Prevalence of seroprotection against the pandemic (H1N1) virus after the 2009 pandemic.
Identifieur interne : 000588 ( Main/Exploration ); précédent : 000587; suivant : 000589Prevalence of seroprotection against the pandemic (H1N1) virus after the 2009 pandemic.
Auteurs : Danuta M. Skowronski [Canada] ; Travis S. Hottes ; Naveed Z. Janjua ; Dale Purych ; Suzana Sabaiduc ; Tracy Chan ; Gaston De Serres ; Jennifer Gardy ; Janet E. Mcelhaney ; David M. Patrick ; Martin PetricSource :
- CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne [ 1488-2329 ] ; 2010.
Descripteurs français
- KwdFr :
- Adolescent, Adulte, Adulte d'âge moyen, Anticorps antiviraux (immunologie), Anticorps antiviraux (sang), Colombie-Britannique (épidémiologie), Enfant, Enfant d'âge préscolaire, Facteurs de l'âge, Femelle, Grippe humaine (), Grippe humaine (immunologie), Humains, Jeune adulte, Mâle, Nourrisson, Pandémies (), Sous-type H1N1 du virus de la grippe A (immunologie), Sujet âgé, Sujet âgé de 80 ans ou plus, Tests d'inhibition de l'hémagglutination, Vaccination (), Vaccins antigrippaux (immunologie), Vaccins antigrippaux (usage thérapeutique).
- MESH :
- immunologie : Anticorps antiviraux, Grippe humaine, Sous-type H1N1 du virus de la grippe A, Vaccins antigrippaux.
- sang : Anticorps antiviraux.
- usage thérapeutique : Vaccins antigrippaux.
- épidémiologie : Colombie-Britannique.
- Adolescent, Adulte, Adulte d'âge moyen, Enfant, Enfant d'âge préscolaire, Facteurs de l'âge, Femelle, Grippe humaine, Humains, Jeune adulte, Mâle, Nourrisson, Pandémies, Sujet âgé, Sujet âgé de 80 ans ou plus, Tests d'inhibition de l'hémagglutination, Vaccination.
English descriptors
- KwdEn :
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Antibodies, Viral (blood), Antibodies, Viral (immunology), British Columbia (epidemiology), Child, Child, Preschool, Female, Hemagglutination Inhibition Tests, Humans, Infant, Influenza A Virus, H1N1 Subtype (immunology), Influenza Vaccines (immunology), Influenza Vaccines (therapeutic use), Influenza, Human (immunology), Influenza, Human (prevention & control), Male, Middle Aged, Pandemics (prevention & control), Pandemics (statistics & numerical data), Vaccination (statistics & numerical data), Young Adult.
- MESH :
- chemical , blood : Antibodies, Viral.
- chemical , immunology : Antibodies, Viral, Influenza Vaccines.
- geographic , epidemiology : British Columbia.
- immunology : Influenza A Virus, H1N1 Subtype, Influenza, Human.
- prevention & control : Influenza, Human, Pandemics.
- statistics & numerical data : Pandemics, Vaccination.
- chemical , therapeutic use : Influenza Vaccines.
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Hemagglutination Inhibition Tests, Humans, Infant, Male, Middle Aged, Young Adult.
Abstract
BACKGROUND
Before pandemic (H1N1) 2009, less than 10% of serum samples collected from all age groups in the Lower Mainland of British Columbia, Canada, showed seroprotection against the pandemic (H1N1) 2009 virus, except those from very elderly people. We reassessed this profile of seroprotection by age in the same region six months after the fall 2009 pandemic and vaccination campaign.
METHODS
We evaluated 100 anonymized serum samples per 10-year age group based on convenience sampling. We measured levels of antibody against the pandemic virus by hemagglutination inhibition and microneutralization assays. We assessed geometric mean titres and the proportion of people with seroprotective antibody levels (hemagglutination inhibition titre ≥ 40). We performed sensitivity analyses to evaluate titre thresholds of 80, 20 and 10.
RESULTS
Serum samples from 1127 people aged 9 months to 101 years were obtained. The overall age-standardized proportion of people with seroprotective antibody levels was 46%. A U-shaped age distribution was identified regardless of assay or titre threshold applied. Among those less than 20 years old and those 80 years and older, the prevalence of seroprotection was comparably high at about 70%. Seroprotection was 44% among those aged 20-49 and 30% among those 50-79 years. It was lowest among people aged 70-79 years (21%) and highest among those 90 years and older (88%).
INTERPRETATION
We measured much higher levels of seroprotection after the 2009 pandemic compared than before the pandemic, with a U-shaped age distribution now evident. These findings, particularly the low levels of seroprotection among people aged 50-79 years, should be confirmed in other settings and closer to the influenza season.
DOI: 10.1503/cmaj.100910
PubMed: 20956500
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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Skowronski</name><affiliation wicri:level="1"><nlm:affiliation>BC Centre for Disease Control, Vancouver, BC. danuta.skowronski@bccdc.ca</nlm:affiliation><country wicri:rule="url">Canada</country></affiliation></author><author><name sortKey="Hottes, Travis S" sort="Hottes, Travis S" uniqKey="Hottes T" first="Travis S" last="Hottes">Travis S. Hottes</name></author><author><name sortKey="Janjua, Naveed Z" sort="Janjua, Naveed Z" uniqKey="Janjua N" first="Naveed Z" last="Janjua">Naveed Z. Janjua</name></author><author><name sortKey="Purych, Dale" sort="Purych, Dale" uniqKey="Purych D" first="Dale" last="Purych">Dale Purych</name></author><author><name sortKey="Sabaiduc, Suzana" sort="Sabaiduc, Suzana" uniqKey="Sabaiduc S" first="Suzana" last="Sabaiduc">Suzana Sabaiduc</name></author><author><name sortKey="Chan, Tracy" sort="Chan, Tracy" uniqKey="Chan T" first="Tracy" last="Chan">Tracy Chan</name></author><author><name sortKey="De Serres, Gaston" sort="De Serres, Gaston" uniqKey="De Serres G" first="Gaston" last="De Serres">Gaston De Serres</name></author><author><name sortKey="Gardy, Jennifer" sort="Gardy, Jennifer" uniqKey="Gardy J" first="Jennifer" last="Gardy">Jennifer Gardy</name></author><author><name sortKey="Mcelhaney, Janet E" sort="Mcelhaney, Janet E" uniqKey="Mcelhaney J" first="Janet E" last="Mcelhaney">Janet E. Mcelhaney</name></author><author><name sortKey="Patrick, David M" sort="Patrick, David M" uniqKey="Patrick D" first="David M" last="Patrick">David M. Patrick</name></author><author><name sortKey="Petric, Martin" sort="Petric, Martin" uniqKey="Petric M" first="Martin" last="Petric">Martin Petric</name></author></analytic><series><title level="j">CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne</title><idno type="eISSN">1488-2329</idno><imprint><date when="2010" type="published">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Age Factors</term><term>Aged</term><term>Aged, 80 and over</term><term>Antibodies, Viral (blood)</term><term>Antibodies, Viral (immunology)</term><term>British Columbia (epidemiology)</term><term>Child</term><term>Child, Preschool</term><term>Female</term><term>Hemagglutination Inhibition Tests</term><term>Humans</term><term>Infant</term><term>Influenza A Virus, H1N1 Subtype (immunology)</term><term>Influenza Vaccines (immunology)</term><term>Influenza Vaccines (therapeutic use)</term><term>Influenza, Human (immunology)</term><term>Influenza, Human (prevention & control)</term><term>Male</term><term>Middle Aged</term><term>Pandemics (prevention & control)</term><term>Pandemics (statistics & numerical data)</term><term>Vaccination (statistics & numerical data)</term><term>Young Adult</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Anticorps antiviraux (immunologie)</term><term>Anticorps antiviraux (sang)</term><term>Colombie-Britannique (épidémiologie)</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Facteurs de l'âge</term><term>Femelle</term><term>Grippe humaine ()</term><term>Grippe humaine (immunologie)</term><term>Humains</term><term>Jeune adulte</term><term>Mâle</term><term>Nourrisson</term><term>Pandémies ()</term><term>Sous-type H1N1 du virus de la grippe A (immunologie)</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Tests d'inhibition de l'hémagglutination</term><term>Vaccination ()</term><term>Vaccins antigrippaux (immunologie)</term><term>Vaccins antigrippaux (usage thérapeutique)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Antibodies, Viral</term></keywords><keywords scheme="MESH" type="chemical" qualifier="immunology" xml:lang="en"><term>Antibodies, Viral</term><term>Influenza Vaccines</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>British Columbia</term></keywords><keywords scheme="MESH" qualifier="immunologie" xml:lang="fr"><term>Anticorps antiviraux</term><term>Grippe humaine</term><term>Sous-type H1N1 du virus de la grippe A</term><term>Vaccins antigrippaux</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>Influenza A Virus, H1N1 Subtype</term><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Influenza, Human</term><term>Pandemics</term></keywords><keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Anticorps antiviraux</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Pandemics</term><term>Vaccination</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Influenza Vaccines</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Vaccins antigrippaux</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Colombie-Britannique</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Age Factors</term><term>Aged</term><term>Aged, 80 and over</term><term>Child</term><term>Child, Preschool</term><term>Female</term><term>Hemagglutination Inhibition Tests</term><term>Humans</term><term>Infant</term><term>Male</term><term>Middle Aged</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Facteurs de l'âge</term><term>Femelle</term><term>Grippe humaine</term><term>Humains</term><term>Jeune adulte</term><term>Mâle</term><term>Nourrisson</term><term>Pandémies</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Tests d'inhibition de l'hémagglutination</term><term>Vaccination</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Before pandemic (H1N1) 2009, less than 10% of serum samples collected from all age groups in the Lower Mainland of British Columbia, Canada, showed seroprotection against the pandemic (H1N1) 2009 virus, except those from very elderly people. We reassessed this profile of seroprotection by age in the same region six months after the fall 2009 pandemic and vaccination campaign.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>We evaluated 100 anonymized serum samples per 10-year age group based on convenience sampling. We measured levels of antibody against the pandemic virus by hemagglutination inhibition and microneutralization assays. We assessed geometric mean titres and the proportion of people with seroprotective antibody levels (hemagglutination inhibition titre ≥ 40). We performed sensitivity analyses to evaluate titre thresholds of 80, 20 and 10.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Serum samples from 1127 people aged 9 months to 101 years were obtained. The overall age-standardized proportion of people with seroprotective antibody levels was 46%. A U-shaped age distribution was identified regardless of assay or titre threshold applied. Among those less than 20 years old and those 80 years and older, the prevalence of seroprotection was comparably high at about 70%. Seroprotection was 44% among those aged 20-49 and 30% among those 50-79 years. It was lowest among people aged 70-79 years (21%) and highest among those 90 years and older (88%).</p></div><div type="abstract" xml:lang="en"><p><b>INTERPRETATION</b></p><p>We measured much higher levels of seroprotection after the 2009 pandemic compared than before the pandemic, with a U-shaped age distribution now evident. These findings, particularly the low levels of seroprotection among people aged 50-79 years, should be confirmed in other settings and closer to the influenza season.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">20956500</PMID><DateCompleted><Year>2010</Year><Month>12</Month><Day>17</Day></DateCompleted><DateRevised><Year>2018</Year><Month>11</Month><Day>13</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1488-2329</ISSN><JournalIssue CitedMedium="Internet"><Volume>182</Volume><Issue>17</Issue><PubDate><Year>2010</Year><Month>Nov</Month><Day>23</Day></PubDate></JournalIssue><Title>CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne</Title><ISOAbbreviation>CMAJ</ISOAbbreviation></Journal><ArticleTitle>Prevalence of seroprotection against the pandemic (H1N1) virus after the 2009 pandemic.</ArticleTitle><Pagination><MedlinePgn>1851-6</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1503/cmaj.100910</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Before pandemic (H1N1) 2009, less than 10% of serum samples collected from all age groups in the Lower Mainland of British Columbia, Canada, showed seroprotection against the pandemic (H1N1) 2009 virus, except those from very elderly people. We reassessed this profile of seroprotection by age in the same region six months after the fall 2009 pandemic and vaccination campaign.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">We evaluated 100 anonymized serum samples per 10-year age group based on convenience sampling. We measured levels of antibody against the pandemic virus by hemagglutination inhibition and microneutralization assays. We assessed geometric mean titres and the proportion of people with seroprotective antibody levels (hemagglutination inhibition titre ≥ 40). We performed sensitivity analyses to evaluate titre thresholds of 80, 20 and 10.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Serum samples from 1127 people aged 9 months to 101 years were obtained. The overall age-standardized proportion of people with seroprotective antibody levels was 46%. A U-shaped age distribution was identified regardless of assay or titre threshold applied. Among those less than 20 years old and those 80 years and older, the prevalence of seroprotection was comparably high at about 70%. Seroprotection was 44% among those aged 20-49 and 30% among those 50-79 years. It was lowest among people aged 70-79 years (21%) and highest among those 90 years and older (88%).</AbstractText><AbstractText Label="INTERPRETATION" NlmCategory="CONCLUSIONS">We measured much higher levels of seroprotection after the 2009 pandemic compared than before the pandemic, with a U-shaped age distribution now evident. These findings, particularly the low levels of seroprotection among people aged 50-79 years, should be confirmed in other settings and closer to the influenza season.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Skowronski</LastName><ForeName>Danuta M</ForeName><Initials>DM</Initials><AffiliationInfo><Affiliation>BC Centre for Disease Control, Vancouver, BC. danuta.skowronski@bccdc.ca</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hottes</LastName><ForeName>Travis S</ForeName><Initials>TS</Initials></Author><Author ValidYN="Y"><LastName>Janjua</LastName><ForeName>Naveed Z</ForeName><Initials>NZ</Initials></Author><Author ValidYN="Y"><LastName>Purych</LastName><ForeName>Dale</ForeName><Initials>D</Initials></Author><Author ValidYN="Y"><LastName>Sabaiduc</LastName><ForeName>Suzana</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Chan</LastName><ForeName>Tracy</ForeName><Initials>T</Initials></Author><Author ValidYN="Y"><LastName>De Serres</LastName><ForeName>Gaston</ForeName><Initials>G</Initials></Author><Author ValidYN="Y"><LastName>Gardy</LastName><ForeName>Jennifer</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>McElhaney</LastName><ForeName>Janet E</ForeName><Initials>JE</Initials></Author><Author ValidYN="Y"><LastName>Patrick</LastName><ForeName>David M</ForeName><Initials>DM</Initials></Author><Author ValidYN="Y"><LastName>Petric</LastName><ForeName>Martin</ForeName><Initials>M</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2010</Year><Month>10</Month><Day>18</Day></ArticleDate></Article><MedlineJournalInfo><Country>Canada</Country><MedlineTA>CMAJ</MedlineTA><NlmUniqueID>9711805</NlmUniqueID><ISSNLinking>0820-3946</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000914">Antibodies, Viral</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007252">Influenza Vaccines</NameOfSubstance></Chemical></ChemicalList><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000293" MajorTopicYN="N">Adolescent</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000367" MajorTopicYN="N">Age Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000914" MajorTopicYN="N">Antibodies, Viral</DescriptorName><QualifierName UI="Q000097" MajorTopicYN="N">blood</QualifierName><QualifierName UI="Q000276" MajorTopicYN="Y">immunology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001955" MajorTopicYN="N" Type="Geographic">British Columbia</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002648" MajorTopicYN="N">Child</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002675" MajorTopicYN="N">Child, Preschool</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006385" MajorTopicYN="N">Hemagglutination Inhibition Tests</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007223" MajorTopicYN="N">Infant</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D053118" MajorTopicYN="N">Influenza A Virus, H1N1 Subtype</DescriptorName><QualifierName UI="Q000276" MajorTopicYN="Y">immunology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007252" MajorTopicYN="N">Influenza Vaccines</DescriptorName><QualifierName UI="Q000276" MajorTopicYN="N">immunology</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007251" MajorTopicYN="N">Influenza, Human</DescriptorName><QualifierName UI="Q000276" MajorTopicYN="Y">immunology</QualifierName><QualifierName UI="Q000517" MajorTopicYN="N">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName><QualifierName UI="Q000517" MajorTopicYN="N">prevention & control</QualifierName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D014611" MajorTopicYN="N">Vaccination</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2010</Year><Month>10</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate 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IdType="pubmed">19887665</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></pubmed><affiliations><list><country><li>Canada</li></country></list><tree><noCountry><name sortKey="Chan, Tracy" sort="Chan, Tracy" uniqKey="Chan T" first="Tracy" last="Chan">Tracy Chan</name><name sortKey="De Serres, Gaston" sort="De Serres, Gaston" uniqKey="De Serres G" first="Gaston" last="De Serres">Gaston De Serres</name><name sortKey="Gardy, Jennifer" sort="Gardy, Jennifer" uniqKey="Gardy J" first="Jennifer" last="Gardy">Jennifer Gardy</name><name sortKey="Hottes, Travis S" sort="Hottes, Travis S" uniqKey="Hottes T" first="Travis S" last="Hottes">Travis S. Hottes</name><name sortKey="Janjua, Naveed Z" sort="Janjua, Naveed Z" uniqKey="Janjua N" first="Naveed Z" last="Janjua">Naveed Z. Janjua</name><name sortKey="Mcelhaney, Janet E" sort="Mcelhaney, Janet E" uniqKey="Mcelhaney J" first="Janet E" last="Mcelhaney">Janet E. Mcelhaney</name><name sortKey="Patrick, David M" sort="Patrick, David M" uniqKey="Patrick D" first="David M" last="Patrick">David M. Patrick</name><name sortKey="Petric, Martin" sort="Petric, Martin" uniqKey="Petric M" first="Martin" last="Petric">Martin Petric</name><name sortKey="Purych, Dale" sort="Purych, Dale" uniqKey="Purych D" first="Dale" last="Purych">Dale Purych</name><name sortKey="Sabaiduc, Suzana" sort="Sabaiduc, Suzana" uniqKey="Sabaiduc S" first="Suzana" last="Sabaiduc">Suzana Sabaiduc</name></noCountry><country name="Canada"><noRegion><name sortKey="Skowronski, Danuta M" sort="Skowronski, Danuta M" uniqKey="Skowronski D" first="Danuta M" last="Skowronski">Danuta M. 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