No changes on viral load and CD4+ T-cell counts following immunization with 7-valent pneumococcal conjugate vaccine among HIV-infected adults in Malawi.

Vaccination has been associated with a transient increase in viremia in HIV-infected individuals, although contradicting evidence persist in the literature. As part of a randomized placebo-controlled efficacy trial of the PCV7 in Malawi, we collected viral load and CD4+ T-cell counts from 237 adults who received two doses of vaccine or placebo, administered 4 weeks apart. Analyses were conducted separately for cART and non-cART users. Our analysis show no difference in viral loads between vaccine and placebo groups, regardless of cART use. Viremia decreased from 4.1 to 2.9 log10 copies/mL (p < 0.0001) among those using cART, consistent vaccine and placebo groups, but no changes were seen among the non-cART cohort. CD4+ T-cell counts remained unchanged regardless of cART use, or allocation to vaccine or placebo. We concluded that there was no evidence of detrimental effects of PCV7 administration on viral load or CD4+ T-cell counts six months after vaccination with PCV7.

Pilot study of the completeness of notification of adult tuberculosis in Athens, Greece.

SETTING: Sotiria Chest Diseases Hospital (SCDH), a referral hospital in Athens, Greece, 2012. OBJECTIVE: To assess the completeness of the mandatory notification system for tuberculosis (TB) at the SCDH, and compare the observed and estimated annual incidence rates. DESIGN: Record linkage and the capture-recapture method were applied. Data sources were the registers from the national mandatory notification register (Hellenic Centre for Disease Control and Prevention [HCDCP]), the National Reference Laboratory for Mycobacteria (NRLM) and SCDH records. The log-linear model with the lowest Akaike information criterion was selected as the most valid statistical model. RESULTS: The observed and estimated TB under-reporting rates at the national level were respectively 55% (95%CI 49-60) and 75% (95%CI 71-78). The observed completeness of the HCDCP, NRLM and SCDH registers were respectively 45% (95%CI 40-51), 66% (95%CI 61-71) and 36.5% (95%CI 31-42). The estimated TB incidence rate was 15 cases per 100 000 (range 13-19/100 000), compared to the 4.9/100 000 rate officially notified. CONCLUSION: Adult TB incidence has been largely underestimated, and the TB burden is likely to be much higher than officially notified in our setting. A thorough review of the notification system should be carried out. The implementation of a network-based notification system and retraining of all relevant personnel is advised.

Procalcitonin and C-reactive protein as predictors of blood culture positivity among hospitalised children with severe pneumonia in Mozambique.

OBJECTIVES: To evaluate the benefits of using procalcitonin (PCT) and C-reactive protein (CRP) as pre-screening tools to predict blood culture positivity among Mozambican children with clinical severe pneumonia (CSP). METHODS: 586 children <5 years with CSP and no concurrent malaria fulfilled criteria to be included in the study groups. We determined PCT and CRP for all children with positive bacterial culture (BC+ group, n = 84) and of a random selection of children with negative bacterial culture (BC- group, n = 246). RESULTS: PCT and CRP levels were higher in the BC+ group than the BC- one (PCT: median 7.73 versus 0.48 ng/ml, P < 0.001; CRP: 177.65 mg/l vs. 26.5 mg/l, P < 0.001). In multivariate analysis, PCT was the only independent predictor of the group. To be used as pre-screening tool, PCT presented higher specificities for predetermined sensitivities (≥85%) than CRP. Pursuing a sensitivity of 95%, PCT could reduce the need for bacterial culture by 49% and overall diagnosis costs by 7-35% [assuming variable costs for PCT measurement (ranging from 10 to 30 USD) and a fixed cost of 72.5 USD per blood culture]. CONCLUSIONS: Among hospitalised children with CSP and absence of concurrent malaria, PCT pre-screening could help reduce the number of blood cultures and diagnosis costs by specifically targeting patients more likely to yield positive results.