[Epidemic problems of measles and mumps inoculation].
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Biomedical subjects
Publications and source records attributed to H Allerdist.
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In Hamburg 18 cases of neurological complications following vaccination with live measles virus vaccine (including 2 cases of abortive encephalopathy) have been observed between 1971--1978. A causal connection was assumed in 14 cases, that means an incidence of 1 neurological complication per 2,500 vaccinees and an incidence of 1 abortive encephalopathy per 17,650 vaccinees. These results differ from studies of various countries which used the same vaccine strain (Schwarz). Clinical symptoms, age distribution and incubation period are demonstrated. The prognosis seems to be good; the risk of vaccination compared to the risk following original measles is between 1:10 (convulsions) and 1:18 (encephalopathy).
Within 11 days following vaccination with live virus vaccine in Hamburg 18 cases of neurological complications have been observed between 1971--1977, including 2 cases of abortive encephalitis. A causal connection was assumed only when the onset of symptoms was later than on the 7th day after the vaccination. The following parameters were evaluated; clinical symptoms, laboratory data, seasonal distribution of the neurological complications and their relationship to the total number of vaccinations, and the different results of studies from various countries using the same vaccine strain (Schwarz). The age disposition to convulsions following measles vaccination is comparable to convulsive reactions after smallpox vaccination.
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The authors studied the seroconversion of 307 children, 1-11 years old, induced by Mumpsvax (136 children) and a bivalent mumps-measles vaccine (strain Jeryl Lynn/strain Moraten; 171 vaccines) by the HI-test. The seroconversion induced by the measles component of the bivalent vaccine covered 96.3% of the seronegatives prior to immunization. The comparable values for mumps antibodies were lower (Mumpsvax:80.6%; bivlant vaccine: 82.2%). An increase in titer in seropositive children was obtained in 57.1% after immunization with Mumpsvax and in 50.8% with the bivalent vaccine. Comparative studies to investigate the sensitivity of the HI-test versus the neutralisation test (NT) showed the greater accuracy of the latter. Before the vaccination with Mumpsvax, only 26.6% of 60 sera studied were found to be seronegative, whilst the NT gave a more reliable figure (55%). Similar data were found in 62 sera before immunization with the bivalent vaccine (HI-test: 33.8%; NT:66.1% seronegative). The seroconversion rates were slightly higher when the NT had been used: 75.6% (bivalent) and 81.8% (monovalent vaccine) versus 75.6% and 75%, respectively, by the HI-test.
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The clinical aspects and differential diagnosis of 11 neural complications following influenza vaccination (Guillain-Barré syndrome, serogenetic polyneuritis, encephalomyelitis) are discussed. Etiopathogenetically a hypersensitivity to components in the serum must be taken into consideration, as a case with anaphylactoid reaction shows. The incubation period of the remaining cases (beginning only after the 4th day post vaccination) is on the other hand consistent with the assumption of a pathomechanism rather like that of serum sickness. The number of influenza vaccinations previously administered in the individual case bears no relation to the neurological disturbances described. Vaccines of different manufacture can, in the same way, provoke these rare inoculation complications (frequency: 1 case per 0.7-1.3 mio vaccinations). The indication for influenza vaccinations is not limited by these occurrences.
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A study of measles was undertaken from the case histories of 3 093 children under 15 years of age, treated in the children's clinics of Hamburg between 1960 to 1973. 562 children were suffering from pneumonia (18,2%), 230 had otitis (7,4%) and 229 (7,4%) showed neural affections (143 cases with fits and 86 patients with encephalopathy or encephalitis), Various parameters were analysed: age, sex, seasonal distribution, fatality, age disposition to convulsions and measles encephalitis, "incubation period" of neural affections, sequelae. Permanent sequelae due to measles encephalitis were seen in 14% of the cases. A plea is made for an universal immunisation against measles.
The local and general reactions of 489 individuals vaccinated with an adsorbed killed influenza vaccine (containing A/New Jersey 8/76, A/Victoria 3/75, B/Hong kong 8/73 antigens) were studied on the fourth day after vaccination. 179 participants were vaccinated by syringe, the rest by jet injector. Local indurations were observed in 7.3% of participants injected by needle versus 14.1% to 19.5%, respectively in individuals immunized with two different jet guns (Lodi, Scherer). 2 ulcerations on the injection site were found in the jet group. Complaints about local sensations were much fewer in the group injected by needle (2.8%) than in the groups injected by jet injectors (11.8-14.1%). Postvaccinal systemic reactions were similar (between 8.5-11.2%) in both groups. Febrile reactions were altogether low (2.8%).