RESUMEN
We evaluated the functional activities of antibodies, serum bactericidal activity (SBA), and immunoglobulin G (IgG) antibody avidity indices, using sodium thiocyanate (NaSCN) elution, elicited after vaccination with fractional doses of the Haemophilus influenzae type b conjugate (polyribosylribitol phosphate [PRP] conjugated to tetanus toxoid [PRP-T]) vaccine. A cohort of 600 infants from the Dominican Republic were randomized to receive one of three regimens of the PRP-T vaccine at ages 2, 4, and 6 months: full doses (10 microg of PRP antigen), one-half doses (5.0 microg), and one-third doses (3.3 microg) (J. Fernandez et al., Am. J. Trop. Med. Hyg. 62:485-490, 2000). Sixty serum samples, collected at age 7 months, with > or =2.0 microg of anti-PRP IgG per ml were randomly selected for avidity determinations. Geometric mean IgG concentrations were 13, 14, and 17 microg/ml for infants who received the full-dose (n = 19), one-half-dose (n = 19), and one-third-dose (n = 22) regimens, respectively. SBA geometric mean titers (1/dilution) were 85.0, 82.0, and 76.1 in sera from infants receiving the full-, one-half-, and one-third-dose regimens, respectively. Avidity indices (mean +/- standard error weighted average of NaSCN molar concentration x serum dilution factor) were 71.9 +/- 9.4, 123.6 +/- 26.8, and 150.9 +/- 24.9 for the full-, one-half-, and one-third-dose regimens, respectively. Upon comparison, the only significant difference (P = 0.024) found was a greater avidity index for sera from infants receiving the one-third-dose regimen than for sera from infants receiving the the full-dose regimen. We conclude that fractional doses elicit similar functional antibody activities in infants with > or = 2 microg of anti-PRP IgG per ml, corresponding to 89, 90, and 97% of infants receiving three doses of either the full concentration or one-half or one-third of the labeled concentration, respectively. This approach offers an alternative strategy for the prevention of H. influenzae type b disease in countries with limited resources.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Toxoide Diftérico/administración & dosificación , Toxoide Diftérico/inmunología , Infecciones por Haemophilus/prevención & control , Vacunas contra Haemophilus/administración & dosificación , Vacunas contra Haemophilus/inmunología , Haemophilus influenzae/inmunología , Estudios de Cohortes , Países en Desarrollo , Toxoide Diftérico/economía , República Dominicana , Infecciones por Haemophilus/inmunología , Vacunas contra Haemophilus/economía , Costos de la Atención en Salud , Humanos , Inmunoglobulina G/sangre , LactanteRESUMEN
Concentrations of serum anti-Haemophilus influenzae type b (anti-Hib) capsular polysaccharide (CPS) >/=0.15 and >/=1.0 microgram/mL are widely used as surrogates for protection against invasive Hib disease. However, the relationship between serum anti-Hib CPS following immunization and protection against colonization is not known, making it difficult to evaluate new Hib vaccines or combination vaccines. In the Dominican Republic, nasopharyngeal swabs were collected from 546 9-month-old infants who had received Hib conjugate vaccine at ages 2, 4, and 6 months and from 600 unvaccinated infants of the same age. The prevalence of Hib colonization was lower among vaccinated infants than among unvaccinated infants (0.9% vs. 2.3%). Among vaccinated infants, protection against colonization was significantly correlated with anti-Hib CPS concentrations >/=5 microgram/mL 1 month following the third dose of vaccine. These results suggest that the concentration of serum anti-Hib CPS needed for protection against colonization is greater than that needed for protection for invasive disease.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Cápsulas Bacterianas/inmunología , Infecciones por Haemophilus/prevención & control , Vacunas contra Haemophilus/inmunología , Haemophilus influenzae/inmunología , Inmunoglobulina G/sangre , Polisacáridos Bacterianos/inmunología , Humanos , Lactante , VacunaciónRESUMEN
To assess the immunogenicity of more economical regimens of Haemophilus influenzae type b (Hib) conjugate vaccine, a randomized trial of fractional doses of polyribosylribitol phosphate-tetanus toxoid (PRP-T) Hib vaccine was undertaken in the Dominican Republic. Six hundred children were assigned to one of six regimens with PRP-T vaccine: full-dose, half-dose, and one-third-dose of Hib vaccine given separately or combined with diphtheria, tetanus, and pertussis (DTP) vaccine at ages 2, 4, and 6 months. Regimens that elicited antibody levels > 1.0 microg/mL in >70% of children and < or = 0.15 microg/mL in > 90% of children were considered acceptable. At 1 month post Dose 3, all regimens met the criteria for acceptable response. Among those who received Hib as a separate injection, geometric mean concentrations of anti-PRP bodies (GMCs) at age 1 month post Dose 3 were 11.2, 11.9, and 16.3 in the full, half, and one-third dose groups, respectively. Among those who received Hib and DTP combined, the GMCs were 6.4, 5.2, and 5.7 in the full-, half-, and one-third-dose groups respectively.
Asunto(s)
Anticuerpos Antibacterianos/biosíntesis , Vacunas contra Haemophilus/administración & dosificación , Vacunas contra Haemophilus/inmunología , Toxoide Tetánico/administración & dosificación , Toxoide Tetánico/inmunología , Anticuerpos Antibacterianos/sangre , Relación Dosis-Respuesta Inmunológica , Ensayo de Inmunoadsorción Enzimática , Humanos , Lactante , Método Simple Ciego , Vacunas Conjugadas/administración & dosificación , Vacunas Conjugadas/inmunologíaRESUMEN
Quantifying the local burden of disease is an important step towards the introduction of new vaccines, such as Haemophilus influenzae type b (Hib) conjugate vaccine. We adapted a generic protocol developed by the World Health Organization for population-based surveillance of bacterial meningitis. All hospitals that admit paediatric patients with meningitis in the National District, Dominican Republic were included in the system and standard laboratory methods were used. The system identified 111 cases of confirmed bacterial meningitis. Hib was the leading cause of bacterial meningitis, followed by group B streptococcus, S. pneumoniae, and N. meningitidis. Unlike hospital-based case series, this population-based system was able to calculate incidence rates. The incidence of Hib meningitis was 13 cases per 100,000 children < 5 years old. The data from this study were used by the Ministry of Health to support the introduction of routine Hib vaccination and will be used to monitor its effectiveness.
Asunto(s)
Vacunas contra Haemophilus , Haemophilus influenzae , Meningitis por Haemophilus/epidemiología , Preescolar , República Dominicana/epidemiología , Femenino , Haemophilus influenzae/inmunología , Política de Salud , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Meningitis por Haemophilus/prevención & control , Formulación de Políticas , Vigilancia de la PoblaciónRESUMEN
OBJECTIVES: To compare the efficacy and safety of meropenem with cefotaxime for the treatment of infants and children with bacterial meningitis. METHODS: Infants and children with strongly suspected or documented bacterial meningitis were randomly assigned in a prospective multicenter study to receive either meropenem or cefotaxime. Patients were assessed at the end of therapy and at 5 to 7 weeks and 5 to 7 months after the end of treatment for the presence of neurologic and sensory neural sequelae. RESULTS: A total of 258 children were randomized to either treatment group. A further 8 patients with suspected pneumococcal meningitis were treated with meropenem without randomization. Of the randomized patients 154 were fully evaluable, 79 in the meropenem group and 75 in the cefotaxime group. At the end of treatment there were no significant differences in clinical outcome between the two treatment groups. Clinical cure with or without sequelae was achieved in 97 and 96% of the meropenem- and cefotaxime-treated patients, respectively. At the end of treatment and at 5 to 7 weeks, 46 and 54% of meropenem patients were cured with no sequelae, respectively. Corresponding results for cefotaxime patients were 56 and 58%. All pathogens were eradicated. In total 37 patients had seizures during treatment, 15 (12%) in the meropenem and 22 (17%) in the cefotaxime group. None of the seizures was considered to be drug-related. CONCLUSIONS: This trial shows that meropenem is suitable therapy for bacterial meningitis in infants and children and that it offers an efficacy and safety profile similar to that of cefotaxime.
Asunto(s)
Cefotaxima/uso terapéutico , Cefalosporinas/uso terapéutico , Meningitis Bacterianas/tratamiento farmacológico , Tienamicinas/uso terapéutico , Cefotaxima/efectos adversos , Cefalosporinas/efectos adversos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Meropenem , Estudios Prospectivos , Método Simple Ciego , Tienamicinas/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Whether herd immunity will occur with widespread Haemophilus influenzae type b (Hib) vaccination in developing countries is dependent on whether the vaccines are capable of reducing carriage in these settings. However, few population-based studies of Hib carriage in developing countries exist. METHODS: To study Hib carriage in the Dominican Republic, we collected nasopharyngeal swab specimens from a population-based sample of 983 children 0 to 47 months old in a periurban area of Santo Domingo. RESULTS: Nasopharyngeal swabs of 76 (7.7%) children were positive for Hib. Hib carriage varied by age group with a low of 1.5% among 0 to 5 month olds, a peak of 12.5% in 6 to 11 month olds and prevalence rates of 6.0, 7.9 and 9.8% among 1-, 2- and 3-year-olds, respectively. Hib carriage was 51% lower among currently breast-fed 6 to 11 month olds than among those not currently breast-fed (18.2% vs. 9.0%; P=0.08). CONCLUSIONS: Infants and young children in Santo Domingo have high rates of Hib carriage, characterized by an early peak in carriage that corresponds with the peak of risk for Hib meningitis. The ability of Hib vaccines to diminish carriage to levels that will effectively reduce transmission and lead to herd immunity in this setting needs to be determined.
Asunto(s)
Portador Sano/epidemiología , Infecciones por Haemophilus/epidemiología , Haemophilus influenzae tipo b , Preescolar , Países en Desarrollo , República Dominicana/epidemiología , Haemophilus influenzae tipo b/aislamiento & purificación , Humanos , Lactante , Nasofaringe/microbiologíaAsunto(s)
Apoyo Financiero , Vacunación/economía , Costos y Análisis de Costo , Países en Desarrollo/economía , República Dominicana , Vacunas contra Haemophilus/administración & dosificación , Vacunas contra Haemophilus/economía , Haemophilus influenzae tipo b/inmunología , Humanos , Programas de Inmunización/economía , Vacunas Conjugadas/administración & dosificación , Vacunas Conjugadas/economíaRESUMEN
Presentamos la casuística de tumores hepáticos farmacoinducidos por anovulatorios en nuestra área geográfica. Del total de 42 pacientes con tumores de hígado, en 4 casos (10 por ciento) se detectaron neoplasias en mujeres jóvenes que estaban usando anticonceptivos. Se discuten algunos aspectos patogénicos y diagnósticos
Asunto(s)
Femenino , Humanos , Adulto , Adenoma de Células Hepáticas/inducido químicamente , Anticonceptivos Femeninos/efectos adversos , Anticonceptivos Femeninos/farmacología , Neoplasias Hepáticas/inducido químicamenteRESUMEN
Diseñamos un estudio prospectivo a dos años con el objetivo fundamental de establecer cuáles son las enfermedades hepáticas más frecuentes e identificar, en la medida de lo posible, los factores etiológicos en los distintos grupos de pacientes que consultan a la sala de urgencias de nuestro hospital. Estudiamos 68 pacientes, con biopsia hepática, predominando la infecciones, luego las neoplasias y la cirrosis
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Adolescente , Adulto , Persona de Mediana Edad , Hepatopatías/etiología , Absceso Hepático/etiología , Hepatitis Crónica/etiología , Metástasis de la Neoplasia , Estudios Prospectivos , Tuberculosis/etiologíaRESUMEN
PIP: Measles is caused by a virus which exclusively affects humans. Erroneously it has been considered benign, although it causes high morbidity and mortality because of the complications it precipitates. The Expanded Program of Immunization estimated that 1.5 million children in the world die every year because of measles. The objective was to analyze the incidence of measles and complicated measles in children who had been admitted to Dr. Robert Reid Cabral Pediatric Clinic, Santo Domingo, Dominican Republic, during the period of January 1991 to January 1992. A total of 311 patients were enrolled with the diagnosis of measles during the 13 months of the study, with an average of 24 cases per month. October and December were the months when most patients presented with measles: respectively, 56 (18%) and 60 (19.4%) patients of the total caseload. Pneumonia was the most frequent complication with 277 cases (87.1%), followed by acute diarrheal disease with 25 cases (8.0%). The most affected was the 1-3 year age group with 143 patients (46.0%). In 135 cases (43.4%) the children with measles had not been vaccinated; only 72 patients (23.3%) had received vaccination. Furthermore, 104 patients (33.3%) did not know their vaccination history. 170 patients (54.7%) were malnourished. During the study period 37 children (11.9%) died in the hospital and 24 of these children (64.9%) died as a result of the complication of pneumonia. Other causes of death were: laryngotracheitis (4), encephalitis (3), subcutaneous emphysema (4), and septicemia (2). This investigation showed that pneumonia is a very grave complication in malnourished children and in children under one year of age.^ieng
Asunto(s)
Niño , Mortalidad Infantil , Sarampión , Trastornos Nutricionales , Vacunación , Adolescente , Factores de Edad , Américas , Región del Caribe , Atención a la Salud , Demografía , Países en Desarrollo , Enfermedad , República Dominicana , Salud , Servicios de Salud , Inmunización , América Latina , Mortalidad , América del Norte , Población , Características de la Población , Dinámica Poblacional , Atención Primaria de Salud , VirosisRESUMEN
PIP: The archives of the blood bank of the hospital of Dr. Louis Manual Morillo King, in the city of La Vega, Dominican Republic, were reviewed to identify all children who had been given blood transfusion during the period of July 1983 to July 1987 in order to identify HIV and the surface antigen of hepatitis B (HBsAg). Those who were released were visited in their homes for administration of HIV and hepatitis tests. Positive tests were confirmed by another test (AUSYME MONOCLONAL and Western Blot). Mothers were also tested to detect vertical transmission. 256 patients had been transfused, of whom 61 died. 80 of the 195 remaining patients could not be located. Of the 115 patients located, 52 had died in their homes after release from the hospital. Thus, the sample comprised 63 patients: 36 were 0-3 years old, 21 were 4-7 years old, and 6 were 8-11 years old. 50 lived in rural and 13 in urban areas. 56 patients had one transfusion and 4 had two transfusions. 28 patients had transfusion for anemia, 19 for malnutrition, 7 for sepsis, 6 for various reasons (meningitis, pleuritis, pneumonia), and 3 for sickle cell disease. 47 patients had been transfused at the hospital using the blood bank, 13 used blood from relatives, and 3 received blood from friends. Out of the 63 samples processed, 2 patients presented seropositivity for hepatitis B, while none were seropositive for HIV. Among the 2 patients who were seropositive for hepatitis B, the mother of one of them was also seropositive.^ieng
Asunto(s)
Serodiagnóstico del SIDA , Factores de Edad , Antígenos , Transfusión Sanguínea , Infecciones por VIH , Pruebas Hematológicas , Hepatitis , Estudios Retrospectivos , Américas , Biología , Región del Caribe , Técnicas de Laboratorio Clínico , Demografía , Países en Desarrollo , Diagnóstico , Enfermedad , República Dominicana , Inmunidad , Factores Inmunológicos , América Latina , América del Norte , Fisiología , Población , Características de la Población , Investigación , Terapéutica , VirosisRESUMEN
Ninety patients (41 males, 49 females) with a diagnosis of meningitis, urinary tract infection (UTI), gastroenteritis or other miscellaneous gram-negative infections were enrolled. Their ages ranged from 7 days to 10 years, with a mean age of 4 months. 58 (63%) patients had an etiology confirmed by either positive culture (52; 89%) or latex agglutination (6; 10%). 41 of these patients had meningitis diagnosed by positive CSE culture (38) or by positive CSF latex agglutination (3); 27/41 patients also had positive blood cultures. Aztreonam MIC100 for 27 isolates of Haemophilus influenzae, all ampicillin-sensitive, was 0.19 micrograms/ml; 4 Salmonella sp., 1 Neisseria meningitidis and 1 Serratia marcescens isolates were inhibited by 0.19 micrograms/ml, and the MIC100 for 2 Klebsiella pneumoniae, 1 Proteus vulgaris and 2 Pseudomonas aeruginosa isolates were 0.045 and 0.19, 0.022 and 12.5 micrograms/ml, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Aztreonam/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Meningitis/tratamiento farmacológico , Niño , Preescolar , Femenino , Gastroenteritis/tratamiento farmacológico , Bacterias Gramnegativas , Humanos , Lactante , Recién Nacido , Masculino , Meningitis por Haemophilus/tratamiento farmacológico , Infecciones Urinarias/tratamiento farmacológicoAsunto(s)
Pruebas de Fijación de Látex , Faringitis/diagnóstico , Faringe/microbiología , Infecciones Estreptocócicas/diagnóstico , Tonsilitis/diagnóstico , Adolescente , Niño , Preescolar , Humanos , Faringitis/microbiología , Valor Predictivo de las Pruebas , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/inmunología , Streptococcus pyogenes/aislamiento & purificación , Tonsilitis/microbiologíaRESUMEN
En 45 ninos con encefalitis aguda primaria, durante el periodo de noviembre del 1981 a octubre del 1982, se investigaron la elevacion de titulos de anticuerpos para la infeccion por virus de la encefalitis equina, encefalitis venezolana, fiebre amarilla, polio y dengue, encontrandose 6 casos asociados a polio y 4 a dengue. El estudio puntualiza la necesidad de mayores investigaciones en este campo