PubMed · 7245099
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H M Seybold, M M Warren. 1981. Postsplenectomy immunologic impairment.. https://pubmed.ncbi.nlm.nih.gov/7245099/
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BACKGROUND: During 2001 and the first half of 2002, the United States experienced severe shortages of five of the eight universally recommended vaccines for children. OBJECTIVES: To evaluate the impact of shortages of diphtheria-tetanus-acellular pertussis vaccine (DTaP), pneumococcal conjugate vaccine (PCV7), and tetanus and diphtheria vaccine (Td) shortages on state and urban area immunization programs and immunization providers between September 2001 and January 2002. METHODS: (1) Survey of state and urban area immunization program managers. Outcome measures included changes in vaccine distribution and suspension of daycare/Head Start and school entry immunization requirements for Td, DTaP, and PCV7. (2) Interviews with Vaccines for Children Program immunization providers scheduled to receive a routine site visit between January 21 and February 1, 2002. Outcome measures included problems experienced with vaccine orders, implementation of Advisory Committee on Immunization Practices (ACIP) interim recommendations for DTaP and PCV7, and length of time with no DTaP or PCV7 vaccines in stock. RESULTS: Over 85% of immunization programs changed the way they distributed PCV7, DTaP, and Td vaccines to providers, including limiting the amount of vaccine ordered or distributing partial orders. Additionally, 76% of programs experienced problems purchasing or receiving varicella vaccine. Sixty-eight percent of programs suspended school entry requirements for Td. Immunization providers reported problems with orders of Td (56%), PCV7 (45%), DTaP (30%), and varicella (29%). Approximately 16% and 29% of providers implemented the interim ACIP recommendations for DTaP and PCV7, respectively. However, 21% of providers suspended administration of all doses of PCV7 because they ran out of vaccine before learning of the shortage. CONCLUSIONS: From suspension of school entry requirements to delaying administration of vaccine, the recent vaccine shortages affected immunization programs' and providers' ability to administer vaccines in a timely manner.
Tuberculoid (TT) and lepromatous leprosy (LL) develop in the human host depending on his ability to trigger a specific cellular immune response(CIR). Different genes have been demonstrated in susceptibility/protection and may explain the forms of leprosy. The major histocompatibility complex (MHC) play an important role. The aim of the study was to explore the contribution of human leukocyte antigen (HLA) DRB1, DQA1, DQB1 and DQ promoter genes in LL Mexican patients. Six families (26 LL, three TT patients and 27 controls) were analyzed; 114 unrelated patients were compared with 204 controls. Class I typing was done by the standard microlymphocytotoxicity and class II typing using PCR-SSOP. Haplotype segregation correlated with specific CIR in vivo and in vitro using lepromin. Haplotype sharing was significantly deviated in the affected sibs (p=0.01). Six healthy sibs were non-responders to lepromin and four of them were DQ1 homozgotes. DQ1 was significantly associated with LL and with non-responders. We set up macrophage activation experiments after infecting these cells with 5x10(6) bacilli to demonstrate if elimination occurred in the context or DQ1. When DQ1 was present on macrophages and on T cells, bacteria were poorly eliminated from the cell (32%) while when absent, 76% of the individuals were able to eliminate the bacilli (p=0.03). DRB1*1501 DQA1*0102-DQB1*0602 (DQ1 subtype) was significantly increased in the patients, indicating its participation in susceptibility. QBP 5.11/5.12 promoter present in the mentioned haplotype, and QAP 1.4, linked to DRB1*1301/02 haplotypes were also associated. Two mechanisms are suggested: the promoter polymorphisms may influence allele expression and thus the amount of peptides presented to the T-cell receptor, leading to a deficient CIR: HLA restriction is important for vaccine design; the way peptides anchor the DRB1*1501 groove may be relevant to the activation of TH1 cells, which contribute to an efficient presentation of peptides inducing a protective T-cell response.
Autologous and allogeneic bone marrow transplantation (BMT) recipients lose immune memory of exposure to infectious agents and vaccines accumulated through a lifetime and therefore need to be revaccinated. Diphtheria toxoid, tetanus toxoid, pertussis vaccine (children <7 years old), Haemophilus influenzae type b conjugate, 23-valent pneumococcal polysaccharide, inactivated influenza vaccine, inactivated polio vaccine and live-attenuated measles-mumps-rubella vaccine are the currently recommended vaccines to be included in a vaccination program after BMT. For most of them, the best time to vaccinate, the number of vaccine doses and/or the duration of immunity after vaccination have not been established. Vaccination protocols vary greatly among BMT centers, suggesting that the lack of sufficient data has not permitted the formulation of reliable recommendations. The use of other vaccines and the perspectives for different vaccination protocols are analyzed in this review.