Impact of Recommended Maternal Vaccination Programs on the Clinical Presentation of SARS-CoV-2 Infection: A Prospective Observational Study

The COVID-19 pandemic has raised questions about the possible cross immunity resulting from common vaccination programs and SARS-CoV-2 infection. Therefore, the Spanish Obstetric Emergency group performed a multicenter prospective study on the vaccination status of Influenza and Tdap (diphtheria, tetanus and pertussis vaccine boost administered in adulthood) in consecutive cases of SARS-CoV-2 infection in a pregnancy cohort, in order to assess its possible association with the clinical presentation and severity of symptoms of SARS-CoV-2 infection, as well as to determine the factors that may affect vaccination adherence. A total of 1150 SARS-CoV-2 positive pregnant women from 78 Spanish hospitals were analyzed: 183 had not received either vaccine, 23 had been vaccinated for Influenza only, 529 for Tdap only and 415 received both vaccines. No association was observed between the vaccination status and the clinical presentation of SARS-CoV-2 infection and/or the severity of symptoms. However, a lower adherence to the administration of both vaccines was observed in the Latin-American subgroup. Based on the results above, we reinforce the importance of maternal vaccination programs in the actual pandemic. Health education campaigns should be specially targeted to groups less likely to participate in these programs, as well as for a future SARS-CoV-2 vaccination campaign.

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Impact of Recommended Maternal Vaccination Programs on the Clinical Presentation of SARS-CoV-2 Infection: A Prospective Observational Study

10.20944/preprints202012.0709.v1 ◽

2020 ◽

Author(s):

Maria Luisa de la Cruz Conty ◽

Maria Begoña Encinas Pardilla ◽

Marta Garcia Sanchez ◽

Laura Gonzalez Rodriguez ◽

Marta Luisa Muner-Hernando ◽

...

Keyword(s):

Latin American ◽

Clinical Presentation ◽

Vaccination Campaign ◽

Vaccination Status ◽

Vaccination Programs ◽

Maternal Vaccination ◽

Emergency Group ◽

Education Campaigns ◽

Multicenter Prospective Study ◽

Lower Adherence

The COVID-19 pandemic has raised questions about the possible cross immunity resulting from common vaccination programs and SARS-CoV-2 infection. Therefore, the Spanish Obstetric Emergency group performed a multicenter prospective study on the vaccination status of Influenza and Tdap (diphtheria, tetanus and pertussis vaccine boost administered in adulthood) in consecutive cases of SARS-CoV-2 infection in a pregnancy cohort, in order to assess its possible association with the clinical presentation and severity of symptoms of SARS-CoV-2 infection, as well as to determine the factors that may affect vaccination adherence. 1,150 SARS-CoV-2 positive pregnant women from 78 Spanish hospitals were analyzed: 183 had not received either vaccine, 23 had been vaccinated for Influenza only, 529 for Tdap only and 415 received both vaccines. No association was observed between the vaccination status and the clinical presentation of SARS-CoV-2 infection and/or the severity of symptoms. However, a lower adherence to the administration of both vaccines was observed in the Latin-American subgroup. Based on the results above, we reinforce the importance of maternal vaccination programs in the actual pandemic. Health education campaigns should be specially targeted to groups less likely to participate in these programs, as well as for a future SARS-CoV-2 vaccination campaign.

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Pneumococcal and influenza vaccination status of hospitalized adults with community acquired pneumonia and the effects of vaccination on clinical presentation

Human Vaccines & Immunotherapeutics ◽

10.1080/21645515.2017.1339851 ◽

2017 ◽

Vol 13 (9) ◽

pp. 2072-2077 ◽

Cited By ~ 5

Author(s):

Ezgi Demirdogen Cetinoglu ◽

Esra Uzaslan ◽

Abdullah Sayıner ◽

Aykut Cilli ◽

Oguz Kılınc ◽

...

Keyword(s):

Influenza Vaccination ◽

Clinical Presentation ◽

Community Acquired Pneumonia ◽

Vaccination Status

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Vaccine refusal/hesitancy—the ethical point of view

European Journal of Public Health ◽

10.1093/eurpub/ckab120.029 ◽

2021 ◽

Vol 31 (Supplement_2) ◽

Author(s):

João Gentil

Keyword(s):

Ethical Issues ◽

Vaccination Campaign ◽

Herd Immunity ◽

Cost Benefit ◽

Point Of View ◽

Vaccine Hesitancy ◽

Moral Conflicts ◽

Vaccination Programs ◽

Individual Level ◽

Vaccine Refusal

Abstract Background In 2019, WHO classified vaccine hesitancy as one of the top 10 threats to global health. Vaccination is an area of excellence in nursing that has gained a new focus and has become a challenge in the provision of care and in the management field. Vaccine hesitation raises questions about mandatory vaccination, individual versus collective freedom that are highlighted in the current context due to the emergence of new vaccines. In this paper, we want to analyze and update knowledge about vaccines hesitancy from an ethical and bioethical perspective. Methods A combination of literature reviews on vaccine refusal/hesitancy, ethics and COVID-19 vaccine confidence, accessed on SciELO and PubMed databases and analysis of documents from General Directorate of Health and Ordem dos Enfermeiros (National Nurses Association). Results Vaccination programs aim is a collective protection. The desirable effects at individual level do not have the same ethical value at collective level, leading to cost-benefit imbalances. Moral conflicts between the individual and the collective, cost-benefit imbalances and the insufficiency of bioethics principles, lead us to the use of other moral values and principles, such as responsibility, solidarity and social justice, as a tool for ethical reflection problems related to COVID-19 vaccines. Conclusions There are no perfect solutions to ethical dilemmas and some optimal solutions could depend the context. In a pandemic situation, one of the most relevant ethical issues is the herd immunity since it leaves public health at risk. Equity and the principle of justice in vaccination campaign are shown daily in the nursing profession.

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Hepatitis B vaccination status and knowledge, attitude, and practice regarding Hepatitis B among preclinical medical students of a medical college in Nepal

PLoS ONE ◽

10.1371/journal.pone.0242658 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242658

Author(s):

Dhan Bahadur Shrestha ◽

Manita Khadka ◽

Manoj Khadka ◽

Prarthana Subedi ◽

Subashchandra Pokharel ◽

...

Keyword(s):

Medical Students ◽

Hepatitis B ◽

Vaccination Status ◽

Hepatitis B Vaccination ◽

Vaccination Programs ◽

Medical College ◽

Attitude And Practice ◽

Preclinical Medical Students ◽

Study Participants ◽

Knowledge Attitude And Practice

Background Hepatitis B imposes a major public health problem with an increased risk of occupational exposure among unvaccinated health care workers. This study was conducted to determine the Hepatitis B vaccination status, along with the knowledge, attitude, and practice regarding Hepatitis B, among preclinical medical students of a medical college in Nepal. Materials and methods This descriptive study was conducted among preclinical students of a medical college in Kathmandu, Nepal from 6th July to 14th July 2020. The whole sampling technique was used. Data were collected using a pretested, self-administered questionnaire which was emailed to individuals and analyzed with the statistical package for social sciences version-22. Results A total of 181 students participated in the study out of 198, giving a response rate of 91.4%. Among the study participants, only 67 (37%) were fully vaccinated against Hepatitis B while 71 (39.2%) were never vaccinated. For the majority (74.6%) of the non-vaccinated participants, the main reason for not getting vaccination was a lack of vaccination programs. Half the study participants (n = 92, 50.8%) had good knowledge, attitude and practice regarding hepatitis B. The median knowledge, attitude and practice scores towards Hepatitis B were 61.00 (57.00–66.00), 20(18.00–21.00) and 21(19.00–23.00) respectively. Conclusions The majority of preclinical medical students were not fully vaccinated against Hepatitis B and only half of them had acceptable knowledge, attitude and practice towards Hepatitis B, which makes them vulnerable to the infection. This might represent the situation of not only Nepal, but also all South Asian countries, and creates concern about whether students take the vaccination programs seriously. Since unavailability of vaccination program is the main cause of non-vaccination, we strongly recommend the provision of the Hepatitis B vaccination program to the preclinical medical students.

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REACT-1 round 13 final report: exponential growth, high prevalence of SARS-CoV-2 and vaccine effectiveness associated with Delta variant in England during May to July 2021

10.1101/2021.09.02.21262979 ◽

2021 ◽

Author(s):

Paul Elliott ◽

David Haw ◽

Haowei Wang ◽

Oliver Eales ◽

Caroline E. Walters ◽

...

Keyword(s):

Exponential Growth ◽

Vaccination Campaign ◽

Vaccine Effectiveness ◽

Vaccine Uptake ◽

Final Report ◽

Infection Prevalence ◽

Symptomatic Infection ◽

Complete Replacement ◽

Vaccination Programs ◽

High Prevalence

AbstractBackgroundThe prevalence of SARS-CoV-2 infection continues to drive rates of illness and hospitalisations despite high levels of vaccination, with the proportion of cases caused by the Delta lineage increasing in many populations. As vaccination programs roll out globally and social distancing is relaxed, future SARS-CoV-2 trends are uncertain.MethodsWe analysed prevalence trends and their drivers using reverse transcription-polymerase chain reaction (RT-PCR) swab-positivity data from round 12 (between 20 May and 7 June 2021) and round 13 (between 24 June and 12 July 2021) of the REal-time Assessment of Community Transmission-1 (REACT-1) study, with swabs sent to non-overlapping random samples of the population ages 5 years and over in England.ResultsWe observed sustained exponential growth with an average doubling time in round 13 of 25 days (lower Credible Interval of 15 days) and an increase in average prevalence from 0.15% (0.12%, 0.18%) in round 12 to 0.63% (0.57%, 0.18%) in round 13. The rapid growth across and within rounds appears to have been driven by complete replacement of Alpha variant by Delta, and by the high prevalence in younger less-vaccinated age groups, with a nine-fold increase between rounds 12 and 13 among those aged 13 to 17 years. Prevalence among those who reported being unvaccinated was three-fold higher than those who reported being fully vaccinated. However, in round 13, 44% of infections occurred in fully vaccinated individuals, reflecting imperfect vaccine effectiveness against infection despite high overall levels of vaccination. Using self-reported vaccination status, we estimated adjusted vaccine effectiveness against infection in round 13 of 49% (22%, 67%) among participants aged 18 to 64 years, which rose to 58% (33%, 73%) when considering only strong positives (Cycle threshold [Ct] values < 27); also, we estimated adjusted vaccine effectiveness against symptomatic infection of 59% (23%, 78%), with any one of three common COVID-19 symptoms reported in the month prior to swabbing. Sex (round 13 only), ethnicity, household size and local levels of deprivation jointly contributed to the risk of higher prevalence of swab-positivity.DiscussionFrom end May to beginning July 2021 in England, where there has been a highly successful vaccination campaign with high vaccine uptake, infections were increasing exponentially driven by the Delta variant and high infection prevalence among younger, unvaccinated individuals despite double vaccination continuing to effectively reduce transmission. Although slower growth or declining prevalence may be observed during the summer in the northern hemisphere, increased mixing during the autumn in the presence of the Delta variant may lead to renewed growth, even at high levels of vaccination.

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Changes in Clinical Presentation and Perioperative Management of Pheochromocytomas and Paragangliomas: A Four-Decade Experience in a Academic Center

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.158 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A78-A79

Author(s):

Thomas Uslar ◽

Ignacio San Francisco ◽

Roberto Ignacio Olmos ◽

Stefano Pietro Macchiavello ◽

Alvaro Zuñiga ◽

...

Keyword(s):

Genetic Testing ◽

Latin American ◽

Clinical Presentation ◽

Length Of Hospital Stay ◽

Female Gender ◽

Perioperative Outcomes ◽

Multidisciplinary Program ◽

Academic Center ◽

Frequent Mutations ◽

Biochemical Genetic

Abstract Objective: Latin American reports on pheochromocytomas and paragangliomas (PPGL) are scarce. Recent studies have shown changes in both clinical presentation and management of these patients. We aimed to assess the main characteristics of PPGL patients in a single academic center over the last four decades. Experimental design: Cohort study. Patients and methods: Demographic, clinical, biochemical, genetic and perioperative data from 105 PPGL patients were retrospectively and prospectively collected over the 1980–2019 period. Patients were categorized into four groups (14 patients in the 1st, 25 patients in the 2nd, 27 patients in the 3th and 39 patients in the 4th decade) according to the date of diagnosis. Results: The mean age at diagnosis was 46±19 years, and the tumor size was 5.3±2.2 cm, female gender was 63%, bilateral tumor of 15%, paragangliomas 9% and metastatic disease in 15%. The aforementioned parameters remained stable across the four decades. During the study period we observed significant increases in doxazosin dosing (2.7±2.6 mg vs. 8.0±4.5 p<0.003) and laparoscopic procedures (28% vs. 84% p<0.001) along with a decrease in the length of hospital stay (10.0±8.9 vs. 3.8±1.7 days p=0.007). Among the 24 genetic tests performed, we identified 59% germline mutations. The most frequent mutations were RET (18%) and SDHX (18%), followed by VHL (14%), MAX (5%) and NF1 (4%). Notably, in the last decade we observed a dramatic increase in the proportion of incidental PPGL diagnosis (0% vs. 53% p<0.001) and genetic testing analyses (0 vs. 19 p<0.001). When comparing incidental diagnosis (n=25) versus clinically suspicious cases(n=50), incidentalomas had fewer adrenergic symptoms (38 vs. 62%; p<0.001), and lower rates of hypertension (64 vs. 80%; p=0.01), hypertension crises (28 vs. 44%; p=0.02), functionality (79 vs. 100%; p=0.01) and total catecholamines and/or metanephrine levels (8.4 vs. 12.5 fold above the upper normal limit; p=0.04). Conclusions: The implementation of a multidisciplinary program increased diagnosis and genetic testing and also optimized anesthesia and surgical procedure, translating into a notorious improvement in perioperative outcomes. In addition, we observed a change in the clinical presentation of PPGL in recent decades with a marked increase in incidental cases, which highlights the importance of early diagnosis and treatment.

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Clinical Presentation and Outcome of ABVD-Treated Elderly Versus Younger Patients with Classical Hodgkin´s Lymphoma

Blood ◽

10.1182/blood.v124.21.4404.4404 ◽

2014 ◽

Vol 124 (21) ◽

pp. 4404-4404

Author(s):

Brenda Lizeth Acosta-Maldonado ◽

Ana Ramirez-Ibarguen ◽

Flavio A Grimaldo-Gomez ◽

Silvia Rivas-Vera

Keyword(s):

Latin American ◽

Clinical Presentation ◽

Conflicts Of Interest ◽

Prognostic Score ◽

Combined Treatment ◽

The Elderly ◽

Stage I ◽

Combined Modality Treatment ◽

Mixed Cellularity ◽

Younger Patients

Abstract Background Approximately 20% of classical Hodgkin’s Lymphoma (cHL) patients are over 60 years of age. There is no standard of care for this age group. Although most patients receive ABVD (Doxorubicin, bleomycin, vinblastine and dacarbazine), a standard regimen in younger patients, little is known regarding the clinical presentation of cHL, and the long term efficacy of ABVD in young and elderly Latin American Mestizo patients.. Defining whether individuals in all age groups and social circumstances benefit from a common treatment approach requires investigation.. Thus we sought to evaluate and compare the clinical presentation and the efficacy of ABVD in the elderly (60 years of age and above) versus the younger population of individuals with cHD. Methods We retrospectively analyzed 44 consecutive cHL patients treated with ABVD at the National Cancer Institute in Mexico between 2006 and 2013, as compared to 218 patients under 60 years of age. Results Median age for the elderly was 65 (60-89y), without a difference in gender (21m/2 f). According to Ann Arbor staging 6-8-13-14 were stage I, II, III, or IV , respectively. The International Prognostic Score (IPS) was > 3 in all patients. B symptoms were present in 34 patients (77.3%). Mixed cellularity subtype was present in 52.3% of cases and nodular sclerosis subtype (34.1%). The great majority of patients (93%) received at least 1 ABVD (1-6), 27 patients received chemotherapy alone, 14 patients received combined modality treatment and 3 patients only received radiotherapy. Twenty four patients achieved a CR (54.5%), 5 partial responses, 5 had refractory /relapsed disease and 10 couldn’t be evaluated. Unlike younger patients a better response was not demonstrated with combined treatment modality (Table 1). Overall survival for the whole group at 7.2 years was estimated at 75.4% (95% CI 57.1-79.4) The OS (7 y) in elderly group was 75% versus 92% in younger group, however patients with age >75 had a lower survival, 50%. The median follow-up was of 8 years. Summary Our study showed no clinical differences between elderly vs younger population and confirms the efficacy of ABVD in elderly patients. The lower OS compared to other series may be related to the advanced stage of disease and poor IPS in our series Table 1.Clinical characteristics of elderly versus younger patientsFeature< 60 years (%)>60 years (%)P valueGenderMale/female61.8/38.247.5/52.30.10B Symptoms77.077.30.86Ann Arbor stage I II III IV7.424.931.835.913.618.224.538.60.45IPS >348.865.90.07Bulky disease48.838.60.26Histology Mixed cellularity Nodular Sclerosis43.848.852.334.10.60Treatment ABVD ABVD + RT RT Other42.455.32.32.361.431.86.84.50.37Response CR PR Relapse/progression NV60.89.718.910.654.511.411.422.70.37Overall survival (8 years)92%75%0.000 Disclosures No relevant conflicts of interest to declare.

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Axial spondyloarthritis in Latin America

10.1093/med/9780198734444.003.0029 ◽

2016 ◽

Author(s):

Percival Sampaio-Barros ◽

Rafael Valle-Oñate

Keyword(s):

Latin America ◽

Socioeconomic Factors ◽

Latin American ◽

Rheumatic Diseases ◽

Population Genetic ◽

Clinical Presentation ◽

Axial Spondyloarthritis ◽

Homogeneous Population ◽

The Many ◽

Latin American Countries

Latin American countries are often characterized by a significant miscegenation among whites, blacks, and Amerindians. These heterogeneous populations frequently represent a challenge for the design of studies analysing the genetics, incidence, and prevalence of rheumatic diseases. In this setting, axial spondyloarthritis (axSpA) frequently shows an increased associated peripheral involvement, compared with the homogeneous population. Genetic and socioeconomic factors can be associated with this clinical presentation, although further studies are necessary to confirm this hypothesis. Regarding treatment, Latin American spondyloarthritis (SpA) patients also show a higher prescription of corticosteroids, methotrexate, and sulfasalazine than European series. This chapter presents and discusses the many aspects related to the presentation of axSpA in Latin America.

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Smallpox: An Update for Nurses

Biological Research For Nursing ◽

10.1177/1099800403252014 ◽

2003 ◽

Vol 4 (4) ◽

pp. 282-294 ◽

Cited By ~ 1

Author(s):

Carolyn M. Constantin ◽

Angela M. Martinelli ◽

Elizabeth A. Bonney ◽

Ora L. Strickland

Keyword(s):

Homeland Security ◽

Health Care Workers ◽

Clinical Presentation ◽

Case Fatality ◽

Vaccination Status ◽

Clinical Aspects ◽

Care Workers ◽

Global Eradication ◽

Potential Use ◽

Overall Mortality

The global eradication of smallpox in the late 1970s was a major achievement of the 20th century and brought out the best in science and public health. Prior to eradication, smallpox was a devastating disease with an overall mortality rate of approximately 5% to 30% for the most common form of the disease depending on vaccination status and the clinical presentation. The more severe forms of smallpox (i.e., flat and hemorrhagic type) had case fatality rates of approximately 96% to 100%. Currently, there is heightened international concern regarding the potential use of the smallpox virus as an agent for bioterrorism. Therefore, it is imperative that health care workers become familiar with clinical aspects of this disease as part of the national efforts to ensure homeland security. This article reviews the history, disease progression, and adverse events of smallpox; immunization practices; and nursing considerations.

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Invasive meningococcal disease in children in Ireland, 2001–2011

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-310215 ◽

2016 ◽

Vol 101 (12) ◽

pp. 1125-1129 ◽

Cited By ~ 12

Author(s):

Cilian Ó Maoldomhnaigh ◽

Richard J Drew ◽

Patrick Gavin ◽

Mary Cafferkey ◽

Karina M Butler

Keyword(s):

Meningococcal Disease ◽

Clinical Presentation ◽

Assessment Tool ◽

Vaccination Campaign ◽

Invasive Meningococcal Disease ◽

Historical Cohort ◽

Vaccine Introduction ◽

Group B ◽

Study Hospital ◽

Paediatric Intensive Care Units

BackgroundIn 1999, invasive meningococcal disease was hyperendemic in Ireland at 14.75/100 000 population, with 60% group B and 30% group C diseases. National sepsis guidelines and meningococcal C vaccines were introduced in 2000. Despite a spontaneous decline in group B infection, invasive meningococcal disease remains a leading cause of sepsis. This study characterises the epidemiology of invasive meningococcal disease in children in Ireland since the introduction of meningococcal C vaccine and reviews its clinical presentation, hospital course and outcome in anticipation of meningococcal B vaccine introduction.MethodsNational surveillance data were obtained from the Health Protection Surveillance Centre. A retrospective study of all meningococcal cases at two tertiary paediatric hospitals was conducted from 2001 to 2011. Records were reviewed using a standardised assessment tool. A study of 407 meningococcal cases published in 2002 provided comparative data.ResultsOf 1820 cases <19 years of age notified nationally, 382 (21%) cases attended a study hospital; 94% group B, 3% group C, 225 (59%) male, median age 5 years (range 0.1–18). Fever was absent at presentation in 18%. Fifteen patients (3.6%) died. 221 (61%) were admitted to paediatric intensive care units (PICU). Permanent sequelae occurred in 9.4%. Compared with the historical cohort, there were differences in presentation, an increase in PICU interventions, but no significant decline in morbidity or mortality.ConclusionsDespite the meningococcal C vaccination campaign, invasive meningococcal disease continues to cause serious morbidity and claim lives. Group B infections remain dominant. As children who die often present with fulminant disease, preventive strategies including use of meningococcal B vaccine are needed to avert death and sequelae.

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