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PubMed1993

[Certain problems with limits of immunity against measles, mumps and rubella].

Strategic goals and schemes of immunization against measles, mumps and rubella in European countries with special attention for positive and negative sides of immunization against rubella and control of congenital rubella were described. Vaccines against mumps with strain Urabe AM9 were withdrawn in September 1992 in Great Britain. Decision was caused by increasing of complications after vaccination to 1 for 4000 doses of vaccine. (Former 1:4,000,000). Only mumps vaccine with strain Jeryl Lynn is there accepted. Including of vaccination against mumps to the calendar of vaccination in Poland was advised, when vaccine MMR with Jeryl Lynn mumps vaccine strain would be available. Monitoring of immunization of women against rubella would be necessary after above mentioned change in calendar of vaccinations.

Adolescent↗
PubMedDate not supplied

Hepatitis B vaccination results in 140 liver transplant recipients.

BACKGROUND/AIMS: Human autologous liver transplantation is possible due to an adequate suppression of the body's immune response. This also causes a higher hepatitis infection rate, making hepatitis prevention very important. MATERIALS AND METHODS: We describe our experience with hepatitis B virus vaccination in 140 adult liver transplant recipients, transplanted from 1986 to 1994 with more than one year of follow-up. Excluded were those who had hepatitis B surface antigens or antibodies to those antigens before the transplant. The vaccination schedule was 0-1-2 months with a double dose of recombinant vaccine. RESULTS: The total response rate (surface antigen antibodies > 10 U) was 40% (56/140); the rate was 47.7% in men and 26% in women. At the end of the study, only 17.1% (24/140) of the patients had antibodies > 10 U. The response rate was higher in patients with antibodies to hepatitis B core antigen (66.6%) than in those lacking antibodies (31.7%), and more long lasting (42.4% vs 11.2%). The response rate in 116 patients with booster doses was 12.9%. Six correctly vaccinated patients (4.28%) acquired new hepatitis B virus infections after the operation. CONCLUSIONS: The total response rate in these patients is much lower than in the general population, and there is a rapid decline of titers, probably due to immunosuppression. The role of booster doses in these patients should be clarified.

Adolescent↗
PubMed1993

Bacillus Calmette-Guérin infection after vaccination of human immunodeficiency virus-infected children.

The use of Mycobacterium bovis/Bacillus Calmette-Guérin (BCG) to vaccinate against tuberculosis remains controversial. The development of tuberculosis in human immunodeficiency virus (HIV)-infected children demands specific evaluation of the risk/benefit ratio of BCG vaccination in this situation. In our institution 9 of 68 HIV-infected children vaccinated with BCG before the diagnosis of HIV infection was suspected developed vaccine-related complications: 7 of these children had a large satellite adenopathy with or without skin fistulae, whereas the other 2 had disseminated BCG infection beyond the satellite ganglion (involvement of the spleen and mesenteric and mediastinal lymph nodes in one case and the liver and lungs in the other). The children were vaccinated soon after birth; no particular problems were observed at that time, but complications appeared 3 to 35 months later. All but one of these children had a rapidly progressive form of HIV disease. The possibility of delayed local or disseminated BCG infection must be considered in analysis of the risk/benefit ratio of vaccination of HIV-infected children. The prognosis of HIV infection must be taken into account, even if the child is asymptomatic when vaccination is being considered.

BCG Vaccine↗
PubMed1989

[Side effects and complications of measles-mumps vaccination].

Within three years we have observed three patients with parotitis after measles-mumps-vaccination, one child with idiopathic thrombocytopenic purpura, one with meningitis, and one patient with a preexisting severe cerebral damage died of central vasomotor and breath regulation dysfunction 20 days after the vaccination. Their case histories are described here, and the literature dealing with this question is reviewed. The following incidences of side effects may have to be accepted: "vaccination measles" (fever, rash, conjunctivitis, coughing) 5%, parotid swelling 1%. Furthermore, there are reports and observations on 38 patients who have developed ITP after vaccination, and on 8 other children who developed meningitis. From their lumbar liquor, mumps- or vaccine mumps viruses have been cultured. There are, as yet, no markers that would permit a typing of these viruses. Parents will have to be informed of these possible side effects and observations. In addition to that further information is not necessary on other very rare observations with as yet not established causal relationship with the vaccination. The measles-mumps-vaccination correctly is regarded as to be of low risk. Its usefulness is apparent when the frequency of side effects discussed here is compared to the incidence of grave complications of wild measles and mumps infections.

Child, Preschool↗
PubMed2005

Osteoarticular side effects of BCG therapy.

Although osteoarticular side effects of the Bacillus Calmette-Guérin (BCG) are rare compared to the number of administrations, BCG vaccination and cancer therapy are so widely used that the absolute number of cases is not negligible. Osteoarticular infection is an exceedingly rare complication of vaccination with the BCG. Intravesical BCG instillations used to treat superficial bladder cancer may cause arthralgia, reactive arthritis or osteoarticular infections. Intradermal BCG therapy used to treat a number of malignancies can cause osteoarticular infections or bilateral symmetric polyarthritis predominating in the wrists and fingers. In practice, when intravesical BCG instillation is followed by arthritis, hyperthermia is unhelpful for distinguishing septic arthritis from reactive arthritis. Arguments pointing to reactive arthritis include oligo- or polyarticular involvement and onset a few weeks (as opposed to a few months) after the last instillation. Nevertheless, joint fluid examination is in order to rule out septic arthritis. BCG-induced reactive arthritis usually responds well to nonsteroidal anti-inflammatory drugs. Osteoarticular infections related to BCG therapy should be treated by rifampin, isoniazid and ethambutol for 2 months, followed by rifampin and isoniazid for 10 months.

Adjuvants, Immunologic↗
PubMedDate not supplied

The economic impact of pandemic influenza in the United States: priorities for intervention.

We estimated the possible effects of the next influenza pandemic in the United States and analyzed the economic impact of vaccine-based interventions. Using death rates, hospitalization data, and outpatient visits, we estimated 89,000 to 207,000 deaths; 314,000 to 734,000 hospitalizations; 18 to 42 million outpatient visits; and 20 to 47 million additional illnesses. Patients at high risk (15% of the population) would account for approximately 84% of all deaths. The estimated economic impact would be US$71.3 to $166.5 billion, excluding disruptions to commerce and society. At $21 per vaccinee, we project a net savings to society if persons in all age groups are vaccinated. At $62 per vaccinee and at gross attack rates of 25%, we project net losses if persons not at high risk for complications are vaccinated. Vaccinating 60% of the population would generate the highest economic returns but may not be possible within the time required for vaccine effectiveness, especially if two doses of vaccine are required.

Adolescent↗
PubMed2003

SWOT analysis: strengths, weaknesses, opportunities and threats of the Israeli Smallpox Revaccination Program.

During September 2002, Israel began its current revaccination program against smallpox, targeting previously vaccinated "first responders" among medical and emergency workers. In order to identify the potential strengths and weaknesses of this program and the conditions under which critical decisions were reached, we conducted a SWOT analysis of the current Israeli revaccination program, designed to identify its intrinsic strengths and weaknesses, as well as opportunities for its success and threats against it. SWOT analysis--a practical tool for the study of public health policy decisions and the social and political contexts in which they are reached--revealed clear and substantial strengths and weaknesses of the current smallpox revaccination program, intrinsic to the vaccine itself. A number of threats were identified that may jeopardize the success of the current program, chief among them the appearance of severe complications of vaccination. Our finding of a lack of a generation of knowledge on smallpox vaccination highlights the need for improved physician education and dissipation of misconceptions that are prevalent in the public today.

Contraindications↗
PubMed2002

The Victorian Ambulatory Care Sensitive Conditions study: reducing demand on hospital services in Victoria.

Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable if preventive care and early disease management are applied, usually in the ambulatory setting. The Victorian ACSCs study offers a new set of indicators describing differentials and inequalities in access to the primary healthcare system in Victoria. The study used the Victorian Admitted Episodes Dataset (1999-2000) for analysing hospital admissions for diabetes complications, asthma, vaccine preventable influenza and pneumococcal pneumonia. The analyses were performed at the level of Primary Care Partnerships (PCPs). There were 12,100 admissions for diabetes complications in Victoria. There was a 12-fold variation in admission rates for diabetes complications across PCPs, with 13 PCPs having significantly higher rates than the Victorian average, accounting for just over half of all admissions (6114) and 39 per cent total bed days. Similar variations in admission rates across PCPs were observed for asthma, influenza and pneumococcal pneumonia. This analysis, with its acknowledged limitations, has shown the potential for using these indicators as a planning tool for identifying opportunities for targeted public health and health services interventions in reducing demand on hospital services in Victoria.

Ambulatory Care↗
PubMed2005

Ultrastructural changes of the tracheal epithelium after vaccination of day-old chickens with the La Sota strain of Newcastle disease virus.

The progression of tracheal lesions induced by vaccination of day-old specific pathogen-free chicks with the La Sota strain of Newcastle disease virus (NDV) was examined by relating surface changes as observed by scanning electron microscopy with subcellular changes seen by transmission electron microscopy. NDV infection resulted in hypertrophy of goblet cells, their rupture, and the formation of excess mucus. Activation of goblet cells peaked within 4 days postvaccination. Afterward, the activation levels gradually decreased. At the level of the ciliated cells, a marked increase in the proportion of nonciliated to ciliated cells and later an almost complete deciliation of the tracheal surface were observed because a simple squamous to cuboidal epithelium replaced the original pseudostratified epithelium. Fifteen days postvaccination, all epithelial damage was restored. Because the observed vaccination-induced lesions are detrimental to epithelial integrity and function as a barrier against invading microorganisms, they might explain at the ultrastructural level the secondary complications of vaccination with the La Sota strain against NDV.

Animals↗
PubMedDate not supplied

Control measures and the outcome of the measles epidemic of 1999 in the Eastern Highlands Province.

In the Eastern Highlands Province (EHP) of Papua New Guinea (PNG) measles outbreaks have occurred regularly every 3 to 4 years since 1980. The latest was between September 1998 and March 2000. Between July 1999 and March 2000 314 children with measles were reviewed at Goroka Base Hospital. The majority of these children were very young: 55% were under 1 year and 27% under 6 months. The median age of the measles cases was 11 months (range 10 days to 13 years). 40% of the children had a verifiable history of having received at least one dose of measles vaccine. The majority were vaccinated during the epidemic and included many children who either were below 6 months of age or who developed measles within 2 weeks of vaccination. Measles complications occurred in 82% of the children, the most common being pneumonia. Serious complications, particularly severe pneumonia, were more common among the unvaccinated children than in those who had received at least a single dose of the measles vaccine. No deaths occurred among 82 children who had received measles vaccine more than 2 weeks before the onset of clinical measles, compared with 10 deaths in 206 children who had never been vaccinated against measles or were vaccinated in the 2 weeks before presentation (p=0.067). The overall case fatality was 4%: 14% among the hospital-acquired and 2.5% in community-acquired measles. Improvement in the measles vaccination coverage and supplementary vaccination campaigns are required to prevent measles outbreaks in PNG. Intensified measles vaccination campaigns, such as the one conducted in EHP in 1999, are recommended during epidemics to minimize deaths due to measles and to rapidly control outbreaks. The efficacy of measles vaccination can only be measured in total mortality, not in the prevention of clinical measles.

Adolescent↗
PubMed1975

[Complications after antirabies treatment using the Hempt-vaccine].

A report is given on experiences with complications after antirabic treatment with hempt-vaccine gathered during 15 years (1960 to 1974). Among 4,315 inoculated persons local reactions appeared in 1.9%, a phenol shock in 0.11%, general reactions in 0.21% and neurological complications in 0.069%. In casuistic form is reported on postvaccinal neuritis, dorsolumbal myelitis and meningoencephalitis.

Adult↗
PubMed1991

Rubella vaccination in pregnancy.

Ninety-two pregnancies complicated by rubella vaccination were reported to the Rubella Vaccination in Pregnancy Study between 1981 and 1990. These pregnancies resulted in 87 live births, 3 stillbirths and two spontaneous abortions. One infant had serological evidence of congenital rubella infection but was healthy and normal with no indication of rubella damage at the age of two and half years. These findings suggest that the risk of rubella-associated damage following inadvertent rubella vaccination in pregnancy or shortly before is low, and support the current advice that termination of pregnancy should not be routinely recommended in these circumstances.

Antibodies, Viral↗
PubMedDate not supplied

[Thrombopenic purpura following measles vaccination].

A case of acute thrombocytopenic purpura complicating live measles vaccination is reported. Clinically and morphologically this case is identical to the postinfectious thrombocytopenic purpura. An immunological mechanism has been postulated to explain the thrombocytopenia.

Child, Preschool↗
PubMed1998

Genetically engineered vaccines: an overview.

Despite the early success demonstrated with the hepatitis B vaccine, no other recombinant engineered vaccine has been approved for use in humans. It is unlikely that a recombinant vaccine will be developed to replace an existing licensed human vaccine with a proven record of safety and efficacy. This is due to the economic reality of making vaccines for human use. Genetically engineered subunit vaccines are more costly to manufacture than conventional vaccines, since the antigen must be purified to a higher standard than was demanded of older, conventional vaccines. Each vaccine must also be subjected to extensive testing and review by the FDA, as it would be considered a new product. This is costly to a company in terms of both time and money and is unnecessary if a licensed product is already on the market. Although recombinant subunit vaccines hold great promise, they do present some potential limitations. In addition to being less reactogenic, recombinant subunit vaccines have a tendency to be less immunogenic than their conventional counterparts. This can be attributed to these vaccines being held to a higher degree of purity than was traditionally done for an earlier generation of licensed subunit vaccines. Ironically, the contaminants often found in conventional subunit vaccines may have aided in the inflammatory process, which is essential for initiating a vigorous immune response. This potential problem may be overcome by employing one of the many new types of adjuvants that are becoming available for use in humans. Recombinant subunit vaccines may also suffer from being too well-defined, because they are composed of a single antigen. In contrast, conventional vaccines contain trace amounts of other antigens that may aid in conferring an immunity to infectious agents that is more solid than could be provided by a monovalent vaccine. This problem can be minimized, where necessary, by creating recombinant vaccines that are composed of multiple antigens from the same pathogen. These issues are less of a concern with a live attenuated vaccine, since these vaccines are less costly, require fewer steps to manufacture, and elicit long-lived immunity after only a single dose. Unfortunately, live vaccines carry a higher risk of vaccine-induced complications in recipients that make their use in highly developed, litiginous countries unlikely. In lesser developed countries, where the prevalence of disease and the need for effective vaccines outweighs the risk associated with their administration, live vaccines may play an important role in human health. This review has attempted to make the reader aware of some of the current approaches and issues that are associated with the development of these vaccines. Genetically engineered vaccines hold great promise for the future, but the potential of these vaccines to improve human and animal health has yet to be fully realized.

Animals↗
PubMed2001

Associations between human leukocyte antigens and nonresponsiveness to influenza vaccine.

Influenza remains a major cause of morbidity and mortality, particularly in at-risk groups where vaccination reduces complications of infection but is not universally protective. In order to determine whether human leukocyte antigen (HLA) class II polymorphisms modulate anti-influenza antibody responses to vaccination, a cohort of HLA-typed at-risk donors was investigated. The subjects were recruited from a single urban family practice. Hemagglutination-inhibition (HAI) titers were measured immediately before and 28 days after subunit vaccination. Nonresponsiveness was defined as failure to mount an HAI response to any component of the trivalent influenza vaccine. When the nonresponders and responders with HLA class II were compared, the nonresponder group had more HLA-DRB1*07-positive donors (13/32 vs. 6/41 responders; P=.016, Fisher's exact test) and fewer HLA-DQB1*0603-9/14-positive donors (2/32 vs. 14/41 responders; P=.0045). Thus, polymorphisms in HLA class II molecules appear to modulate antibody responses to influenza vaccination.

Adult↗