Clinical Study The Prevalence and Antibiotic Susceptibility Pattern of Salmonella typhi among Patients Attending a Military Hospital in Minna, Nigeria

The threat to human health posed by antibiotic-resistant bacterial pathogens is of growing concern to medical practice. This study investigated the antibiotic sensitivity pattern of Salmonella typhi isolated from blood specimen. One hundred blood samples were collected from suspected typhoid fever patients in 31 Artillery Brigade Medical Centre, Minna, and were analyzed for S. typhi while antibiotic sensitivity testing was done Kirby-Bauer method. Sixty (60.0%) samples out of the total 100 were positive for bacterial growth. The organisms isolated 2 include Salmonella typhi; 45 (75.0%), Shigella; 6 (10.0%), E. coli; 3 (5.0%), Klebsiella; 3 (5.0%), Enterobacter; 2 (3.3%), and Citrobacter; 1 (1.7%). Result of the sensitivity test showed that the isolates were resistant to all the antibiotics; ceftriaxone, cefuroxime, amoxicillin, ampicillin, ciprofloxacin, and augmentin, which are the drug of choice routinely used in the study area for the treatment of typhoid fever. They were however sensitive to chloramphenicol and ofloxacin, which, unfortunately, are not used in this study area for the treatment of typhoid fever. There appear to be multiple drug resistant (MDR) strain of S. typhi in the study area. These may be as a result of overdependence or uncontrolled use of the few available antibiotics and/or inaccurate or inconclusive diagnosis resulting in the development and spread of resistant strains of S. typhi. The study, therefore, highlights the need for a strong collaboration between the physicians and the laboratory in the choice of antibiotics for the treatment of bacterial diseases in order to discourage the development of resistant strain of bacterial pathogen

A Three-Way Comparison of Tuberculin Skin Testing, QuantiFERON-TB Gold and T-SPOT.TB in Children

BACKGROUND: There are limited data comparing the performance of the two commercially available interferon gamma (IFN-gamma) release assays (IGRAs) for the diagnosis of tuberculosis (TB) in children. We compared QuantiFERON-TB gold In Tube (QFT-IT), T-SPOT.TB and the tuberculin skin test (TST) in children at risk for latent TB infection or TB disease. METHODS AND FINDINGS: The results of both IGRAs were compared with diagnosis assigned by TST-based criteria and assessed in relation to TB contact history. Results from the TST and at least one assay were available for 96 of 100 children. Agreement between QFT-IT and T-SPOT.TB was high (93% agreement, kappa = 0.83). QFT-IT and T-SPOT.TB tests were positive in 8 (89%) and 9 (100%) children with suspected active TB disease. There was moderate agreement between TST and either QFT-IT (75%, kappa = 0.50) or T-SPOT.TB (75%, kappa = 0.51). Among 38 children with TST-defined latent TB infection, QFT-IT gold and T-SPOT.TB assays were positive in 47% and 39% respectively. Three TST-negative children were positive by at least one IGRA. Children with a TB contact were more likely than children without a TB contact to have a positive IGRA (QFT-IT LR 3.9; T-SPOT.TB LR 3.9) and a positive TST (LR 1.4). Multivariate linear regression analysis showed that the magnitude of both TST induration and IGRA IFN-gamma responses was significantly influenced by TB contact history, but only the TST was influenced by age. CONCLUSIONS: Although a high level of agreement between the IGRAs was observed, they are commonly discordant with the TST. The correct interpretation of a negative assay in a child with a positive skin test in clinical practice remains challenging and highlights the need for longitudinal studies to determine the negative predictive value of IGRAs

An australian audit of vaccination status in children and adolescents with inflammatory bowel disease

<p>Abstract</p> <p>Background</p> <p>Children and adolescents with inflammatory bowel disease (IBD) are at increased risk of vaccine preventable diseases (VPD). This includes invasive pneumococcal disease and influenza. The primary aim of this study was to describe compliance with current Australian guidelines for vaccination of children and adolescents diagnosed with IBD. A secondary aim was to review the serological screening for VPD.</p> <p>Methods</p> <p>A random sample of patients (0-18 years at diagnosis), were selected from the Victoria Australia state based Pediatric Inflammatory Bowel Disease Register. A multi-faceted retrospective review of immunization status was undertaken, with hospital records audited, a telephone interview survey conducted with consenting parents and the vaccination history was checked against the primary care physician and Australian Childhood Immunization Register (ACIR) records. The routine primary childhood vaccinations and administration of the recommended additional influenza and pneumococcal vaccines was clarified.</p> <p>Results</p> <p>This 2007 audit reviewed the immunization status of 101individuals on the Victorian Pediatric IBD database. Median age at diagnosis was 12.1 years, 50% were on active immunosuppressive therapy. 90% (38/42) [95% confidence intervals (CI) 77%; 97%] with complete immunization information were up-to-date with routine primary immunizations. Only 5% (5/101) [95% CI 2%; 11%] received a recommended pneumococcal vaccine booster and 10% (10/101) [95% CI 5%; 17%] had evidence of having ever received a seasonal influenza vaccine. Those living in rural Victoria (p = 0.005) and younger at the age of diagnosis (p = 0.002) were more likely to have ever received an influenza vaccine Serological testing, reviewing historical protection from VPD, identified 18% (17/94) with evidence of at least one serology sample.</p> <p>Conclusion</p> <p>This study highlights poor compliance in IBD patients for additional recommended vaccines. A multi-faceted approach is required to maximize protection from VPD in this vulnerable special risk population.</p

Genetic improvement of tomato by targeted control of fruit softening

Controlling the rate of softening to extend shelf life was a key target for researchers engineering genetically modified (GM) tomatoes in the 1990s, but only modest improvements were achieved. Hybrids grown nowadays contain 'non-ripening mutations' that slow ripening and improve shelf life, but adversely affect flavor and color. We report substantial, targeted control of tomato softening, without affecting other aspects of ripening, by silencing a gene encoding a pectate lyase

Clinical update: Rotavirus gastroenteritis and its prevention

The licensing of oral rotavirus vaccines in many countries has refocused attention on the epidemiology and disease burden of rotaviruses. Rotaviruses infect nearly all children by age 5 years, and are the most common cause of severe gastroenteritis during childhood. Every year, rotaviruses cause 114 million diarrhoea episodes, 2·4 million hospital admissions, and 600 000 deaths in children younger than 5 years worldwide. 98% of rotavirus-related deaths occur in developing countries, whereas in developed countries 220 000 children are admitted to hospital every year, and about one in 50 children are admitted to hospital by age 5 years. Rotavirus epidemics that arise every winter and spring coincide with peak activity of respiratory viruses and place extra demands on primary and hospital care. Rotavirus vaccines could reduce child mortality from all causes by 5% and admission to hospital for gastroenteritis by 40% or more worldwide. However, these reductions will take at least several years and will vary by setting. In the USA, where vaccine coverage is 90%, rotavirus vaccination should prevent about 80% of the 40 deaths and 60 000 rotavirus-associated hospital admissions annually. By contrast, modelling has found that 6000 deaths and 235 000 severe rotavirus episodes could be avoided annually in Nigeria. However, because of only 22% vaccine coverage in the Expanded Program on Immunisation (EPI), these figures are only 15% of the estimated disease burden. Therefore efforts to ensure that rotavirus vaccines are safe and efficacious must be matched by those making EPI vaccines available for all infants

Information systems for vaccine safety surveillance

Immunization implementation in the community relies upon post-licensure vaccine safety surveillance to maintain safe vaccination programs and to detect rare AEFI not observed in clinical trials. The increasing availability of electronic health-care related data and correspondence from both health-related providers and internet-based media has revolutionized health-care information. Many and varied forms of health information related to adverse event following immunization (AEFI) are potentially suitable for vaccine safety surveillance. The utilization of these media ranges from more efficient use of electronic spontaneous reporting, automated solicited surveillance methods, screening various electronic health record types, and the utilization of natural language processing techniques to scan enormous amounts of internet-based data for AEFI mentions. Each of these surveillance types have advantages and disadvantages and are often complementary to each other. Most are “hypothesis generating,” detecting potential safety signals, where some, such as vaccine safety datalinking, may also serve as “hypothesis testing” to help verify and investigate those potential signals

Surveillance of adverse events following H1N1/09 influenza immunisation in Victoria, Australia

BACKGROUND: The H1N1 pandemic in 2009 required a systematic coordinated response, which in Australia included a monovalent (H1N1/09) vaccine (Panvax?). SAEFVIC (Surveillance of Adverse Events Following Vaccination In the Community) is the Victorian, Australia state-based vaccine safety unit. The aim of the study was to review SAEFVIC reports of adverse events following immunisations (AEFI) temporally associated with H1N1/09 vaccines [monovalent and Trivalent Influenza Vaccines (TIV)]. METHODS: 1) Analysis of AEFI related to H1N1/09 vaccines reported to SAEFVIC from September 2009 to December 2010; 2) Review of febrile convulsions (ICD-10 code R56.0), in children under 5 years of age presenting to the Royal Children’s Hospital (RCH) Melbourne, Emergency Department between 1 March-30 April 2010. The presentation details and immunisation history were clarified by a telephone interview. RESULTS: 1) There were 659 reports of 749 adverse events following H1N1 vaccines. Among the TIV group, Fluvax had the most AEFI reported, with 77 per 100,000 doses distributed. Serious AEFI temporally associated with H1N1/09 vaccines included: 3 deaths, 2 anaphylactic reactions, and 3 GuillainBarre Syndrome. There were 7 reports of drug administration error; 2) There were 179 presentations with fever and 67 reported febrile convulsions out of 11025 presentations (0.61%), 11 following H1N1 vaccines. Fluvax? was associated with 55% (6/11) reports. The mean onset time of AEFI was 13.2 hours post vaccination, and there was complete resolution of symptoms in allcases with no significant morbidity. CONCLUSION: Consistent with other Australian states in 2010, there was a TIV brand specific [Fluvax?] increase in febrile convulsions post vaccination. As a result this vaccine is no longer licensed for children <5 years of age. Comprehensive passive and active surveillance for AEFI needs to be incorporated into future pandemic planning

Early signal detection of adverse events following influenza vaccination using proportional reporting ratio, Victoria, Australia

INTRODUCTION:Timely adverse event following immunisation (AEFI) signal event detection is essential to minimise further vaccinees receiving unsafe vaccines. We explored the proportional reporting ratio (PRR) ability to detect two known signal events with influenza vaccines with the aim of providing a model for prospective routine signal detection and improving vaccine safety surveillance in Australia. METHODS:Passive AEFI surveillance reports from 2008-2017 relating to influenza vaccines were accessed from the Australian SAEFVIC (Victoria) database. Proportional reporting ratios were calculated for two vaccine-event categories; fever and allergic AEFI. Signal detection sensitivity for two known signal events were determined using weekly data; cumulative data by individual year and; cumulative for all previous years. Signal event thresholds of PRR ≥2 and Chi-square ≥4 were applied. RESULTS:PRR provided sensitive signal detection when calculated cumulatively by individual year or by all previous years. Known signal events were detected 15 and 11 days earlier than traditional methods used at the time of the actual events. CONCLUSION:Utilising a single jurisdiction's data, PRR improved vaccine pharmacovigilance and showed the potential to detect important safety signals much earlier than previously. It has potential to maximise immunisation safety in Australia. This study progresses the necessary work to establish national cohesion for passive surveillance signal detection and strengthen routine Australian vaccine pharmacovigilance

Recurrent 6^th nerve palsy in a child following different live attenuated vaccines: case report

Abstract Background Recurrent benign 6th nerve palsy in the paediatric age group is uncommon, but has been described following viral and bacterial infections. It has also been temporally associated with immunization, but has not been previously described following two different live attenuated vaccines. Case presentation A case is presented of a 12 month old Caucasian boy with recurrent benign 6th nerve palsy following measles-mumps-rubella and varicella vaccines, given on separate occasions with complete recovery following each episode. No alternate underlying etiology was identified despite extensive investigations and review. Conclusions The majority of benign 6th nerve palsies do not have a sinister cause and have an excellent prognosis, with recovery expected in most cases. The exact pathophysiology is unknown, although hypotheses including autoimmune mechanisms and direct viral invasion could explain the pathophysiology behind immunization related nerve palsies. It is important to rule out other aetiologies with thorough history, physical examination and investigations. There is limited information in the literature regarding the safety of a repeat dose of a live vaccine in this setting. Future immunizations should be considered on a case-by-case basis.</p