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PubMed1984

Immune responses of cattle following vaccination with living and non-living Babesia bovis antigens.

Twenty-four yearling Hereford (Bos taurus) cattle were vaccinated against Babesia bovis using either live parasites or non-living antigens obtained from the supernatant of in vitro cultures. A single dose of live parasites was given subcutaneously, while the non-living supernatant antigen (NLSA) was combined with saponin and 2 doses given, 2 weeks apart. Following vaccination with live parasites, serum antibodies remained at high levels for 6 months, but the lymphocyte transformation response was low and lasted only 10-18 days. In contrast, NLSA vaccination was followed, after 21-28 days, by a peak of serum antibodies which then slowly declined. The lymphocyte transformation response in these animals was much higher and persisted for 6 months. Following heterologous challenge all unvaccinated cattle had severe reactions and required treatment to prevent death. Cattle vaccinated with live parasites had mild reactions with only 1 of the 12 requiring treatment. Cattle vaccinated with NLSA were only partially protected and 6 of the 12 required treatment.

Animals↗
PubMed2006

Population analyses of amlodipine in patients living in the community and patients living in nursing homes.

OBJECTIVE: Our objective was to determine the effects of age, sex, and morbidity on the apparent oral clearance (CL/F) of amlodipine. METHODS: Population pharmacokinetic analyses were performed on data from 211 patients receiving oral racemic amlodipine (dose of 7.2 +/- 3.6 mg/d [mean +/- SD]) on a long-term basis. Of the patients, 105 were men, with a mean age of 72 +/- 13 years and lean body weight (LBW) of 60.7 +/- 7.6 kg, and 106 were women, with a mean age of 79 +/- 11 years and LBW of 44.2 +/- 6.0 kg; 119 lived in the community, 20 in assisted living facilities, and 72 in nursing homes. Amlodipine was measured by liquid chromatography-tandem mass spectrometry. Population analyses were performed by use of NONMEM with sex, age, race, living site, alcohol intake, and concomitant medications considered as covariates. The significance of covariates was determined by likelihood ratio tests. RESULTS: Female sex and living in a nursing home were associated with a faster CL/F compared with men and community-dwelling patients, respectively. The mean CL/F was 7.83 +/- 0.50 mL.min(-1).kg(-1) (LBW) in women compared with 6.31 +/- 1.01 in men and 8.68 +/- 1.00 mL.min(-1).kg(-1) in nursing home residents compared with 6.32 +/- 1.17 in community-dwelling patients. Increasing age was associated with decreasing CL/F only in community-dwelling patients and residents of assisted living facilities. CONCLUSIONS: In middle-aged and very old (>80 years) patients, amlodipine CL/F was faster in women compared with men and was faster in nursing home residents compared with community-dwelling patients, with increasing age decreasing CL/F only in community-dwelling patients and residents of assisted-living facilities.

Aged↗
PubMed2006

Taste bud contains both short-lived and long-lived cell populations.

Taste bud cells undergo continual turnover even in adulthood, and their average lifespan has been estimated as approximately 10 days. However, it is not clear whether this figure can be applied to all the different cell types contained in a taste bud. Here, we describe the age and life cycle of taste bud cells in rat circumvallate papillae, and indicate that the lifespan is heterogeneous, ranging from 2 days to over 3 weeks. Taste bud cells were incorporated from the basal proliferative layer in 1-2 days after birth. After incorporation, approximately half of the cells were eliminated within 2-3 days, and the remaining half were maintained with gradual decrease, suggesting that there are at least two types of cells; short-lived cells and long-lived cells. Moreover, above 10% of the incorporated cells were maintained at 3 weeks. In order to gain information about the relationship between the cell functions and the cell age, we carried out double-labeling experiments using 5-bromo-2'-deoxyuridine and each of two markers for in situ hybridization: mammalian achaete-scute homolog 1 (Mash1) and phospholipase C beta 2 (PLCbeta2) as markers of early differentiation and functional taste signaling, respectively. Mash1 expression began immediately after the incorporation and reached a maximum at 5-6 days after birth. Fewer but distinct Mash1-positive cells were still observed after 3 weeks. PLCbeta2 expression was observed from day 5, reached a maximum at day 12, and continued over 3 weeks. Taken together, a taste bud contains both short-lived and long-lived cells: the short-lived cells are eliminated in a time course similar to the surrounding epithelial cells, and the long-lived cells including taste receptor cells have a lifespan longer than the previous estimation.

Analysis of Variance↗
PubMedDate not supplied

Rehabilitation of the elderly - influence of age, sex, main diagnosis and activities of daily living (ADL) on the elderly patients' return to their previous living conditions.

In geriatric rehabilitation, discharge to the living conditions in which elderly patients lived before admission is one of the most important treatment goals. The objective of this study therefore was to determine the extent to which this criterion was influenced by age, sex, main diagnosis and activities of daily living. For that purpose the results of 1845 patients, admitted consecutively from 1993 to 1995 were analysed. With advancing age an increasing number of patients was unable to return to their previous living conditions (10% vs. 24% comparing the age groups '64 years and younger' versus '85 years and older'). This age-associated decline was present for both sexes and for several diagnosis groups. A low (0-40 points) ADL-score on admission was found to be associated with a significantly smaller percentage of patients returning home (75%) than a high (90-135 points) score (95%). The criteria sex and main diagnosis were not significantly linked with the return home. According to multiple regression analysis, ADL-score on admission was the only parameter found to be significantly associated with return to preadmission living conditions, but not age. But if the ADL-score at discharge was added to the regression analysis, this criterion proved to be the only predictor. Despite the negative correlations between age as well as ADL-score on admission with return home and due to the fact that nearly three quarters of the oldest patients and of those most severely impaired on admission were able to return to their previous living conditions it seems worthwhile not to exclude patients only because of their age or the initial degree of dependence on care alone from rehabilitation services.

Journal Article↗
PubMed1989

Vanadate inhibits degradation of short-lived, but not of long-lived, proteins in L-132 human cells.

Vanadate, at concentrations higher than 0.04 mM, inhibits the intracellular degradation of short-lived proteins in exponentially growing L-132 human cells. The inhibition is not due to a decrease in viability or in the ATP contents of the cells. Since vanadate decreases proteolysis in cell extracts, the inhibition appears to affect the proteinases which degrade these proteins. Under optimal nutritional conditions, the degradation of long-lived proteins is accelerated by vanadate, thus providing additional evidence that in exponentially growing cultured cells degradation of short- and long-lived proteins occurs by different processes. Vanadate also efficiently inhibits the lysosomal degradation of endocytosed proteins and of long-lived proteins under step-down conditions. However, this effect seems to be unrelated to the observed inhibition of degradation of short-lived proteins, because chloroquine and leupeptin, which inhibit degradation of proteins by lysosomes, do not modify the degradation of these proteins. Our results provide for the first time a probe which, owing to its opposite effects on the degradation of short- and long-lived proteins, could be useful to clarify the mechanisms involved in protein degradation in cultured cells.

Cell Division↗
PubMed2004

Short-lived plasmablasts and long-lived plasma cells contribute to chronic humoral autoimmunity in NZB/W mice.

The current view holds that chronic autoimmune diseases are driven by the continuous activation of autoreactive B and T lymphocytes. However, despite the use of potent immunosuppressive drugs designed to interfere with this activation the production of autoantibodies often persists and contributes to progression of the immunopathology. In the present study, we analyzed the life span of (auto)antibody-secreting cells in the spleens of NZB x NZW F1 (NZB/W) mice, a murine model of systemic lupus erythematosus. The number of splenic ASCs increased in mice aged 1-5 mo and became stable thereafter. Less than 60% of the splenic (auto)antibody-secreting cells were short-lived plasmablasts, whereas 40% were nondividing, long-lived plasma cells with a half-life of >6 mo. In NZB/W mice and D42 Ig heavy chain knock-in mice, a fraction of DNA-specific plasma cells were also long-lived. Although antiproliferative immunosuppressive therapy depleted short-lived plasmablasts, long-lived plasma cells survived and continued to produce (auto)antibodies. Thus, long-lived, autoreactive plasma cells are a relevant target for researchers aiming to develop curative therapies for autoimmune diseases.

Animals↗
PubMed1983

Salmonella typhimurium infection in calves: cell-mediated and humoral immune reactions before and after challenge with live virulent bacteria in calves given live or inactivated vaccines.

Groups of six calves, 4 to 5 weeks old, were vaccinated either orally with a live auxotrophic Salmonella typhimurium (O-antigen 1,4,12) SL1479 vaccine (10(8) bacteria on day zero, 10(10) bacteria on days 7 and 14) or subcutaneously with a heat-inactivated (56 degrees C, 30 min) S. typhimurium SVA1232 vaccine (10(10) bacteria suspended in 30% [vol/vol] aluminum hydroxide on days zero, 7, and 14). The calves were then orally challenged with either 10(6) (approximately 100 X the 25% lethal dose) or 10(9) (approximately 100,000 X the 25% lethal dose) live bacteria of the calf-virulent S. typhimurium SVA44 strain. The immune reactivity of these calves and of nonvaccinated control calves was followed before and after the challenge infection up to 42 days by (i) intradermal injection of S. typhimurium crude extract, outer membrane protein preparation (porins), and lipopolysaccharide (LPS), (ii) in vitro stimulation of peripheral blood lymphocytes estimated by using uptake of [3H]thymidine, with S. typhimurium crude extract, porins, LPS, and polysaccharide (O-antigenic polysaccharide chain free of lipid A), and Salmonella sp. serotype thompson (O-antigen 6,7) strain IS40 LPS and polysaccharide, and (iii) estimation of the class-specific immunoglobulin G (IgG) and IgM antibody responses against S. typhimurium LPS and porins, and Salmonella sp. serotype thompson LPS. The immune studies showed that in calves given the live vaccine orally, the skin test reactivity and lymphocyte stimulation indices were significantly higher (P values ranging from less than 0.025 to less than 0.0005) against homologous, but not heterologous, antigens than those seen in calves given the heat-inactivated vaccine subcutaneously. In contrast, the IgG and IgM antibody titers against homologous LPS and porins were significantly higher (P less than 0.0005) in sera collected on day 21 from calves given the heat-inactivated vaccine than in calves given the live vaccine. After the oral challenge, calves given the live vaccine showed reduced cell-mediated immune reactions, in agreement with the observation that the host defense could eradicate the challenge organism, whereas calves given the heat-inactivated vaccine showed significantly increased cell-mediated immune reactions (P values ranging from less than 0.025 to less than 0.005), in agreement with the observation that in these calves, the challenge strain caused enteritis as well as systemic invasion. The increased cell-mediated immune reactivity in calves given the live vaccine correlated well with the excellent protection against challenge infection seen in these animals.

Administration, Oral↗
PubMed2007

A comparison of small and large assisted living facilities for the diagnosis and care of dementia: the Maryland Assisted Living Study.

OBJECTIVES: To compare the demographic, clinical, and psychiatric characteristics of residents living in small (< or = 15 beds) and large assisted living (AL) facilities in the United States. METHODS: One hundred and ninety-eight residents in 10 large and 12 small assisted living facilities were comprehensively assessed as part of the Maryland Assisted Living Study (MD-AL). The presence or absence of dementia and psychiatric disturbances and the facilities' recognition and management of these disorders were compared across the two types of AL. Aspects of care delivery were also compared. RESULTS: Small facilities had a higher prevalence of dementia (81%) compared to larger facilities (63%) and the mean Mini-Mental State Examination (MMSE) across all residents in small facilities (mean 13.04) was than in large facilities (mean 19.93)(p = 0.000). Almost all (98%) of the residents of small homes carried a diagnosis of a dementia or other psychiatric diagnosis, compared to 74% of residents in large facilities (p < 0.001). Psychosis in particular was more prevalent in the smaller homes and the mean Neuropsychiatric Inventory score, a measure of neuropsychiatric symptoms, was higher compared to large homes. Falls were more common in larger homes despite a greater number of personal care hours per week. The use of safety devices and restraints was significantly less common in large facilities compared to smaller homes, where 'geri-chair' and bedrails were more often used. CONCLUSIONS: Rates of dementia and psychiatric disorder differ in assisted living facilities depending on size of facility.

Accidental Falls↗
PubMed2006

Lessons learned from 1,000 living donor liver transplantations in a single center: how to make living donations safe.

Serious complications have occurred in a considerable proportion of living donors of liver transplants, but data from a single high-volume center has rarely been available. We analyzed the medical records of donors and recipients of the first 1,000 living donor liver transplants, performed at Asan Medical Center from December 1994 to June 2005, with a focus on donor safety. There were 107 pediatric and 893 adult transplants. The most common diagnoses were biliary atresia in pediatric recipients (63%) and hepatitis B-associated liver cirrhosis (80%) in adult recipients. Right lobe donors were strictly selected based on liver resection rate and steatosis. From 1,162 living donors, 588 right lobes, 6 extended right lobes, 7 right posterior segments, 464 left lobes, and 107 left lateral segments were obtained. Of these, 837 grafts were implanted singly, whereas 325, along with 1 cadaveric split graft, were implanted as dual grafts into 163 recipients. The 5-yr survival rates were 84.8% in pediatric recipients and 83.2% in adult recipients. There was no donor mortality, but 3.2% of donors experienced major complications. Until the end of 2001, the major donor complication rate was 6.7%, with most occurring in right liver donors. Since 2002, liver resection exceeding 65% of whole liver volume were avoided except for young donors with no hepatic steatosis, and the donor complication rate has been reduced to 1.3%. In conclusion, a majority of major living donor complications appear to be avoidable through the strict selection of living donor and graft type, intensive postoperative surveillance, and timely feedback of surgical techniques. Selection of right lobe graft should be very prudently considered if the donor right liver appears to be larger than 65% of the whole liver volume.

Adolescent↗
PubMed2002

Validity of the Kohlman Evaluation of Living Skills (KELS) with Israeli elderly individuals living in the community.

The Kohlman Evaluation of Living Skills (KELS) was developed to evaluate Activities of Daily Living (ADL) and Instrumental ADL (IADL) in a psychiatric population. Later the KELS was assessed and adapted for a geriatric population. The purpose of this study was to determine the validity of the KELS with elderly individuals living in the community in Israel. The subjects included 92 elderly people living in the community, in protected housing facilities for the elderly, and those living in the community and attending day care. Instruments included the Mini-Mental State Examination (MMSE) to determine cognitive function, the Functional Independent Measure (FIM) to determine performance in ADL, and the Routine Task Inventory (RTI) as a measure of IADL to determine criterion validity. Results showed high correlations between the KELS and the RTI (r = 0.895) and the FIM (r = 0.70). The KELS was also found to be highly sensitive to the differences between all three groups, supporting construct validity. Furthermore, the KELS was found to be more sensitive to these differences than the other instruments used in the study. In conclusion, the results show the KELS to be valid and appropriate for use by occupational therapists with the Israeli elderly population, similar to the US population. The study's small sample size limits the generalizability of the findings. It is recommended that further research be done on the KELS with larger and more diverse elderly populations.

Activities of Daily Living↗
PubMed2006

Living unrelated versus living related kidney transplantation: 20 years' experience with 2155 cases.

PURPOSE: To compare the long-term results of kidney transplantation from living unrelated donors (LURDs) with that from living related donors (LRDs). MATERIALS AND METHODS: From 1984 to 2004, we performed 2155 kidney transplantations of which 374 were from LRDs and 1760 from LURDs. We reviewed and compared the long-term data from these cases. RESULTS: The LURD group included 64.2% men with an overall mean age of 33.46 +/- 14.61 (range 3 to 76) years. Laparoscopic donor nephrectomy was performed in 329 cases (18.7%) with mean follow-up of 45.68 +/- 46.80 months. The LRD group included 66.5% of male recipients with overall mean age of 28.97 +/- 9.58 (range 9 to 65) years. Laparoscopic donor nephrectomy was performed in 12 cases (3.2%) of LRDs with mean follow-up of 81.15 +/- 67.03 months. One-, 3-, 5-, 10-, and 15-year graft survivals among LRDs were 91.6%, 81.7%, 76.4%, 64.4%, and 48.4%; and for LURDs, 91.5%, 86.7%, 81.4%, 68.2%, and 53.2%, respectively (P = .07). Patient survivals for 1, 3, 5, 10, and 15 years in LRDs were 94.6%, 91.9%, 83%, 79.5%, and 73.9%, and in LURDs were 93.6%, 91.7%, 89.3%, 84%, and 76.4%, respectively (P = .14). CONCLUSION: The results of living unrelated kidney transplantation upon long-term follow-up with a large number of cases were as good as living related kidney transplantation. The organ shortage can be alleviated by using living unrelated kidney transplantation. To our knowledge this is the largest experience with long-term follow-up reported from one center to date.

Adolescent↗
PubMed2004

Increased rejection in living unrelated versus living related kidney transplants does not affect short-term function and survival.

BACKGROUND: At our institution, increased kidney donation from unrelated donors accounts for a steady rise in live donor kidney transplantation rates. We compared outcomes of living related (LRT) versus living unrelated kidney transplants (LURT) and analyzed the effect of early rejection upon graft survival. METHODS: A retrospective analysis on 428 adult living donor kidney transplants was performed. Graft function and survival were compared between LRT and LURT and risk factors for 1-year rejection were defined by multivariate analysis. RESULTS: Between 1/1/97 and 12/31/01, 308 LRT and 120 LURT were performed at the University of California San Francisco. Donor age and number of mismatches were significantly higher in the LURT group. Patient and graft survival were similar in both groups. After a median follow-up of 26 months, graft survival was 94.8% (LRT) versus 93.3% (LURT). Five-year serum creatinine levels were comparable in both populations. One-year rejection was higher in the LURT group (30% vs. 18.5%; P<0.01). Rejection was influenced by the number of human leukocyte antigen mismatches. Other independent risk factors for early rejection were poor initial graft function, donor age greater than 55 years, and recipient body mass index greater than 30. Patients with poor initial graft function and early rejection had a statistically greater incidence of subtherapeutic tacrolimus trough levels on postoperative day 7. CONCLUSIONS: Despite a higher incidence of early rejection, LURT show similar function and survival compared with LRT. In high-risk patients receiving living unrelated renal transplants, consideration should be given to intensify initial immunosuppression to prevent early rejection episodes.

Adult↗
PubMed2005

Older living donors provide excellent quality kidneys: a single center experience (older living donors).

BACKGROUND: The role of advanced age live donors remains controversial because of decline in glomerular filtration rate and perceived increased risks of perioperative complications. METHODS: A retrospective review of all live donor transplants performed from January 2000 to December 2003. RESULTS: Seventy-eight live donor transplants were performed during the period of review, 47 (60.3%) female and 31 (39.7%) male. Twenty-two (28.2%) of the donors were >50 yr old, 15 (68%) female and seven (32%) male. Living related donation was performed in 56 (74.4%) and unrelated in 20 (35.6%). Laparoscopic nephrectomy was performed in 29 (37.2%) and open nephrectomy in 49 (62.8%). More donors >50 underwent laparoscopic nephrectomy, 13 of 22 (59.1%) vs. 16 of 56 (28.6%). Overall patient and graft survival at 1 yr are 97 and 97%. One-year patient and graft survival is 100% vs. 96% and 100% vs. 96% in the older vs. young donors. Rejection occurred in nine of 78 (11.5%), but was not different between groups. Older donors had a reduced creatinine clearance 107.5 +/- 3.4 vs. 124.2 +/- 3.1 mL/min (p = 0.002) and a reduced clearance normalized for body surface area 60.6 +/- 3.6 mL/(min m2) vs. 70.2 +/- 2.6 mL/(min m2) (p = 0.045). Recipient serum creatinine was higher on postoperative day 1 in the older donor group 5.4 mg/dL vs. 4.4 mg/dL (p = 0.009). There was no difference in recipient serum creatinine at postoperative day 7, 30, 90, 180, 365 and 730. Donor serum creatinine was not different between groups on postoperative days 1, 7 and 30 but was higher in group 1 vs. group 2 on postoperative day 365, 1.26 +/- 0.26 mg/dL vs. 1.01 +/- 0.18 mg/dL (p = 0.020). CONCLUSIONS: Despite a reduced initial creatinine clearance, renal function is comparable in recipients of both young and old donor kidneys. Older donors had a slightly reduced serum creatinine 1 yr post-donation that warrants additional follow-up to determine if the observations continue. The introduction of laparoscopic nephrectomy may provide additional incentive for older donors to present for live donor nephrectomy.

Adult↗
PubMed2004

Alone and content: frail seniors living in their own homes compared to those who live with others.

This study compared the psychosocial well-being and functioning of frail elderly people who live alone to those who live with others. An exploratory study was conducted with a sample of 5,265 members of a social HMO in Southern California. Those living alone were more likely to be widowed, female, and European American. Elderly people living with others reported higher levels of depression and poorer functioning. Both groups reported having a social support network, but the sources of support varied. This study contradicts older research with its finding that living alone is not synonymous with depression. Further research is recommended.

Activities of Daily Living↗
PubMedDate not supplied

[Ethical and legal features of living donor kidney transplantation. Management and coordination of the process of living donation].

OBJECTIVES: Living donors for kidney transplantation have attracted interest from different points of view because medical issues are accompanied by other features involving ethical, legal and social issues. We analyze all aspects involved in living donation for kidney transplantation. METHODS: We analyze: (1) ETHICAL ISSUES: requirements to become living donor, donor-receptor relationship, informed consent, donor's motivations, risk/benefit. (2) Legal issues: We review Spanish laws and Council of Europe's recommendations. (3) We also analyze how to coordinate the process in order to guarantee protection to donors. RESULTS/CONCLUSIONS: Living donor kidney transplantation is a growing therapeutic option. The process of living donation should comply with several legal and ethical requirements, and cooperation between different professionals to guarantee protection to donors.

Humans↗
PubMed2006

A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities: evaluation of the applicability with focus on cognitive function.

BACKGROUND AND PURPOSE: Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments. The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities. A second aim was to analyze whether cognitive function was associated with the applicability of the program. SUBJECTS: The subjects were 91 older people (mean age=85.3 years, SD=6.1, range=68-100) who were dependent in personal activities of daily living and randomly assigned to participate in an exercise intervention. Their mean score for the Mini-Mental State Examination (MMSE) was 17.5 (SD=5.0, range=10-29). METHODS: A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists. There were 29 exercise sessions over 13 weeks. Attendance, intensity of lower-limb strength and balance exercises, and occurrence and seriousness of adverse events were the outcome variables in evaluating the applicability of the program. RESULTS: The median attendance rate was 76%. Lower-limb strength exercises with high intensity were performed in a median of 53% of the attended exercise sessions, and balance exercises with high intensity were performed in a median of 73% of the attended exercise sessions. The median rate of sessions with adverse events was 5%. All except 2 adverse events were assessed as minor and temporary, and none led to manifest injury or disease. No significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, there was no significant correlation between applicability and the MMSE score. DISCUSSION AND CONCLUSION: The results suggest that a high-intensity functional weight-bearing exercise program is applicable for use, regardless of cognitive function, among older people who are dependent in activities of daily living, living in residential care facilities, and have an MMSE score of 10 or higher.

Activities of Daily Living↗
PubMed2001

Constitutively dead, conditionally live HIV-1 genomes. Ex vivo implications for a live virus vaccine.

An effective vaccine against AIDS is unlikely to be available for many years. As we approach two decades since the first identification of human immunodeficiency virus, type 1 (HIV-1), currently, only one subunit vaccine candidate has reached phase 3 of clinical trials. The subunit approach has been criticized for its inability to elicit effectively cytotoxic T-lymphocyte (CTL) response, which is felt by many to be needed for protection against HIV-1 infection. In subhuman primates, a live attenuated simian immunodeficiency virus (SIV) vaccine candidate, capable of inducing CTL, has been found to confer prophylactic immunity sufficient to prevent simian AIDS. Because replication competent (live) attenuated viruses could over time revert to virulence, such a live attenuated approach has largely been dismissed for HIV-1. Here, we describe the creation of constitutively dead conditionally live (CDCL) HIV-1 genomes. These genomes are constitutively defective for the Tat/TAR axis and are conditionally dependent on tetracycline for attenuated replication with robust expression of viral antigens. Our results suggest that CDCL genomes merit consideration as safer "live" attenuated HIV-1 vaccine candidates.

AIDS Vaccines↗
PubMed1994

Antibody response and viral excretion after live polio vaccine or a combined schedule of live and inactivated polio vaccines.

A randomized controlled trial was performed in infants undergoing routine immunization in North Hertfordshire. Ninety-six children received a single dose of inactivated polio vaccine, followed by two doses of live attenuated oral polio vaccine and 97 children received three doses of live attenuated oral polio vaccine at 2, 3 and 4 months of age. Blood samples were taken by study nurses 6 weeks after vaccination and stool samples were collected by parents weekly for 4 weeks after each dose of vaccine. Follow-up was completed for 92 of 96 (96%) children in the combined schedule group and 92 of 97 (95%) in the control group. After vaccination the proportions of children with detectable antibody to poliovirus serotypes 1, 2 and 3 were high and similar between groups and geometric mean titers (95% confidence interval) to poliovirus types 1, 2 and 3 were 264 (200 to 347), 375 (311 to 450) and 189 (144 to 250) in the combined schedule group and 369 (290 to 469), 401 (321 to 498) and 206 (145 to 293) in the live vaccine group, respectively. The only significant difference between groups in rates of viral excretion was observed after the second dose of live attenuated oral polio vaccine, when excretion of type 3 poliovirus was reduced in those children who had received prior inactivated polio vaccine (P = 0.05). This study suggests that, compared with the current schedule, a combined schedule of inactivated and live poliovaccines is likely to produce equivalent individual protection against poliomyelitis and is unlikely to substantially alter circulation of poliovirus in the community.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Viral↗