ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The safety and immunogenicity ofHaemophilus influenzaevaccine (tetanus toxoid conjugate (PRP-T)) administered concurrently in separate sites or mixed in the same syringe with diphtheria and tetanus toxoids, pertussis vaccine and inactivated poliomyelitis vaccine were assessed in 439 infatns at 2, 4 and 6 months of age. The proportions with local redness, tenderness and swelling in the separate and combined groups were 18%vs.11% (P< 0.001), 27%vs.24% and 15%vs.13%, respectively. Systemic reactions occurred at similar rates in both groups. The combined vaccine induced tetanus and diphtheria antitoxin titers ≥ 0.01 IU/ml in 99.5 and 99.1% of infants, pertussis agglutinin titers ≥ 64 in 92.4%, anti-polyribosylribitol phosphate titers ≥ 0.15 μg/ml in 93.8% and ≥ 1.0 μg/ml in 75% and polio-neutralizing titers ≥ 8 in > 98 ≥ of infants. However, antibody concentrations to PRP-T. some pertussis antigens and tetanus toxoid were significantly lower after combined than after separate injections of DPT/diphtheria and tetanus toxoids, pertussis vaccine and in-activated poliomyelitis vaccine and PRP-T. The clinical significance of these differences is not knon, but the interactions observed among the components of the pentavalent vaccine may be of concern because they might influence antibody persistence until the fourth dose is administered.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Because inactivated poliovirus vaccine (IPV) andHaemophilus influenzaeb vaccine are advised in many programs and may be incorporated further in other programs, we undertook a study to determine whether the administration of a tetravalent preparation of diphtheria-tetanus-pertussis-IPV mixed in one syringe with tetanus-conjugateH. influenzaeb vaccine (DTP-IPV-PRPT) is associated with increased reactogenicity or interference with immunogenicity of individual vaccine components. In a placebo-controlled, double blind study, a total of 161 infants were enrolled (80 DTP-IPV-PRPT and 81 DTP-IPV-placebo). Vaccine was administered at 2, 4 and 6 months of age. Oral polio-virus vaccine was added at 7 months of age and a booster of oral poliovirus vaccine and DTP-IPV was also administered at 12 months of age, according to the policy in Israel. Local and systemic side effects were similar in both groups except for irritability after the second dose and use of acetaminophen which we observed slightly but significantly more often in the DTP-IPV-PRPT recipients. After the third dose the geometrie mean titers of anti-polyribosyl-ribitol phosphate antibodies were 3.7 and 0.05 μg/ml in the PRPT and placebo groups, respectively (P< 0.001). Higher tetanus antitoxin titers were observed among recipients of DPT-IPV-placebo (1.1 IU/mlvs.0.7 IU/ml,P= 0.003). A similar trend was found for pertussis agglutinin titers (93.4vs.65.4,P= 0.054). No difference was observed for anti-diphtheria toxoid and poliovirus 1, 2 and 3. Protective titers against diphtheria and tetanus (≥0.02 IU/ml) after the third dose were demonstrated in ≥99% of all infans. At 18 months of age (6 months after the DTP-IPV booster) no significant difference between the groups was demonstrated showing good priming for all components, although the trend for lower anti-tetanus antibodies was still present. We conclude that although a mild, clinically insignificant interference occurred for some components after the primary series, no interference with priming was shown and that DTP-IPV mixed with PRPT is safe and immunogenic in young infants.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Haemophilus influenzaetype b (Hib) is a major cause of serious childhood bacterial infections. Before 1989 Alaska Native infants in the Yukon Kuskokwim Delta (YKD) had the highest recorded Hib disease rate, 2960: 100 000 in children less than 1 year of age with 6 to 35 (mean, 13) cases/year between 1980 and 1988. In July, 1989, Alaska Area Nativa Health Service initiated a passive immunization project in the YKD using bacterial polysaccharide immunoglobulin (BPIG) administered at 3-month intervals to prevent Hib infections in infants less than 13 months of age. On January 1, 1991, after licensure of Hib conjugate vaccines for infants, the program was modified to a passive-active strategy using BPIG at birth and Pedvax HIB at 2, 4 and 12 months of age. Between July 1, 1989, and December 31, 1990, 80% of YKD children less than 1 year of age received at least 1 dose of BPIG. During this period there were 7 Hib cases in this age group, but only 1 of the cases had received any BPIG. Between January 1, 1991, and December 31, 1992, 4 Hib cases occurred in 2 YKD children. During the combined period, July 1, 1989, to December 31, 1992, the incidence of Hib disease for infants less than 1 year of age was 302:100 000. A dramatic decrease in Hib disease was observed in this high incidence region concurrent with implementation of passive and passive-active immunization strategies.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Because most childhood invasive pneumococcal disease occurs before the age of 2 years, the development of a pneumococeal vaccine that is immunogenic in infants is a priority. We assessed the safety and serum antibody responses to two dose levels of three bivalent pneumococcal capsular polysaccharide (CPS)-protein conjugate vaccines incorporating the poorly immunogenic serotypes 6A and 23F. The conjugate vaccines differed in CPS size and chemical linkage, but all used a nontoxic cross-reactive mutant diphtheria toxin (CRM197) as the protein carrier. 118 young children 18 to 30 months of age received a single immunization with one of the three glyeoconjugates or with licensed pneumococcal vaccine. Sera were obtained before and 1 month after immunization and analyzed by enzyme-linked immunosorbent assay for serotype-specific antibody titers. The 23F CPS was more immunogenic than the 6A CPS in all vaccine formats. The most immunogenic 23F conjugate vaccine consisted of native CPS directly linked to the carrier protein; smaller CPS or the use of a six-carbon linker did not appear to enhance immunogenicity in these young children. Conjugation of two pneumococeal CPSs is associated with an increase in immunogenicity, and the characteristics of the CPS and of the CPS-protein linkage appear to influence the antibody response.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Physician attidues and practices regarding universal infant vaccination against hepatitis B virus infection in Minnesota were assessed approximately 1 year after publication of the Immunization Practices Advisory Committee recommendations. Four-hundred eighteen Minnesota family physicians and pediatriciens were sent self-administered questionnaires, with follow-up by telephone. Among physicians who provide care to infants, 67 (29%) of 234 family physicians and 29 (50%) of 58 pediatricians routinely offered hepatitis B vaccine to all infants (overall 33%) (P=0.002). The recommendations of the Immunization Practices Advisory Committee, the American Academy of Pediatrics and the American Academy of Family Physicians had the greatest positive influence on physicians' opinions regarding routine hepatitis B vaccination. The factors with the greatest negative influence on their opinions were the low prevalence of hepatitis B virus infection in Minnesota and the addition of three injections to the current childhood immunization schedule. Universal infant hepatitis B vaccination remains controversial among Minnesota family physicians and pediatricians. We believe, given the variability in hepatitis B virus incidence and prevalence in the United States and the relatively low risk of most infants, that a single national policy based solely on universal infants immunization may be difficult to implement.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In 1985 we reported that eosinophilia was found in many children with Mycoplasma pneumonia. We measured the serum concentrations of eosinophil catonic protein (ECP) produced by eosinophils in 25 children withMycoplasmapneumonia, 25 with asthma and 11 with no disease (normal controls). The mean concentrations (×SD) of serum ECP in children withMycoplasmapneumonia, with asthma and the normal controls were 18.7 ≥ 12.6, 23.7 ≥ 12.2 and 6.5 ≥ 1.4 μg/ml, respectively. When compared with those of normal controls, these higher serum concentrations of ECP in children withMycoplasmapneumonia and asthma were statistically significant (P≤ 0.001). The data were directly correlated with the presence of eosinophilia (r= 0.349). There was no relationship between the amount of ECP and the age of children withMycoplasmapneumonia. These results suggest that ECP may work as a factor causing a persistent cough similar to asthma in children withMycoplasmapneumonia.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

There is little information on the outcome of occult pneumococcal bacteremia in children who appear well at the time of first reevaluation. To determine the outcome of such children we reviewed the medical records of 364 children with blood cultures positive forStreptococcus pneumoniaemanaged at 2 hospitals in New Haven from 1973 to 1987. One hundred eighty of the 364 children were initially managed as outpatients; 111 of the 180 (62%) were afebrile and appeared well at the first reevaluation. Twenty-two of these 111 children (20%) were hospitalized and treated with intravenously administered antimicrobials at the first reevaluation visit; 2 of these 22 were still bacteremic, although no focal infection was found. Seventy-eight children (70%) were sent home after the first reevaluation visit with orally administered antimicrobials; 1 of these 78 children was still bacteremic and another subsequently was found to have meningitis that had been present at the first visit (culture of the cerebrospinal fluid obtained at the first visit subsequently grewS. pneumoniae). Eleven children (10%) were sent home from the reevaluation visit without antimicrobial treatment and none had persistent or recurrent pneumococcal infection. We conclude that the child who is afebrile and appears well at reevaluation for a blood culture positive forS. pneumoniaeis unlikely to develop serious sequelae. Outpatient management with careful follow-up is essential for such children.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID