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Fleisher, Gary

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Fleisher

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Gary

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Fleisher, Gary

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2001 - 200922010 - 20111

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Author's Publications: search.filters.isAuthorOfPublication.9fc09039-f3cb-4873-8056-1a2ae396bbb0

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    Intranasal Immunization with Killed Unencapsulated Whole Cells Prevents Colonization and Invasive Disease by Capsulated Pneumococci
    (American Society for Microbiology, 2001) Malley, Richard; Lipsitch, Marc; Stack, Anne; Saladino, R.; Fleisher, Gary; Pelton, S.; Thompson, Claudette; Briles, D.; Anderson, Porter
    A whole-cell killed unencapsulated pneumococcal vaccine given by the intranasal route with cholera toxin as an adjuvant was tested in two animal models. This vaccination was highly effective in preventing nasopharyngeal colonization with an encapsulated serotype 6B strain in mice and also conferred protection against illness and death in rats inoculated intrathoracically with a highly encapsulated serotype 3 strain. When the serotype 3 challenge strain was incubated in the sera of immunized rats, it was no longer virulent in an infant-rat sepsis model, indicating that the intranasal immunization elicited protective systemic antibodies. These studies suggest that killed whole-cell unencapsulated pneumococci given intranasally with an adjuvant may provide multitypic protection against capsulated pneumococci.
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    Factors Associated With the Use of Cervical Spine Computed Tomography Imaging in Pediatric Trauma Patients
    (Wiley-Blackwell, 2011) Mannix, Rebekah; Nigrovic, Lise E.; Schutzman, Sara; Hennelly, Kara; Bourgeois, Florence; Meehan, William P.; Fleisher, Gary; Monuteaux, Michael; Lee, Lois
    Objectives: To identify patient and hospital characteristics associated with the use of computed tomography (CT) imaging of the cervical spine (c-spine) in the evaluation of injured children and, in particular, to examine the influence of hospital setting. Methods: This was a retrospective cohort of children younger than 19 years of age from the Massachusetts Hospital Emergency Department (ED) database who were discharged from the ED with an injury diagnosis from 2005 through 2009. Multivariable logistic regression was used to analyze characteristics associated with CT imaging of the c-spine. Results: Of the 929,626 pediatric patients diagnosed with an injury in Massachusetts EDs and then discharged home, 1.3% underwent CT imaging of the c-spine. Rates of CT imaging nearly doubled over the five years. In the multivariable model, patient age (adjusted odds ratio [AOR] 2.3, 95% confidence interval [CI] = 2.0 to 2.7 for children age 12 to 18 years vs. under 1 year of age), and evaluation outside of a pediatric Level I trauma center (AOR 2.2, 95% CI = 1.1 to 4.3 for children evaluated at non Level I trauma centers vs. pediatric Level I trauma centers; AOR 2.1, 95% CI = 0.93 to 4.7 for children evaluated at adult Level I trauma centers vs. pediatric Level I trauma centers) were associated with higher rates of CT imaging of the c-spine. Conclusions: C-spine CT imaging for children discharged from the ED with trauma diagnoses increased from 2005 through 2009. Older age and evaluation outside a Level I pediatric trauma center were associated with a higher c-spine CT rate. Educational interventions focused outside pediatric trauma centers may be an effective approach to decreasing CT imaging of the c-spine of pediatric trauma patients.
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    Development of a model of focal pneumococcal pneumonia in young rats
    (BioMed Central, 2004) Malley, Richard; Stack, Anne; Husson, Robert; Thompson, Claudette; Fleisher, Gary; Saladino, Richard A
    Background: A recently licensed pneumococcal conjugate vaccine has been shown to be highly effective in the prevention of bacteremia in immunized children but the degree of protection against pneumonia has been difficult to determine. Methods: We sought to develop a model of Streptococcus pneumoniae pneumonia in Sprague-Dawley rats. We challenged three-week old Sprague-Dawley pups via intrapulmonary injection of S. pneumoniae serotypes 3 and 6B. Outcomes included bacteremia, mortality as well histologic sections of the lungs. Results: Pneumonia was reliably produced in animals receiving either 10 or 100 cfu of type 3 pneumococci, with 30% and 50% mortality respectively. Similarly, with type 6B, the likelihood of pneumonia increased with the inoculum, as did the mortality rate. Prophylactic administration of a preparation of high-titered anticapsular antibody prevented the development of type 3 pneumonia and death. Conclusion: We propose that this model may be useful for the evaluation of vaccines for the prevention of pneumococcal pneumonia.