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OBJECTIVE: To determine the effectiveness of povidone-iodine application after skin closure to prevent surgical site infection after an emergency cesarean section and to assess risk factors associated with surgical site infection. METHODS: A randomized controlled trial enrolled 352 pregnant women who required emergency cesarean delivery at King Chulalongkorn Memorial Hospital, from August 2018 to March 2019. Participants were randomly assigned to receive the povidone-iodine application at the incision after skin closure (n = 176) or without application (n = 176). Thirty-day surveillance of complications and adverse effects was performed. The primary outcome was the incidence of surgical site infection, which was compared between groups using the chi-squared test. The adjusted odds ratios (ORs) of the factors associated with surgical site infection were determined by logistic regression analysis. RESULTS: There were no significant differences in the incidence of surgical site infection and adverse effects between the povidone-iodine and control groups (9.5% vs 7.1%, P = 0.430). The significant factor associated with surgical site infection was a long interval (≥60 min) from the administration of prophylactic antibiotics to the incision (adjusted OR 4.06, 95% CI 1.49-11.03). CONCLUSION: The application of povidone-iodine after skin closure in an emergency cesarean section did not have the advantage of reducing the incidence of surgical site infection. CLINICAL TRIAL REGISTRATION: This study was registered in TCTR registry on March 10, 2018 with trial identification number: TCTR20180310002 (https://www.thaiclinicaltrials.org/show/TCTR20180310002). The first participant was recruited on August 2, 2018.
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AIM/OBJECTIVE: This study investigates placental antibody transfer following recombinant pertussis vaccination in pregnancy in a real-world setting. METHODS: This postmarketing observational study recruited pregnant women vaccinated with monovalent recombinant acellular pertussis (aP) vaccine (aPgen; n = 199) or combined to tetanus-diphtheria (TdaPgen; n = 200), or Td-vaccine only (n = 54). Pregnancy, delivery, and neonatal outcomes were assessed. Cord blood was collected postdelivery and pertussis toxin (PT)-IgG, filamentous hemagglutinin (FHA)-IgG, and PT-neutralizing antibodies (PT-Nab) were assessed. RESULTS: No adverse pregnancy, delivery, or neonatal outcomes attributed to aPgen, TdaPgen, or Td vaccination were reported. High anti-PT antibody levels were detected in cord samples from women vaccinated with aPgen (geometric mean concentration [GMC] PT-IgG 206.1 IU/ml, 95% confidence intervals [CI]: 164.3-258.6; geometric mean titer [GMT] PT-Nab 105.3 IU/ml, 95% CI: 81.7-135.8) or TdaPgen (GMC PT-IgG 153.1 IU/ml, 95% CI: 129.1-181.5; GMT PT-Nab 81.5 IU/ml, 95% CI: 66.4-100.0). In the Td-only group, anti-PT antibodies were low (GMC PT-IgG 6.5 IU/ml, 95% CI: 4.9-8.8; GMT PT-Nab 3.8 IU/ml, 95% CI: 2.8-5.1). The same was found for FHA-IgG. Recombinant pertussis vaccination at <27 or 27-36 weeks gestation induced similar cord pertussis antibody levels. CONCLUSION: This first real-world study confirms that recombinant pertussis vaccination in the second or third trimester of pregnancy results in high levels of passive immunity in infants. Thai Clinical Trial Registry: TCTR20200528006.
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Anticuerpos Antibacterianos , Inmunidad Materno-Adquirida , Tos Ferina , Humanos , Femenino , Embarazo , Adulto , Anticuerpos Antibacterianos/sangre , Anticuerpos Antibacterianos/inmunología , Tos Ferina/prevención & control , Tos Ferina/inmunología , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Sangre Fetal/inmunología , Vacunas Sintéticas/inmunología , Vacunas Sintéticas/administración & dosificación , Vacuna contra la Tos Ferina/inmunología , Vacuna contra la Tos Ferina/administración & dosificación , Adulto Joven , Intercambio Materno-Fetal/inmunología , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/inmunología , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Recién Nacido , Toxina del Pertussis/inmunología , Anticuerpos Neutralizantes/sangre , Anticuerpos Neutralizantes/inmunología , Bordetella pertussis/inmunología , VacunaciónRESUMEN
We compared high-risk human papillomavirus (HPV) detection on first-stream urine from self-sampled collection device (Colli-Pee) and same-day clinician-collected cervical swab in 240 women. Testing with automated cobas 4800 system showed 96.7 % concordance (198 concordant-negative, 34 concordant-positive, Cohen's kappa=0.87). HPV testing on Colli-Pee urine offers advantages for acceptable non-invasive HPV screening.
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Infecciones por Papillomavirus , Displasia del Cuello del Útero , Neoplasias del Cuello Uterino , Femenino , Humanos , Reacción en Cadena en Tiempo Real de la Polimerasa , Infecciones por Papillomavirus/diagnóstico , Sensibilidad y Especificidad , Papillomaviridae/genética , ADN Viral/genética , ADN Viral/análisis , Neoplasias del Cuello Uterino/diagnóstico , Detección Precoz del Cáncer , Displasia del Cuello del Útero/diagnósticoRESUMEN
INTRODUCTION: Recombinant acellular pertussis (ap) vaccines containing genetically inactivated pertussis toxin (PTgen) and filamentous hemagglutinin (FHA) with or without tetanus (TT) and diphtheria (DT) vaccines (Td) were found safe and immunogenic in non-pregnant and pregnant women. We report here maternal antibody transfer and safety data in mothers and neonates. METHODS: This is the follow up of a phase 2 trial in 2019 among 400 pregnant women who randomly received one dose of recombinant pertussis-only vaccine containing 1 µg PTgen and 1 µg FHA (ap1gen), or Td combined with ap1gen (Tdap1gen), or with 2 µg PTgen and 5 µg FHA (Tdap2gen), or with 5 µg PTgen and 5 µg FHA (TdaP5gen, Boostagen®, BioNet, Thailand) or chemically-inactivated acellular pertussis comparator (Tdap8chem, Boostrix™, GSK, Belgium), either in the second or third trimester of gestation. IgG against PT, FHA, TT and DT were assessed by ELISA, PT-neutralizing antibodies (PTNA) by Chinese Hamster Ovary cell assay and safety outcomes at delivery in mothers and at birth. RESULTS: Anti-PT and anti-FHA geometric mean concentration (GMC) ratio between infants at birth and mothers at delivery was above 1 in all groups. PT GMC in infants at birth were ≥30 IU/mL in all groups with the highest titers in infants found in TdaP5gen group at birth (118.8 [95% CI 93.9-150.4]). At 2 months, PT GMC ratio to Tdap8chem (98.75% CI) was significantly higher for TdaP5gen (2.6 [1.7-4.0]) and comparable for other recombinant vaccines. No difference in PTNA titers at birth was observed between all groups nor between time of vaccination. Adverse events were comparable in all vaccine groups. CONCLUSIONS: BioNet licensed (TdaP5gen and Tdap2gen) and candidate vaccines (Tdap1gen and ap1gen) when given to pregnant women in the second or third trimester of gestation are safe and have induced passive pertussis immunity to infants.
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Vacunas contra Difteria, Tétanos y Tos Ferina Acelular , Tétanos , Tos Ferina , Lactante , Recién Nacido , Cricetinae , Animales , Humanos , Femenino , Embarazo , Tos Ferina/prevención & control , Células CHO , Anticuerpos Antibacterianos , Cricetulus , Vacuna contra la Tos Ferina , Vacunación , Vacunas Sintéticas , Toxoide Tetánico , Anticuerpos Neutralizantes , Madres , Periodo PospartoRESUMEN
INTRODUCTION: Despite a decrease in infections caused by Bordetella pertussis due to COVID-19 pandemic, booster vaccination of pregnant women is still recommended to protect newborns. Highly immunogenic vaccines containing genetically inactivated pertussis toxin (PTgen) and filamentous hemagglutinin (FHA) may generate comparable anti-PT antibody concentrations, even at lower doses, to chemically inactivated acellular pertussis vaccines (Tdapchem) shown effective for maternal immunization. METHODS: This phase 2 randomized, observer-blind, active-controlled non-inferiority trial was conducted in healthy Thai pregnant women randomly assigned to receive one dose of low-dose recombinant pertussis-only vaccine containing 1 µg PTgen and 1 µg FHA (ap1gen), or tetanus, reduced-dose diphtheria combined with ap1gen (Tdap1gen), or combined with 2 µg PTgen and 5 µg FHA (Tdap2gen), or with 5 µg PTgen and 5 µg FHA (TdaP5gen, Boostagen®) or comparator containing 8 µg of chemically inactivated pertussis toxoid, 8 µg FHA, and 2.5 µg pertactin (Boostrix™, Tdap8chem). Blood was collected at Day 0 and Day 28 post-vaccination. The non-inferiority of the study vaccines was assessed based on anti-PT IgG antibody levels on Day 28 pooled with results from a similarly structured previous trial in non-pregnant women. RESULTS: 400 healthy pregnant women received one dose of vaccine. Combined with data from 250 non-pregnant women, all study vaccines containing PTgen were non-inferior to comparator vaccine (Tdap8chem). Both ap1gen and TdaP5gen vaccines could be considered to have superior immunogenicity to Tdap8chem. Local and systemic solicited reactions were similar among all vaccine groups. CONCLUSIONS: Vaccine formulations containing PTgen were safe and immunogenic in pregnant women. The ap1gen vaccine, with the lowest cost and reactogenicity, may be suitable for use in pregnant women when diphtheria and tetanus toxoids are not needed. This study is registered in the Thai Clinical Trial Registry (www. CLINICALTRIALS: in.th), number TCTR20180725004.
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COVID-19 , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular , Difteria , Tétanos , Tos Ferina , Recién Nacido , Humanos , Femenino , Toxina del Pertussis/genética , Pandemias , Vacuna contra la Tos Ferina , Inmunización Secundaria/métodos , Toxoide Tetánico , Vacunas Sintéticas , Anticuerpos Antibacterianos , Vacuna contra Difteria, Tétanos y Tos FerinaRESUMEN
Objective To evaluate the performance of hepatitis B-e antigen (HBeAg) for identifying pregnant women infected with hepatitis B virus (HBV) who are having a high viral load. Methods A cross-sectional study was conducted at the tertiary care hospital in Bangkok, Thailand between August 2017 and August 2018. Ninety-six pregnant women having positive hepatitis B-s antigen (HBsAg) results were invited to participate into the study. Clinical data and blood samples were collected and tested for HBeAg and HBV DNA levels. Data were reported as percentage and 95% confidence interval (CI). Results High viral load was found in 25 women (26.0%, 95% CI: 18.3% to 35.6%) and HBeAg showed positive results in 33 women (34.4%, 95% CI: 25.6% to 44.3%). Among antiviral-naïve women, 24 of 30 cases having positive HBeAg results had high viral load (80.0%, 95% CI: 62.7% to 90.5%) while only 1 of 62 negative HBeAg women had high viral load (1.6%, 95% CI: 0.3% to 8.6%). Conclusion About one-fourth of HBV-infected pregnant women were at high risk for mother-to-child transmission (MTCT) of the virus and needed antiviral drugs for reducing MTCT. HBeAg may be used to identify women at high risk for MTCT of HBV in a low-resource setting where HBV DNA level test is not available.
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BACKGROUND: The compromised gut microbiome that results from C-section birth has been hypothesized as a risk factor for the development of non-communicable diseases (NCD). In a double-blind randomized controlled study, 153 infants born by elective C-section received an infant formula supplemented with either synbiotic, prebiotics, or unsupplemented from birth until 4 months old. Vaginally born infants were included as a reference group. Stool samples were collected from day 3 till week 22. Multi-omics were deployed to investigate the impact of mode of delivery and nutrition on the development of the infant gut microbiome, and uncover putative biological mechanisms underlying the role of a compromised microbiome as a risk factor for NCD. RESULTS: As early as day 3, infants born vaginally presented a hypoxic and acidic gut environment characterized by an enrichment of strict anaerobes (Bifidobacteriaceae). Infants born by C-section presented the hallmark of a compromised microbiome driven by an enrichment of Enterobacteriaceae. This was associated with meta-omics signatures characteristic of a microbiome adapted to a more oxygen-rich gut environment, enriched with genes associated with reactive oxygen species metabolism and lipopolysaccharide biosynthesis, and depleted in genes involved in the metabolism of milk carbohydrates. The synbiotic formula modulated expression of microbial genes involved in (oligo)saccharide metabolism, which emulates the eco-physiological gut environment observed in vaginally born infants. The resulting hypoxic and acidic milieu prevented the establishment of a compromised microbiome. CONCLUSIONS: This study deciphers the putative functional hallmarks of a compromised microbiome acquired during C-section birth, and the impact of nutrition that may counteract disturbed microbiome development. TRIAL REGISTRATION: The study was registered in the Dutch Trial Register (Number: 2838 ) on 4th April 2011.
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Bacterias/genética , Cesárea/efectos adversos , Heces/microbiología , Microbioma Gastrointestinal/genética , Metagenoma/genética , Biodiversidad , Método Doble Ciego , Humanos , Lactante , Recién NacidoRESUMEN
Despite significant progress in reaching some milestones of the United Nations Sustainable Development Goals, neonatal and early infant morbidity and mortality remain high, and maternal health remains suboptimal in many countries. Novel and improved preventative strategies with the potential to benefit pregnant women and their infants are needed, with maternal and neonatal immunization representing effective approaches. Experts from immunology, vaccinology, infectious diseases, clinicians, industry, public health, and vaccine-related social sciences convened at the 5th International Neonatal and Maternal Immunization Symposium (INMIS) in Vancouver, Canada, from 15 to 17 September 2019. We critically evaluated the lessons learned from recent clinical studies, presented cutting-edge scientific progress in maternal and neonatal immunology and vaccine development, and discussed maternal and neonatal immunization in the broader context of infectious disease epidemiology and public health. Focusing on practical aspects of research and implementation, we also discussed the safety, awareness, and perception of maternal immunization as an existing strategy to address the need to improve maternal and neonatal health worldwide. The symposium provided a comprehensive scientific and practical primer as well as an update for all those with an interest in maternal and neonatal infection, immunity, and vaccination. The summary presented here provides an update of the current status of progress in maternal and neonatal immunization.
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Vacunas contra la COVID-19/inmunología , Complicaciones Infecciosas del Embarazo/prevención & control , Vacunación , Femenino , Humanos , Salud del Lactante , Recién Nacido , Salud Materna , Embarazo , Vacunación/efectos adversosRESUMEN
A new generation of recombinant acellular pertussis vaccine containing genetically inactivated pertussis toxin (PTgen) was licensed as a monovalent pertussis vaccine (aPgen; Pertagen®) and in combination with tetanus and reduced-dose diphtheria (TdaPgen; Boostagen®) for active immunization in individuals aged 11 years and older in Thailand in 2016. We here report post-marketing safety data on the use of the vaccines in individuals in the community obtained through active pharmacovigilance surveillance including pregnant women participating in a prospective observational study. Between May 2017 and February 2020 for TdaPgen and between June 2018 and February 2020 for aPgen, participating health care providers vaccinated and collected safety data for 11,429 exposed adolescents and adults. This included 1778 pregnant women. The incidence rate of adverse events following immunization (AEFIs) was 11.5 per 1000 of vaccinated individuals (95% confidence interval (95% CI) 9.7-13.6). AEFIs mostly concerned local pain at the injection site and muscle pain, and symptoms were mild and mostly resolved within a few days with no complications. The incidence rate of AEFIs in women vaccinated during pregnancy was 1.1 per 1000 (95% CI 0.3-4.1). Of 833 pregnant women vaccinated with recombinant aPgen or TdaPgen, 91.4% (95% CI 89.3-93.3) had uncomplicated pregnancies and 98.7% (95% CI 97.7-99.4) of the 855 babies delivered by these women were born healthy, which exceeds rates generally reported in Thailand. There were no vaccine-related serious adverse events reported during the surveillance period. In conclusion, active pharmacovigilance confirms that the recombinant pertussis vaccines aPgen (Pertagen) and TdaPgen (Boostagen) are safe in adolescents and adults, including pregnant women vaccinated in the second or third trimester of pregnancy.
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Vacunas contra Difteria, Tétanos y Tos Ferina Acelular , Difteria , Tétanos , Tos Ferina , Adolescente , Adulto , Anticuerpos Antibacterianos , Niño , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/efectos adversos , Femenino , Humanos , Inmunización , Inmunización Secundaria , Vacuna contra la Tos Ferina , Embarazo , Tailandia , Vacunación , Tos Ferina/prevención & controlRESUMEN
BACKGROUND: The World Health Organization has set a goal to eliminate mother-to-child transmission of syphilis to a target of <50 cases per 100 000 live births. This study aimed to determine the rate of congenital syphilis and identify gaps in prevention. METHODS: A retrospective chart review was conducted in a tertiary care center in Bangkok, Thailand. The study included all pregnant women with positive syphilis serology and their infants. All congenital syphilis cases were categorized according to Centers for Disease Control criteria. RESULTS: From 2013 to 2017, 69 syphilis-infected pregnant women were included, with 30 congenital syphilis cases. The rate of congenital syphilis was 115 cases (95% CI 78-164) per 100 000 live births. The median (interquartile range) maternal age was 21 (18-32) years and 12 (17%) women had human immunodeficiency virus co-infection. Regarding maternal treatment, 28 (41%) women had inadequate treatment due to 13 cases (19%) of late or no antenatal care, six cases (8%) of recent infection near delivery, five cases (7%) of failure of treatment provision, and four (6%) others. There were three syphilitic stillbirths who were prematurely born to untreated pregnant women and 67 live births (one set of twins) of which 27 met definitions of probable congenital syphilis. They received complete treatment with penicillin and had non-reactive rapid plasma reagin within the first 6 months of life, with the exception of one who had non-reactive rapid plasma reagin at the age of 7 months. CONCLUSIONS: Congenital syphilis remains a problem in our setting. Nearly half of pregnant women who had syphilis had inadequate treatment. There is an urgent need to strengthen diagnosis and the treatment cascade of syphilis during antenatal care.
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Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Sífilis Congénita/epidemiología , Sífilis Congénita/prevención & control , Centros de Atención Terciaria , Adolescente , Adulto , Antibacterianos/uso terapéutico , Femenino , Humanos , Recién Nacido , Penicilinas/uso terapéutico , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/terapia , Resultado del Embarazo , Atención Prenatal , Estudios Retrospectivos , Sífilis/epidemiología , Sífilis/terapia , Sífilis Congénita/tratamiento farmacológico , Tailandia/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Female youth with perinatally acquired human immunodeficiency virus (PHIV) may be at higher risk than uninfected youth for persistent anogenital human papillomavirus (HPV) infection, due to prolonged immunodeficiency. METHODS: A 3-year cohort study was conducted between 2013 and 2017 among Thai and Vietnamese PHIV and HIV-uninfected females 12-24 years, matched by age group and number of lifetime sexual partners. For HPV genotyping, cervical and anal samples were obtained at baseline and annually. Vaginal samples were collected at baseline and every 6 months. Factors associated with high-risk HPV (HR-HPV) persistence and incidence were assessed. RESULTS: We enrolled 93 PHIV and 99 HIV-uninfected females. Median age was 19 (interquartile range [IQR] 18-20) years. For the 7 HR-HPV types (16, 18, 31, 33, 45, 52, 58) in the nonavalent HPV vaccine, PHIV had significantly higher incidence (P = .03) and persistence (P = .01) than HIV-uninfected youth over a 3-year period. Having HIV (adjusted hazard ratio [aHR] 2.1, 95% confidence interval [CI] 1.1-3.9) and ever using illegal substances (aHR 4.8, 95% CI 1.8-13.0) were associated with incident 7 HR-HPV infections. HIV-positive status (adjusted prevalence ratio [aPR] 2.2, 95% CI 1.5-3.2), recent alcohol use (aPR 1.75, 95% CI 1.2-2.5), and higher number of lifetime partners (aPR 2.0, 95% CI 1.4-3.1, for 3-5 partners; aPR 1.93, 95% CI 1.2-3.2, for ≥6 partners) were significantly associated with persistent 7 HR-HPV infections. CONCLUSIONS: Female PHIV were at higher risk of having anogenital HR-HPV acquisition and persistence. Primary and secondary prevention programs for HPV infection and HPV-related diseases should be prioritized for PHIV children and youth.
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Infecciones por VIH , Infecciones por Papillomavirus , Adolescente , Adulto , Niño , Estudios de Cohortes , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Incidencia , Papillomaviridae/genética , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/epidemiología , Prevalencia , Factores de Riesgo , Tailandia , Adulto JovenRESUMEN
Objectives: The rate of vertical HIV transmission for women at high risk of HIV transmission stands at approximately 7.6%. In the present study we describe infant infection rates in women who had received raltegravir (RAL) intensification during pregnancy to a standard three-drug antiretroviral (ART) regimen in Thailand. Methods: This prospective cohort study enrolled HIV-1-positive pregnant women at high risk of vertical transmission, as defined by (1) ART initiation at a gestational age (GA) ≥32 weeks or (2) HIV-1 RNA >1000 copies/mL at GA of 32-38 weeks while on ART. Women received a standard three-drug ART regimen with RAL intensification (400 mg twice daily) until delivery and continued on a three-drug ART regimen after delivery. Plasma HIV-1 RNA testing was performed before intensification and at delivery. Infant HIV-1 status was determined using DNA PCR at birth, and at 1, 2 and 4 months of life. Results: Between February 2016 and November 2017, 154 pregnant women on ART were enrolled into the study with a median CD4 cell count and plasma HIV-1 RNA level of 382 cells/mm3 and 4.0 log10 copies/mL, respectively. The three-drug combination consisted of either a lopinavir/ritonavir- (53%) or efavirenz-based (43%) regimen. Median GA at time of RAL initiation was 34 weeks (interquartile range [IQR] 33-36) and median duration was 21 days (IQR 8-34). The proportion of women who had a plasma HIV-1 RNA <50 and <1000 copies/mL at delivery was 45% and 76%, respectively. There were six infants with HIV infection, three in utero and three peripartum. Overall vertical transmission rate was 3.9% (95% confidence interval [CI] 1.4-8.2). Conclusion: The majority of high-risk pregnant women living with HIV-1 who had received RAL intensification achieved viral suppression at delivery with a relatively low rate of vertical transmission. This intensification strategy represents an option for prevention in HIV-positive women at high risk of vertical transmission.
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Background: Infection with high-risk human papillomavirus (HR-HPV) may be higher in perinatally human immunodeficiency virus (HIV)-infected (PHIV) than HIV-uninfected (HU) adolescents because of long-standing immune deficiency. Methods: PHIV and HU females aged 12-24 years in Thailand and Vietnam were matched by age group and lifetime sexual partners. At enrollment, blood, cervical, vaginal, anal, and oral samples were obtained for HPV-related testing. The Wilcoxon and Fisher exact tests were used for univariate and logistic regression for multivariate analyses. Results: Ninety-three PHIV and 99 HU adolescents (median age 19 [18-20] years) were enrolled (June 2013-July 2015). Among PHIV, 94% were currently receiving antiretroviral therapy, median CD4 count was 593 (392-808) cells/mm3, and 62% had a viral load <40 copies/mL. Across anogenital compartments, PHIV had higher rates of any HPV detected (80% vs 60%; P = .003) and any HR-HPV (60% vs 43%, P = .02). Higher proportions of PHIV had abnormal Pap smears (eg, atypical squamous cells of unknown significance [ASC-US], 12% vs 14%; low-grade squamous intraepithelial neoplastic lesions, 19% vs 1%). After adjusting for ever being pregnant and asymptomatic sexually transmitted infections (STI) at enrollment, PHIV were more likely to have HR-HPV than HU (odds ratio, 2.02; 95% confidence interval, 1.09-3.77; P = .03). Conclusions: Perinatal HIV infection was associated with a higher risk of HR-HPV and abnormal cervical cytology. Our results underscore the need for HPV vaccination for PHIV adolescents and for prevention and screening programs for HPV and other STIs.
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Cuello del Útero/patología , Infecciones por VIH/complicaciones , Infecciones por Papillomavirus/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Enfermedades de Transmisión Sexual/complicaciones , Adolescente , Recuento de Linfocito CD4 , Femenino , VIH/aislamiento & purificación , Infecciones por VIH/epidemiología , Humanos , Estudios Longitudinales , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Factores de Riesgo , Enfermedades de Transmisión Sexual/epidemiología , Tailandia/epidemiología , Frotis Vaginal , Vietnam/epidemiología , Carga Viral , Adulto JovenRESUMEN
The study assessed and compared bacterial vaginosis (BV) prevalence in Thai women in reproductive age in four study groups - group 1, HIV-positive with copper intrauterine device (Cu-IUD); group 2, HIV-positive without Cu-IUD; group 3, HIV-negative with Cu-IUD; and group 4, HIV-negative without Cu-IUD. We conducted a cross-sectional study. BV prevalence was assessed by Nugent score and Amsel criteria. Descriptive statistics was used to present baseline characteristics; kwallis rank test - to compare variables between the four groups; logistic regression - to assess factors, related to BV prevalence. The analysis included 137 women in the four study groups with a median age of 39 years. Median BV prevalence by Nugent score was 45%, intermediate vaginal flora - 7% and normal vaginal flora - 48%. There was no statistically significant difference in the BV prevalence between the four study groups, p = 0.711. Threefold lower BV prevalence was found, assessed by Amsel criteria compared to Nugent score. Women with body mass index (BMI) < 20 had higher probability to have BV or intermediate vaginal flora, OR = 3.11, 95% CI (1.2-8.6), p = 0.025. The study found a high BV prevalence in the four study groups, related neither to HIV status, nor to Cu-IUD use. BV prevalence was associated only with low BMI. Thus, Cu-IUD could be a good contraceptive choice for HIV-positive women. Research in defining normal vaginal microbiota and improve diagnostic methods for BV should continue.
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Infecciones por VIH/complicaciones , Dispositivos Intrauterinos de Cobre/efectos adversos , Vaginosis Bacteriana/epidemiología , Adulto , Estudios Transversales , Femenino , Humanos , Prevalencia , Tailandia , Vaginosis Bacteriana/etiologíaRESUMEN
INTRODUCTION: Pregnant Thai women have low antibody titers against B. pertussis antigens, which coincide with an increasing incidence of pertussis among Thai infants. Thus, there exists a potential benefit of a booster dose of tetanus- diphtheria-acellular pertussis (Tdap) vaccine administered during pregnancy. Here, we report the vaccine reactogenicity profile and birth outcomes in Tdap-vaccinated pregnant women who have or have not had prior immunization with tetanus vaccine, and the IgG levels to B. pertussis antigens in maternal and cord sera at delivery. MATERIALS AND METHODS: Pregnant women (Nâ¯=â¯370) aged 18-40â¯years were administered the Tdap vaccine (Boostrix®, GlaxoSmithKline, Rixensart, Belgium) at 26-36â¯weeks gestation. Adverse events following vaccination were identified by follow-up telephone call and medical record review. IgG against pertussis toxin (anti-PT), filamentous hemagglutinin (anti-FHA) and pertactin (anti-PRN) in both maternal and umbilical cord blood obtained at delivery were quantitatively evaluated using enzyme-linked immunosorbent assay (EUROIMMUN®, Lübeck, Germany). RESULTS: There was no reported increase in the severity or duration of adverse events associated with the administration of an extra tetanus-containing vaccine within the previous five years (Nâ¯=â¯181) or multiple doses of tetanus-containing vaccines during the current pregnancy (Nâ¯=â¯98). Vaccination at least eight weeks prior to delivery resulted in high antibody titers to all B. pertussis antigens studied. CONCLUSIONS: The reactogenicity of Tdap vaccine administered during pregnancy was not affected by prior tetanus toxoid immunization. High transplacental antibody against B. pertussis antigens in the cord blood provides evidence of antibody transfer and should thus help to protect newborns from pertussis during early life.
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Anticuerpos Antibacterianos/inmunología , Antígenos Bacterianos/inmunología , Bordetella pertussis/inmunología , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/inmunología , Inmunogenicidad Vacunal , Tos Ferina/inmunología , Tos Ferina/prevención & control , Adolescente , Adulto , Anticuerpos Antibacterianos/sangre , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/efectos adversos , Femenino , Sangre Fetal/inmunología , Humanos , Exposición Materna , Embarazo , Tailandia/epidemiología , Vacunación , Tos Ferina/sangre , Adulto JovenRESUMEN
OBJECTIVES: First, to evaluate the longitudinal changes of HIV RNA in genital secretions in HIV-positive women with plasma HIV RNA <50 copies/mL before and after the onset of menopause. Second, to assess inflammatory markers and prevalence of comorbidities after the onset of menopause. METHODS: This was a prospective observational study with two time points. HIV RNA in genital secretions (GVL) was measured in 15 HIV-positive menopausal women (second time point). Results were compared to earlier available data for GVL from the same participant before the onset of menopause (first time point). RESULTS: Median age at the first time point was 42 years, and 52 years at the second time point. Median time since the onset of menopause was 2 years and 33% of women were sexually active. Eighty per cent had at least one comorbidity. The GVL before menopause was >50 copies/mL in 27% of the participants, and in 40% after menopause. The GVL was <1000 copies/mL in all but one measurement. There was no significant difference between the two time points (P=0.687). Intermediate vaginal flora or bacterial vaginosis was found in 73% of participants during the second time point. CONCLUSIONS: There was a high prevalence of low-level GVL shedding before and after menopause. This needs further investigation, especially in relation to the vaginal microbiome and the complex interactions between micro-organisms. HIV-infected women in menopause do not seem to present a major public health risk for HIV transmission. Nevertheless, safe sex should be discussed with all, regardless of age. The high prevalence of non-communicable diseases after menopause requires special attention and comprehensive care.
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We determined the effect of short-chain galacto-oligosaccharides (scGOS), long-chain fructo-oligosaccharides (lcFOS) and Bifidobacterium breve M-16V on the gut microbiota of cesarean-born infants. Infants were randomized to receive a standard formula (control), the same with scGOS/lcFOS and B. breve M-16V (synbiotic), or with scGOS/lcFOS (prebiotic) from birth until week 16, 30 subjects born vaginally were included as a reference group. Synbiotic supplementation resulted in a higher bifidobacteria proportion from day 3/5 (Pâ<â0.0001) until week 8 (Pâ=â0.041), a reduction of Enterobacteriaceae from day 3/5 (Pâ=â0.002) till week 12 (Pâ=â0.016) compared to controls. This was accompanied with a lower fecal pH and higher acetate. In the synbiotic group, B. breve M-16V was detected 6 weeks postintervention in 38.7% of the infants. This synbiotic concept supported the early modulation of Bifidobacterium in C-section born infants that was associated with the emulation of the gut physiological environment observed in vaginally delivered infants.
Asunto(s)
Cesárea , Microbioma Gastrointestinal , Fórmulas Infantiles , Simbióticos , Bifidobacterium breve , Método Doble Ciego , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Oligosacáridos , Evaluación de Resultado en la Atención de Salud , EmbarazoRESUMEN
BACKGROUND: Thailand has made progress in reducing perinatal HIV transmission rates to levels that meet the World Health Organization targets for so-called "elimination" (<2%) of mother-to-child transmission (MTCT). OBJECTIVES: To highlight the Thailand National Guidelines on HIV/AIDS Treatment Prevention Working Group issued a new version of its National Prevention of MTCT guidelines in March 2017 aimed to reduce MTCT rate to <1% by 2020. DISCUSSION OF GUIDELINES: The guidelines include recommending initiation of antepartum antiretroviral therapy (ART) containing tenofovir disoproxil fumarate (TDF) plus lamivudine (3TC)/emtricitabine (FTC) plus efavirenz regardless of CD4 cell count as soon as HIV is diagnosed for ART naïve HIV-infected pregnant women. An alternative regimen is TDF or zidovudine (AZT) plus 3TC/FTC plus lopinavir/ritonavir (LPV/r) for HIV-infected pregnant women suspected resistant to non-nucleoside reverse transcriptase inhibitors. Treatment should be started immediately irrespective of gestational age and continued after delivery for life. Raltegravir is recommended in addition to the ART regimen for HIV-infected pregnant women who present late (gestational age (GA) ≥32 weeks) or those who have a viral load (VL) >1000 copies/mL at GA ≥32 weeks. HIV-infected pregnant women who conceive while receiving ART should continue their treatment regimen during pregnancy. HIV-infected pregnant women who present in labor and are not receiving ART should receive single-dose nevirapine immediately along with oral AZT, and continue ART for life. Infants born to HIV-infected mothers are categorized as high or standard risk for MTCT. High MTCT risk is defined as an infant whose mother has a viral load (VL) > 50 copies/mL at GA > 36 weeks or has received ART <12 weeks before delivery, or has poor ART adherence. These infants should be started on AZT plus 3TC plus NVP for 6 weeks after delivery. Infants with standard MTCT risk should receive AZT for 4 weeks. Formula feeding exclusively is recommended for all HIV-exposed infants.
RESUMEN
Many adolescents living with or without HIV are sexually active and in need of continuous free access to a variety of contraceptive methods. Dual contraception, condom use together with reversible effective contraception (hormonal contraception [HC] or intrauterine device), seems to be the most effective option for female adolescents for protection from unintended pregnancy and sexually transmitted infections. When counselling on specific contraceptive choice, healthcare providers should be aware about possible interactions of some types of HC with the immune system, with possible changes in infectivity, as well as about drug interactions between mainly efavirenz and some types of progestins. Adding HC to HIV-positive status and antiretroviral therapy could have additive effects on metabolism. At the same time, the possible disadvantages of using HC in women living with HIV should be balanced against the advantages of very reliable methods of preventing unintended pregnancies. To reach and deliver a contraceptive service to more young women, it has proven effective to organise adolescent-friendly clinics and/or integrate them with HIV services. Diverse approaches, including community-based contraceptive service provision and the use of modern technologies, can complement the effort of providing contraceptive services to this target group of female adolescents living with HIV or at risk of HIV.
RESUMEN
OBJECTIVE: This study evaluated the diagnostic performance of chemiluminescent microparticle immunoassay (CMIA) in screening for syphilis in Asian pregnant women. MATERIAL AND METHOD: This study retrospectively reviewed the CMA results of pregnant women attending the antenatal care clinic, King Chulalongkorn Memorial Hospital. Women with reactive CMA results were extracted from the laboratory database and further analyzed. A reactive/positive result for Treponema pallidum was defined as having a sample/cut-off absorbance ratio of ≥ 1.0. Samples were also tested by rapid plasma reagin (RPR) and Treponema pallidum particle agglutination assay (TPPA). RESULTS: From February 2011 to January 2013, a total of 11,640 pregnant women were tested and 65 women (0.56%) had reactive CMIA results. Among these cases, 58 women (89.2%) had non-reactive RPR results. TPPA were non-reactive in 35 women (60.3%) who had non-reactive RPR results. A total of 23 women (39.7%) with RPR non-reactive and TPPA reactive results; therefore, the prevalence rate of syphilis in this population was estimated as 1.98 per 1,000 pregnant women. Among this, 7 cases had a history of past, partial treatment for syphilis and 16 cases were considered as untreated, late, latent syphilis. If RPR tests were used as the screening test, 16/23 cases (69.6%) cases with untreated syphilis would be missed. CONCLUSION: Even though CMIA has high false positive results, however it is still recommended that this reverse sequence screening be used instead of the traditional algorithm. The rate of false positive results can be decreased by adjusting the sample/cut-off absorbance ratio of CMIA.