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Identifier 000414875
Title Επίδραση εμβολιασμών σε φορία και λοιμώξεις από Staphylococcus aureus
Alternative Title Impact of immunizations on Staphylococcus aureus infection and carriage
Author Τσιριγωτάκη, Μαρία
Thesis advisor Γαλανάκης, Εμμανουήλ
Κοφτερίδης, Διαμαντής
Σκούλικα Ευσταθία
Abstract Background: The development and use of vaccines have had an important impact on rates of vaccine-preventable diseases. In the ecological niche of the nasopharynx, pathogens maintain a dynamic balance. Elimination of some of the pathogens can impact on non-targeted commensals like Staphylococcus aureus (S. aureus). Aim of this thesis is to investigate the evidence of the indirect effects of vaccines on S. aureus carriage and infection. Methods: We systematically reviewed the English literature on the effect of vaccinations on S. aureus carriage and infection for outcomes on children of all age and adults. Our search included studies published from 1963 to December 2017 regarding pneumococcal vaccines, vaccines for Haemophilus influenzae and other pathogens. The studies were categorized based on the study design, the characteristics of the population and the type of vaccine. Studies that provided comparison data from the pre- and post-vaccination period were metanalysed based on the random effect model and results were presented using forest plot charts. When only pre or post vaccination data was available a qualitative analysis was used. Results: A total of 147 studies were analyzed including randomized control trials, observational studies, mathematical models and animal studies. An increase of S. aureus carriage was noted at the age of 11-12 months in children vaccinated for pneumococcus with no significant differences after the second year of life (15/20, 75%). Studies looking into vaccine effects in infancy and adult life were highly heterogenous with the majority showing no significant changes in the carriage rate in the postvaccination period. Data regarding non-pneumococcal vaccines was scarce. Relative increase in S. aureus infections (bacteremia, upper respiratory tract infections and septic arthritis) was noted in the postvaccination period (2000-2013). The observed changes were explained by the niche dynamic theory, integrating inter-species interactions and host immune responses. Conclusion: Immunizations can have indirect effects on S. aureus carriage and infection related to changes in niche balances after the implication of vaccinations. Large, randomized trials are needed to further elucidate these effects. Consideration of indirect effects on non- targeted pathogens is needed in future immunization planning.
Language Greek
Subject Haemophilus influenzae
Niche
Streptococcus pneumoniae
Vaccines
Issue date 2018-03-28
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
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