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Biomedical subjects

H Wilde

Publications and source records attributed to H Wilde.

At least 73 records · Page 4Linked to original sources
PubMed1997

An immunogenicity and efficacy study of purified chick embryo cell culture rabies vaccine manufactured in Japan.

Purified chick embryo cell rabies vaccine manufactured by the Chemo-Sero-Therapeutic Institute(Kaketsuken) at Kumamoto, Japan (Kaketsuken) was submitted to an immunogenicity and efficacy study. 52 severely rabies exposed patients were treated with the conventional five doses intramuscular WHO approved ('Essen') postexposure schedule. This included the administration of 40 IU kg-1 of equine rabies immune globulin on Day 0. A control group of equally severely exposed subjects were treated with human diploid cell rabies vaccine manufactured by the Swiss Serum and Vaccine Institute as well as human rabies immune globulin. There were no deaths in either group in the more than 2 years follow-up period. Subjects treated with the chick embryo vaccine showed greater suppression of the neutralizing antibody response by the equine rabies immune globulin than those given the human diploid cell vaccine and human rabies immune globulin. A group of 20 less severely rabies exposed patients who received only the chick embryo vaccine without immune globulin all had antibody titers greater than the WHO minimal acceptable level on Day 14, 30, 90 and 180. Fourteen subjects among the severely exposed vaccine and immune globulin study group were given vaccine boosters on Day 180 because of low antibody titers. It is concluded that chick embryo rabies vaccine manufactured by Kaketsuken is an immunogenic and effective rabies vaccine, but that the potency of future batches must be increased to provide a greater safety margin.

Animals↗
PubMed1997

Immune response to simulated postexposure rabies booster vaccinations in volunteers who received preexposure vaccinations.

Several studies of the efficacy of intradermal postexposure rabies vaccination have shown that this procedure is safe, effective, and cost saving. Less is known about the reliability of the present World Health Organization (WHO)-approved intradermal preexposure regimen, which consists of three 0.1-mL doses that are generally given on days 0, 7, and 28. Previous studies have shown that neutralizing antibody responses are lower and of shorter duration in subjects given the reduced-dose intradermal regimen. Thus, it is still uncertain whether the WHO-recommended single intramuscular or intradermal booster injections given on days 0 and 3 would prevent death in all cases. In this preliminary study, we evaluated titers of neutralizing antibody in Thai student volunteers given two simulated postexposure boosters, as recommended by WHO, and we compared these volunteers to a group given vaccine intramuscularly. We observed a lower, although adequate, accelerated immune response in those given the preexposure series and postexposure boosters intradermally.

Adolescent↗
PubMed1997

Fluorescent antibody test for rabies: prospective study of 8,987 brains.

A prospective study of 8,987 canine, feline, human, and other mammalian brains (and one avian brain) was undertaken. The brains were analyzed for rabies antigens; two samples were obtained from each brainstem, and one sample was obtained from each hippocampus. The samples were stained with rabies conjugate and examined by use of fluorescence microscopy. There were no false-negative results. We conclude, therefore, that postexposure rabies treatment is not requisite in all cases, provided that the fluorescent antibody test is performed without delay in a laboratory experienced with the procedure and microscopy results are fluorescent negative.

Animals↗
PubMed1997

Current status of animal rabies in Thailand.

Canine rabies remains a serious public health problem in Thailand. The Queen Saovabha Memorial Institute (QSMI) is the principal rabies diagnostic center in central Thailand. The retrospective study of canine rabies cases submitted in 1992-1995 revealed that: (1) The prevalence of rabid dogs decreased, which was associated with an overall decrease in the number of animals examined. However, the proportion of FA positive dogs examined remains the same at approximately 50%. (2) The majority of rabies cases occurred in domestic dogs rather than stray dogs but the ratio of positive cases between domestic and stray animals remained the same. (3) More than 60% of domestic rabid dogs were below age one. Dogs at this age are thought to be more active and also most likely not adequately vaccinated. It should be noted that approximately 70% of rabid dogs were never vaccinated against rabies.

Age Factors↗
PubMed1997

Management of thai cobra bites with a single bolus of antivenin.

Between January 1981 and December 1991, 68 adults were treated at Chulalongkorn University for cobra bites. Respiratory failure developed in the bite victims even when an adequate genus-specific antivenin was administered at the onset of neuromuscular paralysis. The duration of time spent on a respirator was, however, significantly less in patients treated with an intravenous 100-ml antivenin bolus given at the onset of neurotoxic signs. We found that a bolus of 100 ml of purified equine antivenin produced by the Queen Saovabha Memorial Institute, Bangkok, from Naja kauthia venom was adequate and that increasing the dose did not lead to added benefits. Time spent on a respirator was approximately 10 h in antivenin-treated groups and 40 h if no antivenin or an inadequate dose was used. Competent respiratory and nursing care alone without antivenin will lead to eventual recovery and prevent death. Local bite site tissue necrosis and duration of hospitalization were not related to the dose of antivenin given. Hospitalization was prolonged in subjects who developed sepsis or who had severe tissue necrosis or other surgical or medical complications.

Adolescent↗
PubMed1997

Spontaneous recovery from severe neurotoxic envenoming by a Malayan krait Bungarus candidus (Linnaeus) in Thailand.

A patient bitten by Bungarus candidus (Malayan krait) developed nausea, vomiting, weakness, and myalgia 30 minutes after being bitten. One hour later, ptosis and occulomotor palsies as well as tightness of his chest were noted. Respiratory failure requiring mechanical respiration appeared 8 hours after the bite and lasted for nearly 96 hours. The two bite sites were virtually painless and resulted in slight transient erythema and edema. No specific antivenin was available, and treatment consisted of respiratory support and management of aspiration pneumonitis. Recovery was complete.

Animals↗
PubMed1996

Heterologous antisera and antivenins are essential biologicals: perspectives on a worldwide crisis.

Active immunization against infectious disease is important. However, much of our world faces poverty, social injustice, and warfare, all of which cause universal immunization to remain a distant dream. Agents that provide passive immunity thus remain essential biologicals. The most important of these are human or equine antisera against rabies, tetanus, diphtheria, and snake antivenins. Homologous products are either unavailable or unaffordable in places where they are needed the most. Less expensive heterologous (equine) antisera can be purified and are safe to use, but these antisera are also in short supply. Monoclonal antibodies have been developed but are even less likely to be affordable in poor countries. Several traditional sources of equine antisera are becoming depleted as a result of economic disincentives; a poor reputation based on the high adverse reaction rates of the old, unpurified products; and the activities of animal rights activists who object to the use of horses as blood donors. Purified, pepsin-digested equine antisera are preferred; but developing countries sometimes are forced to make crude products that are less safe or have no specific therapy available at all.

Antivenins↗
PubMed1996

What is an acceptable delay in rabies immune globulin administration when vaccine alone had been given previously?

Rabies immune globulins (RIG) are not always available. Rabies-exposed patients often present to medical centers, particularly in canine rabies infested regions, after a vaccine series has been started without immune globulin administration. It is known that rabies immune globulin can result in suppression of the neutralizing antibody response which usually yields detectable antibodies by day 7. We have shown that it can be administered with a delay of up to 5 days after the start of vaccine treatment without significant antibody suppression within the first month. This study utilized the WHO approved multisite Thai Red Cross intradermal postexposure regimen. Effective use of rabies immune globulin in severe and multiple wounds, particularly in small children, may require dilution of the RIG in normal saline to provide a volume adequate for infiltration of all wounds.

Antibodies, Viral↗
PubMed1996

Immune response to tissue culture rabies vaccine in subjects who had previous postexposure treatment with Semple or suckling mouse brain vaccine.

Nerve tissue derived Semple and suckling mouse brain rabies vaccines are still widely used. Patients who experience a new rabies exposure and who were given such vaccines decades earlier are not uncommon in rabies endemic countries. The World Health Organization recommends that persons who have had a previous course of a potent tissue or avian culture rabies vaccine and are reexposed, be given booster infections on days 0 and 3 without rabies immune globulin. Persons who have had previous pre- or postexposure vaccination with a vaccine of unproven potency, should receive a full course of tissue or avian cell vaccine and immune globulin in the event of a new exposure. This study evaluated the immune response in 98 Thai patients who gave a history of rabies postexposure treatment with Semple or suckling mouse brain vaccines 10-50 years previously. The majority (81) had an anamnestic response and developed neutralizing antibodies that were above the recommended minimal acceptable level (0.5 IU ml-1) on day 7. This suggests that they still had immunological memory. A minority of 18% had antibody titers below this level on day 7. However, they all developed titers above 0.5 IU ml-1 on days 14 and 30. Failure to have an accelerated response to revaccination by day 7 did not appear to be related to age or time elapsed since previous nerve tissue derived vaccine administration. It was not possible to predict which subject will or will not have an acceptable level of antibody before day 14. Rabies exposed patients who give a prior history of vaccination with an unknown or nerve tissue derived vaccine should therefore be treated as if they had never been vaccinated.

Adolescent↗
PubMed1996

Failure of postexposure treatment of rabies in children.

Five failures of postexposure treatment of rabies in small children with multiple severe bites on the face and head are discussed. All had received rabies immune globulin and a potent tissue-culture vaccine. However, not all wounds had been infiltrated with immune globulin. Surgical closure prior to wound injection with immune globulin was performed in three cases. Another patient had wounds sutured after an intramuscular injection of immune globulin, without wound infiltration.

Animals↗
PubMed1995

Efficacy study of a new albumin-free human diploid cell rabies vaccine (Lyssavac-HDC, Berna) in 100 severely rabies-exposed Thai patients.

A newly developed human diploid cell rabies vaccine (Lyssavac-HDC), produced without added serum albumin and with an effort to remove the virus-inactivating beta-propriolactone prior to addition of the gelatin, L-cysteine and potassium phosphate stabilizer, was tested for safety immunogenicity, adverse reactions and efficacy in 100 severely rabies-exposed Thais. All patients also received human rabies immune globulin and vaccine was administered using the conventional 5-dose intramuscular schedule of one dose on days 0, 3, 7, 14 and 28. One hundred percent of a subgroup of 40 subjects, where blood had been collected, had neutralizing antibodies greater than 0.5 IU ml-1 on days 28 and 90 and all had detectable titers on days 7, 14, 28, 90, 180 and 360. All patients could be followed for at least 1 year and remained well. No significant side-effects from this vaccine were noted.

Adolescent↗
PubMed1995

Immunogenicity of purified duck embryo rabies vaccine (Lyssavac-N) with use of the WHO-approved intradermal postexposure regimen.

The World Health Organization (WHO) has recommended the following regimen for administration of intradermal postexposure rabies vaccines (tissue or avian cultures): 0.1 mL of the vaccine given intradermally at two sites on days 0, 3, and 7 and at one site on days 28 and 90. WHO did not specify which types of vaccines should be used when following this regimen. We evaluated the efficacy of purified duck embryo rabies vaccine (Lyssavac-N) under the above regimen conditions; although purified duck embryo rabies vaccine is highly immunogenic when given intramuscularly, it differs significantly from the other rabies vaccination products in that it is not a solution, but rather, a suspension with an added preservative. Lyssavac-N was found to produce lower mean neutralizing antibody titers with the WHO-recommended intradermal regimen. However, when the volume of each dose was increased from 0.1 mL to 0.2 mL and the same schedule of administration was followed, satisfactory titers were obtained. We concluded that the WHO intradermal postexposure rabies vaccine regimen should only be used with vaccines that have been subjected to immunogenicity studies with satisfactory results.

Adolescent↗
PubMed1995

Postexposure rabies vaccination during pregnancy: effect on 202 women and their infants.

This prospective study of 202 pregnant Thai women who received postexposure treatment for rabies with a tissue culture-derived rabies vaccine and human or equine rabies immune globulin revealed an adverse reaction rate similar to that seen among nonpregnant Thai patients who received the same treatment. Tissue culture-derived rabies vaccines as well as immune globulins are safe to use for postexposure prophylaxis during pregnancy. Such treatment should never be withheld or delayed if the patient possibly was exposed to rabies.

Adult↗
PubMed1995

Value of skin testing for predicting reactions to equine rabies immune globulin.

The high cost of postexposure prophylaxis for rabies is one reason that treatment is inadequate in developing countries. This problem has kindled interest in the use of equine rabies immune globulin, which is a less expensive, yet effective, substitute for human rabies immune globulin. Fatal anaphylaxis is a feared complication of the administration of heterologous serum; therefore, authoritative sources recommend prior skin testing. However, recommendations for methods of administering such a skin test and for its interpretation vary greatly. We embarked on a long-term study to develop guidelines for administration and interpretation of skin test results and to eventually determine a cost-benefit ratio. The skin test is not predictive of serum sickness. Anaphylaxis is rare with modern purified and pepsin-digested equine rabies immune globulins. We consider a skin test to be positive only if a wheal of > 10 mm in diameter, with or without flare, or a wheal of 5-10 mm in diameter with a flare of > 20 mm develops. Long-term studies will be required to answer the remaining questions regarding test criteria and cost benefits.

Adolescent↗