Classification of measles breakthrough cases in an elimination setting using a comprehensive algorithm of laboratory results: why sensitive and specific IgM assays are important.

OBJECTIVE: In 2006, a measles outbreak occurred in Catalonia (Spain), six years after endemic measles was declared eliminated. This study aimed to classify 19 confirmed measles breakthrough cases (BC) using a high-performance avidity assay developed in 2010. METHODS: Serum specimens were tested by indirect IgG, indirect IgM, capture IgM enzyme immunoassay, an endpoint-titer IgG avidity assay, and a plaque reduction neutralization assay. Serology and RNA detection results were combined in an algorithm for measles confirmation and classification of breakthrough cases and analyzed with clinical and epidemiological data. RESULTS: Of 19 samples, thirteen (68%) were conclusive with the classification of BCs, and six (32%) had false-positive IgM results on an indirect-format assay; they were classified as rash and fever illness of undetermined etiology. BCs were primary vaccine failures (seven or 54%), secondary vaccine failures (four or 31%), and two (15%) could not be classified. CONCLUSIONS: In measles elimination settings, high-performing assays and a comprehensive algorithm of laboratory results (IgG, IgM, and RNA detection), including IgG avidity and PRN results when necessary, can assist in accurate laboratory confirmation and classification of suspected measles cases for surveillance. Highly specific IgM assays are required to minimize the number of false-positive results.

The effect of timing of sample collection on the detection of measles-specific IgM in serum and oral fluid samples after primary measles vaccination.

This study compares the timing of the rise and decline of measles-specific IgM in serum samples and in oral fluid samples. Two hundred and eighty 9-month-old infants presenting for routine measles vaccination in Addis Ababa, Ethiopia, were enrolled. Paired serum and oral fluid samples were collected before and 1, 2, 3 or 4 weeks after measles vaccination. Samples were tested by using a modified antibody-capture enzyme immunoassay. For the 321 IgM-negative pre- and post-vaccination serum samples, 317 (99 %) of their corresponding oral fluid samples were IgM-negative. Among the 130 IgM-positive serum samples, 75% of their paired oral fluid samples were IgM-positive, with the percentage rising to 87% after oral fluid samples collected > or =3.5 weeks after vaccination were excluded. Among the post-vaccination serum samples, the percent IgM-positive peaked in week 3 and declined to 79% in week 4. For post-vaccination oral fluid samples, the percent IgM-positive peaked in weeks 2 and 3, and then declined to 43% in week 4. This modified antibody-capture enzyme immunoassay appears to detect vaccine-induced measles-specific IgM in the first 3 weeks after vaccination.

Early curbing of protein hyper-catabolism in postoperative patients by nutritional support with glucose plus amino acids, but not with glucose alone.

This work attempts to determine if there are differences in protein metabolism in post-surgical patients who receive parenteral nutrition with amino acids plus glucose (G+AA) or conventional gluco-salinal solution (GS). Eighteen patients submitted to gastrointestinal surgery were randomized and double-blindly administered either G+AA (1 g AA/kg x d and 28 kJ/kg x d), or GS (28 kJ/kg x d). Protein metabolism was determined 12 h after surgery (day 0) and after 5 days of nutritional support. On day 0, protein breakdown was similarly elevated, with respect to reference values, in both groups (GS: 4.62 +/- 0.25; G+AA: 5.25 +/- 0.50 g prot/kg x d) as a result of surgical stress. These values increased significantly at day 5 (P < 0.03) with the administration of GS to 6.93 +/- 1.00 g prot/kg x d, while they decreased (P < 0.002, 3.30 +/- 0.42 g prot/kg x d) with G+AA. Protein synthesis was increased (5.69 +/- 0.86 g prot/kg x d) with GS (P < 0.02), and was decreased (2.79 +/- 0.44 g prot/kg x d) with G+AA (P < 0.0002). Both synthesis and breakdown were inside normal reference values after 5 days for group G+AA. In both groups, nitrogen balance did not change significantly at day 5 compared to day 0. G+AA is effective in curbing the hypermetabolism produced by postoperative stress, achieving normal protein metabolism in 5 days, while GS increases the protein breakdown and synthesis. Nitrogen balance does not detect these modifications of the protein metabolism. Undernutrition on prognosis is not yet fully recognized.

[Suitability of a tobacco dependence clinic in primary care]. / Idoneidad de una consulta de tabaquismo en atención primaria.

OBJECTIVE: To evaluate the results of a tobacco dependency clinic after 41 months functioning. DESIGN: A descriptive and retrospective study. SETTING: The tobacco dependency clinic of the Primary Care team at Sant Just Desvern. PARTICIPANTS: 134 smokers who asked for an interview with the nurse in charge of the clinic were attended. MEASUREMENTS AND MAIN RESULTS: 47.01% wanted to stop smoking: 66.42% anticipated difficulties in achieving this. Treatment was counter-indicated in 17.16% of the smokers. 57 people (42.54%) stopped smoking of whom 26 then restarted. 35 smokers (26.12%) cut down and 17 (12.69%) changed their attitude. CONCLUSIONS: The clinic fulfilled its initial objective, but we must move towards a strategy of systematic intervention on all smokers within the general clinics.

[Nurse care in primary health care: diagnosis and follow-up of health problems]. / Cuidados de enfermería en atención primaria: diagnóstico y seguimiento de problemas de salud.

OBJECTIVE: To evaluate the results of nursing staff putting into practice a number of health prevention and promotion schemes, with particular emphasis on the follow-up of the health problems detected. DESIGN: A crossover study. SITE. A care unit of the Sant Just Desvern Primary Care team. PATIENTS: A total of 136 people were seen. 58% were men and 42% women. Their average age was 39.30 +/- 16. MAIN MEASUREMENTS AND RESULTS: The risk factors found were: tobacco, alcohol, exercise, arterial tension, cholesterol, weight, dental and oral hygiene, gynecological check-ups, self-examination of breasts and anti-tetanus, German measles and flu vaccinations. Using the clinical records it was found that 42.64% were smokers; 1.58% were alcoholics and 20.63% consumed an excessive amount of alcohol; 47.58% were sedentary; 17.09% were diagnosed with dyslipaemia; and 1.58% with hypertension. After the intervention, 18.96% gave up smoking and 14.28% of excessive drinkers managed to stop. 76.47% of women advised to attend the gynaecologist did so. 89.61% of patients completed the series of anti-tetanus vaccinations. CONCLUSIONS: The favorable response of the population to a periodic health check-up should be emphasised. The changes in life-style brought about after the detection and subsequent follow-up of health problems was extremely positive.