Safety of measles immunization in egg-allergic children

Measles vaccines are prepared in chick embryo fibroblast culture and used throughout the world. Since 1963 dramatic reductions in the incidence of measles have been observed where the vaccination was extensively applied in the pediatric population. The best results were observed when the target population in the initial phase was that which produced over 90% of cases in the pre-vaccinal era. A possible limiting factor to the diffusion of measles vaccination is the assumption that allergy to egg proteins is a contraindication. In this paper current knowledge about the safety of measles immunization in children with egg allergy is discussed.     

Measles vaccine efficacy study in a Canberra high school: A study following a measles outbreak

Abstract  An outbreak of measles which occurred in Canberra between October and December, 1991, was investigated to estimate the public health utility of the vaccine. The measles vaccine efficacy was determined for the 13–15 year old children in a selected high school. During the outbreak, at least 82 Canberra children contracted measles. Teenage males accounted for 56% of total cases, and 22% of cases were confirmed by serology. The vaccine coverage in the high school studied decreased with increasing school years, varying from 85.8% in Grade 8 to 79.2% in Grade 10. The highest attack rate occurred in Grade 10 (66/1000). The vaccine efficacy for age 13–15 was estimated to be 72% (95% CI, 45–86%) but varied from 67 to 73%. Measles remains a serious disease of childhood in Australia. The elimination of measles is only partly dependent on the vaccine coverage of children. Issues relating to the effectiveness of vaccine are also important. A two dose vaccine strategy with the second dose of measles, mumps, rubella vaccine (MMR), given preferably in the last year of primary school or the first year of high school, is supported by the findings of this study.     

Appropriate strategy for immunisation of children in India IV: Measles and its control,priority number one

Although a hidden health problem, measles is the commonest vaccinepreventable disease and the most common preventable cause of death among our underfives. These facts, plus the availability of a safe and effective vaccine make measles vaccination the highest priority in the control of communicable disease in India. The use of the pulse vaccination strategy will result in better coverage rates than the conventional strategy of immunisation in fixed health centres. India’s annual requirement of measles vaccine is 20 million doses. For economy and uninterrupted supply, measles vaccine must be manufactured in India without any further delay. The opinions expressed here are those of the authors and not necessarily of the supporting institutions.     

The role of aluminium for adverse reactions and immunogenicity of diphtheria-tetanus booster vaccine

In a randomized, double-blind clinical trial, 235 schoolchildren aged 10 years received either a regular, aluminium-adsorbed diphtheria-tetanus vaccine or the same vaccine in fluid form, in order to investigate if local side effects could be diminished by exclusion of aluminium. System reactions were rare and local reactions frequent in both groups but larger local reactions were even more pronounced in the non-adsorbed vaccine group. Antibody responses to both vaccines were excellent and even slightly higher to the non-adsorbed diphtheria-tetanus vaccine ( p = 0.0135 and 0.0014 for anti-diphtheria and anti-tetanus, respectively). This study has shown that fluid diphtheria-tetanus vaccine does not solve the problem of extensive local side effects induced by the diphtheria-tetanus school booster. Alternative strategies, such as changes in vaccine composition. dosage and spacing, will have to be considered.     

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目的探讨儿童过敏性结肠炎(AC)的临床特点及诊治方法。方法回顾性分析浙江大学医学院附属儿童医院2008年1月至2010年12月收治的53例AC患儿的临床、结肠镜及病理学表现以及实验室检查和治疗情况等。结果 (1)AC以2岁以下儿童多见,共49例(92.5%)。临床表现以血便[46例(86.8%),包括黏液血便和鲜血便]及腹泻(35例)最常见。(2)内镜下表现为局部红斑33例(62.3%),颗粒样结节31例(58.5%),表面糜烂10例(18.9%),溃疡形成1例(1.9%),镜下黏膜正常3例(5.7%),病变主要累及直肠[43例次(81.1%)]及乙状结肠[45例(84.9%)]。组织病理学主要表现为黏膜固有层嗜酸粒细胞浸润,以6～20个/HP浸润为主(62.3%)。(3)病史及实验室检查结果:16例患儿有特应性体质史,部分食物蛋白及吸入性过敏原特异性抗体检测阳性8例,外周血嗜酸粒细胞升高16例,贫血12例,外周血总IgE升高5例。(4)患儿平均住院时间(6.9±4.0)d,均好转出院。<1岁患儿纯母乳喂养者单独使用白三烯受体拮抗剂较单独更换特殊配方奶粉及二者合用平均住院天数少(P<0.05),而非纯母乳喂养组各种治疗方法的住院天数差异无统计学意义。(5)结肠镜下多发淋巴样颗粒结节表现与组织病理上嗜酸粒细胞浸润程度有相关性(P<0.05)。结论儿童AC临床表现以腹泻及血便为主,内镜下表现各异,多发淋巴样颗粒结节可能是AC较特异性表现,详细的病史询问、体格检查、辅助检查对诊断具有重要意义。回避饮食疗法及抗过敏奶粉治疗是目前儿童AC的主要治疗方法,白三烯受体拮抗剂可能对AC患儿有效。     

Comparative immunogenicity of hepatitis B vaccine administered into the ventrogluteal area and anterolateral thigh in infants

OBJECTIVE: To compare the immunological response of hepatitis B vaccine given by intramuscular injection into the anterolateral thigh and ventrogluteal site of infants up to 10 months old at initiation of vaccination. METHODS: An open, randomized study of 200 healthy infants recruited from a single practice in a small regional town in New South Wales was carried out. Infants were vaccinated with hepatitis B vaccine (Engerix-B 10 microg) using a 0 months, 1 month, 6 months regimen, with venous blood being collected from children 4-6 weeks after the last dose of vaccine for quantitative determination of hepatitis B surface antibody (anti-HBs) titre. Infants with anti-HBs titre > or = 100 m IU/mL were considered to be 'good' responders and were unlikely to acquire clinically significant hepatitis B infection. Infants with anti-HBs titre < 100 m IU/mL were considered to be 'poor' responders and were given a booster dose of Engerix-B 20 micro g; serology was repeated for anti-HBs titre 2-3 months after this injection. RESULTS: Quantitative anti-HBs titre was obtained from 177 infants: 171 4-6 weeks after the last dose of vaccine; 87 at the ventrogluteal site (46 boys, 41 girls); and 84 at the anterolateral thigh site (38 boys, 46 girls). Good antibody response (anti-HBs titre > or = 100 m IU/mL) was not significantly different for the two sites (ventrogluteal 96.6%, anterolateral thigh 93.2%), and antibody geometric mean titres (GMT) for anti-HBs were comparable for the two sites (ventrogluteal 2071.2 +/- 5.8m IU/mL, anterolateral thigh 2073.2 +/- 5.2m IU/mL). CONCLUSION: The ventrogluteal and anterolateral thigh vaccination sites in infants are immunologically comparable for hepatitis B vaccine. Presumably the variance of this study with studies of adults reflected the uniform injection of vaccine antigen into muscle tissue in infants.     

儿童肺炎链球菌感染与疫苗

肺炎链球菌是儿童呼吸道感染中最常见的病原之一,也是导致儿童重症肺炎、肺炎并发症和死亡的主要致病菌.近年来,由于世界各地肺炎链球菌对抗生素的耐药不断增加和广泛传播,造成疾病的负担日益增加,也使临床诊治面临严峻挑战.疫苗的出现和推广在肺炎链球菌病的防治方面有着光明的前景.     

Effect of specific immunotherapy in Dermatophagoides pteronyssinus allergic children

The effect of immunotherapy on 21 Dermatophagoides pteronyssinus (Dpt)-sensitive patients (15 children with extrinsic asthma and six children with extrinsic asthma plus allergic rhinitis) aged 8.9±0.71 years was studied. Their subjective and objective respiratory symptom score was recorded before beginning and after the first year of immunotherapy. The respiratory subjective symptoms, such as cough day/night, running nose, sputum production, sneezing, shortness of breath at night and asthma attacks, decreased significantly from pretreatment level (P < 0.05). The objective symptoms, such as wheezing, dyspnea with prolonged expiration, sibilant rales and retractions score, gradually decreased during treatment (P < 0.01). Total eosinophil count decreased in 76.2% of patients after immunotherapy (P < 0.01). While total immunoglobulin E (IgE) decreased in 81% of patients and specific IgE for Dpt decreased in 90.5% of patients, specific IgG for Dpt increased in 76% of patient (P < 0.001). Our results suggested that rising IgG and falling IgE values do not always coexist in the patients who benefit from immunotherapy.     

新疆地区过敏性鼻炎患儿过敏原检测分析

目的 了解新疆地区过敏性鼻炎患儿过敏原的分布状况,为儿童过敏性鼻炎的防治提供科学依据。方法 采用体外特异性过敏原检测试剂盒（IVT）对104例过敏性鼻炎患儿进行吸入过敏原（IVT701）检测,其中88例患儿同时行食物过敏原（IVT702）检测。结果 104例过敏性鼻炎患儿IVT701测试总阳性率73．1％,以蒿属植物最高38．5％,其后依次为榆杨柳树31．7％,豚草（巨大豚草、普通豚草）20．2％,霉菌（点青霉、交链孢霉、黑根霉）14．4％,螨（粉螨、尘螨）11．5％,屋尘7．7％等。88例患儿IVT702的总阳性率为56．8％。过敏原主要为大豆、花生28．4％,其次为鳕鱼和鸡蛋,分别为15．9％、13．6％,蟹虾为11．4％,牛奶和牛羊猪肉分别为5．7％和4．5％。65例患儿对2种及2种以上过敏原过敏。蒿属的阳性率随年龄的增长而增长（X^2=4．662．P〈0．050）。结论 蒿属为新疆地区过敏性鼻炎患儿最主要的过敏原,食物过敏亦占相当比例。明确过敏原后对特异性免疫治疗具有重要的指导意义。     

儿童过敏性结肠炎33例诊治分析

目的探讨儿童过敏性结肠炎(AC)的诊治特点。方法分析33例AC儿童的临床表现、结肠镜及病理学特点、相关的实验室检查及治疗情况。结果①AC以2岁以下儿童多见,共24例(占72.7%)。临床主要表现为腹泻28例(84.8%),便血25例(75.8%),其他还有腹痛、体重下降、腹胀、呕吐等。②内镜下表现为灶性红斑、粘膜变脆7例(21.2%),多发性小结节12例(36.4%),血管减少、多发浅表糜烂10例(30.3%),明显溃疡、表面渗出4例(12.1%),主要累及直肠24例(72.7%),乙状结肠28例(84.8%)。组织病理学主要表现为粘膜各层EOS浸润,以固有层轻中度浸润为主(94%)。③病史及辅助检查包括有:血红蛋白下降23例,外周血EOS增高8/20例。血清白蛋白下降5/33例,IgA下降6/10例,IgE增高6/18例。过敏原阳性9/18例,其中牛奶阳性3例,鱼虾、蟹阳性3例,鸡蛋阳性2例,豚草阳性1例。11例病儿有过敏性体质史。10例症状发作与进食食物明显有关(牛奶6例,鸡蛋2例,豆制品1例,动物肝脏1例),5例患儿母亲有明显进食牛奶及海鲜食物史。④患儿经住院治疗均缓解出院,平均住院时间(10.2±4.7)d。结论儿童AC临床表现及内镜特点各异;详细的病史、辅助检查、内镜检查结合多点粘膜活检有助于AC的诊断;停食可疑食物是治疗AC的关键。     

Measles encephalomyelitis in a patient with a history of vaccination

Secondary vaccine failure (SVF) of measles is generally believed to run a milder course of illness than an ordinary course of infection. Severe complications such as central nervous system involvement have rarely been reported. A 12 year old girl, who had received a live attenuated measles vaccine 10 years earlier, developed an encephalomyelitis in the absence of symptoms indicative of ordinary measles such as Koplik spots. Anti-measles hemagglutination inhibition (HI) titer and measles IgM and IgG anitbody titers were measured in a commercial laboratory. Measles virus genomic sequence was detected by polymerase chain reaction. Both serum and cerebrospinal fluid (CSF) samples obtained at acute phase already showed extremely high titers of HI (x 8192 in serum and x 1024 in CSF, respectively) and IgG antibody along with the presence of IgM antibody. Polymerase chain reaction detected the measles virus genomic sequence in the acute phase CSF. The patient's definite history of measles vaccination, high titers of HI and IgG antibodies observed at the very early stage of illness and the clinical course indicated that this patient had an encephalomyelitis due to SVF of measles. It is suggested that measles virus can be a pathogen of encephalitis without symptoms indicative of ordinary measles in individuals who received live attenuated measles vaccines.     

Follow-up of the Antibody Response to Measles Vaccine in a Rural Area of Guinea-Bissau

ABSTRACT. One hundred and fourty-four children who either were already immune or had been successfully immunized against measles were reexamined after 16 months. All still had circulating Elisa antibodies at a clearly detectable level. Titres were higher in the group of children stated to have had measles prior to the immunization. None of the children had measles after immunization. Boostering by the wild virus may have occurred, whereas no evidence of a booster effect from the vaccine was found. About one third of the children were underweight. Plasmodium falciparum parasitaemia rate, and also its seasonality, varied with the location of the child's homestead. Even children exposed to mesoendemic P. falciparum malaria and moderate malnutrition can be successfully immunized with a conventional live attenuated measles vaccine from 8 months of age, which probably results in a lasting protection.     

自然杀伤细胞在儿童过敏性哮喘和(或)鼻炎中的变化

目的探讨自然杀伤细胞(nature killer cells,NK)在过敏性哮喘和(或)鼻炎患儿中的变化。方法选择2009年8月—2010年12月在儿科门诊和病房诊断明确、3～14岁过敏性哮喘和(或)变应性鼻炎发作且未用药物治疗的患儿45例,正常对照儿童30例,采用乳酸脱氢酶释放法检测外周血NK细胞杀伤活性,流式细胞技术测定外周血NK细胞数量,应用免疫磁珠分选技术纯化NK细胞,分别采用标准刺激剂(离子霉素+佛波酯)和尘螨试剂刺激NK细胞,流式细胞技术检测NK细胞内γ-干扰素(IFN-γ)和白介素(IL-4)的表达情况。结果过敏性哮喘和(或)鼻炎患儿与对照组比较,NK细胞数量减少,差异有统计学意义(P=0.015);NK细胞活性下降,差异有统计学意义(P=0.023)。在尘螨刺激下,NK细胞内IFN-γ和IL-4表达均升高,但IL-4升高幅度较IFN-γ强,导致IFN-γ/IL-4比值显著降低,差异有统计学意义(P<0.05)。结论在过敏性哮喘和(或)鼻炎发作患儿中,NK细胞数量与活性均下降;在尘螨刺激下,NK细胞内IFN-γ/IL-4比值升高,导致NK细胞向NKⅡ型细胞方向失衡。推测NK细胞的数量、功能变化及...     

小儿乙肝疫苗接种失败相关因素分析

目的分析小儿乙肝疫苗接种后免疫失败原因并探讨其预防措施。方法筛选经乙肝疫苗全程接种后抗-HBs阴性者280例,分析其接种失败相关因素。结果引起免疫失败相关因素有：免疫力低下（71.8%）、反复呼吸道感染（63.6%）、锌缺乏（67.4%）、母婴传播（29.1%）、滥用激素（14.4%）等。结论可通过免疫疗法、补锌、合理应用激素及产前、产后联合阻断母婴传播等措施,提高乙肝疫苗免疫成功率。     

有无疫苗接种史麻疹患儿心肌酶谱变化的意义

目的了解有无麻疹疫苗接种史麻疹患儿急性期心肌酶谱变化及临床意义,探讨疫苗接种对麻疹患儿心肌的保护作用。方法对71例住院麻疹患儿按有无麻疹疫苗接种史分为有疫苗接种史组23例（有接种组）和无疫苗接种史组48例（无接种组）,并设健康对照组30例。分别检测各组血清肌酸激酶（CK）及其同工酶（CK-MB）,乳酸脱氢酶（LDH）及其同工酶1（LDH1）,α-羟丁酸脱氢酶（α-HBD）水平,同时行心电图检查。结果无接种组与有接种组比较,CK-MB、LDH1及α-HBD明显升高（Pa〈0.05）,并肺炎增多（P〈0.05）,平均住院天数增加（P〈0.01）。二组分别与健康对照组比较,CK-MB、LDH、LDH1及α-HBD均明显升高（Pa〈0.01）。结论麻疹患儿急性期存在心肌酶谱升高,接种麻疹疫苗对急性期麻疹患儿心肌有一定保护作用,可减少合并症。     

Patterns of Measles Pneumonitis

As a result of the enlarging pool of unvaccinated children and young adults, there has been an increase in serious measles pneumonitis in our areas. We recently examined autopsy and/or lung biopsy material from five children with fatal measles pneumonitis. Two patients were immunocompromised because of either prematurity or acute leukemia and died 13-16 days following onset of symptoms. Both had classic giant cell pneumonitis, with readily demonstrable intranuclear inclusions. Three other children without known immunocompromise had a more prolonged course. The lungs of these patients lacked the classic pattern and displayed instead a spectrum of less specific findings ranging from organizing diffuse alveolar damage to interstitial pneumonia with giant cells, but without viral inclusions. An accompanying necrotizing bronchiolitis was also present. Electron microscopy and/or detection of elevated measles-specific immunoglobulin M was necessary to confirm the diagnosis in these apparently immunocompetent patients. We conclude that the histologic features of fatal or serious measles pneumonitis are variable and depend to some extent on the immunocompetence of the host as well as the duration and tempo of the disease. Ancillary studies may be necessary to establish the diagnosis in cases lacking classic histopathologic features.     

Immunogenicity of hepatitis a vaccine in children with cancer

This study evaluated the immuned response of the hepatitis A vaccine in children with cancer who were receiving chemotherapy. Twenty-eight patients with lymphomas or solid tumors and who had negative serology for hepatitis A were enrolled. The median age was 4.7 years (range 2-16). The patients received 1440 IU hepatitis A vaccine at 0 and 6 months. Seroconversion rates at the first and seventh months were 60% (n = 17/28 patients) and 89% (n = 24/27 patients). No adverse effects were observed. The hepatitis A vaccine was found to be effective and safe in children with cancer.