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PubMed1992

Medical considerations for the pregnant traveler.

The care of pregnant travelers requires clinical information and skills that are derived from many disciplines. Issues to be considered include the safety of both mother and fetus during commercial air travel, vigorous exercise, scuba diving, and even high-altitude trekking. Immunizations require a balanced approach to the risk of disease versus the risks of vaccine complications. Safe or treated water sources are of paramount importance to prevent unnecessary exposure to antimicrobial and antiparasitic agents during pregnancy. Malaria prophylaxis is made even more difficult by an increasingly widespread resistance of Plasmodium species to chloroquine.

Diarrhea↗
PubMed1990

Genetic variability in HIV-1 gp120 affects interactions with HLA molecules and T cell receptor.

The propensity of HIV-1 to undergo sequence variation, particularly in the envelope glycoprotein gp120, complicates vaccine development and may enable the virus to evade ongoing immune responses in infected individuals. We present here a molecular analysis of the effects of this variability on human T cell recognition of HIV-1 gp120. Synthetic peptides representing a defined CD4+ human T cell epitope in gp120 were used to survey gp120 molecules from various HIV-1 strains for the capacity to be recognized in the context of a single human MHC molecule, DR4. Variation affected recognition at two levels. For some strains, variation in this epitope was sufficient to alter the interaction of Ag receptors on gp120-specific human T cell clones with peptide-DR4 complexes on APC. In the case of two strains, the natural variation was sufficient to prevent the critical initial interaction between the relevant gp120 peptides and DR4 on the APC. However, these strains were highly divergent from the reference strain. Thus it is encouraging to note that the range of natural sequence variation in this T cell epitope falls, for the most part, within the range of peptide sequences that can be accommodated by the relevant human MHC molecule.

Amino Acid Sequence↗
PubMed1969

Smallpox vaccination by intradermal jet injection. I. Introduction, background and results of pilot studies.

Jet injection has met with great success in the rapid and effective mass administration of several immunizing agents. The recent development of a jet injector nozzle specifically designed for intradermal inoculation suggested the possible extension of jet injector methodology to mass smallpox vaccination. A total of 156 volunteer subjects, 16 unvaccinated and 140 vaccinated more than 5 years previously, received either undiluted smallpox vaccine by the multiple-pressure technique, or 0.1 ml of various dilutions of smallpox vaccine by jet injector using the new nozzle. Cutaneous and serological responses in revaccinees revealed that jet injection of diluted vaccine with a titre of 10(7) TCID(50)/ml was as effective as multiple-pressure inoculation of undiluted vaccine. Among the small number of primary vaccinees, jet injection of diluted vaccine with a titre of 10(6) TCID(50)/ml appeared as effective as multiple-pressure inoculation of undiluted vaccine. No complications of vaccination occurred.The findings confirm the utility of the intradermal nozzle for jet injection of smallpox vaccine. In view of the speed of administration and the economy of vaccine, it is suggested that there is a distinct role for jet injection in global smallpox eradication efforts. Further studies on larger numbers of unvaccinated subjects and on persons with significant residual vaccinial immunity are needed to define the optimal concentration of vaccine for mass vaccination by jet injection.

Animals↗
PubMed1989

[Recommendations for the therapy of atypical immunization courses and complications of BCG vaccination (Position: April, 1988)].

After introduction of the "direct" BCG-vaccination of the 16 years old youngsters in 1981 a small increase of atypical reactions and complications of the vaccination was probable. References and experiences about different therapy methods of these atypical reactions and complications gave rise to recommend uniform guide-lines for definition, diagnostic and therapy.

Adolescent↗
PubMed2005

Yellow fever and Japanese encephalitis vaccines: indications and complications.

Appropriate administration of yellow fever or Japanese encephalitis vaccines to travelers requires an assessment of the traveler's risk for infection with these vector-borne flaviviruses during their travels and the presence of risk factors for adverse events following immunization. Japanese encephalitis and yellow fever vaccines have been more frequently associated with serious adverse events following immunization since the early 1980s and the late 1990s, respectively. This article describes the adverse events, the magnitude of their risk, and associated risk factors.

Encephalitis, Japanese↗
PubMed1979

[BCG sepsis as a fatal complication of BCG vaccination].

Fatal septicemia with Bacillus Calmette-Guérin (BCG) following BCG vaccination is always caused by an underlying defect of immunologic mechanisms. At the Children's Hospital, University of Berne, two cases of BCG septicemia were recently observed. The clinical picture, course, and pathogenesis of the illness are discussed. The harmless complications of BCG vaccination are summarized, and a review of the literature on fatal disseminated BCG infection stresses the different type of immunologic mechanism defect and clinical course. Therapy with antituberculous drugs is ineffective. Other therapeutic measures are mentioned. Immunologic tests must be performed rapidly when fatal disseminated BCG infection is suspected, in order to organize genetic counselling as soon as possible. The question whether newborns should still be vaccinated in spite of the numerous complications is discussed and answered in the affirmative.

Antigen-Antibody Reactions↗
PubMed1975

Neurological complication of antirabies vaccination in São Paulo, Brazil. Clinical and therapeutical aspects.

The author studied especially the clinical aspects and therapeutic results in 73 patients with neurological complication of anti-rabies vaccination. The neuroparalytic accidents and the most constant neurologic signs and symptoms were emphasized. The most common clinical syndrome was thoraco-lumbar meningomyelitis and there were CSF alterations in 88% of the cases studied. Eighteen patients presented neurologic complications after Fuenzalida vaccine: only 1 of them had Guillain-Barré syndrome, 1 had meningoradiculitis, 4 had myelitis and in the other 12 cases there was diffuse involvement of the nervous system especially of the spinal cord and meninges (meningomyelitis and meningoencephalomyelitis).

Adolescent↗
PubMed1977

[Relationship between the incidence of neurologic complications following smallpox vaccination and the generation and infectious activity of vaccine from strain L-IVP].

A strictly controlled epidemiological trial was applied to the study of the incidence of neurological complications in children inoculated with vaccine from the L-IVP strain of the 2nd, 3rd, and 5th passages (generations). To ascertain a possible connection between the neuropathogenicity with the infectious activity the persons vaccinated were divided into 3 groups in accordance with the infectiousness level of the preparation obtained: the I group--3--5-10(8)OOU/ml; the II group--6--8-9-10(8) OOU/ml; the III group over 9-10(8) OOU/ml. The least number of neurological complications was recorded among children primarily inoculated with the vaccine of the 3rd passage with the infectiousness titre of over 9-10(8) OOU/ml.

Child↗
PubMed1987

Osteomyelitis deriving from BCG-vaccination.

Secondary complications after BCG-vaccination are unusual. There is an almost invariably lethal generalized infection affecting the immunodepressed. Late dissemination of BCG to bone is characterized by lytic lesions, it is not normally associated with immunologic changes and has a good prognosis. The histology of BCG-osteomyelitis resembles that produced by Koch bacillus. We present a rare case of a lytic lesion in the femur improving after specific treatment.

BCG Vaccine↗
PubMed2003

Neurological complications of rabies vaccines.

The rabies vaccines containing neural elements are used in some countries including India. We report three cases that presented with various neurological complications following the use of these vaccines. The presenting manifestations included those of encephalitis, radiculitis and acute inflammatory demyelinating polyradiculoneuropathy. These neurological complications are highlighted so that scientific evidence compels the community to discontinue the use of the neural tissue rabies vaccines. Newer generation cell culture rabies vaccines should be preferred over the neural tissue rabies vaccines for post-exposure prophylaxis.

Cerebral Ventricles↗
PubMed1992

Infection with Mycobacterium bovis in a patient with AIDS: a late complication of BCG vaccination.

We present a 28-year-old HIV-infected man with a 2-year delayed complication of BCG immunization. When immunized the man was healthy, with an unknown HIV status, but 2 years later he was diagnosed with AIDS because of a Pneumocystis carinii pneumonia. He was successfully treated and discharged in a state of good health. A few months later he presented with an enlarged lymph node and Mycobacterium bovis, BCG strain, was cultured. No sign of dissemination was found. We discuss the indications for BCG vaccination in adults, especially in areas and in populations with a high prevalence of HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1975

Complications of BCG vaccination in neoplastic disease.

More than 300 patients with neoplastic disease (most with lymphoma or leukemia) were given one or more BCG vaccinations. In the great majority of cases, these were well tolerated. The complications we observed were of three types: (A) persistent BCG infection that could disseminate widely, (B) activation of old, dormant acid-fast infection, and (C) hypersensitivity reactions. The latter were related to the frequency of administration and dose of organisms. It is important to recognize that BCG organisms may not be completely destroyed by patients with impaired immunologic defenses, and that their inoculation may create a source of disseminated acid-fast infection at a later time. In our limited experience, treatment with isoniazid for 2 to 3 months has resulted in cure of BCG infection. Hypersensitivity reactions may constitute a more serious problem than such infections.

Adrenal Gland Neoplasms↗