Exploring indirect protection associated with influenza immunization - A systematic review of the literature.

BACKGROUND: Influenza causes significant annual morbidity and mortality, particularly in older adults, for whom influenza vaccine effectiveness (VE) is also lower. Immunizing one group (e.g., children) against influenza may indirectly protect another group (e.g., older adults) against influenza and its complications. METHODS: We updated previous systematic reviews on indirect protection against influenza by searching MEDLINE and EMBASE for relevant human studies published until January 4, 2017. We abstracted and critically appraised English language publications that reported or provided information to calculate indirect VE against influenza, as a percentage, in non-institutional settings. We developed a term called 'estimated actual protection' to explore the relationship between indirect protection and the product of direct VE and relative vaccine coverage. We calculated estimated actual protection for a subset of studies that reported coverage and indirect VE for: laboratory-confirmed influenza; outpatient care for respiratory illness; influenza-associated emergency visits; or influenza-associated hospitalizations. We ran linear mixed models to compare estimated actual protection against indirect VE for the four outcomes, and graphed the data. RESULTS: Of 2320 unique records identified, we abstracted and appraised 26 articles describing 24 studies. The majority of included studies reported at least one outcome suggesting that immunizing one group reduced influenza-related outcomes in another group. Critical appraisal of the abstracted studies identified recurring methodological weaknesses, such as lack of laboratory-confirmed influenza. Our exploratory analyses of 18 studies indicated a positive but not statistically significant relationship between estimated actual protection and indirect protection for each of the four outcomes. CONCLUSIONS: Our systematic review and exploratory analyses suggest influenza immunization provides some level of indirect protection. However, our critical appraisal highlights the need for a standardized and consistently applied approach to measuring indirect protection against influenza to fill existing knowledge gaps. Additionally, the concept of estimated actual protection requires validation.

Scoping review shows wide variation in the definitions of bronchopulmonary dysplasia in preterm infants and calls for a consensus.

The use of different definitions for bronchopulmonary dysplasia (BPD) has been an ongoing challenge. We searched papers published in English from 2010 and 2015 reporting BPD as an outcome, together with studies that compared BPD definitions between 1978 and 2015. We found that the incidence of BPD ranged from 6% to 57%, depending on the definition chosen, and that studies that investigated correlations with long-term pulmonary and/or neurosensory outcomes reported moderate-to-low predictive values regardless of the BPD criteria. CONCLUSION: A comprehensive and evidence-based definition for BPD needs to be developed for benchmarking and prognostic use.

Dopamine-mediated MK-801-induced elevation in food-based extinction responding in rats and associated changes in region-specific phosphorylated ERK.

RATIONALE: The current study examined the effect of the noncompetitive N-methyl-D: -aspartate (NMDA) receptor antagonist (+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine maleate (MK-801) on the extinction of food-based operant responding. OBJECTIVES: Experiments were carried out to determine (1) the nature of the elevated responding when rats were under the influence of MK-801, (2) the effect of combined and separate D1- and D2-like dopaminergic antagonists (SCH 23390 and haloperidol) on this MK-801-induced behavioral effect and (3) the neural correlates on and off MK-801 using immunohistochemical localization of the phosphorylated forms of the extracellular signal-regulated kinase-1 and -2. METHODS: Male Long Evans rats were trained using operant conditioning procedures then treated with the various compounds, and resultant extinction pressing was measured. RESULTS: A moderate dose (0.1 mg/kg) of MK-801 produced a persistent, elevated lever pressing throughout the entire 30-min extinction session. When animals were pretreated with combined or separate dopamine (DA) D1- or D2-like receptor antagonists, extinction responding under MK-801 was significantly reduced. Examination of pERK1/2 labeling in MK-801-treated animals showed reduced staining in the infralimbic and piriform cortices and elevated staining in the nucleus accumbens compared with controls. CONCLUSIONS: These data show that MK-801 elevates food-based extinction behavior that can be reduced by DA receptor antagonists. The disrupted extinction behavior may be mediated, in part, by disinhibition of corticostriatal circuits.