Summary Background After the introduction of a quadrivalent human papillomavirus (HPV) vaccination programme in Australia in April, 2007, we measured the prevalence of vaccine-targeted and closely ...related HPV types with the aim of assessing direct protection, cross-protection, and herd immunity. Methods In this repeat cross-sectional study, we recruited women aged 18–24 years who attended Pap screening between October, 2005, and July, 2007, in three major metropolitan areas of Australia to form our prevaccine-implementation sample. For our postvaccine-implementation sample, we recruited women aged 18–24 years who attended Pap screening in the same three metropolitan areas from August, 2010, to November, 2012. We compared the crude prevalence of HPV genotypes in cervical specimens between the prevaccine and the postvaccine implementation groups, with vaccination status validated against the National HPV Vaccination Program Register. We estimated adjusted prevalence ratios using log linear regression. We estimated vaccine effectiveness both for vaccine-targeted HPV types (16, 18, 6, and 11) and non-vaccine but related HPV types (31, 33, and 45). Findings 202 women were recruited into the prevaccine-implementation group, and 1058 were recruited into the postvaccine-implementation group. Crude prevalence of vaccine-targeted HPV genotypes was significantly lower in the postvaccine-implementation sample than in the prevaccine-implementation sample (58 29% of 202 vs 69 7% of 1058; p<0·0001). Compared with the prevaccine-implementation sample, adjusted prevalence ratios for vaccine-targeted HPV genotypes were 0·07 (95% CI 0·04–0·14; p<0·0001) in fully vaccinated women and 0·65 (0·43–0·96; p=0·03) in unvaccinated women, which suggests herd immunity. No significant declines were noted for non-vaccine-targeted HPV genotypes. However, within the postvaccine-implementation sample, adjusted vaccine effectiveness against vaccine-targeted HPV types for fully vaccinated women compared with unvaccinated women was 86% (95% CI 71–93), and was 58% (26–76) against non-vaccine-targeted but related genotypes (HPV 31, 33, and 45). Interpretation 6 years after the initiation of the Australian HPV vaccination programme, we have detected a substantial fall in vaccine-targeted HPV genotypes in vaccinated women; a lower prevalence of vaccine-targeted types in unvaccinated women, suggesting herd immunity; and a possible indication of cross-protection against HPV types related to the vaccine-targeted types in vaccinated women. Funding Australian National Health and Medical Research Council and Cancer Council Victoria.
Category: Trauma Introduction/Purpose: Ankle fractures are commonly treated fractures by orthopaedic surgeons with unique challenges to skin closure due to the lack of subcutaneous support. Metallic ...staples are a commonly accepted method of skin closure in other specialties, though the use of staples in orthopaedics, and more specifically in foot and ankle surgery, remains a topic of debate. Proponents of staples report several potential advantages to using staples instead of sutures, including reduced closure time, faster and less painful removal, or improved cosmetic appearance. This study aimed to compare outcomes of suture versus staple closure as well as to evaluate the safety of staple closure after open fixation of acute traumatic ankle fractures. Methods: The medical records of 94 patients treated at our institution with open fixation of an acute traumatic ankle fracture by a single surgeon between January 2011 and June 2017 were retrospectively reviewed. Demographics, preoperative characteristics, relevant comorbidities, operative characteristics, and postoperative outcomes were compared between patients who received superficial skin closure using staples versus suture techniques. Statistical analysis was performed using chi-squared test and Fisher’s exact test. Results: The staple and suture group patients were demographically similar at baseline. Of the 94 patients included in this study, 10 patients developed local wound related complications postoperatively, including 5 with wound dehiscence, 4 with superficial wound infections, and 1 deep infection . Eight patients required revision surgery due to infection or wound dehiscence. Four patients in the suture group developed superficial wound infections, compared with zero in the staple group. One patient in the staple group developed a deep infection. With the numbers available, no significant differences could be detected in the incidence of postoperative infections, local wound related complications and revision surgeries between two wound closure groups. Conclusion: Our data suggests that there is no statistical difference in outcomes between staple and suture closure after open fixation of acute ankle fractures. Because there was no difference in morbidity with possible benefits of reduced closure time, faster removal, and improved cosmetic appearance, we conclude that staple closure may be a safe alternative to sutures for superficial skin closure. This study adds evidence to a growing body of literature and suggests that staples can be used in some instances, clinical decision making, surgeon preference, and technique proficiency should remain the cornerstone of closure in ankle fracture surgery.
Summary Background In survivors of Ebola virus disease, clinical sequelae including uveitis, arthralgia, and fatigue are common and necessitate systematic follow-up. However, the infection risk to ...health-care providers is poorly defined. Here we report Ebola virus RT-PCR data for body site and fluid samples from a large cohort of Ebola virus survivors at clinic follow-up. Methods In this cross-sectional cohort study, consecutive survivors of Ebola virus disease attending Kerry Town survivor clinic (Freetown, Sierra Leone), who had been discharged from the Kerry Town Ebola treatment unit, were invited to participate. We collected and tested axillary, blood, conjunctival, forehead, mouth, rectal, semen, urine, and vaginal specimens for presence of Ebola virus using RT-PCR. We regarded samples to be positive for Ebola virus disease if the cycle threshold was 40 or lower. We collected demographic data from survivors of their age, sex, time since discharge from the treatment unit, and length of acute admission in the Ebola treatment unit using anonymised standard forms. Findings Between April 2, and June 16, 2015, of 151 survivors of Ebola virus disease invited to participate, 112 (74%) provided consent. The median age of participants was 21·5 years (IQR 14–31·5) with 34 (30%) participants younger than 16 years. 50 (45%) of 112 participants were male. We tested a total of 555 specimens: 103 from the axilla, 93 from blood, 92 from conjunctiva, 54 from forehead, 105 from mouth, 17 from the rectum, one from semen, 69 from urine, and 21 from the vagina. The median time from Ebola treatment unit discharge to specimen collection was 142 days (IQR 127–159). 15 participants had a total of 74 swabs taken less than 100 days from discharge. The semen sample from one participant tested positive for Ebola virus at 114 days after discharge from the treatment unit; specimens taken from the axilla, blood, conjunctiva, forehead, mouth, rectum, and urine of the same participant tested negative. All specimens from the other 111 participants tested negative. Interpretation Patients recovering from Ebola virus disease who do not meet the case definition for acute disease pose a low infection risk to health-care providers 6 weeks after clearance of viraemia. Personal protective equipment after this time might be limited to standard barrier precautions, unless contact with fluids from sanctuary sites is envisaged. Funding Save the Children International, Public Health England.
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