Influenza vaccination in immunocompromised patients: efficacy and safety.

Yearly administration of the influenza vaccine is the main strategy to prevent influenza in immunocompromised patients. Here, we reviewed the recent literature regarding the clinical significance of the influenza virus infection, as well as the immunogenicity and safety of the influenza vaccine in HIV‑infected individuals, solid-organ and stem-cell transplant recipients and patients receiving biological agents. Epidemiological data produced during the 2009 influenza pandemic have confirmed that immunocompromised patients remain at high risk of influenza-associated complications, namely viral and bacterial pneumonia, hospitalization and even death. The immunogenicity of the influenza vaccine is overall reduced in immunocompromised patients, although a significant clinical protection from influenza is expected to be obtained with vaccination. Influenza vaccination is safe in immunocompromised patients. The efficacy of novel strategies to improve the immunogenicity to the vaccine, such as the use of adjuvanted vaccines, boosting doses and intradermal vaccination, needs to be validated in appropriately powered clinical trials.

Prevalence rate and reasons for refusals of influenza vaccine in the elderly

RESUME Peu d'informations sont disponibles concernant la prévalence et les motifs de refus de la vaccination contre la grippe dans la population âgée. Le but de notre recherche était d'investiguer les vrais motifs de refus de la vaccination (c'est-à-dire pas uniquement les raisons de non-vaccination parfois indépendantes du patient lui- même) chez les personnes âgées. Tous les patients ambulatoires de plus de 65 ans consultant la Policlinique Médicale Universitaire (PMU) de Lausanne ou leur médecin traitant durant les périodes de vaccination contre la grippe 1999-2000 et 2000-2001 ont été inclus. Chaque patient recevait une information sur la grippe et ses complications, de même que sur la nécessité de la vaccination, son efficacité et ses effets seconda ires éventuels. En l'absence de contre-indication, la vaccination était proposée. En cas de refus, les motifs étaient investigués par une question ouverte. Sur 1398 sujets inclus, 148 (12%) ont refusé la vaccination. Les raisons principales de refus étaient la perception d'être en bonne santé (16%), de ne pas être susceptible à la grippe (15%) ou le fait de ne jamais avoir été vacciné contre la grippe dans le passé (15%). On retrouvait également la mauvaise expérience personnelle ou d'un proche lors d'une vaccination (15%) et l'impression d'inutilité du vaccin (10%). 17% des personnes interrogées ont donné des motifs autres et 12% n'ont pas explicité leur non-acceptation. Les refus de vaccination contre la grippe dans la population âgée sont essentiellement liés aux convictions intimes du patient quant à son état de santé et à sa susceptibilité à la grippe, de même qu'à l'efficacité supposée de la vaccination. La résistance au changement semble être un obstacle majeur à l'introduction de la vaccination chez les personnes de plus de 65 ans. SUMMARY More knowledge on the reasons for refusal of the influenza vaccine in elderly patients is essential to target groups for additional information, and hence improve coverage rate. The objective of the present study was to describe precisely the true motives for refusal. All patients aged over 64 who attended the Medical Outpatient Clinic, University of Lausanne, or their private practitioner's office during the 1999 and 2000 vaccination periods were included. Each patient was informed on influenza and its complications, as well as on the need for vaccination, its efficacy and adverse events. The vaccination was then proposed. In case of refusal, the reasons were investigated with an open question. Out of 1398 patients, 148 (12%) refused the vaccination. The main reasons for refusal were the perception of being in good health (16%), of not being susceptible to influenza (15%), of not having had the influenza vaccine in the past (15%), of having had a bad experience either personally or a relative (15%), and the uselessness of the vaccine (10%). Seventeen percent gave miscellaneous reasons and 12% no reason at all for refusal. Little epidemiological knowledge and resistance to change appear to be the major obstacles for wide acceptance of the vaccine by the elderly.

Naturaleza humana y lenguaje en el pensamiento de Descartes

Frente a interpretaciones estandarizadas, el presente trabajo pretende poner de relieve elmomento de trascendencia del cogito, acudiendo al concepto de 'naturaleza' y a la noción de 'lenguaje'. Destácase la importancia del concepto de 'encarnación' como idea clave para la constitución del 'hombre verdadero', así como su dimensión intersubjetiva.

Composição centesimal e conteúdo de aminoácidos, ácidos graxos e minerais de seis cultivares de soja destinadas à alimentação humana

Seis cultivares de soja (Glycine max L. Merrill): IAS-4, EMBRAPA-4, Davis, BR-16, Iguaçu e IAS-5, destinadas à alimentação humana, foram caracterizadas quanto à composição centesimal, conteúdo de aminoácidos, ácidos graxos e minerais. Os teores de fibra, proteína e óleo variaram significativamente nas amostras analisadas, enquanto que os teores de cinzas não apresentaram diferenças significativas. Com relação aos teores de minerais, o potássio foi o que obteve o maior valor, 1.824,02 mg/100 g para a cultivar Iguaçu, ficando a EMBRAPA-4 com o maior teor de cálcio, 313,93 mg/100 g. Para a composição em ácidos graxos, notou-se que a cultivar IAS-5 apresentou o maior teor de insaturados, 87,45%, enquanto que a Davis, o menor, 83,93%. A cultivar EMBRAPA-4 apresentou um teor de ácido oléico maior e de linoléico e linolênico bem menores que as demais cultivares estudadas, 39,93%, 42,46% e 4,64%, respectivamente. Os demais ácidos graxos estão de acordo com os valores encontrados na literatura no tocante a óleo de soja. Todas as cultivares estudadas apresentaram excelente balanço em aminoácidos essenciais (AAE). Os teores de cada AAE foram superiores aos da proteína padrão estabelecido pela FAO/WHO, com valor total de AAE variando de 39,5 a 45,0 g/100 g de proteína.

Subjetividad humana y "error" en la filosofía cartesiana

El presente trabajo, continuando la línea investigadora acerca de las nociones derazón, conciencia y subjetividad en Descartes, tal como se ha defendido en otros artículos ya publicados, aporta un nuevo argumento a una línea de trabajo previamente iniciada, poniendo de relieve que el problema gnoseológico del error viene condicionado por la misma noción cartesiana de racionalidad, y que ésta dista mucho de lo que tradicionalmente se ha entendido como una racionalidad abstracta y formal, libre de los imperativos humanos. Por otro lado, y a la inversa, también se intenta mostrar como el hecho del error contribuye, cartesianamente hablando, a definir un modelo de racionalidad profundamentehumanizada. El artículo, tras una introducción, se propone analizar las relaciones entre los conceptos básicos de racionalidad, dogma, y naturaleza, lo que permitirá a continuación dejar constancia de la copertenencia entre racionalidad y error, para acabar viendo como la libertad humana es la vez, y para ambos, su fundamento último.

Estudio de la motivación humana

En este articulo se estudia La motivaci6n humana, definiendo las caracteristicas basicas de la misma. A continuación, se presentan los principales modelos que interpretan los fenómenos motivacionales humanos dentro de una Linea interpretativa intencionisld. Después dc un analisis de la teoria de ALkinson, como principal representante de dicha corriente, se plantea la hipótesis de una teoria bi-dimensional de la motivación

L'esquerda ecològica: residus industrials i geografia humana

L'article presenta una visió global de la problemitica dels residus industrials des d'una doble perspectiva que destaca el caracter sbcioterritorial dels impactes, associats a la seva preskncia en el medi, i els conflictes que s'esdevenen entorn a les opcions de gestió actualment vigents. Després d'examinar els residus en relació amb la producció industrial, i la producció i "eliminació", dels residus industrials des de la dimensió territorial, es fa un reph de les polítiques de gestió, sobre la base de diferents palsos productors, i s'estudien les implicacions socio-polítiques dels models de gestió, tot centrant-se en l'analisi de les iniciatives ciutadanes alemanyes i de les mobilitzacions a Catalunya en resposta al cepla Director per a la Gestió dels Residus Industrials a Catalunyau. A les conclusions s'enceta una reflexió a l'entorn de la recerca en Geografia Humana i l'anilisi dels residus industrials, i es plantegen les implicacions tebriques i epistemologiques de cara a una visió social dels problemes ambientals.

Flúor. Beneficios sobre la salud humana.

E1 flúor en su forma más elemental es, en condiciones normales de presión y temperatura, un gas, incluido en el grupo VII de la tabla periódica. Es el más electronegativo de todos los elementos, y no sólo posee notables cualidades químicas sino también fisiológicas, de la máxima importancia para la salud y el bienestar del hombre. Por su comportamiento químico, es el más activo de todos los iones elementales.

Bilateral anterior ischemic optic neuropathy following influenza vaccination.

Optic neuritis is an occasional complication of vaccination. Visual loss can be unilateral or bilateral, and most patients recover substantially without treatment. The presumptive mechanism is an immune-mediated demyelinating injury of the optic nerve. We report two patients who had permanent visual loss following influenza vaccination. Their pattern of visual loss, segmental optic disc changes, and failure of visual recovery were atypical for demyelinating optic neuritis and reminiscent of a primary ischemic injury to the optic nerve. We speculate that an immune complex-mediated vasculopathy following vaccination can cause anterior ischemic optic neuropathy. Clinicians should be aware of this entity because of the less favorable prognosis for visual recovery in these cases.

Report of The Iowa Pandemic Influenza Ethics Committee, September 2007

This ethical framework document, compiled by the Iowa Pandemic Influenza Ethics Committee, provides ethical guidance to the Iowa Department of Public Health (IDPH) for a pandemic influenza situation. The ethics committee proposes the document as a foundation for decision making in preparing for and responding to pandemic influenza. The document addresses four ethical or moral focal points that public health and health care workers may need to address during a public health disaster.

Does Influenza Vaccination Induce De Novo HLA Alloantibody Formation in Transplant Recipients?

Introduction: Infl uenza vaccination is recommended for all solid organ transplant recipients. However, some centers are reluctant to give annual vaccination due to concerns about precipitating rejection. A proposed mechanism of this is vaccineinduced development of cellular and humoral responses to donor HLA antigens. We studied the induction of HLA Ab in a cohort of lung transplant recipients receiving infl uenza vaccination. Methods: Adult lung transplant recipients were immunized with 0.5 mL intramuscular seasonal infl uenza vaccine followed by 0.1 mL intradermal booster at 4 weeks as part of a previous study. Sera were collected pre-vaccination and at 4, 8 weeks post-vaccination. Post-vaccination sera were analyzed for HLA Ab using fl owPRA specifi c beads (One Lambda Inc). A positive result was defi ned as 5%. Positive samples were further analyzed for antibody specifi city by single antigen bead testing. Pre-vaccination sera were tested only only if post-vaccination sample screen was positive for HLA Ab. The presence of HLA Ab was correlated to vaccine seroresponse and rejection episodes. Results: Sixty patients were included with equal numbers of men and women. Mean age of patients was 47.3 years (range 20.7-72.4). Median time post-transplant was 1.3 years (range 85 days - 17 years). One patient was excluded due to an uninterpretable baseline screen result. 16/59 (27.1%) patients were positive for HLA Ab both in both pre- and post-vaccination samples. Of these, 12/16 (75%) had antibody against HLA Class I (majority A30,A31,B27,B44), 2/16 (12.5%) had antibody against HLA class II (majority DQ4, DQ7), and 2/16 (12.5%) had antibody against both Class I & II. There was no signifi cant increase in existing HLA Ab post-vaccination. Of the 16 patients, only one (6.3%) patient had de novo HLA Ab and this was determined to be non donor specifi c. Factors such as gender, time from transplant, immunosuppression, and acute rejection episodes did not correlate with presence of HLA Ab. HLA Ab was not associated with seroconversion to to vaccine antigens. Conclusions: Our data support that receiving the annual infl uenza vaccine does not lead to the generation of de novo donor specifi c antibodies in lung transplant recipients or upregulation of existing HLA Ab.

Who knew? Awareness of being recommended for influenza vaccination among US adults

Please cite this paper as: Maurer et al. (2012) Who knew? Awareness of being recommended for influenza vaccination among US adults. Influenza and Other Respiratory Viruses 6(4), 284-290. Background  Starting with the 2010-2011 influenza season, the Advisory Committee on Immunization Practices at the US Centers for Disease Control and Prevention recommends annual influenza vaccination to all people aged 6 months and older unless contraindicated. Objectives  To measure perceived influenza vaccination recommendation status among US adults (n = 2122) and its association with socio-demographic characteristics and recommendation status during the 2009-2010 pandemic influenza season. Methods  We analyze nationally representative data from longitudinal Internet surveys of US adults conducted in November-December 2009 and September-October 2010. Results  During the 2010-2011 vaccination season, 46·2 percent (95%-CI: 43·3-49·1%) of US adults correctly reported to be covered by a government recommendation for influenza vaccination. Awareness of being covered by a government influenza vaccination recommendation was statistically significantly higher among non-working adults and adults who had been recommended for seasonal vaccination or both seasonal and H1N1 vaccination during the 2009-2010 pandemic influenza vaccination season. Conclusion  Our results highlight that a majority of US adults do not know that they are recommended for annual influenza vaccination by the government. The fraction of adults who are unaware of their recommendation status is especially large among newly recommended healthy young adults. The universal vaccination recommendations will only be successful if they reach both patients and physicians and lead to changing vaccination practices. The universal nature of the new recommendation simplifies vaccination-related outreach and compliance with government vaccination guidelines considerably, as it does not require any identification of specific recommendation groups based on complex personal or health risk factors.

L'alimentació humana del Paleolític Superior al Neolític. Canvis i efectes de la Revolució Neolítica en la salut

Dieta Flash, Dieta Dukan, Dieta Mediterrània, Dieta Vegetariana o Dieta Paleolítica són només alguns exemples de les setanta-dos diferents dietes que es practiquen en l’actualitat (Dukan, 2011). Tanmateix, tot i convergir a l’hora d’autoproclamer-se com a baluard d’una “forma de vida sana” que portarà als seus seguidors a la “felicitat” i a evitar les anomenades “malalties de la civilització”1 (Milton, 2000; Cordain, 2011; Pérez, 2012; Campos, 2012), alhora, el tret comú de totes aquestes dietes és la manca de quòrum –àdhuc posicions antagòniques− en llur concepció del que hauria de ser una “dieta sana”.

Targeting IL-1β and IL-17A driven inflammation during influenza-induced exacerbations of chronic lung inflammation.

For patients with chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), exacerbations are life-threatening events causing acute respiratory distress that can even lead to hospitalization and death. Although a great deal of effort has been put into research of exacerbations and potential treatment options, the exact underlying mechanisms are yet to be deciphered and no therapy that effectively targets the excessive inflammation is available. In this study, we report that interleukin-1β (IL-1β) and interleukin-17A (IL-17A) are key mediators of neutrophilic inflammation in influenza-induced exacerbations of chronic lung inflammation. Using a mouse model of disease, our data shows a role for IL-1β in mediating lung dysfunction, and in driving neutrophilic inflammation during the whole phase of viral infection. We further report a role for IL-17A as a mediator of IL-1β induced neutrophilia at early time points during influenza-induced exacerbations. Blocking of IL-17A or IL-1 resulted in a significant abrogation of neutrophil recruitment to the airways in the initial phase of infection or at the peak of viral replication, respectively. Therefore, IL-17A and IL-1β are potential targets for therapeutic treatment of viral exacerbations of chronic lung inflammation.