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PubMed1993

Management of bacterial meningitis.

In developed countries the mortality from bacterial meningitis acquired outside the neonatal period is relatively low. In contrast, in developing countries it is often higher (20%-40%). In developed countries despite (and perhaps because of) the introduction of increasingly potent antimicrobials, the morbidity of bacterial meningitis has remained high. For example, up to 25% of patients with Haemophilus influenzae meningitis have some form of neurological deficit. Neisseria meningitidis is the major cause of bacterial meningitis in many areas of the world. A clone of Group A meningococcus has spread from China to cause the most recent major epidemic in Sub-Saharan Africa. Group B meningococcal infections causing sporadic meningitis are increasing in parts of Europe and South America. The mortality from meningococcal disease is greatest when there is a septicaemic component to the infection. Although antimicrobial chemotherapy is of major importance some adjuncts to therapy are beneficial. High dose corticosteroid therapy has been shown to decrease mortality in pneumococcal meningitis in an uncontrolled study and to speed recovery and decrease neurological sequelae in H. influenzae meningitis. Nevertheless to prevent infection would be of greater benefit. Prevention can be achieved by either chemoprophylaxis or immunoprophylaxis. Although safe and effective vaccines are available to prevent pneumococcal, H. influenzae (Hib) and Groups A and C meningococcal meningitis; apart from the protein conjugate Hib vaccine they are less effective in children under two years of age. There is no effective vaccine to protect against group B meningococcal meningitis.

Adolescent↗
PubMed1987

Protective efficacy of monoclonal antibodies to class 1 and class 3 outer membrane proteins of Neisseria meningitidis B:15:P1.16 in infant rat infection model: new prospects for vaccine development.

The protective efficacy of monoclonal antibodies to class 1 and class 3 outer membrane proteins of Neisseria meningitidis B:15:P1.16 was tested in an infant rat infection model. Four monoclonal antibodies to class 1 protein had bactericidal titres exceeding 20,000 and they protected infant rats completely against bacterial challenge with meningococci carrying the same class 1 protein, P1.16. One monoclonal antibody to class 3 protein was highly bactericidal (titer greater than 20,000), whereas two others had no bactericidal activity. All these antibodies gave some protection from infection, resulting in mortalities varying from 66 to 83% as compared to 100% in control rats who had received either unrelated monoclonal antibody or saline. These results strongly speak for class 1 outer membrane protein as a vaccine candidate for meningococcus group B.

Animals↗
PubMed2002

Mucosal immune responses to meningococcal conjugate polysaccharide vaccines in infants.

BACKGROUND: Serogroup C meningococcal conjugate polysaccharide vaccines have been reported to induce significant serum IgG antibodies and immunologic memory in infants. Because meningococcus is a mucosal pathogen colonizing the nasopharynx, local mucosal immune responses may play an important role in host defense against infection and carriage. We have investigated the mucosal IgA and IgG antibody responses to two meningococcal C conjugate vaccines in the saliva of healthy infants. METHODS: Specific salivary IgA and IgG antibodies to two meningococcal C polysaccharide conjugate vaccines (Menjugate from Chiron Corp., n = 46; and Meningitec from Wyeth Lederle, n = 54) were investigated by immunoassay in infants after parenteral vaccinations at the ages of 2, 3 and 4 months. Unstimulated saliva samples were collected immediately before the first immunization and 1 month after the third immunizations. Forty healthy infants receiving the same routine vaccines but no meningococcal C vaccine were recruited as controls. RESULTS: There were significant increases in meningococcal C polysaccharide-specific IgG antibody concentrations postvaccination compared with prevaccination concentrations in both vaccinated groups (both P < 0.001), but no change in the control group. There were no significant increases in specific IgA postvaccination geometric mean concentrations in either the vaccine or the control groups. The number of IgA positives postvaccination increased slightly in the Wyeth vaccine group vs. controls (P < 0.05). CONCLUSIONS: Significant salivary IgG antibodies to meningococcal C polysaccharide were observed after parenteral immunization with two meningococcal C conjugate vaccines, whereas there was no significant increase in specific IgA antibody levels for these two vaccines.

Antibodies, Bacterial↗
PubMedDate not supplied

Up-to-date aspects of meningoencephalitis. Anatomo-clinical researches.

The anatomo-clinical study of the deaths caused by meningoencephalitis at the Infectious Diseases Clinics in Bucharest in 1986 and 1987 showed the increase of morbidity, 194 lethal cases being registered. The most affected age group was up to 1 year, followed by older persons, then by children between 1 and 10 years, the male sex prevailing. The most incriminated pathogenic agents were meningococcus, pneumococcus, as well as negative Gram germs, Escherichia coli, whereas the favouring factors were especially malnutrition, premature birth, dystrophies, focal infections. The lesional pictures are described, underlying the frequency of vascular lesions, ventriculitis cerebral abscesses, as well as the role of demyelinizations and of the glial reactions in pathogenesis.

Adolescent↗
PubMedDate not supplied

[Epidemiologic and serologic studies of pneumococcal infections with reference to the new STIKO recommendations].

Pneumococcal diseases play an important role especially for babies and toddlers (otitis media) and for older persons (pneumonia). 28% of the 481 reported cases of bacterial meningitides (without meningococcus) in Mecklenburg-Vorpommern were caused by pneumoniae streptococcus. A pneumococcus antibody study by the land register confirms the high contamination in older people. Therefore STIKO recommends since March 1998 to effect pneumococcal vaccination with every person from the age of 60 and dove as well as for children, adolescents and adults with higher risk due to a primary disease.

Adolescent↗
PubMed1982

Bacterial meningitis--ten years experience.

Between January 1968 and December 1977, 635 cases of acute bacterial meningitis were admitted to hospitals in the Birmingham Area Health Authority. The epidemiology of these cases was analysed and compared with the 270 cases which were admitted to the regional infectious diseases unit at East Birmingham Hospital (E.B.H.). In children and young adults the meningococcus was the commonest causative organism while over the age of 25 pneumococcal meningitis predominated. Although Haemophilus influenzae was the second commonest infecting organism it was a rare cause of meningitis in school children and adults, only four cases presenting in these age groups in the Birmingham Area. A detailed analysis was made of the symptoms, signs, laboratory investigations and clinical course of the 270 cases treated at E.B.H. The mortality in the patients with pneumococcal meningitis was 30%. In the meningococcal group it was 3.5% and in the haemophilus groups 7.7%. An analysis of the various treatment regimes employed in the 270 E.B.H. patients supports the view that a single antibiotic is sufficient for the therapy of most forms of bacterial meningitis. Intrathecal antibiotic administration is unnecessary in pyogenic meningitis caused by meningococci, pneumococci or H. influenzae.

Adolescent↗
PubMed2004

Meningococcal vaccines.

Meningococcal disease is one of the most feared and serious infections in the young and its prevention by vaccination is an important goal. The high degree of antigenic variability of the organism makes the meningococcus a challenging target for vaccine prevention. Meningococcal polysaccharide vaccines against serogroup A and C are efficacious and have been widely used, often in combination with serogroup Y and W135 components. Their relative lack of immunogenicity in young children and infants can be overcome by conjugation to a protein carrier. The effectiveness of serogroup C glycoconjugate vaccines in children of all ages has been demonstrated and they have now been introduced into routine vaccination schedules. Conjugate vaccines against other serogroups, including A, Y, and W135 will soon be available and it is hoped they may emulate this success. Prevention of serogroup B disease has proven more elusive. Several serogroup B vaccines based on outer membrane vesicles have been shown to be immunogenic and reasonably effective in adults and older children, but the protection offered by them is chiefly strain-specific. Multivalent recombinant PorA vaccines have been developed to broaden the protective effect, but no efficacy data are available as yet. Intensive efforts have been directed at other outer membrane protein vaccine candidates and lipopolysaccharide, and some of these have been shown to offer protection in experimental animal models. Nonpathogenic Neisseriae spp. such as Neisseria lactamica are also possible vaccine candidates. Previously unknown proteins have been identified from in silico analysis of the meningococcal genome and their vaccine potential explored. However, none of these has yet been presented as the 'universal' protective antigen and work in this field continues to be held back by our limited knowledge concerning the mechanisms of natural protection against serogroup B meningococci.

Adolescent↗
PubMed1985

[Pathogenetic and pathomorphological problems of viral-bacterial associations in children dying of meningococcal infection].

The information on 63 children dying from hypertoxic forms of meningococcal infection is presented. Four groups of brain damage by respiratory viruses (RV) are distinguished on the basis of the results of morphological and virological examination: 1) with a recent RV generalization (26 cases); 2) with dissemination of an etiological agent but without clear-cut structural changes (6 cases); 3) with an isolated affection of the brain (13 cases); 4) without clear-cut brain damage. Experimental influenza-meningococcal infection was reproduced in 260 white rats. Enhancement of the animal death rate, multiplication of virus and the degree of brain damage in cases of combined action of both etiological agents is demonstrated. The ability of influenza virus, when inoculated intranasally together with meningococcus, to penetrate and to multiply in the brain provoking meningitis and choroiditis is shown virologically, histologically and electron microscopically.

Adenovirus Infections, Human↗
PubMed2004

[Adult immunization in France: an update].

French immunisation schedule recommends tetanus and poliomyelitis vaccine every 10 years and influenza every year after the age of 65. Several other vaccinations related to occupational health are implemented. Travellers or immunocompromised people who could be exposed to infections need some other vaccinations, too. Pneumoccocal vaccine coverage is insufficient. Reinforcing diphteria immunization is considered, using a recently licensed combined vaccine. Maintenance of immunity against "childhood infectious diseases" preventable with vaccinations is a new challenge; measles, rubella and pertussis occur now quite often in adults: the risk of complications is higher in these ages (measles), or expose to specific risk (rubella in pregnant women); adults may even become the source of the contamination of younger people (many infants affected with whooping cough have contracted the disease from their own parents). The immunisation against these diseases should be prosecuted in adults. Related with the development of more efficacious new vaccines, the indications of pneumococcus, meningococcus or varicella vaccines should be defined in some populations of adults. Immunization policy of adults should be revised in order to continue the vaccination program of childhood. Some infections that may affect adults should be prevented by improving vaccine application. A real adult immunisation schedule and recommendations should be set up towards populations at risk of preventable infections. The implementation of these recommendations should be reinforced.

Adult↗
PubMed2003

[Adult immunization].

Adults receive several vaccinations related to occupational health. Travellers or immunocompromised people who are exposed to infections need some other vaccinations, too. People older than 65 receive influenza vaccine every year. Tetanus and poliomyelitis immunity should be maintained with a decennial injection following adult immunisation schedule but the application of this vaccine remains rather erratic. Diphtheria valence included in a recently licensed combined vaccine could be done together. Maintenance of immunity against "childhood infectious diseases" preventable with vaccinations is a new challenge; measles, rubella and pertussis occur now quite often in adults: the risk of complications is higher in these ages. Adults may even become the source of the contamination of youngers: many infants affected with whooping cough have contracted the disease from their own parents. The immunisation against these diseases should be prosecuted in adults. Related with the development of more efficacious new vaccines, the indications of pneumococcus, meningococcus or varicella vaccines should be defined in some populations of adults. Immunization policy of adults should be revised in order to continue the vaccination program of childhood. Some infections that may affect adults should be prevented by improving vaccine application. A real adult immunisation schedule and recommendations for populations at risk of preventable infections should be set up and their application reinforced.

Adult↗