Antibody responses to four Haemophilus influenzae type b conjugate vaccines

Article Abstract:

The agent responsible for the majority of bacteremic infections (those associated with bacteria in the blood, a serious condition) in infants and young children is Haemophilus influenzae type b (Hib). Although improved treatment has reduced the number of deaths from such infections to approximately five percent, serious consequences among survivors often cannot be avoided. Thus, development of an effective vaccine would be well worthwhile. A study was carried out to compare four conjugate Hib vaccines (vaccines made by attaching an Hib-related antigen to a protein carrier); the vaccines are listed. At the ages of four and six months, 72 infants received PRP-D; 46 received HbOC; 32 received C7p; and 25 received PRP-T. Eighty-five adults and 140 two-year-old children (children did not receive PRP-T) were also studied. Blood samples were taken from subjects before and after vaccination, and tested for the development of antibodies to the Hib antigen (a polysaccharide or PS). This allows evaluation of the immune response elicited by the vaccine. Results showed that between 41 percent and 60 percent of the vaccinated infants developed irritability after the first dose of vaccine, but fever and soreness at the vaccination site were uncommon. Two months after the first dose of vaccine, the anti-Hib PS levels (antibody levels) were markedly elevated in subjects who had received PRP-T. They rose only slightly in subjects who received one of the other three agents. By the age of seven months (one month after the second dose), anti-Hib levels were similar for subjects vaccinated with HbOC, C7p, or PRP-T; those vaccinated with PRP-D had lower levels. Similar responses were elicited in adults by all four agents. Children had a greater response to HbOC than to the other two vaccines. The results show that these four conjugate vaccines produced different responses in infants. The factors that control the immunogenicity of such agents are not well characterized. One disheartening implication of these findings is that the immune responses of infants cannot be predicted on the basis of data from adults or two-year-olds. A discussion is presented of the variability in immune responding among infants. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Prevention, Hemophilus infections, Hib vaccines

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Outpatient assessment of infants with bronchiolitis

Article Abstract:

Bronchiolitis in infants is a condition in which the smaller airways (bronchioles) become inflamed. Since some organisms that cause bronchiolitis, notably respiratory syncytial virus (RSV), are associated with serious illness and even death if patients go untreated, early and accurate prediction of disease severity in outpatients is highly desirable. To learn more concerning the factors that predict disease severity among children with RSV bronchiolitis, 213 infants (maximum age, 13 months; primarily black and poor) were studied. These infants were brought to the emergency department of one hospital during the 1987 epidemic season for this disease (January through April). They underwent clinical examination, including an evaluation of respiratory distress, general appearance, and degree of oxygen saturation (of hemoglobin, the protein that carries oxygen in the blood). X-ray studies were performed and cultures were taken from the nose and throat to determine whether RSV was present. Results showed that 139 patients were classified as having mild disease, and 74 with more severe disease. Within the latter group, 59 were given oxygen therapy, 13 required hospitalization in the intensive care unit, and 8 needed ventilation (machine-aided breathing). Most infants appeared well when examined, had no fevers, and did not have high scores on the scale for rating asthma severity; however, the clinical impression was a better predictor of illness severity than the rating scale. Infants with more severe illness tended to have: an ill or toxic general appearance; oxygen saturation that was less than 95 percent when measured by pulse oximetry (a noninvasive method); a gestational age of less than 34 weeks; a respiratory rate equal to or greater than 70 breaths per minute; an incompletely expanded lung (atelectasis) on X-ray examination; and an age at examination younger than 3 months. A discussion is presented of the importance of these variables. The results indicate that pulse oximetry, a simple technique, is valuable for identifying severely ill infants; the method should be included in emergency-room patient evaluation of patients with bronchiolitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Physiological aspects, Development and progression, Respiratory syncytial virus, Bronchiolitis, Pediatric respiratory diseases

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Focal scleroderma and severe cardiomyopathy: patient report and brief review

Article Abstract:

A 21-month-old infant developed focal scleroderma (development of tough, leathery skin) and heart abnormalities, a very unusual combination. While cardiac disease often accompanies generalized scleroderma (progressive systemic sclerosis, PSS), its occurrence with focal scleroderma has not been previously reported. The patient began to develop white blotches on the legs, buttocks, and in the armpits at the age of 19 months, and was eventually unable to fully extend her legs. Examination showed that the heart was generally enlarged and had depressed contractility (reduced ability to pump blood). Other cardiac disorders were noted. The patient was treated with prednisone (an anti-inflammatory and immunosuppressive drug), medication for the heart disorders, and physical therapy to the legs. Four months later, the patient's heart was normal; after several more months, the skin had improved considerably. Seven years later, no further signs of disease had been noted, and the skin disease had not progressed. A brief discussion is presented of focal scleroderma; no definitive treatment has yet been discovered. While steroid drugs may be effective, this is not always the case, particularly in cases where inflammation is not acute. Penicillamine is reported to be effective against PSS, but, since it has several side effects, should be used judiciously. The case illustrates the possibility that internal organs are involved in focal, as well as systemic, scleroderma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Scleroderma (Disease), Pediatric cardiology

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