Vaccine confidence and hesitancy in Brazil Brown, Amy Louise; Sperandio, Marcelo; Turssi, Cecília P ...
Cadernos de Saúde Pública,
09/2018, Volume:
34, Issue:
9
Journal Article
Peer reviewed
Open access
Despite the overall benefits of immunization, vaccine hesitancy has been a growing trend and has been associated with the resurgence of vaccine-preventable diseases. The aim of this study was to ...assess vaccine confidence and hesitancy in Brazil, as part of a wider project to map vaccine confidence globally. One thousand subjects were interviewed, either online or face-to-face, based on a general questionnaire regarding perceptions on vaccines and vaccination. Further exploratory questions were used with the subset of respondents who were parents of children aged under 5. Such questions extracted information regarding vaccination behavior, opinions on vaccination and government health services, and vaccine hesitancy. Reasons for hesitancy were classified as relating to confidence, convenience and/or complacency, and the population was also analyzed socio-demographically. The results showed that overall confidence in immunization was higher than confidence in family planning services, community health workers and emergency services. Seventy-six people reported hesitancy to vaccinate. The commonest reasons for hesitancy were issues with confidence (41.4%), efficacy/safety of the vaccine (25.5%) and concerns about adverse events (23.6%). The sociodemographic analysis revealed that vaccine hesitancy was associated with marital status, level of education and income. Despite overall vaccine confidence being high, a clear trend toward lower levels of confidence was associated with higher levels of hesitancy, which warrants on-going monitoring, due to the dynamic and changing nature of vaccine hesitancy.
In utero transmission of HIV-1 occurs on average in only 3%-15% of HIV-1-exposed neonates born to mothers not on antiretroviral drug therapy. Thus, despite potential exposure, the majority of infants ...remain uninfected. Weak HIV-1-specific T-cell responses have been detected in children exposed to HIV-1, and potentially contribute to protection against infection. We, and others, have recently shown that the removal of CD4(+) CD25(+) T-regulatory (Treg) cells can reveal strong HIV-1 specific T-cell responses in some HIV-1 infected adults. Here, we hypothesized that Treg cells could suppress HIV-1-specific immune responses in young children.
We studied two cohorts of children. The first group included HIV-1-exposed-uninfected (EU) as well as unexposed (UNEX) neonates. The second group comprised HIV-1-infected and HIV-1-EU children. We quantified the frequency of Treg cells, T-cell activation, and cell-mediated immune responses. We detected high levels of CD4(+) CD25(+) CD127(-) Treg cells and low levels of CD4(+) and CD8(+) T cell activation in the cord blood of the EU neonates. We observed HIV-1-specific T cell immune responses in all of the children exposed to the virus. These T-cell responses were not seen in the cord blood of control HIV-1 unexposed neonates. Moreover, the depletion of CD4(+) CD25(+) Treg cells from the cord blood of EU newborns strikingly augmented both CD4(+) and CD8(+) HIV-1-specific immune responses.
This study provides new evidence that EU infants can mount strong HIV-1-specific T cell responses, and that in utero CD4(+) CD25(+) T-regulatory cells may be contributing to the lack of vertical transmission by reducing T cell activation.
Immunological and clinical findings suggestive of some immune dysfunction have been reported among HIV-exposed uninfected (HEU) children and adolescents. Whether these defects are persistent or ...transitory is still unknown. HEU pediatric population at birth, 12 months, 6-12 years were evaluated in comparison to healthy age-matched HIV-unexposed controls. Plasma levels of LPS, sCD14, cytokines, lymphocyte immunophenotyping and T-cell receptor excision circles (TREC) were assessed. HEU and controls had similar LPS levels, which remained low from birth to 6-12 years; for plasma sCD14, IL-2, IL-6, IL-7, IL-10, IL-12p70, IL-13, IL-17, IFN-γ, TNF-α, G-CSF, GM-CSF and MCP-1, which increased from birth to 12 months and then decreased at 6-12 years; and for TREC/106 PBMC at birth in HEU and controls. By contrast, plasma MIP-1β levels were lower in HEU than in controls (p=0.009) at 12 months, and IL-4 levels were higher in HEU than controls (p=0.04) at 6-12 years. Immune activation was higher in HEU at 12 months and at 6-12 years than controls based on frequencies of CD38+HLA-DR+CD8+T cells (p=0.05) and of CD38+HLA-DR+CD4+T cells (p=0.006). Resting memory and activated mature B cells increased from birth to 6-12 years in both groups. The development of the immune system in vertically HEU individuals is comparable to the general population in most parameters, but subtle or transient differences exist. Their role in influencing clinical incidences in HEU is unknown.
Objectives To assess the risks of and factors associated with mortality, loss to follow-up, and changing regimens after children with HIV infected perinatally initiate combination antiretroviral ...therapy (cART) in Latin America and the Caribbean. Study design This 1997-2013 retrospective cohort study included 1174 antiretroviral therapy–naïve, perinatally infected children who started cART age when they were younger than 18 years of age (median 4.7 years; IQR 1.7-8.8) at 1 of 6 cohorts from Argentina, Brazil, Haiti, and Honduras, within the Caribbean, Central and South America Network for HIV Epidemiology. Median follow-up was 5.6 years (IQR 2.3-9.3). Study outcomes were all-cause mortality, loss to follow-up, and major changes/interruption/stopping of cART. We used Cox proportional hazards models stratified by site to examine the association between predictors and times to death or changing regimens. Results Only 52% started cART at younger than 5 years of age; 19% began a protease inhibitor. At cART initiation, median CD4 count was 472 cells/mm3 (IQR 201-902); median CD4% was 16% (IQR 10-23). Probability of death was high in the first year of cART: 0.06 (95% CI 0.04-0.07). Five years after cART initiation, the cumulative mortality incidence was 0.12 (95% CI 0.10-0.14). Cumulative incidences for loss to follow-up and regimen change after 5 years were 0.16 (95% 0.14-0.18) and 0.30 (95% 0.26-0.34), respectively. Younger children had the greatest risk of mortality, whereas older children had the greatest risk of being lost to follow-up or changing regimens. Conclusions Innovative clinical and community approaches are needed for quality improvement in the pediatric care of HIV in the Americas.
This study aimed to compare phenotypic and genetic characteristics of
Lactobacillus rhamnosus strains isolated at the end of the ripening of Parmigiano Reggiano cheese and to investigate an important ...prerequisite of probiotic interest, such as the capability to survive at low pH and in presence of bile salts. The use of API 50 CH, RAPD-PCR analysis and species-specific PCR allowed to ascertain the identity of 63
L. rhamnosus strains. Three
L. rhamnosus strains isolated from Parmigiano Reggiano cheese,
L. rhamnosus ATCC 7469
T and the commercial strain
L. GG were assayed to estimate the resistance to various stress factors reproducing in vitro some conditions of the gastro-intestinal environment such as low pH and different amounts of bile salts and acids. The behaviour of almost all the tested strains isolated from Parmigiano Reggiano cheese resulted analogous to that showed by
L. GG.
We have performed a detailed investigation of the photoluminescence features taken at 2
K on a series of Ga
x
In
1−
x
N alloys grown by metal-organic vapour-phase epitaxy through the whole ...composition range. The evolution of the photoluminescence lineshape of GaInN alloys in the indium-rich region is dominated by doping effects rather than by band-gap tailing effects correlated to existence of random chemical crystal inhomogeneities. The lineshape of the photoluminescence indicates a residual electron concentration of about 10
18–10
19
cm
−3 in the bulk part of the epilayers. The value we get for the bowing parameter is
b=2.8
eV.
This study assessed the levels of microbial contaminants in liquid, compressed and dry commercial baker's yeasts used as starters in breadmaking. Eumycetes, Enterobacteriaceae, total and fecal ...coliforms, Bacillus spp., and lactic acid bacteria (LAB), in particular enterococci, were quantified. Results obtained in this study highlighted that baker's yeast could represent a potential vehicle of spoilage and undesirable microorganisms into the baking environment, even if these do not influence the leavening activity in the dough, as ascertained by rheofermentometer analysis. Different microbial groups, such as spore‐forming bacteria and moulds, were found in baker's yeast starters. Moreover, different species of LAB, which are considered the main contaminants in large‐scale yeast fermentations, were isolated and identified by Denaturing Gradient Gel Electrophoresis (DGGE) and 16S rDNA sequencing. The most recurrent species were Lactobacillus plantarum, Enterococcus faecalis, and Enterococcus durans, isolated from both compressed and dry starters, whereas strains belonging to Leuconostoc and Pediococcus genera were found only in dry ones. Nested‐Polymerase Chain Reaction (Nested‐PCR) and Randomly Amplified Polymorphic DNA–PCR (RAPD‐PCR) were also used to highlight the biodiversity of the different commercial yeast strains, and to ascertain the culture purity.
Practical Application
Our study highlighted that baker's yeast starters can be considered an important source of numerous and undesirable spoilage microorganisms such as Bacillaceae, moulds, coliforms, and enterococci. Bacillus genus and different species of moulds are the main cause of substantial economic loss in the bakery industry and might also cause public health problems due to the production of cytotoxic substances. Since the microbiological quality control of baker's yeast starter in breadmaking is of crucial importance, we suggest that the bakery industry routinely performs appropriate microbiological controls throughout the entire production line to guarantee the quality, safety and acceptability of final products. At the same time, precautions against the introduction of spoilage and potentially pathogen bacteria during the fermentation process should also be taken through the observance of Good Manufacturing Practice.
Lymphocyte subsets, activation markers and apoptosis were assessed in 20 HIV-exposed noninfected (ENI) children born to HIV-infected women who were or not exposed to antiretroviral (ARV) drugs during ...pregnancy and early infancy. ENI children and adolescents were aged 6–18 years and they were compared to 25 age-matched healthy non-HIV-exposed children and adolescents (Control). ENI individuals presented lower CD4+ T cells/mm3 than Control group (control: 1120.3 vs. ENI: 876.3; t-test, p = 0.030). ENI individuals had higher B-cell apoptosis than Control group (Control: 36.6%, ARV exposed: 82.3%, ARV nonexposed: 68.5%; Kruskal–Wallis, p < 0.05), but no statistical difference was noticed between those exposed and not exposed to ARV. Immune activation in CD4+ T, CD8+ T and in B cells was comparable in ENI and in Control children and adolescents. Subtle long-term immune alterations might persist among ENI individuals, but the clinical consequences if any are unknown, and these children require continued monitoring.
HIV-exposed uninfected (HEUs) infants have frequent severe infection, hospitalization, and death. We performed a serologic investigation to determine the role of common childhood respiratory ...pathogens in the excess incidence of infections in HEUs.
Prospective cohort study of mother-infant pairs.
Among 247 HEUs and 88 HIV-unexposed uninfected (HUU) infant-mother pairs, we measured maternal antibodies to respiratory syncytial virus (RSV) and pneumococcus (PNC 1, 5, 6B, 14); infant antibodies to RSV, influenza A (flu), parainfluenza viruses (1, 2, 3), and PNC 1, 5, 6B, and 14 were measured at 0 and 6 months, and antitetanus antibodies at 6 months.
HIV-infected mothers had higher RSV and lower PNC antibody concentrations at delivery than uninfected mothers. Transplacental transfer of maternal antibodies, particularly for RSV, was lower in HEUs compared with HUUs. At birth, HEUs had higher concentrations of anti-RSV antibodies than HUUs, but lower antibodies to the other respiratory agents. At 6 months, HEUs had significantly higher proportions of seroconversions and higher antibody concentrations against parainfluenza viruses 1, 2, and 3. There were no significant differences in seroconversions to flu and RSV, but antibody concentrations to RSV were six-fold lower in HEUs versus HUUs at 6 months. Antibody responses to at least two doses of tetanus vaccine were also six-fold lower in HEUs compared with HUUs.
Six-month-old HEUs had a higher incidence of respiratory viral infections than HUUs. In addition to the low passive protection from maternal antibodies, low antibody responses of HEUs may contribute to increased morbidity and mortality.
► HCPB (Helium Cooled Pebble Bed) Test Blanket Module (TBM) to be tested in ITER. ► Tritium extraction by gas purging, removal and transfer to the Tritium Plant. ► Conceptual design of TES and ...revision of the previous configuration. ► Main components: adsorption column, ZrCo getter beds and PERMCAT reactor.
The HCPB (Helium Cooled Pebble Bed) Test Blanket Module (TBM), developed in EU to be tested in ITER, adopts a ceramic containing lithium as breeder material, beryllium as neutron multiplier and helium at 80bar as primary coolant.
In HCPB-TBM the main function of Tritium Extraction System (TES) is to extract tritium from the breeder by gas purging, to remove it from the purge gas and to route it to the ITER Tritium Plant for the final tritium processing.
In this paper, starting from a revision of the so far reference process considered for HCPB-TES and considering a new modeling activity aimed to evaluate tritium concentration in purge gas, an updated conceptual design of TES is reported.
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