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Recent studies have demonstrated that rhinovirus infections can be prevented in the family setting through use of intranasal interferon sprays which are commenced when another family member develops a cold. One hundred and twenty-seven children aged 4-9 years who had been hospitalized during their first year of life for severe infections caused by respiratory syncytial virus were studied virologically and epidemiologically during a seven-month period which included the winter months. The hypothesis was that a significant part of their respiratory morbidity would be preventable by a contact prophylaxis approach using intranasal interferon. However, the findings suggest that a preventive approach of this kind would not substantially reduce the burden of respiratory illness in these children because: the target children themselves more often introduced illness into the family than did other household members; rhinovirus infections preventable by interferon were associated with little lower respiratory morbidity; and rhinoviruses were minor contributors to the total respiratory illness burden in these respiratory illness-prone children.

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Effervescent lozenges containing 10 mg of zinc acetate were evaluated as a treatment of upper respiratory tract infections in a double-blind randomized trial by using a placebo which was indistinguishable to most observers in taste and appearance from the active material. Of the 70 treatment courses used by 55 individuals in 34 families, 63 (33 zinc and 30 placebo) were considered evaluable, in that the volunteer used the medication at least four times daily for at least 3 days, the average utilization being 5.4 days at an average dose of six lozenges daily. Six users of zinc reported nausea (versus no placebo users), and eight reported an unpleasant taste or aftertaste (versus one placebo user). No benefit was observed among the users of zinc acetate. The mean duration of symptoms in users of the zinc was 12.1 days, compared with 7.7 days in those who used the placebo. Nor was any beneficial effect of zinc evident among the four zinc-treated versus the two placebo-treated individuals from whom rhinovirus was grown.

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No consistent effect on nasal carriage rates of Streptococcus pneumoniae belonging to vaccine types was observed during a randomized, controlled trial of a 14-valent pneumococcal vaccine, which included 1273 Australian children aged 6 to 54 months. Nasal carriage of S pneumoniae was associated with a significantly elevated homotypic serum antibody concentration for types 18C, 19F, and 23F, but not for types 6A and 14 (these five types are the most important causes of pneumococcal infections in children). Upper respiratory tract carriage seems to play an important role in natural acquisition of antibody to some but not all pneumococcal serotypes. These findings help to explain why pneumococcal vaccine fails to protect young children from acute otitis media.

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In a double-blind evaluation of alpha 2-interferon as prophylaxis against naturally acquired respiratory infections, 120 adult members of 46 Australian families used 325 courses of intranasal spray during a six-month period, applying 5 million IU to the anterior nasal mucosa daily for seven days when respiratory symptoms developed in another member of the family. Used in this way, the alpha 2-interferon was well tolerated, and the rate of minor nasal bleeding (12 percent) did not increase with repeated courses. By comparison with the control group of 109 members of 49 families who used 319 seven-day courses of placebo spray, the users of alpha 2-interferon experienced 33 percent fewer days with nasal symptoms and 41 percent fewer episodes of "definite" respiratory illness. The users of alpha 2-interferon who were exposed to rhinovirus infections experienced 76 percent fewer days with symptoms and 86 percent fewer "definite" illnesses than their counterparts who used placebo. All of the observed clinical benefits, which suggested prevention of 6.8 "definite" respiratory illnesses per 100 courses of medication used, could be explained by a protective effect against illness associated with rhinoviruses that was not demonstrated for influenza A or B or coronavirus 229E.

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A double-blind, randomized, controlled trial of a 14-valent Streptococcus pneumoniae polysaccharide vaccine, with saline as placebo, was performed on 1,273 healthy children six to 54 months of age. Different dosage regimens were used for children younger and older than two years of age. The vaccine was well tolerated. Follow-up continued for two years, during which time 95% of mothers submitted diaries of their children's respiratory-tract and otic symptoms. Data from diaries and medical and hospital case notes failed to reveal consistent or significant benefits in those who received the vaccine. In the first 16 months after immunization, recipients of placebo experienced an average of 0.69 episodes of otitis media per child, compared with 0.63 in recipients of vaccine (P = .6). Recipients of vaccine had no consistent reduction in days of respiratory morbidity, antibiotic consumption, hospitalization, or visits to a physician, when compared with recipients of placebo.

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