Moving influenza vaccines forward

Moving influenza vaccines forwar

Influenza A/H1N1 in 2009: a pandemic in evolution

Influenza A/H1N1 in 2009: a pandemic in evolutio

The impact, effectiveness and outcomes of targeted screening thresholds for programmatic latent TB infection testing in HIV: cohort study results.

Background:  Screening and treatment for latent tuberculosis infection (LTBI) are key for TB control. In the UK, the National Institute of Health and Care Excellence (NICE) and the British HIV Association (BHIVA) give conflicting guidance on which groups of people living with HIV (PLWH) should be screened, and previous national analysis demonstrated heterogeneity in how guidance is applied. There is an urgent need for a firmer clinical effectiveness evidence base on which to build screening policy. Methods:  We conducted a systematic, programmatic LTBI screening intervention for all PLWH receiving care in Leicester, UK. We compared yields (percentage IGRA positive) and number of tests required when applying the NICE and BHIVA testing strategies, as well as strategies targeting screening by TB incidence in patients’ countries of birth. Results:  Of 1053 PLWH tested, 118 were IGRA-positive (11.2%). Positivity was associated with higher TB incidence in country-of-birth (adjusted odds ratio, 50–149 cases compared to 150/100,000 or any sub-Saharan African country, would have correctly identified 89·8% of all LTBI cases while cutting tests required by 46·1% compared to NICE guidance, performing as well as BHIVA 2018 guidance. Conclusions:  Targeting screening to higher-risk PLWH increases yield and reduces the number requiring testing. Our proposed ‘PLWH-LTBI streamlined guidance’ offers a simplified approach, with the potential to improve national LTBI screening implementation.</p

Latent tuberculosis infection screening and treatment in HIV: Insights from evaluation of UK practice

Latent TB infection (LTBI) screening and treatment in HIV-positive individuals in the UK is advocated by the British HIV Association (BHIVA) and National Institute for Health and Care Excellence (NICE), although each recommends differing strategies. We undertook an evaluation of UK practice, relating the responses to the local HIV/TB disease burden. 162 of 188 (86%) UK geographical areas responded; only 93/162 (57.4%) offer LTBI testing with considerable heterogeneity in practice, and no difference in HIV/TB burden between areas offering testing and those who do not. Only 33/93 (35.5%) and 6/93 (6.5%) reported full compliance with BHIVA and NICE guidance respectively. A uniform national guideline is required

Letter to the Editor: Variability but not admission or trends in NEWS2 score predicts clinical outcome in elderly hospitalised patients with COVID-19.

In a recent article in the Journal, Bruno and colleagues present short-term outcomes in elderly patients with severe COVID-19 disease admitted to a single Italian Infectious Disease unit.1 The study found that elderly patients are at increased risk of adverse outcomes due to high number of comorbidities and emphasises the need to improve clinical management in these patients. In particular, elderly patients who are likely to deteriorate will need to be rapidly identified.2 Existing prognostic models for COVID-19 based on clinical, laboratory and radiological variables are at high risk of bias.3 In the UK, the National Early Warning Score (NEWS) and its updated version NEWS2 – an a priori weighted composition of the patient's observations - is used routinely to monitor patients in hospital and identify early those who may deteriorate.4 [Opening paragraph]<br

Multi-Centre Observational Study of Transplacental Transmission of Influenza Antibodies following Vaccination with AS03(A)-Adjuvanted H1N1 2009 Vaccine

Introduction: Illness and death from influenza increase during pregnancy. In the United Kingdom pregnant women were targeted in a national programme for vaccination during the H1N1 2009–10 pandemic. Methods: In this study, pregnant women were recruited in labour from November 9, 2009 to March 10, 2010. Pandemic vaccination status was determined. Venous cord blood collected at delivery was evaluated for transplacental transfer of antibodies by measurement of haemagglutination inhibition and microneutralization titres. Results: Samples were collected from 77 vaccinated and 27 unvaccinated women. Seroprotection (HI titre ≥1:40) was detected in 58 (75.3%, 95% CI 64.2–84.4) cord blood samples from vaccinated women and 5 (18.5%, 95% CI 6.3–38.1) from unvaccinated women (P<0.0001). There was evidence of transplacental seroprotection 8 days after maternal immunization (77.9%, 95 CI 66.2–87.1), maintained in most cases for at least 16 weeks. Discussion: Immunization of pregnant women with AS03A-adjuvanted vaccine is followed by transplacental transfer of passive immunity at titres consistent with clinical protection in three-quarters of new-born infants. The findings support national and international pandemic H1N1 2009 recommendations for immunization during pregnancy

Multi-Centre Observational Study of Transplacental Transmission of Influenza Antibodies following Vaccination with AS03_A-Adjuvanted H1N1 2009 Vaccine

<div><h3>Introduction</h3><p>Illness and death from influenza increase during pregnancy. In the United Kingdom pregnant women were targeted in a national programme for vaccination during the H1N1 2009–10 pandemic.</p> <h3>Methods</h3><p>In this study, pregnant women were recruited in labour from November 9, 2009 to March 10, 2010. Pandemic vaccination status was determined. Venous cord blood collected at delivery was evaluated for transplacental transfer of antibodies by measurement of haemagglutination inhibition and microneutralization titres.</p> <h3>Results</h3><p>Samples were collected from 77 vaccinated and 27 unvaccinated women. Seroprotection (HI titre ≥1∶40) was detected in 58 (75.3%, 95% CI 64.2–84.4) cord blood samples from vaccinated women and 5 (18.5%, 95% CI 6.3–38.1) from unvaccinated women (P<0.0001). There was evidence of transplacental seroprotection 8 days after maternal immunization (77.9%, 95 CI 66.2–87.1), maintained in most cases for at least 16 weeks.</p> <h3>Discussion</h3><p>Immunization of pregnant women with AS03_A-adjuvanted vaccine is followed by transplacental transfer of passive immunity at titres consistent with clinical protection in three-quarters of new-born infants. The findings support national and international pandemic H1N1 2009 recommendations for immunization during pregnancy.</p> </div

Boxplot GMT haemagglutinination inhibition titre by interval from maternal vaccination to delivery.

<p>(Titres are expressed as reciprocal of the dilution and are given on a log₂ scale.).</p

Reverse cumulative distribution curves of haemagglutinination inhibition and microneutralization antibody titres in cord blood serum samples.

<p>(Titres are expressed as reciprocal of the dilution and are given on a log₂ scale.) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0047448#pone.0047448-Puleston1" target="_blank">[33]</a>.</p

Scatter-plots for cord blood haemagglutinination inhibition and microneutralization titres against interval between vaccination and delivery.

<p>(Titres are expressed as reciprocal of the dilution and are given on a log₂ scale.).</p