Post-vaccine immunity against hepatitis B in Moroccan children

Background: Hepatitis B is a major public health issue worldwide. Immunization of infants against this disease has been effective in Morocco since 1999. However, evaluation of post-vaccination response is rarely performed in our setting. The purpose of this study was to evaluate immunity against HBV in fully vaccinated children in the city of Marrakech in Morocco and to investigate the factors influencing the level of post-vaccination immunity. Methods: A descriptive cross-sectional study was conducted on fully vaccinated children who have medical and vaccination records, from three primary healthcare centers in Marrakech. Children with anti-HBs antibody levels between 10 and 100 IU/L were considered moderately immune, and those with antibody levels above 100 IU/L as highly immune, while those with antibody levels below 10 IU/L were considered non-immune. Results: Of the 123 children recruited, 114 (92.7%) had protective anti-HBs antibody titers, of which 37 (30%) were moderately immunized and 77 (62.7%) were highly immunized, and nine (7.3%) were non-immune. Age, birth weight, vaccine type, and time since the previous dose have all been significantly associated with the degree of post-vaccination immunity. Anti-HBs antibody levels were not significantly related to factors potentially linked to post-vaccination non-response, such as chronic disease, immunosuppressive medication and others.Conclusion: Our findings denote that the HBV vaccine used in The Moroccan Expanded Program on Immunization (EPI) is effective against HBV. Nevertheless, in non-responders, corrective actions such as re-vaccination and monitoring of post-vaccination anti-HBs antibody levels should be implemented

Déficits immunitaires primitifs: approche diagnostique pour les pays émergents

International audiencePrimary immunodeficiencies (PIDs) correspond to various genetic diseases characterized by a heterogeneous clinical expression in children and a frequent revelation in adults Faced to clinical suspicion of an immune deficiency, the existence of syndrome features may evoke defined PID entities that need specific immunological analysis Otherwise, the diagnostic approach of PID requires four steps the first one is to rule out an acquired immune deficiency mainly HIV infection The second step is based on elementary biological investigations cell blood count, measure of G, A, and M immunoglobulins combined or not to protein electrophoresis, and an assessment of total hemolytic complement This line of analysis permit to discriminate cellular, humoral, phagocytic or complement deficiencies which can be further illustrated using specialized immunological investigations such as lymphocyte subpopulations phenotyping, quantification of immunoglobulin subclasses, detection of specific antibodies, T lymphocytes proliferation assay, nitroblue tetrazolium reduction (NBT) test, CD18 phenotyping, measure of C3 and C4 complement components The last step needs collaboration with genetic research laboratories in order to establish the genotype of the immunodeficiency (C) 2010 Elsevier Masson SAS All rights reservedLes déficits immunitaires primitifs (DIP) correspondent à environ 300 maladies génétiques actuellement connues, d’expression clinique hétérogène se révélant parfois tardivement chez l’adulte. Devant la suspicion d’un déficit immunitaire, la présence de signes syndromiques permet d’emblée d’évoquer des entités de DIP bien définies nécessitant un bilan étiologique spécifique. Sinon, dans l’optique d’optimiser les moyens exploratoires, la mise en évidence d’un DIP impose une démarche diagnostique en étapes. La première étape vise surtout à éliminer un déficit immunitaire acquis notamment, une infection à VIH ; la deuxième étape repose sur un bilan biologique de base (numération formule sanguine-plaquette, dosage des immunoglo-bulines [IgG, IgA, IgM] et/ou électrophorèse des protides, étude du complément hémolytique CH50). Confronté à la clinique, ce bilan initial permettra de distinguer quatre catégories de déficits : cellulaire, humoral, phagocytaire ou du complément pour lesquels la troisième étape grâceà des explorations immunologiques spécialisées (étude des sous-populations lymphocytaires, dosage des sous-classes d’Ig, recherche d’anticorps spécifiques, tests de prolifération lymphoctaire, test au NBT, étude phénotypique de CD18, dosage des fractions du complément... ) permettra de confirmer le DIP et de préciser sa nature. Enfin, la quatrième étape sera menée en collaboration avec des laboratoires de recherche spécialisés pour déterminer le type moléculaire du déficit

Atypical Celiac Disease: From Recognizing to Managing

The nonclassic clinical presentation of celiac disease (CD) becomes increasingly common in physician’s daily practice, which requires an awareness of its many clinical faces with atypical, silent, and latent forms. Besides the common genetic background (HLA DQ2/DQ8) of the disease, other non-HLA genes are now notably reported with a probable association to atypical forms. The availability of high-sensitive and specific serologic tests such as antitissue transglutuminase, antiendomysium, and more recent antideamidated, gliadin peptide antibodies permits to efficiently uncover a large portion of the submerged CD iceberg, including individuals having conditions associated with a high risk of developing CD (type 1 diabetes, autoimmune diseases, Down syndrome, family history of CD, etc.), biologic abnormalities (iron deficiency anemia, abnormal transaminase levels, etc.), and extraintestinal symptoms (short stature, neuropsychiatric disorders, alopecia, dental enamel hypoplasia, recurrent aphtous stomatitis, etc.). Despite the therapeutic alternatives currently in developing, the strict adherence to a GFD remains the only effective and safe therapy for CD

Clinical and immunological status of a newly diagnosed HIV positive population, in Marrakech, Morocco

Objective: To evaluate the clinical and the immune status of newly HIV diagnosed patients, in Marrakech city and its neighboring area, in Morocco. Methods: We performed a retrospective study on 235 patients who have been previously confirmed for HIV infection, and underwent a CD4 T cells using flow cytometry (FacsCount, Becton Dickinson®). Results: The mean age of patients was 34,3 ± 8,4 years (range: 14-55), with a male predominance (sex-ratio M/F=1.4). On basis of clinical data of the patients, 62% (n=146) of them were categorized as "category C", 18.4% (n=43) as "category B", and 19.6% (n=46) as "category A" according to CDC (Center for Disease Control) HIV classification. Among all of them, 60.4% (n=142) had less than 200 CD4T cells, 26% (n=61) had between 200 and 499 CD4T cells, and only 13.6% (n=32) showed a number of CD4T cells less or equal to 500/mm3. Conclusion: The results of this study reflect a significant delay in the diagnosis of HIV infected patients. Therefore, this delay may compromise timely management of HIV infected individuals and enhances propagation of the epidemic in our country. These data confirm the need for intensifying prevention efforts among high-risk population. Moreover, continuing education in HIV/AIDS among healthcare providers should be reinforced