Echovirus infections of newborn infants.
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Cross Infection↗
Biomedical subjects
J F Modlin
Publications and source records attributed to J F Modlin.
Perinatal echovirus and group B coxsackievirus infections.
Enteroviral infections late in pregnancy are common, especially during periods of high prevalence of community infection. Most of these infections, however, are not associated with significant maternal or neonatal disease. Conversely, as many as 65 per cent of women who give birth to infants with proven enteroviral infection have symptomatic disease during the perinatal period. Maternal echovirus or coxsackievirus B infections are not associated with an increased risk of spontaneous abortions, but stillbirths late in pregnancy have been described. Although a slightly increased risk for congenital heart defects and urogenital anomalies has been reported for the offspring of women who seroconverted to the group B coxsackievirus during pregnancy, these data are highly tentative. Transmission of enteroviruses from mother to infant is relatively common (30-50 per cent) and may occur through contact with maternal secretions during vaginal delivery, blood, or upper respiratory tract secretions. Intrauterine transmission has been documented, but its frequency is unknown. Postnatal transmission from maternal or nonmaternal sources also occurs regularly. Neonatal disease may range from inapparent infection to overwhelming systemic illness and death. Common clinical syndromes associated with neonatal enteroviral infections are meningoencephalitis, pneumonia, myocarditis, and hepatitis. The severity and outcome of perinatally acquired enteroviral infection is influenced by several factors, including the virus strain involved, mode of transmission, and presence of passively acquired serotype-specific maternal antibody. Newborn nursery outbreaks of nonpolio enteroviral infections usually coincide with seasonal peaks of enteroviral disease in the community. These outbreaks have been due mostly to echovirus 11 or group B coxsackievirus serotypes 1 to 5 and are associated with attack rates of up to 50 per cent.
Animals↗
Perinatal transmission of coxsackievirus B3 in mice.
Oral infection of pregnant mice with coxsackievirus B3 (CB3) late in gestation produced maternal viremia, which peaked three to four days after challenge, then rapidly diminished. Ninety percent of mice developed IgG antibody to CB3 by ten days after challenge. CB3 titers from placental tissue peaked at two to four days after maternal infection, but moderate titers persisted for at least eight days. Though virus could be recovered (less than 1.0-1.5 log10 pfu/g) from fetal tissue in only a small percentage (3%-13%) of pregnancies, virus could be found in some fetuses eight days after maternal infection. Despite the low rate of fetal infection, many pups born to dams infected one to eight days before delivery were either stillborn (4%-41%) or died from infection shortly after birth (14%-68%). The actual percentages depended on the time interval from infection of the dams to delivery. Maternal IgG antibody to CB3, which appeared at six to eight days after infection, protected against postnatal mortality, but did not protect against stillbirth.
Animals↗
Rationale for the sequential use of inactivated poliovirus vaccine and live attenuated poliovirus vaccine for routine poliomyelitis immunization in the United States.
Despite the concerns mentioned in the last section, there are many reasons to believe that a polio immunization schedule that incorporates sequential doses of inactivated poliovirus vaccine and live attenuated poliovirus vaccine would provide both humoral and intestinal immunity to the fully immunized person that is at least as good, if not better, than the immunity achieved by the use of IPV or OPV alone. A substantial degree of protection should also extend to partially immunized and unimmunized preschool aged children in the community. Furthermore most of the cases of OPV-associated paralytic poliomyelitis could be prevented. Because the reasons for these beliefs are based on data from small studies and on inferences from related research, specific recommendations for a change from current polio immunization policy must depend on additional clinical research. Well-designed trials comparing several different options for sequencing both inactivated and live vaccines are needed, and these studies should focus carefully on both humoral and intestinal immunity conferred by the various vaccine schedules.
Drug Administration Schedule↗
Perinatal enterovirus infections.
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Animals↗
Pseudomonas cepacia: an emerging pathogen in chronic granulomatous disease.
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Adolescent↗
Serial cardiac function tests in myocarditis.
Sixteen patients (mean age 27 years, range 16 to 39 years) with the diagnosis of myopericarditis established by strict clinical criteria were evaluated following recovery 0.7 to 4.0 years (mean 2.7 years) later. Evidence of an acute viral infection was present in 44%. During the acute illness, the major clinical manifestations consisted of pericarditis in 10 patients, acute myocardial infarction in 5, right ventricular dysfunction in 5, bundle branch or hemiblock in 4, ventricular arrhythmias in 3, congestive heart failure in 3 and cardiogenic shock and inappropriate sinus tachycardia in one patient each. Holter monitoring, echophonocardiography and radionuclide ventriculography results were abnormal in 57, 67 and 64% of patients respectively. At follow-up, these tests were abnormal in 67, 7 and 73%. Focal wall motion abnormalities were present in five. Seventy-five percent of patients had one or more abnormal tests at last follow-up. Although 8 patients had improved by a scoring system, 5 patients had an increase in the number of abnormal tests, including one who died. These findings indicate that persistent abnormalities following recovery from myopericarditis are not rare and support the hypothesis that the syndrome of dilated cardiomyopathy may be a sequel of myopericarditis.
Acute Disease↗
A controlled comparison of joint reactions among women receiving one of two rubella vaccines.
While transient rheumatic side-effects are not uncommon in women receiving any of the attenuated rubella virus vaccines yet developed, few comparative data are available on the only rubella vaccine currently available in the United States - the RA 27/3 vaccine. In this study, the frequency and severity of joint reactions were compared among seronegative women receiving HPV77DE5 vaccine (n = 59) or RA 27/3 vaccine (n = 53), and in seropositive vaccinees receiving either vaccine (n = 60). The proportions of vaccinees developing arthralgia/arthritis were similar (29 per cent and 26 per cent, respectively) in the seronegative groups, and were significantly higher than in the seropositive control group (3%). The onset of symptoms was earlier and their duration was briefer in those receiving RA 27/3 vaccine compared to the HPV77DE5 vaccine recipients. No chronic or recurrent symptoms were observed. These data, along with previous studies, suggest that while transient rheumatic reactions following rubella vaccination are not uncommon, they are not associated with serious disability and should not interfere with ongoing immunization programs.
Adult↗
Coxsackievirus B infection in pregnant mice and transplacental infection of the fetus.
Direct instillation of coxsackievirus B1 into the gastrointestinal tracts of albino mice caused viremia in more than 85% of the animals within 1 day. In pregnant mice infected early in gestation (7 days), the geometric mean titer of virus in the blood was lower (P = 0.02) and the duration of viremia was shorter (P = 0.07) than in nonpregnant female mice, but infection of the heart, liver, and uterus did not differ on each of 5 days after infection. Although transplacental infection of the placenta or fetus or both occurred, the high spontaneous abortion rate (48%) obviated comparison of transplacental infection in these mice with mice infected later in gestation. Pregnant mice infected in the third trimester had significantly greater geometric mean titers of virus in the blood, heart, liver, and uterus, and infection persisted longer than in nonpregnant mice (P = 0.04). A very high geometric mean titer of virus was recovered from the uteri of these mice for 3 days after infection, whereas simultaneous geometric mean titers of virus in the placentas and fetuses were lower. In the majority of third trimester pregnant mice, virus was found in low titers in the fetuses at 2 and 3 days after maternal infection, and virus was not detected after day 3. We conclude that coxsackievirus B1 infection in late gestational pregnant mice is more severe than in mice at earlier gestational stages and in nonpregnant mice and that transplacental infection of the fetus occurs transiently during maternal infection. This model will prove useful in the study of perinatal enterovirus infection and in examination of the numerous factors that may influence outcome of infection of perinatally infected newborn infants.
Animals↗
Perinatal echovirus infection: risk of transmission during a community outbreak.
During a community outbreak of enterovirus infection, seven of 194 pregnant women (3.6 per cent) were found to be excreting a prime strain of echovirus 11 at term. Each of the seven women possessed serum neutralizing echovirus 11 antibody in titers ranging from 1:20 to 1:320, and the cord serum of their seven infants had antibody in titers of 1:10 to 1:640. None of these seven infants became ill, but four were shedding virus from the respiratory or gastrointestinal tract by three days of age. In a previous study, four infants who died of generalized infection due to the same strain of echovirus 11 had no detectable antibody in cord serum. None of the infants of virus-negative mothers became infected, according to cultures at hospital discharge (151 infants) or at two weeks of age (135 infants). We conclude that passive transplacental acquisition of antibody prevents severe, systemic echovirus disease but does not prevent mucosal infection in the perinatally infected infant.
Antibodies, Viral↗
Kawasaki syndrome: description of two outbreaks in the United States.
Investigation of two outbreaks of Kawasaki syndrome (KS) in the United States in 1979 and in 1980 revealed no evidence of person-to-person transmission or of a common-source exposure among patients. Questionnaire data showed that KS was more likely to occur in children of middle and upper socioeconomic status than in those of lower status (P less than 0.05 and P less than 0.001 for the respective outbreaks) and that patients with KS had a higher incidence of an antecedent, primarily respiratory illness than did controls matched for age, sex, and race (83% of patients in the first outbreak vs. 30% of one control group, P less than 0.01, and vs. 36% of another control group, P less than 0.02; and 56% of patients in the second outbreak vs. 32% of their controls, P less than 0.02). However, laboratory studies did not identify an etiologic agent for either KS or for the antecedent illness that may be a risk factor for KS.
Adolescent↗
An outbreak of rubella among hospital personnel.
An outbreak of 47 cases of rubella occurred among hospital personnel in a large medical-surgical hospital. As a result, one pregnancy was terminated and 475 employee workdays were lost. Epidemiologic investigation of the outbreak suggested a common source; a dietary worker was identified as the probable index case. Serum samples of 12 per cent of women employees were negative for rubella antibody at the time of the outbreak. Neither a history of rubella nor a history of immunization with rubella vaccine was reliable in the prediction of the presence or absence of immunity. Two thirds of all hospital personnel were immunized through a voluntary mass-immunization program, but the response of physicians to the program was disappointing. Outbreaks of rubella that occur in hospitals with prenatal clinics are of special concern. Testing of all employees for rubella antibody and immunization of those determined to be seronegative should be considered.
Adolescent↗
Risk factors in subacute sclerosing panencephalitis: a case-control study.
Fifty-two persons with subacute sclerosing panencephalitis (SSPE) were compared with playmate and hospital controls matched for age, sex, and race. Persons with SSPE were more likely to have had measles than their age-matched controls. The age at measles infection for children with SSPE was significantly younger than that for controls who had had measles. Persons with SSPE were less likely to have received measles vaccine than were playmate or hospital controls. There were no differences with regard to the average age at vaccination, having received more than one measles vaccination, or having received measles vaccine after natural measles. Although measles vaccine may rarely predispose a child to develop SSPE, the overall impact of vaccination has been to prevent SSPE by preventing natural measles. No significant differences were observed between cases and controls for infections other than measles, or for vaccines other than measles vaccine. Previous epidemiologic studies have noted significant geographic clustering of SSPE and higher rates in children living in rural areas. These findings suggest that environmental factors other than measles are important in the pathogenesis of SSPE. In this study, children with SSPE were more likely to have suffered a serious head injury and to have come from larger families and more crowded homes than control children. Persons with SSPE were significantly more likely to have close exposure to birds (p less than 0.001) and to swine (p less than 0.05) than were control persons. No differences between cases and controls were found for exposure to other animals. These data suggest that some infectious agent(s), transmitted from birds to man, may have contributed to the development of SSPE in predisposed individuals. A variety of other factors were investigated and found not to correlate with SSPE. These included birth weight, breastfeeding, maternal age at birth, nutritional status, source of drinking water, development, and allergic or atopic disorders.
Adolescent↗
Fatal echovirus 11 disease in premature neonates.
Four cases of fatal echovirus 11 disease occurred in premature infants during a community outbreak of enteroviral disease in Massachusetts in 1979. Each infant developed nonspecific symptoms and jaundice at 4 to 6 days of age, and subsequent progressive hepatic failure and generalized bleeding. Only one infant survived longer than six days. Virus was recovered from multiple sites premortem, and from virtually all tissue cultured at autopsy. Myocarditis was not present clinically or pathologically. Clinical and laboratory evidence implicated perinatal transmission of virus from mother to infant. Three mothers experienced a febrile illness with abdominal pain within the last five days of pregnancy. In two, the illness led to a false diagnosis of abruptio placenta and interruption of pregnancy by cesarian section. Review of case reports of this syndrome caused by other echovirus serotypes revealed that many had similar perinatal events. Each mother ultimately developed neutralizing antibody to echovirus 11. However, all four infants were born without passively acquired antibody, probably because they were delivered prior to the appearance of specific maternal IgG. Although laboratory studies by others have shown other factors may be responsible for the ability of enterovirus to cause overwhelming disease in neonates, uncontrolled data from these four infants and their mothers suggest that timing of maternal illness in relation to delivery of the infant may also be important.
Adult↗
Epidemiology of subacute sclerosing panencephalitis.
The Subacute Sclerosing Panencephalitis Registry has compiled data from 453 instances of SSPE occurring in the United States from 1960 through 1976. The mean annual incidence during this period was 3.5 per 10 million persons under 20 years of age, 2.3 times higher for males than females, and 4.0 times higher for whites than blacks. Although the long-term pattern of incidence is unknown, the incidence of reported SSPE declined dramatically from 1970 to 1976. There are marked geographic variations of SSPE activity within the United States and also a higher incidence for children from farms (9.4 per 10 million persons under 20) compared with children from other rural domiciles (3.7 per 10 million), suburban children (2.9 per 10 million), and inner-city children (1.6 per 10 million). Available epidemiologic evidence suggests that some extrinsic factor, unrelated to measles or measles vaccine, is important in the pathogenesis of the disease.
Adolescent↗
From the Center for Disease control: current status of measles in the United States, 1973--1977.
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Age Factors↗
Clinical trials of bivalent A/New Jersey/76-A/Victoria/75 influenza vaccines in high-risk children.
Various doses of two whole-virus and one split-product bivalent influenza A/New Jersey/76-A/Victoria/75 vaccines were administered to 253 children aged six to 18 years. There were no statistically significant differences in either reactivity or humoral antibody response among the 167 children in seven chronic disease categories and 86 healthy children. The whole-virus vaccines were associated with unacceptably high rates of reaction when given in sufficiently antigenic initial doses but were relatively nonreactive when used for booster immunization. Split-product vaccines were no more reactive than placebo. All vaccine preparations induced adequate seroconversion rates and protective titers of antibody to A/Victoria virus after one dose and to A/New Jersey virus after two doses.
Adolescent↗