OBJECTIVE: The main aim was to determine the overall vaccine effectiveness (VE) against recurrent cervical intraepithelial neoplasia grade 2 or worse (CIN2+) including specific VE associated with timing of human papillomavirus (HPV) vaccination using data from published studies. DESIGN: Meta-analysis and meta-regression. DATA SOURCES: A computerised literature search was undertaken using the MEDLINE, EMBASE, International Pharmaceutical Abstracts, Derwent Drug File, ProQuest Science and Technology, Cochrane and MedRxiv databases. To be eligible, the studies, with no language restrictions, had to be published between 1 January 2001 and 25 May 2023. REVIEW METHODS: Included were studies with an unvaccinated reference group that assessed CIN2+ recurrence irrespective of the HPV genotype in women undergoing conisation provided. The present study was carried out in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analyses and Meta-analysis Of Observational Studies in Epidemiology guidelines. The risk of study bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. The Grading of Recommendations Assessment, Development, and Evaluation guidelines were used to assess the strength of evidence for the primary outcome. Data synthesis was conducted using meta-analysis and meta-regression. RESULTS: Out of a total of 14 322 publications, 20 studies with a total of 21 estimates were included. The overall VE against recurrent CIN2+ irrespective of the HPV genotype achieved 69.5% (95% CI: 54.7% to 79.5%). While the HPV vaccine valency, follow-up duration, type of study including its risk of bias had no effect on VE, the highest VE of 78.1% (95% CI: 68.7% to 84.7%) was reported for women receiving their first dose not earlier than the day of excision. This outcome was supported by additional analyses and a VE prediction interval ranging from 67.1% to 85.4%. CONCLUSIONS: The outcome of this meta-analysis and meta-regression convincingly showed the beneficial effect of post-excisional HPV vaccination against CIN2+ recurrence. Studies published to date have been unable to determine whether or not vaccination, completed or initiated before conisation, would be associated with more favourable results. PROSPERO REGISTRATION NUMBER: CRD42022353530.
- MeSH
- dysplazie děložního hrdla * MeSH
- infekce papilomavirem * MeSH
- lidé MeSH
- nádory děložního čípku * prevence a kontrola chirurgie MeSH
- vakcinace MeSH
- vakcíny proti papilomavirům * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- systematický přehled MeSH
- MeSH
- lidé MeSH
- nemoci z povolání * klasifikace MeSH
- posouzení stavu pacienta MeSH
- posuzování zdravotní způsobilosti MeSH
- pracovní podmínky organizace a řízení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- lidé MeSH
- služby zdravotní péče o pracující * klasifikace metody organizace a řízení zákonodárství a právo MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Elevated anti-apolipoprotein A-1 (AAA1) antibody levels associated with cardiovascular risk have been observed in previously SARS-CoV-2-infected or COVID-19-vaccinated individuals. Since patient safety is generally a priority in vaccination, we sought to investigate AAA1 antibody levels in healthy adults after mRNA vaccination. We conducted a prospective cohort study in healthy adult volunteers recruited from military workers of the Transport Air Base in Prague who had received two doses of mRNA vaccines. Anti-apolipoprotein A-1 antibody levels were determined using ELISA from serum samples obtained at three and four time points after the first and second vaccine doses, respectively, within almost 17 weeks of follow-up. The transient AAA1 positivity rate achieved 24.1% (95% confidence interval CI: 15.4-34.7%), i.e., 20 out of 83 participants had at least one positive post-vaccination sample, with a repeat positivity confirmed in only 5 of them. This rate was associated with a BMI > 26 kg/m2, as documented by an adjusted odds ratio of 6.79 (95% CI: 1.53-30.01). In addition, the highest positivity rate of 46.7% (21.3-73.4%) was observed in obese subjects with >30 kg/m2. Since the incidence rate of AAA1 positivity remained unchanged after the first and second vaccine doses, any relationship between AAA1 positivity and mRNA vaccination was inconclusive. The present study showed a transient AAA1 positivity rate associated with overweight or obesity without a proven association with mRNA vaccination.
- Publikační typ
- časopisecké články MeSH
Continuous assessment of the effectiveness of approved COVID-19 vaccines is crucial to gain an insight into the longer-term impact on health outcomes, and eventually boosting public confidence. For this reason, we conducted a multicenter, retrospective cohort study using data on infection and vaccination rates among employees of three Prague hospitals in the period between 27 December 2020 and 31 August 2021. The post-vaccination and post-infection protectiveness were assessed in a total of 11,443 hospital workers who were followed up for more than 14 days either after their Comirnaty vaccination or study enrolment, depending on their previous SARS-CoV-2 infection. The effectiveness of full vaccination against any SARS-CoV-2 infection achieved 88.3% (83.2-91.8%) over the eight months of follow-up, a figure not much different from the 92.5% (76.5-97.6%) level of protection built by a previous infection. Despite this, the post-vaccination level of protection declined to about 65% between June and August. No case of breakthrough infection was registered among hospital workers having received one or two vaccine doses more than three months after previous infection. The eight-month effectiveness of the Comirnaty vaccine exhibited a declining trend requiring a new booster dose. The need for vaccination in the previously infected employees was not demonstrated conclusively in this study.
- Publikační typ
- časopisecké články MeSH
Ciele práce: Cieľom práce bolo zistiť prevalenciu latentnej tuberkulózy (LTBI) u pacientov s reumatoidnou artritídou stredne ťažkého a ťažkého stupňa liečených konvenčnou a anticytokínovou terapiou, identifikovať možné rizikové faktory tuberkulózy (TB) a hodnotiť efektivitu profylaktickej liečby u pozitívne skrínovaných pacientov. Pacienti a metodika: Observačná retrospektívna štúdia so zaradením pacientov s reumatoidnou artritídou po absolvovaní skríningových vyšetrení na zistenie LTBI (röntgenologické vyšetrenie hrudníka, tuberkulínový kožný test, interferon gamma release assay test – IGRA test). Výsledky: V skupine 124 pacientov sme zistili u 7,25 % LTBI počas kombinovanej liečby konvenčným syntetickým liečbu modifikujúcim antireumatikom (csDMARD) a kortikoterapiou. U ďalších 21,77 % LTBI bola diagnostikovaná počas biologickej liečby alebo terapie inhibítorom Janusových kináz. Najvyššia incidencia LTBI bola zistená v skupine pacientov liečených inhibítormi tumor nekrotizujúceho faktoru (66,66 % z LTBI pozitívnych pacientov), avšak pozitívne skrínovaní pacienti sa vyskytli aj pri liečbe inými modalitami. Priemerná doba detekcie LTBI pozitivity bola 39,5 mesiacov (12–134 mesiacov) od začatia anticytokínovej terapie. Klinicky manifestná aktívna TB sa potvrdila u jedného pacienta. Štatistická analýza nepreukázala asociáciu medzi rizikom LTBI a vekom, pohlavím alebo liečebnou modalitou. Záver: Výsledky tejto štúdie potvrdzujú opodstatnenie skríningu a stáleho monitorovania LTBI u pacientov s RA liečených anticytokínovou terapiou. Naše aktuálne národné odporúčania sú dostatočne senzitívne na identifikáciu LTBI. Nezodpovedanou otázkou zostáva potreba skríningu a profylaktickej liečby antituberkulotikami u pacientov liečených csDMARD v kombinácii s glukokortikoidmi.
Aim: This study aims to determine the prevalence of latent tuberculosis infection (LTBI) in patients with moderate to severe rheumatoid arthritis (RA) who receive conventional and anti-cytokine therapy, to identify possible risk factors for tuberculosis (TB) and to evaluate the prophylactic treatment in positively screened patients. Patient and Methods: We conducted an observational, retrospective study in patients with RA, who underwent LTBI screening (chest X-ray, tuberculin skin test and interferon gamma release assay test – IGRA test). Results: Out of 124 patients included, 7.25% of patients were diagnosed with LTBI during the treatment with conventional synthetic anti-rheumatic drugs in combination with glucocorticoids before initiation of anti-cytokine therapy. Another 21.77% were diagnosed during treatment with biologics or Janus kinase inhibitors. We confirmed the highest incidence of LTBI in TNF-treated group (66.66% LTBI positive patients), but also found positive screening in patients treated with other modalities. The mean LTBI detection time since the initiation of anti-cytokine therapy was 39.5 months (12–134 months). Active TB with clinical manifestation has occurred in one patient. Statistical analysis did not show an association between risk of LTBI and age, sex or treatment modality. Conclusion: The results of this study confirm the necessity of LTBI screening and long-term monitoring in RA patients treated with any kind of anti-cytokine therapy. The currently used national recommendations are sufficiently sensitive to identify TB in these patients. There remains a question of screening and prophylactic antituberculosis therapy in patients treated with conventional synthetic anti-rheumatic drugs in combination with glucocorticoids.
- MeSH
- biologická terapie škodlivé účinky MeSH
- latentní tuberkulóza * diagnóza epidemiologie etiologie MeSH
- lidé MeSH
- mykobakteriózy * diagnóza epidemiologie etiologie MeSH
- retrospektivní studie MeSH
- revmatoidní artritida farmakoterapie MeSH
- test pomocí interferonu gama metody MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Slovenská republika MeSH
The aim of this serological survey was to assess the persistence of measles antibodies among health care workers (HCWs) at risk of incidental measles. A prospective study of measles-specific antibodies in serum samples obtained from a total of 2782 participants aged 19-89 years was conducted between May 2018 and December 2019. The seropositivity rate of 93.7% (95% CI: 92.4-94.9%) in fully vaccinated participants aged 19-48 years was significantly lower than that of 98.0% (95% CI: 96.5-99.0%) in participants naturally immunised before 54 years. A cohort of those born in 1971-1975, vaccinated predominantly with one dose, showed lower seropositivity persistence (86.6%) than those fully vaccinated with two doses or naturally immunised. Otherwise, seropositivity was not markedly influenced by sex, age, smoking status, overweight, obesity or concomitant disease. The presence of sufficient antibody levels in a high proportion of HCWs irrespective of the way they acquired immunity is a favourable finding for managing incidental measles; hence, in the presence of a risk of a measles outbreak, it would be possible to perform targeted vaccination of only at-risk HCWs with a history of incomplete vaccination or missing information about the way in which immunity is acquired.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- prospektivní studie MeSH
- protilátky virové MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- séroepidemiologické studie MeSH
- spalničky * MeSH
- vakcinace MeSH
- zdravotnický personál MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Předkládaná kazuistika popisuje případ bakteriemické bilaterální pneumokokové pneumonie komplikované rozvojem akutního respiračního selhání a významného fluidothoraxu u 23letého pacienta. Invazivní pneumokoková onemocnění představují i v současné době mnohdy závažně probíhající infekce, které postihují především pacienty krajních věkových skupin a nemocné s významnými komorbiditami. Přestože v ČR je očkování proti pneumokokovým onemocněním pro ohrožené rizikové skupiny hrazeno z prostředků veřejného zdravotního pojištění, i nadále zůstává proočkovanost relativně nízká. Za hlavní rizikový faktor pro rozvoj onemocnění u jinak zdravého pacienta byla v této kazuistice prokázána dlouhodobá profesní expozice svářečským dýmům. Cílem sdělení je proto upozornit odbornou veřejnost na opomíjené rizikové faktory pro rozvoj invazivního pneumokokového onemocnění, které mohou souviset s vykonávanou profesí.
Presented case report describes a bacteraemic bilateral pneumococcal pneumonia complicated by the development of acute respiratory failure and fluidothorax in a previously healthy 23 years old male. Invasive pneumococcal diseases represent often severe and complicated infections affecting especially infants, toddlers, seniors and patients with comorbidities. Despite the established programme of fully reimbursed vaccination against pneumococcal diseases for high risk groups in the Czech Republic, the vaccine uptake rates are still low. However, in this case we have identified long-term professional exposure to metal fumes as significant contributing risk factors for the development of complicated invasive pneumococcal pneumonia. The aim of presented case report is therefore to raise awareness among clinicians about neglected professional risk factors for the development of invasive pneumococcal disease.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- lidé MeSH
- mladý dospělý MeSH
- nemoci z povolání epidemiologie patofyziologie MeSH
- nozokomiální pneumonie diagnóza farmakoterapie MeSH
- péče o pacienty v kritickém stavu MeSH
- penicilin G terapeutické užití MeSH
- pleurální výpotek diagnostické zobrazování terapie MeSH
- pneumokokové infekce diagnostické zobrazování diagnóza terapie MeSH
- pneumokokové vakcíny terapeutické užití MeSH
- pneumonie pneumokoková * diagnostické zobrazování diagnóza terapie MeSH
- pracovní expozice škodlivé účinky MeSH
- svařování * MeSH
- umělé dýchání MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
