[Prophylactic immunization against enterotoxin-forming Escherichia coli travellers' diarrhea and cholera: does it make sense and for whom?].
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Biomedical subjects
Publications and source records attributed to N Frühwein.
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AIM: The efficacy and tolerability of Saccharomyces boulardii (S.b.) were investigated in patients with diarrhea contracted while travelling abroad. METHOD: The efficacy of S.b. was determined on the basis of the frequency and consistency of stools (fewer than 3 unformed stools a day), and symptom changes. A total of 95 patients (49 females, 46 males) aged between 19 and 69 (mean age 32) years were treated with S.b. at a daily dose of between 150 and 450 mg (mean 428 mg) (3 x 1-3 capsules). RESULTS: Prior to admission to the study, diarrhea had persisted for an average of 11 days; under treatment with S.b. it cleared up after a mean of 5 days. A tendency towards greater efficacy in patients returning from The Middle East and South America was noted. Tolerability was assessed to be very good or good by almost all participants, with side effects occurring in only 2 cases. CONCLUSION: The study demonstrates that S.b. is both effective and well tolerated when used for the treatment of persistent diarrhea (mean duration 11 days) that had often failed (67% of the cases) to respond to previous antidiarrheal or antibiotic drugs.
Immunity against tetanus in an urban population: gaps of immunity among elderly persons. In a sero-epidemiological survey we investigated the immunity against tetanustoxoid in an urban population. Children and adolescents born in Germany (n = 193) showed an excellent immunity, negative findings being the exception. Among soldiers of the army (n = 136), negative findings were rare too. In these both groups the antibody titiers averaged 4,5 IU/ml. It is generally agreed that an antibody titer of 0,01 IU/ml protects against tetanus. Adults born in Germany (n = 295) had a good immunity: 84% showed antibody - titers against tetanus. Among elderly persons, however, above 60 years of age (n = 1576) there was a striking incidence of negative findings: in 1043 persons (65%) no antibodies could be detected. The remaining 533 persons with positive findings (35%) had antibody-titers in the lower range (average 0,482 IU/ml). Also among foreigners and immigrant labourers from mediterrean countries (Greece, Turkey, Yugoslavia) the frequency of negative findings was high: 183 persons were examined, 70 (39%) were negative 113 (61%) were positive. The incidence of negative findings was highest among women from the mediterrean countries. Several small studies published in Switzerland show a similar tendency. Our paper will encourage further seroepidemiological studies.
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Different specimens of one of the most common polyvalent immunoglobulin-preparations in the Federal Republic of Germany contain tetanus-antitoxin with an average titer of 40 I.E.Hml. The injection of 5 ml of this conventional gammaglobulin effects in an adult person a titer of ca. 0,75 I.E. Tetanus-antitoxin/ml serum (minimal protectin level = 0,01 I.E./ml). The prophylactic application of 5 ml of the conventional IgG-preparation (gammaglobulin) in travelers against epidemic hepatitis results in a protection against tetanus, too, at least for 3-4 weeks.
Among 1546 elderly persons (above 60 years of age) from a large town the immunity against tetanus was tested. 1043 persons (66.18%) had no antibodies against tetanus-toxoid in their serum. Almost half of the remaining positive sera (33.82%) showed antibody titers between 0.01 and 0.1 IU/ml. It is open to discussion if these titers warrant complete protection against the disease. On the contrary, children or young men serving in the army showed good immunity with high antibody titers. Tetanus has become a rare disease in the western countries, but cases still occur. The disease affects nowadays mainly adults. The older the patient the higher is its mortality. According to our study, many old people are not protected against tetanus. The risk of infection is widespread. It is strongly recommended to immunize also elderly persons at regular intervals. The vaccination against tetanus is cheap, well tolerated and yields a good immunity even in old age.