RESUMEN
The rational laboratory use and implementation of test ordering procedures aim to reduce unnecessary test requests. This study aimed to determine the financial burden caused by inappropriate serological test requests for viral hepatitis and to investigate physicians' reasons for making unnecessary test requests. We performed a retrospective evaluation of inappropriate requests for hepatitis serology testing and the financial burden they caused at a tertiary care hospital over a 1-year period. The study found 2183 (3.84%) inappropriate test requests, costing $3309.00. Of these, 357 were same-day repeat requests and 1826 were requests not following diagnostic algorithms. In the logistic regression analysis of the factors affecting unnecessary test requests, a statistically significant difference was found between whether the unit was internal or surgical, whether the request came from inpatient services or outpatient clinics, and the professional titles (Pâ <â .05). Both types of inappropriate requests were more common among male physicians (Pâ <â .05). The highest rates of inappropriate test requesting were in physical therapy and rehabilitation, pediatrics, and adult emergency units. To identify the reasons behind unnecessary test requests, 135 physicians from 23 different departments participated in the survey. The main reasons for requesting tests were identified as protecting against malpractice and fears of misdiagnosis or overlooking a diagnosis. It has been observed that physicians often order tests routinely, without being fully familiar with standard test ordering procedures based on diagnostic algorithms, and lacking knowledge about rational laboratory use. The cost of tests is mostly unknown to clinicians. The study concludes that there are laboratory tests that incur much higher costs. When this assessment is applied to the entire laboratory, it becomes clear how significant a financial burden, unnecessary workload, and loss of time this situation can cause. Identifying the presence of unnecessary test requests is the first step in preventing them. Appropriate measures include highlighting these issues, providing necessary information, and offering in-service training.
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Procedimientos Innecesarios , Humanos , Estudios Retrospectivos , Masculino , Femenino , Procedimientos Innecesarios/economía , Procedimientos Innecesarios/estadística & datos numéricos , Pruebas Serológicas/economía , Pruebas Serológicas/estadística & datos numéricos , Hepatitis Viral Humana/diagnóstico , Hepatitis Viral Humana/economía , Adulto , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pautas de la Práctica en Medicina/economía , Centros de Atención Terciaria , Persona de Mediana EdadRESUMEN
Resumen A fines de 2019 se describieron en China los primeros casos de neumonía asociada a SARS-CoV-2. La OMS la llamó COVID-19 y declaró emergencia sanitaria internacional en enero de 2020, ante la rápida diseminación de la infección a nivel mundial. En la Argentina los primeros casos se detectaron en marzo de 2020 y casi inmediatamente comenzaron a utilizarse métodos directos para detección de SARS-CoV-2 (RT PCR, LAMP, entre otros). Los métodos para detección de anticuerpos fueron aprobados posteriormente y no son de elección para realizar el diagnóstico de la enfermedad. En este laboratorio estos últimos comenzaron a utilizarse durante la primera ola de COVID-19 y con estos datos se realizó un estudio observacional retrospectivo de una serie de pacientes con resultados de anticuerpos IgG positivos. Se calculó la tasa de notificación al Sistema Integrado de Información Sanitaria Argentino (SISA) y se evaluaron los niveles de anticuerpos, agrupándolos de acuerdo a: si estaban notificados y si tenían resultado de RT PCR/LAMP, los síntomas presentados y el tiempo transcurrido post RT PCR/LAMP. No fue posible demostrar diferencias entre los pacientes con RT PCR/LAMP detectable y no detectable, tampoco con el tipo de síntomas declarados ni con respecto a los días transcurridos posinfección. Sin embargo, se observó que existía una diferencia significativa entre el grupo de pacientes notificados y no notificados y una alta tasa de pacientes con anticuerpos positivos que no fueron declarados en SISA, por lo que su detección podría considerarse como marcador subrogante de contacto cuando no fuera posible arribar al diagnóstico por métodos moleculares.
Abstract At the end of 2019 the first cases of SARS-CoV-2-associated pneumonia were reported in China. Consequently, the World Health Organization (WHO) named it COVID-19 and in January 2020, it declared the international health emergency due to the worldwide rapid spread of the infection. The first cases in Argentina were detected in early March 2020. Molecular tests like RT PCR and LAMP were immediately used. Serological tests for antibody detection were approved a few months later; however, these are still not the preferred evidiagnostic method for the disease. In our laboratory, the latter began to be used during the first wave of COVID-19. With the results obtained in that moment, an observational retrospective study in a cohort of patients who came voluntarily to test for SARS-CoV-2 IgG antibodies and whose results were positive was performed. The notification rate to the Argentine Integrated System for Health Information (SISA for its acronym in Spanish) was calculated and antibody levels were evaluated, clustering them according to the following facts: if the event had been notified to the SISA and if they had a previous RT PCR/LAMP result, the symptoms experienced by these patients and the time elapsed between RT PCR/LAMP and antibody test results. It was not possible to demonstrate differences between patients with detectable and undetectable RT PCR/LAMP, neither with the type of declared symptoms nor with respect to the days elapsed post-infection. However, it was found that there was a significant difference between notified and non-notified patients, and a high rate of non-notified patients with positive antibodies. Therefore, antibodies level might be considered as a surrogate marker of SARS-CoV-2 contact when a diagnosis through molecular methods is not available.
Resumo No final de 2019 foram reportados na China os primeiros casos de pneumonia associados a SARS-CoV-2. A Organização Mundial da Saúde (OMS) chamou-a de COVID-19 e declarou emergência sanitária internacional em janeiro de 2020, frente à rápida disseminação da infecção em nível mundial. Na Argentina os primeiros casos foram detectados no início de março de 2020 e de forma quase imediata, começaram a ser utilizados métodos diretos para detectar SARS-CoV-2 (RT PCR, LAMP, entre outros). Os métodos para detectar anticorpos foram posteriormente aprovados e não são de eleição para realizar o diagnóstico da doença. Em nosso laboratório, a utilização destes últimos começou durante a primeira onda de COVID-19 e com os resultados obtidos nesse momento foi realizado um estudo observacional retrospectivo de uma série de pacientes com resultados de anticorpos IgG positivos. Foi calculada a taxa de notificação ao Sistema Integrado de Informação em Saúde da Argentina (SISA) e foram avaliados os níveis de anticorpos agrupando- os de acordo a: se estavam notificados e se eles tinham resultado de RT PCR/LAMP, os sintomas apresentados e o tempo decorrido pós RT PCR/LAMP. Não foi possível demonstrar diferenças entre pacientes com RT PCR/LAMP detectável e não detectável, nem com o tipo de sintomas declarados nem com relação aos dias decorridos após a infecção. No entanto, verificou-se que existia uma diferença significativa entre o grupo de pacientes notificados e não notificados, e uma alta taxa de pacientes com anticorpos positivos que não foram declarados no SISA, portanto, sua detecção poderia ser considerada como um marcador substituto de contato quando não fosse possível chegar ao diagnóstico por métodos moleculares.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Sangre/inmunología , Pruebas Serológicas/estadística & datos numéricos , COVID-19/virología , Anticuerpos/análisis , Inmunoglobulina G/sangreRESUMEN
BACKGROUND AND AIMS: Achieving HBsAg loss is an important landmark in the natural history of chronic hepatitis B (CHB). A more personalized approach to prediction of HBsAg loss is relevant in counseling patients. This study sought to develop and validate a prediction model for HBsAg loss based on quantitative HBsAg levels (qHBsAg) and other baseline characteristics. METHODS: The Hepatitis B Research Network (HBRN) is a prospective cohort including 1240 untreated HBeAg-negative patients (1150 adults, 90 children) with median follow-up of 5.5 years. Incidence rates of HBsAg loss and hepatitis B surface antibody (anti-HBs) acquisition were determined, and a predictor score of HBsAg loss using readily available variables was developed and externally validated. RESULTS: Crude incidence rates of HBsAg loss and anti-HBs acquisition were 1.6 and 1.1 per 100 person-years (PY); 67 achieved sustained HBsAg loss for an incidence rate of 1.2 per 100 PY. Increased HBsAg loss was significantly associated with older age, non-Asian race, HBV phenotype (inactive CHB vs. others), HBV genotype A, lower HBV-DNA levels, and lower and greater change in qHBsAg. The HBRN-SQuARe (sex,∆quantHBsAg, age, race) score predicted HBsAg loss over time with area under the receiver operating characteristic curve (AUROC) (95% CIs) at 1 and 3 years of 0.99 (95% CI: 0.987-1.00) and 0.95 (95% CI 0.91-1.00), respectively. In validation in another cohort of 1253 HBeAg-negative patients with median follow-up of 3.1 years, HBRN SQuARe predicted HBsAg loss at 1 and 3 years with AUROC values of 0.99 (0.98-1.00) and 0.88 (0.77-0.99), respectively. CONCLUSION: HBsAg loss in predominantly untreated patients with HBeAg-negative CHB can be accurately predicted over a 3-year horizon using a simple validated score (HBRN SQuARe). This prognostication tool can be used to support patient care and counseling.
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Anticuerpos contra la Hepatitis B , Antígenos de Superficie de la Hepatitis B , Hepatitis B Crónica , Adulto , Factores de Edad , Niño , Etnicidad/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Anticuerpos contra la Hepatitis B/análisis , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/análisis , Antígenos de Superficie de la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/inmunología , Virus de la Hepatitis B/genética , Hepatitis B Crónica/diagnóstico , Hepatitis B Crónica/inmunología , Humanos , Incidencia , Masculino , Valor Predictivo de las Pruebas , Pronóstico , Pruebas Serológicas/métodos , Pruebas Serológicas/estadística & datos numéricos , Respuesta Virológica SostenidaRESUMEN
BACKGROUND & AIMS: HBsAg-specific antibody responses are difficult to detect during chronic hepatitis B infection (CHB) and are often overlooked. The aim of this study was to examine whether anti-HBs may be involved in functional cure (FC) by profiling anti-HBs responses in patients with CHB using a panel of specific assays. METHODS: Longitudinal serum samples were obtained from 25 patients with CHB who were infected with HBV genotype A and were undergoing nucleos(t)ide analogue (NA) treatment: 14 achieved FC while 11 remained infected (non-FC). Anti-HBs immune complexes (HBsAg-IC), FcγRIIIa dimer binding, epitope specificity and neutralisation efficacy were measured. RESULTS: HBsAg-IC peaks were detected prior to HBsAg loss in 10/14 FC patients. These HBsAg-IC peaks overlapped with either an alanine aminotransferase (ALT) flare (8/10 patients), or a rise in ALT (2/10 patients). HBsAg-IC peaks were detected in 7/11 non-FC patients, but were not associated with an ALT flare. FCγRIIIa binding was detected in 9/14 FC patients, independent from detection of overlapping HBsAg-IC/ALT peaks. FC patients had stable HBsAg epitope occupancy across the study, whereas non-FC patients had a reduction in HBsAg epitope occupancy within the first 12-24 weeks of NA treatment. Convalescent sera from FC patients recognised more HBsAg epitopes and neutralised HBV infection more potently than anti-HBs derived from vaccinees. Neutralisation potency appeared to increase post-HBsAg loss in 4/5 FC patients examined. CONCLUSIONS: Using these assays, we confirm that anti-HBs responses are present and fluctuate over time in this cohort of patients with HBeAg+ CHB, who were infected with HBV genotype A and treated with NAs. Key anti-HBs profiles associated with either FC or failure to achieve FC were also identified, suggesting a role for anti-HBs responses in FC. LAY SUMMARY: Using a panel of assays to characterise hepatitis B surface antibody (anti-HBs) responses in a group of patients with chronic hepatitis B, we identified anti-HBs profiles associated with either functional cure, or failure to achieve functional cure. Functional cure was associated with immune complex peaks which overlapped with alanine aminotransferase flares. Conversely, in those who did not achieve functional cure, immune complex peaks were present, but were not associated with alanine aminotransferase flares, and a decline in anti-HBs diversity was observed early during treatment.
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Genotipo , Antígenos de Superficie de la Hepatitis B/análisis , Hepatitis B Crónica/sangre , Adulto , Femenino , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/metabolismo , Hepatitis B Crónica/fisiopatología , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pruebas Serológicas/métodos , Pruebas Serológicas/estadística & datos numéricosRESUMEN
OBJECTIVES: HIV-positive men who have sex with men (MSM) may be at a higher risk of repeat syphilis, have different clinical manifestations and have a different serological response to treatment compared with HIV-negative MSM. The objective of this study was to assess whether HIV-negative and HIV-positive MSM with infectious syphilis (primary, secondary or early latent) differed in history of previous syphilis episodes, disease stage and non-treponemal titre of initial and repeat episodes, and the titre response 6 and 12 months after treatment. Furthermore, determinants associated with an inadequate titre response after treatment were explored. METHODS: This retrospective analysis used data of five longitudinal studies (four cohorts; one randomised controlled trial) conducted at the STI clinic in Amsterdam, the Netherlands. Participants were tested for syphilis and completed questionnaires on sexual risk behaviour every 3-6 months. We included data of participants with ≥1 syphilis diagnosis in 2014-2019. Pearson's χ² test was used to compare HIV-negative and HIV-positive MSM in occurrence of previous syphilis episodes, disease stage of initial and repeat syphilis episode and non-treponemal titre treatment responses. RESULTS: We included 355 participants with total 459 syphilis episodes. HIV-positive MSM were more likely to have a history of previous syphilis episodes compared with HIV-negative MSM (68/90 (75.6%) vs 96/265 (36.2%); p<0.001). Moreover, HIV-positive MSM with repeat syphilis were less often diagnosed with primary syphilis (7/73 (9.6%) vs 36/126 (28.6%)) and more often diagnosed with secondary syphilis (16/73 (21.9%) vs 17/126 (13.5%)) and early latent syphilis (50/73 (68.5%) vs 73/126 (57.9%)) (p=0.005). While not significantly different at 12 months, HIV-negative MSM were more likely to have an adequate titre response after 6 months compared with HIV-positive MSM (138/143 (96.5%) vs 66/74 (89.2%); p=0.032). CONCLUSIONS: In repeat syphilis, HIV infection is associated with advanced syphilis stages and with higher non-treponemal titres. HIV infection affects the serological outcome after treatment, as an adequate titre response was observed earlier in HIV-negative MSM.
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Infecciones por VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Sífilis/epidemiología , Sífilis/inmunología , Treponema/inmunología , Adulto , Anticuerpos Antibacterianos/sangre , Anticuerpos Antibacterianos/inmunología , Análisis de Datos , Infecciones por VIH/complicaciones , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Asunción de Riesgos , Pruebas Serológicas/estadística & datos numéricos , Conducta SexualRESUMEN
BACKGROUND: Test utilization for the diagnosis of celiac disease may affect the prevalence and incidence of the disease in Korea. We aimed to investigate the test utilization of serological biomarkers for celiac disease in Korea. METHODS: We retrospectively investigated the test utilization of tissue transglutaminase IgA, gliadin IgA and IgG, and endomysial IgA antibody (Ab) assays between January 2011 and June 2020. RESULTS: During a nine-year-and-six-month study period, overall 307,322,606 clinical tests were requested from different clinical settings, such as local clinics, hospitals, university hospitals, and tertiary medical centers. Among them, only 58 tissue transglutaminase IgA, 22 gliadin IgA, 12 gliadin IgG, and 16 endomysial IgA Ab tests were performed on 79 Korean patients. Among them, one patient had positive transglutaminase IgA Ab result (1.3%). CONCLUSION: Low prevalence and incidence of celiac disease in Korea may be due to an underutilization of diagnostic assays.
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Enfermedad Celíaca/diagnóstico , Pruebas Serológicas/estadística & datos numéricos , Enfermedad Celíaca/epidemiología , Pruebas Diagnósticas de Rutina , Gliadina/inmunología , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Proteína Glutamina Gamma Glutamiltransferasa 2/inmunología , República de Corea/epidemiología , Estudios RetrospectivosAsunto(s)
Vacunas contra la COVID-19/inmunología , COVID-19/prevención & control , Personal de Salud/estadística & datos numéricos , Inmunogenicidad Vacunal , Vacunas Sintéticas/inmunología , Adulto , Anticuerpos Neutralizantes/sangre , Vacuna BNT162 , COVID-19/epidemiología , Vacunas contra la COVID-19/administración & dosificación , Femenino , Hong Kong/epidemiología , Humanos , Inmunoglobulina G/sangre , Modelos Logísticos , Masculino , Persona de Mediana Edad , SARS-CoV-2 , Pruebas Serológicas/métodos , Pruebas Serológicas/estadística & datos numéricos , Glicoproteína de la Espiga del Coronavirus/inmunología , Vacunas de Productos Inactivados/administración & dosificación , Vacunas de Productos Inactivados/inmunología , Vacunas Sintéticas/administración & dosificación , Vacunas de ARNmRESUMEN
To identify the prevalence and risk factors for primary Epstein-Barr virus (EBV) infection in human immunodeficiency virus (HIV)-1-positive adult treatment-naïve patients between January 2018 and December 2019 in a state of the Brazilian Amazon region. A total of 268 HIV-1 positive patients and 65 blood donors participated in the study. Epidemiological data were obtained from medical records and through a designed questionnaire. EBV infection was screened by the semiquantitative detection of anti-viral capsid antigen (VCA) EBV IgM and IgG, followed by molecular detection of the EBNA-3C gene. The plasma viral loads of HIV-1 and EBV were quantified using a commercial kit. The prevalence of primary coinfection was 7.12%. The associated risk factors were education level, family income, history of illicit drug use and sexually transmitted infections, homosexual contact and condom nonuse. Approximately 58.5% had late initiation of highly active antiretroviral therapy, which influenced the risk of HIV-EBV 1/2 multiple infection (odds ratio (OR): 4.76; 95% CI 1.51-15.04) and symptom development (p = 0.004). HIV viral load was associated with patient age (OR: 2.04; 95% CI 2.01-2.07; p = 0.026) and duration of illicit drug use (OR: 1.57; 95% CI 1.12-2.22; p = 0.0548). EBV viral load was associated with younger age (OR: 0.82; 95% CI 0.79-1.03; p = 0.0579). The replication of both viruses was associated with symptom development (HIV = OR: 2.06; 95% CI 1.22-3.50; p = 0.0073; EBV = OR: 8.81; 95% CI 1-10; p = 0.0447). The prevalence of HIV/EBV coinfection was lower than that observed in other studies, and social vulnerability and promiscuous sexual behavior were associated risk factors. A long time of HIV-1 infection, without therapy, influenced the risk of coinfection and disease progression. The viral loads of both viruses may be associated with some epidemiological aspects of the population.
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Infecciones por Virus de Epstein-Barr/epidemiología , Infecciones por VIH/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/virología , VIH-1/patogenicidad , Humanos , Masculino , Persona de Mediana Edad , Pruebas Serológicas/estadística & datos numéricos , Sexualidad/estadística & datos numéricos , Factores Socioeconómicos , Carga ViralRESUMEN
BACKGROUND: Colonization and marginalization have affected the risk for and experience of hepatitis C virus (HCV) infection for First Nations people in Canada. In partnership with the Ontario First Nations HIV/AIDS Education Circle, we estimated the publicly borne health care costs associated with HCV infection among Status First Nations people in Ontario. METHODS: In this retrospective matched cohort study, we used linked health administrative databases to identify Status First Nations people in Ontario who tested positive for HCV antibodies or RNA between 2004 and 2014, and Status First Nations people who had no HCV testing records or only a negative test result (control group, matched 2:1 to case participants). We estimated total and net costs (difference between case and control participants) for 4 phases of care: prediagnosis (6 mo before HCV infection diagnosis), initial (after diagnosis), late (liver disease) and terminal (6 mo before death), until death or Dec. 31, 2017, whichever occurred first. We stratified costs by sex and residence within or outside of First Nations communities. All costs were measured in 2018 Canadian dollars. RESULTS: From 2004 to 2014, 2197 people were diagnosed with HCV infection. The mean net total costs per 30 days of HCV infection were $348 (95% confidence interval [CI] $277 to $427) for the prediagnosis phase, $377 (95% CI $288 to $470) for the initial phase, $1768 (95% CI $1153 to $2427) for the late phase and $893 (95% CI -$1114 to $3149) for the terminal phase. After diagnosis of HCV infection, net costs varied considerably among those who resided within compared to outside of First Nations communities. Net costs were higher for females than for males except in the terminal phase. INTERPRETATION: The costs per 30 days of HCV infection among Status First Nations people in Ontario increased substantially with progression to advanced liver disease and finally to death. These estimates will allow for planning and evaluation of provincial and territorial population-specific hepatitis C control efforts.
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Costos de la Atención en Salud/estadística & datos numéricos , Hepacivirus , Hepatitis C Crónica , Estudios de Casos y Controles , Bases de Datos Factuales/estadística & datos numéricos , Progresión de la Enfermedad , Femenino , Asignación de Recursos para la Atención de Salud/economía , Asignación de Recursos para la Atención de Salud/estadística & datos numéricos , Hepacivirus/genética , Hepacivirus/inmunología , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/economía , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/fisiopatología , Humanos , Indígena Canadiense/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Estudios Retrospectivos , Análisis de Secuencia de ARN/estadística & datos numéricos , Pruebas Serológicas/estadística & datos numéricosRESUMEN
We assessed serology results of clinically suspected rickettsiosis episodes in the hospital setting. Overall, 322 of 963 (33%) cases were serology positive. Among those, rash rates were low (30%), murine typhus (MT) predominated over spotted fever and IgM positivity rate was higher in MT. These findings suggest that during acute rickettsiosis, serology may reliably identify MT infection but may underdiagnose spotted fever.
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Anticuerpos Antibacterianos/sangre , Infecciones por Rickettsia/diagnóstico , Rickettsia typhi/inmunología , Adolescente , Animales , Niño , Preescolar , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Lactante , Israel/epidemiología , Masculino , Ratones , Estudios Retrospectivos , Infecciones por Rickettsia/sangre , Infecciones por Rickettsia/epidemiología , Infecciones por Rickettsia/inmunología , Pruebas Serológicas/estadística & datos numéricos , Tifus Endémico Transmitido por Pulgas/inmunologíaAsunto(s)
Vacunas contra la COVID-19 , COVID-19/prevención & control , Personal de Salud/estadística & datos numéricos , Inmunogenicidad Vacunal , Adulto , Anticuerpos Neutralizantes/sangre , Vacuna BNT162 , COVID-19/epidemiología , Vacunas contra la COVID-19/administración & dosificación , Vacunas contra la COVID-19/inmunología , Femenino , Hong Kong/epidemiología , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , SARS-CoV-2 , Pruebas Serológicas/métodos , Pruebas Serológicas/estadística & datos numéricos , Glicoproteína de la Espiga del Coronavirus/inmunología , Vacunas de Productos Inactivados/administración & dosificación , Vacunas de Productos Inactivados/inmunología , Vacunas Sintéticas/administración & dosificación , Vacunas Sintéticas/inmunología , Vacunas de ARNmRESUMEN
BACKGROUND: Women with cosmetic breast implants have significantly lower rates of subsequent breast cancer than the general population (relative risk, 0.63; 95 percent CI, 0.56 to 0.71). The authors hypothesize that breast implant-induced local inflammation stimulates immunosurveillance recognition of breast tumor antigen. METHODS: Sera were collected from two cohorts of healthy women: women with long-term breast implants (i.e., breast implants for >6 months) and breast implant-naive women. Antibody responses to breast tumor antigens were tested by enzyme-linked immunosorbent assay and compared between cohorts by unpaired t test. Of the implant-naive cohort, nine women underwent breast augmentation, and antibody responses before and after implant placement were compared by paired t test. RESULTS: Sera were collected from 104 women: 36 (34.6 percent) long-term breast implants and 68 (65.4 percent) implant-naive women. Women with long-term breast implants had higher antibody responses than implant-naive women to mammaglobin-A (optical density at 450 nm, 0.33 versus 0.22; p = 0.003) and mucin-1 (optical density at 450 nm, 0.42 versus 0.34; p = 0.02). There was no difference in antibody responses to breast cancer susceptibility gene 2, carcinoembryonic antigen, human epidermal growth factor receptor-2, or tetanus. Nine women with longitudinal samples preoperatively and 1 month postoperatively demonstrated significantly elevated antibody responses following implant placement to mammaglobin-A (mean difference, 0.13; p = 0.0002) and mucin-1 (mean difference 0.08; p = 0.02). There was no difference in postimplant responses to other breast tumor antigens, or tetanus. CONCLUSIONS: Women with long-term breast implants have higher antibody recognition of mammaglobin-A and mucin-1. This study provides the first evidence of implant-related immune responses to breast cancer antigens. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
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Anticuerpos Antineoplásicos/sangre , Implantación de Mama/instrumentación , Implantes de Mama , Neoplasias de la Mama/prevención & control , Vigilancia Inmunológica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antineoplásicos/inmunología , Antígenos de Neoplasias/inmunología , Neoplasias de la Mama/inmunología , Estudios de Casos y Controles , Estudios de Cohortes , Ensayo de Inmunoadsorción Enzimática , Femenino , Voluntarios Sanos , Humanos , Persona de Mediana Edad , Pruebas Serológicas/estadística & datos numéricos , Geles de Silicona , Adulto JovenRESUMEN
BACKGROUND: Despite completion of the vaccine schedule for hepatitis B virus (HBV), children may display levels of HBV surface antibodies (anti-HBs) that are considered inadequate for sufficient protection (<10 IU/L). AIMS: Our aim was to investigate if age and gap time between HBV vaccine doses may negatively affect the levels of anti-HBs in children, and if these relationships are modified by sex. METHODS: In a high-endemic HBV region of the western Brazilian Amazon we enrolled children who had completed the HBV vaccine schedule. All children underwent analysis of anti-HBs and a clinical examination. RESULTS: We included 522 children (mean age 4.3 ± 0.8 years; 50% male). Median anti-HBs was 28.4 [interquartile range (IQR) 5.4 to 128.6] IU/L and 32% had anti-HBs <10 IU/L. The median gap time from last to preceding dose was 2.4 [IQR 2.1 to 3.3] months. Levels of anti-HBs decreased with higher age (-42% per year increase [95%CI -56% to -24%], p<0.001), but not with longer gap time (+23% per month increase [95%CI -16% to +62%], p = 0.249). After adjusting for relevant confounders, gap time became significant (p = 0.032) and age remained a significant predictor of anti-HBs (p<0.001). CONCLUSION: One third of assessed children displayed anti-HBs <10 IU/L. Levels of anti-HBs decreased with higher age and increased with longer gap time between the last two doses.
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Anticuerpos contra la Hepatitis B/sangre , Virus de la Hepatitis B/inmunología , Hepatitis B/inmunología , Esquemas de Inmunización , Factores de Edad , Brasil , Preescolar , Estudios Transversales , Enfermedades Endémicas/prevención & control , Femenino , Hepatitis B/sangre , Hepatitis B/prevención & control , Hepatitis B/virología , Anticuerpos contra la Hepatitis B/inmunología , Antígenos de Superficie de la Hepatitis B/inmunología , Vacunas contra Hepatitis B/administración & dosificación , Vacunas contra Hepatitis B/inmunología , Humanos , Masculino , Vacunación Masiva , Pruebas Serológicas/estadística & datos numéricos , Factores de TiempoRESUMEN
OBJECTIVE: Plasma Epstein-Barr virus (EBV) DNA is considered a biomarker for nasopharyngeal carcinoma (NPC). However, its long-term role in NPC development is unclear. MATERIALS AND METHODS: A total of 1363 participants seropositive for EBV VCA-IgA and EBNA1-IgA in a community-based NPC screening program in southern China were tested for plasma EBV DNA levels by real-time qPCR between 2008 and 2015. New NPC cases were confirmed by active follow-up approach and linkage to local cancer registry through the end of 2016. Cox proportional hazards regression analysis was performed to calculate the hazard ratios (HRs) for NPC risk with plasma EBV DNA. RESULTS: Thirty patients were newly diagnosed during a median 7.5 years follow-up. NPC incidence increased with the plasma EBV DNA load ranging from 281.46 to 10,074.47 per 100,000 person-years in participants with undetectable and ≥ 1000 copies/ml levels; the corresponding cumulative incidence rates were 1.73 and 50%. Furthermore, plasma EBV DNA loads conferred an independent risk for NPC development after adjustment for other risk factors, with HRs of 7.63 for > 3-999 copies/ml and 39.79 for ≥1000 copies/ml. However, the HRs decreased gradually after excluding NPC cases detected in the first 2 to 3 years and became statistically nonsignificant by excluding cases detected during the first 4 years. CONCLUSION: Elevated plasma EBV DNA can predict NPC risk over 3 years. Monitoring plasma EBV DNA can be used as a complementary approach to EBV serological antibody-based screening for NPC.
Asunto(s)
Biomarcadores de Tumor/sangre , ADN Viral/sangre , Infecciones por Virus de Epstein-Barr/epidemiología , Carcinoma Nasofaríngeo/epidemiología , Neoplasias Nasofaríngeas/epidemiología , Adulto , Anciano , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , Antígenos Virales/inmunología , Proteínas de la Cápside/inmunología , Infecciones por Virus de Epstein-Barr/sangre , Infecciones por Virus de Epstein-Barr/diagnóstico , Infecciones por Virus de Epstein-Barr/virología , Femenino , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/inmunología , Herpesvirus Humano 4/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Carcinoma Nasofaríngeo/sangre , Carcinoma Nasofaríngeo/diagnóstico , Carcinoma Nasofaríngeo/virología , Neoplasias Nasofaríngeas/sangre , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/virología , Estudios Prospectivos , Reacción en Cadena en Tiempo Real de la Polimerasa , Factores de Riesgo , Pruebas Serológicas/estadística & datos numéricosRESUMEN
Rift Valley fever virus (RVFV), an arbovirus belonging to the Phlebovirus genus of the Phenuiviridae family, causes the zoonotic and mosquito-borne RVF. The virus, which primarily affects livestock (ruminants and camels) and humans, is at the origin of recent major outbreaks across the African continent (Mauritania, Libya, Sudan), and in the South-Western Indian Ocean (SWIO) islands (Mayotte). In order to be better prepared for upcoming outbreaks, to predict its introduction in RVFV unscathed countries, and to run efficient surveillance programmes, the priority is harmonising and improving the diagnostic capacity of endemic countries and/or countries considered to be at risk of RVF. A serological inter-laboratory proficiency test (PT) was implemented to assess the capacity of veterinary laboratories to detect antibodies against RVFV. A total of 18 laboratories in 13 countries in the Middle East, North Africa, South Africa, and the Indian Ocean participated in the initiative. Two commercial kits and two in-house serological assays for the detection of RVFV specific IgG antibodies were tested. Sixteen of the 18 participating laboratories (88.9%) used commercial kits, the analytical performance of test sensitivity and specificity based on the seroneutralisation test considered as the reference was 100%. The results obtained by the laboratories which used the in-house assay were correct in only one of the two criteria (either sensitivity or specificity). In conclusion, most of the laboratories performed well in detecting RVFV specific IgG antibodies and can therefore be considered to be prepared. Three laboratories in three countries need to improve their detection capacities. Our study demonstrates the importance of conducting regular proficiency tests to evaluate the level of preparedness of countries and of building a network of competent laboratories in terms of laboratory diagnosis to better face future emerging diseases in emergency conditions.
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Fiebre del Valle del Rift/diagnóstico , África/epidemiología , Animales , Anticuerpos Antivirales/sangre , Enfermedades Endémicas/veterinaria , Ensayo de Inmunoadsorción Enzimática/normas , Ensayo de Inmunoadsorción Enzimática/estadística & datos numéricos , Ensayo de Inmunoadsorción Enzimática/veterinaria , Humanos , Inmunoglobulina G/sangre , Océano Índico/epidemiología , Laboratorios/normas , Medio Oriente/epidemiología , Garantía de la Calidad de Atención de Salud , Reproducibilidad de los Resultados , Fiebre del Valle del Rift/epidemiología , Fiebre del Valle del Rift/inmunología , Virus de la Fiebre del Valle del Rift/inmunología , Factores de Riesgo , Pruebas Serológicas/normas , Pruebas Serológicas/estadística & datos numéricos , Pruebas Serológicas/veterinariaRESUMEN
Successful achievement of global targets for elimination of trachoma as a public health problem and eradication of yaws will require control efforts to reach marginalized populations, including refugees. Testing for serologic evidence of transmission of trachoma and yaws in residents of registered camps and a Makeshift Settlement in Cox's Bazar District, Bangladesh, was added to a serosurvey for vaccine-preventable diseases (VPDs) conducted April-May 2018. The survey was primarily designed to estimate remaining immunity gaps for VPDs, including diphtheria, measles, rubella, and polio. Blood specimens from 1- to 14-year-olds from selected households were collected and tested for antibody responses against antigens from Treponema pallidum and Chlamydia trachomatis using a multiplex bead assay to evaluate for serologic evidence of the neglected tropical diseases (NTDs) yaws and trachoma, respectively. The prevalence of antibodies against two C. trachomatis antigens in children ranged from 1.4% to 1.5% for Pgp3 and 2.8% to 7.0% for CT694. The prevalence of antibody responses against both of two treponemal antigens (recombinant protein17 and treponemal membrane protein A) tested was 0% to 0.15% in two camps. The data are suggestive of very low or no transmission of trachoma and yaws, currently or previously, in children resident in these communities. This study illustrates how integrated serologic testing can provide needed data to help NTD programs prioritize limited resources.
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Anticuerpos Antibacterianos/sangre , Refugiados/estadística & datos numéricos , Pruebas Serológicas/estadística & datos numéricos , Tracoma/epidemiología , Tracoma/inmunología , Buba/epidemiología , Buba/inmunología , Adolescente , Bangladesh/epidemiología , Niño , Preescolar , Chlamydia trachomatis/inmunología , Femenino , Humanos , Lactante , Masculino , Prevalencia , Salud Pública , Estudios Seroepidemiológicos , Tracoma/sangre , Treponema pallidum/inmunología , Buba/sangreRESUMEN
BACKGROUND & AIMS: Two SARS-CoV-2 mRNA vaccines were approved to prevent COVID-19 infection, with reported vaccine efficacy of 95%. Liver transplant (LT) recipients are at risk of lower vaccine immunogenicity and were not included in the registration trials. We assessed vaccine immunogenicity and safety in this special population. METHODS: LT recipients followed at the Tel-Aviv Sourasky Medical Center and healthy volunteers were tested for SARS-CoV-2 IgG antibodies directed against the Spike-protein (S) and Nucleocapsid-protein (N) 10-20 days after receiving the second Pfizer-BioNTech BNT162b2 SARS-CoV-2 vaccine dose. Information regarding vaccine side effects and clinical data was collected from patients and medical records. RESULTS: Eighty LT recipients were enrolled. Mean age was 60 years and 30% were female. Twenty-five healthy volunteer controls were younger (mean age 52.7 years, p = 0.013) and mostly female (68%, p = 0.002). All participants were negative for IgG N-protein serology, indicating immunity did not result from prior COVID-19 infection. All controls were positive for IgG S-protein serology. Immunogenicity among LT recipients was significantly lower with positive serology in only 47.5% (p <0.001). Antibody titer was also significantly lower in this group (mean 95.41 AU/ml vs. 200.5 AU/ml in controls, p <0.001). Predictors for negative response among LT recipients were older age, lower estimated glomerular filtration rate, and treatment with high dose steroids and mycophenolate mofetil. No serious adverse events were reported in either group. CONCLUSION: LT recipients developed substantially lower immunological response to the Pfizer-BioNTech SARS-CoV-2 mRNA-based vaccine. Factors influencing serological antibody responses include age, renal function and immunosuppressive medications. The findings require re-evaluation of vaccine regimens in this population. LAY SUMMARY: The Pfizer-BioNTech BNT162b2 SARS-CoV-2 vaccine elicited substantially inferior immunity in liver transplant recipients. Less than half of the patients developed sufficient levels of antibodies against the virus, and in those who were positive, average antibody levels were 2x less compared to healthy controls. Factors predicting non-response were older age, renal function and immunosuppressive medications.
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Anticuerpos Antivirales/sangre , Vacunas contra la COVID-19 , COVID-19 , Inmunogenicidad Vacunal/inmunología , Inmunoglobulina G/sangre , Inmunosupresores/uso terapéutico , Trasplante de Hígado/métodos , Vacuna BNT162 , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19/administración & dosificación , Vacunas contra la COVID-19/efectos adversos , Vacunas contra la COVID-19/inmunología , Femenino , Humanos , Terapia de Inmunosupresión/métodos , Israel/epidemiología , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Factores de Riesgo , SARS-CoV-2/inmunología , Pruebas Serológicas/métodos , Pruebas Serológicas/estadística & datos numéricos , Vacunación/efectos adversos , Vacunación/métodosRESUMEN
Our goal was to provide a comprehensive overview of the antibody response to Staphylococcus aureus antigens in the general population as a basis for defining disease-specific profiles and diagnostic signatures. We tested the specific IgG and IgA responses to 79 staphylococcal antigens in 996 individuals from the population-based Study of Health in Pomerania. Using a dilution-based multiplex suspension array, we extended the dynamic range of specific antibody detection to seven orders of magnitude, allowing the precise quantification of high and low abundant antibody specificities in the same sample. The observed IgG and IgA antibody responses were highly heterogeneous with differences between individuals as well as between bacterial antigens that spanned several orders of magnitude. Some antigens elicited significantly more IgG than IgA and vice versa. We confirmed a strong influence of colonization on the antibody response and quantified the influence of sex, smoking, age, body mass index, and serum glucose on anti-staphylococcal IgG and IgA. However, all host parameters tested explain only a small part of the extensive variability in individual response to the different antigens of S. aureus.
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Anticuerpos Antibacterianos/sangre , Antígenos Bacterianos/inmunología , Variación Biológica Poblacional/inmunología , Infecciones Estafilocócicas/sangre , Staphylococcus aureus/inmunología , Factores de Edad , Anticuerpos Antibacterianos/inmunología , Índice de Masa Corporal , Femenino , Alemania , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina A/inmunología , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Masculino , Persona de Mediana Edad , Pruebas Serológicas/estadística & datos numéricos , Factores Sexuales , Fumar/sangre , Fumar/inmunología , Infecciones Estafilocócicas/inmunología , Infecciones Estafilocócicas/microbiologíaRESUMEN
Hepatitis E virus (HEV) is a major cause of viral hepatitis around the world, especially in developing countries. Recently, HEV has also been recognized as important cause of hepatitis in Europe and Japan, however, there is a paucity of clinical data from the United States. The overall seroprevalence of HEV antibodies is around 10% in the United States, but considerable variation is seen based on geographic location, year, and assay used. In this study, 63 adults and 417 children from New York State were tested for anti-HEV IgG antibodies using the commercially available Wantai IgG assay. The overall seroprevalence of HEV antibodies among adult participants was 9.52% (95% CI: 3.58-19.59%). Positive adults tended to be older than HEV negative adults, all positive adults were female. Only 3 (0.7%, 95% CI:: 0.15-2.09%) of the children were positive, all positive children were male. These results are consistent with global and United States trends in HEV seroprevalence.