In settings where measles has been eliminated, vaccine-derived immunity may in theory wane more rapidly due to a lack of immune boosting by circulating measles virus. We aimed to assess whether measles vaccine effectiveness (VE) waned over time, and if so, whether differentially in measles-eliminated and measles-endemic settings.We performed a systematic literature review of studies that reported VE and time since vaccination with measles-containing vaccine (MCV). We extracted information on case definition (clinical symptoms and/or laboratory diagnosis), method of vaccination status ascertainment (medical record or vaccine registry), as well as any biases which may have arisen from cold chain issues and a lack of an age at first dose of MCV. We then used linear regression to evaluate VE as a function of age at first dose of MCV and time since MCV.After screening 14,782 citations, we identified three full-text articles from measles-eliminated settings and 33 articles from measles-endemic settings. In elimination settings, two-dose VE estimates increased as age at first dose of MCV increased and decreased as time since MCV increased; however, the small number of studies available limited interpretation. In measles-endemic settings, one-dose VE increased by 1.5% (95% CI 0.5, 2.5) for every month increase in age at first dose of MCV. We found no evidence of waning VE in endemic settings.The paucity of data from measles-eliminated settings indicates that additional studies and approaches (such as studies using proxies including laboratory correlates of protection) are needed to answer the question of whether VE in measles-eliminated settings wanes. Age at first dose of MCV was the most important factor in determining VE. More VE studies need to be conducted in elimination settings, and standards should be developed for information collected and reported in such studies.
Background: Evidence shows that individuals achieving AHA’s “Life’s Simple 7” cardiovascular health metrics have significantly reduced risk of CVD incidence and mortality. Geographic variation in CVD risk factors has been previously described. We sought to determine whether CV risk as defined by optimal CV health metrics varied geographically among women. Methods: In 2009, Sister to Sister provided free cardiovascular screenings to 9,442 women in 12 cities, including Atlanta, Baltimore, Boston, Chicago, Dallas, Detroit, Jacksonville, Los Angeles, Miami, St. Louis, Tampa, and Washington, DC. Using biometric data collected from screenings supplemented by surveys on CVD risk, we analyzed variance in the “Simple 7” cardiovascular metrics by city. These metrics were defined as being physically active, having normal blood pressure, weight and blood glucose and total cholesterol levels, and eating a healthy diet. We used 6 of these 7 metrics, excluding diet, to assign each city with a risk score. Results: Few cities were at optimal health. On average, cities achieved 3.8 out of 6 cardiovascular metrics. From a regional perspective, Atlanta, Dallas and Detroit were significantly lower, and Boston and St. Louis were significantly higher than the city-wide average (see figure 1). Conclusion: Significant geographic variation exists in proportion of individuals achieving “ideal CV health” as measured by the AHA’s “Life’s Simple 7”. Given this, solutions to improve community based CV risk will need to be tailored by region.
The risk of myocarditis or pericarditis after COVID-19 messenger RNA vaccines varies by age and sex, and there is some evidence to suggest increasing risk with shorter intervals between dose 1 and 2 (ie, interdose interval).To estimate the incidence of reported myocarditis or pericarditis after BNT162b2 vaccine among adolescents and to describe the clinical information associated with these events.This was a population-based cohort study using passive vaccine safety surveillance data linked to the provincial COVID-19 vaccine registry. Included in the study were all adolescents aged 12 to 17 years in Ontario, Canada, who received 1 or more doses of BNT162b2 vaccine between December 14, 2020, and November 21, 2021, and reported an episode of myocarditis or pericarditis. Data were analyzed from December 15, 2021, to April 22, 2022.Receipt of BNT162b2 (Comirnaty [Pfizer-BioNTech]) vaccine.Reported incidence of myocarditis or pericarditis meeting level 1 to 3 of the Brighton Collaboration case definition per 100 000 doses of BNT162b2 administered by age group (12-15 years vs 16-17 years), sex, dose number, and interdose interval. All clinical information associated with symptoms, health care usage, diagnostic test results, and treatment at the time of the acute event were summarized.There were approximately 1.65 million doses of BNT162b2 administered and 77 reports of myocarditis or pericarditis among those aged 12 to 17 years, which met the inclusion criteria during the study period. Of the 77 adolescents (mean [SD] age, 15.0 [1.7] years; 63 male individuals [81.8%]), 51 (66.2%) developed myocarditis or pericarditis after dose 2 of BNT162b2. Overall, 74 individuals (96.1%) with an event were assessed in the emergency department, and 34 (44.2%) were hospitalized (median [IQR] length of stay, 1 [1-2] day). The majority of adolescents (57 [74.0%]) were treated with nonsteroidal anti-inflammatory drugs only, and 11 (14.3%) required no treatment. The highest reported incidence was observed among male adolescents aged 16 to 17 years after dose 2 (15.7 per 100 000; 95% CI, 9.7-23.9). Among those aged 16 to 17 years, the reporting rate was highest in those with a short (ie, ≤30 days) interdose interval (21.3 per 100 000; 95% CI, 11.0-37.2).Results of this cohort study suggest that there was variation in the reported incidence of myocarditis or pericarditis after BNT162b2 vaccine among adolescent age groups. However, the risk of these events after vaccination remains very rare and should be considered in relation to the benefits of COVID-19 vaccination.
To present a new measure, the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES), with evidence for its reliability and validity in a normative study. The FAVRES is designed to evaluate the subtle cognitive-communication deficits of individuals with ABI.The FAVRES consists of four complex, contextually rich, verbal reasoning tasks that simulate everyday situations and require processing of text and discourse. Scoring considers the time, accuracy and justification of reasoning responses. The FAVRES scores of 52 adults with ABI were compared to those of 101 adults without ABI.FAVRES scores clearly differentiated the performances of individuals with and without ABI. Individuals with ABI were slower and less accurate in reasoning and presented fewer adequate rationales for their decisions. Inter-rater reliability for scoring was acceptable.The FAVRES provides a reliable, functional and quantifiable measure of the cognitive-communication difficulties of individuals with ABI.
Flying robots capable of perch-and-stare are desirable for reconnaissance missions. Current solutions for perch-and-stare applications utilize various methods to create an aircraft that can land on a limited set of surfaces that are typically horizontal or vertical planes. This paper presents a bio-inspired concept that allows for passive perching on cylindrical-type surfaces. The prototype provides compliant gripping through the use of an underactuated foot. A mechanism inspired by songbird anatomy is integrated that utilizes rotorcraft weight as a way to passively actuate the foot. Successful perching trials on two rods of differing diameters were performed and are discussed. The purpose of this initial design is to act as a proof of concept for the mechanical action of the mechanism; our results demonstrate that passive perching can be achieved through the integration of underactuated gripping with mechanism-generated mechanical advantage.
Adolescents make decisions about their own vaccinations and will be the childhood vaccine decision makers of tomorrow. It is therefore essential to educate adolescents about the risks of vaccine-preventable diseases and immunization safety. This study evaluated the impact of an interactive education initiative among adolescents at a high school in North Bay Ontario.An anonymized questionnaire to assess students' knowledge, attitudes and beliefs about immunization and vaccine-preventable diseases was administered before and after delivering an interactive session. Chi-squared and Kruskal-Wallis tests were performed to test for differences between pre and post responses.The intervention increased the students' awareness that measles is a disease that affects their generation (P < 0.05). Improvements were also noted in the perceived risk of pertussis (P < 0.05) and tetanus (0.05). After the session, respondents were also more willing to participate with their parents in decisions affecting their healthcare (P < 0.05). Students' perception of vaccine safety also improved (P < 0.001).Post survey results suggest that the interactive educational intervention had a positive effect on the adolescents' perceptions and attitudes towards immunization. Further research is required to determine the impact of this type of intervention on adolescents' future decision-making with respect to immunization.
Increased rates of myocarditis or pericarditis following receipt of COVID-19 mRNA vaccines have been observed. However, few available data are associated with differences in rates of myocarditis or pericarditis specific to vaccine products, which may have important implications for vaccination programs.
Objective
To estimate rates of reported myocarditis or pericarditis following receipt of a COVID-19 mRNA vaccine by product, age, sex, dose number, and interdose interval.
Design, Setting, and Participants
This population-based cohort study was conducted in Ontario, Canada (population: 14.7 million) from December 2020 to September 2021 and used data from Ontario's COVID-19 vaccine registry and passive vaccine-safety surveillance system. All individuals in Ontario, Canada, who received at least 1 dose of COVID-19 mRNA vaccine between December 14, 2020, and September 4, 2021, and had a reported episode of myocarditis or pericarditis following receipt of the COVID-19 vaccine during this period were included. We obtained information on all vaccine doses administered in the province to calculate reported rates of myocarditis or pericarditis.
Exposures
Receipt of a COVID-19 mRNA vaccine (mRNA-1273 [Moderna Spikevax] or BNT162b2 [Pfizer-BioNTech Comirnaty]).
Main Outcomes and Measures
All reports of myocarditis or pericarditis meeting levels 1 to 3 of the Brighton Collaboration case definitions were included. Rates and 95% CIs of reported cases of myocarditis or pericarditis per 1 000 000 mRNA vaccine doses administered were calculated by age, sex, dose number, vaccine product, and interdose interval.
Results
Among 19 740 741 doses of mRNA vaccines administered, there were 297 reports of myocarditis or pericarditis meeting the inclusion criteria; 228 (76.8%) occurred in male individuals, and the median age of individuals with a reported event was 24 years (range, 12-81 years). Of the reported cases, 207 (69.7%) occurred following the second dose of the COVID-19 mRNA vaccine. When restricted to individuals who received their second dose during the period of enhanced passive surveillance (on or after June 1, 2021), the highest rate of myocarditis or pericarditis was observed in male individuals aged 18 to 24 years following mRNA-1273 as the second dose (299.5 cases per 1 000 000 doses; 95% CI, 171.2-486.4 cases per 1 000 000 doses); the rate following BNT162b2 as the second dose was 59.2 cases per 1 000 000 doses (95% CI, 19.2-138.1 cases per 1 000 000 doses). Overall rates for both vaccine products were significantly higher when the interdose interval was 30 or fewer days (BNT162b2: 52.1 cases per 1 000 000 doses [95% CI, 31.8-80.5 cases per 1 000 000 doses]; mRNA-1273: 83.9 cases per 1 000 000 doses [95% CI, 47.0-138.4 cases per 1 000 000 doses]) compared with 56 or more days (BNT162b2: 9.6 cases per 1 000 000 doses [95% CI, 6.5-13.6 cases per 1 000 000 doses]; mRNA-1273: 16.2 cases per 1 000 000 doses [95% CI, 10.2-24.6 cases per 1 000 000 doses]).
Conclusions and Relevance
The findings of this population-based cohort study of Ontario adolescents and adults with myocarditis or pericarditis following mRNA COVID-19 vaccination suggest that vaccine products and interdose intervals, in addition to age and sex, may be associated with the risk of myocarditis or pericarditis after receipt of these vaccines. Vaccination program strategies, such as age-based product considerations and longer interdose intervals, may reduce the risk of myocarditis or pericarditis following receipt of mRNA vaccines.
