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Biomedical subjects

W P Glezen

Publications and source records attributed to W P Glezen.

At least 19 recordsLinked to original sources
PubMed2000

Spectrum of clinical illness in hospitalized patients with "common cold" virus infections.

The viruses associated most frequently with the "common cold" are rhinoviruses and coronaviruses. The first prospective cohort study to determine the prevalence of rhinovirus and coronavirus infections in patients of all ages hospitalized for acute respiratory illnesses is described. Hospital admissions for acute respiratory illnesses were identified, and cell culture for rhinovirus and serologic assays on paired sera for coronaviruses 229E and OC43 were performed. A total of 61 infections with rhinoviruses and coronaviruses were identified from 1198 respiratory illnesses (5.1%); in addition, 9 additional infections associated with >/=1 other respiratory viruses were identified. Of those infected with only rhinovirus or coronavirus, underlying cardiopulmonary diseases were present in 35% of the patients aged <5 years, in 93% aged between 5 and 35 years, and in 73% aged >35 years. The predominant clinical syndromes varied by age: pneumonia and bronchiolitis in children aged <5 years; exacerbations of asthma in older children and young adults; and pneumonia and exacerbations of chronic obstructive pulmonary disease and congestive heart failure in older adults. Therefore, rhinovirus and coronavirus infections in hospitalized patients were associated with lower respiratory tract illnesses in all age groups.

Adolescent↗
PubMed2000

Impact of respiratory virus infections on persons with chronic underlying conditions.

CONTEXT: While hospitalization rates have declined overall, hospitalizations for acute lower respiratory tract infections have increased steadily since 1980. Development of new approaches for prevention of acute respiratory tract conditions requires studies of the etiologies of infections and quantification of the risk of hospitalization for vulnerable patients. OBJECTIVE: To determine the frequency of specific virus infections associated with acute respiratory tract conditions leading to hospitalization of chronically ill patients. DESIGN: Analysis of viral etiology of patients hospitalized with acute respiratory tract conditions between July 1991 and June 1995. SETTING: Four large clinics and related hospitals serving diverse populations representative of Harris County, Texas. PATIENTS: A total of 1029 patients who were hospitalized for pneumonia, tracheobronchitis, bronchiolitis, croup, exacerbations of asthma or chronic obstructive pulmonary disease, and/or congestive heart failure. MAIN OUTCOME MEASURE: Virus infection, defined by culture, antigen detection, and significant rise in serum antibodies, by underlying condition; hospitalization rates by low- vs middle-income status. RESULTS: Ninety-three percent of patients older than 5 years had a chronic underlying condition; a chronic pulmonary condition was most common. Patients with chronic pulmonary disease from low-income populations were hospitalized at a rate of 398.6 per 10000, almost 8 times higher than the rate for patients from middle-income groups (52.2 per 10000; P<.001). Of the 403 patients (44.4% of adults and 32.3% of children) who submitted convalescent serum specimens for antibody testing, respiratory tract virus infections were detected in 181 (44.9%). Influenza, parainfluenza, and respiratory syncytial virus (RSV) infections accounted for 75% of all virus infections. CONCLUSIONS: Our study suggests that respiratory virus infections commonly trigger serious acute respiratory conditions that result in hospitalization of patients with chronic underlying conditions, highlighting the need for development of effective vaccines for these viruses, especially for parainfluenza and RSV.

Acute Disease↗
PubMed1999

Effectiveness of live, attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial.

CONTEXT: Influenza virus is a major cause of illness, disruption to daily life, and increased use of health care in all age groups. OBJECTIVE: To assess the safety and effectiveness of intranasally administered trivalent, live, attenuated influenza virus (LAIV) vaccine for reducing illness, absenteeism, and health care use among healthy, working adults. DESIGN: Randomized, double-blind, placebo-controlled trial conducted from September 1997 through March 1998. SETTING: Thirteen centers across the United States. PARTICIPANTS: A total of 4561 healthy, working adults aged 18 to 64 years recruited through health insurance plans, at work sites, and from the general population. INTERVENTION: Participants were randomized 2:1 to receive intranasally administered trivalent LAIV vaccine (n = 3041) or placebo (n = 1520) in the fall of 1997. MAIN OUTCOME MEASURES: Episodes of febrile illness, severe febrile illness, febrile upper respiratory tract illness, work loss, and health care use during the peak and total influenza outbreak periods, and adverse events. RESULTS: Recipients of LAIV vaccine were as likely to experience 1 or more febrile illnesses as placebo recipients during peak outbreak periods (13.2% for vaccine vs 14.6% for placebo; P=.19). However, vaccination significantly reduced the numbers of severe febrile illnesses (18.8% reduction; 95% confidence interval [CI], 7.4%-28.8%) and febrile upper respiratory tract illnesses (23.6% reduction; 95% CI, 12.7%-33.2%). Vaccination also led to fewer days of illness across all illness syndromes (22.9% reduction for febrile illnesses; 27.3% reduction for severe febrile illnesses), fewer days of work lost (17.9% reduction for severe febrile illnesses; 28.4% reduction for febrile upper respiratory tract illnesses), and fewer days with health care provider visits (24.8% reduction for severe febrile illnesses; 40.9% reduction for febrile upper respiratory tract illnesses). Use of prescription antibiotics and over-the-counter medications was also reduced across all illness syndromes. Vaccine recipients were more likely to experience runny nose or sore throat during the first 7 days after vaccination, but serious adverse events between the groups were not significantly different. The match between the type A(H3N2) vaccine strain and the predominant circulating virus strain (A/Sydney/05/97[H3N2]) for the 1997-1998 season was poor, suggesting that LAIV provided substantial cross-protection against this variant influenza A virus strain. CONCLUSION: Intranasal trivalent LAIV vaccine was safe and effective in healthy, working adults in a year in which a drifted influenza A virus predominated.

Administration, Intranasal↗
PubMed1999

Maternal immunization.

Maternal immunization can enhance passive immunity of infants to pathogens that cause life-threatening illnesses. In most instances, immunization during pregnancy will provide important protection for the woman as well as for her offspring. The tetanus toxoid and influenza vaccines are examples of vaccines that provide a double benefit. Other vaccines under evaluation include those for respiratory syncytial virus, pneumococci, group B streptococci, and Haemophilus influenzae type b. Although most IgG antibody crosses the placenta in the third trimester, the process is time-dependent, dictating that immunization should be accomplished ideally at least 6 weeks prior to delivery. IgG1 antibodies are transferred preferentially. Maternal immunization has not interfered with active immunization of the infant. Inactivated vaccines administered in the third trimester of pregnancy pose no known risk to the woman or to her fetus.

Bacterial Capsules↗
PubMed1997

Dual respiratory virus infections.

We retrospectively reviewed eight prospective epidemiological studies conducted between 1991 and 1995 for dual respiratory virus infection (DRVI) to determine the frequency, associated comorbid conditions, clinical presentations, and morbidity related to DRVI among immunocompetent persons. Two viruses were identified as the cause of 67 (5.0%) of 1,341 acute respiratory virus infections. DRVI was detected in patients from < 1 year to 79 years of age, in both sexes, and in many races. Forty-two percent of patients with DRVI were < or = 4 years old. Fifty-eight percent of patients with DRVI had underlying chronic lung disease. DRVI was associated with upper respiratory tract illness; lower respiratory tract illness, including pneumonia; systemic influenza-like illnesses; and exacerbations of asthma or chronic obstructive pulmonary disease. All of the common acute respiratory viruses were identified; picornaviruses and influenzavirus A were the most common. The rate of DRVI (11.6%) was highest in the epidemiological studies in which cell culture, serology, and polymerase chain reaction were used together. Patients with DRVI were hospitalized significantly more often than those with respiratory infection due to a single virus (46.3% vs. 21.7%; P < .01). The percentage of DRVIs increased proportionally with the number of diagnostic methods used.

Comorbidity↗
PubMed1997

Influenza virus infections in infants.

BACKGROUND: Universal immunization of children with live attenuated cold recombinant vaccine has been proposed. The renewed recommendation for maternal immunization with influenza vaccine should increase the amount of antibody transmitted to the infant and postpone the need for active immunization. This study examines the risk of influenza during the first year of life to provide information about the time to initiate active immunization. METHODS: Infants followed from birth to 1 year of age in the Houston Family Study were monitored weekly for influenza virus infection. Serum specimens were tested for evidence of infection at 4-month intervals. RESULTS: One-third of 209 infants were infected during the first year; most of the infections occurred during the second 6 months of life. Only 26 of 69 infections were detected before 6 months of age compared with 43 afterward. More striking was the concentration of serious illnesses in the latter half of the first year; 8 of 9 otitis media episodes and 9 of 11 lower respiratory tract illnesses occurred in the older infants. CONCLUSIONS: The combination of increased maternal antibody titers that should result from influenza immunization and the lesser risk of influenza in the first 6 months of life allows initiation of active immunization of children after 6 months of age.

Antibodies, Viral↗
PubMed1997

Haemophilus influenzae type b-specific antibody in infants after maternal immunization.

OBJECTIVE: To study the kinetics of Haemophilus influenzae type b (Hib)-specific antibody in infants born to mothers immunized with an Hib polysaccharide or one of two Hib conjugate vaccines. STUDY DESIGN: Serum antibody to the polyribosylribitol (PRP) moiety of Hib was measured by radioimmunoassay and enzyme-linked immunosorbent assay at birth and at 2 and 6 months of age in infants born to women immunized with Hib polysaccharide or conjugate vaccine (PRP-D and HbOC). A subset of infants > or = 6 months of age was immunized with Hib conjugate vaccine after licensure of this vaccine for infants. A comparison group of 18 infants born to unimmunized women received the same Hib conjugate vaccine on a similar schedule. RESULTS: Total PRP antibody concentrations were 1.50, 14.4 and 20.4 microg/ml in 2-month-old infants born to mothers immunized with polysaccharide, PRP-D and HbOC vaccines, respectively, and 2.54, 1.35 and 2.46 microg/ml in 6-month-old infants. Infants born to mothers immunized with polysaccharide vaccine had significantly less PRP antibody at 2 months of age but similar antibody concentrations at 6 months of age. Persistence or increases in total PRP antibody during 6 months were noted in 21 of 47 (44.6%) study infants. A subset of study and comparison infants was immunized with a mean of 2.6 doses of Hib vaccines between 6 months and 2 years of age, and all infants had total PRP antibody concentrations > or = 0.15 microg/ml. CONCLUSION: Conjugate Hib vaccines administered during the last trimester of pregnancy resulted in significantly higher PRP antibody titers in infants at birth and 2 months of age than did polysaccharide vaccine. A subset of infants born to immunized mothers was subsequently immunized with Hib conjugate vaccine and had antibody concentrations similar to those in infants born to nonimmunized women.

Antibodies, Bacterial↗
PubMed1996

Maternal immunization with Haemophilus influenzae type b polysaccharide-tetanus protein conjugate vaccine in The Gambia.

OBJECTIVE: To evaluate maternal responses to Haemophilus influenzae type b (Hib) polysaccharide-tetanus protein conjugate (polyribosylribitol phosphate-tetanus or PRP-T) given to pregnant Gambian women, the transplacental transfer of antibody, and the effect of maternal immunization on infant responses to the vaccine. DESIGN: An open, randomized immunogenicity study. SETTING: A busy urban health center in The Gambia. STUDY PARTICIPANTS: A total of 451 pregnant women enrolled during the third trimester of pregnancy. INTERVENTION: Study participants were randomized to three groups. In one group, mothers were given PRP-T during the third trimester and their infants were given PRP-T at 2, 3, and 4 months of age. In the second group, mothers received PRP-T and infants were given inactivated poliovirus vaccine. In the third group, mothers received meningococcal A and C vaccine, and their infants received PRP-T. MAIN OUTCOME MEASURES: Anti-PRP antibody measurements of maternal cord, and infant blood. RESULTS: Vaccinated women had a marked increase in total anti-PRP antibody (geometric mean titer 9.0 micrograms/mL), which was greatest in women in their first or second pregnancy. Previous tetanus vaccination during the same pregnancy and high concentrations of antitetanus antibody were associated with lower anti-PRP responses. In infants of PRP-T recipients, cord blood anti-PRP IgG concentrations were 61% of simultaneous maternal concentrations. In vaccinated infants of vaccinated mothers, geometric mean anti-PRP antibody concentrations at birth, 2 months of age, and 5 months of age were 1.92, 0.35 and 2.84 micrograms/mL, respectively, while in vaccinated infants of unvaccinated mothers, the corresponding concentrations were 0.29, 0.12, and 3.91 micrograms/mL. At 2 months of age, 60% of infants of vaccinated mothers and 26% of infants of unvaccinated mothers had anti-PRP antibody concentrations considered to be protective (>0.15 micrograms/mL). CONCLUSIONS: In areas where much invasive Hib disease occurs in infants younger than 6 months, maternal immunization may help to reduce the risk of Hib disease in infants too young for immunization.

Antibodies, Bacterial↗
PubMed1996

Association of placental transfer of anti-Haemophilus influenzae type b polysaccharide antibodies with their V regions.

Immunization of mothers during pregnancy may be an effective means of providing protection to infants during the first months of life against many pathogens. Previous studies have identified factors that influence the transfer of immunoglobulin across the placenta, including the time of vaccination during pregnancy and isotypes of specific immunoglobulins. By studying antibodies to Haemophilus influenzae type b polysaccharide (Hib-PS) in 26 pairs of maternal-cord sera obtained from unimmunized healthy women and 22 pairs of maternal-cord sera from women immunized with one of three different Hib vaccines, we have found that the immunoglobulin transfer is also dependent on the V region of antibodies. Anti-Hib-PS derived from the V kappa II gene "A2" was transferred about ten times more efficiently to the fetus than other anti-Hib-PS antibodies (20% vs 1-2%). It was found that antibodies derived from the A2 V kappa gene are primarily IgG whereas other antibodies are preferentially associated with the IgM isotype. The potential association between the antibody V region with preferential placental transfer should be considered for future studies involving maternal immunization.

Antibodies, Bacterial↗
PubMed1996

Association of invasive pneumococcal disease with season, atmospheric conditions, air pollution, and the isolation of respiratory viruses.

We examined the relation of invasive pneumococcal disease to season, atmospheric conditions, and the rate of respiratory virus isolation in a community-wide surveillance program in Houston. Among adults, the number of cases of pneumococcal bacteremia peaked in midwinter and declined strikingly in midsummer, indicating a high degree of inverse correlation with the ambient temperature. We detected significant correlations between the occurrence of pneumococcal disease and the isolation of respiratory syncytial virus (P < .001), influenza virus (P < .001), and all viruses except influenza virus (P < .001), as well as with air pollution, as measured by SO2 levels (P < .001). In contrast, the rate of invasive pneumococcal disease among infants and children was relatively more sustained from October through May, with a notable decrease in summer months; the incidence of pneumococcal disease was therefore less strongly correlated with cold weather and less closely associated with the isolation of respiratory syncitial virus or influenza virus. However, pneumococcal disease among infants and children was associated with isolation of these viruses after a 4-week lag period as well as with isolation of adenovirus and ragweed pollen counts. The finding, with regard to children, that correlations tended to be stronger for events that occurred 1 month previously than for those that occurred contemporaneously is consistent with the concept that viral or allergic events predispose to otitis media with effusion, which becomes suppurative and leads to pneumococcal bacteremia or meningitis. For adults, a more immediate predisposition to pneumococcal pneumonia and bacteremia because of viral infection or air pollution was suggested.

Adenoviruses, Human↗
PubMed1996

Prevalence of neutralizing antibody to respiratory syncytial virus in sera from mothers and newborns residing in the Gambia and in The United States.

The prevalence of maternal respiratory syncytial virus (RSV)-neutralizing antibodies has been documented in developed countries, but there is little information from developing countries. We assessed the prevalence of RSV-neutralizing antibody in sera from Gambian women and their newborns and compared them with their American counterparts during a similar period. The geometric mean titers of maternal antibodies to RSV subgroup A in the two populations were similar, while titers of antibodies to RSV subgroup B in Gambian mothers were significantly higher (8.7 +/- 1.4 versus 7.9 +/- 1.3 [mean +/- standard deviation], P < 0.001). The titers of neutralizing antibody in newborns in both populations correlated with the neutralizing-antibody titers of their mothers. Thus, the status of neutralizing antibody to both major RSV subgroups was comparable among infants and mothers in a developing country, The Gambia, and those in a developed country, the United States.

Antibodies, Viral↗