Standard Titer Research Articles

Brucellosis Coinfecting with Liver Hydatid Cyst: Case Report and Literature Review of Zoonoses Coinfection of Human Brucellosis.

Background: Brucellosis is a major global public health problem. Brucellosis usually coinfects with zoonoses because of their similar reservoir and infection routes. Materials and Methods: Here, we present a patient who was diagnosed with coinfecting with liver cyst and brucellosis. Results: A 57-year-old female farmer was hospitalized with right hip joint pain approximately 4 weeks earlier. The patient reported a history of hydatid cysts and a family history of brucellosis. Abdominal computerized tomography and ultrasonography revealed a liver hydatid cyst. The standard agglutination test titer of Wright's test was 1:100. Computerized tomography and magnetic resonance imaging revealed brucellosis hip arthritis. The patient was treated with a combination of doxycycline, rifampicin, and cefotaxime. The symptoms immediately improved. The patient was well and asymptomatic during the 6-month follow-up. We reviewed the literature on other zoonoses superinfection with brucellosis. Conclusion: Brucellosis coinfects with multiple zoonosis organisms and poses a serious health threat to humans. Awareness of possible brucellosis coinfection with other zoonoses, especially professionally exposed persons in endemic regions, is warranted.

A Significant Contribution of the Classical Pathway of Complement in SARS-CoV-2 Neutralization of Convalescent and Vaccinee Sera.

Although high titers of neutralizing Abs in human serum are associated with protection from reinfection by SARS-CoV-2, there is considerable heterogeneity in human serum-neutralizing Abs against SARS-CoV-2 during convalescence between individuals. Standard human serum live virus neutralization assays require inactivation of serum/plasma prior to testing. In this study, we report that the SARS-CoV-2 neutralization titers of human convalescent sera were relatively consistent across all disease states except for severe COVID-19, which yielded significantly higher neutralization titers. Furthermore, we show that heat inactivation of human serum significantly lowered neutralization activity in a live virus SARS-CoV-2 neutralization assay. Heat inactivation of human convalescent serum was shown to inactivate complement proteins, and the contribution of complement in SARS-CoV-2 neutralization was often >50% of the neutralizing activity of human sera without heat inactivation and could account for neutralizing activity when standard titers were zero after heat inactivation. This effect was also observed in COVID-19 vaccinees and could be abolished in individuals who were undergoing treatment with therapeutic anti-complement Abs. Complement activity was mainly dependent on the classical pathway with little contributions from mannose-binding lectin and alternative pathways. Our study demonstrates the importance of the complement pathway in significantly increasing viral neutralization activity against SARS-CoV-2 in spike seropositive individuals.

Incidence and warning signs for complications of human brucellosis: a multi-center observational study from China

BackgroundBrucellosis is a severe zoonotic disease that is often overlooked, particularly in impoverished countries. Timely identification of focal complications in brucellosis is crucial for improving treatment outcomes. However, there is currently a lack of established indicators or biomarkers for diagnosing these complications. Therefore, this study aimed to investigate potential warning signs of focal complications in human brucellosis, with the goal of providing practical parameters for clinicians to aid in the diagnosis and management of patients.MethodsA multi-center cross-sectional study was conducted in China from December 2019 to August 2021. The study aimed to investigate the clinical characteristics and complications of patients with brucellosis using a questionnaire survey and medical record system. The presence of warning signs for complications was assessed using univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used for variable screening and model evaluation.ResultsA total of 880 participants diagnosed with human brucellosis were enrolled. The median age of the patients was 50 years [interquartile range (IQR): 41.5–58.0], and 54.8% had complications. The most common organ system affected by complications was the osteoarticular system (43.1%), with peripheral arthritis (30.0%), spondylitis (16.6%), paravertebral abscess (5.0%), and sacroiliitis (2.7%) being the most prevalent. Complications in other organ systems included the genitourinary system (4.7%), respiratory system (4.7%), and hematologic system (4.6%). Several factors were found to be associated with focal brucellosis. These factors included a long delay in diagnosis [odds ratio (OR) = 3.963, 95% confidence interval (CI) 1.906–8.238 for > 90 days], the presence of underlying disease (OR = 1.675, 95% CI 1.176–2.384), arthralgia (OR = 3.197, 95% CI 1.986–5.148), eye bulging pain (OR = 3.482, 95% CI 1.349–8.988), C-reactive protein (CRP) > 10 mg/L (OR = 1.910, 95% CI 1.310–2.784) and erythrocyte sedimentation rate (ESR) elevation (OR = 1.663, 95% CI 1.145–2.415). The optimal cutoff value in ROC analysis was > 5.4 mg/L for CRP (sensitivity 73.4% and specificity 51.9%) and > 25 mm/h for ESR (sensitivity 47.9% and specificity 71.1%).ConclusionsMore than 50% of patients with brucellosis experienced complications. Factors such as diagnostic delay, underlying disease, arthralgia, eye pain, and elevated levels of CRP and ESR were identified as significant markers for the development of complications. Therefore, patients presenting with these conditions should be closely monitored for potential complications, regardless of their culture results and standard tube agglutination test titers.

Testicular involvement of Brucellosis: A 10-year, multicentre study.

The genito-urinary system is one of the most common areas of involvement in brucellosis. To present the epidemiological, clinical, and laboratory characteristics of patients with testicular involvement associated with brucellosis, together with the diagnostic and therapeutic approaches. Patients followed up for brucellosis-related testicular involvement between January 2012 and November 2022 were included in the study. Brucellosis is defined as the production of Brucella spp. in cultures, or clinical symptoms together with the serum standard tube agglutination test titer of ≥ 1/160. Inflammation in scrotal Doppler ultrasonography was based on testicular involvement. A retrospective evaluation was made of the data of 194 patients with brucellosis-related testicular involvement. The rate of determination of testicular involvement in brucellosis was 2.57%. The most affected patients were determined in the 16-30 years age range. On presentation, brucellosis was in the acute stage in 83.7% of patients. The most common symptoms on presentation were swelling and/or pain in the testes (86.6%). In the patients where a spermiogram could be performed, oligospermia was determined in 41.7%, and aspermia in 8.3%. When the testicular involvement of brucellosis was evaluated, epididymo-orchitis was present at the rate of 55.7%, epididymitis at 27.3%, and testis abscess at 5.1%. Although epididymo-orchitis was the most frequently determined form of involvement in this study, there was also seen to be a significant number of patients presenting with epididymitis. Male patients presented with the clinical status of brucellosis should be questioned about swelling and pain in the testes to avoid overlooking testicular involvement.

Measles, mumps, and rubella vaccine at age 6 months and hospitalisation for infection before age 12 months: randomised controlled trial

ObjectiveTo test for potential non-specific effects of an additional, early measles, mumps, and rubella (MMR) vaccine at age 5-7 months on risk of infection related hospitalisation before age 12 months.DesignRandomised,...

Correlation between anti-S IgG and neutralizing antibody titers against three live SARS-CoV-2 variants in BNT162b2 vaccine recipients

ABSTRACT We analyzed serially collected serum samples from healthy adults who underwent BNT162b2 vaccination to elucidate the association between spike (S)-IgG antibody titers determined by ELISA using the WHO international standard (NIBSC code 20/136) and neutralizing antibody titers against three live SARS-CoV-2 variants. This study included 53 health care workers who received two doses of the BNT162b2 vaccine. S-IgG and nucleocapsid (N)-IgG antibody titers were measured by ELISA. Neutralizing (NT) antibody responses against three variants (Wuhan D614 G: KUH003, Alpha, and Delta) were evaluated before and after the first and second vaccination. N-IgG were not detected in any serum samples. S-IgG antibody titers remarkably increased after two BNT162b2 vaccine doses in all participants. S-IgG antibody titers were strongly correlated with NT titers against three variants of live viruses: KUH003 (r = 0.86), Alpha (r = 0.72), and Delta (r = 0.84). Serum samples from participants after one dose of BNT162b2 neutralized Alpha efficiently (median titer, 113.0), but median NT titers against KUH003 and Delta variants were lower, 57.0 and 28.0, respectively (p < .01). Two doses of the BNT162b2 vaccine elicited a strong immune response in this study. The second dose was required for induction of a strong booster effect. Serum collected from BNT162b2 vaccine recipients contained significantly lower neutralizing activity against Delta than that of against KUH003 (p < .0001) and Alpha (p < .0001). If a new variant emerges, live virus-based NT titers should be examined in serum obtained from vaccine recipients to evaluate vaccine efficacy for protection against infection.

The antibody landscapes following AS03 and MF59 adjuvanted H5N1 vaccination

Current seasonal and pre-pandemic influenza vaccines induce short-lived predominantly strain-specific and limited heterosubtypic responses. To better understand how vaccine adjuvants AS03 and MF59 may provide improved antibody responses to vaccination, we interrogated serum from subjects who received 2 doses of inactivated monovalent influenza A/Indonesia/05/2005 vaccine with or without AS03 or MF59 using hemagglutinin (HA) microarrays (NCT01317758 and NCT01317745). The arrays were designed to reflect both full-length and globular head HA derived from 17 influenza A subtypes (H1 to H16 and H18) and influenza B strains. We observed significantly increased strain-specific and broad homo- and heterosubtypic antibody responses with both AS03 and MF59 adjuvanted vaccination with AS03 achieving a higher titer and breadth of IgG responses relative to MF59. The adjuvanted vaccine was also associated with the elicitation of stalk-directed antibody. We established good correlation of the array antibody responses to H5 antigens with standard HA inhibition and microneutralization titers.

Human brucellosis in the southern West Bank, 2015–17: a seroprevalence and molecular characterisation study

BackgroundBrucellosis is a global zoonotic disease ranked by WHO as being among the top seven neglected zoonoses. After implementing a livestock vaccination strategy in 1998, the incidence rate of human brucellosis in Palestine dropped significantly. However, in 2015 the disease re-emerged with alarming incidence rates similar to those in the period before 1998. The aim of this study was to characterise the strains associated with this episode using genetic and genomic tools. MethodsAll patients were referred to the department of preventive medicine from several public or private clinics in the southern West Bank due to undulant fever. After a careful analysis of a patients’ history to evaluate exposure to Brucella, blood samples from patients suspected of brucellosis were collected. Samples positive for the Rose Bengal test with an antibody titre of 1:80 IU/mL or more by Brucella standard agglutination test, and not under antibiotic treatment, were further cultured using the BACTEC 9240 blood culture system. DNA was extracted from the positive culture samples and analysed using three biomarkers to validate the presence of the Brucella genus, establish the species, and identify the Brucella melitensis Rev 1 vaccine strain. Nine randomly chosen isolates were sequenced using targeted next generation sequencing technology to screen for the rpoB gene mutations. Multiple-locus variable number of tandem repeats analysis (MLVA) with 16 variable number of tandem repeats markers was used to genotype the isolates and BioNumerics version 7.6 software was used to analyse the data using the categorical coefficient and unweighted pair group method using the arithmetic averages algorithm. FindingsBlood samples were obtained from a total of 1324 patients during 2015–17. 704 (53·2%) of 1324 serum samples showed agglutination in the Rose Bengal test and 559 (79·4%) of the 704 were considered seropositive based on a standard agglutination test titre of 1:80 IU/mL or more. Only 130 (23·3%) of the 559 seropositive samples were from patients not under antibiotic treatment. Upon culturing, only 72 (12·9%) of the seropositive samples showed growth signals and were positive by PCR for the Brucella genus marker, and all isolates were B melitensis. None of the samples were associated with the B melitensis Rev 1 vaccine strain. The results of sequencing the rpoB gene by next generation sequencing showed four different single nucleotide variations that were not located within the rifampicin resistance-determining region. Using MLVA-16 analysis and the MLVA bank benchmark, the studied isolates were divided into 22 unique genotypes. A hierarchical clustering analysis for the 72 isolates and 18 B melitensis global isolates representing four major regions in the Middle East, Europe, Africa, and America, clustered the 73 isolates in the Middle East clade, providing a similarity cutoff value of more than 97% for genotype and more than 75% for clade. InterpretationThis study shows that the brucellosis episode of 2015–17 was due to B melitensis local isolates and was not associated with the Rev 1 vaccine stain. The results show that MLVA-16 is a useful tool for the public health surveillance of human brucellosis. The present study analysed samples from the Hebron governorate only. It is recommended to include more human and animal samples from different areas in Palestine to understand the molecular epidemiology of brucellosis in Palestine and to make more effective decisions regarding control and treatment programmes. FundingPalestine Polytechnic University.

A case report of endocarditis and spondylitis caused by Brucella melitensis biovar 3

BackgroundThis case report describes the clinical process of a shepherd who suffered brucellosis-related endocarditis (BE) and spondylitis (BS) and was infected with Brucella melitensis biovar 3 (B. melitensis biovar 3).Case presentationA 55-year-old male patient was admitted to The First Affiliated Hospital of Shihezi University on October 11, 2018, due to over 3 months of intermittent fever, back pain, and heart trouble. The Rose Bengal Plate test was positive, the standard agglutination test titer for brucellosis was 1/800, and the blood culture was positive for B. melitensis biovar 3. Three instances of transthoracic echocardiography examination at days 1, 25, and 376 after admission to the hospital and magnetic resonance imaging (MRI) and computed tomography (CT) checks at days 5 and 38 revealed that the size of the vegetation on the posterior leaflet of the mitral valve increased from 0.7 × 1.4 cm to 1.2 × 1.5 cm and that the left atrium and ventricle were enlarged. The MRI and CT results showed hyperplasia of the second and third vertebra, a cold abscess formed on both sides of the psoas major muscles, and the vertebra hyperplasia became aggravated at a later time point. The patient’s situation deteriorated, and heart failure was discovered on October 22, 2019. At the moment of submission of this manuscript, the patient remains in bed at home because of severe debility caused by brucellosis.ConclusionsThis is the first reported case of endocarditis combined with spondylitis caused by B. melitensis biovar 3 in a shepherd. Brucellosis infection can cause work-power losses because of misdiagnosis or a lack of proper treatment. Early diagnosis and treatment are essential for a successful outcome.

Results of pilot comparisons of national standards for the activity of hydrogen ions in aqueous solutions

The enormous needs in ensuring the measurement of the hydrogen index in various industries and the national economy of Russia make the measurement of the hydrogen index one of the most important methods for monitoring aqueous media. In 2013, work was carried out to enter into the State Register of Measuring Instruments of the Russian Federation a buffer solution and a standard titer with a pH value of 7.00 – a working pH standard of the 2nd category, which is one of the most demanded of non-standard solutions for verification and calibration pH measuring instruments. To confirm the metrological characteristics, pilot comparisons were organized within COOMET. This article presents the results of a pilot comparison to determine the pH of a phosphate buffer solution – a working standard of рН=7.00. 8 metrological institutes and 10 metrological organizations took part in the comparisons. The results obtained showed that the overwhelming majority of the participants in the comparisons presented the results of pH measurements, which have an uncertainty not exceeding ±0.03 of the average value, which is an acceptable criterion for measuring the pH.

Anti-Toxoplasma IgG assays: What performances for what purpose? A systematic review.

Chronic infection with Toxoplasma gondii is attested by the detection of specific anti-Toxoplasma IgG. A wide panel of serologic methods is currently marketed, and the most suitable method should be chosen according to the laboratory resources and the screened population. This systematic review of evaluation studies aimed at establishing an overview of the performances, i.e. sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of marketed anti-Toxoplasma IgG assays, and discussing their technical characteristics to guide further choice for routine diagnostic use. According to PRISMA guidelines, the search performed in PubMed and Web of Science databases recovered 826 studies, of which 17 were ultimately included. Twenty commercial anti-Toxoplasma IgG assays were evaluated, in comparison with an accepted reference method. Most of them were enzyme-immunoassays (EIAs, n = 12), followed by agglutination tests (n = 4), immunochromatographic tests (n = 3), and a Western-Blot assay (WB, n = 1). The mean sensitivity of IgG assays ranged from 89.7% to 100% for standard titers and from 13.4% to 99.2% for low IgG titers. A few studies pointed out the ability of some methods, especially WB to detect IgG early after primary infection. The specificity of IgG assays was generally high, ranging from 91.3% to 100%; and higher than 99% for most EIA assays. The PPV was not a discriminant indicator among methods, whereas significant disparities (87.5%–100%) were reported among NPVs, a key-parameter assessing the ability to definitively rule out a Toxoplasma infection in patients at-risk for opportunistic infections.

In Vitro Study of “Protected Fats” Based on Lecithin and Calcium Alginate

Background: Today, the urgent tasks of feeding cattle is to increase milk yield, increase the fat content in milk, and improve the quality of other animal products. However, the recommended amount of fat is not enough during calving and during lactation of cows. This leads to the fact that the fat content of milk is reduced by 30%. The aim of the study : To study the behavior of encapsulated fats in model media corresponding to the gastrointestinal tract of cattle. Materials and methods: The study was conducted by direct gravimetric analysis using a Programix TX 50 muffle furnace. As model media for the gastrointestinal tract of cattle, standard pH titers were used, adjusted to the required pH value with 0.1 M solutions of hydrochloric acid/sodium hydroxide. Results: After analyzing the data obtained, it was found that in a slightly alkaline medium (pH range 7.4–7.8), the time for complete release of phospholipids is 12 hours. During experiment No. 2, the behavior of “protected fats” was revealed in model environments corresponding to physiological parameters of the gastrointestinal tract of cattle. The equivalent amount of phosphorus to phospholipids was 11.90%, which corresponds to a proportion of the liberated phospholipids of higher fatty acids equal to 97.30%. Conclusion: “Protected fats” reach the model environment of the small intestines of ruminants in an unchanged form, where capsule disintegration is observed, followed by the release of the phospholipid mixture. Full release of the encapsulated mixture in a slightly alkaline medium (pH 7.4–7.8) is achieved within 12 hours.

The assessment of imaging diagnosis of brucellar spondylitis

Objective To explore the imaging features of brucellar spondylitis (BS). Methods The imaging data of 49 cases who were diagnosed as brucellar spondylitis by a positive standard tube agglutination titer test (≥1∶100) and (or) the isolation of brucella species from blood or other tissue at our institution between September 2012 and October 2016 were retrospectively reviewed. X-ray, CT scan and MRI examination was performed in 49, 28 and 42 cases, respectively, of which 19 cases underwent both CT scan and MRI examination. The imaging manifestations of the spine were analyzed. The χ2 test or Fisher's exact test were applied to compare the imaging manifestations of the patients who underwent both CT scan and MRI examination. Results Of the 49 patients, 34 patients (69.4%) had involvement of the lumbar vertebra. Forty-five patients (91.8%) had contiguous involvement at adjacent 2 vertebral bodies. There were 10 cases (20.4%) with bony spur or bone bridge, 3 cases (6.1%) with spondylolisthesis and 3 cases (6.1%) with slightly kyphosis deformity. There were 8 cases (28. 6%) showing bone destruction of more than half of the vertebral body and 6 cases (21.4%) with sequestra on CT. There were 14 cases (33.3%) with psoas abscesses, of which 2 (4.8%) had migrating abscess. Epidural abscesses with dural sac compression were found in 17 cases (40.5%) and 3 cases (7.1%) showed nerve roots compression. There were statistically significant differences in the detection of vertebral bone destruction, bone marrow edema, hyperosteogeny, intervertebral disc changes, abscess formation and sequestrum between CT and MRI (P<0.05). Conclusion BS has characteristic imaging features. The presence of bone destruction, sequestrum, and migrating abscess should warrant the possibility of BS. Key words: Brucellosis; Spondylitis; Tomography, X-ray computed; Magnetic resonance imaging; Diagnosis

Validation of real-time reverse transcription polymerase chain reaction to detect virus titer and thermostability of Newcastle disease live virus vaccine.

Background and Aim:Newcastle disease is one of the most common diseases affecting poultry in Bangladesh. The disease can cause up to 100% mortality but is preventable if birds are timely and properly vaccinated with a vaccine of standard virus titer. Different live vaccines are commercially available in the country - most, if not all, are produced using lentogenic strains of the virus with variable virulence. One of the disadvantages of these vaccines is that they are not stable at high environmental temperature, and therefore, a proper cold chain must be maintained during transportation and storage. Information on how long these vaccine viruses can withstand environmental temperature, which is near the vicinity of 37°C in the summer season in Bangladesh, is scanty. The aim of this research was to measure the effect of temperature on virus titer of live ND virus vaccines and to develop a real-time reverse transcription polymerase chain reaction (rRT-PCR) standard curve to indirectly determine hemagglutination (HA) titer of virus by this highly sensitive method.Materials and Methods:In this study, thermostability of five commercial live vaccines containing LaSota, F, Clone 30, and B1 type LaSota strains was observed for up to 35 days keeping them at 37°C. From the most thermostability yielding sample, two rRT-PCR standard curves were developed: (1) By plotting the cycle threshold (CT) values as obtained from 10-fold serial dilutions up to 10−3 against their corresponding log (to the base 10) dilutions and (2) by plotting the CT values obtained from serial HA dilutions up to 2−4 against their corresponding HA titer dilutions. The PCR efficiencies based on which the graphs were fitted were also evaluated.Results:The vaccine from the LaSota strain withstood 37°C for 35 days with a gradual declination of HA titer over time, and this vaccine also had the highest initial HA titer, which was 211. The vaccine made from F strain was inactivated quickly, and it had the lowest HA titer at the beginning of the study. The first standard curve developed can be used to assess the level of virus titer in a diluted sample compared with the titer in the original undiluted vaccine preparation by plotting the CT value obtained from the dilution by rRT-PCR. The second standard curve can be used to calculate the HA titer of a vaccine dilution by plotting the CT value as obtained from the dilution by rRT-PCR.Conclusion:The regression equations for the first and second graphs were y=−3.535x+14.365 and y=−1.081x+13.703, respectively, suggesting that, for every 3.53 cycles, the PCR product would have increased 10 times and 2 times for every 1.08 cycles, respectively, indicating nearly (but not exactly) 100% PCR efficiency.

Discrepant serological assays forPneumococcusin renal transplant recipients - a prospective study

Vaccine immunoprotection for Streptococcus pneumoniae is mediated by opsonizing antibodies targeting serotype-specific capsular polysaccharides. Quantitative antibody levels enzyme-linked immunosorbent assay (ELISA) and antibody-mediated opsonophagocytic assays (OPA) measure vaccine-induced protection; correlation of these assays in transplantation requires investigation. This study examines the laboratory assessment of antibody titers in vaccinated renal recipients. Streptococcus pneumoniae 19A is common in immunocompromised hosts and is represented in protein-conjugate vaccines (PCV) and polysaccharide vaccines (PSV). Antibodies to 19A in serial sera from 30 vaccinated renal transplant recipients were compared using ELISA and OPA assays. Subject titers were classified as protected or not by ELISA (>0.35 μg/ml) and OPA titer (>1:8). Antibody titers analyzed using McNemar's test indicate that protection measured by the two assays are not the same (P = 0.0078); simple linear regression of within-subject geometric means of 19A enzyme-linked immunosorbent assay (ELISA) antibody levels versus 19A opsonophagocytic assays (OPA) titers demonstrates significant correlation between the two assays (P < 0.001). Vaccination is increasingly important given increasing antimicrobial resistance worldwide. OPA and ELISA antibody assays do not correlate well using current values for protective immunity against the Pneumococcus in immunosuppressed transplant recipients. Future studies of vaccination in transplant recipients should evaluate protective antibody levels using both functional antibody assays and standard ELISA antibody titers. (ClinicalTrials.gov: NCT00307125).

Randomized Trials Comparing Inactivated Vaccine After Medium- or High-titer Measles Vaccine With Standard Titer Measles Vaccine After Inactivated Vaccine: A Meta-analysis.

Observational studies have suggested that girls have higher mortality if their most recent immunization is an inactivated vaccine rather than a live vaccine. We therefore reanalyzed 5 randomized trials of early measles vaccine (MV) in which it was possible to compare an inactivated vaccines [after medium-titer MV (MTMV) or high-titer MV (HTMV)] and a live standard titer MV (after an initial inactivated vaccine). The trials were conducted in Sudan, Senegal, The Gambia and Guinea-Bissau. The intervention group received live MTMV or HTMV from 4 to 5 months and then an inactivated vaccine from 9 to 10 months of age; the control children received inactivated vaccine/placebo from 4 to 5 months and standard titer MV from 9 to 10 months of age. We compared mortality from 9 months until end of study at 3 to 5 years of age for children who received inactivated vaccine (after MTMV or HTMV) and standard titer MV (after inactivated vaccine), respectively. The original datasets were analyzed using a Cox proportional hazards model stratified by trial. The mortality rate ratio (MRR) was 1.38 (95% confidence interval: 1.05-1.83) after an inactivated vaccine (after MTMV or HTMV) compared with a standard titer MV (after inactivated vaccine). Girls had a MRR of 1.89 (1.27-2.80), whereas there was no effect for boys, the sex-differential effect being significant (P = 0.02). Excluding measles cases did not alter these conclusions, the MRR after inactivated vaccines (after MTMV or HTMV) being 1.40 (1.06-1.86) higher overall and 1.92 (1.29-2.86) for girls. Control for variations in national immunization schedules for other vaccines did not modify these results. After 9 months of age, all children had been immunized against measles, and mortality in girls was higher when they had received inactivated vaccines (after MTMV or HTMV) rather than live standard titer MV (after an inactivated vaccine).

Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review

Objectives To evaluate the effects on non-specific and all cause mortality, in children under 5, of Bacillus Calmette-Guérin (BCG), diphtheria-tetanus-pertussis (DTP), and standard titre measles containing vaccines (MCV); to examine...

Clinical manifestations, complications, and treatment of brucellosis: evaluation of 72 cases.

Brucellosis is an important disease in developing countries. We aimed to determine the epidemiologic, clinical, and laboratory characteristics of brucellosis, which still has a high morbidity in Turkey. Seventy-two patients with brucellosis, monitored at our clinic from January 2004 to July 2010, were reviewed retrospectively. The average age was determined to be 44.8 ± 18 years, and 40 of the patients were female (55.6%). The most frequent transmission route was the use of raw milk and dairy products, in 45 of the patients (62.5%). The most frequent complaints were joint pain, high fever, weakness, low back pain, and gastrointestinal symptoms, whereas the most frequent physical examination findings were fever, osteoarticular involvement, splenomegaly, hepatomegaly, and lymphadenopathy. All of the patients were positive for Rose Bengal testing. The standard tube agglutination titer was 1/160 or higher in 64 (88.9%) patients. Brucella melitensis was isolated from blood cultures of 13 (18.1%) patients and bone marrow cultures of 7 (9.7%) patients. Complications of sacroiliitis in 6 (8.3%), spondylodiscitis in 4 (5.6%), endocarditis in 2 (2.8%), neurobrucellosis in 1 (1.4%), and epididymo-orchitis in 1 (1.4%) of the patients were observed. Brucellosis has various clinical presentations. It should be included in the differential diagnosis of high fever and joint pains in endemic countries.

Measles antibody levels after vaccination with Edmonston-Zagreb and Schwarz measles vaccine at 9 months or at 9 and 18 months of age: A serological study within a randomised trial of different measles vaccines

Standard–titre Schwarz (SW) and Edmonston-Zagreb (EZ) measles vaccines (MV) are both used in the routine immunisation programme. Within a trial of different strains of MV, we examined antibody responses in both one-dose and two-dose schedules when the first dose was administered at 9 months. Setting and MethodsThe trial was conducted in an urban area in Guinea-Bissau where we have had a health and demographic surveillance system and studied strategies to prevent measles infection since 1978. In the present study, children were randomised to SW or EZ as the first MV and furthermore randomised to a second dose of the same MV or no vaccine at 18 months of age. We obtained blood samples from 996 children at baseline; post-vaccination blood samples were collected at 18 and 24 months of age to assess measles antibody levels after one or two doses of MV. ResultsAt age 18 months all had responded to the first dose and only 1% (8/699) of the children had non-protective antibody levels irrespective of vaccine type. SW was associated with significantly higher levels of measles antibodies (geometric mean titre (GMT)=2114mIU/mL (95%CI 1153–2412)) than EZ (GMT=807mIU/mL (722–908)) (p=0.001). Antibody concentration was significantly higher in girls than in boys after EZ but not after SW. Antibody levels were higher in the rainy than the dry season. There was no clear indication that a booster dose at 18 months increased the antibody level at 24 months of age. ConclusionsMaternal antibody levels have declined significantly in recent years and 99% had protective levels of measles antibody following primary MV at 9 months of age. It is unlikely that measles prevention and child health will be improved by increasing the age of MV as currently recommended.

Analysis of 161 adult patients with brucellosis

To evaluate the epidemiology, clinical features, and complications of brucellosis. Materials and methods: Between January 2005 and December 2008, 161 patients with brucellosis who were admitted to our clinic were evaluated prospectively. Results: Of the patients, 97 (60.2%) were male, and the mean age was 47 ± 17 years (range: 16-79). There were 99 patients (61.5%) classified as acute, 36 (22.4%) classified as subacute, and 6 (3.7%) classified as having a chronic infection. Relapse or reinfection was observed in 20 (12.4%) patients. Blood culture positivity rates were 60.7% and 44.8% among acute and subacute cases, respectively (P = 0.008). In 40 of 70 culture positive patients, standard Brucella tube agglutination titers were found above 1/1280 (P = 0.03). Blood culture positivity was also higher in febrile patients (P = 0.001). Complications were detected in 66 of 161 patients (41.0%). Osteoarticular system involvement was the most common complication (50 patients, 31.1%). Fever, positive blood cultures, and hepatosplenomegaly were significantly higher in the group without complications (P < 0.05). Complications were significantly lower in acute infections than in subacute infections (P < 0.05). There were also higher complication rates detected in the patients with reinfection and relapse (P < 0.05). Conclusion: In endemic regions, brucellosis is an important infectious disease causing chronic infections and complications.