Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is an opportunistic pathogen... more Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is an opportunistic pathogen that colonizes the gastrointestinal and genitourinary tracts of up to 50% of healthy adults and newborns; it is responsible for significant morbidity and mortality. Early detection can be used to establish the use of antibiotic prophylaxis to significantly reduce neonatal sepsis. This article reviews methods of detection and prevention of GBS infection in the neonate.
The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie médicale / AMMI Canada, 2006
Although decennial adult boosters of tetanus and diphtheria toxoids are recommended in Canada and... more Although decennial adult boosters of tetanus and diphtheria toxoids are recommended in Canada and the United States, a second dose of pertussis vaccine is not currently recommended for adults. This open-label, postmarketing, multicenter study evaluated the tolerability and immunogenicity of a second dose of an adult formulation of tetanus, diphtheria, and pertussis vaccine (Tdap) in adolescents and adults 5 years after a first dose. A total of 545 participants from previous Tdap vaccine studies, ranging in age from 15 to 69 years, participated in this study. Of these participants, 94.2% had at least one solicited adverse event after the booster dose such as injection-site erythema (28.6%), swelling (25.6%), or pain (87.6%) or a systemic adverse event such as myalgia (61.0%), headache (53.2%), malaise (38.2%), or fever (6.5%). These adverse events were slightly more frequent than after the initial dose. Postvaccination, 100% of participants had a tetanus antibody level ≥0.10IU/mL and 95% had a diphtheria antibody level ≥0.10IU/mL. For pertussis, 82.1% (pertussis toxoid), 96.7% (filamentous hemagglutinin), 95.6% (pertactin), and 99.8% (fimbriae) had a postvaccination antibody threshold of ≥50EU/mL. A second dose of Tdap vaccine 5 years after the initial dose was well tolerated and immunogenic in adolescents and adults.
An 8-week-old female infant presented with a history of active varicella complicated by Escherich... more An 8-week-old female infant presented with a history of active varicella complicated by Escherichia coli sepsis, oral thrush, hypoalbuminemia, intermittent fevers, diarrhea and feeding intolerance. Rhesus monkey kidney cells inoculated with cerebrospinal fluid revealed reovirus-like particles by electron microscopy. Virus neutralization and RNA-gel electrophoresis studies identified the isolated pathogen as reovirus serotype 2. This report represents one of only a few to isolate reovirus from the central nervous system in humans.
To estimate the prevalence of pediatric health care-associated infections (HAI) in Canadian acute... more To estimate the prevalence of pediatric health care-associated infections (HAI) in Canadian acute care hospitals. A point-prevalence study conducted in February 2002 in 25 hospitals across Canada. Information on HAI, utilization of antimicrobial agents and invasive devices, isolation precautions, and microbial etiology was collected. Nine hundred ninety-seven children were surveyed. Ninety-one HAI were detected in 80 patients for a prevalence of 91 per 1000 patients surveyed. Bloodstream infections were the most common HAI (3% of patients; 34% of all HAI). The prevalence of patients with HAI was 8%, ranging from 0% in trauma/bum units to 19% in the pediatric intensive care units, and 27% in transplant units. By multivariate logistic regression analysis, having a central venous catheter (OR, 2.54; 95% CI, 1.46-4.40) or endotracheal tube with mechanical ventilation (OR, 2.59; 95% CI, 1.16-5.76) were independently associated with an HAI, as were being in isolation (OR, 2.90; 95% CI, 1.54-5.45), and receiving antimicrobial agents (OR, 9.27; 95% CI, 4.71-18.52). In this first national point-prevalence study in Canada, the prevalence of HAI was similar to that reported in other industrialized countries. These data will also be useful to provide an estimate of the health burden of pediatric HAI in Canada.
To identify factors affecting HIV-1 breastfeeding transmission. Longitudinal observational cohort... more To identify factors affecting HIV-1 breastfeeding transmission. Longitudinal observational cohort study. HIV-1 seropositive pregnant women and seronegative controls were enrolled at a maternity hospital in Nairobi. Women and their children were followed from birth, and data on HIV-1 transmission, breastfeeding, clinical illness, and growth were collected. Specimens for HIV-1 serology and/or polymerase chain reaction were obtained at birth, 2, 6, and 14 weeks, 6, 9, 12, and 18 months, and every 6 months thereafter. Children were classified as HIV-1 uninfected, perinatally, or postnatally infected. Potentially breastfeeding transmission related risk factors were compared between postnatally infected and uninfected children. Among children born to seropositive or seroconverting mothers, 317 were uninfected, 51 infected perinatally and 42 infected postnatally. Identified risk factors for postnatal transmission were maternal nipple lesions (OR = 2.3, CI 95% 1.1-5.0), mastitis (OR = 2.7, CI 95% 1.1-6.7), maternal CD4 cell count < 400 mm3 (OR = 4.4, CI 95% 1.9-9.9), maternal seroconversion while breastfeeding (OR = 6.0, CI 95% 1.8-19.8), infant oral thrush at < 6 months of age (OR = 2.8, CI 95% 1.3-6.2) and breastfeeding longer than 15 months (OR = 2.4, CI 95% 1.2-5.1). All factors, except maternal seroconversion due to its rarity, were independently associated with an increased postnatal transmission risk by multivariate logistic regression analysis. In addition perinatal antiretroviral therapies, public health strategies should address: (i) prevention of maternal nipple lesions, mastitis and infant thrush; (ii) reduction of breastfeeding duration by all HIV-1-infected mothers; (iii) absolute avoidance of breastfeeding by those at high risk, and (iv) prevention of HIV-1 transmission to breastfeeding mothers.
Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is an opportunistic pathogen... more Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is an opportunistic pathogen that colonizes the gastrointestinal and genitourinary tracts of up to 50% of healthy adults and newborns; it is responsible for significant morbidity and mortality. Early detection can be used to establish the use of antibiotic prophylaxis to significantly reduce neonatal sepsis. This article reviews methods of detection and prevention of GBS infection in the neonate.
The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie médicale / AMMI Canada, 2006
Although decennial adult boosters of tetanus and diphtheria toxoids are recommended in Canada and... more Although decennial adult boosters of tetanus and diphtheria toxoids are recommended in Canada and the United States, a second dose of pertussis vaccine is not currently recommended for adults. This open-label, postmarketing, multicenter study evaluated the tolerability and immunogenicity of a second dose of an adult formulation of tetanus, diphtheria, and pertussis vaccine (Tdap) in adolescents and adults 5 years after a first dose. A total of 545 participants from previous Tdap vaccine studies, ranging in age from 15 to 69 years, participated in this study. Of these participants, 94.2% had at least one solicited adverse event after the booster dose such as injection-site erythema (28.6%), swelling (25.6%), or pain (87.6%) or a systemic adverse event such as myalgia (61.0%), headache (53.2%), malaise (38.2%), or fever (6.5%). These adverse events were slightly more frequent than after the initial dose. Postvaccination, 100% of participants had a tetanus antibody level ≥0.10IU/mL and 95% had a diphtheria antibody level ≥0.10IU/mL. For pertussis, 82.1% (pertussis toxoid), 96.7% (filamentous hemagglutinin), 95.6% (pertactin), and 99.8% (fimbriae) had a postvaccination antibody threshold of ≥50EU/mL. A second dose of Tdap vaccine 5 years after the initial dose was well tolerated and immunogenic in adolescents and adults.
An 8-week-old female infant presented with a history of active varicella complicated by Escherich... more An 8-week-old female infant presented with a history of active varicella complicated by Escherichia coli sepsis, oral thrush, hypoalbuminemia, intermittent fevers, diarrhea and feeding intolerance. Rhesus monkey kidney cells inoculated with cerebrospinal fluid revealed reovirus-like particles by electron microscopy. Virus neutralization and RNA-gel electrophoresis studies identified the isolated pathogen as reovirus serotype 2. This report represents one of only a few to isolate reovirus from the central nervous system in humans.
To estimate the prevalence of pediatric health care-associated infections (HAI) in Canadian acute... more To estimate the prevalence of pediatric health care-associated infections (HAI) in Canadian acute care hospitals. A point-prevalence study conducted in February 2002 in 25 hospitals across Canada. Information on HAI, utilization of antimicrobial agents and invasive devices, isolation precautions, and microbial etiology was collected. Nine hundred ninety-seven children were surveyed. Ninety-one HAI were detected in 80 patients for a prevalence of 91 per 1000 patients surveyed. Bloodstream infections were the most common HAI (3% of patients; 34% of all HAI). The prevalence of patients with HAI was 8%, ranging from 0% in trauma/bum units to 19% in the pediatric intensive care units, and 27% in transplant units. By multivariate logistic regression analysis, having a central venous catheter (OR, 2.54; 95% CI, 1.46-4.40) or endotracheal tube with mechanical ventilation (OR, 2.59; 95% CI, 1.16-5.76) were independently associated with an HAI, as were being in isolation (OR, 2.90; 95% CI, 1.54-5.45), and receiving antimicrobial agents (OR, 9.27; 95% CI, 4.71-18.52). In this first national point-prevalence study in Canada, the prevalence of HAI was similar to that reported in other industrialized countries. These data will also be useful to provide an estimate of the health burden of pediatric HAI in Canada.
To identify factors affecting HIV-1 breastfeeding transmission. Longitudinal observational cohort... more To identify factors affecting HIV-1 breastfeeding transmission. Longitudinal observational cohort study. HIV-1 seropositive pregnant women and seronegative controls were enrolled at a maternity hospital in Nairobi. Women and their children were followed from birth, and data on HIV-1 transmission, breastfeeding, clinical illness, and growth were collected. Specimens for HIV-1 serology and/or polymerase chain reaction were obtained at birth, 2, 6, and 14 weeks, 6, 9, 12, and 18 months, and every 6 months thereafter. Children were classified as HIV-1 uninfected, perinatally, or postnatally infected. Potentially breastfeeding transmission related risk factors were compared between postnatally infected and uninfected children. Among children born to seropositive or seroconverting mothers, 317 were uninfected, 51 infected perinatally and 42 infected postnatally. Identified risk factors for postnatal transmission were maternal nipple lesions (OR = 2.3, CI 95% 1.1-5.0), mastitis (OR = 2.7, CI 95% 1.1-6.7), maternal CD4 cell count < 400 mm3 (OR = 4.4, CI 95% 1.9-9.9), maternal seroconversion while breastfeeding (OR = 6.0, CI 95% 1.8-19.8), infant oral thrush at < 6 months of age (OR = 2.8, CI 95% 1.3-6.2) and breastfeeding longer than 15 months (OR = 2.4, CI 95% 1.2-5.1). All factors, except maternal seroconversion due to its rarity, were independently associated with an increased postnatal transmission risk by multivariate logistic regression analysis. In addition perinatal antiretroviral therapies, public health strategies should address: (i) prevention of maternal nipple lesions, mastitis and infant thrush; (ii) reduction of breastfeeding duration by all HIV-1-infected mothers; (iii) absolute avoidance of breastfeeding by those at high risk, and (iv) prevention of HIV-1 transmission to breastfeeding mothers.
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Papers by Joane Embre