[Vaccination against rubella in Sweden--a follow-up].
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Biomedical subjects
Publications and source records attributed to L Grillner.
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Three rapid methods for the detection of Chlamydia trachomatis were compared: one immunofluorescence test and two enzyme immunoassays. Cervical and urethral specimens were obtained from 75 women in an outpatient clinic for therapeutic abortions and from 50 women in a sexually transmitted disease clinic. Urethral specimens were also obtained from 154 men in the same clinic. One hundred and nineteen cervical and 272 urethral specimens of a total 391 specimens were tested by the three methods. The direct immunofluorescence test detected Chlamydia trachomatis in 8% and the two enzyme immunoassays in 10% and 12% of the patients. The sensitivity of the immunofluorescence test was 76% compared to 91% and 80% for the two enzyme immunoassay tests. All three tests had a specificity of 99%. Dilution experiments confirmed that one immunoassay test, Chlamydiazyme, detected most of the positive specimens. The rapid and easily automated enzyme immunoassays are a valuable complement to the culture technique.
A commercially available monoclonal antibody directed against early cytomegalovirus (CMV) antigen was used for the demonstration of CMV by immunofluorescence (IF) in cell culture within 2 days. The results were compared with the appearance of CMV-specific cytopathogenic effect (CPE). Urine specimens from 31 healthy children in day-care centers were inoculated on human embryonic fibroblasts. In addition, 45 CMV strains that had been stored at -70 degrees C were reinoculated. CMV was detected in 8/31 urine specimens by IF and 7 of these gave a specific CPE at an average of 16 days post-inoculation. One specimen was negative by IF but specific CPE was found at day 13. After reinoculation, CMV was detected in 76% by IF while 44 specimens developed CPE within a 6-week period. Demonstration of early CMV antigen in cell culture was found to be a rapid method for early diagnosis of CMV. Since the conventional cell culture with detection of CPE was more sensitive it may be useful to combine the two methods.
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A commercial enzyme-linked immunosorbent assay, Rubazyme, was compared with the hemolysis-in-gel (HIG) test for antibodies to rubella in 826 sera. The results were in agreement for 99.4% of the 725 sera tested for immunity. However, the Rubazyme assay was no more efficient that either the hemagglutination-inhibition or HIG test in discriminating between sera with low levels of antibody and negative sera. Thus, it was concluded that the HIG test is the method of choice for immunity testing because of the low cost and simplicity. Rubazyme may be of value to confirm equivocal HIG results.
An outbreak of rotavirus infections among newborns at Karolinska Hospital, Stockholm, which has been going on for greater than 2 years has been followed with clinical and epidemiological investigations. About one third of the babies born in the hospital were infected at the age of 3 days. The clinical symptoms were mild, 8.8% of the rotavirus positive babies had loose stools compared to 1.9% of those who did not excrete the virus. An epidemiological survey in the neonatal intensive care unit suggested that rotavirus was introduced into the unit by babies admitted from the obstetric wards. The main reservoir of rotavirus was the babies and rotavirus was not found among staff or mothers. In the beginning hygienic measures seemed to be effective but after some weeks the colonization rate again increased. Electropherotyping of samples collected during different periods showed that one single rotavirus electropherotype belonging to the subgroup 1 of human rotavirus was found throughout the outbreak.
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Cytomegalovirus (CMV) isolates were investigated by restriction enzyme analysis. A method for extraction of cellular CMV DNA is described which uses CMV DNA released into the Hirt supernatant after precipitation of cellular DNA. CMV DNA is further purified by ultracentrifugation in neutral sucrose gradient. Fifteen strains from unrelated patients all had unique cleavage patterns with three restriction enzymes, although many of the fragments comigrated. Strains from related patients mostly showed identical patterns. The CMV genome seems to be stable since the pattern did not change in five isolates obtained from the same patient during a 5-year period.
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An enzyme-linked immunosorbent assay for herpes simplex virus was tested using commercially available peroxidase-conjugated and unconjugated rabbit antibodies to herpes simplex virus type 1 and type 2 (DAKO immunoglobulins A/S, Copenhagen, Denmark). One hundred and thirty-seven clinical specimens from vesicles and superficial cutaneous lesions were tested and the results compared with virus isolation. In addition 210 herpes simplex virus isolates were typed. Forty-four specimens yielded herpes simplex virus both in the enzyme-linked immunosorbent assay and in tissue culture and 79 were negative in both tests. Fourteen were positive in isolation but negative in the enzyme-linked immunosorbent assay. Seventy-three isolates were typed as herpes simplex virus type 1 and 137 as herpes simplex virus type 2. The enzyme-linked immunosorbent assay was found to be rapid and easy to perform but less sensitive than conventional isolation in routine diagnostic work. For typing of isolates it was found to be a useful method for distinguishing herpes simplex virus type 1 and type 2.
In serum and amniotic fluid (AF) from 30 pregnant women, antibodies against the anaerobe Bacteroides fragilis were determined by enzyme-linked immunosorbent assay (ELISA) and the results were compared with those of previously performed tests of B. fragilis growth inhibition by AF. The neutralizing effects of serum and AF against herpes simplex virus (HSV), cytomegalovirus (CMV) and coxsackie B 5 virus were also investigated, and antibody titres were determined by ELISA. No correlation could be demonstrated between the growth-inhibitory capacity of AF and the presence of antibodies against B. fragilis in serum or AF. Neutralizing antibodies against HSV and coxsackie B 5 virus were found in 73% and 51%, respectively, of the sera and in 36% and 13%, respectively, of both serum and corresponding AF. In no case could an AF neutralizing effect upon HSV, coxsackie B5 or CMV be demonstrated without a corresponding positive serum neutralization. It is concluded that the growth-inhibitory effect of AF on viruses in antibody-mediated, while AF inhibition of B. fragilis, and possibly other bacteria as well, seems to depend upon other antimicrobial mechanisms.
The consequences of rubella during pregnancy were studied with special reference to infections occurring during the 17th to 24th weeks of gestation. Laboratory confirmed rubella infected pregnancies were followed and the infants were examined clinically and serologically at a mean age of 20 months. In addition children born to mothers with verified rubella in earlier epidemics were examined clinically at the age of 4 or 7 yr. 491 cases of rubella in pregnant women from 1978-1980 were reported and 118 children were followed-up. Intrauterine transmission occurred in greater than 50% during the 16 first weeks of pregnancy compared to in 17% during the 21st to 24th weeks. Rubella defects appeared in a declining rate from 5/6 congenitally infected during the first 12 weeks to 1/7 at weeks 15 and 16. Three cases with deafness were found among the 65 children from earlier epidemics. Only 1 child with hearing impairment was found among children whose mothers were infected after the 16th week. Although rubella infections during the 17th to 24th weeks of pregnancy result in transmission to the fetus in about one fifth, sequelae seem to be a rare event.
In recent years evidence has emerged that most post-transfusion hepatitis is caused by one or more previously unknown agents named non-A, non-B. A prospective investigation was made of 74 patients who underwent open-heart surgery. Only volunteer blood was used for transfusions. Transfusion-associated hepatitis appeared in 15 (20%) of the patients 4-12 weeks after the operation. In no case was the hepatitis found to be caused by hepatitis B, A or Epstein-Barr virus. One patient had a cytomegalovirus infection; the other 14 cases (19%) were classified by definition as non-A, non-B hepatitis. Although most of the patients were asymptomatic and all were anicteric, the course of the hepatitis was protracted in many cases. Thus, 6/12 observed patients still had pathologic transferase values more than a year after the onset of hepatitis. Liver biopsy was performed in 3 cases and showed histologic signs of chronic active hepatitis in all of them.
A mixed hemadsorption (MH) test for naturally acquired rubella immunity and immune responses after rubella vaccination has been compared with the hemagglutination-inhibition (HI) test, the immunodiffusion (ID) test, the neutralization test (NT), the hemolysis-in-gel (HIG) test and the indirect immunofluorescence (IF) test. The MH test was approximately equivalent to the HI test and the NT as to sensitivity for the early response to rubella vaccination, and all three tests are thought to measure protective antibodies, i.e. antibodies supposedly directed against envelope antigens, to about the same extent. The MH test for rubella antibodies is especially suited for laboratories in which this type of test is routinely used for other purposes, e.g. rabies, respiratory syncytial virus, herpes simplex, varicella and certain auto-antibodies. Where the method is already standard it may be preferable to the NT which, although of similar clinical value requires tedious standardization. Both tests may be necessary in cases where the HI test is equivocal or hampered by non-removable on-specific inhibitors.
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The persistence of antibodies was studied in 143 women two years after postpartum rubella vaccination. In addition, the effect of intranasal revaccination with the RA 27/3 strain was studied in 99 women after two years. All women had responded to primary immunization with the development of hemagglutination-inhibiting antibodies. Intranasal revaccination resulted in a significant rise in titer of hemagglutination-inhibiting antibodies in 9% of the vaccinees who received the RA 27/3 strain compared with 53% and 24% of those who received the Cendehill and HPV-77 DE-5 vaccines, respectively. The difference between the response in the RA 27/3 group and that in the C Cendehill group was statistically significant (P less than 0.001), as was the difference between the response of the latter group and that of the HPV-77 DE-5 group (0.03 greater than P greater than 0.01). The susceptibility to intranasal challenge was found to be related to low levels of serum hemagglutination-inhibiting antibodies. The titers of hemagglutination-inhibiting antibody were well maintained during the follow-up period, but three of the 52 Cendehill vaccinees had titers of less than 1:10 after two years.
The hemolysis-in-gel method for detection of antibodies to rubella virus gave results which correlated well with results of hemagglutination inhibition and neutralization tests. With a diffusion time of 24 or 48 h, a linear correlation was obtained between the logarithm of antibody concentration and the diameter of the hemolytic zone. Fourfold, and even twofold, differences in serum antibody concentrations were shown to give statistically significant differences in hemolytic zone diameters. It could therefore be concluded that the hemolysis-in-gel test is well suited for the serological diagnosis of primary rubella infection, as well as of reinfection. The sensitivity of the hemolysis-in-gel test was comparable to that of the hemagglutination inhibition test. Pigeon erythrocytes were superior to sheep erythrocytes for use in the test. Studies of the antibody response after natural rubella infection or vaccination showed that the appearance and persistence of antibodies measured by hemolysis in gel is similar to that of hemagglutination inhibition antibodies.
A hemolysis-in-gel test for the demonstration of antibodies to mumps virus is described. The results were compared with those of neutralization tests using a modified microtechnique. In the neutralization test viral replication was demonstrated by the hemadsorption of guinea pig erythrocytes, the visibility of which could be further enhanced by the use of o-tolidine. Good correlation was found between the results of the two techniques. The hemolysis-in-gel test was simple to perform, rapid, sensitive, and shown to be a useful test for the demonstration of mumps antibodies.