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  • 1.
    Hansson, Karin
    et al.
    Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious diseases, Södersjukhuset, Stockholm, Sweden.
    Rosdahl, Anja
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    Insulander, Mona
    Department of Communicable Disease Control and Prevention, Stockholm County, Stockholm, Sweden.
    Vene, Sirkka
    Public Health Agency of Sweden, Solna, Sweden.
    Lindquist, Lars
    Department of Medicine, Karolinska Institutet, Stockholm, Huddinge, Sweden; Department of Infectious diseases, Karolinska University Hospital, Stockholm, Sweden.
    Gredmark-Russ, Sara
    Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious diseases, Karolinska University Hospital, Stockholm, Sweden.
    Askling, Helena H.
    Division of Infectious Diseases, Unit for Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Communicable Disease Control and Prevention, Sörmland County, Sweden.
    Tick-borne encephalitis (TBE) vaccine failures: A ten-year retrospective study supporting the rationale for adding an extra priming dose in individuals from the age of 50 years2020In: Clinical Infectious Diseases, ISSN 1058-4838, E-ISSN 1537-6591, Vol. 70, no 2, p. 245-251Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Southern Sweden is endemic for tick borne encephalitis (TBE), with Stockholm County as one of the high-risk areas. The aim of this study was to describe cases of vaccine failures, and to optimize future vaccination recommendations.

    METHODS: Patients with TBE were identified in the notification database at the Department of Communicable Disease Control and Prevention in the county of Stockholm during 2006-2015. Vaccine failure was defined as TBE despite adherence to the recommended vaccination schedule with at least two doses. Clinical data were extracted from medical records.

    RESULTS: A total of 1004 TBE cases were identified, 53 (5%) were defined as vaccine failures. In this latter group the median age was 62 years (6-83). Forty-three (81%) patients were over 50 years of age and two were children. Approximately half of the patients had comorbidities with diseases affecting the immune system accounting for 26% of all cases.Vaccine failures following the third or fourth vaccine dose accounted for 36 (68%) of the patients. Severe and moderate TBE disease affected 81% of the cases.

    CONCLUSION: To our knowledge, this is the largest documented cohort of TBE-vaccine failures. Vaccine failure after five TBE-vaccine doses is rare. Our data provides rationale for adding an extra priming dose to the age group 50 years and older.

  • 2.
    Rono, Josea
    et al.
    Karolinska Institutet, Stockholm, Sweden; KEMRI-Wellcome Trust Research Programme, Centre for Geographical Medicine Research-Coast, Kilifi, Kenya.
    Osier, Faith H. A.
    KEMRI-Wellcome Trust Research Programme, Centre for Geographical Medicine Research-Coast, Kilifi, Kenya.
    Olsson, Daniel
    Unit of Biostatistics, Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
    Mhoja, Leah
    Nyamisati Malaria Research, Dar es Salaam, Tanzania.
    Rooth, Ingegerd
    Nyamisati Malaria Research, Dar es Salaam, Tanzania.
    Marsh, Kevin
    KEMRI-Wellcome Trust Research Programme, Centre for Geographical Medicine Research-Coast, Kilifi, Kenya; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom.
    Färnert, Anna
    Infectious Diseases Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Breadth of Anti-Merozoite Antibody Responses Is Associated With the Genetic Diversity of Asymptomatic Plasmodium falciparum Infections and Protection Against Clinical Malaria2013In: Clinical Infectious Diseases, ISSN 1058-4838, E-ISSN 1537-6591, Vol. 57, no 10, p. 1409-1416Article in journal (Refereed)
    Abstract [en]

    Background. Elucidating the mechanisms of naturally acquired immunity to Plasmodium falciparum infections would be highly valuable for malaria vaccine development. Asymptomatic multiclonal infections have been shown to predict protection from clinical malaria in a transmission-dependent manner, but the mechanisms underlying this are unclear. We assessed the breadth of antibody responses to several vaccine candidate merozoite antigens in relation to the infecting parasite population and clinical immunity.

    Methods. In a cohort study in Tanzania, 320 children aged 1-16 years who were asymptomatic at baseline were included. We genotyped P. falciparum infections by targeting the msp2 gene using polymerase chain reaction and capillary electrophoresis and measured antibodies to 7 merozoite antigens using a multiplex assay. We assessed the correlation between the number of clones and the breadth of the antibody response, and examined their effects on the risk of malaria during 40 weeks of follow-up using age-adjusted multivariate regression models.

    Results. The antibody breadth was positively correlated with the number of clones (RR [risk ratio], 1.63; 95% confidence interval [CI], 1.32-2.02). Multiclonal infections were associated with a nonsignificant reduction in the risk of malaria in the absence of antibodies (RR, 0.83; 95% CI, .29-2.34). The breadth of the antibody response was significantly associated with a reduced risk of malaria in the absence of infections (RR, 0.25; 95% CI, .09-.66). In combination, these factors were associated with a lower risk of malaria than they were individually (RR, 0.14; 95% CI, .04-.48). Conclusions. These data suggest that malaria vaccines mimicking naturally acquired immunity should ideally induce antibody responses that can be boosted by natural infections.

  • 3.
    Safreed-Harmon, Kelly
    et al.
    Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
    Blach, Sarah
    Center for Disease Analysis Foundation, Lafayette, Colorado, United States.
    Aleman, Soo
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Sweden.
    Boe Kielland, Knut
    Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.
    Bollerup, Signe
    Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark.
    Cooke, Graham
    Faculty of Medicine, Imperial College London, United Kingdom.
    Dalgard, Olav
    Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of clinical medicine, University of Oslo, Oslo, Norway.
    Dillon, John F.
    Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom.
    Dore, Gregory J.
    The Kirby Institute, UNSW Sydney, Sydney, Australia.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Grebely, Jason
    The Kirby Institute, UNSW Sydney, Sydney, Australia.
    Midgard, Håvard
    Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
    Porter, Kholoud
    Institute for Global Health, University College London, London, United Kingdom.
    Razavi, Homie
    Center for Disease Analysis Foundation, Lafayette, Colorado, United States.
    Tyndall, Mark
    School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
    Weis, Nina
    Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Lazarus, Jeffrey V.
    Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; CHIP, WHO Collaborating Centre on HIV and Viral Hepatitis, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    The Consensus Hepatitis C Cascade of Care: standardized reporting to monitor progress toward elimination2019In: Clinical Infectious Diseases, ISSN 1058-4838, E-ISSN 1537-6591, Vol. 69, no 12, p. 2218-2227Article in journal (Refereed)
    Abstract [en]

    Cascade-of-care (CoC) monitoring is an important component of the response to the global hepatitis C virus (HCV) epidemic. CoC metrics can be used to communicate in simple terms the extent to which national and subnational governments are advancing on key targets, and CoC findings can inform strategic decision-making regarding how to maximize the progression of HCV-infected individuals to diagnosis, treatment and cure. The value of reporting would be enhanced if reporting entities utilized a standardized approach for generating their CoCs. We have described the Consensus HCV CoC that we developed to address this need and have presented findings from Denmark, Norway and Sweden, where it was piloted. We encourage the uptake of the Consensus HCV CoC as a global instrument for facilitating clear and consistent reporting via the World Health Organization (WHO) viral hepatitis monitoring platform and ensuring the accurate monitoring of progress toward WHO's 2030 hepatitis C elimination targets.

  • 4.
    Wind, Carolien M.
    et al.
    STI Outpatient Clinic, Department of Infectious Diseases Public Health Service Amsterdam, Amsterdam, The Netherlands; Department of Dermatology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
    Schim van der Loeff, Maarten F.
    Department of Infectious Diseases Public Health Service Amsterdam, Amsterdam, The Netherlands; Center for Infection and Immunity, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
    Unemo, Magnus
    Örebro University, School of Health Sciences. WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Schuurman, Rob
    Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
    van Dam, Alje P.
    Public Health Laboratory, Public Health Service Amsterdam, Amsterdam, The Netherlands; Department of Medical Microbiology, Onze Lieve Vrouwe Gasthuis General Hospital, Amsterdam, The Netherlands.
    de Vries, Henry J. C.
    STI Outpatient Clinic, Department of Infectious Diseases Public Health Service Amsterdam, Amsterdam, The Netherlands; Department of Dermatology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
    Test of cure for anogenital gonorrhoea using modern RNA-based and DNA-based nucleic acid amplification tests: a prospective cohort study2016In: Clinical Infectious Diseases, ISSN 1058-4838, E-ISSN 1537-6591, Vol. 62, no 11, p. 1348-1355Article in journal (Refereed)
    Abstract [en]

    Background: The use of nucleic acid amplification tests (NAATs) to diagnose Neisseria gonorrhoeae infections complicates the performance of a test of cure (TOC) to monitor treatment failure, if this is indicated. As evidence for the timing of TOC using modern NAATs is limited, we performed a prospective cohort study to assess time to clearance when using modern RNA- and DNA-based NAATs.

    Methods: We included patients with anogenital gonorrhoea visiting the STI Clinic Amsterdam from March through October 2014. After treatment with ceftriaxone mono- or dual therapy (with azithromycin or doxycycline) anal, vaginal or urine samples were self-collected during 28 consecutive days, and analysed using an RNA-based NAAT (Aptima Combo 2) and a DNA-based NAAT (Cobas 4800). Clearance was defined as three consecutive negative results, and blips as isolated positive results following clearance.

    Results: We included 77 patients; five self-cleared gonorrhoea before treatment and ten were lost to follow-up. Clearance rate of the remaining 62 patients was 100%. Median time to clearance was two days, with a range of 1-7 days for RNA-based NAAT, and 1-15 days for DNA-based NAAT. The risk of finding a blip after clearance was 0.8% and 1.4%, respectively. One patient had a reinfection.

    Conclusions: If indicated, we recommend to perform a TOC for anogenital gonorrhoea at least 7 or 14 days after administering therapy, when using modern RNA- or DNA-based NAATs, respectively. When interpreting TOC results for possible treatment failure, both the occurrence of blips and a possible reinfection need to be taken into account.

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