Prior Vaccination History Research Articles

Study of Mumps in Children attending a Tertiary Care Centre

Introduction: Mumps is a self-limiting viral infection of the salivary glands with systemic manifestations and complications. It primarily affects young children, with increased incidence in winter and spring. Mumps infection is endemic in developing countries because of poor vaccination coverage. This study is intended to highlight the increased number of mumps cases in children attending tertiary care center in Nepal and thus to emphasize the importance of mumps vaccination, so as to decrease the disease occurrence and disease burden by vaccinating all children. Materials and Methods: This was a prospective study done in Civil Service Hospital of Nepal over a period of 2 years from November 2009 to October 2011. All children less than 14years of age with symptoms of fever and parotid swelling were included in the study group. A detailed history pertaining to the disease was taken, that included; history of exposure and prior vaccination against mumps. Children were asked to follow up either after 5 days or in case of noticing any signs and symptoms of complication. Results: There were total 113 cases diagnosed clinically as mumps of which there were 71 males (62.83%) and 42 females (37.16%) with the peak incidence of disease in the month of March and September with 22 cases (19.46%) in each month. The increase incidence was seen in 4-6 years of age with 58 cases (51.32%). There were 70 patients (61.94%) that had history of exposure to mumps infection. All the patients in this study had either unilateral or bilateral parotitis. None of the children were vaccinated against mumps. And all the school going children had to be off school for a period of 3-5 days. Conclusion: There were large number of children with mumps and none of them were vaccinated. Child can be prevented from the infection by vaccination and thus avoiding possible sufferings and complications. Thus we recommend the use of mumps vaccination in Routine immunization programme. Key words: Mumps; Parotitis; School absenteeism; Nepal; Vaccine DOI: http://dx.doi.org/10.3126/jnps.v32i1.5499 J. Nepal Paediatr. Soc. Vol.32(1) 2012 53-56

Humoral Immunity to AAV-6, 8, and 9 in Normal and Dystrophic Dogs

Adeno-associated virus (AAV)-6, 8, and 9 are promising gene-delivery vectors for testing novel Duchenne muscular dystrophy gene therapy in the canine model. Humoral immunity greatly influences in vivo AAV transduction. However, neutralizing antibodies to AAV-6, 8, and 9 have not been systemically examined in normal and dystrophic dogs. To gain information on the seroprevalence of antibodies to AAV-6, 8, and 9, we measured neutralizing antibody titers using an in vitro transduction inhibition assay. We examined 72 naive serum samples and 26 serum samples obtained from dogs that had received AAV gene transfer. Our data demonstrated that AAV-6 neutralizing antibody was the most prevalent antibody in dogs irrespective of age, gender, disease status (dystrophic or not), and prior parvovirus vaccination history. Surprisingly, high-level anti-AAV-6 antibody was detected at birth in newborn puppies. Further, a robust antibody response was induced in affected, but not normal newborn dogs following systemic AAV gene transfer. Taken together, our data have provided an important baseline on the seroprevalence of AAV-6, 8, and 9 neutralizing antibodies in normal and Duchenne muscular dystrophy dogs. These results will help guide translational AAV gene-therapy studies in dog models of muscular dystrophy.

Comparative assessment of two commonly used commercial ELISA tests for the serological diagnosis of contagious agalactia of small ruminants caused by Mycoplasma agalactiae

BackgroundContagious agalactia (CA) of sheep and goats caused by Mycoplasma agalactiae is a widely occurring economically important disease that is difficult to control. The ELISA is commonly used for the serological detection of CA but it has some limitations and the performance of the available tests have not been properly evaluated.Two commercial ELISA kits are widely used, one involving a fusion protein as target antigen and the other a total antigen. The objectives were to compare these tests by evaluating:i. Their diagnostic sensitivity and specificity, the relevance of the recommended cut-off points, the correlation between the two tests, and, the correlation between serology data and the milk shedding of M. agalatiae;ii. The influence of extrinsic factors such as the targeted animal species, geographical origin of the samples, intra-specific variability of M. agalactiae and concurrent mycoplasma infections.A sample of 5900 animals from 211 farms with continuous CA monitoring for 20 years and no prior vaccination history was used. The infection status was known from prior bacteriological, epidemiological and serological monitoring with a complementary immunoblotting test.ResultsThe average diagnostic sensitivity was 56% [51.8–59.8] for the fusion protein ELISA and 84% [81.3–87.2] for the total antigen ELISA, with noteworthy flock-related variations. The average diagnostic specificity for the fusion protein ELISA was 100% [99.9–100], and for the total antigen ELISA differed significantly between goats and sheep: 99.3% [97.4–99.9] and 95.7% [93.8–97.2] respectively.Experimental inoculations with different M. agalactiae strains revealed that the ELISA kits poorly detected the antibody response to certain strains. Furthermore, test performances varied according to the host species or geographical origin of the samples.Finally, the correlation between milk shedding of M. agalactiae and the presence of detectable antibodies in the blood was poor.ConclusionsThese serological tests are not interchangeable. The choice of a test will depend on the objectives (early detection of infection or disease control program), on the prevalence of infection and the control protocol used. Given the variety of factors that may influence performance, a preliminary assessment of the test in a given situation is recommended prior to widespread use.

Vaccine history, gender and influenza vaccination in a household context

Few studies have investigated the effect of the history of vaccination on the current influenza vaccine uptake. The objective of this paper is to study the effects of vaccine history, for each sex separately, on the likelihood of vaccine uptake among single-head households and two-person households, controlling not only for the respondents' own prior vaccination history but also the history of vaccination among possible co-residents. We used logistic regression and data from a nationally representative telephone survey of the non-institutionalized Norwegian population aged ≥ 65 years to estimate our models (N=354). The survey was carried out in November 2008. The lowest vaccine uptake was found among those who live alone with no prior history of vaccination and among those who live in two-person households where both members had no prior history of vaccination (10-22%). Those who live in two-person households where both members had previously been vaccinated had the highest vaccine uptake (86%). While a man who has previously been vaccinated has a higher likelihood of continued vaccination if his wife also has a prior history of vaccination, a woman with a prior history of vaccination is not dependent on her husband's prior practice with respect to the probability of continued vaccination. Of those who have no history of vaccination, more women than men are vaccinated for the first time when they have a spouse who has a history of vaccination. Our study shows that the history of vaccination of a co-resident/spouse has an effect above and beyond the respondent's own vaccination history. The results indicate that there are gender differences in the willingness to encourage family members to be vaccinated or to embark upon a familial vaccination regime in order to protect the individual's own personal health and that of other family members from influenza. To the best of our knowledge such gender differences have never been shown before in research on influenza vaccine uptake. However, the finding is in accordance with a number of studies on the role of gender and the positive effect on health and mortality of social support and social control in marriage.

Passive Transfer of Antibodies in Pregnant Cattle Following Vaccination with Bovi-Shield®

Prior research has shown that neonatal calves have various levels of immunoglobulins (IgG) following passive antibody transfer from the dam. Variability in neonate serum IgG is related to the dam's prior vaccination history, the interval from vaccination to parturition, and type of vaccine administered. Strategic vaccination could improve passive transfer and positively impact neonatal morbidity and mortality.

Seasonal Influenza Vaccine and Protection against Pandemic (H1N1) 2009-Associated Illness among US Military Personnel

IntroductionA novel A/H1N1 virus is the cause of the present influenza pandemic; vaccination is a key countermeasure, however, few data assessing prior seasonal vaccine effectiveness (VE) against the pandemic strain of H1N1 (pH1N1) virus are available.Materials and MethodsSurveillance of influenza-related medical encounter data of active duty military service members stationed in the United States during the period of April–October 2009 with comparison of pH1N1-confirmed cases and location and date-matched controls. Crude odds ratios (OR) and VE estimates for immunized versus non-immunized were calculated as well as adjusted OR (AOR) controlling for sex, age group, and history of prior influenza vaccination. Separate stratified VE analyses by vaccine type (trivalent inactivated [TIV] or live attenuated [LAIV]), age groups and hospitalization status were also performed. For the period of April 20 to October 15, 2009, a total of 1,205 cases of pH1N1-confirmed cases were reported, 966 (80%) among males and over one-half (58%) under 25 years of age. Overall VE for service members was found to be 45% (95% CI, 33 to 55%). Immunization with prior season's TIV (VE = 44%, 95% CI, 32 to 54%) as well as LAIV (VE = 24%, 95% CI, 6 to 38%) were both found to be associated with protection. Of significance, VE against a severe disease outcome was higher (VE = 62%, 95% CI, 14 to 84%) than against milder outcomes (VE = 42%, 95% CI, 29 to 53%).ConclusionA moderate association with protection against clinically apparent, laboratory-confirmed Pandemic (H1N1) 2009-associated illness was found for immunization with either TIV or LAIV 2008–09 seasonal influenza vaccines. This association with protection was found to be especially apparent for severe disease as compared to milder outcome, as well as in the youngest and older populations. Prior vaccination with seasonal influenza vaccines in 2004–08 was also independently associated with protection.

Generalised tetanus in an unvaccinated adult

A 76-year-old previously well farmer presented having caught his left index finger in a gate. He gave no history of prior tetanus vaccination. The patient was treated in the emergency department; the wound cleaned, sutured and he was given tetanus toxoid prior to discharge. Eleven days later he represented unable to open his mouth. On examination he was noted to have trismus, generalised muscle spasms, diaphoresis and emotional lability and he was diagnosed with generalised tetanus.

Comparison of QuantiFERON-TB Gold In-Tube Test and Tuberculin Skin Test for Identification of LatentMycobacterium tuberculosisInfection in Healthcare Staff and Association Between Positive Test Results and Known Risk Factors for Infection

We compared a whole-blood interferon-gamma release assay (QuantiFERON-TB Gold In-Tube test, hereafter "QFT-in tube test") with a tuberculin skin test (TST) to determine which test more accurately identified latent Mycobacterium tuberculosis infection in healthcare staff. A total of 481 hospital staff members were recruited from 5 hospitals in Melbourne, Australia. They provided information about demographic variables and tuberculosis (TB) risk factors (ie, birth or travel in a country with a high prevalence of TB, working in an occupation likely to involve contact with M. tuberculosis or individuals with TB, or being a household contact of an individual with a proven case of pulmonary TB). The QFT-in tube test and the TST were administered in accordance with standardized protocols. Concordance between the test results and positive risk factors was analyzed using the kappa statistic, the McNemar test, and logistic regression. A total of 358 participants had both a TST result and a QFT-in tube test result available for comparison. There were fewer positive QFT-in tube test results than positive TST results (6.7% vs. 33.0%; P<.001). Agreement between the tests was poor (71%; kappa=0.16). A positive QFT-in tube test result was associated with birth in a country with a high prevalence of TB, the number of years an individual had lived in a country with a high prevalence of TB (ie, the effect of each additional year, treated as a continuous variable), and high-risk occupational contact. A positive TST result was associated with older age, receipt of bacille Calmette-Guérin (BCG) vaccination, and working in an occupation that involved patient contact. Receipt of BCG vaccination was most strongly associated with discordant results in instances in which the TST result was positive and the QFT-in tube test result was negative. In a population of healthcare staff with a low prevalence of TB and a significant rate of BCG vaccination, a positive QFT-in tube test result was associated with the presence of known risk factors for TB exposure, whereas a positive TST result was more strongly associated with a prior history of BCG vaccination.

Hepatitis B Knowledge, Attitudes, and Susceptibility in an Immigrant Caribbean Community

Purpose: Hepatitis B (HBV) is the most common underlying cause of liver cancer among immigrant populations, and the prevalence of HBV is 10–75 per 1000 blood donors in the Caribbean. Although Caribbean communities continue to grow in the U.S. little is known about how they are impacted by HBV. Our objective was to evaluate knowledge and attitudes about HBV, as well as susceptibility in an immigrant Caribbean community. Methods: In-person interviews were conducted with Caribbean immigrant men and women attending four community-based health fairs during a six-month period. Knowledge, beliefs, and risk factors for HBV were assessed along with socio-demographic characteristics. Phlebotomy was performed on all consenting participants to determine HBV status. Results: A total of 147 individuals (55% women) representing 9 Caribbean countries completed the screening sessions. The cohort had a mean age of 46 ± 15 years and had been in the U.S. for 14 ± 12 years. The formal education of 75% of the cohort was at High school level or below, and nearly half (48%) had a median household income below $24,000. While 7% of individuals self-identified as being at risk for HBV, 11% were found to have at least one risk factor. The most common identified HBV risk factors were multiple sexual partners (5%) and blood product transfusion (3%). The majority of individuals (70%) were either unsure or did not believe that HBV can be transmitted through sharing dirty needles. Only 28.5% correctly identified unprotected sex as a risk factor for HBV and only 21% believed that using condoms could help prevent its transmission. Men were significantly more likely to believe that HBV is inherited compared to women (41.8% vs. 14.7%; P= 0.003) and they were less willing to seek medical attention if they tested positive for HBV (41.5% vs. 73.8%; P= 0.001). The majority of individuals (67%) were susceptible to HBV with no detectable markers. Among the 47 individuals who tested positive for HBsAb, 42 (89%) had no prior history of vaccination. HBsAg positivity was confirmed in 1 individual. Conclusion: In this representative community-based Caribbean immigrant cohort we identified significant knowledge deficits about HBV. By extension attitudes towards prevention and treatment of HBV may help increase its spread in the community. Studies should be extended to further characterize HBV seroprevalence in the immigrant Caribbean community and efforts should be made to develop and implement community-based HBV interventions aimed at improving knowledge and reducing risk of infection in this susceptible population.

Predictors of first and second dose acceptance of hepatitis B vaccine among STD clinic patients

Our goal was to identify attitudinal, behavioural and pragmatic factors predictive of receipt of the first and second doses of hepatitis B virus (HBV) vaccine. In this study, 431 adult sexually transmitted disease clinic patients with no reported history of prior HBV vaccination or infection completed a computer-assisted questionnaire, then were offered free HBV vaccine. Those who accepted were scheduled for follow-up doses. Twenty-nine percent received the first dose of vaccine. Of these individuals, 21% returned for the second dose. Seven participants received all three doses. Health beliefs and caring for three or more children predicted first dose acceptance. Less travel time to the clinic and caring for two or fewer children predicted return for the second dose. HBV vaccination rates were low in this study. Interventions designed to modify health beliefs may increase first dose uptake. Increases in receipt of subsequent vaccine doses might best be accomplished through approaches designed to decrease pragmatic barriers to vaccine access.

A case of herpes zoster in a 4-month-old infant

Herpes zoster in infancy is very rare but can be developed following intrauterine or postnatal exposure to varicella zoster virus. We report a case of herpes zoster in a 4-month-old male infant. He had no prior history of primary varicella or varicella vaccination. His mother had no history of varicella infection and no contact history with varicella during pregnancy. He had a history of exposure to his father with herpes zoster 3 months ago, and to his cousin with convalescent chickenpox 2 months ago. Multinucleated, giant cells were shown on a Tzanck smear. He was treated with acyclovir and first generation cephalosporin for herpes zoster with Staphylococcal skin infection, with complete resolution without sequelae.

Erythema Nodosum, Mycobacterium avium Lymphadenitis, and a 15-mm Mantoux Test

To the Editors: We report the case of a girl with erythema nodosum (EN)1 that was triggered by a Mycobacterium avium intracellulare (MAC) cervical lymphadenitis. The association of EN with nontuberculous mycobacteria (NTM) is very rare in pediatrics.2 A 2-year-old healthy girl was admitted to our children's hospital with a 3-week illness that began with an upper respiratory infection with fever. She then developed left cervical lymphadenitis followed by erythematous maculopapular lesions in her skin, 2 weeks before admission. Outpatient amoxicillin and cefixime courses were given for presumed bacterial lymphadenitis, with no improvement. On admission, she had a solitary 5 cm indurated, warm, nonfluctuant, painful, left cervical mass and multiple erythematous and violaceous demarcated, shiny, painful raised lesions on her legs, arms, and shoulders. They erupted in patches consistent with EN. She was Canadian born and had no prior BCG vaccination, contacts with or family history of tuberculosis. Ultrasound examination confirmed extensive left-sided cervical lymphadenopathy without abscesses. Tuberculin skin test induration was 15 mm. Chest radiograph was normal and gastric aspirates were negative for M. tuberculosis. Serologic tests were negative for cytomegalovirus, Lyme disease, Epstein-Barr virus, Mycoplasma pneumoniae, and Bartonella henselae. Throat, blood, and stool cultures revealed no pathogens. Screening tests for connective tissue disorders and antistreptolysin O titer were negative. Intravenous clindamycin was administered for 6 days but the patient did not improve. Surgical drainage of the mass revealed pus that contained no organisms on Gram stain. She was discharged without antibiotics, pending culture results. Eight days later, her EN rash had resolved, but drainage was again required. Initial investigations for bacteria and fungi were negative on both specimens. The second specimen contained acid-fast bacilli. MAC was grown after 10 days of incubation from both specimens. Clarithromycin was prescribed but stopped because of oral intolerance. She required a complete excision after which rifampin was given for 6 months. No further recurrence occurred. EN is an acute panniculitis occuring more commonly in adults, associated with infectious and noninfectious etiologies.1 It presents as tender, erythematous nodules predominantly in the lower limbs, with associated symptoms including fever. It usually resolves in weeks and the etiology remains undetermined in up to half of the cases. In one of the largest EN series ever published,1 no case of NTM infection was found among 129 patients seen during 35 years. Among the infectious etiologies, Streptococcus pyogenes and tuberculosis have been the most common triggers. BCG vaccination has been occasionally implicated, and reports of pediatric EN triggered by NTM as in our patient are extremely rare in the literature.2 This case illustrates that a positive Mantoux skin test, independently of the induration size, can be seen in NTM infections.2–4 In this girl, it seems likely that a massive MAC antigen release might have contributed to the EN lesions. In children, NTM should be considered among the infectious etiologies of EN. Cervical lymphadenitis in presence of a positive Mantoux test should include suspicion of NTM infection. Presented in part as an abstract at the 41st Annual Meeting of the Infectious Diseases Society of America (IDSA)—San Diego, CA. October 9–12, 2003. Abstract No. 810.5 Heidi Budden, MD Department of Pediatrics British Columbia's Children's Hospital and The University of British Columbia Vancouver, British Columbia Canada Rolando Ulloa-Gutierrez, MD Simon Dobson, MD, FRCPC David Scheifele, MD Infectious and Immunological Diseases Division

Antibody response to hepatitis B re-vaccination in HIV-infected children with immune recovery on highly active antiretroviral therapy

Despite a history of hepatitis B virus (HBV) vaccination prior to highly active antiretroviral therapy (HAART), most of HIV-infected children do not have protective antibody to HBV infection. The efficacy of an additional booster dose in children with immune recovery on HAART remains unknown. This study was conducted to determine the response rate of HBV antibody after re-vaccination in HIV-infected children with immune recovery on HAART. Sixty-three successfully HAART-treated HIV-infected children with history of prior HBV vaccination received 10microg doses of recombinant HBV vaccine (Government Pharmaceutical Organization-Merieux Biological Product, Bangkok, Thailand) intramuscularly at 0, 2 and 6 months. The vaccine response rates were 17.4, 82.5, and 92.1% at 2, 6 and 7 months after the first dose of vaccine, respectively. Plasma HIV RNA level below the limit of detection at the time of re-vaccination was associated with successful vaccine response. HIV-infected children with immune recovery after HAART are likely to benefit from three-dose HBV re-vaccination.

Analysis of factors associated with varicella-zoster virus susceptibility among children 0–12 years old in Taiwan

Objectives Varicella is a highly infectious disease caused by varicella-zoster virus (VZV). The aim of this study was to explore the geographical difference of VZV antibody seroprevalence among children in private vaccination areas in Taiwan, controlling for potential factors relating to varicella susceptibility. Patients and method A cross-sectional survey of the seroprevalence of VZV antibodies among children 0–12 years of age was conducted in Taiwan between August and December 2003. Sera of children visiting the outpatient unit of the participating hospitals around the island were collected. Six hundred and fifty-six parents among those of the 931 children studied agreed to answer the self-administered questionnaire regarding the possible factors associated with varicella susceptibility. IgG antibodies to VZV were measured using an enzyme-linked immunosorbent assay kit, Enzygnost anti VZV/IgG. Results The susceptibility was the highest at age 1 year, and then decreased as the age increased. Children living in southern and eastern Taiwan showed higher susceptibility to varicella than those living in northern area (odds ratio (OR) = 2.71 and 2.10, respectively). Prior history of varicella infection, varicella vaccination, and contact with cases remained to be associated with the susceptibility after multivariate analysis. Conclusions Children who lived in tropical and rural regions and those who had no history of varicella infection, varicella vaccination, and contact with cases, might be more susceptible to varicella. Island-wide VZV seroprevalence surveillance is required to examine whether the geographical difference of susceptibility in Taiwan will become less significant or disappear after the mass varicella vaccination program initiated in 2004.

Évaluation de la prise en charge en pneumologie: tuberculose

The management of patients affected by tuberculosis raises issues including epidemiology, the identification and treatment of disease or infection, infection control measures, BCG vaccination and national and international strategies against the disease.BCG vaccination is controversial because of its undesirable effects and the conflicting evidence from trials. It provides partial but undeniable protection; 50% against all forms and 80% against the most severe forms, particularly in children. Vaccination strategies (generalised, selective or not at all) provide different cost/benefits depending on the population involved and its prior vaccination history. This variation in response does not outweigh the ethical and pragmatic considerations underlying the current approach of universal vaccination. The directly observed therapy, short course (DOTS) strategy has been well evaluated notwithstanding the huge potential scope of its global implementation.A more effective vaccine is one of the possible solutions for eliminating tuberculosis. DOTS could be usefully implemented in France as part of a strategy to eliminate the disease.BCG vaccination and elements of DOTS are effective interventions for the management of TB.

HBV Reverse Seroconversion and Intervention with Vaccination after Allogeneic HSCT in Patients with Previous HBV Infection.

Appearance of anti-hepatitis B surface antigen antibody (anti-HBs) and clearance of hepatitis B virus (HBV) from serum usually indicates resolution of hepatitis in patients infected with HBV. However, in most patients in whom HBV has been eliminated from serum, HBV DNA is still detectable in the liver using polymerase chain reaction. Reactivation of this dormant HBV in the liver is known as reverse seroconversion (RS). Previously, we reported that HBV-RS after allogeneic hematopoietic stem cell transplantation (allo-HSCT) was a frequent late-onset complication that can be predicted by careful monitoring of progressive disappearance of anti-HBs. RS hepatitis after allo-HSCT is thought to be a phenomenon caused by naive donor immunity after loss of recipient-oriented immunity against HBV. We speculated that vaccination could prevent reactivation of HBV in allo-HSCT recipients. Safety and efficacy of recombinant HBV vaccine in allo-HSCT recipients have already been confirmed. We studied HBV serological markers in 23 patients with anti-HBs and/or anti-HBc before allo-HSCT who were followed for more than 1 year. Patients' characters are following; Age at HSCT 22 to 65 (median, 38) years; M:F ratio 14:9; Hematological disorders CML 6, AML 1, ALL 4, MDS 4, SAA 2, NHL 4, MM 1 and CAEBV 1; Serological markers anti-HBc(+) and anti-HBs(+) 17, anti-HBc(+) and anti-HBs(−) 3, anti-HBc(−) and anti-HBs(+) 3. No patients had a prior history of vaccination or HBV-specific immunoglobulin usage. All patients were negative for hepatitis B surface antigen (HBsAg) and were considered to have previous HBV infection. The follow-up period varied from 12 to 116 (median, 36) months. Eighteen patients were followed without intervention. Five patients were vaccinated with recombinant HBV vaccine by the standard three-dose protocol after cessation of immunosuppressant administration. RS was defined as disappearance of anti-HBs and appearance of HBsAg and HBV-DNA with or without clinical hepatitis. Progressive decreases in anti-HBs titer were observed in all pre-HSCT anti-HBs-positive recipients. In 18 of the 20 patients with pre-HSCT anti-HBs, anti-HBs titer decreased to less than the protective value (<10.0 mIU/ml) at 4 to 38 (median, 12) months after HSCT. RS occurred in 11 of the 18 patients without intervention (61%) at 12 to 51 (median, 20) months after HSCT. Timing of onset and severity of hepatitis were not correlated. In patients with RS, anti-HBs had disappeared 0 to 26 (median, 8) months prior to RS. Although re-seroconversion occurred in 7 patients, the remaining 4 patients remained in HBV carrier status after resolution of transient hepatitis. In the 7 patients with re-seroconversion, hepatitis subsided and HBsAg disappeared with acquisition of anti-HBe shortly after RS. On the other hand, reappearance of anti-HBs was delayed by 6 to 51 (median, 32) months after onset of RS. Four of the 5 patients with intervention were successfully immunized by HBV vaccine (80%), and none of those 5 patients had RS during the follow-up period (12–40 months; median, 20 months). In conclusion, all patients with previous HBV infection are considered to be at high risk for RS after allo-HSCT. Recombinant HBV vaccines effectively immunize allo-HSCT recipients and are protective against HBV-RS.

Duration of Virus Shedding After Trivalent Intranasal Live Attenuated Influenza Vaccination in Adults

To characterize the probability and duration of viral shedding among adults given trivalent live attenuated influenza vaccine (LAIV). Prospective surveillance study. Nasal wash samples were collected from adult volunteers at baseline and on days 3, 7, and 10 and between days 17 and 21 following intranasal LAIV vaccination. The presence, titer, and identification of each specific strain of influenza virus shed were determined by standard methodology. Twenty subjects received LAIV. No samples were positive for influenza virus at baseline. After LAIV vaccination, influenza virus was recovered from 10 of 20 vaccinees on day 3, from 1 of 18 vaccinees on day 7, and from none of the samples on days 10 or 17 through 21. Vaccinees who shed vaccine virus were significantly younger than those who did not (mean age, 26.4 vs 38.6 years; P < .01). Although the presence of specific mucosal immunoglobulin A to influenza B was associated with significantly less shedding of influenza B after vaccination (P = .02), associations of shedding with other measures of immunity were not detected. The duration of shedding of vaccine virus after LAIV in adults i s limited and may be associatedwith an individual's prior influenza vaccination history.

Síndrome de Gianotti-Crosti: aspectos clínicos, laboratoriais e perfis sorológicos observados em 10 casos procedentes de Belém-PA (Brasil)

FUNDAMENTOS: A síndrome de Gianotti-Crosti (SGC) é uma doença rara e autolimitada caracterizada por erupção eritematopapulosa acrolocalizada e simétrica. Relaciona-se, na maioria das vezes, com infecção pelos vírus da hepatite B e Epstein-Barr, porém há poucas publicações relacionando a SGC com herpesvírus humano tipo 6 (HHV6). OBJETIVO: Estudar aspectos clínicos e laboratoriais e investigar a participação de patógenos virais na etiologia de casos de SGC procedentes de Belém-PA. PACIENTES E MÉTODOS: Dez crianças com diagnóstico clínico de SGC foram investigadas no período de agosto de 1996 a dezembro de 2002, utilizando-se provas laboratoriais de rotina e pesquisa de anticorpos séricos específicos para determinados vírus. O diagnóstico de SGC estabeleceu-se quando, além de aspectos clínicos considerados compatíveis, um ou mais dos seguintes critérios estavam presentes: elevação das enzimas hepáticas, linfocitose, positividade sorológica para um ou mais agentes virais ou história de vacinação prévia. RESULTADOS: Seis pacientes (60%) apresentaram evidência de infecção primária pelo HHV6 demonstrada pela presença de anticorpos específicos da classe IgM. CONCLUSÃO: A detecção de anticorpos anti-HHV6 da classe IgM em seis dos pacientes apresentados sugere um possível papel etiológico desse vírus na doença, recomendando-se que seja acrescentado ao painel sorológico rotineiramente pesquisado em processos exantemáticos com morfologia sugestiva de SGC.

Progressive Disappearance of Anti-HBs and Reverse Seroconversion after allo-HSCT in Patients with Previous HBV Infection.

Development of anti-hepatitis B surface antigen antibody (anti-HBs) and clearance of hepatitis B virus (HBV) from serum usually indicate resolution of hepatitis in patients infected with HBV. However, most patients in whom HBV has been eliminated from the serum still have HBV DNA in the liver that is detectable by using polymerase chain reaction. Reactivation of this dormant HBV in the liver is known as reverse seroconversion (RS), which was reported to be a rare complication of hematopoietic stem cell transplantation (HSCT). However, the precise frequency of RS and results of long-term follow-up after RS have not yet been reported. We retrospectively studied HBV serological markers in fourteen patients with anti-HBs before allogeneic HSCT who were followed up for more than 1 year. Patients' characteristics are as follows: median age at time of HSCT, 35 years (range, 22–52 years); M:F ratio, 9:5; hematological disorders: CML 5, ALL 4, MDS 3, SAA 2. No patients had prior history of vaccination or HBV-specific immunoglobulin usage. All donors were negative for hepatitis B surface antigen (HBsAg), and four donors were confirmed to be negative for anti-HBs. Only one case (case 1) had relapse of hematological malignancy during the follow-up period. RS is defined as disappearance of anti-HBs and appearance of HBsAg, HBV-DNA, and clinical hepatitis. The follow-up period varied from 15 to 92 months (median, 48 months). The actual risk of disappearance of anti-HBs and RS were calculated using the Kaplan-Meier method. Progressive decreases in anti-HBs titer were observed in all 14 cases. In 12 of the 14 cases, anti-HBs titer had decreased to under the protective value (<10.0 mIU/ml) at 10 to 38 months (median, 13 months) after HSCT. RS occurred in 7 cases at 12 to 51 months (median, 20 months) after HSCT. Onset and severity of hepatitis were not correlated. Although re-seroconversion occurred in 5 cases, the other 2 cases remained in HBV carrier status after resolution of transient hepatitis. In the other 5 cases, reactivation of HBV did not occurre even after disappearance of anti-HBs. In case with RS, disappearances of anti-HBs occurred up to 18 months before the occurrence of RS. The actual risks of disappearance of anti-HBs and RS were estimated to be 75.0% and 39.8% at 2 years and 100.0% and 70.0% at 5 years, respectively. Progressive disappearance of anti-HBs would be an inevitable phenomenon accompanied by progressive loss of recipient-derived B cells. In our study, RS after allo-HSCT was not such a rare event. RS hepatitis after allo-HSCT would be caused by reconstructed naive donor immunity after loss of recipient-derived immunity against HBV. In conclusion, RS is a late-onset complication with high frequency that can be predicted by careful monitoring of progressive disappearance of anti-HBs. Pre-transplant vaccination of the donor and/or vaccination for recipients depending on the decrease in anti-HBs titer would be prophylactic for reactivation of HBV. [Display omitted]

Serologic response of maned wolves (Chrysocyon brachyurus) to canine and canine parvovirus vaccination distemper virus.

This study evaluated the immune response of 47 (22 males, 25 females) captive maned wolves (Chrysocyon brachyurus) to modified-live canine parvovirus and canine distemper virus (Onderstepoort and Rockborn strains) vaccines. Sera were collected from 33 adults and 14 pups, including five free-ranging pups captured at 1 yr of age or younger. All the adults and four captive-born pups had been vaccinated prior to this first blood collection. Virus neutralization and hemagglutination-inhibition assays were performed for quantitating antibodies against canine distemper and canine parvovirus, respectively. Distemper antibody titers > or = 100 were present in 57% of adults and 14% of pups. All adults and 29% of pups had parvovirus antibody titers > or = 80. After vaccination, 72% of the wolves developed antibody titers > or = 100 against distemper and 98% developed titers > or = 80 against parvovirus. Both vaccines used were safe and immunogenic to juvenile and adult maned wolves, regardless of prior vaccination history.