DOUBLE-DOSED NON-INVASIVE BRAIN STIMULATION: IS MORE BETTER?

Since the FDA-approved once-daily intermittent theta-burst stimulation (iTBS) treatment for depression rapidly extends to six weeks, patients and caregivers face a considerable logistic burden. Therefore, twice-daily stimulation has gained popularity as a therapeutic tool for stress-related psychiatric disorders. However, the neuro-endocrinological effect of one or two (double-dosed) iTBS sessions remains unclear. Considering that the most frequently stimulated target of non-invasive brain stimulation in psychiatry, the dorsolateral prefrontal cortex (DLPFC), is involved in regulating the hypothalamic-pituitary-adrenal (HPA) system, stress regulation responses, such as cortisol secretion, are of interest. Using a two-period crossover design, this study looked at the effect of double-dosed iTBS over the left DLPFC on salivary cortisol in 38 healthy volunteers after being stressed with the Trier Social Stress Test (TSST). After the first active iTBS session, no differential effects on salivary output were observed as contrasted to sham. However, after the second active session, there was a significantly smaller decrease in salivary cortisol concentrations in the active iTBS condition than in the sham condition. Our results suggest that double-dosed iTBS after being stressed might affect stress recovery differently than a single session of iTBS

Nasopharyngeal S. pneumoniae carriage and density in Belgian infants after 9 years of pneumococcal conjugate vaccine programme

Background: In Belgium, the infant pneumococcal conjugate vaccine (PCV) programme changed from PCV7 (2007-2011) to PCV13 (2011-2015) and to PCV10 (2015-2016). A 3-year nasopharyngeal carriage study was initiated during the programme switch in 2016. Main objective of the year 1 assessment was to obtain a baseline measurement of pneumococcal carriage prevalence, carriage density, serotype distribution and antibiotic resistance. Materials/methods: Two infant populations aged 6-30 months and without use of antibiotics in the seven days prior to sampling were approached: (1) attending one of 85 randomly selected day-care centres (DCC); (2) presenting with AOM at study-trained general practitioners and paediatricians. Demographic and clinical characteristics were documented and a single nasopharyngeal swab was taken. S. pneumoniae were cultured, screened for antibiotic resistance and serotyped, and quantitative Taqman real-time PCR (qRT-PCR) targeting LytA was performed. Results: Culture-based (DCC: 462/760; 60.8%- AOM: 27/39; 69.2%) and LytA-based (DCC: 603/753; 80.1% - AOM: 32/39; 82.1%) carriage prevalence was high. Average pneumococcal DNA load in LytA-positive day-care samples was 6.5 x 10(6) copies/mu l (95%Cl = 3.9-9.2 x 10(6), median = 3.5 x 10(5)); DNA load was positively associated with signs of common cold and negatively with previous antibiotic use. Culture based frequency of 13 pneumococcal vaccine (PCV) serotypes was 5.4% in DCC and 7.7% in AOM, with 19F and 14 being most frequent, and frequencies below 0.5% for serotypes 3, 6A, 19A in both populations. Predominant non-PCV serotypes were 23B and 23A in day-care and 11A in infants with AOM. In day-care, resistance to penicillin was rare (<0.5%) and absent against levofloxacin; 32.7% and 16.9% isolates were cotrimoxazole- and erythromycin-resistant respectively. Conclusion: Four years after PCV13 introduction in the vaccination programme, PCV13 serotype carriage was rare in infants throughout Belgium and penicillin resistance was rare. Continued surveillance in the context of a PCV programme switch is necessary

How nasopharyngeal pneumococcal carriage evolved during and after a PCV13-to-PCV10 vaccination programme switch in Belgium, 2016 to 2018

Background: The current carriage study was set up to reinforce surveillance during/after the PCV13-to-PCVC10 switch in Belgium. Aim: This observational study monitored carriage of Streptococcus pneumoniae (Sp) serotypes, particularly those no longer covered (3, 6A, 19A), as well as Haemophilus influenzae (Hi), because PCV10 contains the non-typeable Hi protein D. Methods: A total of 2,615 nasopharyngeal swabs from children (6-30 months old) attending day care were collected in three periods over 2016-2018. Children's demographic and clinical characteristics and vaccination status were obtained through a questionnaire. Sp and Hi were identified by culture and PCR. Pneumococcal strains were tested for antimicrobial (non-)susceptibility by disc diffusion and serotyped by Quellung-reaction (Quellung-reaction and PCR for serotypes 3, 6A, 19A). Results: The carriage prevalence of Sp (> 75%) remained stable over the successive periods but that of Hi increased (87.4%, 664 Hi-carriers/760 in 2016 vs 93.9%, 895/953 in 2017-2018). The proportion of non-PCV13 vaccine serotypes decreased (94.6%, 438 isolates/463 in 2016 vs 89.7%, 599/668 in 2017-2018) while that of PCV13-non-PCV10 vaccine serotypes (3 + 6A + 19A) increased (0.9%, 4 isolates/463 in 2016 vs 7.8%, 52/668 in 2017-2018), with serotype 19A most frequently identified (87.9%, 58/66 isolates). Non-susceptibility of pneumococci against any of the tested antibiotics was stable over the study period (> 44%). Conclusions: During and after the PCV13-to-PCV10 vaccine switch, the proportion of non-PCV13 serotypes decreased, mainly due to a serotype 19A carriage prevalence increase. These results complement invasive pneumococcal disease surveillance data, providing further basis for pneumococcal vaccination programme policy making