Influenza vaccine failure in the tropics: a retrospective cohort study of waning effectiveness.

Influenza vaccine effectiveness (VE) wanes over the course of a temperate climate winter season but little data are available from tropical countries with year-round influenza virus activity. In Singapore, a retrospective cohort study of adults vaccinated from 2013 to 2017 was conducted. Influenza vaccine failure was defined as hospital admission with polymerase chain reaction-confirmed influenza infection 2-49 weeks after vaccination. Relative VE was calculated by splitting the follow-up period into 8-week episodes (Lexis expansion) and the odds of influenza infection in the first 8-week period after vaccination (weeks 2-9) compared with subsequent 8-week periods using multivariable logistic regression adjusting for patient factors and influenza virus activity. Records of 19 298 influenza vaccinations were analysed with 617 (3.2%) influenza infections. Relative VE was stable for the first 26 weeks post-vaccination, but then declined for all three influenza types/subtypes to 69% at weeks 42-49 (95% confidence interval (CI) 52-92%, P = 0.011). VE declined fastest in older adults, in individuals with chronic pulmonary disease and in those who had been previously vaccinated within the last 2 years. Vaccine failure was significantly associated with a change in recommended vaccine strains between vaccination and observation period (adjusted odds ratio 1.26, 95% CI 1.06-1.50, P = 0.010).

First nosocomial cluster of COVID-19 due to the Delta variant in a major acute care hospital in Singapore: investigations and outbreak response.

OBJECTIVES: The first large nosocomial cluster of coronavirus disease 2019 (COVID-19) in Singapore in April 2021 led to partial closure of a major acute care hospital. This study examined factors associated with infection among patients, staff and visitors; investigated the possible role of aerosol-based transmission; evaluated the effectiveness of BNT162.b2 and mRNA1273 vaccines; and described the successful containment of the cluster. METHODS: Close contacts of patients with COVID-19 and the affected ward were identified and underwent surveillance for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Patient, staff and visitor cohorts were constructed and factors associated with infection were evaluated. Phylogenetic analysis of patient samples was performed. Ward air exhaust filters were tested for SARS-CoV-2. RESULTS: In total, there were 47 cases, comprising 29 patients, nine staff, six visitors and three household contacts. All infections were of the Delta variant. Ventilation studies showed turbulent air flow and swabs from air exhaust filters were positive for SARS-CoV-2. Vaccine breakthrough infections were seen in both patients and staff. Among patients, vaccination was associated with a 79% lower odds of infection with COVID-19 (adjusted odds ratio 0.21, 95% confidence interval 0.05-0.95). CONCLUSIONS: This cluster occurred despite enhancement of infection control measures that the hospital had undertaken at the onset of the COVID-19 pandemic. It was brought under control rapidly through case isolation, extensive contact tracing and quarantine measures, and led to enhanced use of hospital personal protective equipment, introduction of routine rostered testing of inpatients and staff, and changes in hospital infrastructure to improve ventilation within general wards.

Variation in latency times of visually evoked cortical potentials.

Latency times of visually evoked cortical potentials stimulated by reversal of a slow checkerboard pattern are highly dependent on the time needed to accomplish the reversal movement. If, owing to the method, the pattern reversal time is not kept stable, variability of the latency times is unnecessarily high for clinical purposes. This may be the case when television equipment is used.

Thymic heterotypic cellular complexes in gene-targeted mice with defined blocks in T cell development and adhesion molecule expression.

Thymocytes form unique multicellular complexes with epithelial cells (thymic nurse cells, TNC) and rosettes (ROS) with macrophages, epithelial cells and dendritic cells. To investigate the role of differentiation checkpoints in the formation of the thymic heterotypic complexes in vivo, we used mutant mice which have genetically defined blocks at early and late stages of T cell development. We show that RAG-1-/-, TCRbeta-/- , and p56lck-/- mice lack thymocyte ROS formation with epithelial cells, macrophages, or dendritic cells. TNC formation was not affected by TCRbeta and p56lck gene mutations but partially decreased in RAG-1-/- mice, indicating that TNC are the earliest thymocyte-stromal cell complexes formed in development, whereas ROS only appear after thymocytes have rearranged and expressed a functional TCRbeta chain. Genetic blocks in CD8 lineage commitment (CD8-/- and IFN regulatory factor-1-/- mice) and positive and negative T cell selection (CD45-/-, TCRalpha-/-, and CD30-/- mice) did not affect thymocyte-stromal cell complexes. Surprisingly, CD4-/- mice, but not MHC class II-/- mice, had significantly reduced numbers of TNC and ROS, in particular, a severe defect in ROS formation with thymic dendritic cells. The CD4-/- block in ROS and TNC formation was rescued by the introduction of a human CD4 transgene. Moreover, we show that the adhesion receptors CD44 and LFA-1 cooperate in the formation of the thymic microenvironment. These results provide genetic evidence on the role of defined stages in T cell development and adhesion molecules on thymocyte/stromal cell interactions in vitro.