Long-term immunogenicity of an inactivated virosome hepatitis A vaccine.

The aim of this study was to predict the long-term protection induced after immunisation with inactivated, aluminium-free virosome hepatitis A vaccine. The study population consisted of adult volunteers enrolled in four different clinical trials. Lower 95% confidence interval limits and seroconversion rate were calculated by using a linear mixed model to estimate the persistence of serum antibodies over time. To assess the robustness of the mathematical model, several sensitivity analyses were performed with more conservative protective threshold (20 mIU/ml vs. 10 mIU/ml), higher yearly decline rate, and exclusion of volunteers who had increasing titres over time. Based on 190 volunteers with at least two valid assessments of titres from year 3 onward, the median duration of protection was 55.5 years, with a lower limit of the 95% CI of 48.7 years. Duration below 25.3 years was predicted for only 5% of the subjects. Women tended to have higher titres to start with, but their rate of decline was higher, resulting in similar duration of protection overall. The use of a more conservative threshold, higher yearly decline rate, and exclusion of volunteers with increasing titres over time did not affect these results. According to this model, 95% of the volunteers should have anti-HAV titres above the minimum protective threshold for 20 years or more following immunisation with two doses of this aluminium-free vaccine.

Ivermectin treatment of a traveler who returned from Peru with cutaneous gnathostomiasis.

We describe a 21-year-old patient who experienced a relapse of cutaneous gnathostomiasis after receiving initial treatment with albendazole and who had a successful outcome after receiving a short course of ivermectin for the relapse. This is the first reported case of gnathostomiasis acquired by a human in Peru.

Medical interpreters have feelings too.

All 22 members of the interpreter service of the Geneva Red Cross were invited to answer an anonymous questionnaire with questions about their work with refugees and asylum seekers. Five (28%) reported having been exposed to a major traumatic event such as war, torture, detention, being beaten. Seven interpreters reported that more than 50% of their sessions involved patients exposed to violence. Five interpreters (28%) frequently experienced difficult feelings during sessions. Twelve (66%) had frequently painful memories. The proportion of interpreters having painful feelings and symptoms increases with the number of sessions with victims of violence. Interpreters also expressed a strong need to talk and share feelings after the session with the medical doctor (83%) or with relatives or spouse (44%). Fifteen (83%) reported seeing patients again outside the consultation. Doctors should be aware of these pressures and give time to interpreters to share their feelings and emotions, to help them cope with their reactions.

Safety and immunogenicity of a new inactivated hepatitis A vaccine in concurrent administration with a typhoid fever vaccine or a typhoid fever + yellow fever vaccine.

Two clinical studies were conducted to evaluate the safety and immunogenicity of concomitant administration of a new inactivated hepatitis A (HA) vaccine and either a typhoid fever (Vi) vaccine or a combination of Vi and yellow fever (YF) vaccines. In study 1, 62 healthy adults received HA+Vi into the deltoid muscle on contralateral sides. In study 2, 59 healthy adults received HA and a combined Vi/YF vaccine into the contralateral deltoid muscles. Reactogenicity was evaluated for 14 days following vaccination. Blood samples (for antibody titration) were obtained prior to vaccination on days 0 and 28 in study 1 and prior to vaccination on day 0 and on days 14 and 28 in study 2. The overall rate of local reactions was 19% at the HA injection site and 75% at the Vi injection site in study 1; the rate of systemic reactions was 41%. In study 2, local reactions occurred at 27% and 78% of the HA and Vi/YF injection sites; the rate of systemic reactions was 42%. All reactions were transient. Twenty-eight days after vaccination, the seroconversion rate was 100% for HA antibodies and 90% for the Vi vaccine in study 1. Rates of seroconversion in study 2 were 100% for the HA vaccine, 92% for the Vi vaccine, and 100% for the YF vaccine. Although this study was not comparative, both tested combinations were safe and immunogenic, and their routine use for persons at risk, such as travelers, can be recommended.

[Acute schistosomiasis or Katayama syndrome: apropos of 2 mini-epidemics]. / La schistosomiase aiguë ou syndrome de Katayama: á propos de deux mini-épidémies.

Schistosomiasis, or bilharziasis, is often oligosymptomatic but there is also an acute form, the Katayama syndrome. Observation of two groups of travelers who swam in the same lake near Banfora in western Burkina Faso, separated by an interval of one year, illustrates the high infection rate of Schistosoma mansoni (100% of swimmers, of whom 82% were symptomatic and 55% presented with fever). The incubation period was 4 to 6 weeks after exposure. 10 of the 11 subjects had eosinophilia (> or = 500/mm3) and IFAT serology was positive in all tested subjects. More than one year after exposure, one traveler (untreated) presented with a neurological deficit due to acute schistosomal myelitis. The diagnosis of schistosomiasis in a patient requires a search for the disease among his fellow travelers, even if they are asymptomatic.