Analysis of adverse events following immunization of adsorbed acellular DPT vaccine at different vaccination sites / 上海预防医学

ObjectiveTo analyze the occurrence of suspected adverse events following immunization （AEFI） after changing the priority vaccination sites of the adsorbed acellular diphtherior-pertussis-tetanus vaccine （hereinafter referred to as DPT vaccine）， so as to provide scientific basis for mass vaccination. MethodsMonitoring data of AEFI for the DPT vaccine in Wujiang District from September 2020 to August 2022 were collected from China's disease prevention and control information system， and the vaccination information of DPT vaccine in all children's vaccination clinics in Wujiang District during the same period was selected. The incidence of AEFI for the DPT vaccine was analyzed and compared. ResultsThe reported incidence of AEFI was significantly lower in the buttocks than that in other sites （P<0.05）. The reported incidence of AEFI was significantly higher in booster immunization than that in basic immunization （P<0.05）. After inoculation at different sites， the main clinical symptoms of AEFI were local redness and swelling. There were significant differences in the incidence of local redness and swelling， local induration， pruritus and other symptoms （lethargy， abnormal crying， etc.） （P<0.05）. There were significant differences in the severity of local redness and swelling in different sites （P<0.05）. The degree of redness and swelling in the anterolateral thigh was lower than that in other sites （P<0.05）. The local strong reaction of swelling （>5.0 cm） in the deltoid muscle of the upper arm was significantly higher than that in the buttocks （P<0.05）. ConclusionThe DPT vaccine is safe in different parts of the body and is worth popularizing.

Erythema and induration of the Bacillus Calmette-Guérin site for diagnosing Kawasaki disease

INTRODUCTION@#Kawasaki disease (KD) is a challenging diagnosis. Erythema and induration of the Bacillus Calmette-Guérin (BCG) site is increasingly recognised as a significant clinical clue. However, there is little data to support its specificity for KD as compared to other febrile illnesses. We aimed to evaluate BCG reaction or induration as a diagnostic tool for KD.@*METHODS@#A retrospective case-controlled study of patients discharged with a diagnosis of KD from 2007 to 2010 was conducted. Another group of patients admitted over the same period for possible KD, but later found not to have KD, served as control.@*RESULTS@#Significantly more infants with KD (69.7%) had BCG site changes than older children (27.8%; p < 0.001). It also presented earlier in the course of KD; < 5 days (53.3%) compared to ≥ 5 days of fever (30.0%; p < 0.001). Positive predictive value of BCG site reaction or induration for KD was 90.8% (95% confidence interval [CI] 0.819-0.962) for infants and 96.2% (95% CI 0.868-0.995) for older children. The prevalence rate of changes at the BCG site was 9.9% among patients with non-KD febrile illnesses and 42.6% among patients with KD.@*CONCLUSION@#BCG site reaction or induration is a useful clinical clue for the diagnosis of KD in both infants and older children, with a higher prevalence in infants. Physicians should consider KD in children with febrile illness and redness or crust formation at the BCG site, especially in view of low rates of BCG reaction or induration in non-KD febrile illnesses.

Cytokine Expression at the Inoculation Site and Nearby Tissues in an Animal Model Infected with Metacyclic Trypomastigotes of Trypanosoma cruzi

Background. <I>Trypanosoma cruzi</I> infection is induced by triatomine contaminated feces containing metacyclic trypomastigotes acquired via small wounds in the skin. Natural unspecific and adaptive humoral and cellular immune responses play an important role in controling primary infection.<br>Objective: To determine the cytokine profile at the inoculation site and nearby tissues such as draining lymph nodes, as well as the heart and serum, throughout the acute and chronic phases in mice infected with metacyclic <I>T. cruzi</I> trypomastigotes.<br>Material and methods. Balc⁄c mice were intradermally inoculated with vector derived metacyclic trypomastigotes of <I>T. cruzi</I>. The RT-PCR technique was used to analyze the cytokine profile at the inoculation site, draining lymph nodes and heart. ELISA was used to determine cytokines in serum.<br>Results. A poor induction of cytokines within the two weeks after infection such as IL-12, IFN-gamma, IL-4, IL-10 and TGF-beta and undetectable IL-2 was observed at the inoculation site. On the other hand, in draining lymph nodes, cytokines such as IL-2, IL-10, IL-12, TGF-beta were detected from the first day after infection. In the heart, a mixed inflammatory and anti-inflammatory cytokine pattern was identified. In serum, all cytokines tested (IL-4, IL-10 IL-12 and IFN-gamma) were detected from the 5<SUP>th</SUP> day post-infection with the notorious exception of IL-2. Conclusion. A poor and late induction of protective cytokines such as IFN-gamma and IL-12 was observed at the inoculation site, in spite of adequate immune responses in lymph nodes. In addition, the pattern of cytokine expression strongly depended on the kind of tissue.