Guillain-Barré syndrome and adjuvanted pandemic influenza A (H1N1) 2009 vaccines: A multinational self-controlled case series in Europe

BACKGROUND: The risk of Guillain-Barré syndrome (GBS) following the United States' 1976 swine flu vaccination campaign in the USA led to enhanced active surveillance during the pandemic influenza (A(H1N1)pdm09) immunization campaign. This study aimed to estimate the risk of GBS following influenza A(H1N1)pdm09 vaccination. METHODS: A self-controlled case series (SCCS) analysis was performed in Denmark, Finland, France, Netherlands, Norway, Sweden, and the United Kingdom. Information was collected according to a common protocol and standardised procedures. Cases classified at levels 1-4a of the Brighton Collaboration case definition were included. The risk window was 42 days starting the day after vaccination. Conditional Poisson regression and pooled random effects models estimated adjusted relative incidences (RI). Pseudo likelihood and vaccinated-only methods addressed the potential contraindication for vaccination following GBS. RESULTS: Three hundred and three (303) GBS and Miller Fisher syndrome cases were included. Ninety-nine (99) were exposed to A(H1N1)pdm09 vaccination, which was most frequently adjuvanted (Pandemrix and Focetria). The unadjusted pooled RI for A(H1N1)pdm09 vaccination and GBS was 3.5 (95% Confidence Interval (CI): 2.2-5.5), based on all countries. This lowered to 2.0 (95% CI: 1.2-3.1) after adjustment for calendartime and to 1.9 (95% CI: 1.1-3.2) when we accounted for contra-indications. In a subset (Netherlands, Norway, and United Kingdom) we further adjusted for other confounders and there the RI decreased from 1.7 (adjusted for calendar month) to 1.4 (95% CI: 0.7-2.8), which is the main finding. CONCLUSION: This study illustrates the potential of conducting European collaborative vaccine safety studies. The main, fully adjusted analysis, showed that the RI of GBS was not significantly elevated after influenza A(H1N1)pdm09 vaccination (RI = 1.4 (95% CI: 0.7-2.8). Based on the upper limits of the pooled estimate we can rule out with 95% certainty that the number of excess GBS cases after influenza A(H1N1)pdm09 vaccination would be more than 3 per million vaccinated

The genesis of supported cobalt catalysts

The general objectives of this research were to investigate the effect of the support and the gas atmosphere on the decomposition and reduction of cobalt nitrate hexahydrate supported on silica and alumina to gain a greater understanding of the calcination and reduction procedures used in catalyst manufacturing processes. The decomposition was followed by TGA-DSC-MS. The observed breakdown on the unsupported complex is similar but not identical to previous reports with NO detected as an evolved gas. In an oxygen/argon atmosphere the decomposition is generally simplified for the supported samples with a fewer number of weight loss events. When supported on alumina, cobalt nitrate is stabilised with decomposition events shifting to higher temperatures, whereas when supported on silica, cobalt nitrate is destabilised with only one significant decomposition event, which occurs at a lower temperature than that of the unsupported complex. In a hydrogen/nitrogen atmosphere partial decomposition of cobalt nitrate occurs before reduction is initiated with both supported samples. When supported on alumina, cobalt nitrate reduction is catalysed with the two events that occur below 350 °C happening at lower temperatures, while reduction above 350 °C is moved to higher temperatures. The silica-supported complex in contrast exhibits reduction events that are all reduced in temperature relative to the unsupported salt. However, there is evidence of the formation of cobalt silicate with a high temperature reduction. The study has shown that the calcination and direct reduction of supported cobalt nitrate is significantly affected by the support and that different conditions are required to achieve the same state