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Skog L.,KTH Royal Institute of Technology | Linde A.,Public Health Agency of Sweden | Palmgren H.,Umea University | Hauska H.,KTH Royal Institute of Technology | Elgh F.,Umea University
BMC Infectious Diseases | Year: 2014

Background: Prediction of timing for the onset and peak of an influenza pandemic is of vital importance for preventive measures. In order to identify common spatiotemporal patterns and climate influences for pandemics in Sweden we have studied the propagation in space and time of A(H1N1)pdm09 (10,000 laboratory verified cases), the Asian Influenza 1957-1958 (275,000 cases of influenza-like illness (ILI), reported by local physicians) and the Russian Influenza 1889-1890 (32,600 ILI cases reported by physicians shortly after the end of the outbreak).Methods: All cases were geocoded and analysed in space and time. Animated video sequences, showing weekly incidence per municipality and its geographically weighted mean (GWM), were created to depict and compare the spread of the pandemics. Daily data from 1957-1958 on temperature and precipitation from 39 weather stations were collected and analysed with the case data to examine possible climatological effects on the influenza dissemination.Results: The epidemic period lasted 11 weeks for the Russian Influenza, 10 weeks for the Asian Influenza and 9 weeks for the A(H1N1)pdm09. The Russian Influenza arrived in Sweden during the winter and was immediately disseminated, while both the Asian Influenza and the A(H1N1)pdm09 arrived during the spring. They were seeded over the country during the summer, but did not peak until October-November. The weekly GWM of the incidence moved along a line from southwest to northeast for the Russian and Asian Influenza but northeast to southwest for the A(H1N1)pdm09. The local epidemic periods of the Asian Influenza were preceded by falling temperature in all but one of the locations analysed.Conclusions: The power of spatiotemporal analysis and modeling for pandemic spread was clearly demonstrated. The epidemic period lasted approximately 10 weeks for all pandemics. None of the pandemics had its epidemic period before late autumn. The epidemic period of the Asian Influenza was preceded by falling temperatures. Climate influences on pandemic spread seem important and should be further investigated. © 2014 Skog et al.; licensee BioMed Central Ltd. Source


Dahl V.,Karolinska Institutet | Dahl V.,Public Health Agency of Sweden | Peterson J.,University of California at San Francisco | Fuchs D.,Innsbruck Medical University | And 5 more authors.
AIDS | Year: 2014

Objective and design: Though combination antiretroviral therapy reduces the concentration of HIV-1 RNA in both plasma and cerebrospinal fluid (CSF) below the detection limit of clinical assays, low levels of HIV-1 RNA are frequently detectable in plasma using more sensitive assays. We examined the frequency and magnitude of persistent low-level HIV-1 RNA in CSF and its relation to the central nervous system (CNS) immune activation. Methods: CSF and plasma HIV-1 RNA were measured using the single-copy assay with a detection limit of 0.3 copies/ml in 70 CSF and 68 plasma samples from 45 treated HIV- 1-infected patients with less than 40 copies/ml of HIV-1 RNA in both fluids by standard clinical assays. We also measured CSF neopterin to assess intrathecal immune activation. Theoretical drug exposure was estimated using the CNS penetration-efficacy score of treatment regimens. Results: CSF HIV-1 RNA was detected in 12 of the 70 CSF samples (17%) taken after up to 10 years of suppressive therapy, compared to 39 of the 68 plasma samples (57%) with a median concentration of less than 0.3 copies/ml in CSF compared to 0.3 copies/ml in plasma (P<0.0001). CSF samples with detectable HIV-1 RNA had higher CSF neopterin levels (mean 8.2 compared to 5.7 nmol/l; P=0.0085). Patients with detectable HIV-1 RNA in CSF did not differ in pretreatment plasma HIV-1 RNA levels, nadir CD4+ cell count or CNS penetration-efficacy score. Conclusion: Low-level CSF HIV-1 RNA and its association with elevated CSF neopterin highlight the potential for the CNS to serve as a viral reservoir and for persistent infection to cause subclinical CNS injury. © 2014 Wolters Kluwer Health- Lippincott Williams & Wilkins. Source


Vogt H.,Linkoping University | Braback L.,Sundsvall Hospital | Kling A.-M.,Unit for Statistics and Surveillance | Grunewald M.,Public Health Agency of Sweden | Nilsson L.,Linkoping University
Pediatrics | Year: 2014

BACKGROUND AND OBJECTIVES: Childhood immunization may influence the development of asthma, possibly due to lack of infections or a shift in the T-helper cell type 1/T-helper cell type 2/regulatory T cells balance. We therefore investigated whether pertussis immunization in infancy is associated with asthma medication in adolescence.METHODS: After 14 years of no general pertussis vaccination, almost 82,000 Swedish children were immunized for pertussis in a vaccination trial between June 1, 1993, and June 30, 1994. In a follow-up analysis of almost 80,000 children, their data were compared with those of ∼100,000 nonvaccinated children, born during a 5-month period before and a 7-month period after the vaccination trial. Data for the main outcome variable (ie, dispensed prescribed asthma medication for each individual in the cohort during 2008-2010) were obtained from the national prescription database. Multivariate regression models were used to calculate the effect size of vaccination on dispensed asthma medication (odds ratios [OR], 95% confidence intervals [CI]). Approaches similar to intention-to-treat and per-protocol methods were used.RESULTS: The prevalence rates of various asthma medications for study patients at 15 years of age differed between 4.6% and 7.0%. The crude ORs for any asthma medication and antiinflammatory treatment in pertussis-vaccinated children after intention-to-treat analysis were 0.97 (95% CI: 0.93-1.00) and 0.94 (95% CI: 0.90-0.98), respectively. Corresponding adjusted ORs were 0.99 (95% CI: 0.95-1.03) and 0.97 (95% CI: 0.92-1.01). Similar ORs were found after per-protocol analysis.CONCLUSIONS: Pertussis immunization in infancy does not increase the risk of asthma medication use in adolescents. Our study presents evidence that pertussis immunization in early childhood can be considered safe with respect to long-term development of asthma. Copyright © 2014 by the American Academy of Pediatrics. Source


Soderlund-Strand A.,Laboratory Medicine Skane | Uhnoo I.,Public Health Agency of Sweden | Dillner J.,Karolinska Institutet
Cancer Epidemiology Biomarkers and Prevention | Year: 2014

Background: Organized human papillomavirus (HPV) vaccination was introduced in Sweden in 2012. On-demand vaccination was in effect from 2006 to 2011. We followed the HPV prevalences in Southern Sweden from 2008 to 2013.Methods: Consecutive, anonymized samples from the Chlamydia trachomatis screening were analyzed for HPV DNA for two low-risk types and 14 high-risk types using PCR with genotyping using mass spectrometry. We analyzed 44,146 samples in 2008, 5,224 in 2012, and 5,815 in 2013.Results: Registry-determined HPV vaccination coverages of the population in Southern Sweden increased mainly among 13-to 22-year-old women. Most analyzed samples contained genital swabs from women and the HPV6 prevalence in these samples decreased from 7.0% in 2008 to 4.2% in 2013 [- 40.0%; P < 0.0005 (%2 test)]. HPV16 decreased from 14.9% to 8.7% (- 41.6%; P < 0.0005) and HPV18 decreased from 7.9% to 4.3% (- 45.6%; P < 0.0005) among 13-to 22-year-old women. There were only small changes in vaccination coverage among 23-to 40-year-old women. In this age group, HPV18 decreased marginally (- 19.6%; P = 0.04) and there were no significant changes for HPV6 or HPV16. Two nonvaccine HPV types (HPV52 and HPV56) were increased among 13-to 22-year-old women, both in 2012 and 2013.Conclusions: A major reduction of HPV6,16, and 18 prevalences is seen in the age groups with a concomitant increase in HPV vaccination coverage. The minor changes seen for nonvaccine types will require further investigation.Impact: Monitoring of type-specific HPV prevalences may detect early effects of HPV vaccination. © 2014 American Association for Cancer Research. Source


Bremberg S.,Public Health Agency of Sweden | Bremberg S.,Karolinska Institutet
Acta Paediatrica, International Journal of Paediatrics | Year: 2015

Mental health problems increased in adolescents and young adults in Europe between 1950 and 1990, and the cause is largely unknown. Denmark, Finland, the Netherlands, Norway and Sweden form a relatively homogenous group of countries with favourable conditions for children. Our review examined the time trends for mental health problems in these countries between 1990 and 2010. Conclusion In general, there were only small changes in mental health problems in the countries studied. However, we did note a marked rising trend in mental health problems among adolescents in Sweden, which also has more issues with school achievement and unemployment rates. © 2015 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd. Source

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