Varicella vaccination in pediatric oncology patients without interruption of chemotherapy

AbstractBackgroundMorbidity and mortality from primary varicella-zoster virus (VZV) infection is increased in immunocompromised children. Vaccination of VZV-seronegative cancer patients with live-attenuated varicella vaccine is safe when chemotherapy is interrupted. However, VZV vaccination without interruption of chemotherapy would be preferable.ObjectiveTo vaccinate VZV-seronegative pediatric oncology patients with live-attenuated VZV vaccine without interrupting their chemotherapy.Study-designWe performed a single-center prospective cohort study.ResultsThirty-one patients with either a hematological malignancy (n=24) or a solid tumor (n=7) were vaccinated early during their course of chemotherapy. VZV IgG seroconversion occurred in 14 of the 31 patients (45%) after one vaccination. Only 20 patients were revaccinated after 3 months. These were patients who did not seroconvert (5 patients) and patients who serocoverted (15 patients) to induce or sustain seropositivity. Of these 20 patients the final seroconversion rate was 70%. Seven out of the 31 patients (23%) developed a mild rash of which 5 were treated with antivirals and recovered completely without interrupting chemotherapy, and 2 recovered untreated. Of these 31 immunized patients 26 were available for cellular testing. After one vaccination 20 of 26 patients (77%) tested positive for VZV-specific CD4+ T cells, of which 7 patients had remained VZV-seronegative. After the second vaccination 11 of 11 patients showed VZV-specific CD4+ T cells to sustain positivity, although 4 remained VZV-seronegative.ConclusionsThis study indicates that live-attenuated VZV vaccine can be safely administered to closely monitored pediatric oncology patients without interruption of chemotherapy and adaptive immunity was induced despite incomplete seroconversion

Typologies de trajectoires administratives des migrants congolais, indiens et américains en Belgique : une exploitation des données du registre national

Qu'ont en commun un informaticien indien, une réfugiée congolaise et un journaliste américain ? Tous sont confrontés à un cadre juridique qui insécurise leurs parcours et trajectoires de vie, dans un contexte où les titres de séjour deviennent de plus en plus temporaires. Cet ouvrage pluridisciplinaire analyse finement la manière dont le cadre juridique contraint ces trajectoires, les stratégies déployées pour contourner les obstacles, et formule des recommandations visant une plus grande justice migratoire

Multiple (il)legal pathways: The diversity of immigrants' legal trajectories in Belgium

Background: A growing number of primarily qualitative studies have shown that the legal trajectories of immigrants in Western countries are often complex. However, immigrants’ long-term legal trajectories remain a blind spot in quantitative migration research. Objective: This paper aims to provide new empirical insights into the variety of legal pathways among non-European immigrants who arrived in Belgium between 1999 and 2008. We build a typology of legal trajectories, and we investigate how these trajectories are related to immigrants’ country of origin, asylum status, and social ties in Belgium. Methods: The micro longitudinal data is from the Belgian National Register. We use sequence analysis to identify clusters of legal trajectories, and multinomial logistic regressions to explore how they are related to immigrants’ characteristics. Results: We identify seven types of legal trajectory. While some are simple and smooth, others are characterized by moves back and forth between legal statuses and frequent periods of irregularity. Immigrants from the least developed countries and rejected asylum seekers are more likely to experience slow and chaotic trajectories. By contrast, simple and short trajectories are more common among immigrants from higher- or middle-income countries. We also find that social and family ties are a key factor in long-term immigrants experiencing smooth legal trajectories. Conclusions: Legal statuses vary substantially over time, and trajectories differ widely among immigrants. Some categories of immigrants are more at risk of highly precarious long-term trajectories that may lead to situations of ‘permanent temporariness’. Contribution: The paper highlights the relevance of a quantitative longitudinal perspective on immigrants’ legal status and underlines the need to take into account not only the legal status upon arrival but also the complexity of legal trajectories during the stay in the destination country

The fecal immunochemical test (fit): Selected aspects regarding its effectiveness for colorectal cancer screening in Quebec City

Background and aims: FIT's value has been ascertained across Canada and worldwide, but still needs to be assessed within the province of Quebec. There also remains a gap between formal indications for FIT, and its actual use in clinical practice. This research aims to evaluate some aspects of FIT's effectiveness in our setting, and its application by prescribers. Methods: We retrospectively identified and reviewed all the colonoscopies conducted for a positive FIT in 2014 at 2 hospitals located in Quebec City. Results: Five hundred and fifty-nine (559) colonoscopies were reviewed. We obtained PPVs of 6.8% and 46.9% for the detection of CRC and AA, respectively. The PPV for the detection of SCL was higher in men compared to women (OR 1.56, 95%CI 1.11–2.20) and among justified FITs compared to unwarranted ones (OR 1.88, 95%CI 1.34–2.63). The PPV for CRC detection was 25.0% in the presence of unexplained iron deficiency anemia and 6.5% when anemia was absent (p = 0.0058). In 49.9% of cases, the prescription of a FIT was inappropriate. Conclusion: The FIT holds a better PPV for detecting SCL among men and when it is indicated. Anemia is associated with a higher CRC detection rate. Half of the FITs were not initially indicated. Keywords: Colorectal neoplasms, Mass screening, Gastroenterology, Occult blood, Colonoscop