Subject(s)
Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy , Primary Health Care/methods , Age Factors , Antacids/therapeutic use , Child , Child, Preschool , Diagnosis, Differential , Fundoplication , Gastroesophageal Reflux/etiology , Histamine H2 Antagonists/therapeutic use , Humans , Infant , Infant Food , Medical History Taking/methods , Nurse Practitioners , Nursing Assessment/methods , Pediatric Nursing/methods , Physical Examination/methods , Posture , Risk FactorsABSTRACT
Few data are available on the effect of a booster dose of acellular pertussis vaccine in children primed as infants with acellular vaccine. We administered acellular pertussis vaccine (ACV) at 19 months to children immunized in infancy with ACV or whole cell vaccine. Forty-one infants had been randomly assigned to receive either ACV or whole cell vaccine at 2, 4 and 6 months of age. Antibody titers to pertussis toxin and filamentous hemagglutinin were significantly higher in ACV than whole cell vaccine recipients at 7 months; at 15 months antibody to filamentous hemagglutinin (but not pertussis toxin) remained significantly higher among those receiving ACV. At 19 months all 41 children received an ACV booster. Local and systemic reactions were few and minor and were equally distributed between the two groups. All children responded to booster with significant increases in antibody; these increases tended to be greater for those having been primed with ACV. ACV booster immunization appears safe and immunogenic, regardless of the vaccine given for primary immunization.
Subject(s)
Antibodies, Bacterial/analysis , Immunization, Secondary , Pertussis Toxin , Pertussis Vaccine/immunology , Virulence Factors, Bordetella/immunology , Age Factors , Hemagglutinins/immunology , Humans , Immunization Schedule , Infant , Pertussis Vaccine/adverse effectsABSTRACT
Purified acellular pertussis vaccine (12.5 micrograms of lymphocytosis promoting factor [LPF] and 12.5 micrograms of filamentous hemagglutinin [FHA]) was compared with conventional pertussis vaccine in a randomized double-blind study involving 40 children aged 4-6 y, 40 children aged 18-24 mo, and 50 infants. Increases in antibody were significantly greater among recipients of acellular vaccine than among recipients of conventional vaccine for antibodies to LPF in all age groups and for antibodies to FHA in infants and children aged 4-6 y; the increase in FHA antibody was also greater with acellular vaccine among children aged 18-24 mo but not significantly so. Compared with conventional vaccine, acellular vaccine was significantly associated with reduced frequency of leg pain and fretfulness at all ages and less frequent fever and anorexia at some ages. The reduced reaction rates and comparable or enhanced immunogenicity of the acellular vaccine make it an attractive candidate for larger field trials, particularly among infants.
Subject(s)
Antibodies, Bacterial/biosynthesis , Pertussis Vaccine/immunology , Cell-Free System , Child, Preschool , Double-Blind Method , Drug Evaluation , Hemagglutinins/immunology , Humans , Infant , Pertussis Toxin , Pertussis Vaccine/adverse effects , Virulence Factors, Bordetella/immunologyABSTRACT
ARDS yearly afflicts more than 150,000 people, many of whom are young and otherwise healthy and yet the mortality rate remains in excess of 60% to 70%. This high mortality has not yielded to the significant gains made in intensive care patient management and rapid advances in technology. Acute lung injury research in the past 15 to 20 years has greatly enhanced our understanding of the pathophysiologic mechanisms underlying this complicated disorder. Therapeutic goals should be aimed at total patient surveillance and support, including the psychosocial aspects of patient care. Fortunately, basic research has recently yielded promising results with pharmacologic interventions designed to limit lung injury or prompt lung repair. Clinical trials underway and proposed will determine which, if any, of these approaches is effective. Until success is achieved, supportive intensive care with diligent attention to infection control, fluid therapy, nutrition, and ventilator management will remain the focal point of therapy for ARDS.
