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PubMedDate not supplied

Nosocomial postoperative tetanus infection.

In light of the fact that tetanus spores are present throughout the environment, this article presents a case of nosocomial postoperative tetanus. A review of the immunization schedule is included to familiarize the surgeon with the active and passive methods of immunization. The authors recognize that tetanus infections are uncommon in our society, but all doctors should become aware of the appropriate treatment program as presented in this article.

Anti-Bacterial Agents↗

PubMed1997

Immunogenicity of the recombinant SAPA protein of Trypanosoma cruzi for mice.

The humoral and cellular immune responses induced by the recombinant SAPA (shed acute phase antigen) of Trypanosoma cruzi were studied in mice and correlated with the immunologic control of parasitemia. The immunizing schedule used consisted of 2 weekly injections of 50 micrograms glutathione-S-transferase (GST)-SAPA in Freund's adjuvant. Specific alpha GST-SAPA antibodies were detected by enzyme-linked immunosorbent assay 1 wk after each antigen dose, the concentration of antibodies after the second injection being 30-fold higher than after the first. Immediate- (ITH) and delayed-type hypersensitivity (DTH) reactions were observed as footpad swelling after injecting 50 micrograms GST-SAPA in preimmunized mice as compared to naive controls. Adoptive transfer experiments indicated that these cutaneous reactions were mediated by lymphoid cells and not by serum. Both humoral and cellular responses were specific for the GST-SAPA antigen and did not cross-react with either the GST or the recombinant GST-1 T. cruzi antigen. Immunized mice that had developed high levels of antibody and DTH reaction to GST-SAPA were able to control the level of parasitemia after challenge with 10(3) blood trypomastigotes. The levels of parasitemia obtained were lowered to about 1/3 (P < 0.05) and mortality at day 60 was reduced from 67 to 25% (P = 0.085). Comparison of this immunizing method with other schedules involving more injections or higher antigen doses indicates that control of parasitemia can be obtained with low amounts of antigen and seems to be associated with the development of DTH.

Animals↗

PubMed2005

Immunogenicity and immunologic memory of meningococcal C conjugate vaccine in premature infants.

BACKGROUND: Protein-polysaccharide conjugate vaccines against Neisseria meningitidis serogroup C were introduced into the U.K. routine immunization schedule in 1999. This study is the first to describe both persistence of antibody and evidence for induction of immune memory using meningococcal C conjugate (MCC) vaccine in preterm infants. METHODS: Immunogenicity and induction of immunologic memory by as MCC vaccine was assessed in premature infants; 62 preterm and 60 term controls received MCC at the accelerated schedule (2, 3 and 4 months of age). A meningococcal C polysaccharide challenge was administered at 12 months of age. RESULTS: Both groups achieved similar protective titers after primary immunization that then waned significantly by 1 year of age. Postchallenge serum bactericidal activity was significantly lower in preterm infants (P = 0.03); 73% of preterm versus 88% of term controls achieved a 4-fold rise in serum bactericidal activity (P = 0.07). CONCLUSIONS: MCC vaccine is immunogenic and primes for immunologic memory in preterm infants. The decreased memory responses in these preterm infants in conjunction with waning clinical efficacy data for all U.K. infants suggest a role for a routine booster dose of vaccine in all infants receiving MCC, especially those born preterm.

Antibodies, Bacterial↗

PubMed1999

Development of combination vaccines.

Breakthroughs in molecular biology, biochemistry, process development, immunology and related fields have provided the means for improving current vaccines and developing new ones. The increasing availability of these vaccines is providing the unprecedented opportunity to prevent serious infectious disease in different age groups and to significantly reduce associated morbidity and mortality. However, since the great majority of licensed and experimental vaccines in advanced clinical studies are injected, each new vaccine creates the need for additional needlesticks which could become so numerous as to discourage full compliance with immunization schedules. Therefore, the development of combination vaccines is a major way to assure compliance with immunization needs. The leading types of licensed and experimental vaccines which have been or may be made into combination vaccines will be described. In addition, key challenges common to the development of all combination vaccines will be discussed; these include pharmaceutical, immunological, clinical, regulatory, manufacturing, public health and marketing issues. In order to assure timely development and availability of such combination products, these issues must be integrated successfully early in a development program.

Animals↗

PubMed2006

Phase I trial of a novel intradermal idiotype vaccine in patients with advanced B-cell lymphoma: specific immune responses despite profound immunosuppression.

The immunoglobulin receptor of B-cell lymphomas constitutes a specific tumor antigen (idiotype) and a target for active immunotherapy. Encouraging results have been reported in phase II trials after s.c. vaccination of follicular lymphoma patients during clinical remission with idiotype produced from eukaryotic cell lines and coupled to an immunogenic carrier macromolecule. We have developed a good manufacturing protocol for rapid expression of idiotype vaccines as recombinant Fab fragments in Escherichia coli. The objectives of this trial were to show safety and feasibility of intradermal immunization with this vaccine and to investigate whether immune responses were induced by this immunization route. Patients (n = 18) with advanced B-cell malignancies received repetitive intradermal vaccinations with 0.5 to 1.65 mg recombinant idiotype Fab fragment mixed with lipid-based adjuvant in combination with 150 mug granulocyte macrophage colony-stimulating factor s.c. at the same location. The patients' immune status was assessed by flow cytometry of peripheral blood lymphocytes and concomitant hepatitis B vaccination. Cellular and humoral immune responses to the vaccine were assessed by enzyme-linked immunospot and ELISA. Side effects of a total of 65 vaccinations were mild and did not affect the immunization schedule. No patient developed hepatitis B surface antibodies (anti-HBs) after two hepatitis B immunizations. Of 17 evaluable patients, five developed specific anti-vaccine antibodies, and eight developed anti-Fab T-cell responses. T-cell reactivity was independent of the cellular immune status and was idiotype specific as shown by statistical regression analysis (P = 0.0024) and epitope mapping studies. Intradermal administration of uncoupled recombinant idiotype with appropriate adjuvants may overcome profound clinical immunosuppression and induce specific immune responses.

Adult↗

PubMedDate not supplied

Long term effects of malnutrition during lactation on GALT.

In this report we present data that help to define the impact of malnutrition during the suckling period on the gut associated lymphoid tissues (GALT). Fifty-day old rats malnourished during lactation presented a diminished percentage of s alpha +B cells and IgA level in the intestinal fluid. Also, a decrease in the CD4+ and CD8+ T cell subsets was found. At 120 days of age the percentage of s alpha +B cells and IgA level in the intestinal fluid was similar to the control. However, the percentage of T cells remained altered. When three doses of chorea toxin were administered orally since day 28, the IgA anti CT antibodies were diminished in the intestinal fluid, while the immunization schedule started after seven days of refeeding (28 days of age). This impairment of the immune response remained even after a CT booster was given to animals 113 days old. This diminishing in the CD4+ T cells may be the major cause of the nonresponsiveness described herewith.

Animals↗

PubMed1996

Hepatitis A: epidemiology and prevention.

Hepatitis A is a disease with worldwide distribution. Conditions of sanitation and hygiene determine the overall epidemiological situation in any area, but risk behaviour determines an individual's chance of exposure. The recent licensing of formalin-inactivated vaccines for the prevention of hepatitis A requires an understanding of the epidemiology in order to devise how best to use this the vaccine in individuals or populations. Although higher-risk groups can be identified in developed countries, and vaccine will be useful to those groups, it is not likely that the vaccine will have a large effect on the prevalence of hepatitis A until it becomes a part of the routine childhood immunization schedule.

Hepatitis A↗

PubMedDate not supplied

New York State's two-dose schedule for measles immunization.

In April 1989, New York became the first State in the United States to adopt a two-dose schedule for routine measles immunization. Although a two-dose schedule had been under discussion for the previous 10 years, this policy change was finally prompted in New York State by widespread measles outbreaks in 1989 among college and high school students who had been appropriately vaccinated with a single dose of measles vaccine. These outbreaks affected 21 college and secondary school campuses with 91 cases of measles and led to the administration of 53,093 doses of vaccine at a cost in excess of $859,000 for vaccine alone. In addition, there were major disruptions of intercollegiate athletic and scholastic events and physician and public confusion over the different recommendations for "outbreak" versus "routine" measles immunization. In response, the New York State Department of Health adopted a policy of two doses of measles vaccine required for entrance into kindergarten and college beginning in the fall of 1990. This report describes the data and process that were used in reaching this policy decision.

Adolescent↗

PubMed2004

Cost-effectiveness of three different vaccination strategies against measles in Zambian children.

The vaccination program in Zambia includes one dose of measles vaccine at 9 months of age. The objective of this study was to compare the cost-effectiveness of the current one-dose measles vaccination program with an immunization schedule in which a second dose is provided either through routine health services or through supplemental immunization activities (SIAs). We simulated the expected cost and impact of the vaccination strategies for an annual cohort of 400,000 children, assuming 80% vaccination coverage in both routine and SIAs and an analytic horizon of 15 years. A vaccination program which includes SIAs reaching children not previously vaccinated would prevent on additional 29,242 measles cases and 1462 deaths for each vaccinated birth cohort when compared with a one-dose program. Given the parameters established for this analysis, such a program would be cost-saving and the most cost-effective vaccination strategy for Zambia.

Cost of Illness↗

PubMedDate not supplied

Immunotherapy for Alzheimer's disease and other dementias.

OBJECTIVE: The aim of this article is to review the role of immunotherapy in the removal of proteins which accumulate abnormally in neurodegenerative disorders associated with dementia, in particular amyloid-beta accumulation in Alzheimer's disease. RESULTS: In both transgenic mouse models and in two trials of amyloid-beta immunotherapy for human Alzheimer's disease, active immunization with amyloid-beta 1-42 results in the removal of amyloid-beta plaques from the cerebral cortex associated with, in the mouse models, improvement in cognitive function. Cerebral amyloid angiopathy and neurofibrillary tangles persist, however, and there is also concern about T lymphocyte immune reactions in the meninges in the human cases. Active immunization schedules are being developed to minimize T lymphocyte reactions and to maximize antibody production and passive immunization protocols are being devised. Immunotherapy for removal of the proteins which accumulate in other neurodegenerative disorders associated with dementia such as prion proteins and alpha-synuclein are in the early stages of development. CONCLUSION: Dementias in the elderly are an increasing medical, social and economic problem and current treatments are only effective. In the majority of dementias, proteins accumulate within cells and in the extracellular compartments of the brain. In the most common dementia, Alzheimer's disease, amyloid-beta accumulates as plaques in the extracellular space of the grey matter and in artery walls as cerebral amyloid angiopathy and tau protein accumulates as neurofibrillary tangles within neurons.

Journal Article↗

PubMed2005

Immunotherapy for Alzheimer's disease and other dementias.

PURPOSE OF REVIEW: The aim of this article is to review the role of immunotherapy in the removal of proteins which accumulate abnormally in neurodegenerative disorders associated with dementia, in particular amyloid-beta accumulation in Alzheimer's disease. RECENT FINDINGS: In both transgenic mouse models and in two trials of amyloid-beta immunotherapy for human Alzheimer's disease, active immunization with amyloid-beta 1-42 results in the removal of amyloid-beta plaques from the cerebral cortex associated with, in the mouse models, improvement in cognitive function. Cerebral amyloid angiopathy and neurofibrillary tangles persist, however, and there is also concern about T lymphocyte immune reactions in the meninges in the human cases. Active immunization schedules are being developed to minimize T lymphocyte reactions and to maximize antibody production and passive immunization protocols are being devised. Immunotherapy for removal of the proteins which accumulate in other neurodegenerative disorders associated with dementia such as prion proteins and alpha-synuclein are in the early stages of development. SUMMARY: Dementias in the elderly are an increasing medical, social and economic problem and current treatments are only effective. In the majority of dementias, proteins accumulate within cells and in the extracellular compartments of the brain. In the most common dementia, Alzheimer's disease, amyloid-beta accumulates as plaques in the extracellular space of the grey matter and in artery walls as cerebral amyloid angiopathy and tau protein accumulates as neurofibrillary tangles within neurons.

Alzheimer Disease↗

PubMed1992

[Polyclonal avian antibodies extracted from egg yolk as an alternative to the production of antibodies in mammals - a review]

Polyclonal avian antibodies (AB) extracted from chicken egg yolk can be considered as a real alternative to the traditional AB production in laboratory mammals. Besides the advantage of a non-invasive AB sampling, the amount of specific extractable AB is much higher in egg yolk than in rabbits in the same time period. This paper presents the methodology of IgY production and extraction particularly considering the mode of antigen injection, immunization schedule as well as titre development. The paper gives information about groups of antigens used for immunization so far, immunological methods applied and fields of IgY application. Furthermore, based on data from literature, IgY and IgG are compared with respect to properties important for immunological use.

Journal Article↗

PubMed1992

A survey of invasive Haemophilus influenzae infections--England and Wales.

A survey of invasive H. influenzae infections has been underway in 6 regions of England and Wales since September 1990. In the first year, there were 433 cases of which 362 (84%) were due to H. influenzae type b (Hib). The majority of Hib infections were in children aged less than 5 years (annual incidence in this age group is 26.4/100,000). Meningitis occurred in 56% of cases of Hib infection. The results confirm previous evidence of the need to incorporate Hib vaccination into the childhood immunization schedule. The ongoing survey data will provide useful information to assess the impact of an Hib immunization program.

Cause of Death↗

PubMed2003

Facilitating the WHO expanded program of immunization: the clinical profile of a combined diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b vaccine.

BACKGROUND: Vaccines are important weapons in the fight against infectious diseases. The World Health Organization (WHO) Expanded Program on Immunization (EPI) has been extended to include recommendations for hepatitis B and Haemophilus influenzae type b (Hib) vaccinations. The WHO has recommended that combined vaccines be used where possible, to reduce the logistic costs of vaccine delivery. This paper reviews the efficacy, safety and cost-effectiveness of Tritanrix-HB/Hib, the only commercially available combined diphtheria, tetanus, whole cell pertussis, hepatitis B and conjugated Hib vaccine. METHODS: The immunogenicity and reactogenicity results of five published clinical trials involving Tritanrix-HB/Hib in a variety of immunization schedules and countries were reviewed. Based on these data and cost-effectiveness studies, an assessment of its suitability for use in national immunization programs was made. RESULTS: Tritanrix-HB/Hib has shown excellent immunogenicity in clinical trials using a variety of schedules, with no reduced immunogenicity observed for any of the components of the combined vaccine. It has similar reactogenicity to DTPw vaccines alone. Pharmacoeconomic analyses have shown combined DTP-HB/Hib vaccines to be cost-effective compared to separate vaccines. CONCLUSIONS: Replacement of DTPw vaccination by Tritanrix-HB/Hib can be done without modifying the existing national immunization programs. This should facilitate widespread coverage of hepatitis B and Hib vaccinations and their rapid incorporation into the EPI.

Antibodies, Bacterial↗

PubMed2003

Safety, immunogenicity and tolerability of a new pediatric tick-borne encephalitis (TBE) vaccine, free of protein-derived stabilizer.

A total of 3,559 children aged 1-11 years were enrolled in two clinical studies to evaluate immunogenicity and safety of a new pediatric tick-borne encephalitis (TBE) vaccine, free of protein-derived stabilizer. Immunogenicity was evaluated in the rapid immunization schedule (Days 0, 7, and 21) from sera collected at baseline and on Day 42 post-immunization by in vitro TBE virus neutralization test. All subjects analyzed achieved levels of TBE antibodies to fulfil the definition of seroconversion or a four-fold increase in antibody titres from baseline. The frequency of solicited post-immunization reactions ranged from 1 to 32% for reported local reactions and from 1 to 14% for systemic reactions. Overall, this can be regarded as expected for an inactivated, aluminium-adjuvanted, TBE vaccine. There was no indication for any new safety issues. An acceptably low number of febrile reactions above 38 degrees C with the highest frequency after first immunization (i.e. 15% and 5% in children aged 1-2 and 3-11 years, respectively), mainly below 39 degrees C, was reported. The results of both studies clearly show that TBE vaccination with this new TBE vaccine formulation can be achieved with a high degree of safety in children from 1 to 11 years of age.

Antibodies, Viral↗

PubMed1998

An assessment of the value of Haemophilus influenzae type b conjugate vaccine in Asia.

Haemophilus influenzae type b (Hib) is a leading cause of bacterial meningitis and pneumonia. Although invasive Hib disease has been reduced substantially wherever Hib conjugate vaccines have been introduced into routine childhood immunization schedules, these vaccines are more costly compared with the vaccines routinely used in the Expanded Program for Immunization. Consequently a model was constructed to compare the expected burden of Hib disease with and without a national vaccine program for various Asian countries. Cost of the vaccine program, expected benefits of reduced deaths and savings from prevented disease treatment were assessed for each country based on the model assumptions. Model outcomes were expressed as a net cost, cost per death prevented and cost per disability-adjusted life year for each country and economic stratum. With the assumption of a disease burden of meningitis and pneumonia comparable with that observed in other regions, the model predicts that 668000 cases of Hib pneumonia and 136000 cases of Hib meningitis would occur annually in this cohort resulting in 156000 deaths. Based on current vaccination coverage rates for the individual countries, the model predicted that approximately 136000 (87%) Hib deaths could be prevented annually with incorporation of Hib vaccine into the Expanded Program for Immunization. For each of the countries considered, routine vaccination with Hib would cost between 0.1 and 3.0% of per capita gross national product per child <5 years of age. Although Hib vaccine would be considered a cost-effective public health intervention, it may be cost-prohibitive to implement in the lowest income countries without initial donor assistance.

Asia↗

PubMed2002

Can nonliving nasal vaccines be made to work?

Nasal vaccines consisting of nonliving particulate formulations can induce immune responses of importance for protection against infection. The most promising results have been obtained with vaccines against influenza, pertussis and group B meningococcal disease. So far, however, the results do not challenge the standing of corresponding injectable vaccines, although results of experiments in animals do indicate that effective nonliving nasal vaccines may soon be developed. This will depend on refined immunization schedules to benefit from immunological memory and on formulations to make the vaccines more accessible to the immune system by way of mucosal adjuvants or immune modulators.

Adjuvants, Immunologic↗

PubMed2002

Effectiveness of chart prompt about immunizations in an urban health center.

OBJECTIVE: To determine whether a nurse-initiated chart review and prompt to physicians is an effective method to increase immunization rates. STUDY DESIGN: This study was a controlled trial with systematic assignment of children to intervention or control groups based on chart number. Each day, a nurse reviewed the charts of children to be seen that day who were in the intervention group. The nurse prepared a 1-page form about the child's immunization status that requested permission from the physician to administer needed vaccines and attached the form to the chart. The duration of the study period was 1 year. POPULATION: Nine hundred ninety-seven pediatric patients attending 2 inner-city primary care health centers. OUTCOME MEASURED: On-time immunization rates in both groups. RESULTS: Among children eligible to receive vaccines during the study period, a higher percentage in the intervention group received on-time vaccines for diphtheria/tetanus/pertussis-4 (DTP4; 51% vs 36%; P=.03), oral polio vaccine-3 (OPV3; 70% vs 56%, P=.04), and measles/mumps/rubella-1 (42% vs 26%; P=.01) than did children in the control group. No statistically significant differences were noted for DTP3, DTP5, hepatitis B3, or OPV4. No statistically significant difference was noted for the combined series (ie, all age-appropriate immunizations as recommended by the 1995 Childhood Immunization Schedule of the Centers for Disease Control and Prevention). CONCLUSIONS: The chart prompt increased on-time immunizations for some antigens.

Child, Preschool↗