RESUMO
BACKGROUND: Influenza immunization is recommended in pregnancy to prevent severe infections in pregnant women and newborns, yet vaccine uptake remains low. Studies suggest that cautionary language in vaccine product monographs regarding safety and use in pregnancy affects health care providers' perceptions of vaccine safety and how they counsel pregnant women. OBJECTIVE: To conduct a qualitative analysis of health care provider perceptions of the safety of inactivated influenza vaccines and their recommendations for use in pregnancy based on product monograph language statements. METHODS: Health care providers were recruited at two international health conferences and from teaching programs in Ethiopia, Ghana, Uganda, and Laos during September and October 2015. After reading the product monograph excerpts for three licensed inactivated influenza vaccines, participants completed a ten-item online survey with quantitative and qualitative components that captured perceptions of vaccine safety. RESULTS: Health care providers identified a lack of trust in manufacturers' and product monograph information. They perceived product monograph language as ambiguous and not "up-to-date" with current evidence. Health care providers wanted product monograph language that clearly conveyed evidence for the risks and benefits of the vaccine in an understandable manner. CONCLUSION: This study suggests that adopting best practices in the wording of product monographs would help to support evidence-based use of vaccines in pregnant women.
RESUMO
SDS-PAGE analysis of plasma samples from mice injected with high, but nontoxic, concentrations of indomethacin led to the detection of elevated levels of a 125,000 dalton protein. The appearance of this protein was rapid, occurring within 24 hrs after a single injection of the drug. Treatment of mice with similar concentrations of sulindac and derivatives, the indomethacin analogs MK-410 and MK-555, or high doses (1 mg/day) of aspirin, did not induce the appearance of this protein. However, the appearance of this protein was rapidly induced by inflammatory agents such as turpentine or bacterial lipopolysaccharide. In addition, the protein was induced by RES stimulating agents such as C. parvum and BCG but it was not induced in tumor-bearing animals with activated RE systems. Administration of [3H]-leucine to animals treated with indomethacin, turpentine or lipopolysaccharide revealed the accelerated synthesis of primarily the 125 kilodalton protein but also the synthesis of several other plasma proteins as well. These results indicate that treatment of mice with indomethacin uniquely induces changes in plasma proteins with the characteristics of an acute phase response. This ability of indomethacin may reside in its ability to activate murine macrophages.
