scholarly journals Updated Postlicensure Surveillance of the Meningococcal C Conjugate Vaccine in England and Wales: Effectiveness, Validation of Serological Correlates of Protection, and Modeling Predictions of the Duration of Herd Immunity

2010 ◽  
Vol 17 (5) ◽  
pp. 840-847 ◽  
Author(s):  
Helen Campbell ◽  
Nick Andrews ◽  
Ray Borrow ◽  
Caroline Trotter ◽  
Elizabeth Miller
Keyword(s):  
Confidence Interval ◽  
Herd Immunity ◽  
Vaccine Effectiveness ◽  
Short Term ◽  
Correlates Of Protection ◽  
The United Kingdom ◽  
Herd Immunity Effect ◽  
Bactericidal Antibody ◽  
Low Levels

ABSTRACT Meningococcal serogroup C conjugate (MCC) vaccines were licensed in the United Kingdom more than 10 years ago based on correlates of protection that had previously been established for serogroup C-containing polysaccharide vaccines by using the serum bactericidal antibody (SBA) assay. These correlates of protection were subsequently validated against postlicensure estimates of observed vaccine effectiveness up to 7 to 9 months after the administration of the MCC vaccine. Vaccine effectiveness was, however, shown to fall significantly more than 1 year after the administration of a 3-dose course in infancy. Despite this finding, the marked impact on serogroup C disease has been sustained, with the lowest recorded incidence (0.02 case per 100,000 population) in the 2008-2009 epidemiological year, mainly due to the indirect herd immunity effect of the vaccine in reducing carriage. Updated estimates of vaccine effectiveness through 30 June 2009 confirmed high short-term protection after vaccination in infancy, at 97% (95% confidence interval [CI], 91% to 99%), falling to 68% (95% CI, −63% to 90%) more than a year after vaccination. The observed vaccine effectiveness more than 12 months postvaccination was consistent with measured declining SBA levels, but confidence intervals were imprecise; vaccine effectiveness estimates were consistent with SBA titers of 1:4 or 1:8 as correlates of long-term protection after a primary course in infants. Modeling suggested that protection against carriage persists for at least 3 years and predicted the stabilization of serogroup C disease at low levels (fewer than 50 cases per year) up to 2015-2016.

Commentary: The Savings-Investment Balance: Is there a UK investment shortfall?

2006 ◽  
Vol 196 ◽  
pp. 4-9 ◽  
Author(s):  
Martin Weale
Keyword(s):  
Interest Rates ◽  
Yield Curve ◽  
The United States ◽  
Short Term ◽  
The Past ◽  
The United Kingdom ◽  
The World ◽  
Short And Long Term ◽  
Low Levels

In the first half of this decade, the world experienced a period of low short and long-term interest rates. Shortterm rates have risen from these low levels, first in Canada and the United Kingdom, then in the United States and finally in the Euro Area. Long-term rates, by contrast, remained low, suggesting that holders of longterm debt expected the rise in short-term rates to be only temporary. Only in the past few months has the apparently anomalous pricing of long-term debt started to disappear. But with interest rates on long-term debt similar to short-term market rates internationally, the market does not yet show that the traditional upwardsloping yield curve and, on this basis, long rates remain depressed. They are also markedly below the levels of two to three years ago.

scholarly journals Blood Pressure Variability, Mortality, and Cardiovascular Outcomes in CKD Patients

2019 ◽  
Vol 14 (2) ◽  
pp. 233-240 ◽  
Author(s):  
Francesca Mallamaci ◽  
Giovanni Tripepi ◽  
Graziella D’Arrigo ◽  
Silvio Borrelli ◽  
Carlo Garofalo ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Clinic Visit ◽  
Hazard Ratio ◽  
Interquartile Range ◽  
Short Term ◽  
End Point

Background and objectivesShort-term BP variability (derived from 24-hour ambulatory BP monitoring) and long-term BP variability (from clinic visit to clinic visit) are directly related to risk for cardiovascular events, but these relationships have been scarcely investigated in patients with CKD, and their prognostic value in this population is unknown.Design, setting, participants, & measurementsIn a cohort of 402 patients with CKD, we assessed associations of short- and long-term systolic BP variability with a composite end point of death or cardiovascular event. Variability was defined as the standard deviation of observed BP measurements. We further tested the prognostic value of these parameters for risk discrimination and reclassification.ResultsMean ± SD short-term systolic BP variability was 12.6±3.3 mm Hg, and mean ± SD long-term systolic BP variability was 12.7±5.1 mm Hg. For short-term BP variability, 125 participants experienced the composite end point over a median follow-up of 4.8 years (interquartile range, 2.3–8.6 years). For long-term BP variability, 110 participants experienced the composite end point over a median follow-up of 3.2 years (interquartile range, 1.0–7.5 years). In adjusted analyses, long-term BP variability was significantly associated with the composite end point (hazard ratio, 1.24; 95% confidence interval, 1.01 to 1.51 per 5-mm Hg higher SD of office systolic BP), but short-term systolic BP variability was not (hazard ratio, 0.92; 95% confidence interval, 0.68 to 1.25 per 5-mm Hg higher SD of 24-hour ambulatory systolic BP). Neither estimate of BP variability improved risk discrimination or reclassification compared with a simple risk prediction model.ConclusionsIn patients with CKD, long-term but not short-term systolic BP variability is related to the risk of death and cardiovascular events. However, BP variability has a limited role for prediction in CKD.

scholarly journals Low Levels of Immunoglobulins and Mannose-Binding Lectin Are Not Associated With Etiology, Severity, or Outcome in Community-Acquired Pneumonia

2018 ◽  
Vol 5 (2) ◽  
Author(s):  
William W Siljan ◽  
Jan C Holter ◽  
Ståle H Nymo ◽  
Einar Husebye ◽  
Thor Ueland ◽  
...  
Keyword(s):  
Disease Severity ◽  
Community Acquired Pneumonia ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Short Term Outcome ◽  
Mannose Binding ◽  
Microbial Etiology ◽  
Low Levels

Abstract Background Disease severity and outcome in community-acquired pneumonia (CAP) depend on the host and on the challenge of the causal microorganism(s). We measured levels of immunoglobulins (Igs) and complement in 257 hospitalized adults with CAP and examined the association of low levels of Igs or complement to microbial etiology, disease severity, and short-term and long-term outcome. Methods Serum Igs were analyzed in blood samples obtained at admission and at 6 weeks postdischarge if admission levels were low. Serum complement deficiencies were screened with a total complement activity enzyme-linked immunosorbent assay (ELISA), with further analyzes performed if justified. Disease severity was assessed by the CURB-65 severity score. Short-term outcome was defined as a composite end point of intensive care unit (ICU) admission and 30-day mortality, and long-term outcome as 5-year all-cause mortality. Results At admission, 87 (34%) patients had low levels of at least 1 Ig, with low IgG2 as the most prevalent finding (55/21%). IgG levels were lower in bacterial than viral CAP (8.48 vs 9.97 g/L, P = .023), but low Igs were not associated with microbial etiology. Fifty-five (21%) patients had low lectin pathway activity, of which 33 (13%) were mannose-binding lectin (MBL) deficient. Low admission levels of any Ig or MBL were not associated with disease severity, short-term outcome, or long-term outcome. Excluding patients defined as immunocompromised from analysis did not substantially affect these results. Conclusion In hospitalized adults with CAP, low admission levels of Igs or complement were in general not associated with microbial etiology, disease severity, short-term outcome, or long-term outcome.

scholarly journals Differential Requirements for T Cells in Viruslike Particle- and Rotavirus-Induced Protective Immunity

2008 ◽  
Vol 82 (6) ◽  
pp. 3135-3138 ◽  
Author(s):  
Sarah E. Blutt ◽  
Kelly L. Warfield ◽  
Mary K. Estes ◽  
Margaret E. Conner
Keyword(s):  
T Cells ◽  
T Cell ◽  
T Lymphocytes ◽  
Protective Immunity ◽  
Short Term ◽  
Correlates Of Protection ◽  
Viruslike Particles ◽  
Term Maintenance ◽  
B And T Lymphocytes

ABSTRACT Correlates of protection from rotavirus infection are controversial. We compared the roles of B and T lymphocytes in protective immunity induced either by intranasally administered nonreplicating viruslike particles or inactivated virus or by orally administered murine rotavirus. We found that protection induced by nonreplicating vaccines requires CD4+ T cells and CD40/CD40L. In contrast, T cells were not required for short-term protective immunity induced by infection, but both T-cell-dependent and -independent mechanisms contributed to long-term maintenance of protection. Our findings indicate that more than one marker of protective immunity exists and that these markers depend on the vaccine that is administered.

scholarly journals THE SCALE OF THE SPREAD OF COVID-19 IN GEORGIA AND EFFECTIVENESS OF PREVENTIVE MEASURES IMPLIMENTED BY THE GOVERNMENT – WHAT DO MODELS SAY?

2020 ◽  
pp. 49-57
Author(s):  
IURI ANANIASHVILI ◽  
LEVAN GAPRINDASHVILI
Keyword(s):  
Machine Learning ◽  
Preventive Measures ◽  
Herd Immunity ◽  
Optimal Level ◽  
Short Term ◽  
Machine Learning Methods ◽  
Data Limitations ◽  
The Government ◽  
Different Characteristics

. In this article we present forecasts of the spread of COVID-19 virus, obtained by econometric and machine learning methods. Furthermore, by employing modelling method, we estimate effectiveness of preventive measures implemented by the government. Each of the models discussed in this article is modelling different characteristics of the COVID-19 epidemic’s trajectory: peak and end date, number of daily infections over different forecasting horizons, total number of infection cases. All these provide quite clear picture to the interested reader of the future threats posed by COVID-19. In terms of existing models and data, our research indicates that phenomenological models do well in forecasting the trend, duration and total infections of the COVID- 19 epidemic, but make serious mistakes in forecasting the number of daily infections. Machine learning models, deliver more accurate short –term forecast of daily infections, but due to data limitations, they struggle to make long-term forecasts. Compartmental models are the best choice for modelling the measures implemented by the government for preventing the spread of COVID-19 and determining optimal level of restrictions. These models show that until achieving herd immunity (i.e. without any epidemiological or government implemented measures), approximate number of people infected with COVID-19 would be 3 million, but due to preventive measures, expected total number of infections has reduced to several thousand (1555-3189) people. This unequivocally indicates the effectiveness of the preventive measures.

scholarly journals Medical students’ mood adversely affected by COVID-19 pandemic: An interim analysis from the SPICE-19 prospective cohort study of 2075 medical students and interim foundation doctors

2020 ◽  
Author(s):  
Soham Bandyopadhyay ◽  
Ioannis Georgiou ◽  
Bibire Baykeens ◽  
Conor S Gillespie ◽  
Marta de Andres Crespo ◽  
...  
Keyword(s):  
Medical Students ◽  
A Priori ◽  
Workforce Planning ◽  
Short Term ◽  
The United Kingdom ◽  
Exam Preparation ◽  
Course Material ◽  
The Impact ◽  
Exam Preparation Course

Abstract Background:Currently, we can only speculate on what the effects of the COVID-19 pandemic have been on medical students and interim foundation year doctors. In order to support them appropriately both now and, in the future, it is imperative that we understand the impact it has had upon them. This study assessed the effects of the COVID-19 pandemic on medical students and interim foundation year doctors across the United Kingdom (UK), and the support that they received and sought. Methods:A prospective, observational, multicentre study was conducted. All medical students and interim foundation year doctors were eligible to participate. The data analysis was carried out as detailed a priori in the protocol. Findings:A total of 2075 individuals participated in the SPICE-19 survey from 33 medical schools. There was a significant (p < 0.0001) decrease in participants’ mood when comparing their mood before the pandemic to during the pandemic. Social distancing and more time at home/with family were the factors that negatively and positively respectively impacted the mood of the greatest number of participants. All areas of life included in the survey were found to have been significantly more negatively impacted than positively impacted (p < 0.0001). 931 participants wanted more support from their university. Participants were mainly seeking support with exam preparation, course material, and financial guidance. Discussion:Medical and foundation schools need to prepare adequate and effective support. If no action is taken, there may be a knock-on effect on workforce planning and the health of our future workforce. When medical students return to their universities, there is likely to be need for enhanced wellbeing support, adaptations in the short-term and long-term strategies for medical education, and provision of financial guidance.

scholarly journals Waning Effectiveness of the BNT162b2 Vaccine Against Infection in Adolescents

2022 ◽  
Author(s):  
Ottavia Prunas ◽  
Daniel M. Weinberger ◽  
Virginia E. Pitzer ◽  
Sivan Gazit ◽  
Tal Patalon
Keyword(s):  
Control Design ◽  
Healthcare Services ◽  
Case Control ◽  
Vaccine Effectiveness ◽  
Age Group ◽  
Short Term ◽  
Symptomatic Infection ◽  
Matched Case ◽  
Induced Immunity

Background: The short-term effectiveness of a two-dose regimen of the BioNTech/Pfizer mRNA BNT162b2 vaccine for adolescents has been demonstrated. However, little is known about the long-term effectiveness in this age group. It is known, though, that waning of vaccine-induced immunity against infection in adult populations is evident within a few months. Methods: Leveraging the centralized computerized database of Maccabi Healthcare Services (MHS), we conducted a matched case-control design for evaluating the association between time since vaccination and the incidence of infections, where two outcomes were evaluated separately: a documented SARS-CoV-2 infection (regardless of symptoms) and a symptomatic infection (COVID-19). Cases were defined as individuals aged 12 to 16 with a positive PCR test occurring between June 15 and December 8, 2021, when the Delta variant was dominant in Israel. Controls were adolescents who had not tested positive previously. Results: We estimated a peak vaccine effectiveness between 2 weeks and 3 months following receipt of the second dose, with 85% and 90% effectiveness against SARS-CoV-2 infection and COVID-19, respectively. However, in line with previous findings for adults, waning of vaccine effectiveness was evident in adolescents as well. Long-term protection conferred by the vaccine was reduced to 75-78% against infection and symptomatic infection, respectively, 3 to 5 months after the second dose, and waned to 58% against infection and 65% against COVID-19 after 5 months. Conclusions: Like adults, vaccine-induced protection against both SARS-CoV-2 infection and COVID-19 wanes with time, starting three months after inoculation and continuing for more than five months.

scholarly journals Low case numbers enable long-term stable pandemic control without lockdowns

2020 ◽  
Author(s):  
Sebastian Contreras ◽  
Jonas Dehning ◽  
Sebastian B Mohr ◽  
F. Paul Spitzner ◽  
Viola Priesemann
Keyword(s):  
Large Scale ◽  
Compartmental Model ◽  
Stable Equilibrium ◽  
Herd Immunity ◽  
Circuit Breakers ◽  
Viable Solution ◽  
Large Scale Testing ◽  
Low Levels ◽  
Parameter Ranges

The traditional long-term solutions for epidemic control involve eradication or herd immunity. Neither of them will be attained within a few months for the COVID-19 pandemic. Here, we analytically derive the existence of a third, viable solution: a stable equilibrium at low case numbers, where test-trace-and-isolate policies partially compensate for local spreading events, and only moderate contact restrictions remain necessary. Across wide parameter ranges of our complementary compartmental model, the equilibrium is reached at or below 10 daily new cases per million people. Such low levels had been maintained over months in most European countries. However, this equilibrium is endangered (i) if contact restrictions are relaxed, or (ii) if case numbers grow too high. The latter destabilisation marks a novel tipping point beyond which the spread self-accelerates because test-trace-and-isolate capacities are overwhelmed. To reestablish control quickly, a lockdown is required. We show that a lockdown is either effective within a few weeks, or tends to fail its aim. If effective, recurring lockdowns are not necessary --- contrary to the oscillating dynamics previously presented in the context of circuit breakers, and contrary to a regime with high case numbers --- if moderate contact reductions are maintained. Hence, at low case numbers, the control is easier, and more freedom can be granted. We demonstrate that this strategy reduces case numbers and fatalities by a factor of 5 compared to a strategy focused only on avoiding major congestion of hospitals. Furthermore, our solution minimises lockdown duration, and hence economic impact. In the long term, control will successively become easier due to immunity through vaccination or large scale testing programmes. International coordination would facilitate even more the implementation of this solution.

scholarly journals Immunogenicity and Protective Efficacy of a Novel Recombinant BCG Strain Overexpressing Antigens Ag85A and Ag85B

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Chun Wang ◽  
Ruiling Fu ◽  
Zhenhua Chen ◽  
Kun Tan ◽  
Lingxia Chen ◽  
...  
Keyword(s):  
Vaccine Candidate ◽  
Protective Efficacy ◽  
Short Term ◽  
Endogenous Expression ◽  
Single Antigen ◽  
Immunodominant Antigens ◽  
Low Levels ◽  
Promising Vaccine Candidate

Recombinant Bacillus Calmette-Guérin (rBCG) strain is the promising vaccine candidate for tuberculosis (TB) prevention, which aims at providing more enduring and enhanced protection than the parental BCG vaccine. In this study, three rBCG strains overexpressing immunodominant antigens Ag85B (rBCG::85B), Ag85A (rBCG::85A), or both (rBCG::AB) ofMycobacterium tuberculosiswere constructed, respectively. rBCG strains showed higher level of overexpression of Ag85A and/or Ag85B proteins than BCG containing empty vector pMV261(rBCG::261), which had low levels of endogenous expression of both proteins as expected. rBCG::AB strain could provide the strongest short-term and long-term protection in the lung against intravenous infection with virulentM. tuberculosisthan rBCG::261 control and other two rBCG strains overexpressing single antigen. The stronger and longer-lasting protection provided by rBCG::AB than rBCG::261 was correlated with systemicin vitroantigen-specific IFN-γresponses. Therefore, our results indicate that rBCG::AB could be a very promising TB vaccine candidate and should be further evaluated for the preclinical test.

scholarly journals Exploring the Health Case for Universal Basic Income: Evidence from GPs Working with Precarious Groups

2019 ◽  
Vol 14 (2) ◽  
Author(s):  
Matthew Johnson ◽  
Dan Degerman ◽  
Robert Geyer
Keyword(s):  
Clinical Experience ◽  
Welfare Recipients ◽  
Potential Contribution ◽  
Basic Income ◽  
Short Term ◽  
North East ◽  
The North ◽  
Low Levels ◽  
Patient Side

Abstract This article draws upon clinical experience of GPs working in a deprived area of the North East of England to examine the potential contribution of Universal Basic Income to health by mitigating ‘patient-side barriers’ among three cohorts experiencing distinct forms of ‘precariousness’: 1) long-term unemployed welfare recipients with low levels of education (lumpenprecariat); 2) workers on short-term/zero-hours contracts with low levels of education (‘lower’ precariat); 3) workers on short-term/zero-hours contracts with relatively high levels of education (‘upper’ precariat). We argue that any benefits must be accompanied by robust institutions capable of promoting health.

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