Safety and immunogenicity of live attenuated human-bovine (UK) reassortant rotavirus vaccines with VP7-specificity for serotypes 1, 2, 3 or 4 in adults, children and infants.

Live rotavirus vaccine candidates representing VP7 serotypes 1, 2, 3 or 4 derived by reassortment between bovine UK rotavirus and human rotavirus strains D, DS-1, P or ST3 were evaluated for safety and immunogenicity in adults, children and infants. Infection was defined by evidence of rotavirus shed in stools or a 4-fold or greater increase in serum rotavirus-specific IgA or IgG ELISA or plaque reduction neutralization antibody. A single oral dose (10(5.3) or 10(5.8) pfu) of reassortant virus was well tolerated and infected most infants: 10/20 (50%) by D x UK; 9/11 (82%) by DS-1 x UK; 8/10 (80%) by P x UK and 13/14 (93%) by ST3 x UK. All 14 infants given two doses of D x UK were infected. These findings demonstrating satisfactory levels of attenuation, safety, infectivity and immunogenicity of each reassortant in infants warrant additional studies of a candidate vaccine containing these four strains.

Effective immunization with live attenuated influenza A virus can be achieved in early infancy. Pediatric Care Center.

The immunogenicity of vaccines can be modified in infancy by maternal antibodies and other immunizations. Hence, the safety and immunogenicity of two doses of 10(7) TCID50 of live, attenuated cold-adapted (ca) influenza A/Kawasaki/86 (H1N1) reassortant virus vaccine given with or apart from childhood immunizations were evaluated in infants, starting at 2, 4, or > 6 months of age, in randomized, double-blind trials. The ca vaccine was safe and did not significantly reduce the immunogenicity of the childhood vaccines in these infants. Infectivity of ca virus (virus shedding, > or = 4-fold rise in serum hemagglutination inhibition antibody titer, or both) was affected by age, quantity of ca virus given, and prior ca virus infection. Two doses of 10(7) TCID50 of ca influenza virus infected all infants, indicating that both doses are probably needed to achieve immunity against influenza in infants < 6 months of age.

Clinical presentations and complications of suspected measles in hospitalized children.

We evaluated clinical presentations and complications retrospectively in 48 pediatric patients hospitalized for suspected measles during a measles epidemic in Chicago. Fifty-one percent were < 15 months of age and 75% were < 4 years of age. Measles, diagnosed in 44 patients, was culture-proved in 18. Presentations were not always classic. Respiratory complications, otitis media, hepatitis, preterm labor, keratitis and central nervous system involvement were reported. The presence of stomatitis and hypotension in some patients raised the differential diagnoses of Kawasaki disease and toxic shock syndrome. Six patients with stomatitis, admitted with a measles-like illness, fulfilled the Centers for Disease Control and Prevention criteria for Kawasaki disease. Three were diagnosed with Kawasaki disease and 3 with measles. In addition to serology and echocardiographic changes, the platelet count and the erythrocyte sedimentation rate may be useful in distinguishing between measles and Kawasaki disease. Two of 10 patients with hypotension met the Centers for Disease Control and Prevention criteria for toxic shock syndrome. The diagnosis of measles, solely on clinical grounds, may therefore not be as straightforward as is generally accepted.