Immunogenicity of virosomal adjuvanted trivalent influenza vaccination in allogeneic stem cell transplant recipients.

BACKGROUND: Influenza vaccination is generally recommended to hematopoietic stem cell transplant (HSCT) recipients. However, the seasonal subunit vaccination response is frequently suboptimal, and alternate more efficient vaccination systems must be examined. We compared the immunogenicity of an adjuvanted virosomal influenza and subunit vaccine in HSCT recipients. METHODS: The immunogenicity after a single dose (0.5 mL) of adjuvanted trivalent virosomal vaccination was evaluated in a study cohort of 21 HSCT recipients and compared to a control cohort of 30 HSCT recipients who received a single dose (0.5 mL) of non-adjuvanted seasonal trivalent subunit vaccination over 4 seasons from 2010 to 2014. Whole blood interferon-gamma (IFN-γ) release assays were tested, both before and 30 days after vaccination, in response to influenza pandemic (pdm) H1N1, H3N2, and B antigens. HLA-A*02 dextramers, to gauge for the absolute number of antigen-specific CD8(+) T-cells, and pdm 2009 hemagglutinin inhibition (HI) assays, to test for neutralizing antibodies, were used as immunological readouts. RESULTS: The pdm HI titers were poor in both cohorts with only 23% (5/21) after virosomal vaccination and 13.3% (4/30) in the seasonal vaccine cohort having protective titers (≥40). The delta change of IFN-γ production in response to influenza pdm H1N1 (P = 0.005) and influenza B antigens (P = 0.01) were significantly elevated in blood from individuals who received the virosomal as compared to the seasonal vaccine. The IFN-γ response to pdm H1N1 was stronger (P < 0.001), as compared to seasonal vaccination, in patients vaccinated >6 month post HSCT. We detected a significant increase in the frequency of matrix 1 (GILGFVTL) dextramer-specific CD8(+) T-cells after the virosomal vaccine (P = 0.01). No differences were seen in the hemagglutinin-specific CD8(+) T-cells between the 2 cohorts. CONCLUSION: Vaccination using a virosomal delivery system is beneficial in eliciting robust cellular immune responses to pdm H1N1 influenza in SCT recipients.

[Validation of an Icelandic version of the Geriatric Depression Scale (GDS).].

OBJECTIVE: The GDS is a widely used tool world wide, both in clinical practice and in research of the elderly. The objective was to translate and validate the Geriatric Depression Scale (GDS) in Iceland. The short version of the GDS was also studied. MATERIAL AND METHODS: GDS was translated from English to Icelandic and backtranslated. Individuals, both hospitalised and healthy, born 1933 or before were included in the study. Those who had MMSE (Mini Mental State Examination) score under 23 were excluded. Seventy-one individuals were examined for depression both with a structured interview, Composite International Diagnostic Interview; 1993 (CIDI-a) and with the GDS. RESULTS: The GDS results were comparable to the results from the interview. The cutoff score for depression was chosen 13/14 according to the most favorable values of sensitivity (0.77), specificity (0.95), positive predictive value (0.77) and kappa (0.72). One cutoff was chosen because in our study there were persons with moderate or severe depression but no one with mild depression was detected. Our cutoff score for depression was identical with the cutoff score in the original american GDS version, but the original american version included a cutoff for mild depression also. CONCLUSIONS: The Icelandic GDS is a reliable method to screen for depression among the elderly. We conclude that GDS is an useful tool in unravelling depressive illness amongst the elderly although not diagnostic per se.

The Icelandic Child Mental Health Study. An epidemiological study of Icelandic children 2-18 years of age using the child behaviour checklist as a screening instrument.

The purpose of this study was to test the applicability of a standardised procedure for assessing Icelandic children's behaviour/emotional problems and competencies, and to identify differences related to demographic variables. This study focuses upon the method of using the Child Behavior Checklist (CBCL) by Achenbach to estimate the reported prevalence of parents and adolescents of emotional and behaviour problems in children from 2-16 years of age and self-reported prevalence of adolescents from 11-18 years, selected at random from the general population, both in urban and rural areas. The information was obtained by mailing checklists with a letter to parents of children 2-10 years of age. The checklists for adolescents 11-18 years of age were distributed by teachers in school. Those adolescents who were not in school received the checklists by mail at their homes. The Child Behavior Checklists used for analyses were completed by 109 parents of 2-3 year old children; 943 parents of 4-16 year old children, and 545 non-referred adolescents from the general population. The rate of response was lowest for the youngest age group 47%, but increased to 62% with increasing age of the child. The response rate among the adolescents answering the Youth Self Report was 64%. Comparisons with the Child Behavior Checklists from this study are presented with Dutch, American, French, Canadian, German and Chilean samples and show striking similarities in four of these countries on the behaviour/emotional problems reported.

Familial macroglobulinaemia: hyperactive B-cells but normal natural killer function.

An Icelandic family with two cases of benign monoclonal gammopathy and one case each of Waldenström's macroglobulinaemia, histiocytic lymphoma and multiple myeloma was first described in 1978. Nine family members had then shown raised values for se-IgM. Of these one has since died and another was not available for testing. In four of the remaining seven se-IgM had returned to normal; the three subjects who still showed raised se-IgM included the case of multiple myeloma diagnosed in 1985. Baseline production of IgM, IgG and Ig in vitro was normal in the 35 family members studied compared with 13 healthy control subjects, but the mean production of all immunoglobulin classes in response to minimal stimulation with PWM (1 microgram/ml) was significantly increased (P < 0.05). Ten family members showed markedly increased production of all three immunoglobulin classes (> 3 x SD above mean for controls). Raised production of IgM never occurred alone, indicating intact class switching. One family member showed extremely high values: IgA: 5.15 micrograms/ml, IgG: 16.3 micrograms/ml, IgM: 24.8 micrograms/ml (means for controls: 0.066, 0.123, 0.185 respectively). These 10 family members were of both sexes, ranged in age from 16 to 84 years and were clustered mainly in three distinct groups within the pedigree suggesting heredity. Proliferative responses to PWM were not significantly increased. Serum levels of interleukin-4 were tested in the patient with multiple myeloma and the family member with highest Ig production and found to be normal. We found no evidence for depressed NK function. Thus, in this family with a tendency for macroglobulinaemia and B cell derived malignancies B cell hyperreactivity was detectable by in vitro testing in several asymptomatic family members, of both sexes and all ages. No evidence was obtained for defects in regulatory mechanisms.