Symptoms after accelerated immunisation.

OBJECTIVE--To document the incidence of symptoms after accelerated immunisation with diphtheria-tetanus-pertussis vaccine. DESIGN--Controlled study of children immunised with adsorbed diphtheria-tetanus-pertussis vaccine at accelerated and standard schedules. SETTING--Colchester and north Hertfordshire. SUBJECTS--107 children scheduled to receive immunisation at 2, 3, and 4 months of age and 115 children scheduled to receive immunisation at 3, 4 1/2 to 5, and 8 1/2 to 11 months of age. MAIN OUTCOME MEASURES--Parentally recorded symptoms, axillary temperatures, and size of local redness and swelling at the injection site during the seven days after immunisation. RESULTS--In general symptoms occurred less frequently with the accelerated schedule. Proportions of parents reporting axillary temperatures greater than 37.2 degrees C or local redness or swelling greater than 2.5 cm after the third dose of vaccine were significantly reduced in the accelerated schedule group. CONCLUSION--Immunisation at 2, 3, and 4 months of age is likely to cause fewer reactions than immunisation at 3, 4 1/2 to 5, and 8 1/2 to 11 months of age.     

Whooping cough after stopping pertussis immunisation.

An epidemic of whooping cough occurred in a rural practice in Shetland, containing 144 children under 16. Before July 1974 all children were immunised against pertussis, but after that date immunisation was stopped. Of the 134 children studied, 93 had been immunised. Sixty-five of the children developed whooping cough. The incidence of infection was similar in those who had and had not been immunised. The incidence was also similar in those born before and after July 1974. There was no evidence to support the routine use of pertussis immunisation in rural Shetland.     

Outcome of pregnancy after amniocentesis for chromosome analysis.

A consecutive series of 1177 pregnant women examined by amniocentesis for chromosomal abnormalities delivered 1039 live-born babies weighing over 2500 g and 79 live-born babies weighing under 2500 g. Twenty-six abortions were induced (2.2%)--13 (1.1%) because of chromosomal abnormalities--and 28 women (2.4%) aborted spontaneously; in these cases chromosomes were normal. Analysis of all spontaneous abortions in the series suggested that 0.3-0.7% might have resulted from amniocentesis.     

Adverse effect of plasma exchange on anti-D production in rhesus immunisation owing to removal of inhibitory factors.

Intensive plasma exchange was used to reduce the maternal anti-D concentration in case of severe rhesus haemolytic disease. Initially the concentration fell from 30 to 4 IU/ml, but after six exchanges it increased to 490 IU/ml despite continued exchanges, and intrauterine fetal death eventually ensued. The increase in the rate of maternal anti-D production coincided with, and may have resulted from, removal of plasma immuno-regulatory factors that inhibited in-vitro lymphocyte functions. These results that the role of plasma exchange in haemolytic disease of the newborn is more complex than simply removing the antibody and that further investigations are needed.