Legal and illegal drug use among female sex workers in bar and club prostitution in Belgium: a quantitative and qualitative study

Aims: This study describes the amounts and effects of drug use in bar and club sex work, and the use of healthcare for the drug-related needs of sex workers (SW). Methods: A cross-sectional study was carried out in Belgium. In a quantitative component, 120 bar and club SW were interviewed face-to-face by means of a semi-structured questionnaire. In a qualitative component, 25 SW were interviewed face-to-face and 5 focus group discussions with key actors professionally involved with the study's subject were conducted. Findings: Many bar and club SW drink frequently alcohol and engage in heavy drinking. Illegal drugs such as cannabis, cocaine and benzodiazepines are also frequently used. The drug use often involves poly or combined drug use. More than one-third experienced a certain degree of dependence on a product and many experienced effects from drug use on their sex work. The study shows that SW have difficulties accessing drug-related healthcare. Conclusions: SW use often legal and illegal drugs. The prevalence and influence of drug use among bar and club SW illustrates the need for drug and sex work related healthcare. Distribution of more information about the risks of drug use, the possible negative effects, and the available drug-related healthcare is needed

Immunogenicity at delivery after Tdap vaccination in successive pregnancies

BackgroundTetanus, diphtheria, acellular pertussis (Tdap) vaccination is recommended to be administered in every pregnancy. Although the safety of this strategy has been confirmed, the immunogenicity of Tdap vaccination in two successive pregnancies has not yet been described. This study investigated Tdap-specific immunity levels and transplacental transfer in two successive pregnancies after repeated Tdap-vaccination.MethodsWomen enrolled in prior studies on Tdap vaccination during pregnancy were invited to participate in a follow-up study if they became pregnant again. Women who received a Tdap vaccine in both pregnancies were considered for this analysis. Tdap-specific total IgG and IgG subclasses were measured with a multiplex immunoassay.ResultsIn total, 27 participants with a mean interval between deliveries of 2.4 years were included in the analysis. In maternal serum, Tdap-specific total IgG levels were comparable at both deliveries whereas in cord serum, all Tdap-specific total IgG antibody levels were reduced at the second compared to the first delivery. This was largely reflected in the IgG1 levels in maternal and cord serum. Transplacental transfer ratios of total IgG and IgG1 were also mostly reduced in the second compared to the first pregnancy.ConclusionThis study reports for the first time Tdap-specific total IgG and IgG subclass levels and transfer ratios after repeated Tdap vaccination in successive pregnancies. We found reduced transfer of most Tdap-specific IgG and IgG1 antibodies in the successive pregnancy. As pertussis-specific antibodies wane quickly, Tdap vaccination in each pregnancy remains beneficial. However, more research is needed to understand the impact of closely spaced booster doses during pregnancy on early infant protection against pertussis

Antibodies to Bordetella pertussis antigens in maternal and cord blood pairs: a Thai cohort study

Background Pertussis is a vaccine-preventable disease, yet an increasing incidence of pertussis occurs in many countries. Thailand has a long-standing pertussis vaccination policy, therefore most expectant mothers today had received vaccines as children. The resurgence of pertussis among Thai infants in recent years led us to examine the pre-existing antibodies to Bordetella pertussis antigens in a cohort of 90 pregnant women. Methods We evaluated the IgG to the Pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (PRN) in maternal and cord blood sera using commercial enzyme-linked immunosorbent assays (ELISA). Results When values of >10 IU/ml were accepted as potential protective concentrations, we found that the percentages of unprotected infants were 73.3%, 43.3% and 75.5% for anti-PT, anti-FHA and anti-PRN IgG, respectively. Discussion These results may explain the susceptibility for pertussis among newborn infants in Thailand and support the requirement for a pertussis booster vaccine during pregnancy, which may contribute to the passive seroprotection among newborns during the first months of life

Acquisition of Adult-Like TLR4 and TLR9 Responses during the First Year of Life

BACKGROUND: Characteristics of the human neonatal immune system are thought to be responsible for heightened susceptibility to infectious pathogens and poor responses to vaccine antigens. Using cord blood as a source of immune cells, many reports indicate that the response of neonatal monocytes and dendritic cells (DC) to Toll-like receptor (TLR) agonists differs significantly from that of adult cells. Herein, we analyzed the evolution of these responses within the first year of life. METHODOLOGY/PRINCIPAL FINDINGS: Blood samples from children (0, 3, 6, 9, 12 month old) and healthy adults were stimulated ex vivo with bacterial lipopolysaccharide (LPS, TLR4 agonist) or CpG oligonucleotides (TLR9 agonist). We determined phenotypic maturation of monocytes, myeloid (m) and plasmacytoid (p) DC and production of cytokines in the culture supernatants. We observed that surface expression of CD80 and HLA-DR reaches adult levels within the first 3 months of life for mDCs and 6-9 months of life for monocytes and pDCs. In response to LPS, production of TNF-alpha, IP-10 and IL-12p70 reached adult levels between 6-9 months of life. In response to CpG stimulation, production of type I IFN-dependent chemokines (IP-10 and CXCL9) gradually increased with age but was still limited in 1-year old infants as compared to adult controls. Finally, cord blood samples stimulated with CpG ODN produced large amounts of IL-6, IL-8, IL-1beta and IL-10, a situation that was not observed for 3 month-old infants. CONCLUSIONS: The first year of life represents a critical period during which adult-like levels of TLR responses are reached for most but not all cytokine responses

Global Perspectives on Immunization During Pregnancy and Priorities for Future Research and Development: An International Consensus Statement.

Immunization during pregnancy has been recommended in an increasing number of countries. The aim of this strategy is to protect pregnant women and infants from severe infectious disease, morbidity and mortality and is currently limited to tetanus, inactivated influenza, and pertussis-containing vaccines. There have been recent advancements in the development of vaccines designed primarily for use in pregnant women (respiratory syncytial virus and group B Streptococcus vaccines). Although there is increasing evidence to support vaccination in pregnancy, important gaps in knowledge still exist and need to be addressed by future studies. This collaborative consensus paper provides a review of the current literature on immunization during pregnancy and highlights the gaps in knowledge and a consensus of priorities for future research initiatives, in order to optimize protection for both the mother and the infant