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HYPOTHESIS: The low titer of measles antibody in infants of mothers with vaccine-induced immunity may allow immunization against measles before 15 months of age. METHODS: Six- and 15-month-old infants born to mothers < or = 30 years of age with no history of measles were recruited. Infants enrolled at 6 months of age were immunized with monovalent measles vaccine (Attenuvax), and maternal serum and infant pre- and postvaccination sera were obtained. Those enrolled for primary vaccination at 15 months of age received either Attenuvax (N = 12) or M-M-RII (N = 3). Six-month-old infants were revaccinated with M-M-RII at 15 months of age; pre- and postrevaccination sera were again obtained. Three antibody assays were used: a measles neutralizing assay (NT) and two enzyme immunoassays (EIA) for measles IgG and measles IgM. RESULTS: Among primary vaccinees, 14 of 19 infants aged 6 months (74%) developed NT antibody, as did 15 of 15 infants aged 15 months (100%). The reciprocal geometric mean titer of 6-month-old seroresponders was 23.3, significantly lower than that of the 15-month-old primary vaccinees (87.7, P < .001). Primary seroconversion rates by EIA were 53% for 6-month-old infants and 100% for those aged 15 months. Revaccination of infants who had received Attenuvax at 6 months of age resulted in 100% NT positivity; the geometric mean titer rose to equal that of the group given primary immunization at 15 months of age. Measles IgM antibody was detected in 10 of 14 infants tested 1 month after primary vaccination at 15 months, but was not detected in any of the revaccinated infants after the second dose at 15 months of age (P < .001). CONCLUSIONS: 1) Immunization with measles vaccine in infants born to vaccine-immune mothers at 6 months of age induced NT antibody in 74% of infants. 2) Revaccination of prior 6-month-old vaccinees at 15 months resulted in antibody titers equivalent to 15-month-old vaccinees. 3) Lack of an IgM response following revaccination suggests that even seronegative infants may be primed to respond on re-exposure to measles.

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The worldwide experience to date with VAQTA, a highly purified formalin-inactivated hepatitis A vaccine containing alum-adjuvant, is reviewed. No serious adverse experience related to vaccination has been reported. The vaccine has proven highly immunogenic, with seroconversion detectable after a single dose in 90-99% of children 2-16 years old, and of adults under 77 kg (170 lb) body weight. There is a trend toward lower one-dose seroconversion rates with increasing age and with weight > 77 kg. Early seroconversion in the latter groups may require two 25-unit doses given 2, 4 or 8 weeks apart, or a higher priming dose. Seroconversion induced by this vaccine has been shown to signify protection from clinical hepatitis A disease. The few vaccines whose titers have waned to borderline levels responded anamnestically to a booster, suggesting that the vaccine induces an immune memory response and should provide long-term protection.

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Since ivermectin, a mixture of 2 closely related macrocyclic lactones, has proven highly effective against animal intestinal nematodes, trials were undertaken to determine its efficacy against human intestinal nematodes. We tested 110 patients with strongyloidiasis and 90 with enterobiasis; many had other intercurrent intestinal nematode infections. Stool examinations were done before and after patients were given a single dose of oral ivermectin capsules (50, 100, 150, or 200 micrograms/kg body wt); 55 recipients of 100 or 200 micrograms/kg doses received a second identical dose the next day. Kato and saline smears, ethyl acetate concentration, modified Baermann's technique, and Harada-Mori cultures were repeated; cure was defined as complete absence of eggs and/or larvae from stools tested 30 days after dosing. Ivermectin was well tolerated. Overall cure rates at all doses 30 days after therapy averaged 88% for strongyloidiasis, 100% for ascariasis, 85% for trichuriasis, and 85% for enterobiasis. Ancylostoma duodenale and Necator americanus were little affected.

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High relapse rates and low tolerability to ampicillin characterize present therapy for carriers of Salmonella typhi. Norfloxacin, a carboxyquinolone with a 90% minimum inhibitory concentration for S. typhi of less than or equal to 0.5 micrograms/mL, is a promising alternative. Carriers of S. typhi were treated in a double-blind trial with either norfloxacin (400 mg) or matching placebo given every 12 h for 28 d. Twelve assessable individuals were treated in each group. After therapy, 11 of 12 individuals treated with norfloxacin had negative stool and bile cultures for S. typhi. All placebo-treated carriers still had positive cultures immediately after therapy. Subsequently, 11 individuals were treated openly with norfloxacin. S. typhi was eradicated in seven of 11. Overall, the eradication rate for 23 individuals treated with norfloxacin was 78%. Eighteen individuals were followed up for one year, and their stool and/or bile cultures remained negative. From our results, norfloxacin is an effective and well-tolerated antimicrobial agent for eradicating the chronic typhoid carrier state.

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Nonenterotoxigenic strains no. 1196-78 and no. 1074-78 of Vibrio cholerae serogroup O1 (biotype El Tor, serotype Ogawa) were isolated from sewage water in Brazil and fed to 20 volunteers. Neither strain caused diarrhea. None of the seven volunteers who ingested Ogawa strain no. 1074-78 (10(6) organisms) excreted the organism whereas eight of the 13 volunteers who ingested Ogawa strain no. 1196-78 (10(6) or 10(8) organisms) did excrete the organism in their stools. None of 114 stool-culture isolates yielded cholera enterotoxin, and none of the 20 volunteers had significant increases in serum titers of antitoxin as measured by enzyme-linked immunosorbent assay although six of the volunteers had slightly elevated vibriocidal antibody levels. Six volunteers used as controls and four volunteers who had stool cultures positive for strain no. 1196-78 of V. cholerae were challenged with pathogenic El Tor Ogawa strain no. E7946 (10(6) organisms) to determine if previous ingestion of the Brazilian strain would induce protective immunity. All 10 of the volunteers developed diarrhea, and the severity of the illness was similar in both groups.

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PIP: Oral rehydration solutions (ORS) with low and high sodium or potassium contents were compared in 84 infants aged 3-15 months with dehydration caused by acute watery diarrhea. In randomized, double-blind trials, the ORS contained (in mmol/liter): glucose, 110; HCO3, 30; K, 10; Na, 60 (low) or 90 (high), or, in a second trial, the high Na formula plus 20 vs. 35 mEq/liter of K and extra oral water, given in the ratio of 2 bottles (240 ml) of ORS followed by 1 bottle of plain water (the 2:1 regimen). The balance technique was used to measure net absorption. Of the 84 infants, only 1 required intravenous therapy. During the first 6 hours of therapy, mean sodium absorption was significantly lower in the low Na group, and hyponatremia was more common. A few high Na group infants receiving no extra oral water had transient mild asymptomatic hypernatremia. Mean K absorption from 0-6 hours was significantly higher in the high K group, and they had no hypokalemia after oral rehydration; in contrast, 33% of the low K infants had hypokalemia. High Na ORS in the 2:1 regimen caused no electrolyte abnormalites, yielded better sodium absorption, and was usable in all age groups and for all diarrheas. High K ORS corrected K deficits better than the low K ORS. An increase in potassium concentration above that in the currently recommended ORS formula should be considered.^ieng

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Studies of oral rehydration have been carried out in patients three months of age or older. With the exception of a previous report by us, nothing has been written before about the method of rehydration in patients of less than three month of age. During the period comprised between March 1978 and May 1979, we attended 106 patients; age ranging from seven days to three months and weighing 1,900 to 6,080 grams. The The dehydration status ranged from 2% - 4%; in all cases due to watery diarrhoea. Oral or nasogastric rehydration was accomplished in 97% of cases in an average time of seven hours. Several patients presented severe water and electrolyte unbalance, namely metabolic acidosis or hypernatremia. This returned near normality as the patients became rehydrated. We conclude that patients under 3 months of age respond as well as older ones to oral rehydration.

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In a randomised double-blind trial, 51 5--10% dehydrated infants were rehydrated with oral electrolyte solutions containing sucrose or glucose. Most infants in both groups were successfully rehydrated, but the sucrose solution produced a slower correction of electrolyte abnormalities and a higher percentage of patients who needed more than 24 h of therapy. Where there is adequate knowledge of the oral therapy method sucrose can substitute for glucose in many cases; where there is a choice glucose is recommended.

PIP: 51 infants aged 3 to 12 months with dehydration due to acute watery diarrhea were randomly assigned to either the glucose or sucrose oral therapy group on admission to the hospital. Oral rehydration and maintenance without any intravenous fluids was successful in 100% and 92% of patients in the glucose and sucrose groups respectively, as evidenced by the subjects' weight gain, fall in plasma proteins and hematocrit, and disappearance of clinical signs of dehydration. There was a greater improvement in mean HC03 in the glucose group than in the sucrose group. Both groups exhibited decline in mean serum osmolarity. The 2 oral treatment failures in the sucrose group occurred in patients who could not absorb the solutions adequately. This study shows that oral therapy with sucrose is less efficient than oral therapy with glucose. However, in areas where only sucrose is available and where knowledge and means of using oral therapy exist, the oral sucrose solution can be used to treat most infants with diarrhea and 5 to 10% dehydration.

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Malathion, an organic phosphate insecticide, has become the agent most commonly used for suicides attempts in Guyana. The clinical characteristics of 264 cases are described. As with other types of organic phosphate poisoning, atropine is the mainstay of therapy after exposure to the toxin is terminated. The value of oximes in the treatment of malathion poisoning is not clear. The increase in malathion suicides is related to sociocultural factors.(Summary)

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