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Acquisition of extended spectrum ß-lactamases during travel abroad-A qualitative study among Swedish travellers examining their knowledge, risk assessment, and behaviour.

https://arctichealth.org/en/permalink/ahliterature282072
Source
Int J Qual Stud Health Well-being. 2016;11:32378
Publication Type
Article
Date
2016
Author
Susanne Wiklund
Ingegerd Fagerberg
Åke Örtqvist
Kristina Broliden
Ann Tammelin
Source
Int J Qual Stud Health Well-being. 2016;11:32378
Date
2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anti-Bacterial Agents
Bacterial Infections
Bacterial Proteins
Carrier state
Drug Resistance, Bacterial
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Prevalence
Qualitative Research
Risk assessment
Risk-Taking
Sweden
Travel
beta-Lactamases
Abstract
Travel to foreign countries involves the risk of becoming a carrier of antibiotic-resistant bacteria, especially when the destination is a country with a high prevalence of this type of bacteria.
The aim of this study was to learn about the knowledge of antibiotic resistance, and the behaviour and risk-taking among travellers, who had become carriers of extended spectrum beta-lactamases (ESBL)-producing bacteria during travel to a high-prevalence country. A modified version of grounded theory was used to analyse 15 open interviews.
The analysis resulted in a core category: A need for knowledge to avoid risk-taking. Before the journey, the participants did not perceive there to be any risk of becoming a carrier of antibiotic- resistant bacteria. The low level of knowledge of antibiotic-resistant bacteria and transmission routes influenced their behaviour and risk-taking during their journey, resulting in them exposing themselves to risk situations. After their trip, the majority did not believe that their personal risk behaviour could have caused them to become carriers of ESBL.
The participants' lack of knowledge of antibiotic-resistant bacteria resulted in unconscious risk-taking during their journey, which may have resulted in becoming carriers of ESBL-producing bacteria.
Notes
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PubMed ID
27806830 View in PubMed
Less detail

Clinical manifestations of invasive pneumococcal disease by vaccine and non-vaccine types.

https://arctichealth.org/en/permalink/ahliterature264841
Source
Eur Respir J. 2014 Dec;44(6):1646-57
Publication Type
Article
Date
Dec-2014
Author
Sarah Browall
Erik Backhaus
Pontus Naucler
Ilias Galanis
Karin Sjöström
Diana Karlsson
Stefan Berg
Joachim Luthander
Margareta Eriksson
Carl Spindler
Mikael Ejdebäck
Birger Trollfors
Jessica Darenberg
Mats Kalin
Ake Örtqvist
Rune Andersson
Birgitta Henriques-Normark
Source
Eur Respir J. 2014 Dec;44(6):1646-57
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Carrier state
Child
Child, Preschool
Cohort Studies
Comorbidity
DNA, Bacterial - analysis
Diabetes Mellitus - epidemiology
Female
Hematologic Neoplasms - epidemiology
Humans
Infant
Infant, Newborn
Logistic Models
Lung Diseases - epidemiology
Male
Meningitis, Pneumococcal - epidemiology - microbiology - prevention & control
Middle Aged
Molecular Epidemiology
Odds Ratio
Pneumococcal Infections - epidemiology - microbiology - prevention & control
Pneumococcal Vaccines - immunology - therapeutic use
Pneumonia, Pneumococcal - epidemiology - microbiology - prevention & control
Serogroup
Serotyping
Streptococcus pneumoniae - genetics - immunology - isolation & purification
Sweden - epidemiology
Young Adult
Abstract
Pneumococcal conjugated vaccines (PCVs) have shown protection against invasive pneumococcal disease by vaccine serotypes, but an increase in non-vaccine serotype disease has been observed. Type-specific effects on clinical manifestation need to be explored. Clinical data from 2096 adults and 192 children with invasive pneumococcal disease were correlated to pneumococcal molecular serotypes. Invasive disease potential for pneumococcal serotypes were calculated using 165 invasive and 550 carriage isolates from children. The invasive disease potential was lower for non-PCV13 compared to vaccine-type strains. Patients infected with non-PCV13 strains had more underlying diseases, were less likely to have pneumonia and, in adults, tended to have a higher mortality. Furthermore, patients infected with pneumococci belonging to clonal serotypes only expressing non-PCV13 capsules had a higher risk for septicaemia and mortality. PCV vaccination will probably lead to a decrease in invasive pneumococcal disease but an alteration in the clinical manifestation of invasive pneumococcal disease. Genetic lineages causing invasive pneumococcal disease in adults often express non-vaccine serotypes, which can expand after vaccination with an increased risk of infection in patients with underlying diseases.
PubMed ID
25323223 View in PubMed
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Clinical presentation of intussusception in Swedish children under 3 years of age and the validity of diagnostic coding.

https://arctichealth.org/en/permalink/ahliterature299602
Source
Pediatr Surg Int. 2019 Mar; 35(3):373-381
Publication Type
Journal Article
Date
Mar-2019
Author
Lina Schollin Ask
Jan F Svensson
Ola Olén
Åke Örtqvist
Author Affiliation
Sach´s Children and Youth Hospital, South General Hospital, Sjukhusbacken 10, 118 83, Stockholm, Sweden. lina.schollin-ask@sll.se.
Source
Pediatr Surg Int. 2019 Mar; 35(3):373-381
Date
Mar-2019
Language
English
Publication Type
Journal Article
Keywords
Child
Child, Preschool
Female
Hospitalization - trends
Humans
Incidence
Infant
Intussusception - diagnosis - epidemiology
Male
Radiography, Abdominal - methods
Registries
Retrospective Studies
Sweden - epidemiology
Abstract
Intussusception has been associated with rotavirus vaccine. The rotavirus vaccine will soon be introduced in the Swedish national immunization program. A validation of the diagnosis of intussusception among Swedish children in the Swedish National Patient Register is needed, as a basis for future vaccine safety surveillance by Swedish registers.
This diagnostic study reviewed the medical admission records of 392 Swedish children with intussusception from 1987 to 2013. The records were randomly selected by The National Board of Health and Welfare from all Sweden and from both pediatric and pediatric surgery care. Positive predictive values (PPV) were calculated to study the concordance between the diagnosis coded in the Swedish Patient Register and the accepted international criteria of case definitions.
The PPV for a definitive diagnosis, based on certain radiology findings or surgery, was 84%. When clinically probable cases were added the PPV was 87%. When cases of possible intussusception were added the PPV was 89%. The PPV for the 240 children under 1 year was 88%.
Swedish health care registers can be used in the evaluation of incidences of intussusception when rotavirus vaccine will be introduced, due to a high validity of the diagnosis of intussusception in the registers.
PubMed ID
30478702 View in PubMed
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Contribution of host, bacterial factors and antibiotic treatment to mortality in adult patients with bacteraemic pneumococcal pneumonia.

https://arctichealth.org/en/permalink/ahliterature116023
Source
Thorax. 2013 Jun;68(6):571-9
Publication Type
Article
Date
Jun-2013
Author
Pontus Naucler
Jessica Darenberg
Eva Morfeldt
Ake Ortqvist
Birgitta Henriques Normark
Author Affiliation
Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden. pontus.naucler@ki.se
Source
Thorax. 2013 Jun;68(6):571-9
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Antigens, Bacterial - immunology
Bacteremia - drug therapy - epidemiology - microbiology
Community-Acquired Infections - drug therapy - microbiology - mortality
Female
Hospital Mortality - trends
Humans
Male
Middle Aged
Pneumonia, Pneumococcal - drug therapy - microbiology - mortality
Prognosis
Risk factors
Streptococcus pneumoniae - immunology - isolation & purification
Survival Rate - trends
Sweden - epidemiology
Treatment Outcome
Abstract
Host and bacterial factors as well as different treatment regimens are likely to influence the outcome in patients with bacteraemic pneumococcal pneumonia.
To estimate the relative contribution of host factors as well as bacterial factors and antibiotic treatment to mortality in bacteraemic pneumococcal pneumonia.
A cohort study of 1580 adult patients with community-acquired bacteraemic pneumococcal pneumonia was conducted between 2007 and 2009 in Sweden. Data on host factors and initial antibiotic treatment were collected from patient records. Antibiotic resistance and serotype were determined for bacterial isolates. Logistic regression analyses were performed to assess risk factors for 30-day mortality.
Smoking, alcohol abuse, solid tumour, liver disease and renal disease attributed to 14.9%, 13.1%, 13.1%, 8.0% and 7.4% of the mortality, respectively. Age was the strongest predictor, and mortality increased exponentially from 1.3% in patients
PubMed ID
23442364 View in PubMed
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Cost-effectiveness of pneumococcal vaccination for elderly in Sweden.

https://arctichealth.org/en/permalink/ahliterature312047
Source
Vaccine. 2020 07 06; 38(32):4988-4995
Publication Type
Journal Article
Date
07-06-2020
Author
Ellen Wolff
Jann Storsaeter
Åke Örtqvist
Pontus Naucler
Sofie Larsson
Tiia Lepp
Adam Roth
Author Affiliation
Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Medicinarergatan 18A, Box 463, 405 30 Göteborg, Sweden. Electronic address: ellen.wolff@folkhalsomyndigheten.se.
Source
Vaccine. 2020 07 06; 38(32):4988-4995
Date
07-06-2020
Language
English
Publication Type
Journal Article
Keywords
Aged
Cost-Benefit Analysis
Humans
Immunization Programs
Pneumococcal Infections - epidemiology - prevention & control
Pneumococcal Vaccines
Quality-Adjusted Life Years
Sweden - epidemiology
Vaccination
Abstract
The aim was to assess cost-effectiveness of including pneumococcal vaccination for elderly in a national vaccination programme in Sweden, comparing health-effects and costs of pneumococcal related diseases with a vaccination programme versus no vaccination.
We used a single-cohort deterministic decision-tree model to simulate the current burden of pneumococcal disease in Sweden. The model accounted for invasive pneumococcal disease (IPD) and pneumonia caused by pneumococci. Costs included in the analysis were those incurred when treating pneumococcal disease, and acquisition and administration of the vaccine. Health effects were measured as quality-adjusted life years (QALY). The time-horizon was set to five years, both effects and costs were discounted by 3% annually. Health-effects and costs were accumulated over the time-horizon and used to create an incremental cost-effectiveness ratio. The 23-valent polysaccharide vaccine (PPV23) was used in the base-case analysis. The 13-valent pneumococcal conjugate vaccine PCV13 was included in sensitivity analyses.
A vaccination programme using PPV23 would reduce the burden of pneumococcal related disease significantly, both when vaccinating a 65-year-old cohort and a 75-year-old cohort. IPD would decrease by 30% in the 65-year-old cohort, and by 29% in the 75-year-old cohort. The corresponding figures for CAP (communicable acquired pneumonia) are 19% and 15%. The cost per gained QALY was estimated to EUR 94,000 for vaccinating 65-year-olds and EUR 29,500 for 75-year-olds. With one dose PCV13 given instead of PPV23, the cost per gained QALY would increase by around 400% for both cohorts. The results were robust in sensitivity analyses.
Introducing a vaccination programme against pneumococcal disease for 65-year-olds in Sweden is unlikely to be cost-effective, whereas it for 75 year-olds and using PPV23 can be considered good value for money. Our model indicates that vaccine price needs to be reduced by 55% for vaccination of 65-year-olds to be cost-effective, given a threshold of EUR 50,000.
PubMed ID
32536548 View in PubMed
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Effectiveness of an adjuvanted monovalent vaccine against the 2009 pandemic strain of influenza A(H1N1)v, in Stockholm County, Sweden.

https://arctichealth.org/en/permalink/ahliterature135127
Source
Clin Infect Dis. 2011 May;52(10):1203-11
Publication Type
Article
Date
May-2011
Author
Ake Ortqvist
Ingela Berggren
Mona Insulander
Birgitta de Jong
Bo Svenungsson
Author Affiliation
Department of Communicable Diseases Control and Prevention, Stockholm County, Sweden. ake.ortqvist@sll.se
Source
Clin Infect Dis. 2011 May;52(10):1203-11
Date
May-2011
Language
English
Publication Type
Article
Keywords
Adjuvants, Immunologic - administration & dosage
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Cohort Studies
Female
Humans
Infant
Influenza A Virus, H1N1 Subtype - immunology
Influenza Vaccines - administration & dosage - immunology
Influenza, Human - prevention & control
Male
Middle Aged
Prospective Studies
Sweden
Treatment Outcome
Young Adult
Abstract
Vaccination against the pandemic influenza A(H1N1)v was performed in many countries during 2009, but population-based data on vaccine effectiveness are lacking.
We conducted a prospective cohort study involving all inhabitants in Stockholm County (n = 2,019,183) who were offered a monovalent AS03-adjuvanted influenza A(H1N1)v vaccine (Pandemrix, GSK), between 12 October and 31 December 2009. Overall vaccine coverage was 52%. A Web-based register with data on all vaccinated was linked by unique personal identification number to mandatory reports of influenza A(H1N1)v diagnoses. Vaccine failure was defined as a diagnosis or admission to hospital because of influenza >14 days after vaccination. Risk factors associated with vaccine failure were investigated by conditional stepwise logistic regression in a nested case-control study. The weekly incidence rate ratio for being diagnosed with influenza among vaccinated versus nonvaccinated persons was calculated.
Vaccine failure was seen in 25 patients, 11 children and 14 adults, of 2594 patients diagnosed with influenza A(H1N1)v. Compared with age-matched controls, patients with vaccine failure were more often immunocompromised (Hazard Ratio, 4.89; 95% confidence interval [CI], 2.19-10.89). During the 4 weeks with maximum influenza activity, the relative risk per week for an influenza A(H1N1)v diagnosis in the vaccinated population was .06 (95% CI .008-.41), .13 (95% CI .06-.27), .05 (95% CI .02-.12), and .07 (95% CI .03-.15), respectively, corresponding to a weekly vaccine effectiveness of 87-95%.
The monovalent AS03-adjuvanted influenza vaccine was highly effective in prevention of the pandemic influenza in Stockholm County. A single dose seemed to be sufficient in most, both children and adults, except in immunocompromised hosts.
PubMed ID
21507917 View in PubMed
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Effectiveness of the monovalent AS03-adjuvanted influenza A(H1N1)pdm09 vaccine against hospitalization in children because of influenza.

https://arctichealth.org/en/permalink/ahliterature122416
Source
Vaccine. 2012 Aug 24;30(39):5699-702
Publication Type
Article
Date
Aug-24-2012
Author
Ake Ortqvist
Rutger Bennet
Malin Ryd Rinder
Hans Lindblad
Margareta Eriksson
Author Affiliation
Karolinska Institutet, Department of Medicine, Unit of Infectious Diseases, Karolinska Solna, Sweden. ake.ortqvist@sll.se
Source
Vaccine. 2012 Aug 24;30(39):5699-702
Date
Aug-24-2012
Language
English
Publication Type
Article
Keywords
Adjuvants, Immunologic - administration & dosage
Adolescent
Case-Control Studies
Child
Child, Preschool
Hospitalization - statistics & numerical data
Humans
Infant
Influenza A Virus, H1N1 Subtype
Influenza Vaccines
Influenza, Human - epidemiology - prevention & control
Retrospective Studies
Sweden - epidemiology
Vaccination - statistics & numerical data
Abstract
We studied the effectiveness of the AS03-adjuvanted monovalent vaccine (Pandemrix(®)) for the prevention of severe pandemic influenza A(H1N1)pdm09 in children, in 2009. All children hospitalized for influenza-like illness in Stockholm County during the peak of the pandemic were included. We compared the frequency of vaccinated children between influenza A(H1N1)pdm09 PCR positive cases and PCR negative controls in a retrospective case-control study. 95 cases and 177 controls were identified. About half of the children in both groups were between 6 months and 2 years of age. Only 1/95 (1%) cases had been vaccinated more than 14 days prior to admission, compared to 23/177 controls (13%), corresponding to a vaccine effectiveness, adjusted for co-morbid conditions, of 91% (95% confidence interval [CI] 30-99). In contrast, the risk for being a case was significantly higher among children vaccinated between 1 and 14 days prior to hospitalization, than among those who were non-vaccinated 13/95 vs. 7/177 (OR 3.6, 95% CI 1.4-9.5). We conclude that a single dose of adjuvanted vaccine was highly protective against hospitalization for influenza A(H1N1)pdm09 in children 6 month to 17 years. The reason for the increased rate of hospitalizations with confirmed influenza in children just following immunization is unclear and should be studied further.
PubMed ID
22819987 View in PubMed
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Imported methicillin-resistant Staphylococcus aureus, Sweden.

https://arctichealth.org/en/permalink/ahliterature98215
Source
Emerg Infect Dis. 2010 Feb;16(2):189-96
Publication Type
Article
Date
Feb-2010
Author
Mikael Stenhem
Ake Ortqvist
Hakan Ringberg
Leif Larsson
Barbro Olsson Liljequist
Sara Haeggman
Mats Kalin
Karl Ekdahl
Author Affiliation
Swedish Institute for Infectious Disease Control, Solna, Sweden.
Source
Emerg Infect Dis. 2010 Feb;16(2):189-96
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adoption
Adult
Aged
Carrier State - epidemiology
Child
Child, Preschool
Community-Acquired Infections - epidemiology
Female
Genotype
Humans
Infant
Male
Methicillin-Resistant Staphylococcus aureus - genetics - isolation & purification
Middle Aged
Odds Ratio
Prevalence
Staphylococcal Infections - epidemiology
Sweden - epidemiology
Travel
Young Adult
Abstract
Countries such as Sweden that have a low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) offer the opportunity to discern and study transmission of imported cases of MRSA. We analyzed 444 imported cases of MRSA acquisition reported in Sweden during 2000-2003. Risk for MRSA in returning travelers ranged from 0.1 (95% confidence interval [CI] 0.01-0.4) per 1 million travelers to Nordic countries to 59.4 (95% CI 44.5-79.3) per 1 million travelers to North Africa and the Middle East. Most imported cases (246, 55%) were healthcare acquired, but regions with the highest risk for MRSA in travelers showed a correlation with community acquisition (r = 0.81, p = 0.001). Characteristic differences in MRSA strains acquired were dependent on the region from which they originated and whether they were community or healthcare acquired. Knowledge of differences in transmission of MRSA may improve control measures against imported cases.
PubMed ID
20113546 View in PubMed
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Influenza epidemiology among hospitalized children in Stockholm, Sweden 1998-2014.

https://arctichealth.org/en/permalink/ahliterature286770
Source
Vaccine. 2016 Jun 14;34(28):3298-302
Publication Type
Article
Date
Jun-14-2016
Author
Rutger Bennet
Johan Hamrin
Benita Zweygberg Wirgart
Maria Rotzén Östlund
Åke Örtqvist
Margareta Eriksson
Source
Vaccine. 2016 Jun 14;34(28):3298-302
Date
Jun-14-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Age Distribution
Child
Child, Hospitalized
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Influenza A Virus, H1N1 Subtype
Influenza A Virus, H3N2 Subtype
Influenza B virus
Influenza, Human - epidemiology
Intensive Care Units, Pediatric
Male
Retrospective Studies
Sweden - epidemiology
Abstract
Influenza remains a common reason for the hospitalization of children. There is a need for long term studies that are also population based. We describe the epidemiology of severe influenza in a defined population 1998-2014.
Retrospective study of annually collected data of virologically confirmed influenza in hospitalized children 0-17 years living in the catchment area (230,000 children). We gathered information about comorbidity and complications from case records, and compared Influenza A, B and A(H1N1)pdm09 with respect to these factors.
A total of 922 children with influenza were hospitalized. The mean rate remained unchanged at 22.5-24.2 per 100,000 children per year. There were two major outbreaks: influenza A(H3N2) in 2003-2004 and the A(H1N1) pandemic in 2009-2010. The proportion of children with influenza B increased from 8% during the first half of the study period to 28% during the second half. The highest admission rate was found in children
PubMed ID
27155498 View in PubMed
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26 records – page 1 of 3.