An open study of subcutaneous administration of inactivated hepatitis A vaccine (VAQTA) in adults: safety, tolerability, and immunogenicity.

A number of patients in clinical practice would be candidates for hepatitis A vaccine administered subcutaneously (SC), including patients with inherited and acquired coagulopathies. To assess the safety, tolerability, and immunogenicity of VAQTA (Hepatitis A Vaccine, Inactivated, Merck and Co. Inc., West Point, PA) was administered SC to healthy adults. A total of 114 healthy adults received two doses of vaccine SC 24 weeks apart. No serious vaccine-related adverse experiences were reported. Four weeks after dose 1, the seropositivity rate (SPR) was 77.9% (CI, 69.1, 85.1%). The geometric mean titer (GMT) was 21.0 mIU/ml. Twenty-four weeks after dose 1 (just prior to dose 2) and 28 weeks after dose 1 (4 weeks following dose 2), the SPRs were 95.3% [corrected] and 100%, respectively; the GMTs were 153.2 and 1563.9 mIU/mL, respectively [corrected]. Although the kinetics of the immune response were slower when VAQTA was administered SC compared to intramuscular injection, SPRs and GMTs increased over time, indicating that the vaccine administered SC demonstrated immunogenicity.

An increase in sudden unexpected cardiac deaths among young Swedish orienteers during 1979-1992.

BACKGROUND: Sixteen cases of sudden unexpected cardiac death, 15 males and one female, are known to have occurred among young Swedish orienteers from 1979 to 1992, of which seven cases occurred between 1989 and 1992. This is considered to be indicative of an increased death rate. RESULTS: Histopathological evaluation showed myocarditis in a higher than expected proportion of cases. In one such case, which we studied before the sudden unexpected death occurred, the victim had suffered a Chlamydia pneumoniae infection verified by serology, and a nucleotide sequence was found in the heart and lung by means of the polymerase chain reaction (PCR) that hybridized with a probe specific for that organism. Male Swedish orienteers do not, however, seem to have an increased rate of exposure to this agent. No further sudden unexpected deaths among young orienteers have occurred over the past 3.5 years. At the beginning of that period, attempts were made to modify training habits and attitudes.

Hepatitis B in parts of former USSR.

Hepatitis B is more frequent in many countries in eastern Europe than in the western part. In Poland the incidence is as high as 34 notified cases per 100,000 inhabitants. In the Baltic states the incidence is between 10 and 20, and in Russia 23 cases per 100,000 inhabitants. In the Baltic states the incidence has declined since 1986. This reduction has been most prominent in Lithuania, with 69%, followed by Latvia with 43% and Estonia with 23%. The infection is very often (> 50%) spread by non-sterile medical instruments.

Piperacillin in paediatric surgery.

23 infants and children, aged 1 month - 15 years, were treated with piperacillin, a new semi-synthetic penicillin with a broad spectrum of activity. The indications were perforated appendicitis with peritonitis or abscess formation (12 patients), urinary tract infection due to congenital anomalies (3 patients), miscellaneous infections (3 patients) and peroperative prophylactic treatment (5 patients). The clinical response was good. Few adverse reactions were noted. The drug seems to be effective and safe.

Meningitis in a newborn infant caused by Mycoplasma hominis.

When 10 days old an infant born after 34-35 weeks of gestation developed meningitis with pleocytosis and a low glucose concentration in the cerebrospinal fluid. Mycoplasma hominis was recovered from the cerebrospinal fluid and treatment with doxycycline was given. The strain was later found to be resistant to tetracycline. After institution of lincomycin, cultures for mycoplasmas were negative. The infant, who during the course of the meningitis had developed a transient increase in intracranial pressure, was healthy and normally developed at the age of one year.--This is the first report on an infection caused by a tetracycline-resistant strain of Mycoplasma hominis.

Fulminant hepatitis A.

During a small epidemic of infectious hepatitis, a fulminant infection with fatal outcome occurred in a 54-year-old woman. IgM antibody to hepatitis A virus was demonstrated in the serum and large amounts of hepatitis A virus were found in the liver. It is suggested that the pathogenesis may be different for fulminant hepatitis A and B infection.