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  • 1. Abu-Elyazeed, R R
    et al.
    Heineman, T
    Dubin, G
    Fourneau, M
    Leroux-Roels, I
    Leroux-Roels, G
    Richardus, J H
    Ostergaard, L
    Diez-Domingo, J
    Poder, A
    Van Damme, P
    Romanowski, B
    Blatter, M
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Berglund, J
    Josefsson, A
    Cunningham, A L
    Flodmark, C E
    Tragiannidis, A
    Dobson, S
    Olafsson, J
    Puig-Barbera, J
    Mendez, M
    Barton, S
    Bernstein, D
    Mares, J
    Ratner, P
    Safety and immunogenicity of a glycoprotein D genital herpes vaccine in healthy girls 10-17 years of age: results from a randomised, controlled, double-blind trial2013In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 31, no 51, p. 6136-6143Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The investigational AS04-adjuvanted herpes simplex virus type 2 (HSV-2) glycoprotein D (gD2) subunit prophylactic vaccine ('HSV vaccine'; GlaxoSmithKline Vaccines) has been shown to be well tolerated in adults, but limited data exist for pre-teen and adolescent girls, a likely target population. The primary objective of this study was to compare the occurrence of serious adverse events (SAEs) over 12 months between HSV vaccine recipients and saline recipients (placebo control group) in pre-teen and adolescent girls. The immunogenicity of the HSV vaccine was also assessed.

    METHODS: Healthy girls aged 10-17 years, stratified by age (10-15 years; 16-17 years), were randomised 2:1:1 to receive the HSV vaccine, a hepatitis A vaccine (Havrix™; HAV control) or placebo (saline) according to a 0-, 1-, 6-month schedule. Participants and study personnel not involved in the preparation or administration of vaccines were blinded to treatment. Safety and immunogenicity analyses were performed overall and by age (10-15 years; 16-17 years) and HSV serostatus.

    RESULTS: No statistically significant difference in the percentage of subjects with SAEs was observed between the HSV and saline group, or between the HSV and pooled control (HAV and saline) groups. The HSV vaccine was well tolerated, although a higher incidence of solicited local symptoms was observed in the HSV group than in the control group. Neither age nor HSV serostatus at the time of study entry had an impact on the safety profile of this vaccine. The HSV vaccine was immunogenic regardless of pre-vaccination HSV serostatus. Higher anti-gD geometric mean concentrations were observed in HSV-1 seropositive participants than in HSV-1 seronegative participants.

    CONCLUSION: The HSV vaccine had an acceptable safety profile, and was well tolerated and immunogenic when administered to girls aged 10-17 years regardless of age or HSV pre-vaccination serostatus.

  • 2. Axelsson, Inge
    et al.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Pneumonia mortality among children in Brazil: a success story.2011In: Jornal de pediatria, ISSN 1678-4782, Vol. 87, no 2, p. 85-87Article in journal (Other academic)
  • 3. By, Asa
    et al.
    Sobocki, Patrik
    Forsgren, Arne
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Comparing health outcomes and costs of general vaccination with pneumococcal conjugate vaccines in sweden: a markov model.2012In: Clinical Therapeutics, ISSN 0149-2918, E-ISSN 1879-114X, Vol. 34, no 1, p. 177-89Article in journal (Refereed)
    Abstract [en]

    Background: Two new pneumococcal conjugate vaccines were licensed to immunize infants and young children against pneumococcal disease.

    Objectives: The objective of this study was to estimate the expected health benefits, costs, and incremental cost-effectiveness of routine vaccination with the 10-valent pneumococcal nontypeable hemophilus influenza protein-D conjugate vaccine (PHiD-CV) compared with the 13-valent pneumococcal conjugate vaccine (PCV13) in Sweden.

    Methods: A Markov cohort model was used to estimate the effect of vaccination at vaccine steady state, taking a societal perspective and using a 2+1 vaccination schedule. Price parity was assumed between the vaccines. Outcomes were measured by reduction in disease burden, costs, quality-adjusted life–years (QALYs) and incremental cost-effectiveness ratio.

    Results: The results predicted that PCV13 would prevent 3 additional cases of invasive pneumococcal disease and 34 additional cases of pneumonia, whereas PHiD-CV would avoid 3 additional cases of mastoiditis, 1010 tube insertions, and 10,420 cases of ambulatory acute otitis media compared with PCV13. By combining morbidity and mortality benefits of all clinical outcomes, PHiD-CV would generate 45.3 additional QALYs compared with PCV13 and generate savings of an estimated 62 million Swedish kronors.

    Conclusion: The present study predicted lower costs and better health outcome (QALYs) gained by introducing PHiD-CV compared with PCV13 in routine vaccination. Our results indicated that PHiD-CV is cost-effective compared with PCV13 in Sweden.

  • 4.
    Garpenholt, Örjan
    et al.
    Department of Clinical Microbiology, Divisions of Infectious Epidemiology, Örebro Medical Centre Hospital, Örebro.
    Silfverdal, Sven Arne
    The Departments Immunology, Örebro Medical Centre Hospital, Örebro.
    Hugosson, Svante
    Paediatrics, Örebro Medical Centre Hospital, Örebro.
    Fredlund, Hans
    Department of Clinical Microbiology, Divisions of Infectious Epidemiology, Örebro Medical Centre Hospital, Örebro.
    Bodin, Lennart
    Otorhinolaryngology, Örebro Medical Centre Hospital, Örebro.
    Romanus, Victoria
    Swedish Institute for Infectious Disease Control, Stockholm, Sweden.
    Olcén, Per
    Occupational Medicine, Unit of Biostatistics and Epidemiology, Örebro Medical Centre Hospital, Örebro.
    The impact of Haemophilus influenzae type b vaccination in Sweden1996In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 28, no 2, p. 165-169Article in journal (Refereed)
    Abstract [en]

    The number of patients with meningitis and bacteremia due to Haemophilus influenzae was studied in Sweden over the period 1987-1994. Conjugated H. influenzae type b vaccines were introduced in Sweden in 1992, and all children born after December 31, 1992, were offered vaccination free of charge. A rapid decline of H. influenzae meningitis and bacteraemia was observed in the autumn of 1993, when the expected peak incidence failed to appear. In the prevaccination period 1987-1991, the average annual incidence (cases/100,000) was 34.4 in children aged 0-4 years. In 1994, the annual incidence fell to 3.5. No significant decline was observed in older children or adults. There was a 92% reduction in the number of meningitis cases and an 83% reduction in cases of bacteraemia. A similar decline was noted in 2 regions which followed different strategies for the introduction of the vaccination programme.

  • 5. Garpenholt, Örjan
    et al.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hugosson, Svante
    Fredlund, Hans
    Olcén, Per
    [Good effect of general HIB vaccination of children]1997In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 94, no 3, p. 113-Article in journal (Refereed)
  • 6.
    Garpenholt, Örjan
    et al.
    Clinical Microbiology, Unit of Infectious Disease Epidemiology, Örebro medical center hospital, Örebro, Sweden.
    Silfverdal, Sven Arne
    Paediatrics, Division of School Health, Örebro Medical Centre Hospital, Örebro,.
    Levin, Lars-Åke
    Department of Health and Society, Linköping university, Linköping, Sweden.
    Economic evaluation of general childhood vaccination against Haemophilus influenzae type b in Sweden1998In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 30, no 1, p. 5-10Article in journal (Refereed)
    Abstract [en]

    The objective of the study was to evaluate the economic consequences of a general childhood vaccination programme against Haemophilus influenzae type b (Hib) in Sweden. A retrospective pre-vaccination annual cohort of 0-4-y-old children was compared with an annual cohort of the same age group after a complete implemented vaccination program against Hib. The cost analysis shows that vaccination against Hib is cost saving when indirect costs are included in the analysis. In the cost-benefit analysis it is shown that society will gain approximately 88 million Swedish Crowns (SEK) annually when Hib vaccination is totally implemented. In conclusion, general childhood Hib vaccination is a cost-effective public health intervention in Swedish society.

  • 7.
    Gottlieb, Philip
    et al.
    Kvinnokliniken, Karlskoga lasarett.
    Bergström, Staffan
    IHCAR, Karolinska institutet, Uppsala.
    Silfverdal, Sven Arne
    Barn- och ungdomskliniken, Universitetssjukhuset, Örebro.
    Wesström, Göran
    Barn- och ungdomskliniken, Universitetssjukhuset, Örebro.
    Silfverdal, Lena
    Kvinnokliniken, Universitetssjukhuset, Örebro.
    Lindmark, Gunilla
    IMHC (International maternal and child health), Akademiska sjukhuset, Uppsala.
    [Time for the Medical Society to comment the issue of the apathetic refugee children]2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 32-33, p. 2236-2237Article in journal (Other academic)
  • 8. Gustafsson, Anna
    et al.
    Granström, Elisabeth
    Umeå University, Faculty of Medicine, Department of Odontology.
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology.
    West, Christina E.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    The Antisecretory Factor in Plasma and Breast Milk in Breastfeeding Mothers: A Prospective Cohort Study in Sweden2018In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 10, no 9, article id 1227Article in journal (Refereed)
    Abstract [en]

    Inflammation and infection postpartum threaten the mother and her infant. Human milk provides a defense for the infant, but inflammatory complications like mastitis may lead to the cessation of breastfeeding. Antisecretory factor (AF) has a role in the regulation of secretory processes and inflammation. The objective of the study was to describe AF-levels in plasma and breast milk, and in relation to breast complications. Breastfeeding mothers (n = 95) were consecutively recruited at a Well Baby Clinic in Umeå, Sweden. At inclusion four weeks postpartum, samples of venous blood (10 mL) and breast milk (10 mL) were collected. Active AF was analyzed with ELISA using a monoclonal antibody mAb43, and was detected in all samples of plasma and breast milk with a positive correlation (Spearman coefficient = 0.40, p < 0.001; Pearson correlation = 0.34, p < 0.01). High AF-levels in plasma correlated with high AF-levels in breast milk. The results suggest a co-regulation between active AF in plasma and breastmilk, and/or a local regulation of AF in the breast. Further studies are needed to determine the pathways for the activation of AF-levels in breast milk and plasma.

  • 9. Gustafsson, Anna M.
    et al.
    Fransson, Emma
    Dubicke, Aurelija
    Hjelmstedt, Anna K.
    Ekman-Ordeberg, Gunvor
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lange, Stefan
    Jennische, Eva
    Bohlin, Kajsa
    Low levels of anti-secretory factor in placenta are associated with preterm birth and inflammation2018In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 3, p. 349-356Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Anti-secretory factor is a protein that regulates secretory and inflammatory processes and preterm birth is associated with inflammation. Therefore, our hypothesis was that anti-secretory factor might play a role in immune reactivity and homeostasis during pregnancy.

    MATERIAL AND METHODS: Following spontaneous onset of labor and preterm or term delivery, placenta biopsies were collected. The levels of anti-secretory factor and markers of inflammation (CD68, CD163) and vascularization (CD34, smooth muscle actin) were analyzed by immunohistochemistry.

    RESULTS: The 61 placental biopsies included 31 preterm (<37 weeks of gestation) and 30 term (37-41 weeks) samples. The preterm placentas exhibited lower levels of anti-secretory factor (p = 0.008) and larger numbers of CD68-positive cells (p < 0.001) compared to term. Preterm placentas had blood vessel of smaller diameter (p = 0.036) indicative of immaturity. The level of interleukin-6 in cord blood was higher after very preterm than term birth, suggesting a fetal inflammatory response. The placenta level of anti-secretory factor was positively correlated to the length of gestation (p = 0.025) and negatively correlated to the levels of the inflammatory markers CD68 (p = 0.015) and CD163 (p = 0.028).

    CONCLUSIONS: Preterm delivery is associated with low levels of anti-secretory factor in placenta. Inflammation, a potential trigger of preterm birth, is more pronounced in the preterm placenta and inversely related to the placental level of anti-secretory factor, suggesting both a link and a potential target for intervention.

  • 10. Hanson, Lars A
    et al.
    Korotkova, Marina
    Håversen, LilIana
    Mattsby-Baltzer, Inger
    Hahn-Zoric, Mirjana
    Silfverdal, Sven-Arne
    Strandvik, Birgitta
    Telemo, Esbjörn
    Breast-feeding, a complex support system for the offspring.2002In: Pediatrics International, ISSN 1328-8067, E-ISSN 1442-200X, Vol. 44, no 4, p. 347-52Article in journal (Refereed)
    Abstract [en]

    The newborn has an immune system, very limited in size at birth and its postnatal expansion and maturation takes time. In the meantime the transplacental IgG antibodies from the mother play an important role for the protection of the infant. However, these antibodies act in tissues and induce inflammation and are energy-consuming. In contrast, the milk secretory IgA antibodies stop microbes already on the mucosa preventing infection, tissue engagement and energy loss. In addition, the milk contains many protective factors such as lactoferrin and oligosacharides functioning as analogues for microbial receptors preventing mucosal attachment, the initial step of most infections. As a result, breast-feeding significantly reduces the risk of neonatal septicemia, respiratory tract infections, otitis media, diarrhea, urinary tract infections, infection-induced wheezing and necrotizing enterocolitis. Via several mechanisms it seems that human milk can actively stimulate the immune system of the breast-fed infant. This reduces the risk of infections like otitis media, respiratory tract infections, diarrhea and infection-induced wheezing for several years after the termination of breast-feeding. Furthermore, it seems that breast-feeding decreases the risk of attracting celiac disease and allergic diseases. The latter has been much debated, but a recent critical review of published reports gives good support for long-term protection of allergic diseases, especially in high-risk children.

  • 11. Hanson, Lars A
    et al.
    Korotkova, Marina
    Lundin, Samuel
    Håversen, Liljana
    Silfverdal, Sven-Arne
    Mattsby-Baltzer, Inger
    Strandvik, Birgitta
    Telemo, Esbjörn
    The transfer of immunity from mother to child.2003In: Annals of the New York Academy of Sciences, ISSN 0077-8923, E-ISSN 1749-6632, Vol. 987, p. 199-206Article in journal (Refereed)
    Abstract [en]

    The newborn's immune system grows fast from a small size at birth by exposure primarily to the intestinal microflora normally obtained from the mother at and after birth. While building up its immune system, the infant is supported by the transplacental IgG antibodies, which also contain anti-idiotypic antibodies, possibly also actively priming the offspring. The second mode of transfer of immunity occurs via the milk. Numerous major protective components, including secretory IgA (SIgA) antibodies and lactoferrin, are present. The breastfed infant is better protected against numerous common infections than the non-breastfed. Breastfeeding also seems to actively stimulate the infant's immune system by anti-idiotypes, uptake of milk lymphocytes, cytokines, etc. Therefore, the breastfed child continues to be better protected against various infections for some years. Vaccine responses are also often enhanced in breastfed infants. Long-lasting protection against certain immunological diseases such as allergies and celiac disease is also noted.

  • 12. Hanson, Lars A
    et al.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    The mother's immune system is a balanced threat to the foetus, turning to protection of the neonate.2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 2, p. 221-228Article in journal (Refereed)
    Abstract [en]

    Immunological tolerance by the mother prevents rejection of the foetus, but aberrations may increase risk of abnormalities like spontaneous abortion, or foetal growth restriction. The neonate is normally colonized with mother's gut microflora, mainly composed of protective anaerobes. This least threatening form of microbial colonization of the neonate, is impaired by sectio delivery, but supported by breastfeeding. Mother's transplacental IgG, secretory IgA and other milk components help protect the neonate together with its own slowly expanding immune system. CONCLUSION: The mother's immune system tolerates her foetus via several mechanisms. Failure to do so may cause foetal growth retardation, or spontaneous abortion. The mother and the neonate cooperate in preventing infections in the offspring.

  • 13.
    Hanson, Lars A.
    et al.
    From the Department of Clinical Immunology, University of Gothenburg, Sweden.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Vaccination immunology2008In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 40, no 9, p. 696-701Article in journal (Refereed)
    Abstract [en]

    We are now entering 'the second golden era of vaccines'. The first gave us many good vaccines, but some inadequately protective and some with unacceptable side-effects. Worse, we have no adequate vaccines against some of the most killing diseases in the world, such as tuberculosis, malaria and HIV. The development within this second golden era will build on the rapidly growing knowledge about the genetics of the immune system, uncovering the problems and possibilities of the variability of genes for HLA, cytokines and cell-surface receptors. Furthermore, we need to consider factors such as birth weight, gestational age, short- and long-term effects of breastfeeding, interference by helmith infestation and climate.

  • 14.
    Hanson, Lars A
    et al.
    Univ Gothenburg, Dept Clin Immunol & Clin Bacteriol, Gothenburg, Sweden.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hahn-Zoric, M
    Håversen, L
    Mattsby Baltzer, I
    Moisei, M
    Motas, C
    Immune function2009In: Advances in Experimental Medicine and Biology, ISSN 0065-2598, E-ISSN 2214-8019, Vol. 639, p. 97-111Article in journal (Refereed)
  • 15. Hanson, Lars A
    et al.
    Silfverdal, Sven-Arne
    Korotkova, Marina
    Erling, Valdemar
    Strömbeck, Louise
    Olcén, Per
    Ulanova, Marina
    Hahn-Zoric, Mirjana
    Zaman, Shakila
    Ashraf, Rifat
    Telemo, Esbjörn
    Immune system modulation by human milk.2002In: Advances in Experimental Medicine and Biology, ISSN 0065-2598, E-ISSN 2214-8019, Vol. 503, p. 99-106Article in journal (Refereed)
  • 16. Hanson, Lars Å
    et al.
    Blennow, Margareta
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Oetiskt att ge amningsråd2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 40, p. 1974-1975Article in journal (Other academic)
  • 17.
    Hanson, Lars Å
    et al.
    Department of Clinical Immunology, Göteborg University, Göteborg, Sweden.
    Silfverdal, Sven Arne
    Departments of Paediatrics, Microbiology and Immunology, Örebro medical center hospital, Örebro, Sweden.
    Strömbäck, L
    Department of Clinical Immunology, Göteborg university, Göteborg, Sweden.
    Erling, V
    Department of Clinical Immunology, Göteborg university, Göteborg, Sweden.
    Zaman, S
    Department of Social and Preventive Pediatrics, King Edward Medical College, Lahore, Pakistan.
    Olcén, P
    Departments of Paediatrics, Microbiology and Immunology, Örebro medical center hospital, Örebro, Sweden.
    Telemo, E
    Department of Clinical Immunology, Göteborg university, Göteborg, Sweden.
    The immunological role of breast feeding2001In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 12, no suppl 14, p. 15-19Article in journal (Refereed)
  • 18.
    Hanson, Lars Å
    et al.
    Departments of Clinical Immunology and Bacteriology, Göteborg University, Göteborg, Sweden.
    Zaman, Shakila
    Department of Social and Preventive Pediatrics, Fatima Jinnah Medical College, Lahore, Pakistan.
    Werner, B
    Departments of Public Health and Microbiology, Tumor and Cell Biology (MTC), Karolinska Institute, Stockholm, Sweden.
    Håversen, Liliana
    Departments of Clinical Immunology and Bacteriology, Göteborg University, Göteborg, Sweden.
    Motas, Cecilia
    Institute of Biochemistry, Romanian Academy, Bucharest, Romania.
    Moisei, Magda
    Institute of Biochemistry, Romanian Academy, Bucharest, Romania.
    Mattsby-Baltzer, Inger
    Departments of Clinical Immunology and Bacteriology, Göteborg University, Göteborg, Sweden.
    Lange, Stefan
    Departments of Clinical Immunology and Bacteriology, Göteborg University, Göteborg, Sweden.
    Banasaz, Mahnaz
    Departments of Public Health and Microbiology, Tumor and Cell Biology (MTC), Karolinska Institute, Stockholm, Sweden.
    Midtvedt, Tore
    Departments of Public Health and Microbiology, Tumor and Cell Biology (MTC), Karolinska Institute, Stockholm, Sweden.
    Norin, Elisabeth
    Departments of Public Health and Microbiology, Tumor and Cell Biology (MTC), Karolinska Institute, Stockholm, Sweden.
    Silfverdal, Sven-Arne
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Growth and nutrition: the first six months2008In: Nestlé Nutrition workshop series. Paediatric programme, ISSN 1661-6677, Vol. 61, p. 123-34Article in journal (Refereed)
    Abstract [en]

    Today the WHO Growth Chart Standards, based on the growth of breastfed infants, are used. These growth curves solve the problem of the deviating observations for breastfed compared to non-breastfed infants using previous growth charts. Presently it is not clear how the mother's diet, especially the fat intake, influences the growth of the offspring. Animal experiments indicate that a low intake of n-3 polyunsaturated fatty acids via the milk may have short- and long-term negative consequences. There is limited information in man. It has been suggested that the mammary glands may have phylogenetically originated from glands providing innate immunity, later developing capacities for providing nutrition. This would agree with the fact that human milk contains so many major components which do not primarily function as nutrients, but seem to protect nutrition and growth. Lactoferrin, oligosaccharides, glycoproteins, secretory IgA antibodies, alpha-lactalbumin and the antisecretory factor have such functions.

  • 19.
    Hasslöf, Pamela
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Karlsson Videhult, Frida
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    West, Christina E
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology.
    Vitamin D Insufficiency among Women Post-Partum in Northern Sweden: A Public Health Concern2017In: Food and Nutrition Sciences, ISSN 2157-944X, E-ISSN 2157-9458, no 8, p. 99-109Article in journal (Refereed)
    Abstract [en]

    Pregnancy and post-partum represent a period of susceptibility for vitamin D insufficiency. This study investigated S-25 [OH] D levels in women in northern Sweden 4 weeks post-partum and its association with selected background factors. Blood from 100 healthy women were analyzed for iron status and serum levels of S-25[OH] D using ionization-mass spectrometry (HPLC-APCI-MS). <50 nmol/L was categorized as insufficiency and <25 nmol/L as deficiency. Maternal BMI, dietary habits, fungal infections during pregnancy, and infant birth characteristics were collected using questionnaires and medical charts. 58% were vitamin D insufficient whereas 10% had deficiency. Insufficiency was most common during winter (OR = 2.77; 95% CI = 1.1-6.96) and women with deficiency reported lower milk consumption; 11.3 ± 22.8 intakes per months vs. 34.0 ± 28.9 for those above 25 nmol/L (p < 0.05). Vitamin D-insufficient women had lower serum ferritin levels (p < 0.01) and higher serum transferrin levels (p < 0.05). A history of vaginal fungal infection during pregnancy was associated with insufficiency (OR = 5.10; 95% CI = 1.01-25.73), however, the confidence interval of the estimate was wide, resulting in uncertainty. It is concluded that vitamin D insufficiency 4 weeks post-partum was common in women living at 63°49'N. The odds of being insufficient were increased during winter whereas milk consumption was negatively associated with deficiency. The low vitamin D-levels particularly during winter is a public health concern. From a public health perspective it has to be considered whether dietary advices alone should be modified or if supplementation with vitamin D during pregnancy and the post-partum period also is needed.

  • 20. Holl, Katsiaryna
    et al.
    Rosenlund, Mats
    Giaquinto, Carlo
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Carmona, Alfonso
    Larcombe, James
    Garcia-Sicilia, Jose
    Fuat, Ahmet
    Eulalia Munoz, Maria
    Luisa Arroba, Maria
    Sloesen, Brigitte
    Vollmar, Jens
    Pircon, Jean-Yves
    Liese, Johannes G.
    The Impact of Childhood Acute Otitis Media on Parental Quality of Life in a Prospective Observational Cohort Study2015In: Clinical drug investigation, ISSN 1173-2563, E-ISSN 1179-1918, Vol. 35, no 10, p. 613-624Article in journal (Refereed)
    Abstract [en]

    Acute otitis media (AOM) not only affects childhood quality of life (QoL), but can also affect parental QoL. We adapted a previously published questionnaire on the effect of childhood recurrent ear, nose and throat infections on parental QoL for use with AOM and used it in an observational, multicentre, prospective study of children with AOM. The AOM-specific parental QoL questionnaire grouped 15 items into emotional, daily disturbance, total and overall parental QoL impact scores. The questionnaire was assessed using item-convergent and item-discriminant validity criteria and internal consistency reliability; and then used with parents of children aged < 6 years diagnosed with AOM at 73 practices in Germany, Italy, Spain, Sweden and the UK. Bivariate analyses explored the differences in mean parental QoL impact scores by various characteristics. The questionnaire demonstrated good to excellent internal consistency reliability for the various components (Cronbach's alpha 0.82-0.97). There were 1419 AOM episodes among 5882 healthy children over 1 year, of which 1063 episodes (74.9 %) among 852 children had a questionnaire. Parents reported interrupted sleep (68.4 %), worry (51.0 %), altered daily schedule (44.6 %) and less leisure time (41.5 %) with a score a parts per thousand yen3 (1 = least to 5 = most impact). Factors that adversely affected parental QoL included: increased parental perception of AOM severity, younger child age and multiple AOM episodes. The AOM-specific parental QoL questionnaire demonstrated good performance across five European countries. Parental QoL was affected by childhood AOM proportionally to severity, number of episodes and younger child age.

  • 21.
    Hugosson, Svante
    et al.
    Departments of Otorhinolaryngology, Örebro Medical Center Hospital, Örebro, Sweden.
    Silfverdal, Sven Arne
    Departments of Paediatrics, Örebro Medical Center Hospital, Örebro, Sweden.
    Garpenholt, Örjan
    Departments of Clinical Microbiology and Immunology, Örebro Medical Center Hospital, Örebro, Sweden.
    Esbjörner, Elisabeth
    Departments of Paediatrics, Örebro Medical Center Hospital, Örebro, Sweden.
    Lindquist, Bo
    Departments of Paediatrics, Örebro Medical Center Hospital, Örebro, Sweden.
    Vikerfors, Thomas
    Departments of Infectious Diseases, Örebro Medical Center Hospital, Örebro, Sweden.
    Werner, Bo
    Departments of Community Medicine and Public Health, Örebro Medical Center Hospital, Örebro, Sweden.
    Olcén, Per
    Departments of Clinical Microbiology and Immunology, Örebro Medical Center Hospital, Örebro, Sweden.
    Invasive Haemophilus influenzae disease: epidemiology and clinical spectrum before large-scale H. influenzae type b vaccination1995In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 27, no 1, p. 63-67Article in journal (Refereed)
    Abstract [en]

    In a prospective study between January 1987 and December 1992, 103 patients with invasive Haemophilus influenzae (Hi) infection were identified in a well-defined population before large-scale Haemophilus influenzae type b (Hib) vaccination was introduced. The incidence (case/100,000/year) of invasive Hi infection was 5.9 for the whole population, 55 for children 0-4 years old and as high as 2.8 for adults. Hib was the predominant cause of the infection (83 cases) in children but, in adults, 13/39 (30%) cases were caused by non-typable Hi and 6/39 (19%) by Hi serotype f. Three patients (3%) died and 6 (5.8%) suffered a permanent sequel from the infection. All patients with such a sequel had invasive Hib infection. No significant difference between patients 0-6 years old and matched controls regarding the frequency of subnormal serum levels of immunoglobulins was found.

  • 22.
    Hörnell, Agneta
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Amning och tillvänjning till fast föda för friska fullgångna barn: En kunskapsöversikt från Barnläkarföreningen och Livsmedelsverket2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 8, p. 405-409Article in journal (Refereed)
  • 23.
    Hörnell, Agneta
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Lind, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Maten i skolan - långt mellan kostråden och verkligheten2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 5, p. 287-90Article in journal (Refereed)
    Abstract [sv]

    Skolan bör ha en positiv roll i folkhälsoarbetet, dels genom att ge eleverna kunskap om sambanden mellan hälsa, kost, fysisk aktivitet och livsstil, dels genom att erbjuda god och näringsriktig mat och möjlighet till regelbunden fysisk aktivitet. Skolmaten utgör fortfarande en utjämnande faktor när det gäller näringsintag mellan barn från resursstarka och resurssvaga områden. Svenska skolbarn till och med årskurs 9 garanteras kostnadsfri mat i skolan genom nu gällande lagstiftning. Livsmedelsverkets råd »Bra mat i skolan« och »Bra mat i förskolan« kompletterar de svenska näringsrekommendationerna och underlättar planeringen för måltider i skolan.

  • 24.
    Jacquet, J M
    et al.
    GlaxoSmithKline Biologicals, Rixensart, Belgium.
    Bégué, P
    Hôpital d’enfants Armand Trousseau, Paris, France.
    Grimprel, E
    Hôpital d’enfants Armand Trousseau, Paris, France.
    Reinert, P
    Hôpital Intercommunal de Créteil, France.
    Sandbu, S
    Norwegian Institute of Public Health, Oslo, Norway.
    Silfverdal, S A
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Faldella, G
    Universita di Bologna, Italy.
    Nolan, T
    Murdoch Children's Research Institute, and the School of Population Health at the University of Melbourne, Parkville, Australia.
    Lambert, S
    Murdoch Children's Research Institute, and the School of Population Health at the University of Melbourne, Parkville, Australia.
    Richmond, P
    University of Western Australia, Perth, Australia.
    Marshall, H
    University of Adelaide, North Adelaide, Australia.
    Roberton, D
    University of Adelaide, North Adelaide, Australia.
    Schuerman, L
    GlaxoSmithKline Biologicals, Rixensart, Belgium.
    Safety and immunogenicity of a combined DTPa-IPV vaccine administered as a booster from 4 years of age: a review2006In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 24, no 13, p. 2440-2448Article in journal (Refereed)
    Abstract [en]

    A combined DTPa-IPV booster vaccine was administered as a 4th or 5th dose after DTPa or DTPw priming. Over 99% vaccines developed antibody levels considered to be protective to diphtheria, tetanus and poliovirus, and >95% mounted a response to acellular pertussis antigens. Rectal temperature >39.5 degrees C was observed in at most 3.2% of vaccinees. Swelling >50 mm occurred in 24% of DTPa-primed compared to 5.5% of DTPw-primed children. Large swelling involving the entire upper arm (extending to involve the elbow joint) was reported for up to 1.2% of DTPa-primed subjects, which is consistent with literature reports for other DTPa vaccines.

  • 25.
    Johansson Kostenniemi, Urban
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Norman, David
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Borgström, Malin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    The clinical presentation of acute bacterial meningitis varies with age, sex and duration of illness2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 11, p. 1117-1124Article in journal (Refereed)
    Abstract [en]

    AIM: This Swedish study reviewed differences in clinical presentation and laboratory findings of acute bacterial meningitis in children aged one month to 17 years in Vasterbotten County, Sweden. METHODS: A register-based study was performed for the period 1986 to 2013 using the Vasterbotten County Council's patient registration and laboratory records at the Department of Laboratory Medicine at Umea University Hospital. The medical records were reviewed to extract data and confirm the diagnosis. RESULTS: We found 103 cases of acute bacterial meningitis, and Haemophilus influenzae was the most common pathogen, causing 40.8% of all cases, followed by Streptococcus pneumoniae at 30.1% and Neisseria meningitidis at 9.7%. Significant differences in clinical presentation and laboratory findings were found. Younger children were more unwell than older ones and had more diffuse symptoms on admission. In addition, important sex-related differences were found that might explain the higher case fatality rates for boys than girls. For example, boys tended to have a higher disturbance in the blood-brain barrier, which is known to be a negative prognostic factor. CONCLUSION: This study showed that clinical presentation for acute bacterial meningitis varied with age and sex and, to a lesser extent, on the duration of the illness.

  • 26. Karlsland Åkeson, Pia
    et al.
    Lind, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Öhlund, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serum Vitamin D Depends Less on Latitude Than on Skin Color and Dietary Intake During Early Winter in Northern Europe2016In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 62, no 4, p. 643-649Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate if dietary vitamin D intake is adequate for sufficient vitamin D status during early winter in children living in Sweden, irrespective of latitude or skin color.

    METHODS: As part of a prospective, comparative, two-center intervention study in northern (63°N) and southern (55°N) Sweden, dietary intake, serum 25-hydroxyvitamin D (S-25(OH) D), associated laboratory variables, and socio-demographic data were studied in 5 to 7-year-old children with fair and dark skin in November and December.

    RESULTS: 206 children with fair/dark skin were included, 44/41 and 64/57 children in northern and southern Sweden, respectively. Dietary vitamin D intake was higher in northern than southern Sweden (p=0.001), irrespective of skin color, partly due to higher consumption of fortified foods, but only met 50-70% of national recommendations (10 μg/day). S-25(OH) D was higher in northern than southern Sweden, in children with fair (67 vs. 59 nmol/L; p < 0.05) and dark skin (56 vs. 42 nmol/L; p < 0.001). S-25(OH) D was lower in dark than fair skinned children at both sites (p < 0.01), and below 50 nmol/L in 40 and 75% of dark-skinned children in northern and southern Sweden, respectively.

    CONCLUSIONS: Insufficient vitamin D status was common during early winter in children living in Sweden, particularly in those with dark skin. Although, higher dietary vitamin D intake in northern than southern Sweden attenuated the effects of latitude, a northern country of living combined with darker skin and vitamin D intake below recommendations are important risk factors for vitamin D insufficiency.

  • 27.
    Kilpi, Terhi M
    et al.
    Department of Vaccines; National Public Health Institute (KTL); Helsinki, Finland .
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Nilsson, Lennart
    Department of Pediatrics/Allergy Centre; University Hospital; Linköping, Sweden.
    Syrjänen, Ritva
    Department of Vaccines; National Public Health Institute (KTL); Helsinki, Finland .
    Belloni, Cesare
    Division of Neonatology-Neonatal Pathology-Intensive Care; I.R.C.C.S. San Matteo Hospital; Pavia, Italy.
    Desole, Maria
    Public Health Service; AUSL 1; Sassari, Italy.
    Triban, Chiara
    GlaxoSmithKline Biologicals; Verona, Italy; Solna, Sweden; Espoo, Finland; Rixensart, Belgium.
    Storsaeter, Jann
    GlaxoSmithKline Biologicals; Verona, Italy; Solna, Sweden; Espoo, Finland; Rixensart, Belgium.
    Soila, Maaria
    GlaxoSmithKline Biologicals; Verona, Italy; Solna, Sweden; Espoo, Finland; Rixensart, Belgium.
    Jacquet, Jeanne-Marie
    GlaxoSmithKline Biologicals; Verona, Italy; Solna, Sweden; Espoo, Finland; Rixensart, Belgium.
    Immunogenicity and reactogenicity of two diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated polio virus-Haemophilus influenzae type b vaccines administered at 3, 5 and 11-12 months of age2009In: Human vaccines, ISSN 1554-8619, Vol. 5, no 1, p. 18-25Article in journal (Refereed)
    Abstract [en]

    The use of combination vaccines in the routine childhood program reduces distress to the recipients and is likely to improve uptake rates and timeliness of vaccination but requires careful evaluation and surveillance. The aim of this study was to evaluate the immunogenicity and reactogenicity of two commercial diphtheria-tetanus- acellular pertussis-hepatitis b-inactivated polio virus-Haemophilus influenzae type b (DTaP-HBV-IPV/Hib) combination vaccines when administered to infants at 3, 5 and 11-12 months of age. A total of 494 infants were randomized to receive three doses of either Infanrix hexa (GlaxoSmithKline Biologicals; N = 246) or Hexavac (Sanofi Pasteur MSD; N = 248) in 10 centers in Italy, Finland and Sweden. After the third dose, antibodies to diphtheria, tetanus, polio and Hib were at the protective level in nearly all infants in both groups whereas the proportion of subjects who had achieved the protective concentration of >or=10 mIU/ml to hepatitis B surface antigen was 99.1% (95% CI 96.7-99.9) in the Infanrix hexa group as compared to 94.4% (95% CI 90.4.97.1) in the Hexavac group. Antibody titers to all three polio antigens were highest in Italy and lowest in Finland. Clinically relevant general reactions (such as fever of >39.5 degrees C) were mostly reported in less than 5% of the vaccinees. Three doses of DTaP-HBV-IPV/Hib combination vaccines produced sufficient immune responses in nearly all vaccinees.

  • 28. Liese, J. G.
    et al.
    Giaquinto, C.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Carmona, A.
    Larcombe, J.
    Garcia-sicilia, J.
    Fuat, A.
    Munoz Hiraldo, E.
    Arroba Basanta, M. L.
    Sloesen, B.
    Vollmar, J.
    Holl, K.
    Pircon, J. Y.
    Rosenlund, M.
    The effect of acute otitis media in children on parents' quality of life: Development and validation of a questionnaire implemented in a prospective observational cohort study in europe2011In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 14, no 7, p. A509-A509Article in journal (Refereed)
  • 29. Liese, J. G.
    et al.
    Giaquinto, C.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Carmona, A.
    Larcombe, J.
    Garcia-Sicilia, J.
    Fuat, A.
    Munoz Hiraldo, E.
    Arroba Basanta, M. L.
    Vollmar, J.
    Holl, K.
    Delgleize, E.
    Knerer, G.
    Pircon, J. Y.
    Rosenlund, M.
    The clinical and economic burden of acute otitis media: A large prospective observational cohort study in europe2011In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 14, no 7, p. A508-A509Article in journal (Refereed)
  • 30. Liese, J. G.
    et al.
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Giaquinto, C.
    Carmona, A.
    Larcombe, J. H.
    Garcia-Sicilia, J.
    Fuat, A.
    Garces-Sanchez, M.
    Arroba Basanta, M. L.
    Munoz Hiraldo, E.
    Cantarutti, L.
    Kroeniger, W.
    Vollmar, J.
    Holl, K.
    Pircon, J. Y.
    Rosenlund, M. R.
    Incidence and clinical presentation of acute otitis media in children aged < 6 years in European medical practices2014In: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 142, no 8, p. 1778-1788Article in journal (Refereed)
    Abstract [en]

    We conducted an epidemiological, observational cohort study to determine the incidence and complications of acute otitis media (AOM) in children aged <6 years. Data on physician-diagnosed AOM were collected from retrospective review of medical charts for the year preceding enrolment and then prospectively in the year following enrolment. The study included 5776 children in Germany, Italy, Spain, Sweden, and the UK. AOM incidence was 256/1000 person-years [95% confidence interval (CI) 243-270] in the prospective study period. Incidence was lowest in Italy (195, 95% CI 171-222) and highest in Spain (328, 95% CI 296-363). Complications were documented in < 1% of episodes. Spontaneous tympanic membrane perforation was documented in 7% of episodes. Both retrospective and prospective study results were similar and show the high incidence during childhood in these five European countries. Differences by country may reflect true differences and differences in social structure and diagnostic procedures.

  • 31.
    Lindkvist, Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Associations between toddlers' and parents' BMI, in relation to family sociodemography: a cross-sectional study2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 1252Article in journal (Refereed)
    Abstract [en]

    Background:

    It is well established that the pregnancy and the first years of life are important for future childhood health and body weight. Even though current evidence suggests that both parents are important for childhood health, the influence that parents' BMI and socio-demography has on toddlers' BMI has so far received little attention. This study aimed to increase our knowledge on the association between toddlers' and parents' BMI, in relation to family socio-demography. Further, the aim was to investigate the interaction between the mothers' and fathers' BMI in relation to their child's BMI.

    Methods:

    A total of 697 children with a median age of 18 months (range 16-24 months) participated in the study along with their mothers (n = 697) and fathers (n = 674). As regards representability, our parental sample had a lower proportion of immigrants and the parents were more gainfully employed compared to parents in the rest of Sweden (when the child was 18 months old). The parents completed a questionnaire on parental and child health. Data on parental weight, height, and socio-demographics were recorded along with the child's weight and height measured at an ordinary child health care visit. We used the thresholds for children's BMI that were recommended for surveillance by the Royal College of Paediatrics and Child Health in 2012 based on the WHO reference population.

    Results:

    Among the toddlers, 33 % had a BMI above the WHO 85th percentile and 14 % had a BMI above the WHO 95th percentile. The probability of a toddler having a BMI above the WHO 95th percentile was significantly increased if either the mother or father was overweight (BMI >= 25 kg/m(2)). Furthermore, we found a positive synergistic effect between the mother and father being overweight and their child having a BMI above the WHO 85th percentile. No associations were found between the toddlers' BMI and the family's socio-demographics, but there were associations between the parents' BMI and the family's socio-demographics.

    Conclusion: High BMI is common even in toddlers in this population. The risk increases if one parent is overweight, and it increases even more if both parents are overweight. The results in this study confirm the importance of considering familial risk factors when examining child health and BMI at ordinary child health care visits already at an early age.

  • 32. Medina, Doris M Rivera
    et al.
    Valencia, Alejandra
    de Velasquez, Alet
    Huang, Li-Min
    Prymula, Roman
    García-Sicilia, Jose
    Rombo, Lars
    David, Marie Pierre P
    Descamps, Dominique
    Hardt, Karin
    Dubin, Gary
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Safety and immunogenicity of the HPV-16/18 AS04-adjuvanted vaccine: a randomized, controlled trial in adolescent girls2010In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 46, no 5, p. 414-421Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Immunization of girls against oncogenic human papillomavirus (HPV) types before sexual debut is important for cervical cancer prevention. This phase III blinded, randomized, controlled trial in adolescent girls assessed safety of the HPV-16/18 AS04-adjuvanted vaccine.

    METHODS: Girls (mean age 12 years) in 12 countries received the HPV-16/18 L1 virus-like particle AS04-adjuvanted vaccine (N = 1,035) or hepatitis A virus vaccine as control (N = 1,032) at 0, 1, and 6 months. The primary objective was to compare the occurrence of serious adverse events (SAEs) between groups. HPV-16 and HPV-18 antibody titers were assessed by enzyme-linked immunosorbent assay post-vaccination.

    RESULTS: Up to study month 7, 11 girls in the HPV-16/18 vaccine group reported 14 SAEs and 13 girls in the control group reported 15 SAEs. The difference in SAE incidence between groups was .20% (95% CI, -.78, 1.20). No SAE in the HPV-16/18 vaccine group was considered related to vaccination or led to withdrawal. The incidence of solicited local and general symptoms up to 7 days post-vaccination was moderately higher with the HPV-16/18 vaccine than with control. The incidence of unsolicited symptoms, new onset of chronic diseases, and medically significant conditions was similar between groups. All girls seroconverted for both antigens after three doses of the HPV-16/18 vaccine; geometric mean titers were 19,882.0 and 8,262.0 EU/mL for anti-HPV-16 and -18 antibodies, respectively, in initially seronegative girls.

    CONCLUSIONS: The HPV-16/18 AS04-adjuvanted vaccine was generally well tolerated and immunogenic when administered to young adolescent females, the primary target of organized vaccination programs.

  • 33. Nilsson, Lennart
    et al.
    Faldella, Giacomo
    Jacquet, Jeanne-Marie
    Storsaeter, Jann
    Silfverdal, Sven-Arne
    Paediatric University Clinic, Örebro, Sweden.
    Ekholm, Leif
    A fourth dose of DTPa-IPV vaccine given to 4-6 year old children in Italy and Sweden following primary vaccination at 3, 5 and 11-12 months of age2005In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 37, no 3, p. 221-229Article in journal (Refereed)
    Abstract [en]

    Healthy 4-6 y old children from Italy and Sweden immunized with DTPa and inactivated or oral polio vaccines at 3, 5 and 11-12 months of age, received 1 dose of combined DTPa-IPV (n = 211) or DTPa + IPV as separate doses (n = 205) in a randomized trial. The pre-booster seroprotection rates were similar in each group and were above 60% against all antigens except diphtheria (31.3% and 37.0%) and PT (21.5% and 25.9%) in the DTPa-IPV and DTPa + IPV groups, respectively. At least 99.5% of subjects had seroprotective antibody levels against diphtheria, tetanus and polioviruses and > or = 96% showed a vaccine response to each pertussis antigen after vaccination. Post-booster antibody levels increased at least 51-fold for anti-diphtheria and anti-tetanus, at least 18-fold for anti-pertussis antibodies and at least 32-fold for antibodies against all 3 poliovirus types, compared to prior levels. DTPa-IPV was comparable to DTPa + IPV in terms of seroprotection rates and mean antibody levels against each vaccine antigen. Similar reactogenicity profiles were observed between groups including swelling > 50 mm [13% (9.1, 18.7) vs 17% (12.4, 23.4)] or involving an adjacent joint [0% (-,-) vs 1.5% (0.3, 4.3)] and were consistent with previous reports. The combined DTPa-IPV vaccine could be used to add DTP valences to the IPV vaccine currently given to children in Scandinavia and Italy at 4-6 y of age and reinforce protection against 4 diseases.

  • 34. Pedersen, Court
    et al.
    Breindahl, Morten
    Aggarwal, Naresh
    Berglund, Johan
    Oroszlán, György
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Szüts, Péter
    O'Mahony, Michael
    David, Marie-Pierre
    Dobbelaere, Kurt
    Dubin, Gary
    Descamps, Dominique
    Randomized trial: immunogenicity and safety of coadministered human papillomavirus-16/18 AS04-adjuvanted vaccine and combined hepatitis A and B vaccine in girls.2012In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 50, no 1, p. 38-46Article in journal (Refereed)
    Abstract [en]

    Purpose: This randomized, open, controlled, multicenter study (110886/NCT00578227) evaluated human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine (HPV-16/18 vaccine) coadministered with inactivated hepatitis A and B (HAB) vaccine. Coprimary objectives were to demonstrate noninferiority of hepatitis A, hepatitis B, and HPV-16/18 immune responses at month 7 when vaccines were coadministered, compared with the same vaccines administered alone.

    Methods: Healthy girls (9–15 years) were age-stratified (9, 10–12, and 13–15 years) and randomized to receive HPV (n = 270), HAB (n = 271), or HPV + HAB (n = 272). Vaccines were administered at months 0, 1, and 6. Immunogenicity was evaluated at months 0 and 7.

    Results: The hepatitis A immune response was noninferior for HPV + HAB, versus HAB, for seroconversion rates (100% in each group) and geometric mean antibody titers (GMTs) (95% CI) (4,504.2 [3,993.0–5,080.8] and 5,288.4 [4,713.3–5,933.7] mIU/mL, respectively). The hepatitis B immune response was noninferior for HPV + HAB, versus HAB, for anti-HBs seroprotection rates (98.3% and 100%); GMTs were 3,136.5 [2,436.0–4,038.4] and 5,646.5 [4,481.3–7,114.6] mIU/mL, respectively. The HPV-16/18 immune response was noninferior for HPV + HAB, versus HPV, for seroconversion rates (99.6% and 100% for both antigens) and GMTs (22,993.5 [20,093.4–26,312.0] and 26,981.9 [23,909.5–30,449.1] EL.U/mL for HPV-16; 8,671.2 [7,651.7–9,826.6] and 11,182.7 [9,924.8–12,600.1] EL.U/mL for HPV-18, respectively). No subject withdrew because of adverse events. No vaccine-related serious adverse events were reported. Immune responses and reactogenicity were similar in girls aged 9 years compared with the entire study population.

    Conclusions: Results support coadministration of HPV-16/18 vaccine with HAB vaccine in girls aged 9–15 years. The HPV-16/18 vaccine was immunogenic and generally well tolerated in 9-year-old girls.

  • 35. Prymula, Roman
    et al.
    Szenborn, Leszek
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Wysocki, Jacek
    Albrecht, Piotr
    Traskine, Magali
    Gardev, Asparuh
    Song, Yue
    Borys, Dorota
    Safety, reactogenicity and immunogenicity of two investigational pneumococcal protein-based vaccines: results from a randomized phase II study in infants2017In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 35, no 35B, p. 4603-4611Article in journal (Refereed)
    Abstract [en]

    Introduction: Vaccination with formulations containing pneumococcal protein antigens such as pneumolysin toxoid (dPly) and histidine-triad protein D (PhtD) may extend serotype-related protection of pneumococcal conjugate vaccines (PCVs) against Streptococcus pneumoniae.

    Methods: This phase II, multi-center, observer-blind trial conducted in Europe (NCT01204658) assessed 2 investigational vaccines containing 10 serotype-specific polysaccharide conjugates of PHiD-CV and either 10 or 30 mu g of dPly and PhtD each. Infants randomized 1:1:1:1 received 4 doses of PHiD-CV/dPly/PhtD-10, PHiD-CV/c1Ply/PhtD-30, PHiD-CV, or 13-valent PCV (PCV13), co-administered with DTPa-HBV-IPV/Flib, at ages 2, 3, 4 and 12-15 months. Occurrences of fever >40.0 degrees C following primary vaccination with PHiD-CV/dPly/PhtD vaccines compared to PHiD-CV (non-inferiority objective), dose superiority, safety and immunogenicity were assessed.

    Results: 575 children received primary vaccination, and 564 booster vaccination. The non-inferiority objective was met; no fever >40.0 degrees C causally related to vaccination was reported during primary vaccination. Incidence of adverse events appeared similar between the 3 PHiD-CV groups. Serious adverse events were reported in 13, 9, 21 (1 related to vaccination), and 17 children in the PHiD-CV/c1Ply/PhtD-10, PHiD-CV/dPly/PhtD-30, PHiD-CV, and PCV13 groups, respectively. PHiD-CV/dPly/PhtD-30 was superior to PHiD-CV/c1Ply/PhtD-10 in terms of post-dose 3 anti-Ply and Anti-PhtD antibody levels. Anti-Ply and anti-PhtD antibody levels were higher in both PHiD-CV/dPly/PhtD groups than in controls and increased from post-primary to post-booster timepoint. Post-primary and booster vaccination, for each PHiD-CV serotype, >= 98.5% of participants in PHiD-CV/dPly/PhtD groups had antibody concentrations >= 0.2 mu g/mL, except for 6B (>= 72.3%) and 23 F (>= 82.7%) post-primary vaccination. Similar results were observed in the PHiD-CV group. Immune responses to protein D and DTPa-HBV-IPV/Hib were within similar ranges for the 3 PHiD-CV groups.

    Conclusion: Both PHiD-CV/dPly/PhtD formulations co-administered with DTPa-HBV-IPV/Hib in infants were well-tolerated and immunogenic for dPly and PhtD antigens, while immune responses to serotype-specific, protein D and co-administered antigens did not appear altered in comparison to PHiD-CV group. 

  • 36. Renman, C
    et al.
    Engström, I
    Silfverdal, S A
    Aman, J
    Mental health and psychosocial characteristics in adolescent obesity: a population-based case-control study.1999In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 88, no 9, p. 998-1003Article in journal (Refereed)
    Abstract [en]

    In this population-based study we compared self-esteem, social background, social and academic competence, behavioural problems and lifestyle in 58 obese adolescents (BMI > or =99.6th percentile or > or =30 kg/m2), aged 14-18 y, with 58 sex- and age-matched controls of normal weight. The instruments used were: I Think I Am, Youth Self Report and a lifestyle questionnaire. The obese group was on average, 40 kg heavier than the controls. The obese individuals rated themselves significantly lower in physical characteristics, but in all other aspects of self-esteem, mental health and social and academic competence there were no differences between the two groups. There were significant socioeconomic differences, with more obese adolescents living with only one parent and with the mothers in the obese group having, in general, lower education than those in the control group. This study confirms previous observations that obesity is associated with special socioeconomic conditions in youth, but that obese adolescents do not differ from their normal-weight peers in other aspects of mental health.

  • 37.
    Silfverdal, Sven A
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Assudani, Deepak
    Kuriyakose, Sherine
    Van der Meeren, Olivier
    Immunological persistence in 5 y olds previously vaccinated with hexavalent DTPa-HBV-IPV/Hib at 3, 5, and 11 months of age2014In: Human Vaccines & Immunotherapeutics, ISSN 2164-5515, E-ISSN 2164-554X, Vol. 10, no 10, p. 2795-2798Article in journal (Refereed)
    Abstract [en]

    The combined diphtheria-tetanus-acellular pertussis-hepatitis B-poliomyelitis/Haemophilus influenza vaccine (DTPa-HBV-IPV/Hib: Infanrix hexa, GlaxoSmithKline Vaccines) is used for primary vaccination of infants in a range of schedules world-wide. Antibody persistence after 4 DTPa-HBV-IPV/Hib doses in the first 2 y of life has been documented, but long-term persistence data following the 3, 5, 11-12 months (3-5-11) infant vaccination schedule, employed for example in Nordic countries, are limited. We assessed antibody persistence in 57 5-year-old children who had received either DTPa-HBV-IPV/Hib or DTPa-IPV/Hib (Infanrix-IPV/Hib, GlaxoSmithKline Vaccines) in the 3-5-11 schedule. Among DTPa-HBV-IPV/Hib recipients, 7/12 retained seroprotective antibody concentrations for diphtheria, 10/12 for tetanus, 5/12 for hepatitis and 10/12 for Hib. Detectable antibodies were observed for 0/12 children for pertussis toxin (PT), 12/12 for filamentous haemagglutinin (FHA) and 8/12 for pertactin (PRN). Among DTPa-IPV/Hib recipients, 28/45 retained seroprotective anti-diphtheria concentrations, 34/44 for tetanus and 40/45 for Hib. Detectable antibodies were observed for 9/45 children for PT, 41/45 for FHA and 34/45 for PRN. Antibody persistence in DTPa-HBV-IPV/Hib and DTPa-IPV/Hib-vaccinees appeared similar in 5 y olds to that previously observed in children of a similar age who had received 4 prior doses of DTPa-HBV-IPV/Hib (or DTPa-IPV/Hib). As in subjects primed with 4 prior doses, we observed that antibodies markedly declined by 5 y of age, calling for the administration of a pre-school booster dose in order to ensure continued protection against pertussis.

  • 38.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Clinical Sciences, Paediatrics.
    [Vaccination yields good immune response in children]2008In: Lakartidningen, ISSN 0023-7205, Vol. 105, no 22, p. 1670-4Article in journal (Other academic)
  • 39.
    Silfverdal, Sven Arne
    et al.
    Umeå University, Faculty of Medicine, Clinical Sciences, Paediatrics.
    Berg, Stefan
    Hemlin, Claes
    Jokinen, Iiro
    The cost-burden of paediatric pneumococcal disease in Sweden and the potential cost-effectiveness of prevention using 7-valent pneumococcal vaccine.2009In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 27, no 10, p. 1601-1608Article in journal (Refereed)
    Abstract [en]

    AIMS: A cost-effectiveness model was used to estimate the change in disease burden that might be expected if PCV7 was included as part of the routine 3-dose vaccination schedule in Sweden. METHODS: An economic model was populated with data from the main clinical PCV7 efficacy trials, demographic data from government sources, surveillance and epidemiologic data from the US and Nordic region, and average treatment costs, considering the impact of disease on the whole national population. RESULTS: The model estimated that PCV7 would prevent 18,856 cases of AOM, 684 of pneumonia, 86 of pneumococcal bacteraemia and 21 cases of pneumococcal meningitis in children <10 years, further 221 cases of IPD would be avoided in older children and adults and 397 cases of pneumonia in adults aged 18-39 years. Annually, 4 childhood (<10 years) deaths and 39 deaths in older children and adults would be prevented, resulting in an annual saving of 632 life years. The reduction of cost for the society was estimated to 27.9 (-205, +160) million SEK. The sensitivity analysis showed that it was most sensitive to the efficacy of the vaccine against AOM, the cost of managing infections and the incidence of all disease. CONCLUSION: This model demonstrates that implementing a universal vaccine programme in Sweden with PCV7 would be cost-effective with an estimated net reduction of costs for the society.

  • 40.
    Silfverdal, Sven Arne
    et al.
    Department of Pediatrics, Orebro Medical Centre Hospital, Sweden.
    Bodin, L
    Department of Pediatrics, Orebro Medical Centre Hospital, Sweden.
    Hugosson, S
    Department of Pediatrics, Orebro Medical Centre Hospital, Sweden.
    Garpenholt, O
    Department of Pediatrics, Orebro Medical Centre Hospital, Sweden.
    Werner, B
    Department of Pediatrics, Orebro Medical Centre Hospital, Sweden.
    Esbjörner, E
    Department of Pediatrics, Orebro Medical Centre Hospital, Sweden.
    Lindquist, B
    Department of Pediatrics, Orebro Medical Centre Hospital, Sweden.
    Olcén, P
    Department of Pediatrics, Orebro Medical Centre Hospital, Sweden.
    Protective effect of breastfeeding on invasive Haemophilus influenzae infection: a case-control study in Swedish preschool children1997In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 26, no 2, p. 443-450Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In Orebro County a 2.5-fold increase in the incidence of Haemophilus influenzae (HI) meningitis was found between 1970 and 1980, an observation that initiated the present study.

    MATERIALS AND METHODS: In order to search for associations between morbidity in invasive HI infection and possible risk factors, a case-control study was conducted over a 6-year period from 1987 to 1992, before general Hib vaccination was introduced in Sweden. Fifty-four cases with invasive HI infection 139 matched controls were studied for possible risk factors such as day-care outside the home, short duration of breastfeeding, passive smoking, low socioeconomic level of the household, many siblings in the family, allergy, frequent, infections, repeated antibiotic treatments and immunoglobulin deficiency.

    RESULTS: Multivariate analysis showed a significant association between invasive HI infection and two independent factors, i.e. short duration (< 13 weeks) of exclusive breastfeeding, odds ratio (OR) 3.79 (95% confidence interval [CI] 1.6-8.8) and history of frequent infections, OR 4.49 (95% CI : 1.0-21.0). For the age at onset 12 months or older, the associations were stronger, OR 7.79 (95% CI : 2.4-26.6) and 5.86 (95% CI : 1.1-30.6), respectively. When breastfeeding duration in weeks was analysed as a continuous variable the OR was 0.95 (95% CI : 0.92-0.99), indicating a decreased risk with each additional week. Increased OR were observed for other risk factors as well but not of the magnitude found for short duration of breastfeeding.

    DISCUSSION: The association of decreased risk for invasive HI infection and long duration of breastfeeding was persisting beyond the period of breastfeeding itself. This finding supports the hypothesis of a long-lasting protective effect of breastfeeding on the risk for invasive HI infection.

    CONCLUSION: A decreased risk for invasive HI infection with long duration of breastfeeding was found. Our results do have implications for strategies in breastfeeding promotion, especially in countries where Hib vaccination is too costly and not yet implemented.

  • 41.
    Silfverdal, Sven Arne
    et al.
    Department of paediatrics, Örebro medical center hospital, Örebro, Sweden.
    Bodin, Lennart
    Department of occupational and environmental medicine, Unit of biostatistics and epidemiology, Örebro medical center hospital, Örebro, Sweden.
    Olcén, Per
    Department of clinical microbiology and immunology, Örebro medical center hospital, Örebro, Sweden.
    Protective effect of breastfeeding: an ecologic study of Haemophilus influenzae meningitis and breastfeeding in a Swedish population1999In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 28, no 1, p. 152-156Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In Orebro County, Sweden, a 2.5-fold increase in the incidence of Haemophilus influenzae (HI) meningitis was found between 1970 and 1980. In a case-control study of possible risk factors for invasive HI infection conducted in the same area, 1987-1992, breastfeeding was found to be a strong protective factor.

    MATERIAL AND METHODS: In order to study the relation between incidence rates of HI meningitis between 1956-1992 and breastfeeding rates in the population an ecologic study was performed.

    RESULTS: A strong (negative) correlation between breastfeeding and incidence of HI infection 5 to 10 years later (rho(xy) (s) approximately -0.6) was seen, whereas no relation seems to exist for the time lag 15 years and beyond. The correlation for contemporary data was intermediate. There were similar results for the breastfeeding proportions at 2, 4 as well as 6 months of age.

    DISCUSSION: Our ecologic data are consistent with results from our case-control study. The time-lag for the delayed effect on the population level could be estimated although sparse data make the estimates vulnerable to sampling fluctuations. Limitations with ecologic studies are discussed.

    CONCLUSION: There seems to be an association between high breastfeeding rate in the population and a reduced incidence of HI meningitis 5 to 10 years later. These results do have implications on strategies for breastfeeding promotion, especially in countries where Hib vaccination is too costly and not yet implemented.

  • 42.
    Silfverdal, Sven Arne
    et al.
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Bodin, Lennart
    Biostatistics and Epidemiology, Örebro University Hospital, Örebro, Sweden.
    Olcén, Per
    Clinical Microbiology and Immunology, Örebro University Hospital, Örebro, Sweden.
    Why the rise in Haemophilus influenzae type b infections?2003In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 362, no 9380, p. 331-Article in journal (Other (popular science, discussion, etc.))
  • 43.
    Silfverdal, Sven Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Coremans, Vanessa
    Francois, Nancy
    Borys, Dorota
    Cleerbout, Jan
    Safety profile of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV)2017In: Expert Review of Vaccines, ISSN 1476-0584, E-ISSN 1744-8395, Vol. 16, no 2, p. 109-121Article, review/survey (Refereed)
    Abstract [en]

    Safety and reactogenicity data were reviewed following 10 years of experience with the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in clinical development and from post-licensure settings. Analyses of pooled clinical trial data and post-marketing reports provided an overview of its safety profile and allowed assessment of rare adverse events that might not have been identified previously. The safety of PHiD-CV was also evaluated in children at higher risk for pneumococcal infection (preterm and HIV-infected or HIV-exposed infants), for different vaccination schedules and co-administered pediatric vaccines, and with a focus on special categories of adverse events (febrile convulsions, apnea, Kawasaki disease and sudden deaths). Following the distribution of over 235 million doses, PHiD-CV has been well tolerated when co-administered with other pediatric vaccines to children aged less than 5 years from diverse ethnic and geographic backgrounds. Detailed examination of various aspects has confirmed its favorable benefit: risk profile.

  • 44.
    Silfverdal, Sven Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ehlin, A
    Montgomery, S M
    Breast-feeding and a subsequent diagnosis of measles2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 4, p. 715-719Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Breast-feeding protects against many infectious diseases and may also influence immunization outcomes. AIM: This study investigated if breast-feeding protects against clinical measles and if it modified the effect of immunization. METHODS: We used logistic regression with data for 10 207 individuals from the 1970 British Cohort study (BCS70). Breast-feeding data were collected at five years of age, and information on clinical measles infection, as well as socio-economic measures was collected at the age of ten years. Breast feeding was categorized as: breast-fed <1 month (n = 1611), breast-fed for 1-3 months (n = 1016), breast-fed for more than three months (n = 1108), breast-feeding of uncertain duration (n = 21) and never breast-fed (n = 6451). RESULTS: Breast-feeding for more than three months was negatively associated with a diagnosis of clinical measles infection after adjustment for crowding, social class, measles vaccination, parity and sex with an odds ratio (95% confidence interval) of 0.69 (0.60-0.81) compared with those who never breast-fed. Measles vaccination was highly associated with low risk for measles with: 0.14 (0.13-0.16). Age at acute measles infection was not associated with breastfeeding. Breast-feeding did not notably alter measles immunization efficacy. CONCLUSION: Immunization against measles provides effective protection against the disease. A more modest reduction in the risk of a measles diagnosis is associated with breast-feeding. The associations with a diagnosis of measles for breast-feeding and measles immunization are independent of each other.

  • 45.
    Silfverdal, Sven Arne
    et al.
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Ehlin, A
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Hospital, Karolinska Institutet, Sweden.
    Montgomery, S M
    Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Protection against clinical pertussis induced by whole-cell pertussis vaccination is related to primo-immunisation intervals2007In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 25, no 43, p. 7510-7515Article in journal (Refereed)
    Abstract [en]

    AIMS: Information on subjects who had at least three immunisations against pertussis was provided by longitudinal data from the 1970 British Cohort Study (BCS70) and used to assess whether three whole-cell pertussis (wP) immunisations given within less than 5 months confer less effective protection in childhood compared with a schedule with a longer interval. METHODS: Age at pertussis infection was the dependent variable in a Cox regression analysis, to investigate associations with duration between first and third pertussis immunisation; with third immunisation modelled as a time-dependent covariate. Adjustment was for number of pertussis immunisations (three or four), sex, social class and other potential confounding factors. RESULTS: A total of 8545 children were included in the analysis and 556 had a history of whooping cough. A duration of over 4 months between first and third pertussis immunisations is statistically significantly associated with a reduced risk of pertussis infection by age 10 years, compared with three immunisations given over a shorter period, producing a statistically significant adjusted hazard ratio of 0.74 (0.62-0.92). A fourth immunisation against pertussis further enhanced the protective effect with a hazard ratio of 0.59 (0.44-0.82). CONCLUSION: These results were based on a historical UK cohort using wP vaccine, and indicate that a vaccination schedule with an interval between the immunisations greater than 4 months, and also including a fourth immunisation, would be more effective in this population than a three dose schedule within a shorter interval without booster.

  • 46.
    Silfverdal, Sven Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ekholm, L
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Bodin, L
    Clinical Research Centre, Biostatistics and Epidemiology Unit, Örebro University Hospital, Örebro, Sweden.
    Breastfeeding enhances the antibody response to Hib and Pneumococcal serotype 6B and 14 after vaccination with conjugate vaccines2007In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 25, no 8, p. 1497-1502Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study was performed in order to investigate the relationship between breastfeeding and the antibody response after vaccination with conjugate vaccines against Hib and pneumococcal diseases. METHODS: This was an open non-randomised multi-centre study enrolling 101 healthy Swedish infants. PncCRM was administered concomitantly with DTaP/IPV/Hib at 3, 5, and 12 months at separate site. Duration of breastfeeding was calculated for days of almost exclusive as well as of total (any form of) breastfeeding. RESULTS: At 13 months of age 6 out of 83 children did not reach 0.2mug/ml against serotype 6B, and five of these were breastfed less than 90 days (Fisher's Exact test, P=0.011). Four children did not reach 1mug/ml against Hib and all those were breastfed less than 90 days (Fisher's Exact test, P=0.008). One month after the second dose, at 6 months of age, children breastfed 90 days or more showed significantly higher GMC against serotype 14 (P=0.003). CONCLUSION: This study indicates that children exclusively breastfed 90 days or more might get a better serological protection against Hib, and the pneumococcal serotypes 6B and 14 after vaccination, compared to children less breastfed.

  • 47.
    Silfverdal, Sven Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Flodmark, Carl-Erik
    Rombo, Lars
    Tansey, Susan P.
    Sidhu, Mohinder
    Trammel, James
    Emini, Emilio A.
    Gruber, William C.
    Scott, Daniel A.
    Gurtman, Alejandra
    13-Valent pneumococcal conjugate vaccine (PCV13) in children partially immunized with 7-valent pneumococcal conjugate vaccine (PCV7): A phase 3, open-label trial2013In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 31, no 9, p. 1284-1292Article in journal (Refereed)
    Abstract [en]

    Background: As 13-valent pneumococcal conjugate vaccine (PCV13) is introduced, children who began vaccination with 7-valent pneumococcal conjugate vaccine (PCV7) may complete their vaccination with PCV13. This open-label phase 3 study evaluated immunogenicity and safety of PCV13 in Swedish infants and toddlers previously given 1 or 2 doses of PCV7 during infancy. Methods: Healthy infants previously given PCV7 at ages 3 months (group 1; n = 118) or 3 and 5 months (group 2; n = 116) received PCV13 at ages 5 (group 1) and 12 months (both groups). IgG responses were assessed 1 month after each PCV13 dose and before the 12-month dose. Local reactions and systemic events were collected for 7 days postvaccination. Other adverse events were also collected. Results: Post-5-month dose, IgG geometric mean concentrations (GMCs) in group 1 were 1.56-4.70 mu g/ml for most PCV7 serotypes except 6B (0.40 mu g/ml) and 23F (0.57 mu g/ml) and 0.72-1.88 mu g/ml for most of the 6 additional serotypes, except 6A (0.28 mu g/ml). Post-12-month dose, IgG GMCs for the PCV7 serotypes were 2.93-9.63 mu g/ml (group 1) and 3.33-9.30 mu g/ml (group 2); and for the 6 additional serotypes, 1.85-14.65 mu g/ml (group 1) and 1.34-13.16 mu g/ml (group 2). GMCs increased by >4-fold in both groups from pre- to post-12-month dose. Proportions of subjects in group 1 with pneumococcal serotype-specific IgG concentrations >= 0.35 mu g/ml (WHO-designated postprimary reference antibody level) post-5-month dose were 92.2-99.1% for most PCV7 serotypes except 6B (53.0%) and 23F (62.6%) and 80.9-100.0% for most of the 6 additional serotypes except 6A (36.8%). Local reactions and fever were mostly mild or moderate. Conclusions: PCV13 was immunogenic and safe in infants and toddlers previously partially immunized with PCV7. Even a single dose in an infant or toddler induces an immune response to the 6 additional serotypes. (C) 2013 Published by Elsevier Ltd.

  • 48.
    Silfverdal, Sven Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Gothefors, Leif
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    [Time to vaccinate infants and small children against pneumococci]2006In: Lakartidningen, ISSN 0023-7205, Vol. 103, no 7, p. 477-8Article in journal (Other academic)
    Abstract [sv]

    Article in Swedish

  • 49.
    Silfverdal, Sven Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Livsmedelstillsatser kan ökahyperaktivitet hos barn: Resultat från brittisk studie stärker sambandet2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 6, p. 354-355Article in journal (Other academic)
  • 50.
    Silfverdal, Sven Arne
    et al.
    Umeå University, Faculty of Medicine, Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Clinical Sciences, Paediatrics.
    [Who is responsible for dietary advice for our children?]2008In: Lakartidningen, ISSN 0023-7205, Vol. 105, no 24-25, p. 1863-4Article in journal (Other academic)
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