Immunogenicity of a Haemophilus influenzae type b-tetanus conjugate vaccine when administered separately or in combined vaccines for primary immunization in two consecutive national schedules in Turkey.

BACKGROUND: In Turkey, the Haemophilus influenzae type b-tetanus toxoid conjugate vaccine (Hib) was replaced by the combined diphtheria-tetanus-acellular pertussis and inactivated polio vaccine (DTaP-IPV/Hib) in 2008. This shift to the new schedule created different cohorts of vaccinated children as a consequence of the different schedules used. We evaluated the immunogenicity of the Hib vaccine in infants vaccinated with these different schedules. METHODS: Three groups of children were evaluated: group 1 comprised 145 infants vaccinated with diphtheria, tetanus, and whole cell pertussis (DTwP), oral polio vaccine (OPV), and Hib vaccines simultaneously at separate sites; group 2 comprised 204 infants vaccinated with the DTaP-IPV/Hib combined vaccine; group 3 comprised 100 infants vaccinated with a mixed schedule of DTwP, OPV, and Hib for the first one or two doses, followed by DTaP-IPV/Hib vaccine to complete the series. RESULTS: Anti-polyribosylribitol phosphate (anti-PRP) titers ≥0.15µg/ml were similar in groups 1, 2, and 3. However, in group 1, who received all the vaccines at separate sites, ≥ l.0µg/ml long-lasting antibody titers and anti-PRP geometric mean titers were higher (p=0.001). CONCLUSION: This study showed that even one dose administered in combination with other vaccines in a primary series decreased the level of anti-PRP.

A case report of amitriptyline poisoning successfully treated with the application of plasma exchange.

Amitriptyline is a very frequently prescribed antidepressant agent and is very often involved in attempted suicides. Amitriptyline intoxication necessitates primary therapeutic approaches that include gastric irrigation and recurrent administration of activated charcoal. In the case of pronounced anticholinergic findings, physostigmine is of proven benefit and hypertonic sodium bicarbonate can be used to shorten the QRS duration and AV interval. In cases of a comatosed state, hemoperfusion and plasma exchange can be used. In this case report we present a case of severe amitriptyline poisoning that we successfully managed with plasma exchange. We confirmed a 59.5% reduction in the amitriptyline plasma level in our patient after a single plasma exchange session. She was discharged by the third day of admission without any complications. According to current literature, our patient is the fifth patient treated with plasma exchange to be the subject of a publication.