10 JUNE 2011, 86th YEAR /10 JUIN 2011, 86s ANNÉE
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 0, - "coordinates": [ - { - "x0": 233.74, - "y0": 94.75, - "x1": 395.38, - "y1": 101.96 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "9fc1a4077074e19816d270062e94604c", - "text": "No. 24, 2011, 86, 241-256 http://www.who.int/wer", - "metadata": { - "category_depth": 1, - "page_number": 1, - "parent_id": "812d1555d65dd4e24fa082894df0a572", - "text_as_html": "No. 24, 2011, 86, 241-256 http://www.who.int/wer
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 0, - "coordinates": [ - { - "x0": 233.96, - "y0": 103.49, - "x1": 327.04, - "y1": 119.75 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-2", - "text": "\n\n\nVaccines against tick-borne encephalitis: WHO position", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "6a659986ae56d6cf71aaba4210ed4ca4", - "text": "Vaccines against tick-borne encephalitis: WHO position", - "metadata": { - "category_depth": 1, - "page_number": 1, - "parent_id": "", - "text_as_html": "In accordance with its mandate to provide guidance to Member States on health pol icy matters, WHO issues a series of regu larly updated position papers on vaccines and combinations of vaccines against dis eases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background in formation on diseases and vaccines, and conclude with the current WHO position on their use worldwide. The papers have been reviewed by experts within and out side WHO, and since 2006 they have been reviewed and endorsed by the WHO Stra tegic Advisory Group of Experts on Im munization (SAGE).1 Position papers are designed to be used mainly by national public health officials and managers of immunization programmes. They may also be of interest to international funding agencies, vaccine manufacturers, the med ical community, the scientific media and
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 0, - "coordinates": [ - { - "x0": 169.26, - "y0": 188.94, - "x1": 342.76, - "y1": 405.51 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "27509af48177806f6c8b506d614978f0", - "text": "Conformément à son mandat, qui est de formu ler des avis destinés aux États Membres sur les questions de politique de santé, l’OMS publie une série de notes de synthèse régulièrement actualisées sur les vaccins et les associations vaccinales contre les maladies ayant des réper cussions sur la santé publique au niveau inter national. Ces notes portent essentiellement sur l’utilisation des vaccins dans le cadre de programmes de vaccination à grande échelle; elles récapitulent les informations générales sur les maladies et les vaccins et présentent en conclusion la position actuelle de l’OMS concer nant leur utilisation dans le monde. Ces notes ont été examinées par un certain nombre d’ex perts appartenant ou non à l’OMS et, depuis 2006, sont examinées et approuvées par le Groupe stratégique consultatif d’experts (SAGE) de l’OMS sur la vaccination.1 Elles s’adressent avant tout aux responsables nationaux de la santé publique et aux administrateurs des programmes de vaccination, mais elles peuvent également présenter un intérêt pour les orga nismes internationaux de financement, les fabricants de vaccins, le corps médical, les milieux scientifiques et le grand public.", - "metadata": { - "category_depth": 1, - "page_number": 1, - "parent_id": "780401d2f175811dcca59921e8df8db8", - "text_as_html": "Conformément à son mandat, qui est de formu ler des avis destinés aux États Membres sur les questions de politique de santé, l’OMS publie une série de notes de synthèse régulièrement actualisées sur les vaccins et les associations vaccinales contre les maladies ayant des réper cussions sur la santé publique au niveau inter national. Ces notes portent essentiellement sur l’utilisation des vaccins dans le cadre de programmes de vaccination à grande échelle; elles récapitulent les informations générales sur les maladies et les vaccins et présentent en conclusion la position actuelle de l’OMS concer nant leur utilisation dans le monde. Ces notes ont été examinées par un certain nombre d’ex perts appartenant ou non à l’OMS et, depuis 2006, sont examinées et approuvées par le Groupe stratégique consultatif d’experts (SAGE) de l’OMS sur la vaccination.1 Elles s’adressent avant tout aux responsables nationaux de la santé publique et aux administrateurs des programmes de vaccination, mais elles peuvent également présenter un intérêt pour les orga nismes internationaux de financement, les fabricants de vaccins, le corps médical, les milieux scientifiques et le grand public.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 0, - "coordinates": [ - { - "x0": 361.01, - "y0": 188.94, - "x1": 552.5, - "y1": 416.35 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-5", - "text": "\n\n\nthe public.\nThis is the first WHO position paper on vaccines against tick-borne encephalitis. Recommendations on the use of these vac cines were discussed by SAGE at its meet ing in April 2011. Evidence presented at the meeting can be accessed at http://www. who.int/immunization/sage/previous/en/ index.html.\nIl s’agit là de la première note de synthèse de l’OMS sur les vaccins contre l’encéphalite à tiques. Les recommandations relatives à l’utili sation de ces vaccins ont été évoquées par le SAGE lors de sa réunion d’avril 2011. Les données présentées lors de la réunion peuvent être consultées à l’adresse suivante: http://www.who. int/immunization/sage/previous/en/index.html.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "6e145490890cb2241aca0e0911a55e8e", - "text": "the public.", - "metadata": { - "category_depth": 1, - "page_number": 1, - "parent_id": "", - "text_as_html": "This is the first WHO position paper on vaccines against tick-borne encephalitis. Recommendations on the use of these vac cines were discussed by SAGE at its meet ing in April 2011. Evidence presented at the meeting can be accessed at http://www. who.int/immunization/sage/previous/en/ index.html.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 0, - "coordinates": [ - { - "x0": 169.13, - "y0": 420.7, - "x1": 342.35, - "y1": 489.8 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "74ee3b6baa53e68ce97ebbb5fa0d915a", - "text": "Il s’agit là de la première note de synthèse de l’OMS sur les vaccins contre l’encéphalite à tiques. Les recommandations relatives à l’utili sation de ces vaccins ont été évoquées par le SAGE lors de sa réunion d’avril 2011. Les données présentées lors de la réunion peuvent être consultées à l’adresse suivante: http://www.who. int/immunization/sage/previous/en/index.html.", - "metadata": { - "category_depth": 1, - "page_number": 1, - "parent_id": "6e145490890cb2241aca0e0911a55e8e", - "text_as_html": "Il s’agit là de la première note de synthèse de l’OMS sur les vaccins contre l’encéphalite à tiques. Les recommandations relatives à l’utili sation de ces vaccins ont été évoquées par le SAGE lors de sa réunion d’avril 2011. Les données présentées lors de la réunion peuvent être consultées à l’adresse suivante: http://www.who. int/immunization/sage/previous/en/index.html.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 0, - "coordinates": [ - { - "x0": 362.25, - "y0": 420.92, - "x1": 551.11, - "y1": 489.81 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-6", - "text": "\n\n\nWORLD HEALTH ORGANIZATION Geneva", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "b75d9b276373a2838be21833148ce1c4", - "text": "WORLD HEALTH ORGANIZATION Geneva", - "metadata": { - "category_depth": 1, - "page_number": 1, - "parent_id": "", - "text_as_html": "In this paper, footnotes provide a limited number of core references including refer ences to grading tables that assess the quality of scientific evidence for a few key conclusions; a more comprehensive list of references is offered in the Background document on vaccines and vaccination against tick-borne encephalitis.2
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 0, - "coordinates": [ - { - "x0": 169.51, - "y0": 494.3, - "x1": 342.46, - "y1": 563.9 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "5de20b219718c92f588f4d16d9ec5384", - "text": "Dans cette note de synthèse, les notes de bas de page fournissent un nombre limité de réfé rences essentielles, notamment des références à des tableaux de cotations évaluant la qualité des données scientifiques relatives aux recom mandations essentielles; on trouvera une liste plus complète de références dans le Background document on vaccines and vaccination against tick-borne encephalitis.2", - "metadata": { - "category_depth": 1, - "page_number": 1, - "parent_id": "61d1e51ec86cdc2d1a391055f5675653", - "text_as_html": "Dans cette note de synthèse, les notes de bas de page fournissent un nombre limité de réfé rences essentielles, notamment des références à des tableaux de cotations évaluant la qualité des données scientifiques relatives aux recom mandations essentielles; on trouvera une liste plus complète de références dans le Background document on vaccines and vaccination against tick-borne encephalitis.2
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", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 0, - "coordinates": [ - { - "x0": 64.03, - "y0": 608.15, - "x1": 118.62, - "y1": 628.49 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "001763fda9056dd867d2b75d6dcc01d8", - "text": "1 For additional information, see http://www.who.int/immuniza- tion/sage/en/.", - "metadata": { - "category_depth": 1, - "page_number": 1, - "parent_id": "61d1e51ec86cdc2d1a391055f5675653", - "text_as_html": "241
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 0, - "coordinates": [ - { - "x0": 538.46, - "y0": 634.36, - "x1": 548.13, - "y1": 639.25 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-8", - "text": "\n\n\nBackground", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "e6f84e38fa6eb9d70ff2d5143f6a649d", - "text": "Background", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "", - "text_as_html": "Tick-borne encephalitis virus is an important cause of viral infections of the central nervous system in eastern, central and northern European countries, in northern China, Mongolia, and the Russian Federation. The areas where tick-borne encephalitis is endemic cover the southern part of the nontropical Eurasian forest belt, extending from north-eastern France to the Japanese Hokkaido Island.* Approximately 10000-12000 clinical cases of tick-borne encephalitis are reported each year, but this figure is believed to significantly underestimate the actual total. Even in the most severely affected areas, the disease is usually limited to particular sylvan foci. Some countries, such as Germany, define risk-areas at district level, based on the reported number of clinical cases. However, there are no standard diagnostic criteria for tick-borne encephalitis, and no definition for areas considered to be at risk.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 1, - "coordinates": [ - { - "x0": 45.35, - "y0": 87.03, - "x1": 273.26, - "y1": 272.29 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4b8a58ea3e152559d9bdebe9e8a9016c", - "text": "Currently, the highest incidences of clinical cases are being reported from the Baltic States, Slovenia and the Russian Federation. For example, in 2009, the national incidence per 100 000 inhabitants was 10.40 for Estonia, 7.50 for Latvia, 6.89 for Lithuania and 9.90 for Slovenia.’ In 2006, the average incidence of the disease in the Rus- sian Federation was 2.44, but in the Siberian Federal Area morbidity was >5 times higher, including some areas where it was 10 times higher than the national average. High incidences of tick-borne encephalitis were also reported from the North-Western Federal Area of the Russian Federation. Other countries which have reported cases within their territories, or are con- sidered to be at-risk due to focally high prevalence of the virus in ticks, include Albania, Austria, Belarus, Bos- nia, Bulgaria, China, Croatia, Denmark, Finland, Ger- many, Greece, Hungary, Italy, Mongolia, Norway, Poland, the Republic of Korea, Romania, Serbia, Slovakia, Slove- nia, Sweden, Switzerland, Turkey and Ukraine.”*", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "0580aaf59f318a384641b3fce9f24682", - "text_as_html": "Currently, the highest incidences of clinical cases are being reported from the Baltic States, Slovenia and the Russian Federation. For example, in 2009, the national incidence per 100 000 inhabitants was 10.40 for Estonia, 7.50 for Latvia, 6.89 for Lithuania and 9.90 for Slovenia.’ In 2006, the average incidence of the disease in the Rus- sian Federation was 2.44, but in the Siberian Federal Area morbidity was >5 times higher, including some areas where it was 10 times higher than the national average. High incidences of tick-borne encephalitis were also reported from the North-Western Federal Area of the Russian Federation. Other countries which have reported cases within their territories, or are con- sidered to be at-risk due to focally high prevalence of the virus in ticks, include Albania, Austria, Belarus, Bos- nia, Bulgaria, China, Croatia, Denmark, Finland, Ger- many, Greece, Hungary, Italy, Mongolia, Norway, Poland, the Republic of Korea, Romania, Serbia, Slovakia, Slove- nia, Sweden, Switzerland, Turkey and Ukraine.”*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 1, - "coordinates": [ - { - "x0": 45.11, - "y0": 280.54, - "x1": 273.47, - "y1": 487.08 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "6231f993795370deaf7775635cf85f53", - "text": "In most epidemic settings, the disease affects males more frequently than females. All age groups may be affected, but the distribution of cases may vary by re- gion. In the highly endemic region of western Siberia, people aged 20-49 years were at highest risk, although 20-30% of cases occurred in children aged <14 years.’ In southern Germany during 1994-1998, 12% (79) of the 656 cases occurred in children aged <14 years, 42% (276) in people aged 21-50 years, and 24% (157) in people aged >60 years.°", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "0580aaf59f318a384641b3fce9f24682", - "text_as_html": "In most epidemic settings, the disease affects males more frequently than females. All age groups may be affected, but the distribution of cases may vary by re- gion. In the highly endemic region of western Siberia, people aged 20-49 years were at highest risk, although 20-30% of cases occurred in children aged <14 years.’ In southern Germany during 1994-1998, 12% (79) of the 656 cases occurred in children aged <14 years, 42% (276) in people aged 21-50 years, and 24% (157) in people aged >60 years.°
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 1, - "coordinates": [ - { - "x0": 45.06, - "y0": 493.92, - "x1": 273.37, - "y1": 602.81 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "84aa4c20b0a6787d76e40614f46098f2", - "text": "Changes in climate and habitation, and in recreational activities, are altering the epidemiology of tick-borne encephalitis. The disease may represent an increasing problem because it is now being reported from areas", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "0580aaf59f318a384641b3fce9f24682", - "text_as_html": "Changes in climate and habitation, and in recreational activities, are altering the epidemiology of tick-borne encephalitis. The disease may represent an increasing problem because it is now being reported from areas
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 1, - "coordinates": [ - { - "x0": 45.55, - "y0": 611.18, - "x1": 272.07, - "y1": 652.39 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "38fc20e7efbca8d0ca8e7464de016907", - "text": "Stiss J. Tick-borne encephalitis in Europe and beyond—the epidemiological situa- tion as of 2007. FuroSurveillance, 2008,13(26):pii =18916 (http://www.eurosur- veillance.org/viewarticle.aspx?articleld=18916, accessed May 2011).", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "0580aaf59f318a384641b3fce9f24682", - "text_as_html": "Le virus de l’encéphalite a tiques est une cause importante d’in- fection du systeme nerveux central dans les pays d’Europe orientale, centrale et septentrionale; dans le nord de la Chine; en Mongolie; et en Fédération de Russie. Les zones d’endémie de l’encéphalite 4 tiques couvrent la partie méridionale de la ceinture non tropicale de la forét eurasienne, s’étendant du nord-est de la France jusqu’a l’ile japonaise d’ Hokkaido.’ Prés de 10 000 a 12 000 cas cliniques d’encéphalite a tiques sont notifiés chaque année, mais on pense que ce chiffre est une sous-estimation importante du total réel. Méme dans les zones les plus gravement touchées, la maladie reste en général limitée a certains foyers sylvestres. Quelques pays, comme |’Allemagne, définissent des zones a risque a l’échelon du district en se basant sur le nombre de cas cliniques notifiés. Cependant, il nexiste pas de critéres de diagnostic communs pour I’encépha- lite a tiques, pas plus qu'il n’existe de définition pour les zones considérées comme a risque.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 1, - "coordinates": [ - { - "x0": 294.31, - "y0": 87.05, - "x1": 554.21, - "y1": 272.53 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "48d221f5a73ca06bccb53b07042b4c32", - "text": "Actuellement, les incidences de cas cliniques les plus élevées sont notifiées par des Etats baltes, la Slovénie et la Fédération de Russie. Par exemple, en 2009, lincidence nationale pour 100 000 habitants était de 10,40 en Estonie, 7,50 en Lettonie, 6,89 en Lituanie et de 9,90 en Slovénie.* En 2006, l’incidence moyenne de cette maladie en Fédération de Russie était de 2,44, mais dans la zone fédérale de Sibérie, la morbidité était >5 fois plus élevée - et jusqu’a 10 fois plus élevée dans certaines zones sibériennes - que la moyenne nationale. De fortes incidences de lencéphalite a tiques ont été également signalées dans la zone fédérale du nord-ouest de la Fédération de Russie. Les autres pays ayant notifié des cas sur leur territoire, ou consi- dérés comme étant a risque en raison de la forte prévalence du virus chez les tiques dans certains foyers, sont |’Albanie, |’Autri- che, le Bélarus, la Bosnie, la Bulgarie, la Chine, la Croatie, le Danemark, la Finlande, |’Allemagne, la Gréce, la Hongrie, l’Ita- ie, la Mongolie, la Norvége, la Pologne, la République de Corée, a Roumanie, la Serbie, la Slovaquie, la Slovénie, la Suéde, la Suisse, la Turquie et Ukraine.” *", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "Actuellement, les incidences de cas cliniques les plus élevées sont notifiées par des Etats baltes, la Slovénie et la Fédération de Russie. Par exemple, en 2009, lincidence nationale pour 100 000 habitants était de 10,40 en Estonie, 7,50 en Lettonie, 6,89 en Lituanie et de 9,90 en Slovénie.* En 2006, l’incidence moyenne de cette maladie en Fédération de Russie était de 2,44, mais dans la zone fédérale de Sibérie, la morbidité était >5 fois plus élevée - et jusqu’a 10 fois plus élevée dans certaines zones sibériennes - que la moyenne nationale. De fortes incidences de lencéphalite a tiques ont été également signalées dans la zone fédérale du nord-ouest de la Fédération de Russie. Les autres pays ayant notifié des cas sur leur territoire, ou consi- dérés comme étant a risque en raison de la forte prévalence du virus chez les tiques dans certains foyers, sont |’Albanie, |’Autri- che, le Bélarus, la Bosnie, la Bulgarie, la Chine, la Croatie, le Danemark, la Finlande, |’Allemagne, la Gréce, la Hongrie, l’Ita- ie, la Mongolie, la Norvége, la Pologne, la République de Corée, a Roumanie, la Serbie, la Slovaquie, la Slovénie, la Suéde, la Suisse, la Turquie et Ukraine.” *
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 1, - "coordinates": [ - { - "x0": 293.74, - "y0": 280.17, - "x1": 553.45, - "y1": 486.95 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "c5e50793fbe3be5c0904165be21479ad", - "text": "Dans la plupart des épidémies, la maladie touche plus fréquem- ment les hommes que les femmes. Toutes les classes d’age peuvent étre touchées, mais la distribution des patients peut varier selon la région. Dans la région fortement endémique de ’ouest de la Sibérie, les sujets 4gés de 20 a 49 ans étaient les plus exposés au risque, méme si 20% a 30% des cas se sont produits chez des enfants de <14 ans.’ Dans le sud de l’Alle- magne, entre 1994 et 1998, 12% (79) des 656 cas ont touché des enfants agés de <14 ans, 42% (276) des personnes agées de 21 a 50 ans et 24% (157) des personnes agées de >60 ans.°", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "Dans la plupart des épidémies, la maladie touche plus fréquem- ment les hommes que les femmes. Toutes les classes d’age peuvent étre touchées, mais la distribution des patients peut varier selon la région. Dans la région fortement endémique de ’ouest de la Sibérie, les sujets 4gés de 20 a 49 ans étaient les plus exposés au risque, méme si 20% a 30% des cas se sont produits chez des enfants de <14 ans.’ Dans le sud de l’Alle- magne, entre 1994 et 1998, 12% (79) des 656 cas ont touché des enfants agés de <14 ans, 42% (276) des personnes agées de 21 a 50 ans et 24% (157) des personnes agées de >60 ans.°
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 1, - "coordinates": [ - { - "x0": 293.68, - "y0": 494.04, - "x1": 553.22, - "y1": 603.19 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "dae2b7ef304483cf5f67614f80dd75d6", - "text": "Les changements survenus au niveau du climat et de Phabitat, ainsi que dans les activités de loisir, modifient ’épidémiologie de lencéphalite a tiques. Cette maladie pourrait représenter un probléme toujours plus grand parce quelle est désormais signa-", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "Les changements survenus au niveau du climat et de Phabitat, ainsi que dans les activités de loisir, modifient ’épidémiologie de lencéphalite a tiques. Cette maladie pourrait représenter un probléme toujours plus grand parce quelle est désormais signa-
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 1, - "coordinates": [ - { - "x0": 293.65, - "y0": 610.67, - "x1": 550.91, - "y1": 652.47 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "7e5b510acf7feef7b006ec9f03e655fc", - "text": "Stiss J. Tick-borne encephalitis in Europe and beyond — the epidemiological situation as of 2007. EuroSurveillance, 2008, 13(26): pii=18916 (http://www.eurosurveillance.org/viewarticle. aspx?articleld=18916, consulté en mai 2011).", - "metadata": { - "category_depth": 1, - "page_number": 2, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "previously not known to be endemic - for example, from parts of Germany, Lithuania, Scandinavia, several regions in the Russian Federation and Switzerland.’ Also, endemic zones are apparently expanding in alti- tude, from <800 m above sea level to about 1500 m, as was recently reported from Austria and Slovakia.’
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 45.51, - "y0": 56.36, - "x1": 273.15, - "y1": 120.85 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "f9eaf8b70aa35d23e898c9ce9737ca83", - "text": "Three subtypes of the tick-borne encephalitis virus cause human disease:’ (i) the European subtype is prev- alent in western, northern, central and eastern parts of Europe; (ii) the Far-Eastern subtype occurs in eastern parts of the Russian Federation, in China and Japan; (iii) the Siberian subtype occurs in all parts of the Rus- sian Federation (but predominately in the Asian parts). All 3 subtypes cocirculate in the Baltic, the European part of the Russian Federation, and in Siberia.’", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "Three subtypes of the tick-borne encephalitis virus cause human disease:’ (i) the European subtype is prev- alent in western, northern, central and eastern parts of Europe; (ii) the Far-Eastern subtype occurs in eastern parts of the Russian Federation, in China and Japan; (iii) the Siberian subtype occurs in all parts of the Rus- sian Federation (but predominately in the Asian parts). All 3 subtypes cocirculate in the Baltic, the European part of the Russian Federation, and in Siberia.’
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 45.69, - "y0": 138.74, - "x1": 273.16, - "y1": 236.07 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "a861eda60fa024882ac13c67f46c6c72", - "text": "Most infections with the virus result from tick bites ac- quired during outdoor activities in forested areas, although in about one third of confirmed cases, the patients do not recall any exposure to ticks preceding their illness.’ The seasonal incidence of the disease coincides with increased exposure during spring, summer and autumn.’", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "Most infections with the virus result from tick bites ac- quired during outdoor activities in forested areas, although in about one third of confirmed cases, the patients do not recall any exposure to ticks preceding their illness.’ The seasonal incidence of the disease coincides with increased exposure during spring, summer and autumn.’
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 45.96, - "y0": 242.95, - "x1": 273.05, - "y1": 308.0 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "844cce941b6e0d69d71ac6aa1ff9a9a0", - "text": "The European subtype is transmitted primarily by Ixodes ricinus, and the Far-Eastern and Siberian sub- types mainly by Ixodes persulcatus. The proportion of ticks infected with the virus varies considerably with time and location; in endemic areas of Austria and southern Germany, 1-3 % of ticks were found to carry the virus, whereas in highly affected locations in Lithu- ania, the Russian Federation and Switzerland, the prev- alence of infection in ticks may occasionally reach 10-30%.’ However, the incidence of disease among in- habitants of an area depends on a variety of factors and is not directly correlated with the prevalence of the vi- rus in the local tick population.*®", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "The European subtype is transmitted primarily by Ixodes ricinus, and the Far-Eastern and Siberian sub- types mainly by Ixodes persulcatus. The proportion of ticks infected with the virus varies considerably with time and location; in endemic areas of Austria and southern Germany, 1-3 % of ticks were found to carry the virus, whereas in highly affected locations in Lithu- ania, the Russian Federation and Switzerland, the prev- alence of infection in ticks may occasionally reach 10-30%.’ However, the incidence of disease among in- habitants of an area depends on a variety of factors and is not directly correlated with the prevalence of the vi- rus in the local tick population.*®
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 45.57, - "y0": 315.32, - "x1": 273.26, - "y1": 456.3 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "5caa94cdac272fb90c38784db37e088c", - "text": "Larvae, nymphs and adult ticks become infected when they ingest blood from viraemic animals, particularly small rodents; they may subsequently infect vertebrate species, including humans, during the next blood-meal. In addition, ticks may acquire the virus transovarially or through cofeeding.", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "Larvae, nymphs and adult ticks become infected when they ingest blood from viraemic animals, particularly small rodents; they may subsequently infect vertebrate species, including humans, during the next blood-meal. In addition, ticks may acquire the virus transovarially or through cofeeding.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 46.64, - "y0": 462.63, - "x1": 273.07, - "y1": 528.02 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "7fe4a624108532c63e3dd28d50aa09ac", - "text": "More than 100 different species of animals may be in- fected with the virus, and some of these act as a reser- voir. Occasionally, infected cows, goats or sheep may pass on the virus in unpasteurized milk or milk prod- ucts, and thus infect humans through the alimentary route.'° Person-to-person transmission of the virus has not been described.", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "More than 100 different species of animals may be in- fected with the virus, and some of these act as a reser- voir. Occasionally, infected cows, goats or sheep may pass on the virus in unpasteurized milk or milk prod- ucts, and thus infect humans through the alimentary route.'° Person-to-person transmission of the virus has not been described.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 45.57, - "y0": 534.35, - "x1": 273.0, - "y1": 610.79 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "d16eb009a8ac426322da0ec9cfcc8e7c", - "text": "Attempts to eliminate the disease through chemical ex- termination of the tick population have been unsuccess- ful; the protective impact of insecticide-impregnated clothing, or the use of repellents, have been short-lived, at best. However, the use of personal protective mea- sures when outdoors in endemic areas can reduce the", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "Attempts to eliminate the disease through chemical ex- termination of the tick population have been unsuccess- ful; the protective impact of insecticide-impregnated clothing, or the use of repellents, have been short-lived, at best. However, the use of personal protective mea- sures when outdoors in endemic areas can reduce the
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 45.97, - "y0": 617.34, - "x1": 273.21, - "y1": 682.45 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "cbcb0433116a5d232005adb0d71eb5c0", - "text": "7 Fauquet CM et al, eds. Virus taxonomy: Vi//th report of the International Committee on Taxonomy of Viruses. San Diego, CA, Elsevier Academic Press, 2005: 986", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "lée dans des zones qui métaient pas connues auparavant pour étre des zones d’endémie - par exemple dans certaines parties de l Allemagne, de la Lituanie, de la Scandinavie, et dans plusieurs régions de la Fédération de Russie et de la Suisse.’ De plus, les zones d’endémie s’étendent apparemment en altitude, de <800 m au-dessus du niveau de la mer jusqu’a environ 1500 m, comme cela a été récemment rapporté en Autriche et en Slovaquie.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 293.58, - "y0": 56.32, - "x1": 550.76, - "y1": 131.26 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "20d6b19ed8f885e4f752358dc5e85750", - "text": "Chez ’homme, la maladie est due 4 3 sous-types du virus de Pencéphalite a tiques.’ Le sous-type européen est prédominant en Europe occidentale, septentrionale, centrale et orientale; le sous-type extréme oriental se retrouve dans les régions orien- tales de la Fédération de Russie, en Chine et au Japon; et le sous-type sibérien est présent dans toutes les régions de la Fédération de Russie (mais surtout dans sa partie asiatique). Les 3 sous-types circulent conjointement dans la Baltique, la partie européenne de la Fédération de Russie et en Sibérie.’", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "Chez ’homme, la maladie est due 4 3 sous-types du virus de Pencéphalite a tiques.’ Le sous-type européen est prédominant en Europe occidentale, septentrionale, centrale et orientale; le sous-type extréme oriental se retrouve dans les régions orien- tales de la Fédération de Russie, en Chine et au Japon; et le sous-type sibérien est présent dans toutes les régions de la Fédération de Russie (mais surtout dans sa partie asiatique). Les 3 sous-types circulent conjointement dans la Baltique, la partie européenne de la Fédération de Russie et en Sibérie.’
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 293.14, - "y0": 138.73, - "x1": 552.55, - "y1": 236.06 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "2a6d3775b5edcbcb73805821e5af6723", - "text": "La plupart des infections résultent de piqires de tiques contrac- tées au cours d’activités de plein air dans des zones forestiéres, méme si dans prés d’un tiers des cas confirmés les patients ne se souviennent pas avoir été exposés a des tiques avant leur maladie.> Lincidence saisonniére de la maladie coincide avec une exposition accrue au printemps, en été et en automne.*", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "La plupart des infections résultent de piqires de tiques contrac- tées au cours d’activités de plein air dans des zones forestiéres, méme si dans prés d’un tiers des cas confirmés les patients ne se souviennent pas avoir été exposés a des tiques avant leur maladie.> Lincidence saisonniére de la maladie coincide avec une exposition accrue au printemps, en été et en automne.*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 293.47, - "y0": 242.85, - "x1": 550.87, - "y1": 307.76 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "b206f602a35cf8120d329a669d7d7cb9", - "text": "Le sous-type européen est principalement transmis par Ixodes ricinus et les sous-types extréme-orientaux et sibériens par Ixodes persulcatus. Le pourcentage de tiques infectées par le virus varie considérablement au cours du temps et selon les endroits; dans les zones d’endémie d’Autriche et du sud de PAllemagne, 1 4 3% des tiques se sont avérées porteuses du virus, tandis que dans les endroits trés touchés de Lituanie, de Fédération de Russie et de Suisse, la prévalence de l’infection chez les tiques peut parfois atteindre 10 a 30%.’ Toutefois, Pin- cidence de la maladie chez les habitants d’une région dépend de divers facteurs et nest pas directement corrélée a la préva- lence du virus dans la population locale de tiques.*°", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "Le sous-type européen est principalement transmis par Ixodes ricinus et les sous-types extréme-orientaux et sibériens par Ixodes persulcatus. Le pourcentage de tiques infectées par le virus varie considérablement au cours du temps et selon les endroits; dans les zones d’endémie d’Autriche et du sud de PAllemagne, 1 4 3% des tiques se sont avérées porteuses du virus, tandis que dans les endroits trés touchés de Lituanie, de Fédération de Russie et de Suisse, la prévalence de l’infection chez les tiques peut parfois atteindre 10 a 30%.’ Toutefois, Pin- cidence de la maladie chez les habitants d’une région dépend de divers facteurs et nest pas directement corrélée a la préva- lence du virus dans la population locale de tiques.*°
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 293.73, - "y0": 315.3, - "x1": 551.42, - "y1": 445.45 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "15dbdc6318df782d8454ebe74b2d7f33", - "text": "Les larves, les nymphes et les tiques adultes s’infectent lorsqu’elles ingérent le sang d’animaux virémiques, en particulier de petits rongeurs; elles peuvent alors infecter par la suite des espéces vertébrées, notamment l’homme, au cours de leur repas de sang suivant. En outre, les tiques peuvent contracter le virus par voie trans-ovarienne ou a l’occasion de repas de sang conjoints.", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "Les larves, les nymphes et les tiques adultes s’infectent lorsqu’elles ingérent le sang d’animaux virémiques, en particulier de petits rongeurs; elles peuvent alors infecter par la suite des espéces vertébrées, notamment l’homme, au cours de leur repas de sang suivant. En outre, les tiques peuvent contracter le virus par voie trans-ovarienne ou a l’occasion de repas de sang conjoints.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 293.92, - "y0": 463.19, - "x1": 551.75, - "y1": 528.19 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "eeed5e56804c8eb381d9226d049e0f74", - "text": "Plus de 100 espéces animales différentes peuvent étre infectées par le virus et certains d’entre elles en sont les réservoirs. Il arrive parfois que des vaches, des chévres ou des brebis infec- tées transmettent le virus dans le lait ou les produits laitiers non pasteurisés et infectent ainsi homme par la voie alimen- taire.’° La transmission d’homme a homme du virus n’a jamais été décrite.", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "Plus de 100 espéces animales différentes peuvent étre infectées par le virus et certains d’entre elles en sont les réservoirs. Il arrive parfois que des vaches, des chévres ou des brebis infec- tées transmettent le virus dans le lait ou les produits laitiers non pasteurisés et infectent ainsi homme par la voie alimen- taire.’° La transmission d’homme a homme du virus n’a jamais été décrite.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 294.61, - "y0": 534.83, - "x1": 551.45, - "y1": 611.0 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "1c07cb6e68c6584baff618b55d37c92f", - "text": "Les tentatives d’élimination de la maladie par l’extermination chimique des populations de tiques ont échoué; l’effet protecteur des vétements imprégnés d’insecticide ou de [utilisation de répulsifs a été au mieux de courte durée. Cependant, le recours a des mesures de protection individuelle lorsqu’on est en plein air dans des régions d’endémie permet de réduire le risque d’ex-", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "Les tentatives d’élimination de la maladie par l’extermination chimique des populations de tiques ont échoué; l’effet protecteur des vétements imprégnés d’insecticide ou de [utilisation de répulsifs a été au mieux de courte durée. Cependant, le recours a des mesures de protection individuelle lorsqu’on est en plein air dans des régions d’endémie permet de réduire le risque d’ex-
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 291.77, - "y0": 617.49, - "x1": 552.42, - "y1": 682.71 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "abf2b9043cdff5e3bcc1f844a835fa44", - "text": "Fauquet CM et al, eds. Virus taxonomy: Villth report of the International Committee on Taxo- nomy of Viruses. San Diego, CA, Elsevier Academic Press, 2005: 986.", - "metadata": { - "category_depth": 1, - "page_number": 3, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "243
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 2, - "coordinates": [ - { - "x0": 538.12, - "y0": 778.47, - "x1": 550.18, - "y1": 786.64 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "a38d552d580f903fe45f8b8ca8a4b7e6", - "text": "risk of exposure to the virus; these measures include wearing appropriate clothing and inspecting the skin daily for ticks. The risk of infection is negligible for people who remain in urban or unforested areas, and who do not consume unpasteurized dairy products.", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "da575365134dbd67bfab748b436e66e6", - "text_as_html": "risk of exposure to the virus; these measures include wearing appropriate clothing and inspecting the skin daily for ticks. The risk of infection is negligible for people who remain in urban or unforested areas, and who do not consume unpasteurized dairy products.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 3, - "coordinates": [ - { - "x0": 43.65, - "y0": 56.11, - "x1": 274.73, - "y1": 109.49 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-13", - "text": "\n\n\nThe virus, pathogenesis, and etiological diagnosis\nThe tick-borne encephalitis virus is a member of the genus Flavivirus of the Flaviviridae family, which com- prises about 70 viruses including dengue viruses, yellow fever virus, Japanese encephalitis virus and West Nile virus. The virion consists of a single-stranded RNA mol- ecule enclosed by the core membrane and the envelope (E) protein. The E protein contains the antigenic deter- minants responsible for haemagglutination and neutral- ization, and induces protective immunity in the host. The 3 genetically and antigenically closely related sub- types of tick-borne encephalitis virus (Western, Sibe- rian and Far-Eastern) are not subject to significant antigenic variation.\" After an infected tick bites a per- son, the virus first replicates in local dermal cells, then subsequently in the regional lymph nodes and the re- ticuloendothelial system. The virus crosses the blood- brain barrier after infecting the capillary endothelium. In fatal cases, characteristic neuropathological changes include polioencephalomyelitis, which is accentuated in the spinal cord, brain stem and cerebellum.”\nThe etiological diagnosis of tick-borne encephalitis re- quires laboratory confirmation because clinical mani- festations are relatively nonspecific. During the initial viraemic phase of the disease, the virus may be detected by polymerase chain reaction (PCR) or recovered through inoculation into suitable cell cultures or suck- ling mice. During the second, neurological stage, the virus may in rare cases be detected in the cerebrospinal fluid or brain. Antibodies against the virus are normally detectable at the time neurological symptoms develop, and serodiagnosis uses a variety of methods, including enzyme-linked immunosorbent assay (ELISA), tests for neutralizing antibodies (NT), and haemagglutination inhibition (HI) techniques. In cases of previous expo- sure to other flaviviruses, including vaccination against yellow fever or Japanese encephalitis, tests for virus- specific immunoglobulin G may show false-positive re- sults due to cross-reacting antibodies. In those cases, the use of a highly specific NT is required for determi- nation of immunity.”", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "51ec90c01cddb70d4c684270e411aa89", - "text": "The virus, pathogenesis, and etiological diagnosis", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "", - "text_as_html": "The tick-borne encephalitis virus is a member of the genus Flavivirus of the Flaviviridae family, which com- prises about 70 viruses including dengue viruses, yellow fever virus, Japanese encephalitis virus and West Nile virus. The virion consists of a single-stranded RNA mol- ecule enclosed by the core membrane and the envelope (E) protein. The E protein contains the antigenic deter- minants responsible for haemagglutination and neutral- ization, and induces protective immunity in the host. The 3 genetically and antigenically closely related sub- types of tick-borne encephalitis virus (Western, Sibe- rian and Far-Eastern) are not subject to significant antigenic variation.\" After an infected tick bites a per- son, the virus first replicates in local dermal cells, then subsequently in the regional lymph nodes and the re- ticuloendothelial system. The virus crosses the blood- brain barrier after infecting the capillary endothelium. In fatal cases, characteristic neuropathological changes include polioencephalomyelitis, which is accentuated in the spinal cord, brain stem and cerebellum.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 3, - "coordinates": [ - { - "x0": 44.51, - "y0": 146.62, - "x1": 273.9, - "y1": 364.69 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "9ed6d73b3a26ca11d11dd911deef2e30", - "text": "The etiological diagnosis of tick-borne encephalitis re- quires laboratory confirmation because clinical mani- festations are relatively nonspecific. During the initial viraemic phase of the disease, the virus may be detected by polymerase chain reaction (PCR) or recovered through inoculation into suitable cell cultures or suck- ling mice. During the second, neurological stage, the virus may in rare cases be detected in the cerebrospinal fluid or brain. Antibodies against the virus are normally detectable at the time neurological symptoms develop, and serodiagnosis uses a variety of methods, including enzyme-linked immunosorbent assay (ELISA), tests for neutralizing antibodies (NT), and haemagglutination inhibition (HI) techniques. In cases of previous expo- sure to other flaviviruses, including vaccination against yellow fever or Japanese encephalitis, tests for virus- specific immunoglobulin G may show false-positive re- sults due to cross-reacting antibodies. In those cases, the use of a highly specific NT is required for determi- nation of immunity.”", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "51ec90c01cddb70d4c684270e411aa89", - "text_as_html": "The etiological diagnosis of tick-borne encephalitis re- quires laboratory confirmation because clinical mani- festations are relatively nonspecific. During the initial viraemic phase of the disease, the virus may be detected by polymerase chain reaction (PCR) or recovered through inoculation into suitable cell cultures or suck- ling mice. During the second, neurological stage, the virus may in rare cases be detected in the cerebrospinal fluid or brain. Antibodies against the virus are normally detectable at the time neurological symptoms develop, and serodiagnosis uses a variety of methods, including enzyme-linked immunosorbent assay (ELISA), tests for neutralizing antibodies (NT), and haemagglutination inhibition (HI) techniques. In cases of previous expo- sure to other flaviviruses, including vaccination against yellow fever or Japanese encephalitis, tests for virus- specific immunoglobulin G may show false-positive re- sults due to cross-reacting antibodies. In those cases, the use of a highly specific NT is required for determi- nation of immunity.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 3, - "coordinates": [ - { - "x0": 45.12, - "y0": 371.62, - "x1": 273.7, - "y1": 590.27 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-14", - "text": "\n\n\nThe disease\nThe incubation period lasts 2-28 days (most commonly 7-14 days) and is followed by 1-8 days of nonspecific signs and symptoms, such as fatigue, headache and gen- eral malaise, usually combined with fever of 238°C. After an asymptomatic interval of 1-20 days about one third of clinical cases experience a second phase of the\n\" Ecker M et al. Sequence analysis and genetic classification of tick-borne encepha- litis viruses from Europe and Asia. Journal of General Virology, 1999, 80:179-185.\n\"2 Gelpi E. Inflammatory response in human tick-borne encephalitis: analysis of post- mortem brain tissue. Journal of Neurovirology, 2006, 12:322-327.\n'3 Sonnenberg K et al. State-of-the-art serological techniques for detection of antibo- dies against tick-borne encephalitis virus. /nternational Journal of Medical Micro- biology, 2004, 293(Suppl. 37):$148-S151.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "b1eb8faa9a4600869584c0bec67889a3", - "text": "The disease", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "", - "text_as_html": "The incubation period lasts 2-28 days (most commonly 7-14 days) and is followed by 1-8 days of nonspecific signs and symptoms, such as fatigue, headache and gen- eral malaise, usually combined with fever of 238°C. After an asymptomatic interval of 1-20 days about one third of clinical cases experience a second phase of the
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 3, - "coordinates": [ - { - "x0": 46.48, - "y0": 625.85, - "x1": 273.27, - "y1": 690.43 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "5be9db12d54e86603ae8089b2acdf60d", - "text": "\" Ecker M et al. Sequence analysis and genetic classification of tick-borne encepha- litis viruses from Europe and Asia. Journal of General Virology, 1999, 80:179-185.", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "b1eb8faa9a4600869584c0bec67889a3", - "text_as_html": "position au virus. Ces mesures comprennent le fait de porter des vétements appropriés et de s’inspecter quotidiennement 4 la recherche de tiques. Le risque d’infection est négligeable pour les gens qui restent dans des zones urbaines ou non forestiéres et qui ne consomment pas de produits laitiers non pasteurisés.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 3, - "coordinates": [ - { - "x0": 294.15, - "y0": 56.21, - "x1": 549.54, - "y1": 109.81 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-16", - "text": "\n\n\nLe virus, pathogenése et diagnostic étiologique\nLe virus de Pencéphalite a tiques appartient au genre Flavivirus de la famille des flaviviridés, qui renferme environ 70 virus dont les virus de la dengue, le virus de la fiévre jaune, le virus de lencéphalite japonaise et le virus West Nile. Le virion est constitué d’une molécule d ARN monocaténaire enfermée dans une membrane centrale et une protéine d’enveloppe (E). Cette derniére renferme les déterminants antigéniques responsables de Phémagglutination et de la neutralisation et induit une immunité protectrice chez l’héte. Les 3 sous-types du virus de Pencéphalite a tiques étroitement apparentés sur le plan géné- tique et antigénique (occidental, sibérien et extréme-oriental) ne sont pas sujets 4 une variation antigénique importante.\" Lorsquw une tique infectée pique une personne, le virus se répli- que au début localement dans les cellules du derme, puis par la suite dans les ganglions lymphatiques régionaux et le systeme réticulo-endothélial. Le virus traverse la barriére hémato- encéphalique aprés avoir infecté l’endothélium capillaire. Dans les cas mortels, des modifications neuropathologiques caracté- ristiques se produisent, dont une polio-encéphalomyélite, accen- tuée dans la moelle épiniére, le tronc cérébral et le cervelet.’”\nLe diagnostic étiologique de lencéphalite a tiques exige une confirmation au laboratoire parce que les manifestations cliniques sont relativement peu spécifiques. Au cours de la phase virémique initiale de la maladie, le virus peut étre dépisté par amplification génique (PCR) ou mis en évidence par inoculation dans des cultu- res cellulaires appropriées ou chez le souriceau a la mamelle. Au cours de la deuxiéme phase, neurologique, le virus peut, en de rares cas, étre dépisté dans le liquide céphalo-rachidien ou le cerveau. Les anticorps antivirus sont normalement détectables au moment ou les symptémes neurologiques apparaissent et le séro- diagnostic fait appel a diverses méthodes, notamment au titrage avec un immunoadsorbant lié 4 une enzyme (ELISA), aux tests de recherche d’anticorps neutralisants (TN) et aux techniques d’inhi- bition de ?hémagglutination (IH). Dans les cas ot il y a eu une exposition antérieure a d’autres flavivirus, notamment a l’occasion une vaccination contre la fiévre jaune ou contre Pencéphalite japo- naise, des épreuves de recherche de immunoglobuline G spécifique du virus peuvent donner des résultats faussement positifs en raison de la présence d’anticorps présentant des réactions croisées. En pareil cas, Putilisation d'un test de neutralisation hautement spéci- fique est nécessaire pour la détermination de limmunité.”", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "4a155dd8f8b1e737e3d892bfebc9192d", - "text": "Le virus, pathogenése et diagnostic étiologique", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "", - "text_as_html": "Le virus de Pencéphalite a tiques appartient au genre Flavivirus de la famille des flaviviridés, qui renferme environ 70 virus dont les virus de la dengue, le virus de la fiévre jaune, le virus de lencéphalite japonaise et le virus West Nile. Le virion est constitué d’une molécule d ARN monocaténaire enfermée dans une membrane centrale et une protéine d’enveloppe (E). Cette derniére renferme les déterminants antigéniques responsables de Phémagglutination et de la neutralisation et induit une immunité protectrice chez l’héte. Les 3 sous-types du virus de Pencéphalite a tiques étroitement apparentés sur le plan géné- tique et antigénique (occidental, sibérien et extréme-oriental) ne sont pas sujets 4 une variation antigénique importante.\" Lorsquw une tique infectée pique une personne, le virus se répli- que au début localement dans les cellules du derme, puis par la suite dans les ganglions lymphatiques régionaux et le systeme réticulo-endothélial. Le virus traverse la barriére hémato- encéphalique aprés avoir infecté l’endothélium capillaire. Dans les cas mortels, des modifications neuropathologiques caracté- ristiques se produisent, dont une polio-encéphalomyélite, accen- tuée dans la moelle épiniére, le tronc cérébral et le cervelet.’”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 3, - "coordinates": [ - { - "x0": 292.86, - "y0": 146.14, - "x1": 551.23, - "y1": 364.97 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "786890b8b547765b9cddf97b75524ef8", - "text": "Le diagnostic étiologique de lencéphalite a tiques exige une confirmation au laboratoire parce que les manifestations cliniques sont relativement peu spécifiques. Au cours de la phase virémique initiale de la maladie, le virus peut étre dépisté par amplification génique (PCR) ou mis en évidence par inoculation dans des cultu- res cellulaires appropriées ou chez le souriceau a la mamelle. Au cours de la deuxiéme phase, neurologique, le virus peut, en de rares cas, étre dépisté dans le liquide céphalo-rachidien ou le cerveau. Les anticorps antivirus sont normalement détectables au moment ou les symptémes neurologiques apparaissent et le séro- diagnostic fait appel a diverses méthodes, notamment au titrage avec un immunoadsorbant lié 4 une enzyme (ELISA), aux tests de recherche d’anticorps neutralisants (TN) et aux techniques d’inhi- bition de ?hémagglutination (IH). Dans les cas ot il y a eu une exposition antérieure a d’autres flavivirus, notamment a l’occasion une vaccination contre la fiévre jaune ou contre Pencéphalite japo- naise, des épreuves de recherche de immunoglobuline G spécifique du virus peuvent donner des résultats faussement positifs en raison de la présence d’anticorps présentant des réactions croisées. En pareil cas, Putilisation d'un test de neutralisation hautement spéci- fique est nécessaire pour la détermination de limmunité.”", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "4a155dd8f8b1e737e3d892bfebc9192d", - "text_as_html": "Le diagnostic étiologique de lencéphalite a tiques exige une confirmation au laboratoire parce que les manifestations cliniques sont relativement peu spécifiques. Au cours de la phase virémique initiale de la maladie, le virus peut étre dépisté par amplification génique (PCR) ou mis en évidence par inoculation dans des cultu- res cellulaires appropriées ou chez le souriceau a la mamelle. Au cours de la deuxiéme phase, neurologique, le virus peut, en de rares cas, étre dépisté dans le liquide céphalo-rachidien ou le cerveau. Les anticorps antivirus sont normalement détectables au moment ou les symptémes neurologiques apparaissent et le séro- diagnostic fait appel a diverses méthodes, notamment au titrage avec un immunoadsorbant lié 4 une enzyme (ELISA), aux tests de recherche d’anticorps neutralisants (TN) et aux techniques d’inhi- bition de ?hémagglutination (IH). Dans les cas ot il y a eu une exposition antérieure a d’autres flavivirus, notamment a l’occasion une vaccination contre la fiévre jaune ou contre Pencéphalite japo- naise, des épreuves de recherche de immunoglobuline G spécifique du virus peuvent donner des résultats faussement positifs en raison de la présence d’anticorps présentant des réactions croisées. En pareil cas, Putilisation d'un test de neutralisation hautement spéci- fique est nécessaire pour la détermination de limmunité.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 3, - "coordinates": [ - { - "x0": 293.52, - "y0": 371.63, - "x1": 552.47, - "y1": 600.06 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-17", - "text": "\n\n\nLa maladie\nLa période d’incubation s’étend entre 2 et 28 jours (le plus souvent 7 a 14 jours) et est suivie par 1 a 8 jours durant lesquels il y a des signes et symptémes non spécifiques, comme de la fatigue, des céphalées, une sensation de malaise général, habi- tuellement associés a une fiévre 238°C. Aprés un intervalle asymptomatique de 1 a 20 jours, prés d’un tiers des cas clini-\n\"| Ecker M et al. Sequence analysis and genetic classification of tick-borne encephalitis viruses from Europe and Asia. Journal of General Virology, 1999, 80: 179-185.\n\"2 Gelpi E. Inflammatory response in human tick-borne encephalitis: analysis of postmortem brain tissue. Journal of Neurovirology, 2006, 12: 322-327.\n\"3 Sonnenberg K et al. State-of-the-art serological techniques for detection of antibodies against tick-borne encephalitis virus. /nternational Journal of Medical Microbiology, 2004, 293 (Suppl. 37): $148-S151.\ndisease characterized by fever frequently exceeding 40°C and signs of central nervous system involvement, such as meningitis, encephalitis (notably cerebellar ataxia), myelitis or radiculitis. Encephalitic patients may develop stupor and pyramidal tract dysfunction, as well as paralyses that frequently involve muscles of the shoulder region. In <40% of encephalitic cases the dis- ease results in permanent central nervous system sequelae, including various neuropsychiatric and cogni- tive complaints characteristic of postencephalitic syn- drome.’ There is no specific treatment for tick-borne encephalitis.\nClinical observations have suggested an association between the severity of the disease and the viral sub- type involved whereby the Far-Eastern variety appears to cause more severe disease than its European coun- terpart, and the Siberian subtype seems to occupy an intermediate position. Case-fatality rates have been re- ported of 220% for the Far-Eastern subtype, 6-8% for the Siberian subtype, and 1-2% for the European sub- type.’ Fatal haemorrhagic fever has been associated with the Far-Eastern subtype. Rare cases of chronic dis- ease, characterized by slow progression for 26 months, have been reported mainly with the Siberian subtype; these have included cases in children.’ However, differ- ent criteria for patient selection and variability in access to medical services, as well as differences in age-specific exposure, could account in part for these subtype-associated discrepancies.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "b65f1824e3b437f349dba2c009d8b04c", - "text": "La maladie", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "", - "text_as_html": "La période d’incubation s’étend entre 2 et 28 jours (le plus souvent 7 a 14 jours) et est suivie par 1 a 8 jours durant lesquels il y a des signes et symptémes non spécifiques, comme de la fatigue, des céphalées, une sensation de malaise général, habi- tuellement associés a une fiévre 238°C. Aprés un intervalle asymptomatique de 1 a 20 jours, prés d’un tiers des cas clini-
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 3, - "coordinates": [ - { - "x0": 294.99, - "y0": 626.38, - "x1": 550.66, - "y1": 691.66 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "50444f77b50d06a57a47ec72ab3c78ab", - "text": "\"| Ecker M et al. Sequence analysis and genetic classification of tick-borne encephalitis viruses from Europe and Asia. Journal of General Virology, 1999, 80: 179-185.", - "metadata": { - "category_depth": 1, - "page_number": 4, - "parent_id": "b65f1824e3b437f349dba2c009d8b04c", - "text_as_html": "disease characterized by fever frequently exceeding 40°C and signs of central nervous system involvement, such as meningitis, encephalitis (notably cerebellar ataxia), myelitis or radiculitis. Encephalitic patients may develop stupor and pyramidal tract dysfunction, as well as paralyses that frequently involve muscles of the shoulder region. In <40% of encephalitic cases the dis- ease results in permanent central nervous system sequelae, including various neuropsychiatric and cogni- tive complaints characteristic of postencephalitic syn- drome.’ There is no specific treatment for tick-borne encephalitis.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 4, - "coordinates": [ - { - "x0": 45.8, - "y0": 56.15, - "x1": 272.69, - "y1": 186.45 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "98681555435124610cb8e2eaa779a084", - "text": "Clinical observations have suggested an association between the severity of the disease and the viral sub- type involved whereby the Far-Eastern variety appears to cause more severe disease than its European coun- terpart, and the Siberian subtype seems to occupy an intermediate position. Case-fatality rates have been re- ported of 220% for the Far-Eastern subtype, 6-8% for the Siberian subtype, and 1-2% for the European sub- type.’ Fatal haemorrhagic fever has been associated with the Far-Eastern subtype. Rare cases of chronic dis- ease, characterized by slow progression for 26 months, have been reported mainly with the Siberian subtype; these have included cases in children.’ However, differ- ent criteria for patient selection and variability in access to medical services, as well as differences in age-specific exposure, could account in part for these subtype-associated discrepancies.", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "b65f1824e3b437f349dba2c009d8b04c", - "text_as_html": "Clinical observations have suggested an association between the severity of the disease and the viral sub- type involved whereby the Far-Eastern variety appears to cause more severe disease than its European coun- terpart, and the Siberian subtype seems to occupy an intermediate position. Case-fatality rates have been re- ported of 220% for the Far-Eastern subtype, 6-8% for the Siberian subtype, and 1-2% for the European sub- type.’ Fatal haemorrhagic fever has been associated with the Far-Eastern subtype. Rare cases of chronic dis- ease, characterized by slow progression for 26 months, have been reported mainly with the Siberian subtype; these have included cases in children.’ However, differ- ent criteria for patient selection and variability in access to medical services, as well as differences in age-specific exposure, could account in part for these subtype-associated discrepancies.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 4, - "coordinates": [ - { - "x0": 44.57, - "y0": 193.2, - "x1": 273.98, - "y1": 379.75 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-18", - "text": "\n\n\nVaccines against tick-borne encephalitis\nThe first vaccine against the virus was developed in 1937 in the former Soviet Union, where outbreaks of the disease (then called Russian spring and summer en- cephalitis) were of considerable public health concern. The first generation viral vaccine derived from mouse brain was efficacious but resulted in frequent adverse events. Modern, less reactogenic vaccines are based on formalin-inactivated strains of the virus produced in cell cultures. Currently, there are 4 widely used vaccines of assured quality: FSME-Immun and Encepur are man- ufactured in Austria and Germany, respectively, and are based on European strains of the virus; TBE vaccine Mos- cow (TBE-Moscow) and EnceVir are manufactured in the Russian Federation and based on Far-Eastern strains. There is also a Chinese vaccine which is being used in the northern border areas of China. Details on the com- position, safety, efficacy and effectiveness of this vaccine have not been published in international journals.\nAlthough numerous observational studies testify to their effectiveness, no randomized controlled trials have been conducted to demonstrate the efficacy of these vaccines in protecting against clinical disease. It would now be considered unethical to conduct randomized controlled trials of the effectiveness of these vaccines.\nImmunogenicity is assessed using ELISA, NT, or HI tests. The presence of circulating antibodies to the virus at or above locally agreed concentrations (for example, an NT titre of 210) is commonly considered to be a sur- rogate marker of protection.'* However, systematic clin-\n4 Holzmann H et al. Correlation between ELISA, hemagglutination inhibition, and neutralization tests after vaccination against tick-borne encephalitis. Journal of Medical Virology, 1996, 48:102-107.\nques présentent une deuxiéme phase de la maladie caractérisée par de la fiévre qui dépasse souvent 40°C et des signes d’atteinte du systéme nerveux central: méningite, encéphalite (en parti- culier ataxie cérébelleuse), myélite ou radiculite. Ces patients peuvent présenter un état de stupeur et un dysfonctionnement du faisceau pyramidal, de méme que des paralysies qui concer- nent fréquemment les muscles de la région scapulaire. Dans <40% des cas d’atteintes encéphalitiques, la maladie entraine des séquelles permanentes au niveau du systeme nerveux central, notamment diverses atteintes neuropsychiatriques et cognitives caractéristiques du syndrome postencéphalitique.’ II ny a pas de traitement spécifique de l’encéphalite a tiques.\nLes observations cliniques ont suggéré qu’il existe une associa- tion entre la gravité de la maladie et le sous-type viral en cause, qui fait que la variété extréme-orientale semble provoquer une maladie plus grave que son homologue européenne et que le sous-type sibérien semble occuper une position intermédiaire. On a signalé des taux de létalité >20% pour le sous-type extréme-oriental, de 6% a 8% pour le sous-type sibérien et de 1% a 2% pour le sous-type européen.’ Une fiévre hémorragique mortelle a été associée au sous-type extréme-oriental. De rares cas d’affection chronique, caractérisés par une évolution lente pendant 26 mois, ont été principalement rapportés pour le sous-type sibérien; ils comprenaient des cas touchant des enfants.‘ Cependant, l’application de critéres différents pour la sélection des patients et la variabilité de l’accés a des services médicaux, de méme que des différences dans exposition selon Page, pourraient expliquer en partie ces disparités entre sous- types.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "b6e21f2ff918530539b5babfdddff543", - "text": "Vaccines against tick-borne encephalitis", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "", - "text_as_html": "The first vaccine against the virus was developed in 1937 in the former Soviet Union, where outbreaks of the disease (then called Russian spring and summer en- cephalitis) were of considerable public health concern. The first generation viral vaccine derived from mouse brain was efficacious but resulted in frequent adverse events. Modern, less reactogenic vaccines are based on formalin-inactivated strains of the virus produced in cell cultures. Currently, there are 4 widely used vaccines of assured quality: FSME-Immun and Encepur are man- ufactured in Austria and Germany, respectively, and are based on European strains of the virus; TBE vaccine Mos- cow (TBE-Moscow) and EnceVir are manufactured in the Russian Federation and based on Far-Eastern strains. There is also a Chinese vaccine which is being used in the northern border areas of China. Details on the com- position, safety, efficacy and effectiveness of this vaccine have not been published in international journals.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 4, - "coordinates": [ - { - "x0": 45.14, - "y0": 404.53, - "x1": 272.85, - "y1": 600.64 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "bc42954b11062877f32ddd3e02339711", - "text": "Although numerous observational studies testify to their effectiveness, no randomized controlled trials have been conducted to demonstrate the efficacy of these vaccines in protecting against clinical disease. It would now be considered unethical to conduct randomized controlled trials of the effectiveness of these vaccines.", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "b6e21f2ff918530539b5babfdddff543", - "text_as_html": "Although numerous observational studies testify to their effectiveness, no randomized controlled trials have been conducted to demonstrate the efficacy of these vaccines in protecting against clinical disease. It would now be considered unethical to conduct randomized controlled trials of the effectiveness of these vaccines.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 4, - "coordinates": [ - { - "x0": 45.99, - "y0": 607.78, - "x1": 272.19, - "y1": 672.58 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "723929fa6b523f5cdd2f005a06de6969", - "text": "Immunogenicity is assessed using ELISA, NT, or HI tests. The presence of circulating antibodies to the virus at or above locally agreed concentrations (for example, an NT titre of 210) is commonly considered to be a sur- rogate marker of protection.'* However, systematic clin-", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "b6e21f2ff918530539b5babfdddff543", - "text_as_html": "Immunogenicity is assessed using ELISA, NT, or HI tests. The presence of circulating antibodies to the virus at or above locally agreed concentrations (for example, an NT titre of 210) is commonly considered to be a sur- rogate marker of protection.'* However, systematic clin-
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 4, - "coordinates": [ - { - "x0": 44.08, - "y0": 679.83, - "x1": 273.85, - "y1": 732.89 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "27fc7f9b1a8ae62015009cf01658f465", - "text": "4 Holzmann H et al. Correlation between ELISA, hemagglutination inhibition, and neutralization tests after vaccination against tick-borne encephalitis. Journal of Medical Virology, 1996, 48:102-107.", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "b6e21f2ff918530539b5babfdddff543", - "text_as_html": "ques présentent une deuxiéme phase de la maladie caractérisée par de la fiévre qui dépasse souvent 40°C et des signes d’atteinte du systéme nerveux central: méningite, encéphalite (en parti- culier ataxie cérébelleuse), myélite ou radiculite. Ces patients peuvent présenter un état de stupeur et un dysfonctionnement du faisceau pyramidal, de méme que des paralysies qui concer- nent fréquemment les muscles de la région scapulaire. Dans <40% des cas d’atteintes encéphalitiques, la maladie entraine des séquelles permanentes au niveau du systeme nerveux central, notamment diverses atteintes neuropsychiatriques et cognitives caractéristiques du syndrome postencéphalitique.’ II ny a pas de traitement spécifique de l’encéphalite a tiques.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 4, - "coordinates": [ - { - "x0": 293.12, - "y0": 56.16, - "x1": 550.93, - "y1": 186.68 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "f9c94929ab3db2f92b248a2affc84a16", - "text": "Les observations cliniques ont suggéré qu’il existe une associa- tion entre la gravité de la maladie et le sous-type viral en cause, qui fait que la variété extréme-orientale semble provoquer une maladie plus grave que son homologue européenne et que le sous-type sibérien semble occuper une position intermédiaire. On a signalé des taux de létalité >20% pour le sous-type extréme-oriental, de 6% a 8% pour le sous-type sibérien et de 1% a 2% pour le sous-type européen.’ Une fiévre hémorragique mortelle a été associée au sous-type extréme-oriental. De rares cas d’affection chronique, caractérisés par une évolution lente pendant 26 mois, ont été principalement rapportés pour le sous-type sibérien; ils comprenaient des cas touchant des enfants.‘ Cependant, l’application de critéres différents pour la sélection des patients et la variabilité de l’accés a des services médicaux, de méme que des différences dans exposition selon Page, pourraient expliquer en partie ces disparités entre sous- types.", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "", - "text_as_html": "Les observations cliniques ont suggéré qu’il existe une associa- tion entre la gravité de la maladie et le sous-type viral en cause, qui fait que la variété extréme-orientale semble provoquer une maladie plus grave que son homologue européenne et que le sous-type sibérien semble occuper une position intermédiaire. On a signalé des taux de létalité >20% pour le sous-type extréme-oriental, de 6% a 8% pour le sous-type sibérien et de 1% a 2% pour le sous-type européen.’ Une fiévre hémorragique mortelle a été associée au sous-type extréme-oriental. De rares cas d’affection chronique, caractérisés par une évolution lente pendant 26 mois, ont été principalement rapportés pour le sous-type sibérien; ils comprenaient des cas touchant des enfants.‘ Cependant, l’application de critéres différents pour la sélection des patients et la variabilité de l’accés a des services médicaux, de méme que des différences dans exposition selon Page, pourraient expliquer en partie ces disparités entre sous- types.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 4, - "coordinates": [ - { - "x0": 293.33, - "y0": 193.06, - "x1": 553.74, - "y1": 379.31 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-19", - "text": "\n\n\nVaccins contre I’encéphalite a tiques\nLe premier vaccin contre ce virus a été préparé en 1937 dans Pancienne Union soviétique, ot des flambées de la maladie (appelée alors encéphalite verno-estivale russe) suscitaient des préoccupations importantes pour la santé publique. La premiére génération de vaccins viraux préparés sur cerveaux de souris était efficace, mais entrainait de fréquentes manifestations indé- sirables. Les vaccins modernes, moins réactogénes, sont basés sur des souches de virus inactivées au formol et produites en cultures cellulaires. A Pheure actuelle, 4 vaccins de qualité garantie sont largement employés: le FSME-Immun et l’Encepur, respectivement fabriqués en Autriche et en Allemagne, et prépa- rés a partir de souches européennes du virus; le vaccin TBE Moscow et le vaccin EnceVir fabriqués en Fédération de Russie et préparés a partir de souches extréme-orientales. I] existe également un vaccin chinois utilisé dans les zones frontaliéres du nord de la Chine. Aucune information sur la composition, Pinnocuité et lefficacité de ce vaccin n’a été publiée dans des revues internationales.\nBien que de nombreuses études d’observation témoignent de leur efficacité, aucun essai contrélé randomisé n’a été mené pour mettre en évidence lefficacité de ces vaccins pour proté- ger contre la maladie clinique. Il ne serait pas actuellement considéré comme éthique de procéder a des essais contrélés randomisés sur l’efficacité de ces vaccins.\nLeur immunogénicité est établie a Paide d’épreuves ELISA, de TN ou @’H. La présence d’anticorps circulants contre le virus 4 des concentrations convenues localement ou supérieures (par exemple un titre de neutralisation >10) est communément considérée comme un marqueur de substitution de la protection.'* Cependant,\n™ Holzmann H et al. Correlation between ELISA, hemagglutination inhibition, and neutralization tests after vaccination against tick-borne encephalitis. Journal of Medical Virology, 1996, 48: 102-107.\n245\nical studies that substantiate this assumption are not available. Also, data on the immunogenicity of different vaccines are not directly comparable since the manu- facturers use different tests, and independent head-to- head comparisons are rare.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "6fb8382a62716ac4e799293a35267328", - "text": "Vaccins contre I’encéphalite a tiques", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "", - "text_as_html": "Le premier vaccin contre ce virus a été préparé en 1937 dans Pancienne Union soviétique, ot des flambées de la maladie (appelée alors encéphalite verno-estivale russe) suscitaient des préoccupations importantes pour la santé publique. La premiére génération de vaccins viraux préparés sur cerveaux de souris était efficace, mais entrainait de fréquentes manifestations indé- sirables. Les vaccins modernes, moins réactogénes, sont basés sur des souches de virus inactivées au formol et produites en cultures cellulaires. A Pheure actuelle, 4 vaccins de qualité garantie sont largement employés: le FSME-Immun et l’Encepur, respectivement fabriqués en Autriche et en Allemagne, et prépa- rés a partir de souches européennes du virus; le vaccin TBE Moscow et le vaccin EnceVir fabriqués en Fédération de Russie et préparés a partir de souches extréme-orientales. I] existe également un vaccin chinois utilisé dans les zones frontaliéres du nord de la Chine. Aucune information sur la composition, Pinnocuité et lefficacité de ce vaccin n’a été publiée dans des revues internationales.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 4, - "coordinates": [ - { - "x0": 293.77, - "y0": 404.46, - "x1": 554.12, - "y1": 601.11 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "5e5a6d071e7e856d4915eaeccfaa6691", - "text": "Bien que de nombreuses études d’observation témoignent de leur efficacité, aucun essai contrélé randomisé n’a été mené pour mettre en évidence lefficacité de ces vaccins pour proté- ger contre la maladie clinique. Il ne serait pas actuellement considéré comme éthique de procéder a des essais contrélés randomisés sur l’efficacité de ces vaccins.", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "6fb8382a62716ac4e799293a35267328", - "text_as_html": "Bien que de nombreuses études d’observation témoignent de leur efficacité, aucun essai contrélé randomisé n’a été mené pour mettre en évidence lefficacité de ces vaccins pour proté- ger contre la maladie clinique. Il ne serait pas actuellement considéré comme éthique de procéder a des essais contrélés randomisés sur l’efficacité de ces vaccins.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 4, - "coordinates": [ - { - "x0": 295.38, - "y0": 607.56, - "x1": 551.55, - "y1": 672.36 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4bee0aae03301652b9698a8e5aadc793", - "text": "Leur immunogénicité est établie a Paide d’épreuves ELISA, de TN ou @’H. La présence d’anticorps circulants contre le virus 4 des concentrations convenues localement ou supérieures (par exemple un titre de neutralisation >10) est communément considérée comme un marqueur de substitution de la protection.'* Cependant,", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "6fb8382a62716ac4e799293a35267328", - "text_as_html": "Leur immunogénicité est établie a Paide d’épreuves ELISA, de TN ou @’H. La présence d’anticorps circulants contre le virus 4 des concentrations convenues localement ou supérieures (par exemple un titre de neutralisation >10) est communément considérée comme un marqueur de substitution de la protection.'* Cependant,
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 4, - "coordinates": [ - { - "x0": 294.4, - "y0": 679.34, - "x1": 550.78, - "y1": 733.04 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "37796e224bb889a783c5a178c5b81c3c", - "text": "™ Holzmann H et al. Correlation between ELISA, hemagglutination inhibition, and neutralization tests after vaccination against tick-borne encephalitis. Journal of Medical Virology, 1996, 48: 102-107.", - "metadata": { - "category_depth": 1, - "page_number": 5, - "parent_id": "6fb8382a62716ac4e799293a35267328", - "text_as_html": "245
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 4, - "coordinates": [ - { - "x0": 539.14, - "y0": 779.62, - "x1": 549.57, - "y1": 784.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "29eb281eea5ac68c11bec58a148f6e96", - "text": "ical studies that substantiate this assumption are not available. Also, data on the immunogenicity of different vaccines are not directly comparable since the manu- facturers use different tests, and independent head-to- head comparisons are rare.", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "6fb8382a62716ac4e799293a35267328", - "text_as_html": "ical studies that substantiate this assumption are not available. Also, data on the immunogenicity of different vaccines are not directly comparable since the manu- facturers use different tests, and independent head-to- head comparisons are rare.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 5, - "coordinates": [ - { - "x0": 43.73, - "y0": 56.02, - "x1": 275.04, - "y1": 109.57 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-20", - "text": "\n\n\nAustrian and German vaccines\nThe Austrian and German vaccines are marketed as FSME-Immun (new formulation introduced after 2001) and Encepur-Adults; their respective paediatric formu- lations are FSME-Immun Junior and Encepur-Children. For FSME-Immun Junior, children are defined as aged 1-15 years, and for Encepur-Children as aged 1-11 years. FSME-Immun and Encepur were originally licensed in 1976 and 1994, respectively.\nThe new formulation of FSME-Immun is based on the Neud6rfl strain of the European subtype; human serum albumin is used as stabilizer. The antigen content per dose is 2.4 ug for adults and 1.2 ug for children. Encepur is based on the K23 strain of the virus. Sucrose is used as stabilizer. The antigen content is 1.5 yg per dose for adults and 0.75 yg for children. Both vaccines are pro- duced according to WHO manufacturing requirements.'* They are produced on chicken embryonic fibroblast cells, inactivated by formaldehyde, using aluminium hy- droxide as adjuvant. The vaccines do not contain poly- geline or thiomersal, but traces of formaldehyde (in FSME-Immun only), gentamicin, neomycin and chlortet- racycline (in Encepur only) may be found in the final products. Both vaccines have a shelf-life of 30 months when stored at 2-8°C. They are supplied in prefilled syringes for intramuscular administration, each syringe containing 0.5 ml for adults and 0.25 ml for children.\nAccording to their manufacturers, both FSME-Immun and Encepur require 3 doses for a complete primary course of immunization. For the conventional vaccina- tion schedule the dose intervals are 1-3 months between doses 1 and 2, and 5-12 months between doses 2 and 3 (for Encepur, the requirement is 9-12 months between doses 2 and 3). For the accelerated schedule for FSME-Immun, the recommendation is vaccination on days 0 and 14, followed by a third dose 5-12 months after the second dose. For Encepur, the accelerated schedule requires vaccination on days 0 and 14, followed by a third dose delivered 9-12 months later. In addition, Encepur may be used on a rapid schedule, with vaccina- tion on days 0, 7 and 21, followed by a fourth dose delivered 12-18 months later. For both vaccines the manufacturers recommend a booster dose to be admin- istered 3 years after completion of the primary series and subsequent boosters at intervals of 5 years (or 3-year intervals for individuals aged >50 years; in Aus- tria 3-year intervals are recommended for people aged >60 years).\nTo identify the most suitable schedule for Encepur- Adults and Encepur-Children, 2 randomized controlled studies were conducted to compare the immune re- sponses (by ELISA and NT) obtained from 4 different\n‘5 Requirements for tick-borne encephalitis vaccine (inactivated) [Annex 2]. Geneva, World Health Organization, 1997, WHO technical report series 889. Available from http://whqlibdoc.who.int/trs/)WHO_TRS_889.pdf; accessed May 2011.\non ne dispose pas d’études cliniques qui viennent corroborer cette hypothése. De plus, les données relatives 4 Pimmunogénicité des différents vaccins ne sont pas directement comparables puisque les fabricants utilisent des épreuves différentes et que les compa- raisons indépendantes directes sont rares.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "aa9aa0537ca6d692f37b76517ac84543", - "text": "Austrian and German vaccines", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "", - "text_as_html": "The Austrian and German vaccines are marketed as FSME-Immun (new formulation introduced after 2001) and Encepur-Adults; their respective paediatric formu- lations are FSME-Immun Junior and Encepur-Children. For FSME-Immun Junior, children are defined as aged 1-15 years, and for Encepur-Children as aged 1-11 years. FSME-Immun and Encepur were originally licensed in 1976 and 1994, respectively.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 5, - "coordinates": [ - { - "x0": 45.67, - "y0": 135.02, - "x1": 274.14, - "y1": 221.04 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "85a3dd914b1d886828060bd6599aee53", - "text": "The new formulation of FSME-Immun is based on the Neud6rfl strain of the European subtype; human serum albumin is used as stabilizer. The antigen content per dose is 2.4 ug for adults and 1.2 ug for children. Encepur is based on the K23 strain of the virus. Sucrose is used as stabilizer. The antigen content is 1.5 yg per dose for adults and 0.75 yg for children. Both vaccines are pro- duced according to WHO manufacturing requirements.'* They are produced on chicken embryonic fibroblast cells, inactivated by formaldehyde, using aluminium hy- droxide as adjuvant. The vaccines do not contain poly- geline or thiomersal, but traces of formaldehyde (in FSME-Immun only), gentamicin, neomycin and chlortet- racycline (in Encepur only) may be found in the final products. Both vaccines have a shelf-life of 30 months when stored at 2-8°C. They are supplied in prefilled syringes for intramuscular administration, each syringe containing 0.5 ml for adults and 0.25 ml for children.", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "aa9aa0537ca6d692f37b76517ac84543", - "text_as_html": "The new formulation of FSME-Immun is based on the Neud6rfl strain of the European subtype; human serum albumin is used as stabilizer. The antigen content per dose is 2.4 ug for adults and 1.2 ug for children. Encepur is based on the K23 strain of the virus. Sucrose is used as stabilizer. The antigen content is 1.5 yg per dose for adults and 0.75 yg for children. Both vaccines are pro- duced according to WHO manufacturing requirements.'* They are produced on chicken embryonic fibroblast cells, inactivated by formaldehyde, using aluminium hy- droxide as adjuvant. The vaccines do not contain poly- geline or thiomersal, but traces of formaldehyde (in FSME-Immun only), gentamicin, neomycin and chlortet- racycline (in Encepur only) may be found in the final products. Both vaccines have a shelf-life of 30 months when stored at 2-8°C. They are supplied in prefilled syringes for intramuscular administration, each syringe containing 0.5 ml for adults and 0.25 ml for children.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 5, - "coordinates": [ - { - "x0": 45.02, - "y0": 228.48, - "x1": 273.5, - "y1": 424.79 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "ad24fb0d23ff9b72f0c61ece737ff0c3", - "text": "According to their manufacturers, both FSME-Immun and Encepur require 3 doses for a complete primary course of immunization. For the conventional vaccina- tion schedule the dose intervals are 1-3 months between doses 1 and 2, and 5-12 months between doses 2 and 3 (for Encepur, the requirement is 9-12 months between doses 2 and 3). For the accelerated schedule for FSME-Immun, the recommendation is vaccination on days 0 and 14, followed by a third dose 5-12 months after the second dose. For Encepur, the accelerated schedule requires vaccination on days 0 and 14, followed by a third dose delivered 9-12 months later. In addition, Encepur may be used on a rapid schedule, with vaccina- tion on days 0, 7 and 21, followed by a fourth dose delivered 12-18 months later. For both vaccines the manufacturers recommend a booster dose to be admin- istered 3 years after completion of the primary series and subsequent boosters at intervals of 5 years (or 3-year intervals for individuals aged >50 years; in Aus- tria 3-year intervals are recommended for people aged >60 years).", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "aa9aa0537ca6d692f37b76517ac84543", - "text_as_html": "According to their manufacturers, both FSME-Immun and Encepur require 3 doses for a complete primary course of immunization. For the conventional vaccina- tion schedule the dose intervals are 1-3 months between doses 1 and 2, and 5-12 months between doses 2 and 3 (for Encepur, the requirement is 9-12 months between doses 2 and 3). For the accelerated schedule for FSME-Immun, the recommendation is vaccination on days 0 and 14, followed by a third dose 5-12 months after the second dose. For Encepur, the accelerated schedule requires vaccination on days 0 and 14, followed by a third dose delivered 9-12 months later. In addition, Encepur may be used on a rapid schedule, with vaccina- tion on days 0, 7 and 21, followed by a fourth dose delivered 12-18 months later. For both vaccines the manufacturers recommend a booster dose to be admin- istered 3 years after completion of the primary series and subsequent boosters at intervals of 5 years (or 3-year intervals for individuals aged >50 years; in Aus- tria 3-year intervals are recommended for people aged >60 years).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 5, - "coordinates": [ - { - "x0": 45.42, - "y0": 444.31, - "x1": 273.12, - "y1": 671.47 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "f9f193e77d79f6efff471cf0b2f1f3be", - "text": "To identify the most suitable schedule for Encepur- Adults and Encepur-Children, 2 randomized controlled studies were conducted to compare the immune re- sponses (by ELISA and NT) obtained from 4 different", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "aa9aa0537ca6d692f37b76517ac84543", - "text_as_html": "To identify the most suitable schedule for Encepur- Adults and Encepur-Children, 2 randomized controlled studies were conducted to compare the immune re- sponses (by ELISA and NT) obtained from 4 different
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 5, - "coordinates": [ - { - "x0": 44.9, - "y0": 680.09, - "x1": 272.97, - "y1": 722.26 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "a6a23e41bb720ac0b4957e9af9143c22", - "text": "‘5 Requirements for tick-borne encephalitis vaccine (inactivated) [Annex 2]. Geneva, World Health Organization, 1997, WHO technical report series 889. Available from http://whqlibdoc.who.int/trs/)WHO_TRS_889.pdf; accessed May 2011.", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "aa9aa0537ca6d692f37b76517ac84543", - "text_as_html": "on ne dispose pas d’études cliniques qui viennent corroborer cette hypothése. De plus, les données relatives 4 Pimmunogénicité des différents vaccins ne sont pas directement comparables puisque les fabricants utilisent des épreuves différentes et que les compa- raisons indépendantes directes sont rares.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 5, - "coordinates": [ - { - "x0": 294.4, - "y0": 56.05, - "x1": 551.81, - "y1": 109.46 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-21", - "text": "\n\n\nVaccins autrichiens et allemands\nLes vaccins autrichiens et allemands sont commercialisés sous e nom de FSME-Immun (nouvelle formulation introduite aprés 2001) et Encepur-Adults; leurs formulations pédiatriques respectives sont FSME-Immun Junior et Encepur-Children. Pour e FSME-Immun Junior, les enfants sont définis comme étant agés de 1 a 15 ans, et pour lEncepur-Children comme étant agés de 1 4 11 ans. Ces 2 vaccins ont été homologués a l’origine en 1976 et 1994, respectivement.\nLa nouvelle formulation du FSME-Immun est préparée a partir de la souche Neudérfl du sous-type européen; on utilise de l’al- bumine sérique humaine comme stabilisant. La teneur en anti- gene est de 2,4 ug par dose pour l’adulte et de 1,2 pg par dose pour l’enfant. LEncepur est préparé a partir de la souche K23 du virus. Le sucrose est utilisé comme stabilisant. La teneur en anti- gene est de 1,5 yg par dose pour l’adulte et de 0,75 ug par dose pour l’enfant. Ces 2 vaccins sont produits conformément aux normes de fabrication de OMS.\" Ils sont produits sur fibroblas- tes d’embryons de poulet, inactivés au formol et utilisent de *hydroxyde d’aluminium comme adjuvant. Ces vaccins ne contiennent pas de polygéline ni de thiomersal, mais des traces de formaldéhyde (uniquement dans le FSME-Immun), de genta- micine, de néomycine et de chlortétracycline (uniquement dans ’Encepur) peuvent étre trouvées dans le produit final. Conservés entre 2 et 8°C, ces 2 vaccins ont une durée de conservation de 30 mois. Ils sont fournis en seringues préremplies pour adminis- tration intramusculaire, chaque seringue contenant 0,5 ml de vaccin pour l’adulte et 0,25 ml pour l’enfant.\nSelon leurs fabricants, le FSME-Immun et l’Encepur nécessitent Padministration de 3 doses pour une primovaccination complete. Pour un calendrier de vaccination conventionnel, l’intervalle entre les doses est de 1 a 3 mois entre la dose 1 et la dose 2, et de 5 a 12 mois entre la dose 2 et la dose 3 (pour l’Encepur, la norme est de 9 4 12 mois entre la dose 2 et la dose 3). Pour le calendrier accéléré du FSME-Immun, la recommandation est de vacciner aux jours 0 et 14, et de compléter par une troisiéme dose 5 a 12 mois aprés la deuxiéme. Pour |’Encepur, le calen- drier accéléré nécessite de vacciner aux jours 0 et 14, et de compléter par une troisiéme dose 9 4 12 mois plus tard. En outre, on peut utiliser ’Encepur pour une vaccination rapide aux jours 0,7 et 21, complétée par une quatriéme dose admi- nistrée 12 4 18 mois plus tard. Les fabricants recommandent pour ces 2 vaccins une dose de rappel a administrer 3 ans aprés la fin de primovaccination et, par la suite, des rappels tous les 5 ans (ou tous les 3 ans pour les sujets 4gés de >50 ans; en Autriche, on recommande des intervalles de 3 ans pour les sujets agés de >60 ans).\nPour déterminer le calendrier le plus approprié pour l’Encepur- Adults et ’Encepur-Children, 2 études contrélées randomisées ont été menées pour comparer les réponses immunitaires (par ELISA et TN) obtenues avec 4 calendriers différents; 1 étude\n‘5 Normes relatives au vaccin anti-encéphalite a tiques (inactivé) [Annexe 2]. Geneve, Organisa- tion mondiale de la Santé, 1997. Série de rapports techniques de I'OMS, No 889. Disponible sur: http://whqlibdoc.who.int/trs/)WHO_TRS_889_fre.pdf; consulté en mai 2011.\nWEEKLY EPIDEMIOLOGICAL RECORD, NO. 24, 10 JUNE 2011\nschedules; 1 study included 398 individuals aged 212 years,'* the other 294 children aged 1-11 years.” Both studies concluded that the rapid immunization schedule prescribing vaccination on days 0, 7 and 21 compared favourably with vaccination on days 0, 28 and 300; days 0, 21 and 300; and days 0, 14 and 300, in terms of fast induction of an immune response and of stable NT titres lasting for 2300 days. Similar studies are not available for FSME-Immun.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "92c104209cd3ebab7170aa2b29c108d4", - "text": "Vaccins autrichiens et allemands", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "", - "text_as_html": "Les vaccins autrichiens et allemands sont commercialisés sous e nom de FSME-Immun (nouvelle formulation introduite aprés 2001) et Encepur-Adults; leurs formulations pédiatriques respectives sont FSME-Immun Junior et Encepur-Children. Pour e FSME-Immun Junior, les enfants sont définis comme étant agés de 1 a 15 ans, et pour lEncepur-Children comme étant agés de 1 4 11 ans. Ces 2 vaccins ont été homologués a l’origine en 1976 et 1994, respectivement.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 5, - "coordinates": [ - { - "x0": 294.86, - "y0": 134.83, - "x1": 552.2, - "y1": 220.91 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "c023da86e94c34d5ce77ec748a9d2fc0", - "text": "La nouvelle formulation du FSME-Immun est préparée a partir de la souche Neudérfl du sous-type européen; on utilise de l’al- bumine sérique humaine comme stabilisant. La teneur en anti- gene est de 2,4 ug par dose pour l’adulte et de 1,2 pg par dose pour l’enfant. LEncepur est préparé a partir de la souche K23 du virus. Le sucrose est utilisé comme stabilisant. La teneur en anti- gene est de 1,5 yg par dose pour l’adulte et de 0,75 ug par dose pour l’enfant. Ces 2 vaccins sont produits conformément aux normes de fabrication de OMS.\" Ils sont produits sur fibroblas- tes d’embryons de poulet, inactivés au formol et utilisent de *hydroxyde d’aluminium comme adjuvant. Ces vaccins ne contiennent pas de polygéline ni de thiomersal, mais des traces de formaldéhyde (uniquement dans le FSME-Immun), de genta- micine, de néomycine et de chlortétracycline (uniquement dans ’Encepur) peuvent étre trouvées dans le produit final. Conservés entre 2 et 8°C, ces 2 vaccins ont une durée de conservation de 30 mois. Ils sont fournis en seringues préremplies pour adminis- tration intramusculaire, chaque seringue contenant 0,5 ml de vaccin pour l’adulte et 0,25 ml pour l’enfant.", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "92c104209cd3ebab7170aa2b29c108d4", - "text_as_html": "La nouvelle formulation du FSME-Immun est préparée a partir de la souche Neudérfl du sous-type européen; on utilise de l’al- bumine sérique humaine comme stabilisant. La teneur en anti- gene est de 2,4 ug par dose pour l’adulte et de 1,2 pg par dose pour l’enfant. LEncepur est préparé a partir de la souche K23 du virus. Le sucrose est utilisé comme stabilisant. La teneur en anti- gene est de 1,5 yg par dose pour l’adulte et de 0,75 ug par dose pour l’enfant. Ces 2 vaccins sont produits conformément aux normes de fabrication de OMS.\" Ils sont produits sur fibroblas- tes d’embryons de poulet, inactivés au formol et utilisent de *hydroxyde d’aluminium comme adjuvant. Ces vaccins ne contiennent pas de polygéline ni de thiomersal, mais des traces de formaldéhyde (uniquement dans le FSME-Immun), de genta- micine, de néomycine et de chlortétracycline (uniquement dans ’Encepur) peuvent étre trouvées dans le produit final. Conservés entre 2 et 8°C, ces 2 vaccins ont une durée de conservation de 30 mois. Ils sont fournis en seringues préremplies pour adminis- tration intramusculaire, chaque seringue contenant 0,5 ml de vaccin pour l’adulte et 0,25 ml pour l’enfant.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 5, - "coordinates": [ - { - "x0": 293.51, - "y0": 228.56, - "x1": 553.28, - "y1": 436.13 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "f68d28578bf2dfd4e78c050624a043d8", - "text": "Selon leurs fabricants, le FSME-Immun et l’Encepur nécessitent Padministration de 3 doses pour une primovaccination complete. Pour un calendrier de vaccination conventionnel, l’intervalle entre les doses est de 1 a 3 mois entre la dose 1 et la dose 2, et de 5 a 12 mois entre la dose 2 et la dose 3 (pour l’Encepur, la norme est de 9 4 12 mois entre la dose 2 et la dose 3). Pour le calendrier accéléré du FSME-Immun, la recommandation est de vacciner aux jours 0 et 14, et de compléter par une troisiéme dose 5 a 12 mois aprés la deuxiéme. Pour |’Encepur, le calen- drier accéléré nécessite de vacciner aux jours 0 et 14, et de compléter par une troisiéme dose 9 4 12 mois plus tard. En outre, on peut utiliser ’Encepur pour une vaccination rapide aux jours 0,7 et 21, complétée par une quatriéme dose admi- nistrée 12 4 18 mois plus tard. Les fabricants recommandent pour ces 2 vaccins une dose de rappel a administrer 3 ans aprés la fin de primovaccination et, par la suite, des rappels tous les 5 ans (ou tous les 3 ans pour les sujets 4gés de >50 ans; en Autriche, on recommande des intervalles de 3 ans pour les sujets agés de >60 ans).", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "92c104209cd3ebab7170aa2b29c108d4", - "text_as_html": "Selon leurs fabricants, le FSME-Immun et l’Encepur nécessitent Padministration de 3 doses pour une primovaccination complete. Pour un calendrier de vaccination conventionnel, l’intervalle entre les doses est de 1 a 3 mois entre la dose 1 et la dose 2, et de 5 a 12 mois entre la dose 2 et la dose 3 (pour l’Encepur, la norme est de 9 4 12 mois entre la dose 2 et la dose 3). Pour le calendrier accéléré du FSME-Immun, la recommandation est de vacciner aux jours 0 et 14, et de compléter par une troisiéme dose 5 a 12 mois aprés la deuxiéme. Pour |’Encepur, le calen- drier accéléré nécessite de vacciner aux jours 0 et 14, et de compléter par une troisiéme dose 9 4 12 mois plus tard. En outre, on peut utiliser ’Encepur pour une vaccination rapide aux jours 0,7 et 21, complétée par une quatriéme dose admi- nistrée 12 4 18 mois plus tard. Les fabricants recommandent pour ces 2 vaccins une dose de rappel a administrer 3 ans aprés la fin de primovaccination et, par la suite, des rappels tous les 5 ans (ou tous les 3 ans pour les sujets 4gés de >50 ans; en Autriche, on recommande des intervalles de 3 ans pour les sujets agés de >60 ans).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 5, - "coordinates": [ - { - "x0": 293.35, - "y0": 444.02, - "x1": 552.9, - "y1": 650.31 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "2513157c532c7595746fd621fd43857d", - "text": "Pour déterminer le calendrier le plus approprié pour l’Encepur- Adults et ’Encepur-Children, 2 études contrélées randomisées ont été menées pour comparer les réponses immunitaires (par ELISA et TN) obtenues avec 4 calendriers différents; 1 étude", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "92c104209cd3ebab7170aa2b29c108d4", - "text_as_html": "Pour déterminer le calendrier le plus approprié pour l’Encepur- Adults et ’Encepur-Children, 2 études contrélées randomisées ont été menées pour comparer les réponses immunitaires (par ELISA et TN) obtenues avec 4 calendriers différents; 1 étude
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 5, - "coordinates": [ - { - "x0": 294.93, - "y0": 679.82, - "x1": 549.61, - "y1": 722.19 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "c0f6e3a90f921b57812f95a2746928b6", - "text": "‘5 Normes relatives au vaccin anti-encéphalite a tiques (inactivé) [Annexe 2]. Geneve, Organisa- tion mondiale de la Santé, 1997. Série de rapports techniques de I'OMS, No 889. Disponible sur: http://whqlibdoc.who.int/trs/)WHO_TRS_889_fre.pdf; consulté en mai 2011.", - "metadata": { - "category_depth": 1, - "page_number": 6, - "parent_id": "92c104209cd3ebab7170aa2b29c108d4", - "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 24, 10 JUNE 2011
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 5, - "coordinates": [ - { - "x0": 393.6, - "y0": 778.62, - "x1": 550.92, - "y1": 786.53 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "d6b8d611a062163e5f551409bd7f0362", - "text": "schedules; 1 study included 398 individuals aged 212 years,'* the other 294 children aged 1-11 years.” Both studies concluded that the rapid immunization schedule prescribing vaccination on days 0, 7 and 21 compared favourably with vaccination on days 0, 28 and 300; days 0, 21 and 300; and days 0, 14 and 300, in terms of fast induction of an immune response and of stable NT titres lasting for 2300 days. Similar studies are not available for FSME-Immun.", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "92c104209cd3ebab7170aa2b29c108d4", - "text_as_html": "schedules; 1 study included 398 individuals aged 212 years,'* the other 294 children aged 1-11 years.” Both studies concluded that the rapid immunization schedule prescribing vaccination on days 0, 7 and 21 compared favourably with vaccination on days 0, 28 and 300; days 0, 21 and 300; and days 0, 14 and 300, in terms of fast induction of an immune response and of stable NT titres lasting for 2300 days. Similar studies are not available for FSME-Immun.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 6, - "coordinates": [ - { - "x0": 44.97, - "y0": 55.73, - "x1": 273.41, - "y1": 153.82 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-22", - "text": "\n\n\nVaccine immunogenicity and effectiveness\nSeveral studies have been published on immunogenicity following primary immunization with either Encepur or FSME-Immun.' '* 1 !8 221 A recent Cochrane re- view” summarized seroconversion data from 11 vaccine trials including 4 randomized controlled trials of cur- rently licensed vaccines (Encepur-Children, Encepur- Adults and the new formulation of FSME-Immun). A total of 5063 children and adults were included in these 4 trials, and with each of the vaccines, seroconversion as measured by ELISA, HI or NT tests was obtained in 92-100% of vaccinees. Similarly high immunogenicity was achieved with both the conventional schedule (days 0, 28, and 300) and the rapid schedule (days 0, 7 and 21). In a subsequent randomized controlled trial, >95% of the 334 children enrolled developed neutralization titres 210 following 2 doses of Encepur-Children or FSME-Immun Junior.”\nLittle information is available on the immunogenicity and effectiveness of vaccines in situations where the recommended immunization intervals were grossly ex- tended. A study* on the persistence of immune memory in individuals whose immunizations had not followed the manufacturer’s recommended schedule concluded that in the majority of cases evidence of immunological priming (as reflected by an anamnestic antibody re- sponse to the tick-borne encephalitis antigen) persisted irrespective of the time elapsed since the last vaccina- tion (that is, <20 years) even in individuals who had previously received only 1 dose, and in those who were seronegative prior to receiving a booster dose. This finding suggests that timing between the first 2 or 3 doses is not a critical parameter for the success of subsequent immunization. On the other hand, the dem-\n‘6 Schondorf | et al. Tick-borne encephalitis (TBE) vaccination: applying the most sui- table vaccination schedule. Vaccine, 2007, 25:1470-1476.\nSchoendorf | et al. Tick-borne encephalitis (TBE) vaccination in children: advantage of the rapid immunization schedule (i.e., days 0, 7, 21). Human Vaccines, 2007, 2:42-47,\nWittermann C et al. Antibody response following administration of two tick-borne encephalitis vaccines using two different vaccination schedules. Vaccine, 2009, 27:1661-1666.\nEhrlich HJ et al. Randomised, phase II dose finding studies of a modified tick-borne encephalitis vaccine. Vaccine, 2006, 24:5256-5263.\nLoew-Baselli LA et al. Safety and immunogenicity of the modified adult tick-borne encephalitis vaccine. Vaccine, 2006, 24:5256-5263.\nPoellabauer E.M et al. Comparison of immunogenicity and safety between two paediatric TBE vaccines. Vaccine, 2010, 28:4680-4685.\nDemicheli V et al. Vaccines for preventing tick-borne encephalitis. Cochrane Data- base of Systematic Reviews, 2009, (1):CD000977.\nSchosser R et al. Seropositivity before and seroprotection after a booster vaccina- tion with FSME-IMMUN® adults in subjects with a time interval of > 4,5 years since the last TBE vaccination. Abstract presented at the 10th International Jena Symposium on tick-borne diseases (formerly IPS), Weimar, Germany, 19-21 March 2009.\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 24, 10 JUIN 2011\nportait sur 398 sujets a4gés de 212 ans;’* autre sur 294 enfants agés de 1 a 11 ans.” Ces deux études ont conclu que le calen- drier de vaccination rapide prescrivant de vacciner aux jours 0, 7 et 21, semblait meilleur que la vaccination aux jours 0, 28 et 300; aux jours 0, 21 et 300; et aux jours 0, 14 et 300, sur le plan de induction rapide d’une réponse immunitaire et de titres stables d’anticorps neutralisants pendant 2300 jours. On ne dispose pas d’études comparables pour le FSME-Immun.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "198820b7e55dce1d59d95859a7b0ee69", - "text": "Vaccine immunogenicity and effectiveness", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "", - "text_as_html": "Several studies have been published on immunogenicity following primary immunization with either Encepur or FSME-Immun.' '* 1 !8 221 A recent Cochrane re- view” summarized seroconversion data from 11 vaccine trials including 4 randomized controlled trials of cur- rently licensed vaccines (Encepur-Children, Encepur- Adults and the new formulation of FSME-Immun). A total of 5063 children and adults were included in these 4 trials, and with each of the vaccines, seroconversion as measured by ELISA, HI or NT tests was obtained in 92-100% of vaccinees. Similarly high immunogenicity was achieved with both the conventional schedule (days 0, 28, and 300) and the rapid schedule (days 0, 7 and 21). In a subsequent randomized controlled trial, >95% of the 334 children enrolled developed neutralization titres 210 following 2 doses of Encepur-Children or FSME-Immun Junior.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 6, - "coordinates": [ - { - "x0": 44.66, - "y0": 178.74, - "x1": 273.14, - "y1": 363.97 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "36eaf77b591ad7a1797efd7d2de3fabf", - "text": "Little information is available on the immunogenicity and effectiveness of vaccines in situations where the recommended immunization intervals were grossly ex- tended. A study* on the persistence of immune memory in individuals whose immunizations had not followed the manufacturer’s recommended schedule concluded that in the majority of cases evidence of immunological priming (as reflected by an anamnestic antibody re- sponse to the tick-borne encephalitis antigen) persisted irrespective of the time elapsed since the last vaccina- tion (that is, <20 years) even in individuals who had previously received only 1 dose, and in those who were seronegative prior to receiving a booster dose. This finding suggests that timing between the first 2 or 3 doses is not a critical parameter for the success of subsequent immunization. On the other hand, the dem-", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "198820b7e55dce1d59d95859a7b0ee69", - "text_as_html": "Little information is available on the immunogenicity and effectiveness of vaccines in situations where the recommended immunization intervals were grossly ex- tended. A study* on the persistence of immune memory in individuals whose immunizations had not followed the manufacturer’s recommended schedule concluded that in the majority of cases evidence of immunological priming (as reflected by an anamnestic antibody re- sponse to the tick-borne encephalitis antigen) persisted irrespective of the time elapsed since the last vaccina- tion (that is, <20 years) even in individuals who had previously received only 1 dose, and in those who were seronegative prior to receiving a booster dose. This finding suggests that timing between the first 2 or 3 doses is not a critical parameter for the success of subsequent immunization. On the other hand, the dem-
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 6, - "coordinates": [ - { - "x0": 45.67, - "y0": 370.92, - "x1": 272.24, - "y1": 546.12 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "be8ea3385288c3c705ad8097aabadf2a", - "text": "‘6 Schondorf | et al. Tick-borne encephalitis (TBE) vaccination: applying the most sui- table vaccination schedule. Vaccine, 2007, 25:1470-1476.", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "198820b7e55dce1d59d95859a7b0ee69", - "text_as_html": "RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 24, 10 JUIN 2011
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 6, - "coordinates": [ - { - "x0": 44.77, - "y0": 778.56, - "x1": 219.14, - "y1": 786.33 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "fd751c2ed3ae830bb9b42d6e69b9d701", - "text": "portait sur 398 sujets a4gés de 212 ans;’* autre sur 294 enfants agés de 1 a 11 ans.” Ces deux études ont conclu que le calen- drier de vaccination rapide prescrivant de vacciner aux jours 0, 7 et 21, semblait meilleur que la vaccination aux jours 0, 28 et 300; aux jours 0, 21 et 300; et aux jours 0, 14 et 300, sur le plan de induction rapide d’une réponse immunitaire et de titres stables d’anticorps neutralisants pendant 2300 jours. On ne dispose pas d’études comparables pour le FSME-Immun.", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "198820b7e55dce1d59d95859a7b0ee69", - "text_as_html": "portait sur 398 sujets a4gés de 212 ans;’* autre sur 294 enfants agés de 1 a 11 ans.” Ces deux études ont conclu que le calen- drier de vaccination rapide prescrivant de vacciner aux jours 0, 7 et 21, semblait meilleur que la vaccination aux jours 0, 28 et 300; aux jours 0, 21 et 300; et aux jours 0, 14 et 300, sur le plan de induction rapide d’une réponse immunitaire et de titres stables d’anticorps neutralisants pendant 2300 jours. On ne dispose pas d’études comparables pour le FSME-Immun.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 6, - "coordinates": [ - { - "x0": 293.87, - "y0": 55.71, - "x1": 551.55, - "y1": 142.77 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-23", - "text": "\n\n\nImmunogénicité et efficacité du vaccin\nPlusieurs études ont été publiées concernant rimmunogénicité de Encepur ou du FSME-Immun suite a la primovaccina- tion.’ !% 1718192921 Une revue Cochrane récente” a récapitulé les données relatives a la séroconversion provenant de 11 essais vaccinaux, dont 4 essais contrélés randomisés de vaccins actuellement homologués (Encepur-Children, Ence- pur-Adults et la nouvelle formulation du FSME-Immun). Au total, 5063 enfants et adultes ont participé a ces 4 essais et, pour chacun des vaccins, la séroconversion mesurée par ELISA, IH ou TN a été obtenue chez 92 4 100% des vaccinés. On a obtenu une immunogénicité élevée comparable avec le calen- drier habituel (jours 0, 28 et 300) et le calendrier rapide (jours 0, 7 et 21). Dans un essai contrélé randomisé ultérieur, >95% des 334 enfants recrutés ont atteint des titres de neutralisation 210 aprés 2 doses d’Encepur-Children ou de FSME-Immun Junior.'®\nOn dispose de peu d’informations concernant l’immunogénicité et Pefficacité des vaccins dans les cas ou les intervalles entre chaque injection ont été considérablement allongés. Une étude” sur la persistance de la mémoire immunologique chez des sujets dont la vaccination n’avait pas suivi le calendrier recom- mandé par le fabricant a conclu que, dans la majorité des cas, des signes d’amorcage immunologique tels que traduits par une réponse anamnestique en anticorps vis-a-vis de l’antigéne de Pencéphalite a tiques ont persisté, quelle que soit la durée écou- lée depuis la derniére vaccination (c’est-a-dire <20 ans), méme chez des sujets n’ayant regu précédemment quune seule dose de vaccin et chez ceux qui étaient séronégatifs avant de recevoir 1 dose de rappel. Ce résultat laisse 4 penser que le délai entre les 2 ou 3 premiéres doses rest pas un paramétre essentiel du succés de la vaccination ultérieure. D’autre part, la mise en évidence du seul amorcgage immunologique est probablement\n18 Schoendorf | et al. Tick-borne encephalitis (TBE) vaccination: applying the most suitable vacci- nation schedule. Vaccine, 2007, 25: 1470-1476.\nSchoendorf | et al. Tick-borne encephalitis (TBE) vaccination in children: advantage of the rapid immunization schedule (i.e., days 0, 7, 21). Human Vaccines, 2007, 2: 42-47.\nWittermann C et al. Antibody response following administration of two tick-borne encephalitis vaccines using two different vaccination schedules. Vaccine, 2009, 27: 1661-1666.\nEhrlich HJ et al. Randomised, phase II dose finding studies of a modified tick-borne encephalitis vaccine. Vaccine, 2006, 24: 5256-5263.\nLoew-Baselli LA et al. Safety and immunogenicity of the modified adult tick-borne encephalitis vaccine. Vaccine, 2006, 24: 5256-5263.\nPoellabauer E.M et al. Comparison of immunogenicity and safety between two paediatric TBE vaccines. Vaccine, 2010, 28: 4680-4685.\nDemicheli V et al. Vaccines for preventing tick-borne encephalitis. Cochrane Database of Syste- matic Reviews, 2009, (1): CD000977.\nSchosser R et al. Seropositivity before and seroprotection after a booster vaccination with FS- ME-IMMUN® adults in subjects with a time interval of >4,5 years since the last TBE vaccina- tion. Résumé présenté lors du 10@me Symposium international de Jena sur les maladies transmises par les tiques (précédemment appeleé IPS), Weimar, Allemagne, 19-21 mars 2011.\n247\nonstration of immunological priming alone is likely to be an insufficient surrogate marker for protection against the disease.”\nBreakthrough disease in people who have been previ- ously vaccinated is rare, but it does occur, particularly in elderly individuals. Thus, 25 cases of disease were reported in Austria“ during 2002-2008, 8 of which oc- curred in people who had been vaccinated according to the manufacturer’s recommended schedule; during 2000-2008, 27 cases occurred in Sweden,” 21 of which occurred in people who had received 22 doses accord- ing to the appropriate schedule.\nStudies of field effectiveness in Austria during 1994- 2001 showed that protection rates against clinical dis- ease were 96.4-100% following 2 doses of FSME-Immun, and 96-98.7% following 3 doses.” In similar studies cov- ering 2000-2006, the overall effectiveness of vaccines (predominantly FSME-Immun) was about 99% in those with a documented history of 23 vaccinations following the recommended schedule.” The Austrian experience shows that with current vaccines, high vaccination cov- erage can lead to a dramatic decline in the incidence of tick-borne encephalitis.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "49f2cbc9f0542495ad25e7d492673389", - "text": "Immunogénicité et efficacité du vaccin", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "", - "text_as_html": "Plusieurs études ont été publiées concernant rimmunogénicité de Encepur ou du FSME-Immun suite a la primovaccina- tion.’ !% 1718192921 Une revue Cochrane récente” a récapitulé les données relatives a la séroconversion provenant de 11 essais vaccinaux, dont 4 essais contrélés randomisés de vaccins actuellement homologués (Encepur-Children, Ence- pur-Adults et la nouvelle formulation du FSME-Immun). Au total, 5063 enfants et adultes ont participé a ces 4 essais et, pour chacun des vaccins, la séroconversion mesurée par ELISA, IH ou TN a été obtenue chez 92 4 100% des vaccinés. On a obtenu une immunogénicité élevée comparable avec le calen- drier habituel (jours 0, 28 et 300) et le calendrier rapide (jours 0, 7 et 21). Dans un essai contrélé randomisé ultérieur, >95% des 334 enfants recrutés ont atteint des titres de neutralisation 210 aprés 2 doses d’Encepur-Children ou de FSME-Immun Junior.'®
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 6, - "coordinates": [ - { - "x0": 293.64, - "y0": 179.5, - "x1": 553.34, - "y1": 353.1 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "c9dde4eb53636b197012fa89debf8daa", - "text": "On dispose de peu d’informations concernant l’immunogénicité et Pefficacité des vaccins dans les cas ou les intervalles entre chaque injection ont été considérablement allongés. Une étude” sur la persistance de la mémoire immunologique chez des sujets dont la vaccination n’avait pas suivi le calendrier recom- mandé par le fabricant a conclu que, dans la majorité des cas, des signes d’amorcage immunologique tels que traduits par une réponse anamnestique en anticorps vis-a-vis de l’antigéne de Pencéphalite a tiques ont persisté, quelle que soit la durée écou- lée depuis la derniére vaccination (c’est-a-dire <20 ans), méme chez des sujets n’ayant regu précédemment quune seule dose de vaccin et chez ceux qui étaient séronégatifs avant de recevoir 1 dose de rappel. Ce résultat laisse 4 penser que le délai entre les 2 ou 3 premiéres doses rest pas un paramétre essentiel du succés de la vaccination ultérieure. D’autre part, la mise en évidence du seul amorcgage immunologique est probablement", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "49f2cbc9f0542495ad25e7d492673389", - "text_as_html": "On dispose de peu d’informations concernant l’immunogénicité et Pefficacité des vaccins dans les cas ou les intervalles entre chaque injection ont été considérablement allongés. Une étude” sur la persistance de la mémoire immunologique chez des sujets dont la vaccination n’avait pas suivi le calendrier recom- mandé par le fabricant a conclu que, dans la majorité des cas, des signes d’amorcage immunologique tels que traduits par une réponse anamnestique en anticorps vis-a-vis de l’antigéne de Pencéphalite a tiques ont persisté, quelle que soit la durée écou- lée depuis la derniére vaccination (c’est-a-dire <20 ans), méme chez des sujets n’ayant regu précédemment quune seule dose de vaccin et chez ceux qui étaient séronégatifs avant de recevoir 1 dose de rappel. Ce résultat laisse 4 penser que le délai entre les 2 ou 3 premiéres doses rest pas un paramétre essentiel du succés de la vaccination ultérieure. D’autre part, la mise en évidence du seul amorcgage immunologique est probablement
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 6, - "coordinates": [ - { - "x0": 293.69, - "y0": 371.99, - "x1": 551.24, - "y1": 546.04 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "7ab17855e102e5ee4b84e433bd1d6a9b", - "text": "18 Schoendorf | et al. Tick-borne encephalitis (TBE) vaccination: applying the most suitable vacci- nation schedule. Vaccine, 2007, 25: 1470-1476.", - "metadata": { - "category_depth": 1, - "page_number": 7, - "parent_id": "49f2cbc9f0542495ad25e7d492673389", - "text_as_html": "247
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 6, - "coordinates": [ - { - "x0": 539.14, - "y0": 779.62, - "x1": 549.57, - "y1": 784.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "2012765580b81a10b9efac2e2a05d6c6", - "text": "onstration of immunological priming alone is likely to be an insufficient surrogate marker for protection against the disease.”", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "49f2cbc9f0542495ad25e7d492673389", - "text_as_html": "onstration of immunological priming alone is likely to be an insufficient surrogate marker for protection against the disease.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 7, - "coordinates": [ - { - "x0": 44.08, - "y0": 55.97, - "x1": 273.25, - "y1": 86.65 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "0226a6a3d94e2d220531628a2db77370", - "text": "Breakthrough disease in people who have been previ- ously vaccinated is rare, but it does occur, particularly in elderly individuals. Thus, 25 cases of disease were reported in Austria“ during 2002-2008, 8 of which oc- curred in people who had been vaccinated according to the manufacturer’s recommended schedule; during 2000-2008, 27 cases occurred in Sweden,” 21 of which occurred in people who had received 22 doses accord- ing to the appropriate schedule.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "49f2cbc9f0542495ad25e7d492673389", - "text_as_html": "Breakthrough disease in people who have been previ- ously vaccinated is rare, but it does occur, particularly in elderly individuals. Thus, 25 cases of disease were reported in Austria“ during 2002-2008, 8 of which oc- curred in people who had been vaccinated according to the manufacturer’s recommended schedule; during 2000-2008, 27 cases occurred in Sweden,” 21 of which occurred in people who had received 22 doses accord- ing to the appropriate schedule.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 7, - "coordinates": [ - { - "x0": 45.78, - "y0": 94.19, - "x1": 273.38, - "y1": 192.2 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "5c52df019ec3ac75a861c227c3e267f8", - "text": "Studies of field effectiveness in Austria during 1994- 2001 showed that protection rates against clinical dis- ease were 96.4-100% following 2 doses of FSME-Immun, and 96-98.7% following 3 doses.” In similar studies cov- ering 2000-2006, the overall effectiveness of vaccines (predominantly FSME-Immun) was about 99% in those with a documented history of 23 vaccinations following the recommended schedule.” The Austrian experience shows that with current vaccines, high vaccination cov- erage can lead to a dramatic decline in the incidence of tick-borne encephalitis.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "49f2cbc9f0542495ad25e7d492673389", - "text_as_html": "Studies of field effectiveness in Austria during 1994- 2001 showed that protection rates against clinical dis- ease were 96.4-100% following 2 doses of FSME-Immun, and 96-98.7% following 3 doses.” In similar studies cov- ering 2000-2006, the overall effectiveness of vaccines (predominantly FSME-Immun) was about 99% in those with a documented history of 23 vaccinations following the recommended schedule.” The Austrian experience shows that with current vaccines, high vaccination cov- erage can lead to a dramatic decline in the incidence of tick-borne encephalitis.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 7, - "coordinates": [ - { - "x0": 45.24, - "y0": 198.79, - "x1": 273.8, - "y1": 318.78 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-24", - "text": "\n\n\nDuration of protection and the need for booster doses\nLongitudinal studies show that the annual decline in geometric mean titres of neutralizing antibody follow- ing the primary series is pronounced during the first year and then levels off. Long-term studies following primary immunization plus 21 booster dose show that immunity lasts longer than the 5 years previously ex- pected. Comparative analysis suggests that persistence of titres may be longer after 21 booster dose than after primary immunization alone.'****>!%% Similar rates of decline were observed irrespective of age, but those aged 50 to 60 years and above were more likely than younger individuals to become seronegative because older people developed lower antibody titres following booster doses.2® 29, 30, 31, 34, 35\n4 Stiasny K et al. Characteristics of antibody responses in tick—borne encephalitis vaccination breakthroughs. Vaccine, 2009, 27:7021-7026.\nAndersson CR et al. Vaccine failures after active immunisation against tick-borne encephalitis. Vaccine, 2010, 28:2827-2831. 2\n26 Kunz C. TBE vaccination and the Austrian experience. Vaccine, 2003, 21(Suppl. 1): $50-S55.\nHeinz FX et al. Field effectiveness of vaccination against tick-borne encephalitis. Vaccine, 2007, 25:7559-7567.\nPaulke-Korinek M et al. Booster vaccinations against tick-borne encephalitis: 6 years follow-up indicates long-term protection. Vaccine, 2009, 27:7027-7030.\n28 Rendi-Wagner P et al. Antibody persistence following booster vaccination against tick-borne encephalitis: 3-year post-booster follow-up, Vaccine, 2007, 25:5097— 5101.\nRendi-Wagner P et al. Persistence of protective immunity following vaccination against tick-borne encephalitis-longer than expected? Vaccine, 2004, 22:2743- 2749.\nRendi-Wagner P et al. Persistence of antibodies after vaccination against tick— borne encephalitis. /nternational Journal of Medical Microbiology, 2006, 296 (Sup- pl. 40):S202-S207.\nLoew-Baselli A et al. Seropersistence of tick-borne encephalitis antibodies, safety and booster response to FSME-IMMUN® 0.5 ml in adults aged 18-67 years. Hu- man Vaccines, 2009, 5: 551-556.\nPlentzA et al. Long-term persistence of tick-borne encephalitis antibodies in adults 5 years after booster vaccination with Encepur Adults. Vaccine, 2009,27:853-856.\nHainz U et al. Insufficient protection for healthy elderly adults by tetanus and TBE vaccines. Vaccine, 2005, 23:3232-3235.\nWeinberger B et al. Decreased antibody titers and booster responses in tick-borne encephalitis vaccinees aged 50-90 years. Vaccine, 2010, 28:3511-3515.\n248\nun marqueur de substitution insuffisant de la protection contre la maladie.”\nLa percée de la maladie chez des sujets précédemment vaccinés est rare, mais peut se produire, en particulier chez les person- nes agées. Ainsi, 25 cas de maladie ont été notifiés en Autriche™ entre 2002 et 2008, dont 8 chez des personnes qui avaient été vaccinées conformément au calendrier recommandé par le fabricant; entre 2000 et 2008, 27 cas de ce type se sont produits en Suéde,* dont 21 chez des personnes ayant regu 22 doses conformément au calendrier préconisé.\nDes études sur lefficacité du vaccin sur le terrain effectuées en Autriche entre 1994 et 2001 ont montré que les taux de protec- tion contre la maladie clinique étaient de 96,4 a 100% aprés 2 doses de FSME-Immun et de 96.0-98,7% aprés 3 doses.” Dans des études comparables portant sur la période 2000-2006, l’ef- ficacité générale des vaccins (principalement du FSME-Immun) a été d’environ 99% chez les sujets ayant des antécédents docu- mentés concernant 23 vaccinations suivant le calendrier recom- mandé.”” Lexpérience autrichienne montre qu’avec les vaccins actuels, une couverture vaccinale élevée peut conduire 4 une chute spectaculaire de l’incidence de l’encéphalite a tiques.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "833750dcd362d7bd346e079050221576", - "text": "Duration of protection and the need for booster doses", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "", - "text_as_html": "Longitudinal studies show that the annual decline in geometric mean titres of neutralizing antibody follow- ing the primary series is pronounced during the first year and then levels off. Long-term studies following primary immunization plus 21 booster dose show that immunity lasts longer than the 5 years previously ex- pected. Comparative analysis suggests that persistence of titres may be longer after 21 booster dose than after primary immunization alone.'****>!%% Similar rates of decline were observed irrespective of age, but those aged 50 to 60 years and above were more likely than younger individuals to become seronegative because older people developed lower antibody titres following booster doses.2® 29, 30, 31, 34, 35
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 7, - "coordinates": [ - { - "x0": 45.6, - "y0": 354.98, - "x1": 273.45, - "y1": 505.97 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "801a405a11037506069495f2906421c1", - "text": "4 Stiasny K et al. Characteristics of antibody responses in tick—borne encephalitis vaccination breakthroughs. Vaccine, 2009, 27:7021-7026.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "833750dcd362d7bd346e079050221576", - "text_as_html": "248
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 7, - "coordinates": [ - { - "x0": 45.35, - "y0": 779.62, - "x1": 55.79, - "y1": 784.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "852116b41ee9efdba4bd2dcd98f8e963", - "text": "un marqueur de substitution insuffisant de la protection contre la maladie.”", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "833750dcd362d7bd346e079050221576", - "text_as_html": "un marqueur de substitution insuffisant de la protection contre la maladie.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 7, - "coordinates": [ - { - "x0": 292.75, - "y0": 55.64, - "x1": 550.01, - "y1": 75.8 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "0e8f9b62690c962ac9c905a7746cf95a", - "text": "La percée de la maladie chez des sujets précédemment vaccinés est rare, mais peut se produire, en particulier chez les person- nes agées. Ainsi, 25 cas de maladie ont été notifiés en Autriche™ entre 2002 et 2008, dont 8 chez des personnes qui avaient été vaccinées conformément au calendrier recommandé par le fabricant; entre 2000 et 2008, 27 cas de ce type se sont produits en Suéde,* dont 21 chez des personnes ayant regu 22 doses conformément au calendrier préconisé.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "833750dcd362d7bd346e079050221576", - "text_as_html": "La percée de la maladie chez des sujets précédemment vaccinés est rare, mais peut se produire, en particulier chez les person- nes agées. Ainsi, 25 cas de maladie ont été notifiés en Autriche™ entre 2002 et 2008, dont 8 chez des personnes qui avaient été vaccinées conformément au calendrier recommandé par le fabricant; entre 2000 et 2008, 27 cas de ce type se sont produits en Suéde,* dont 21 chez des personnes ayant regu 22 doses conformément au calendrier préconisé.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 7, - "coordinates": [ - { - "x0": 293.53, - "y0": 94.0, - "x1": 552.34, - "y1": 181.39 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "5549d3b32c09e8b6e745866ed39a5375", - "text": "Des études sur lefficacité du vaccin sur le terrain effectuées en Autriche entre 1994 et 2001 ont montré que les taux de protec- tion contre la maladie clinique étaient de 96,4 a 100% aprés 2 doses de FSME-Immun et de 96.0-98,7% aprés 3 doses.” Dans des études comparables portant sur la période 2000-2006, l’ef- ficacité générale des vaccins (principalement du FSME-Immun) a été d’environ 99% chez les sujets ayant des antécédents docu- mentés concernant 23 vaccinations suivant le calendrier recom- mandé.”” Lexpérience autrichienne montre qu’avec les vaccins actuels, une couverture vaccinale élevée peut conduire 4 une chute spectaculaire de l’incidence de l’encéphalite a tiques.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "833750dcd362d7bd346e079050221576", - "text_as_html": "Des études sur lefficacité du vaccin sur le terrain effectuées en Autriche entre 1994 et 2001 ont montré que les taux de protec- tion contre la maladie clinique étaient de 96,4 a 100% aprés 2 doses de FSME-Immun et de 96.0-98,7% aprés 3 doses.” Dans des études comparables portant sur la période 2000-2006, l’ef- ficacité générale des vaccins (principalement du FSME-Immun) a été d’environ 99% chez les sujets ayant des antécédents docu- mentés concernant 23 vaccinations suivant le calendrier recom- mandé.”” Lexpérience autrichienne montre qu’avec les vaccins actuels, une couverture vaccinale élevée peut conduire 4 une chute spectaculaire de l’incidence de l’encéphalite a tiques.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 7, - "coordinates": [ - { - "x0": 293.81, - "y0": 198.93, - "x1": 552.57, - "y1": 318.91 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-25", - "text": "\n\n\nDurée de protection et nécessité des rappels\nDes études longitudinales montrent que la diminution annuelle des titres moyens géométriques d’anticorps neutralisants suite a la primovaccination est prononcée au cours de la premiére année puis marque le pas. Des études de longue durée menées suite 4 la primovaccination plus 21 dose de rappel montrent que limmunité dure plus longtemps que les 5 ans attendus précédemment. Lanalyse comparative laisse 4 penser que la persistance des titres peut étre meilleure aprés 21 dose de rappel qu’aprés la seule primovaccination.'® * * * 3) 3% 3) Des vitesses de diminution analogues ont été observées quel que soit Page, mais les sujets 4gés de 50 a 60 ans et plus étaient davantage susceptibles que les plus jeunes de devenir séroné- gatifs parce quils obtenaient des titres d’anticorps plus faibles suite aux rappels.” 2% 2% 3} 3435\n24 Stiasny K et al. Characteristics of antibody responses in tick-borne encephalitis vaccination breakthroughs. Vaccine, 2009, 27: 7021-7026.\n25 Andersson CR et al. Vaccine failures after active immunisation against tick-borne encephalitis. Vaccine, 2010, 28: 2827-2831.\n26 Kunz C. TBE vaccination and the Austrian experience. Vaccine, 2003, 21 (Suppl. 1): $50-S55.\n27 Heinz FX et al. Field effectiveness of vaccination against tick-borne encephalitis. Vaccine, 2007, 25: 7559-7567.\n28 Paulke-Korinek M et al. Booster vaccinations against tick-borne encephalitis: 6 years follow-up indicates long-term protection. Vaccine, 2009, 27: 7027-7030.\n® Rendi-Wagner P et al. Antibody persistence following booster vaccination against tick-borne encephalitis: 3-year post-booster follow-up, Vaccine, 2007, 25: 5097-5101.\nRendi-Wagner P et al. Persistence of protective immunity following vaccination against tick- borne encephalitis — longer than expected? Vaccine, 2004, 22: 2743-2749.\nRendi-Wagner P et al. Persistence of antibodies after vaccination against tick-borne encephali- tis. International Journal of Medical Microbiology, 2006, 296 (Suppl. 40): $202-S207.\nLoew-Baselli A et al. Seropersistence of tick-borne encephalitis antibodies, safety and booster response to FSME IMMUN® 0.5 ml in adults aged 18 67 years. Human Vaccines, 2009, 5: 551- 556.\nPlentzA et al. Long-term persistence of tick-borne encephalitis antibodies in adults 5 years after booster vaccination with Encepur Adults. Vaccine, 2009,27: 853-856.\nHainz U et al. Insufficient protection for healthy elderly adults by tetanus and TBE vaccines. Vaccine, 2005, 23:3232-3235.\nWeinberger B et al. Decreased antibody titers and booster responses in tick-borne encephalitis vaccinees aged 50-90 years. Vaccine, 2010, 28:3511-3515.\n35\nData from Austria indicate that in >90% of vaccinees, a booster dose induces protective antibody levels that remain stable for 26 years, and that occasional break- through infections occur independently of the time since last immunization.” Subsequent data from Austria have shown that in >90% of vaccinees antibody titres persist for 28 years following the last booster immuni- zation.’ Similar data after primary immunization are not available, but there are no data to suggest a strong decline in antibody titres. The threshold for protective antibody titres has not been formally established.\nBecause extending the intervals between booster doses will reduce costs and may improve acceptability, the recommendations for booster doses are being revised in several countries. Currently, only Switzerland recom- mends 10-year intervals between the primary series and the first booster, as well as between subsequent booster doses.”", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "6d1a4017481c0052fd186607b2a5f659", - "text": "Durée de protection et nécessité des rappels", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "", - "text_as_html": "Des études longitudinales montrent que la diminution annuelle des titres moyens géométriques d’anticorps neutralisants suite a la primovaccination est prononcée au cours de la premiére année puis marque le pas. Des études de longue durée menées suite 4 la primovaccination plus 21 dose de rappel montrent que limmunité dure plus longtemps que les 5 ans attendus précédemment. Lanalyse comparative laisse 4 penser que la persistance des titres peut étre meilleure aprés 21 dose de rappel qu’aprés la seule primovaccination.'® * * * 3) 3% 3) Des vitesses de diminution analogues ont été observées quel que soit Page, mais les sujets 4gés de 50 a 60 ans et plus étaient davantage susceptibles que les plus jeunes de devenir séroné- gatifs parce quils obtenaient des titres d’anticorps plus faibles suite aux rappels.” 2% 2% 3} 3435
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 7, - "coordinates": [ - { - "x0": 294.44, - "y0": 354.29, - "x1": 553.05, - "y1": 506.4 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "304b8d8fb3f240a0a02ccba24ee1d78a", - "text": "24 Stiasny K et al. Characteristics of antibody responses in tick-borne encephalitis vaccination breakthroughs. Vaccine, 2009, 27: 7021-7026.", - "metadata": { - "category_depth": 1, - "page_number": 8, - "parent_id": "6d1a4017481c0052fd186607b2a5f659", - "text_as_html": "35
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 7, - "coordinates": [ - { - "x0": 293.68, - "y0": 757.67, - "x1": 297.28, - "y1": 760.54 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "5a5979eb95d5c33c5f35cf50dc3a9cd9", - "text": "Data from Austria indicate that in >90% of vaccinees, a booster dose induces protective antibody levels that remain stable for 26 years, and that occasional break- through infections occur independently of the time since last immunization.” Subsequent data from Austria have shown that in >90% of vaccinees antibody titres persist for 28 years following the last booster immuni- zation.’ Similar data after primary immunization are not available, but there are no data to suggest a strong decline in antibody titres. The threshold for protective antibody titres has not been formally established.", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "6d1a4017481c0052fd186607b2a5f659", - "text_as_html": "Data from Austria indicate that in >90% of vaccinees, a booster dose induces protective antibody levels that remain stable for 26 years, and that occasional break- through infections occur independently of the time since last immunization.” Subsequent data from Austria have shown that in >90% of vaccinees antibody titres persist for 28 years following the last booster immuni- zation.’ Similar data after primary immunization are not available, but there are no data to suggest a strong decline in antibody titres. The threshold for protective antibody titres has not been formally established.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 8, - "coordinates": [ - { - "x0": 45.55, - "y0": 56.27, - "x1": 272.76, - "y1": 175.97 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "7f4fbda85cccf74eee2070b4d0d51512", - "text": "Because extending the intervals between booster doses will reduce costs and may improve acceptability, the recommendations for booster doses are being revised in several countries. Currently, only Switzerland recom- mends 10-year intervals between the primary series and the first booster, as well as between subsequent booster doses.”", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "6d1a4017481c0052fd186607b2a5f659", - "text_as_html": "Because extending the intervals between booster doses will reduce costs and may improve acceptability, the recommendations for booster doses are being revised in several countries. Currently, only Switzerland recom- mends 10-year intervals between the primary series and the first booster, as well as between subsequent booster doses.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 8, - "coordinates": [ - { - "x0": 46.18, - "y0": 182.33, - "x1": 273.05, - "y1": 257.56 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-26", - "text": "\n\n\nSafety of Encepur and FSME-Immun\nAdverse events occurred relatively frequently with the pre-2001 formulations of of FSME-Immun and Encepur. The current formulations represent considerable im- provements in this regard, and these vaccines are con- sidered safe.”\nThe Cochrane review” cited above summarized safety data obtained from the 4 randomized controlled trials of Encepur-Children, Encepur-Adults, and the new for- mulation of FSME-Immun. A total of 5063 children and adults were included in these trials. Although adverse events were commonly reported (transient redness and pain at the site of injection in <45% of cases and fever 238°C in <5-6%), none of these events were serious or life threatening. A randomized controlled, single-blind multicentre trial that included 334 children aged 1-11 years found that both FSME-Immun Junior and Encepur-Children were well tolerated and had compa- rable safety profiles; no vaccine-related serious adverse events were reported.\" In a similar single-blind multi- centre randomized controlled, phase III clinical study comparing the immunogenicity and safety of these 2 vaccines in 303 children aged 1-11 years, rates of sys- temic reactions were low and similar with both vac- cines.”\nAdverse events following booster doses of the vaccines were investigated in adults aged 18-67 years whose pri- mary series had consisted of 2 doses of either FSME- Immun or Encepur-Adults and a third vaccination with FSME-Immun. Adverse events associated with the booster given 3 years later were predominantly mild and infrequent.’ In another study, a second Encepur booster given 3 years after the first booster vaccination was well tolerated by all vaccinees.*\n36 [Recommendations on immunization against tick-borne encephalitis]. Bulletin des Bundesamt fiir Gesundheit (Schweiz), 2006, 13:225-231 [Available in German only].\n37 Zent O et al. Kinetics of the immune response after primary and booster immuniza- tion against tick-borne encephalitis (TBE) in adults using the rapid immunization schedule. Vaccine, 2003, 21:4655-4660.\n8 Beran J et al. Long-term immunity after vaccination against tick-borne encephalitis with Encepur using the rapid vaccination schedule. /nternational Journal of Medical Microbiology, 2004, 293 (Suppl. 37):$130-S133.\nEn Autriche, les données indiquent que chez >90% des vaccinés, un rappel provoque la formation de concentrations d’anticorps protecteurs qui restent stables pendant 26 ans et que des infec- tions se produisent parfois indépendamment de la durée écou- lée depuis la derniére vaccination.* Dans ce pays, des données ultérieures ont montré que, chez >90% des vaccinés les titres d’anticorps persistent pendant 28 ans aprés le dernier rappel.” On ne dispose pas des données analogues suite a la primovac- cination, mais rien ne laisse a penser qu'il y ait une forte chute des titres d’anticorps. Aucun seuil pour les titres protecteurs d’anticorps n’a été officiellement fixé.\nParce que le fait d’allonger les intervalles entre les rappels permettra de réduire les coiits et d’améliorer l’acceptabilité du vaccin, les recommandations relatives aux rappels sont révisées dans plusieurs pays. Actuellement, seule la Suisse recommande un intervalle de 10 ans entre la primovaccination et le premier rappel et entre chaque rappel.**", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "01efaa73bae9006057013f725eea887a", - "text": "Safety of Encepur and FSME-Immun", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "", - "text_as_html": "Adverse events occurred relatively frequently with the pre-2001 formulations of of FSME-Immun and Encepur. The current formulations represent considerable im- provements in this regard, and these vaccines are con- sidered safe.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 8, - "coordinates": [ - { - "x0": 44.81, - "y0": 283.27, - "x1": 274.6, - "y1": 336.01 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "f1c8166d21b32a4e6b0dd37e1b22ce8f", - "text": "The Cochrane review” cited above summarized safety data obtained from the 4 randomized controlled trials of Encepur-Children, Encepur-Adults, and the new for- mulation of FSME-Immun. A total of 5063 children and adults were included in these trials. Although adverse events were commonly reported (transient redness and pain at the site of injection in <45% of cases and fever 238°C in <5-6%), none of these events were serious or life threatening. A randomized controlled, single-blind multicentre trial that included 334 children aged 1-11 years found that both FSME-Immun Junior and Encepur-Children were well tolerated and had compa- rable safety profiles; no vaccine-related serious adverse events were reported.\" In a similar single-blind multi- centre randomized controlled, phase III clinical study comparing the immunogenicity and safety of these 2 vaccines in 303 children aged 1-11 years, rates of sys- temic reactions were low and similar with both vac- cines.”", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "01efaa73bae9006057013f725eea887a", - "text_as_html": "The Cochrane review” cited above summarized safety data obtained from the 4 randomized controlled trials of Encepur-Children, Encepur-Adults, and the new for- mulation of FSME-Immun. A total of 5063 children and adults were included in these trials. Although adverse events were commonly reported (transient redness and pain at the site of injection in <45% of cases and fever 238°C in <5-6%), none of these events were serious or life threatening. A randomized controlled, single-blind multicentre trial that included 334 children aged 1-11 years found that both FSME-Immun Junior and Encepur-Children were well tolerated and had compa- rable safety profiles; no vaccine-related serious adverse events were reported.\" In a similar single-blind multi- centre randomized controlled, phase III clinical study comparing the immunogenicity and safety of these 2 vaccines in 303 children aged 1-11 years, rates of sys- temic reactions were low and similar with both vac- cines.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 8, - "coordinates": [ - { - "x0": 44.91, - "y0": 344.3, - "x1": 273.43, - "y1": 550.58 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "615b55cc5aca267e2dbd95d4b05dc312", - "text": "Adverse events following booster doses of the vaccines were investigated in adults aged 18-67 years whose pri- mary series had consisted of 2 doses of either FSME- Immun or Encepur-Adults and a third vaccination with FSME-Immun. Adverse events associated with the booster given 3 years later were predominantly mild and infrequent.’ In another study, a second Encepur booster given 3 years after the first booster vaccination was well tolerated by all vaccinees.*", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "01efaa73bae9006057013f725eea887a", - "text_as_html": "Adverse events following booster doses of the vaccines were investigated in adults aged 18-67 years whose pri- mary series had consisted of 2 doses of either FSME- Immun or Encepur-Adults and a third vaccination with FSME-Immun. Adverse events associated with the booster given 3 years later were predominantly mild and infrequent.’ In another study, a second Encepur booster given 3 years after the first booster vaccination was well tolerated by all vaccinees.*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 8, - "coordinates": [ - { - "x0": 45.36, - "y0": 558.46, - "x1": 272.78, - "y1": 656.31 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "d0aade629cd9561261a8df0b73cc9cc9", - "text": "36 [Recommendations on immunization against tick-borne encephalitis]. Bulletin des Bundesamt fiir Gesundheit (Schweiz), 2006, 13:225-231 [Available in German only].", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "01efaa73bae9006057013f725eea887a", - "text_as_html": "En Autriche, les données indiquent que chez >90% des vaccinés, un rappel provoque la formation de concentrations d’anticorps protecteurs qui restent stables pendant 26 ans et que des infec- tions se produisent parfois indépendamment de la durée écou- lée depuis la derniére vaccination.* Dans ce pays, des données ultérieures ont montré que, chez >90% des vaccinés les titres d’anticorps persistent pendant 28 ans aprés le dernier rappel.” On ne dispose pas des données analogues suite a la primovac- cination, mais rien ne laisse a penser qu'il y ait une forte chute des titres d’anticorps. Aucun seuil pour les titres protecteurs d’anticorps n’a été officiellement fixé.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 8, - "coordinates": [ - { - "x0": 294.81, - "y0": 56.04, - "x1": 552.04, - "y1": 175.87 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "e5c3406bd63bb50217f0b22c043ff96b", - "text": "Parce que le fait d’allonger les intervalles entre les rappels permettra de réduire les coiits et d’améliorer l’acceptabilité du vaccin, les recommandations relatives aux rappels sont révisées dans plusieurs pays. Actuellement, seule la Suisse recommande un intervalle de 10 ans entre la primovaccination et le premier rappel et entre chaque rappel.**", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "", - "text_as_html": "Parce que le fait d’allonger les intervalles entre les rappels permettra de réduire les coiits et d’améliorer l’acceptabilité du vaccin, les recommandations relatives aux rappels sont révisées dans plusieurs pays. Actuellement, seule la Suisse recommande un intervalle de 10 ans entre la primovaccination et le premier rappel et entre chaque rappel.**
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 8, - "coordinates": [ - { - "x0": 293.94, - "y0": 182.27, - "x1": 552.94, - "y1": 247.44 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-27", - "text": "\n\n\nInnocuité de I'Encepur et du FSME-Immun\nDes manifestations indésirables se produisaient relativement fréquemment avec les formulations du FSME-Immun et de l’En- cepur antérieures a 2001. Les formulations actuelles constituent des améliorations considérables a cet égard et ces vaccins sont considérés comme stirs.”\nLa revue Cochrane mentionnée ci-dessus” récapitulait les données relatives 4 linnocuité obtenues pour les 4 essais contrélés randomisés de l’Encepur-Children, Encepur-Adults et de la nouvelle formulation du FSME-Immun. Au total, 5063 enfants et adultes ont été recrutés dans ces essais. Bien que des manifestations indésirables aient été communément rapportées (rougeur et douleur transitoires au point @ injection dans <45% des cas et fiévre >38°C dans <5-6% des cas), aucune na été grave ni n’a engagé le pronostic vital. Un essai contrélé, randomisé, en simple aveugle, multicentrique, portant sur 334 enfants agés de 1 a 11 ans a permis de constater que le FSME-Immun Junior et l’Encepur-Children étaient bien tolérés et avaient des profils d’innocuité comparables; aucune manifes- tation indésirable postvaccinale grave n’a été signalée.'* Dans un essai clinique de phase III, contrélé, randomisé, en simple aveugle, multicentrique, comparant limmunogénicité et ’inno- cuité de ces 2 vaccins chez 303 enfants agés de 1 a 11 ans, les pourcentages de réactions systémiques étaient faibles et analo- gues pour les deux vaccins.”!\nOn a étudié les manifestations indésirables faisant suite aux rappels chez des adultes agés de 18 a 67 ans dont la primovac- cination avait consisté en 2 doses de FSME-Immun ou d’Ence- pur-Adults et une troisiéme dose de FSME-Immun. Les mani- festations indésirables associées au rappel administré 3 ans plus tard ont été principalement bénignes et peu fréquentes.*' Dans une autre étude, un deuxiéme rappel d’Encepur administré 3 ans aprés le premier a été bien toléré par tous les vacci- nés.**\n36 [Recommandations sur la vaccination contre l'encéphalite a tiques]. Bulletin des Bundesamt fir Gesundheit (Schweiz), 2006, 13:225-231 [Disponible uniquement en allemand].\n37 Zent O et al. Kinetics of the immune response after primary and booster immunization against tick-borne encephalitis (TBE) in adults using the rapid immunization schedule. Vaccine, 2003, 21:4655-4660.\n38 Beran J et al. Long-term immunity after vaccination against tick-borne encephalitis with Ence- pur using the rapid vaccination schedule. /nternational Journal of Medical Microbiology, 2004, 293 (Suppl. 37):S130-S133.\n249\nPostmarketing studies’ have confirmed the absence of severe adverse events following administration of these vaccines. Thus, in 2002 an independent postmarketing sentinel study reported adverse events occurring after 0.41% of 25 905 vaccinations with Encepur and FSME- Immun; the most common complaints were mild-to- moderate fever (<40 °C), local reactions and pain at the injection site. Similarly, postmarketing surveillance fol- lowing the distribution of >5 million doses of the vac- cines did not reveal any potential safety risk. There are no reports indicating impaired immunogenicity or safety when the Austrian or German vaccines are administered simultaneously with other vaccines, for example in travellers.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "bf0e8c23868832105308753d5e8709e9", - "text": "Innocuité de I'Encepur et du FSME-Immun", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "", - "text_as_html": "Des manifestations indésirables se produisaient relativement fréquemment avec les formulations du FSME-Immun et de l’En- cepur antérieures a 2001. Les formulations actuelles constituent des améliorations considérables a cet égard et ces vaccins sont considérés comme stirs.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 8, - "coordinates": [ - { - "x0": 295.55, - "y0": 283.55, - "x1": 551.81, - "y1": 336.14 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "8e3195187ea39c3a9e6f6c94a5219276", - "text": "La revue Cochrane mentionnée ci-dessus” récapitulait les données relatives 4 linnocuité obtenues pour les 4 essais contrélés randomisés de l’Encepur-Children, Encepur-Adults et de la nouvelle formulation du FSME-Immun. Au total, 5063 enfants et adultes ont été recrutés dans ces essais. Bien que des manifestations indésirables aient été communément rapportées (rougeur et douleur transitoires au point @ injection dans <45% des cas et fiévre >38°C dans <5-6% des cas), aucune na été grave ni n’a engagé le pronostic vital. Un essai contrélé, randomisé, en simple aveugle, multicentrique, portant sur 334 enfants agés de 1 a 11 ans a permis de constater que le FSME-Immun Junior et l’Encepur-Children étaient bien tolérés et avaient des profils d’innocuité comparables; aucune manifes- tation indésirable postvaccinale grave n’a été signalée.'* Dans un essai clinique de phase III, contrélé, randomisé, en simple aveugle, multicentrique, comparant limmunogénicité et ’inno- cuité de ces 2 vaccins chez 303 enfants agés de 1 a 11 ans, les pourcentages de réactions systémiques étaient faibles et analo- gues pour les deux vaccins.”!", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "bf0e8c23868832105308753d5e8709e9", - "text_as_html": "La revue Cochrane mentionnée ci-dessus” récapitulait les données relatives 4 linnocuité obtenues pour les 4 essais contrélés randomisés de l’Encepur-Children, Encepur-Adults et de la nouvelle formulation du FSME-Immun. Au total, 5063 enfants et adultes ont été recrutés dans ces essais. Bien que des manifestations indésirables aient été communément rapportées (rougeur et douleur transitoires au point @ injection dans <45% des cas et fiévre >38°C dans <5-6% des cas), aucune na été grave ni n’a engagé le pronostic vital. Un essai contrélé, randomisé, en simple aveugle, multicentrique, portant sur 334 enfants agés de 1 a 11 ans a permis de constater que le FSME-Immun Junior et l’Encepur-Children étaient bien tolérés et avaient des profils d’innocuité comparables; aucune manifes- tation indésirable postvaccinale grave n’a été signalée.'* Dans un essai clinique de phase III, contrélé, randomisé, en simple aveugle, multicentrique, comparant limmunogénicité et ’inno- cuité de ces 2 vaccins chez 303 enfants agés de 1 a 11 ans, les pourcentages de réactions systémiques étaient faibles et analo- gues pour les deux vaccins.”!
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 8, - "coordinates": [ - { - "x0": 293.62, - "y0": 344.29, - "x1": 553.0, - "y1": 550.76 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "c519fff79144990c6cebf7caa9f535f4", - "text": "On a étudié les manifestations indésirables faisant suite aux rappels chez des adultes agés de 18 a 67 ans dont la primovac- cination avait consisté en 2 doses de FSME-Immun ou d’Ence- pur-Adults et une troisiéme dose de FSME-Immun. Les mani- festations indésirables associées au rappel administré 3 ans plus tard ont été principalement bénignes et peu fréquentes.*' Dans une autre étude, un deuxiéme rappel d’Encepur administré 3 ans aprés le premier a été bien toléré par tous les vacci- nés.**", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "bf0e8c23868832105308753d5e8709e9", - "text_as_html": "On a étudié les manifestations indésirables faisant suite aux rappels chez des adultes agés de 18 a 67 ans dont la primovac- cination avait consisté en 2 doses de FSME-Immun ou d’Ence- pur-Adults et une troisiéme dose de FSME-Immun. Les mani- festations indésirables associées au rappel administré 3 ans plus tard ont été principalement bénignes et peu fréquentes.*' Dans une autre étude, un deuxiéme rappel d’Encepur administré 3 ans aprés le premier a été bien toléré par tous les vacci- nés.**
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 8, - "coordinates": [ - { - "x0": 292.91, - "y0": 558.15, - "x1": 552.53, - "y1": 655.55 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "bc62f726ae51092c07a8e389d87e5bd1", - "text": "36 [Recommandations sur la vaccination contre l'encéphalite a tiques]. Bulletin des Bundesamt fir Gesundheit (Schweiz), 2006, 13:225-231 [Disponible uniquement en allemand].", - "metadata": { - "category_depth": 1, - "page_number": 9, - "parent_id": "bf0e8c23868832105308753d5e8709e9", - "text_as_html": "249
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 8, - "coordinates": [ - { - "x0": 539.14, - "y0": 779.62, - "x1": 549.57, - "y1": 784.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "b6802e6bb663ab320ed183e0f3f9ee09", - "text": "Postmarketing studies’ have confirmed the absence of severe adverse events following administration of these vaccines. Thus, in 2002 an independent postmarketing sentinel study reported adverse events occurring after 0.41% of 25 905 vaccinations with Encepur and FSME- Immun; the most common complaints were mild-to- moderate fever (<40 °C), local reactions and pain at the injection site. Similarly, postmarketing surveillance fol- lowing the distribution of >5 million doses of the vac- cines did not reveal any potential safety risk. There are no reports indicating impaired immunogenicity or safety when the Austrian or German vaccines are administered simultaneously with other vaccines, for example in travellers.", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "bf0e8c23868832105308753d5e8709e9", - "text_as_html": "Postmarketing studies’ have confirmed the absence of severe adverse events following administration of these vaccines. Thus, in 2002 an independent postmarketing sentinel study reported adverse events occurring after 0.41% of 25 905 vaccinations with Encepur and FSME- Immun; the most common complaints were mild-to- moderate fever (<40 °C), local reactions and pain at the injection site. Similarly, postmarketing surveillance fol- lowing the distribution of >5 million doses of the vac- cines did not reveal any potential safety risk. There are no reports indicating impaired immunogenicity or safety when the Austrian or German vaccines are administered simultaneously with other vaccines, for example in travellers.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 9, - "coordinates": [ - { - "x0": 44.74, - "y0": 56.76, - "x1": 274.51, - "y1": 208.63 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-28", - "text": "\n\n\nRussian vaccines\nTwo vaccines are manufactured in the Russian Federa- tion. The TBE-Moscow vaccine was approved for use in adults in 1982; in 1999, following further improvement of the purification process, it was approved for use in children aged 23 years. Since 1982, >25 million people in the Russian Federation and neighbouring countries have received this vaccine. EnceVir was licensed in the Russian Federation in 2001, and is also licensed for use in children aged 23 years.”\nTBE-Moscow is based on the Sofjin strain of the Far- Eastern viral subtype. Following passages in mouse brain, the virus is further propagated in primary chicken embryo cells. The harvested virus is: inactivated by for- malin; filtered; concentrated; treated with the excipient protamine sulfate; stabilized through the addition of human albumin (500pg/ dose), gelatin and sucrose; and finally lyophilized. The concentration of viral protein per dose is 0.50-0.75 pg, and immunogenicity is adjusted to preset standards. Before use, lyophilized vaccine is dissolved in fluid containing the adjuvant aluminium hydroxide.\nThe development steps of EnceVir, which is based on Far-Eastern strain 205, are almost identical to those used to produce the TBE-Moscow vaccine. The concen- tration of viral protein per dose is 1.5-2.5 ug; alumin- ium hydroxide is used as adjuvant; and the vaccine contains human serum albumin (250yg/dose) as stabi- lizer; however, EnceVir is not lyophilized. The antibiotic kanamycin is used during manufacturing. Residuals of protamine sulfate may be found in the final products.\nThe production processes for both TBE-Moscow and EnceVir follow WHO manufacturing requirements\" and are controlled by national authorities.» When stored at 2-8 °C, the shelf life for EnceVir is 2 years and for TBE- Moscow is 3 years. Both vaccines are stable for 2 days at 9-25 °C.\nThe Russian vaccines are not licensed for use in chil- dren aged <3 years. Above this age, all vaccinees receive 0.5 ml of either vaccine, administered intramuscularly. The manufacturer of TBE-Moscow recommends a stan- dard primary immunization schedule of 2 doses given at an interval of 1-7 months; the manufacturer of Ence- Vir recommends 2 doses given at an interval of\n2 Vorob‘eva MS et al. [Vaccines, immunoglobulins, and test systems for the preven- tion and diagnosis of tick-borne encephalitis]. Voprosy Virusologii, 2007, 52:30-36 [Available in Russian only].\nDes études postcommercialisation' ont confirmé l’absence de manifestations indésirables graves suite 4 l’administration de ces vaccins. Ainsi, en 2002, une étude sentinelle indépendante postcommercialisation a fait état de manifestations indésirables pour 0,41% des 25 905 vaccinations par l’Encepur et le FSME- Immun; les plaintes les plus courantes faisaient état d’une fiévre bénigne a modérée (<40°C), de réactions locales et d'une douleur au point dinjection. De la méme facon, la pharmaco- vigilance ayant fait suite a la distribution de >5 millions de doses de ces vaccins n’a pas révélé de risque potentiel concer- nant l’innocuité. Il n’y a pas de rapport indiquant une altération de Pimmunogénicité ou de Pinnocuité lorsque les vaccins autri- chiens ou allemands sont administrés en méme temps que d’autres vaccins, par exemple chez les voyageurs.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "f47150f66f4731562b008069475ecefd", - "text": "Russian vaccines", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "", - "text_as_html": "Two vaccines are manufactured in the Russian Federa- tion. The TBE-Moscow vaccine was approved for use in adults in 1982; in 1999, following further improvement of the purification process, it was approved for use in children aged 23 years. Since 1982, >25 million people in the Russian Federation and neighbouring countries have received this vaccine. EnceVir was licensed in the Russian Federation in 2001, and is also licensed for use in children aged 23 years.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 9, - "coordinates": [ - { - "x0": 45.29, - "y0": 233.34, - "x1": 274.29, - "y1": 330.83 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "20ebb5edc3f0d7ee6335eed3fdcefdbf", - "text": "TBE-Moscow is based on the Sofjin strain of the Far- Eastern viral subtype. Following passages in mouse brain, the virus is further propagated in primary chicken embryo cells. The harvested virus is: inactivated by for- malin; filtered; concentrated; treated with the excipient protamine sulfate; stabilized through the addition of human albumin (500pg/ dose), gelatin and sucrose; and finally lyophilized. The concentration of viral protein per dose is 0.50-0.75 pg, and immunogenicity is adjusted to preset standards. Before use, lyophilized vaccine is dissolved in fluid containing the adjuvant aluminium hydroxide.", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "f47150f66f4731562b008069475ecefd", - "text_as_html": "TBE-Moscow is based on the Sofjin strain of the Far- Eastern viral subtype. Following passages in mouse brain, the virus is further propagated in primary chicken embryo cells. The harvested virus is: inactivated by for- malin; filtered; concentrated; treated with the excipient protamine sulfate; stabilized through the addition of human albumin (500pg/ dose), gelatin and sucrose; and finally lyophilized. The concentration of viral protein per dose is 0.50-0.75 pg, and immunogenicity is adjusted to preset standards. Before use, lyophilized vaccine is dissolved in fluid containing the adjuvant aluminium hydroxide.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 9, - "coordinates": [ - { - "x0": 45.27, - "y0": 338.16, - "x1": 273.59, - "y1": 468.86 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "3bc952eae0a0a2e24aafa67e6f963f75", - "text": "The development steps of EnceVir, which is based on Far-Eastern strain 205, are almost identical to those used to produce the TBE-Moscow vaccine. The concen- tration of viral protein per dose is 1.5-2.5 ug; alumin- ium hydroxide is used as adjuvant; and the vaccine contains human serum albumin (250yg/dose) as stabi- lizer; however, EnceVir is not lyophilized. The antibiotic kanamycin is used during manufacturing. Residuals of protamine sulfate may be found in the final products.", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "f47150f66f4731562b008069475ecefd", - "text_as_html": "The development steps of EnceVir, which is based on Far-Eastern strain 205, are almost identical to those used to produce the TBE-Moscow vaccine. The concen- tration of viral protein per dose is 1.5-2.5 ug; alumin- ium hydroxide is used as adjuvant; and the vaccine contains human serum albumin (250yg/dose) as stabi- lizer; however, EnceVir is not lyophilized. The antibiotic kanamycin is used during manufacturing. Residuals of protamine sulfate may be found in the final products.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 9, - "coordinates": [ - { - "x0": 45.37, - "y0": 476.13, - "x1": 273.26, - "y1": 573.73 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "2a786c63e3ba9061e22fb8fd78a22af6", - "text": "The production processes for both TBE-Moscow and EnceVir follow WHO manufacturing requirements\" and are controlled by national authorities.» When stored at 2-8 °C, the shelf life for EnceVir is 2 years and for TBE- Moscow is 3 years. Both vaccines are stable for 2 days at 9-25 °C.", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "f47150f66f4731562b008069475ecefd", - "text_as_html": "The production processes for both TBE-Moscow and EnceVir follow WHO manufacturing requirements\" and are controlled by national authorities.» When stored at 2-8 °C, the shelf life for EnceVir is 2 years and for TBE- Moscow is 3 years. Both vaccines are stable for 2 days at 9-25 °C.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 9, - "coordinates": [ - { - "x0": 46.51, - "y0": 580.27, - "x1": 273.04, - "y1": 645.11 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "b1824c0f417e12f0352ce25ab59dac48", - "text": "The Russian vaccines are not licensed for use in chil- dren aged <3 years. Above this age, all vaccinees receive 0.5 ml of either vaccine, administered intramuscularly. The manufacturer of TBE-Moscow recommends a stan- dard primary immunization schedule of 2 doses given at an interval of 1-7 months; the manufacturer of Ence- Vir recommends 2 doses given at an interval of", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "f47150f66f4731562b008069475ecefd", - "text_as_html": "The Russian vaccines are not licensed for use in chil- dren aged <3 years. Above this age, all vaccinees receive 0.5 ml of either vaccine, administered intramuscularly. The manufacturer of TBE-Moscow recommends a stan- dard primary immunization schedule of 2 doses given at an interval of 1-7 months; the manufacturer of Ence- Vir recommends 2 doses given at an interval of
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 9, - "coordinates": [ - { - "x0": 45.66, - "y0": 651.97, - "x1": 273.16, - "y1": 727.6 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "2c6291d2518bd1683dcd249cd5213b13", - "text": "2 Vorob‘eva MS et al. [Vaccines, immunoglobulins, and test systems for the preven- tion and diagnosis of tick-borne encephalitis]. Voprosy Virusologii, 2007, 52:30-36 [Available in Russian only].", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "f47150f66f4731562b008069475ecefd", - "text_as_html": "Des études postcommercialisation' ont confirmé l’absence de manifestations indésirables graves suite 4 l’administration de ces vaccins. Ainsi, en 2002, une étude sentinelle indépendante postcommercialisation a fait état de manifestations indésirables pour 0,41% des 25 905 vaccinations par l’Encepur et le FSME- Immun; les plaintes les plus courantes faisaient état d’une fiévre bénigne a modérée (<40°C), de réactions locales et d'une douleur au point dinjection. De la méme facon, la pharmaco- vigilance ayant fait suite a la distribution de >5 millions de doses de ces vaccins n’a pas révélé de risque potentiel concer- nant l’innocuité. Il n’y a pas de rapport indiquant une altération de Pimmunogénicité ou de Pinnocuité lorsque les vaccins autri- chiens ou allemands sont administrés en méme temps que d’autres vaccins, par exemple chez les voyageurs.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 9, - "coordinates": [ - { - "x0": 294.42, - "y0": 56.59, - "x1": 552.45, - "y1": 208.68 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-29", - "text": "\n\n\nVaccins russes\nDeux vaccins sont fabriqués en Fédération de Russie. Le TBE- Moscow a été approuvé pour une utilisation chez l’adulte en 1982; en 1999, suite 4 une amélioration du processus de purifi- cation, il a été approuvé pour l’utilisation chez enfant agé de 23 ans. Depuis 1982, >25 millions de personnes ont recu ce vaccin en Fédération de Russie et dans les pays voisins. LEnceVir a été homologué en Fédération de Russie en 2001 et Pest également pour utilisation chez l’enfant agé de 23 ans.”\nLe TBE-Moscow est préparé a partir de la souche Sofjin appar- tenant au sous-type viral extréme-oriental. Aprés plusieurs passages en cerveau de souris, le virus est propagé en cultures primaires de cellules d’embryons de poulets. Le virus ainsi récolté est inactivé au formol; filtré; concentré; traité par le sulfate de protamine, un excipient; stabilisé par Padjonction d@albumine humaine (500 jig/dose), de gélatine et de sucrose; et enfin, lyophilisé. La concentration de protéine virale par dose est de 0,50-0,75 pg et Pimmunogénicité est ajustée sur des normes fixées a l’avance. Avant utilisation, le vaccin lyophilisé est dissout dans un liquide contenant de l’hydroxyde d’alumi- nium comme adjuvant.\nLes étapes du développement de l’EnceVir, qui est préparé a partir de la souche 205 extréme-orientale, sont pratiquement identiques a celles utilisées pour produire le vaccin TBE-Moscow. La concen- tration de protéine virale par dose est de 1,5 a 2,5 ug; Phydroxyde aluminium est utilisé comme adjuvant, et le vaccin renferme de a sérum-albumine humaine (250 pg/dose) comme stabilisant; mais, lEnceVir n’est pas lyophilisé. On utilise de la kanamycine, un antibiotique, en cours de fabrication. On peut trouver dans le produit final des résidus de sulfate de protamine.\nLes procédés de production du TBE-Moscow et de |’EnceVir suivent les normes de fabrication de OMS\" et sont contrélés par les autorités nationales.*? Entre 2-8°C, la durée de conser- vation de l’EnceVir est de 2 ans et celle du TBE-Moscow de 3 ans. Ces deux vaccins sont stables pendant 2 jours a une température comprise entre 9°C et 25°C.\nLes vaccins russes ne sont pas homologués pour une utilisation chez lenfant agé de <3 ans. Au-dessus de cet age, tous les vacci- nés recoivent 0,5 ml d’un vaccin ou l’autre, administré par voie intramusculaire. Le fabricant du TBE-Moscow recommande un calendrier standard de primovaccination de 2 doses adminis- trées 4 un intervalle de 1 4 7 mois. Le fabricant de lEnceVir recommande 2 doses administrées a un intervalle de 5 47 mois.\n° Vorob'eva MS et al. [Vaccines, immunoglobulins, and test systems for the prevention and dia- gnosis of tick-borne encephalitis]. Voprosy Virusologii, 2007, 52:30-36 [Disponible uniquement en russe].\n5-7 months. For EnceVir, there is a rapid schedule for emergency situations: an interval of 1-2 months be- tween the first 2 doses. Both schedules require a booster dose to be delivered 12 months after the second dose, and further booster doses are recommended at 3-year intervals.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "23c670619e5b597ce1a88eb3fff695c6", - "text": "Vaccins russes", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "", - "text_as_html": "Deux vaccins sont fabriqués en Fédération de Russie. Le TBE- Moscow a été approuvé pour une utilisation chez l’adulte en 1982; en 1999, suite 4 une amélioration du processus de purifi- cation, il a été approuvé pour l’utilisation chez enfant agé de 23 ans. Depuis 1982, >25 millions de personnes ont recu ce vaccin en Fédération de Russie et dans les pays voisins. LEnceVir a été homologué en Fédération de Russie en 2001 et Pest également pour utilisation chez l’enfant agé de 23 ans.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 9, - "coordinates": [ - { - "x0": 294.37, - "y0": 233.18, - "x1": 552.36, - "y1": 320.46 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "011cc1daefbd84d387d972c36976c0ac", - "text": "Le TBE-Moscow est préparé a partir de la souche Sofjin appar- tenant au sous-type viral extréme-oriental. Aprés plusieurs passages en cerveau de souris, le virus est propagé en cultures primaires de cellules d’embryons de poulets. Le virus ainsi récolté est inactivé au formol; filtré; concentré; traité par le sulfate de protamine, un excipient; stabilisé par Padjonction d@albumine humaine (500 jig/dose), de gélatine et de sucrose; et enfin, lyophilisé. La concentration de protéine virale par dose est de 0,50-0,75 pg et Pimmunogénicité est ajustée sur des normes fixées a l’avance. Avant utilisation, le vaccin lyophilisé est dissout dans un liquide contenant de l’hydroxyde d’alumi- nium comme adjuvant.", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "23c670619e5b597ce1a88eb3fff695c6", - "text_as_html": "Le TBE-Moscow est préparé a partir de la souche Sofjin appar- tenant au sous-type viral extréme-oriental. Aprés plusieurs passages en cerveau de souris, le virus est propagé en cultures primaires de cellules d’embryons de poulets. Le virus ainsi récolté est inactivé au formol; filtré; concentré; traité par le sulfate de protamine, un excipient; stabilisé par Padjonction d@albumine humaine (500 jig/dose), de gélatine et de sucrose; et enfin, lyophilisé. La concentration de protéine virale par dose est de 0,50-0,75 pg et Pimmunogénicité est ajustée sur des normes fixées a l’avance. Avant utilisation, le vaccin lyophilisé est dissout dans un liquide contenant de l’hydroxyde d’alumi- nium comme adjuvant.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 9, - "coordinates": [ - { - "x0": 293.88, - "y0": 337.76, - "x1": 551.83, - "y1": 468.9 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "aadd0457e839456f94e63f17b85b22f1", - "text": "Les étapes du développement de l’EnceVir, qui est préparé a partir de la souche 205 extréme-orientale, sont pratiquement identiques a celles utilisées pour produire le vaccin TBE-Moscow. La concen- tration de protéine virale par dose est de 1,5 a 2,5 ug; Phydroxyde aluminium est utilisé comme adjuvant, et le vaccin renferme de a sérum-albumine humaine (250 pg/dose) comme stabilisant; mais, lEnceVir n’est pas lyophilisé. On utilise de la kanamycine, un antibiotique, en cours de fabrication. On peut trouver dans le produit final des résidus de sulfate de protamine.", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "23c670619e5b597ce1a88eb3fff695c6", - "text_as_html": "Les étapes du développement de l’EnceVir, qui est préparé a partir de la souche 205 extréme-orientale, sont pratiquement identiques a celles utilisées pour produire le vaccin TBE-Moscow. La concen- tration de protéine virale par dose est de 1,5 a 2,5 ug; Phydroxyde aluminium est utilisé comme adjuvant, et le vaccin renferme de a sérum-albumine humaine (250 pg/dose) comme stabilisant; mais, lEnceVir n’est pas lyophilisé. On utilise de la kanamycine, un antibiotique, en cours de fabrication. On peut trouver dans le produit final des résidus de sulfate de protamine.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 9, - "coordinates": [ - { - "x0": 293.93, - "y0": 475.89, - "x1": 553.11, - "y1": 573.72 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "6063080352151c322f6726264aff23f8", - "text": "Les procédés de production du TBE-Moscow et de |’EnceVir suivent les normes de fabrication de OMS\" et sont contrélés par les autorités nationales.*? Entre 2-8°C, la durée de conser- vation de l’EnceVir est de 2 ans et celle du TBE-Moscow de 3 ans. Ces deux vaccins sont stables pendant 2 jours a une température comprise entre 9°C et 25°C.", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "23c670619e5b597ce1a88eb3fff695c6", - "text_as_html": "Les procédés de production du TBE-Moscow et de |’EnceVir suivent les normes de fabrication de OMS\" et sont contrélés par les autorités nationales.*? Entre 2-8°C, la durée de conser- vation de l’EnceVir est de 2 ans et celle du TBE-Moscow de 3 ans. Ces deux vaccins sont stables pendant 2 jours a une température comprise entre 9°C et 25°C.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 9, - "coordinates": [ - { - "x0": 293.79, - "y0": 580.01, - "x1": 553.51, - "y1": 644.97 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "ccea5d48643541d825df7f45c8f9937d", - "text": "Les vaccins russes ne sont pas homologués pour une utilisation chez lenfant agé de <3 ans. Au-dessus de cet age, tous les vacci- nés recoivent 0,5 ml d’un vaccin ou l’autre, administré par voie intramusculaire. Le fabricant du TBE-Moscow recommande un calendrier standard de primovaccination de 2 doses adminis- trées 4 un intervalle de 1 4 7 mois. Le fabricant de lEnceVir recommande 2 doses administrées a un intervalle de 5 47 mois.", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "23c670619e5b597ce1a88eb3fff695c6", - "text_as_html": "Les vaccins russes ne sont pas homologués pour une utilisation chez lenfant agé de <3 ans. Au-dessus de cet age, tous les vacci- nés recoivent 0,5 ml d’un vaccin ou l’autre, administré par voie intramusculaire. Le fabricant du TBE-Moscow recommande un calendrier standard de primovaccination de 2 doses adminis- trées 4 un intervalle de 1 4 7 mois. Le fabricant de lEnceVir recommande 2 doses administrées a un intervalle de 5 47 mois.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 9, - "coordinates": [ - { - "x0": 293.26, - "y0": 652.18, - "x1": 552.28, - "y1": 727.79 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "72a3b9fdc501383613bf6f6d78baac38", - "text": "° Vorob'eva MS et al. [Vaccines, immunoglobulins, and test systems for the prevention and dia- gnosis of tick-borne encephalitis]. Voprosy Virusologii, 2007, 52:30-36 [Disponible uniquement en russe].", - "metadata": { - "category_depth": 1, - "page_number": 10, - "parent_id": "23c670619e5b597ce1a88eb3fff695c6", - "text_as_html": "5-7 months. For EnceVir, there is a rapid schedule for emergency situations: an interval of 1-2 months be- tween the first 2 doses. Both schedules require a booster dose to be delivered 12 months after the second dose, and further booster doses are recommended at 3-year intervals.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 10, - "coordinates": [ - { - "x0": 45.68, - "y0": 55.88, - "x1": 273.83, - "y1": 120.35 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-30", - "text": "\n\n\nImmunogenicity and effectiveness\nThe immunogenicity (as measured by HI tests) of TBE- Moscow and FSME-Immun were compared in children aged 7-17 years. Four weeks after the second dose, 91.5% of those who had received TBE-Moscow and 98.7% of the FSME-Immun recipients had seroconverted. Comparative immunogenicity studies of TBE-Moscow and EnceVir were carried out during 2001-2002.\" Using HI tests, the immune response after 2 doses of either TBE-Moscow or EnceVir was assessed in 200 adults, of whom half had received the second dose after 2 months, the other half after 5 months. With TBE-Moscow anti- body titres 21:80 were detected in 84% of those who received the second dose after 2 months and 93% of those who received the second dose after 5 months; with EnceVir the corresponding results were 82% for the sec- ond dose at 2 months and 89% for the second dose at 5 months.\nIn 2003, the Russian national regulatory authority con- ducted a comparative evaluation of the TBE-Moscow and EnceVir in 325 children and adolescents.*! The par- ticipants were stratified into 3 age groups (3-6 years, 7-14 years and 15-18 years). After 2 doses of vaccine administered 2 months apart, in those who received TBE-Moscow there was a 24-fold increase in HI anti- body titres in 96% of those aged 3-6 years, 93% in those aged 7-14 years and 89% of those aged 15-18 years; the corresponding results for EnceVir were 84% for those aged 3-6 years, 97% for those aged 7-14 years and 92% for those aged 15-18 years (confidence intervals not available - study based on small numbers).\nA recent study involving a total of 290 adults compared the immunogenicity of TBE-Moscow, EnceVir, the new formulation of FSME-Immun and Encepur-Adults.” Im- munogenicity was measured 2-5 months and 2 years after administration of 3 doses. All vaccines induced neutralizing antibody against Far-Eastern subtype strain P-73. With TBE-Moscow, antibody was detected in 100% of vaccinees after 2-5 months and in 94% after 2 years. For EnceVir the corresponding figures were 88% after 2-5 months and 84% after 2 years; for FSME- Immun antibody was detected in 88.2% after 2-5 months and 78.1% after 2 years; and for Encepur-Adults anti- body was detected in 100% after 2-5 months and 100% after 2 years (confidence intervals not available - study based on small numbers).\nA mass immunization programme was initiated in 1996 in the Sverdlovsk Region and it demonstrated that the\n© Gorbunov MA et al. Results of clinical evaluation of EnceVir vaccine against tick— borne encephalitis. Epidemiology and Vaccinoprophylaxis, 2002, 5:49 [Available in Russian only].\n“| Pavlova BG et al .[Immunization of children and adolescents with inactivated vacci- nes against tick-borne encephalitis]. Biopreparations, 2003, 1:24-28 [in Russian].\n® Leonova GN et al. Evaluation of vaccine Encepur-Adult for induction of human neu- tralizing antibodies against recent Far Eastern subtype strains of tick-borne ence- phalitis virus. Vaccine, 2007, 25:895-901.\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 24, 10 JUIN 2011\nPour ’EnceVir, il existe un calendrier rapide pour les situations d@urgence: lintervalle entre les 2 premiéres doses est alors de 142 mois. Ces deux calendriers vaccinaux nécessitent un rappel a administrer 12 mois aprés la deuxiéme dose et des rappels ultérieurs sont recommandeés tous les 3 ans.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "d24286fda1b73c9e2b3ee795e4bd266f", - "text": "Immunogenicity and effectiveness", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "", - "text_as_html": "The immunogenicity (as measured by HI tests) of TBE- Moscow and FSME-Immun were compared in children aged 7-17 years. Four weeks after the second dose, 91.5% of those who had received TBE-Moscow and 98.7% of the FSME-Immun recipients had seroconverted. Comparative immunogenicity studies of TBE-Moscow and EnceVir were carried out during 2001-2002.\" Using HI tests, the immune response after 2 doses of either TBE-Moscow or EnceVir was assessed in 200 adults, of whom half had received the second dose after 2 months, the other half after 5 months. With TBE-Moscow anti- body titres 21:80 were detected in 84% of those who received the second dose after 2 months and 93% of those who received the second dose after 5 months; with EnceVir the corresponding results were 82% for the sec- ond dose at 2 months and 89% for the second dose at 5 months.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 10, - "coordinates": [ - { - "x0": 45.52, - "y0": 146.02, - "x1": 272.75, - "y1": 330.49 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "195709b3ff4e77132936e4031f388df6", - "text": "In 2003, the Russian national regulatory authority con- ducted a comparative evaluation of the TBE-Moscow and EnceVir in 325 children and adolescents.*! The par- ticipants were stratified into 3 age groups (3-6 years, 7-14 years and 15-18 years). After 2 doses of vaccine administered 2 months apart, in those who received TBE-Moscow there was a 24-fold increase in HI anti- body titres in 96% of those aged 3-6 years, 93% in those aged 7-14 years and 89% of those aged 15-18 years; the corresponding results for EnceVir were 84% for those aged 3-6 years, 97% for those aged 7-14 years and 92% for those aged 15-18 years (confidence intervals not available - study based on small numbers).", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "d24286fda1b73c9e2b3ee795e4bd266f", - "text_as_html": "In 2003, the Russian national regulatory authority con- ducted a comparative evaluation of the TBE-Moscow and EnceVir in 325 children and adolescents.*! The par- ticipants were stratified into 3 age groups (3-6 years, 7-14 years and 15-18 years). After 2 doses of vaccine administered 2 months apart, in those who received TBE-Moscow there was a 24-fold increase in HI anti- body titres in 96% of those aged 3-6 years, 93% in those aged 7-14 years and 89% of those aged 15-18 years; the corresponding results for EnceVir were 84% for those aged 3-6 years, 97% for those aged 7-14 years and 92% for those aged 15-18 years (confidence intervals not available - study based on small numbers).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 10, - "coordinates": [ - { - "x0": 45.75, - "y0": 338.56, - "x1": 272.64, - "y1": 480.01 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "f6ae1bfd60ecf21d44d862434919a864", - "text": "A recent study involving a total of 290 adults compared the immunogenicity of TBE-Moscow, EnceVir, the new formulation of FSME-Immun and Encepur-Adults.” Im- munogenicity was measured 2-5 months and 2 years after administration of 3 doses. All vaccines induced neutralizing antibody against Far-Eastern subtype strain P-73. With TBE-Moscow, antibody was detected in 100% of vaccinees after 2-5 months and in 94% after 2 years. For EnceVir the corresponding figures were 88% after 2-5 months and 84% after 2 years; for FSME- Immun antibody was detected in 88.2% after 2-5 months and 78.1% after 2 years; and for Encepur-Adults anti- body was detected in 100% after 2-5 months and 100% after 2 years (confidence intervals not available - study based on small numbers).", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "d24286fda1b73c9e2b3ee795e4bd266f", - "text_as_html": "A recent study involving a total of 290 adults compared the immunogenicity of TBE-Moscow, EnceVir, the new formulation of FSME-Immun and Encepur-Adults.” Im- munogenicity was measured 2-5 months and 2 years after administration of 3 doses. All vaccines induced neutralizing antibody against Far-Eastern subtype strain P-73. With TBE-Moscow, antibody was detected in 100% of vaccinees after 2-5 months and in 94% after 2 years. For EnceVir the corresponding figures were 88% after 2-5 months and 84% after 2 years; for FSME- Immun antibody was detected in 88.2% after 2-5 months and 78.1% after 2 years; and for Encepur-Adults anti- body was detected in 100% after 2-5 months and 100% after 2 years (confidence intervals not available - study based on small numbers).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 10, - "coordinates": [ - { - "x0": 45.73, - "y0": 487.09, - "x1": 272.71, - "y1": 650.32 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4a63e9f6e4f492bc8dfb12c7ec53b6c0", - "text": "A mass immunization programme was initiated in 1996 in the Sverdlovsk Region and it demonstrated that the", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "d24286fda1b73c9e2b3ee795e4bd266f", - "text_as_html": "A mass immunization programme was initiated in 1996 in the Sverdlovsk Region and it demonstrated that the
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 10, - "coordinates": [ - { - "x0": 44.07, - "y0": 658.44, - "x1": 272.34, - "y1": 677.92 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "77245ff35df62f82af10f82a337a7fbb", - "text": "© Gorbunov MA et al. Results of clinical evaluation of EnceVir vaccine against tick— borne encephalitis. Epidemiology and Vaccinoprophylaxis, 2002, 5:49 [Available in Russian only].", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "d24286fda1b73c9e2b3ee795e4bd266f", - "text_as_html": "Pour ’EnceVir, il existe un calendrier rapide pour les situations d@urgence: lintervalle entre les 2 premiéres doses est alors de 142 mois. Ces deux calendriers vaccinaux nécessitent un rappel a administrer 12 mois aprés la deuxiéme dose et des rappels ultérieurs sont recommandeés tous les 3 ans.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 10, - "coordinates": [ - { - "x0": 295.18, - "y0": 55.87, - "x1": 551.22, - "y1": 110.01 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-31", - "text": "\n\n\nImmunogénicité et efficacité\nOn a comparé Pimmunogénicité (mesurée par des épreuves IH) du TBE-Moscow et celle du FSME-Immun chez des enfants agés de 7 a 17 ans. Quatre semaines aprés la deuxiéme dose, 91,5% de ceux qui avaient recu le TBE-Moscow et 98,7% de ceux qui avaient recu le FSME-Immun présentaient une séroconversion. Des études comparatives sur l’immunogénicité du TBE-Moscow et de l’EnceVir ont été effectuées en 2001 et 2002. La réponse immunitaire aprés 2 doses de l'un ou l’autre vaccin a été évaluée par des épreuves IH chez 200 adultes, dont la moitié avait recu la deuxiéme dose au bout de 2 mois et autre au bout de 5 mois. Avec le TBE-Moscow, des titres d’anticorps 21:80 ont été détec- tés chez 84% de ceux qui avaient recu la deuxiéme dose au bout de 2 mois et chez 93% de ceux qui avaient regu la deuxiéme dose au bout de 5 mois; avec l’EnceVir, les résultats correspon- dants ont été de 82% pour la deuxiéme dose recue au bout de 2 mois et de 89% pour la deuxiéme dose recue au bout de 5 mois.\nEn 2003, autorité nationale de réglementation russe a effectué une évaluation comparative du TBE-Moscow et de l’EnceVir chez 325 enfants et adolescents.\"' Les participants ont été stra- tifiés en 3 classes d’Age (3-6 ans, 7-14 ans et 15-18 ans). Aprés 2 doses de vaccin administrées 4 2 mois d’intervalle, chez ceux qui avaient regu le TBE-Moscow, il y a eu une multiplication des titres d’anticorps IH 24 chez 96% des 3-6 ans, 93% des 7-14 ans et 89% des 15-18 ans; les résultats correspondants pour PEnceVir ont été de 84% pour les 3-6 ans, 97% pour les 7-14 ans et 92% pour les 15-18 ans (intervalles de confiance non dispo- nibles; étude basée sur de petits nombres).\nUne étude récente portant sur un total de 290 adultes a comparé Pimmunogénicité du TBE-Moscow, de l’EnceVir, de la nouvelle formulation du FSME-Immun et de lEncepur-Adults.” Cimmu- nogénicité a été mesurée entre 2 et 5 mois et 2 ans aprés l’ad- ministration des 3 doses. Tous les vaccins ont induit la fabri- cation d’anticorps neutralisants contre la souche P-73 du sous-type extréme-oriental. Avec le TBE-Moscow, des anticorps ont été détectés chez 100% des vaccinés au bout de 2 4 5 mois et chez 94% au bout de 2 ans. Pour I’EnceVir, les chiffres corres- pondants ont été de 88% au bout de 2 a5 mois et 84% au bout de 2 ans, pour le FSME-Immun, ils ont été de 88,2% au bout de 2 a5 mois et de 78,1% au bout de 2 ans; pour |’Encepur-Adults, ils ont été de 100% au bout de 2 a 5 mois et de 100% au bout de 2 ans (intervalles de confiance non disponibles; étude basée sur de petits nombres).\nUn programme de vaccination de masse a été lancé en 1996 dans la région de Sverdlovsk et a démontré que les vaccins\n#0 Gorbunov MA et al. [Résultats de |'évaluation clinique du vaccin EnceVir (vaccin contre l'encéphalite a tiques)]. Epidemiology and Vaccinoprophylaxis, 2002, 5:49 [Disponible unique- ment en russe].\n41 Pavlova BG et al .[Vaccination des enfants et adolescents avec des vaccins inactivés contre le virus de | ‘encéphalite a tiques]. Biopreparations, 2003, 1:24-28 [Disponible uniquement en russe].\n® Leonova GN et al. Evaluation of vaccine Encepur-Adult for induction of human neutralizing antibodies against recent Far Eastern subtype strains of tick-borne encephalitis virus. Vaccine, 2007, 25:895-901.\n251\nRussian-made vaccines were highly effective. By 2005, 2.7 million people had received 3 doses of a vaccine, in most cases TBE-Moscow.” Vaccination coverage in- creased from 35% at the beginning of the programme to 55% in 2000 and to 72% in 2006. In this region, the incidence of cases per 100 000 inhabitants decreased from 42.1 in 1996 to 9.7 in 2000 and to 5.1 in 2006. The number of cases was reduced in all age groups. Comparison of the number of cases in vaccinated and unvaccinated groups suggested that the vaccine’s effec- tiveness increased from 62% in 2000 to 89% in 2006. In part, this increase may be a consequence of the use of more stringent diagnostic criteria.” Following routine immunization of children in the Krasnoyarsk Region, the incidence of the disease decreased from 48.5 in 1999 to 6.1 in 2003.'\nExtensive surveillance following administration of 3 primary doses of EnceVir showed that high antibody titres persisted for 23 years.“ In the Sverdlovsk Region in 2006, the incidence of breakthrough cases in fully immunized people was calculated to be 1.5/100 000 (the incidence in unvaccinated individuals was 13.0/100 000). The Russian vaccines and those manufactured in Aus- tria and Germany were used in the programme initiated in 1996, but about 80% of all vaccinees received TBE- Moscow.® There are no data on the induction and per- sistence of immunity in elderly people who receive the Russian vaccines.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "1f70f590b8ebc5303e9d58c262e8c67e", - "text": "Immunogénicité et efficacité", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "", - "text_as_html": "On a comparé Pimmunogénicité (mesurée par des épreuves IH) du TBE-Moscow et celle du FSME-Immun chez des enfants agés de 7 a 17 ans. Quatre semaines aprés la deuxiéme dose, 91,5% de ceux qui avaient recu le TBE-Moscow et 98,7% de ceux qui avaient recu le FSME-Immun présentaient une séroconversion. Des études comparatives sur l’immunogénicité du TBE-Moscow et de l’EnceVir ont été effectuées en 2001 et 2002. La réponse immunitaire aprés 2 doses de l'un ou l’autre vaccin a été évaluée par des épreuves IH chez 200 adultes, dont la moitié avait recu la deuxiéme dose au bout de 2 mois et autre au bout de 5 mois. Avec le TBE-Moscow, des titres d’anticorps 21:80 ont été détec- tés chez 84% de ceux qui avaient recu la deuxiéme dose au bout de 2 mois et chez 93% de ceux qui avaient regu la deuxiéme dose au bout de 5 mois; avec l’EnceVir, les résultats correspon- dants ont été de 82% pour la deuxiéme dose recue au bout de 2 mois et de 89% pour la deuxiéme dose recue au bout de 5 mois.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 10, - "coordinates": [ - { - "x0": 293.97, - "y0": 145.7, - "x1": 553.65, - "y1": 330.13 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4e7553755e80e24ef0564c8b30841e83", - "text": "En 2003, autorité nationale de réglementation russe a effectué une évaluation comparative du TBE-Moscow et de l’EnceVir chez 325 enfants et adolescents.\"' Les participants ont été stra- tifiés en 3 classes d’Age (3-6 ans, 7-14 ans et 15-18 ans). Aprés 2 doses de vaccin administrées 4 2 mois d’intervalle, chez ceux qui avaient regu le TBE-Moscow, il y a eu une multiplication des titres d’anticorps IH 24 chez 96% des 3-6 ans, 93% des 7-14 ans et 89% des 15-18 ans; les résultats correspondants pour PEnceVir ont été de 84% pour les 3-6 ans, 97% pour les 7-14 ans et 92% pour les 15-18 ans (intervalles de confiance non dispo- nibles; étude basée sur de petits nombres).", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "1f70f590b8ebc5303e9d58c262e8c67e", - "text_as_html": "En 2003, autorité nationale de réglementation russe a effectué une évaluation comparative du TBE-Moscow et de l’EnceVir chez 325 enfants et adolescents.\"' Les participants ont été stra- tifiés en 3 classes d’Age (3-6 ans, 7-14 ans et 15-18 ans). Aprés 2 doses de vaccin administrées 4 2 mois d’intervalle, chez ceux qui avaient regu le TBE-Moscow, il y a eu une multiplication des titres d’anticorps IH 24 chez 96% des 3-6 ans, 93% des 7-14 ans et 89% des 15-18 ans; les résultats correspondants pour PEnceVir ont été de 84% pour les 3-6 ans, 97% pour les 7-14 ans et 92% pour les 15-18 ans (intervalles de confiance non dispo- nibles; étude basée sur de petits nombres).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 10, - "coordinates": [ - { - "x0": 293.88, - "y0": 338.03, - "x1": 551.57, - "y1": 457.99 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "612b400d783d0f4ce77b464fdd8ae48a", - "text": "Une étude récente portant sur un total de 290 adultes a comparé Pimmunogénicité du TBE-Moscow, de l’EnceVir, de la nouvelle formulation du FSME-Immun et de lEncepur-Adults.” Cimmu- nogénicité a été mesurée entre 2 et 5 mois et 2 ans aprés l’ad- ministration des 3 doses. Tous les vaccins ont induit la fabri- cation d’anticorps neutralisants contre la souche P-73 du sous-type extréme-oriental. Avec le TBE-Moscow, des anticorps ont été détectés chez 100% des vaccinés au bout de 2 4 5 mois et chez 94% au bout de 2 ans. Pour I’EnceVir, les chiffres corres- pondants ont été de 88% au bout de 2 a5 mois et 84% au bout de 2 ans, pour le FSME-Immun, ils ont été de 88,2% au bout de 2 a5 mois et de 78,1% au bout de 2 ans; pour |’Encepur-Adults, ils ont été de 100% au bout de 2 a 5 mois et de 100% au bout de 2 ans (intervalles de confiance non disponibles; étude basée sur de petits nombres).", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "1f70f590b8ebc5303e9d58c262e8c67e", - "text_as_html": "Une étude récente portant sur un total de 290 adultes a comparé Pimmunogénicité du TBE-Moscow, de l’EnceVir, de la nouvelle formulation du FSME-Immun et de lEncepur-Adults.” Cimmu- nogénicité a été mesurée entre 2 et 5 mois et 2 ans aprés l’ad- ministration des 3 doses. Tous les vaccins ont induit la fabri- cation d’anticorps neutralisants contre la souche P-73 du sous-type extréme-oriental. Avec le TBE-Moscow, des anticorps ont été détectés chez 100% des vaccinés au bout de 2 4 5 mois et chez 94% au bout de 2 ans. Pour I’EnceVir, les chiffres corres- pondants ont été de 88% au bout de 2 a5 mois et 84% au bout de 2 ans, pour le FSME-Immun, ils ont été de 88,2% au bout de 2 a5 mois et de 78,1% au bout de 2 ans; pour |’Encepur-Adults, ils ont été de 100% au bout de 2 a 5 mois et de 100% au bout de 2 ans (intervalles de confiance non disponibles; étude basée sur de petits nombres).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 10, - "coordinates": [ - { - "x0": 293.06, - "y0": 487.62, - "x1": 553.08, - "y1": 650.49 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "3ed9c628811ba4b5e0c8c376d7de9795", - "text": "Un programme de vaccination de masse a été lancé en 1996 dans la région de Sverdlovsk et a démontré que les vaccins", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "1f70f590b8ebc5303e9d58c262e8c67e", - "text_as_html": "Un programme de vaccination de masse a été lancé en 1996 dans la région de Sverdlovsk et a démontré que les vaccins
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 10, - "coordinates": [ - { - "x0": 294.72, - "y0": 657.5, - "x1": 549.19, - "y1": 678.05 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "fdd91a8d52c906dab2764d06bfa95c2d", - "text": "#0 Gorbunov MA et al. [Résultats de |'évaluation clinique du vaccin EnceVir (vaccin contre l'encéphalite a tiques)]. Epidemiology and Vaccinoprophylaxis, 2002, 5:49 [Disponible unique- ment en russe].", - "metadata": { - "category_depth": 1, - "page_number": 11, - "parent_id": "1f70f590b8ebc5303e9d58c262e8c67e", - "text_as_html": "251
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 10, - "coordinates": [ - { - "x0": 539.14, - "y0": 779.62, - "x1": 548.85, - "y1": 784.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "672a99e5f044ba8de10b1f5a017f51f9", - "text": "Russian-made vaccines were highly effective. By 2005, 2.7 million people had received 3 doses of a vaccine, in most cases TBE-Moscow.” Vaccination coverage in- creased from 35% at the beginning of the programme to 55% in 2000 and to 72% in 2006. In this region, the incidence of cases per 100 000 inhabitants decreased from 42.1 in 1996 to 9.7 in 2000 and to 5.1 in 2006. The number of cases was reduced in all age groups. Comparison of the number of cases in vaccinated and unvaccinated groups suggested that the vaccine’s effec- tiveness increased from 62% in 2000 to 89% in 2006. In part, this increase may be a consequence of the use of more stringent diagnostic criteria.” Following routine immunization of children in the Krasnoyarsk Region, the incidence of the disease decreased from 48.5 in 1999 to 6.1 in 2003.'", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "1f70f590b8ebc5303e9d58c262e8c67e", - "text_as_html": "Russian-made vaccines were highly effective. By 2005, 2.7 million people had received 3 doses of a vaccine, in most cases TBE-Moscow.” Vaccination coverage in- creased from 35% at the beginning of the programme to 55% in 2000 and to 72% in 2006. In this region, the incidence of cases per 100 000 inhabitants decreased from 42.1 in 1996 to 9.7 in 2000 and to 5.1 in 2006. The number of cases was reduced in all age groups. Comparison of the number of cases in vaccinated and unvaccinated groups suggested that the vaccine’s effec- tiveness increased from 62% in 2000 to 89% in 2006. In part, this increase may be a consequence of the use of more stringent diagnostic criteria.” Following routine immunization of children in the Krasnoyarsk Region, the incidence of the disease decreased from 48.5 in 1999 to 6.1 in 2003.'
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 11, - "coordinates": [ - { - "x0": 45.27, - "y0": 56.97, - "x1": 273.34, - "y1": 230.29 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4de0d26ff141c2daefe456fa0eee78ec", - "text": "Extensive surveillance following administration of 3 primary doses of EnceVir showed that high antibody titres persisted for 23 years.“ In the Sverdlovsk Region in 2006, the incidence of breakthrough cases in fully immunized people was calculated to be 1.5/100 000 (the incidence in unvaccinated individuals was 13.0/100 000). The Russian vaccines and those manufactured in Aus- tria and Germany were used in the programme initiated in 1996, but about 80% of all vaccinees received TBE- Moscow.® There are no data on the induction and per- sistence of immunity in elderly people who receive the Russian vaccines.", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "1f70f590b8ebc5303e9d58c262e8c67e", - "text_as_html": "Extensive surveillance following administration of 3 primary doses of EnceVir showed that high antibody titres persisted for 23 years.“ In the Sverdlovsk Region in 2006, the incidence of breakthrough cases in fully immunized people was calculated to be 1.5/100 000 (the incidence in unvaccinated individuals was 13.0/100 000). The Russian vaccines and those manufactured in Aus- tria and Germany were used in the programme initiated in 1996, but about 80% of all vaccinees received TBE- Moscow.® There are no data on the induction and per- sistence of immunity in elderly people who receive the Russian vaccines.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 11, - "coordinates": [ - { - "x0": 45.1, - "y0": 237.67, - "x1": 274.14, - "y1": 368.28 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-32", - "text": "\n\n\nSafety of TBE-Moscow and EnceVir\nLarge-scale randomized controlled trials of the safety of these vaccines have not been published. Small-scale studies on systemic and local adverse events suggest a moderate reactogenicity profile and that there are no significant differences between the 2 vaccines. During 2002-2003, the Tarasevich State Institute for Standard- ization and Control of Medical Biological Products as- sessed the local and systemic reactogenicity of TBE- Moscow and EnceVir in a trial that included 325 chil- dren and 400 adults.\" No severe adverse events were recorded. Both vaccines were found to be moderately reactogenic without statistically significant differences between them. Similar conclusions on the safety of TBE- Moscow were reached in other studies.” Furthermore, postmarketing surveillance of EnceVir did not reveal any severe adverse events.\nHowever, in both 2010 and 2011, some lots of EnceVir were associated with frequent (occurring in <19% of vaccinees) high fever and allergic reactions, in particu- lar in children. These lots were withdrawn by the man- ufacturer, and owing to ongoing assessment, EnceVir is not recommended for use in children aged 3-17 years.\"* A paediatric formulation of this vaccine that delivers half of the adult dose of antigen is under develop- ment.\n#3 Romanenko WV et al. [Experience in implementing the mass immunization program against tick-borne encephalitis in the Sverdlovsk Region]. Voprosy Virusologii, 2007, 6: 22-25 [Available in Russian only].\n|l'ichenko TE et al. [Organization of Public Health], Siberian Journal of Medicine, 2009, 2:50-55 [Available in Russian only].\n“5 See http://www.roszdravnadzor.ru/i/upload/files/1304670552.66323-5245.pdf", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "aaab6685b23044d5c9c3df07eb463fcb", - "text": "Safety of TBE-Moscow and EnceVir", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "", - "text_as_html": "Large-scale randomized controlled trials of the safety of these vaccines have not been published. Small-scale studies on systemic and local adverse events suggest a moderate reactogenicity profile and that there are no significant differences between the 2 vaccines. During 2002-2003, the Tarasevich State Institute for Standard- ization and Control of Medical Biological Products as- sessed the local and systemic reactogenicity of TBE- Moscow and EnceVir in a trial that included 325 chil- dren and 400 adults.\" No severe adverse events were recorded. Both vaccines were found to be moderately reactogenic without statistically significant differences between them. Similar conclusions on the safety of TBE- Moscow were reached in other studies.” Furthermore, postmarketing surveillance of EnceVir did not reveal any severe adverse events.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 11, - "coordinates": [ - { - "x0": 45.2, - "y0": 393.9, - "x1": 273.87, - "y1": 567.9 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "68c61c84659b59254eb56d625a1f92d8", - "text": "However, in both 2010 and 2011, some lots of EnceVir were associated with frequent (occurring in <19% of vaccinees) high fever and allergic reactions, in particu- lar in children. These lots were withdrawn by the man- ufacturer, and owing to ongoing assessment, EnceVir is not recommended for use in children aged 3-17 years.\"* A paediatric formulation of this vaccine that delivers half of the adult dose of antigen is under develop- ment.", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "aaab6685b23044d5c9c3df07eb463fcb", - "text_as_html": "However, in both 2010 and 2011, some lots of EnceVir were associated with frequent (occurring in <19% of vaccinees) high fever and allergic reactions, in particu- lar in children. These lots were withdrawn by the man- ufacturer, and owing to ongoing assessment, EnceVir is not recommended for use in children aged 3-17 years.\"* A paediatric formulation of this vaccine that delivers half of the adult dose of antigen is under develop- ment.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 11, - "coordinates": [ - { - "x0": 45.77, - "y0": 574.72, - "x1": 273.59, - "y1": 672.13 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "fb31f7f9a304df176db2041d81989ba2", - "text": "#3 Romanenko WV et al. [Experience in implementing the mass immunization program against tick-borne encephalitis in the Sverdlovsk Region]. Voprosy Virusologii, 2007, 6: 22-25 [Available in Russian only].", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "aaab6685b23044d5c9c3df07eb463fcb", - "text_as_html": "fabriqués en Russie étaient extrémement efficaces. En 2005, 2,7 millions de personnes avaient recu 3 doses de vaccin, dans la plupart des cas de TBE-Moscow.* La couverture vaccinale est passée de 35% au début du programme a 55% en 2000 et a 72% en 2006. Dans cette région, lincidence des cas pour 100 000 habitants a diminué, passant de 42,1 en 1996 a 9,7 en 2000 et a 5,1 en 2006. Le nombre de cas a été réduit dans toutes les classes d’Age. La comparaison du nombre de cas dans les groupes vaccinés et non vaccinés laisse a penser que l’efficacité du vaccin a augmenté, passant de 62% en 2000 a 89% en 2006. Cette efficacité accrue est peut étre en partie une conséquence de application de critéres de diagnostic plus stricts.* Suite a la vaccination systématique des enfants dans la région de Kras- noyarsk, incidence de la maladie a chuté, passant de 48,5 en 1999 a 6,1 en 2003.'
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 11, - "coordinates": [ - { - "x0": 294.18, - "y0": 56.48, - "x1": 552.9, - "y1": 219.13 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "b4ae9b0ff7e273162d39c19ef35e3d14", - "text": "Une surveillance étendue suite 4 l’administration des 3 premié- res doses d’EnceVir a montré que les titres d’anticorps élevés persistaient pendant 23 ans.“ Dans la région de Sverdlovsk en 2006, Pincidence des cas de percée de la maladie chez des personnes dont la vaccination était compléte a été calculée; elle était de 1,5/100 000 (incidence de la maladie chez les sujets non vaccinés étant de 13,0/100 000). On avait utilisé les vaccins russes et ceux fabriqués en Autriche et en Allemagne dans le programme lancé en 1996, mais prés de 80% des vaccinés avaient recu le TBE-Moscow.* I] n’existe pas de données rela- tives a induction et a la persistance de ?immunité chez les personnes agées ayant recu les vaccins russes.", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "21414623c97a103c30cfc9dd4d4e6456", - "text_as_html": "Une surveillance étendue suite 4 l’administration des 3 premié- res doses d’EnceVir a montré que les titres d’anticorps élevés persistaient pendant 23 ans.“ Dans la région de Sverdlovsk en 2006, Pincidence des cas de percée de la maladie chez des personnes dont la vaccination était compléte a été calculée; elle était de 1,5/100 000 (incidence de la maladie chez les sujets non vaccinés étant de 13,0/100 000). On avait utilisé les vaccins russes et ceux fabriqués en Autriche et en Allemagne dans le programme lancé en 1996, mais prés de 80% des vaccinés avaient recu le TBE-Moscow.* I] n’existe pas de données rela- tives a induction et a la persistance de ?immunité chez les personnes agées ayant recu les vaccins russes.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 11, - "coordinates": [ - { - "x0": 294.44, - "y0": 237.61, - "x1": 552.08, - "y1": 368.2 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-34", - "text": "\n\n\nInnocuité du TBE-Moscow et d’EnceVir\nAucun essai contrélé randomisé a grande échelle sur Pinnocuité de ces vaccins n’a été publié. Des études a petite échelle sur les manifestations indésirables générales et locales laissent 4 penser quils ont un profil de réactogénicité modérée et quil n y a pas de différences importantes entre les 2 vaccins. En 2002 et 2003, l'Institut de standardisation et de contréle des produits biolo- giques a usage médical de l’Etat de Tarasevich a évalué la réac- togénicité locale et générale du TBE-Moscow et de |’EnceVir dans un essai portant sur 325 enfants et 400 adultes.\"' Aucune manifestation indésirable grave n’a été enregistrée. Les 2 vaccins se sont avérés modérément réactogénes, sans qu'il y ait de diffé- rences statistiquement significatives entre eux. D’autres études sont parvenues a des conclusions analogues concernant l’inno- cuité du TBE-Moscow.’ En outre, pour l’EnceVir, la pharmaco- vigilance n’a révélé aucune manifestation indésirable grave.\nToutefois, en 2010 comme en 2011, certains lots d’EnceVir ont été associés a une forte fiévre et a des réactions allergiques (survenant chez <19% des vaccinés) fréquentes, en particulier chez Penfant. Ces lots ont été retirés par le fabricant et, en raison de l’évaluation en cours, l’EnceVir n’est pas recommandé chez lenfant de 3 a 17 ans.** Une formulation pédiatrique de ce vaccin délivrant une demi-dose d’antigéne est en cours de développement.\n® Romanenko WV et al. [Expérience concernant la mise en oeuvre d'un programme de vaccination de masse contre Iencéphalite a tiques dans la région de Sverdlovsk]. Voprosy Virusologii, 2007, 6: 22-25 [Disponible uniquement en russe].\n4 II'ichenko TE et al. [Organization of Public Health], Siberian Journal of Medicine, 2009, 2:50-55 [Disponible uniquement en russe].\n“© Voir http://www.roszdravnadzor.ru/i/upload/files/1304670552.66323-5245.pdf.\nWEEKLY EPIDEMIOLOGICAL RECORD, NO. 24, 10 JUNE 2011\nThere are no indications that immunogenicity or safety are impaired when the Russian vaccines are adminis- tered simultaneously with other vaccines (in travellers, for example) but independent publications in this field are limited.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "9fa0042107de5487ba3173295973c554", - "text": "Innocuité du TBE-Moscow et d’EnceVir", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "", - "text_as_html": "Aucun essai contrélé randomisé a grande échelle sur Pinnocuité de ces vaccins n’a été publié. Des études a petite échelle sur les manifestations indésirables générales et locales laissent 4 penser quils ont un profil de réactogénicité modérée et quil n y a pas de différences importantes entre les 2 vaccins. En 2002 et 2003, l'Institut de standardisation et de contréle des produits biolo- giques a usage médical de l’Etat de Tarasevich a évalué la réac- togénicité locale et générale du TBE-Moscow et de |’EnceVir dans un essai portant sur 325 enfants et 400 adultes.\"' Aucune manifestation indésirable grave n’a été enregistrée. Les 2 vaccins se sont avérés modérément réactogénes, sans qu'il y ait de diffé- rences statistiquement significatives entre eux. D’autres études sont parvenues a des conclusions analogues concernant l’inno- cuité du TBE-Moscow.’ En outre, pour l’EnceVir, la pharmaco- vigilance n’a révélé aucune manifestation indésirable grave.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 11, - "coordinates": [ - { - "x0": 294.13, - "y0": 393.6, - "x1": 551.98, - "y1": 557.3 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "454bccda44f008b8e1abf3c48866feb2", - "text": "Toutefois, en 2010 comme en 2011, certains lots d’EnceVir ont été associés a une forte fiévre et a des réactions allergiques (survenant chez <19% des vaccinés) fréquentes, en particulier chez Penfant. Ces lots ont été retirés par le fabricant et, en raison de l’évaluation en cours, l’EnceVir n’est pas recommandé chez lenfant de 3 a 17 ans.** Une formulation pédiatrique de ce vaccin délivrant une demi-dose d’antigéne est en cours de développement.", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "9fa0042107de5487ba3173295973c554", - "text_as_html": "Toutefois, en 2010 comme en 2011, certains lots d’EnceVir ont été associés a une forte fiévre et a des réactions allergiques (survenant chez <19% des vaccinés) fréquentes, en particulier chez Penfant. Ces lots ont été retirés par le fabricant et, en raison de l’évaluation en cours, l’EnceVir n’est pas recommandé chez lenfant de 3 a 17 ans.** Une formulation pédiatrique de ce vaccin délivrant une demi-dose d’antigéne est en cours de développement.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 11, - "coordinates": [ - { - "x0": 295.0, - "y0": 575.31, - "x1": 551.15, - "y1": 661.75 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "d1e823de9b9a9e0564049530d26e198a", - "text": "® Romanenko WV et al. [Expérience concernant la mise en oeuvre d'un programme de vaccination de masse contre Iencéphalite a tiques dans la région de Sverdlovsk]. Voprosy Virusologii, 2007, 6: 22-25 [Disponible uniquement en russe].", - "metadata": { - "category_depth": 1, - "page_number": 12, - "parent_id": "9fa0042107de5487ba3173295973c554", - "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 24, 10 JUNE 2011
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 11, - "coordinates": [ - { - "x0": 395.81, - "y0": 778.9, - "x1": 549.18, - "y1": 786.31 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "483d5ce495039a17e72a29877cbde415", - "text": "There are no indications that immunogenicity or safety are impaired when the Russian vaccines are adminis- tered simultaneously with other vaccines (in travellers, for example) but independent publications in this field are limited.", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "9fa0042107de5487ba3173295973c554", - "text_as_html": "There are no indications that immunogenicity or safety are impaired when the Russian vaccines are adminis- tered simultaneously with other vaccines (in travellers, for example) but independent publications in this field are limited.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 44.07, - "y0": 55.82, - "x1": 273.97, - "y1": 109.23 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-35", - "text": "\n\n\nCross-protection with current vaccines\nThere is limited clinical evidence that the 2 vaccines manufactured in Austria and Germany induce protec- tive immunity not only against the homologous sub- type, but also against the Far-Eastern and Siberian sub- types. The genetic and antigenic similarity between these subtypes, as well as evidence from nonclinical studies, makes such cross-protection likely.“° Immuniza- tion of adults with Encepur induced antibodies with high neutralizing capacity against strains of both the Western and the Far-Eastern subtypes of the virus,” and similarly, all 4 vaccines induce neutralizing anti- bodies against the Far-Eastern subtype.” Furthermore, a recent study using postimmunization serum samples from participants given FSME-Immun showed identical neutralization titres against the European, Far-Eastern and Siberian virus.“ Additional support for cross-pro- tective immunity is provided by preclinical studies showing that immunization of mice with vaccine of the European subtype protected against lethal challenges with a variety of eastern virus isolates.”\nSeveral studies suggest that existing vaccines can be used interchangeably.’", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "77578276d33c54847afed4a9f3ffa148", - "text": "Cross-protection with current vaccines", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "", - "text_as_html": "There is limited clinical evidence that the 2 vaccines manufactured in Austria and Germany induce protec- tive immunity not only against the homologous sub- type, but also against the Far-Eastern and Siberian sub- types. The genetic and antigenic similarity between these subtypes, as well as evidence from nonclinical studies, makes such cross-protection likely.“° Immuniza- tion of adults with Encepur induced antibodies with high neutralizing capacity against strains of both the Western and the Far-Eastern subtypes of the virus,” and similarly, all 4 vaccines induce neutralizing anti- bodies against the Far-Eastern subtype.” Furthermore, a recent study using postimmunization serum samples from participants given FSME-Immun showed identical neutralization titres against the European, Far-Eastern and Siberian virus.“ Additional support for cross-pro- tective immunity is provided by preclinical studies showing that immunization of mice with vaccine of the European subtype protected against lethal challenges with a variety of eastern virus isolates.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 44.88, - "y0": 135.67, - "x1": 273.72, - "y1": 353.77 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "26e4fddbc453fb9d930bdc42972443c6", - "text": "Several studies suggest that existing vaccines can be used interchangeably.’", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "77578276d33c54847afed4a9f3ffa148", - "text_as_html": "Several studies suggest that existing vaccines can be used interchangeably.’
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 43.94, - "y0": 371.0, - "x1": 274.02, - "y1": 391.57 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-36", - "text": "\n\n\nContraindications and precautions\nAlthough currently licensed vaccines are produced in chicken embryo cells, mild allergy to egg protein is not considered a contraindication.\nThe induction of protective immunity may be markedly reduced in individuals undergoing immunosuppressive therapy; in such cases the antibody response should be assessed using serological techniques and, if necessary, an additional dose of the vaccine should be adminis- tered.’ In general, vaccination should be postponed if the patient has fever >38.5°C or other signs of serious disease. The vaccine should be used in pregnant women who live in areas where the incidence of the disease is high (>5 cases/100 000 population per year). In areas where the incidence is moderate or low (<5/100 000 population per year) the risks and benefits of the vac- cine should be considered (for example, health profes- sionals should assess whether a pregnant women par- ticipates in outdoor activities that increase her risk of the disease).\nPeople who have been exposed to flaviviruses other than the tick-borne encephalitis virus can develop cross-reactive antibodies that may interfere with the\nKlockmann U et al. Protection against European isolates of tick-borne encephalitis virus after vaccination with a new tick-borne encephalitis vaccine. Vaccine, 1991, 9: 210-212.\n7 Leonova GN et al. Characterization of neutralizing antibodies to Far Eastern of tick— borne encephalitis virus subtype and the antibody avidity for four tick-borne ence- phalitis vaccines in human. Vaccine, 2009, 27:2899-2904.\nOrlinger KK et al. A tick-borne encephalitis vaccine based on the European proto- type strain induces broadly reactive cross-neutralizing antibodies in humans. Jour- nal of Infectious Diseases, 2011, 203:1556-1564.\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 24, 10 JUIN 2011\nRien ne permet de penser qu'il y ait une altération de Pimmu- nogénécité ou de linnocuité de ces vaccins russes lorsquwils sont administrés en méme temps que d’autres vaccins (par exemple chez les voyageurs), mais les publications indépendan- tes dans ce domaine sont limitées.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "e4464c3439aaa4bcef2e2bbca274f27f", - "text": "Contraindications and precautions", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "", - "text_as_html": "Although currently licensed vaccines are produced in chicken embryo cells, mild allergy to egg protein is not considered a contraindication.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 44.67, - "y0": 416.54, - "x1": 274.34, - "y1": 448.58 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "dab3b758619d466bf125740f5ee481b9", - "text": "The induction of protective immunity may be markedly reduced in individuals undergoing immunosuppressive therapy; in such cases the antibody response should be assessed using serological techniques and, if necessary, an additional dose of the vaccine should be adminis- tered.’ In general, vaccination should be postponed if the patient has fever >38.5°C or other signs of serious disease. The vaccine should be used in pregnant women who live in areas where the incidence of the disease is high (>5 cases/100 000 population per year). In areas where the incidence is moderate or low (<5/100 000 population per year) the risks and benefits of the vac- cine should be considered (for example, health profes- sionals should assess whether a pregnant women par- ticipates in outdoor activities that increase her risk of the disease).", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "e4464c3439aaa4bcef2e2bbca274f27f", - "text_as_html": "The induction of protective immunity may be markedly reduced in individuals undergoing immunosuppressive therapy; in such cases the antibody response should be assessed using serological techniques and, if necessary, an additional dose of the vaccine should be adminis- tered.’ In general, vaccination should be postponed if the patient has fever >38.5°C or other signs of serious disease. The vaccine should be used in pregnant women who live in areas where the incidence of the disease is high (>5 cases/100 000 population per year). In areas where the incidence is moderate or low (<5/100 000 population per year) the risks and benefits of the vac- cine should be considered (for example, health profes- sionals should assess whether a pregnant women par- ticipates in outdoor activities that increase her risk of the disease).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 45.31, - "y0": 466.15, - "x1": 273.42, - "y1": 642.1 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "8a4e172ea79ac5a217962c657e19c003", - "text": "People who have been exposed to flaviviruses other than the tick-borne encephalitis virus can develop cross-reactive antibodies that may interfere with the", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "e4464c3439aaa4bcef2e2bbca274f27f", - "text_as_html": "People who have been exposed to flaviviruses other than the tick-borne encephalitis virus can develop cross-reactive antibodies that may interfere with the
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 44.81, - "y0": 649.35, - "x1": 272.51, - "y1": 681.4 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "176ed1af36809f7f416d3b98358e85ca", - "text": "Klockmann U et al. Protection against European isolates of tick-borne encephalitis virus after vaccination with a new tick-borne encephalitis vaccine. Vaccine, 1991, 9: 210-212.", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "e4464c3439aaa4bcef2e2bbca274f27f", - "text_as_html": "RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 24, 10 JUIN 2011
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 44.22, - "y0": 778.65, - "x1": 219.33, - "y1": 786.35 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "28ea68282776e9b6736d9dbfd1ca693c", - "text": "Rien ne permet de penser qu'il y ait une altération de Pimmu- nogénécité ou de linnocuité de ces vaccins russes lorsquwils sont administrés en méme temps que d’autres vaccins (par exemple chez les voyageurs), mais les publications indépendan- tes dans ce domaine sont limitées.", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "e4464c3439aaa4bcef2e2bbca274f27f", - "text_as_html": "Rien ne permet de penser qu'il y ait une altération de Pimmu- nogénécité ou de linnocuité de ces vaccins russes lorsquwils sont administrés en méme temps que d’autres vaccins (par exemple chez les voyageurs), mais les publications indépendan- tes dans ce domaine sont limitées.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 294.34, - "y0": 55.91, - "x1": 551.62, - "y1": 109.47 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-37", - "text": "\n\n\nProtection croisée avec les vaccins actuels\nLes données cliniques indiquant que les 2 vaccins fabriqués en Autriche et en Allemagne induisent une immunité protectrice non seulement contre le sous-type homologue, mais aussi contre les sous-types extréme-oriental et sibérien, sont limitées. La similitude génétique et antigénique de ces sous-types ainsi que les données d’étude non cliniques portent a croire quune telle protection croisée est probable.** La vaccination des adul- tes par l'Encepur induit la fabrication d’anticorps ayant une forte capacité de neutralisation des souches appartenant aussi bien aux sous-types occidental et extréme-oriental du virus,” et, de la méme facon, les 4 vaccins induisent la fabrication d’anticorps neutralisants contre le sous-type extréme-oriental.”” En outre, une étude récente portant sur des échantillons de sérums postvaccinaux de participants ayant recu le FSME-Immun a montré des titres d’anticorps neutralisants identiques contre les virus européen, extréme-oriental et sibérien.* Des études précliniques montrant que la vaccination de souris par le vaccin préparé a partir du sous-type européen protégeait contre des inoculations d’épreuve létales par une variété d’isolements viraux orientaux viennent a l’appui de cette protection croisée conférée par les vaccins.**\nPlusieurs études laissent a penser que les vaccins existants sont interchangeables.”", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "41c9b655500513f83766dac31bb67fd4", - "text": "Protection croisée avec les vaccins actuels", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "", - "text_as_html": "Les données cliniques indiquant que les 2 vaccins fabriqués en Autriche et en Allemagne induisent une immunité protectrice non seulement contre le sous-type homologue, mais aussi contre les sous-types extréme-oriental et sibérien, sont limitées. La similitude génétique et antigénique de ces sous-types ainsi que les données d’étude non cliniques portent a croire quune telle protection croisée est probable.** La vaccination des adul- tes par l'Encepur induit la fabrication d’anticorps ayant une forte capacité de neutralisation des souches appartenant aussi bien aux sous-types occidental et extréme-oriental du virus,” et, de la méme facon, les 4 vaccins induisent la fabrication d’anticorps neutralisants contre le sous-type extréme-oriental.”” En outre, une étude récente portant sur des échantillons de sérums postvaccinaux de participants ayant recu le FSME-Immun a montré des titres d’anticorps neutralisants identiques contre les virus européen, extréme-oriental et sibérien.* Des études précliniques montrant que la vaccination de souris par le vaccin préparé a partir du sous-type européen protégeait contre des inoculations d’épreuve létales par une variété d’isolements viraux orientaux viennent a l’appui de cette protection croisée conférée par les vaccins.**
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 293.7, - "y0": 136.41, - "x1": 553.83, - "y1": 363.54 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "ddc03e65ec78df5bb083ff6e5adf2a50", - "text": "Plusieurs études laissent a penser que les vaccins existants sont interchangeables.”", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "41c9b655500513f83766dac31bb67fd4", - "text_as_html": "Plusieurs études laissent a penser que les vaccins existants sont interchangeables.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 292.91, - "y0": 370.76, - "x1": 551.69, - "y1": 390.93 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-38", - "text": "\n\n\nContre-indications et précautions d'emploi\nBien que les vaccins actuellement homologués soient produits en cellules d’embryons de poulet, une allergie bénigne aux protéines de l’ceuf n’est pas considérée comme une contre-indi- cation.\nVinduction d’une immunité protectrice peut étre sensiblement réduite chez les sujets soumis a un traitement immunosuppres- seur; en pareil cas, la réponse en anticorps doit étre évaluée a Paide de techniques sérologiques et, si nécessaire, on adminis- trera une dose supplémentaire de vaccin.? En général, la vacci- nation doit étre différée si la température du patient est >38,5°C ou s'il présente d’autres signes de maladie grave. Le vaccin doit étre utilisé chez les femmes enceintes vivant dans des zones ou Pincidence de la maladie est élevée (>5 cas/100 000 habitants par an); dans les régions ot lincidence est modérée a faible (<5/100 000 habitants par an), il faut peser les risques et les avantages du vaccin (par exemple les professionnels de santé devront évaluer si une femme enceinte pratique des activités de plein air qui augmentent son risque d’exposition a la mala- die).\nLes personnes qui ont été exposées a d’autres flavivirus que le virus de l’encéphalite a tiques peuvent développer des anticorps dont les réactions croisées peuvent interférer avec la réponse\n46 Klockmann U et al. Protection against European isolates of tick-borne encephalitis virus after vaccination with a new tick borne encephalitis vaccine. Vaccine, 1991, 9: 210 212.\n47 Leonova GN et al. Characterization of neutralizing antibodies to Far Eastern of tick-borne ence- phalitis virus subtype and the antibody avidity for four tick-borne encephalitis vaccines in hu- man. Vaccine, 2009, 27: 2899-2904.\n“8 Orlinger KK et al. A tick-borne encephalitis vaccine based on the European prototype strain induces broadly reactive cross—neutralizing antibodies in humans. Journal of Infectious Diseases, 2011, 203:1556-1564.\n253\nserological response following vaccination against tick- borne encephalitis,» ° and pre-existing antibodies to the disease have been found to interfere with the anti- body response to Japanese encephalitis vaccine.”", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "87d1686119aba85ab9e4bb8b7c84f8ae", - "text": "Contre-indications et précautions d'emploi", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "", - "text_as_html": "Bien que les vaccins actuellement homologués soient produits en cellules d’embryons de poulet, une allergie bénigne aux protéines de l’ceuf n’est pas considérée comme une contre-indi- cation.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 295.03, - "y0": 417.05, - "x1": 554.83, - "y1": 459.02 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "67f1cb548ddc89ddce1009f68cc521cd", - "text": "Vinduction d’une immunité protectrice peut étre sensiblement réduite chez les sujets soumis a un traitement immunosuppres- seur; en pareil cas, la réponse en anticorps doit étre évaluée a Paide de techniques sérologiques et, si nécessaire, on adminis- trera une dose supplémentaire de vaccin.? En général, la vacci- nation doit étre différée si la température du patient est >38,5°C ou s'il présente d’autres signes de maladie grave. Le vaccin doit étre utilisé chez les femmes enceintes vivant dans des zones ou Pincidence de la maladie est élevée (>5 cas/100 000 habitants par an); dans les régions ot lincidence est modérée a faible (<5/100 000 habitants par an), il faut peser les risques et les avantages du vaccin (par exemple les professionnels de santé devront évaluer si une femme enceinte pratique des activités de plein air qui augmentent son risque d’exposition a la mala- die).", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "87d1686119aba85ab9e4bb8b7c84f8ae", - "text_as_html": "Vinduction d’une immunité protectrice peut étre sensiblement réduite chez les sujets soumis a un traitement immunosuppres- seur; en pareil cas, la réponse en anticorps doit étre évaluée a Paide de techniques sérologiques et, si nécessaire, on adminis- trera une dose supplémentaire de vaccin.? En général, la vacci- nation doit étre différée si la température du patient est >38,5°C ou s'il présente d’autres signes de maladie grave. Le vaccin doit étre utilisé chez les femmes enceintes vivant dans des zones ou Pincidence de la maladie est élevée (>5 cas/100 000 habitants par an); dans les régions ot lincidence est modérée a faible (<5/100 000 habitants par an), il faut peser les risques et les avantages du vaccin (par exemple les professionnels de santé devront évaluer si une femme enceinte pratique des activités de plein air qui augmentent son risque d’exposition a la mala- die).
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 293.41, - "y0": 466.25, - "x1": 553.73, - "y1": 630.97 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "9d8a5339de84dfb6d4e8bb0e5ef91a03", - "text": "Les personnes qui ont été exposées a d’autres flavivirus que le virus de l’encéphalite a tiques peuvent développer des anticorps dont les réactions croisées peuvent interférer avec la réponse", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "87d1686119aba85ab9e4bb8b7c84f8ae", - "text_as_html": "Les personnes qui ont été exposées a d’autres flavivirus que le virus de l’encéphalite a tiques peuvent développer des anticorps dont les réactions croisées peuvent interférer avec la réponse
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 293.13, - "y0": 649.43, - "x1": 551.38, - "y1": 681.2 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "5a6d9c9c1e243ab5df2ff3aed9845432", - "text": "46 Klockmann U et al. Protection against European isolates of tick-borne encephalitis virus after vaccination with a new tick borne encephalitis vaccine. Vaccine, 1991, 9: 210 212.", - "metadata": { - "category_depth": 1, - "page_number": 13, - "parent_id": "87d1686119aba85ab9e4bb8b7c84f8ae", - "text_as_html": "253
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 12, - "coordinates": [ - { - "x0": 539.14, - "y0": 779.62, - "x1": 549.57, - "y1": 784.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "ecd1054b522aa7c7d8d4b1260711b3eb", - "text": "serological response following vaccination against tick- borne encephalitis,» ° and pre-existing antibodies to the disease have been found to interfere with the anti- body response to Japanese encephalitis vaccine.”", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "87d1686119aba85ab9e4bb8b7c84f8ae", - "text_as_html": "serological response following vaccination against tick- borne encephalitis,» ° and pre-existing antibodies to the disease have been found to interfere with the anti- body response to Japanese encephalitis vaccine.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 13, - "coordinates": [ - { - "x0": 44.59, - "y0": 56.01, - "x1": 273.37, - "y1": 98.53 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-39", - "text": "\n\n\nPostexposure prophylaxis\nBased on the assumption that vaccination after a tick bite is unlikely to induce immunity before possible on- set of disease, and considering the theoretical risk of antibody-dependent enhancement, postexposure pro- phylaxis is not recommended after a tick bite occurs in unvaccinated patients.’\nIn western Europe, the injection of immunoglobulins containing high concentrations of antibodies against tick-borne encephalitis virus had no beneficial effect when used for postexposure prophylaxis, and this ap- proach is no longer recommended. In contrast, a recent review of Russian experiences with immunoglobulins indicates that there was some protective effect of early postexposure administration using Russian immuno- globulin preparations.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "f88705be3816cc5fbcec468589c4d371", - "text": "Postexposure prophylaxis", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "", - "text_as_html": "Based on the assumption that vaccination after a tick bite is unlikely to induce immunity before possible on- set of disease, and considering the theoretical risk of antibody-dependent enhancement, postexposure pro- phylaxis is not recommended after a tick bite occurs in unvaccinated patients.’
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 13, - "coordinates": [ - { - "x0": 45.81, - "y0": 123.0, - "x1": 275.47, - "y1": 187.82 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "01446ead659feae25e8256e0d83dcc28", - "text": "In western Europe, the injection of immunoglobulins containing high concentrations of antibodies against tick-borne encephalitis virus had no beneficial effect when used for postexposure prophylaxis, and this ap- proach is no longer recommended. In contrast, a recent review of Russian experiences with immunoglobulins indicates that there was some protective effect of early postexposure administration using Russian immuno- globulin preparations.", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "f88705be3816cc5fbcec468589c4d371", - "text_as_html": "In western Europe, the injection of immunoglobulins containing high concentrations of antibodies against tick-borne encephalitis virus had no beneficial effect when used for postexposure prophylaxis, and this ap- proach is no longer recommended. In contrast, a recent review of Russian experiences with immunoglobulins indicates that there was some protective effect of early postexposure administration using Russian immuno- globulin preparations.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 13, - "coordinates": [ - { - "x0": 45.17, - "y0": 205.94, - "x1": 274.01, - "y1": 303.97 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-40", - "text": "\n\n\nCost-effectiveness of vaccination\nWhere tick-borne encephalitis is prevalent, the disease has high costs both for the individual and society, par- ticularly as a result of its frequent long-term neuro- logical sequelae.’ Immunization campaigns in Austria during 1991-2000 were estimated to have saved an equivalent of US$ 80 million by reducing costs associ- ated with caring for patients, loss of productivity and premature retirement.*® No recent cost-effectiveness analysis of vaccination has been published. It has been suggested, however, that cost effectiveness will be strongly influenced by the price of the vaccine and by how well the target populations are defined.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "1195dc5d716691aae733c394b334671a", - "text": "Cost-effectiveness of vaccination", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "", - "text_as_html": "Where tick-borne encephalitis is prevalent, the disease has high costs both for the individual and society, par- ticularly as a result of its frequent long-term neuro- logical sequelae.’ Immunization campaigns in Austria during 1991-2000 were estimated to have saved an equivalent of US$ 80 million by reducing costs associ- ated with caring for patients, loss of productivity and premature retirement.*® No recent cost-effectiveness analysis of vaccination has been published. It has been suggested, however, that cost effectiveness will be strongly influenced by the price of the vaccine and by how well the target populations are defined.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 13, - "coordinates": [ - { - "x0": 45.2, - "y0": 328.48, - "x1": 274.42, - "y1": 459.72 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-41", - "text": "\n\n\nWHO policy on the use of the vaccine\nImmunization offers the most effective protection against tick-borne encephalitis.’ The 2 vaccines manu- factured in Austria and Germany are considered to be safe and efficacious for individuals aged 21 year. The 2 vaccines manufactured in the Russian Federation are also considered safe and efficacious for individuals aged 23 years although supporting data are more limited for the Russian products.” Current vaccines appear to pro- tect against all virus subtypes circulating in endemic areas of Asia and Europe.*\nSince the incidence of tick-borne encephalitis may vary considerably between and even within geographical re- gions, public immunization strategies should be based on risk assessments conducted at country, regional or\n“9 Schuller E et al. Effect of pre-existing anti-tick-borne encephalitis virus immunity on neutralising antibody response to the Vero cell derived, inactivated Japanese ence- phalitis virus vaccine candidate IC51. Vaccine, 2008, 26:6151-6156.\n50 Schwarz B. [Health economics of early summer meningoencephalitis in Austria. Effects of a vaccination campaign 1981 to 1990]. Wiener Medizinische Wochens- chrift, 1993, 143:551-555 [Available in German only].\n51 Grading of scientific evidence — Table | (vaccine efficacy and effectiveness). Availa- ble at http://www.who.int/entity/immunization/TBE_grad_efficacy.pdf\n2 Grading of scientific evidence — Table II (vaccine safety). Available at http://www. who.int/entity/immunization/TBE_grad_safety.pdf\n53 Grading of scientific evidence — Table III (induction of cross-protection). Available at http:/www.who.int/entity/immunization/TBE_grad_crossprotection.pdf", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "fdb2252168fc6c8a6a9d30a6eab2561b", - "text": "WHO policy on the use of the vaccine", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "", - "text_as_html": "Immunization offers the most effective protection against tick-borne encephalitis.’ The 2 vaccines manu- factured in Austria and Germany are considered to be safe and efficacious for individuals aged 21 year. The 2 vaccines manufactured in the Russian Federation are also considered safe and efficacious for individuals aged 23 years although supporting data are more limited for the Russian products.” Current vaccines appear to pro- tect against all virus subtypes circulating in endemic areas of Asia and Europe.*
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 13, - "coordinates": [ - { - "x0": 45.86, - "y0": 484.41, - "x1": 273.51, - "y1": 592.8 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "a15481de0d124c078c4771e484ea2e40", - "text": "Since the incidence of tick-borne encephalitis may vary considerably between and even within geographical re- gions, public immunization strategies should be based on risk assessments conducted at country, regional or", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "fdb2252168fc6c8a6a9d30a6eab2561b", - "text_as_html": "Since the incidence of tick-borne encephalitis may vary considerably between and even within geographical re- gions, public immunization strategies should be based on risk assessments conducted at country, regional or
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 13, - "coordinates": [ - { - "x0": 45.04, - "y0": 599.99, - "x1": 273.3, - "y1": 643.01 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "579375e310f58fa4b92172718e00da87", - "text": "“9 Schuller E et al. Effect of pre-existing anti-tick-borne encephalitis virus immunity on neutralising antibody response to the Vero cell derived, inactivated Japanese ence- phalitis virus vaccine candidate IC51. Vaccine, 2008, 26:6151-6156.", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "fdb2252168fc6c8a6a9d30a6eab2561b", - "text_as_html": "séologique faisant suite a la vaccination contre l’encéphalite a tiques,’” ° et on s’est apercu que des anticorps préexistants contre la maladie interféraient avec la réponse en anticorps suscitée par le vaccin contre l’encéphalite japonaise.”
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 13, - "coordinates": [ - { - "x0": 294.11, - "y0": 55.49, - "x1": 552.42, - "y1": 98.63 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-43", - "text": "\n\n\nProphylaxie post-exposition\nSur la base de ’hypothése quune vaccination pratiquée aprés une piqtire de tique a peu de chances d’induire une immunité avant lapparition potentielle de la maladie et compte tenu du risque théorique de renforcement de la toxicité cellulaire dépen- dant des anticorps, il n’est pas recommandé d’administrer une prophylaxie post-exposition en cas de piqtre de tique chez une personne non vaccinée.?\nEn Europe occidentale, injection d’immunoglobulines renfer- mant de fortes concentrations d’anticorps dirigés contre le virus de lencéphalite a tiques n’a eu aucun effet bénéfique lorsquelle était utilisée en tant que prophylaxie post-exposition et cette pratique nest plus recommandée. En revanche, une revue récente de l’expérience acquise en Russie avec les immu- noglobulines fait apparaitre un certain effet protecteur de l’ad- ministration précoce aprés exposition de préparations d’immu- noglobulines russes.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "ea533b129c387a232c0c2ce17d559fdb", - "text": "Prophylaxie post-exposition", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "", - "text_as_html": "Sur la base de ’hypothése quune vaccination pratiquée aprés une piqtire de tique a peu de chances d’induire une immunité avant lapparition potentielle de la maladie et compte tenu du risque théorique de renforcement de la toxicité cellulaire dépen- dant des anticorps, il n’est pas recommandé d’administrer une prophylaxie post-exposition en cas de piqtre de tique chez une personne non vaccinée.?
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 13, - "coordinates": [ - { - "x0": 295.2, - "y0": 123.5, - "x1": 552.57, - "y1": 198.43 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "d501cd8d9fd5de6b46275b6b8989f1e9", - "text": "En Europe occidentale, injection d’immunoglobulines renfer- mant de fortes concentrations d’anticorps dirigés contre le virus de lencéphalite a tiques n’a eu aucun effet bénéfique lorsquelle était utilisée en tant que prophylaxie post-exposition et cette pratique nest plus recommandée. En revanche, une revue récente de l’expérience acquise en Russie avec les immu- noglobulines fait apparaitre un certain effet protecteur de l’ad- ministration précoce aprés exposition de préparations d’immu- noglobulines russes.", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "ea533b129c387a232c0c2ce17d559fdb", - "text_as_html": "En Europe occidentale, injection d’immunoglobulines renfer- mant de fortes concentrations d’anticorps dirigés contre le virus de lencéphalite a tiques n’a eu aucun effet bénéfique lorsquelle était utilisée en tant que prophylaxie post-exposition et cette pratique nest plus recommandée. En revanche, une revue récente de l’expérience acquise en Russie avec les immu- noglobulines fait apparaitre un certain effet protecteur de l’ad- ministration précoce aprés exposition de préparations d’immu- noglobulines russes.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 13, - "coordinates": [ - { - "x0": 294.42, - "y0": 205.96, - "x1": 552.6, - "y1": 303.96 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-44", - "text": "\n\n\nRapport coat/efficacité de la vaccination\nDans les zones de prévalence de l’encéphalite a tiques, cette mala- die présente un coiit élevé pour les individus et la société en raison notamment de la fréquence des séquelles neurologiques a long terme.' On estime que les campagnes de vaccination menées en Autriche entre 1991 et 2000 ont permis d’économiser l’équivalent de US$ 80 millions en réduisant les coits liés 4 la prise en charge, a la perte de productivité et au départ a la retraite anticipé des personnes touchées par cette maladie.*° Aucune analyse récente de a vaccination sous l’angle du rapport cott/efficacité n’a été rappor- tée dans la littérature. Il semblerait néanmoins que ce rapport dépende fortement du prix du vaccin et de la précision avec laquelle les populations cibles sont définies.", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "0b867124b3a3ee3b1b9a563a09b33da9", - "text": "Rapport coat/efficacité de la vaccination", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "", - "text_as_html": "Dans les zones de prévalence de l’encéphalite a tiques, cette mala- die présente un coiit élevé pour les individus et la société en raison notamment de la fréquence des séquelles neurologiques a long terme.' On estime que les campagnes de vaccination menées en Autriche entre 1991 et 2000 ont permis d’économiser l’équivalent de US$ 80 millions en réduisant les coits liés 4 la prise en charge, a la perte de productivité et au départ a la retraite anticipé des personnes touchées par cette maladie.*° Aucune analyse récente de a vaccination sous l’angle du rapport cott/efficacité n’a été rappor- tée dans la littérature. Il semblerait néanmoins que ce rapport dépende fortement du prix du vaccin et de la précision avec laquelle les populations cibles sont définies.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 13, - "coordinates": [ - { - "x0": 294.57, - "y0": 328.22, - "x1": 552.68, - "y1": 459.65 - } - ] - } - } - ] - }, - { - "type": "CompositeElement", - "element_id": "chunk-45", - "text": "\n\n\nPolitique de I'OMS concernant l'utilisation du vaccin\nLa vaccination est la solution la plus efficace pour se protéger de lencéphalite a tiques.*! Les 2 vaccins fabriqués en Autriche et en Allemagne sont considérés comme siirs et efficaces pour es sujets 4gés de 21 an. Les 2 vaccins fabriqués par la Fédéra- tion de Russie sont également considérés comme sirs et effi- caces, mais pour les sujets de >3 ans. Néanmoins, les données étayant ce jugement sont plus limitées pour les produits russes.” Les vaccins actuels semblent conférer une protection contre tous les sous-types viraux circulant dans les zones d’endémie d’Asie et d’Europe.*\nLincidence de l’encéphalite 4 tiques pouvant varier considéra- blement dune région géographique a l’autre, voire au sein dune méme région, les stratégies publiques de vaccination doivent s’appuyer sur des évaluations du risque menées au\n“© Schuller E et al. Effect of pre-existing anti-tick-borne encephalitis virus immunity on neutralising antibody response to the Vero cell derived; inactivated Japanese encephalitis vaccine candidate 1C51. Vaccine, 2008, 26 : 6151-6156.\n50 Schwarz B. [Health economics of early summer meningoencephalitis in Austria. Effects of a vaccination campaign 1981 to 1990]. Wiener Medizinische Wochenschrift, 1993, 143:551-555, [Disponible en allemand uniquement].\n51 Cotation des preuves scientifiques — Tableau | (efficacité/efficience du vaccin). Disponible sur http:/Awww.who.int/entity/immunization/TBE_grad_efficacy.pdf\n2 Cotation des preuves scientifiques — Tableau II (innocuité du vaccin). Disponible sur http://www. who.int/entity/immunization/TBE_grad_safety.pdf\nCotation des preuves scientifiques — Tableau III (induction d'une protection croisée). Disponible sur http:/Awww.who.int/entity/immunization/TBE_grad_crossprotection.pdf\n3\nWEEKLY EPIDEMIOLOGICAL RECORD, NO. 24, 10 JUNE 2011\ndistrict level, and they should be appropriate to the local endemic situation. Therefore, establishing case reporting of the disease is essential before deciding on the most appropriate preventive measures to be taken. Similarly, health authorities’ decision-making on pro- grammatic vaccination could be informed by an analy- sis of the cost-effectiveness.\nIn areas where the disease is highly endemic (that is, where the average prevaccination incidence of clinical disease is 25 cases/100 000 population per year), imply- ing that there is a high individual risk of infection, WHO recommends that vaccination be offered to all age groups, including children. Inclusion of vaccination against tick-borne encephalitis into immunization pro- grammes at regional level or national level should be considered, depending on the epidemiological situa- tion.\nBecause the disease tends to be more serious in individu- als aged >50-60 years this age group constitutes an im- portant target for immunization.\nWhere the prevaccination incidence of the disease is moderate or low (that is, the annual average during a 5-year period is <5/100 000) or is limited to particular geographical locations or certain outdoor activities, im- munization should target individuals in the most se- verely affected cohorts.\nPeople travelling from nonendemic areas to endemic areas should be offered vaccination if their visits will include extensive outdoor activities.\nVaccination against the disease requires a primary series of 3 doses; those who will continue to be at risk should probably have 21 booster doses. Within the considerable range of acceptable dose intervals, the relevant national authorities should select the most rational primary schedule for their national, regional or district immunization programmes.\nFor the vaccines manufactured in Austria and Germany, an interval of 1-3 months is recommended between the first 2 doses, and 5-12 months between the second and third doses. When rapid protection is required, for ex- ample for people who will be travelling to endemic ar- eas, the interval between the first 2 doses may be re- duced to 1-2 weeks.\nLittle information is available on the duration of protec- tion following completion of the primary 3-dose im- munization series and on the need for, and optimal intervals between, possible booster doses. Although there is a strong indication that the spacing of boosters could be expanded considerably from the intervals cur- rently recommended by the manufacturers, the evidence is still insufficient for a definitive recommendation on the optimal frequency and number of booster doses. Countries should therefore continue to recommend the\n% Grading of scientific evidence — Tables IVa and IVb (duration of protection after primary immunization only and after primary immunizations plus one booster dose). Available at http://www.who.int/entity/immunization/TBE_duration_protec- tion.pdf\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 24, 10 JUIN 2011\nniveau du pays, de la région ou méme du district et étre adap- tées a la situation d’endémie locale. Par conséquent, il est indis- pensable de mettre en place la notification des cas de la mala- die avant de décider des mesures préventives les plus appropriées. De méme, l’analyse coiit/efficacité peut servir a étayer la prise de décisions des autorités sanitaires concernant les program- mes de vaccination.\nDans les zones ot l’encéphalite a tiques est fortement endémi- que (c’est-a-dire ot Pincidence moyenne de la maladie clinique avant la vaccination est 25 cas/100 000 habitants par an), ce qui implique un risque individuel dinfection élevé, TOMS recom- mande de proposer la vaccination dans toutes les classes d’age, y compris les enfants. En fonction de la situation épidémiolo- gique, il convient d’envisager l’intégration de la vaccination contre lencéphalite a tiques dans les programmes de vaccina- tion a Péchelon régional ou national.\nSachant que l’encéphalite a tiques tend a étre plus grave au-dela de 50-60 ans, il est important que cette classe d’age soit visée par la vaccination.\nDans les zones ot lincidence prévaccinale de la maladie est faible ou modérée (moyenne annuelle <5/100 000 habitants sur 5 ans) ou limitée a des lieux géographiques particuliers ou a certaines activités de plein air, la vaccination doit viser des sujets appartenant aux cohortes les plus sévérement touchées.\nIl faut aussi proposer la vaccination aux personnes qui viennent de zones de non-endémie et se rendent dans des zones d’en- démie si leur séjour doit comprendre des activités de plein air prolongées.\nLa vaccination contre l’encéphalite a tiques nécessite une premiére série de 3 doses; les personnes qui vont continuer d’étre exposées a ce risque devront probablement recevoir au moins 1 dose de rappel. Les autorités sanitaires concernées doivent choisir, parmi la gamme étendue d’intervalles accepta- bles entre les doses, le calendrier de primovaccination le plus rationnel pour leurs programmes de vaccination a l’échelle du pays, de la région ou du district.\nPour les vaccins fabriqués en Autriche et en Allemagne, on recommande un intervalle de 1 a 3 mois entre les 2 premiéres doses et de 5 4 12 mois entre la deuxiéme et la troisiéme dose. Si la protection doit étre obtenue rapidement, par exemple pour les voyageurs devant se rendre dans des zones d’endémie, l’in- tervalle entre les 2 premiéres doses peut étre ramené a 1-2 semaines.\nOn dispose de peu d’informations sur la durée de la protection conférée par l’administration de la primovaccination en 3 doses, sur la nécessité d’éventuelles doses de rappel et sur l’intervalle idéal entre ces derniéres. Bien que tout porte a croire quon puisse espacer considérablement les rappels par rapport aux intervalles actuellement préconisés par les fabricants, on ne dispose pas encore de suffisamment d’éléments pour recom- mander avec certitude le nombre et la fréquence de ces rappels.* Les pays peuvent donc continuer de recommander @utiliser les vaccins en fonction de lépidémiologie locale de\nCotation des preuves scientifiques — Tableaux IVa and IVb (durée de la protection conférée par l'administration de la primovaccination seule ou suivant I'administration de la primovaccination en plusieurs doses plus 1 dose de rappel). Disponible sur http://www.who.int/entity/immuniza- tion/TBE_duration_protection.pdf\n255\nuse of vaccines in accordance with local disease epide- miology and current schedules until more definitive information becomes available.\nIn healthy individuals aged <50 years booster doses are conventionally offered at intervals of 3-5 years, although in some endemic areas, such as in Switzerland, intervals <10 years are now used.\nSince the disease tends to be more severe and immune responses weaker in individuals aged 50 to 60 years and above, it may be prudent to maintain booster intervals at 3-5 years for these age groups until more definitive information becomes available.\nWith the vaccines manufactured in the Russian Federa- tion, the recommended intervals are 1-7 months be- tween the first 2 doses, and 12 months between the second and third doses. Booster doses are recommended every 3 years for those at continued risk of exposure. The currently recommended booster interval should be maintained until more data have been obtained on the duration of protection induced by the Russian vac- cines.\nRegardless of the duration of the delay, interrupted schedules should be resumed without repeating previ- ous doses.\nAlthough there is no evidence to suggest any interfer- ence between existing vaccines against tick-borne en- cephalitis and other simultaneously administered vac- cines, the issue of potential immunological interactions needs to be addressed by appropriate studies. In addi- tion, more information is needed on the immune re- sponse to the vaccine in individuals who have been previously immunized against yellow fever or Japanese encephalitis.\nPostexposure vaccination following a tick bite is not recommended. Administration of specific immunoglob- ulin for passive postexposure prophylaxis is not recom- mended in western Europe, but is sometimes used in the Russian Federation.\nThere are substantial knowledge gaps that hinder the formulation of more specific guidance for controlling this disease. In particular, more research is necessary to assess the need for and timing of boosters. Countries are encouraged to assess the effectiveness, and the cost- effectiveness, of the immunization regimens being used.\nSurveillance for tick-borne encephalitis is critical for characterizing its epidemiology, measuring the burden of disease, identifying high-risk areas and areas of new disease activity, as well as for documenting the impact of control measures. Standardization is needed for clin- ical case definitions and reporting requirements, as well as for follow-up processes to identify long-term seque- lae resulting from tick-borne encephalitis. Similarly, standardized reagents are needed to allow test results to be compared across laboratories.\nIn all endemic areas information on the disease, its vec- tor and transmission patterns, as well as on available prophylactic measures, should be readily available, for example in schools, doctors’ offices, and in tourist in- formation leaflets. B\n256\nla maladie et selon les calendriers actuels jusqu’a ce quon dispose d’informations plus précises.\nDes rappels tous les 3 a 5 ans étaient traditionnellement propo- sés aux sujets en bonne santé de <50 ans mais dans certaines zones d’endémie telles que la Suisse, des intervalles <10 ans sont désormais préconisés.\nComme la maladie tend a étre plus grave et la réponse immu- nitaire plus faible chez les sujets a4gés de 50 a 60 ans et plus, il peut étre prudent de maintenir des intervalles de 3-5 ans entre es rappels dans ces classes d’age en attendant de disposer de données plus précises.\nour les vaccins fabriqués dans la Fédération de Russie, on recommande des intervalles de 1-7 mois entre les deux premié- res doses et de 12 mois entre la deuxiéme et la troisiéme dose. Les rappels sont préconisés tous les 3 ans pour les personnes constamment exposées au risque. Il convient de maintenir les intervalles entre les rappels actuellement recommandés jusqu’a ce que davantage de données aient été générées sur la durée de a protection conférée par les vaccins russes.\nQuel que soit le retard pris, les calendriers vaccinaux interrom- pus doivent étre repris sans répétition des doses antérieures.\nMalgré labsence d’indice d’une quelconque interférence entre es vaccins contre l’encéphalite a tiques existants et d’autres vaccins administrés simultanément, la question des interactions immunologiques possibles doit étre convenablement étudiée. En outre, il est nécessaire d’en savoir plus sur la réponse immu- nitaire au vaccin des sujets précédemment vaccinés contre la fiévre jaune ou l’encéphalite japonaise.\nLa vaccination post-exposition aprés une piqtire de tique nest pas recommandée. Ladministration d’immunoglobulines spéci- fiques a titre de prophylaxie post-exposition passive n’est pas non plus recommandée en Europe occidentale, mais se pratique parfois en Fédération de Russie.\n1 existe d’importantes lacunes dans les connaissances qui empéchent de formuler des recommandations plus spécifiques pour lutter contre l’encéphalite 4 tiques. En particulier, des recherches plus poussées sont nécessaires pour évaluer la nécessité des rappels et lintervalle auquel les administrer. Les pays sont encouragés a évaluer lefficacité et le rapport cotit/ efficacité des schémas de vaccination quils appliquent.\nLa surveillance de l’encéphalite 4 tiques est essentielle pour caractériser épidémiologie de cette maladie, déterminer la charge de morbidité, identifier les zones a haut risque, les nouvel- les zones d’activité de cette maladie et obtenir des données sur les effets des mesures de lutte. Des efforts de normalisation sont nécessaires pour les définitions de cas cliniques et les exigences de la notification, comme pour les modalités de suivi permettant identifier les séquelles 4 long terme de l’encéphalite a tiques. De méme, des réactifs normalisés sont nécessaires pour pouvoir comparer les résultats des tests entre laboratoires.\nDans toutes les zones d’endémie, des informations relatives a a maladie, a ses vecteurs et 4 ces modes de transmission, ainsi qu’aux mesures prophylactiques disponibles, doivent étre faci- ement disponibles, par exemple dans les écoles, les cabinets médicaux et les dépliants touristiques. Ml", - "filename": "WER8624_241-256.PDF", - "filetype": "application/pdf", - "elements": [ - { - "type": "Title", - "element_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text": "Politique de I'OMS concernant l'utilisation du vaccin", - "metadata": { - "category_depth": 1, - "page_number": 14, - "parent_id": "", - "text_as_html": "La vaccination est la solution la plus efficace pour se protéger de lencéphalite a tiques.*! Les 2 vaccins fabriqués en Autriche et en Allemagne sont considérés comme siirs et efficaces pour es sujets 4gés de 21 an. Les 2 vaccins fabriqués par la Fédéra- tion de Russie sont également considérés comme sirs et effi- caces, mais pour les sujets de >3 ans. Néanmoins, les données étayant ce jugement sont plus limitées pour les produits russes.” Les vaccins actuels semblent conférer une protection contre tous les sous-types viraux circulant dans les zones d’endémie d’Asie et d’Europe.*
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", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 13, - "coordinates": [ - { - "x0": 395.2, - "y0": 779.08, - "x1": 549.52, - "y1": 786.3 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "04d82205362b8c3ac2634f41f60940b8", - "text": "district level, and they should be appropriate to the local endemic situation. Therefore, establishing case reporting of the disease is essential before deciding on the most appropriate preventive measures to be taken. Similarly, health authorities’ decision-making on pro- grammatic vaccination could be informed by an analy- sis of the cost-effectiveness.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "district level, and they should be appropriate to the local endemic situation. Therefore, establishing case reporting of the disease is essential before deciding on the most appropriate preventive measures to be taken. Similarly, health authorities’ decision-making on pro- grammatic vaccination could be informed by an analy- sis of the cost-effectiveness.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 45.01, - "y0": 55.97, - "x1": 274.23, - "y1": 131.26 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "9df5ca90a94457f8f08cf598ac8e65af", - "text": "In areas where the disease is highly endemic (that is, where the average prevaccination incidence of clinical disease is 25 cases/100 000 population per year), imply- ing that there is a high individual risk of infection, WHO recommends that vaccination be offered to all age groups, including children. Inclusion of vaccination against tick-borne encephalitis into immunization pro- grammes at regional level or national level should be considered, depending on the epidemiological situa- tion.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "In areas where the disease is highly endemic (that is, where the average prevaccination incidence of clinical disease is 25 cases/100 000 population per year), imply- ing that there is a high individual risk of infection, WHO recommends that vaccination be offered to all age groups, including children. Inclusion of vaccination against tick-borne encephalitis into immunization pro- grammes at regional level or national level should be considered, depending on the epidemiological situa- tion.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 45.62, - "y0": 138.55, - "x1": 273.38, - "y1": 246.83 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4b5d489f0f666a3c8733cb6eda355d83", - "text": "Because the disease tends to be more serious in individu- als aged >50-60 years this age group constitutes an im- portant target for immunization.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Because the disease tends to be more serious in individu- als aged >50-60 years this age group constitutes an im- portant target for immunization.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 44.31, - "y0": 253.79, - "x1": 273.87, - "y1": 286.81 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "f3b6ba2f38a189bbb1367b503af1897f", - "text": "Where the prevaccination incidence of the disease is moderate or low (that is, the annual average during a 5-year period is <5/100 000) or is limited to particular geographical locations or certain outdoor activities, im- munization should target individuals in the most se- verely affected cohorts.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Where the prevaccination incidence of the disease is moderate or low (that is, the annual average during a 5-year period is <5/100 000) or is limited to particular geographical locations or certain outdoor activities, im- munization should target individuals in the most se- verely affected cohorts.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 45.53, - "y0": 293.53, - "x1": 273.81, - "y1": 358.5 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "1e84fa049fc197175b2135b091823e8a", - "text": "People travelling from nonendemic areas to endemic areas should be offered vaccination if their visits will include extensive outdoor activities.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "People travelling from nonendemic areas to endemic areas should be offered vaccination if their visits will include extensive outdoor activities.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 44.44, - "y0": 365.25, - "x1": 274.01, - "y1": 397.04 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "0745a37b5a9f527dd9328e27379cd1ed", - "text": "Vaccination against the disease requires a primary series of 3 doses; those who will continue to be at risk should probably have 21 booster doses. Within the considerable range of acceptable dose intervals, the relevant national authorities should select the most rational primary schedule for their national, regional or district immunization programmes.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Vaccination against the disease requires a primary series of 3 doses; those who will continue to be at risk should probably have 21 booster doses. Within the considerable range of acceptable dose intervals, the relevant national authorities should select the most rational primary schedule for their national, regional or district immunization programmes.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 45.82, - "y0": 414.84, - "x1": 273.54, - "y1": 490.88 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "2b360cebd34476feac35de09c1623a8e", - "text": "For the vaccines manufactured in Austria and Germany, an interval of 1-3 months is recommended between the first 2 doses, and 5-12 months between the second and third doses. When rapid protection is required, for ex- ample for people who will be travelling to endemic ar- eas, the interval between the first 2 doses may be re- duced to 1-2 weeks.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "For the vaccines manufactured in Austria and Germany, an interval of 1-3 months is recommended between the first 2 doses, and 5-12 months between the second and third doses. When rapid protection is required, for ex- ample for people who will be travelling to endemic ar- eas, the interval between the first 2 doses may be re- duced to 1-2 weeks.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 45.44, - "y0": 508.37, - "x1": 273.26, - "y1": 584.4 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "7afefbfe807116536ca641bb183dc4c2", - "text": "Little information is available on the duration of protec- tion following completion of the primary 3-dose im- munization series and on the need for, and optimal intervals between, possible booster doses. Although there is a strong indication that the spacing of boosters could be expanded considerably from the intervals cur- rently recommended by the manufacturers, the evidence is still insufficient for a definitive recommendation on the optimal frequency and number of booster doses. Countries should therefore continue to recommend the", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Little information is available on the duration of protec- tion following completion of the primary 3-dose im- munization series and on the need for, and optimal intervals between, possible booster doses. Although there is a strong indication that the spacing of boosters could be expanded considerably from the intervals cur- rently recommended by the manufacturers, the evidence is still insufficient for a definitive recommendation on the optimal frequency and number of booster doses. Countries should therefore continue to recommend the
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 45.8, - "y0": 591.31, - "x1": 272.55, - "y1": 700.04 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "e71836814f87f5a2807bc8415fe40152", - "text": "% Grading of scientific evidence — Tables IVa and IVb (duration of protection after primary immunization only and after primary immunizations plus one booster dose). Available at http://www.who.int/entity/immunization/TBE_duration_protec- tion.pdf", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 24, 10 JUIN 2011
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 43.74, - "y0": 778.87, - "x1": 220.03, - "y1": 786.36 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "3397440ea31447ad7ae7b90d64fe8147", - "text": "niveau du pays, de la région ou méme du district et étre adap- tées a la situation d’endémie locale. Par conséquent, il est indis- pensable de mettre en place la notification des cas de la mala- die avant de décider des mesures préventives les plus appropriées. De méme, l’analyse coiit/efficacité peut servir a étayer la prise de décisions des autorités sanitaires concernant les program- mes de vaccination.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "niveau du pays, de la région ou méme du district et étre adap- tées a la situation d’endémie locale. Par conséquent, il est indis- pensable de mettre en place la notification des cas de la mala- die avant de décider des mesures préventives les plus appropriées. De méme, l’analyse coiit/efficacité peut servir a étayer la prise de décisions des autorités sanitaires concernant les program- mes de vaccination.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 294.55, - "y0": 55.78, - "x1": 551.94, - "y1": 131.54 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "f8f4a8c6650b4a377440ea645a9ea9ac", - "text": "Dans les zones ot l’encéphalite a tiques est fortement endémi- que (c’est-a-dire ot Pincidence moyenne de la maladie clinique avant la vaccination est 25 cas/100 000 habitants par an), ce qui implique un risque individuel dinfection élevé, TOMS recom- mande de proposer la vaccination dans toutes les classes d’age, y compris les enfants. En fonction de la situation épidémiolo- gique, il convient d’envisager l’intégration de la vaccination contre lencéphalite a tiques dans les programmes de vaccina- tion a Péchelon régional ou national.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Dans les zones ot l’encéphalite a tiques est fortement endémi- que (c’est-a-dire ot Pincidence moyenne de la maladie clinique avant la vaccination est 25 cas/100 000 habitants par an), ce qui implique un risque individuel dinfection élevé, TOMS recom- mande de proposer la vaccination dans toutes les classes d’age, y compris les enfants. En fonction de la situation épidémiolo- gique, il convient d’envisager l’intégration de la vaccination contre lencéphalite a tiques dans les programmes de vaccina- tion a Péchelon régional ou national.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 293.29, - "y0": 138.27, - "x1": 552.93, - "y1": 236.24 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "3fc31d8f79129a401ed6ed342397babc", - "text": "Sachant que l’encéphalite a tiques tend a étre plus grave au-dela de 50-60 ans, il est important que cette classe d’age soit visée par la vaccination.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Sachant que l’encéphalite a tiques tend a étre plus grave au-dela de 50-60 ans, il est important que cette classe d’age soit visée par la vaccination.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 294.12, - "y0": 253.78, - "x1": 550.38, - "y1": 286.54 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "0272c0f2cfab2afdc516bb50ee201928", - "text": "Dans les zones ot lincidence prévaccinale de la maladie est faible ou modérée (moyenne annuelle <5/100 000 habitants sur 5 ans) ou limitée a des lieux géographiques particuliers ou a certaines activités de plein air, la vaccination doit viser des sujets appartenant aux cohortes les plus sévérement touchées.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Dans les zones ot lincidence prévaccinale de la maladie est faible ou modérée (moyenne annuelle <5/100 000 habitants sur 5 ans) ou limitée a des lieux géographiques particuliers ou a certaines activités de plein air, la vaccination doit viser des sujets appartenant aux cohortes les plus sévérement touchées.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 295.12, - "y0": 293.25, - "x1": 551.0, - "y1": 347.58 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "933e4fa24f637a6df17f19ad6c459ca4", - "text": "Il faut aussi proposer la vaccination aux personnes qui viennent de zones de non-endémie et se rendent dans des zones d’en- démie si leur séjour doit comprendre des activités de plein air prolongées.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Il faut aussi proposer la vaccination aux personnes qui viennent de zones de non-endémie et se rendent dans des zones d’en- démie si leur séjour doit comprendre des activités de plein air prolongées.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 294.5, - "y0": 365.53, - "x1": 550.17, - "y1": 407.58 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "c37d2a5eedea6acef68433cdf1c5fb3f", - "text": "La vaccination contre l’encéphalite a tiques nécessite une premiére série de 3 doses; les personnes qui vont continuer d’étre exposées a ce risque devront probablement recevoir au moins 1 dose de rappel. Les autorités sanitaires concernées doivent choisir, parmi la gamme étendue d’intervalles accepta- bles entre les doses, le calendrier de primovaccination le plus rationnel pour leurs programmes de vaccination a l’échelle du pays, de la région ou du district.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "La vaccination contre l’encéphalite a tiques nécessite une premiére série de 3 doses; les personnes qui vont continuer d’étre exposées a ce risque devront probablement recevoir au moins 1 dose de rappel. Les autorités sanitaires concernées doivent choisir, parmi la gamme étendue d’intervalles accepta- bles entre les doses, le calendrier de primovaccination le plus rationnel pour leurs programmes de vaccination a l’échelle du pays, de la région ou du district.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 293.35, - "y0": 414.65, - "x1": 553.09, - "y1": 501.85 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "13274b13c771fdb6d42809cb349858bf", - "text": "Pour les vaccins fabriqués en Autriche et en Allemagne, on recommande un intervalle de 1 a 3 mois entre les 2 premiéres doses et de 5 4 12 mois entre la deuxiéme et la troisiéme dose. Si la protection doit étre obtenue rapidement, par exemple pour les voyageurs devant se rendre dans des zones d’endémie, l’in- tervalle entre les 2 premiéres doses peut étre ramené a 1-2 semaines.", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Pour les vaccins fabriqués en Autriche et en Allemagne, on recommande un intervalle de 1 a 3 mois entre les 2 premiéres doses et de 5 4 12 mois entre la deuxiéme et la troisiéme dose. Si la protection doit étre obtenue rapidement, par exemple pour les voyageurs devant se rendre dans des zones d’endémie, l’in- tervalle entre les 2 premiéres doses peut étre ramené a 1-2 semaines.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 295.17, - "y0": 508.52, - "x1": 552.19, - "y1": 584.5 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "84e8f723b59de95e5bcc4730998c514f", - "text": "On dispose de peu d’informations sur la durée de la protection conférée par l’administration de la primovaccination en 3 doses, sur la nécessité d’éventuelles doses de rappel et sur l’intervalle idéal entre ces derniéres. Bien que tout porte a croire quon puisse espacer considérablement les rappels par rapport aux intervalles actuellement préconisés par les fabricants, on ne dispose pas encore de suffisamment d’éléments pour recom- mander avec certitude le nombre et la fréquence de ces rappels.* Les pays peuvent donc continuer de recommander @utiliser les vaccins en fonction de lépidémiologie locale de", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "On dispose de peu d’informations sur la durée de la protection conférée par l’administration de la primovaccination en 3 doses, sur la nécessité d’éventuelles doses de rappel et sur l’intervalle idéal entre ces derniéres. Bien que tout porte a croire quon puisse espacer considérablement les rappels par rapport aux intervalles actuellement préconisés par les fabricants, on ne dispose pas encore de suffisamment d’éléments pour recom- mander avec certitude le nombre et la fréquence de ces rappels.* Les pays peuvent donc continuer de recommander @utiliser les vaccins en fonction de lépidémiologie locale de
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 293.64, - "y0": 591.12, - "x1": 553.32, - "y1": 700.24 - } - ] - } - }, - { - "type": "ListItem", - "element_id": "cb1eb76f0e594556613e09da7a79445f", - "text": "Cotation des preuves scientifiques — Tableaux IVa and IVb (durée de la protection conférée par l'administration de la primovaccination seule ou suivant I'administration de la primovaccination en plusieurs doses plus 1 dose de rappel). Disponible sur http://www.who.int/entity/immuniza- tion/TBE_duration_protection.pdf", - "metadata": { - "category_depth": 1, - "page_number": 15, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "255
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 14, - "coordinates": [ - { - "x0": 539.14, - "y0": 779.62, - "x1": 549.57, - "y1": 784.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "83186d80baa110e41ad8154700ded1cf", - "text": "use of vaccines in accordance with local disease epide- miology and current schedules until more definitive information becomes available.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "use of vaccines in accordance with local disease epide- miology and current schedules until more definitive information becomes available.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 43.57, - "y0": 55.62, - "x1": 274.28, - "y1": 87.85 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "1fc2bea07a8aeb8c22352da3ee5f5983", - "text": "In healthy individuals aged <50 years booster doses are conventionally offered at intervals of 3-5 years, although in some endemic areas, such as in Switzerland, intervals <10 years are now used.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "In healthy individuals aged <50 years booster doses are conventionally offered at intervals of 3-5 years, although in some endemic areas, such as in Switzerland, intervals <10 years are now used.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 43.86, - "y0": 94.65, - "x1": 274.4, - "y1": 137.94 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "4cbd33e2c102a2e664d3fca4f1c961b0", - "text": "Since the disease tends to be more severe and immune responses weaker in individuals aged 50 to 60 years and above, it may be prudent to maintain booster intervals at 3-5 years for these age groups until more definitive information becomes available.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Since the disease tends to be more severe and immune responses weaker in individuals aged 50 to 60 years and above, it may be prudent to maintain booster intervals at 3-5 years for these age groups until more definitive information becomes available.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 43.78, - "y0": 146.12, - "x1": 274.83, - "y1": 199.27 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "87973a0d195f5b47d9c2b7d4951ea00b", - "text": "With the vaccines manufactured in the Russian Federa- tion, the recommended intervals are 1-7 months be- tween the first 2 doses, and 12 months between the second and third doses. Booster doses are recommended every 3 years for those at continued risk of exposure. The currently recommended booster interval should be maintained until more data have been obtained on the duration of protection induced by the Russian vac- cines.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "With the vaccines manufactured in the Russian Federa- tion, the recommended intervals are 1-7 months be- tween the first 2 doses, and 12 months between the second and third doses. Booster doses are recommended every 3 years for those at continued risk of exposure. The currently recommended booster interval should be maintained until more data have been obtained on the duration of protection induced by the Russian vac- cines.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 45.87, - "y0": 207.12, - "x1": 273.61, - "y1": 304.6 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "6e4a9a70dd1f35e2872cdadb5b21bed3", - "text": "Regardless of the duration of the delay, interrupted schedules should be resumed without repeating previ- ous doses.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Regardless of the duration of the delay, interrupted schedules should be resumed without repeating previ- ous doses.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 44.73, - "y0": 312.51, - "x1": 273.25, - "y1": 344.37 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "965d8a35ee9e739404a9b21b2b9f312f", - "text": "Although there is no evidence to suggest any interfer- ence between existing vaccines against tick-borne en- cephalitis and other simultaneously administered vac- cines, the issue of potential immunological interactions needs to be addressed by appropriate studies. In addi- tion, more information is needed on the immune re- sponse to the vaccine in individuals who have been previously immunized against yellow fever or Japanese encephalitis.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Although there is no evidence to suggest any interfer- ence between existing vaccines against tick-borne en- cephalitis and other simultaneously administered vac- cines, the issue of potential immunological interactions needs to be addressed by appropriate studies. In addi- tion, more information is needed on the immune re- sponse to the vaccine in individuals who have been previously immunized against yellow fever or Japanese encephalitis.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 45.22, - "y0": 352.14, - "x1": 273.76, - "y1": 449.51 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "77515dfb5c4405eb83ed36adf94b4355", - "text": "Postexposure vaccination following a tick bite is not recommended. Administration of specific immunoglob- ulin for passive postexposure prophylaxis is not recom- mended in western Europe, but is sometimes used in the Russian Federation.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Postexposure vaccination following a tick bite is not recommended. Administration of specific immunoglob- ulin for passive postexposure prophylaxis is not recom- mended in western Europe, but is sometimes used in the Russian Federation.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 44.64, - "y0": 457.48, - "x1": 274.48, - "y1": 511.34 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "fdf51bc35fdaf1ea236b8770b68121a8", - "text": "There are substantial knowledge gaps that hinder the formulation of more specific guidance for controlling this disease. In particular, more research is necessary to assess the need for and timing of boosters. Countries are encouraged to assess the effectiveness, and the cost- effectiveness, of the immunization regimens being used.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "There are substantial knowledge gaps that hinder the formulation of more specific guidance for controlling this disease. In particular, more research is necessary to assess the need for and timing of boosters. Countries are encouraged to assess the effectiveness, and the cost- effectiveness, of the immunization regimens being used.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 45.43, - "y0": 518.79, - "x1": 273.24, - "y1": 594.82 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "5ae17bbf75975b42475647419c70afea", - "text": "Surveillance for tick-borne encephalitis is critical for characterizing its epidemiology, measuring the burden of disease, identifying high-risk areas and areas of new disease activity, as well as for documenting the impact of control measures. Standardization is needed for clin- ical case definitions and reporting requirements, as well as for follow-up processes to identify long-term seque- lae resulting from tick-borne encephalitis. Similarly, standardized reagents are needed to allow test results to be compared across laboratories.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Surveillance for tick-borne encephalitis is critical for characterizing its epidemiology, measuring the burden of disease, identifying high-risk areas and areas of new disease activity, as well as for documenting the impact of control measures. Standardization is needed for clin- ical case definitions and reporting requirements, as well as for follow-up processes to identify long-term seque- lae resulting from tick-borne encephalitis. Similarly, standardized reagents are needed to allow test results to be compared across laboratories.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 45.94, - "y0": 602.65, - "x1": 272.71, - "y1": 711.54 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "712aebc6c5b4d3ea5f541db9957d8a6d", - "text": "In all endemic areas information on the disease, its vec- tor and transmission patterns, as well as on available prophylactic measures, should be readily available, for example in schools, doctors’ offices, and in tourist in- formation leaflets. B", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "In all endemic areas information on the disease, its vec- tor and transmission patterns, as well as on available prophylactic measures, should be readily available, for example in schools, doctors’ offices, and in tourist in- formation leaflets. B
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 44.66, - "y0": 719.95, - "x1": 274.51, - "y1": 773.38 - } - ] - } - }, - { - "type": "UncategorizedText", - "element_id": "f428c468199ee78f094d9dcd8d1aa376", - "text": "256", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "256
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 45.35, - "y0": 779.62, - "x1": 55.79, - "y1": 784.66 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "689a6ad0162ac62015944e257ea51d8f", - "text": "la maladie et selon les calendriers actuels jusqu’a ce quon dispose d’informations plus précises.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "la maladie et selon les calendriers actuels jusqu’a ce quon dispose d’informations plus précises.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 292.93, - "y0": 55.49, - "x1": 549.9, - "y1": 76.93 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "00ed4904ca9a7cc9ab498ae6d9394396", - "text": "Des rappels tous les 3 a 5 ans étaient traditionnellement propo- sés aux sujets en bonne santé de <50 ans mais dans certaines zones d’endémie telles que la Suisse, des intervalles <10 ans sont désormais préconisés.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Des rappels tous les 3 a 5 ans étaient traditionnellement propo- sés aux sujets en bonne santé de <50 ans mais dans certaines zones d’endémie telles que la Suisse, des intervalles <10 ans sont désormais préconisés.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 293.92, - "y0": 94.95, - "x1": 552.0, - "y1": 137.94 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "be4ba9705fa329098fc07bb2146bff95", - "text": "Comme la maladie tend a étre plus grave et la réponse immu- nitaire plus faible chez les sujets a4gés de 50 a 60 ans et plus, il peut étre prudent de maintenir des intervalles de 3-5 ans entre es rappels dans ces classes d’age en attendant de disposer de données plus précises.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Comme la maladie tend a étre plus grave et la réponse immu- nitaire plus faible chez les sujets a4gés de 50 a 60 ans et plus, il peut étre prudent de maintenir des intervalles de 3-5 ans entre es rappels dans ces classes d’age en attendant de disposer de données plus précises.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 294.57, - "y0": 145.95, - "x1": 551.93, - "y1": 199.4 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "6d25eb02d9f8f5f4d62b7b6ab9c5a02c", - "text": "our les vaccins fabriqués dans la Fédération de Russie, on recommande des intervalles de 1-7 mois entre les deux premié- res doses et de 12 mois entre la deuxiéme et la troisiéme dose. Les rappels sont préconisés tous les 3 ans pour les personnes constamment exposées au risque. Il convient de maintenir les intervalles entre les rappels actuellement recommandés jusqu’a ce que davantage de données aient été générées sur la durée de a protection conférée par les vaccins russes.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "our les vaccins fabriqués dans la Fédération de Russie, on recommande des intervalles de 1-7 mois entre les deux premié- res doses et de 12 mois entre la deuxiéme et la troisiéme dose. Les rappels sont préconisés tous les 3 ans pour les personnes constamment exposées au risque. Il convient de maintenir les intervalles entre les rappels actuellement recommandés jusqu’a ce que davantage de données aient été générées sur la durée de a protection conférée par les vaccins russes.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 294.66, - "y0": 207.04, - "x1": 552.14, - "y1": 294.35 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "e9695512442e7a5ad334a3aa77f69e90", - "text": "Quel que soit le retard pris, les calendriers vaccinaux interrom- pus doivent étre repris sans répétition des doses antérieures.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Quel que soit le retard pris, les calendriers vaccinaux interrom- pus doivent étre repris sans répétition des doses antérieures.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 293.95, - "y0": 312.42, - "x1": 550.23, - "y1": 333.88 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "433db26ceaa34bc95b0c3f6a088904a4", - "text": "Malgré labsence d’indice d’une quelconque interférence entre es vaccins contre l’encéphalite a tiques existants et d’autres vaccins administrés simultanément, la question des interactions immunologiques possibles doit étre convenablement étudiée. En outre, il est nécessaire d’en savoir plus sur la réponse immu- nitaire au vaccin des sujets précédemment vaccinés contre la fiévre jaune ou l’encéphalite japonaise.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Malgré labsence d’indice d’une quelconque interférence entre es vaccins contre l’encéphalite a tiques existants et d’autres vaccins administrés simultanément, la question des interactions immunologiques possibles doit étre convenablement étudiée. En outre, il est nécessaire d’en savoir plus sur la réponse immu- nitaire au vaccin des sujets précédemment vaccinés contre la fiévre jaune ou l’encéphalite japonaise.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 293.52, - "y0": 352.2, - "x1": 551.92, - "y1": 428.09 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "20935a8a39874fed9e2cc3f9aafde7e0", - "text": "La vaccination post-exposition aprés une piqtire de tique nest pas recommandée. Ladministration d’immunoglobulines spéci- fiques a titre de prophylaxie post-exposition passive n’est pas non plus recommandée en Europe occidentale, mais se pratique parfois en Fédération de Russie.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "La vaccination post-exposition aprés une piqtire de tique nest pas recommandée. Ladministration d’immunoglobulines spéci- fiques a titre de prophylaxie post-exposition passive n’est pas non plus recommandée en Europe occidentale, mais se pratique parfois en Fédération de Russie.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 293.19, - "y0": 457.37, - "x1": 550.99, - "y1": 511.38 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "5424f4184876b97af376fb5e61d10532", - "text": "1 existe d’importantes lacunes dans les connaissances qui empéchent de formuler des recommandations plus spécifiques pour lutter contre l’encéphalite 4 tiques. En particulier, des recherches plus poussées sont nécessaires pour évaluer la nécessité des rappels et lintervalle auquel les administrer. Les pays sont encouragés a évaluer lefficacité et le rapport cotit/ efficacité des schémas de vaccination quils appliquent.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "1 existe d’importantes lacunes dans les connaissances qui empéchent de formuler des recommandations plus spécifiques pour lutter contre l’encéphalite 4 tiques. En particulier, des recherches plus poussées sont nécessaires pour évaluer la nécessité des rappels et lintervalle auquel les administrer. Les pays sont encouragés a évaluer lefficacité et le rapport cotit/ efficacité des schémas de vaccination quils appliquent.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 293.13, - "y0": 519.1, - "x1": 552.66, - "y1": 595.03 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "6eed837eb0bfd0e3827c326a19398b40", - "text": "La surveillance de l’encéphalite 4 tiques est essentielle pour caractériser épidémiologie de cette maladie, déterminer la charge de morbidité, identifier les zones a haut risque, les nouvel- les zones d’activité de cette maladie et obtenir des données sur les effets des mesures de lutte. Des efforts de normalisation sont nécessaires pour les définitions de cas cliniques et les exigences de la notification, comme pour les modalités de suivi permettant identifier les séquelles 4 long terme de l’encéphalite a tiques. De méme, des réactifs normalisés sont nécessaires pour pouvoir comparer les résultats des tests entre laboratoires.", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "La surveillance de l’encéphalite 4 tiques est essentielle pour caractériser épidémiologie de cette maladie, déterminer la charge de morbidité, identifier les zones a haut risque, les nouvel- les zones d’activité de cette maladie et obtenir des données sur les effets des mesures de lutte. Des efforts de normalisation sont nécessaires pour les définitions de cas cliniques et les exigences de la notification, comme pour les modalités de suivi permettant identifier les séquelles 4 long terme de l’encéphalite a tiques. De méme, des réactifs normalisés sont nécessaires pour pouvoir comparer les résultats des tests entre laboratoires.
", - "languages": [ - "eng" - ], - "filetype": "application/pdf", - "partitioner_type": "vlm_partition", - "filename": "WER8624_241-256.PDF", - "page": 15, - "coordinates": [ - { - "x0": 293.99, - "y0": 602.83, - "x1": 552.63, - "y1": 711.64 - } - ] - } - }, - { - "type": "NarrativeText", - "element_id": "093de43afaffb4a342d1cd61695d392c", - "text": "Dans toutes les zones d’endémie, des informations relatives a a maladie, a ses vecteurs et 4 ces modes de transmission, ainsi qu’aux mesures prophylactiques disponibles, doivent étre faci- ement disponibles, par exemple dans les écoles, les cabinets médicaux et les dépliants touristiques. Ml", - "metadata": { - "category_depth": 1, - "page_number": 16, - "parent_id": "6cc64add244f3fabea6cdd5e442ef3cb", - "text_as_html": "Dans toutes les zones d’endémie, des informations relatives a a maladie, a ses vecteurs et 4 ces modes de transmission, ainsi qu’aux mesures prophylactiques disponibles, doivent étre faci- ement disponibles, par exemple dans les écoles, les cabinets médicaux et les dépliants touristiques. Ml
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