Vacinação antissarampo / Antiserum vaccination

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Immunogenicity and safety of Abhay M and M-vac vaccines in healthy infants: a phase III multicentric randomized single blind trial.

OBJECTIVE: To study immunogenicity and safety of Abhay M and M-Vac vaccines in prevention of measles in healthy infants. METHODS: In a randomized, single blind, comparative, multi-centric phase III trial, a total of 600 healthy infants between 9 - 15 months of age were recruited in the study from seven participating sites during five months. The block randomization design was used for randomizing the subjects into 2 vaccine groups (Investigational Vaccine - Abhay M and Control Vaccine - M-Vac) in the ratio 2:1. At base line (visit 1) a venous blood sample 1.5 ml was collected and subjects were then administered a single dose 0.5 ml of measles vaccine (Abhay M or M-Vac vaccine) subcutaneously according to randomization. Following administration of vaccine, subjects were observed closely for 30 - 60 minutes at the study hospitals for local reactions and systemic events. At visit 2 (follow up visit) another venous blood sample 1.5 ml was collected and the paired sera (both pre and post vaccination serum) were tested concurrently. Safety and immunogenicity were assessed through follow-up of adverse events and anti measles antibody response respectively. RESULTS: Overall 95.7 % seroconversion was achieved in both the groups, 96% in Abhay M vaccine group and 95.1%. in M-Vac vaccine group. There were no statistically significant differences in the observed seroconversion rates. In Abhay M vaccine group, the pre vaccination geometric mean titers (GMT) significantly increased from 35.5 mIU/ml to 486.9 mIU/ml after vaccination. The observed significant increase of GMT in M-Vac vaccine group was from 33.3 mIU/ml to 375.8 mIU/ml. Overall 459 (82.5%) out of 556 subjects were seroprotected after vaccination i.e. > or equal to [corrected] 200 mIU/ml (Protective levels). Of the 459 seroprotected, 315 (84.9%) subjects were in Abhay M vaccine group and 144 (77.8%) subjects were in M-Vac vaccine group. The frequencies of the reported local and general symptoms were similar between the Abhay M vaccine group and M-Vac vaccine group. CONCLUSION: Human Biologicals Institute's Abhay M vaccine is equally immunogenic and as safe as M-Vac vaccine when administered to healthy infants in single dose schedule.

Early onset optic neuritis following measles-rubella vaccination

To report two cases of optic neuritis with onset less than 24 hours following measles-rubella [MR] vaccination. Two teenage patients developed acute optic neuritis 6 to 7 hours after MR booster vaccination. The first patient demonstrated bilateral papillitis and severe visual loss but improved significantly with pulse intravenous steroid therapy with methylprednisolone 500 mg/day. The second patient had unilateral retrobulbar optic neuritis and demonstrated excellent visual recovery without intervention. Acute optic neuritis is a rare complication of MR vaccination and may occur early after immunization

Use of a-interferon, amantadin and isoprinosine in subacute sclerosing panencephalitis [SSPE]: comparing the effectiveness

Sub acute Sclerosing Pan Encephalitis [SSPE], a progressive neurological disorder characterized by inflammation of the brain [encephalitis], is the result of an inappropriate immune response to the measles virus or measles vaccination. SSPE usually develops 2 to 10 years after the original viral attack. Some of the major signs and symptoms are mental deterioration, jerky movements, and seizures specially myoclonic type, involuntary movements, and/or behavioral changes, difficulty in walking, speech, and loss of cognition, respiratory distress and death. During the ten years, from July 1991 to July 2001, we admitted 45 cases of [SSPE], at different stages of the disorder. Regardless of their stage of disease, for intervention, randomly, we used one of three drugs; Amantadin, Interferon alfa and Isoprinosine, administered to the patients, for between one month to one year. Fourteen cases received Amantadin, 15 Alfa interferon, and 16 were given Isoprinosine. While the results show all three drugs to be relatively effective, Isoprinosine showed four times more effectiveness than Amantadin and twice as much as Interferon. The results showed Isoprinosine to be much more effective than Amantadin and Alfa interferon in treating the condition

Desarrollo de anticuerpos y frecuencia de eventos temporalmente asociados a las vacunas contra el sarampión y rubéola en personal de salud universitario de Jalisco / Antibody development and frequency of events temporarily with measles and rubella vaccines among university health personnel in Jalisco

Objetivo: Evaluar el estado inmune y la seroconversión o respuesta anamnésica posterior a inmunización con vacuna de sarampión-rubéola (SR) y eventos temporalmente asociados, en personal de salud universitario. Materiales y métodos: Estudio prospectivo, longitudinal y comparativo de mayo a junio de 2000 en 120 adultos sanos de un Hospital de la Universidad Autónoma de Guadalajara. Previo consentimiento informado se aplicó la vacuna SR de sarampión (Schwarz) y rubéola (RA 27/3). Se realizó seguimiento telefónico semanal para identificar eventos locales y sistémicos temporalmente asociados a la vacunación (30 días posteriores a su aplicación, no atribuibles a otro proceso mórbido). Se tomó suero antes y seis semanas después de la vacunación. Los anticuerpos (IgG) contra sarampión y rubéola fueron cuantificados por análisis inmunoenzimático (Enzygnost®, Dade Behring) con puntos de corte de > 300mUI/mL y > 8UI/mL, respectivamente. Análisis: media, desviación estándar (DS), Prueba t de Student pareada (significancia de P < 0.05). Resultados: Se logró seguimiento en 105/120 (87.5%) durante seis semanas. El 87.4% fue personal de salud y 44.6% varones. Rango de edad 17-71 años (mediana = 21). En la historia clínica hubo antecedente de posible sarampión en 57.1%. Se obtuvo suero pareado en 75 casos. La proporción de voluntarios con anticuerpos para sarampión y rubéola antes (90.7 y 94.7%) y después (100 y 100%) de la vacuna se incrementó de manera significativa (P < 0.001). Dolor, calor, rubor e induración en el sitio de inyección se presentó en 4/105 (~4%). Fiebre, exantema, artralgias y artritis en 9/105 (~9%). Conclusiones: La proporción de susceptibles a sarampión fue alta si tomamos en consideración la potencialidad de transmisión del virus de sarampión a la población que atenderían durante el período de contagiosidad (3-5 días). La respuesta de inmunidad postvacunal fue óptima. La vacunación en personal de salud debe ser prioritaria.

Objective: To evaluate the seroprevalence, seroconversion, anamnesic response and events temporally associated with immune status pre and post immunization with measles and rubella vaccine in health personnel from a public University in Guadalajara, Mexico. Material and methods: We carried out a prospective, longitudinal and comparative study from May to June 2000 among 120 healthy volunteers. Informed consent was obtained from all participants. We administered measles (Schwarz) and rubella (RA 27/3) vaccines. Weekly phone calls during six weeks were recorded from each volunteer to assess local and systemic events temporally associated with immunization non attributable to any other disease. Serum samples were obtained before and after vaccination in 75 volunteers. Antibodies against measles and rubella were measured by an enzyme immunoassay kit (Behring) with cut-off points of ³300mUI/mL and ³8UI/mL respectively. Statistical analysis included mean, standard deviation and paired Student's t-test (P < 0.05). Results: 105/120 participants (87.5%) were followed during 6 weeks. 87.4% were health personnel and 44.6% were males. The age range was 17-71 years (median = 21). We found a prior history of measles in 57.1%. Local events included pain, heat, redness and induration and were reported by 4/105. Systemic events such as fever, exanthema, pain in joints and arthritis was reported by 9/105. The proportion of study subjects with protective antibodies against measles and rubella prior to vaccination was 90.7 and 94.7% respectively. Both groups reached 100% after vaccination. Conclusions: The proportion of non-immune health personnel was low and similar to other reports. However, the potential spread of measles and rubella virus from a non-immunized infected health care provider could be amplified by the number of patients seen daily during the peak period of 3-5 days. The vaccination of health personnel should be encouraged.

Anestesia em criança com síndrome de Guillain-Barré após vacina de sarampo: relato de caso / Anesthesia in children with Guillain-Barré syndrome after measles vaccination: case report

JUSTIFICATIVA E OBJETIVOS: A síndrome de Guillain-Barré após vacina de sarampo é rara. O diagnóstico muitas vezes é tardio, o que leva a um aumento da morbidade. O presente relato apresenta um caso avançado e os cuidados especiais exigidos durante a anestesia. RELATO DO CASO: Paciente do sexo masculino, com quatro anos de idade com síndrome de Guillain-Barré desde um ano de idade, foi submetido a gastrostomia sob anestesia geral sem intercorrências, com sevoflurano e sem bloqueadores neuromusculares. CONCLUSÕES: O caso ilustra a raridade etiológica de uma síndrome importante na prática anestésica assim como os eventos adversos pós-vacinação, a melhor escolha para a equipe anestésica e as complicações da síndrome de Guillain-Barré na infância.

[Bilatral optic neuritis following measles/rubella [MR] vaccination [a case report]]

A thirteen years old female caucasition admitted in 5 Azar General hospital with a 3-day history of deteriorating vision. Two weeks prior to admission she had received a measles-rubella vaccination at school [as a mass campain of MR vaccination in IRAN]. General and neurological examination except lung wheezing and occular findings were normal. In visual exam she had questionable light perception in right eye and hand motion sensation in left eye. Funduscopy revealed moderate bilateral opitc disc hypermia. Investigations revealed normal full cell blood count, biochemistry profile, clotting studies and sputum. Brain CT scan and MRI were normal except pansinusitis. CSF examination revealed normal constituents. The patient treated with methyl prednisolon [1 gr/daily] for 7 days and patient had dramatic response to therapy. After 6 weeks of starting medical treatment ophthalmologic exam revealed 2 meters finger count vision in Rt eye and 6/10 visual aquity in Lt side. This patient is a rare case of bilateral optic neuritis after MR vaccination

Rash after measles vaccination: laboratory analysis of cases reported in Säo Paulo, Brazil

OBJETIVO: O diagnóstico diferencial de doenças exantemáticas causadas por vírus é geralmente difícil, e equívocos näo säo raros, especialmente depois da introduçäo da vacina contra o sarampo e a rubéola. Um estudo laboratorial foi conduzido com o objetivo de estabelecer o diagnóstico etiológico de casos de exantema em crianças que receberam a vacina contra o sarampo. MÉTODOS: Soros de casos de exantema em crianças que receberam vacina contra o sarampo, em 1999, foram analisados para anticorpos IgM contra os vírus do sarampo, da rubéola e do parvovírus humano B19 (HPV B19), por técnicas comerciais de Elisa, e o herpes vírus humano tipo 6 (HHV 6), por técnica comercial de imunofluorecência. A viremia para cada um desses vírus foi testada pela reaçäo em cadeia da polimerase (PCR). RESULTADOS: Foram notificados, em 1999, 17 casos de crianças com exantema pós-vacinal. A idade das crianças era de nove a 12 meses (mediana, dez meses). Uma amostra de sangue colhida para investigaçäo laboratorial foi obtida para cada criança. O tempo decorrido entre a aplicaçäo da vacina e o aparecimento do exantema variou de um a 60 dias. Os resultados da sorologia das 17 crianças sugeriram o seguinte diagnóstico etiológico para o exantema: 17,6por cento (três em 17) infecçäo pelo HPV B19; 76,5por cento (13 em 17) infecçäo pelo HHV 6; 5,9por cento (um em 17) exantema originado pela vacina do sarampo. CONCLUSAO: Os resultados indicaram que a infecçäo pelo HPV B19 ou pelo HHV 6 pode ser diagnosticada como sarampo de origem vacinal. Portanto, é fundamental incluir esses vírus no diagnóstico laboratorial para corretamente apontar a etiologia das doenças exantemáticas, evitando, assim, atribuir à vacina do sarampo efeito colateral

Tipos de vacunas pediátricas / Types of pediatric vaccines

La autora describe las vacunas pediátricas de uso obligatorio en nuestro país en la actualidad. Se menciona su acción, vía de administración, efectos adversos y contraindicaciones

Immune responses to measles immunization and the impacts on HIV-infected children.

This prospective cohort study was conducted to determine the seroconversion rate and the pattern of antibody response to measles vaccine administered at age 9 months in HIV infected and non-infected children born to HIV-1 seropositive mothers. Thirty children born to HIV-1 seropositive mothers and 3 born to HIV-1 seronegative mothers were recruited. One single dose of Schwarz strain of measles virus vaccine (Rouvax) was given to every child at 9 months of age. Clinical status and measles antibody levels were evaluated at the time just before vaccination, 2 and 12 weeks post-vaccination. Antibody was measured by an enzyme immunoassay commercial kit (Enzygnost, Dade Behring Manufacturer, Germany). Children were classified into 3 groups, groups 1 and 2 were children with and without HIV infection respectively. Group 3 children were those born to HIV-1 seronegative mothers. Of the 33 enrolled children, 16, 14 and 3 were classified as groups 1, 2 and 3 respectively. Four children, 2 of each, in groups 1 and 3 did not complete the study. Group 3 was excluded due to the small number of children recruited. There was no short term complication and no measles infection noted during the course of study. None of the children had pre-existing antibodies. The median (range) of CD4 count and CD4/CD8 ratio measured at the time of vaccination were statistically different between groups 1 and 2 children. Group 2 children had better antibody response than group 1 in terms of seroconversion rate and median of antibody levels at 12 weeks post-vaccination. Only 7 of 29 children (24.1%) had detectable measles antibodies at 2 weeks post-vaccination. A decrease in antibody was noted in 2 symptomatic HIV infected children as their disease had progressed. Various potential predictors of measles vaccine responses in HIV infected children including CD4 count and CD4/CD8 ratio were not statistically different between the responders and non-responders. All 4 asymptomatic HIV infected children were responders. This study demonstrated that all of the children had already lost their maternal acquired antibodies at age 9 months. HIV infected children had a poorerantibody response to measles vaccine than the non-infected children.

Reaçöes adversas a vacina MMR em pacientes alergicos a ovo: revisao da literatura / Adverse reactions to MMR vaccine in patients with egg allergy: review

Reacoes adversas agudas apos a administracao da vacina MMR podem ocorrer em pacientes com hipersensibilidade a ovo. Essas reacoes podem decorrer da presenca de proteinas originadas do tecido embrionario da galinha, incluindo substancias antigenicamente similares ao ovo. Os autores deste relato discutem o risco da administracao da vacina MMR em criancas alergicas a ovo, concluindo que se trata de...