The safety and immunogenicity of a MF59-adjuvanted H5N1 prepandemic influenza vaccine in healthy adults primed with homologous or heterologous H5N1 vaccines: an observational study.

BACKGROUND: World Health Organization (WHO) has recommended individuals with increased risk of contracting influenza A H5N1 infection to be immunized against the virus during the inter-pandemic period. Safety and immunogenicity of H5N1 vaccine among participants primed with homologous or heterologous H5N1 vaccines produced by diverse manufactures have not been reported. METHODS: Healthy individuals aged 20 to 60 years old were recruited and stratified into three groups: participants without priming (control group), participants primed with A/Indonesia/05/2005 vaccine, participants primed with A/Vietnam/1194/2004 vaccine and A/Indonesia/05/2005 vaccine. Enrolled participants received two doses of MF59-adjuvanted A/Vietnam/1194/2004 vaccine (study vaccine). Solicited reactions were recorded by vaccine recipients. Blood samples were obtained for hemagglutination inhibition test. RESULTS: A total of 131 participants were enrolled. No significant adverse events were recorded. Tenderness, fatigue and general muscle ache were the most common solicited reactions which alleviated within one week of immunization. Three weeks after two doses of the study vaccine, 63%, 68% and 88% were in seroprotective status in the control group, A/Indonesia/05/2005 primed group and A/Vietnam/1194/2004 and A/Indonesia/05/2005 primed group, respectively. Participants primed with A/Vietnam/1194/2004 and A/Indonesia/05/2005 showed high immune response after booster with one dose of the study vaccine. CONCLUSION: The study vaccine did not cause severe adverse events. It elicited mostly mild to moderate reactions among participants. Participants primed with A/Vietnam/1194/2004 and A/Indonesia/05/2005 vaccine showed higher immune response than those without priming or primed with A/Indonesia/05/2005 vaccine. The report suggested those with an increased risk of influenza A H5N1 virus exposure may benefit from receiving influenza A H5N1 priming during the inter-pandemic period if the antigenicity of the pandemic influenza strain is similar to that of the priming strain.

Discontinuation of secondary prophylaxis in AIDS patients with disseminated non-tuberculous mycobacteria infection.

From June 1994 to June 2002, disseminated infections due to non-tuberculous mycobacteria (NTM) were diagnosed in 42 of 716 (5.9%) non-haemophiliac HIV-infected patients aged > or =15 years who were treated at National Taiwan University Hospital. The median age of these patients was 35 years (range, 27 to 60 years). The median CD4+ cell count and plasma viral load at the time of diagnosis of disseminated NTM infections were 8 x 10(6)/L (range, 0 to 892 x 10(6)/L) and 37,600 copies/mL (range, <400 to >750,000 copies/mL), respectively. The nadir CD4+ count during the observation period was 6 x 10(6)/L (range, 0 to 30 x 10(6)/L). The species of NTM isolated included Mycobacterium avium complex (MAC) [n = 35], Mycobacterium kansasii (4), Mycobacterium chelonae (1), Mycobacterium abscessus (1), and unidentified NTM (3). Co-infection with 2 species of NTM was diagnosed in 2 patients. NTMs were isolated from blood (n = 18), liver (18), lymph node (12), bone marrow (10), cerebral spinal fluid (1), ascites (1), and pericardial effusion (1). The median duration of antimycobacterial therapy of the 42 patients was 7 months (range, 0 to 24 months). Mortality during the study period was greater in the patients enrolled before highly active antiretroviral therapy (HAART) was introduced (14 of 15, 93%) than in those who received HAART (9 of 27, 33%). As of December 31, 2002, 15 patients (35.7%) had discontinued secondary prophylaxis against disseminated NTM infections when their median CD4+ count had increased to 119 x 10(6)/L (range, 25 to 465 x 10(6)/L), and 86.7% (13/15) of the patients had achieved an undetectable plasma viral load after HAART. During the median observation duration of 12 months (range, 2 to 57 months), none of the 15 patients had relapse of disseminated NTM infections. Our findings indicate that disseminated NTM infections without primary prophylaxis were associated with a high mortality rate, especially before HAART became available. In patients who received HAART and had a favorable response with viral suppression and immune restoration, discontinuation of secondary prophylaxis against disseminated NTM infections was safe.

Nutritionally variant streptococcal infections at a University Hospital in Taiwan: disease emergence and high prevalence of beta-lactam and macrolide resistance.

From January 1993 to December 2002, 28 patients with nutritionally variant streptococci (NVS) infections were treated at a university hospital in Taiwan. Twelve (43%) of these patients had various underlying malignancies, and 7 (25%) had underlying valvular heart diseases. Nine patients (32%) had infective endocarditis, and 9 (32%) had primary bacteremia. The deaths of 7 patients (25%) were directly related to NVS infection. Among the 28 isolates recovered from these patients, 50% were not susceptible to penicillin, 33% were not susceptible to cefotaxime, and 93% were not susceptible to azithromycin.