Typhoid Vi: a less reactogenic vaccine.

A typhoid vaccine derived from the purified Vi capsular polysaccharide (CPS) antigen of Salmonella typhi was compared with a heat-killed whole-cell typhoid vaccine in 637 healthy male volunteers. The individuals were placed in three groups: group 1 received two doses of heat-killed whole-cell typhoid vaccine, at an interval of 28 days; group 2 received a single dose of typhoid Vi CPS vaccine followed after 28 days by water for injection; and group 3 received water for injection on the first occasion and a single dose of typhoid Vi CPS vaccine 28 days later. Local and systemic adverse reactions were recorded for 5 days following each injection. Subjects receiving the typhoid Vi CPS vaccine complained of fewer local adverse reactions on each of the first 3 days following immunization: on day 1, 18.6% of subjects given typhoid Vi CPS vaccine reported local reactions compared with 59.7% of those receiving heat-killed whole-cell vaccine (P less than 0.001). The percentage of subjects receiving the heat-killed whole-cell vaccine who complained of systemic reactions was more than twice that of subjects receiving the Vi CPS vaccine (7.9% and 3.4%, respectively, on day 1; P less than 0.01).

Reduced peripheral vascular symptoms in elderly patients treated with alpha-methyldopa--a comparison with propranolol.

A multicentre study of 6-10 weeks duration was performed in 60 ambulant hypertensive patients aged over 60 years to compare the efficacy of methyldopa and propranolol with particular reference to the occurrence of cold extremities and sleep disturbances. Blood pressure was effectively controlled by both drugs being reduced from a mean of 180/108 mmHg to 161/93 with methyldopa and 180/108 to 162/94 with propranolol. More patients treated with methyldopa (74%) achieved the target diastolic blood pressure of 95 mmHg or below compared with those treated with propranolol (58%). Side effects were more frequent in the propranolol group necessitating the withdrawal of four patients from the study. Only one patient on methyldopa was withdrawn. The incidence of cold extremities was significantly greater with propranolol. The occurrence of sleep disturbances was similar in both groups. In this group of elderly patients methyldopa was better tolerated than propranolol.

A multicentre open trial indapamide in general practice.

In a multicentre open study, 99 patients were treated with indapamide (2.5 mg daily) by 19 general practitioners. Fourteen patients failed to complete the study and in most cases this was unrelated to active therapy. Fifty patients had not previously received antihypertensive therapy, 25 patients had been on previous antihypertensive therapy with either unsatisfactory blood pressure control of side effects and the remaining 10 patients had indapamide added to their existing therapy. Of the 85 patients who did complete, the mean reduction in blood pressure at the end of 4 months treatment was 26 mmHg systolic and 17 mmHg diastolic. In those patients who were studied for at least 12 months treatment, blood pressure control was maintained in the majority. No severe side effects were reported.

Immunity to challenge in volunteers vaccinated with an inactivated current or earlier strain of influenza A(H3N2).

Volunteers were inoculated with vaccine made from the 30c mutant, A/Port Chalmers/73 or B/Hong Kong/8/73. Preliminary experiments showed that the 30 c strain was antigenically quite close to A/HK/8/68. Volunteers given 30c developed haemagglutination inhibiting antibodies against the 'current' 1973 serotypes (as well as to the vaccine virus) but the titres were less than those after the A/PC/73 vaccine. Volunteers were then challenged with a live attenuated virus, WRL 105, with A/Finland/4/74 antigens, by intranasal inoculation. The rates of infection were 43% after B/Hong Kong/8/73, 20% after 30c and 5% after A/PC/73. This indicated that the 30c gave some protection but that the vaccine prepared from the current strain gave more.

Vaccination of rubella-susceptible women during oral contraceptive care in general practice.

Over a six-month period women attending a general practice surgery for contraceptive pill prescriptions were asked whether they had had rubella and if they would give a blood sample to test for immunity. Of 459 interview, 104 (23%) did not want any more children and 69 (15%) had been vaccinated or had been shown to be immune by serotesting. Only three refused to give a blood sample, and 283 patients (62%) had their antibody concentrations checked. Two hundred and twenty-five (79-5%) could be reassured that they were immune, and the rest were offered rubella vaccination. It is thus quite feasible, and would add little to the work load, to screen the susceptible women in a practice and offer rubella vaccination to those needing it.

A clinical trial of WRL 105 strain live attenuated influenza vaccine comparing four methods of intranasal vaccination.

A single intranasal dose of 10(7-0) EID50 recombinant WRL 105 strain live attenuated influenza vaccine was administered intranasally to 193 volunteers either as nose drops or by one of three spray devices which produced sprays of differing physical characteristics. In volunteers with homologous haemagglutinating inhibiting antibody titres of less than or equal to 20 before vaccination, seroconversion rates varied widely from 80% following the administration of drops to 71%, 57% and 28% with the three spray devices. In the week following vaccination 16 (22%) of 74 volunteers who were found to show a fourfold or greater antibody response to took analgesics to control symptoms in comparison with 4 (7%) of 58 volunteers who exhibited no serological response to vaccination (P less than 0-05). However, neither the occurrence of upper respiratory nor systemic symptoms were significantly different in these two groups and the degree of attenuation of the recombinant WRL 105 strain appears to be acceptable for future use.

A clinical trial of WRL 105 strain live attenuated influenza vaccine comparing four methods of intranasal vaccination.

A single intranasal dose of 10(7.0)EID50 recombinant WRL 105 strain live attenuated influenza vaccine was administered intranasally to 193 volunteers either as nose drops or by one of three spray devices which produced sprays of differing physical characteristics. In volunteers with homologous hemagglutinating inhibiting antibody titres of less than or equal to 20 before vaccination, seroconversion rates varied widely from 80% following the administration of drops to 71%, 57% and 28% with each of the spray devices. In the week following vaccination 16 (22%) of 74 volunteers who were found to show a fourfold or greater antibody response took analgesics to control symptoms in comparison with 4 (7%) of 58 volunteers who exhibited no serological response to vaccination (p less than 0.05). However, neither of the occurrence of upper respiratory nor systemic symptoms were significantly different in these two groups and the level of attenuation of the recombinant WRL 105 strain appears to be acceptable for future use.