Performance indicators for wastewater treatment plants.

The Swedish Water & Wastewater Association has operated a web-based system, VASS, for the collection and compilation of key data from the Swedish water utilities since 2003. The VASS system will now be expanded to include data on operation of individual wastewater treatment plants (WWTP). The objective is to provide performance indicators (PIs) for performance and economy and the use of resources such as energy, chemicals and manpower. A set of PIs has been developed that also includes explanatory factors to compensate for differences in the condition of operation between plants. This paper discusses the data required for the calculation of PI but also for explanatory factors, quality checks and for plant operation context. The discussion is based on the experiences from a test round with the participation of 24 WWTP.

Immunogenicity of a heptavalent conjugate pneumococcal vaccine administered concurrently with a combination diphtheria, tetanus, five-component acellular pertussis, inactivated polio, and Haemophilus influenzae type B vaccine and a meningococcal group C conjugate vaccine at 2, 3, and 4 months of age.

The immunogenicities of conjugate pneumococcal vaccines have been demonstrated when they are administered at 2, 3, and 4 months of age. There is a paucity of data on the immunogenicity of this vaccine when it is administered concurrently with other vaccines in the primary immunization schedule of the United Kingdom. We immunized 55 term infants at 2, 3, and 4 months of age with the seven-valent pneumococcal conjugate vaccine (PCV7), the meningococcal group C conjugate (MCC) vaccine, and the diphtheria, tetanus, five-component acellular pertussis, inactivated polio, and Haemophilus influenzae type b (DTaP(5)/IPV/Hib-TT) vaccine. The immune responses to the H. influenzae type b (Hib), MCC, and tetanus vaccines were measured at 2, 5, and 12 months of age; and the immune responses to PCV7 were measured at 2 and 5 months and then either at 12 months or following a 4th dose of PCV7. There were increases in the geometric mean concentrations (GMCs) of all antigens postimmunization. Greater than or equal to 90% of the infants achieved putatively protective levels postimmunization for all vaccine antigens except pneumococcal serotype 6B and Hib. The GMCs of the PCV7 serotypes increased following a 4th dose, although one infant had not reached putative levels of protection against serotype 6B. In conclusion, when infants were vaccinated according to the schedule described above, they had lower postprimary immunization responses to Hib, meningococcus group C capsular polysaccharide, and pneumococcal serotype 6B than the responses demonstrated by use of the other schedules. Despite this finding, there was a good response following a 4th dose of PCV7.

Competitive inhibition flow analysis assay for the non-culture-based detection and serotyping of pneumococcal capsular polysaccharide.

Traditional confirmation procedures for the identification of a pneumococcal serotype require an isolate. Non-culture-based confirmation protocols are available. Some of these confirm only the presence of pneumococci, and others are capable of identifying a limited number of serotypes. The increased use of pneumococcal polysaccharide and conjugate vaccines, especially in high-risk patient groups, and the likely increase in the number of serotypes included in future versions of the conjugate vaccines have necessitated the need for improved enhanced surveillance in order to assess their impact on public health. Since 2006, a multiplexed assay has been used at the Health Protection Agency of the United Kingdom for the detection of 14 pneumococcal serotypes which requires pneumococcal serotype-specific monoclonal antibodies (MAbs). We have developed a microsphere competitive inhibition method capable of detecting 23 pneumococcal capsular polysaccharide serotypes in cerebrospinal fluid (CSF) and urine and serotyping pneumococcal suspensions, utilizing an international reference serum, 89-SF. The assay was shown to be reproducible and specific for homologous polysaccharide. Validation of the assay was performed with a selection of MAbs specific for pneumococcal capsular polysaccharide serotypes, which confirmed the specificity of the assay. Analysis of pneumolysin PCR-positive CSF samples in the competitive inhibition assay determined a serotype for 89% of the samples. The assay developed here is well suited to large-scale epidemiologic studies because the assay is simple, robust, and rapid and utilizes readily available resources.

Different trends of MRSA and VRE in a German hospital, 1999-2005.

Some of the clinically most menacing nosocomial pathogens are Methicillin-resistent Staphylococcus aureus (MRSA) and Vancomycin-resistent Enterococcus (VRE). During the last years both pathogens showed dramatic increases in colonization and infection rates in Germany. This study covers all patients positively tested for MRSA and VRE in a German University Hospital from 1999-2005. About 1,179 MRSA cases and 116 VRE cases have been reported. VRE was significantly associated with less infection, female gender, more death and higher nosocomial acquisition than MRSA. While MRSA rates increased impressively from 1999 to 2005 VRE rates decreased clearly. Assuming that compliance with hygienic measures is similar in dealing with MRSA and VRE it is quite unclear why these two major pathogens differ so much in their trends. One possibility is that the MRSA problem has been caused by an increasing share of nonnosocomially acquired MRSA.

Immunogenicity of meningococcal ACYW135 polysaccharide vaccine in Saudi children 5 to 9 years of age.

Meningococcal tetravalent polysaccharide vaccines were observed to be immunogenic in Saudi children 5 to 9 years of age, with >90% having serum bactericidal antibody titers of > or = 8 for serogroups A, Y, and W135; for serogroup C, 77% were putatively protected after vaccination.

Serologic responses to ACYW135 polysaccharide meningococcal vaccine in Saudi children under 5 years of age.

An immunization campaign with meningococcal ACYW135 polysaccharide vaccine was conducted in 2003 by the Saudi Arabian Ministry of Health and included a study to evaluate the immune responses in children under 5 years of age in the Al Qassim region of Saudi Arabia. Children who were >/=24 months old were given one dose of tetravalent polysaccharide vaccine, while younger children were given two doses with an interval of 2 to 3 months. Blood samples were collected prevaccination and 1 month after the second dose for children younger than 24 months old and 1 month after the single dose for older children. Serogroup-specific antibody responses were determined by serum bactericidal antibody (SBA) assays and a tetraplex immunoglobulin G (IgG) bead assay. Significant increases in the proportions of individuals who were >/=24 months old with SBA titers of >/=8 were observed pre- to postvaccination for all serogroups. Age-dependent increases in the percentage of individuals with SBA titers of >/=8 1 month postvaccination were observed for each serogroup. Age-dependent increases in postvaccination IgG levels were observed for serogroup A (menA), serogroup W135 (menW), and serogroup Y (menY) but not for serogroup C (menC). Two doses of tetravalent polysaccharide vaccine in individuals who were /=8. A high percentage of subjects who were >/=2 years of age were putatively protected for menA; a similar level was observed for menY for children who were 4 years of age but not for younger children. However, for menC and menW poor levels of putative protection were still evident at 4 years of age.

Phosphorus recovery--an overview of potentials and possibilities.

The endeavour towards a sustainable society has led to an interest in the recovery and recirculation or reuse of phosphorus from wastewater among environmentalists and politicians. In a recent interdisciplinary investigation commissioned by the Swedish Environmental Protection Agency, an attempt was made to evaluate different possibilities to recover phosphorus from wastewater or its fractions; systems based on source separation of urine or of combined toilet wastes, on the extraction of phosphorus from sludge, from ashes after incineration of sludge or from wastewater as well as the direct recirculation of hygienised digested and dewatered sludge were studied. Aspects like technology, environmental effects, resource economy, economy, markets, organisational aspects and user aspects were studied. In this overview the potential and possibility to recover and recirculate phosphorus from wastewater is discussed, mainly based on the findings in this investigation.

Measurement and interpretation of pneumococcal IgG levels for clinical management.

The detection of pneumococcal IgG antibodies is helpful for the evaluation of response to pneumococcal vaccination and need for revaccination. Results generated by the clinical assay which is currently used, in which the 23 valent polysaccharide vaccine is the antigen, were compared to those obtained by a capsular polysaccharide serotype-specific assay that measures IgG antibodies to 9 common serotypes causing invasive disease. Discrepancies in 21/47 (45%) of the results were observed in a direct comparison between the two assays. In each case a positive titre was obtained on the clinical assay but IgG levels on the serotype-specific assay were below the putative protective level of 0.2 micro g/ml for at least one of the 9 serotypes assayed. The generation of false positives by the current clinical assay is due to its lack of specificity. Antibodies to C-polysaccharide and all of the 23 serotypes included in the pneumococcal polysaccharide vaccine are incorporated into the final titre whereas the serotype-specific assay adsorbs out noncapsular polysaccharide antibodies. The discrepancies between the two assays highlight the importance of standardized assays that measure putative correlates of protection and demonstrate the need to re-evaluate the current clinical assay. A tool that allows the interpretation of the results of the serotype-specific assay is provided and its potential for assessing individual susceptibility levels to vaccine preventable pneumococcal infection is discussed.

Impact of meningococcal C conjugate vaccine in the UK.

This review details the impact of the introduction of meningococcal serogroup C conjugate (MCC) vaccines in the UK. An overall reduction of 86.7% in the incidence of serogroup C infection in the targeted age groups has been observed from 1999 to 2001, with a concomitant decrease in deaths, from 67 in 1999 to 5 in 2001. The enhanced surveillance programme initiated to complement the introduction of MCC vaccines has been essential in generating data relating to vaccine coverage, vaccine failures and efficacy estimates. Vaccine coverage has exceeded 80% in all age groups targeted and up to the end of 2001, 25 confirmed and 1 probable vaccine failure have been observed in England and Wales. Efficacy estimates for England up to September 2001 were 91.5% in infants receiving three doses of MCC vaccine and 89.3% in toddlers receiving one dose of MCC vaccine (England). There is some evidence of herd immunity in unvaccinated cohorts of the target age groups, ranging from a reduction in disease incidence of 34% in 9-14 year olds to 61% in 15-17 year olds. Surveillance of the genotypic and phenotypic characteristics of invasive and carriage isolates has shown no evidence to date of capsular switching from serogroup C to serogroup B.

Possibilities to improve the quality of wastewater sludges.

Falling heavy metal concentrations in wastewater sludges are an indicator of the improvements in sludge quality achieved over the past thirty years. Studies of the sources of heavy metals in wastewater sludges, particularly the loads introduced by domestic and industrial wastewater and storm water, show the potential improvement that may still be made.

Protective immunity to erythrocytic Plasmodium chabaudi AS infection involves IFNgamma-mediated responses and a cellular infiltrate to the liver.

IFNgamma receptor (IFNgammaR) deficient mice and IL-4 deficient mice were infected with blood-stage Plasmodium chabaudi AS in order to analyse the role of Th1 (IFNgamma) and Th2 (IL-4)-associated cytokines in the development of protective immunity to the parasite. A high mortality rate and failure to reduce the primary parasitaemia to subpatent levels was observed in the IFNgammaR deficient mice. IL-4 deficient mice controlled a primary P. chabaudi AS infection in a similar manner to control mice and no mortality was observed. IFNyR deficient mice had a reduction in parasite-specific IgG and a significantly increased level of total IgE compared to control mice. There was no reduction in the level of parasite-specific IgG in IL-4 deficient mice. Cytological analysis of the cells present in the spleen and liver during the primary parasitaemia revealed a reduction in the numbers of lymphocytes, monocytes and polymorphonuclear (PMN) cells in the liver at the peak of parasitaemia in both IFNgammaR deficient mice and IL-4 deficient mice compared to control mice. Adoptive transfer studies demonstrated that cells isolated from the liver at day 11 post-infection could confer some protective immunity to P. chabaudi AS infection.

Experimental erythrocytic malaria infection induces elevated serum amyloid P production in mice.

Experimental blood-stage malaria infection of NIH mice was observed to induce an acute phase response (APR). Infection of mice with either P. chabaudi, P. vinckei (both non-lethal) or P. berghei (lethal infection) resulted in elevated serum amyloid P (SAP) production, the major acute phase protein in mice. Peak production occurred at the peak of the parasitaemia (approximately day 10 post infection). SAP isolated from the serum of P. chabaudi infected mice was shown to inhibit the growth of intra-erythrocytic malaria parasites in vitro. Furthermore, isolated SAP suppressed the proliferative response of splenocytes taken from a naïve mouse to concanavalin A. To assess if SAP had a protective role in vivo during experimental blood-stage infection, IL-6 deficient mice, which have a significantly reduced APR, were infected with P. chabaudi. A significant extension to the primary parasitaemia was observed in IL-6 deficient mice compared to infected wild type mice. These observations demonstrate that blood-stage malaria infection induces a systemic APR and that this may contribute to the immune response to infection in an anti-parasitic or immunomodulatory manner.

The effect of nitric oxide on the growth of Plasmodium falciparum, P. chabaudi and P. berghei in vitro.

Protective immune mechanisms to the asexual erythrocytic stages of the malaria parasite Plasmodium chabaudi AS strain include antibody-independent mechanisms. Nitric oxide (NO) is produced during the infection and indirect evidence suggests that it can contribute to the antiparasitic mechanisms. We examined the effect of an NO producer, S-nitroso-acetyl-penicillamine (SNAP), on the growth and survival in vitro of P. chabaudi AS, P. berghei and P. falciparum. Growth of the parasites was monitored by the uptake of tritiated hypoxanthine and, in the case of P. falciparum, by morphological examination in stained blood smears. DL-penicillamine and sodium nitrite, as controls, had no inhibitory activity at the concentrations used. The results showed that at SNAP concentrations of approximately 182 microM and above NO was cytotoxic to P. falciparum but, at lower concentrations, there was a cytostatic effect and some parasites resumed growth and division after NO production had ceased. Rings were less susceptible to NO effects than later stages in the asexual cycle. The antimalarial activity of NO from SNAP also extended to the rodent parasites but, under the experimental conditions used, they were less sensitive than the human species. In the cultures of P. chabaudi, increasing the numbers of noninfected erythrocytes present did not diminish the antimalarial activity of SNAP, suggesting that here at least haemoglobin was not scavenging NO significantly.

Antigenic variation during malaria infection--the contribution from the murine parasite Plasmodium chabaudi.

P. chabaudi AS strain in laboratory mice provides an accessible and useful model for investigating antigenic variation in malaria parasites. Evidence that P. chabaudi AS undergoes antigenic variation is summarized. A live indirect fluorescent test (IFAT) detects a variable antigen on the surface of schizont-infected erythrocytes. Five different variable antigen types (VATS) (detected using the live IFAT) are described from a cloned mosquito transmitted parent population. Even during the rising primary parasitaemia VATS switch at high and variable rates (1.2-1.6%). Work towards cloning genes coding for the variable antigen is briefly summarized. Acquired immunity to blood-stage P. chabaudi AS is initially mediated through Th1 CD4+ T cells and after the primary parasitaemia there is a switch to Th2 CD4+ T cells. Acquired immune effector mechanisms are discussed in the context of antigenic variation by the parasite.

Pharmacokinetics of amiodarone, desethylamiodarone and other iodine-containing amiodarone metabolites.

In 23 patients treated with the iodine-containing antiarrhythmic drug amiodarone, the plasma concentrations of amiodarone, desethylamiodarone and iodine have been studied. Besides amiodarone and desethylamiodarone, a pool of iodine-containing substances, NANDAI (non-amiodarone-, non-desethylamiodarone-iodine), was present. At steady state the iodine content of NANDAI amounted to 64% and the iodine content of amiodarone plus desethylamiodarone to 36% of total serum iodine. At steady state 26% of the NANDAI fraction was made up of inorganic iodide, the average plasma concentration of which was at least 40 times above the upper limit of the normal range. The serum elimination half-life of NANDAI of 57-160 days exceeded that of amiodarone (35-68 days) and of desethylamiodarone (31-110 days). At steady state the serum concentration of desethylamiodarone appears to be related to the concentration of amiodarone by a Michaelis-Menten type function, yielding a Km of amiodarone of 2.45 mumol/l and a maximal desethylamiodarone concentration of 3.61 mumol/l.