Acellular pertussis vaccines in infants: evaluation of single component and two-component products.

Two acellular pertussis vaccines, one containing only LPF toxoid (25 micrograms) and the other containing LPF toxoid (25 micrograms) and FHA (25 micrograms) and each combined with diphtheria and tetanus toxoids, were evaluated in two groups of 25 infants. A third group of 25 infants served as controls and received a DTP whole-cell pertussis vaccine. Infants given either acellular pertussis vaccine had significantly fewer local and systemic reactions than infants given whole-cell vaccine. Among the three vaccine groups, infants given the LPF vaccine (single component) had the highest concentration of antibody to LPF after three immunizations. Infants receiving the LPF/FHA vaccine (two-component) had the highest concentration of antibody to FHA after three immunizations. Infants vaccinated with the two-component vaccine had a significantly lower serological response to LPF than infants given the single component vaccine, as measured by either enzyme-linked immunosorbent assay or CHO cell assay. Further studies are necessary to determine why differences in immunogenicity of the two investigational vaccines occurred.

Rabies Vaccine Adsorbed: neutralizing antibody titers after three-dose pre-exposure vaccination.

Field trials at several schools of veterinary medicine showed that three-dose pre-exposure rabies vaccination with Rabies Vaccine Adsorbed developed by the Michigan Department of Health elicited neutralization antibody in practically all recipients two to three weeks after immunization. Titers declined during the first six months after vaccination. However, by 18 to 24 months, 98 percent of recipients still had titers equal or greater than a 1:5 dilution of serum.

Rhesus diploid rabies vaccine (adsorbed), a new rabies vaccine. II. Results of clinical studies simulating prophylactic therapy for rabies exposure.

Rhesus diploid-cell-strain rabies vaccine (RDRV) (adsorbed) is a new rabies vaccine intended for use in man. Sixty volunteers were given five doses of RDRV at 0, 3, 7, 14, and 28 days to simulate prophylactic treatment of persons exposed to a rabid animal. Thirty-five volunteers were given commercial high-titer rabies immune globulin, 20 IU/kg, before the first dose of RDRV, and 25 were given RDRV without prior rabies immune globulin. Antibody responses at 14, 28, and 42 days were comparable with those reported with human diploid rabies vaccine. Simulated postexposure prophylactic treatment with RDRV was associated with acceptable levels of local and constitutional symptoms.

Rhesus diploid rabies vaccine (adsorbed), a new rabies vaccine. Results of initial clinical studies of preexposure vaccination.

To meet the need for a safe, efficacious, and low-cost rabies vaccination program, the Michigan Department of Public Health developed a new rabies vaccine: rhesus diploid rabies vaccine, adsorbed (RDRV). Initial clinical studies were conducted in 534 volunteers using preexposure protocols consisting of two injections of RDRV given 1, 2, or 4 weeks apart. This new rabies vaccine induced an excellent rabies virus antibody response two to three weeks after vaccination: antibody levels were superior to those reported after duck embryo rabies vaccine and were similar to those reported with human diploid rabies vaccine. In addition, vaccination with RDRV was associated with an acceptable level of local and constitutional symptoms.

Antibody responses to influenza vaccination in patients with chronic renal failure.

A bivalent type A inactivated influenza virus vaccine containing both sets of H3N2 and Hsw1N1 antigens was given to patients with chronic renal failure and to control subjects. The patients were divided into an azotemic group in whom dialysis was not yet required and a hemodialyzed group. Hemagglutination-inhibition (HI) antibody responses were measured at time intervals of 1,3, and 4 weeks after vaccination. We found that the mean postvaccination HI titers against both sets of antigens in the patients as a group did not differ significantly from those found in the control subjects as a group. The proportion of responders showing a fourfold or greater increase in post-vaccination antibody responses over prevaccination antibody values for either set of antigens was similar in both groups of patients and the group of control subjects. In general, an inverse correlation was found between prevaccination antibody levels and postvaccination antibody responses in both patients and control subjects. The only exception to this trend was the response of two of the azotemic patients to the H3N2 antigens who failed to respond despite low prevaccination antibody levels. These were the patients with the highest serum creatinine values.

Bacterial or nonbacterial pneumonia: accuracy of radiographic diagnosis.

The initial chest radiographs of 31 patients with laboratory-proved pneumonia were evaluated by a panel of 6 radiologists who had no prior knowledge of the clinical data. No statistical reliability was found for distinguishing bacterial from nonbacterial pneumonia. Radiographic diagnoses were 67% accurate for the 16 cases of bacterial pneumonia, and 65% accurate for the 9 viral cases. Six cases of Mycoplasma pneumonia were diagnosed as nonbacterial 19% of the time, and as "bacterial pneumonia" 81% of the time.

Anti-"i" antibody and hemolytic anemia associated with spontaneous cytomegalovirus mononucleosis.

Hemolytic anemia occurred in a 23-year-old woman with spontaneous cytomegalovirus mononucleosis who had not received a blood transfusion. The patient's serum gave positive reactions in Coombs' antiglobulin test with human cord erythrocytes but did not react with adult "O" cells. Complement-fixation antibody titers against cytomegalovirus and levels of activity against cord erythrocytes increased as the anemia worsened and remained at high levels when recovery from the anemia occurred.

Some facets of clinical virology.

The availability of virus diagnostic laboratories now makes possible improved diagnosis of viral infections. Some of the benefits to the patient of diagnosing a viral infection are that further diagnostic procedures can be stopped with a saving of money and avoidance of discomfort, that unneeded therapy can be stopped, and that the prognosis of the disease can be more accurate. New developments in clinical virology are leading to a clearer definition of the role of viruses in both infectious and non-infectious diseases, and they hold out the promise of rapid diagnosis and specific antiviral therapy.