PubMed Health⌕ Search

Biomedical subjects

O Simonsen

Publications and source records attributed to O Simonsen.

At least 37 records · Page 2Linked to original sources
PubMed1988

Immunity against diphtheria and tetanus in the age group 30-70 years.

In Denmark, childhood primary vaccination against diphtheria and tetanus has been recommended since 1950. No routine revaccinations or general vaccination of adults have been offered. In most other western countries revaccinations are recommended later in childhood. However, death still occurs from diphtheria and tetanus in countries with such vaccination programs although it is generally accepted that protective immunity can be obtained by vaccination. On this basis the immunity against diphtheria and tetanus was assessed in a random sample of 351 subjects in the age range 30-70 years. Diphtheria antitoxin titres were determined by in vitro neutralization technique using VERO cells. 26% had diphtheria antitoxin titres below protective level (0.01 international antitoxin units/ml serum). The highest number of unprotected against diphtheria was found among 30-39 year old women (68%) and 60-69 year old subjects (36%). Tetanus titres were determined by a combination of ELISA technique and an in vivo neutralization assay. 51% were unprotected against tetanus (less than 0.01 international antitoxin units/ml serum). The highest number of unprotected against tetanus was found among 60-69 year old subjects (68%) and especially among females in this age group (77%). To avoid epidemics of diphtheria in the future the immunity among adults must be raised within the coming years. Thus, revaccination must be recommended and high attendance ensured. One revaccination is sufficient only when complete primary vaccination is documented.

Adult↗
PubMed1988

Plasmapheresis and haemodialysis in a case of septic cholangitis complicated by hepatic and renal failure. Case report.

Plasmapheresis was used as a complement to conventional therapy in a patient with multiorgan failure and disseminated intravascular coagulation (DIC) following biliary obstruction and septic cholangitis. The patient's remarkable improvement after plasmapheresis suggests a beneficial influence on the pathophysiologic mechanisms. Plasmapheresis is concluded to inhibit DIC and eliminate endotoxins.

Aged↗
PubMed1987

The significance of age on symptoms and urodynamic- and cystoscopic findings in benign prostatic hypertrophy.

To evaluate influence of age on symptomatology and objective parameters in benign prostatic hypertrophy, preoperative findings in 199 unselected patients during one year were analysed. Symptoms of bladder instability increased with age, as did incidence of uninhibited detrusor contractions and bladder trabeculation, whereas maximum urine flow and obstructive complaints decreased, although prostatic size was the same. In the oldest age groups only was increasing prostatic size associated with increasing bladder trabeculation. Age related changes in neurological control and in the structure of the bladder may be involved, and the present results suggest age to be an important factor in the interpretation of symptoms and objective findings in prostatic hypertrophy.

Age Factors↗
PubMed1987

Modification of the ELISA for the estimation of tetanus antitoxin in human sera.

The use of indirect ELISA for the quantitation of tetanus toxin neutralizing antibodies in human sera is limited by marked overestimations in low titered sera. The reasons for the discrepancy between the results obtained by ELISA and by in vivo assay and modifications of the ELISA to overcome the problem were investigated. Catching ELISA and indirect ELISA using trays coated with the contaminant proteins in toxoid preparations indicated that antibodies to contaminants were only partly responsible for the discrepancy and the introduction of these modifications did not solve the problem. In ELISA competition experiments with toxin neutralizing monoclonal antibodies, the human immunoglobulins irrelevant in toxin neutralization, but detectable in indirect ELISA, were found to be difficult to inhibit in their binding to the solid antigen phase. These might represent antitoxins bound bivalently to the solid phase but with affinities in monovalent binding insufficient for toxin neutralization or other coupled antibodies due to conformational changes of the antigen. A competition ELISA with toxin in solution was therefore developed to assess selectively the antitoxin capable of binding the antigen in solution and by this approach the in vivo activities of even low titered sera were accurately predicted. This antigen competition ELISA may be easily introduced into routine tetanus serology and the principle may also be of value for the in vitro detection of functional antibodies to other antigens.

Antibodies, Monoclonal↗
PubMed1987

Evaluation of vaccination requirements to secure continuous antitoxin immunity to tetanus.

To investigate minimal requirements for tetanus revaccination to secure continuous protection, recently recommended by WHO, 637 subjects with documented vaccination history were studied. Antitoxin concentration in serum relative to time corresponded to a steep decline in the first years after vaccination continuing exponentially. By multiple regression analyses duration of immunity after three-dose primary vaccination was calculated to be 5 years (upper 95% confidence limit of estimated risk of serum antitoxin concentration below 0.01 IU ml-1 still less than 0.1%). Serum antitoxin concentration relative to time after revaccination depended upon age at revaccination and interval from primary vaccination. When given in childhood 5 years after primary vaccination revaccination was calculated to offer protection for approximately equal to 21 years, but protection was considerably shorter when given to the elderly. Cross-sectional and longitudinal analyses were compared and statistical approaches were introduced which may be generally applicable for evaluation of vaccination programmes. It was concluded that a vaccination programme consisting of primary vaccination in infancy and one revaccination 5 years later will secure continuous protection to about the age of 25 years. This is considerably simpler than programmes recommended in many countries, in which risk of hyperimmunization is apparent.

Adult↗
PubMed1987

Revaccination against tetanus 17 to 20 years after primary vaccination: kinetics of antibody response.

In 24 military recruits vaccinated against tetanus 17-20 years earlier antibody responses were studied 4, 11, and 24 days after revaccination. Antitoxin concentration in serum showed a sigmoid increase with titres at day 4 only just above protective level, corresponding to a risk of susceptibility to be expected even 4 days after revaccination (2.0%, 95% confidence limit). Only after 7 days the risk of unprotection was less than 1%. As the incubation period of tetanus can be as short as 24 hours, revaccination only may not be regarded sufficient if more than 17-20 years have elapsed since primary vaccination and conditions favoring rapid development of tetanus are present. The findings may explain some of the cases of tetanus which have occurred in spite of primary vaccination supplemented by emergency booster. The statement that prophylactic tetanus immunoglobulin is never indicated to persons completely vaccinated earlier should be considered for revision.

Adult↗
PubMed1987

Susceptibility to diphtheria in populations vaccinated before and after elimination of indigenous diphtheria in Denmark. A comparative study of antitoxic immunity.

The need for routine diphtheria revaccination is still controversial. Only single cases of diphtheria have been observed in Denmark since the mass vaccinations in the 1940s and the introduction of routine vaccination of infants in 1950, despite the fact that general revaccination has not been recommended. An investigation of antitoxin immunity in 1.188 probands 2-69 years of age, randomly or cluster selected, indicated that immunity in the Danish population is still above the limit generally believed to guard against diphtheria epidemics (around 70% being immune in a population). The highest frequency of susceptibility (46%) was found among females 30-39 years of age. Serum antitoxin concentrations in 529 subjects with documentation for complete primary vaccination 1-40 years previously corresponded to a continuous fall-off. Relative to time from vaccination, individuals born when diphtheria occurred frequently in Denmark had significantly higher antitoxin levels than those born later, and among children susceptibility had increased considerably as compared to observations in the 1950s. These phenomena were explained by the effect of natural immune stimulation previously. The present concept of relatively high frequencies of immune subjects also in other western countries may not be valid in the future, when the number of subjects born after the elimination of indigenous diphtheria increases. General revaccinations seem required to maintain herd immunity.

Adolescent↗
PubMed1987

Epidemiology of tetanus in Denmark 1920-1982.

Tetanus is still a major health problem in developing countries and still occurs in countries with a high medical standard. To guide planning of future prophylactic programs, incidence and mortality from tetanus in Denmark previous and present prophylactic efforts have been studied. Incidence and mortality from neonatal tetanus decreased in the thirties probably consequently to social and hygienic improvement, and a very marked decrease coincided with the introduction of vaccination against tetanus in 1947. Since 1970 no case of neonatal tetanus has been observed. Mortality from non-neonatal tetanus was reduced markedly in 2 steps, coinciding with an increased use of tetanus antitoxin around 1930 and the introduction of vaccination respectively. The effect of routine vaccination in childhood from 1950 was especially prominent. Tetanus in childhood is now nearly eradicated. A survey of all hospitalized cases of tetanus 1978-1982 showed that the majority of patients were incompletely or never vaccinated, but 10% had a history of complete vaccination. The majority of cases developed from minor posttraumatic lesions, of which only 41% had been professionally treated, and 13% developed from non-traumatic lesions. It is concluded that vaccination programs offering continuous protection are needed for a complete eradication of tetanus. Fatality remains high, in the present series 9.4%, and is mostly due to cardiovascular manifestations.

Adult↗
PubMed1987

Determination of tetanus and diphtheria antitoxin content in dried samples of capillary blood: a convenient method applied to infants.

To assess the effect of vaccination of infants against tetanus and diphtheria capillary blood was drawn from 51 randomly selected healthy infants 2 years of age. The blood was applied directly to filter paper. In the laboratory the blood dots were eluted in phosphate buffered saline for 2 h at room temperature yielding 100% recovery of antitoxin activity. Serum volume in the blood dots was determined by calculation of dot area or by measuring albumin content in the eluted samples by means of rocket immunoelectrophoresis. These approaches were found to be equally applicable. Concentration of antitoxin to tetanus and diphtheria was assessed with ELISA and in vitro toxin neutralization assay respectively. Mean diphtheria antitoxin concentration was 0.53 IU/ml, and mean tetanus antitoxin concentration 4.1 IU/ml. Low initial immune response to diphtheria vaccination may be responsible for the risk among school children to have antitoxin concentration below protective level (reported elsewhere). In environments where diphtheria is disappearing a lowered vaccination response may be expected.

Blood Specimen Collection↗
PubMed1987

Immunity against tetanus and response to revaccination in surgical patients more than 50 years of age.

Several instances of fatal postoperative tetanus have been reported, and it has recently been stated that failure to secure adequate immunization for surgical patients may have medicolegal repercussions. In order to investigate according to which criteria for the immunization surgical patients can be considered protected, 178 patients who were more than 50 years of age and who were admitted electively during one year to two surgical departments were studied. To investigate immunity relative vaccination history, all patients admitted during the first two months were offered participation in this study. One hundred and twenty-seven (86 per cent) of these patients were studied by detailed registration of vaccination history and determination of antitoxin concentration in serum. Forty-seven per cent had never been vaccinated against tetanus and 67 per cent had antitoxin concentrations in serum below the protective level. To investigate in detail the duration of immunity and the effect of revaccination, patients with documented complete primary vaccination only were studied during the entire period. An additional 51 patients have been entered into the study during the last ten months. Antibody concentration in the serum corresponded to a continuous fall off in immunity after vaccination. Patients who had received a complete three dose primary vaccination within the last five years or a revaccination within the last ten years were well protected. Forty-four patients received revaccination during the study and were controlled by blood sample four weeks later. Every patient obtained satisfactory antibody concentrations, and it was concluded that no special requirements in recommendations for vaccination are needed, even for elderly patients. Thirteen patients who underwent extensive surgical procedures had serial blood samples taken every three days. Antitoxin concentrations in serum increased sigmoidally with time, and the slow initial increase suggested that revaccination should optimally be given some days before the operation to assure protection in the first few postoperative days.

Age Factors↗