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1.
BMC Infect Dis ; 20(1): 237, 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32192451

RESUMO

BACKGROUND: Infections with multidrug-resistant organisms (MDRO) pose a serious threat to patients with dysregulated immunity such as in hemophagocytic lymphohistiocytosis (HLH), but such infections have rarely been comprehensively characterized. Here, we present a fatal case of HLH secondary to cytomegalovirus (CMV) infection complicated by both anti-viral drug resistance and sepsis from multiple MDROs including pandrug-resistant superbug bacteria. CASE PRESENTATION: A previously healthy, six-year-old boy presented with a 45-day history of fever prior to a diagnosis of hemophagocytic lymphohistiocytosis and hemorrhagic colitis, both associated with CMV. On hospital admission, the patient was found to be colonized with multiple, multidrug-resistant (MDR) bacteria including vancomycin-resistant enterococci (VRE) and carbapenamase-producing organisms (CPO). He eventually developed respiratory, urine and bloodstream infections with highly drug-resistant, including pandrug-resistant bacteria, which could not be controlled by antibiotic treatment. Antiviral therapy also failed to contain his CMV infection and the patient succumbed to overwhelming bacterial and viral infection. Whole genome sequencing (WGS) of the MDR bacteria and metagenomic analysis of his blood sample revealed an unusual accumulation of a wide range of antimicrobial resistance mechanisms in a single patient, including antiviral resistance to ganciclovir, and resistance mechanisms to all currently available antibiotics. CONCLUSIONS: The case highlights both the risk of acquiring MDR superbugs and the severity of these infections in HLH patients.


Assuntos
Infecções por Citomegalovirus/complicações , Citomegalovirus/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla/genética , Farmacorresistência Viral Múltipla , Linfo-Histiocitose Hemofagocítica/virologia , Sepse/mortalidade , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Antivirais/efeitos adversos , Antivirais/uso terapêutico , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Criança , Citomegalovirus/genética , Citomegalovirus/imunologia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/virologia , Evolução Fatal , Ganciclovir/efeitos adversos , Ganciclovir/uso terapêutico , Genótipo , Humanos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Masculino , Sepse/tratamento farmacológico , Sepse/microbiologia , Enterococos Resistentes à Vancomicina/efeitos dos fármacos , Enterococos Resistentes à Vancomicina/genética
2.
Clin Infect Dis ; 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31617568

RESUMO

BACKGROUND: Several countries have implemented a 2-dose (2D) human papillomavirus (HPV) vaccination schedule for adolescents based on immunobridging studies. We compared immunogenicity of 2D vs 3-dose (3D) schedules of the quadrivalent vaccine (4vHPV) up to 10 years after the first dose. METHODS: Girls aged 9-13 years were randomized to receive 2D or 3D and were compared with women aged 16-26 receiving 3D at day 1 and months 7, 24, and 120 after the first dose. Antibody levels for HPV6/11/16/18 were evaluated using the competitive Luminex immunoassay (cLIA) and total immunoglobulin G assay. Geometric mean titers (GMTs) and seropositivity rates were compared between the different groups at different time points. Noninferiority of GMT ratios was defined as the lower bound of the 2-sided 95% confidence interval (CI) being greater than 0.5. Kinetics of antibody titers over time among study groups were examined. RESULTS: At 120 months, data from 35 2D girls, 38 3D girls, and 30 3D women were used for analyses. cLIA seropositivity rates were above 95% for all HPV vaccine types and all schedules, except HPV18, with the lowest seropositivity observed among 3D women (60.0%; 95% CI, 40.6%-77.3%). GMT ratios (cLIA) for both 2D and 3D girls were noninferior to 3 doses in women for HPV6/11/16/18. Trends were comparable between assays. CONCLUSIONS: GMTs for HPV6/11/16/18 after 2D or 3D of 4vHPV in girls were noninferior to 3D in adult women up to 120 months postvaccination. This study demonstrates long-term immunogenicity of the 2D HPV vaccine schedule.

3.
Vaccine ; 37(49): 7203-7206, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31648910

RESUMO

HPV vaccines are highly immunogenic. A two-dose schedule for 9-14 year-old is recommended. However, no data exist regarding the impact of age, menarche status and body mass index (BMI) on the immune response to a two-dose schedule. In this post-hoc analysis, we present antibody titers to HPV6/11/16/18 in 9-13 year-old girls participating in a randomized clinical trial and assigned to receive two doses of quadrivalent HPV vaccine at 6 months interval (NCT00501137). Antibody titers were measured at month 7 and 24 of the study by using a competitive Luminex immunoassay (cLIA).Both, at Month 7 and 24 the GMTs for four HPV genotypes were similar across the age bands, and did not vary significantly by menarche status. Overweight and obese girls had lower GMTs. More than 99% of girls remained seropositive for HPV 6/11/16 and 89% for HPV18 at month 24. Comprehensive data in overweight and obese vaccines are warranted.

4.
Ann Clin Transl Neurol ; 6(2): 397-400, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30847373

RESUMO

A 17-month-old boy from Vancouver, Canada, presented with a 5-day history of progressive somnolence, ataxia, and torticollis. Additional investigations revealed eosinophilic encephalitis with deep white matter changes on MR imaging. On day 13, serology came back positive for Baylisascaris procyonis antibodies. While prophylaxis after ingestion of soil or materials potentially contaminated with raccoon feces can prevent baylisascariasis, timely treatment can sometimes alter a disastrous outcome. Populations of infected raccoons are propagating globally, but cases of Baylisascaris neural larva migrans have so far only been reported from North America.


Assuntos
Infecções por Ascaridida/patologia , Infecções Parasitárias do Sistema Nervoso Central/patologia , Larva Migrans/patologia , Guaxinins/genética , Adolescente , Animais , Infecções por Ascaridida/genética , Ascaridoidea/genética , Ascaridoidea/imunologia , Infecções Parasitárias do Sistema Nervoso Central/diagnóstico , Encefalite/genética , Encefalite/patologia , Humanos , Larva Migrans/diagnóstico , Larva Migrans/genética , Masculino , Infecções por Nematoides/genética , América do Norte
5.
Pediatr Blood Cancer ; 66(5): e27604, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30666782

RESUMO

Clostridium difficile is the leading cause of healthcare-associated infections worldwide. The diagnosis of C. difficile infection (CDI) in pediatric oncology patients is complex as diarrhea is common, and there is a high rate of colonization in infants and young children. This study was conducted to assess the accuracy of the surveillance definitions of healthcare-associated CDI (HA-CDI) and to determine the prevalence of toxigenic C. difficile colonization among pediatric oncology and stem cell transplant patients. METHODS: A prospective cohort study was conducted over a three-year period in an inpatient pediatric oncology and stem cell transplant setting. Baseline stool samples were collected within three days of admission and were genotypically compared with clinically indicated samples submitted after three days of admission. RESULTS: A total of 175 patients were recruited with a total of 536 admissions. The adjusted prevalence of baseline toxigenic C. difficile colonization among admissions was 32.8%. Seventy-eight percent of positive admissions did not have history of CDI. Colonization with a toxigenic strain on admission was predictive of CDI (OR = 28.6; 95% CI, 6.58-124.39; P < 0.001). Nearly all clinical isolates (8/9) shared identical pulsed-field gel electrophoresis patterns with baseline isolates or were closely related (1/9). Only one of the 11 cases that were considered HA-CDI was potentially nosocomially acquired. CONCLUSION: The prevalence of colonization with toxigenic C. difficile in our cohort is high. Unfortunately, the current CDI surveillance definitions overestimate the incidence of HA-CDI in pediatric oncology and stem cell transplantation settings.


Assuntos
Infecções por Clostridium/epidemiologia , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/epidemiologia , Neoplasias Hematológicas/terapia , Hospitalização/estatística & dados numéricos , Transplante de Células-Tronco/efeitos adversos , Canadá/epidemiologia , Criança , Pré-Escolar , Infecções por Clostridium/etiologia , Infecção Hospitalar/etiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Prognóstico , Estudos Prospectivos
6.
CMAJ ; 190(41): E1221-E1226, 2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30322986

RESUMO

BACKGROUND: The human papillomavirus (HPV) vaccine is delivered widely through school-based immunization programs. Some groups have expressed concern that HPV vaccination programs will result in an increase in sexual risk-taking behaviours among adolescents. We aimed to evaluate population-level changes in sexual behaviours before and after implementation of the school-based HPV vaccination program in British Columbia. METHODS: In 2008, a school-based HPV vaccination program for girls was introduced in British Columbia. Using data from the BC Adolescent Health Survey - a longitudinal provincial survey administered in schools to capture adolescent physical and emotional health indicators, we conducted a linear trend analysis on sexual health behaviours and risk factors in adolescent girls before and after the implementation of vaccination for HPV (2003, 2008 and 2013). RESULTS: We analyzed data for 298 265 girls who self-identified as heterosexual. The proportion of girls reporting ever having sexual intercourse decreased from 21.3% (2003) to 18.3% (2013; adjusted odds ratio [OR] 0.79). Self-report of sexual intercourse before the age of 14 years decreased significantly from 2008 to 2013 (adjusted OR 0.76), as did reported substance use before intercourse (adjusted OR for 2003-2013 0.69). There was no significant change in the number of sexual partners reported (2003-2013). Between 2003 and 2013, girls' reported use of contraception and condoms increased, while pregnancy rates decreased. INTERPRETATION: Since the implementation of school-based HPV vaccination program in BC, sexual risk behaviours reported by adolescent girls either reduced or stayed the same. These findings contribute evidence against any association between HPV vaccination and risky sexual behaviours.


Assuntos
Comportamento do Adolescente , Vacinas contra Papillomavirus/uso terapêutico , Comportamento Sexual/estatística & dados numéricos , Mulheres , Adolescente , Fatores Etários , Colúmbia Britânica , Coito , Preservativos/tendências , Comportamento Contraceptivo/tendências , Feminino , Humanos , Programas de Imunização , Razão de Chances , Crescimento Demográfico , Gravidez , Gravidez na Adolescência/estatística & dados numéricos , Assunção de Riscos , Serviços de Saúde Escolar , Autorrelato , Parceiros Sexuais
7.
J Otolaryngol Head Neck Surg ; 47(1): 56, 2018 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-30223896

RESUMO

BACKGROUND: An Infectious Disease vaccine specialist joined our institution's Cochlear Implant Team in 2010 in order to address the high percentage of non-compliance to immunization prior to surgery identified previously from an internal review. The purpose of this study was to (1) review the immunization status of cochlear implant recipients in 2010-2014, (2) assess if introducing a vaccine specialist made a significant change in vaccination compliance and (3) elucidate any barriers to vaccination compliance. METHODS: Retrospective chart review and a telephone survey. Medical records of 116 cochlear implant recipients between 2010 and 2014 were reviewed. A telephone survey was conducted to obtain the current vaccination status in children who required post-operative vaccinations with incomplete records on chart review and, if applicable, the reason for non-compliance. RESULTS: Between 2010 and 2014, 98% of children were up-to-date at the time of surgery, compared to 67% up-to-date at the time of surgery between 2002 and 2007. 27 children were included in our post-operative immunization analysis. 29.6% (8/27) failed to receive necessary vaccinations post-surgery. Pneumovax-23, a vaccine for high-risk patients (such as cochlear implant candidates) was missed in all cases. CONCLUSION: Pre-operative vaccination for cochlear implant recipients improved dramatically with the addition of a vaccine specialist. However, a significant proportion of patients requiring vaccinations post-surgery did not receive them. The main reason for non-compliance was due to parents being unaware that their children required this vaccine postoperatively by being "high-risk". Although improvement was demonstrated, a communication gap continued to impede the adequacy of vaccination uptake in pediatric cochlear implant recipients following surgery at age 2 when the high-risk vaccine was due.


Assuntos
Implantes Cocleares , Cooperação do Paciente , Complicações Pós-Operatórias/prevenção & controle , Vacinação/normas , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pais , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
8.
Clin Infect Dis ; 67(7): 1063-1071, 2018 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-30010773

RESUMO

Background: Immunization of pregnant women with tetanus-diphtheria-acellular pertussis vaccine (Tdap) provides protection against pertussis to the newborn infant. Methods: In a randomized, controlled, observer-blind, multicenter clinical trial, we measured the safety and immunogenicity of Tdap during pregnancy and the effect on the infant's immune response to primary vaccination at 2, 4, and 6 months and booster vaccination at 12 months of age. A total of 273 women received either Tdap or tetanus-diphtheria (Td) vaccine in the third trimester and provided information for the safety analysis and samples for the immunogenicity analyses; 261 infants provided serum for the immunogenicity analyses. Results: Rates of adverse events were similar in both groups. Infants of Tdap recipients had cord blood levels that were 21% higher than maternal levels for pertussis toxoid (PT), 13% higher for filamentous hemagglutinin (FHA), 4% higher for pertactin (PRN), and 7% higher for fimbriae (FIM). These infants had significantly higher PT antibody levels at birth and at 2 months and significantly higher FHA, PRN, and FIM antibodies at birth and 2 and 4 months, but significantly lower PT and FHA antibody levels at 6 and 7 months and significantly lower PRN and FIM antibody levels at 7 months than infants whose mothers received Td. Differences persisted prebooster at 12 months for all antigens and postbooster 1 month later for PT, FHA, and FIM. Conclusions: This study demonstrated that Tdap during pregnancy results in higher levels of antibodies early in infancy but lower levels after the primary vaccine series. Clinical Trials Registration: NCT00553228.


Assuntos
Anticorpos Antibacterianos/sangue , Vacina contra Difteria, Tétano e Coqueluche/imunologia , Vacinas contra Difteria, Tétano e Coqueluche Acelular/imunologia , Adulto , Difteria/prevenção & controle , Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Vacina contra Difteria, Tétano e Coqueluche/efeitos adversos , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Vacinas contra Difteria, Tétano e Coqueluche Acelular/efeitos adversos , Feminino , Humanos , Recém-Nascido , Gravidez , Tétano/prevenção & controle , Coqueluche/prevenção & controle , Adulto Jovem
9.
Appl Netw Sci ; 3(1): 33, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30839831

RESUMO

Tuberculosis (TB) is an ancient disease that, although curable, still accounts for over 1 million deaths worldwide. Shortening treatment time is an important area of research but is hampered by the lack of models that mimic the full range of human pathology. TB shows distinct localisations during different stages of infection, the reasons for which are poorly understood. Greater understanding of how heterogeneity within the human lung influences disease progression may hold the key to improving treatment efficiency and reducing treatment times. In this work, we present a novel in silico software model which uses a networked metapopulation incorporating both spatial heterogeneity and dissemination possibilities to simulate a TB infection over the whole lung and associated lymphatics. The entire population of bacteria and immune cells is split into a network of patches: members interact within patches and are able to move between them. Patches and edges of the lung network include their own environmental attributes which influence the dynamics of interactions between the members of the subpopulations of the patches and the translocation of members along edges. In this work, we detail the initial findings of a whole-organ model that incorporates distinct spatial heterogeneity features which are not present in standard differential equation approaches to tuberculosis modelling. We show that the inclusion of heterogeneity within the lung landscape when modelling TB disease progression has significant outcomes on the bacterial load present: a greater differential of oxygen, perfusion and ventilation between the apices and the basal regions of the lungs creates micro-environments at the apex that are more preferential for bacteria, due to increased oxygen availability and reduced immune activity, leading to a greater overall bacterial load present once latency is established. These findings suggest that further whole-organ modelling incorporating more sophisticated heterogeneities within the environment and complex lung topologies will provide more insight into the environments in which TB bacteria persist and thus help develop new treatments which are factored towards these environmental conditions.

10.
Pediatr Infect Dis J ; 37(6): 595-597, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29278613

RESUMO

We evaluated quadrivalent human papillomavirus vaccine seroresponses among 35 girls living with HIV (9-13 years of ages) and compared with data on girls without HIV, as part of a subgroup analysis. The quadrivalent human papillomavirus vaccine was safe and well tolerated. However, antibody response was significantly lower in girls living with HIV relative to girls without HIV. HIV virologic suppression predicted better antibody response.


Assuntos
Infecções por HIV/virologia , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18/imunologia , Imunogenicidade da Vacina , Infecções por Papillomavirus/prevenção & controle , Adolescente , Anticorpos Antivirais/sangue , Contagem de Linfócito CD4 , Canadá , Criança , Feminino , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18/efeitos adversos , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18/uso terapêutico , Humanos , Estudos Longitudinais , Estudos Prospectivos
11.
J Infect ; 74 Suppl 1: S1, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28646946
12.
J Infect ; 74 Suppl 1: S120-S127, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28646951

RESUMO

Fecal microbiota transplantation (FMT) is a relatively simple, promising treatment for recurrent Clostridium difficile infection. While there are a wide variety of approaches including mode of delivery, the results are nonetheless encouraging, even amongst younger children. Experience with FMT in the pediatric population is increasing, showing similar success compared to adults. This article will provide an overview of C. difficile infection along with review of the rationale, methods and complications of FMT including the current experience of FMT in children.


Assuntos
Infecções por Clostridium/terapia , Transplante de Microbiota Fecal/métodos , Transplante de Microbiota Fecal/estatística & dados numéricos , Prevenção Secundária , Adolescente , Criança , Pré-Escolar , Transplante de Microbiota Fecal/efeitos adversos , Humanos , Lactente , Resultado do Tratamento , Adulto Jovem
13.
J Infect ; 74 Suppl 1: S47-S53, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28646962

RESUMO

Lemierre's syndrome is a rare and feared complication of pharyngitis, occurring most commonly in adolescents and young adults. It is typically defined by the constellation of septic internal jugular vein thrombophlebitis, pulmonary and other septic emboli, and sterilesite infection by Fusobacterium necrophorum. The rarity and severity of Lemierre's syndrome has made it an attractive subject for case reports but there is a paucity of evidence to inform areas of persistent uncertainty. In recent years, heightened attention and controversy has focused upon speculation that a purported rise in the incidence of Lemierre's syndrome is due to reduced antibiotic prescribing for respiratory tract infections, that F. necrophorum is an under-appreciated cause of acute tonsillopharyngitis and that testing and targeted treatment would prevent cases of Lemierre's syndrome.


Assuntos
Fusobacterium necrophorum/isolamento & purificação , Síndrome de Lemierre/epidemiologia , Síndrome de Lemierre/patologia , Faringite/complicações , Tonsilite/complicações , Antibacterianos/uso terapêutico , Humanos
15.
JAMA Pediatr ; 170(12): 1181-1187, 2016 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-27775765

RESUMO

Importance: Excessive antibiotic use has been associated with altered bacterial colonization and may result in antibiotic resistance, fungemia, necrotizing enterocolitis (NEC), and mortality. Exploring the association between antibiotic exposure and neonatal outcomes other than infection-related morbidities may provide insight on the importance of rational antibiotic use, especially in the setting of culture-negative neonatal sepsis. Objective: To evaluate the trend of antibiotic use among all hospitalized very low-birth-weight (VLBW) infants across Canada and the association between antibiotic use rates (AURs) and mortality and morbidity among neonates without culture-proven sepsis or NEC. Design, Setting, and Participants: A retrospective cohort study was conducted among VLBW infants (<1500 g) admitted to level III neonatal intensive care units between January 1, 2010, and December 31, 2014, using data obtained from the Canadian Neonatal Network database. Exposure: Duration of antibiotic use during the hospitalization period. Main Outcomes and Measures: The AUR was defined as the number of days an infant was exposed to 1 or more antimicrobial agents divided by the total length of hospital stay. The composite primary outcome was defined as mortality or major morbidity, including any of the following: persistent periventricular echogenicity or echolucency on neuroimaging, chronic lung disease, and stage 3 or higher retinopathy of prematurity. Multivariable regression analysis was used to calculate adjusted odds ratios (aORs) and 95% CIs for the association between AURs and outcomes. Results: Among 13 738 eligible VLBW infants, 11 669 (84.9%) (mean [SD] gestational age, 27.7 [2.5] weeks; 47.4% female) received antibiotics during their hospital course and were included in the study. The annual AUR decreased from 0.29 in 2010 to 0.25 in 2014 (slope for the best-fit line, -0.011; 95% CI, -0.016 to -0.006; P < .01), which occurred in parallel with a reduction in the rate of late-onset sepsis from 19.0% in 2010 to 13.8% in 2014 during the same period. Of the 11 669 infants who were treated with antibiotics of varying duration during their hospital stay, 2845 were diagnosed as having sepsis-related complications. Among the remaining 8824 infants without early-onset sepsis, late-onset sepsis, or NEC, a 10% increase in the AUR was associated with an increased odds of the primary composite outcome (aOR, 1.18; 95% CI, 1.13-1.23), mortality (aOR, 2.04; 95% CI, 1.87-2.21), and stage 3 or higher retinopathy of prematurity (aOR, 1.18; 95% CI, 1.06-1.32). Conclusions and Relevance: Antibiotic use in VLBW infants decreased between 2010 and 2014 in Canada. However, among infants without culture-proven sepsis or without NEC, higher AURs were associated with adverse neonatal outcomes.


Assuntos
Antibacterianos/efeitos adversos , Recém-Nascido de muito Baixo Peso , Canadá , Cuidados Críticos/estatística & dados numéricos , Enterocolite Necrosante , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Morbidade , Assistência Perinatal/estatística & dados numéricos , Estudos Retrospectivos , Sepse/mortalidade
16.
Pediatr Infect Dis J ; 35(12): e384-e391, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27626920

RESUMO

BACKGROUND: For patients who have experienced adverse events following immunization (AEFI) or who have specific medical conditions, there is limited evidence regarding the best approach to immunization. The Special Immunization Clinics (SICs) Network was established to standardize patient management and assess outcomes after reimmunization. The study objective was to describe the first 2 years of the network's implementation. METHODS: Twelve SICs were established across Canada by infectious diseases specialists and allergists. Inclusion criteria were as follows: local reaction ≥ 10 cm, allergic symptoms < 24 hours postimmunization, neurologic symptoms and other AEFI or medical conditions of concern. Eligible patients underwent a standardized evaluation, causality assessment was performed, immunization recommendations were made by expert physicians and patients were followed up to capture AEFI. After individual consent, data were transferred to a central database for analysis. RESULTS: From June 2013 to May 2015, 151 patients were enrolled. Most were referred for prior AEFI (132/151, 87%): 42 (32%) for allergic-like reactions, 31 (23%) for injection-site reactions, 20 (15%) for neurologic symptoms and 39 (30%) for other systemic symptoms. Nineteen patients (13%) were seen for underlying conditions that complicated immunization. Reimmunization was recommended for 109 patients, 60 of whom (55%) were immunized and followed up. Eleven patients (18%) experienced recurrence of their AEFI; none were serious (eg, resulting in hospitalization, permanent disability or death). CONCLUSIONS: The most frequent reasons for referral to a SIC were allergic-like events and injection site reactions. Reimmunization was safe in most patients. Larger studies are needed to determine outcomes for specific types of AEFI.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Imunização/efeitos adversos , Canadá/epidemiologia , Criança , Pré-Escolar , Contraindicações , Bases de Dados Factuais , Feminino , Humanos , Imunização/estatística & dados numéricos , Lactente , Masculino , Estudos Prospectivos
17.
J Infect ; 72 Suppl: 1, 2016 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-27339109
18.
Can J Infect Dis Med Microbiol ; 26(4): 183-90, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26361485

RESUMO

As key stakeholders in immunization policy decisions, the Pediatricians of Ontario held an accredited conference on January 18, 2014, to discuss prevention of invasive meningococcal disease. Five key recommendations were put forth regarding immunization strategies to protect children from meningococcal serogroup B disease. The recently approved four-component meningococcal B (4CMenB) vaccine should be recommended and funded as part of Ontario's routine immunization schedule and should also be mandated for school attendance. Public funding for 4CMenB immunization is justified based on current MenB epidemiology, vaccine coverage, cost effectiveness and acceptability, as well as legal, political and ethical considerations related to 4CMenB immunization, particularly because routine recommendations and funding are currently in place for vaccination against meningococcal serogroups that cause significantly less disease in Canada than MenB. Broadly, the goals are to assist individual practitioners in advocating the benefits of 4CMenB vaccination to parents, and to counterbalance recommendations from the National Advisory Committee on Immunization and the Canadian Paediatric Society.

19.
J R Soc Interface ; 12(111): 20150651, 2015 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-26400198

RESUMO

Most large cities are spanned by more than one transportation system. These different modes of transport have usually been studied separately: it is however important to understand the impact on urban systems of coupling different modes and we report in this paper an empirical analysis of the coupling between the street network and the subway for the two large metropolitan areas of London and New York. We observe a similar behaviour for network quantities related to quickest paths suggesting the existence of generic mechanisms operating beyond the local peculiarities of the specific cities studied. An analysis of the betweenness centrality distribution shows that the introduction of underground networks operate as a decentralizing force creating congestion in places located at the end of underground lines. Also, we find that increasing the speed of subways is not always beneficial and may lead to unwanted uneven spatial distributions of accessibility. In fact, for London­but not for New York­there is an optimal subway speed in terms of global congestion. These results show that it is crucial to consider the full, multimodal, multilayer network aspects of transportation systems in order to understand the behaviour of cities and to avoid possible negative side-effects of urban planning decisions.


Assuntos
Planejamento de Cidades , Transportes , Algoritmos , Cidades , Geografia , Londres , Modelos Estatísticos , New York , Ferrovias
20.
J Infect ; 71 Suppl 1: S42-6, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25917804

RESUMO

Intracranial infections in children are a relatively rare, but potentially severe condition. Because of the potential for rapid deterioration, timely diagnosis and treatment are necessary. These infections are categorized based on their intracranial location: epidural abscess, subdural empyema, and brain abscess. They largely arise from direct extension of adjacent infection, hematogenous seeding, or trauma. Clinical presentations of intracranial infections also vary. However, common signs and symptoms include headache, fever, nausea and vomiting, altered mental status, focal neurologic deficits, and seizures. In general, MRI demonstrates a peripherally enhancing lesion with high signal on diffusion weighted imaging (DWI). Bacterial isolates vary, but most commonly are a single pathogen. Successful treatment requires a multidisciplinary team approach including such modalities as antibiotic therapy and surgical drainage. When possible, open surgical evacuation of the abscess is preferred, however, in cases of deep-seated lesions, or in unstable patients, aspiration has also been performed with good results.


Assuntos
Abscesso Encefálico , Empiema Subdural , Abscesso Epidural , Criança , Humanos , Lactente , Recém-Nascido
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