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[Comparison of duck embryo vaccine and Hempt's vaccine for rabies vaccination (author's transl)].

For many years, Hempt's vaccine has been used in Germany for vaccination against rabies. In recent years the duck embryo vaccine has been gradually introduced in its place. From 1970 to 1975, 658 consultations were undertaken at the Hospital of the Tropical Institute at Hamburg because of the risk of rabies. 267 persons had to undergo vaccination, 159 of them being treated with Hempt's vaccine and 108 with duck embryo vaccine. Side effects of a more severe type were not seen in either group. Disadvantages of the duck embryo vaccine are that more individual inoculations are necessary, significantly more frequent and more persistent local and general vaccination reactions occur and that there is a delayed, possibly weaker formation of antibodies.

Animals↗

[Specific immunotherapy of allergic diseases: application, effect and side-effects (author's transl)].

Based on the results of 500 patients suffering from bee-venom allergy, allergic rhinitis, bronchial asthma, atopic dermatitis and food allergy the necessary diagnostic procedures leading to specific immunotherapy are discussed. The immunstimulating potential of the vaccines varies from patient to patient and is decreased after some viral infections. Good results are seen in young patients and when a low number of allergens is incorporated in the vaccine. Side effects of minor importance are seen in about half the patients. Systemic reactions following specific immunotherapy are seen more often in aqueous solutions compared to depot vaccines. The treatment should be reconsidered, if the patient has not improved after half a year.

Asthma↗

Breaking the barriers to childhood immunization.

Although about 98 percent of children have received their basic series of immunizations at the time of school entry, only 67 percent of two-year-old children are appropriately immunized. Parental, provider, economic and system barriers to immunization must be overcome if the United States is to achieve the objective that 90 percent of two-year-old children receive the basic vaccination series against the major preventable childhood diseases by 1996. Parents must be educated about the importance of vaccines and the hazards of the diseases they prevent, and they must be given proper information about vaccine side effects and contraindications. Physicians should take advantage of all appropriate patient contacts, including acute office visits for minor illnesses, to keep children's immunizations current. Audits of office records, as well as tracking or reminder systems, improve vaccination rates. The Vaccines for Children Program is intended to remove cost as a barrier to the immunization of some children. The single immunization schedule endorsed by the American Academy of Family Physicians, the American Academy of Pediatrics and the Advisory Committee on Immunization Practices may alleviate confusion about the appropriate time to administer different vaccines.

Child↗

Rare adverse events associated with oral poliovirus vaccine in Brazil.

Oral poliovirus vaccine (OPV) developed by A. Sabin has been effectively used to control poliomyelitis in Brazil, and the last case with the isolation of a wild poliovirus strain occurred in March 1989. Although the vaccine controlled the circulation of wild strains and poliomyelitis cases associated with these strains were not detected during the last eight years, rare cases classified as vaccine-associated paralytic poliomyelitis (VAPP) have been detected. Molecular characterization studies of poliovirus strains isolated from VAPP cases and from healthy contacts have confirmed that the isolates are derived from the Sabin vaccine strains and also detected genomic modifications known or suspected to increase neurovirulence such as mutations and recombination. The molecular characterization of polioviruses isolated during the last eight years from paralysis cases classified as Guillain-Barré (GBS) syndrome and transverse myelitis (TM), and from facial paralysis (FP) cases also confirmed the vaccine origin of the strains and demonstrated mutations known to increase neurovirulence. Analysis of the epidemiologic data of these GBS, TM and FP cases demonstrated that in most of them the last OPV dose was given months or years before the onset of the disease and the isolation of the polioviruses. The temporal association between the isolation of these strains and the GBS, TM and FP suggested that the Sabin vaccine-derived poliovirus strains could also rarely trigger the diseases.

Brazil↗

Symptoms after primary immunisation with DTP and with DT vaccine.

Symptoms after routine primary immunisation of 6004 infants with diphtheria/tetanus/pertussis (DTP) vaccine and 4024 infants with diphtheria/tetanus (DT) vaccine have been compared. After each dose, crying, screaming, and feverishness were more frequent with adsorbed DTP than adsorbed DT, but the difference was small. Attacks of high-pitched screaming, episodes of pallor or cyanosis with limpness, convulsions, and local reactions occurred with similar frequency after both vaccines. There was a considerable increase in local reactions after the 3rd dose with both vaccines. Over 1000 doses of plain DTP (with no aluminium hydroxide adjuvant) were given during the study. Post-vaccination symptoms were more common after the plain than after the 2 adsorbed preparations.

Crying↗

Factors associated with clinical reactions to rubella vaccination in women.

Two types of rubella vaccine were given to 272 seronegative healthy Japanese adult women. Clinical and laboratory studies on clinical reaction after vaccination were carried out on HI antibody response, HLA types, basal body temperature (BBT), menstrual cycles and serum progesterone levels of vaccinees. Clinical reactions were not associated with HLA types of vaccinees, but arthropathy occurred significantly more often in women vaccinated at the progestational stage than in women vaccinated at the estrogenic stage.

Adult↗

Oral immunisation against typhoid fever in Indonesia with Ty21a vaccine.

When tested under conditions of moderate transmission of typhoid fever, a liquid formulation of the oral typhoid fever vaccine Ty21a had a protective efficacy of 96% in Egypt, and an enteric coated capsule formulation had an efficacy of 67% in Chile. We compared the two formulations under conditions of intense transmission of typhoid fever in Indonesia in a randomised, double-blind trial. 20,543 subjects (age range 3-44 years) received either three doses of enteric coated capsules containing placebo or live Ty21a, or three doses of lyophilised placebo or live Ty21a reconstituted with phosphate buffer. During 30 months of follow-up, the rate of blood-culture-positive typhoid fever among controls was 810/100,000 per year. Rates of typhoid fever were 379/100,000 per year for subjects who received the liquid formulation of vaccine and 468/100,000 per year for subjects who received enteric coated capsules. The protective efficacies of the liquid and enteric coated formulations were 53% and 42%, respectively. Neither formulation protected against infection with Salmonella paratyphi A. No major side-effects were noted, but the overall incidence of side-effects was greater in the vaccine groups. Under conditions of intense transmission, Ty21a protected against typhoid fever; however, because Ty21a will not protect all individuals, there is a need for additional approaches to prevent the disease.

Administration, Oral↗

Safety and immunogenicity of single-dose live oral cholera vaccine CVD 103-HgR in 5-9-year-old Indonesian children.

Oral vaccines offer great promise as public-health measures to prevent disease in less-developed countries. CVD 103-HgR, a genetically engineered, attenuated, Vibrio cholerae O1 strain has proved effective in industrialised countries. We have assessed the safety, immunogenicity, and excretion of this live cholera vaccine in children in north Jakarta, Indonesia. 412 children aged 5-9 years received single doses of 5 x 10(6), 5 x 10(7), 5 x 10(8), 5 x 10(9), or 1 x 10(10) colony forming units (CFU) of CVD 103-HgR or placebo (5 x 10(8) inactivated Escherichia coli K-12) with buffer. All doses were well tolerated. The 5 x 10(8) CFU dose, which is highly immunogenic in subjects in industrialised countries (greater than 90% seroconversion), elicited seroconversions of vibriocidal antibody in only 16% of Indonesian children. By contrast, a single 5 x 10(9) CFU dose of vaccine resulted in high rates (75% and 87%) of seroconversion with two different batches of vaccine. A batch prepared with a centrifugation step gave significantly higher geometric mean titres (16-fold increase over baseline) than did a batch in which there was a filtration step between fermentation and lyophilisation (10-fold increase over baseline). At a 5 x 10(9) CFU dose, CVD 103-HgR is well tolerated and highly immunogenic in Indonesian children and should therefore be further investigated for use as a one-dose live oral cholera vaccine in developing countries.

Administration, Oral↗

Trial of high-dose Edmonston-Zagreb measles vaccine in the Gambia: antibody response and side-effects.

In a randomised trial, infants living in a large village in The Gambia were immunised either at 4 months of age with 40,000 plaque forming units (PFU) of the Edmonston-Zagreb (EZ) measles vaccine or at the usual age of 9 months with 6000 TCID50 of a conventional Schwarz measles vaccine. Measles developed in 2 of 119 children who received the EZ vaccine, in 1 before and in the other after 9 months of age. In the Schwarz group measles developed in 7 of 120 children--in 5 before and in 2 after 9 months of age. Serological responses measured at 5 months after vaccination and at 18 months of age were satisfactory in both groups although in the Schwarz group levels were on average 2-fold higher than in the EZ group. The frequencies of fever, cough, vomiting, and diarrhoea were no higher in the EZ vaccinees in the 3 weeks following vaccination than in age-matched non-immunised controls. Long-term morbidity as assessed by clinic attendances and weight at 18 months of age was much the same in the two groups. The EZ measles vaccine is thus safe and clinically and serologically effective when used in a high dose to immunise young Gambian infants.

Age Factors↗

The immunogenicity and safety of Haemophilus influenzae type b-tetanus toxoid conjugate vaccine in Gambian infants.

In developing countries, Haemophilus influenzae type b is a major cause of meningitis and pneumonia in the 1st year of life. The safety and immunogenicity of a Haemophilus influenzae type b polysaccharide-tetanus toxoid conjugate vaccine (PRP-T) were evaluated in two studies of Gambian infants. In the first study, 131 infants were recruited and randomized into three groups to receive PRP-T at 1 and 3 months (group A), PRP-T at 2 and 4 months (group B) or no PRP-T (group C). The liquid form of PRP-T was used. The geometric mean titre (GMT) of anti-PRP antibody 1 month after the second dose was 0.26 microgram/ml in group A and 0.41 microgram/ml in group B. In the second study, 66 infants were given PRP-T in the lyophilized form at 2, 3 and 4 months of age. The GMT 1 month after the first dose was 0.09 microgram/ml, after the second 0.74 microgram/ml and after the third 2.32 micrograms/ml. After the third dose, 72% of children had antibody levels greater than 1.0 microgram/ml and 93% greater than 0.15 microgram/ml. No serious side-effects were observed and the rate of adverse reactions was consistent with the concurrent administration of diphtheria-tetanus-pertussis (DPT) vaccine.

Age Factors↗

Intradermal administration of measles vaccines.

The aim of the study reported here was to determine if bifurcated needles or multiple puncture cylinders would prove suitable for administration of measles vaccines. Children 9 to 11 months old in São Paulo, Brazil, were assigned to receive either Biken-Cam 70 (5,000 TCID50/0.5 ml) or Edmonston-Zagreb (7,000 TCID50/0.5 ml) measles vaccines intradermally with a bifurcated needle or a multiple puncture cylinder. These devices are usually used to administer smallpox or BCG vaccine. The volume of vaccine inoculated was approximately 0.003 ml. Measles IgG antibodies were measured by enzyme-linked immunosorbent assay (ELISA) at the time of vaccination and 8 weeks later. The study participants were examined 14 days after inoculation for possible adverse reactions. Overall, the children's average age was 9.5 +/- 0.66 months at vaccination. None of the 45 recipients of Biken-Cam vaccine responded serologically. The 49 Edmonston-Zagreb vaccine recipients immunized with the multiple puncture cylinder had a somewhat higher serologic response rate (35%) and mean concentration of measles antibodies (323 mIU/ml) than those 51 who received the same vaccine administered with the bifurcated needle (26% and 291 mIU/ml, respectively). The rates of reported symptoms after vaccination did not differ significantly among the groups. Overall, the low serologic response rates following intradermal immunization with for devices tested in this study indicate that this route of administration is not suitable for routine administration of standard-titer vaccines.

Antibodies, Viral↗

BCG vaccination of full-term infants with chronic intrauterine malnutrition: influence of immunization age on development of post-vaccination, delayed tuberculin hypersensitivity.

To determine the effect of intrauterine growth retardation (IUGR) on the response to BCG vaccination, we evaluated the specific delayed tuberculin hypersensitivity of 57 full-term infants with symmetric IUGR (SGA or small for gestational age) and 52 full-term infants with normal intrauterine growth (AGA or appropriate for gestational age). The infants were evaluated using post-vaccination skin tests to tuberculin purified protein derivative (PPD) and tuberculin lymphocyte transformation tests. Using a positive response to the skin test as an indicator of delayed hypersensitivity, we found that the rate of response to BCG in the SGA and AGA groups was similar. A total of 65% of infants with IUGR responded to BCG vaccination. The response rate among SGA infants who were vaccinated at 5 days of age, about 26 days of age (weight > or = 2500 g), 3 months of age, and 6 months of age was 68%, 47%, 69%, and 88%, respectively. The overall response rate for infants with no IUGR was 71%; the rate response to BCG vaccination among this group was 52% (those vaccinated at 5 days of age), 90% (3 months of age), and 80% (6 months of age). Our data suggest that the immunogenicity of BCG vaccine is similar in term infants who have normal or abnormal intrauterine growth and the presence of IUGR should not be a reason for delaying BCG vaccination.

BCG Vaccine↗

Safety and immunogenicity of oral killed whole cell recombinant B subunit cholera vaccine in Barranquilla, Colombia.

In January and February 1992, an assessment was conducted of the safety and immunogenicity of two doses of a new oral cholera vaccine prepared from the recombinant B subunit of the toxin and from killed whole cells (rBS/WC) in 1,165 individuals between the ages of 12 months and 64 years in Barranquilla, Colombia. This was a randomized, double-blind placebo-controlled study. Participants received two doses of either the vaccine or a placebo (killed Escherichia coli K12) over a two-week interval. Few symptoms were detected during the three days following administration of the initial dose and even fewer following the second. Sera obtained upon administration of the first dose and two weeks after administration of the second were tested for Vibrio cholerae 01 Inaba vibriocidal antibodies and antitoxins. Geometric mean titers (GMT) of vibriocidal antibodies were found to increase two-fold in subjects receiving the vaccine. In the paired samples taken from vaccinated subjects, two-fold or greater increases were observed in 44% and four-fold or greater increases were observed in 34%, as compared to similar increases in 9.2% and 2.2% of the sera taken from those receiving the placebo (P < 0.05). The GMTs of IgG and IgA antitoxins, as determined by ELISA, increased by factors of 4 and 3.2, respectively, in those receiving the vaccine, as compared to factors of 1.1 and 1.1 in those given the placebo (P < 0.001 for IgG, P < 0.01 for IgA). Approximately 80% of the paired samples from the vaccinated group showed an increase of both IgG and IgA antitoxins > or = 1.5, as compared to only about 20% of those in the placebo group (P < 0.000001). Belonging to the O blood group did not significantly affect the immune response. Children under age four tended to show a weaker vibriocidal antibody response and a stronger antitoxin response than older subjects. The two doses of oral vaccine were found to be safe and without attributable side-effects. The vibriocidal antibody and antitoxin responses were similar to those obtained previously with the conventional oral killed whole cell B subunit cholera vaccine.

Administration, Oral↗