Polysaccharide vaccines of group A Neisseria meningtitidis and Haemophilus influenzae type b: a field trial in Finland.
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Biomedical subjects
Publications and source records attributed to A Sivonen.
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A convenient and reliable method for serogrouping meningococci, based on immunospecific precipitation haloes in antiserum-agar plates, is described. It gave concordant results with conventional slide-agglutination in 900 strains of groups A, B or C tested. The antiserum-agar can also be used as a primary isolation medium for detecting nasopharyngeal carriers of a certain serogroup if antibiotics are added.
A recently developed Haemophilus influenzae type b capsular polysaccharide vaccine was given to 48,977 children 3 months to 5 years of age; an equal number of children receiving group A meningococcal vaccine served as controls. The protection as well as serum antibody response was strongly age-dependent. Among children who had received the H. influenzae type b vaccine when 18 months of age or older, there were no cases of bacteremic disease caused by H. influenzae type b in the first year after vaccination. At the same time 11 such cases were seen in the control group of the same age, a highly significant difference. In the second year after vaccination two cases occurred in the H. influenzae type b-vaccinated group, five in the meningococcal-group A vaccinated group. No protection was seen among children who had been younger than 18 months when vaccinated, even if they received a booster dose of the vaccine. The serum antibody response to the H. influenzae type b polysaccharide, measured by radioimmunoassay, was poor in children below 18 months of age and good in those above it. No effect of the vaccine could be seen on the nasopharyngeal carriage of H. influenzae type b, which was approximately 6% in this age group. Adverse effects of the vaccine were mild.
Meningococcal group A polysaccharide vaccine was used in children 3 months to 5 years of age in the winter 1974-75 during an epidemic caused by sulphanamide-resistant group A meningococci. In 3 provinces, the vaccine was offered on a double-blind basis, using Haemophilus influenzae type b polysaccaride vaccine as control. Approximately 100 000 children were vaccinated with either one of the vaccines. In the Kymi province, approximately 22 000 children representing 90% of the child population of this age received the meningococcus vacine. Infants below 18 months received a booster dose of vaccine 3 months after the first dose. The meningococcus vaccine caused local symptoms in 71%, mild systemic reactions in 37%, and high fever (38.5 degrees C or more) in 1.8% The haemophilus vaccine produced fewer side effects. No clinical infections caused by group A meningococci were reported in the first 6 months after vaccination among those who had received the meningococcal vaccine. At the same time, group A cases continued to appear in other age groups and other areas of the country.
During an epidemic caused by group-A, sulphonamide-resistant meningococci in Finland, group-A polysaccharide vaccine was administered in 1974 to 16 458 recruits of the Armed Forces, leaving 20 748 as controls. Specific antibody response was good, and after vaccination only 1% of the men were without anti-meningococcal group-A antibodies. Pharyngeal carriage of the epidemic strain was low, about 1-5%, in the men when entering service. Group-A meningococcal disease occurred during the nine months' mean observation period in 1 of the vaccinated men (an annual incidence of 11 per 100 000) and in 8 of those not vaccinated (71 per 100 000), indicating 89% protective effect of the vaccine. Furthermore, the total number of cases of group-A meningococcal disease was reduced to non-epidemic levels at a time when 36% of the men in service were vaccinated, and has remained low for the next twelve months even though the epidemic in the general population continued.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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We conducted a prospective study in order to compare ultrasonography, computed tomography and magnetic resonance imaging in the detection of liver foci in patients with acute leukaemia and clinical suspicion of hepatic candidiasis. 28 adult patients fulfilling set entry criteria after recovery from neutropenia were studied. Lesions in the liver were detected by at least one imaging modality in 21 patients: by ultrasonography in 7 (33% of detected cases), computed tomography in 12 (57%) and by magnetic resonance imaging in 20 patients (95%). Magnetic resonance imaging was significantly more sensitive than ultrasonography (p<0.001) and computed tomography (p<0.02). The difference between computed tomography and ultrasonography was not statistically significant (p=0.1). Invasive procedures performed in 10 patients provided definite proof of candidiasis in 5 patients, and nodes on the liver surface, compatible with yeast infection, were seen during laparoscopy in 3 other patients without proof of fungal infection. We confirm that magnetic resonance imaging is superior to ultrasonography and computed tomography in imaging liver foci in leukaemic patients recovering from neutropenia with persistent non-specific signs of infection or hepatic involvement.