The association between acute flaccid myelitis (AFM) and enterovirus D68 (EV-D68) – what is the evidence for causation?

© 2018, European Centre for Disease Prevention and Control (ECDC). All rights reserved. Background: Enterovirus D68 (EV-D68) has historically been a sporadic disease, causing occasional small outbreaks of generally mild infection. In recent years, there has been evidence of an increase in EV-D68 infections globally. Large outbreaks of EV-D68, with thousands of cases, occurred in the United States, Canada and Europe in 2014. The outbreaks were associated temporally and geographically with an increase in clusters of acute flaccid myelitis (AFM). Aims: We aimed to evaluate a causal association between EV-D68 and AFM. ?Methods: Using data from the published and grey literature, we applied the Bradford Hill criteria, a set of nine principles applied to examine causality, to evaluate the relationship between EV-D68 and AFM. Based on available evidence, we defined the Bradford Hill Criteria as being not met, or met minimally, partially or fully. Results: Available evidence applied to EV-D68 and AFM showed that six of the Bradford Hill criteria were fully met and two were partially met. The criterion of biological gradient was minimally met. The incidence of EV-D68 infections is increasing worldwide. Phylogenetic epidemiology showed diversification from the original Fermon and Rhyne strains since the year 2000, with evolution of a genetically distinct outbreak strain, clade B1. Clade B1, but not older strains, is associated with AFM and is neuropathic in animal models. Conclusion: While more research is needed on dose–response relationship, application of the Bradford Hill criteria supported a causal relationship between EV-D68 and AFM

Influenza and pneumococcal vaccination in Australian adults: A systematic review of coverage and factors associated with uptake

© 2016 The Author(s). Background: In the absence of an adult vaccination register, coverage estimates for influenza and pneumococcal vaccination come from surveys and other data sources. Methods: Systematic review and meta-analysis of studies examining vaccination coverage in Australian adults from 1990 to 2015, focusing on groups funded under the National Immunisation Program, and intervals prior to and following the introduction of universal funding. Results: Twenty-two studies met the inclusion criteria; 18 used self-report to determine vaccination status. There were 130 unique estimates of coverage extracted. Among adults aged ≥65y, during the period of universal funding (1999-onwards), the summary estimate of annual influenza vaccination coverage from 27 point estimates was 74.8 % (95 % CI 73.4-76.2 %; range 63.9-82.4 %); prior to this period (1992-1998) from 10 point estimates it was 61.3 % (95 % CI 58.0-64.6 %; range 44.3-71.3 %). For the period of universal funding for pneumococcal vaccination (2005-onwards) the summary estimate for coverage was 56.0 % (95 % CI 53.2-58.8 %; range 51.2-72.8 %, 10 point estimates); prior to 2005 it was 35.4 % (95 % CI 18.8-52.0 %; range 15.4-45.2 %). Coverage for both vaccines was significantly higher following the introduction of universal funding. Influenza vaccination coverage in those aged 18-65 years with a medical indication was lower but data were not combined. Seven studies reported on Aboriginal Australians with three studies reporting five coverage estimates for influenza vaccination in adults ≥65 years (range 71 % - 89 %). Conclusions: Adult influenza and pneumococcal vaccination coverage has increased since the introduction of universal funding, but remains sub-optimal, with pneumococcal coverage lower than influenza. Implications: This review highlights the need for more coverage data overall and in high risk groups, to support public health programs to improve coverage

An Improved Model for Dynamin Assembly Revealed by Cryo-EM

Continua com: Avaluació de la qualitat de l'aire a la ciutat de Barcelon

An ionized accretion disc wind in Hercules X-1

Hercules X-1 is one of the best-studied highly magnetized neutron star X-ray binaries with a wealth of archival data. We present the discovery of an ionized wind in its X-ray spectrum when the source is in the high state. The wind detection is statistically significant in most of the XMM-Newton observations, with velocities ranging from 200 to 1000 km s-1. Observed features in the iron K band can be explained by both wind absorption and a forest of iron emission lines. However, we also detect nitrogen, oxygen, and neon absorption lines at the same systematic velocity in the high-resolution Reflection Grating Spectrometer grating spectra. The wind must be launched from the accretion disc, and could be the progenitor of the ultraviolet absorption features observed at comparable velocities, but the latter likely originate at significantly larger distances from the compact object. We find strong correlations between the ionization level of the outflowing material and the ionizing luminosity as well as the superorbital phase. If the luminosity is driving the correlation, the wind could be launched by a combination of Compton heating and radiation pressure. If instead the superorbital phase is the driver for the variations, the observations are likely scanning the wind at different heights above the warped accretion disc. If this is the case, we can estimate the wind mass outflow rate, corrected for the limited launching solid angle, to be roughly 70 per cent of the mass accretion rate