Immunogenicity of a liquid hexavalent DTaP-IPV-HB-PRP∼T vaccine after primary and booster vaccination of term and preterm infants born to women vaccinated with Tdap during pregnancy.

BACKGROUND: Vaccination during pregnancy with tetanus, diphtheria, acellular pertussis (aP) (Tdap) antigens is important for early protection of newborn infants against pertussis, particularly for preterm infants. This study evaluated the effect of Tdap vaccination during pregnancy on the immunogenicity of a diphtheria (D), tetanus (T), aP, inactivated poliovirus (IPV), hepatitis B (HB), and Haemophilus influenzae type b (PRP âˆ¼ T) vaccine in term and preterm populations. METHODS: A prospective, observational study (NCT02511327) recruited women and their infants based on delivery (term or preterm) and vaccination status (vaccinated with a Tdap vaccine [Boostrix™, GlaxoSmithKline] during pregnancy or not vaccinated in the last 5 years). All infants received licensed DTaP-IPV-HB-PRP âˆ¼ T (Hexyon™, Sanofi) (8, 12, 16 week primary series and booster at 13 months of age [preterm infants] or 15 months of age [term infants]). Immunogenicity was evaluated using validated assays. Data were pooled into term (N = 127) and preterm infants (N = 105), and infants of women who received a Tdap vaccine during pregnancy (N = 199) or not (N = 33). RESULTS: Before primary vaccination, antibody levels were higher for term than preterm infants for anti-D, anti-polio 1, 2, 3, anti-PT, anti-FHA, and anti-PRP, and similar for anti-HBs and anti-T. At this time, infants of Tdap-vaccinated women had higher anti-D, anti-T, anti-PT, anti-FHA, and anti-PRP antibody levels than infants of Tdap-unvaccinated women; anti-HBs and anti-polio antibody levels were similar in both groups. Post-primary, pre-booster, and post-booster, there were only small differences in seroprotection rates (anti-D, anti-T, anti-polio 1, 2, 3, anti-HBs, anti-PRP) and seroconversion rates (anti-PT, anti-FHA), except for anti-HBs ≥ 10 mIU/mL and anti-PRP ≥ 0.15 µg/mL post-primary vaccination (higher for term [98.31 % and 90.91 %, respectively] versus preterm infants [89.80 % and 79.41 %, respectively]). CONCLUSIONS: These data support the use of DTaP-IPV-HB-PRP âˆ¼ T vaccine for primary and booster vaccination in term and preterm born infants and in infants born to Tdap-vaccinated or Tdap-unvaccinated women.

Can Flanders resist the measles outbreak? Assessing vaccination coverage in different age groups among Flemish residents.

The Belgian strategic plan to eliminate measles contains several vaccination strategies including routine immunisation programmes and catch-up campaigns. A new expanded programme on immunisation-based survey (2016) assessed the uptake of the recommended measles-mumps-rubella (MMR) vaccine in three different cohorts: toddlers, adolescents and parents of toddlers. A two-stage cluster sampling technique was used to select 875 toddlers (age 18-24 months) and 1250 adolescents (born in 2000) from 107 municipalities in Flanders. After consent of the parent(s), 746 (85.2%) families of toddlers and 1012 (81.0%) families of adolescents were interviewed at home. Measles vaccination coverage was high at 18-24 months (96.2%) and 81.5% were vaccinated at recommended age. Toddlers who had two siblings or a non-working mother or changed vaccinator were more at risk for not being vaccinated. Coverage of the teenager dose reached 93.5% and was lower in adolescents with educational underachievement or whose mother was part-time working or with a non-Belgian background. Only 56.0% of mothers and 48.3% of fathers remembered having received at least one measles-containing vaccine. Although measles vaccination coverage in toddlers meets the required standards for elimination, administration of the teenager dose of MMR vaccine and parent compliance to the recent measles catch-up campaign in Flanders leave room for improvement.

Interrater and intrarater reliability of the Semmes Weinstein aesthesiometer to assess touch pressure threshold in burn scars.

Burn scars are frequently accompanied with sensory deficits often remaining present months or even years after injury. Clinimetric properties of assessment tools remain understudied within burn literature. Tactile sense of touch can be examined with the touch pressure threshold (TPT) method using the Semmes Weinstein monofilament test (SWMT). There is in recent research no consensus on the exact measurement procedure when using the SWMT. The aim of this paper was to determine the interrater and intrarater reliability of TPT within burn scars and healthy controls using the 'ascending descending' measurement procedure. We used the newly developed guidelines for reporting reliability and agreement studies (GRRAS) as a basis to report this reliability study. In total 36 individuals were tested; a healthy control group and a scar group. The interrater reliability was excellent in the scar group (ICC=0.908/SEM=0.21) and fair to good in the control group (ICC=0.731/SEM=0.12). In the scar group intrarater ICC value was excellent (ICC=0.822/SEM=0.33). Within the control group also an excellent intrarater reliability (ICC=0.807/SEM=0.27) was found. In conclusion this study shows that the SWMT with the 'ascending descending' measurement procedure is a feasible and reliable objective measure to evaluate TPT in (older) upper extremities burn scars as well as in healthy skin.

Susceptibility to measles, mumps, and rubella in 5-year-old children in Flanders, Belgium.

UNLABELLED: The second dose of an MMR vaccine is a catch up for persons who did not receive the first dose or for primary vaccine failures. Catch up doses can be scheduled according to convenience into the program of the country. The second MMR dose is often administered at the age of 5 years, before school entry. Some countries chose to implement the second dose at the age of 10-13 years, as is the case for Belgium. The here presented long-term follow-up of a cohort of children, set up originally to analyze maternal antibodies against vaccine preventable diseases, offers a unique opportunity to evaluate ad interim the current long-interval MMR vaccination schedule in Belgium. After 1 MMR dose at 12 months of age, rubella immunity is almost intact at 5 years of age (94.5 % is seropositive), measles seropositivity scores 86.8 %, and mumps 32 %, measured with ELISA. A seroneutralization (SN) test for mumps antibodies reveals much higher seropositivity rates (88 %). Using a regression model on the log (IgG) titer for all antigens, no influence was found from any of the studied variables, except for girls who had a significantly higher rubella IgG titer (p=0.002) compared to boys. CONCLUSION: The data show considerable susceptibility to mumps and measles in 5-year-old children, confirming a previously conducted seroprevalence study (2006). Both advantages and disadvantages of shortening or enlarging the vaccine schedule are discussed.

Classification of quality of life subscales within the ICF framework in burn research: identifying overlaps and gaps.

OBJECTIVE: Quality of life (QOL) is one of the leading outcomes in burn care research. This study classifies subscales of common QOL measures within the International Classification of Functioning disability and health (ICF) framework to determine to which extent the measures are complementary or overlapping and to investigate whether the instruments are able to describe the full spectrum of patients' functioning. METHODS: A literature search was performed to determine the most frequently used questionnaires in burn research. The subscales of the three mostly used questionnaires were classified within the ICF framework. RESULTS: Two generic measures, the Short Form-36 items (SF-36) and the European Quality of Life 5 Dimensions (EQ-5D), and a disease specific measure, the Burn Specific Health Scale-Brief (BSHS-B), were analyzed. The BSHS-B covered most domains and was the only scale that included personal factors. The SF-36 included only one domain in the activity limitations and similar to the EQ-5D no contextual factors were included. Environmental factors were not addressed in the questionnaires, even though these may have an impact on the quality of life in patients with burns. CONCLUSION: To capture the full spectrum of dysfunctioning a combination of the BSHS-B with a generic questionnaire seems obligatory. However still some domains of functioning remain uncovered.

[Mobile biosensor-based gait analysis: a diagnostic and therapeutic tool in Parkinson's disease]. / Mobile biometrische Ganganalyse : Potenzial für Diagnose und Therapiemonitoring beim Parkinson-Syndrom.

Parkinson's disease (PD) is characterized by progressive motor and non-motor symptoms, leading to distinct diagnostic and therapeutic challenges in all stages of the disease. This study investigated a mobile biosensor-based gait analysis system for patients in early and intermediate stages of PD compared to controls. Subjects wearing a motion sensor-equipped shoe performed a standardized gait exercise. Accelerometer- and gyroscope-based signals were analysed using a complex set of pattern recognition algorithms. The analysis was able (1) to distinguish between PD patients and controls, (2) to identify patients at an early stage of the disease and (3) to distinguish between early and intermediate stage patients. Thus, using this mobile biosensor-based analysis system we were able to obtain objective classifications of gait characteristics in PD. Future studies will show that mobile biosensor-based movement detection technology will support identification of early PD stages and allow objective characterization of motor fluctuations in advanced stages of the disease. This will provide an important and supportive tool for patients, caregivers and therapists.

The voice handicap index as a tool for assessment of the biopsychosocial impact of voice problems.

BACKGROUND: Objective measurements do not evaluate the biopsychosocial impact of a voice disorder. The Voice Handicap Index (VHI) measures the influence of voice problems on a patient's quality of life. OBJECTIVE: To investigate if the VHI can monitor biopsychosocial impact of voice disorders and to provide a frame of reference for use of the VHI in general ENT practice. METHODS: VHI scores and subscores were analysed in 272 controls, 237 patients with initial voice complaints ("new patients") and 92 patients before and after microsurgery ("operated patients"). RESULTS: The VHI scores of the controls were not normally distributed (Kolmogorov-Smirnov test: < .001). The total VHI scores for the 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles were, respectively, 0.0, 0.0, 2.0, 6.0, 12.0, 23.0 and 32.8. In the controls, there was not a significant effect of gender on either VHI totals or subscores (p = 0.060-0.858). In the "new patients" group, males scored significantly higher on the functional subscore (p = 0.004). There was a very weak negative correlation between age and VHI totals and subscores in controls (correlation coefficient: -0.092 to -0.187). There was a significant difference in VHI totals and subscores between subjects with and without voice complaints (p < 0.001). In the patient group, VHI scores of professional voice users (PVUs) were not significantly different from those of non-PVUs (p = 0.112-0.753). In controls, a significantly higher score was found for PVUs in the P domain of the VHI (p = 0.017). After microsurgical treatment, 82.0% of patients had a lower total VHI score, and 93.3% reported an improvement in voice. In the patient group, the median postoperative VHI score was almost halved. CONCLUSION: Gender and profession did not have a significant influence on the total VHI score. There was a weak tendency for VHI to decrease with age. The VHI is a useful instrument for quantifying the biopsychosocial impact of a voice disorder, and is able to monitor changes in self-perception of voice handicap after treatment.

Changes of the eye caused by the climate in Rwanda, Africa.

Rwanda is a small but densely populated country, situated at the watershed between East and West Africa, close to the equator. The mean elevation is around 1500 m. We studied 114 males (mean age 28.42 years) and 111 females (mean age 29.84 years) at the ophthalmological outpatient department of the Centre Hospitalier in Kigali. Changes to the eye caused by the climate were fewer than expected. Only 10 patients (5 males, 5 females) with pterygium (mean age 33.0 years), and four males and two females with climatic droplet keratopathy (mean age 47.5 years) were observed. However, the size of the pinguecula was marked. Corneal thickness, measured with Haag-Streit's device, averaged 0.524 mm in 38 males and 0.521 mm in 38 females. The Rwandans showed a normal chamber depth, a mean of 2.98 mm being noted in 107 males and a mean of 2.80 mm in 106 females.

Ocular ulcerative herpes following measles in Kinshasa, Zaire.

Eight cases of ocular ulcerative herpes following measles are reported. The clinical features are characterized by dendritic corneal ulcer (6 cases) and ulcero-erosive blepharitis associated with corneal ulcer (2 cases). Bacteriologic examination disclosed Pseudomonas aeruginosas in 2 cases. The serum level of retinol, RBP, prealbumin and albumin were generally diminished in cases of dendritic corneal ulcer. These data are discussed in relation to the onset and severity of ocular ulcerative herpes associated with measles.

The onchocerciasis focus at Kinsuka/Kinshasa (Republic of Zaire) in 1985. II. Parasitological and clinical aspects.

Since the antivectorial control in 1948, the parasitological and clinical aspects of the onchocerciasis focus at Kinsuka/Kinshasa have not been studied further until now. The population examined was selected for its daily contact with the vector. It constituted 143 adults, including fishermen, stonebreakers and women cultivators, and 26 children aged from 10 to 16 years. People were subjected to an ophthalmological examination as well as to an investigation for Onchocerca volvulus microfilariae. Adults were examined for the presence of nodules as well as for dermal and lymphatic manifestations of onchocerciasis. The microfilaria carrier rate (MfCR) was 59.2%. The mean microfilaria density (MfD) was 9.7 mf mg-1. Only 20% of the adults presented with small onchocercal nodules. Cutaneous lesions were mild. Lymphatic complications such as adenolymphocele, hydrocele and elephantiasis of the lower limbs were observed in 18% of the adults. No one was blind from onchocerciasis, although nine patients of 60 years or over had lost the use of one eye. Punctate keratitis occurred commonly in young people. Ocular lesions, except for punctate keratitis, developed progressively after 55 years and they became worse with the degree of infection, age and length of stay. Hyperendemic and insufferable in 1940, onchocerciasis has become, in 1985, hypoendemic and no longer a public health problem. One could deduce that a situation similar to that in Kinsuka may occur within 30 years in other foci which are today hyperendemic and where prophylaxis has been started.

Onchocerciasis in Zaïre.

The first mention in Africa of ocular lesions and of blindness due to onchocerciasis was made by Hissette in Zaïre in 1931, although the disease had already been known there since 1903. On a map of Zaïre were indicated all the known data of the geographical distribution of onchocerciasis: data from the literature, from field work and from the patients seen in Kinshasa. An estimation of the relative incidence of the disease was made by comparing the number of patients with the number of the latest population census for each administrative zone. The environmental and developmental factors determining the epidemiological aspects are discussed. The clinical aspects of the typical eye symptoms are reviewed. Their correlation with age, with immunology and with some specialized eye examinations are discussed.

[Strabismus and heterophoria: the situation in Zaire]. / Strabismes et hétérophories: la situation au Zaïre.

The results of a prospective study of 66 cases of squint among black Zaïrian people are presented. The frequency of strabismus in routine ophthalmic consultation was estimated at 1.5% with a large number of exodeviations (1.25%). Excessive divergence was by far the commonest form of exodeviations. A large pupillary distance and telorism are common in Zaïrian people.

[Amplitude of accommodation in Zairian subjects]. / L'amplitude d'accommodation chez le Zaïrois.

The authors studied the amplitude of accommodation in Zairian patients who consulted the Ophthalmic Clinic of University of Kinshasa from February 24 to July 31, 1986. During this period, of 1326 Zairians seen, 159 (318 eyes) were included in this study. Patients with monocular visual acuities less than 10/10, or with ocular pathology, astigmatisms and anisometropias exceeding one diopter were excluded from the study. The mean age +/- SD was 32 years +/- 12 with a range of 10 to 58 years. There were 101 males and 58 females. The measurements were performed, once for each patient, with Osterberg Bino-Oculus apparatus according to the "push-up" method and the plus spherical method. The amplitude of accommodation decreased with the age. This decrease was more notable between 30 and 40 years. The age of onset of presbyopia calculated from the amplitude of accommodation according to the "push-up" method was 39 years. The values of the amplitude of accommodation obtained by the both methods could be superposed (p greater than 0.05). They were similar to those of black patients and were also inferior to the white patients obtained by other authors.

Epidemic spastic paraparesis in Bandundu (Zaire).

Epidemiological findings of twenty sporadic cases of epidemic spastic paraparesis (buka-buka) in three areas of Bandundu (Zaire) are reported. These findings suggest the involvement of an infectious agent and do not support the hypothesis of a dietary cyanide intoxication, which has been advanced to explain the outbreak of a very similar disease (Mantakassa) in Mozambique.