Outbreak of rotavirus gastroenteritis among premature infants.
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Biomedical subjects
Publications and source records attributed to S Vella.
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The antibody reactive in antibody-dependent, cell-mediated cytotoxicity (ADCC) to influenza virus-infected cells was measured in two groups of seven volunteers each, before and after immunization with inactivated or live attenuated A/Victoria/3/75 influenza virus vaccines. Age-matched controls were seven adult individuals who experienced natural influenza infection due to A/Victoria/3/75-like virus strain. After inactivated whole influenza virus immunization all the subjects showed a significant rise of the antibody reactive in ADCC (from a mean value of 4.7% to 17.1% cytotoxicity, before and 5 weeks after immunization, respectively) as well as of hemagglutination inhibition (HI) antibody (fourfold or greater increase). These immune responses were similar to those observed among naturally infected controls. After live attenuated virus vaccination, no significant increase in titer of antibody reactive in ADCC was detected, even though the vaccine induced significant increase of HI antibody titer. Little correlation was found between ADCC and HI antibody rises in sera of recipients of inactivated virus vaccine and of naturally infected individuals while, in live attenuated influenza virus vaccines, the rise of HI antibody titer did not correspond to a significant increase of ADCC antibody titer did not show subjects who developed a significant rise in ADCC antibody titer did not show significant variation in antibody to neuraminidase and/or to complement fixation influenza virus antigens.
Immunoglobulins and virus-specific antibody in nasal secretions were measured in 18 volunteers before and after intra-nasal vaccination with two live-attenuated type A influenza virus strains. Specific serum antibody rises occurred in 14 out of 18 vaccinees; of those, 11 and 10, respectively, showed significant increase of IgA concentration and of virus-specific antibody in nasal secretions collected 2-4 weeks after vaccination. In one case, a volunteer showed appreciable increase of virus neutralizing antibody in nasal secretions without increase of local IgA concentration and of serum HI antibody. This data indicate that administration of live virus vaccines by upper respiratory route confers effective immunity associated with local antibody synthesis.
Immunization procedures with live attenuated and inactivated vaccines were carried out on a group of young recruits at the beginning of an outbreak of infection due to an A/Victoria/3/75-related virus strain, which occurred in February 1977 in a military camp. A retrospective investigation on protection from clinical influenza was then performed in order to investigate whether immunization with live virus vaccines, administered at the beginning of an epidemic, could provide early protection from the disease. In the course of the two weeks following vaccination, laboratory-confirmed clinical influenza cases occurred in 4 subjects among the 110 volunteers of the control group which received placebo, and in 8, 7 and 4 subjects respectively of the 3 groups of about 125 individuals, each of which received one of the following vaccine preparations: (a), live attenuated A/Victoria/3/75 influenza virus oral vaccine, grown on chick embryo kidney culture; (b), live attenuated nasal vaccine, a recombinant of A/Puerto Rico/8/34 with A/Victoria/3/75 virus; and (c), inactivated A/Victoria/3/75 virus intramuscular vaccine. These data do not support the hypothesis that, during an epidemic of infection, early protection from clinical influenza can be achieved through immunization with live attenuated or inactivated influenza virus vaccines, in spite of the high immunizing capability of the vaccine preparations.
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PURPOSE: To describe the cost of hospitalization and treatment in patients with very advanced disease who tart different regimens based on a protease inhibitor (PI). METHOD: An observational retrospective analysis was performed on data from a 48-week randomized, multicenter study. Analysis was based on a subgroup of centers that were geographically defined. Costs of ordinary hospital admissions and of antiretroviral treatment were considered. Incidence of hospitalization and number of days free from hospitalization during the period of observation were calculated. Cost and hospitalization measures were compared among patients receiving three different therapeutic regimens: only PI, PI plus one nucleoside, or PI plus two nucleosides. A multivariate analysis was used to assess cost differences, controlling for variables potentially able to influence outcome. RESULTS: Overall, among 166 patients starting PI (PI plus two nucleosides, 71;PI plus one nucleoside, 65; only PI, 30), 162 ordinary hospital admissions were observed during about 1 year of follow-up. Monthly rates of admission per person and incidence of first hospitalization on 100 person-months showed a clear inverse relationship with the number of drugs comprising the baseline treatment regimen, with the lower rates for the triple therapy group (0.06 and 3.9, respectively), intermediate values for the dual therapy group (0.10 and 8.1, respectively), and higher rates for the PI monotherapy group (0.15 and 13.7, respectively). The average number of days free from hospitalization per month was 29.5 in the triple therapy group, 28.6 in the dual therapy group, and 27.9 in the monotherapy group. The results of cost analysis showed, despite higher cost of antiretroviral treatment, that global costs were progressively lower using regimens of increasing potency: Compared to PI monotherapy, global cost (costs of antiretroviral treatment and of hospitalizations combined) per month per patient was 31.9% lower for the triple therapy group and 19.3% lower for the dual therapy. Global cost for the triple therapy was 15.7% lower compared to global cost for dual therapy. After adjustment for CD4 count, AIDS status, and Karnofsky score, both hospitalization costs and global costs were significantly lower for triple therapy compared to monotherapy (p =.002 and.039, respectively). CONCLUSION: In advanced and nucleoside-experienced patients, PI-containing regimens have a differential impact according to the overall strength of the regimen, with the best effects on both hospitalizations and treatment costs obtained using PI within potent combination regimens.
Over the past three years, most efforts of virologists and immunologists involved in the field of Human Immunodeficiency Virus (HIV) have been focussed on strategies aimed at eradicating the infection. So far, however, all the approaches have been unsuccessful. Indeed, even if the currently available potent antiretroviral regimens are able to induce a profound and durable suppression of viral replication, they have poor effect on a viral reservoir of latently infected CD4+ T lymphocytes that rapidly reactivate after treatment discontinuation. Different approaches, including combined (immune based and antiretroviral) therapies, are therefore under investigation. The goal is to achieve an equilibrium where virus-induced immune dysfunction is prevented by an effective anti HIV immune response.
We evaluated the incidence of AIDS dementia complex (ADC) in groups of patients who acquired infection through different risk behaviours, and attempted to evaluate the possible role of zidovudine (AZT) treatment in preventing or delaying the onset of ADC. The Italian National AIDS Registry was used to study patients with AIDS for whom ADC was reported as an index disease. Relative risk of presenting ADC between different patient categories has been determined. Logistic regression was used to analyse temporal trends in the proportion of AIDS cases presenting with ADC. Of the 6466 cases reported between August '87 and August '90, ADC was seen in 640 (9.9%). I. V. drug addicts had twice the risk (estimated odds ratio: 1.9; 95% confidence interval: 1.5-2.6, p less than 0.001), compared to homo/bisexuals, of presenting with ADC. There is significant evidence (p less than 0.0001) that after a progressive increase in the period '87-'89, it began a definite decrease in the monthly proportion of ADC cases, starting August '89. AZT was introduced in Italy in July 1987 for patients with AIDS or advanced ARC. The incidence of AIDS dementia complex at the moment of AIDS diagnosis in our population of patients, began to decline 24 months after the introduction of systematic AZT treatment in Italy. This could have been due to inhibition of HIV replication in the Central Nervous System among patients who initiated AZT-treatment before developing full-blown AIDS.
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Since 1982, 2911 adult AIDS cases have been officially reported in Italy up to December 31, 1988. The clinical presentation of all cases, reported to the Istituto Superiore di Sanità, Rome, and contained into the National AIDS Register, has been analyzed, with particular attention to opportunistic infections. 168 cases (mainly homosexual men) were found exclusively affected at diagnosis by Kaposi's Sarcoma (KS), while the other 2743 patients were affected by opportunistic infections and/or other pathologies. At diagnosis, 23.5% of patients had Pneumocystis carinii pneumonia (PCP), 32% esophageal or pulmonary candidiasis, and 7% cerebral toxoplasmosis. A decrease in frequency of Cytomegalovirus (CMV) diseases has been observed, as well as an increase of HIV encephalopathy from 1982 to 1988. The clinical picture of full-blown AIDS showed stability during the whole period of observation, with slight geographical variations.
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