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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 universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    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 trial2013Ingår i: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 31, nr 51, s. 6136-6143Artikel i tidskrift (Refereegranskat)
    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 universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Pneumonia mortality among children in Brazil: a success story2011Ingår i: Jornal de pediatria, ISSN 1678-4782, Vol. 87, nr 2, s. 85-87Artikel i tidskrift (Övrigt vetenskapligt)
  • 3.
    Bhavsar, Amit
    et al.
    Epidemiology & Health Economics, GSK, Wavre, Belgium.
    Mertsola, Jussi
    Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland.
    Poulsen, Anja
    Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Pertussis in infants in Nordic countries2021Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 110, nr 7, s. 2040-2044Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Aim: A life-course immunisation approach is required to prevent and control pertussis. We aimed at reviewing pertussis incidence among infants in Denmark, Finland, Norway and Sweden, and at putting these data in the context of national surveillance systems and vaccination schedules.

    Methods: We collected 2014–2018 data on pertussis incidence, on pertussis vaccination schedules and on coverage of the third dose of the diphtheria toxoid, tetanus toxoid and acellular pertussis vaccine from publicly available sources. We gathered opinions on national surveillance systems from public health and paediatrics experts of the relevant countries.

    Results: The pertussis vaccination schedules and coverage in infancy were similar across countries. All countries except Denmark recommended an additional booster vaccine dose for adolescents. None of the countries had maternal immunisation recommendation. Mean pertussis incidence in Denmark, Sweden and Finland was 168, 76 and 35 per 100,000 infant-years, respectively. Data were insufficient to derive a mean incidence in Norway. There were no systematic differences in the national surveillance systems across the countries.

    Conclusion: The higher mean pertussis incidence in Denmark may be explained by the lack of recommendations for adolescent pertussis booster vaccination. Further investigations are warranted.

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  • 4.
    Björmsjö, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ekström, Nina
    Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lönnerdal, Bo
    Department of Nutrition, University of California, Davis, USA.
    Berglund, Staffan K.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM).
    Vaccine IgG antibody response is higher in formula-fedcompared to breastfed infants but not affected by added bovine lactoferrin or lowered iron content: results from a randomized controlled trialManuskript (preprint) (Övrigt vetenskapligt)
  • 5.
    Blom, Lisa
    et al.
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Edenius, Anna
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Enebrink, Pia
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Hjern, Anders
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Åhlén, Johan
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Malin
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lindberg, Lene
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Little All Children in Focus (Little ACF), evaluation of a parental support program for parents of children aged 1–2 years: study protocol for a randomized controlled trial2023Ingår i: Trials, E-ISSN 1745-6215, Vol. 24, nr 1, artikel-id 184Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Child health and development can be promoted by strengthening and supporting parents. Research on parental support programs based on positive psychology and a health-promoting approach aimed at all parents, and in particular parents of infants is limited. All Children in Focus (ACF) is a parental support program that has been evaluated in a randomized trial in parents of children 3–12 years. The ACF is based on health promotion aiming to increase parents’ confidence and child’s well-being. In the current study, we will study the effects of a revised version of the ACF called Little ACF adapted to parents with children aged 1–2 years.

    Methods: The study includes a randomized controlled trial (RCT) taking place at several Child Health Centers (CHCs) in Sweden. The RCT will evaluate the efficacy of Little ACF (intervention) in comparison with four digital lectures about child development and parenting (active control). Parents are recruited at the 10-, 12-, or 18-month visits to CHC by CHC-nurses. Data to assess changes in parental competencies and child socio-emotional development are collected through online questionnaires completed by parents at five time points: baseline, post-intervention, after 6 and 12 months, and when the child is 3 years old.

    Discussion: The paper describes a study protocol of a randomized controlled trial evaluating the effects of a parental support program during infancy. Several issues related to the methodology and implementation are discussed.

    Trial registration: ClinicalTrials.gov NCT05445141. Registered on 6 July 2022.

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  • 6. By, Asa
    et al.
    Sobocki, Patrik
    Forsgren, Arne
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Comparing health outcomes and costs of general vaccination with pneumococcal conjugate vaccines in sweden: a markov model.2012Ingår i: Clinical Therapeutics, ISSN 0149-2918, E-ISSN 1879-114X, Vol. 34, nr 1, s. 177-89Artikel i tidskrift (Refereegranskat)
    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.

  • 7.
    Casabona, Giacomo
    et al.
    GSK, Wavre, Belgium.
    Habib, Md Ahsan
    GSK, Wavre, Belgium.
    Povey, Michael
    GSK, Wavre, Belgium.
    Riise Bergsaker, Marianne A.
    The Norwegian Institute of Public Health, Oslo, Norway.
    Flodmark, Carl-Erik
    Department of Paediatrics, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Espnes, Ketil Arne
    Risvollan Legesenter, Trondheim, Norway; Department of Clinical Pharmacology, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway.
    Tøndel, Camilla
    Department of Paediatrics, Haukeland University Hospital, Bergen, Norway.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Randomised controlled trial showed long-term efficacy, immunogenicity and safety of varicella vaccines in Norwegian and Swedish children2022Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 111, nr 2, s. 391-400Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: Several countries, such as Norway and Sweden, have not implemented universal varicella vaccination. We present data for Norway and Sweden that were generated by a paediatric multi-country Phase III study over a 10-year period. This assessed the efficacy, antibody persistence and safety of two varicella vaccines containing the same Oka strain.

    Methods: This was an observer-blind, controlled trial conducted in 10 European countries. Children aged 12–22 months (n = 5803) were randomised 3:3:1 and vaccinated between 1 September 2005 and 10 May 2006. The two-dose group received two tetravalent measles-mumps-rubella-varicella vaccine doses. The one-dose group received one monovalent varicella vaccine dose after a measles-mumps-rubella vaccine dose. Control group participants received two measles-mumps-rubella vaccine doses. Main study outcomes were vaccine efficacy against confirmed varicella cases and incidence of adverse events.

    Results: Vaccine efficacy in the two-dose group was ≥92.1% in both Norwegian and Swedish children compared to 72.3% in Norway and 58.0% in Sweden in the one-dose group. Incidences of adverse events and serious adverse events were similar in the Norwegian and Swedish study populations.

    Conclusion: Consistent with overall study results, high efficacy against varicella and acceptable safety profiles of the two varicella vaccines were observed in Norwegian and Swedish populations. These findings highlight the benefits of varicella vaccines, particularly when administered as a two-dose schedule.

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  • 8.
    Egorova, Olga
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Myte, Robin
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Schneede, Jørn
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Bölte, Sven
    Domellöf, Erik
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Ivars A'roch, Barbro
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Elgh, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
    Ueland, Per Magne
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Maternal blood folate status during early pregnancy and occurrence of autism spectrum disorder in offspring: a study of 62 serum biomarkers2020Ingår i: Molecular Autism, ISSN 2040-2392, Vol. 11, artikel-id 7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Autism spectrum disorder (ASD) evolves from an interplay between genetic and environmental factors during prenatal development. Since identifying maternal biomarkers associated with ASD risk in offspring during early pregnancy might result in new strategies for intervention, we investigated maternal metabolic biomarkers in relation to occurrence of ASD in offspring using both univariate logistic regression and multivariate network analysis.

    Methods: Serum samples from 100 women with an offspring diagnosed with ASD and 100 matched control women with typically developing offspring were collected at week 14 of pregnancy. Concentrations of 62 metabolic biomarkers were determined, including amino acids, vitamins (A, B, D, E, and K), and biomarkers related to folate (vitamin B9) metabolism, lifestyle factors, as well as C-reactive protein (CRP), the kynurenine-tryptophan ratio (KTR), and neopterin as markers of inflammation and immune activation.

    Results: We found weak evidence for a positive association between higher maternal serum concentrations of folate and increased occurrence of ASD (OR per 1 SD increase: 1.70, 95% CI 1.22–2.37, FDR adjusted P = 0.07). Multivariate network analysis confirmed expected internal biochemical relations between the biomarkers. Neither inflammation markers nor vitamin D3 levels, all hypothesized to be involved in ASD etiology, displayed associations with ASD occurrence in the offspring.

    Conclusions: Our findings suggest that high maternal serum folate status during early pregnancy may be associated with the occurrence of ASD in offspring. No inference about physiological mechanisms behind this observation can be made at the present time because blood folate levels may have complex relations with nutritional intake, the cellular folate status and status of other B-vitamins. Therefore, further investigations, which may clarify the potential role and mechanisms of maternal blood folate status in ASD risk and the interplay with other potential risk factors, in larger materials are warranted.

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  • 9.
    Eurenius, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Richter Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Vaezghasemi, Masoud
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik. Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Social-emotional problems among three-year-olds differ based on the child's gender and custody arrangement2019Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, nr 6, s. 1087-1095Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study was to investigate mental health with respect to social-emotional problems among three-year-olds in relation to their gender, custody arrangements and place of residence.

    METHODS: A cross-sectional population-based design was used, encompassing 7,179 three-year-olds in northern Sweden during the period 2014-2017 from the regional Salut Register. Descriptive and comparative analyses were performed based on parents' responses on the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE), supplemented with items on gender, custody arrangement and place of residence.

    RESULTS: Parental-reported social-emotional problems were found in almost 10% of the children. Boys were reported to have more problems (12.3%) than girls (5.6%) (p<0.001). Parents were most concerned about children's eating habits and interactions at mealtimes. Parents not living together reported more problems among their children than those living together (p<0.001). When stratifying by custody arrangement, girls in rural areas living alternately with each parent had more problems compared to those in urban areas (p<0.008).

    CONCLUSION: Gender and custody arrangements appear to be important factors for social-emotional problems among three-year-olds. Thus, such conditions should receive attention during preschool age, preferably by a systematic preventive strategy within Child Health Care.

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  • 10.
    Falkenstein-Hagander, Kathy
    et al.
    Public Health Agency of Sweden, Solna, Sweden.
    Appelqvist, Emma
    Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden.
    Frisk Cavefors, Ann-Sofie
    Central Child Health Services Unit, Gothenburg, Sweden.
    Källberg, Henrik
    Public Health Agency of Sweden, Solna, Sweden.
    Nilsson, Lennart Jan
    Allergy Center, Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Storsaeter, Jann
    Public Health Agency of Sweden, Solna, Sweden.
    Aronsson, Bernice
    Public Health Agency of Sweden, Solna, Sweden.
    Waning infant pertussis during COVID-19 pandemic2022Ingår i: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 107, nr 3, artikel-id e19Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Measures to reduce the spread of COVID-19 have been associated with reduction in other respiratory infections. Results of a national Swedish cohort study of infant pertussis during April 2020-September 2021 were compared with those during January 2014-March 2020. The number of pertussis cases decreased significantly during the COVID-19 pandemic, from an average of 21 infant cases per quarter of a year before the pandemic to an average of 1 case per quarter during the pandemic. Swedish strategies to mitigate the spread of COVID-19 seem to have had an impact on pertussis incidence in infants. Measures to prevent the spread of COVID-19 have also reduced other respiratory viral infections in children. This study from Sewden found that the number of infant pertussis infections also fell during the COVID-19 pandemic. The authors discuss the implications of this finding.

  • 11.
    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 Sweden1996Ingår i: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 28, nr 2, s. 165-169Artikel i tidskrift (Refereegranskat)
    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.

  • 12. Garpenholt, Örjan
    et al.
    Silfverdal, Sven Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hugosson, Svante
    Fredlund, Hans
    Olcén, Per
    [Good effect of general HIB vaccination of children]1997Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 94, nr 3, s. 113-Artikel i tidskrift (Refereegranskat)
  • 13.
    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 Sweden1998Ingår i: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 30, nr 1, s. 5-10Artikel i tidskrift (Refereegranskat)
    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.

  • 14.
    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]2005Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, nr 32-33, s. 2236-2237Artikel i tidskrift (Övrigt vetenskapligt)
  • 15. Gustafsson, Anna
    et al.
    Granström, Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Stecksén-Blicks, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    West, Christina E.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    The antisecretory factor in plasma and breast milk in breastfeeding mothers: a prospective cohort study in Sweden2018Ingår i: Nutrients, E-ISSN 2072-6643, Vol. 10, nr 9, artikel-id 1227Artikel i tidskrift (Refereegranskat)
    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.

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  • 16. Gustafsson, Anna M.
    et al.
    Fransson, Emma
    Dubicke, Aurelija
    Hjelmstedt, Anna K.
    Ekman-Ordeberg, Gunvor
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lange, Stefan
    Jennische, Eva
    Bohlin, Kajsa
    Low levels of anti-secretory factor in placenta are associated with preterm birth and inflammation2018Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, nr 3, s. 349-356Artikel i tidskrift (Refereegranskat)
    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.

  • 17. 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.2002Ingår i: Pediatrics International, ISSN 1328-8067, E-ISSN 1442-200X, Vol. 44, nr 4, s. 347-52Artikel i tidskrift (Refereegranskat)
    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.

  • 18. 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.2003Ingår i: Annals of the New York Academy of Sciences, ISSN 0077-8923, E-ISSN 1749-6632, Vol. 987, s. 199-206Artikel i tidskrift (Refereegranskat)
    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.

  • 19. Hanson, Lars A
    et al.
    Silfverdal, Sven Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    The mother's immune system is a balanced threat to the foetus, turning to protection of the neonate.2009Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, nr 2, s. 221-228Artikel i tidskrift (Refereegranskat)
    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.

  • 20.
    Hanson, Lars A.
    et al.
    From the Department of Clinical Immunology, University of Gothenburg, Sweden.
    Silfverdal, Sven Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Vaccination immunology2008Ingår i: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 40, nr 9, s. 696-701Artikel i tidskrift (Refereegranskat)
    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.

  • 21.
    Hanson, Lars A
    et al.
    Univ Gothenburg, Dept Clin Immunol & Clin Bacteriol, Gothenburg, Sweden.
    Silfverdal, Sven Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hahn-Zoric, M
    Håversen, L
    Mattsby Baltzer, I
    Moisei, M
    Motas, C
    Immune function2009Ingår i: Advances in Experimental Medicine and Biology, ISSN 0065-2598, E-ISSN 2214-8019, Vol. 639, s. 97-111Artikel i tidskrift (Refereegranskat)
  • 22. 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.2002Ingår i: Advances in Experimental Medicine and Biology, ISSN 0065-2598, E-ISSN 2214-8019, Vol. 503, s. 99-106Artikel i tidskrift (Refereegranskat)
  • 23. Hanson, Lars Å
    et al.
    Blennow, Margareta
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Oetiskt att ge amningsråd2011Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, nr 40, s. 1974-1975Artikel i tidskrift (Övrigt vetenskapligt)
  • 24.
    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 feeding2001Ingår i: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 12, nr suppl 14, s. 15-19Artikel i tidskrift (Refereegranskat)
  • 25.
    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 months2008Ingår i: Nestlé Nutrition workshop series. Paediatric programme, ISSN 1661-6677, Vol. 61, s. 123-34Artikel i tidskrift (Refereegranskat)
    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.

  • 26.
    Hasslöf, Pamela
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Karlsson Videhult, Frida
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Silfverdal, Sven Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    West, Christina E
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Stecksén-Blicks, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Vitamin D Insufficiency among Women Post-Partum in Northern Sweden: A Public Health Concern2017Ingår i: Food and Nutrition Sciences, ISSN 2157-944X, E-ISSN 2157-9458, nr 8, s. 99-109Artikel i tidskrift (Refereegranskat)
    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.

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  • 27. Hjern, Anders
    et al.
    Lindblom, Kristin
    Reuter, Antonia
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Centre for Mother and Child Health Care, Region Västerbotten, Umeå, Sweden.
    A systematic review of prevention and treatment of infantile colic2020Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 109, nr 9, s. 1733-1744Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Aim: The aim of this review was to evaluate the evidence for interventions for infantile colic.

    Methods: This was a systematic review based on a literature search in December 2017 for articles published during 2007-2017 about preventive and treatment interventions for infantile colic in infants. The review included original randomised controlled trials (RCTs) and meta-analyses with at least 20 infants in each study group that were assessed according to GRADE criteria.

    Results: The review found moderately strong evidence that administration of Lactobacillus reuteri DSM 17938 shortened the crying duration, with positive evidence from three out of four national contexts. There were four RCTs of acupuncture, all with no or minimal effect on crying duration. All studies reviewed with a follow-up until or beyond three months of age show a quite steep decline over time in crying duration in both treatment and control groups.

    Conclusion: Lactobacillus reuteri DSM 17938 is a promising treatment for infantile colic with moderately strong evidence in this review, but studies in more populations are needed. Acupuncture is not an effective treatment for infantile colic. Systematic support strategies to parents with infantile colic are important knowledge gaps.

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  • 28. Holl, Katsiaryna
    et al.
    Rosenlund, Mats
    Giaquinto, Carlo
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    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 Study2015Ingår i: Clinical drug investigation, ISSN 1173-2563, E-ISSN 1179-1918, Vol. 35, nr 10, s. 613-624Artikel i tidskrift (Refereegranskat)
    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.

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  • 29.
    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 vaccination1995Ingår i: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 27, nr 1, s. 63-67Artikel i tidskrift (Refereegranskat)
    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.

  • 30.
    Hörnell, Agneta
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Amning och tillvänjning till fast föda för friska fullgångna barn: En kunskapsöversikt från Barnläkarföreningen och Livsmedelsverket2013Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, nr 8, s. 405-409Artikel i tidskrift (Refereegranskat)
  • 31.
    Hörnell, Agneta
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Lind, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Silfverdal, Sven Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Maten i skolan - långt mellan kostråden och verkligheten2009Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 5, s. 287-90Artikel i tidskrift (Refereegranskat)
    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.

  • 32.
    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 universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    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 review2006Ingår i: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 24, nr 13, s. 2440-2448Artikel i tidskrift (Refereegranskat)
    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.

  • 33.
    Johansson Kostenniemi, Urban
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Bazan, Aleksander
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Karlsson, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Psychiatric Disabilities and Other Long-term Consequences of Childhood Bacterial Meningitis2020Ingår i: The Pediatric Infectious Disease Journal, ISSN 0891-3668, E-ISSN 1532-0987, Vol. 40, nr 1, s. 26-31Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Bacterial meningitis is known to cause hearing impairments and neurological deficits; however, less is known regarding psychiatric disabilities. In this study, we assessed psychiatric disabilities and other long-term consequences of childhood bacterial meningitis.

    METHODS: From a previously validated dataset, we selected children having had bacterial meningitis. We then reviewed medical records and child health records from discharge onwards to identify disabilities. We calculated the occurrence of disabilities with a 95% confidence interval (CI), and we used a χ test to assess possible individual risk factors associated with occurrence of disabilities.

    RESULTS: Of the 80 children included in this study, permanent disabilities not attributed to preexisting diseases were noted in 56% (CI: 45-67) during the mean observation period of 19 years and 2 months. Psychiatric disease was diagnosed in 30% (CI: 21-41), and another 5% (CI: 2-13) were under ongoing investigations for symptoms of psychiatric disease. Hearing impairments affected at least 30% (CI: 20-40), and neurological deficits affected at least 23% (CI: 15-34). While other disabilities were often detected within the first year, psychiatric disabilities were detected after a mean time period of 14 years (CI: 11:1-16:11). Although some associations were noted, no individual risk factor was able to predict the occurrence of disabilities.

    CONCLUSIONS: Psychiatric disabilities affect more than one-third of survivors and are among the most common long-term consequence of childhood bacterial meningitis. Late discovery and predictive difficulties call for a revision of current guidelines to include a specific long-term strategy for detecting psychiatric disabilities.

  • 34.
    Johansson Kostenniemi, Urban
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    David, Norman
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Sellin, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Sustained reductions of invasive infectious disease following general infant Haemophilus influenzae type b and pneumococcal vaccination in a Swedish Arctic region2019Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, nr 10, s. 1871-1878Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: Vaccine‐preventable pathogens causing severe childhood infections include Haemophilus influenzae type b (Hib), Streptococcus pneumoniae and Neisseria meningitidis. In this study conducted in a Swedish Arctic region, we evaluated the effects of general infant Hib and pneumococcal vaccination on invasive infectious diseases among children and assessed the need of meningococcal vaccination.

    Methods: We identified cases of bacterial meningitis and sepsis from diagnosis and laboratory registers in the Västerbotten Region, Sweden, during 1986–2015. We then reviewed medical records to confirm the diagnosis and extract data for assessing incidence changes, using an exploratory data analysis and a time‐series analysis.

    Results: Invasive Haemophilus disease declined by 89.1% (p < 0.01), Haemophilus meningitis by 95.3% (p < 0.01) and all‐cause bacterial meningitis by 82.3% (p < 0.01) in children aged 0 to four years following general infant Hib vaccination. Following pneumococcal vaccination, invasive pneumococcal disease declined by 84.7% (p < 0.01), pneumococcal meningitis by 67.5% (p = 0.16) and all‐cause bacterial meningitis by 48.0% (p = 0.23). Incidence of invasive meningococcal disease remained low during the study period.

    Conclusion: Remarkable sustained long‐term declines of invasive infectious diseases in younger children occurred following infant Hib and pneumococcal vaccinations in this Swedish Arctic region. Despite not offering general infant meningococcal vaccination, incidence of invasive meningococcal disease remained low.

  • 35.
    Johansson Kostenniemi, Urban
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Karlsson, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Mehle, Christer
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    MeningiSSS: A New Predictive Score to Support Decision on Invasive Procedures to Monitor or Manage the Intracerebral Pressure in Children with Bacterial Meningitis2020Ingår i: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 32, nr 2, s. 586-595Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Knowing the individual child’s risk is highly useful when deciding on treatment strategies, especially when deciding on invasive procedures. In this study, we aimed to develop a new predictive score for children with bacterial meningitis and compare this with existing predictive scores and individual risk factors.

    Methods: We developed the Meningitis Swedish Survival Score (MeningiSSS) based on a previous systematic review of risk factors. From this, we selected risk factors identified in moderate-to-high-quality studies that could be assessed at admission to the hospital. Using data acquired from medical records of 101 children with bacterial meningitis, we tested the overall capabilities of the MeningiSSS compared with four existing predictive scores using a receiver operating characteristic curve (ROC) analysis to assert the area under the curve (AUC). Finally, we tested all predictive scores at their cut-off levels using a Chi-square test. As outcome, we used a small number of predefined outcomes; in-hospital mortality, 30-day mortality, occurrence of neurological disabilities at discharge defined as Pediatric Cerebral Performance Category Scale category two to five, any type of complications occurring during the hospital stay, use of intensive care, and use of invasive procedures to monitor or manage the intracerebral pressure.

    Results: For identifying children later undergoing invasive procedures to monitor or manage the intracerebral pressure, the MeningiSSS excelled in the ROC-analysis (AUC = 0.90) and also was the only predictive score able to identify all cases at its cut-off level (25 vs 0%, p < 0.01). For intensive care, the MeningiSSS (AUC = 0.79) and the Simple Luanda Scale (AUC = 0.75) had the best results in the ROC-analysis, whereas others performed less well (AUC ≤ 0.65). Finally, while none of the scores’ results were significantly associated with complications, an elevated score on the MeningiSSS (AUC = 0.70), Niklasson Scale (AUC = 0.72), and the Herson–Todd Scale (AUC = 0.79) was all associated with death.

    Conclusions: The MeningiSSS outperformed existing predictive scores at identifying children later having to undergo invasive procedures to monitor or manage the intracerebral pressure in children with bacterial meningitis. Our results need further external validation before use in clinical practice. Thus, the MeningiSSS could potentially be helpful when making difficult decisions concerning intracerebral pressure management.

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  • 36.
    Johansson Kostenniemi, Urban
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Norman, David
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Borgström, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Silfverdal, Sven Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    The clinical presentation of acute bacterial meningitis varies with age, sex and duration of illness2015Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, nr 11, s. 1117-1124Artikel i tidskrift (Refereegranskat)
    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.

  • 37.
    Johansson Kostenniemi, Urban
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Predictive scores failing at identifying psychiatric disabilities following childhood bacterial meningitis calls for revision of current follow-up guidelines2022Ingår i: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 54, nr 7, s. 514-521Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Backgrounds: Psychiatric disabilities affect one in three survivors of bacterial meningitis. Since current guidelines do not recommend psychiatric follow-up in all children, disabilities are often detected late. Identifying children with elevated risk of psychiatric disabilities using predictive scores could be one strategy for detecting psychiatric disabilities without having to conduct psychiatric evaluations in all children. Therefore, we searched for existing predictive scores and later tested five predictive scores’ ability to predict psychiatric disabilities following childhood bacterial meningitis.

    Methods: From an existing dataset, we selected 73 children with bacterial meningitis of whom 22 later developed psychiatric disease and 15 experienced concentration or learning difficulties. Using these, we tested each predictive score’s sensitivity at their cut-off level for predicting psychiatric disease and concentration or learning difficulties using a chi-square test. Furthermore, we performed a receiver operating characteristic curve (ROC) analysis to assert the area under the curve (AUC) as a measure of overall predictive performance.

    Results: The sensitivity of each predictive score’ ranged from 6 to 38% for psychiatric disease and from 8 to 57% for concentration or learning difficulties. In the ROC-analysis, the AUC was 0.59–0.73 and 0.53–0.72, respectively.

    Conclusions: All predictive score failed at identifying children later developing psychiatric disabilities, excluding this as a feasible strategy for detecting psychiatric disabilities. Hence, current guidelines for bacterial meningitis need to be revised to recommend psychiatric evaluations in all children.

    KEY NOTES

    • Current guidelines not recommending psychiatric evaluations in all children following bacterial meningitis may result in late detection of psychiatric disabilities.
    • We tested predictive scores’ ability to identify children later developing psychiatric disabilities following bacterial meningitis.
    • All predictive score failed at identifying children later developing psychiatric disabilities, excluding this as a feasible strategy. Hence, current guidelines for bacterial meningitis need to be revised to recommend psychiatric evaluations in all children.
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  • 38. Karlsland Åkeson, Pia
    et al.
    Lind, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Öhlund, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Serum Vitamin D Depends Less on Latitude Than on Skin Color and Dietary Intake During Early Winter in Northern Europe2016Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 62, nr 4, s. 643-649Artikel i tidskrift (Refereegranskat)
    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.

  • 39.
    Kelderer, Fanny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Mogren, Ingrid
    Department of Clinical Sciences, Obstetrics and Gynecology, Umeå, Sweden.
    Eriksson, Catharina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk immunologi.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Domellöf, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    West, Christina E.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Associations between pre- and postnatal antibiotic exposures and early allergic outcomes: a population-based birth cohort study2022Ingår i: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 33, nr 9, artikel-id e13848Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Early life antibiotic treatment is one likely exposure influencing allergy risk. The objective was to investigate associations between pre- and postnatal antibiotic exposures and the development of allergic manifestations until age 18 months.

    Methods: We included 1387 mother–child dyads from the prospective, population-based NorthPop birth cohort study. Data on antibiotic exposures in pregnancy and childhood were collected by web-based questionnaires. Until the child turned 18 months old, parents (n = 1219) reported symptoms of wheeze, eczema, and physician-diagnosed asthma; parents (n = 1025) reported physician-diagnosed food allergy. At age 18 months, serum immunoglobulin E levels to inhalant (Phadiatop) and food (Food mix fx5) allergens were determined. Associations were estimated using bivariable and multivariable logistic regressions.

    Results: Prenatal antibiotic exposure was positively associated with food sensitization in the crude (OR 1.82, 95% CI 1.01–3.26) but not in the adjusted analyses (aOR 1.58, 0.82–3.05). A borderline significant association was found between prenatal exposure and wheeze (aOR 1.56, 0.95–2.57). Postnatal antibiotics were positively associated with wheeze (aOR 2.14, 1.47–3.11), asthma (aOR 2.35, 1.32–4.19), and eczema (aOR 1.49, 1.07–2.06). Postnatal antibiotics were negatively associated with food sensitization (aOR 0.46, 95% CI 0.25–0.83) but not with food allergy nor sensitization to inhalants.

    Conclusion: Pre- and postnatal antibiotic exposure demonstrated positive associations with allergic manifestations and the former also with food sensitization. In contrast, there was a negative association between postnatal antibiotics and food sensitization. Food sensitization is often transient but may precede respiratory allergies. Future studies should investigate the relationship between antibiotic exposure and food sensitization later in childhood.

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  • 40.
    Kilpi, Terhi M
    et al.
    Department of Vaccines; National Public Health Institute (KTL); Helsinki, Finland .
    Silfverdal, Sven Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    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 age2009Ingår i: Human vaccines, ISSN 1554-8619, Vol. 5, nr 1, s. 18-25Artikel i tidskrift (Refereegranskat)
    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.

  • 41. Liese, J. G.
    et al.
    Giaquinto, C.
    Silfverdal, Sven Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    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 europe2011Ingår i: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 14, nr 7, s. A509-A509Artikel i tidskrift (Refereegranskat)
  • 42. Liese, J. G.
    et al.
    Giaquinto, C.
    Silfverdal, Sven Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    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 europe2011Ingår i: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 14, nr 7, s. A508-A509Artikel i tidskrift (Refereegranskat)
  • 43. Liese, J. G.
    et al.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    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 practices2014Ingår i: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 142, nr 8, s. 1778-1788Artikel i tidskrift (Refereegranskat)
    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.

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  • 44.
    Lindkvist, Marie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Silfverdal, Sven Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Associations between toddlers' and parents' BMI, in relation to family sociodemography: a cross-sectional study2015Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 15, artikel-id 1252Artikel i tidskrift (Refereegranskat)
    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.

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  • 45.
    Lundkvist, Ellen
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Stoltz Sjöström, Elisabeth
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kost- och måltidsvetenskap.
    Lundberg, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    West, Christina E.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Domellöf, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Fruit pouch consumption and dietary patterns related to BMIz at 18 months of age2021Ingår i: Nutrients, E-ISSN 2072-6643, Vol. 13, nr 7, artikel-id 2265Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Concerns have been raised that an overconsumption of baby food fruit pouches among toddlers might increase the risk of childhood obesity. This study aimed to quantify the consumption of fruit pouches and other fruit containing food products and to explore potential correlations between the consumption of these products and body-mass index z-score (BMIz) at 18 months, taking other predictive factors into consideration. The study was based on 1499 children and one-month-recall food frequency questionnaires from the Swedish population-based birth cohort NorthPop. Anthropometric outcome data were retrieved from child health care records. BMIz at 18 months of age was correlated to maternal BMI and gestational weight gain and inversely correlated to fruit juice consumption and breastfeeding. BMIz at 18 months of age was not correlated to consumption of fruit pouches, sugar-sweetened beverages, whole fruit or milk cereal drink. Overweight at 18 months of age was correlated to maternal BMI and inversely correlated to breastfeeding duration. To our knowledge, this is the first study that investigates possible associations between baby food fruit pouch consumption and overweight in toddlers. We found that moderate fruit pouch consumption is not associated with excess weight at 18 months of age.

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  • 46.
    Lwin, Min Wai
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Timby, Erika
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Abnormal birth weights for gestational age in relation to maternal characteristics in Sweden: a five year cross-sectional study2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 976Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Abnormal birth weight - small for gestational age (SGA) and large for gestational age (LGA) - are important indicators for newborn health. Due to changes in lifestyle in recent decades, it is essential to keep up-to-date with the latest information on maternal factors linked to abnormal birth weight. The aim of this study is to investigate SGA and LGA in relation to maternal individual, lifestyle and socioeconomic characteristics.

    Methods: This is a register-based cross-sectional study. Self-reported data from Sweden's Salut Programme maternal questionnaires (2010-2014) were linked with records in the Swedish Medical Birth Register (MBR). The analytical sample comprised 5089 singleton live births. A Swedish standard method using ultrasound-based sex-specific reference curves defines the abnormality of birth weight in MBR. Univariable and multivariable logistic regressions were used to examine crude and adjusted associations between abnormal birth weights and maternal individual, lifestyle and socioeconomic characteristics. A sensitivity analysis, using alternative definitions of SGA and LGA under the percentile method, was undertaken.

    Results: In multivariable logistic regression, maternal age and parity were associated with LGA (aOR = 1.05, CI = 1.00, 1.09) and (aOR = 1.31, CI = 1.09, 1.58). Maternal overweight and obesity were strongly associated with LGA (aOR = 2.28, CI = 1.47, 3.54) and (aOR = 4.55, CI = 2.85, 7.26), respectively. As parity increased, the odds of delivering SGA babies decreased (aOR = 0.59, CI = 0.42, 0.81) and preterm deliveries were associated with SGA (aOR = 9.46, CI = 5.67, 15.79). The well-known maternal determinants of abnormal birthweight, such as unhealthy lifestyles and poor socioeconomic factors, were not statistically significant in this Swedish setting.

    Conclusions: The main findings suggest that multiparity, maternal pre-pregnancy overweight and obesity are strong determinants for LGA babies. Public health interventions should address modifiable risk factors, especially maternal overweight and obesity. These findings suggest that overweight and obesity is an emerging public health threat for newborn health. This might also result in the intergenerational transfer of overweight and obesity. These are important messages for public health policy and decision making.

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  • 47. 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 universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Safety and immunogenicity of the HPV-16/18 AS04-adjuvanted vaccine: a randomized, controlled trial in adolescent girls2010Ingår i: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 46, nr 5, s. 414-421Artikel i tidskrift (Refereegranskat)
    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.

  • 48.
    Mohanty, Salini
    et al.
    Center for Observational and Real-World Evidence (CORE), Merck & Co Inc, Rahway, New Jersey, USA.
    Johansson Kostenniemi, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Salomonsson, Stina
    CORE, MSD (Merck Sharpe & Dohme LLC) Sweden, Stockholm, Sweden.
    Iovino, Federico
    Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Sarpong, Eric M.
    Real-World Data Analytics and Innovation, Merck & Co Inc, Rahway, New Jersey, USA.
    Bencina, Goran
    CORE, MSD Spain, Madrid, Spain.
    Bruze, Gustaf
    Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.
    Increased risk of long-term disabilities following childhood bacterial meningitis in Sweden2024Ingår i: JAMA Network Open, E-ISSN 2574-3805, Vol. 7, nr 1, artikel-id e2352402Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IMPORTANCE: Few studies have examined the incidence of long-term disabilities due to bacterial meningitis in childhood with extended follow-up time and a nationwide cohort.

    OBJECTIVE: To describe the long-term risks of disabilities following a childhood diagnosis of bacterial meningitis in Sweden.

    DESIGN, SETTING, AND PARTICIPANTS: This nationwide retrospective registry-based cohort study included individuals diagnosed with bacterial meningitis (younger than 18 years) and general population controls matched (1:9) by age, sex, and place of residence. Data were retrieved from the Swedish National Patient Register from January 1, 1987, to December 31, 2021. Data were analyzed from July 13, 2022, to November 30, 2023.

    EXPOSURE: A diagnosis of bacterial meningitis in childhood recorded in the National Patient Register between 1987 and 2021.

    MAIN OUTCOMES AND MEASURES: Cumulative incidence of 7 disabilities (cognitive disabilities, seizures, hearing loss, motor function disorders, visual disturbances, behavioral and emotional disorders, and intracranial structural injuries) after bacterial meningitis in childhood.

    RESULTS: The cohort included 3623 individuals diagnosed with bacterial meningitis during childhood and 32 607 controls from the general population (median age at diagnosis, 1.5 [IQR, 0.4-6.2] years; 44.2% female and 55.8% male, median follow-up time, 23.7 [IQR, 12.2-30.4] years). Individuals diagnosed with bacterial meningitis had higher cumulative incidence of all 7 disabilities, and 1052 (29.0%) had at least 1 disability. The highest absolute risk of disabilities was found for behavioral and emotional disorders, hearing loss, and visual disturbances. The estimated adjusted hazard ratios (HRs) showed a significant increased relative risk for cases compared with controls for all 7 disabilities, with the largest adjusted HRs for intracranial structural injuries (26.04 [95% CI, 15.50-43.74]), hearing loss (7.90 [95% CI, 6.68-9.33]), and motor function disorders (4.65 [95% CI, 3.72-5.80]). The adjusted HRs for cognitive disabilities, seizures, hearing loss, and motor function disorders were significantly higher for Streptococcus pneumoniae infection (eg, 7.89 [95% CI, 5.18-12.02] for seizure) compared with Haemophilus influenzae infection (2.46 [95% CI, 1.63-3.70]) or Neisseria meningitidis infection (1.38 [95% CI, 0.65-2.93]). The adjusted HRs for cognitive disabilities, seizures, behavioral and emotional disorders, and intracranial structural injuries were significantly higher for children diagnosed with bacterial meningitis at an age below the median.

    CONCLUSIONS AND RELEVANCE: The findings of this cohort study of individuals diagnosed with bacterial meningitis during childhood suggest that exposed individuals may have had an increased risk for long-term disabilities (particularly when diagnosed with pneumococcal meningitis or when diagnosed at a young age), highlighting the need to detect disabilities among surviving children.

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  • 49.
    Mukherjee, Piyali
    et al.
    GSK, Wavre, Belgium.
    Akpo, Essè Ifèbi Hervé
    GSK, Wavre, Belgium.
    Kuznetsova, Anastasia
    GSK, Wavre, Belgium.
    Knuf, Markus
    Children’s Hospital, Helios Dr. Horst Schmidt Clinics, Wiesbaden, Germany; Pediatric Infectious Diseases, University Medicine, Mainz, Germany.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Kosalaraksa, Pope
    Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
    Mihalyi, Attila
    GSK, Wavre, Belgium.
    Hexavalent vaccines in infants: a systematic literature review and meta-analysis of the solicited local and systemic adverse reactions of two hexavalent vaccines2021Ingår i: Expert Review of Vaccines, ISSN 1476-0584, E-ISSN 1744-8395, Vol. 20, nr 3, s. 319-329Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The hexavalent vaccine DT3aP-HBV-IPV-Hib (Infanrix hexa, GSK) was first licensed in Europe in 2000. DT2aP-HBV-IPV-Hib (Hexyon/Hexacima/Hexaxim, Sanofi Pasteur), and DT5aP-HBV-IPV-Hib (Vaxelis, MCM Vaccine Company) were licensed in the EU in 2013 and 2016, respectively, based largely on studies demonstrating non-inferiority to DT3aP-HBV-IPV-Hib for immunogenicity and comparable reactogenicity profiles.

    Methods: We conducted a systematic literature review looking for direct head-to-head trials comparing DT2aP-HBV-IPV-Hib and DT5aP-HBV-IPV-Hib with DT3aP-HBV-IPV-Hib. The incidence of solicited local and systemic reactions following primary series administration of DT3aP-HBV-IPV-Hib or DT2aP-HBV-IPV-Hib were meta-analyzed.

    Results: A total of 317 unique records were retrieved from the search; nine met the predefined inclusion criteria; seven reported studies comparing DT3aP-HBV-IPV-Hib and DT2aP-HBV-IPV-Hib. Six trials assessing outcomes of the primary vaccination series were identified. Odds ratios and 95% confidence intervals (OR; 95%CI) were computed for DT3aP-HBV-IPV-Hib, using DT2aP-HBV-IPV-Hib as reference, for redness (0.72; 0.63–0.83), pain (0.74; 0.62–0.89), swelling (0.86; 0.74–0.99) at injection site, fever (0.67; 0.54–0.83), persistent crying (0.72; 0.61–0.84), drowsiness (0.82; 0.71–0.94), irritability (0.82; 0.69–0.98), anorexia (0.83; 0.72–0.95), and vomiting (0.96; 0.83–1.11).

    Conclusion: ORs of analyzed local and systemic solicited adverse reactions after primary vaccination with DT3aP-HBV-IPV-Hib appear to be slightly lower than with DT2aP-HBV-IPV-Hib.

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  • 50. 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 age2005Ingår i: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 37, nr 3, s. 221-229Artikel i tidskrift (Refereegranskat)
    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.

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