Gram-negative bacilli frequently cause epidemics in high-risk newborn intensive care units. Recently, an epidemic caused by a multiply-resistant K. pneumoniae, serotype 21, occurred in the Vanderbilt University intensive care nursery. The background of this outbreak included an increasing endemic nosocomial sepsis rate, operation of the facility in excess of rated capacity, and increasingly inadequate nurse-to-patient staffing ratios. The epidemic lasted 11 weeks; 26 (12%) of the 232 infants at risk in the unit became colonized. Five infants developed systemic illness and one died. Cohorting, reinforcement of strict handwashing and isolation procedures, and closure of the unit to outborn admissions resulted in rapid termination of the outbreak. Followup studies performed on infants colonized with the epidemic bacterium demonstrated persistent fecal shedding up to 13 months following discharge from the hospital. This epidemic had a detrimental influence on high-risk newborn and obstetric health care delivery in an area encompassing portions of three states. Under a system of progressively more sophisticated referral units, nosocomial infections occurring at a tertiary center can have an impact on other hospitals within the network.

Carrier State↗

PubMedDate not supplied

Control of acute lower respiratory illness in the developing world: an assessment of vaccine intervention.

The major bacterial and viral causes of morbidity and death due to acute lower respiratory infection (ALRI) in the developing world are amenable to control by vaccines. Initially, full use of measles, pertussis, and diphtheria vaccines, in appropriately scheduled programs, can make an immediate contribution to the reduction of severe respiratory infection. Emerging technologies offer the promise of vaccines against bacterial and viral respiratory pathogens that are suitable for infants and children in developing countries. These technologic advances include the use of protein-polysaccharide conjugates of endemic serotypes for Haemophilus influenzae and Streptococcus pneumoniae vaccines and new approaches to the use of purified protein components or attenuated live virus with respiratory syncytial virus and paramyxovirus vaccines. Such vaccines should soon be available for evaluation in developing countries. It is timely to embark upon a program of development, evaluation, and worldwide deployment of vaccines for the control of ALRI.

Acute Disease↗

PubMedDate not supplied

Pathogenesis and prevention of childhood pneumonia in developing countries: recommendations.

Recommendations are presented that emerged from the Conference on the Pathogenesis and Prevention of Pneumonia in Children in Developing Regions held 21-23 August 1989 in Bellagio, Italy. The conference recommendations embrace three major areas: first, the biology, epidemiology, and clinical manifestation of important etiologic agents causing acute lower respiratory infection (ALRI); second, the evaluation of risk factors affecting ALRI in the developing world necessary for planning intervention strategies in diverse ecologic settings; and third, the generation of targeted research questions that will translate into available safe and effective vaccines capable of controlling ALRI-related morbidity and mortality.

Bacterial Vaccines↗

PubMedDate not supplied

Inactivated influenza A/New Jersey/76 vaccines in children: results of a mult-center trial.

Explore the source record for details and available documents.

Adolescent↗

PubMedDate not supplied

Live attenuated influenza vaccines in young seronegative children.

Seronegative children undergoing primary infection sensitively reflect the residual virulence of an experimental attenuated respiratory vitral vaccine. Two temperature sensitive (ts) A/Hong Kong influenza vaccines derived following chemical mutagenesis of a cloned stock of A/Great Lakes/65 have been evaluated in vaccine trials in seronegative children. The two vaccines, ts-1[A] and ts 1[E], differ in their laboratory characteristics. Ts-1[A] has a lower shut-off temperature, 37 degrees C vs 38 degrees C, and more limited replication in the Syrian hamster model system than ts-1[E]. In A/HK seronegative adults ts-1[A] is noninfectious whereas ts-1[E] will replicate and induce an antibody response. The genetic lesion of ts-1[A] was stable in the young child; in contrast, late in the course of virus shedding, ts-1[E] exhibited genetic instability with 4 individuals shedding virus which had lost the ts marker. Transmission to controls was rare with both vaccines being observed in only 1 of 5 controls with ts-1[A] and none of six controls with ts-1[E]. There were no respiratory symptoms associated with ts-1[A] vaccine virus shedding. Ts-1[E] virus shedding had a suggestive association with fever and cough in the seronegative child. The trials in seronegative children extent and confirm the inherent differences between ts-1[A] and ts-1[E] vaccine strains and support the concept that laboratory markers of attenuation are predictive of vaccine behavior in the seronegative child.

Administration, Intranasal↗