Trial of Edmonston-Zagreb measles vaccine in infants aged under nine months.

Due to the recent finding that most infants in developing countries have lost maternal antibody for measles before nine months of age, immunization of infants younger than the recommended age of nine months would help reducing the incidence of measles in these endemic areas. We conducted a trial of Edmonston-Zagreb measles vaccine which is the strain that may be more immunogenic in young infants than the widely used Schwarz strain. Forty-five infants with mean age of 25 weeks received a dose of Edmonston-Zagreb vaccine. Antibody levels were measured, using plaque neutralization test, before and about 3 months after vaccination at which mean age was 38 weeks. The seroconversion rate was 89%. Only two infants (4.4%) had immunity before vaccination. Fifteen infants (33.33%) reported some adverse reactions including fever (13.33%), rhinorrhea (8.89%), rash (4.44%) and local reactions (22.22%). All of the reactions resolved spontaneously. We conclude that Edmonston-Zagreb measles vaccine is efficacious and safe in infants aged under nine months.

Childhood melioidosis in northeastern Thailand.

Eighteen cases of childhood melioidosis in Northeastern Thailand were reviewed. The mean age was 6.8 years with a range from eight months to 15 years. Twelve cases (66.7%) had localized melioidosis, six of which had pneumonia. Three patients were diagnosed as pharyngocervical melioidosis, the newly recognized syndrome. Nine cases (50.0%) had associated diseases including dengue hemorrhagic fever (DHF) in five cases. In all five cases, melioidosis was diagnosed during the convalescent stage as a cause of pyrexia with or without pneumonia. Pseudomonas pseudomallei strains isolated from 12 patients were all sensitive to chloramphenicol, cotrimoxazole and kanamycin. Ceftazidime, cefotaxime and ceftriaxone were also active against all six isolates tested. Three cases died, all were diagnosed as disseminated septicaemic melioidosis at postmortem. The overall mortality rate was 16.7%. The septicaemic form of melioidosis can resemble many diseases such as septicaemia due to Staphylococcus aureus or gram-negative organisms other than P. pseudomallei while the localized from may mimic pulmonary tuberculosis. A high index of clinical suspicion is required in making a diagnosis of melioidosis, particularly in areas where the disease is endemic.

Measles-associated diarrhoea in northeastern Thailand.

A significant proportion of the illness and death of diarrhoeal diseases in the developing world is estimated to be due to the diarrhoea associated with measles. During February 1983-January 1984 a prospective study of measles in a hospital in Northeastern Thailand was conducted. A total of 550 cases of measles were studied. Diarrhoea was the most frequent complication of measles, occurring in 233 cases (42.4%). The largest proportion (46.2%) of cases with diarrhoea occurred in May-July. Children with measles aged 6-11 months had the highest frequency of diarrhoea (65.7%). Cases aged 1 year and 0-5 months had diarrhoea rates of 60% and 57% respectively. The proportion of measles cases with diarrhoea decreased with increasing age. Only 9.1% (9/99) of stools sent for bacteriological culture were positive. In three of these Shigella spp. were isolated. The rest were non-typhoid Salmonella (2), enteropathogenic Escherichia coli (2), Vibrio cholera (1), and Vibrio parahaemolyticus (1). Other complications among measles cases were pneumonia in 168 (30.5%), otitis media in 28 (5.1%), convulsion in 13 (2.4%), croup in 9 (1.6%), encephalitis in 4 (0.7%), and sepsis in 1 (0.2%). Seven cases (1.3%) died, 4 from pneumonia, 2 from encephalitis, and 1 from sepsis.