['Cephalosporinosis", an epidemic among Finnish physicians?].
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Cephalosporins↗
Biomedical subjects
H Peltola
Publications and source records attributed to H Peltola.
Serum C-reactive protein vs. tumor necrosis factor alpha and interleukin 1 beta of the cerebrospinal fluid in diagnosis of bacterial meningitis with low cerebrospinal fluid cell count.
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C-Reactive Protein↗
Prevention of travellers' diarrhoea by oral B-subunit/whole-cell cholera vaccine.
B-subunit/whole-cell cholera vaccine (BS-WC) has been shown to give Bangladeshi mothers and children only 3 months' protection against severe diarrhoea due to enterotoxigenic Escherichia coli (ETEC). Since a long-lasting effect is not necessary for protection against travellers' diarrhoea, a prospective double-blind study was conducted among tourists who went to Morocco from Finland. 307 tourists received two oral doses of BS-WC, whereas 308 controls received a placebo before departure. A research team went out with tourists and a laboratory for enteric pathogens was set up on location. A faecal specimen was taken from 100 randomly selected subjects before departure, from all travellers with diarrhoea, and routinely after return. Enteropathogenic bacteria were not isolated from any of the pre-departure specimens but were present during or after the holiday in 47% of tourists with travellers' diarrhoea, and in 14% of those without diarrhoea. BS-WC induced a 52% protection (p = 0.013) against diarrhoea caused by ETEC. The protection was better for mixed infections (65%, p = 0.016). The protective efficacy against a combination of ETEC and any other pathogen was 71% (p = 0.02), and that against ETEC plus Salmonella enterica even better at 82% (p = 0.01). Partial protection against travellers' diarrhoea is thus obtainable by active immunisation with BS-WC.
Administration, Oral↗
Severity of childhood bacterial meningitis and duration of illness before diagnosis.
Rapid diagnosis of childhood bacterial meningitis (BM) is generally believed to be essential to avoid poor outcome. To see whether duration of illness before admission to hospital was related to the severity of illness, data from children with BM diagnosed in 18 paediatric hospitals in Finland from 1984 to 1989 were collected prospectively. We divided 286 cases with culture-positive cerebrospinal fluid (CSF) into three groups: BM with a history of up to 24 h (short-history group, n = 141), of more than 24 h and up to 48 h (intermediate-history group, n = 75), and of more than 48 h (long-history group, n = 70). The longer the history, the better the clinical condition of the child. If symptoms or signs of BM lasted 48 h or less, the child did significantly worse, as judged by seven variables, than if the history was longer than 48 h (level of consciousness, p less than 0.001; seizures, p less than 0.01; CSF protein concentration, p less than 0.001; positive CSF gram-stain, p less than 0.01; positive blood culture, p less than 0.05 in Haemophilus influenzae meningitis; serum C-reactive protein, p less than 0.01 between intermediate-history and long-history groups; and urine sodium concentration, p less than 0.001). The differences were not affected by causative organism, sex, age, or preadmission oral antimicrobial agents. The findings show that if BM follows an insidious pattern of disease, diagnostic delay may be unavoidable, which may have medicolegal implications.
Adolescent↗
Increase of vaccination coverage by mass media and individual approach: intensified measles, mumps, and rubella prevention program in Finland.
In the 1970s, mass vaccination projects were started in various parts of the world against measles and congenital rubella, with eradication as the final goal. In many developing and industrial countries, including Finland, the elimination of measles failed because of low vaccination coverage. In Finland, a combined measles, mumps, and rubella (Virivac) vaccination program was started in 1982. Computerized recording of the vaccinated children was considered necessary and was integrated with the population registry to identify the hard-to-reach families. Several interventions improved compliance: a mass media campaign and notification of nonvaccinated children to local health professionals and parents. All successive campaigns increased vaccination coverage significantly, with the notification of parents about their nonvaccinated child being especially effective. A vaccination coverage of over 96% was achieved, which theoretically prevents measles, mumps, and rubella transmission.
Child↗
Antibody responses to four Haemophilus influenzae type b conjugate vaccines.
Serum antibody responses to four Haemophilus influenzae type b capsular polysaccharide-protein conjugate vaccines (PRP-D, HbOC, C7p, and PRP-T) were studied and compared in 175 infants, 85 adults and 140 2-year-old children. Antibodies to the H influenzae type b polysaccharide vaccines were determined with a Farr-type radioimmunoassay. The infants received two doses of vaccine at the ages of 4 and 6 months. After the first dose of vaccine, the geometric mean antibody concentration measured at the age of 6 months was 0.09 to 0.10 mg/L, only marginally higher than that measured before immunization in all infants who had received PRP-D, HbOC, or C7p but increased to 0.82 mg/L in those who had received PRP-T. One month after the second dose, the geometric mean antibody concentration was increased in all vaccine groups. No significant differences were noted between recipients of HbOC, C7p, or PRP-T (geometric mean antibody concentrations, 4.32, 3.10, and 6.10 mg/L, respectively), whereas the PRP-D recipients had a significantly lower geometric mean antibody concentration (0.63 mg/L). In contrast, PRP-D, HbOC, C7p, and PRP-T were all highly immunogenic in adults, with no differences noted among them. The 2-year-old children also responded to one dose of these vaccines with a high antibody concentration.
Adult↗
Experience in Finland with Haemophilus influenzae type b vaccines.
The importance of Haemophilus influenzae type b (Hib) as the leading cause of bacteraemic infections in children was recognized in the early 1970s in Finland. An efficacy trial with the capsular polysaccharide vaccine demonstrated the efficacy of this first generation vaccine, but only from ages 18-24 months onwards. For this reason, since 1983 new polysaccharide-protein conjugate vaccines (PRP-D, HbOC, and PRP-T) have been extensively tested. These studies have shown that conjugate vaccines are immunogenic in early infancy and are capable of generating a lasting immunological memory. A second Hib vaccine efficacy trial in 1986-1987 showed that the conjugate vaccine (PRP-D) was 90% efficacious after the primary immunization series at 3, 4 and 6 months. After a booster dose at 14-18 months, no failure cases have occurred during the follow-up period. The same level of protection seems to be true also in a subsequent trial, where two Hib conjugate vaccines (PRP-D or HbOC) were given at 4, 6 and 14-18 months. These vaccinations have led to a significant decline in the number of invasive Hib infections in young children.
Antibodies, Bacterial↗
Serum C-reactive protein in childhood meningitis in countries with limited laboratory resources: a Chilean experience.
Quantitative C-reactive protein (CRP) was determined sequentially by nephelometry and photometry from a finger prick serum sample in 67 children with bacterial meningitis (BM) and 16 children with aseptic meningitis (AM). The initial mean CRP value of 180 mg/liter in children with BM differed significantly from the 12 mg/liter found in those with AM (P less than 0.001). In BM a slow descent instead of rapid normalization or a secondary increase in sequential CRP values were early indicators of complications during recovery, such as resistance to the antibiotic. A significant difference in the mean CRP values between uneventful and complicated courses of BM was observed from the fourth day on (P less than 0.001). The measurements obtained with nephelometry correlated reliably with the more widely available photometry (r = 0.99). Easily performed rapid CRP determinations can considerably improve the quality of care in meningitis patients, especially in those situations where facilities for performing bacterial cultures or antibiotic susceptibility testing are not available.
C-Reactive Protein↗
Types of fluid disorder in children with bacterial meningitis.
As part of a prospective study of children with bacterial meningitis we analyzed in 36 patients of our hospital the fluid balance on admission and during the first three days of treatment. On admission 10 of them (28%) had inappropriate antidiuretic hormone secretion SIADH, 10 (28%) hypo-osmolal and 10 (28%) iso-osmolal contraction. Six patients (17%) had no clear fluid disorder. The patients with SIADH had significantly lower mean serum NA+ (127 vs. 132 mEq/l, p less than 0.01) and higher mean urine Na+ (111 vs. 26 mEq/l, p less than 0.01) concentration as well as higher mean urinary Na+/K+ ratio (2.23 vs. 0.365, p less than 0.005) than the patients with hypo-osmolal contraction. They also tended to be younger and have a shorter history of fever. The patients with SIADH had a less strict fluid restriction than the patients with hypo-osmolal contraction, and their fluid balance normalized more slowly. Our findings support initial water restriction for all children with bacterial meningitis.
Child↗
[Antimicrobial treatment of severe bacterial infections].
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Anti-Bacterial Agents↗
A randomized, prospective field trial of a conjugate vaccine in the protection of infants and young children against invasive Haemophilus influenzae type b disease.
BACKGROUND: Haemophilus influenzae type b is the leading cause of invasive bacterial disease in young children. The capsular polysaccharide vaccine does not protect children at greatest risk (those under the age of 18 months), but a polysaccharide-protein conjugate vaccine has proved to be more immunogenic in this age group. METHODS: We enrolled 114,000 infants in Finland in an open, prospective, randomized trial of a H. influenzae type b capsular polysaccharide-diphtheria toxoid conjugate vaccine (polyribosylribitol phosphate-diphtheria toxoid [PRP-D]). Children born on odd-numbered days were vaccinated at the ages of 3, 4, 6, and 14 to 18 months; those born on even-numbered days formed the control group and received the same vaccine at the age of 24 months. RESULTS: After three doses of the vaccine there were 4 cases of verified bacteremic H. influenzae type b disease in the group receiving early vaccination, as compared with 64 cases in the control group, between the ages of approximately 7 and 24 months. The protective efficacy of the vaccine was thus 94 percent (95 percent confidence interval, 83 to 98). No serious adverse effects were reported. The immune response to the conjugate vaccine was characteristic of a T-cell-dependent response when studied in a cohort of 120 infants. The primary immunization series resulted in a geometric mean concentration of anticapsular antibody of 0.53 micrograms per milliliter at the age of seven months, and the fourth dose evoked an anamnestic response, with a mean antibody concentration of 45.22 micrograms per milliliter. CONCLUSIONS: A new conjugate vaccine consisting of the capsular polysaccharide of H. influenzae type b covalently linked to a protein carrier (PRP-D), administered to infants beginning at the age of 3 months, is highly effective in protecting young Finnish children (7 to 24 months old) against invasive H. influenzae type b infections.
Age Factors↗
Reactogenicity and immunogenicity of combined vaccines for bacteraemic diseases caused by Haemophilus influenzae type b, meningococci and pneumococci in 24-month-old children.
To find a wide spectrum vaccine against bacteraemic disease in childhood, we immunized 293 Finnish children at 24 months of age intramuscularly with different combinations of the currently available vaccines, namely Haemophilus influenzae type b polysaccharide-protein conjugate vaccine (PRP-D) mixed with meningococcal and/or pneumococcal capsular polysaccharide vaccines. All the vaccines were immunogenic. The increase in antibody concentration after vaccinations was not affected by the number of polysaccharide antigens. Although no serious reactions were seen, the frequency of both local and fever reactions was greater in groups that received several vaccine antigens. Halving of the vaccine dose decreased the reactogenicity without impairing the immunogenicity.
Bacterial Infections↗
Septic Haemophilus influenzae polyarthritis demonstrated best with Tc-99m HMPAO labeled leukocytes.
A 5-year-old girl with fever and tenderness in her left wrist and right ankle was hospitalized. Bone scanning and Tc-99m labeled leukocyte imaging showed increased uptake in these joints and also in her left knee. These radionuclide methods helped determine the diagnosis and were superior to plain radiography and CT scanning. Uptake was greater on leukocyte imaging than it was on the bone scan. The patient had infectious polyarthritis caused by Haemophilus influenzae, which is a very rare cause of acute polyarthritis in children older than 2 years. The patient fully recovered with antibiotic therapy, and no surgical procedure was needed.
Ankle Joint↗
Clinical experience with Haemophilus influenzae type b conjugate vaccines.
The importance of Haemophilus influenzae type b as the main cause of serious bacteremic infections in young children and the consequent need for preventive measures have been widely appreciated since the 1970s. The knowledge that serum antibodies to the polysaccharide capsule of H influenzae type b increase with age and correlate with resistance to this infection encouraged work toward a vaccine based on the H influenzae type b polysaccharide. Such a vaccine was used in 1974 in a field trial in Finland. Two important lessons were learned. First, vaccine-induced antibodies to the polyribosylribitol-phosphate (PRP) polysaccharide correlated with protection from disease caused by H influenzae type b, so that the serum anti-PRP concentration predicting protection could be estimated as 1 microgram/mL. Second, the vaccine was not effective in infancy; protection and serum antibody concentrations above 1 microgram/mL were not observed before 18 to 24 months of age. The poor immunogenicity of PRP in infancy has been observed in a large number of studies and is shared by other bacterial polysaccharides. Although the reason for this is not known, the most likely hypothesis associates poor immunizing ability in infancy with the "T-independent" nature of these polysaccharide antigens. Such antigens would be unable to stimulate T lymphocytes; therefore, immunity to them would depend exclusively on B cells and antibodies produced by them. If infants, by and large, lack B cells that could be stimulated directly by a polysaccharide antigen, they cannot respond to the polysaccharide vaccine. This hypothesis immediately suggests possibilities for improvement of the vaccine.(ABSTRACT TRUNCATED AT 250 WORDS)
Antibodies, Bacterial↗
[Treatment of bacterial meningitis in Finland].
The Finnish recommendations for treatment of bacterial meningitis are reported in this article. A new Finnish study is the only one to present a randomised comparison of the advantages and disadvantages inherent in four major drugs against meningitis.
Adolescent↗
[Finnish eradication of measles, mumps and rubella].
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Finland↗
Randomised comparison of chloramphenicol, ampicillin, cefotaxime, and ceftriaxone for childhood bacterial meningitis. Finnish Study Group.
In a multicentre study, 220 consecutive cases of bacterial meningitis in children older than 3 months were randomised to treatment with chloramphenicol, ampicillin (initially with chloramphenicol), cefotaxime, or ceftriaxone. The drugs were given in four equal daily doses for 7 days, except ceftriaxone which was given only once daily. 200 cases could be assessed; the causative organisms were Haemophilus influenzae type b (Hib) in 146; meningococci (Mnc) in 32; pneumococci (Pnc) in 13; and other or unknown in 9. In patients with Hib meningitis, sterilisation of the cerebrospinal fluid occurred most rapidly with ceftriaxone. Otherwise, in terms of overall clinical recovery, normalisation of laboratory indices, clinically significant adverse reactions, toxic effects, sequelae, and mortality rate, the treatment groups were very similar. However, there were 4 bacteriological failures, all in the chloramphenicol group. Also, the treatment was extended or changed in more cases in the chloramphenicol group than in the other groups. Chloramphenicol was thus inferior to the other three antimicrobials. Ampicillin is a good and cheap alternative, but there are difficulties with resistance. Easy administration tempts the use of ceftriaxone rather than cefotaxime but it causes diarrhoea. A 7-day course of ampicillin, cefotaxime, or ceftriaxone is sufficient in Hib, Mnc, or Pnc meningitis.
Adolescent↗
Sero- and subtypes of group B meningococci causing invasive infections in Finland in 1976-87.
Neisseria meningitidis group B (MenB) strains isolated from 1976 to 1987 in Finland in 339 patients with invasive infection were sero/subtyped by whole cell enzyme immunoassay using monoclonal antibodies to class 1 and 2/3 outer membrane proteins. 66.7% of the strains could be serotyped (class 2/3) and 70.2% subtyped (class 1). No single phenotype was clearly predominant. The most common serotypes were 4 (18.6%) and 14 (17.4%) and the most common subtypes P1.16 (20.1%) and P1.2 (12.1%). The Norwegian phenotype B:15:P1.16 was seen only rarely (a total of 18 strains). Strains from Northern Finland did not differ from those from Southern Finland: no single phenotype caused the slight increase seen in the incidence of MenB infections in the end of 1970s in the North.
Antibodies, Monoclonal↗