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H Peltola

Publications and source records attributed to H Peltola.

At least 127 records · Page 7Linked to original sources
PubMed1989

Immunogenicity of Haemophilus influenzae oligosaccharide-protein and polysaccharide-protein conjugate vaccination of children at 4, 6, and 14 months of age.

At 4 and 6 months of age, 118 infants were vaccinated with either one of two Haemophilus influenzae type b capsular polysaccharide-protein conjugate vaccines: 72 infants received the polysaccharide coupled to diphtheria toxoid (PRP-D group), and 46 infants received polysaccharide-derived oligosaccharides coupled to CRM197 protein, a nontoxic mutant form of diphtheria toxin (HbOC group). A third dose of the same vaccine was given to 40 children in the PRP-D group and 25 children in the HbOC group at 14 months of age. Antibodies to the H influenzae type b capsular polysaccharide were measured by Farr-type radioimmunoassay in serum samples taken before each vaccination and 1 month after the second and the third doses. Adverse reactions monitored by a questionnaire were mild. After two vaccine doses, the geometric mean concentration of antibodies to H influenzae type b polysaccharide increased from 0.07 micrograms/mL in the prevaccination samples to 0.63 micrograms/mL in the PRP-D group and to 4.32 micrograms/mL in the HbOC group. In the following 7 months, the geometric mean concentrations declined to 0.38 and 1.12 micrograms/mL, respectively. The booster dose given at 14 months elicited a strong antibody response in both groups (to geometric mean concentrations of 29.7 and 58.3 micrograms/mL, respectively). Both vaccines appear to be capable of immunologic priming by immunization in infancy.

Age Factors↗
PubMed1989

Epidemiology of invasive Haemophilus influenzae type b disease among children in Finland before vaccination with Haemophilus influenzae type b conjugate vaccine.

On the basis of intensified surveillance in Finland we report the epidemiology of invasive Haemophilus influenzae type b disease based on 333 consecutive culture-proved cases recorded during 1985 and 1986. The annual incidence rate among children younger than 5 years of age was 52/100,000; 46% of patients had meningitis, 29% had epiglottitis and 25% had other forms of invasive disease. The median age of patients was 27 months, with 45% younger than 2 years of age. Meningitis and epiglottitis were found more often among boys than among girls, whereas the opposite was found among patients with other types of invasive disease (P = 0.015). Among the latter 68% of children with pneumonia or septicemia were 2 years or older compared with 32% of patients with arthritis, cellulitis or pyelonephritis (P = 0.009). These background data are essential for correct interpretation and application of results from trials with H. influenzae type b conjugate vaccines that are currently ongoing in Finland.

Age Factors↗
PubMed1988

C-reactive protein in early detection of bacteremic versus viral infections in immunocompetent and compromised children.

The value of quantitatively determined C-reactive protein (CRP), measured from a finger prick sample for rapid detection of septicemia, was examined in 76 blood culture-positive infections in 54 immunocompetent and 18 compromised children; 73 patients with systemic viral infections served as controls. Development of a positive CRP reaction was also studied in 40 cases of acute epiglottitis. Beyond the neonatal age, an increased CRP value (greater than or equal to 20 mg/L) was found in 60 of 64 (94%) children with a positive blood culture for bacteria or fungus. By contrast, CRP remained below this value in 56 of 73 (77%) with viral infections. The immunologic status did not influence the CRP response. However, time had a highly significant (p less than 0.001) effect on CRP; a history of 6 to 12 hours of illness was required before CRP increased above normal. We conclude that CRP is a sensitive and rapidly reacting index in bacteremic infections. However, because other factors than septicemia also increase CRP, we deem a negative CRP value most informative; if two determinations taken several hours apart are less than 20 mg/L, the patient is very unlikely to have invasive bacterial infection.

Adolescent↗
PubMed1988

Simultaneous administration of Haemophilus influenzae type b capsular polysaccharide-diphtheria toxoid conjugate vaccine with routine diphtheria-tetanus-pertussis and inactivated poliovirus vaccinations of childhood.

A Haemophilus influenzae type b capsular polysaccharide-diphtheria toxoid conjugate vaccine (PRP-D) is capable of protecting infants against invasive H. influenzae diseases. Therefore it is very likely that it will be incorporated in routine vaccination schedules during the next few years. In order to test the suitability of simultaneous administration of PRP-D and other vaccines we administered it to 25 infants mixed with diphtheria-tetanus-pertussis vaccine at 3, 4 and 6 months and simultaneously, but in a separate syringe, with inactivated polio vaccine at 12 months. A comparison group of equal size received only diphtheria-tetanus-pertussis and inactivated poliovirus vaccines. The concentration of postvaccination antibodies to diphtheria toxoid was 0.411 IU/ml in the group that received PRP-D vs. 0.352 IU/ml in the comparison group, to tetanus toxoid 3.666 vs. 3.668 IU/ml and the neutralization titer to poliovirus type 1 was 370 vs. 320 units in the comparison group, to type 2 titer values were 230 vs. 270 units and to type 3, respectively, 210 vs. 290 units. Thus the seroresponse to antigens in routine vaccines was not affected by the presence of PRP-D in the vaccination schedule, and PRP-D can safely and effectively be included in the vaccination schedule of infancy.

Bacterial Vaccines↗
PubMed1988

Intestinal parasitism of children and mothers in rural Somalia.

A survey on intestinal parasitism was carried out by microscopic examination of stool specimens from 517 children (0 to 16 years old) or from mothers living in two rural towns in Somalia. Burao represented the hot and dry region in the north and Kismayo the more humid area in the south. The overall prevalances of intestinal parasitism were 48 and 88%, respectively. Protozoal infestation was found in 46% (potentially pathogenic protozoa in 20%) in Burao and 37% (potentially pathogenic protozoa in 17%) in Kismayo. In contrast a major difference between the two towns was observed with helminthic infection. In Burao only 6% of the specimens showed worm eggs or larvae, whereas in Kismayo the prevalence was 84% (P less than 0.001). The difference in helminthic infection rates might be explained by the different climatic factors, different population densities or habits of the people. Among 14 detected parasitoses the following five were found with an overall frequency of 10% or greater: trichuriasis (45%); entamebiasis coli (23%); ascariasis (17%); giardiasis (16%); and ancylostomiasis (15%).

Adolescent↗
PubMed1988

Serious bacterial infections. C-reactive protein as a serial index of severity.

The clinical course of 72 septicemic episodes or focal severe bacterial infections was monitored by daily measurements of serum C-reactive protein (CRP) in 59 children beyond the neonatal period, 19 of whom were immunocompromised. CRP was determined quantitatively by an immunoturbidimetric method from a finger prick sample until either clinical recovery occurred and antimicrobial therapy was discontinued or until the death of the patient. The primarily elevated CRP levels (greater than or equal to 20 mg/l) usually increased about for a day but then decreased rapidly, provided the patient recovered uneventfully. If not, CRP remained at a high level or reincreased after transient decrease. Behaviour of CRP was not affected by the immunologic status of the patient. This property makes CRP especially useful in immunocompromised patients in whom other commonly used laboratory parameters may fail.

Adolescent↗
PubMed1988

Immunogenicity and reactogenicity of four Haemophilus influenzae type b capsular polysaccharide vaccines in Finnish 24-month-old children.

Stimulated by questions raised on potential differences between the Haemophilus influenzae type b capsular polysaccharide (PRP) vaccines on the market and the applicability of the efficacy data of a similar PRP vaccine obtained in a large field study in 1974 in Finland, we wished to compare the immunogenicity of all these preparations in 24-month-old Finnish children. In our study 137 children received the now recommended 25-micrograms dose of 1 of 4 H. influenzae type b PRP vaccines currently available, and an additional 86 children received half this dose corresponding to the 12.7 micrograms used in 1974. Anti-PRP antibodies were measured in blood samples taken before and 4 weeks after vaccination by the same radioimmunoassay and in the same laboratory as in 1974. The vaccines were equally immunogenic. Furthermore the now recommended dose of 25 micrograms did not give results (geometric mean concentrations, 2.38 to 3.45 micrograms/ml) differing from those after a 12.5-micrograms (2.01- to 3.45-micrograms/ml) dose which was used in 1974. Antibody concentrations of 0.15 and 1.0 micrograms/ml were achieved in 91 to 95 and 66 to 84% of the children, respectively. The corresponding values after 1974 vaccinations were 3.53 micrograms/ml and 100 and 82% of children, respectively. The percentage of those responding with concentrations greater than or equal to 1 microgram/ml was somewhat higher in these Finnish children than reported for children of the same age receiving the same vaccine lots in the United States. Adverse reactions were mild or moderate and transient.

Antibodies, Bacterial↗
PubMed1987

Efficacy of Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine in infancy.

Haemophilus influenzae type b capsular polysaccharide-diphtheria toxoid conjugate vaccine has recently been shown to be capable of inducing antibodies to H. influenzae in infants. In an evaluation of its clinical efficacy, 60,000 children were enrolled in an open trial in Finland. Children born on odd-numbered days between October 1, 1985, and September 30, 1986, received the vaccine at 3, 4, 6, and 14 months; those born on even-numbered days served as controls. The geometric mean antibody titer measured in a cohort of 99 children rose from a prevaccination level of 0.08 microgram per milliliter at three months of age to 0.42 microgram per milliliter at seven months. Only minor adverse reactions were reported. Up to February 1987, two cases of invasive H. influenzae infection had occurred among the children who had received three doses of vaccine, whereas 12 cases had occurred among the controls (P = 0.0005 by Poisson one-tailed test). The rate of short-term (average follow-up time, five months) protection provided by this conjugate vaccine in infancy was thus 83 percent.

Antibodies, Bacterial↗
PubMed1987

Safe immunization of allergic children against measles, mumps, and rubella.

A series of 135 subjects (134 children and one adult) with documented or suspected systemic allergy were prick-tested before a measles, mumps, and rubella (MMR) vaccination. Atopic eczema was documented in 68, asthma in 47, and cow's-milk allergy in 11 examinees; eight children were evaluated because of severe systemic reactions following diphtheria-pertussis-tetanus, measles, or inactivated polio (Salk) vaccinations. In one child, there was only a suspicion of general allergy. The undiluted MMR prick test gave negative reactions in 126 cases (93%). The highest rate of nonreactivity was observed in those with atopic eczema (96%) and in children with asthma (91%) or cow's-milk allergy (82%). All examinees with systemic reactions after other vaccinations also had negative prick-test reactions. A total of 122 (95%) of the 129 examinees were eventually vaccinated with MMR. No untoward reactions developed, except mild generalized urticaria or fever in two vaccinees. We conclude that at least 95% of children with common forms of systemic allergy can be vaccinated safely with MMR and, in general, that allergic diseases should not interfere with execution of the vaccination programs.

Adolescent↗
PubMed1987

Childhood bacterial meningitis: initial symptoms and signs related to age, and reasons for consulting a physician.

The relationship of symptoms and signs to age and the reasons for consulting a physician were analyzed in 110 cases of culture-proven childhood bacterial meningitis. H. influenzae caused 74, meningococci 28, pneumococci 6 and streptococci 2 of the cases. Apart from fever (present in 94%), the most common symptoms according to age were as follows: 1-5 months: irritability (85%), 6-11 months: impaired consciousness (79%), 12 months or more: vomiting (82%) and neck rigidity (78%). Absence of neck rigidity at diagnosis was associated with young age (less than 12 months, P less than 0.001) and, in older children, to a short duration of symptoms (P less than 0.01) but not to the degree of CSF pleocytosis. Symptoms of meningitis caused by H. influenzae differed from those of meningococcal meningitis. Meningitis should be suspected in irritable or lethargic febrile children despite absence of neck rigidity. Fever and vomiting were the most frequent reasons for consulting a physician (60% and 31%, respectively). Despite the frequency and alarming character of irritability, impaired consciousness and neck rigidity, their presence led infrequently to a consultation (6%, 22% and 3%, respectively). Parental ignorance of such symptoms or of their importance may cause treatment delay, despite readily available medical services.

Adolescent↗
PubMed1987

Secondary cases of invasive disease caused by spread of Haemophilus influenzae type b.

Three 6-year-old girls were admitted to hospital within a period of 9 days because of invasive disease caused by Haemophilus influenzae type b (Hib). Two days after the index case contracted bacterial meningitis, her twin sister developed septicemia. Nine days after onset of illness in the index case, a day-care contact developed a febrile illness. The antibiograms of the bacterial strains isolated from cerebrospinal fluid or blood in the first two cases were identical; in the third case, blood cultures were negative but Hib antigen could be detected in serum and in urine. These cases illustrate the contagiousness of Hib disease. All household contacts of a case should be informed about the risk and their protection with rifampicin considered.

Child↗
PubMed1987

Immunogenicity in infants of a vaccine composed of Haemophilus influenzae type b capsular polysaccharide mixed with DPT or conjugated to diphtheria toxoid.

Fifty-three healthy infants received either Haemophilus influenzae type b capsular polysaccharide (PRP) mixed with diphtheria-pertussis-tetanus vaccine (DPT) or PRP conjugated covalently to diphtheria toxoid (PRP-D). The immunizations were given at 3, 5, 7, and either 14 or 18 months of age and were well tolerated. The geometric mean titers of antibody to PRP at eight months of age (after the first immunizations) were 0.26 micrograms/ml in the PRP + DPT group and 1.56 micrograms/ml in the PRP-D group. After the fourth dose, an IgG response was seen in both groups. The PRP + DPT group had a geometric mean level of antibody to PRP of 3.98 micrograms/ml at 19 months and the PRP-D group, 31.22 or 24.00 micrograms/ml at 15 or 19 months, respectively. Compared with previously published data of children immunized with one dose of PRP at 18 months, the mean level of antibody to PRP in the PRP-D group at 19 months was significantly (P less than .001) higher, whereas that in the PRP + DPT group was not.

Antibodies, Bacterial↗
PubMed1987

Septicemia in a university pediatric hospital: a five-year analysis of the bacterial and fungal isolates and outcome of the infections.

A 5-year analysis comprising all positive blood culture isolates from a 222-bed university pediatric hospital in Helsinki revealed 369 bacteremic but only 8 fungemic cases. Haemophilus influenzae and Staphylococcus aureus, 19% of the total material each, were the most common pathogens isolated, followed by S. epidermidis (11%), Escherichia coli (8%), pneumococci (8%), and group B beta-hemolytic streptococci (6%). Remarkable differences in distribution of the pathogens were observed in different hospital units. However, 5 most common microorganisms covered 62-86% of the spectrum in each unit. Two bacteria, H. influenzae in the unit for infectious diseases and S. aureus in the hematology-oncology unit were significantly (p less than 0.001 or less than 0.01, respectively) more common than any other organism in those units. The average case fatality rate was 14% with a range from 1.5% to 40%, depending upon the causative agent isolated. Also, the mortality was much higher in neonates than in other age groups. We conclude that by monitoring the blood isolates separately in each unit one can find remarkable differences in the same hospital. On the other hand, characteristics of an individual hospital may vary significantly from those described in textbooks. These characteristics should be recognized and taken into account in the antimicrobial policy.

Bacteria↗
PubMed1987

Invasive haemophilus influenzae and meningococcal infections in Finland. A climatic, epidemiologic and clinical approach.

A nationwide epidemiological survey on invasive (blood and/or CSF culture positive) Haemophilus influenzae (HI) and meningococcal infections was performed in Finland in 1976-1980. The mean annual incidence of HI infection was 3.4/100,000 inhabitants (813 cases) vs. 2.0/100,000 (469 cases) of meningococcal infection. HI infections showed no geographical predilection, but meningococcal disease, mainly of group B, was more common in northern than in southern Finland (p less than 0.005). Meningitis accounted for 61% of the HI and 91% of the meningococcal infections. The overall fatality rates were 3.1% and 7.9%, respectively. Children accounted for 94% of the HI and 59% of the meningococcal cases. The overall annual incidence of bacterial meningitis in children (less than 15 years) was 19/100,000; in children less than 5 years it was 52/100,000. HI was the most common (62%) causative agent, followed by meningococci (18%) and pneumococci (5%). The fatality rate was 4%. Major neurological sequelae were found in 5%, minor ones in 16%. It was calculated that 42% of the cases of meningitis could have been prevented by vaccines now available on the market. Vaccines now under field investigation may increase the preventability to about 65%.

Adolescent↗
PubMed1987

Multivariate prognostication in bacterial meningitis of childhood.

A multivariate method for prognosticating the outcome of bacterial meningitis was computerized on the basis of initial clinical and laboratory data in 123 patients. The model, based on likelihood ratios, is simple and rapid. At the time of diagnosis, it predicted the outcome correctly in 104/123 cases (85%) in the basic group and in 67/98 independent controls (68%). The sensitivity of the method in predicting death or mild to severe neurological sequelae was 83% in both groups. The predictive value of a calculated good prognosis was 94% in the basic group and 97% in the control group, and that of a calculated poor prognosis was 63% and 26%, respectively. The predictive system can be used for rapid assessment of prognosis in individual patients and for comparisons between groups.

Adolescent↗
PubMed1986

Frequency of true adverse reactions to measles-mumps-rubella vaccine. A double-blind placebo-controlled trial in twins.

The vast majority of adverse reactions following immunisation of children with live measles-mumps-rubella (MMR) vaccine were shown in a double-blind, placebo-controlled, cross-over study in 581 twin pairs to be only temporally but not causally related to the vaccination. The true frequency of side-effects caused by MMR vaccine, estimated from the discordance rates of individual signs and symptoms between MMR vaccinees and their placebo-injected twins, was between 0.5 and 4.0%. Moreover, respiratory symptoms, nausea, and vomiting were observed more frequently in the placebo-injected group than in the MMR vaccinated group.

Child↗
PubMed1986

Rapid effect on endemic measles, mumps, and rubella of nationwide vaccination programme in Finland.

An immunisation programme to eliminate measles, mumps, and rubella from Finland within 10 years was started in November, 1982. A combined live vaccine is being given twice, at the ages of 14-18 months and 6 years, but at the beginning of the project children between these age limits are also being immunised. Because vaccinations are traditionally done by the public health nurses, special attention was paid to their motivation. 2.5 years after the launch of the project, 80.9% of the target children had been vaccinated. The incidence of measles has fallen by 93% and that of mumps by 87% compared with a normal prevaccination year (1982). A similar fall in incidence was seen for rubella, but only in the vaccinated age groups. Although elimination of measles, mumps, and rubella is not likely to be achieved with the present vaccination coverage, a drastic fall in the incidence of all three target diseases has occurred already. Every effort is being made to improve the coverage and thus to achieve the ultimate goal of the project.

Adolescent↗