Adverse reactions to influenza vaccine in elderly people: randomised double blind placebo controlled trial.

OBJECTIVE--To assess the frequency and type of side effects after influenza vaccination in elderly people. DESIGN--Randomised double blind placebo controlled study. SETTING--15 general practices in the southern Netherlands. SUBJECTS--1806 patients aged 60 or older, of whom 904 received influenza vaccine and 902 placebo. MAIN OUTCOME MEASURES--Adverse reactions reported on postal questionnaire completed four weeks after vaccination. RESULTS--210 (23%) patients given vaccine reported one or more adverse reactions compared with 127 (14%) given placebo. The frequency of local adverse reactions were 17.5% in the vaccine group and 7.3% in the placebo group (p < 0.001). There was no difference in systemic adverse reactions (11% v 9.4%; p = 0.34). In general, men reported fewer side effects than women. CONCLUSION--Only local side effects were more common in vaccinated patients and all side effects were mild.     

Evaluation of the efficacy of split-product trivalent A(H1N1), A(H3N2), and B influenza vaccines: reactogenicity, immunogenicity and persistence of antibodies following two doses of vaccines

The reactogenicity and immunogenicity of Tween-ether split trivalent A(H1N1), A(H3N2), and B influenza vaccine in primary school children aged seven to 12 years, and the persistence of antibodies following two doses of vaccine were studied during 1980-1984. Adverse reactions were infrequent, and, even when reported, were chiefly local ones, mild in nature and of short duration. Most of the reactions were less frequent after the second dose than after the first dose. Most of the systemic reactions occurred during the intervaccination period with almost equal frequency, indicating that careful consideration is required to judge whether they were induced by vaccination or not. This vaccine had induced adequate hemagglutination inhibiting (HAI) antibody because the geometric mean titers (GMTs) of the vaccinees were two- to eightfold higher than those of the nonvaccinees to any of the vaccine antigens following two doses of vaccine. In general, the responses to A(H3N2) virus were the best among the vaccine antigens through the four vaccination seasons, but there was a tendency to show a poorer response to the same type (or subtype) of virus antigen as the causative one during a protracted epidemic. The antibodies induced by either vaccination or natural infection were shown to persist for less than a year, supporting the recommendation for annual vaccination.     

Reactivity, immunogenicity and epidemiological effectiveness of vaccination according to various schemes of immunization against whooping-cough, diphtheria and tetanus]

An extended controlled epidemiological trial was carried out for the purpose of studying the reactogenic properties, immunological and epidemiological efficacy of immunization against whooping cough, diphtheria and tetanus according to a scheme suggested by the authors (AKdeltaC-AKdeltaC-KB) in comparison with the official scheme (AKdeltaC-AKdeltaC-AKdeltaC). There was revealed some increase in the frequency of general reactions in children vaccinated by the experimental scheme; however strong general reactions and local reactions of different intensity were encountered with equal frequency in both groups. Two months after the end of the vaccination significantly higher titres of pertussis agglutinins were revealed in children immunized by the AKdeltaC-AKdeltaC-KB scheme; no significant difference was found in the content of the protective titres of diphtheria and tetanus antitoxins. The duration of preservation of postvaccinal antibodies against all the AKdeltaC-vaccine components and increase in their amount after the first revaccination (in 1.5-2 years) was the same in both the groups of children. A greater epidemiological efficacy of pertussis antigen was revealed by prolonged observation in immunization by the AKdeltaC-AKdeltaC-KB sheme in comparison with immunization by the official scheme (pertussis incidence per 100 thousand children proved to be 12.7 and 71.2, respectively).     

Pneumococcal vaccine campaign based in general practice.

OBJECTIVE: To show whether a general practice setting is a practical and effective medium for increasing uptake of pneumococcal vaccine. DESIGN: Follow up study of responses of general practices (debriefing by questionnaire or small group session) and patients (questionnaire sent to 429 patients vaccinated in a two week period) to vaccination campaign. SETTING AND SUBJECTS: Patients registered with general practices of one family health services authority. INTERVENTIONS: Pneumococcal vaccination campaign including clinical guidelines and support materials. MAIN OUTCOME MEASURES: Proportion of general practitioners offering pneumococcal vaccine; proportion of patients at risk who were vaccinated between 1 May and 31 December 1995; number of splenectomised patients identified and vaccinated in same period; views of patients who were vaccinated. RESULTS: Proportion of general practitioners offering pneumococcal vaccine increased from 17% to 89% during the campaign. Estimated number of patients at risk who were vaccinated increased from 656 (4%) to 5982 (33%) during campaign. Of 61 splenectomised patients identified, 30 had been vaccinated previously and 27 were vaccinated during campaign. Practices in which a general practitioner took or shared the lead had higher vaccination rates and used vaccine up faster. Of the 384 patients whose questionnaires were used in analysis, only 35 had heard of pneumococcal vaccine before the campaign, 198 reported side effects (mostly minor and local, but systemic and severe local reactions were more common than expected), and 337 were pleased they had been vaccinated (only five expressed dissatisfaction). CONCLUSION: A practice based campaign is an effective method of increasing uptake of pneumococcal vaccine by high risk groups.     

Role of whole-cell pertussis vaccine in severe local reactions to the preschool (fifth) dose of diphtheria-pertussis-tetanus vaccine.

OBJECTIVE: To estimate the contribution of whole-cell pertussis vaccine to severe local reactions after the preschool (fifth) dose of adsorbed diphtheria toxoid-pertussis vaccine-tetanus toxoid (DPT) vaccine. DESIGN: Double-blind randomized controlled trial. SETTING: Urban community. PARTICIPANTS: Volunteer sample of 200 healthy children 4 to 6 years old who were eligible for the fifth dose of DPT vaccine. INTERVENTIONS: Children received, in both arms, either diphtheria toxoid-tetanus toxoid (DT) and monovalent pertussis vaccines (group A, 99 children) or DPT and meningococcal vaccines (group B, 101 children). All were licensed products from single lots. The children were assessed 24 hours later by a trained observer. Serum samples obtained before vaccination were tested for antibodies to tetanus and diphtheria toxins and five pertussis antigens by means of enzyme-linked immunosorbent assay. MAIN OUTCOME MEASURES: Rates of severe local reactions (an area of redness or swelling or both of 50 mm or greater) 24 hours after vaccination. Relation between serum antibody levels before vaccination and rates of severe local reactions to corresponding vaccines. RESULTS: All of the subjects were followed up 24 hours after vaccination. Severe redness was present in 38% given DPT vaccine, 29% given intramuscular pertussis vaccine and 9% given DT vaccine (p < or = 0.002, three-way comparison). Severe swelling was common after vaccination with all three products. After intramuscular pertussis vaccination a relation was evident between the prevaccination levels of antibody to whole-cell pertussis bacteria and the rates of redness (p < 0.02) but not between the prevaccination subcellular antibody levels and the rates of redness. CONCLUSION: That pertussis vaccine resembled the DPT vaccine in causing severe redness suggests that it is the principal cause of such reactions after DPT vaccination. The DT vaccine was also reactogenic; thus, cumulative sensitization to one or more of its constituents may be a factor.     

Sister chromatid exchange in peripheral lymphocytes of subjects vaccinated against measles

Summary The SCE frequency was studied in cultures of peripheral lymphocytes from three subjects before and after vaccination against measles. The immunological vaccination reactions were monitored by antibody titration and by measurement of DNA synthesis in peripheral lymphocytes. In two of the subjects, on the 14th day after vaccination, there was a marked decrease of the SCE frequency coinciding with common clinical vaccination reactions and an increase of DNA synthesis in the peripheral lymphocytes. The increase of antibody titers started on the 17th day. One month later, when the immunological reactions had subsided, the SCE frequency was increased by 25% over the prevaccination level. The third subject displayed a delayed vaccination response due to a simultaneous influenza infection. This subject showed a 50% increase in the SCE frequency on the 14th day as well as 6 weeks after vaccination. These results suggest that significant changes in the SCE frequency may be related to immunological vaccination reactions.     

Reactions after pertussis vaccine: a manufacturer's experiences and difficulties since 1964

Pertussis vaccines vary in quality, safety, and efficacy according to the production strains of Bordetella pertussis, the method of manufacture, and quality control procedures. It is therefore not justifiable to combine information on the incidence, nature, and severity of reactions after all manufacturers'' pertussis vaccines as if they were a single product. Attempts were made to collect information on all suspected cases of severe reactions that occurred after administration of about 15 million doses of Wellcome pertussis vaccines in the United Kingdom and Northern Ireland from 1964 to mid-1977. Altogether six deaths, six neurological reactions with sequelae, and 17 convulsions without sequelae were reported, but some were clearly not attributable to the vaccine, while, in other cases, the available information was inadequate for assessing the role of vaccination. Neurological disorders, similar to those reported in a few children after pertussis vaccination, occur unexpectedly in apparently healthy infants at the recommended age for immunisation, so chance association between vaccination and these events can be expected in some children. The Joint Committee on Vaccination and Immunisation has made several recommendations aimed at reducing severe reactions after pertussis vaccination. These include replacing plain vaccine with aluminium-adsorbed vaccine, but there is no clear evidence that the aluminium-adsorbed vaccine produces fewer reactions than the plain.There are difficulties enough in deciding the cause of events that occur after vaccination, since these reactions often occur naturally in children of vaccination age. The task is made even harder by the assumption that various manufacturers'' vaccines are the same and the lack of information available to manufacturers about cases in which their vaccine has been implicated. Information on vaccines administered is entered on immunisation records cards; it should be used and referred to if reactions occur.     

7起乙型脑炎疫苗异常反应的调查和分析

对１９９３～１９９７年间因接种乙脑疫苗引起的７起异常反应进行了调查和分析，主要是Ⅰ型变态反应（０．３３％～１．６％）和心因性反应（１１．７％～２４．２％）。反应一般发生在第３针以后，有些发生在第６针。症状表现为过敏性休克、紫癜、荨麻疹、血管神经性水肿、气喘等。对变态反应的发生频率、反应机理、处理方法和预防等问题进行了讨论     

Impact of porcine circovirus type 2 (PCV2) vaccination on boar semen quality and quantity using two different vaccines

Porcine circovirus type-2 (PCV2) is widespread in domestic pig populations. It can be shed with boar semen, but the role boars have in epidemiology is still unclear. Vaccinating boars against PCV2 can reduce disease and virus load in semen, but may have unwanted side effects, that is, impairment of spermatogenesis. Therefore, the aim of this study was to investigate the effect and impact of two different PCV2 vaccines on boar semen quality and quantity. Healthy normospermic Large White boars in three groups of 12 each were vaccinated with either Circovac, Ingelvac CircoFLEX, or received NaCl. Eight ejaculates were collected starting 1 week after vaccination and assessed for quantitative traits. In general, sperm quantity and quality parameters did not change due to the vaccination (P > 0.05). Only DNA integrity between the Circovac and control group was P < 0.05 but remained at a low level (<2%). One boar showed clinical signs with body temperature up to 39.9 °C and went off feed. For this animal, a clear relation between vaccination, fever period, and impaired sperm quality could be observed. The results indicate that both vaccines did not have a major impact on sperm quality or quantity. Therefore, vaccination of boars against PCV2 seems to be feasible. However, one boar treated with the oil-based vaccine showed a temporarily impaired semen quality after elevated body temperature after vaccination. Thus, possible systemic reactions and the subsequent impact on sperm quality should be taken into account when choosing a PCV2 vaccine for boars.     

Immunogenicity and safety of Vi capsular polysaccharide typhoid vaccine in healthy persons in Korea

The purpose of this study was to evaluate the immunogenicity and safety of Salmonella Typhi Vi capsular polysaccharide vaccine (Vi vaccine) in Korea. The immunogenicity of a single dose of Vi vaccine was evaluated in 157 subjects (75 children and 82 adults) before and at 1, 6, and 12 months after vaccination. Immunogenicity was measured with a passive hemagglutination assay (PHA), quantified as geometric mean titers (GMTs) and seroconversion rates. The safety of the vaccine was investigated by determining adverse reactions occurring within 4 h, 3 days, and 1 month after injection. The seroconversion rate for children and adults 1 month after vaccination was 96.92% and 89.02%, respectively. In the case of children, the GMTs of Vi antibodies before vaccination were 5.87 +/- 1.34 and 142.59 +/- 2.39 at one month after vaccination. For adults, the GMTs before and one month after vaccination were 5.58 +/- 1.28 and 58.56 +/- 3.67, respectively. Vi antibodies persisted for as long as 6 and 12 months after vaccination. All adverse reactions in adults and children were minor and did not require treatment. The Vi CPS vaccine was safe and immunogenic in adults and children older than 5 years.     

Secondary and Apparent Primary Antibody Responses After Group A Streptococcal Vaccination of 21 Children

A partially purified M protein, extracted from a mouse-virulent strain of type 3, group A streptococcus, was administered subcutaneously in gradually increasing amounts at weekly intervals to 21 children in a Family Program. Seven children with type 3 bactericidal antibody in prevaccination sera showed a secondary response. Of 14 children with no detectable type 3 bactericidal antibody prior to vaccination, 13 developed definite type 3 antibody during or soon after vaccination. This response appeared to be of the primary variety in at least some of the 13 children because (i) the total incidence of antibody response (20 of 21) was greater than can be accounted for by the documented incidence of clinical and subclinical type 3 infections among children of our Family Program during a period of 14 years, (ii) the response in the 13 children with no detectable antibody prior to vaccination was more delayed than in those showing a definite secondary response, and (iii) on the average, the amount of vaccine needed for a response in these 13 children was 15 to 28 times greater than that required for the secondary response. Local skin reactions were variable among the vaccinated children. Systemic reactions were infrequent and not severe. The giving of multiple injections of partially purified M protein did not seem to cause cutaneous hypersensitivity.     

Oxidative enzymes in the urinary apparatus of several marine fishes

Summary The distribution and activities of several oxidative enzymes in the urinary apparatus of seven marine fish species (hagfish, lesser spotted dogfish, electric ray, herring, marine catfish, cod, sea-horse) have been studied. Species were selected from three main taxonomic groups: Cyclostomata, Elasmobranchii and Teleostei. Distinctly positive enzyme reactions were found in the tubular elements of the kidney and the collecting duct-archinephric duct system, with the exception of the generally weak staining intensities for NADP-liked malate dehydrogenase. In the proximal tubule segment the second, more distal part (PII) reacted, in general, very strongly when compared with the first proximal part (PI). If present, the distal tubule in teleosts showed only weak reactions, while this segment in elasmobranchs exhibited moderate to strong enzyme activities. In the epithelial cells of the collecting tubule-collecting duct system stronger reactions were confined to the glomerular teleost species, the corresponding part of the elasmobranch kidney showing weak staining intensities. In the urinary duct system distinctly positive enzyme reactions were only to be found in the archinephric duct of the teleost species, except forPlotosus. The ureters of the elasmobranchs exhibited weak enzyme activities throughout.The enzyme patterns of the various types of urinary tubules and ducts are compared with observations from several morphological and physiological studies. The histochemical findings are discussed in relation to corresponding investigations of fresh water fishes and problems arising from phylogenetic divergence of marine fish groups.     

A comparison of combined diphtheria, tetanus and pertussis vaccines produced by different manufacturers, in laboratory animals and in infants

Three DTP vaccines were investigated for potency and toxicity (reactogenicity) both in laboratory animals and in infants. Animal tests were carried out in conformity with the WHO recommendations. Three- to five-month-old infants were investigated for their specific antibody responses and for local and systemic vaccination reactions. No correlation was found between the potency values of the vaccines as expressed in IUs and the antibody titres of the vaccinated infants. The most striking difference between the human and animal responses to vaccination was observed in the case of the tetanus toxoid. The severity of the vaccination reactions in infants correlated with the toxicity of the vaccines as assessed in the mouse weight gain test (MWGT) carried out in CBA mice. No correlation was found, however when conventional or AKR mice were used in the MWGT.     

Assessment of effect of vaccination against pneumococcal infection in children with chronic renal failure and glomerulonephritis

Clinical effect and immune response to vaccination with PNEUMO 23 vaccine was assessed in 18 children with chronic renal failure (CRF) and 40 children with different forms of glomerulonephritis (GN) aged 2 - 15 years. Control group was comprised by nonvaccinated patients (16 patients with CRF; 20 -with GN). Children from two groups were comparable on age and severity of disease's course. Local adverse reactions with duration not longer than 2 days were registered in 22% of vaccinees with CRF, and in 20% of vaccinees with GN. Mild and moderate systemic reactions were registered in 11% and 7.5% of recipients respectively. 1 month after vaccination significant 2.5 - 3.2-fold increase of antibodies concentration was detected in all groups irrespective from nosology and previous treatment. Two-fold increase of concentration of antibodies was observed in 64% and 61% of children with GN and CRF respectively. Clinical effect of vaccination appeared as 2.9-fold decrease of acute respiratory disease (ARD) incidence. Demand in antibacterial therapy decreased by 6.4-fold. Duration of ARD and course of antibacterial treatment decreased by 2.2 and 3 times respectively. Proportion of GN exacerbations related to infecvion decreased from 39% before vaccination to 8% after vaccination. In the control group this proportion did not change (50% and 45% respectively). Vaccine efficacy index was 2.13, coefficient of efficacy - 53.1%.     

Induction of neutralizing antibodies in reindeer (Rangifer tarandus) after administration of a killed West Nile virus vaccine

In 2002, West Nile virus (WNV) infection with clinical neurologic disease and encephalomyelitis was described in reindeer (Rangifer tarandus). The susceptibility of reindeer to WNV prompted questions concerning vaccination of reindeer to prevent WNV infection. Between January and April 2003, eleven 2-4-yr-old, castrated male reindeer, some of which had antibody titers suggestive of prior exposure to WNV, were vaccinated three times at 4-wk intervals with a commercially available vaccine approved for use in horses. No adverse reactions to vaccination were noted. All vaccinated reindeer developed high neutralizing antibody titers to WNV, as determined by the plaque reduction neutralization test. Reindeer without antibody titers from previous natural exposure to WNV required a primary vaccination and one or two booster vaccinations for development of neutralizing antibody to WNV. Protective efficacy of vaccination was not evaluated. Vaccination of reindeer for WNV may be warranted in certain circumstances combined with management practices to limit exposure to potential vectors.     

Clinical studies of vaccine TEOVac under the conditions of remote revaccination

In the clinical trials of vaccine TEOVac in lower and reglamented doses under the conditions of remote vaccination, carried out on 11 volunteers, local reactions in the form of hyperemia, gingival edema (1 vaccinee), faucial hyperemia, enlargement of submaxillary lymph nodes (2 vaccinees) were registered in some of the vaccines; in one vaccinee systemic postvaccinal reaction of medium gravity was observed. Revaccination produced no negative effect on the hematological and biochemical characteristics of the blood, as well as on the urine characteristics. The study of the sensitizing vaccine to the antigens of the accumulation substrate (chick embryo), as well as its influence on the development of autoimmune reactions, revealed the absence of the allergic action of the preparation and its influence on autoimmune processes in the vaccines. The trial of the smallpox vaccine in tablets under the conditions of the primary immunization of adults was the topical and most promising trend in the improvement of smallpox vaccination, as the preparation TEOVac proved to be safe, in contrast to the traditional smallpox vaccine introduced by the scarification method, for both vaccines and nonimmunized persons having contacts with them.     

Pertussis: what percentage of children can we immunise?

The immunisation records of 584 children who were born between 1978 and 1982, in a general practice of average social class distribution, were examined: 3.5% of the children would have been excluded from starting a course of vaccination including pertussis using contra-indications established by the Department of Health and Social Security. A further 3.5% had reactions to immunisation that were judged severe enough to prevent completing the course of vaccination. In 1981 and 1982 13% of parents refused pertussis vaccination, considerably fewer than from 1978 to 80. Concomitantly, immunisation against pertussis rose from 51% to 84% over the five year period. Given the incidence of contra-indications and the level of parental refusal, it is concluded that a pertussis uptake of 80% would be a reasonable target for any population.     

Problem of influenza prophylaxis by vaccines

Scientific data is presented and problems of influenza prophylaxis in various age groups are discussed. Influenza prophylaxis in neonates is possible by inducing maternal antibodies, this dictates the necessity of influenza vaccination in pregnancy. Problems of influenza prophylaxis are most pressing in the group of children from 6 months to 2 years of age. More effective vaccines that do not cause adverse reactions are necessary for the children of this age group. Influenza prophylaxis in healthy working adults is most important for reducing economical impact during influenza epidemics. Influenza prophylaxis in the elderly is reasonable by using novel and more effective vaccines with adjuvants. The optimal method for influenza prophylaxis in the population in general is mass vaccination of children (80%), when, besides the induction of protection in children, influenza morbidity may decrease up to 80% in the other age groups of unvaccinated population.     

The smallpox vaccine: a multidimensional model of choice

Following September 11, 2001, the U.S. government increased its efforts to prepare for future attacks, including those using dangerous biological agents such as smallpox. The smallpox vaccination program called for vaccinating military personnel and smallpox response teams, including healthcare workers and other first responders. The program of vaccinating healthcare workers was largely unsuccessful; few individuals volunteered to be vaccinated, highlighting the importance of understanding the factors that influence choice regarding this complex medical decision. This study examined stated choice and how it was associated with risk perceptions, knowledge, psychological distress, and general vaccine beliefs using a five-dimensional choice model. The model used multivariable modeling strategies in a sample of 256 undergraduate, graduate, and medical students. Sixty-three percent of the sample stated that they would elect to receive the smallpox vaccination. Multiple factors were related to stated choice in multivariable models, including perceived risk/worry, general vaccine beliefs, decisional conflict, and gender. However, the models were more successful at predicting acceptance of the vaccination than vaccine refusal. Although support was obtained for a multidimensional model of choice, several questions were raised by our results, including (a) whether refusal of smallpox vaccination can be more effectively characterized, possibly with additional questions; (b) whether the model translates to actual vaccination behavior; and (c) whether the model describes choice in more at-risk samples (e.g., first responders, healthcare workers). A multidimensional modeling approach should facilitate these and other studies of choice.     

Overprescription of cholera vaccine to travellers by general practitioners.

A questionnaire describing five hypothetical patients intending to travel to different countries was sent to 113 general practitioners, who were asked to state which patients they would recommend cholera vaccination to. The response rate was 80%. The general practitioners'' recommendations were compared with those of the Liverpool School of Tropical Medicine. Sixty three of 86 respondents recommended cholera vaccination when it would probably have been unnecessary. A review of common sources of information on cholera vaccination showed that general practitioners are given confusing or inappropriate advice. General practitioners should be educated about when cholera vaccination is necessary; alternatively, the vaccine should be available only through special centres.