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Antoni S, Nakamura T, Cohen AL, Mwenda JM, Weldegebriel G, Biey JNM, Shaba K, Rey-Benito G, de Oliveira LH, Oliveira MTDC, Ortiz C, Ghoniem A, Fahmy K, Ashmony HA, Videbaek D, Daniels D, Pastore R, Singh S, Tondo E, Liyanage JBL, Sharifuzzaman M, Grabovac V, Batmunkh N, Logronio J, Armah G, Dennis FE, Seheri M, Magagula N, Mphahlele J, Leite JPG, Araujo IT, Fumian TM, EL Mohammady H, Semeiko G, Samoilovich E, Giri S, Kang G, Thomas S, Bines J, Kirkwood CD, Liu N, Lee DY, Iturriza-Gomara M, Page NA, Esona MD, Ward ML, Wright CN, Mijatovic-Rustempasic S, Tate JE, Parashar UD, Gentsch J, Bowen MD, Serhan F. Rotavirus genotypes in children under five years hospitalized with diarrhea in low and middle-income countries: Results from the WHO-coordinated Global Rotavirus Surveillance Network. PLOS Glob Public Health 2023; 3:e0001358. [PMID: 38015834 PMCID: PMC10683987 DOI: 10.1371/journal.pgph.0001358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 10/06/2023] [Indexed: 11/30/2023]
Abstract
Rotavirus is the most common pathogen causing pediatric diarrhea and an important cause of morbidity and mortality in low- and middle-income countries. Previous evidence suggests that the introduction of rotavirus vaccines in national immunization schedules resulted in dramatic declines in disease burden but may also be changing the rotavirus genetic landscape and driving the emergence of new genotypes. We report genotype data of more than 16,000 rotavirus isolates from 40 countries participating in the Global Rotavirus Surveillance Network. Data from a convenience sample of children under five years of age hospitalized with acute watery diarrhea who tested positive for rotavirus were included. Country results were weighted by their estimated rotavirus disease burden to estimate regional genotype distributions. Globally, the most frequent genotypes identified after weighting were G1P[8] (31%), G1P[6] (8%) and G3P[8] (8%). Genotypes varied across WHO Regions and between countries that had and had not introduced rotavirus vaccine. G1P[8] was less frequent among African (36 vs 20%) and European (33 vs 8%) countries that had introduced rotavirus vaccines as compared to countries that had not introduced. Our results describe differences in the distribution of the most common rotavirus genotypes in children with diarrhea in low- and middle-income countries. G1P[8] was less frequent in countries that had introduced the rotavirus vaccine while different strains are emerging or re-emerging in different regions.
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Affiliation(s)
- Sebastien Antoni
- Department of Immunization, Vaccines and Biologicals, World Health Organization Headquarters, Geneva, Switzerland
| | - Tomoka Nakamura
- Department of Immunization, Vaccines and Biologicals, World Health Organization Headquarters, Geneva, Switzerland
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Adam L. Cohen
- Department of Immunization, Vaccines and Biologicals, World Health Organization Headquarters, Geneva, Switzerland
| | - Jason M. Mwenda
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Joseph N. M. Biey
- World Health Organization, Inter Country Support Team, Ouagadougou, Burkina Faso
| | - Keith Shaba
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Gloria Rey-Benito
- Pan American Health Organization, World Health Organization, Washington District of Columbia, Washington, DC, United States of America
| | - Lucia Helena de Oliveira
- Pan American Health Organization, World Health Organization, Washington District of Columbia, Washington, DC, United States of America
| | - Maria Tereza da Costa Oliveira
- Pan American Health Organization, World Health Organization, Washington District of Columbia, Washington, DC, United States of America
| | - Claudia Ortiz
- Pan American Health Organization, World Health Organization, Washington District of Columbia, Washington, DC, United States of America
| | - Amany Ghoniem
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Kamal Fahmy
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Hossam A. Ashmony
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Dovile Videbaek
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Danni Daniels
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Roberta Pastore
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Simarjit Singh
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Emmanuel Tondo
- World Health Organization, Regional Office for South East Asia, Delhi, India
| | | | | | - Varja Grabovac
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Nyambat Batmunkh
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Josephine Logronio
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - George Armah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Francis E. Dennis
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Mapaseka Seheri
- World Health Organization Regional Reference Laboratory for Rotavirus, Diarrhoeal Pathogens Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Nonkululeko Magagula
- World Health Organization Regional Reference Laboratory for Rotavirus, Diarrhoeal Pathogens Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Jeffrey Mphahlele
- World Health Organization Regional Reference Laboratory for Rotavirus, Diarrhoeal Pathogens Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Jose Paulo G. Leite
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - Irene T. Araujo
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - Tulio M. Fumian
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - Hanan EL Mohammady
- Bacterial and Parasitic Diseases Research Program, U.S. Naval Medical Research Unit-3, Cairo, Egypt
| | - Galina Semeiko
- Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus
| | - Elena Samoilovich
- Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus
| | - Sidhartha Giri
- Division of Gastrointestinal Sciences, The Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, The Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | - Sarah Thomas
- Enteric Diseases Group Murdoch Children’s Research Institute, Department of Paediatrics University of Melbourne, Parkville, Victoria, Australia
| | - Julie Bines
- Enteric Diseases Group Murdoch Children’s Research Institute, Department of Paediatrics University of Melbourne, Parkville, Victoria, Australia
| | - Carl D. Kirkwood
- Enteric Diseases Group Murdoch Children’s Research Institute, Department of Paediatrics University of Melbourne, Parkville, Victoria, Australia
| | - Na Liu
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - Deog-Yong Lee
- Division of Viral Diseases, Bureau of Infectious Diseases Diagnosis Control, Korea Diseases Control and Prevention Agency, Osong, Korea
| | | | - Nicola Anne Page
- National Institute for Communicable Diseases, Centre for Enteric Disease, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Medical Virology, University of Pretoria, Arcadia, Pretoria, South Africa
| | - Mathew D. Esona
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M. Leanne Ward
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Jon Gentsch
- Retired Researcher, West Newton, Pennsylvania, United States of America
| | | | - Fatima Serhan
- Department of Immunization, Vaccines and Biologicals, World Health Organization Headquarters, Geneva, Switzerland
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Kraay ANM, Steele MK, Baker JM, Hall EW, Deshpande A, Saidzosa BF, Mukaratirwa A, Boula A, Mpabalwani EM, Kiulia NM, Tsolenyanu E, Enweronu-Laryea C, Abebe A, Beyene B, Tefera M, Willilo R, Batmunkh N, Pastore R, Mwenda JM, Antoni S, Cohen AL, Pitzer VE, Lopman BA. Predicting the long-term impact of rotavirus vaccination in 112 countries from 2006 to 2034: A transmission modeling analysis. Vaccine 2022; 40:6631-6639. [PMID: 36210251 DOI: 10.1016/j.vaccine.2022.09.072] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 01/27/2023]
Abstract
Rotavirus vaccination has been shown to reduce rotavirus burden in many countries, but the long-term magnitude of vaccine impacts is unclear, particularly in low-income countries. We use a transmission model to estimate the long-term impact of rotavirus vaccination on deaths and disability adjusted life years (DALYs) from 2006 to 2034 for 112 low- and middle-income countries. We also explore the predicted effectiveness of a one- vs two- dose series and the relative contribution of direct vs indirect effects to overall impacts. To validate the model, we compare predicted percent reductions in severe rotavirus cases with the percent reduction in rotavirus positivity among gastroenteritis hospital admissions for 10 countries with pre- and post-vaccine introduction data. We estimate that vaccination would reduce deaths from rotavirus by 49.1 % (95 % UI: 46.6-54.3 %) by 2034 under realistic coverage scenarios, compared to a scenario without vaccination. Most of this benefit is due to direct benefit to vaccinated individuals (explaining 69-97 % of the overall impact), but indirect protection also appears to enhance impacts. We find that a one-dose schedule would only be about 57 % as effective as a two-dose schedule 12 years after vaccine introduction. Our model closely reproduced observed reductions in rotavirus positivity in the first few years after vaccine introduction in select countries. Rotavirus vaccination is likely to have a substantial impact on rotavirus gastroenteritis and its mortality burden. To sustain this benefit, the complete series of doses is needed.
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Affiliation(s)
- A N M Kraay
- Department of Kinesiology and Community Health, University of Illinois, Champaign, IL, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - M K Steele
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - J M Baker
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - E W Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - A Deshpande
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - B F Saidzosa
- State Institution "Republican Center of Immunoprophylaxis" of Ministry of Health and Social Protection of Population of the Republic of Tajikistan, Dushanbe, Tajikistan
| | | | - A Boula
- Mother & Child Hospital (MCH), Chantal Biya Foundation, Yaoundé, Cameroon
| | | | - N M Kiulia
- Enteric Pathogens and Water Research Laboratory, Institute of Primate Research, Karen, Nairobi, Kenya
| | - E Tsolenyanu
- Department of Paediatrics, Medical School of Lome, Togo; Ministry of Health, Togo
| | - C Enweronu-Laryea
- Department of Pediatrics, University of Ghana Medical School, Accra, Ghana
| | - A Abebe
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - B Beyene
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - M Tefera
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - R Willilo
- RTI International, Dar es Salaam, Tanzania
| | - N Batmunkh
- Expanded Programme on Immunisation, Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
| | - R Pastore
- Division of Country Health Programmes, Vaccine-preventable Diseases and Immunization (VPI), World Health Organization Regional Office for the Europe, Copenhagen, Denmark
| | - J M Mwenda
- WHO Regional Office for Africa, Immunization and Vaccines Development, Brazzaville, Congo
| | - S Antoni
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - A L Cohen
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - V E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - B A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Donadel M, Scobie HM, Pastore R, Grabovac V, Batmunkh N, O’Connor S, Dahl BA, Murrill CS. Comprehensive Vaccine-Preventable Disease Surveillance in the Western Pacific Region: A Literature Review on Integration of Surveillance Functions, 2000-2021. Glob Health Sci Pract 2022; 10:GHSP-D-22-00017. [PMID: 36316133 PMCID: PMC9622275 DOI: 10.9745/ghsp-d-22-00017] [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] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION A strategic framework for 2021-2030 developed by the World Health Organization (WHO) Regional Office for the Western Pacific emphasizes the need for high-quality and integrated vaccine-preventable disease (VPD) surveillance. We conducted a literature review to document the barriers, enabling factors, and innovations for integrating surveillance functions for VPDs and other communicable diseases in Western Pacific Region (WPR) countries. METHODS We searched published and gray literature on integrated VPD surveillance from 2000 to 2021. Articles in English, Spanish, or French were screened to identify those relating to VPD surveillance in a WPR country and not meeting defined exclusion criteria. We categorized articles using the 8 WHO surveillance support functions and abstracted data on the country; type of surveillance; and reported barriers, enabling factors, and best practices for integration. RESULTS Of the 3,137 references screened, 87 met the eligibility criteria. Of the 8 surveillance support functions, the proportion of references that reported integration related to the laboratory was 56%, followed by workforce capacity (54%), governance (51%), data management and use (47%), field logistics and communication (47%), coordination (15%), program management (13%), and supervision (9%). Several references noted fragmented systems and a lack of coordination between units as barriers to integration, highlighting the importance of engagement across public health units and between the public and private sectors. The literature also indicated a need for interoperable information systems and revealed the use of promising new technologies for data reporting and laboratory testing. In some WPR countries, workforce capacity was strengthened at all administrative levels by the implementation of integrated trainings on data monitoring and use and on laboratory techniques applicable to multiple VPDs. CONCLUSION This literature review supports integrating VPDs into broader communicable disease surveillance systems in WPR countries while ensuring that the minimal WHO-recommended standards for VPD surveillance are met.
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Affiliation(s)
- Morgane Donadel
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Correspondence to Morgane Donadel ()
| | - Heather M. Scobie
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Roberta Pastore
- World Health Organization, Western Pacific Regional Office, Manila, the Philippines
| | - Varja Grabovac
- World Health Organization, Western Pacific Regional Office, Manila, the Philippines
| | - Nyambat Batmunkh
- World Health Organization, Western Pacific Regional Office, Manila, the Philippines
| | - Stephanie O’Connor
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin A. Dahl
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christopher S. Murrill
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Bruni L, Saura-Lázaro A, Montoliu A, Brotons M, Alemany L, Diallo MS, Afsar OZ, LaMontagne DS, Mosina L, Contreras M, Velandia-González M, Pastore R, Gacic-Dobo M, Bloem P. Corrigendum to "HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010-2019" [Preventive Medicine 144 (2021) 106399]. Prev Med 2022; 155:106925. [PMID: 34998610 DOI: 10.1016/j.ypmed.2021.106925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Laia Bruni
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain.
| | - Anna Saura-Lázaro
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain
| | - Alexandra Montoliu
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain
| | - Maria Brotons
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
| | - Mamadou Saliou Diallo
- Data and Analytics Unit, Department of Analysis, Planning & Monitoring, UNICEF, New York, USA
| | - Oya Zeren Afsar
- Maternal, Neonatal & Adolescent Health Unit, Health Section, UNICEF, New York, USA
| | | | - Liudmila Mosina
- Division of Country Health Programmes, Vaccine-preventable Diseases and Immunization (VPI), World Health Organization Regional Office for the Europe, Copenhagen, Denmark
| | - Marcela Contreras
- Comprehensive Family Immunization Unit, Pan American Health Organization, PAHO/WHO, Washington, DC, USA
| | - Martha Velandia-González
- Comprehensive Family Immunization Unit, Pan American Health Organization, PAHO/WHO, Washington, DC, USA
| | - Roberta Pastore
- Division of Country Health Programmes, Vaccine-preventable Diseases and Immunization (VPI), World Health Organization Regional Office for the Europe, Copenhagen, Denmark
| | - Marta Gacic-Dobo
- Immunization Analysis & Insights Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Paul Bloem
- Life Course and Integration/ EPI, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Liu Y, Sandmann FG, Barnard RC, Pearson CA, Pastore R, Pebody R, Flasche S, Jit M. Optimising health and economic impacts of COVID-19 vaccine prioritisation strategies in the WHO European Region: a mathematical modelling study. Lancet Reg Health Eur 2022; 12:100267. [PMID: 34870256 PMCID: PMC8629724 DOI: 10.1016/j.lanepe.2021.100267] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Countries in the World Health Organization (WHO) European Region differ in terms of the COVID-19 vaccine supply conditions. We evaluated the health and economic impact of different age-based vaccine prioritisation strategies across this demographically and socio-economically diverse region. METHODS We fitted age-specific compartmental models to the reported daily COVID-19 mortality in 2020 to inform the immunity level before vaccine roll-out. Models capture country-specific differences in population structures, contact patterns, epidemic history, life expectancy, and GDP per capita.We examined four strategies that prioritise: all adults (V+), younger (20-59 year-olds) followed by older adults (60+) (V20), older followed by younger adults (V60), and the oldest adults (75+) (V75) followed by incrementally younger age groups. We explored four roll-out scenarios (R1-4) - the slowest scenario (R1) reached 30% coverage by December 2022 and the fastest (R4) 80% by December 2021. Five decision-making metrics were summarised over 2021-22: mortality, morbidity, and losses in comorbidity-adjusted life expectancy, comorbidity- and quality-adjusted life years, and human capital. Six vaccine profiles were tested - the highest performing vaccine has 95% efficacy against both infection and disease, and the lowest 50% against diseases and 0% against infection. FINDINGS Of the 20 decision-making metrics and roll-out scenario combinations, the same optimal strategy applied to all countries in only one combination; V60 was more or similarly desirable than V75 in 19 combinations. Of the 38 countries with fitted models, 11-37 countries had variable optimal strategies by decision-making metrics or roll-out scenarios. There are greater benefits in prioritising older adults when roll-out is slow and when vaccine profiles are less favourable. INTERPRETATION The optimal age-based vaccine prioritisation strategies were sensitive to country characteristics, decision-making metrics, and roll-out speeds. A prioritisation strategy involving more age-based stages (V75) does not necessarily lead to better health and economic outcomes than targeting broad age groups (V60). Countries expecting a slow vaccine roll-out may particularly benefit from prioritising older adults. FUNDING World Health Organization, Bill and Melinda Gates Foundation, the Medical Research Council (United Kingdom), the National Institute of Health Research (United Kingdom), the European Commission, the Foreign, Commonwealth and Development Office (United Kingdom), Wellcome Trust.
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Affiliation(s)
- Yang Liu
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine; Keppel St, London, United Kingdom WC1E 7HT
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine; Keppel St, London, United Kingdom WC1E 7HT
| | - Frank G. Sandmann
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine; Keppel St, London, United Kingdom WC1E 7HT
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine; Keppel St, London, United Kingdom WC1E 7HT
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England; 61 Colindale Ave, London, United Kingdom NW9 5EQ
| | - Rosanna C. Barnard
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine; Keppel St, London, United Kingdom WC1E 7HT
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine; Keppel St, London, United Kingdom WC1E 7HT
| | - Carl A.B. Pearson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine; Keppel St, London, United Kingdom WC1E 7HT
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine; Keppel St, London, United Kingdom WC1E 7HT
| | - Roberta Pastore
- World Health Organization (WHO) Regional Office for Europe; UN City, Marmorvej 51, 2100, Copenhagen, Denmark
| | - Richard Pebody
- World Health Organization (WHO) Regional Office for Europe; UN City, Marmorvej 51, 2100, Copenhagen, Denmark
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine; Keppel St, London, United Kingdom WC1E 7HT
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine; Keppel St, London, United Kingdom WC1E 7HT
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine; Keppel St, London, United Kingdom WC1E 7HT
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine; Keppel St, London, United Kingdom WC1E 7HT
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Meslé MM, Brown J, Mook P, Hagan J, Pastore R, Bundle N, Spiteri G, Ravasi G, Nicolay N, Andrews N, Dykhanovska T, Mossong J, Sadkowska-Todys M, Nikiforova R, Riccardo F, Meijerink H, Mazagatos C, Kyncl J, McMenamin J, Melillo T, Kaoustou S, Lévy-Bruhl D, Haarhuis F, Rich R, Kall M, Nitzan D, Smallwood C, Pebody RG. Estimated number of deaths directly averted in people 60 years and older as a result of COVID-19 vaccination in the WHO European Region, December 2020 to November 2021. Euro Surveill 2021; 26:2101021. [PMID: 34823641 PMCID: PMC8619871 DOI: 10.2807/1560-7917.es.2021.26.47.2101021] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/25/2021] [Indexed: 01/31/2023] Open
Abstract
Since December 2019, over 1.5 million SARS-CoV-2-related fatalities have been recorded in the World Health Organization European Region - 90.2% in people ≥ 60 years. We calculated lives saved in this age group by COVID-19 vaccination in 33 countries from December 2020 to November 2021, using weekly reported deaths and vaccination coverage. We estimated that vaccination averted 469,186 deaths (51% of 911,302 expected deaths; sensitivity range: 129,851-733,744; 23-62%). Impact by country ranged 6-93%, largest when implementation was early.
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Affiliation(s)
- Margaux Mi Meslé
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Jeremy Brown
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Piers Mook
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - José Hagan
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Roberta Pastore
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Nick Bundle
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Gianfranco Spiteri
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Giovanni Ravasi
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Nick Andrews
- UK Health Security Agency, London, United Kingdom
| | | | | | | | - Raina Nikiforova
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | | | | | | | - Jan Kyncl
- National Institute of Public Health, Prague, Czechia
| | | | | | | | | | | | - Rivka Rich
- Israel Ministry of Health, Jerusalem, Israel
| | - Meaghan Kall
- UK Health Security Agency, London, United Kingdom
| | - Dorit Nitzan
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Catherine Smallwood
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Richard G Pebody
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
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7
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Liu Y, Sandmann FG, Barnard RC, Pearson CA, Pastore R, Pebody R, Flasche S, Jit M. Optimising health and economic impacts of COVID-19 vaccine prioritisation strategies in the WHO European Region. medRxiv 2021:2021.07.09.21260272. [PMID: 34282421 PMCID: PMC8288152 DOI: 10.1101/2021.07.09.21260272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Countries in the World Health Organization (WHO) European Region differ in terms of the COVID-19 vaccine roll-out speed. We evaluated the health and economic impact of different age-based vaccine prioritisation strategies across this demographically and socio-economically diverse region. METHODS We fitted country-specific age-stratified compartmental transmission models to reported COVID-19 mortality in the WHO European Region to inform the immunity level before vaccine roll-out. Building upon broad recommendations from the WHO Strategic Advisory Group of Experts on Immunisation (SAGE), we examined four strategies that prioritise: all adults (V+), younger (20-59 year-olds) followed by older adults (60+) (V20), older followed by younger adults (V60), and the oldest adults (75+) (V75) followed by incremental expansion to successively younger five-year age groups. We explored four roll-out scenarios based on projections or recent observations (R1-4) - the slowest scenario (R1) covers 30% of the total population by December 2022 and the fastest (R4) 80% by December 2021. Five decision-making metrics were summarised over 2021-22: mortality, morbidity, and losses in comorbidity-adjusted life expectancy (cLE), comorbidity- and quality-adjusted life years (cQALY), and the value of human capital (HC). Six sets of infection-blocking and disease-reducing vaccine efficacies were considered. FINDINGS The optimal age-based vaccine prioritisation strategies were sensitive to country characteristics, decision-making metrics and roll-out speeds. Overall, V60 consistently performed better than or comparably to V75. There were greater benefits in prioritising older adults when roll-out is slow and when VE is low. Under faster roll-out, V+ was the most desirable option. INTERPRETATION A prioritisation strategy involving more age-based stages (V75) does not necessarily lead to better health and economic outcomes than targeting broad age groups (V60). Countries expecting a slow vaccine roll-out may particularly benefit from prioritising older adults. FUNDING World Health Organization, Bill and Melinda Gates Foundation, the Medical Research Council (United Kingdom), the National Institute of Health Research (United Kingdom), the European Commission, the Foreign, Commonwealth and Development Office (United Kingdom), Wellcome Trust. RESEARCH IN CONTEXT Evidence before this study: We searched PubMed and medRxiv for articles published in English from inception to 9 Jun 2021, with the search terms: ("COVID-19" OR "SARS-CoV-2") AND ("priorit*) AND ("model*") AND ("vaccin*") and identified 66 studies on vaccine prioritization strategies. Of the 25 studies that compared two or more age-based prioritisation strategies, 12 found that targeting younger adults minimised infections while targeting older adults minimised mortality; an additional handful of studies found similar outcomes between different age-based prioritisation strategies where large outbreaks had already occurred. However, only two studies have explored age-based vaccine prioritisation using models calibrated to observed outbreaks in more than one country, and no study has explored the effectiveness of vaccine prioritisation strategies across settings with different population structures, contact patterns, and outbreak history.Added-value of this study: We evaluated various age-based vaccine prioritisation strategies for 38 countries in the WHO European Region using various health and economic outcomes for decision-making, by parameterising models using observed outbreak history, known epidemiologic and vaccine characteristics, and a range of realistic vaccine roll-out scenarios. We showed that while targeting older adults was generally advantageous, broadly targeting everyone above 60 years might perform better than or comparably to a more detailed strategy that targeted the oldest age group above 75 years followed by those in the next younger five-year age band. Rapid vaccine roll-out has only been observed in a small number of countries. If vaccine coverage can reach 80% by the end of 2021, prioritising older adults may not be optimal in terms of health and economic impact. Lower vaccine efficacy was associated with greater relative benefits only under relatively slow roll-out scenarios considered.Implication of all the available evidence: COVID-19 vaccine prioritization strategies that require more precise targeting of individuals of a specific and narrow age range may not necessarily lead to better outcomes compared to strategies that prioritise populations across broader age ranges. In the WHO European Region, prioritising all adults equally or younger adults first will only optimise health and economic impact when roll-out is rapid, which may raise between-country equity issues given the global demand for COVID-19 vaccines.
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Affiliation(s)
- Yang Liu
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Frank G. Sandmann
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, United Kingdom
| | - Rosanna C. Barnard
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Carl A.B. Pearson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | | | - Roberta Pastore
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Richard Pebody
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine London, United Kingdom
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Porpora G, Rusciano F, Guida V, Greco F, Pastore R. Understanding charged vesicle suspensions as Wigner glasses: dynamical aspects. J Phys Condens Matter 2021; 33:104001. [PMID: 33246318 DOI: 10.1088/1361-648x/abce6f] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Suspensions of charged vesicles in water with added salt are widespread in nature and industrial production. Here we investigate, via Brownian dynamics simulations, a model that grasps the key features of these systems, with bidisperse colloidal beads interacting via a hard-core and an electrostatic double layer potential. Our goal is to focus on a set of interaction parameters that is not generic but measured in recent experiments, and relevant for a class of consumer products, such as liquid fabric softeners. On increasing the volume fraction in a range relevant to real formulation, we show that the dynamics become progressively slower and heterogeneous, displaying the typical signatures of an approaching glass transition. On lowering the salt concentration, which corresponds to increasing the strength and range of the electrostatic repulsion, the emergence of glassy dynamics becomes significantly steeper, and, remarkably, occurs at volume fractions well below the hard-sphere glass transition. The volume fraction dependence of the structural relaxation time at different salt concentration is well described through a functional law inspired by a recently proposed model (Krausser et al 2015 Proc. Natl Acad. Sci. USA 112 13762). According to our results, the investigated system may be thought of as a Wigner glass, i.e. a low-density glassy state stabilized by long-range repulsive interactions. Overall, our study suggests that glassy dynamics plays an important role in controlling the stability of these suspensions.
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Affiliation(s)
- G Porpora
- Department of Chemical, Materials and Production Engineering, University of Naples Federico II, P.le Tecchio 80, Naples 80125, Italy
| | - F Rusciano
- Department of Chemical, Materials and Production Engineering, University of Naples Federico II, P.le Tecchio 80, Naples 80125, Italy
| | - V Guida
- The Procter and Gamble Company, Brussels Innovation Center, 1853 Strombeek Bever Temselaan 100, 1853 Grimbergen, Belgium
| | - F Greco
- Department of Chemical, Materials and Production Engineering, University of Naples Federico II, P.le Tecchio 80, Naples 80125, Italy
| | - R Pastore
- Department of Chemical, Materials and Production Engineering, University of Naples Federico II, P.le Tecchio 80, Naples 80125, Italy
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Koh WC, Naing L, Chaw L, Rosledzana MA, Alikhan MF, Jamaludin SA, Amin F, Omar A, Shazli A, Griffith M, Pastore R, Wong J. What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors. PLoS One 2020; 15:e0240205. [PMID: 33031427 PMCID: PMC7544065 DOI: 10.1371/journal.pone.0240205] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case. METHODS We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger's meta-regression test. RESULTS 43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%). DISCUSSION While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.
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Affiliation(s)
- Wee Chian Koh
- Centre for Strategic and Policy Studies, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Lin Naing
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Muhammad Ali Rosledzana
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Mohammad Fathi Alikhan
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Sirajul Adli Jamaludin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Faezah Amin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Asiah Omar
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Alia Shazli
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Matthew Griffith
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Roberta Pastore
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Justin Wong
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
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Koh WC, Naing L, Chaw L, Rosledzana MA, Alikhan MF, Jamaludin SA, Amin F, Omar A, Shazli A, Griffith M, Pastore R, Wong J. What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors. PLoS One 2020; 15:e0240205. [PMID: 33031427 DOI: 10.1101/2020.05.21.20108746] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/23/2020] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case. METHODS We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger's meta-regression test. RESULTS 43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%). DISCUSSION While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.
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Affiliation(s)
- Wee Chian Koh
- Centre for Strategic and Policy Studies, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Lin Naing
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Muhammad Ali Rosledzana
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Mohammad Fathi Alikhan
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Sirajul Adli Jamaludin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Faezah Amin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Asiah Omar
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Alia Shazli
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Matthew Griffith
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Roberta Pastore
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Justin Wong
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
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Knapp JK, Mariano KM, Pastore R, Grabovac V, Takashima Y, Alexander JP, Reef SE, Hagan JE. Progress Toward Rubella Elimination - Western Pacific Region, 2000-2019. MMWR Morb Mortal Wkly Rep 2020; 69:744-750. [PMID: 32555136 PMCID: PMC7302473 DOI: 10.15585/mmwr.mm6924a4] [Citation(s) in RCA: 6] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Rubella is the leading vaccine-preventable cause of birth defects. Rubella typically manifests as a mild febrile rash illness; however, infection during pregnancy, particularly during the first trimester, can result in miscarriage, fetal death, or a constellation of malformations known as congenital rubella syndrome (CRS), commonly including one or more visual, auditory, or cardiac defects (1). In 2012, the Regional Committee of the World Health Organization (WHO) Western Pacific Region (WPR)* committed to accelerate rubella control, and in 2017, resolved that all countries or areas (countries) in WPR should aim for rubella elimination† as soon as possible (2,3). WPR countries are capitalizing on measles elimination activities, using a combined measles and rubella vaccine, case-based surveillance for febrile rash illness, and integrated diagnostic testing for measles and rubella. This report summarizes progress toward rubella elimination and CRS prevention in WPR during 2000-2019. Coverage with a first dose of rubella-containing vaccine (RCV1) increased from 11% in 2000 to 96% in 2019. During 1970-2019, approximately 84 million persons were vaccinated through 62 supplementary immunization activities (SIAs) conducted in 27 countries. Reported rubella incidence increased from 35.5 to 71.3 cases per million population among reporting countries during 2000-2008, decreased to 2.1 in 2017, and then increased to 18.4 in 2019 as a result of outbreaks in China and Japan. Strong sustainable immunization programs, closing of existing immunity gaps, and maintenance of high-quality surveillance to respond rapidly to and contain outbreaks are needed in every WPR country to achieve rubella elimination in the region.
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Woodring J, Pastore R, Brink A, Ishikawa N, Takashima Y, Tohme RA. Progress Toward Hepatitis B Control and Elimination of Mother-to-Child Transmission of Hepatitis B Virus - Western Pacific Region, 2005-2017. MMWR Morb Mortal Wkly Rep 2019; 68:195-200. [PMID: 30817746 PMCID: PMC6394384 DOI: 10.15585/mmwr.mm6808a2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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
Hepatitis B vaccine (HepB), which has been available since 1982, provides lifelong protection against hepatitis B virus (HBV) infection and the associated 20%-30% increased lifetime risk for developing cirrhosis or hepatocellular carcinoma among >95% of vaccine recipients (1). Before HepB introduction into national childhood immunization schedules, the estimated hepatitis B surface antigen (HBsAg) prevalence in the World Health Organization (WHO) Western Pacific Region (WPR)* was >8% in 1990 (2). In 2005, the WPR was the first WHO region to establish a hepatitis B control goal, with an initial target of reducing HBsAg prevalence to <2% among children aged 5 years by 2012. In 2013, the WPR set more stringent control targets to achieve by 2017, including reducing HBsAg prevalence to <1% in children aged 5 years and increasing national coverage with both timely HepB birth dose (HepB-BD) (defined as administration within 24 hours of birth) and the third HepB dose (HepB3) to ≥95% (3). All WPR countries/areas endorsed the Regional Action Plan for Viral Hepatitis in the Western Pacific Region 2016-2020 in 2015 (4) and the Regional Framework for the Triple Elimination of Mother-to-Child Transmission of human immunodeficiency virus (HIV), Hepatitis B and Syphilis in Asia and the Pacific 2018-2030 (triple elimination framework) in 2017 (5). These regional targets and strategies are aligned with program targets established by the WHO Global Health Sector Strategy on Viral Hepatitis 2016-2021 that aim to reduce HBsAg prevalence among children aged 5 years to ≤1% by 2020 and to ≤0.1% by 2030 (6). This report describes progress made to achieve hepatitis B control in the WPR and the steps taken to eliminate mother-to-child transmission (MTCT) of HBV during 2005-2017. During this period, regional timely HepB-BD and HepB3 coverage increased from 63% to 85% and from 76% to 93%, respectively. As of December 2017, 15 (42%) countries/areas achieved ≥95% timely HepB-BD coverage; 18 (50%) reached ≥95% HepB3 coverage; and 19 (53%) countries/areas as well as the region as a whole were verified to have achieved the regional and global target of <1% HBsAg prevalence among children aged 5 years. Continued implementation of proven vaccination strategies will be needed to make further progress toward WPR hepatitis B control targets. In addition to high HepB-BD and HepB3 coverage, enhanced implementation of complementary hepatitis B prevention services through the triple elimination framework, including routine HBsAg testing of pregnant women, timely administration of hepatitis B immunoglobulin to exposed newborns, and antiviral treatment of mothers with high viral loads, will be needed to achieve the global hepatitis B elimination target by 2030.
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Hagan JE, Greiner A, Luvsansharav UO, Lake J, Lee C, Pastore R, Takashima Y, Sarankhuu A, Demberelsuren S, Smith R, Park B, Goodson JL. Use of a Diagonal Approach to Health System Strengthening and Measles Elimination after a Large Nationwide Outbreak in Mongolia. Emerg Infect Dis 2018; 23. [PMID: 29155667 PMCID: PMC5711310 DOI: 10.3201/eid2313.170594] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Measles is a highly transmissible infectious disease that causes serious illness and death worldwide. Efforts to eliminate measles through achieving high immunization coverage, well-performing surveillance systems, and rapid and effective outbreak response mechanisms while strategically engaging and strengthening health systems have been termed a diagonal approach. In March 2015, a large nationwide measles epidemic occurred in Mongolia, 1 year after verification of measles elimination in this country. A multidisciplinary team conducted an outbreak investigation that included a broad health system assessment, organized around the Global Health Security Agenda framework of Prevent-Detect-Respond, to provide recommendations for evidence-based interventions to interrupt the epidemic and strengthen the overall health system to prevent future outbreaks of measles and other epidemic-prone infectious threats. This investigation demonstrated the value of evaluating elements of the broader health system in investigating measles outbreaks and the need for using a diagonal approach to achieving sustainable measles elimination.
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Craig AT, Butler MT, Pastore R, Paterson BJ, Durrheim DN. Acute flaccid paralysis incidence and Zika virus surveillance, Pacific Islands. Bull World Health Organ 2018; 95:69-75. [PMID: 28053366 PMCID: PMC5180343 DOI: 10.2471/blt.16.171892] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 11/27/2022] Open
Abstract
PROBLEM The emergence of Zika virus has challenged outbreak surveillance systems in many at-risk, low-resource countries. As the virus has been linked with Guillain-Barré syndrome, routine data on the incidence of acute flaccid paralysis (AFP) may provide a useful early warning system for the emergence of Zika virus. APPROACH We documented all Zika virus outbreaks and cases in 21 Pacific Islands and territories for the years 2007 to 2015. We extracted data from the Global Polio Eradication Initiative database on the reported and expected annual incidence of AFP in children younger than 15 years. Using a Poisson probability test, we tested the significance of unexpected increases in AFP in years correlating with Zika virus emergence. Data were analysed separately for each Pacific Island country and territory. LOCAL SETTING In most Pacific Island countries, early warning surveillance for acute public health threats such as Zika virus is hampered by poor health infrastructure, insufficient human resources and geographical isolation. RELEVANT CHANGES Only one example was found (Solomon Islands in 2015) of a significant increase in reported AFP cases correlating with Zika virus emergence. LESSONS LEARNT We found no conclusive evidence that routinely reported AFP incidence data in children were useful for detecting emergence of Zika virus in this setting. More evidence may be needed from adult populations, who are more likely to be affected by Guillain-Barré syndrome. Reporting of AFP may be deficient in regions certified as polio-free.
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Affiliation(s)
- Adam T Craig
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan 2308, NSW, Australia
| | | | - Roberta Pastore
- Expanded Programme on Immunization, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Beverley J Paterson
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan 2308, NSW, Australia
| | - David N Durrheim
- Population Health, Hunter New England Health, Wallsend, Australia
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Hagan JE, Kriss JL, Takashima Y, Mariano KML, Pastore R, Grabovac V, Dabbagh AJ, Goodson JL. Progress Toward Measles Elimination - Western Pacific Region, 2013-2017. MMWR Morb Mortal Wkly Rep 2018; 67:491-495. [PMID: 29723171 PMCID: PMC5933871 DOI: 10.15585/mmwr.mm6717a3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In 2005, the Regional Committee for the World Health Organization (WHO) Western Pacific Region (WPR)* established a goal for measles elimination† by 2012 (1). To achieve this goal, the 37 WPR countries and areas implemented the recommended strategies in the WPR Plan of Action for Measles Elimination (2) and the Field Guidelines for Measles Elimination (3). The strategies include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) through routine immunization services and supplementary immunization activities (SIAs), when required; 2) conducting high-quality case-based measles surveillance, including timely and accurate testing of specimens to confirm or discard suspected cases and detect measles virus for genotyping and molecular analysis; and 3) establishing and maintaining measles outbreak preparedness to ensure rapid response and appropriate case management. This report updates the previous report (4) and describes progress toward measles elimination in WPR during 2013-2017. During 2013-2016, estimated regional coverage with the first MCV dose (MCV1) decreased from 97% to 96%, and coverage with the routine second MCV dose (MCV2) increased from 91% to 93%. Eighteen (50%) countries achieved ≥95% MCV1 coverage in 2016. Seven (39%) of 18 nationwide SIAs during 2013-2017 reported achieving ≥95% administrative coverage. After a record low of 5.9 cases per million population in 2012, measles incidence increased during 2013-2016 to a high of 68.9 in 2014, because of outbreaks in the Philippines and Vietnam, as well as increased incidence in China, and then declined to 5.2 in 2017. To achieve measles elimination in WPR, additional measures are needed to strengthen immunization programs to achieve high population immunity, maintain high-quality surveillance for rapid case detection and confirmation, and ensure outbreak preparedness and prompt response to contain outbreaks.
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Hagan JE, Takashima Y, Sarankhuu A, Dashpagma O, Jantsansengee B, Pastore R, Nyamaa G, Yadamsuren B, Mulders MN, Wannemuehler KA, Anderson R, Bankamp B, Rota P, Goodson JL. Risk Factors for Measles Virus Infection Among Adults During a Large Outbreak in Postelimination Era in Mongolia, 2015. J Infect Dis 2017; 216:1187-1195. [PMID: 29040627 DOI: 10.1093/infdis/jix449] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 05/08/2017] [Accepted: 08/28/2017] [Indexed: 11/14/2022] Open
Abstract
Background In 2015, a large nationwide measles outbreak occurred in Mongolia, with very high incidence in the capital city of Ulaanbaatar and among young adults. Methods We conducted an outbreak investigation including a matched case-control study of risk factors for laboratory-confirmed measles among young adults living in Ulaanbaatar. Young adults with laboratory-confirmed measles, living in the capital city of Ulaanbaatar, were matched with 2-3 neighborhood controls. Conditional logistic regression was used to estimate adjusted matched odds ratios (aMORs) for risk factors, with 95% confidence intervals. Results During March 1-September 30, 2015, 20 077 suspected measles cases were reported; 14 010 cases were confirmed. Independent risk factors for measles included being unvaccinated (adjusted matched odds ratio [aMOR] 2.0, P < .01), being a high school graduate without college education (aMOR 2.6, P < .01), remaining in Ulaanbaatar during the outbreak (aMOR 2.5, P < .01), exposure to an inpatient healthcare facility (aMOR 4.5 P < .01), and being born outside of Ulaanbaatar (aMOR 1.8, P = .02). Conclusions This large, nationwide outbreak shortly after verification of elimination had high incidence among young adults, particularly those born outside the national capital. In addition, findings indicated that nosocomial transmission within health facilities helped amplify the outbreak.
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Affiliation(s)
| | - Yoshihiro Takashima
- Expanded Programme on Immunization, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | | | | | - Roberta Pastore
- Expanded Programme on Immunization, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | | | - Mick N Mulders
- Vaccine Preventable Diseases Laboratory Network, World Health Organization, Geneva, Switzerland
| | | | - Raydel Anderson
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bettina Bankamp
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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17
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Massafra U, Migliaccio S, Bancheri C, Chiacchiararelli F, Fantini F, Leoni F, Martin LS, Migliore A, Muccifora B, Napolitano C, Pastore R, Ragno A, Ronzoni S, Rotondi M, Tibaldi M, Villa P, Vinicola V, D'Erasmo E, Falaschi P, Minisola G. Approach in glucocorticoid-induced osteoporosis prevention: results from the Italian multicenter observational EGEO study. J Endocrinol Invest 2013; 36:92-6. [PMID: 22398397 DOI: 10.3275/8288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Glucocorticoid-induced osteoporosis (GIO) is the most frequent cause of secondary osteoporosis. GIO is linked to glucocorticoids (GC) daily assumption with maximum effect within first months of treatment and decreasing to basal levels as the therapy is discontinued. In Italy, primary prevention of GIO is suggested when GC therapy (prednisone >5 mg/day or equivalent) is taken for longer than 3 months. Lazio GISMO (Italian Group for Study and Diagnosis of Bone Metabolism Diseases) group organized the GC and Osteoporosis Epidemiology study (EGEO) to evaluate physician's approach in preventing GIO. The study involved 19 osteoporosis centers. Patients taking long-term GC therapy were recruited and information collected: medical history and anthropometric data, GC therapy, primary disease, physician's specialty, osteopororosis screening, and pharmacological intervention. The study included 1334 patients. Mean age was 63 ± 13 yr; 243 (18%) patients had a history of falls from standing position in the previous 12 months, 78 (35%) vertebral fractures, 91 (41%) fractures other than vertebral, 27 (12%) femoral fractures, and 27 (12%) multiple sites fractures. The molecules of GC more often prescribed were prednisone and 6-metil prednisolone. One thousand and forty patients (78%) were taking GC for more than 6 months. GC therapy was prescribed more frequently by rheumatologists (62%). Antiosteoporotic drugs for GIO prevention were prescribed in 431 patients (32%). Among the patients, only 27% (360) received calcium and vitamin D supplements, and 39% (319) treated by rheumatologists received anti-resorptive drugs. In conclusion, our data show that in Italy, as already described elsewhere, only a small subpopulation of GC-treated patients was supported by an anti-osteoporotic therapy, indicating the need to further stimulate awareness of both patients and specialists, prescribing GC therapy, to an appropriate and prompt GIO prevention.
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Affiliation(s)
- U Massafra
- Unità Operativa Semplice Reumatologia, Ospedale S. Pietro Fatebenefratelli, Rome, Italy
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18
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Longtin Y, Sudre P, François P, Schrenzel J, Aramburu C, Pastore R, Gervaix A, Renzi G, Pittet D, Harbarth S. Community-associated methicillin-resistant Staphylococcus aureus: risk factors for infection, and long-term follow-up. Clin Microbiol Infect 2009; 15:552-9. [DOI: 10.1111/j.1469-0691.2009.02715.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Pastore R, Schmid H, Altpeter E, Baumgartner A, Hächler H, Imhof R, Sudre P, Boubaker K. Outbreak of Salmonella serovar Stanley infections in Switzerland linked to locally produced soft cheese, September 2006 – February 2007. Euro Surveill 2008; 13. [PMID: 18801315 DOI: 10.2807/ese.13.37.18979-en] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Salmonella serovar Stanley is rare in Europe. In Switzerland, the number of reported isolates has increased from 2 in 2000 to 25 in 2005. A nationwide outbreak of gastrointestinal illness due to S. Stanley occurred from September 2006 through February 2007. Eighty-two cases were documented. Males were 56%; mean age of the cases was 45.7 years (range 0-92). Forty-seven cases (57%) occurred in three western cantons: Vaud, Bern, and Geneva. Twenty-three cases (28%) were hospitalised. In the case-control study conducted to find the source of the outbreak, cases were more likely than controls to have eaten local soft cheese (OR 11.4, p=0.008). One clone of S. Stanley strain was isolated from soft cheese and from 77 cases (94%) who reported no history of having travelled abroad. The outbreak ended after the withdrawal of the cheese from the market. This is the first S. Stanley outbreak in Switzerland and the first in Europe unrelated to imported products, suggesting an increased local circulation of this previously rare serotype.
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Affiliation(s)
- R Pastore
- General Directorate of Health of Geneva Canton, Geneva, Switzerland
- Federal Office of Public Health (FOPH), Division of Communicable Diseases, Bern, Switzerland
- European Programme of Intervention Epidemiology Training (EPIET)
| | - H Schmid
- Federal Office of Public Health (FOPH), Division of Communicable Diseases, Bern, Switzerland
| | - E Altpeter
- Federal Office of Public Health (FOPH), Division of Communicable Diseases, Bern, Switzerland
| | - A Baumgartner
- Federal Office of Public Health (FOPH), Food Safety Division, Bern, Switzerland
| | - H Hächler
- National Centre for Enteropathogenic Bacteria (NENT), Lucerne, Switzerland
| | - R Imhof
- Agroscope Liebefeld-Posieux Research Station (ALP), Bern, Switzerland
| | - P Sudre
- General Directorate of Health of Geneva Canton, Geneva, Switzerland
| | - K Boubaker
- Federal Office of Public Health (FOPH), Division of Communicable Diseases, Bern, Switzerland
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20
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Le Lin B, Pastore R, Liassine N, Aramburu C, Sudre P. A new sexually transmitted infection (STI) in Geneva? Ciprofloxacin-resistant Neisseria gonorrhoeae, 2002-2005. Swiss Med Wkly 2008; 138:243-6. [PMID: 18431700 DOI: 2008/15/smw-12029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PRINCIPLES Neisseria gonorrhoeae (NG) resistant to ciprofloxacin (CR) was documented for the first time in Geneva in 2002 and increased from 7% that year to 47% in 2005. We describe NG cases during this period and compare characteristics of CR and ciprofloxacin susceptible (CS) cases. METHOD Geneva microbiological laboratories identified NG cases. Antimicrobial susceptibility testing (AST) was performed on a sample of reported cases. The attending physicians completed questionnaires on demographic and epidemiological characteristics. Risk exposures were assessed by comparing CR and CS cases using logistic regression. RESULTS 238 NG cases were reported. Of 91 on which AST was performed, 23 (25%) were CR; 91% of these were male vs 87% of CS patients. Men having sex with men (MSM) represented 38% of CR cases compared with 31% of CS cases (p>0.05). Among CR cases 65% were Swiss compared with 56% of CS cases. Median age was 35 years for both. Casual sexual contacts were reported for 88% of CR cases and 72% of CS cases (p>0.05). The difference between CR and CS cases in terms of sexual activity outside Switzerland (50% and 19% respectively) remained significant after adjusting for sexual preference and nationality (OR: 7.0, CI 95: 1.99-24.6). CONCLUSION Although CR infection was more common among Swiss MSM, only sexual activity outside Switzerland was independently associated with CR. Physicians should request AST before treatment and reconsider first-line use of ciprofloxacin. Surveillance of gonococcal antimicrobial resistance is essential in monitoring epidemiologic trends and updating recommendations on first-line treatment.
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21
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Le Lin B, Pastore R, Liassine N, Aramburu C, Sudre P. A new sexually transmitted infection (STI) in Geneva? Ciprofloxacin-resistant Neisseria gonorrhoeae, 2002-2005. Swiss Med Wkly 2008; 138:243-6. [PMID: 18431700 DOI: 10.4414/smw.2008.12029] [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: 12/13/2022] Open
Abstract
PRINCIPLES Neisseria gonorrhoeae (NG) resistant to ciprofloxacin (CR) was documented for the first time in Geneva in 2002 and increased from 7% that year to 47% in 2005. We describe NG cases during this period and compare characteristics of CR and ciprofloxacin susceptible (CS) cases. METHOD Geneva microbiological laboratories identified NG cases. Antimicrobial susceptibility testing (AST) was performed on a sample of reported cases. The attending physicians completed questionnaires on demographic and epidemiological characteristics. Risk exposures were assessed by comparing CR and CS cases using logistic regression. RESULTS 238 NG cases were reported. Of 91 on which AST was performed, 23 (25%) were CR; 91% of these were male vs 87% of CS patients. Men having sex with men (MSM) represented 38% of CR cases compared with 31% of CS cases (p>0.05). Among CR cases 65% were Swiss compared with 56% of CS cases. Median age was 35 years for both. Casual sexual contacts were reported for 88% of CR cases and 72% of CS cases (p>0.05). The difference between CR and CS cases in terms of sexual activity outside Switzerland (50% and 19% respectively) remained significant after adjusting for sexual preference and nationality (OR: 7.0, CI 95: 1.99-24.6). CONCLUSION Although CR infection was more common among Swiss MSM, only sexual activity outside Switzerland was independently associated with CR. Physicians should request AST before treatment and reconsider first-line use of ciprofloxacin. Surveillance of gonococcal antimicrobial resistance is essential in monitoring epidemiologic trends and updating recommendations on first-line treatment.
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22
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Affiliation(s)
- Yves Jackson
- Geneva University Hospitals, Geneva, Switzerland
| | - Roberta Pastore
- General Directorate of Health, Geneva, Switzerland
- European Programme of Intervention Epidemiology Training, Solna, Sweden
| | | | - Louis Loutan
- Geneva University Hospitals, Geneva, Switzerland
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23
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Casciani E, Polettini E, Bertini L, Rotolo F, Truscelli G, Pittalis A, Masselli G, Campagnano S, Pastore R, Gualdi GF. [16-MDCT angiography coronary artery in the emergency department for patients with acute coronary syndrome (NSTEMI-UA)]. Clin Ter 2008; 159:5-12. [PMID: 18399255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM The diagnosis of acute coronary syndrome (ACS), non-ST-elevation myocardial infarction and unstable angina in the emergency department (ED) remains a challenge. The aim of our study was to investigate quality and the diagnostic accuracy of 16-MDCT coronary angiography, detecting coronary artery lesions in patients with suspected ACS presented in ED. MATERIALS AND METHODS We studied with 16-MDCT (Sensation 16, Siemens, Forchleim, Germania) and coronary angiography 37 patients with the following inclusion criteria: chest pain compatible with myocardial ischemia, normal or no-diagnostic ECG changes and initial concentrations of serum troponin-I < or =1 ng/ml. The 16-MDCT was performed with ECG-gated technique after the intravenous administration of 90-100 ml of iodinated contrast material followed by a saline bolus. The scan parameters were: 120 kV, 650-720 mAs, 16 x 0.75mm collimation, 0.42s rotation time, 3 mm (pitch 0.25) feed/rot, B30f kernel. We evaluated for each patient: image quality and different artefacts, plaques identification and characterization. RESULTS The evaluation of the image quality was based on a total of 453 segments, of which 415 segments (92.2%) were considered to have diagnostic image quality. MDCT correctly detected 15 patients with at least 1 stenosis >50% and correctly ruled out significant coronary artery disease in 19 patients with 1 FP and 2 FN: sensitivity 88%, specificity 95%, PPV 94%, NPV 90%. The plaques were hard in 6 cases, mixt in 16 cases and soft in 14 cases, respectively. CONCLUSIONS Our results point-out that 16-MDCT in ED has the real ability to detect and rule out significant coronary stenoses in patients with ACS.
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Affiliation(s)
- E Casciani
- Radiologia DEA, Azienda Policlinico Umberto I, Università La Sapienza, Roma, Italia.
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24
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Prato R, Germinario C, Pastore R, Napoli C, Squicciarini R, Lopalco PL. [Hospitalisations for cataract surgery in Puglia 2000-2002]. Ig Sanita Pubbl 2005; 61:249-59. [PMID: 17206192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Cataracts are a common condition and represent a frequent cause of visual disability. Nevertheless, data regarding the incidence of cataracts and the progression of and loss of vision due to cataracts is scarce. In this study, hospital discharge abstract data was evaluated to estimate the frequency and type of hospitalisations for cataract surgery that occurred in the Puglia region in the years 2000-2002. The results of this study confirm that cataract surgery accounts for a relevant amount of regional healthcare system costs. In fact, every year, over 25,000 lens surgery procedures, most of which age-related, are performed in the Puglia region. Approximately 90% of such procedures involve cataract surgery; age-specific hospitalisation rates show very high rates in the > 50 year old population. Only 25% of total cataract extractions were performed as a day-surgery procedure and the mean length of hospital stay was found to be 2.5 days. This confirms that inappropriate hospitalisations, with respect to both type and duration, do occur. Cataract surgery is performed in over 30 hospitals in Puglia; the availability of health facilities in the region, therefore, seems to be satisfactory. In fact, on average, in the three-year period, only 7.5% of cases underwent the procedure outside the Puglia region.
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Affiliation(s)
- Rosa Prato
- Dipartimento di Scienze Mediche e del Lavoro, Cattedra di Igiene, Universitr di Foggia
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25
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Prato R, Germinario C, Pastore R, Greco P, Sanguedolce A, Lopalco PL. [Opinions of women regarding a planned home birth project in Apulia (Southern Italy)]. Ann Ig 2005; 17:129-38. [PMID: 16676733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
A growing desire among women to move away from interventions and hospitals to more "natural" childbirth has emerged over several years. The role and autonomy of midwives, a favourable opinion among women about home childbirth and better cooperation between hospitals and district health facilities are all fundamental in order to implement a home birth project. The opinion of women about "planned" home birth was investigated in the Puglia region through a survey conducted among a sample of women who had just delivered in hospital and a representative sample of the general female population. From 20 to 30% of women in the Puglia region would be basically in favour of home birth project. The main difference between the two groups of women concern the higher proportion of caesarean deliveries among mothers who had just delivered and their demand for more specific training of involved health personnel. Both samples are agreed on the specific training of women during pregnancy and on the presence of a specialist during home delivery. The results of the investigation seem to be in favour of planning a home birth project in the Puglia region.
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Affiliation(s)
- R Prato
- Dipartimento di Scienze Mediche e del Lavoro, Cattedra di Igiene, Università degli Studi di Foggia
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26
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Frajese GV, De Martino MU, Calcagni E, Pastore R, Caprio M, Bultrini A, Moretti C, Frajese G, Fabbri A. The epidemiology of partialandrogen deficiency in aging men (PADAM). J Endocrinol Invest 2005; 28:3-7. [PMID: 16042354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
The quest for eternal youth has been prevalent in civilised societies in many cultures for many centuries. Preventing or deferring the disabilities and morbidities associated with aging through judicious pharmacotherapy has become a particularly relevant healthcare target with the rapid and relentless global demographic shift towards an increasingly elderly population in the 21th century. Aging men commonly loose muscle, become frail, have impaired sexual and cognitive functions, low mood, develop osteopenia and/or osteoporosis with increased risk for fractures and gain visceral fat which predisposes to diabetes, dyslipidaemia, and ischemic heart disease. These alterations in body function are reminiscent of states of androgen deficiency in younger patients. Indeed, aging is associated with a progressive age-related but variable decline in sex hormones. This condition has been named partial androgen deficiency in aging men (PADAM) and consists in a gradual decline in sex hormone levels over years resulting in physical and psychological changes as depression, impotence, decreased sex drive, loss of muscle tone or strength and lethargy. In this review we have tried to give a real identity to PADAM and quantify its entitiy, using the power of the epidemiology.
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Affiliation(s)
- G V Frajese
- Department of Internal Medicine, University Tor Vergata, Roma, Italy
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27
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Crema E, Benelli AG, Silva AV, Martins AJ, Pastore R, Kujavao GH, Silva AA, Santana JR. Assessment of pulmonary function in patients before and after laparoscopic and open esophagogastric surgery. Surg Endosc 2004; 19:133-6. [PMID: 15549632 DOI: 10.1007/s00464-004-8102-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2004] [Accepted: 07/14/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND Laparoscopy is a technique used in various surgical procedures. Few studies in the literature compare stress between laparoscopic and open surgery used for esophagogastric surgical procedures. Pulmonary function is known to be significantly affected in open surgeries, increasing postoperative morbidity and mortality. The current study aimed to assess pulmonary function in patients before and after open and laparoscopic esophagogastric surgery. METHODS For this study, 75 patients were divided into two groups: 50 patients undergoing laparoscopy and 25 patients undergoing open surgery. The following parameters were determined by spirometry before and after surgery: forced expiratory volume in the first second (FEV(1)), forced vital capacity (FVC), and forced expiratory flow in the midexpiratory phase (FEF(25-75%)). RESULTS A decrease in FEV(1,) FVC, and FEF((25-75%)) was observed in the two groups on postoperative days 2, 3, and 4, as compared with the preoperative period. Likewise, FEV(1) and FVC showed a significant reduction on postoperative days 2, 3, and 4 in the patients who underwent to open surgery, but only on the day 2 in those who underwent to laparoscopic surgery. A significant decrease in FEF((25-75%)) was observed only on postoperative day 2 in the group that underwent open surgery. Significant differences in FEV(1) between the groups were observed on postoperative days 2, 3, and 4. No significant difference in FVC was noted between the groups, and a difference in FEF((25-75%)) was observed only on postoperative day 4. CONCLUSIONS Postoperative pulmonary dysfunction was more important for the patients undergoing open surgery than for those undergoing laparoscopic surgery.
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Affiliation(s)
- E Crema
- The Academic Unit of Surgery, Federal School of Medicine of Triângulo Minerio, Uberaba, MG, Brazil.
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28
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De Martino MU, Pastore R, Caprio M, Frajese G, Fabbri A. Dynamic testing in the evaluation of male gonadal function. J Endocrinol Invest 2003; 26:107-13. [PMID: 14604073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
The maturation and physiologic functions of male sexual apparatus are under the control of the hypothalamic-pituitary-gonadal (HPG) axis. The determination of gonadotropins and testosterone as secretory products of pituitary and gonads, respectively, represents the first step in the evaluation of male sexual function and the diagnosis of disorders in male reproductive axis. However, there are several clinical situations that require a dynamic evaluation of this system and the measurement of basal gonadotropins and testosterone must be combined with specific dynamic tests. These mainly consist in GnRH stimulation, which evaluates the endocrine reserve capacity of the pituitary, and human chorionic gonadotropin (hCG) stimulation, which is used in the assessment of Leydig cells activity. The paper illustrates the technical aspects, the normal/pathological responses and the role of these two tests in assessing the male HPG axis in respect to different clinical diagnostic queries.
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Affiliation(s)
- M U De Martino
- Endocrinology Unit, Department of Internal Medicine, Tor Vergata University, Rome, Italy
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29
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Blanco E, Carvalho J, Fonseca A, Pinotti J, Pastore R. P3.16.37 Transvaginal color Doppler sonography in ovarian tumors with use of levovist ®
for improved visualization of the blood flow. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)85519-8] [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: 10/26/2022]
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30
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Santiemma V, Garufi G, Magnanti M, Pastore R, Rossi HF, Guerrini HL, De Meo M, Fabbrini A. Luteinizing hormone pulsatility is altered in essential hypertension. Arch Androl 1997; 38:23-8. [PMID: 9017119 DOI: 10.3109/01485019708988528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this investigation was to study the pattern of luteinizing hormone (LH) secretion in men with mild and moderate hypertension. LH pulsatility was evaluated for 8 h in 14 male patients, subdivided into 2 groups; group A, consisting of 8 patients, whose systolic blood pressure ranged between 180 and 160 mm Hg and whose diastolic blood pressure was between 115 and 105 mm Hg; and group B, 6 patients whose systolic blood pressure ranged between 220 and 180 mm Hg and whose diastolic blood pressure was between 104 and 95 mm Hg. Seven healthy males were evaluated as controls (group C). The major changes of LH pulsatility in group A included an increased peak width, increased peak amplitude, and increased peak area. In group B the changes followed the same pattern as in group A, but were more pronounced. The number of LH peaks was reduced, the peak width was increased, and both peak amplitude and peak area were increased as compared to the control group. The pattern of LH pulsatility is altered in essential hypertension and the main feature is represented by the prolonged duration of LH peaks and their greater amplitude. The altered pattern of LH secretion is likely to reflect a primary hypothalamic derangement with the gonadotropin releasing hormone (Gn-RH) secreting neurons remaining synchronized for longer times and secreting larger Gn-RH masses than in normal subjects. Since the nuclei of the brain stem (A1-A6) involved in the control of Gn-RH secretion respond to blood pressure changes, the altered activity of monoaminergic neurons may be the link between hypertension and changes of LH pulsatility.
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Affiliation(s)
- V Santiemma
- Department of Medical Pathophysiology-V Clinica Medica, La Sapienza University, Rome, Italy
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31
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Falaschi P, D'Urso R, Proietti A, Martocchia A, Pastore R, Angelucci L. Effect of r-interferon alpha administration on hypothalamus-pituitary-thyroid axis in chronic hepatitis. Life Sci 1996; 60:43-50. [PMID: 8995531 DOI: 10.1016/s0024-3205(96)00587-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Recent studies pointed out the development of autoimmune thyroid diseases during interferon (IFN) therapy, mainly in patients with positive thyroid autoantibodies (MsAb and TgAb) before treatment. The effects of recombinant human IFN alpha (rhIFNalpha) on thyroid function and thyroid autoantibodies were studied in 12 patients with chronic active hepatitis associated with virus B or C, selected on the basis of negative results for MsAb and TgAb. No significant variation in T3, T4 and TSH levels was observed either after the first administration of rhIFN alpha (3 million IU i.m.) or after three months of therapy (3 million IU i.m. 3 times a week). TSH response to TRH was in the normal range either before or after the therapy. The absence of MsAb and TgAb was confirmed in all the patients at the end of the treatment. These results indicate that no patient developed thyroid disorder during IFN therapy. Nevertheless, since positive MsAb and TgAb have been considered as a risk factor for thyroid diseases, in patients selected for IFN therapy they should be carefully assessed for autoantibodies before undergoing IFN treatment.
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Affiliation(s)
- P Falaschi
- Chair of Medical Therapy, 2nd University of Naples, Italy
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32
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Jacobson DR, Pastore R, Pool S, Malendowicz S, Kane I, Shivji A, Embury SH, Ballas SK, Buxbaum JN. Revised transthyretin Ile 122 allele frequency in African-Americans. Hum Genet 1996; 98:236-8. [PMID: 8698351 DOI: 10.1007/s004390050199] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The transthyretin (TTR) Ile 122 variant is associated with cardiac amyloidosis in individuals of African descent. To determine the prevalence of the allele encoding TTR Ile 122 in African-Americans, we have used PCR and restriction analysis to test DNA from African-Americans from various geographic areas, and found an allele frequency of 66/3376 (0.020), which is higher than the value we previously reported in a much smaller pilot study. Our data indicate that this TTR variant is present at equal frequency in African-Americans throughout the U.S., and suggest that this mutation may be a common, often unrecognized cause of cardiac disease in African-Americans.
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Affiliation(s)
- D R Jacobson
- Department of Medicine, New York University School of Medicine and Research Service, New York Veterans Administration Medical Center 10010, USA
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33
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Santiemma V, Garufi G, Magnanti M, Pastore R, Beligotti F, Malizia S, Mariani S, Fabbrini E, De Meo M, Fabbrini A. [Alteration of luteinizing hormone pulsatility in patients with arterial hypertension]. Recenti Prog Med 1996; 87:58-61. [PMID: 8725081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The pattern of luteinizing hormone (LH) secretion in men with mild and moderate hypertension was studied. LH pulsatility was evaluated for eight hours in 14 male patients, who were subdivided into two groups: group A, consisting of 8 patients, whose systolic blood pressure ranged between 180-160 mmHg and the diastolic between 104-95 mmHg; group B, 6 patients whose systolic blood pressure ranged between 220 and 180 mmHg and the diastolic between 115-105 mmHg. Seven healthy adult males were evaluated as a control. The major changes of LH pulsatility in group A included an increased peak width (p < 0.05), increased peak amplitude (p < 0.001) and increased peak area (p < 0.001). In group B the changes followed the same pattern as in group A, but were more pronounced. The number of LH peaks was reduced (p < 0.01), the peak width was increased (p < 0.05), and both peak amplitude and peak area were increased as compared to the control group (p < 0.001). Our study demonstrates that the pattern of LH pulsatility is altered in essential hypertension and the main feature is represented by the prolonged duration of LH peaks and their greater amplitude. The altered pattern of LH secretion is likely to reflect a primary hypothalamic derangement with the gonadotropin releasing hormone (Gn-RH) secreting neurons remaining synchronized for longer times and secreting larger Gn-RH masses than in normal subjects.
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Affiliation(s)
- V Santiemma
- Dipartimento di Fisiopathologia Medica, Università La Sapienza, Roma
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Falaschi P, Martocchia A, Proietti A, Pastore R, D'Urso R. Immune system and the hypothalamus-pituitary-adrenal axis. Common words for a single language. Ann N Y Acad Sci 1994; 741:223-33. [PMID: 7825810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- P Falaschi
- Chair of Medical Therapy, Faculty of Medicine, 2nd University of Naples, Italy
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Perrone G, Falaschi P, Capri O, Pastore R, Galoppi P, D'Urso R, Martocchia A, Anelli G, Zichella L. Hormonal and metabolic effects of transdermal estradiol/progestagen administration in postmenopausal women. Int J Fertil Menopausal Stud 1994; 39:202-7. [PMID: 7951402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate the effects on hormonal and metabolic variables and bone density of a transdermal system delivering estrogen and progestagen. DESIGN Twenty-one patients were included in the study and randomly assigned to the following treatments: group A was treated with transdermal 17 beta-estradiol, 50 micrograms/day (Estraderm TTS 50), from the first to the fourteenth day of the cycle and with a transdermal combination of 17 beta-estradiol (50 micrograms/day) and norethisterone acetate (NETA) 250 micrograms/day during the following 14 days; group B was treated with Estraderm TTS 50 from the first to the twenty-eighth day, adding oral medroxyprogesterone acetate (MPA), 10 mg/day, during the final 14 days. DHEAS, testosterone, SHBG, prolactin, gonadotropins, and estrogens were measured in basal conditions and after 6 months' therapy. In the same schedule, lipid patterns (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides), phosphocalcium variables (osteocalcin, calcitonin, parathormone), and bone mineral density were also studied. RESULTS Both treatments were efficient in reducing menopausal symptoms. An increase of DHEAS (P < .05) and a decrease of FSH and LH (P < .02, < .01, respectively) were observed in group B. No significant modifications in lipid and lipoprotein metabolism were shown in either group after 6 months. The calcium-regulating hormone osteocalcin (BCG) decreased significantly (P < .05) only in group A; calcitonin, parathormone, and bone density were unchanged after treatment. CONCLUSION Transdermal administration of estrogen plus progestagen reduces menopausal symptoms, but does not induce changes in metabolic variables and hormonal levels (androgens and prolactin).
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Affiliation(s)
- G Perrone
- Institute of 1st Obstetrics and Gynecological Clinic, University of Rome, La Sapienza, Italy
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Falaschi P, Martocchia A, Proietti A, Pastore R, D'Urso R, Barnaba V. Neuroendocrinoimmunology. Ann Ital Med Int 1994; 9:96-9. [PMID: 7917767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Interest in neuroendocrinoimmunology has increased greatly in the last decade. The most important evidence of neuroendocrine-immune system interactions is that spleen, thymus, bone marrow and lymph nodes are innervated by neurons of the autonomic nervous system; changes in brain functions can affect different immune responses; immune and neuroendocrine cells share receptors (e.g., lymphocytes and macrophages have receptors for a vast number of hormones and neuropeptides); hormones and neuropeptides can alter the functional activity of immune system cells; several hormones and neuropeptides can be synthesized by leukocytes; cytokines produced by leukocytes are able to modulate neuroendocrine system activity, behaviour, sleep and thermoregulation. The recent literature on neuroendocrinoimmunology has laid the physiopathological groundwork for a new clinical approach which perceives and treats the patient as a psychic and somatic whole.
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Affiliation(s)
- P Falaschi
- Dipartimento di Internistica Clinica e Sperimentale, II Università degli Studi di Napoli
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Roggi C, Maccarini L, Melzi D'Eril GV, Merlo E, Pastore R, Simonetti P. [Alcohol, smoking and the plasma lipid picture: the results of a study conducted on a general adult population]. Ann Ig 1994; 6:139-48. [PMID: 7532958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- C Roggi
- Dip. di Medicina Preventiva Occupazionale e di Communità, Università di Pavia
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d'Eril GM, Valenti G, Pastore R, Pankopf S. More on stability of albumin, N-acetylglucosaminidase, and creatinine in urine samples. Clin Chem 1994; 40:339-40. [PMID: 8135955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Falaschi P, Pajalich R, Ruotolo G, Pastore R, Martocchia A, Di Biasi C, Trasimeni G, Gualdi G, Balsano F. [The diagnosis and therapy of hyperprolactinemia]. Recenti Prog Med 1993; 84:296-310. [PMID: 8488335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hyperprolactinaemia is the most common result of pituitary dysfunction and is characterized by alteration on the reproductive function. After a review of the hypothalamic control mechanisms and of the local paracrine and autocrine factors regulating prolactin secretion, the most common physiological, pharmacological and pathological causes of hyperprolactinaemia are described. The clinical pictures of hyperprolactinaemia in man and woman are then summarized. The diagnostic protocol used in this Institute is then described: confirmation of the existence and entity of hyperprolactinaemia by means of a prolactin profile; exclusion of pharmacological or extra pituitary causes (cirrhosis, primitive hypothyroidism, chronic renal failure, etc.); neuro-radiological evaluation of the sella region, by means of standard X-ray, computer tomography scan, nuclear magnetic resonance. The drugs commonly used in medical treatment of hyperprolactinaemia such as a bromocriptine, other-derived compounds and then recent CV 205-502, and the surgical approaches (trans-sphenoidal and transcranial routes) are reported. The indication of medical or surgical treatment and the relevance of radiotherapy are finally considered.
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Affiliation(s)
- P Falaschi
- Fondazione Andrea Cesalpino, I Clinica Medica, Università La Sapienza, Roma
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Picardo M, Santucci B, Pastore R, Valesini G, Verducchi D, Bravi D. Immune complexes in patients with contact dermatitis. Dermatologica 1986; 172:52-3. [PMID: 3956821 DOI: 10.1159/000249293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
By C1q binding assay, circulating immune complexes (cic) were detected in 19 out of 30 patients with contact dermatitis to nickel or chromium. Their presence was correlated with the duration of the disease, while any patients positive for cic showed any signs of type III immunopathological lesions. Atomic absorption analysis of the polyethlylene glycol precipitates (PEG ppt) from the sera of 16 patients--8 positive and 8 negative for cic--revealed an amount of nickel or chromium significantly higher in the PEG ppt from the sera of patients positive for cic.
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Gangemi B, Fischer A, Di Gregorio F, Leonardi S, Pastore R, Musumeci S. [Hepatic pathology in beta-thalassemia major]. Pediatr Med Chir 1986; 8:77-83. [PMID: 3725617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Liver function has been evaluated in 74 patients (aged 9 months to 19 years) with beta-thalassemia major. They were selected from 212 patients because their transaminase levels were three times higher than normal for over three months. In 36 of these subjects BSF clearance test was performed. In the majority of patients (70%) average GPT serum values were increased (66.33 +/- 35.41 U/L) while only a few of the youngest age group exhibited normal values. The transaminase level showed a direct relationship with age, ferritin level and transfusional iron. Furthermore a direct correlation was found between iron and gamma globulin levels both being related to age. Test for viral hepatitis markers showed that 60% of all the subjects studied had had HBV infection. Twenty-six of the 36 patients who underwent BSF test had normal values in the first part of the clearance curve, 8 others showed moderate changes while only the 2 remaining revealed severe alterations. The second part of the curve was abnormal in 34 and markedly altered in 2 subjects. Mean GPT serum values correlated with the first part of BSF clearance curve and BSF 45' values correlated with transfused iron. Siderosis, fibrosis, chronic inflammatory infiltration and vacuolar degeneration were seen at liver biopsy. Histological findings of chronic aggressive hepatitis were shown in two patients with high transaminase and gammaglobulin levels who had markedly abnormal BSF curve.
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Valesini G, Pastore R, de Berardinis PG, Serafini U, Vincent A, Bottazzo GN. Appearance of anti-acetylcholine receptor antibodies coincident with onset of myasthenic weakness in patient with systemic lupus erythematosus. Lancet 1983; 1:831. [PMID: 6132176 DOI: 10.1016/s0140-6736(83)91901-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Pini C, Pastore R, Valesini G. Circulating immune complexes in sera of patients infected with Echinococcus granulosus. Clin Exp Immunol 1983; 51:572-8. [PMID: 6406114 PMCID: PMC1536796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Circulating immune complexes (CIC) were investigated by the C1q binding assay in sera of 23 patients infected with Echinococcus granulosus. For the 23 sera studied, nine were found to be positive in the test. When the samples were grouped according to the cyst localization, the highest rate of CIC positively was found in the group of sera from patients with pulmonary cyst; in this group, double diffusion (DD) and indirect haemagglutination (IHA) tests gave a low rate of positivity for antibodies directed against parasitic antigens. Rheumatoid factor, anti-nuclear and anti-mitochondrial autoantibodies were not detectable in patients' sera by indirect immunofluorescence technique (IIF). Anti-smooth muscle autoantibodies, detectable by IIF, were present in 56% of the sera and this positivity was higher in the hepatic (83%) than in the pulmonary form (40%).
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Valesini G, Picardo M, Pastore R, Pivetti P, Serafini U. Circulating immune complexes in Behçet's syndrome: purification, characterization and cross-reactivity studies. Clin Exp Immunol 1981; 44:522-7. [PMID: 6976862 PMCID: PMC1537329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The C1q-binding assay was performed on 30 sera from patients with Behçet's syndrome and circulating immune complexes were found in 46%. Circulating immune complexes were isolated and purified from the sera of two patients by immunoadsorption on a column of polymethylmetacrylate beads coated with C1q and then labelled with 125I. In double immunodiffusion these purified immune complexes were found to contain IgG, C1q, C1s and C3. Anti-IgG activity was not detectable in the purified immune complexes while specific cross-reactivity was found in a solid-phase radioimmunoassay with the majority of the sera of behçet's syndrome.
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Abstract
Leukocyte migration inhibition test (LMT) with semipurified spermatozoal antigen was carried out in two groups: normal males (fertile subjects before vasectomy; normal volunteers) and selected forms of male infertility. The percent positivity to the LMT in all the pathological groups considered, compared with controls positivity in only one out of 40 cases and only at the highest concentrations of Ag, stresses the important role played by cell-mediated antisperm immunity in male infertility. No characteristic seminal pattern was observed in the patients with positive LMT, probably on account of the particular selection of the patients studied. Finally, no significant correlation between humoral and cell-mediated antisperm immunity was observed, at least not in these selected series of patients.
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Pastore R, Pagliarello F. [Clinical use of a new non-steroid drug in the menopausal syndrome and in inhibition of lactation]. Riv Ital Ginecol 1976; 57:37-42. [PMID: 800676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Carollo F, Cadili G, Pastore R. [Study of anemias in pregnancy in patients hospitalized at the obstetric and gynecologic clinic of the University of Palermo]. Riv Ital Ginecol 1974; 55:329-40. [PMID: 4411010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Urso SA, Montalbano ME, Fileccia R, Pastore R. [Correlations between gastric and duodenal electrical activity]. Boll Soc Ital Biol Sper 1972; 48:469-73. [PMID: 4643386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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