Asunto(s)
Vacuna contra la Varicela , Varicela/transmisión , Herpesvirus Humano 3 , Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo/virología , Administración Tópica , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Varicela/congénito , Vacuna contra la Varicela/efectos adversos , Contraindicaciones , Desonida/administración & dosificación , Desonida/uso terapéutico , Eccema/tratamiento farmacológico , Femenino , Enfermedades Fetales/virología , Glucocorticoides , Humanos , Lactante , Masculino , Embarazo , Factores de Riesgo , VacunaciónAsunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , VIH-1 , Transmisión Vertical de Enfermedad Infecciosa , Estudios de Cohortes , ADN Viral/análisis , Reacciones Falso Positivas , Estudios de Seguimiento , Infecciones por VIH/prevención & control , VIH-1/genética , Humanos , Lactante , Reacción en Cadena de la Polimerasa , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To compare the immunogenicity and reactogenicity of a diphtheria and tetanus toxoids and three-component acellular pertussis vaccine (DTaP) with a diphtheria and tetanus toxoids and whole-cell pertussis vaccine (DTwP) when administered as a booster dose to infants 15 through 20 months of age. DESIGN: Randomized, double-blind, comparative study. SETTING: Three pediatric practices (two private; one hospital-based). PARTICIPANTS: One hundred and sixty-five healthy 15- through 20-month old infants. SELECTION PROCEDURES AND INTERVENTIONS: Infants were randomly assigned in a 2:1 ratio to receive vaccine from a single lot of DTaP or from commercially available DTwP. DTaP contained 25 micrograms of pertussis toxoid, 25 micrograms of filamentous hemagglutinin, 8 micrograms of pertactin (69-kilodalton outer membrane protein), 25 flocculating units of diphtheria toxoid, and 10 flocculating units of tetanus toxoid per 0.5-mL dose. DTwP contained one half the concentrations of diphtheria and tetanus toxoids compared with DTaP and a pertussis component with a potency of 4 U/0.5-mL dose. Serum samples were obtained on the day of immunization and 4 weeks later. Adverse reactions were recorded by parents for 7 days after immunization. An interval history was obtained 4 weeks after immunization. MEASUREMENTS AND RESULTS: IgG antibody to pertussis toxoid, filamentous hemagglutinin, pertactin, diphtheria toxoid, and tetanus toxoid was measured by an indirect enzyme-linked immunosorbent assay (ELISA) method. One month after immunization, the geometric mean antibody levels after DTaP compared with DTwP were: pertussis toxoid, 70.6 vs 28 ELISA U/mL (P = .003); filamentous hemagglutinin, 183.4 vs 43 ELISA U/mL (P < .001); pertactin, 216 vs 49.9 ELISA U/mL (P < .001); diphtheria, 14.1 vs 14.9 IU/mL (P = .74); and tetanus, 11.9 vs 14.8 IU/mL (P = .089). After immunization with DTaP, most local and systemic adverse experiences were significantly fewer compared with DTwP (P < .05). CONCLUSIONS: This three-component DTaP vaccine demonstrates significantly greater immune responses to pertussis toxoid, filamentous hemagglutinin, and pertactin, equivalent immune responses to diphtheria and tetanus toxoids, and significantly less reactogenicity compared with a licensed DTwP.
Asunto(s)
Vacuna contra Difteria, Tétanos y Tos Ferina/efectos adversos , Vacuna contra Difteria, Tétanos y Tos Ferina/inmunología , Anticuerpos Antibacterianos/sangre , Toxoide Diftérico/inmunología , Método Doble Ciego , Femenino , Humanos , Inmunización Secundaria , Lactante , Masculino , Toxoide Tetánico/inmunología , Toxoides/inmunologíaRESUMEN
OBJECTIVE: To compare the safety and immunogenicity of Lederle Laboratories' (Pearl River, NY) diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine with diphtheria and tetanus toxoids and whole-cell pertussis (DTwP) vaccine when administered simultaneously with measles-mumps-rubella (MMR) vaccine and trivalent oral poliovirus (OPV) vaccine at 15 to 16 months of age. DESIGN: Randomized and double-blind. SETTING: Two general pediatric practices. PARTICIPANTS: Ninety-seven infants, aged 15 to 16 months, who had received three previous DTwP immunizations. SELECTION PROCEDURES AND INTERVENTIONS: Healthy children received the DTaP or DTwP vaccine. Infants received the MMR vaccine at a separate site and the OPV vaccine concurrently. Blood was obtained on day 0 and at 6 weeks. Adverse events were recorded by parents at specified times after immunization. MEASUREMENTS/RESULTS: Within 3 days of immunization, DTaP vaccine recipients had less fever, drowsiness, and irritability (P = .01, .04, .01, respectively). They also experienced less tenderness, erythema, and induration (.001, .001, and .002, respectively). There was no difference in the frequency of adverse reactions 6 to 14 days after immunization. Enzyme-linked immunosorbent assays were used to determine all antibody values. Antibody responses to filamentous hemagglutinin and pertussis toxoid were significantly greater in the DTaP group (P = .0001 and .02, respectively). Immune responses to the other measured antigens were similar. CONCLUSIONS: Simultaneous administration of the Lederle DTaP with MMR and OPV vaccines did not interfere with antibody response to pertussis antigens measured or measles, mumps, or rubella viruses and was associated with fewer local and systemic adverse events during the first 3 days following immunization when compared with the simultaneous administration of the DTwP, OPV, and MMR vaccines. We conclude that the DTaP vaccine can be administered at 15 months of age concurrently with the MMR and OPV vaccines.
Asunto(s)
Vacuna contra Difteria, Tétanos y Tos Ferina/administración & dosificación , Vacuna Antisarampión/administración & dosificación , Vacuna contra la Parotiditis/administración & dosificación , Vacuna Antipolio Oral/administración & dosificación , Vacuna contra la Rubéola/administración & dosificación , Anorexia/inducido químicamente , Anorexia/epidemiología , Anticuerpos Antibacterianos/sangre , Anticuerpos Antivirales/sangre , Bordetella pertussis/inmunología , Clostridium tetani/inmunología , Corynebacterium diphtheriae/inmunología , Vacuna contra Difteria, Tétanos y Tos Ferina/efectos adversos , Método Doble Ciego , Combinación de Medicamentos , Ensayo de Inmunoadsorción Enzimática , Eritema/inducido químicamente , Eritema/epidemiología , Femenino , Fiebre/inducido químicamente , Fiebre/epidemiología , Humanos , Lactante , Genio Irritable/efectos de los fármacos , Masculino , Vacuna Antisarampión/efectos adversos , Virus del Sarampión/inmunología , Vacuna contra el Sarampión-Parotiditis-Rubéola , Vacuna contra la Parotiditis/efectos adversos , Virus de la Parotiditis/inmunología , Poliovirus/inmunología , Vacuna Antipolio Oral/efectos adversos , Vacuna contra la Rubéola/efectos adversos , Virus de la Rubéola/inmunología , Fases del Sueño/efectos de los fármacosAsunto(s)
Anticuerpos Antibacterianos/inmunología , Proteínas Bacterianas/inmunología , Vacunas Bacterianas/inmunología , Haemophilus influenzae/inmunología , Anticuerpos Antibacterianos/análisis , Vacunas Bacterianas/administración & dosificación , Reacciones Cruzadas , Humanos , Inmunización , LactanteRESUMEN
Infection of a central venous thrombus is a serious but rarely recognized complication of the use of central venous catheters in children. We report the cases of seven children with persistent bacteremia or fungemia in which central venous thrombosis was demonstrated by ultrasonography after removal of the catheter. All patients had signs and symptoms of infection, but only one had clinical evidence of central venous stasis. Bacteremia persisted from 6 to 35 days. Infection did not resolve in any patient prior to catheter removal, and five patients had positive blood cultures for 5 or more days after removal of the catheter. Six patients, including all who survived, were treated parenterally with antibiotics for more than 28 days. Two patients died; neither death was directly attributable to infection. Central venous thrombosis should be suspected in patients with persistent catheter-related bacteremia. Optimal treatment of this problem is not yet known.
Asunto(s)
Cateterismo Venoso Central/efectos adversos , Sepsis/etiología , Tromboflebitis/complicaciones , Adolescente , Antibacterianos/uso terapéutico , Cateterismo Venoso Central/instrumentación , Preescolar , Ecocardiografía , Femenino , Heparina/uso terapéutico , Humanos , Lactante , Masculino , Sepsis/diagnóstico , Sepsis/tratamiento farmacológico , Tromboflebitis/diagnóstico , Tromboflebitis/etiología , UltrasonografíaRESUMEN
An outbreak of pertussis was recognized and investigated in a home for neurologically impaired people. Of 66 residents, 44 (67%) had evidence of recent pertussis infection, although only 12 (27%) had respiratory symptoms. Pertussis was diagnosed by culture, direct fluorescent antibody testing of nasal secretions, agglutinating antibody titer, pertussis antitoxin titer, IgG antibody to pertussis toxin, IgA antibody to pertussis toxin, IgA antibody to filamentous hemagglutinin, or IgG antibody to filamentous hemagglutinin. No single test identified more than 66% of people with pertussis. Of those with positive serologic findings, 95% had a positive test result for IgA antibody to filamentous hemagglutinin or for IgG antibody to pertussis toxin or for both. Pertussis occurred in both immunized and unimmunized residents. Seven carriers were identified; these residents had positive cultures or positive direct fluorescent antigen test results but negative serologic findings. Treatment of residents and caretakers with erythromycin halted the outbreak.
Asunto(s)
Personas con Discapacidad , Brotes de Enfermedades , Instituciones Residenciales , Tos Ferina/epidemiología , Adolescente , Adulto , Anticuerpos Antibacterianos/análisis , Bordetella pertussis/inmunología , Portador Sano/diagnóstico , Niño , Preescolar , Eritromicina/uso terapéutico , Humanos , Inmunoglobulina A/análisis , Inmunoglobulina M/análisis , Lactante , Toxina del Pertussis , Philadelphia , Factores de Virulencia de Bordetella/inmunología , Tos Ferina/diagnóstico , Tos Ferina/tratamiento farmacológicoRESUMEN
The safety and efficacy of simultaneous administration of measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis (DTP), and trivalent oral poliovirus (OPV) vaccines in a test group of 405 children were compared with the safety and efficacy of sequential administration of the same vaccines in a control group of 410 children given MMR followed by booster doses of DTP and OPV 2 months later. The study was double blind and placebo controlled with respect to DTP and OPV. Seroconversion rates to measles, mumps, and rubella exceeded 96% in both groups. Geometric mean titers to measles (P = .05) and rubella (P = .004) were higher in the test group, and titers of antibodies to the other seven antigens were similar in both groups. Clinical reaction data were analyzed in 248 of 405 test children and 249 of 410 control children. The rates of serious vaccine-associated reactions were low and similar in the two groups. Some minor side effects were reported more frequently in the test group, but these differences were judged to be related to study design rather than to differences in the safety of the two vaccine schedules. The results indicate that the safety and serologic efficacy of administering MMR simultaneously with reinforcing doses of DTP and OPV in the second year of life is equivalent to the safety and efficacy observed after administering these antigens separately.
Asunto(s)
Vacuna contra Difteria, Tétanos y Tos Ferina , Esquemas de Inmunización , Vacunas/administración & dosificación , Anticuerpos/análisis , Toxoide Diftérico/administración & dosificación , Método Doble Ciego , Combinación de Medicamentos/administración & dosificación , Humanos , Inmunización Secundaria , Lactante , Vacuna Antisarampión/administración & dosificación , Vacuna contra el Sarampión-Parotiditis-Rubéola , Vacuna contra la Parotiditis/administración & dosificación , Vacuna contra la Tos Ferina/administración & dosificación , Vacuna Antipolio de Virus Inactivados/administración & dosificación , Distribución Aleatoria , Vacuna contra la Rubéola/administración & dosificación , Toxoide Tetánico/administración & dosificación , Vacunas/efectos adversos , Vacunas CombinadasRESUMEN
Stool samples from 196 healthy infants less than ten days of age were cultured to delineate bacterial colonization patterns of the intestine. By one week of age, isolation rates of Bacteroides fragilis and other anaerobic bacteria in term infants following vaginal delivery and formula feeding approach that of adults. Differences in gestational age, type of delivery, and type of feeding are associated with significantly different colonization patterns of anaerobic and aerobic bacteria in the first week after birth.