Abstracts of the 1991 Symposium of the Czechoslovak Society of Histochemistry and Cytochemistry Palacky University School of Medicine, Olomonc, Czecholslovakia, 8–11 September, 1991

In memory of Professor MU Dr M. Obrunník.     

Invasive Haemophilus influenzae type b infections in vaccinated and unvaccinated children in Canada, 2001–2003

Background

Although vaccination of infants against Haemophilus influenzae type b (Hib) invasive infections is effective and has been routinely available in Canada since 1992, cases of the disease continue to occur. We were interested in determining whether recent cases of Hib infection reflected progressive loss of protection with time since vaccination, increasing nonacceptance of vaccination or a deleterious effect of coadministration of recently introduced vaccines such as those for pneumococcal and meningococcal conjugates and hepatitis B. We report on the causes of Hib infections among vaccinated and unvaccinated children between 2001 and 2003 in Canada.

Methods

Through our established network of 12 pediatric tertiary care hospitals we actively searched for cases in each centre by reviewing daily admissions and laboratory reports, visiting the wards and checking discharge diagnosis codes. Culture-confirmed cases were summarized by nurse monitors using a standardized reporting system.

Results

We identified 29 cases during the 3 years: 16 in 2001, 10 in 2002 and 3 in 2003. Half of the 29 patients had meningitis. Hib infection was more common among children less than 6 months of age (11 cases) and in boys (20 cases). Two deaths occurred (7% case-fatality ratio). A total of 20 children had received no or incomplete primary vaccination because of parental refusal (7 cases), because they were too young to have completed the primary series (11 cases, including 1 in which parental refusal was also a factor) or because of delays in completing the primary series (2 cases); the vaccination history was uncertain in the remaining case. Infection despite primary vaccination occurred in 9 children: 2 previously healthy children and 7 who were immunocompromised or who had a predisposing condition. None of the cases identified in 2003 involved children who had received any of the newly introduced vaccines.

Interpretation

Invasive Hib infections remain rare in Canada, with most cases occurring in children too young to have completed the primary series. Protection after vaccination appears to extend into later childhood and does not appear to be diminished by coadministration of newer infant vaccines.Until recently Haemophilus influenzae type b (Hib) was a leading cause of meningitis, epiglottitis and other invasive infections in children, affecting about 1 child in 250 by 5 years of age.¹ The risk of infection was highest among children 6–24 months of age. Antibodies directed against the Hib capsular polysaccharide (polyribosyl ribitol phosphate, PRP) form the basis of protection. PRP protein conjugate vaccines that elicit anti-PRP responses in young infants have been used in Canada since 1992. Doses are recommended at 2, 4 and 6 months of age to establish protection and at 18 months to reinforce it. Since 1995 all provinces have used the same Hib vaccine (a PRP–tetanus protein conjugate [PRP-T], produced by Aventis Pasteur), in combination products based on whole-cell pertussis vaccines (from 1995 to 1997) or acellular pertussis vaccines (1998 to the present).Invasive Hib infections have been monitored since 1992 by a network of Canadian pediatric hospitals known as the Immunization Monitoring Program, Active (IMPACT).² In 1985, before the first Hib vaccine was licensed, 485 invasive Hib cases were seen at 10 centres (those participating in IMPACT when the “look-back” was done).³ Case totals fell progressively as better vaccines became available.^3,4,5 In 2000, only 4 cases were recorded by the IMPACT centres (which by then numbered 12), 99% fewer than in 1985.⁶ Continuing surveillance is important to assess the effectiveness of the current schedule and vaccine. Because Hib vaccination is relatively new, the question of duration of protection remains open. Resurgence of Hib disease occurred recently in the United Kingdom,⁷ prompting addition of a booster dose to the vaccination schedule (as in Canada). Other questions of relevance are whether nonacceptance of Hib vaccine is influencing case totals and whether coadministration of newer vaccines, such as those for pneumococcal and meningococcal group C conjugates and hepatitis B, is adversely affecting Hib responses. A reduced response is most likely to occur when infants are given conjugate vaccines containing the same carrier protein,⁸ which is not the case with PRP-T and pneumococcal conjugate vaccines; however, their compatibility has not been formally demonstrated to date. In this report we present details of cases encountered by IMPACT in the period 2001 to 2003.     

Clarification of the nomenclature for MSC: The International Society for Cellular Therapy position statement

The plastic-adherent cells isolated from BM and other sources have come to be widely known as mesenchymal stem cells (MSC). However, the recognized biologic properties of the unfractionated population of cells do not seem to meet generally accepted criteria for stem cell activity, rendering the name scientifically inaccurate and potentially misleading to the lay public. Nonetheless, a bona fide MSC most certainly exists. To address this inconsistency between nomenclature and biologic properties, and to clarify the terminology, we suggest that the fibroblast-like plastic-adherent cells, regardless of the tissue from which they are isolated, be termed multipotent mesenchymal stromal cells, while the term mesenchymal stem cells is used only for cells that meet specified stem cell criteria. The widely recognized acronym, MSC, may be used for both cell populations, as is the current practice; thus, investigators must clearly define the more scientifically correct designation in their reports. The International Society for Cellular Therapy (ISCT) encourages the scientific community to adopt this uniform nomenclature in all written and oral communications.     

切断两侧内脏神经对绵羊低血糖期间血浆儿茶酚胺激素、葡萄糖和乳酸浓度的影响

在9只装置永久性血管瘘的绵羊(其中5只切断两侧内脏神经,4只对照)共进行了13次实验。静脉注射胰岛素(1—2U/kg)引起低血糖,分析低血糖期间血浆儿茶酚胺激素(Catecho-Iamines,CAs)、葡萄糖和乳酸浓度的变化,同时观察动物的行为反应。 结果表明:绵羊外周血浆中CAs的浓度(ng/ml)是:去甲肾上腺素(Noradrcnaline,NA)0.330±0.069,肾上腺素(Adrenaline,AD)0.452±0.051,多巴胺(Dopamine,DA)0.694±0.114,三者含量比例约为2:3:5;切断两侧内脏神经后 NA、AD、DA和三者的比例分别是0.377±0.202、0.209±0.063、0.106±0.044 和5:3:2;表现AD和DA浓度明显降低,三者含量比例发生了显著变化。 静脉注射胰岛素使绵羊血糖浓度急剧降低。切断两侧内脏神经不仅降低绵羊血糖浓度的基本水平,而且降低绵羊对低血糖的抵抗力,使低血糖痉挛的发生率增加。 在低血糖期间绵羊CAs的释放量增加,切断两侧内脏神经使这种释放反应的敏感性降低,激素释放量减少。