Effect of warming adult diphtheria-tetanus vaccine on discomfort after injection: a randomised controlled trial

OBJECTIVE: To determine whether warming or rubbing adult diphtheria tetanus (ADT) vaccine immediately before administration affects its temperature and reduces the incidence of pain. DESIGN: Double-blind, randomised controlled trial and in-vitro temperature study. SETTING: Emergency department (ED) of a regional hospital between April and December 2001. PATIENTS: Convenience sample of 150 patients aged 16 years or over who presented to the ED requiring ADT booster vaccination. INTERVENTION: Patients were randomised to receive vaccine that was "cold" (no deliberate warming), "rubbed" between the palms for 1 minute, or "warmed" in a 37 degrees C incubator; vaccine was administered as recommended in Australian guidelines. MAIN OUTCOME MEASURES: Incidence of pain and pain score on McGill Present Pain Intensity Questionnaire at 5 minutes, 24 hours and 48 hours after injection; and temperature of vaccine after preparation for simulated administration. RESULTS: The "cold" vaccine had significantly lower temperature (mean, 19.1 degrees C; 95% CI, 17.5-20.7 degrees C) than the "warmed" vaccine (mean, 28.9 degrees C; 95% CI, 28.4-29.4 degrees C) and "rubbed" vaccine (mean, 26.9 degrees C; 95% CI, 24.5-29.3 degrees C). There was no significant difference in incidence of pain between the groups who received vaccine prepared in different ways at any follow-up (5 min: P = 0.62; 24 h: P = 0.58; 48 h: P = 0.61) or overall (P = 0.99). Among those who completed follow-up, incidence of pain at any time was 77/138 (56%); there was no difference in their time-averaged pain scores (P = 0.63) or peak pain scores (P = 0.60). CONCLUSIONS: Warming or rubbing ADT vaccine does not reduce the incidence of pain after administration. Regardless of how ADT vaccine is prepared, its temperature approaches ambient by the time it is injected.     

Using audit to improve senior house officer training.

The British Geriatrics Society has described 16 training objectives for senior house officers (SHOs) in geriatric medicine. We have developed these into an audit standard, and in a controlled trial we consider the effectiveness of audit as a means of monitoring and improving SHO training. SHOs from three hospitals were sent a questionnaire asking about the adequacy of formal and informal training for each objective; there was a response rate of 87%. Results were presented at an audit meeting in one hospital, inadequacies of training identified and the hospital''s programme of teaching modified appropriately. Two control hospitals remained unaware of the audit findings and were therefore unable to modify their training programmes. Re-audit at six months completed the audit cycle; the control hospitals showing no change between the two audits. In the intervention hospital the adequacy of training over the 16 objectives improved from 59% at first audit to 73% at re-audit. The initial audit had highlighted three target objectives as needing special attention; here the improvement from 38% to 69% was even more impressive, and statistically significant at p < 0.05 on chi 2 test. Thus, although a questionnaire approach is inevitably subjective and affected by SHO satisfaction, the discipline of audit appeared effective in identifying and correcting deficiencies in an SHO training programme.     

Enterotoxemia in the goat: the humoral response and local tissue reaction following vaccination with two different bacterin-toxoids

A vaccination trial involving 72 goats was designed to compare the epsilon antitoxin titres and local reactions at the injection sites, of two commercial enterotoxemia vaccines. Three dosage regimens were used for each vaccine (12 goats per group). Although no significant differences were noted in humoral immune response between the two vaccines (P = 0.05), one vaccine regime resulted in low titres (P = 0.05) on two occasions. Local tissue reactions at injection sites persisted for six months in 53% of the goats regardless of vaccine used or dosage administered. No immunological basis for the reported differences in vaccine efficacy between sheep and goats was observed in this trial.     

NHS-MAG3为螯合剂的99mTc-寡核苷酸标记特性

目的 探讨以NHS-MAG,作为螯合剂的^99mTc-寡核苷酸(^99mTc-ON)的标记特性。方法将NHS-MAG,与长度为15个碱基的c-myc mRNA的反义(ASON)、正义(SON)和无义寡核苷酸(MON)偶联,进行^99mTc标记,Sephadex G25 柱层析分离纯化,评价^99mTc-ON的标记率、放化纯和稳定性;将ON-MAG,偶联物置-20℃贮存15 d、1月、2月后进行^99mTc标记,观察标记率的变化,评价ON-MAG3的稳定性;用三氯乙酸沉淀法测定^99mTc-ON的血浆蛋白结合率。结果 ^99mTc-ASON、^99mTc-SON和^99mTc-MON的标记率分别为68．41％、66．24％和69．38％,纯化后放化纯分别为96．98％、95．34％和94．62％。三者在室温和血清中均较稳定。ON-MAG3在-20℃保存2月后,标记率未见明显下降。三种^99mTc-ON的血浆蛋白结合率均小于13％。结论以NHS-MAG3作为螯合剂的^99mTc-ON具备优良的标记特性,标记率、放化纯较高,稳定性好,血浆蛋白结合率低,是一种有临床应用潜力的放射性标记药物。     

CLINICAL APPLICATION OF THE TRAFIX INSTRUMENTATION IN CORRECTING SCOLIOSIS

Ithasbeen４０yearssinceHarringtonappliedasinglerodtocorrectscoliosisinthecoronalplane．Manydeformationsdevelopedaftertheprocedure，forexample，kyphosisofthethoracicorthoracolumbarspine，disap－pearanceofthelumbarlordosis，androtationofvertebrainthehorizontallevel（１）．Itwasrealizedthatscoliosisisaprofounddeformityinthreedimensions．CotrelandDuboussetstudiedthethree－dimensionalcharacteristicsofscoliosisanddevelopedtheCDinstrumentation，whichwasthefirsttimethattreatmentofscoliosisadvancedfr…     

Bacteriology of unheated expressed breast milk stored at room temperature

Thirty samples of unheated expressed breast milk (EBM) from thirty lactating mothers, stored at room temperature (RT) and in the refrigerator (at +4 degrees C), were examined for the degree of bacterial contamination at two hourly intervals upto eight hours. All the EBM samples contained bacteria, mostly of normal skin flora; Staphylococcus albus 76.7%; Streptococcus viridans 40%. Potential pathogens were isolated in small numbers: Escherichia coli 26%, Streptococcus faecalis 13.6% and Staphylococcus aureus 6.7%. The bacterial colony counts (BCC) were consistently low; Mean initially 5.438 x 10(3) cfu/mm3 with a range of 0.15-23.1 x 10(3) cfu/mm3 and showed a significant reduction on storage in both EBM samples stored at RT and at +4 degrees C. The study proved that it is safe for mothers to keep unheated EBM at RT for at least eight hours before bacteria can multiply beyond unacceptable levels.     

132名低龄儿童应用甲型肝炎灭活疫苗初次免疫效果观察

目的 为了评价孩尔来福甲型肝炎灭活疫苗在本地区低龄儿童应用中的初次免疫效果。方法 对初次应用甲型肝炎灭活疫苗免疫的2～6岁甲肝易感儿童132人随机分成4组,观察初次免疫后局部反应和全身反应,检测免疫后1、3、6．7个月的血清抗甲肝病毒抗体（抗-HAV）阳转率和滴度（GUT）。结果 显示孩尔来福甲型肝炎无局部及全身反应,初次免疫后1、3、6、7个月抗-HAV阳转率分别为100％、97．83％、100％、100％,抗-HAV滴度分别为744．35mIU／ml、524．41mIU／ml、354．34mIU／ml、333．13mIU／ml。结论 各组之间差异无显著的统计学意义。表明孩尔来福甲型肝炎灭活疫苗在低龄儿童中应用是非常安全的;并且具有良好的免疫效果：儿童型每剂含病毒抗原250U,适用于儿童接种。     

Mass vaccination programme aimed at eradicating measles, mumps, and rubella in Sweden: first experience

General vaccination with a combined measles, mumps, and rubella vaccine was introduced in Sweden in 1982. The immunisation schedule comprises two vaccine injections, given at 18 months and 12 years of age, respectively. A controlled field study was carried out in 150 children aged 18 months using two different batches of the vaccine. Seroconversion was seen in 96% against measles, 93% against mumps, and 99% against rubella--the same rates with both vaccine lots. Nevertheless, a difference was noted between the two batches with respect to postvaccination reactions. Fever and rash were recorded mainly five to 12 days after vaccination. Moderate fever (38.5-39.4 degrees C) was observed in 22 children, high fever (greater than or equal to 39.5 degrees C) in 33, and rash in 35. Preliminary results obtained by follow up of routinely vaccinated schoolchildren aged 12 indicated considerably lower rates of fever and rash during the postvaccination period, occurring in 3-10% of cases only. These findings show that complete eradication of measles, mumps, and rubella in Sweden is entirely practicable by the mass vaccination programme and that side effects of vaccination are likely to be few and mild.     

国产牛分枝杆菌菌苗联合化疗治疗初治肺结核的疗效

目的　观察和评价国产牛分枝杆菌菌苗用于初治涂阳肺结核治疗的疗效和安全性。　方法　采用随机配对方法 ,将 190例初治涂阳肺结核患者分为治疗组 (95例 )和对照组 (95例 )。化疗方案为2HREZ/ 4H3 R3 。治疗组加用牛分枝杆菌菌苗深部肌肉注射 ,每 2周一次。两组疗程均为 6个月。　结果　治疗组第 2个月涂片阴转率 89.0 % ,对照组为 75 .8% ,差异有显著性 (P <0 .0 5 ) ;两组第 5、6个月末涂片阴转率差异无显著意义 (P >0 .0 5 )。治疗组治疗 2个月的病灶改善情况好于对照组。菌苗应用中不良反应少而轻微。　结论　短程化疗中加用牛分枝杆菌菌苗能加快初治涂阳患者痰菌阴转和病灶吸收 ,改善临床症状 ,不良反应少而轻微。牛分枝杆菌菌苗可作为初治涂阳肺结核短程化疗的辅助治疗     

Breast Feeding Practice among Medical Women in Nigeria

BACKGROUND: Health care workers are important in the promotion, protection and support of breast feeding. Their ability to do this may be influenced by their knowledge, personal experiences and work. PATIENTS AND METHOD: The breast feeding experience of 36 female medical doctors who had babies within the preceding two years and had resumed work was evaluated using a semi-structured self administered questionnaire. RESULT: All respondents knew that babies should be exclusively breast fed for the first six months of life but only 60% knew that breast feeding should continue until two years. The exclusive breast feeding rate for the studied doctors was 11.1%. Before their babies were six months old, about 75% of respondents had resumed work whilst over 50% had started taking calls. Most could not breast feed during working or call hours. Alternative feeds during working or call hours included expressed breast milk in 34.4% and infant formula in 21.9%. Feeding bottle was the major method (77.4%) for feeding these alternatives. Work schedule was rearranged to allow breast feeding in only 27.3% of respondents. CONCLUSION: Failure to carry out exclusive breast feeding, the use of infant formula and feeding bottles (rather than cup feeding) are practices that may be inimical to the practice of breast feeding in society in general. The suboptimal breast feeding experience in these doctors and the identified knowledge deficits may limit their effectiveness in promoting and supporting breast feeding among their patients and communities. Female medical personnel should be empowered to carry out optimal feeding of their own infants.     

儋州市2010-2014年疑似预防接种异常反应监测分析

目的 分析儋州市疑似异常反应(AEFI)的发生特征,评价疫苗的安全性和预防接种质量.方法 通过疑似预防接种反应信息系统,收集2010-2014年累计报告的AEFI数据,采用流行病学描述性统计方法,对相关指标进行分析.结果 2010-2014年儋州市共报告AEFI个案452例,年均发生率20.72/10万,其中一般反应占73.45%,异常反应占25.00%,耦合反应占1.55%.接种单位的报告覆盖率未达到100%,报告卡和调查表完整率为100%,48 h内报告率和调查率均>90%.报告的AEFI主要集中在6~9月;那大镇、东成镇和两院报告AEFI居全市前三位;男女性别比1.58:1,≤1岁占52.43%.一类疫苗中AEFI发生率居前三位的分别为含麻疹成分疫苗、百白破(白破)疫苗和乙脑疫苗;二类疫苗发生率居前三位分别为霍乱疫苗、23价肺炎疫苗和水痘疫苗.90.04%的AEFI发生在接种疫苗1 d以内.临床损害中一般性反应以发热/红肿/硬结为主(100%);异常反应中以过敏性皮疹为主(52.21%).56.63%的AEFI发生在疫苗接种首针.结论 疫苗的安全性和预防接种质量较好,但AEFI监测系统的敏感性较低,监测和报告质量有待提高.小年龄组儿童和首针疫苗接种为重点监测内容.     

儿童乙肝表面抗体定量1260例结果分析

目的观察儿童乙肝表面抗体阳性率及有效保护浓度阳性率。方法回顾性分析2011年—2012年在我院进行健康体检儿童的乙肝表面抗体(HBsAb)电化学发光法定量结果,分析阳性率及有效保护浓度阳性率。结果男女总体HBsAb定量结果比较差异无统计学意义(P>0.05),HBsAb的阳性率在各个年龄段均较高(≥78.3%),但HBsAb有效保护浓度阳性率在6个月~12个月达高峰之后随年龄增长迅速下降,3岁~4岁达低谷(35.8%)后再缓慢上升。各年龄组HBsAb阳性率和有效保护浓度阳性率比较差异有统计学意义(P<0.01)。结论虽然学龄前儿童HBsAb阳性率总体较高,但有效保护浓度阳性率在乙肝疫苗全程免疫半年后迅速下降,需加强对学龄前儿童的HBsAb定量结果监测。     

A foot-and-mouth disease vaccine for swine.

An inactivated vaccine containing purified foot-and-mouth disease virus type O1, strain Brugge, emulsified with incomplete Freund's adjuvant was studied in swine. The antigen mass ranged from 0.02 to 416 mug in 0.25 ml of vaccine. At 90 days postinoculation (DPI) 33 to 100% of the swine which had been inoculated with 0.72% mug or larger amounts of antigen were protected against challenge. There was little protection at 182 DPI although the neutralizing titers obtained with 2.9, 34.6 and 416 mug doses of antigen were similar to those observed at 90 DPI. The 50% protective dose for swine was approximately 2.3 mug of antigen whether used in a freshly prepared state or after storage at 4 degrees C for 105 or 259 days. Significant protection was afforded when small volumes (0.1 and 0.5 ml) of vaccine were applied with a jet injector gun to the ear or neck of swine. Initial tissue reactions at the site of inoculation were minimal with these small doses of vaccine and generally disappeared ny 90 DPI.     

Evaluation of inactivated hepatitis A vaccine in Canadians 40 years of age or more.

OBJECTIVE: To assess the side effects and immune responses after three serial doses of a new inactivated hepatitis A vaccine in people 40 years of age or more. DESIGN: Open, noncomparative trial. SETTING: A hospital, a regional laboratory and public health units in British Columbia. PARTICIPANTS: A volunteer sample of 64 healthy adults aged 40 to 61 years who were seronegative for hepatitis A virus (HAV). All were staff or associates of the health facilities. Exclusion criteria included elevated serum alanine and aspartate aminotransferase levels, a history of liver disease and recent travel to areas of high risk for HAV infection. INTERVENTION: A formalin-inactivated, alum-adsorbed vaccine containing 720 ELISA (enzyme-linked immunosorbent assay) units of antigen from HAV strain HM175 per 1.0-mL dose was injected intramuscularly into the delgoid area. The second and third doses were given 1 and 6 months later respectively. MAIN OUTCOME MEASURES: A detailed diary of any adverse effects for 3 days after each dose. HAV antibody levels in blood samples taken before and 30 days after each dose. RESULTS: All subjects completed the planned series of vaccinations and blood tests; symptom diaries were returned after 190 (99%) of 192 vaccinations. Local symptoms, most often soreness, were reported after 46% of the vaccinations but were mild and usually resolved within 24 hours. A temperature of more than 38.0 degrees C was never reported. Seroconversion occurred in all cases after the two primary doses, and the subjects were still seropositive at 6 months. After the booster dose the geometric mean titre was 2380 mIU/mL, all values being 200 mIU/mL or greater. CONCLUSION: In healthy adults 40 years of age or more the HAV vaccine was well tolerated and highly immunogenic. Final antibody levels were much higher than reported in people passively immunized against HAV with immune serum globulin.     

Comparison of adverse reactions to whole-virion and split-virion influenza vaccines in hospital personnel.

OBJECTIVE: To compare the adverse effects, particularly generalized aching, of a trivalent, inactivated whole-virion vaccine (WVV) and split-virion vaccine (SVV) for influenza in hospital personnel. DESIGN: Recipient-blinded study; first-time vaccinees were randomly assigned to receive either of the vaccines from one manufacturer in the 1989-90 influenza season. Subjects were asked to complete a symptom questionnaire during the 48 hours after immunization. SETTING: Annual influenza program for staff of a tertiary care children's hospital. PARTICIPANTS: Volunteers were sought among approximately 2200 members of the hospital staff. Of the 358 vaccinated for the first time, 333 (93%) returned the questionnaire. RESULTS: During the 48 hours after vaccination 13% of the SVV recipients reported generalized aching, as compared with 26% of the WVV recipients (p less than 0.01). Also, the SVV group reported fewer visible local reactions and more transient arm soreness, but the actual differences between the two groups were small. The occurrence of mild symptoms was equally common in the two groups (local reactions in at least 70% of cases, systemic reactions in at least 33%). In each group 1% of the subjects reported missing work because of the vaccination. CONCLUSIONS: The use of SVV reduces the rate of the most objectionable of the common adverse effects of influenza vaccination. Therefore, as with children, it might be more acceptable to health care workers than the current use of WVV.     

Outbreak of measles in a highly vaccinated secondary school population.

OBJECTIVE: To examine the factors associated with measles vaccine effectiveness and the effect of two doses of vaccine on measles susceptibility during an outbreak. DESIGN: Retrospective cohort study. SETTING: A secondary school in the City of Toronto. SUBJECTS: The entire school population (1135 students 14 to 21 years of age). MAIN OUTCOME MEASURES: Risk of measles during an outbreak associated with age at first measles vaccination, length of time since vaccination, vaccination before 1980 and whether date of vaccination was estimated; vaccine efficacy of one dose versus two doses. RESULTS: Eighty-seven laboratory-confirmed or clinically confirmed cases of measles were identified (for an attack rate of 7.7%). The measles vaccination rate was 94.2%, and 10% of the students had received two doses of measles vaccine before the outbreak. Among those who had received only one dose of vaccine, vaccination at less than 15 months of age was associated with vaccine failure (relative risk 3.62, 95% confidence interval 2.32 to 5.66). There was no increased risk of vaccine failure associated with length of time since vaccination once the relative risk was adjusted for age at vaccination in a stratified analysis. Vaccination before 1980 and an estimated date of vaccination were not associated with increased risk of vaccine failure. Administration of a second dose of vaccine during the outbreak was not protective. Two doses of vaccine given before the outbreak conferred significant protection, and the relative risk of failure after one dose versus two doses was 5.0 (95% confidence interval 1.25 to 20.15). Of the 87 cases, 76 (87%) could have been prevented had all the students received two doses of measles vaccine before the outbreak, with the first at 12 months of age or later. CONCLUSIONS: Delayed primary measles vaccination (at 15 months of age or later) significantly reduced measles risk at later ages. However, revising the timing of the current 12-month dose would leave children vulnerable during a period in which there is increased risk of complications. The findings support a population-based two-dose measles vaccination strategy for optimal measles control and eventual disease elimination.     

Live varicella vaccine in both immunocompromised and healthy children

BACKGROUND: There is no information on the use of live varicella vaccine in Mexican children. Our objective was to evaluate antibody response and safety of the live varicella vaccine in both healthy and immunocompromised Mexican children. METHODS: One hundred children with no history of varicella/zoster were vaccinated with a live attenuated varicella vaccine. According to their immune status, patients were divided into either a compromised (leukemia, solid tumors, chronic renal failure, and cirrhosis) or a healthy children group. Serum IgG antibodies against VZV were measured by ELISA at baseline and at 3 and 6 months after vaccination. RESULTS: A positive VZV-ELISA at baseline was detected in 36 of 67 (53.7%) immunocompromised children and in 22 of 33 (66%) healthy children. Among VZV-seronegative children, seroconversion at 6 months post-vaccination was observed in 90.3% of compromised children and in 100% of healthy children. Increases in serum antibody levels at 3 and 6 months post-vaccination was similar in both groups. VZV vaccine-related adverse reactions, mostly mild and local, were detected in 29% of the children. Three compromised children had a mild rash symptomatic of varicella after vaccination. CONCLUSIONS: About 50% of immunosuppressed children (mean age 8.8 +/- 3.6 years) with no varicella history were VZV-seronegative. Almost all of these compromised VZV-seronegative patients seroconverted 6 months after vaccine. In addition, antibody titers were similar in both compromised and healthy children.     

PREVENTION OF HEPATITIS B VIRUS CARRIAGE OF INFANTS USING HBV VACCINE IN SHANGHAI PRELIMINARY REPORT OF A RANDOMIZED DOUBLE-BLIND PLACEBO- CONTROLLED TRIAL

A double blind randomized placebo-controlled trial was undertaken to determine if hepatitis B virus (HBV) vaccine alone can prevent perinatally-acquired HBV carriage. The vaccine (16pg per dose, plasma derived, produced by the National Institute of Allergy and Infectious Disease, USA) was given to babies born to HBV carrier mothers within 24 hours of birth and repeated at one month and six months. The preliminary results of 84 infants (40 vaccine reci pients and 44 placebo recipients) followed for six months indicated that this vaccine was highly effica. cious. One of the 40 vaccine recipients and 13 0f the 44 placebo recipients were HBsAg positive at six months of age (p-0.0007, protective efficacy 91.5%). For infants born to HBeAg positive mothers, one of 17 vaccine recipients and 12 0f 19 placebo recipients were HBsAg positive at 6 months of age (p=0.0004, protective efficacy 90.7To). These results showed that HBV vaccine alone successfully prevented perinatally. acquired HBV carriage. If further studies confirm these findings, and safe, effective and inexpensive vaccines are available, HBV control is feasible.     

内蒙古自治区2009-2011年百白破疫苗疑似预防接种异常反应监测分析

目的监测并分析百白破疫苗的安全性和疑似预防接种异常反应(AEFI)发生特征,评价AEFI监测系统运转情况。方法对内蒙古2009-2011年百白破疫苗接种后发生并报告的预防接种异常反应进行调查分析。结果全自治区报告AEFI病例351例,一般反应病例332例,占94.59%;异常反应病例18例,占5.13%;待定1例。接种疫苗后24h内监测到AEFI病例302例,占86.04%。结论百白破疫苗安全性较好,AEFI监测系统灵敏度需进一步提高。     

Effects of captopril and enalapril on renal function in elderly patients with chronic heart failure.

OBJECTIVE: To compare the effects on renal function of captopril and enalapril in elderly patients with chronic heart failure. DESIGN: A multi-centre double-blind parallel-group comparison of the two angiotensin-converting enzyme (ACE) inhibitors, captopril (12.5 mg bid) and enalapril (2.5 mg bid). SUBJECTS: 80 elderly patients with chronic heart failure (41 in the captopril group, 39 in the enalapril group). MAIN OUTCOME MEASURES: The blood pressure and pulse rate response to the first dose of ACE inhibitor was assessed in all patients. Glomerular filtration rate (GFR) was measured radioisotopically by 99mTcDTPA or 51CrEDTA clearance after three and six months of each treatment. Subgroups were assessed for effective renal plasma flow (33 patients), exercise tolerance (25 patients) and by a symptom-oriented questionnaire (45 patients). RESULTS: No serious adverse effect on GFR was noticed. There was no significant difference between the two treatments in the mean baseline GFR or in changes from baseline at three and six months (captopril mean baseline GFR 49.6 ml min-1 1.76 m-2, enalapril 54.7 ml min-1 1.76 m-2; mean change (95% confidence interval) at three months captopril 12 ml min-1 (+3.0, +21.0), enalapril -2 ml min-1 (-13.0; +9.0); mean change at six months, captopril 3.7 ml min-1 (-6.7; +14.2), enalapril -6.0 ml min-1 (-21.0; +9.4). Significantly more patients given captopril had an improvement in GFR during the study period (26/31 compared with 20/31 enalapril-treated patients at three months, p = 0.0096, and 23/30 compared with 15/27 at six months, p = 0.021). There were no significant changes in effective renal plasma flow. Three patients treated with enalapril developed symptomatic hypotension within three days of starting treatment. Quality of life questionnaires revealed more gastrointestinal symptoms in the enalapril group (p = 0.039). CONCLUSIONS: Captopril seems marginally preferable to enalapril in the treatment of chronic heart failure in elderly patients.