Hepatitis and death following vaccination with 17D-204 yellow fever vaccine.

We describe a man vaccinated with the 17D204 strain of yellow fever virus, who subsequently died of yellow fever. Sequencing of the NS5-39 untranslated region showed that the virus isolated from the patient was identical to the vaccine strain of the same batch, and different from wild-type virus. Both viruses contained a mutation, although the association of this mutation with virulence is unknown. Severe, rapidly progressive, and ultimately fatal disease can follow use of the 17D204 vaccine strain. There is need for renewed discussion as to the safety of the vaccine and the indications for its use.

Acute hepatitis C virus infection in an Australian prison inmate: tattooing as a possible transmission route.

Clinically apparent hepatitis C virus (HCV) infection developed in a prison inmate after two tattooing episodes within the recognised incubation period for HCV infection. Seroconversion and HCV viraemia with subsequent resolution of hepatitis and loss of plasma viraemia were documented. Introducing licensed tattooists, and thereby improving infection control practices, may reduce the risk of hepatitis C virus infection in prisons.

Comparison between three PCR methods for detection of human cytomegalovirus DNA.

Three methods for the detection of human cytomegalovirus DNA using the polymerase chain reaction (PCR) were compared with and without a wax-mediated hot start. This process yielded a 10-fold increase in the sensitivity of the detection of specific DNA. The PCR method chosen as most suitable for subsequent testing, when applied to urine samples from patients with AIDS, gave a higher proportion of positive results than either the shell vial assay or conventional cell culture. On the basis of these results, further work is being carried out to evaluate the value of the PCR, when the results are expressed quantitatively, in the laboratory diagnosis of cytomegalovirus infection in patients with AIDS.

Specific IgA antibody response in Ross River virus infection.

Sera were collected over a period of several years from the onset of initial symptoms from 77 patients with Ross River virus infection. When tested for virus-specific IgA antibodies, using an enzyme-linked immunosorbent assay (ELISA) based on antibody class capture, 245 out of 704 sera were antibody-positive. Although Ross River virus IgA antibodies were present in the serum of all patients soon after onset of symptoms, the IgA response was relatively short-lived in comparison with specific IgM antibodies. The results suggested that the detection of high levels of Ross River virus IgA antibodies was of potential value in differentiating between recent and past infection, especially in those patients with persisting IgM antibodies.

Human arbovirus infections along the south coast of New South Wales.

The prevalence of antibodies in human sera from the south coast of New South Wales to four arboviruses, isolated from mosquitoes collected along the south coast, was determined in an attempt to estimate the importance of these viruses in human infection. Only two viruses, Barmah Forest and Gan Gan, were considered to be of any significance.

Detection of Ross River virus immunoglobulin M antibodies by enzyme-linked immunosorbent assay using antibody class capture and comparison with other methods.

An enzyme-linked immunosorbent assay based on antibody class capture was developed for the detection of Ross River virus-specific immunoglobulin M antibodies (RRV IgM). The assay was specific, reproducible and precise. When compared with conventional tests for the detection of RRV IgM, such as hemagglutination inhibition following sucrose density gradient centrifugation and indirect enzyme-linked immunosorbent assay, the class capture assay was more sensitive. In 186 sera which were collected from 39 patients with RRV infection over a period of 1-4 yr from onset of initial symptoms, RRV IgM persisted for at least 1-2 yr. Sera were tested both at a single dilution from which the results were expressed as a binding index and in a dilution series in which they were expressed as an antibody titre. Binding index values gave better discrimination between sera collected during acute and later phases of the disease and may be of greater value than antibody titres in the diagnosis of RRV infection.

Ross River virus activity along the south coast of New South Wales.

The sera of 468 blood donors and 63 domestic animals, collected from the south coast of New South Wales, were tested for the presence of antibodies to Ross River virus. Antibodies were detected in 7% of human sera, 25% of cow sera and 65% of horse sera. Using the blood donors as 'human sentinels', seroconversions were demonstrated in two donors from the Nowra-Kiama region and from a patient in the same area; none of the three had been outside of the study area during the period of seroconversion or at the time of infection. Of the 15 seropositive horses, 6 (40%) had lived continuously since birth on the farms on which they were bled. That humans and horses were infected with Ross River and not a related alphavirus was shown by microneutralization tests against Ross River virus and the other two alpha-viruses (Getah, Sindbis) known to occur in Australia.

A two-part study of the aetiological role of rotavirus in intussusception.

The aetiology of intussusception is ill-defined, with viruses being incriminated as one of many possible aetiological agents. A two-part study was performed by us to investigate the aetiological role of rotavirus in intussusception. Retrospective epidemiological data revealed a negative correlation between the incidence of rotaviral gastroenteritis and the incidence of intussusception. A prospective investigation employing electronmicroscopy, enzyme-linked immunosorbent assay (ELISA), and immunofluorescence studies of faeces and fluorescent antibody studies of sera demonstrated evidence of rotavirus infection in only 2 of 24 children with intussusception. No evidence was forthcoming in this study of an aetiological role of rotavirus in intussusception.

Comparison of serum myoglobin and creatine kinase MB isoenzyme in early diagnosis of acute myocardial infarction.

We compared the clinical usefulness of serum myoglobin and creatine kinase MB (CK MB) isoenzyme determinations in the early diagnosis of acute myocardial infarction in 109 consecutive patients admitted to a coronary care unit. Of these, 37 patients were diagnosed as having definite infarction, three possible infarction, and 69 no infarction, using World Heath Organisation criteria. Blood samples were taken on admission and two to four hours later, Both CK MB and myoglobin were raised in the initial serum samples in 24 of the 37 patients with definite infarction. In an additional seven patients both CK MB and myoglobin were negative in the first specimen though both were detected in the second sample. In five patients CK MB preceded the appearance of myoglobin while in the remaining patient myoglobin appeared before CK MB. We conclude that the detection of serum myoglobin does not offer any clinical advantage over CK MG as an early indicator of myocardial infarction.

An enzyme-immunoassay for myoglobin in human serum and urine. Method development, normal values and application to acute myocardial infarction.

An enzyme-immunoassay has been developed for the detection of myoglobin in human serum and urine which is specific, accurate, precise, and has a sensitivity of 3 ng/ml. When compared with radioimmunoassay, the enzyme-immunoassay gives markedly similar results. Sera from normal adults had a myoglobin concentration in the range 3-65 ng/ml, and 64% of the same group had detectable myoglobinuria (range 3-11.5 ng/ml). All of 8 patients with definite acute myocardial infarction had raised serum myoglobin levels (range 200-1125 ng/ml) either at admission or 4 h later. Myoglobin concentration returned to normal in 6 patients, and in the remaining 2 patients there was evidence of infarct extension. Urinary myoglobin excretion was variable. One patient with possible acute myocardial infarction had elevated serum myoglobin (413 ng/ml 4 h post admission) and 5 patients with no evidence of infarction had normal levels (15-53 ng/ml). The results suggest that detection of serum myoglobin by enzyme-immunoassay may be a valuable test in the early diagnosis of acute myocardial infarction.