Effectiveness: A/H1N1 vaccine and underlying chronic diseases – Denmark, 2009-10

British Medical Journal
28 January 2012 (Vol 344, Issue 7841)
http://www.bmj.com/content/current

Effectiveness of vaccine against pandemic influenza A/H1N1 among people with underlying chronic diseases: cohort study, Denmark, 2009-10
BMJ 2012;344:d7901 (Published 25 January 2012)
Hanne-Dorthe Emborg, Tyra Grove Krause, Anders Hviid, Jacob Simonsen, Kåre Mølbak,

Abstract
Objective
To determine the effectiveness of an adjuvanted monovalent vaccine against pandemic influenza A/H1N1 among people with underlying chronic diseases.

Design
Historical cohort study.

Setting
Mandatory national reporting systems, 2 November 2009 to 31 January 2010, Denmark.

Participants
388 069 people under 65 years of age with a diagnosis in the past five years of at least one underlying disease expected to increase the risk of severe illness after influenza.

Main outcome measures
Laboratory confirmed H1N1 infection and influenza related hospital admission with laboratory confirmed H1N1 infection. Estimates of vaccine effectiveness were adjusted for age and underlying disease.

Results
The effectiveness of pandemic vaccine against confirmed H1N1 infection 14 days after one dose of vaccine was 49% (95% confidence interval 10% to 71%). The effectiveness of vaccine against admission to hospital for confirmed H1N1 infection was 44% (−19% to 73%).

Conclusions
The adjuvanted monovalent vaccine against pandemic influenza A/H1N1 was offered late in the 2009-10 influenza season. Among chronically ill people, this vaccine offered protection against laboratory confirmed H1N1 infection but only offered non-significant protection against influenza related hospital admissions confirmed as H1N1 infection. This finding is of public health relevance because the population of chronically ill people is a major target group for pandemic vaccinations and because of the delayed availability of pandemic vaccines in a forthcoming pandemic.

Pathogenic Responses among Young Adults: 1918 Influenza Pandemic

Emerging Infectious Diseases
Volume 18, Number 2—February 2012
http://www.cdc.gov/ncidod/EID/index.htm

Perspective
Pathogenic Responses among Young Adults during the 1918 Influenza Pandemic
G. Shanks and J. F. Brundage

Abstract
Of the unexplained characteristics of the 1918–19 influenza pandemic, the extreme mortality rate among young adults (W-shaped mortality curve) is the foremost. Lack of a coherent explanation of this and other epidemiologic and clinical manifestations of the pandemic contributes to uncertainty in preparing for future pandemics. Contemporaneous records suggest that immunopathologic responses were a critical determinant of the high mortality rate among young adults and other high-risk subgroups. Historical records and findings from laboratory animal studies suggest that persons who were exposed to influenza once before 1918 (e.g., A/H3Nx 1890 pandemic strain) were likely to have dysregulated, pathologic cellular immune responses to infections with the A/H1N1 1918 pandemic strain. The immunopathologic effects transiently increased susceptibility to ultimately lethal secondary bacterial pneumonia. The extreme mortality rate associated with the 1918–19 pandemic is unlikely to recur naturally. However, T-cell–mediated immunopathologic effects should be carefully monitored in developing and using universal influenza vaccines.

Commentaries
1918 Influenza, a Puzzle with Missing Pieces
D. M. Morens and J. K. Taubenberger

Diphtheria in the Postepidemic Period, Europe, 2000–2009

Emerging Infectious Diseases
Volume 18, Number 2—February 2012
http://www.cdc.gov/ncidod/EID/index.htm

Research
Diphtheria in the Postepidemic Period, Europe, 2000–2009
K. S. Wagner et al.

Abstract
Diphtheria incidence has decreased in Europe since its resurgence in the 1990s, but circulation continues in some countries in eastern Europe, and sporadic cases have been reported elsewhere. Surveillance data from Diphtheria Surveillance Network countries and the World Health Organization European Region for 2000–2009 were analyzed. Latvia reported the highest annual incidence in Europe each year, but the Russian Federation and Ukraine accounted for 83% of all cases. Over the past 10 years, diphtheria incidence has decreased by >95% across the region. Although most deaths occurred in disease-endemic countries, case-fatality rates were highest in countries to which diphtheria is not endemic, where unfamiliarity can lead to delays in diagnosis and treatment. In western Europe, toxigenic Corynebacterium ulcerans has increasingly been identified as the etiologic agent. Reduction in diphtheria incidence over the past 10 years is encouraging, but maintaining high vaccination coverage is essential to prevent indigenous C. ulcerans and reemergence of C. diphtheriae infections.

Serum Vaccine Antibody Concentrations in Children Exposed to Perfluorinated Compounds

JAMA   
January 25, 2012, Vol 307, No. 4, pp 335-421
http://jama.ama-assn.org/current.dtl

Original Contributions
Serum Vaccine Antibody Concentrations in Children Exposed to Perfluorinated Compounds
Philippe Grandjean, Elisabeth Wreford Andersen, Esben Budtz-Jørgensen, Flemming Nielsen, Kåre Mølbak, Pal Weihe, Carsten Heilmann
JAMA. 2012;307(4):391-397.doi:10.1001/jama.2011.2034

Abstract
Context
Perfluorinated compounds (PFCs) have emerged as important food contaminants. They cause immune suppression in a rodent model at serum concentrations similar to those occurring in the US population, but adverse health effects of PFC exposure are poorly understood.

Objective
To determine whether PFC exposure is associated with antibody response to childhood vaccinations.

Design, Setting, and Participants
Prospective study of a birth cohort from the National Hospital in the Faroe Islands. A total of 656 consecutive singleton births were recruited during 1999-2001, and 587 participated in follow-up through 2008.

Main Outcome
Measures Serum antibody concentrations against tetanus and diphtheria toxoids at ages 5 and 7 years.

Results
Similar to results of prior studies in the United States, the PFCs with the highest serum concentrations were perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA). Among PFCs in maternal pregnancy serum, PFOS showed the strongest negative correlations with antibody concentrations at age 5 years, for which a 2-fold greater concentration of exposure was associated with a difference of −39% (95% CI, −55% to −17%) in the diphtheria antibody concentration. PFCs in the child’s serum at age 5 years showed uniformly negative associations with antibody levels, especially at age 7 years, except that the tetanus antibody level following PFOS exposure was not statistically significant. In a structural equation model, a 2-fold greater concentration of major PFCs in child serum was associated with a difference of −49% (95% CI, −67% to −23%) in the overall antibody concentration. A 2-fold increase in PFOS and PFOA concentrations at age 5 years was associated with odds ratios between 2.38 (95% CI, 0.89 to 6.35) and 4.20 (95% CI, 1.54 to 11.44) for falling below a clinically protective level of 0.1 IU/mL for tetanus and diphtheria antibodies at age 7 years.

Conclusion
Elevated exposures to PFCs were associated with reduced humoral immune response to routine childhood immunizations in children aged 5 and 7 years.

Validation of Self-swab for Confirmation of Influenza Virus Infections

Journal of Infectious Diseases
Volume 205 Issue 4 February 15, 2012
http://www.journals.uchicago.edu/toc/jid/current

Viruses
Dennis K. M. Ip, Martin Schutten, Vicky J. Fang, Rita O. P. Fung, Regina T. Dutkowski, Kwok-Hung Chan, Gabriel M. Leung, J. S. Malik Peiris, and Benjamin J. Cowling
Validation of Self-swab for Virologic Confirmation of Influenza Virus Infections in a Community Setting
J Infect Dis. (2012) 205(4): 631-634 doi:10.1093/infdis/jir803

Abstract
Few studies have investigated the validity of self-collected nose and throat swabs for influenza confirmation in community settings. We followed outpatients with confirmed influenza with sequential measurement of viral loads and applied log-linear regression models to the viral shedding patterns. Among 176 outpatients with confirmed influenza, the detection of virus and quantitative viral loads obtained from self-swabs was consistent with statistical predictions based on earlier and later measurements, suggesting that self-collected nose and throat swabs can be a valid alternative for virologic confirmation of influenza A or B infection in a community setting.

Tackling drug-resistant tuberculosis in Europe

The Lancet  
Jan 28, 2012  Volume 379  Number 9813  p287 – 384  e20 – 26
http://www.thelancet.com/journals/lancet/issue/current

Tackling the spread of drug-resistant tuberculosis in Europe
Ibrahim Abubakar, Masoud Dara, Davide Manissero, Alimuddin Zumla

Preview
Multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis have become an important health problem in many countries of the WHO European region and currently threaten global efforts to control tuberculosis.1–4 About 81 000 (18·4%) of the 440 000 patients worldwide with MDR tuberculosis live in this region.2 The highest rates occur predominantly in eastern Europe; however, population movement means that drug-resistant tuberculosis is a priority public health issue for all European countries.