RESUMEN
Whether to restart or continue the series when anthrax vaccine doses are missed is a frequent medical management problem. We applied the noninferiority analysis model to this prospective study comparing the Bacillus anthracis protective antigen (PA) IgG antibody response and lethal toxin neutralization activity at day 28 to the anthrax vaccine adsorbed (AVA) (Biothrax®) administered on schedule or delayed. A total of 600 volunteers were enrolled: 354 in the on-schedule cohort; 246 in the delayed cohort. Differences were noted in immune responses between cohorts (p<0.0001) and among the racial categories (p<0.0001). Controlling for covariates, the delayed cohort was non-inferior to the on-schedule cohort for the rate of 4-fold rise in both anti-PA IgG concentration (p<0.0001) and TNA ED50 titers (p<0.0001); as well as the mean log10-transformed anti-PA IgG concentration (p<0.0001) and the mean log10-transformed TNA ED50 titers (p<0.0001). Providing a missed AVA dose after a delay as long as 5-7 years, elicits anti-PA IgG antibody and TNA ED50 responses that are robust and non-inferior to the responses observed when the 6-month dose is given on-schedule. These important data suggest it is not necessary to restart the series when doses of the anthrax vaccine are delayed as long as 5 or more years.
Asunto(s)
Vacunas contra el Carbunco/administración & dosificación , Carbunco/prevención & control , Formación de Anticuerpos , Esquemas de Inmunización , Adolescente , Adulto , Anticuerpos Antibacterianos/sangre , Anticuerpos Neutralizantes/sangre , Antígenos Bacterianos/inmunología , Bacillus anthracis , Toxinas Bacterianas/inmunología , Femenino , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Pruebas de Neutralización , Estudios Prospectivos , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: To determine transfusion compatibility of maternal RBCs for her neonate up to 4 weeks of age, irrespective of maternal-neonatal ABO mismatch. METHODS: This was a prospective observational study involving eligible mothers with their neonates delivered in participating site from 1 July 2012 till 31 December 2012. Mother's blood was collected before child birth. Neonatal blood sample was collected from placental end, shortly after birth. Blood Groups of mother-baby pair were individually tested for ABO and Rh-D groups. Pairs with negative Rh-D antigen/s or with same ABO blood groups were excluded. Thus, 28 pairs with both maternal and neonatal samples positive for Rh-D antigen and with different maternal neonatal ABO blood groups were included in the study. Blood samples were collected at birth and at 4 weeks. Cross matching was done at birth and at 4 weeks for each pair with standard blood bank protocols. RESULTS: All 28 pairs showed positive compatibility with standard blood bank cross-matching protocols at birth and at 4 weeks. CONCLUSIONS: Maternal blood irrespective of ABO compatibility might be a viable and potentially acceptable option for her new born baby in neonatal period. This may be especially important in developing world with limited blood bank resources.
Asunto(s)
Sistema del Grupo Sanguíneo ABO/inmunología , Incompatibilidad de Grupos Sanguíneos/inmunología , Transfusión de Eritrocitos/métodos , Tolerancia Inmunológica , Sistema del Grupo Sanguíneo Rh-Hr/inmunología , Incompatibilidad de Grupos Sanguíneos/sangre , Incompatibilidad de Grupos Sanguíneos/diagnóstico , Tipificación y Pruebas Cruzadas Sanguíneas , Femenino , Humanos , Recién Nacido , Estudios ProspectivosRESUMEN
Statistically significant rises in serum glutamic oxalacetic transaminase and lactic dehydrogenase determinations occurred at exposures to TNT of 0.8 mg/m3 and persisted at exposures of 0.6 mg/m3. Based on these findings, the adequacy of the current threshold limit value for TNT (1.5 mg/m3) is questioned.