Infectious Diseases - Childhood Immunisation

Infectious Diseases - Childhood Immunisation

Pregnancy outcome following maternal exposure to Mirtazapine: Preliminary results of a collaborative ENTIS study.

Introduction: Mirtazapine is a noradrenergic and serotonergic antidepressant mainly acting through blockade of presynaptic alpha-2 receptors. Published data on pregnancy outcome after exposure to mirtazapine are scarce. This study addresses the risk associated with exposure to mirtazapine during pregnancy. Patients (or Materials) and Methods: Multicenter (n = 11), observational prospective cohort study comparing pregnancy outcomes after exposure to mirtazapine with 2 matched control groups: exposure to any selective serotonin reuptake inhibitor (SSRI) as a diseasematched control group, and general controls with no exposure to medication known to be teratogenic or to any antidepressant. Data were collected by members of the European Network of Teratology Information Services (ENTIS) during individual risk counseling between 1995 and 2011. Standardized procedures for data collection were used in each center. Results: A total of 357 pregnant women exposed to mirtazapine at any time during pregnancy were included in the study and compared with 357 pregnancies from each control group. The rate of major birth defects between the mirtazapine and the SSRI group did not differ significantly (4.5% vs 4.2%; unadjusted odds ratio, 1.1; 95% confidence interval, 0.5-2.3, P = 0.9). A trend toward a higher rate of birth defects in the mirtazapine group compared with general controls did not reach statistical significance (4.2% vs 1.9%; OR, 2.4; 95% CI, 0.9-6.3; P = 0.08). The crude rate of spontaneous abortions did not differ significantly between the mirtazapine, the SSRI, and the general control groups (9.5% vs 10.4% vs 8.4%; P = 0.67), neither did the rate of deliveries resulting in live births (79.6% vs 84.3% in both control groups; P = 0.15). However, a higher rate of elective pregnancy-termination was observed in the mirtazapine group compared with SSRI and general controls (7.8% vs 3.4% vs 5.6%; P = 0.03). Premature birth (< 37 weeks) (10.6% vs 10.1% vs 7.5%; P = 0.38), gestational age at birth (median, 39 weeks; interquartile range (IQR), 38-40 in all groups; P = 0.29), and birth weight (median, 3320 g; IQR, 2979-3636 vs 3230 g; IQR, 2910-3629 vs 3338 g; IQR, 2967-3650; P = 0.34) did not differ significantly between the groups. Conclusion: This study did not observe a statistically significant difference in the rate of major birth defects between mirtazapine, SSRI-exposed, and nonexposed pregnancies. A slightly higher rate of birth defects was, however, observed in the mirtazapine and SSRI groups compared with the low rate of birth defects in our general controls. Overall, the pregnancy outcome after mirtazapine exposure in this study is very similar to that of the SSRI-exposed control group.

Twenty-year trends in the prevalence of Down syndrome and other trisomies in Europe: impact of maternal age and prenatal screening.

This study examines trends and geographical differences in total and live birth prevalence of trisomies 21, 18 and 13 with regard to increasing maternal age and prenatal diagnosis in Europe. Twenty-one population-based EUROCAT registries covering 6.1 million births between 1990 and 2009 participated. Trisomy cases included live births, fetal deaths from 20 weeks gestational age and terminations of pregnancy for fetal anomaly. We present correction to 20 weeks gestational age (ie, correcting early terminations for the probability of fetal survival to 20 weeks) to allow for artefactual screening-related differences in total prevalence. Poisson regression was used. The proportion of births in the population to mothers aged 35+ years in the participating registries increased from 13% in 1990 to 19% in 2009. Total prevalence per 10 000 births was 22.0 (95% CI 21.7-22.4) for trisomy 21, 5.0 (95% CI 4.8-5.1) for trisomy 18 and 2.0 (95% CI 1.9-2.2) for trisomy 13; live birth prevalence was 11.2 (95% CI 10.9-11.5) for trisomy 21, 1.04 (95% CI 0.96-1.12) for trisomy 18 and 0.48 (95% CI 0.43-0.54) for trisomy 13. There was an increase in total and total corrected prevalence of all three trisomies over time, mainly explained by increasing maternal age. Live birth prevalence remained stable over time. For trisomy 21, there was a three-fold variation in live birth prevalence between countries. The rise in maternal age has led to an increase in the number of trisomy-affected pregnancies in Europe. Live birth prevalence has remained stable overall. Differences in prenatal screening and termination between countries lead to wide variation in live birth prevalence.

Immunisation Guidelines for Ireland

This revised report on immunisation guidelines for Ireland has been prepared with the assistance of an active committee from associated disciplines in Paediatrics, Infectious Diseases, General Practice and Public Health. The report itself is designed to be simple and concise and of course does not claim to contain all information on any pharmacological material. It does, however, give the current information and guidelines concerning immunisation. Vaccines are continually evolving and guidelines will obviously change given the nature of these developments. This is a tribute to the pharmaceutical industry who invest so much money in research and development in this particular field. Download document here

Immunisation Guidelines for Ireland (2008)

Immunisation Guidelines for Ireland (2008) This revised report on immunisation guidelines for Ireland has been prepared with the assistance of an active Committee from associated disciplines in Paediatrics, Infectious Diseases, General Practice, Public Health, Microbiology, Occupational Health, Travel Medicine and the Irish Medicines Board. The report itself continues to be simple and concise in design and of course does not claim to contain all information on any pharmacological material. Click here to download PDF 2mb

Immunisation Guidelines for Ireland 2008 EDITION - Online only update August 2010

Immunisation Guidelines for Ireland 2008 EDITION – Online only update August 2010 Click here to download PDF 1.73MB

Immunisation for pre-school children three to five years old (English and 10 translations)

This booklet contains the facts about the vaccine against diphtheria, tetanus, whooping cough (pertussis) and polio, and the MMR booster given to children before they start school

Immunisation for babies up to 13 months of age (English and 10 translations)

This booklet provides information on the routine immunisations that are given to babies to protect them from serious childhood diseases.

Immunisation for babies up to a year old (Eglish and translations)

This booklet provides information on the routine immunisations that are given to babies up to a year oldto protect them from serious childhood diseases.

Immunisation for babies just after their first birthday

This booklet provides the facts about the vaccines babies will receive just after their first birthday: the first MMR vaccine and the PCV and Hib/Men C booster vaccines.

Childhood immunisation: Guidance notes for professionals

This booklet summarises the childhood immunisation programme and provides guidance for professionals administering vaccines.

Immunisation update

This poster, for display in public areas, outlines the vaccines given to babies just after their first birthday.

Maternal Obesity in the UK: Findings from a national project

In 2008, the Confidential Enquiry into Maternal and Child Health (CEMACH), now known as the Centre for Maternal and Child Enquiries (CMACE), commenced a 3-year UK-wide Obesity in Pregnancy project. The project was initiated in response to a number of factors. At the time, these included: i) growing evidence that obesity is associated with increased morbidity and mortality for both mother and baby, ii) evidence from the CEMACH 'Saving Mothers' Lives' report showed that women with obesity were over-represented among those who died of direct deaths compared to those who died of indirect deaths, 1 iii) unknown national and regional prevalence rates of maternal obesity, and iv) the need for a national clinical guideline for the care of women with obesity in pregnancy.

Pre-hatching maternal effects and the tasty chick hypothesis

Question: Are maternal effects (i.e. maternal transfer of immune components to their offspring via the placenta or the egg) specifically directed to the offspring on which ectoparasites predictably aggregate? Organisms: The barn owl (Tyto alba) because late-hatched offspring are the main target of the ectoparasitic fly Carnus hemapterus. Hypothesis: Pre-hatching maternal effects enhance parasite resistance of late- compared with early-hatched nestlings. Search method: To disentangle the effect of natal from rearing ranks on parasite intensity, we exchanged hatchlings between nests to allocate early- and late-hatched hatchlings randomly in the within-brood age hierarchy. Result: After controlling for rearing ranks, cross-fostered late-hatched nestlings were less parasitized but lighter than cross-fostered early-hatched nestlings. Conclusion: Pre-hatching maternal effects increase parasite resistance of late-hatched offspring at a growth cost.

Perinatal and Maternal Mortality report

The findings in this report are based on stillbirths and neonatal deaths with a date of birth between 1 January 2008 and 31 December 2008 notified to AWPS/CMACE and reported to the Office for National Statistics (ONS). For maternity provider rates, denominators are based on live births reported to AWPS/CMACE by hospitals. For country rates, denominators are based on live births reported to ONS and NISRA-GRO.Perinatal mortality rates for 2008 are assigned to a geographical area. Country specific findings are derived using maternal postcode of residence. Findings for maternity providers within Northern Ireland are derived using the place of death, and any deaths at home are allocated to the maternity provider that provided the care at the time of death.