Acellular and whole-cell pertussis vaccines in Japan: report of a visit by US scientists.
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Biomedical subjects
Publications and source records attributed to J D Cherry.
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Respiratory syncytial virus (RSV) infections in hospitalized children were identified by indirect fluorescent antibody technique. Patients with RSV infections were assigned to one of two isolation categories. In one category, the health care workers entering the child's room did not wear masks and goggles; in the other category, the workers did wear masks and goggles. The RSV illness rate in health care workers using masks and goggles was 5%, but the rate for those not using masks and goggles was 61%. In the no mask/goggles group, the RSV illness rates in the health care workers correlated directly with the number of exposures. In this modest study, the use of masks and goggles was associated with a significant reduction of RSV illnesses in pediatric health care workers.
Health care workers can reduce risks associated with caring for HIV seropositive individuals by strict adherence to routine infection control procedures. Educating personnel in infection control should be increasingly stressed in all health-related settings. When accidents occur, however, the health care industry must respond with appropriate care and follow-up of their employees. The outlined approach for the management of health care workers with needlestick injuries from HIV-contaminated biological specimens provides increased follow-up for workers at higher risk (those who develop illness in the months following an exposure) than current CDC guidelines; and less but sufficient follow-up of those who have a lower risk (no illness) of acquiring HIV infection. Overall, this protocol will provide a more economical, practical, and medically adequate method for follow-up of exposed health care personnel.
We have prospectively followed for 9-12 months, 246 female health care workers (HCWs): 102 with high exposure (HE), 43 with low exposure (LE), and 101 with no exposure (NE) to AIDS (acquired immunodeficiency syndrome) patients. No HCWs have clinical, serologic, or immunologic evidence of HIV (human immunodeficiency virus) infection. No HCWs in the HE group seroconverted to cytomegalovirus (CMV). One HCW in the HE group seroconverted to Hepatitis B virus (HBV), another HCW in the HE group seroconverted to herpes simplex virus type 2 (HSV-2) although all three groups were similar with respect to HBV and HSV-2 seropositivity. If hospital infection control practices are employed when HCWs care for AIDS patients or work with their biological specimens, the risk of occupationally acquiring a HIV, CMV, HBV or HSV-2 infection appears to be low.
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An acellular pertussis-component diphtheria-tetanus-pertussis (AC-DTP) vaccine was compared with a currently licensed, whole-cell pertussis-component DTP (WC-DTP) vaccine for reactogenicity and immunogenicity when given as the fourth DTP immunization in sixty 18- to 24-month-old children. Reactions over the first 48 hours were significantly less common in the AC-DTP vaccine recipients, as follows (WC-DTP/AC-DTP): fever, 85%/5%; redness, 70%/12.5%; tenderness, 100%/22.5%; swelling, 35%/10%; fretfulness, 70%/12.5%; anorexia, 35%/2.5%; and vomiting, 10%/0%. Antibody responses to pertussis antigens (agglutinogens, lymphocytosis-promoting factor, and filamentous hemagglutinin), diphtheria toxoid, and tetanus toxoid in AC-DTP vaccine recipients were comparable with those in WC-DTP vaccine recipients. The AC-DTP vaccine evaluated in this trial seems to be as immunogenic as WC-DTP vaccine while being markedly less reactogenic.
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Acellular pertussis vaccines have been used for mass immunization of children in Japan since the fall of 1981, but until recently they have not been evaluated in the United States. We report a trial with a DTP vaccine containing an acellular pertussis component in 36 four to six year old children who had previously received four doses of United States DTP licensed vaccine with a whole cell pertussis vaccine component. The study vaccine contained diphtheria and tetanus toxoids and 300 HA units of Takeda acellular pertussis component. The principle immunizing antigens in the pertussis component of the vaccine were lymphocytosis promoting factor (LPF) and filamentous hemagglutinin (FHA). Local and systemic reactions were monitored during the first 48 hours after vaccination, and pre-immunization and one month post-immunization serum specimens were obtained for antibody assay. The following reaction rates were noted: redness 50%, tenderness 50%, swelling 41%, fever (greater than or equal to 38 degrees C) 3%, drowsiness 17%, fretfulness 14%, anorexia 11%, and vomiting 6%. Pertussis antibody values (preimmunization/postimmunization) were as follows: agglutinin GMT, 1:21/1:100; FHA mean ELISA u, 28 +/- 6/greater than or equal to 229 +/- 47; LPF mean ELISA u, 176 +/- 59/1732 +/- 280. The pertussis component of the study vaccine would appear to be less reactogenic than United States whole cell pertussis vaccines but still immunogenic when given as a booster immunization to four to six year old children. Further studies are needed to assess reactions and immunogenicity in younger and previously unimmunized children.
It is generally presumed that children who have had reactions to diphtheria-tetanus-pertussis (DTP) immunization will be more likely to have similar reactions or more severe reactions upon subsequent immunization. To evaluate this contention, we studied the rates of selected reactions occurring within 48 hours of primary DTP immunization in 1,241 infants less than one year of age. Both local and systemic reactions were significantly more frequent following subsequent DTP immunization if present following a prior immunization. The rates of local reactions following subsequent DTP immunization as a function of previous reactions were as follows (no prior reactions/prior reaction): local redness greater than or equal to 2.5 cm, 12.5%/25.5% (p less than 0.0001); local swelling greater than or equal to 2.5 cm, 16.8%/29.0% (p less than 0.0001); local pain, 37.4%/56.4%; (p less than 0.0001). The rates of systemic reactions as a function of previous reactions were as follows (no prior reactions/prior reaction): drowsiness, 24.9%/42.8% (p less than 0.0001); fretfulness, 47.5%/64.7% (p less than 0.0001); vomiting, 4.8%/11.2% (p = 0.0084); anorexia 16.0%/26.3% (p = 0.0001); fever greater than or equal to 38 degrees C, 37.6%/58.5% (p less than) 0.0001); persistent crying, 2.6%/4.5% (p = 0.3557). In addition, infants who experienced a fever greater than or equal to 38 degrees C on the first of two immunizations were more likely to have a temperature greater than or equal to 39 degrees C following the second immunization, 4.2% vs. 12.4% (p = 0.0017). These data strongly support the presumption that children who have had previous reactions following DTP immunization are more likely to have similar reactions upon subsequent immunization.
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Pertussis is a common serious illness of childhood that can be controlled by immunization. It is a unique disease in that it is clinically manifested more often in females than in males. In the 20th century the mortality from pertussis has decreased steadily in both the United Kingdom and the United States. This decline in death rate was well underway prior to the introduction of pertussis vaccine but was accelerated after vaccine use became widespread. In recent years the case fatality rate in the United States has been considerably greater than that in the United Kingdom. One obvious reason for this difference is the difference in age-specific attack rates in the two nations. Available data also suggest that recent pertussis deaths in infants in England and Wales may frequently be reported as due to respiratory diseases other than pertussis. Although it is frequently suggested by some observers, there is no evidence that the incidence of pertussis was declining prior to the widespread use of vaccine. All available evidence indicates that pertussis vaccine use in both the United Kingdom and the United States was responsible for a drastic reduction in the magnitude of both endemic and epidemic pertussis. Decreased utilization of pertussis vaccine in England and Wales beginning in 1975 resulted in two major epidemics of pertussis in 1977-1979 and 1982-1983. Moderate local and systemic reactions commonly occur following pertussis immunization. These reactions appear to be less common and less severe in the United Kingdom than in the United States, but in contrast to recent studies in the United States, there are no recent quantitative studies in the United Kingdom. There are virtually no data available in the United States on the incidence of serious neurologic disease resulting from pertussis immunization. In contrast, the recently published findings of the NCES, a case-control study of national scope, have allowed attributable risk estimates of serious neurologic disease to be made. Although the NCES was a carefully controlled study, its findings in regard to attributable risk were surprisingly similar to those of several other studies in which no allowance was made for background encephalopathy due to other causes.(ABSTRACT TRUNCATED AT 400 WORDS)
In February 1982, a four-year-old Nevada girl with acute lymphoblastic leukemia in remission was hospitalized with fulminant pneumonia and died eight days later at a hospital in California. An influenza virus was the only pathogen detected, and was present in both antemortem and postmortem specimens. The virus was closely related antigenically to A/New Jersey/8/76 (H1N1) and had a genome very similar to a contemporary enzootic swine influenza virus. The patient had had no known contact with swine, and the source of infection could not be determined. Only five possible secondary cases could be detected by retrospective investigation of 62 contacts, and there was no evidence of spread to the general community. Swine influenza viruses circulate among pigs in the United States annually, and it is likely that sporadic transmissions to humans will continue to be detected. Nevertheless, person-to-person spread under these circumstances appears to be limited.
Local and less serious systemic reactions are frequent following immunization with diphtheria-tetanus-pertussis (DTP) vaccine. The effects of injection site, manufacturer, previous reactions, and dosage reduction upon subsequent reactions to DTP immunization were investigated. Local reactions, notably pain and swelling, were less common when the immunization was given in the buttocks than in the thigh. No injection site was consistently associated with lower systemic reaction rates. There was no significant difference in the rate of more serious reactions by vaccine manufacturer. Differences in rates of less serious reactions by manufacturer were observed but seemed to be related to vaccine lot differences rather than the specific vaccines. In a subset of 772 children, in whom data regarding sequential reactions were available, it was noted that all three reactions investigated--local redness, temperature greater than or equal to 39 degrees C, and persistent crying longer than one-half hour--were two to three times more frequent on a subsequent immunization when present on a prior vaccination than if not present on a prior vaccination than if not present previously. One hundred children received a half dose of DTP vaccine because of a less serious reaction associated with prior immunization. In all instances, they had significantly less serious local reactions as well as notable differences in temperature, drowsiness, and persistent crying.
We performed a double-blind placebo-controlled trial of oral acyclovir in the treatment of first episodes of genital herpes simplex virus infections in 48 young adults (31 women and 17 men). Subjects were randomized to receive either placebo or acyclovir (200 mg per dose) five times daily for 10 days; they were examined on at least eight visits until healed and at monthly visits thereafter. Acyclovir treatment, as compared with placebo, significantly reduced virus shedding, new lesion formation after 48 hours, and the duration of genital lesions in both men and women. The total duration and severity of clinical symptoms (such as pain, adenopathy, dysuria, and malaise) were significantly reduced by acyclovir in both men and women by the third and fourth day, respectively (P less than or equal to 0.025), as compared with placebo. No toxicity was observed. Recurrence rates have so far been similar in placebo and acyclovir recipients. Oral acyclovir treatment of first-episode genital herpes simplex virus infections is clinically effective, but it does not seem to prevent virus latency or associated recurrent disease.
The reactogenicity and immunogenicity of a trivalent split-product influenza vaccine and a trivalent subunit influenza vaccine were studied in 67 children and young adults. Subjects received two doses of either vaccine given one month apart. The reactogenicity of the two vaccines was similar. After the second dose of the split-product vaccine, the prevalence of hemagglutination-inhibiting (HAI) antibody titers of 20 or more was as follows: A/Brazil/78, 73%; A/Bangkok/79, 100%; and B/Singapore/79, 73%. Similar data for the subunit vaccine recipients were 78%, 100%, and 74%, respectively. The HAI antibody responses to the A/Brazil/78 and B/Singapore/79 antigens of both vaccines were relatively poor in those subjects who were initially seronegative (HAI antibody titer less than 5) to the specific antigen.
In this monograph I have tried to present several aspects of viral exanthematous diseases that allow for diagnosis. With a systematic approach to the diagnosis, the physician frequently can make a specific diagnosis and nearly always can assign illness to the correct category. Accurate diagnosis is useful because it prevents unnecessary therapy and apprehension in some patients, allows definitive therapy in others, and, most important, it is fun and scientifically rewarding for the physician.
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