolytic fragment that retained the binding activity towards the IgG of the different animal species tested had a molecular mass of approximately 40 kDa. Fragments with Mr < 40 kDa showed specific binding activities. That is, the smallest fragment binding pig and bovine IgG had a Mr of 30 kDa whereas for goat and human IgG a fragment of less than 16 kDa still showed binding activity. Finally, we observed that antisera raised against a heat-shock protein of Pseudomonas aeruginosa reacted with the 60-kDa S. suis protein indicating that the S. suis 60-kDa protein is a member of the 60-kDa hsp family that possesses the characteristic of binding in a non-immune way mammalian IgG and chicken IgY.

Identification of a Streptococcus suis 60-kDa heat-shock protein using western blotting

This study was initiated to investigate the presence of stress or heat shock proteins in Streptococcus suis. SDS-PAGE and Western blotting using polyclonal and monoclonal antibodies directed against different bacterial heat shock proteins demonstrated cross-reactivity with a protein with an apparent molecular mass of 60 kDa in all S. suis serotypes tested. The 60-kDa cross-reactive protein was present in virulent and avirulent strains of S. suis serotype 2 tested. A rabbit antiserum raised against the 60-kDa S. suis protein recognized the 60-65-kDa heat shock proteins in different Gram-positive and Gram-negative bacteria. Finally, the 60-kDa heat shock protein of S. suis was shown to be mostly secreted into the culture supernatant and, to a lesser extent, cell-associated. Growth under heat stress conditions (42 degrees C) increased the expression of the 60-kDa S. suis protein. This protein is, to our knowledge, the first common antigen found in different serotypes of S. suis.

Demonstration of lectin-like activity for the common antigen of Neisseria gonorrhoeae by quantitative immunoelectrophoretic techniques

To overcome problems associated with Western blotting of denatured proteins, we have used quantitative immunoelectrophoretic techniques to perform functional analysis of the Neisseria gonorrhoeae common antigen. Using these techniques, we show (a) that Neisseria gonorrhoeae expresses an antigen that is cross-reactive with the common antigen of Pseudomonas aeruginosa and Legionella micdadei and with the GroEl-like protein of Chlamydia, and (b) that this N. gonorrhoeae common antigen has lectin-like activity and can be precipitated with three different sugars immobilized on agarose beads: alpha-D-glucosamine, maltose and fucose.

Purification and immunological studies of the cross-reaction between the 65-kilodalton gonococcal parietal lectin and an antigen common to a wide range of bacteria

The 65-kDa gonococcal parietal lectin (GPL) has been purified and found to have a lectinlike activity exhibiting both structural and immunological similarities to the common antigen family. Ultrastructural localization of GPL was done by using anti-GPL monoclonal antibodies: GPL is a major component of the outer membrane and is also present in blebs formed by gonococci.