Thesis (Ph. D.)--University of Adelaide, Dept. of Paediatrics, 1989. / Includes bibliographical references (leaves [177-194]).

Thesis (M.Med.Sc.)--University of Hong Kong, 2002. / Includes bibliographical references. Also available in print.

Background: An estimated 50,000 adults in the United States (U.S.) die each year from one of 10 vaccine preventable diseases. For those who survive vaccine preventable infections, health care costs and loss of income become more significant. While children in the U.S. aged 0-2 exhibit vaccine prevalence rates of almost 90%, some adult vaccine prevalence rates in the U.S. population are reported to be nearly 30-40% less than the goals set forth by Healthy People 2010. The purpose of this study was to examine the associations between socio-demographic characteristics of U.S. adults and adult vaccination prevalence for pneumococcal, hepatitis A, hepatitis B, tetanus, and pertussis. Methods: Data from the 2008 National Health Interview Survey were assessed examining various health indicators and characteristics of non-institutionalized adults and children. The sample was restricted to adults ≥18 years of age. Odds ratios were calculated and multivariate logistic regression was also conducted. P-values of Results: There were 21781 total observations; 19.3% received the pneumococcal vaccine, 9.4% received the hepatitis A vaccine, 27.2% received the hepatitis B vaccine, 55.1% received the tetanus vaccine, and 15.2% received the pertussis vaccine. Of the socio-demographic characteristics examined, age, health insurance, marital status, and education were significant for either all five or at least four of the vaccines included in this study. As one might expect those who reported health insurance and those who had a higher level of education usually had a higher likelihood of vaccine receipt as compared to those without health insurance and those with less than a high school education. Age associations varied due to age-related recommendations for certain vaccines such as pneumococcal (recommended for adults ≥65). Compared to the married population (referent), marital status results varied, but for reasons unclear. Whites, the referent group, were the most likely to be vaccinated as compared to Blacks, Hispanics/Latinos, and Asians. Hispanics/Latinos typically had the lowest likelihood of vaccination in this examination. Conclusions: This study further explores the impact of socio-demographic disparities on vaccination status and adds new information to the literature regarding adult vaccination rates for preventable diseases. While research exists related to strengthening interventions such as patient reminder systems, those who do not see the same health care providers on a regular basis remain at risk for lower vaccination prevalence. It is important to better understand the role of social determinants of health, specifically in terms of vaccinations. Future research is needed to further characterize the association of socio-demographic factors with receipt of optional vaccines in adults.

Source: Masters Abstracts International, Volume: 47-06, page: 3554. Adviser: David W. Smith. Includes bibliographical references.

Background Chronic smokers are at risk of premature death associated with underlying pulmonary or cardiovascular diseases. Dual influenza and pneumococcal vaccination has been shown to prevent death and hospitalization secondary to pulmonary or cardiovascular diseases in elderly persons. Its effect in chronic smokers remained unknown. Methods This is a prospective randomized open-labeled trial conducted from April 2010 to March 2013, comprising adult patients aged less than 50 years who were chronic smokers. Subjects were randomly assigned into 4 groups. Group 1 (study group) patients received both trivalent influenza vaccine (TIV) and the 23-valent polysaccharide pneumococcal vaccine (PPV). There were 3 control groups: Group 2 patients received the TIV only. Group 3 patients received the PPV only and Group 4 patients did not receive any vaccines. The TIV used was the Vaxigrip® (Sanofi Pasteur, France) and the PPV used was the Pneumovax®23 (Merck, USA). All enrolled patients were follow-up for 24 months post vaccination. Patient details, Charlson comorbidity index, medications, subsequent hospitalization, diagnosis and mortality were recorded and analyzed. Results A total of 1006 subjects were enrolled and completed the study (Group PPV+TIV: 250; Group TIV: 254, Group PPV: 250 and Group None: 259). The baseline demographics and Charlson comorbidity index were similar among subjects in the 4 groups. The median age was 48 years and 85.9% were male patients. Significantly fewer subjects who received the dual vaccination (Group PPV+TIV) were hospitalized (p<0.001), with shorter mean length of stay (p<0.001), and less frequent hospitalization (p<0.001) for cardiovascular or respiratory diseases than no vaccination (Group None) or single vaccination (Group TIV and Group PPV). Multivariate analysis demonstrated that dual vaccination with PPV + TIV was the only independent factor associated with reduced risk of hospitalization (p<0.001; relative risk 0.288; 95% CI 0.101-0.154). There was no difference in mortality rate among the groups. Both vaccinations were well tolerated and no serious adverse events were reported. Conclusion Dual influenza and pneumococcal vaccinations prevented chronic smokers against hospitalization secondary to pulmonary or cardiovascular causes. Annual influenza and a single pneumococcal vaccination should be promoted among chronic smokers. / published_or_final_version / Microbiology / Master / Master of Medical Sciences

Bibliography: leaves [177]-[194] / [194] leaves : ill ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Paediatrics, 1989

Although there are well-documented benefits from influenza vaccine and 23-valent pneumococcal polysaccharide vaccine (23vPPV) against invasive pneumococcal disease and laboratory confirmed influenza, their effectiveness against pneumonia remains controversial for community-based persons aged >=65years. At the time of this research, within Australia, only the government of Victoria publicly funded these vaccines for elderly persons. With continued growth of the elderly population, the subsequent adoption of an Australia-wide program, and increasing uptake of similar programs in other countries, there is a need for data clarifying the impact of vaccination on pneumonia. This research estimates incremental vaccine effectiveness of 23vPPV over and above influenza vaccine against hospitalisation with community-acquired pneumonia (CAP) in the elderly.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2016-05-11T14:07:03Z No. of bitstreams: 1 Jailton_Azevedo Silva Junior. Impacto da vacina...2015.pdf: 2256825 bytes, checksum: 6da623ba97a2d68604f3b4a098585b07 (MD5) / Approved for entry into archive by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2016-05-11T14:07:15Z (GMT) No. of bitstreams: 1 Jailton_Azevedo Silva Junior. Impacto da vacina...2015.pdf: 2256825 bytes, checksum: 6da623ba97a2d68604f3b4a098585b07 (MD5) / Made available in DSpace on 2016-05-11T14:07:15Z (GMT). No. of bitstreams: 1 Jailton_Azevedo Silva Junior. Impacto da vacina...2015.pdf: 2256825 bytes, checksum: 6da623ba97a2d68604f3b4a098585b07 (MD5) Previous issue date: 2015 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / INTRODUÇÃO: Em 2010, a vacina conjugada 10-valente (PCV10) foi incorporada ao programa nacional de imunizações (PNI) brasileiro. Este imunobiológico confere imunização contra os dez principais tipos capsulares de Streptococcus pneumoniae, patógeno responsável por diversas manifestações clínicas e com elevada contribuição nas taxas de incidência e mortalidade por meningite, que é a condição clínica mais grave. OBJETIVO: O presente estudo teve como objetivo avaliar o impacto da PCV10 na epidemiologia da meningite pneumocócica na região metropolitana de Salvador (RMS) Bahia, comparando o período anterior (2008-2010) e posterior (2011-2013) a sua utilização, bem como realizar uma caracterização molecular minuciosa a partir de uma série histórica (1996-2012) entre os isolados resistentes a penicilina (PNSSP com CIM≥ 0,125 μg/mL) e para os sorotipos não-vacinais (2008-2012). MATERIAL E MÉTODOS: Foram incluídos todos casos de meningite pneumocócica confirmados laboratorialmente no período entre 1996 a 2013. Taxas de incidência para a Salvador e RMS foram calculadas com base nos dados populacionais do IBGE/2010. A determinação do tipo capsular foi realizada através da técnica de Multiplex-PCR e/ou reação de Quellung. A sensibilidade a nove antimicrobianos foi testada através das técnicas disco-difusão, microdiluição e E-test. Para caracterizar o perfil molecular foram aplicadas as técnicas de genotipagem de PFGE e MLST. RESULTADOS: Um total de 939 casos de meningite pneumocócica foram identificados no período de 1996- 2013, sendo que 70 casos ocorrem entre 2011 a 2013 (período pós-vacinal). A incidência de meningite pneumocócica em todas as faixas etárias na RMS reduziu de 0,70 casos/100.000 habitantes para 0,59 casos/100.000 habitantes considerando o período de três anos antes e após a vacinação com PCV10 [p< 0,05; RR IC 95%: 1,46 (1,03-2,05)]. Esta redução foi significativa na faixa etária de 0-2 anos e nos casos por sorotipos relacionados à PCV10. Não houve aumento significativo de casos por sorotipos não vacinais nesta casuística, apesar do surgimento de casos por sorotipos não-vacinais não detectados anteriormente na série histórica de MP (10F, 21, 22F, 15A e 24F). Os isolados resistentes à penicilina analisados na série histórica se restringiram a 13 sorotipos, entre os quais: 14 (45,1 %; 78/173), 23F (19,1%; 33/173), 6B (14,4 %; 25/173), 19F (9,2 %; 16/173) e 19A (5,2 %; 9/173). 94% dos casos nãosusceptíveis à penicilina (PNSSP) foram de sorotipos vacinais. Os grupos clonais caracterizados pelo PFGE/MLST predominantes ao longo dos anos foram representados pelo sorotipo 14, denominado grupo A/ST 66 [35,3 % (61/173)] e grupo GK/ST 156 [4.6 % (8/173)], este último associado com níveis elevados de resistência a penicilina e ceftriaxona. Não foram detectados grupos clonais emergentes associados a tipos capsulares não-vacinais. CONCLUSÕES: Estes achados sugerem que a introdução da PCV10 modificou a epidemiologia da meningite pneumocócica na população estudada. / INTRODUCTION: In 2010, the 10-valent pneumococcal conjugate vaccine (PCV10) was introduced into the Brazilian national immunization program (NIP). This immunobiological provides immunization against the main ten capsular types of Streptococcus pneumoniae, the pathogen responsible for different clinical manifestations and high contribution in the incidence and mortality from meningitis, which is the most severe clinical condition. OBJECTIVE: This study aimed to evaluate the impact of PCV10 in the epidemiology of pneumococcal meningitis in the metropolitan area of Salvador (RMS) Bahia, comparing the previous (2008-2010) and after (2011-2013) periods its use, as well as conduct a thorough molecular characterization from a historical series (1996-2012) among isolates resistant to penicillin (PNSSP with CIM≥ 0.125 g / ml) and nonvaccine serotypes (2008-2012). MATERIAL AND METHODS: We included all cases of pneumococcal meningitis laboratory confirmed for the period 1996 to 2013. Incidence rates for Salvador and RMS were calculated based on population data from IBGE/2010. The capsular type determination was performed by multiplex PCR and/or Quellung reaction. Isolates Nine antibiotics were tested by disk-diffusion test, broth micro-dilution and E-test. To characterize the molecular profiling techniques were applied genotyping PFGE and MLST. RESULTS: A total of 939 cases of pneumococcal meningitis were identified during 1996-2013 period, with 70 cases occurring between 2011-2013 (post-vaccination period). The incidence of pneumococcal meningitis in all age groups in the RMS decreased from 0.70 cases / 100,000 inhabitants to 0.59 cases / 100,000 inhabitants considering the three-year period before and after vaccination with PCV10 [p <0.05; RR 95% CI: 1.46 (1.03 to 2.05)]. This reduction was significant in the age group 0-2 years and in cases by serotypes related to PCV10. There was no significant increase in cases by serotypes not vaccine in this series, despite the emergence of cases by serotypes not-vaccine previously undetected in the historical series of MP (10F, 21, 22F, 15A and 24F). The penicillin resistant isolates analyzed the historical series were restricted to 13 serotypes, including: 14 (45.1%; 78/173), 23F (19.1%; 33/173), 6B (14.4%; 25/173), 19F (9.2%, 16/173) and 19A (5.2%, 9/173). 94% of nonsusceptible to penicillin cases (PNSSP) were vaccine serotypes. Clonal groups characterized by PFGE / MLST predominant over the years have been represented by serotype 14, group called A / ST 66 [35.3% (61/173)] and Group GK / TS 156 [4.6% (8/173) ], the latter associated with elevated levels of penicillin and ceftriaxone resistance. Not were detected emerging clonal groups associated with capsular types non-vaccination. CONCLUSIONS: These findings suggest that the introduction of PCV10 changed the epidemiology of pneumococcal meningitis in the population studied.

Introdução: Pessoas infectadas pelo vírus da imunodeficiência humana (HIV) têm alto risco de desenvolver doença pneumocócica. Infecções invasivas pelo Streptococcus pneumoniae (pneumococo) lideram a morbidade e a mortalidade entre crianças, idosos e pessoas com doenças de base que comprometem o sistema imune ou diminuem a função esplênica. A infecção pelo HIV está associada a um aumento de até dez vezes na incidência das pneumonias bacterianas no mundo. S. pneumoniae é o agente mais comum identificado. A imunização contra S. pneumoniae tem sido recomendada para indivíduos infectados pelo HIV em vários países, incluindo o Brasil, onde a vacina de polissacarídeos antipneumococo com 23 sorotipos (PPV-23) está sendo utilizada desde 1993. A efetividade da vacina de polissacarídeos antipneumococo varia entre 60 a 80% entre adultos com função imunológica relativamente normal. Entre adultos infectados pelo HIV, os estudos realizados até o momento apresentam resultados inconclusivos ou mesmo contraditórios. Objetivo: o objetivo deste estudo é avaliar a efetividade da vacina de polissacarídeos antipneumococo 23-valente (PPV-23) em uma amostra da população adulta infectada pelo HIV, em São Paulo. Métodos: Estudo de caso controle, tipo caso-incidente, entre adultos infectados pelo HIV, em São Paulo. A exposição é ter sido vacinado com a vacina 23 valente e o desfecho é infecção invasiva causada pelo S. pneumoniae. Caso: pessoa infectada pelo HIV, >=18 anos de idade, com doença invasiva por pneumococo, diagnosticada por meio de cultura positiva (isolamento de S. pneumoniae) em material biológico obtido de qualquer fluido corporal normalmente estéril. Controle: pessoa infectada pelo HIV, com >=18 anos de idade, recebendo cuidados nas mesmas instituições, sem doença invasiva por pneumococo, com o mesmo nível de células T CD4+ no mesmo período do diagnóstico do caso, estratificadas por faixas (CD4<200; CD4>=200<=499; >=500) cels/mm3. Foram conduzidas análise univariada e regressão logística condicional. Resultados: 79 casos e 241 controles foram incluídos, média de 39 anos, 63% do sexo masculino, mais de 50% com escolaridade entre média e fundamental, 63,5% brancos, 19% vivendo em condições precárias de habitação. Idade, sexo e raça não diferiram entre casos e controles. Bacteremia foi a manifestação clínica mais freqüente. Fatores de risco associados à doença pneumocócica incluíram: uso de alcool, de drogas injetáveis, ter menor nível de escolaridade, condições precárias de habitação, contato próximo com criança <10 anos e hospitalizações prévias por pneumonia. O uso de anti-retrovirais e a vacina antipneumocócica estiveram associados com uma diminuição do risco. A efetividade da vacina foi de aproximadamente 65% (OR=0,35 IC95%:0,18-0,70). Após ajustar por alguns fatores associados à doença invasiva (uso de drogas injetáveis, hospitalização prévia por pneumonia e uso de ARV), o possível efeito protetor da vacina (OR=, EV=54%) perdeu sua significância estatística (IC95% 0,27-1,13). Amostras de 47 casos foram sorotipadas. Conclusão: Este é o primeiro estudo a avaliar a efetividade da vacina de polissacarídeos antipneumocócica entre os indivíduos infectados pelo HIV no Brasil, e a incluir dados sobre a distribuição dos sorotipos de pneumococo neste subgrupo. A vacina anti-pneumocócica e o uso de anti-retrovirais atuaram como fatores protetores contra doença pneumocócica invasiva. Estes resultados reforçam a recomendação do uso da vacina no Brasil, e indicam a necessidade de estudos com amostras maiores que possam elucidar de forma inequívoca o efeito da vacina antipneumocócica entre portadores do HIV / Background: HIV-infected individuals are at increased risk of bacterial pneumonia in general and of pneumonia due to S. pneumoniae in particular. S. pneumoniae is the leading cause of morbidity and mortality among children, elderly and those with underlying conditions that compromise the immune system or diminish the splenic function. HIV infection is associated to a tenfold increase in the incidence of bacterial pneumonias worldwide and S. pneumoniae is the most common causal agent identified. Immunization against S. pneumoniae with Polysaccharide pneumococcal vaccine is recommended for use in HIV-infected adults in Brazil. The effectiveness of PPV23 ranges from to approximately 30 to 80%, among those with normal immune function. Among HIV-infected adults, studies have suggested contradictory or inconclusive results. Objective: To assess the effectiveness of the 23-valent polysaccharide pneumococcal vaccine among HIV-infected adult patients in São Paulo, Brazil. Methods: A prospective matched case-control study among HIV-infected adults in São Paulo. Exposure is vaccination with PPV-23 and outcome is invasive disease. Case definition: HIV-infected individual over 18 years old, with invasive pneumococcal disease, defined as recovery of S. pneumoniae from a normally sterile site (e.g. such as blood, pleural fluid, spinal fluid, pericardial fluid). Controls: HIV-infected individuals over 18 years of age, with o history of documented or strong suspicion of invasive pneumococcal disease, receiving medical care at the same group of institutions, matched to the cases by level of CD4 lymphocyte cell counts, according to the following (<200; 200=500 cells/mm3), measured during the same period. Results: 79 cases and 241 controls were included; mean age of 39 years; 63% male; education level lower than high school for 50% of the sample; 63,5% whites, 19% reported living in \"sub-standard\" housing. Bacteremia was the most frequent clinical manifestation. Risk factors associated with invasie disease: alcohol use, IDU, lower level of education, \"sub-standard\" housing, close contact with child less than 10 years old and previous hospitalization with pneumonia. ARV use and pneumococcal vaccine were associated to decreased risk. Overall vaccine effectiveness was 65% (OR=0,35 IC95%:0,18-0,70). After adjustment for confounding factors (IDU, hospitalization with pneumonia, and ARV use) the point estimate for the effectiveness of 23-valent polysaccharide against all invasive pneumococcal infection was 45% (95% CI: <0% to 73%). Isolates from 47 were available for serotyping. 40 (85%) were of serotypes included in the PPV-23. All 11 isolates from previously vaccinated cases were of serotypes included in the vaccine. Conclusion To our knowledge this is the first study to evaluate vaccine effectiveness among HIV-infected persons in Brazil and the first to include data on pneumococcal serotype distribution among HIV-infected adults in Sao Paulo. Although we were not able to provide definitive answers regarding vaccine effectiveness among the specific population, we reinforce the role of anti-retroviral therapy on preventing invasive disease. Our findings support the continuity of the recommendation on immunizing HIV-infected patients with the polysaccharide vaccine at the same time that reinforces the need of more data on the subject

Vaccination is one of the most efficacious public health interventions1 and has been increasingly used to combat non-infectious diseases. Mechanisms underlying vaccine responses overlap with those regulating immune responses in health and disease. Therefore, an understanding of mechanisms underpinning these responses will have broad implications. Variation in immune response genes contributes to impaired vaccine responses2-4. Understanding the contribution of genetic variants to vaccine responses is likely to be particularly important in early life given the generalized functional immaturity of the immune system in infants and the highly variable kinetics of its maturation over the first few years of life5-7. However, studies of genetic influences on early childhood vaccine responses are scarce. Since a number of genes from several pathways are likely to be important, a targeted approach is necessary. This thesis explored the effects and interactions of genes associated with atopy, as atopy, or the genetic risk for it, has been associated with modulation of early childhood vaccine responses. This thesis aimed to: 1) investigate genetic variants associated with atopy on early childhood vaccine responses; 2) examine interactions between these genetic variants and non-genetic factors; 3) approach developmental genetic influences on genetic effects and their interactions; and 4) extend findings on vaccine responses to other immunological phenotypes and disease outcomes.