Two-step tuberculin skin test and booster phenomenon prevalence among Brazilian medical students

SETTING: Five medical schools in three cities in Rio de Janeiro State, Brazil, with different tuberculosis (TB) incidence rates. OBJECTIVE: To evaluate the prevalence of the booster phenomenon and its associated factors in a voting universally BCG-vaccinated TB-exposed population. DESIGN: A two-step tuberculin skin test (TST) was performed among undergraduate medical students. Boosting was defined as an induration >= 10 mm in the second TST (TST2), with an increase of at least 6 mm over the first TST (TST1). The association of boosting with independent variables was evaluated using multivariate analysis. RESULTS: Of the 764 participants (mean age 21.9 +/- 2.7 years), 672 (87.9%) had a BCG scar. The overall booster SUMMARY phenomenon prevalence was 8.4% (95%CI 6.5-10.6). Boosting was associated with TST1 reactions of 1-9 mm (aOR 2.5, 95%CI 1.04-5.9) and with BCG vaccination, mostly after infancy, i.e., after age two years (aOR 9.1, 95%,CI 1.2-70.7). CONCLUSION: The prevalence of the booster phenomenon was high. A two-step TST in young BCG-vaccinated populations, especially in those with TST1 reactions of 1-9 mm, can avoid misdiagnosis as a false conversion and potentially reduce unnecessary treatment for latent TB infection.

Pertussis booster vaccine for adolescents and young adults in São Paulo, Brazil

OBJECTIVE: To develop a model to assess different strategies of pertussis booster vaccination in the city of São Paulo. METHODS: A dynamic stationary age-dependent compartmental model with waning immunity was developed. The "Who Acquires Infection from Whom" matrix was used to modeling age-dependent transmission rates. There were tested different strategies including vaccine boosters to the current vaccination schedule and three of them were reported: (i) 35% coverage at age 12, or (ii) 70% coverage at age 12, and (iii) 35% coverage at age 12 and 70% coverage at age 20 at the same time. RESULTS: The strategy (i) achieved a 59% reduction of pertussis occurrence and a 53% reduction in infants while strategy (ii) produced 76% and 63% reduction and strategy (iii) 62% and 54%, respectively. CONCLUSION: Pertussis booster vaccination at age 12 proved to be the best strategy among those tested in this study as it achieves the highest overall reduction and the greatest impact among infants who are more susceptible to pertussis complications.

Effect of a booster-dose of rabies vaccine on the duration of virus neutralizing antibody titers in bovines

Humoral immune response using inactivated rabies vaccine was studied in 35 nelore cross-bred bovines of western region of São Paulo state. Ninety days after vaccination, 13 (92.8%) animals presented titers 30.5IU/ml, through mouse neutralization test. After 180 days, 9 (64.3%) sera showed titers 30.5IU/ml, after 270 days, only one (7.1%) showed a titer of 0.51IU/ml, and after 360 days, all animals showed titers < 0.5IU/ml. Group of animals receiving booster dose 30 days after vaccination presented, two months after, all with titers > 0.5IU/ml. At 180 days, 17 (80.9%) sera presented titers > 0.5IU/ml; at 270 days, 15 (71.4%), with titers 30.5IU/ml and at 360 days, 4 (19.0%), with titers 30.5IU/ml. Booster-dose ensured high levels of neutralizing antibodies for at least three months, and 240 days after revaccination, 71.4% of animals were found with titers 30.5IU/ml.

Effectiveness of a brief integrative multiple substance use intervention among young men with and without booster sessions.

Brief interventions (BI) commonly employ screening and target a single substance. Multi-substance interventions are a more adequate reflection of risk behaviors in adolescents and young adults. Systematic screening complicates BI in many settings. The effectiveness of a voluntary multi-substance intervention among 19-year-old men and the incremental impact of booster sessions were analyzed. Participants were enrolled during mandatory army conscription in Switzerland. Compared with 461 controls, 392 BI subjects showed reduced substance use on 10 of 12 measures (4 tobacco, 4 cannabis, and 2 alcohol measures). Between-group effects were small and non-significant (except for cannabis use prevalence). Three-month booster sessions were not effective and even contraindicated. The usefulness of targeting multi-substances during BIs without prior screening depends on the value of small effects. The addition of booster sessions was not effective and therefore is not recommended.

Brief intervention on tobacco use among young adults - do they benefit from booster sessions?

Introduction Le tabac représente un risque majeur pour la santé de chacun, avec un lien direct établi entre le risque de développer des pathologies et la durée de sa consommation. Les jeunes sont donc des cibles primordiales pour la prévention du tabac ; les quelques recherches effectuées dans ce groupe d'âge ne sont pas encore parvenues à identifier des moyens efficaces afin d'éviter le début de la cigarette ou d'arrêter une consommation préexistante. Les buts de cette étude sont d'identifier les effets de l'intervention motivationnelle brève et de définir la nécessité d'un booster dans cette catégorie particulière de la population que sont les jeunes hommes de 19 ans. Méthodes Cette étude a été menée d'octobre 2008 à septembre 2009 au centre de recrutement de Lausanne, Vaud. Les individus étaient invités à participer à une intervention motivationnelle brève ciblant simultanément le tabac, l'alcool et le cannabis, sans screening préalable. Les 823 volontaires ont été assignés de manière randomisée entre les groupes cas et témoin, avec dans le groupe intervention une nouvelle randomisation attribuant un booster téléphonique trois mois plus tard à certains cas. Ce travail se fixe uniquement sur les résultats concernant le tabac, six mois après l'intervention. Les effets (statut de fumeur et de fumeur quotidien, nombre de cigarettes fumées en moyenne, dépendance à la cigarette selon les critères de Fagerström) étaient analysés sur la base d'un questionnaire écrit au baseline, puis d'un contact téléphonique au follow-up à six mois ; ils ont été analysés séparément pour différents groupes : l'entier des participants, les fumeurs et les fumeurs quotidiens. Résultats Les interventions motivationnelles brèves n'ont aucun effet significatif sur la consommation de tabac. Elles ont cependant une tendance bénéfique sur le fait d'être de fumeur et fumeur quotidien, sur le nombre de cigarettes consommées en moyenne et la dépendance selon Fagerström chez tous les participants, ainsi que dans les sous-groupes de fumeurs et fumeurs quotidiens. Les résultats des boosters ne sont pas significatifs et entraînent des effets mitigés selon les analyses effectuées et les groupes observés. Discussion Les interventions motivationnelles brèves n'ont pas d'effet significatif mais semblent avoir une tendance favorable à une diminution de la consommation de tabac. Les boosters ne paraissent pas avoir d'impact bénéfique mais ces conclusions sont à pondérer avec le fait qu'aucun des résultats obtenus n'est significatif. Des recherches plus systématiques sont nécessaires pour mieux comprendre ces résultats décevants : en ce qui concernent les interventions, les causes à envisager sont le fait d'utiliser des volontaires sans screening préalable, de cibler l'intervention sur de multiples substances pendant un temps relativement court ou encore la difficulté de cibler les jeunes vis-à-vis des risques liés à la cigarette ; quant aux boosters, une augmentation de fréquence ou de durée pourrait représenter une alternative, afin de rendre cette session complémentaire efficace.

Synthetic long peptide booster immunization in rhesus macaques primed with replication-competent NYVAC-C-KC induces a balanced CD4/CD8 T-cell and antibody response against the conserved regions of HIV-1.

The Thai trial (RV144) indicates that a prime-boost vaccine combination that induces both T-cell and antibody responses may be desirable for an effective HIV vaccine. We have previously shown that immunization with synthetic long peptides (SLP), covering the conserved parts of SIV, induced strong CD4 T-cell and antibody responses, but only modest CD8 T-cell responses. To generate a more balanced CD4/CD8 T-cell and antibody response, this study evaluated a pox-vector prime/SLP boost strategy in rhesus macaques. Priming with a replication-competent NYVAC, encoding HIV-1 clade C gag, pol and nef, induced modest IFNγ T-cell immune responses, predominantly directed against HIV-1 Gag. Booster immunization with SLP, covering the conserved parts of HIV-1 Gag, Pol and Env, resulted in a more than 10-fold increase in IFNγ ELISpot responses in four of six animals, which were predominantly HIV-1 Pol-specific. The animals showed a balanced polyfunctional CD4 and CD8 T-cell response and high Ab titres.

Desempenho de um painel fotovoltaico de baixa tensão, acoplado ao protótipo de um conversor dc/dc topologia Booster

Low voltage solar panels increase the reliability of solar panels due to reduction of in series associations the configurations of photovoltaic cells. The low voltage generation requires DCDC converters devices with high efficiency, enabling raise and regulate the output voltage. This study analyzes the performance of a photovoltaic panel of Solarex, MSX model 77, configured to generate an open circuit voltage of 10.5 V, with load voltage of 8.5 V, with short circuit current of 9 A and a power of 77 W. The solar panel was assembled in the isolated photovoltaic system configuration, with and without energy storage as an interface with a DCDC converter, Booster topology. The converter was designed and fabricated using SMD (Surface Mounted Devices) technology IC (integrated circuit) that regulates its output voltage at 14.2 V, with an efficiency of 87% and providing the load a maximum power of 20.88 W. The system was installed and instrumented for measurement and acquisition of the following data: luminosities, average global radiation (data of INPE Instituto Nacional de Pesquisas Espaciais), solar panel and environment temperatures, solar panel and DC-DC converter output voltages, panel, inverter, and battery charge output currents. The photovoltaic system was initially tested in the laboratory (simulating its functioning in ideal conditions of operation) and then subjected to testing in real field conditions. The panel inclination angle was set at 5.5°, consistent with the latitude of Natal city. Factors such as climatic conditions (simultaneous variations of temperature, solar luminosities and ra diation on the panel), values of load resistance, lower limit of the maximum power required by the load (20.88 W) were predominant factors that panel does not operate with energy efficiency levels greater than 5 to 6%. The average converter efficiency designed in the field test reached 95%

The end magnets of the IFUSP race-track microtron booster

The end magnets of the IFUSP race-track microtron booster, second stage of the electron accelerator under construction at the Linear Accelerator Laboratory, are presented. They deflect, focus and return the beam to the accelerating section. Details about the project are discussed, Poisson code was used to give the final geometry of the end magnets. The end magnets incorporate auxiliary pole pieces (clamps) which create a reverse fringe field region that avoids the beam vertical defocusing and reduces the horizontal displacement produced by extended fringe fields (EFF). The small gap height used for the clamps provided reverse field distributions with fringe fields of short extensions, avoiding the traditional use of inactive clamps. Measurements and calculations concerning particle trajectories and reverse field distribution are presented. The floating wire technique, employing an original procedure to register orbits, was used to corroborate the calculated beam trajectories and represents a good experimental option in the lack of the accelerator beam. The experimental results showed agreement of about 0.1% with the calculations.

The IFUSP race-track microtron booster accelerator end magnets antisymmetric perturbations

We will present measurements and calculations related to the antisymmetric perturbations, and comparisons with the symmetric ones, of the IFUSP race-track microtron booster accelerator end magnets. These perturbations were measured in planes situated at +/-12 mm of the middle plane, in a gap height of 4 cm, for a field distribution of about 0.1 T. The measurements were done in 1170 points, separated by a distance of 8 mm, using an automated system with a +/-1.5 mu T differential Hall probe. The race-track microtron booster is the second stage of the 30.0 MeV electron accelerator under construction at the Linear Accelerator Laboratory in which the required uniformity for the magnetic field is of about 10(-3). The method of correction employed to homogenize the IFUSP race-track microtron booster accelerator magnets assures uniformity of 10(-5) in an average field of 0.1 T, over an area of 700 cm(2). This method uses the principle of attaching to the pole pieces correction coils produced by etching techniques, with copper leads shaped like the isofield lines of the normal component of the magnetic field measured. The ideal planes, in which these measurements are done, are calculated and depend on the behavior of the magnetic field perturbations: symmetric or antisymmetric with reference to the middle plane of the magnet gap. These calculations are presented in this work and show that for antisymmetric perturbations there is no ideal plane for the correction of the magnetic field; for the symmetric one, these planes are at +/-60% of the half gap height, from the middle plane. So this method of correction is not feasible for antisymmetric perturbations, as will be shown. Besides, the correction of the symmetric portion of the field distribution does not influence the antisymmetric one, which almost does not change, and corroborates the theoretical predictions. We found antisymmetric perturbations of small intensity only in one of the two end magnets. However, they are not detected at +/- 1 mm of the middle plane and will not damage the electron beam.

Interval between first dose and booster affected antibody production in cattle vaccinated against rabies

In this study, we compared the levels of neutralizing antibodies induced by inactivated rabies vaccine in cattle by using three alternative immunization procedures. Forty-five bovines (breed nelore) were then organized in three groups (A, B and C, with 15 animals/group). Group A received only one vaccine dose at day zero and Group B received the first dose at day zero and then another dose at day 30 (early booster). Group C was also immunized with two doses; however, the booster was postponed until day 180 after the first dose (delayed booster). Blood samples were withdrawn at days zero (before the first dose) and 30, 210, 390, and 540 after the beginning of immunization and the antibody titers were evaluated by mouse neutralization test. The protocol used to immunize Group C (booster at day 180) was clearly more efficient. In this group, antibody levels were higher and also remained higher for longer periods in comparison with the other two groups. These results show that booster timing significantly affected antibody levels. Therefore, programs addressed to control this disease in cattle should consider not only the use of a booster but also its administration time.

Effects of primovaccination and booster vaccination on serum cortisol and humoral immune response in cattle

The objective of this study was to evaluate the effect of one or two doses of the anti-rabies vaccination on the serum concentration of cortisol and the humoral immune response in cattle as well as the correlation between serum cortisol concentrations and the titers of rabies-neutralizing antibodies. Nelore cattle were randomly assigned to one of three groups, which were vaccinated with one dose of rabies vaccine (group GVSR, N = 15), two doses of rabies vaccine (group GVR, N = 15) or were not vaccinated (group Gc, N = 15). A commercial liquid inactivated rabies vaccine was used. The stressors imposed on the cattle were vaccination, corral handling and the presence of people. Blood samples were collected on days 0, 30 and 60 post-vaccination. Serum cortisol concentrations were determined using a solid-phase radioimmunoassay, and rabies antibody titers were determined using a serum neutralization test with BHK21 cells (RFFIT). Both serum cortisol concentrations and antibody titers increased after the second (booster) vaccination (P < 0.05). In all the groups, the serum cortisol concentrations increased after the cattle were handled in the corral (P < 0.05). No correlation was observed between the serum cortisol concentrations and the antibody titers with any treatment or on any observation day. In conclusion, booster vaccination is indispensable for primovaccinated cattle in achieving high and protective levels of rabies antibodies. Although booster vaccination and frequent cattle handling in corrals are stressors, the response is not strong enough to cause immunosuppression in cattle.

The presence of a booster phenomenon among contacts of active pulmonary tuberculosis cases: a retrospective cohort

Abstract Background Assuming a higher risk of latent tuberculosis (TB) infection in the population of Rio de Janeiro, Brazil, in October of 1998 the TB Control Program of Clementino Fraga Filho Hospital (CFFH) routinely started to recommend a two-step tuberculin skin test (TST) in contacts of pulmonary TB cases in order to distinguish a boosting reaction due to a recall of delayed hypersensitivity previously established by infection with Mycobacterium tuberculosis (M.tb) or BCG vaccination from a tuberculin conversion. The aim of this study was to assess the prevalence of boosted tuberculin skin tests among contacts of individuals with active pulmonary tuberculosis (TB). Methods Retrospective cohort of TB contacts ≥ 12 years old who were evaluated between October 1st, 1998 and October 31st 2001. Contacts with an initial TST ≤ 4 mm were considered negative and had a second TST applied after 7–14 days. Boosting reaction was defined as a second TST ≥ 10 mm with an increase in induration ≥ 6 mm related to the first TST. All contacts with either a positive initial or repeat TST had a chest x-ray to rule out active TB disease, and initially positive contacts were offered isoniazid preventive therapy. Contacts that boosted did not receive treatment for latent TB infection and were followed for 24 months to monitor the development of TB. Statistical analysis of dichotomous variables was performed using Chi-square test. Differences were considered significant at a p < 0.05. Results Fifty four percent (572/1060) of contacts had an initial negative TST and 79% of them (455/572) had a second TST. Boosting was identified in 6% (28/455). The mean age of contacts with a boosting reaction was 42.3 ± 21.1 and with no boosting was 28.7 ± 21.7 (p = 0.01). Fifty percent (14/28) of individuals whose test boosted met criteria for TST conversion on the second TST (increase in induration ≥ 10 mm). None of the 28 contacts whose reaction boosted developed TB disease within two years following the TST. Conclusion The low number of contacts with boosting and the difficulty in distinguishing boosting from TST conversion in the second TST suggests that the strategy of two-step TST testing among contacts of active TB cases may not be useful. However, this conclusion must be taken with caution because of the small number of subjects followed.