PubMed Health⌕ Search

Biomedical subjects

J Eskola

Publications and source records attributed to J Eskola.

At least 19 recordsLinked to original sources
PubMed1992

Epidemiology of invasive pneumococcal infections in children in Finland.

OBJECTIVE: To study the epidemiologic characteristics of invasive infections in children caused by Streptococcus pneumoniae to provide background data for vaccination programs. DESIGN: A nationwide laboratory-based prospective surveillance of all invasive pneumococcal infections in children during 1985 through 1989. SETTING: A network of all microbiologic laboratories and pediatric wards in Finland. PATIENTS: Children aged 0 to 15 years who were admitted to a hospital with S pneumoniae isolated from blood, cerebrospinal fluid, or deep aspirate sample. RESULTS: Four hundred fifty-two invasive pneumococcal infections were diagnosed in 1985 through 1989. The annual incidence rate was 8.9 per 100,000 children less than 16 years of age (24.2 per 100,000 among children less than 5 years of age and 45.3 per 100,000 among those less than 2 years of age). The most common clinical entities were bacteremia without focus (310 cases), pneumonia (66 cases), and meningitis (51 cases), with other focal infections seen in 25 cases. The pneumococcal groups/types 14, 6, 19, 7, 18, and 23 comprised 78% of all invasive infections. CONCLUSIONS: Streptococcus pneumoniae is a common cause of invasive infections in children in Finland. A pneumococcal conjugate vaccine containing the six most common groups/types could prevent up to 70% of invasive pneumococcal infections of children in Finland if fully protective in infancy.

Adolescent↗
PubMed1992

Finnish efficacy trials with Haemophilus influenzae type b vaccines.

The first Finnish trial with Haemophilus influenzae type b vaccine was conducted during 1973-1974. It demonstrated that the polysaccharide vaccine was 90% efficacious in children greater than or equal to 18-24 months old. The immunologically superior polysaccharide-protein conjugate vaccines have been used since 1986 in randomized trials. The PRP-D vaccine (polysaccharide conjugated to diphtheria toxoid) was 90% efficacious when given at 3, 4, and 6 months of age to 58,000 infants. In 1988-1989, the PRP-D vaccine was compared with the HbOC vaccine (oligosaccharide conjugated to CRM197 protein). Follow-up is continuing, but both vaccines seem to be efficacious after two doses in infancy.

Antibodies, Bacterial↗
PubMed1992

Epidemiology of invasive Haemophilus influenzae type b disease.

Invasive disease caused by Haemophilus influenzae type b (Hib) is typically a disease of young children, starting when the protection afforded by maternal antibodies is exhausted and ending when the child's own antibody production to the Hib capsular polysaccharide begins efficiently. There are, however, large variations between population groups in the incidence of the disease and the age at which it appears. Potential factors behind this variation include virulence genes of the bacteria and genetic susceptibility genes of the host. Although such genes and their effects can be identified, their impact on the disease's incidence is only minor. Potentially much more important appear to be socioeconomic factors that to a large extent determine the exposure of the child to Hib and to other infectious agents that may enhance both colonization and invasive infection by Hib.

Age Factors↗
PubMed1992

Changes in the distribution of Haemophilus influenzae type b clones associated with widespread infant vaccination in Finland.

Isolates from 646 consecutive Finnish Haemophilus influenzae type b (Hib) patients with systemic disease, collected before and during large-scale vaccinations with Hib conjugate vaccines, were analyzed by major outer membrane protein (OMP) subtyping, lipopolysaccharide (LPS) serotyping, and biotyping (BT). Strains with OMP-BT-LPS combinations (clones) 1-I-1 and 1c-I-1 disappeared at the same rate as the disease they were associated with. A preferential decrease in the number of isolates of clone 1-II-1 was recorded, whereas the reduction in disease caused by strains of clone 1-II-9 occurred at a lower rate than expected. The latter clone occurred mainly in the most densely populated area of Finland. Strains belonging to all the common Hib clones were isolated from the 16 infants who acquired Hib disease despite being (partially) vaccinated. Thus, Hib clones disappeared during mass vaccination with conjugate vaccines, although at different rates.

Adolescent↗
PubMed1991

Antibody responses to four Haemophilus influenzae type b conjugate vaccines.

Serum antibody responses to four Haemophilus influenzae type b capsular polysaccharide-protein conjugate vaccines (PRP-D, HbOC, C7p, and PRP-T) were studied and compared in 175 infants, 85 adults and 140 2-year-old children. Antibodies to the H influenzae type b polysaccharide vaccines were determined with a Farr-type radioimmunoassay. The infants received two doses of vaccine at the ages of 4 and 6 months. After the first dose of vaccine, the geometric mean antibody concentration measured at the age of 6 months was 0.09 to 0.10 mg/L, only marginally higher than that measured before immunization in all infants who had received PRP-D, HbOC, or C7p but increased to 0.82 mg/L in those who had received PRP-T. One month after the second dose, the geometric mean antibody concentration was increased in all vaccine groups. No significant differences were noted between recipients of HbOC, C7p, or PRP-T (geometric mean antibody concentrations, 4.32, 3.10, and 6.10 mg/L, respectively), whereas the PRP-D recipients had a significantly lower geometric mean antibody concentration (0.63 mg/L). In contrast, PRP-D, HbOC, C7p, and PRP-T were all highly immunogenic in adults, with no differences noted among them. The 2-year-old children also responded to one dose of these vaccines with a high antibody concentration.

Adult↗
PubMed1991

The causes of hospital-treated acute lower respiratory tract infection in children.

OBJECTIVE: To determine the etiologic agents in children with acute lower respiratory infection. DESIGN: A survey of a series of patients. SETTING: General pediatric hospital serving an urban population with and without referrals in Helsinki, Finland. PARTICIPANTS: 135 Finnish children aged 2 months to 15 years (mean, 1.75 years), with clinically defined acute lower respiratory infection (with difficulty of breathing), or found to have fever and a pneumonic infiltrate on chest roentgenogram. SELECTION PROCEDURES: Consecutive sample on voluntary basis. INTERVENTIONS: None. MAIN RESULTS: Of 121 children with adequate samples, an etiologic diagnosis could be established in 84 (70%): 30 (25%) had bacterial, 30 (25%) viral, and 24 (20%) mixed infections. Antibody assays alone identified the agent in 91% of positive cases. CONCLUSIONS: Bacterial infections are common but generally underestimated in acute lower respiratory infection; serologic methods add significantly to their detection.

Acute Disease↗
PubMed1991

Experience in Finland with Haemophilus influenzae type b vaccines.

The importance of Haemophilus influenzae type b (Hib) as the leading cause of bacteraemic infections in children was recognized in the early 1970s in Finland. An efficacy trial with the capsular polysaccharide vaccine demonstrated the efficacy of this first generation vaccine, but only from ages 18-24 months onwards. For this reason, since 1983 new polysaccharide-protein conjugate vaccines (PRP-D, HbOC, and PRP-T) have been extensively tested. These studies have shown that conjugate vaccines are immunogenic in early infancy and are capable of generating a lasting immunological memory. A second Hib vaccine efficacy trial in 1986-1987 showed that the conjugate vaccine (PRP-D) was 90% efficacious after the primary immunization series at 3, 4 and 6 months. After a booster dose at 14-18 months, no failure cases have occurred during the follow-up period. The same level of protection seems to be true also in a subsequent trial, where two Hib conjugate vaccines (PRP-D or HbOC) were given at 4, 6 and 14-18 months. These vaccinations have led to a significant decline in the number of invasive Hib infections in young children.

Antibodies, Bacterial↗
PubMed1991

Serum tumor necrosis factor-alpha concentrations in children hospitalized for acute lower respiratory tract infection.

Tumor necrosis factor-alpha (TNF alpha) concentrations were measured by radioimmunoassay in sera of 118 children (median age, 1.7 years; range, 2 months-15 years) hospitalized for acute lower respiratory tract infection (ALRI). Both viral and bacterial ALRI were associated with elevated concentrations of TNF alpha. Concentrations greater than 40 ng/l were seen in children with bacterial or mixed ALRI in 64% and with viral ALRI in 50% of cases. Elevated concentrations were associated with longer duration of fever before admission (P less than .05) and with a higher serum C-reactive protein concentration (P less than .05). There were no significant differences in TNF alpha concentrations between gram-positive and gram-negative infections, nor was there an association with clinical severity of ALRI. TNF alpha concentrations decreased in most patients to normal within 5 days of hospitalization, irrespective of the etiology of the infection.

Acute Disease↗
PubMed1991

Reduction of oropharyngeal carriage of Haemophilus influenzae type b (Hib) in children immunized with an Hib conjugate vaccine.

The oropharyngeal carriage of Haemophilus influenzae type b (Hib) was studied among 725 healthy 3-year-old children who had or had not been immunized with an Hib conjugate vaccine. Oropharyngeal swabs were collected during the childrens' well-child visit to their local child health center. Fourteen (3.5%) of the 398 unvaccinated children were oropharyngeal carriers of Hib, whereas none of the 327 children who had received Hib conjugate vaccine carried Hib (P less than .001). Carriage rates of non-type b H. influenzae (19%) or Streptococcus pneumoniae (18%) were the same irrespective of the Hib vaccination status of the children. Thus Hib conjugate vaccine, unlike Hib polysaccharide vaccine, seems to be able to prevent oropharyngeal colonization by Hib.

Bacterial Vaccines↗
PubMed1991

Treatment of acute exacerbations in early multiple sclerosis: cyclosporin A or prednisolone?

Twenty-six acute exacerbations in 26 patients with early definite multiple sclerosis (MS) were treated with oral cyclosporin-A (CyA) or oral prednisolone in a double-blind, controlled and randomized trial. The duration of the treatment was 6 weeks. All of the patients showed improvement during the treatment. There were no differences in outcome between patients on CyA (7.5 mg/kg) or prednisolone (decreasing doses from 0.8 mg/kg) during the 6 week treatment. However, the improvement of clinical signs 3 months after the treatment was slightly greater in the prednisolone group. The drugs did not have significant side-effects. There was no fluctuation in the CD4/CD8 ratio during the follow-up. The two treatment groups did not differ from each other in respect to the number of CD3 (T3), CD4 (T4), CD8 (T8), CD14 (monocytes), CD20 (B cells) or CD25 (interleukin-2 receptor positive cells). The number of active T cells with the interleukin-2 receptor was high in the beginning of the exacerbation but it decreased during the treatment. To conclude, the effects of CyA and prednisolone were comparable in the treatment of acute MS relapses.

Acute Disease↗
PubMed1991

Neonatal Haemophilus influenzae infections.

Nine cases of neonatal Haemophilus influenzae septicaemia were recorded in Finland during 1985-9; incidence was 2.8/100,000 live births, and 1.6% of all cases of neonatal septicaemia. The onset of the disease was early in all cases, ranging from 0-6 hours after delivery. Seven of the infants were preterm and three died (overall mortality 33%). H influenzae was isolated from blood in seven of the cases, and in two neonates with clinical signs of septicaemia it was found on several surface sites and the placenta. One of the eight strains of H influenzae was capsular type b and biotype I, the rest being non-typable--a distribution similar to those previously reported. Four of the uncapsulated strains were of biotype III, and three were of biotype II. None of the strains of H influenzae was of biotype IV, which has been reported to be characteristic of neonatal and genital isolates of H influenzae. All nine mothers had some sign of infection at the time of or shortly after delivery. H influenzae was isolated from five mothers: from the blood (n = 1) or from the placenta or cervix (n = 4). The use of intrauterine devices may be a possible risk factor for neonatal H influenzae infections; two of the mothers had such devices in place during their pregnancies.

Adolescent↗
PubMed1990

A randomized, prospective field trial of a conjugate vaccine in the protection of infants and young children against invasive Haemophilus influenzae type b disease.

BACKGROUND: Haemophilus influenzae type b is the leading cause of invasive bacterial disease in young children. The capsular polysaccharide vaccine does not protect children at greatest risk (those under the age of 18 months), but a polysaccharide-protein conjugate vaccine has proved to be more immunogenic in this age group. METHODS: We enrolled 114,000 infants in Finland in an open, prospective, randomized trial of a H. influenzae type b capsular polysaccharide-diphtheria toxoid conjugate vaccine (polyribosylribitol phosphate-diphtheria toxoid [PRP-D]). Children born on odd-numbered days were vaccinated at the ages of 3, 4, 6, and 14 to 18 months; those born on even-numbered days formed the control group and received the same vaccine at the age of 24 months. RESULTS: After three doses of the vaccine there were 4 cases of verified bacteremic H. influenzae type b disease in the group receiving early vaccination, as compared with 64 cases in the control group, between the ages of approximately 7 and 24 months. The protective efficacy of the vaccine was thus 94 percent (95 percent confidence interval, 83 to 98). No serious adverse effects were reported. The immune response to the conjugate vaccine was characteristic of a T-cell-dependent response when studied in a cohort of 120 infants. The primary immunization series resulted in a geometric mean concentration of anticapsular antibody of 0.53 micrograms per milliliter at the age of seven months, and the fourth dose evoked an anamnestic response, with a mean antibody concentration of 45.22 micrograms per milliliter. CONCLUSIONS: A new conjugate vaccine consisting of the capsular polysaccharide of H. influenzae type b covalently linked to a protein carrier (PRP-D), administered to infants beginning at the age of 3 months, is highly effective in protecting young Finnish children (7 to 24 months old) against invasive H. influenzae type b infections.

Age Factors↗
PubMed1990

Reactogenicity and immunogenicity of combined vaccines for bacteraemic diseases caused by Haemophilus influenzae type b, meningococci and pneumococci in 24-month-old children.

To find a wide spectrum vaccine against bacteraemic disease in childhood, we immunized 293 Finnish children at 24 months of age intramuscularly with different combinations of the currently available vaccines, namely Haemophilus influenzae type b polysaccharide-protein conjugate vaccine (PRP-D) mixed with meningococcal and/or pneumococcal capsular polysaccharide vaccines. All the vaccines were immunogenic. The increase in antibody concentration after vaccinations was not affected by the number of polysaccharide antigens. Although no serious reactions were seen, the frequency of both local and fever reactions was greater in groups that received several vaccine antigens. Halving of the vaccine dose decreased the reactogenicity without impairing the immunogenicity.

Bacterial Infections↗