ABSTRACT
Two hundred twenty-four immune and non-immune adults were systematically assigned to receive a single dose of Nakayama strain JEVAC in one of four study "arms": 0.1 ml ID, 0.2 ml ID (injection of 0.1 ml at two sites), 0.3 ml ID (injection of 0.1 ml at three sites), or 1.0 ml SC. Immune responses after this single dose (in many cases "booster") was assumed to reflect immune responses of a primary series and was assessed qualitatively (percent seroconvertion) and quantitatively (geometric mean titer) a 30 and 90 days post immunization. The results showed that JEVAC given 0.1 ml. ID at two sites is likely to be as immunogenic as 1.0 ml. given SC.
Subject(s)
Encephalitis Virus, Japanese/immunology , Encephalitis, Japanese/immunology , Viral Vaccines/administration & dosage , Adult , Antibodies, Viral/biosynthesis , Encephalitis, Japanese/prevention & control , Female , Humans , Injections, Intradermal , Male , Vaccination , Vaccines, Inactivated/administration & dosage , Vaccines, Inactivated/immunology , Viral Vaccines/immunologyABSTRACT
Death due to Japanese encephalitis usually occurs in the first 5 days of hospitalization as a result of deepening coma with respiratory arrest. Death may result from edema-induced increases in intracranial pressure that might be reduced by the administration of steroids. Sixty-five patients presenting in Thailand to four hospitals with a diagnosis of acute Japanese encephalitis were randomized in a double-masked fashion and stratified by initial mental status into a placebo group (saline) or a treatment group (dexamethasone 0.6 mg/kg intravenously as a loading dose followed by 0.2 mg/kg every 6 h for 5 days). Fifty-five of the 65 had confirmed Japanese encephalitis as demonstrated by detection of virus or by Japanese encephalitis virus-specific IgM antibody. Important outcome measures included mortality (24%, treatment group; 27%, control group), days to alert mental status (3.9 vs. 6.2), and neurologic status 3 months after discharge (45% abnormal in each group). No statistically significant benefit of high-dose dexamethasone could be detected.
Subject(s)
Dexamethasone/therapeutic use , Encephalitis, Japanese/drug therapy , Acute Disease , Adolescent , Adult , Child , Child, Preschool , Dexamethasone/administration & dosage , Dexamethasone/pharmacology , Double-Blind Method , Encephalitis, Japanese/mortality , Female , Follow-Up Studies , Glucose/cerebrospinal fluid , Humans , Infant , Injections, Intravenous , Intracranial Pressure/drug effects , Male , Middle Aged , Neurologic Examination , Treatment OutcomeABSTRACT
Fifteen patients with acute encephalitis were studied during the epidemic season of Japanese encephalitis (JE) in Northern Thailand; 13 of 15 proved to have the encephalitis. In serial cerebrospinal fluids and blood samples, mononuclear cells were identified using monoclonal antibodies. In cerebrospinal fluid from the patients with Japanese encephalitis, T cells predominated with a 4.2:1 ratio of T helper/inducer cells to T suppressor/cytotoxic cells; B cells and macrophages were often present but in small numbers compared to their presence in blood. Distribution of cell types did not vary between the first and fifth day of hospitalization, were similar in fatal and nonfatal cases, and were unaffected by administration of steroids.
