A 49-year-old health care worker received varicella vaccine in accordance with current Australian guidelines. She developed streptococcal toxic shock syndrome, complicated by acute atraumatic dislocation of the right wrist secondary to poststreptococcal reactive arthritis to our knowledge, the first report of spontaneous wrist dislocation as a complication in this condition. Vaccination was accompanied by prolonged viraemia with the varicella vaccine strain also, we believe, the first report of this in an immunocompetent patient.
Source: MJA 2009; 190 (8): 451-453.
A 4 month-old infant was admitted for a severe form of Hib meningitis with septicemia whose first manifestations developed 3 hours after the first immunization with a conjugate vaccine against Hib (PRP-T). The outcome was good without any sequelae. DISCUSSION: A dramatic decrease in serum antibodies due to antigen-antibody reaction during the first days after immunization has been reported; this mechanism and some epidemiological data could favor the hypothesis that the vaccine is responsible for the infection, at least the unconjugated vaccines. CONCLUSION: Any fever occurring in the immediate post-immunization period must alert the possibility of a Hib infection.
Source: Arch Pediatr. 1996 Apr;3(4):342-4.
Children: a convenience sample of 32 healthy 2-year-old children from diverse locales. Adults: a convenience sample of 16 healthy adults chosen from employees at the Washington University and Tulane University schools of medicine. INTERVENTIONS: PRP or PRP-D vaccine administered to the adults and serum obtained daily for 5 days. PRP vaccine was administered to the children, and serum was sampled 2 or 3 days or 4 or 5 days after immunization, or both. MEASUREMENTS AND MAIN RESULTS: Decline in serum antibody in all seven (100%) adult recipients of PRP. The nadir occurred on days 1 to 3, and the decrease average 26.0% of the preimmunization concentration. Eight (89%) of nine PRP-D recipients had a similar decline that averaged 25.9%. Of 29 children, 20 (69%) had a decline that averaged 14.7%. The magnitude of anticapsular antibody present before immunization was correlated with the magnitude of the observed decrease. CONCLUSIONS: A decrease in serum anticapsular antibody occurs in most children and adults immunized with PRP (adults and children) or PRP-D (adults). Such a decrease might transiently increase the risk of invasive disease if it occurred during a period of asymptomatic colonization with H. influenzae type b.
Source: J Pediatr. 1989 May;114(5):742-7
One concern with the use of PRP vaccine was the suggestion that the incidence of invasive disease caused by H influenzae type b in the immediate period after immunization might be increased; this idea was supported by evidence from several sources. In a case-control study of the efficacy of PRP vaccine, Black et al found that 4 children were hospitalized for invasive disease within 1 week of immunization, a rate of invasive disease 6.4 times greater (95% confidence interval [CI], 2.1 to 19.2) than the background rate in unvaccinated children. In Minnesota, the relative risk for invasive disease in the first week after immunization was 6.2 (95% CI, 0.6 to 45.9), and the results of a study conducted by the Centers for Disease Control in six areas of the United States revealed a 1.8-fold (95% CI, 0.3 to 10.2) increase in the occurrence of invasive disease caused by H influenzae type b in the first week after immunization.
Source: Pediatrics. 1990 Apr;85(4 Pt 2):698-704
An 18-month-old male previously vaccinated with 4 doses of HbOC developed meningitis caused by Hemophilus influenzae type B. Immunological status was normal and antibody titer to Hemophilus influenzae type b was in the normal range for immunized children. Meningitis due to this organism should be considered even in children who are fully vaccinated.
Source: Harefuah. 1994 Oct;127(7-8):231-4, 287
A contagious virus has been reported in schools in the Northern Shenandoah Valley, prompting local health officials to work to stop the outbreak.
And, no, it's not swine flu.
Some 38 cases of chickenpox have been reported in Page County over the past three weeks, according to Dr. Stephen Haering, director of the Lord Fairfax Health District.
Since the introduction of a chickenpox vaccine in 1995, the county has usually seen only five or six cases for an entire year.
But in the past three weeks, "Luray Elementary has had 18 cases and Stanley Elementary has had 17 cases," said Haering.
The outbreak has prompted calls for Page County students to get a second dose of the vaccine to improve their immunity.
Most children get one dose of chickenpox vaccine as a part of routing immunizations for school.
"The one dose is 70 to 85 percent effective," he said.
That's been made painfully clear in Page County.
"All these kids have been vaccinated once," Haering said. "We're seeing breakthrough disease, which is why we're pushing for a second vaccination."
Source: nvdaily.com, 12th May 2009, by Garren Shipley.
The inactivated flu vaccine does not appear to be effective in preventing influenza-related hospitalizations in children, especially the ones with asthma. In fact, children who get the flu vaccine are more at risk for hospitalization than their peers who do not get the vaccine, according to new research that will be presented on Tuesday, May 19, at the 105th International Conference of the American Thoracic Society in San Diego.
Flu vaccine (trivalent inactivated flu vaccineTIV) has unknown effects on asthmatics.
"The concerns that vaccination maybe associated with asthma exacerbations have been disproved with multiple studies in the past, but the vaccine's effectiveness has not been well-established," said Avni Joshi, M.D., of the Mayo Clinic in Rochester, MN. "This study was aimed at evaluating the effectiveness of the TIV in children overall, as well as the children with asthma, to prevent influenza-related hospitalization."
The CDC's Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) recommend annual influenza vaccination for all children aged six months to 18 years. The National Asthma Education and Prevention Program (3rd revision) also recommends annual flu vaccination of asthmatic children older than six months.
In order to determine whether the vaccine was effective in reducing the number of hospitalizations that all children, and especially the ones with asthma, faced over eight consecutive flu seasons, the researchers conducted a cohort study of 263 children who were evaluated at the Mayo Clinic in Minnesota from six months to 18 years of age, each of whom had had laboratory-confirmed influenza between 1996 to 2006. The investigators determined who had and had not received the flu vaccine, their asthma status and who did and did not require hospitalization. Records were reviewed for each subject with influenza-related illness for flu vaccination preceding the illness and hospitalization during that illness.
They found that children who had received the flu vaccine had three times the risk of hospitalization, as compared to children who had not received the vaccine. In asthmatic children, there was a significantly higher risk of hospitalization in subjects who received the TIV, as compared to those who did not (p= 0.006). But no other measured factorssuch as insurance plans or severity of asthmaappeared to affect risk of hospitalization.
Source: The American Thoracic Society, Press Release, 19th May 2009.
Progressive vaccinia (PV), previously known as vaccinia necrosum, vaccinia gangrenosum, or disseminated vaccinia, is a rare, often fatal adverse event after vaccination with smallpox vaccine, which is made from live vaccinia virus (1). During recent vaccination programs potential cases of PV were investigated, but none met standard case definitions (2). PV has not been confirmed to have occurred in the United States since 1987 (3). On March 2, 2009, a U.S. Navy Hospital contacted the Poxvirus Program at CDC to report a possible case of PV in a male military smallpox vaccinee. The service member had been newly diagnosed with acute mylegenous leukemia M0 (AML M0). During evaluation for a chemotherapy-induced neutropenic fever, he was found to have an expanding and nonhealing painless vaccination site 6.5 weeks after receipt of smallpox vaccine. Clinical and laboratory investigation confirmed that the vaccinee met the Brighton Collaboration and CDC adverse event surveillance guideline case definition for PV (4,5). This report summarizes the patient's protracted clinical course and the military and civilian interagency governmental, academic, and industry public health contributions to his complex medical management. The quantities of investigational and licensed therapeutics and diagnostics used were greater than anticipated based on existing smallpox preparedness plans. To support future public health needs adequately, the estimated national supply of therapeutics and diagnostic resources required to care for smallpox vaccine adverse events should be reevaluated.
On January 13, 2009, a healthy service member aged 20 years received a primary smallpox vaccination (ACAM2000 [Acambis, Inc., Cambridge, Massachusetts]) in accordance with the U.S. Department of Defense smallpox vaccination policy*; no other vaccinations were administered that day. Twelve days later, the patient visited a local hospital with fever and headache of 1 day's duration and was admitted for workup of leukopenia after his white blood cell count was found to be 1,400 cells/mm3. On January 28, after transfer to a U.S. Navy tertiary-care facility, he was diagnosed with AML M0. On January 30 and February 13, the patient underwent two successive rounds of induction chemotherapy with cytarabine, idarubicin, and dexamethasone. Before initial chemotherapy, the vaccination site pustule had a central crust and measured approximately 1 cm in diameter with minimal surrounding erythema. During the patient's hospital stay from the end of January to the beginning of March, his vaccination site dressing was changed daily.
On March 2, during the evaluation of neutropenic fever, the failure of the patient's vaccination site to heal was described. An annular lesion with a deep bulla, raised violaceous leading edge, and a central crust that bled with pressure was noted. The size of the lesion had progressed to approximately 4 x 4 cm with minimal surrounding erythema or induration (Figure). The patient described no pain at the site, although he reported occasional pruritus. A swab of the lesion and serum were sent to CDC for viral and serologic analysis. Viral analysis of the swab by multiple real-time polymerase chain reaction (PCR) assays for orthopoxvirus and vaccinia yielded evidence of viral DNA; viral culture was positive for orthopoxvirus. Serum showed equivocal to absent levels of anti-orthopoxvirus immunoglobulin G (IgG) and immunoglobulin M (IgM) by enzyme-linked immunosorbent assay. The results of the diagnostic testing combined with the patient's medical history met the PV level 1 case definition as defined by the Brighton Collaboration and the confirmed case definition as described by CDC surveillance guidelines (4,5). The criteria met by both case definitions were 1) a documented clinical diagnosis of a disease that is known to be associated with cell-mediated immunodeficiency (in this case AML M0), 2) the primary vaccination site's failure to resolve (in this case >6 weeks post vaccination), and 3) the laboratory confirmation of vaccinia virus as the causative agent.
On March 3, imiquimod was applied directly to the lesion. Within 24 hours of confirmation of PV on March 4, the patient received licensed Vaccinia Immune Globulin Intravenous (Human) (VIGIV) (Cangene Corporation, Winnipeg, Canada). On March 5 and March 6, oral and topical ST-246 (SIGA Technologies, Corvallis, Oregon) were administered under an Emergency Investigational New Drug (E-IND) application. The patient remained stable until the evening of March 7, when he became septic with Pseudomonas aeruginosa, likely from a perirectal abscess. He required intubation, maximal vasopressor support, multiple antibiotics, and stress dose corticosteroids. He then developed multiorgan failure and began continuous venovenous hemodialysis. During the next 12 days, the patient slowly stabilized. As a consequence of the duration and amount of vasopressor support, the patient required a bilateral trans-tibial amputation because of dry gangrene of his feet.
During March 6--19, the patient received additional oral and topical ST-246 and VIGIV; his ST-246 levels were noted to be lower than those achieved both in healthy subjects in phase I clinical trials and in successful treatment of nonhuman primates with systemic orthopoxvirus disease. The lesion size remained unchanged, but the central crust of the vaccination site sloughed off, followed by most of the outer "ring" flattening, leaving a shallow ulcer with healthy-appearing granulation tissue. During his steroid taper, additional satellite lesions surrounding the vaccination site appeared on March 18, and viral DNA was detected again in the blood. These lesions became vesicular in nature, and on March 26, after a second E-IND was issued, CMX001 (Chimerix, Inc., Research Triangle Park, North Carolina), a lipid conjugate of cidofovir, was administered.
From March 24 onward, the satellite and main vaccination site lesions continued to crust, the scabs separated, and underlying tissue epithelialized (Figure). Blood viral DNA levels cleared on March 29. On April 10, the borders of lesions again appeared raised; a shave biopsy grew methicillin-resistant Staphylococcus aureus, which responded to antibiotic therapy. The patient received intermittent granulocyte colony-stimulating factor, and his absolute neutrophil and lymphocyte count increased over time. By May 1, significant portions of the scabs/eschars had fallen off or were removed manually, revealing healthy epidermis. Numerous therapeutics with different biologic mechanisms were used to treat PV in this patient (Table).
From February 21 onward, the patient had remained in contact isolation, first for a Clostridium difficile infection and then for his progressive vaccinia infection. On May 5, contact precautions were discontinued because of the lack of viable virus in lesion specimens from the previous 4 weeks. No cases of contact vaccinia were identified among this patient's health-care workers or close contacts.
During March 3--May 18, nearly 200 clinical specimens (lesion and satellite swabs/crusts, ethylenediaminetetraacetic acid [EDTA] blood, bone marrow, and serum) were collected and submitted to CDC to evaluate disease progression and guide therapeutic interventions. After April 23, swabs from satellite lesions or the main vaccination site showed significantly reduced or absent levels of viral DNA, and no viable virus was detected after April 2. Oropharyngeal sampling and bone marrow biopsies from early and late March, respectively, were negative for vaccinia virus. Orthopoxvirus DNA was detected in EDTA blood at intermittent times during the course of the patient's infection; however, no viable virus was cultured from blood. As of May 12, the patient had no demonstrable IgM response to orthopoxvirus; IgG levels appeared fully reliant on VIGIV infusion.
During March 3--May 18, a total of 20 conference calls to discuss patient status and treatment options were held between the Vaccine Healthcare Centers Network, Military Vaccine Agency (MILVAX), Bureau of Medicine and Surgery of the Navy, CDC, Food and Drug Administration (FDA), National Institutes of Health (NIH), SIGA Technologies, Chimerix, Inc., and academic and health-care professionals. As of May 18, MILVAX provided 22 and the Strategic National Stockpile (SNS) provided 254 vials of VIGIV used in treatment of this case.
Reported by: E Lederman, MD, H Groff, MD, T Warkentien, MD, A Reese, MD, US Naval Medical Center. D Hruby, PhD, T Bolken, D Grosenbach, PhD, S Yan, PhD, SIGA Technologies, Corvallis, Oregon. W Painter, MD, L Trost, MD, B Lampert, MD, Chimerix, Inc., Research Triangle Park, North Carolina. J Cohen, MD, National Institutes of Health; R Engler, MD, Walter Reed Vaccine Healthcare Center; W Davidson, MPH, S Smith, MS, K Wilkins, Z Braden, Y Li, PhD, I Damon, MD, Div of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, CDC.
Although PV is a rare adverse event (one case per million during routine vaccination during 1963--1968), its case fatality rate in primary U.S. vaccinees was 15% despite treatment with massive amounts of VIG (intramuscular) (6). Extensive surgical debridement was sometimes required, even necessitating disarticulation of the arm to "debulk" the amount of infectious material (7). Before smallpox vaccination, patients are screened for numerous contraindications (8). At the time of his vaccination, the patient described in this report did not have any obvious signs or symptoms that would meet any exclusion criteria for vaccination. Training in use of, and careful adherence to, screening tools can identify vaccine candidates at risk for PV and other adverse events (2). Despite this, vaccinees with occult immunodeficiencies might not be recognized, and therefore appropriately deferring vaccination in these persons is not always possible.
Lack of inflammation at the expanding vaccination site is the hallmark of PV. Any smallpox vaccinee who has an expanding, nonhealing, painless vaccination site without inflammation for more than 2 weeks should be evaluated for an underlying immunodeficiency, and diagnosis of and treatment for PV should be considered. Health-care providers should report suspected cases of PV or other adverse events to the Vaccine Adverse Event Reporting System (VAERS). Suspected cases of PV also should be reported to state health officials and CDC for clinical consultation and to obtain select therapeutics available only through the SNS. State health departments should call the CDC Emergency Operations Center at 770-488-7100.
This patient's protracted clinical course is consistent with previously published cases reports and surveillance summaries. The development of progressive vaccinia, historically observed in patients with cellular immunodeficiencies, often leads to superinfection and subsequent sepsis (i.e., fungal, parasitic, and bacterial infections resulting in toxic or septicemic shock, then ultimately death). Past treatment typically included massive doses of VIG, administration of thiosemicarbazone, blood products, and supportive care for accompanying infections (7,9). The improvement of progressive vaccinia in this patient was associated with receipt of VIGIV (the only licensed product for treatment of vaccinia adverse events stockpiled by the SNS), ST-246, and CMX001, and an increase in lymphocyte count. The use of two antiviral agents with different mechanisms of action§ was enabled by the research and development of medical countermeasures for smallpox preparedness activities, as well as the use of the emergency IND process. As of May 18, the patient had shed nearly all of the scab material on and around the vaccination site.
The rapid mobilization of military, CDC, FDA, NIH, drug manufacturer, and academic and health-care human resources to review the case's status and to provide daily, then biweekly laboratory findings that guided treatment recommendations, was enabled by smallpox public health preparedness research and training efforts. Future cases of PV likely will require similar intensive and multidisciplinary clinical consultation. Experts with background in vaccine safety, PV treatment, clinical virology, infectious disease, and immunodeficiencies should be engaged.
Continuing medical education and reinforcement of training related to the prevention, early recognition, and treatment of smallpox vaccine--related adverse events should be part of smallpox vaccination programs.¶ The patient described in this report received VIGIV in the amount originally estimated to treat 30 persons. The extraordinary amounts of VIGIV used to treat this single case of PV underscore the need to reevaluate the adequacy of the national stockpiled supply of this or other medical countermeasures (treatment or prophylactic). Such reevaluation, with additional focus on immunocompromised hosts, will aid in the smallpox vaccination program planning and overall smallpox preparedness efforts.
This report is based, in part, on contributions by JM Lane and staff members from SIGA Technologies, Corvallis, Oregon; Chimerix, Inc., Research Triangle Park, North Carolina; Center for Biologics Evaluation and Research and Center for Drug Evaluation and Research, Food and Drug Admin; Military Vaccine Agency; Walter Reed Vaccine Healthcare Center; Bur of Medicine and Surgery of the Navy; Office of the Chief of Naval Operations; Chemical Biological Medical Systems of the US Dept of Defense; and the Emergency Operations Center and Strategic National Stockpile, CDC.
1. CDC. Recommendations for using smallpox vaccine in a pre-event vaccination program. Supplemental recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR 2003;52(No. RR-7).
2. Vellozzi C, Lane JM, Averhoff F, et al. Generalized vaccinia, progressive vaccinia, and eczema vaccinatum are rare following smallpox (vaccinia) vaccination: United States surveillance, 2003. Clin Infect Dis 2005;41:689--97.
3. Redfield RR, Wright DC, James WD, Jones TS, Brown C, Burke DS. Disseminated vaccinia in a military recruit with human immunodeficiency virus (HIV) disease. N Engl J Med 1987;316:673--6.
4. Nell P, Kohl KS, Graham PL, et al. Progressive vaccinia as an adverse event following exposure to vaccinia virus: case definition and guidelines of data collection, analysis, and presentation of immunization safety data. Vaccine 2007;25:5735--44.
5. CDC. Surveillance guidelines for smallpox vaccine (vaccinia) adverse reactions. MMWR 2006;55:(No. RR-1).
6. Aragón TJ, Ulrich S, Fernyak S, Rutherford GW. Risks of serious complications and death from smallpox vaccination: a systematic review of the United States experience, 1963--1968. BMC Public Health 2003;3:26.
7. Maurer DM, Harrington B, Lane JM. Smallpox vaccine: contraindications, administration, and adverse reactions. Am Fam Physician 2003;68:889--96.
8. Fulginiti VA, Papier A, Lane JM, Neff JM, Henderson DA. Smallpox vaccination: a review, part II. Adverse events. Clin Infect Dis 2003;37:251--71.
9. Bray M, Wright ME. Progressive vaccinia. Clin Infect Dis 2003;36:766--74.
10. Quenelle, DC, Prichard MN, Keith KA, et al. Synergistic efficacy of the combination of ST-246 with CMX001 against orthopoxviruses. Antimicrob Agents Chemother 2007;51:4118--24.
* Information about U.S. Department of Defense policies regarding smallpox vaccination and screening before smallpox vaccination is available at http://www.smallpox.army.mil.
Information about VAERS is available at http://vaers.hhs.gov.
§ ST-246 prevents viral egress, whereas CMX001 inhibits viral replication, and some data suggest they are synergistic in vitro (10).
Source: MMWR, May 19, 2009 / 58(Early Release);1-4
Although vaccination coverage is high in Catalonia, Spain, pertussis is still a significant cause of morbidity and mortality among infants, overall due to adolescent and adult contacts. An epidemiological study from voluntary health care centres to detect confirmed pertussis cases was carried out in Catalonia. From 465 pertussis-suspect-cases, we identified 126 confirmed events, 73 of them confirmed by laboratory tests. Most of cases were infants less than 4 months old 23 (18.3%), adolescents 22 (17.4%) and adults 46 (36.5%). Sixty-one cases (49.6%) presented paroxysmal cough, 33 (26.8%) post-tussive vomiting and inspiratory whoop, and 27 (22%) apnoea. The vaccination status was not known for 46 (36.5%) patients. Of the total vaccine status documented, 59 (73.8%) patients had received at least one dose. Sixty patients (47.6%) were considered index cases, 32 of them (53.3%) were children under 1-year old. Among contacts identified as pertussis cases, 63.6% (42/66) were older than 14 years of age. These contacts were parents (30), siblings (19), grandmother (4), and others (13). These results confirm protective efficacy of pertussis vaccine only during few time. Regular pertussis boosters in teenagers, and/or in adults who take care of young children, could decrease the incidence of the infection.
Source: Vaccine, Volume 27, Issues 25-26, 26 May 2009, Pages 3489-3491.
Despite high vaccination coverage for many decades, reported incidence has increased recently, to the highest incidence of 27.5/100,000 in 2006, a 6.5-times increase in comparison to the previous year. Marked shift in age distribution among reported cases was observed in recent years. In 2006, reported age-specific incidence was relatively high in children 812 years old, the highest among 9 years old. Similar to other countries, where children are given pre-school boosters, we also have to consider the revision of the national vaccination policy. A booster dose at school entrance or latest at 8 years of age should be introduced to decrease the transmission of disease among school children and to further reduce the burden of disease among infants.
Volume 26, Issue 15, 28 March 2008, Pages 1874-1878.
Seven cases of pertussis in patients aged between 1 and 6 months detected over 3 months were reported. Paroxysmal cough (six cases), post-tussive vomiting (three cases) and poor feeding (three cases) were the most common presenting symptoms. Bordetella pertussis was isolated from six patients. The total leucocyte counts were mildly increased (10.815.6×109/L). The lymphocyte counts were markly raised (5973%) and appear to be useful indicators of pertussis. It appears that herd immunity does not offer adequate protection to the vulnerable group even in well-vaccinated populations.
Source: Journal of Infection, Volume 48, Issue 2, February 2004, Pages 145-148
This report was from 1955 and unfortunately I am unable to read the full report due to having to purchase it, but the summary says:
It would appear from this study that pertussis is not an uncommon disease and that even in vaccinated children it continues to occur. It may be that the diagnosis is not being made either because of its atypical mild form at the present time or because it is cured by one of the broad-spectrum antibiotics before its full symptomatology erupts.'
So it would appear the report is saying there is just as much whooping cough in the vaccinated as in the unvaccinated and since this dates back to 1955, the DPT vaccine never worked.
Source: The Journal of Pediatrics, Volume 47, Issue 6, December 1955, Pages 716-719.
Bordetella pertussis circulates even in highly vaccinated populations. There is a considerable amount of infection in adults. For designing more effective vaccination schedules it is important to quantify the age-dependent relation between the number of notified cases and the number of infections.
We used a statistical relationship between the time since infection and the IgG antibody titers against pertussis toxin, derived from a longitudinal data set, to estimate time since infection for all individuals in a cross-sectional population-based study (19951996) based on their titers. Age-specific incidence of infection with B. pertussis was calculated and compared with the age-distribution of notified cases of pertussis in 19941996.
Estimated incidence of infection was 6.6% per year for 379-year olds, annual incidence of notified cases 0.01%. Estimated age-specific incidence of infection was lowest for 34-year olds (3.3%) and increased gradually up to the age of 2024 years (10.8%). The number of notified cases was highest for 39-year olds.
Source: Journal of Infection, Volume 53, Issue 2, August 2006, Pages 106-113.
Adolescents have an unknown true incidence of pertussis and are important reservoirs of transmission. We evaluated the incidence of coughing illnesses, serologic evidence of recent infection and the relationship between symptomatology and serology in adolescents. A retrospective respiratory questionnaire and anti-pertussis toxin immunoglobulin G measurement was undertaken in a convenience sample of adolescents and was repeated one year later. The US Centers for Disease Control clinical case definition of pertussis was used. At least a third of coughing illnesses met the CDC clinical case definition. Symptoms correlated with serology. Pertussis was endemic with a high annual incidence of new infections.
Volume 26, Issue 44, 16 October 2008, Pages 5547-5553.
Whooping cough is a common respiratory infection caused by the bacterium Bordetella pertussis. It should be considered as a possible diagnosis in any adolescent or adult with an acute cough of more than two weeks duration, even if they have been fully immunised.
A 17 year old girl presents with a three week history of cough. The cough keeps her awake at night and she has bouts of coughing that disturb her classmates. She is fully immunised. Her general practitioner requests serology for anti-pertussis toxin IgG antibodies, which are found to be raised, indicating a recent infection with Bordetella pertussis.
In the post-vaccination era, whooping cough is under-recognised in primary care as the incidence is incorrectly thought to be low.
Source: BMJ 2009;338:b1772
ndias health ministry is evaluating a proposal to introduce the injectable polio vaccine next year in one region of India, questioning for the first time its three decade policy of using only oral vaccines to eradicate polio.
India accounted for 874 of the total of 1208 polio cases last year in the four countries with endemic polio (the others being Pakistan, Nigeria, and Afghanistan). Despite numerous campaigns with the oral vaccine, polio has persisted.
Source: BMJ 2008;337:a2809.
Pakistan reported its 18th polio case of the year on Sunday when a ten-month-old child belonging to tehsil Shujabad of district Multan was confirmed by the National Institute of Health (NIH) as having been afflicted by the crippling disease.
According to experts, the case is from an area that is part of the polio reservoir axis that extends from northern Balochistan to the southern tip of Punjab. Cases in southern Punjab represent the last remnants of the 2008 outbreak, when the province reported 31 of the 117 cases in total; that was the highest number of polio cases reported in Pakistan in five years, an expert commented.
The latest case, Tahzeeb, is reported by the district health authorities to have received all routine and additional doses of polio vaccine during different campaigns right since birth. The childs immune system may not have responded to the vaccine doses; this can happen in malnourished children and among those living in squalid conditions resulting in frequent episodes of diarrhoea, which do not allow vaccine absorption, a paediatrician reflected.
Source: The International News, 8th June 2009.
My baby is sick. Possibly sick from the vaccine intended to protect her from illness. And I am sick at heart. You see, I took her in for her 9-month well baby visit three days ago. At that time, she received two vaccinations: DTaP and Rotavirus. Those of you really savvy about vaccinations might see the problem already. I didnt realize it at the time, but the rotavirus vaccine is not recommended after the baby reaches the age of 32 weeks (about 8 months).
RotaTeq rotavirus vaccine
RotaTeq rotavirus vaccine
My baby was overdue for her third and final dose of RotaTeq. I had put it off because we were on the waiting list for the Hib vaccine, which is in short supply and must be rationed out by pediatricians. In hindsight I realize I should have proceeded on schedule with my daughters other vaccinations, and I should have re-read the information about each vaccine, rather than relying on my previous decision to approve that vaccination. My initial reasoning was that I have had rotavirus before, and I had never been so sick in my life!
Two days after my baby received the vaccine, she started having mild diarrhea. I didnt think much of it, until 12 hours later when she threw up (and I earned a Mommy Medal by catching it in my hand, thankyouverymuch!) The next day, she spiked a fever of over 102. I am not worried for her. She is generally content and just a bit sleepy. Thank goodness for breastfeeding, which keeps her both hydrated and happy!
I am not pro-vaccine or anti-vaccine. I am all about the informed decision. I fully recognize that my daughter might not actually have rotavirus, or that she might have rotavirus but have contracted it from a source other than the live vaccine. I do feel though that this diarrhea, vomiting, and fever constitute a potential adverse reaction to the vaccine.
State health officials have confirmed a case of whooping cough at Eastern Alamance High School.
Alamance Burlington school officials learned of the case Friday afternoon and are working together to get students' parents up to speed.
"We're able to make contact with those individuals that were in those classrooms as well as those who may have been exposed to the student while riding the school bus," said Eric Nickens, Alamance County Health Dept. spokesman.
Nickens estimates as many as 100 children may have been exposed to the sick student in the last few weeks, either in the classroom or on a school bus shared with Woodlawn middle school students. The last day of school was Wednesday and employees are cleaning classrooms to disinfect.
"We've actually wiped down in the buses, so we have taken some precautions there too," said Caron Myers, Alamance Burlington Schools System spokeswoman.
The confirmed Alamance case comes as Guilford County's Health Dept. is offering free TDAP (Tetanus, Diphtheria and Pertussis) vaccination shots. The vaccine protects children from whooping cough and is mandatory for all rising sixth graders.
Myers said the child with whooping cough was up to date on his vaccinations, including TDAP.
Source: Fox 8 News, 13th June 2009.
Three more area students have been diagnosed with whooping cough, the San Diego County Health and Human Services Agency announced Wednesday.
A 5-year-old at Solana Beach Presbyterian Preschool, an 11-year old at Skyline Elementary and a 14-year-old who goes to Earl Warren Junior High are being treated for the disease, according to the HHSA.
All of the schools are in Solana Beach.
On Tuesday, the HHSA announced that a 5-year-old at Pioneer Elementary School in Escondido also had whooping cough.
HHSA and school officials are working to notify the parents of students who may have been exposed.
"It is not unexpected to see whooping cough in our community," said Dr. Dean Sidelinger, the county's deputy public health officer. "Parents need to make sure their children are immunized to protect against vaccine-preventable diseases."
All of the infected children had been vaccinated.
There were 51 cases of whooping cough reported in the county last year. So far this year, there have been 30 cases.
Source: 10news.com, 10th June 2009.
A 5-year-old kindergarten student at Pioneer Elementary School is recovering from pertussis, or whooping cough, health officials said Tuesday.
The child developed the bacterial disease even after receiving the recommended five-part course of vaccinations, officials said. County Public Heath Officer Wilma Wooten explained that while the whooping cough vaccine greatly reduces the risk of developing the illness, no vaccine is 100 percent effective.
Source: North County Times, 9th June 2009.
With the confirmation of yet another polio case, the total toll of reported polio victims across Sindh province has reached 6 in the current year, Geo news reported.
The Director project of IPI Sindh Dr. Mazhar Khamisani told Geo news the fresh case was confirmed in Tando Alha Yar.
The case is an eighteen-months-old child Dileep who had received three doses of anti-polio while four cases had been confirmed in Karachi, one in Kunbhar district earlier, taking the total number of confirmed polio cases to 6 in Sindh, sources said.
Source: GEO Pakistan, 21st June 2009.
From October 2005 to March 2006, a laboratory-confirmed outbreak of pertussis occurred in preschool-aged children (1-4 years) in Toronto, Canada. A case-control study in children was done to identify the risk factors for being positive for Bordetella pertussis by polymerase chain reaction (PCR).
The main risk factors for PCR positivity for B. pertussis were school or day care attendance. Atypical symptoms were likely moderated by high immunization rates or may have been caused by other respiratory pathogens. In some cases, a positive PCR result might simply have reflected transient nasopharyngeal carriage of B. pertussis.
Source: The Pediatric Infectious Disease Journal:
July 2009 - Volume 28 - Issue 7 - pp 582-587
The World Health Organization says a study has shown that babies with HIV could die if given a standard tuberculosis vaccine.
WHO says a three-year study in South Africa found babies born with HIV had a higher risk of contracting a deadly form of TB if given the widely used BCG vaccine.
The study recommends not vaccinating babies with HIV and delaying vaccination for those babies whose HIV status is unknown.
The study was published Wednesday in the journal Bulletin of the World Health Organization.
Source: The Associated Press, 1st July 2009.
From the time her daughter was born last summer in this remote village of rice paddies and mud huts, Parmeshwar Paswan made sure her baby was vaccinated by medical teams who arrived each month. Now 14 months old, Abhi Lasha has received the pink-coloured oral polio vaccine as many as 10 times.
It made no difference.
Seven weeks ago, Abhi Lasha contracted polio, the highly contagious crippler of children. In the days since her diagnosis, six more cases surfaced in villages near her home.
Paswan was inconsolable.
"I did what I was supposed to," the 20-year-old mother said, seated in the middle of the village, surrounded by oxen and chickens and children with tattered clothing.
It is confusing for her to understand how her daughter could contract polio after all the efforts made to prevent it.
Doctors with the World Health Organization (WHO) say malnutrition probably played a role in Abhi Lasha's case. She may have been so undernourished that the vaccine couldn't be absorbed properly, even after so many courses of treatment.
Source: thestar.com, 11th July 2009.
The families of children from the United Kingdom who developed invasive Hib disease after prior immunization with Hib conjugate vaccine (i.e., Hib vaccine failure) from October 1992 through December 2005 were asked to complete a questionnaire. A blood sample was also obtained from each child.
Results.Of 323 families approached, 260 (80.5%) returned a completed questionnaire, and 175 (54.2%) children provided a blood sample. The median age at follow‐up was 8.4 years (interquartile range [IQR], 6.215.4 years), and the median duration of follow‐up was 4.1 years (IQR, 3.59.7 years). Twenty‐seven children (16.1%) had been born prematurely and/or had an underlying medical condition, and 18 (10.8%) had immunoglobulin deficiency. The median Hib antibody concentration was 0.70 μg/mL (IQR, 0.225.8 μg/mL). Overall, 95 children (56.9%) had antibody concentrations <1.0 μg/mL, and 27 (16.2%) had antibody concentrations <0.15 μg/mL. All 3 children with Down syndrome and 10 (42%) of 24 children aged <5 years at follow‐up had Hib antibody concentrations <0.15 μg/mL. An antibody concentration <0.15 μg/mL was independently associated with underlying conditions, young age at onset of Hib disease, and shorter time from Hib disease to follow‐up.
Conclusions.More than one‐half of the children with Hib vaccine failure had antibody concentrations below those considered to confer long‐term protection, which suggests that these children might be at further risk of invasive Hib disease and would benefit from another dose of Hib vaccine.
Source: Clinical Infectious Diseases 2009;49:372380
Background: In June 2006, the Advisory Committee on Immunization Practices (ACIP) expanded its June 2005 recommendation for a second dose of varicella vaccine during outbreaks to a recommendation for routine school entry second dose varicella vaccination. In October 2006, the Arkansas Department of Health was notified of a varicella outbreak among students where some received a second dose during an outbreak-related vaccination campaign in February 2006.
Methods: The outbreak was investigated using a school-wide parental survey with a follow-up survey of identified case patients. Vaccination status was verified using state and local immunization records. Limited laboratory testing confirmed circulation of wild-type varicella, including varicella in 2-dose vaccine recipients.
Results: Vaccination information was available for 871 (99%) of the 880 children. Varicella vaccination coverage was 97% (2-dose, 39%; 1-dose, 58%). A review of the February vaccination clinic found no deficiencies; lot numbers did not differ between cases and noncases. Varicella was confirmed by PCR in 5 (42%) of 12 lesion specimens and by IgM in 1 (6%) of 16 serum specimens. Varicella was reported in 84 children, including 25 (30%) two-dose and 53 (63%) one-dose recipients. Attack rates among 2-dose recipients (10.4%) and 1-dose recipients (14.6%) were not significantly different (RR: 0.72, 95% CI: 0.44-1.15). All 2-dose recipients and 80% of 1-dose recipients reported having 50 or fewer skin lesions.
Conclusion: This outbreak is the first to document varicella in both 1- and 2-dose vaccine recipients; both groups had mild disease. The vaccine effectiveness of 1 and 2 doses were similar.
The Pediatric Infectious Disease Journal:doi: 10.1097/INF.0b013e31819c1041.
In a tragic case, four daughters of a family at Dhumat-Harinababi village under Kendrapara block were found afflicted with polio since their birth despite the mother and the children being administered the polio vaccine.
The four daughters of Maheswar Sahu have been rendered unable to walk and stand on their feet due to the dreaded disease.
According to Maheswar Sahu, all his eight daughters had taken polio doses but four of them got afflicted with polio and have lost the ability to walk or stand.
He said his 27-year-old and eldest daughter Anusaya Sahu, 19-year-old daughter Ranjulata, 17-year-old Mili Sahu and 15-year-old Kuni Sahu have been crippled for life.
Their mother claimed that she too had taken polio doses when the children were in her womb. She also maintained that she had given polio vaccine to all the daughters who now became victims of the disease.
Source: new kerala.com, 14 August 2009.
Polio, the dreaded paralyzing disease stamped out in the industrialized world, is spreading in Nigeria. And health officials say in some cases, it's caused by the vaccine used to fight it.
In July, the World Health Organization issued a warning that this vaccine-spread virus might extend beyond Africa. So far, 124 Nigerian children have been paralyzed this year -- about twice those afflicted in 2008.
Nigeria and most other poor nations use an oral polio vaccine because it's cheaper, easier, and protects entire communities.
But it is made from a live polio virus -- albeit weakened -- which carries a small risk of causing polio for every million or so doses given. In even rarer instances, the virus in the vaccine can mutate into a deadlier version that ignites new outbreaks.
So when WHO officials discovered a polio outbreak in Nigeria was sparked by the polio vaccine itself, they assumed it would be easier to stop than a natural ''wild'' virus.
They were wrong.
In 2007, health experts reported that amid Nigeria's ongoing outbreak of wild polio viruses, 69 children had also been paralyzed in a new outbreak caused by the mutation of a vaccine's virus.
Back then, WHO said the vaccine-linked outbreak would be swiftly overcome -- yet two years later, cases continue to mount. They have since identified polio cases linked to the vaccine dating back as far as 2005.
It is a worrying development for officials who hope to end polio epidemics in India and Africa by the end of this year, after missing several earlier deadlines. ''It's very disturbing,'' said Dr. Bruce Aylward, who heads the polio department at the World Health Organization.
Source: The New York Times, 14 August 2009.
Exacerbation of viral exanthema has been described after different types of aggression. We report a case of enhanced chickenpox exanthema occurring in the vaccination site of an otherwise healthy boy. Specific local inflammatory modifications may explain the increased number of varicella skin lesions on the site of a previous vaccine-induced inflammation.
Source: Scandinavian journal of infectious diseases, 2006, vol. 38, no10, pp. 920-921 [2 page(s).
We report the first case of chickenpox exanthema localized to the influenza vaccination site in a boy with known egg allergy.
Source: Pediatric Dermatology, Volume 26, Number 4, July/August 2009 , pp. 481-482(2).
Sparked by concerns about a surge of poliomyelitis cases in Nigeria caused by a vaccine-derived strain of type 2 poliovirus, health officials stepped up efforts to curb its spread, according to the Global Polio Vaccine Initiative (http://www.polioeradication.org/content/general/current_monthly_sitrep.asp).
Although type 2 wild poliovirus (1 of the 3 serotypes of wild poliovirus) had been eradicated in 1999, it reemerged a few years ago when weakened type 2 virus in oral polio vaccine mutated. For reasons not well understood, circulating vaccine-derived poliovirus began spreading more aggressively in 2009. By late July, 124 cases of paralysis caused by vaccine-derived virus had been confirmed for 2009, more than 4 times the number of cases confirmed in July 2008.
Source: JAMA. 2009;302(11):1161
Community acquired influenza can be severe and there are few data regarding hospitalization for children with cancer and influenza. Association between prior vaccination and infection severity has not been studied, although vaccination is standard practice.
Patients with malignancy or prior stem cell transplant (SCT) were identified using a database of children with laboratory confirmed influenza (2000-2005). Other data collected included receipt of vaccine, absolute neutrophil count (ANC) and absolute lymphocyte count (ALC). These were compared with intensive care unit (ICU) stay, respiratory complications and hospital days.
There were 39 patients with laboratory-confirmed influenza with a median age of 6.9 years. Twenty-four (62%) were on cancer therapy at time of infection and 18 (46%) had received the influenza vaccination that season. Measures of immune status included ANC at time of infection (median 1,530 cells/µl; inter-quartile range, 315, 4347), presence of graft versus host disease 2 (5%) and steroid therapy 4 (10%) patients. All had a low ALC (median 448 cells/µl; IQR 189, 861). Respiratory complications occurred in 8 (20%), ICU admissions in 4 (10%) and death in 2 (5%) patients. Median hospital stay was 2 days. All ICU admissions occurred in unvaccinated patients (P = 0.1). Vaccine status, ANC (<1,000 cells/µl vs. >1,000) and ALC (<500 cells/µl vs. >500) were not associated with length of stay or respiratory complications.
Influenza infection can be severe in children with cancer and complications occur despite vaccination. Prospective evaluation of vaccine response is worthy of future study. Pediatr Blood Cancer © 2009 Wiley-Liss, Inc.
Source: Pediatric and Blood Cancer,
Bordetella pertussis isolates not expressing Pertussis Toxin (PT) or Pertactin (PRN) have been collected, for the first time in 2007, in France, a highly vaccinated country with acellular vaccines. Non-expression was due to deletion of the entire ptx locus, to IS481 insertion in the prn gene or deletion of a part of this gene. Genome sequencing does not indicate any regions of differences when compared to other circulating isolates. It nevertheless shows some sequence differences and an increased number of repeated sequences. The infant infected by the isolate not expressing pertussis toxin, did not present hyperlymphocytosis. All isolates were found less pathogen in animal or cellular models; their circulation raises the problem of clinical and biological diagnoses.
Source: Vaccine, Volume 27, Issue 43, 9 October 2009, Pages 6034-6041.
Because a previous rotavirus vaccine was associated with intussusception, new rotavirus vaccines are monitored postlicensure for any such association. Accurate background intussusception rates are needed to determine whether the number of cases observed after vaccination exceeds that expected by chance. Previously, intussusception rates were obtained from inpatient discharge databases. We sought to determine the rate of intussusception among infants managed only with short‐stay or emergency department care.
Methods.Intussusception cases occurring in infants were identified retrospectively at 3 childrens hospitals from January 2001 through March 2006, a period without rotavirus vaccine use, by a search of discharge, billing, and radiology databases for International Classification of Diseases, Ninth Revision, Clinical Modification code 560.0 (intussusception) and procedure codes and by review of medical records.
Results.Of 156 infants with intussusception fulfilling Brighton level 1 criteria, 81 (52%) were billed as inpatients, 68 (44%) as short‐stay patients, and 7 (4%) as emergency department patients only. The use of only inpatients assigned code 560.0 underestimated the total number of level 1 cases at the hospitals by 44%. The mean annual intussusception rate for the hospitals catchment counties was 49.3 cases per 100,000 live births (inpatient cases: 27.1 cases per 100,000 live births; short‐stay or emergency department cases: 22.3 cases per 100,000 live births).
Conclusions.Intussusception rates based solely on inpatient discharge databases could underestimate the true incidence of level 1 intussusception by >40%. Background rates used for assessment of risk after vaccination should account for cases managed only with short‐stay or emergency department care.
Source: The Journal of Infectious Diseases 2009;200:S264S270
Since August 21, 2009, the New York City Department of Health and Mental Hygiene (NYC DOHMH) has been investigating an outbreak of mumps that began among children from Borough Park who attended summer camp in Upstate New York. Cases of mumps have continued to occur in Borough Park since the onset of the school year. At this time, there are 57 confirmed or probable cases and additional suspect cases are under investigation. Cases have ranged in age from 1 to 42 years, with the majority occurring among children age 10-15 years. Twenty-five per cent of cases either did not have two doses of mumps containing vaccine or had unknown vaccination status, while the remaining 75% had two documented doses of mumps containing vaccine.
Source: Yeshiva World News, 22 October 2009.
About 100 new cases of polio have been detected in Bihar till first week of November this year despite the immunisation drives, a health department official said here Saturday.
Terming it an alarming situation, he admitted that it was a setback to the polio immunisation drive in the state.
An official of the state health department said that this year again it was found that children already vaccinated against polio were infected by the disease.
According to latest data, collected under the National Polio Surveillance Programme (NPSP) of the World Health Organisation (WHO), of the 98 cases of poliomyelitis detected in Bihar till Oct 30 this year, 93 children had been administered seven doses of oral polio vaccine (OPV).
One child had been given three doses and the vaccination status of the other four kids is unknown.
Bihar Health Minister Nand Kishore Yadav told IANS here that re-surfacing of new polio cases is posing a big challenge to the government agencies trying to eradicate polio. However, he was optimistic that the disease would be eradicted in the state by 2012.
It is a matter of serious concern if children are being affected by polio after being administered doses, Yadav said.
Sources in the Unicef office here said that in Bihar, cases of the P1 and P3 strains were detected.
What is worrying health officials and doctors of the state is that in place of decline, polio cases are showing an increasing trend.
Bihar reported 158 polio cases in 1998 - the year the polio immunisation drive started, 123 in 1999, 49 in 2000, 22 in 2001, 121 in 2002, 18 in 2003, 39 in 2004, 30 in 2005, 61 in 2006 and 193 in 2007. Over 300 new cases were reported in 2008, the highest since the the immunisation drive was launched.
In recent past, health experts expressed concern over rising polio cases in Bihar and fear an outbreak in the state may mar Indias eradication efforts. Uttar Pradesh and Bihar are two states that were posing a real stumbling block in eradicating polio from India, another health official said.
India has spent millions of rupees on the immunisation drive to eradicate polio but the ground reality in Bihar shows much remains to be done.
Though millions were spent on a series of immunisation drives, the battle against polio is far from over in Bihar, Yadav admitted.
Source: Thaindian News, 7 November 2009.
We report a 44-year-old man presenting with left hemiparesis following influenza vaccination. The neuroimaging studies showed a large, contrast-enhancing brainstem lesion and multiple punctate lesions suggesting microhaemorrhages in both cerebral hemispheres. The patient showed a remarkable response to high dose steroid treatment. Detailed diagnostic studies failed to yield any results supporting inflammatory/demyelinating diseases, suggesting that influenza vaccination might have been associated with the clinical findings. Our case implies that vaccination might be related with a wide range of clinical syndromes, including brainstem encephalitis.
Source: Vaccine, Volume 27, Issue 52, 9 December 2009, Pages 7253-7256.
Neuropathy following vaccination has been reported; however, biopsy-confirmed small fiber neuropathy has not been described. We report five patients who developed paresthesias within one day to two months following vaccination for rabies, varicella zoster, or Lyme disease. On examination, there was mild sensory loss in distal extremities, preserved strength, normal or minimally abnormal electrodiagnostic findings, and decreased epidermal nerve fiber densities per skin biopsy. Empiric immunomodulatory therapy was tried in two patients and was ineffective. All patients symptoms have improved, but persist. We conclude that an acute or subacute, post-vaccination small fiber neuropathy may occur and follow a chronic course.
Source: Vaccine, Volume 27, Issue 52, 9 December 2009, Pages 7322-7325.
The fourth case of polio reported from Kayamganj area in the district this year has sent health officials into a tizzy and the state government has decided to launch a special programme to check the disease.
Farrukhabad Chief Medical Officer M H Khan said today that after the confirmation of the case in Putti Madari village in Kayamganj a decision has been taken by the government to launch a special programme in 26 districts, including Farrukhabad.
The new case is of a rare kind with the polio virus afflicting a 12-year-old girl who as per the records had been administered the polio drops for five years, the CMO said adding the virus generally afflicts children up to six years of age and therefore the new case has caused alarm in the department.
Source: Press Trust of India, 30 November 2009.
Administration of rabies vaccine or rabies immune globulin (RIG) during symptomatic rabies is ineffective, and there are concerns about the phenomenon of early death reported in animals that develop rabies after receipt of rabies vaccine or immune globulin. Survival analyses of the original animal data confirm these findings in two species, whereas analyses of human case reports and the Milwaukee Protocol registry suggest lower risk of early death in humans. There may be a deleterious interaction of rabies vaccine and RIG with bat rabies in humans. Animal studies of bat rabies virus with bat-origin vaccines and RIG are urgently needed.
Volume 27, Issue 51, 27 November 2009, Pages 7173-7177
ON the outskirts of Mufulira in a compound called Kawama East lives 28-year-old Elizabeth Changa who has been lying on a mattress, most of the time face down, for the last 18 years.
The fourth born child of the late Davisnado Changa and Godfreda Katamba, Elizabeth was born and grew up a healthy child till tragedy struck. What was meant to be a routine vaccination for school-going children changed her life forever, leaving her paralysed and unable to do anything.
It all started when a team of medical personnel had gone to administer polio and measles vaccination to the pupils at Kawama Primary School. Little did Elizabeth know that the vaccination injection would change her life forever.
In an interview, Elizabeth shares her 18-year ordeal and how her current situation has left her helpless.
"In 1990, while I was at Kawama Primary School, we were being given polio and measles vaccinations. I felt the usual pain we all feel when given an injection. The next day my left arm where the vaccine was administered was swollen. I developed a sore, which looked like I had been burnt. It was very painful. It (sore) took close to three weeks to heal. As time went by, I lost feeling in my arm and I would drop things every time I was given something to hold," she explained.
As time passed, both her arms stopped functioning and she eventually lost muscle in both her legs.
"I suddenly started experiencing loss of muscle power on the left arm and with time I could not do things normally; I was unable to hold cups, plates or other items as they kept falling off my hand unintentionally. Later, my right arm stopped functioning as well. Later in the same year, I started limping and had loss of balance due to the developing weakness in both my legs," Elizabeth said.
Doctors at the hospital could not detect anything, even after conducting tests. they gave her medication but her condition continued deteriorating.
"At this time my condition got worse and I could not do anything. All I could do was sit and crawl. My mother then took me to the clinic but we were referred to Kamuchanga Hospital where they conducted tests but there was nothing in my blood. After undergoing all the necessary tests, doctors still could not find the cause of my problem but warned us that I could develop TB in future. I was not given any medication and was discharged after a week; despite taking this medication my condition continued deteriorating," she said.
Her mother was advised to take her to Dagama School for the handicapped in Luanshya.
"After being discharged, mother took me to Dagama School for the handicapped in Luanshya but was refused admission without a letter from a church. Later during the year, I was admitted to Kitwe Central Hospital for a week and medical personnel there recommended I seek physiotherapy. Every time I was given medicine, I would bleed profusely. While in hospital, a nurse advised my mother to take me to Chinese doctors as nothing more could be done for me," she explained.
Life became more difficult and challenging for the family as her father who had earlier been dismissed from ZCCM Mufulira mine decided to separate from his family and left for Lusaka, leaving his seven children in the custody of their unemployed mother.
"We were advised to go to the mine hospital but unfortunately, mother could not afford and we had no relatives working for the mine. Being a single parent, mother got preoccupied with selling charcoal and firewood to help raise money for our upkeep and paying school fees for the other children," she explained.
In 1998 Elizabeth faced a huge drawback, which left her in the current situation she is, with little or no hope of ever sitting up or walking again.
"My condition got worse as I was not able to do anything. I was confined to bed. I eventually developed bedsores from waist to the legs. At this point I could not even sit, the only thing was to sleep.
The only other time I had visited a hospital was in 2005 when I suffered from malaria and was admitted to Ronald Ross but by then I was already bedridden. Since 1998, I have not been able to do anything. My legs feel heavy and my arms feel dry and lifeless. I answer the call of nature just here (on the mattress)," she lamented.
Elizabeth is bitter with what had happened to her considering she was a healthy child before the tragedy struck but has accepted her situation.
"I am very bitter about the whole thing. I was a normal healthy child who did things every other child my age could do, but now I am in this state. I have accepted that I am disabled but I am not happy because I had to stop school and all my dreams are shattered," said a visibly emotional Elizabeth.
She appealed to well-wishers to help her get specialists' treatment with the hope of being able to walk again.
"I pray that someone can help me by paying for my treatment. If that will be too much, maybe help us in any way. It has really been difficult for my mother, especially being a single parent and there are times she finds herself in debt. I believe I will be ok. I would like to go back to school as long as I have the strength," Elizabeth appealed.
And Elizabeths mother Godfreda Katamba said every time she looked at her daughter, it made her cry as she was a perfectly healthy child who's life had wasted away.
"She was a perfectly healthy child who did everything girls her age could do, but looking at her now makes me cry as her life has just wasted away. I have to do everything for her from feeding her, changing her beddings and bathing her as she has lost control of her bladder and bowels," she lamented.
Asked on whether she had approached the school authorities concerning her daughter's condition, she said she had not thought of it at that time.
"I never approached the school after the incident, maybe it was ignorance. I was confused and the only thing that came to my mind was to take her to the hospital for treatment," she said.
And Dr Gilbert Mukuka who had assessed Elizabeth described her condition as muscular dystrophy a condition associated with muscle wasting.
"She is with some restrictions able to lift her arms but not beyond her shoulders. She cannot hold anything with her hands because of the contractures that have formed on both hands. Her legs are very stiff and cannot be folded on the knee joints or on the ankle, Dr. Mukuka said.
Source: The Post, by Rebecca Chipanta, 29 November 2009.
A 4-year-old child who attends La Jolla Children's Learning Lab at has been diagnosed with pertussis, commonly known as whooping cough, the County of San Diego Health and Human Services Agency (HHSA) announced Tuesday.
The student was up-to-date on immunizations.
Source: Del Mar Times, 1 December 2009.
Kissing, sharing cigarettes and athletes drinking out of each other's water bottles may explain why the mumps outbreak is growing among teenagers and young adults.
The outbreak at Nipissing University and Canadore College last month traced to someone who travelled outside of the country has spread to West Nipissing, with a total of 13 confirmed cases in the district, said Dr. Jim Chirico, medical officer of health with the North Bay Parry Sound District Health Unit.
Anyone born after 1992 likely received two doses of the MMR (mumps, measles, rubella) vaccine, while people born between 1970 to 1992 may have only received one dose and can get a catch-up vaccination.
Two vaccination clinics are planned in West Nipissing.
Chirico said 62% of cases in the district involve people who received both doses, while the U.S. Centers for Disease Control and Prevention has seen that in about 72% of cases.
"One of the theories is that the virus has mutated. That's possible. Other possibilities could be that the vaccine wears off in a shorter period of time than we had anticipated," Chirico said.
Source: North Bay Nugget, 9 December 2009.
A local mother has concerns about its effectiveness, after she followed the recommendations and her son still developed the disease.
"Just because your children have had the H1N1 shot, does not mean you're protected," said Reynolds. "Your children and your family can still get it."
In late October, Sandy Reynolds took her 2-year-old, Zach, to a local vaccine clinic, then followed the recommendations with a follow-up shot earlier this month.
The drug-maker, though, later recalled the second one, over concerns it wasn't strong enough.
"When he started running a fever that's the first thing I thought of and that's why I took him to the doctor to get him tested for the H1N1," said Reynolds.
But according to the Centers for Disease Control, it's not likely the recalled shot played a part. Announcing the recall of 800,000 vaccines last week, scientists said there were no safety concerns.
"Kinda upsetting," said Reynolds. "I've done everything that I could to try to keep him from getting sick. I'm not going to really say I point the blame at anybody, but it's still very upsetting that they tell you that everybody should get the shot, but you still have to be concerned about getting the H1N1."
Dr. Tim Jones, the Tennessee State Epidemiologist, told Channel 4 News it's the first time he's heard of anyone developing H1N1 after receiving the vaccine. But he also said no vaccine is perfect, it takes time to become fully effective and some recipients' immune systems don't react as well as others.
Right now, Zach Reynolds has a high fever and may have to return to the doctor's office tomorrow morning. His parents are taking their own precautions, including medication, to try to reduce their chances of contracting the disease.
Source: WSMV TV, Nashville, reported by Josh DeVine, 23 December 2009.
To determine if the incidence of empyema among children in the United States has changed since the introduction of the pneumococcal conjugate vaccine in 2000.
METHODS: We used the nationally representative Kids' Inpatient Database to estimate the annual total number of hospitalizations of children ≤18 years of age that were associated with empyema in 1997, 2000, 2003, and 2006. Using US Census data, estimated counts were converted into annual incidence rates per 100000 children. Incidence rates were compared between 1997 and later years to determine the impact of pneumococcal conjugate vaccine on hospitalization rates.
RESULTS: During 2006, an estimated total of 2898 (95% confidence interval [CI]: 25323264) hospitalizations of children ≤18 years of age in the United States were associated with empyema. The empyema-associated hospitalization rate was estimated at 3.7 (95% CI: 3.34.2) per 100000 children, an increase of almost 70% from the 1997 empyema hospitalization rate of 2.2 (95% CI: 1.92.5) per 100000. The rate of complicated pneumonia (empyema, pleural effusion, or bacterial pneumonia requiring a chest tube or decortication) similarly increased 44%, to 5.5 (95% CI: 4.86.1) per 100000. The rate of bacterial pneumonia decreased 13%, to 244.3 (95% CI: 231.1257.5) per 100000. The rate of invasive pneumococcal disease (pneumonia, sepsis, or meningitis caused by Streptococcus pneumoniae) decreased 50%, to 6.3 (95% CI: 5.76.9) per 100000.
CONCLUSIONS: Among children ≤18 years of age, the annual empyema-associated hospitalization rates increased almost 70% between 1997 and 2006, despite decreases in the bacterial pneumonia and invasive pneumococcal disease rates. Pneumococcal conjugate vaccine is not decreasing the incidence of empyema.
Source: PEDIATRICS Vol. 125 No. 1 January 2010, pp. 26-33
A new tuberculosis vaccine is urgently needed.
These results demonstrated that neonatal BCG immunization followed by DNAhsp65 boosters is highly immunogenic but is not protective against tuberculosis.
Source: Scandinavian Journal of Immunology, Volume 71 Issue 2, Pages 63 - 69, 30 November 2009.
Tetanus is a rare disease in the United States. From 1995-1997, the average annual incidence of tetanus was 0.15/1,000,000 population. Injecting-drug users, particularly those who use heroin, are among the highest risk population for acquiring tetanus. We present a case of an injecting-drug user who was seen in the emergency department with worsening diffuse midthoracic back pain and spasms. He subsequently developed acute respiratory failure and central nervous system hypoxic injury. Serum obtained before administration of tetanus immune globulin showed a tetanus antibody titer greater than 16 times the level considered protective. Because of limited human data on the minimum protective level of neutralizing antibody, as well as reports of tetanus among individuals with "protective" antibody titers, the diagnosis of tetanus should not be excluded solely on the basis of antitetanus titers.
Source: J Emerg Med. 2000 Feb;18(2):189-93.
This report describes severe, generalized tetanus in a 29-year-old man who had received a primary series as a child and two booster injections. Serum obtained before administration of tetanus immune globulin showed antibody titers to tetanus greater than 100 times the level considered protective. Aggressive supportive care can usually prevent serious consequences. Since most physicians have never seen a case of tetanus, however, the diagnosis can be difficult. Many disorders that exhibit signs and symptoms similar to tetanus must be carefully considered during the evaluation of these patients. Tetanus is a preventable disease. Prevention, however, requires both appropriate immunizations and prompt wound care. While controversy exists regarding the most effective policy to adequately immunize all individuals, this case shows that vaccination alone does not preclude the possibility of tetanus.
Source: J Fam Pract. 1997 Mar;44(3):299-303.
A 66-year-old man sustained an injury to his right foot while gardening. Despite receiving tetanus toxoid one hour later and adequate wound toilet, he developed severe tetanus complicated with autonomic dysfunction six days later. He died 20 days after admission. This case shows that tetanus toxoid alone may not be sufficient to prevent tetanus in wounded patients. Careful consideration must be given to the immune status of the patient and to the nature of the wound sustained.
Source: Med J Malaysia. 1994 Mar;49(1):105-7.
Shimoni et al illustrate a needed caution to clinicians: do not exclude a diagnosis of tetanus in a patient who has been fully immunised.1 Their report adds to the list of rare cases of tetanus that have occurred despite complete immunisation. Although the authors state that all reported cases of tetanus in the United States have occurred in people who have not been immunised, this is not altogether true. A catalogue of the 740 tetanus cases reported by the Centers for Disease Control since 1982 discloses that of the minority whose immunisation status was known, 53 cases had completed a primary series, 22 had received their latest booster between five and nine years before, and two had received a booster within five years.
Source: BMJ. 2000 Feb 5;320(7231):383.
Lesson of the week: Do not rule out a diagnosis of tetanus in a patient who has been immunised fully.
We report a case of severe generalised tetanus in a patient who had been immunised fully.
A previously healthy 34 year old construction worker was admitted to hospital after experiencing what was described as an epileptic fit. Before the fit, the man had had flu-like symptoms for three days. He denied that he had sustained any trauma before the episode, and he had no history of recurrent infections.
BMJ 1999;319:1049-1049 ( 16 October )
Context Reported cases of pertussis among adolescents and adults have increased since the 1980s, despite increasingly high rates of vaccination among infants and children. However, severe pertussis morbidity and mortality occur primarily among infants.
Objective To describe the trends and characteristics of reported cases of pertussis among infants younger than 12 months in the United States from 1980 to 1999.
Design, Setting, and Participants Cases of pertussis in infants younger than 12 months in the United States reported to the National Notifiable Disease Surveillance System of the Centers for Disease Control and Prevention between 1980 and 1999, and detailed case data from the Supplementary Pertussis Surveillance System.
Main Outcome Measures Incidence and demographic and clinical characteristics of cases.
Results The incidence of reported cases of pertussis among infants increased 49% in the 1990s compared with the incidence in the 1980s (19 798 vs 12 550 cases reported; 51.1 cases vs 34.2 cases per 100 000 infant population, respectively). Increases in the incidence of cases and the number of deaths among infants during the 1990s primarily were among those aged 4 months or younger, contrasting with a stable incidence of cases among infants aged 5 months or older.
Source: JAMA. 2003;290:2968-2975
Stemming from an initial mumps outbreak that wreaked havoc at a Jewish camp this summer, 247 New York City residents plus 131 other state residents have since contracted the disease, which remains mostly contained among fervently Orthodox adolescent boys in pockets of New York, New Jersey and Quebec, according to official reports from the New York City and State Departments of Health.
The trigger case occurred back in June, when an 11-year-old boy returned to his Sullivan County summer camp after traveling in the United Kingdom, where an ongoing outbreak has now reached about 4,000 cases, the Centers for Disease Control reported.
From there, the mumps spread to 24 other boys at the camp and continued to plague their local communities when they returned
home, and the median age of patients remains around 14.
But perhaps the most frustrating news to some parents is that most of the affected patients had received their proper two-dose vaccination as children 83 percent, according to the CDC.
This is a very confusing issue not only for ourselves but for providers and parents, said Cindy Schulte vaccine-preventable disease surveillance officer at the New York State Department of Health.
Source: The Jewish Week, 1st December 2009.
Physicians must be aware that epiglottitis may result from vaccine failures or from infection with other pathogenic organisms. Vaccinated children with epiglottitis present in a similar fashion to those who are not vaccinated. We present a rare case of acute epiglottitis in a fully vaccinated child due to nontypeable H. influenzae and discuss the clinical presentation and management.
Source: International Journal of Pediatric Otorhinolaryngology
Volume 74, Issue 2, February 2010, Pages 218-220
I get it. Scientists last week published in a medical journal the retraction of an infamous 1998 study that had linked the measles, mumps and rubella vaccine to autism. Heres what I dont get. My own son had the vaccine, so why on earth did he wake up with the mumps this morning? Now for the rest of the story.
Saturday night, my 15 year old son finished shoveling the few inches of snow on the sidewalk. He comes in and says Dad my jaw is hurting on the right side. A little later he says he thinks he has fever and he has the pink eye look. I first thought that this is strep throat or pink eye but his throat wasnt hurting and pink eye couldnt explain his high fever. After much interrogation, finally my son perks up and says that he had sat next to a classmate who was rumored to have mumps. I look at my son and I said to him I dont see any mumps on you.
Since I really wasnt sure what were the symptoms of mumps, I Googled the word mumps. The first result was a Google Health page with everything one could possibly want to know about mumps.
The Overview: Mumps is a contagious disease that leads to painful swelling of the salivary glands. The salivary glands produce saliva, a liquid that moistens food and helps you chew and swallow.
Now lets review the symptoms:
* Face pain - hes got that
* Fever - hes got that
* Headache - hes got that
* Sore throat - not really
* Swelling of the parotid glands - not sure about this, but his ear is bothering him a bit.
* Swelling of the temples or jaw - hes got that. OMG - we realize how swollen it is, this was the clincher.
Other symptoms of this disease that can occur in males:
* Testicle lump - we wont go there
* Testicle pain - we wont go there
* Scrotal swelling - we wont go there
Thanks Google, hes got the mumps. Now, please answer if we need to go to the doctor? After all, you say There is no specific treatment for mumps. Ice or heat packs applied to the neck area and acetaminophen (Tylenol) may help relieve pain. We went to the doctor this morning and we regret not listening to Google. After waiting in isolation for 1.5 hours, the doctor takes one look at his jaw and says MUMPS. Nothing we can do. Take Motrin and rest for 9-14 days. Bye. As we are getting into the car, the nurse comes running out, oh, the state requires we draw blood for mumps.
So, I can assume that some level of government knows about the resurgence of mumps on kids and adults who already were vaccinated. Where is the outcry of the CDC? Code red, orange or any other color?
Source: Spotlight, 7 February 2010.
Rabbi Yehunda Pirutinsky was surprised when his 14-year-old son was diagnosed with mumps a week ago. Lakewood is in Ocean County.
"He was completely vaccinated," Pirutinsky said. "So it was a surprise to us he came down with mumps."
Anyone fully vaccinated from mumps receives two doses of the vaccine, according to the CDC. Of the New Jersey cases, 77 percent were vaccinated, Terjesen said.
But the vaccine is not 100 percent effective, according to the CDC. At two doses, the vaccine is 76 to 95 percent effective, the CDC says on its Web site.
In November, the CDC called the spike in mumps cases, "the largest U.S. mumps outbreak since 2006, when the United States experienced a resurgence of mumps with 6,584 reported cases." Then, only 179 people were sickened in New York and New Jersey.
Source: CNN Health, 8 February 2010.
The mumps vaccine, routinely given to young children, offers those who get the shot less protection against the infectious disease as they grow older, and does not always prevent them from getting it, especially when they are in close quarters, as in yeshivot or in the military, according the Health Ministrys chief epidemiologist, Dr. Paul Slater.
Since the beginning of January, there have been 525 cases of the mumps in Israel. The new outbreak began as a result of a haredi child who attended a Jewish summer camp in Monsey and New Square, New York, and later spread to Israel.
Slater said that the mumps, which can cause complications, is very infectious and spreads via droplets from the nose and mouth. The outbreak has reached not only Israels haredi community, but also the IDF, he said.
Israel and other Western countries used to give children only one mumps vaccination, but in recent years, it has been changed to two shots, said Slater. Even so, the mumps vaccine is weaker than other viral vaccines and doesnt protect all those who have been vaccinated, he said.
Source: The Jerusalem Post, 8 February 2010
Sullivan County, New York:
A total of 25 cases were reported among camp attendees and staff members. The median age of patients was 12 years (range: 9--30 years), and all were male. Of the 24 patients for whom vaccination status was reported, 20 (83%) had received age-appropriate vaccination with 2 doses, one (4%) had received partial age-appropriate vaccination with 1 dose, and three (13%) were unvaccinated. The attack rate in this camp was approximately 6% (25 of 400).
Brooklyn, New York:
Of the 61 patients (77%) for whom vaccine is recommended and vaccination status and age were reported, 47 (77%) had received age-appropriate vaccination, six (10%) had received partial age-appropriate vaccination, and eight (13%) were unvaccinated.
Ocean County, New Jersey:
By October 30, a total of 40 cases had been reported. The median age of patients was 19.5 years (range: 1--65 years), and 83% were male. Mumps vaccination status was reported for 29 (73%) patients, of whom 28 (97%) had received age-appropriate vaccination.
Rockland County, New York:
The median age of patients was 12 years (range: 1--62 years), and 23 (85%) were male. Mumps vaccination status was reported for 19 (70%), of whom 11 had received age-appropriate vaccination, and two had received partial age-appropriate vaccination.
Orange County, New York:
Eight cases occurred among the travelers. The median age of patients was 18 years (range: 11--23 years), and five were male. Seven patients had received age-appropriate vaccination with 2 doses, and one was unvaccinated.
By October 30, 15 cases (patient age range: 8--47 years) from Montreal and the Laurentian region of the province had been reported to the Public Health Agency of Canada. All patients were male, and 11 had documented vaccination with at least 1 dose of mumps-containing vaccine.
During June 28--October 30, five cases outside the affected religious community were reported. Two cases occurred in New York City, and three occurred in Ocean County, New Jersey. The two New York City patients were a man aged 40 years who had probable worksite exposures to members of the affected community and a boy aged 4 years who had no identified exposure. The three New Jersey cases were patients aged 17, 29, and 66 years who had no identified exposures. Two of the five patients had received 2 documented doses of mumps-containing vaccine, one had received 2 undocumented doses, and two had unknown vaccination status.
Of the 178 (99%) patients whose sex is known, 149 (84%) are male. The median age of the 178 patients for whom age is known is 14 years (range: 8 months--84 years). Of the 141 patients (79%) for whom vaccine is recommended and vaccination status and age were reported, 113 (80%) had received age-appropriate vaccination, nine (6%) had received partial age-appropriate vaccination, and 19 (13%) were unvaccinated (Table). Of the 141 patients, 102 (72%) had received 2 doses, 20 (14%) 1 dose, and 19 (13%) zero doses.
November 12, 2009 / 58(Dispatch);1-4.
Although the WHO recommends genotyping as a tool for mumps epidemiological surveillance, limited data on mumps genotype circulation is available to trace the patterns of virus spread. We described the first complete series of data from Spain. The small hydrophobic region was sequenced from 237 mumps virus (MV) positive samples from several regions of Spain, collected between 1996 and 2007. Six different genotypes were identified: A, C, D (D1), G (G1, G2), H (H1, H2), and J). Genotype H1 was predominant during the 1999-2003 epidemic but was replaced by genotype G1 as the dominant genotype in the 2005-2007 epidemic. The same genotype G1 strain caused concomitant outbreaks in different parts of the world (USA, Canada and UK). The remaining genotypes (A, C, D or J) appeared in sporadic cases or small limited outbreaks. This pattern of circulation seems to reflect continuous viral circulation at the national level despite high vaccine coverage.
Source: J. Clin. Microbiol. doi:10.1128/JCM.02386-09
This article was a pro-vaccine article blaming whooping cough on unvaccinated children, but it said:
Natalie Larkin of Beaumont said her 3½-month-old daughter, Kate, had cold symptoms for a week before whooping cough was diagnosed. Kate, who had undergone her first immunisation, ended up in hospital for four days.
"It's scary.. They choke," she said.
If they actually looked at the status of those infected, they would find that the majority are partially or completely vaccinated or they are adults who were fully vaccinated as children.
Source: Adelaide Now, 5 November 2009.
THE bacteria that causes whooping cough in Australia has mutated, scientists have warned, eroding the protection provided by the vaccine now given to children.
Researchers from the University of New South Wales have identified significant changes in the two most common strains of the Bordetella pertussis bacteria, which they also traced back to events in the late 1990s.
Australian children were given a broad-acting "whole cell" vaccination against whooping cough up to 1997, but this was phased out over two years and replaced with a more targeted version. Concerns over potential side-effects were behind the change over to a vaccine with a narrower scope, but this now appears to have contributed to the promotion of resistant strains.
"A key issue is that the whole cell vaccine contained hundreds of antigens, which gave broad protection against many strains of pertussis," said Associate Professor Ruiting Lan of the UNSW School of Biotechnology and Biomolecular Sciences.
"But the (targeted) acellular vaccine contains only three to five antigens.
"Our findings suggest that the use of the acellular vaccine may be one factor contributing to these genetic changes."
The research team analysed more than 200 samples of the bacterium collected over the past 40 years in Australia, and these were compared with samples from Japan, Canada, USA and Finland.
They found while the vaccine now in use was effective against some of the strains circulating in Australia it may no longer protect against two strains, known as MT27 and MT70.
Dr Lan said more research was needed to confirm the results but health authorities may need to modify the vaccine to broaden the protection it offered, "or over time it could lose effectiveness as the organism evolves".
The discovery comes amid an increase in whooping cough cases in Australia, with several significant outbreaks seen last year in western Sydney.
Source: news.com.au, 10 February 2010.
As many as 557 people have gotten mumps in Kiryas Joel since an outbreak began at a Sullivan County camp last summer and spread to ultra-Orthodox Jewish communities in the tri-state area and Canada, health officials say.
Teenage boys have been most prone to the virus. What has surprised health officials is that most patients had gotten their two recommended vaccination shots, leading to speculation that their immunity had waned since getting the second dose at around age 5.
"Kiryas Joel is very well-immunized," said Dr. Jean Hudson, the Orange County health commissioner.
Nurses provided by her office and New York state recently finished giving free booster shots of vaccine to some 1,800 boys and girls in sixth grade or higher in religious schools in the Satmar Hasidic community. The vaccinations were voluntary and only for kids who previously had their two shots; the state Department of Health provided the doses.
Source: Times-Herald Record, 12 February 2010.
Mumps is a formerly common childhood illness with an average age of infection from five to nine years. Prior to the wide distribution of the mumps vaccine in 1967, more than 90% of the American population had developed natural antibodies, which protected them from developing mumps, by age 15. Most young children contracted mild cases of mumps which gave them lifetime immunity from the disease in the future.
Since 1967, the incidence of mumps has dropped precipitously, although it has been steadily rising since the inception of vaccination. At first glance, this appears to be a medical success. A very small number of mumps cases resulted in hearing loss and other more severe complications. With fewer cases of mumps reported, there should be a corresponding drop of serious mumps complications.
This has not been the case in the United States. The mumps outbreak in the Northeast shows why. When mumps was a rampant childhood illness, the vast majority of children was exposed to it and developed natural protections. Now that mumps is not often encountered, the only protection is the mumps vaccine, which the CDC lists as being 76-95% effective after the recommended two doses. Health officials in New York report that 77% of the 1,000 cases of mumps had been fully immunized. That represents a high vaccine failure rate, especially when taking into consideration the fact that mumps is one of the least contagious diseases in the country.
The danger of shifting a relatively harmless childhood illness to a young adult illness is serious. Most of the more extreme side effects of mumps are experienced by young adults. In children, mumps can cause minor swelling of the salivary glands, along with fever and, occasionally, rash. In older people, mumps can be responsible for serious or even permanent conditions. It can cause abortions in pregnant women and swelling of the brain stem for both men and women. Had the patients in the current outbreak been exposed to mumps at a younger age, they would have been immune from contracting it today.
Source: Associated Content, 9 February 2010.
Twenty-three cases of clinical mumps in young people have been reported in North Wales over a five-week period since late December 2008. All cases have social links, and most of them have received two doses of mumps-containing vaccine.
The first case reported on 27 December was a student in Manchester where, as confirmed by the Health Protection Unit, a number of mumps cases have occurred among students in recent weeks. They received an increase in notifications in the first week of December 2008 which peaked in the second week of December, and it is plausible that the student was infected at this time. Transmission from this case probably occurred at a Young Farmers party held on Anglesey on the 27 December 2008. Members of two local Young Farmers groups were invited, comprising around 50 young people aged 13 to 27 years.
An unusual feature of this outbreak is that 20 of the cases had received two doses of the measles, mumps, rubella (MMR) vaccine and two cases had had one dose. The only unvaccinated case was a 37 year-old patient who was too old to have been offered MMR as a child. Most cases appear to be mild, with no reports to date of orchitis or other complications.
Although rotavirus vaccines are known to be shed in stools, transmission of vaccine-derived virus to unvaccinated contacts resulting in symptomatic rotavirus gastroenteritis has not been reported to our knowledge. We document here the occurrence of vaccine-derived rotavirus (RotaTeq [Merck and Co, Whitehouse Station, NJ]) transmission from a vaccinated infant to an older, unvaccinated sibling, resulting in symptomatic rotavirus gastroenteritis that required emergency department care. Results of our investigation suggest that reassortment between vaccine component strains of genotypes P7G1 and P1AG6 occurred during replication either in the vaccinated infant or in the older sibling, raising the possibility that this reassortment may have increased the virulence of the vaccine-derived virus.
Source: PEDIATRICS (doi:10.1542/peds.2009-1901)
School officials announced this week that a fourth grade student at Meadow Pond Elementary School had been diagnosed with pertussis, also known as whooping cough. While the district emphasized that "there was no cause for alarm," a letter to parents on Monday encouraged them to contact their child's doctor if the child develops a persistent cough.
While most children receive vaccines against pertussis, in some people vaccines may not work.
According to the district, the child at Meadow Pond was infected despite their vaccination.
Source: Lewisboroledger.com, 24 February 2010.
He called in sick on Monday, saw a doctor on Tuesday and went to Urgent Care Wednesday and Thursday, Barron said. Then they flew him to Salt Lake on Friday.
Unlike Barrons employee, Benefiel had been vaccinated, friends said. Despite the vaccination, Benefiel contracted severe pneumonia as a result of H1N1 and had to be transported from St. Johns Medical Center in Jackson to Utah.
The above comments describe two of three Wyoming residents who contracted a severe form of H1N1 which required transfer to Utah. At least one was said to have been vaccinated, raising concerns that the H1N1 has evolved away from the current vaccine.
Source: Before it's News, 23 February 2010.
A life-threatening disease has made a comeback in twin cities. Cases of persons falling prey to the potentially fatal bacterial ailment diphtheria are on the rise. The baffling part is that 95 per cent the diphtheria cases reported from January 2009 are those of adults, who were inoculated during their childhood.
Medical authorities suspect three reasons for the incidence of diphtheria waning potency of the vaccine; patient not taking the booster doses and other environmental factors. Last year, 300 cases of diphtheria were reported in different governments hospitals in the State capital.
Strangely, in January and February of this year, the number of diphtheria cases reported has already touched the 100 mark. All these cases have been reported from slum areas and a majority of the patients are from economically weaker sections.
Source: The Hindu, 12 March 2010.
The local health unit has confirmed a case of the mumps in a nine-year-old boy at Northwood elementary school.
The Windsor-Essex County Health Unit said the public school board has been notified of the case and the child is no longer going to classes.
The boy had received an immunization shot for the illness outside of Windsor and Essex County, but the procedure was either incomplete or inadequate.
Source: The Windsor Star, 13 March 2010
Between May 21, 2007, and October 8, 2009, 1,091 pediatric healthcare personnel were vaccinated with Tdap. Eighty personnel were exposed a total of 94 times. Twenty-four personnel were not eligible for randomization. Thirty-four personnel were randomly assigned to receive azithromycin prophylaxis, and 36 received no prophylaxis. Pertussis infection occurred following a healthcare exposure in 6 persons (16.7%) in the group without prophylaxis and 1 person (2.9%) in the antibiotic prophylaxis group (absolute risk difference -13.7%; lower bound of the one-sided 95% CI, -25.0%; p=0.06).
Giving nursing home workers a flu vaccine is ineffective at preventing the spread of influenza among residents, a new Canadian study suggests.
Researchers at the University of Calgary tested whether vaccinating nursing home workers had any effect on residents' rates of lab-confirmed cases of influenza, pneumonia, or deaths from pneumonia. Though they did discover a correlation between staff inoculations and reduced rates of flu-like illnesses (which could include illnesses cause by bacteria or viruses other that the influenza virus), researchers could not make a connection between staff vaccinations and reduced rates of confirmed influenza among residents, according to the report.
Many healthcare workers are reluctant to get a flu shot due to concerns over the shot's effectiveness, potential side effects, and perceptions that they and their patients are not at risk, according to the report. In light of their findings, researchers recommend further study into non-vaccine related interventions, such as hand washing, face masks, early influenza detection and asking workers with the flu to stay home.
Source: McKnights.com, 18th March 2010
We report 3 cases of orchitis following vaccination with mumpsmeaslesrubella (MMR) vaccine, two with an onset within 3 days following vaccination. Orchitis is a common complication of mumps infection, particularly in post-pubertal males, and is also recognized as a very rare complication of mumps vaccination. These cases, discussed together with a comprehensive review of the existing literature regarding post-vaccine orchitis, highlight uncertainty regarding the pathogenesis of post-vaccine orchitis.
Source: Vaccine, Volume 28, Issue 14, 19 March 2010, Pages 2671-2673.
Plattsburgh State has another confirmed case of the mumps.
That brings the total to four confirmed cases and five pending lab results, compared to three confirmed and three suspected when the outbreak was announced.
University health officials said the students with confirmed and pending cases had been fully vaccinated against the mumps.
We cant give an answer as to why we are seeing mumps, said Dr. Kathleen Camelo, director of the Center for Student Health and Psychological Services at Plattsburgh State.
We dont know if the virus mutated or if there is a problem with the vaccine.
Source: Press Republican, 22 March 2010.
Six of the H1N1-positive cases recorded in Brunei this year are patients who had already been vaccinated. Four of the cases were recorded in February and the remaining two were recorded just this month.
However, despite the startling revelation made yesterday by Dr Hjh Maslina Hj Mohsin, Director of Health Services at Ministry of Health, Dr Hjh Maslina said, "Most H1N1positive cases in 2010 are due to the (people) not yet vaccinated."
The director explained that the six positive cases were due to chronic diseases and exposure to the virus immediately after being vaccinated.
"You have to understand that the vaccine is not 100 per cent (immediately effective). It depends on the person themselves. If they are suffering from chronic diseases, their immunity will be lower. Some of the six cases had chronic diseases and some were infected two days after their vaccination - the time to develop immunity was not enough," she said.
Source: BruDirect.com, 30 March 2010.
Local health authorities have expressed concern about the rise in the number of persons in Lanao del Sur and Maguindanao suffering from measles even if they had been immunized.
Dr. Kadil Sinolinding, health secretary of the Autonomous Region in Muslim Mindanao said on Tuesday that at least 39 persons, aged eight months to 21 years old, were infected with measles in Lanao del Sur and Maguindanao.
The number of cases have been recorded since January but Sinolinding said the fact that most of those with measles had received anti-measles vaccines was "quite alarming."
Sinolinding said that in the case of Maguindanao, many of the victims were evacuees from the ongoing conflict in Mindanao.
The good news, he said, was that no one had died of the viral infection which could be fatal if complications arose.
"No fatality and all the patients have recovered," Sinolinding told the Philippine Daily Inquirer.
He said the Department of Health has started investigating the cases to find out why patients, who had been immunized, still contracted the disease.
"We are trying to determine why despite the immunization, these patients still contacted the virus of measles," Sinolinding said.
He said the immune systems of patients might have weakened over time due to some other factors.
He said the appalling conditions in evacuation centers might have weakened the peoples immune systems.
Source: Inquirer.net, 30th March 2010.
In September 2004 a mumps outbreak occurred at an international hotel school in The Netherlands. We investigated this outbreak to identify risk factors for mumps. There were 105 mumps cases (overall mumps attack rate (AR) 12% (95% CI: 1015%)). The AR for Dutch vaccinated and unvaccinated participants was 12% (95% CI: 1015%) and 15% (95% CI: 342%), respectively. Independent risk factor was mumps contact. Explanations for the relatively high AR among vaccinated participants include primary vaccine failure, waning immunity and incomplete vaccine-induced immunity in the context of high mumps virus exposure in a school party and a crowded boarding school.
Source: Vaccine, Volume 28, Issue 17, 9 April 2010, Pages 2932-2936.
Central Texas doctors are seeing a surge in the number of children coming down with whooping cough.
In total, the Austin-Travis County Health and Human Services Department said nearly 500 cases of whooping cough, which starts out with symptoms similar to a cold, have been confirmed or considered probable cases.
"It can be a very severe illness, and that's why it's really important to stay on top of this and prevent the spread," Austin-Travis County Medical Director Dr. Philip Huang said.
Of the 200 confirmed or probable cases of pertussis reported in Williamson County this year, the majority are kids in school.
No deaths have occurred this year in our area as a result of the increase, but Jennifer Jackson, with the Williamson County and Cities Health District, said unvaccinated or under-vaccinated infants are at high risk of becoming seriously ill if they contract the infection through the air.
"Going into this year we're seeing many more cases," Jackson said.
Eanes Independent School District sent home a letter to parents of children attending Barton Creek Elementary School this week, notifying them that a couple of students had contracted the infection. A similar letter was sent to Westlake High School parents right before spring break.
One pediatric physician at Dell Children's Medical Center said he's seen about 200 cases since the middle of February.
"Kids who are getting vaccinated, as they get older, we used to think didn't need any routine booster or re-immunization. Now, we're finding out that they do. And so consequently, the kids 10-14 years old are able to get pertussis and consequently spreading it to younger children," Dr. Robert Vezzetti said.
Local doctors said they have also seen a trend in adults, with milder symptoms, spreading the infection to children.
"If you have a 30-year-old or 40-year-old adult, they can easily get pertussis and their symptoms may not be as severe necessarily," he said.
Source: News 8 Austin, 24 March 2010.
We measured IgA and IgG antibodies to pertussis toxin (PT) and filamentous hemagglutinin (FHA) in sera from 203 1-year-old children who had received one to three doses of a monocomponent PT toxoid vaccine. Ten children (5%) had IgA antibody to PT indicating recent infection; seven of these children had received three doses of vaccine. PT IgA responders did not have significantly longer coughing episodes than PT IgA non-responders. Since an IgA antibody response occurs in only approximately 50% of infected children, the actual infection rate in our cohort is estimated to approximately 10%. The apparent high Bordetella pertussis infection rate in Danish infants suggests that the monocomponent PT toxoid vaccine used in Denmark has limited efficacy against B. pertussis infection. A prospective immunization study comparing a multi-component vaccine with the present monocomponent PT toxoid vaccine should be undertaken.
Source: Eur J Pediatr. 2010 Apr 8. [Epub ahead of print].
Wild-type poliovirus can be found in the faeces of kids who have received more than 10 doses of the oral vaccine in northern India, say epidemiologists online in the Journal of Infectious Diseases this week. The finding suggests that these kids, who do not fall ill when infected with the virus, may play a part in transmitting the disease to others and could explain how polio persists in the region despite high levels of vaccination.
The authors of the research, Nicholas Grassly from Imperial College London, UK, and colleagues from the World Health Organization (WHO), say that transmission of the wild poliovirus among vaccinated kids could hamper herd immunity (the protective effect of vaccination on unvaccinated people). New immunisation strategies may be needed to eliminate the disease from India, they add.
Experts say the research provides good evidence to confirm a phenomenon reported on numerous occasions over the past 25 years, but which has not been widely accepted by the international community.
Only four countries have not yet put an end to the transmission of wild-type polioviruses: India, Afghanistan, Pakistan and Nigeria. The persistence of the disease in India poses a unique problem to polio eradication programmes as the virus continues to spread in the country even though vaccination coverage is high. In the three other endemic countries the virus persists largely because pockets of people remain unvaccinated, maintaining the spread of the disease.
An oral vaccine against all three strains of the wild-type poliovirus is used to immunise children in India. Scientists have known for some time that kids vaccinated in this way are not fully protected from polioviruses and can still become infected without falling ill. A field investigation into an outbreak of polio in Oman in the late 1980s suggested these vaccinated yet infected kids may help to spread the virus to others. Numerous reports from India have also documented the phenomenon, but until recently the idea has not been acknowledged by the WHO, according to experts EHTF News has contacted.
The researchers launched an investigation to see if vaccinated kids in India are shedding poliovirus in their faeces, which could implicate them in the spread of the virus. They looked for the virus in stool samples, collected during routine diagnosis and surveillance for the disease in India between 2003 and 2008, from suspected polio cases as well as kids with whom they had come into contact. Samples from more than 14,000 healthy kids and over 2700 kids with suspected polio were tested, and 42 cases of polio were confirmed.
At least 13% of the healthy children who came into contact with a laboratory-confirmed case of the polio had detectable wild-type virus in their stool sample, say Grassly and colleagues. This proportion increased to 20% for samples collected within three weeks of polio symptoms first appearing in a confirmed case of the disease. The majority of healthy contacts who excreted wild-type poliovirus were well vaccinated, add the authors.
Children in areas at risk of polio are given extra doses of the vaccine to top up their immunity. This is in addition to the four doses given routinely in early childhood. Most kids who took part in the study reported receiving more than 10 doses of the oral vaccine.
These findings are consistent with a potential role for these children in the asymptomatic transmission of wild-type poliovirus in northern India, write Grassly and colleagues.
Ellie Ehrenfeld, from the US National Institutes of Allergy and Infectious Diseases, agrees with this conclusion. There is no question that this plays a part in the spread of polio in India, she says. The data is absolutely clear.
Source: Emerging Health Threats Forum, 9 April 2010.
Quebec is in the midst of a minor outbreak of mumps in certain communities, the Montreal Public Health Department reported Thursday.
There have been 239 cases in Quebec in five months, according to Rue Frontenac, a Montreal-based news website.
A spokesperson for the Montreal Public Health Department was not immediately available to comment, but a document on the departments website said there have been cases in Montreals Orthodox Jewish community and in certain Aboriginal communities in the Outaouais and in Cree villages near James Bay.
There were 33 cases reported in Montreal as of Feb. 24 and 58 per cent of those individuals had received at least one dose of vaccine, according to the health department. Some people in Montreal who were sick had contact with relatives in New York State and New Jersey, where there 1,529 cases as of Jan. 29.
Read more: http://www.montrealgazette.com/health/Minor+outbreak+mumps+reported/2910462/story.html#ixzz0lIy48gGH
Indian paediatricians have accused these agencies - USAID, Johns Hopkins Bloomberg School of Public Health, The Hib Initiative and The GAVI Alliance - of misrepresentation of facts by selectively and inaccurately reporting the actual findings of the Bangladesh Hib probe study in order to promote the vaccine's wider use.
According to the agencies' joint press release, the results of the Bangladesh study conducted in 2007 'showed that routine immunization of infants with a Hib conjugate vaccine prevented over one-third of life-threatening pneumonia cases and approximately 90 percent of Hib meningitis cases'.
It further said 'this vaccine study builds on the evidence of the real burden of Hib pneumonia' in Indonesia.
Both these statements argue in favour of Hib vaccination in developing countries through 'selective interpretation/presentation of the actual research findings', says Jacob Puliyel at St.Stephens Hospital in New Delhi and one of the doctors finding fault with the press release.
The Bangladesh study compared Hib vaccination status among children with confirmed pneumonia or meningitis against those without these diseases (controls). The major finding that there was 'no difference' in the Hib vaccination status of children with pneumonia compared to community controls was omitted in the press release, the Indian doctors claim.
The study also found that among those who received all three doses of the vaccine, there was 'no statistically significant protective effect' against either confirmed meningitis or probable meningitis but it found statistical significance in a sub-group that received only two doses of the vaccine.
'This latter point was highlighted in the press release in a manner suggesting benefit of the vaccine, without mentioning that no significant difference was found with three doses of vaccine,' Puliyel points out.
The press release made another misrepresentation by saying the study 'builds on' evidence of the burden of Hib pneumonia from Indonesia whereas the Indonesia study actually reported more pneumonia in the Hib vaccinated group than controls, says Puliyel.
In fact, the Indonesia study paper concludes by saying 'Hib vaccine will not have a major role in efforts to reduce the overall burden of respiratory illness.....as improvements in nutritional status, maternal education and socioeconomic status' (can have).'
Source: Yahoo India, 15 April 2010.
The relation between the risk of intussusception and age at the time of receipt of the first dose of rhesus-human reassortant rotavirus tetravalent vaccine (RRV-TV) has been studied extensively on the basis of Centers for Disease Control and Prevention (CDC) matched case-control study data, using various statistical methods, including conditional logistic regression and quadratic smoothing splines. However, different conclusions have been reported in published analyses regarding the dependence of the risk of intussusception on age at first dose. The authors reanalyzed the CDC matched case-control data set using unrestricted and restricted quadratic smoothing spline methods for various exposure windows (i.e., intervals postvaccination). These analyses indicated that the use of different models may lead to different conclusions. The restricted quadratic smoothing spline with appropriately chosen knot locations showed a statistically significant increased risk of intussusception associated with RRV-TV for the exposure window 314 days after the first dose at an age as young as 49 days, the youngest age in the data set at which vaccine was administered; this implies an increased risk of intussusception associated with RRV-TV at all ages studied.
American Journal of Epidemiology Advance Access published online on April 16, 2010
American Journal of Epidemiology, doi:10.1093/aje/kwq048
The Department of Public Health and Social Services said it is through investigation that it found the number of mumps cases on island had grown.
Rita Oliva, acting supervisor for Public Health's Immunization Program, said once the department gets reports of the number of mumps cases from every clinic on-island, an investigator checks in with physicians to learn the progress of the patients.
The investigator then calls the patients' homes to find out how long they have been sick and if there are other people at the premises with an illness.
"That's how we found out there were probable cases," Oliva said. "They never went to see a doctor. We just don't know when it began because many people haven't gone to seek medical attention, and the symptoms may have been mild."
More than 100 cases
On Thursday, Public Health issued a release stating that since January, there were more than 100 cases of the mumps reported on island. It added that new cases are being reported daily.
Mumps is a contagious viral illness with fever, headache, muscle aches, tiredness and painful swelling of the salivary glands under the ears as its symptoms.
Two epidemiologists from the Centers for Disease Control and Prevention are currently on island helping Public Health manage the outbreak.
Amy Parker, a CDC epidemiologist, said researchers are finding that people who are up to date with the two doses of the measles, mumps and rubella vaccine are still getting mumps disease.
She said the outbreak isn't unique to Guam, as 3,000 mumps cases have been reported in the northeastern U.S.
Parker said the outbreak is among individuals who have received two doses of the MMR vaccine, and are in close contact with one another. She said that close contact could be fueling transmission here.
Both my kids got it and their necks to their ears were swollen.
The doc said it can't be mumps because they had the vaccine. We still think it was the mumps. It is VERY under reported here.
4/24/2010 4:45:46 AM
Parents who get their children the meningococcal vaccination before they head off to college thought their children were protected from bacterial meningitis.
After the death of an Iowa State University student last week, though, they are learning that the vaccination is not 100 percent effective.
Travis James T.J. Good of Omaha reported feeling ill April 13. His roommates took him to the emergency room at Mary Greeley Medical Center, but within hours he was dead.
He died from meningococcal disease, also known as bacterial meningitis or spinal meningitis, an infection of the membrane that surrounds the brain and spinal cord. It is a rare but quick-striking disease that most often hits teens and young adults.
Good had been vaccinated against the disease before entering college.
Source: Omaha.com, 24 April 2010.
Researchers from several institutions in Iran reviewed these cases to define the prevalence of vaccine-associated paralytic poliomyelitis. They also aimed to determine whether changing to an inactivated polio vaccine schedule and screening neonates for immunodeficiencies could reduce the risk for infection.
The first patient was a 17-month-old girl who acquired the infection in 1995. She was administered the inactivated polio vaccine due to a known antibody deficiency. She also had a healthy sibling who was administered the oral polio vaccine. Fecal samples indicated vaccine-derived poliovirus type 2. Recombination with the Sabin 1 strain was detected, with a crossover site at nt 5355, according to the results.
The second case occurred in a 7-month-old boy in 2005. He had been administered the oral polio vaccine at birth and at 2, 4 and 6 months. His fecal samples also indicated vaccine-derived poliovirus type 2 and recombination with the Sabin 1 strain with a crossover site at nt 5358. He did not have HIV, but the expression of human leukocyte antigen DR on his lymphocytes was low, indicating major histocompatibility complex class II deficiency.
The third patient was a boy who had a variety of health concerns in early 2006 at age 2 months. He was eventually admitted to a hospital with paralytic complications in October 2006. He was also administered the oral polio vaccine at birth and at 2, 4 and 6 months. A number of immunodeficiencies were observed, including decreased CD3+, CD4+ and CD8+ cell counts. Vaccine-derived poliovirus type 2 was detected and he was ultimately diagnosed with severe combined immunodeficiency caused by RAG2 mutation.
The fourth patient was a 15-month-old boy given the oral polio vaccine at birth and at 2, 4 and 6 months. Vaccine-derived poliovirus type 3 was isolated from his feces. Recombination with the Sabin 1 strain was detected at the 3Dpol region of the genome.
The fifth patient was a girl born in September 2006. She was given the oral polio vaccine at birth and at 2 months. In February 2007, she was admitted to a hospital with pneumonia and paraparesis, at which point fecal specimen results indicated the presence of vaccine-derived poliovirus types 1 and 2. She was diagnosed with B cellnegative T cellnegative severe combined immunodeficiency.
The final patient was a boy who developed paralysis at 7 months old. An initial fecal specimen indicated the presence of the Sabin 2 strain. After hospitalization for several complications, he was diagnosed with X-linked agammaglobulinemia. Subsequent fecal samples were positive for vaccine-derived poliovirus type 2. Treatment with IV immunoglobulin substitution at 600 mg/kg every four weeks was ongoing. Follow-up fecal samples became negative for polioviruses and his immunodeficiency was under control. Residual paralysis of the right leg remained. He was the only patient who survived.
The median interval between administration of the last oral vaccine dose and onset of vaccine-associated paralytic poliomyelitis was 3.1 months. Immune deficiency was diagnosed after onset of vaccine-associated paralytic poliomyelitis in five of the studied patients.
Along with switching to an inactivated polio vaccine schedule, the researchers also recommended screening children for immunodeficiencies.
Source: Shahmahmoodi S, Mamishi S, Aghamohammadi A, Aghazadeh N, Tabatabaie H, Goya MM, et al. Vaccine-associated paralytic poliomyelitis in immunodeficient children, Iran, 19952008. Emerg Infect Dis. 2010 Jul; [Epub ahead of print]
KTSP.com in Minneapolis/St. Paul has reported an outbreak of pertussis in schools in Wright County.
There have been 46 cases so far primarily in students from Maple Lake Elementary and St. Timothy's Catholic School.
Most cases are in 5th and 6th graders and the outbreak may be due to waning immunity from vaccinations received when they were toddlers. Booster shots are given to 7th graders.
Source: The Examiner, 14th May 2010.
More people are contracting Hib infection despite a child vaccination programme, government advisors warn.
Rates of the meningitis-causing bacteria among adults have reached levels higher than before 1992, when routine vaccination of babies started.
Rates in children are also rising, mainly among those immunised as babies, according to Health Protection Agency (HPA) experts.
Booster jabs should reduce rates they told the British Medical Journal.
Hib is the term commonly used to describe a disease caused by the bacteria Haemophilus influenzae type b.
As well as meningitis, it can cause infection in joints, pneumonia and epiglottitis (swelling of part of the windpipe causing noisy, painful breathing and even blockage of the airway).
The Hib vaccine was introduced into the routine immunisation programme for babies in 1992, and led to a big reduction in Hib infection rates and deaths.
However, a number of factors, including problems with the type of vaccine used at the time, led to a drop in its effectiveness, and a corresponding rise in cases of Hib, according to the HPA.
From 1998, Hib cases in children started to rise significantly, almost doubling each year and mostly among those who were immunised in the programme as babies.
To combat this rise, the Department of Health launched a Hib booster campaign between May 2003 and January 2004, targeting all children aged from six months up to four years.
Following this campaign, the number of cases reported fell in the age groups vaccinated.
But a smaller decline occurred in older children and in adults.
Rates of adult Hib infection are now higher than they were before the vaccination was introduced, say the HPA researchers.
There were 0.27 cases per 100,000 in 2003, compared with 0.17 in 1992.
Dr Mary Ramsay from the HPA's immunisation department, who led the research, blamed the introduction of the Hib vaccine in 1992 for the rise in adult cases.
"The drop in infection rates among children meant reduced exposure to the disease for adults, and therefore lower rates of infection.
"This means that the level of antibodies in adults, to enable them to fight Hib infection, was no longer being boosted.
"Therefore, as the disease started to rise once again amongst children, some adults were less able than before to fight the infection."
Addition of Severe Combined Immunodeficiency as a Contraindication for Administration of Rotavirus Vaccine
June 11, 2010 / 59(22);687-688
In response to reported cases of vaccine-acquired rotavirus infection in infants with severe combined immunodeficiency (SCID) following rotavirus vaccine administration, both Merck & Co. and GlaxoSmithKline Biologicals have revised the prescribing information and patient labeling for their respective rotavirus vaccine products, pentavalent rotavirus vaccine (RV5) and monovalent rotavirus vaccine (RV1), with approval from the Food and Drug Administration (1,2). Merck revised the prescribing information and patient labeling for RV5 in December 2009, and GlaxoSmithKline Biologicals did so for RV1 in February 2010. After the revision to the RV5 prescribing information, CDC sought consultation from members of the former Rotavirus Vaccine Work Group of the Advisory Committee on Immunization Practices (ACIP). On the basis of that consultation and available data, CDC is updating the list of contraindications for rotavirus vaccine. Rotavirus vaccine (both RV5 and RV1) is contraindicated in infants diagnosed with SCID.
SCID includes a group of rare, life-threatening disorders caused by at least 15 different single gene defects that result in profound deficiencies in T- and B- lymphocyte function (3). The estimated annual incidence of SCID is one case per 40,000--100,000 live births, or a total of approximately 40--100 new cases among infants in the United States each year (3). SCID usually is diagnosed after an infant has acquired a severe, potentially life-threatening infection caused by one or more pathogens. Infants with SCID commonly experience chronic diarrhea, failure to thrive, and early onset of infections. Chronic, wild-type rotavirus infection has been reported in infants with SCID, with resulting prolonged diarrhea or shedding of rotavirus (4). Diagnosis and hematopoietic stem cell transplantation before onset of severe infections offer the best chance for long-term survival of SCID patients (3,5).
The median age at diagnosis of SCID is 4--7 months, which overlaps with the ages for rotavirus vaccination recommended by ACIP (ages 2, 4, and 6 months for RV5; ages 2 and 4 months for RV1). Prenatal diagnosis is possible for the minority of infants with a known family history of SCID. Newborn screening for SCID through evaluation of dried blood spots is available in two states, Massachusetts and Wisconsin. On January 21, 2010, the Federal Advisory Committee on Heritable Disorders in Newborns and Children recommended that a screening test for SCID be included in the core panel of the recommended uniform screening panel for all newborn infants. On May 21, the U.S. Department of Health and Human Services approved the addition of SCID to the uniform screening panel.
Since introduction of rotavirus vaccine in the United States in 2006, five cases (four in the United States and one in Australia) of vaccine-acquired rotavirus infection in RV5-vaccinated infants with SCID have been reported in the literature (6--8). Two additional U.S. cases of vaccine-acquired infection in RV5-vaccinated infants with SCID and one case of vaccine-acquired infection in an RV1-vaccinated infant with SCID from outside the United States have been reported to the Vaccine Adverse Event Reporting System (VAERS). The eight infants (four males and four females) were diagnosed with SCID between ages 3 months and 9 months and had received 1--3 doses of rotavirus vaccine before the diagnosis. All the infants had diarrhea, and most had additional infections (e.g., Pneumocystis jirovecii, rhinovirus, adenovirus, Salmonella, Escherichia coli, and Giardia) at the time of SCID diagnosis. Rotavirus infection was diagnosed by enzyme immunoassay in seven of the eight patients for whom this information was available. In all eight cases, vaccine-acquired rotavirus infection was confirmed by reverse transcription--polymerase chain reaction (RT-PCR) and nucleotide sequencing. Prolonged shedding of vaccine virus was documented in at least six of these cases, with duration of up to 11 months.
Rotavirus vaccine (both RV5 and RV1) is contraindicated in infants diagnosed with SCID. Consultation with an immunologist or infectious disease specialist is advised for infants with known or suspected altered immunocompetence before rotavirus vaccine is administered (9). General guidelines on immunodeficiency and use of live virus vaccines are available in the 2009 Red Book, Table 1.14 (10).
1. Food and Drug Administration. Product approval-prescribing information [package insert]. RotaTeq [rotavirus vaccine, live, oral pentavalent], Merck & Co, Inc: Food and Drug Administration; 2009. Available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm094063.htmExternal Web Site Icon. Accessed June 4, 2010.
2. Food and Drug Administration. Product approval-prescribing information [package insert]. Rotarix [rotavirus vaccine, live, oral], GlaxoSmithKline Biologicals: Food and Drug Administration; 2010. Available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm133920.htmExternal Web Site Icon. Accessed June 4, 2010.
3. Puck JM. Population-based newborn screening for severe combined immunodeficiency: steps toward implementation. J Allergy Clin Immunol 2007;120:760--8.
4. Saulsbury FT, Winkelstein JA, Yolken RH. Chronic rotavirus infection in immunodeficiency. J Pediatr 1980;97:61--5.
5. Buckley RH, Schiff SE, Schiff RI, et al. Hematopoietic stem-cell transplantation for the treatment of severe combined immunodeficiency. N Engl J Med 1999;340:508--16.
6. Patel NC, Hertel PM, Estes MK, et al. Vaccine-acquired rotavirus in infants with severe combined immunodeficiency. N Engl J Med 2010;362:314--9.
7. Uygungil B, Bleesing JJ, Risma KA, McNeal MM, Rothenberg ME. Persistent rotavirus vaccine shedding in a new case of severe combined immunodeficiency: a reason to screen. J Allergy Clin Immunol 2010;125:270--1.
8. Werther RL, Crawford NW, Boniface K, Kirkwood CD, Smart JM. Rotavirus vaccine induced diarrhea in a child with severe combined immune deficiency. J Allergy Clin Immunol 2009;124:600.
9. CDC. Cortese MM, Parashar UD. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2009;58(No. RR-2).
10. American Academy of Pediatrics. Immunocompromised children. Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red book: 2009 report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:24--5.
After having sex with a soldier recently vaccinated against smallpox, a young woman in Washington state developed an illness caused by the vaccinia virus used in the shot, US health officials report.
This type of viral transmission, while rare, is not unheard of, according to the US Centres for Disease Control and Prevention.
"The patient visited an urgent care clinic with painful, ring-shaped vaginal swelling," explained Andrea McCollum, an Epidemic Intelligence Service Officer with the CDC. "A few days before that, she had sexual contact with her boyfriend who was a recent smallpox vaccinee via the military."
Although smallpox is now almost eradicated, US military personnel have been vaccinated in recent years as a precaution against the potential use of the virus in a biological attack. The smallpox vaccine comes in the form of a live vaccine, so there is always some risk of infection, McCollum said. "The vaccine is not smallpox virus," she stressed, "but it's a closely related virus called vaccinia."
Second doc confirmed diagnosis
Although the woman told her doctor about her possible exposure to smallpox vaccine via sexual contact with her recently vaccinated boyfriend, the doctor tested her for common STDs but did not test for vaccinia, according to the report published in the CDC journal Morbidity and Mortality Weekly Report.
Despite taking the antibiotics and antiviral medications that the doctor had prescribed, the woman continued having lesions and pain for the next three days, McCollum said.
A second doctor then sent her to an infectious disease specialist who confirmed that she had the vaccinia virus.
Vaccinia is relatively mild compared to smallpox, and the woman did not need any specific treatment. She did suffer some pain, soreness and irritation, which eventually resolved, McCollum said.
However, "we were quite concerned that she might transmit it to her household contacts," McCollum said, because one of her roommates had had a kidney transplant. The transplant patient was immunosuppressed and taking a lot of medication. "A vaccinia virus infection, particularly in an immunosuppressed individual, can be very serious and life-threatening," McCollum noted.
Other cases out there
McCollum noted that there have been other cases of this infection transmitted from smallpox-vaccinated individuals to others. "At CDC, we don't know about every case of vaccinia that occurs," she said.
Including this case, the CDC is aware of five similar cases occurring over the past year, she said. "All the cases were women presenting with genital lesions that had had recent sexual contact exposure to military vaccinees."
In addition to military personnel, others who are vaccinated include some health care workers and laboratory personnel who work with the virus, McCollum said.
In terms of immunisations generally, McCollum said the danger of transmitting a virus via a recent vaccination is present with vaccines that contain what's known as live virus. Most vaccines - including most childhood and flu vaccines - are made from the killed virus, and therefore pose no such danger, she said.
Infectious disease expert Dr. Marc Siegel, an associate professor of medicine at New York University in New York City, said that "smallpox vaccine being a live virus, there is a two-to-three-week period when you are still infectious from the vaccination site and you have to be very careful to cover it."
Source: Health24.com, News, 2nd July 2010.
Whooping cough has made a comeback, and right now California is in the midst of its worst outbreak in half a century with 3,600 cases and eight deaths.
Last year, Texas had 3,358 cases of the pertussis disease, which is also the most in fifty years. Three deaths were reported.
"Pertussis itself is a very bad bug, it is highly contagious," said UT Health Pediatrician Jason Sanders.
Doctors say the increase is due partly because the series of pertussis vaccinations you get as a child, does not provide lifetime immunity. The vaccine wears off by about age 12.
That's what happened to the Throgmorton family.
In 2003, Haleigh Throgmorton came into the world a little ahead of schedule, so her father delivered her at home near Amarillo. Five-and-a-half weeks later Haleigh died from pertussis.
"It was a shock, I mean we were floored that that's what it was, because it was something you never thought of being around anymore," said Jerri Lynn Throgmorton, the babys mother.
Rodney Throgmorton, who hadn't been immunized since childhood, got whooping cough at age 34 and then unknowingly passed it on to his newborn.
"By the time she passed away I had had the disease for a month, and coughing for a month," he said.
The disease is uncomfortable for adults, but can be deadly for infants under 6 months old, who haven't been fully immunized.
That's why in 2005, the U.S. Food and Drug Administration approved
a whooping cough booster for everyone over age 11.
But there is another side to this story that is far more controversial.
Some doctors wonder if the actions of some parents are partly to blame for the rise of the disease. A growing number of them have decided not to vaccinate their children.
Rebecca Rex is among those parents.
"I'm fully aware of the risk we've taken and the consequences of those risks if they don't go well," she said.
Her two sons, ages 17 and 11, have never been vaccinated
and she said they have never gotten whooping cough.
Rex is the co-founder of Parents Requesting Open Vaccine Education, or PROVE. She says there is evidence that vaccines can have dangerous side effects.
"I'm not telling a parent to vaccinate or not, I am telling a parent to go out and do as much research as they can -- of information that is not hysterical," Rex said.
11News checked with the Centers For Disease Control and found they have what's called the Adverse Vaccine Reporting System. We found reports where people said that within minutes, or hours of getting the pertussis vaccine, they suffered from either abdominal pain, nausea, seizures or rashes. And in rare cases, some children died.
Source: Kvue.com, 10th September 2010.
Methods.The families of UK children with Hib vaccine failure diagnosed during the period October 1992 through December 2005 were identified through enhanced national surveillance and approached for the study at a median interval of 4 years after invasive disease. The Wellcome Trust Case Control Consortium data sets were used as controls. Nineteen functional SNPs in 14 immune response genes were investigated in 172 white children.
CONTEXT: The rapid increase in multiresistant serotype 19A as a cause of invasive and respiratory pneumococcal disease has been associated in time with the widespread implementation of 7-valent pneumococcal conjugate vaccination (PCV-7) in several countries. Because spontaneous fluctuations in time and antibiotic selective pressure may have induced this serotype 19A increase, controlled studies are needed to assess the role of PCV-7.
OBJECTIVE: To examine the association of PCV-7 vaccination and nasopharyngeal acquisition of serotype 19A pneumococci, their clonal distribution, and antibiotic susceptibility.
DESIGN, SETTING, AND PATIENTS: Post hoc per-protocol completer's analysis as part of a randomized controlled trial of nasopharyngeal Streptococcus pneumoniae carriage enrolling 1003 healthy newborns with follow-up to the age of 24 months in The Netherlands, which has low antibiotic resistance rates. The study was conducted before widespread PCV-7 implementation in infants, between July 7, 2005, and February 14, 2008. Nasopharyngeal swabs were obtained at the age of 6 weeks and at 6, 12, 18, and 24 months.
INTERVENTION: Infants were randomly assigned to receive 2 doses of PCV-7 at 2 and 4 months; 2 + 1 doses of PCV-7 at 2, 4, and 11 months; or no dosage (unvaccinated control group).
MAIN OUTCOME MEASURE: Cumulative proportion of children with nasopharyngeal acquisition of a new serotype 19A strain from 6 through 24 months of age.
RESULTS: Nine hundred forty-eight children completed the study. Fifty-four nasopharyngeal serotype 19A carriage isolates from 318 in the 2-dose group, 66 isolates from 327 in the 2 + 1-dose group, and 33 isolates from 303 in the unvaccinated were collected from 6 weeks through 24 months. The cumulative proportion who tested positive for new nasopharyngeal serotype 19A acquisition from 6 through 24 months of age was significantly higher in those having received the 2 + 1-dose PCV-7 schedule (16.2%; 95% confidence interval [CI], 12.6%-20.6%) vs those who were unvaccinated (9.2%; 95% CI, 6.5%-13.0%; relative risk [RR], 1.75; 95% CI, 1.14-2.70) but not after a 2-dose schedule (13.2%; 95% CI, 9.9%-17.4%; RR, 1.43; 95% CI, 0.91-2.25). There were 28 different sequence types identified, including 6 new types. The proportion of children with new 19A acquisition who had used antibiotics in the last 6 months (18.7%) did not differ among groups. Five isolates were penicillin-intermediate susceptible and another 3 were nonsusceptible to erythromycin and azithromycin, all in the vaccine groups.
CONCLUSION: A 2 + 1-dose PCV-7 schedule was associated with an increase in serotype 19A nasopharyngeal acquisition compared with unvaccinated controls.
Source: JAMA. 2010 Sep 8;304(10):1099-106
Objective To estimate the proportion of school age children with a persistent cough who have evidence of a recent Bordetella pertussis infection.
Design Prospective cohort study (October 2001 to March 2005).
Setting General practices in Oxfordshire, England.
Participants 172 children aged 5-16 years who presented to their general practitioner with a cough lasting 14 days or more who consented to have a blood test.
Main outcome measures Serological evidence of a recent Bordetella pertussis infection; symptoms at presentation; duration and severity of cough; sleep disturbance (parents and child).
Results 64 (37.2%, 95% confidence interval 30.0% to 44.4%) children had serological evidence of a recent Bordetella pertussis infection; 55 (85.9%) of these children had been fully immunised. At presentation, children with whooping cough were more likely than others to have whooping (odds ratio 2.85, 95% confidence interval 1.39 to 5.82), vomiting (4.35, 2.04 to 9.25), and sputum production (2.39, 1.14 to 5.02). Children with whooping cough were also more likely to still be coughing two months after the start of their illness (85% v 48%; P = 0.001), continue to have more than five coughing episodes a day (P = 0.049), and cause sleep disturbance for their parents (P = 0.003).
Conclusions For school age children presenting to primary care with a cough lasting two weeks or more, a diagnosis of whooping cough should be considered even if the child has been immunised. Making a secure diagnosis of whooping cough may prevent inappropriate investigations and treatment.
The largest recorded outbreak of a circulating vaccine-derived poliovirus (cVDPV), detected in Nigeria, provides a unique opportunity to analyze the pathogenicity of the virus, the clinical severity of the disease, and the effectiveness of control measures for cVDPVs as compared with wild-type poliovirus (WPV).
We identified cases of acute flaccid paralysis associated with fecal excretion of type 2 cVDPV, type 1 WPV, or type 3 WPV reported in Nigeria through routine surveillance from January 1, 2005, through June 30, 2009. The clinical characteristics of these cases, the clinical attack rates for each virus, and the effectiveness of oral polio vaccines in preventing paralysis from each virus were compared.
Source: Helen E. Jenkins, M.Sc., R. Bruce Aylward, M.D., Alex Gasasira, M.B., Ch.B., Christl A. Donnelly, Sc.D., Michael Mwanza, B.Comm., Jukka Corander, Ph.D., Sandra Garnier, B.Sc., Claire Chauvin, R.N., M.P.H., Emmanuel Abanida, M.P.H., Muhammad Ali Pate, M.D., Festus Adu, D.V.M., Ph.D., Marycelin Baba, Ph.D., and Nicholas C. Grassly, D.Phil.
N Engl J Med 2010; 362:2360-2369June 24, 2010
A rise in the number of pertussis cases in the area has hit two Orange County elementary schools particularly hard.
"We had 11 cases 2 weeks ago. Now we have 17," said Gene Kotulka, director of student services for the school system.
Kotulka said tests on four other students Friday came back negative, "but it comes in waves, so we may see more."
All of the affected students attend either Lightfoot Elementary or Unionville Elementary, which are near each other on U.S. 522. According to Kotulka, all the students have been vaccinated.
Source: fredericksburg.com, 22nd November 2010.
Whooping cough, caused by B. pertussis and B. parapertussis, has increased in incidence throughout much of the developed world since the 1980s despite high vaccine coverage, causing an increased risk of infection in infants who have substantial disease-induced mortality. Duration of immunity and epidemically significant routes of transmission across age groups remain unclear and deserve further investigation to inform vaccination strategies to better control pertussis burden. The authors analyze age- and species-specific whooping cough tests and vaccine histories in Massachusetts from 1990 to 2008. On average, the disease-free duration is 10.5 years. However, it has been decreasing over time, possibly due to a rising force of infection through increased circulation. Despite the importance of teenage cases during epidemics, wavelet analyses suggest that they are not the most important source of transmission to infants. In addition, the data indicate that the B. pertussis vaccine is not protective against disease induced by B. parapertussis.
Source: Vaccine, Volume 29, Issue 1, 10 December 2010, Pages 11-16.
Matthew Jacob Bryce was born a healthy 8 pounds, 9 ounces on Oct 11, 2010, so when he showed signs of a cold at just two weeks, his parents knew something more might be wrong. They were not first-time parents.
He was just really stuffy. He was having difficulty breathing, Marlon Bryce, Matthews father, recalled.
The doctor suspected whooping cough, although everyone in the house had been vaccinated. For Marlon and Cindy Bryce, a young couple who had met in San Diego when both were in the Navy, it was a terrible prospect. Whooping cough, known also as pertussis, can be fatal in babies.
The doctor took a nasal swab, and started the infant on antibiotics.
It took six days to get the lab results. Matthew, at 23 days old, had pertussis.
California is experiencing its worst whooping cough outbreak in more than 60 years. Thousands of people have gotten sick and 10 infants have died, including two in San Diego County.
Health officials across the country are trumpeting pertussis vaccinations, but a four-month investigation by KPBS and the Watchdog Institute, a nonprofit investigative center based at San Diego State University, has found that many people who have come down with whooping cough have been immunized.
Two of the worlds most respected experts on the disease disagree about why there are such high numbers of people who are getting sick. Dr. James Cherry, a prominent researcher at UCLA, says increased awareness of whooping cough has led to more reports of it. However, Dr. Fritz Mooi, a well-known Dutch scientist who has been studying mutations of the pertussis bacteria for 15 years, says a more virulent strain of bacteria is contributing to outbreaks.
KPBS and the institute have been asking about the possibility of more virulent whooping cough strains for months, and the Centers for Disease Control and Prevention (CDC) recently announced studies of the disease, and the bacteria causing it, in California and Ohio. Two members of the California study group said it was prompted by the increasing death toll and KPBS-institute inquiries.
Officials from the CDC, the California Department of Public Health (CDPH) and two pertussis experts from UCLA held a conference call Oct. 13 to discuss studying whether a more virulent strain was responsible for infant deaths and is contributing to the current epidemic. That same day, whooping cough claimed the life of its tenth newborn in California.
Dr. Jeff Miller, a scientist involved in the study at UCLA, said the possibility that the pertussis bacterium has mutated is an important hypothesis to test. He added, I wish we would have started it in 2005.
Mooi, the scientist who has been studying the bacterial mutations, said his research has been ignored by those who influence public policy on pertussis in the U.S. and beyond, in part because they rely on vaccine makers to fund their meetings and research.
There is little incentive for pharmaceutical companies to pursue a new vaccine because it would cost billions, he said. The circulation of a more virulent strain of pertussis could mean a new vaccine should be created.
VideoAbove: Dr. Frits Mooi is a scientist with The Netherlands Center for Infectious Diseases Control. Mooi says his research suggests there is "mis-match" between the current pertussis vaccine and a new more virulent strain of the disease which is now circulating.
In examining the pertussis epidemic, KPBS and the Watchdog Institute collected federal, state and county statistics and consulted and interviewed experts from Los Angeles to the Netherlands.
Key findings include:
For pertussis cases in which vaccination histories are known, between 44 and 83 percent were of people who had been immunized, according to data from nine California counties with high infection rates. In San Diego County, more than two thirds of the people in this group were up to date on their immunizations.
Health officials in Ohio and Texas, two states also experiencing whooping cough outbreaks, report that of all cases, 75 and 67.5 percent, respectively, reported having received a pertussis vaccination.
Today, the rate of disease in some California counties is as high as 139 per 100,000, rivaling rates before vaccines were developed.
Public officials around the world rely heavily on two groups of pertussis experts when setting vaccine policy relating to the disease. Both groups, and many of their members, receive money from the two leading manufacturers of pertussis vaccine.
Pertussis is a highly contagious respiratory illness that may mimic a cold for the first 10 days. It then can produce a violent and persistent cough with a unique whooping sound.
For adults, pertussis may only be a nuisance, like a bad cold. But to infants it can be deadly because they cant cough up what collects in their lungs and infections can spread.
Vaccinations nearly wiped out whooping cough more than 30 years ago, but it has made a vengeful comeback in California and other highly vaccinated communities around the U.S.
While public health officials and scientists agree that vaccines are still the best available tool against pertussis, they argue over how effective they are with time and in the face of a possible increase in virulence.
Dr. Mark Horton, director of the California Department of Public Health, said health officials expect to see a certain percentage of people who have been vaccinated contracting whooping cough. He says no vaccine is 100 percent effective, and those who are immunized and getting sick are likely those for whom the vaccine did not work or whose immunity has waned.
Thats no surprise to us, he said, nor is it a reflection on the efficacy of the vaccine.
Mooi, who heads the Pertussis Surveillance Project at the National Institute of Health in the Netherlands, said an epidemic in 1996 in his country gave the need for research more urgency.
And we found really a kind of new mutation in that bug, Mooi said.
In tests, Moois lab found the mutated strain produced more toxins, which could make people sicker.
At the Bryces home in Chula Vista, Marlon, who is 31 and a contract specialist at the Naval Medical Center, and Cindy, 27, puzzle over how Matthew could have contracted pertussis. He hadnt been out of the house much, they said.
Their other boys Jordan, 4, and Joshua, 3, were up to date on their vaccinations. Marlon had gotten his a month before Matthew was born. Cindy was immunized before leaving the hospital after giving birth.
Marlon clearly remembers Cindys call when she learned Matthew had whooping cough. She was crying The moment that I heard it, I immediately started thinking the worst. Youve heard the news about the babies that have passed away Why is this happening?
Marlon is soft-spoken and thoughtful.
The one thing I would want to know is: Is the vaccine working? Is it as effective? I thought that if I did everything I was told to do that our sons would be protected, Marlon said.
The bacterium that causes whooping cough was first identified in 1906, when the illness was a common cause of death in infants and young children.
The discovery lead to the first attempts at a vaccine, but it wasnt until the late 1940s, when the rate of disease was around 157 cases per 100,000 population, that scientists developed a vaccine effective enough to prevent pertussis. By the 1970s, the pertussis infection rate had dropped to less than one per 100,000.
But the vaccine, made of whole bacterial cells killed in labs, had side effects, such as prolonged crying spells in babies and seizures.
By 1996, the FDA approved a new whooping cough vaccine: an acellular version, which uses only purified components of the disease-causing organism. It is considered safer than the whole-cell vaccine and is the only one used in the U.S. today.
Just as the vaccines were changing, health officials across the country were reporting increasing numbers of whooping cough cases. According to a CDC report, most of the children four years old and younger who got whooping cough nationwide between 1990 and 1996 were not fully immunized.
That trend appears to have reversed in Californias latest outbreak.
KPBS and the Watchdog Institute requested information from 19 California counties most affected by pertussis. Nine counties supplied pertussis case information and vaccination history. In all but Stanislaus County, more than half the people sick with whooping cough had been immunized.
As of the end of October, and in cases where immunization history was known, data showed 83 percent of the people with whooping cough in Fresno had been vaccinated. In San Luis Obispo, 76 percent were up to date on their immunizations. In San Diego, 68 percent were up to date.
Public health experts say the surge of the disease is cyclical, with increased diagnoses every two to five years.
And that tells us bordatella pertussis is circulating today exactly as it did in the prevaccine era, Cherry said. The main reason is increased awareness, he explained. People, particularly public health people, are much more aware, and that trickles down.
Cherry and Mooi agree that immunity provided by vaccines wanes over time. But, they disagree over how long immunity lasts, and whether a mutated strain of pertussis is exploiting waning immunity.
Dr. James Cherry says there is no evidence current whooping cough vaccines are less effective then they were 15 years ago.
Drug package inserts included with the two most common pertussis vaccines in the U.S. state they are 85 percent effective. Cherry, who was involved in the efficacy studies when the vaccines were licensed by the FDA, estimates the efficacy is between 70 and 80 percent. Mooi said theres no way to know how effective the vaccines are because they havent been tested against the new strain.
The vaccines have less efficacy than many people believe, Mooi said.
Public health agencies recommend five vaccine doses by age 6, and they recommend adults get a booster every 10 years. The California state legislature passed a law in September requiring all children entering middle school to receive a pertussis booster.
Cherry advocates booster shots. Mooi isnt so sure adult boosters are cost effective. Both agree that the current vaccine offers the best protection against the disease, especially for families with an infant in the house.
In the long run, Mooi says there should be better vaccines.
Money should be spent studying todays strains and making a vaccine that would work against them, Mooi said. After all, every year we have a new flu vaccine, so, I think we should have something like that for bacterial vaccines, too, he said.
Cherry believes a new, better vaccine is a long way off.
I think the likelihood of the logistics of getting a new vaccine right now in this country is almost impossible, because of the FDA rules and requirements, he said. Theres a lot of things you could do (to improve current vaccines), but to get it approved would cost billions of dollars.
Cindy and Marlon Bryce were certainly aware of the deadly nature of whooping cough. Six weeks in October and November were harrowing for them. Today, their routine is more normal. Matthew has started day care.
The one thing I would want to say to parents is watch your kids, just be concerned, Marlon said. At first we thought we were being overprotective. But Im glad we were."
He continued, I would just hope that there is something we can do about this. If theres something that we can do, if theres something that the scientists who look at these things every day, if they think that theres a better way to do this, if theres a way that they can improve this vaccine, then please. I would support it.
Source:KPBS, by Joanne Faryon and Kevin Crowe, Watchdog Institute, 14th December 2010.
Objective: To describe the events leading to the epidemic of congenital rubella syndrome in Greece in 1993 after a major rubella epidemic.
Design: Retrospective survey and systematic review.
Setting: Greece (population 10 million), 1950-95.
Subjects: Children, adolescents, and women of childbearing age.
Results: Around 1975 in Greece the measles, mumps, and rubella vaccine started being given to boys and girls aged 1 year without policies to attain high vaccination coverage and to protect adolescents and young women During the 1980s, vaccination coverage for rubella remained consistently below 50%, and the proportion of pregnant women susceptible to rubella gradually increased. In 1993 the incidence of rubella in young adults was higher than in any previous epidemic year. The epidemic of congenital rubella that followed, with 25 serologically confirmed cases (24.6 per 100 000 live births), was probably the largest such epidemic in Greece after 1950.
Conclusions: With low vaccination coverage, the immunisation of boys and girls aged 1 year against rubella carries the theoretical risk of increasing the occurrence of congenital rubella. This phenomenon, which has not been previously reported, occurred in Greece.
Source: BMJ 1999; 319 : 1462 (Published 4 December 1999)
A Croatian doctor says a 46-year-old man has died of swine flu even though he had been vaccinated against it.
Dr. Ante Beus, head of the Infective Disease Clinic in Zagreb, says the man the countrys third flu fatality this season did not respond to the vaccine he received a month ago.
People should develop immunity after two weeks.
Beus said Wednesday that the man, who died this week, was obese and had diabetes and several other illnesses, which might have prevented vaccine from working. Doctors are studying the case.
Croatian health authorities urge people to get the shots, but many are reluctant.
More than 20 people died last year in Croatia during the global swine flu outbreak. About 1,000 are believed to be infected now.
Source: The Star.com, 12th January 2011.
A grandmother-of-three thought she was safe from swine flu after she had the vaccine months ago.
But Eleanor Carruthers, 68, from Merseyside became the latest victim of the outbreak on Saturday.
Mrs Carruthers was seriously ill with emphysema and lung cancer, but had had the flu vaccination in October to protect her from the illness.
Despite the step, she was rushed to the Royal Liverpool Hospital last week and later died. H1N1 (swine flu) was recorded as one of the main causes of her death.
She leaves behind three children and her husband Alf, 69. Today her daughter, Carole, 46, said they were all shocked by how quickly her condition deteriorated.
She said: 'What we don't understand is that mum had the vaccine in October, because she was in an at risk group.
'And even though she was ill, she had been OK until her breathing worsened very quickly on Saturday morning. 'It was such a sudden thing, she died that night.'
Read more: http://www.dailymail.co.uk/health/article-1347171/Swine-flu-Merseyside-Grandmother-Eleanor-Carruthers-dies-AFTER-jab.html#ixzz1BQyJj9xs
Read more: http://www.dailymail.co.uk/health/article-1347171/Swine-flu-Merseyside-Grandmother-Eleanor-Carruthers-dies-AFTER-jab.html#ixzz1BQyCOdmq
The highly transmissible nature of pertussis has been highlighted by an incident at a Sydney maternity hospital in which a fully-immunised nurse infected four neonates.
Described this week in Communicable Diseases Intelligence, the incident shows that extra vigilance is needed in healthcare staff working with newborns, in whom any coughing illness must be suspected to be pertussis, say the report authors.
Source: 6Minutes of interesting stuff for doctors today, 31st January 2011. http://www.6minutes.com.au/news/pertussis-spread-to-neonates-by-immunised-staff
The overall incidence of IPD decreased from 2002 to 2007, primarily driven
by a reduction in IPD caused by 7vPCV serotypes. However, this was partially offset by a
significant increase in the incidence of IPD caused by non-7vPCV serotypes, particularly
19A, in non-Indigenous children.
A childhood vaccine against pneumonia-causing bacteria introduced in 2000 hasn't made a visible dent in the disease, U.S. researchers said Monday.
In the first study to provide national estimates of childhood pneumonia, they found rates of the lung infection had stayed more or less constant between 1994 and 2007.
At the beginning of that period, 19 in 1,000 children got a pneumonia diagnosis at the doctor's office or at an emergency department, compared to 22 in 1,000 at the end.
But that doesn't mean the vaccine -- Pfizer's Prevnar, or PCV7 -- has been useless.
For instance, earlier work found the number of kids who had to be treated for pneumonia at the hospital dropped by more than half after the vaccine became available.
"It's possible that the vaccination has had a major impact on the more serious complications of pneumonia," said Dr. Samir S. Shah of the University of Pennsylvania School of Medicine in Philadelphia, who led the work.
Prevnar protects against a type of bacteria called Streptococcus pneumoniae, or just pneumococcus, which causes several kinds of infections -- including pneumonia, meningitis and middle ear infections.
"If you look at how effective the vaccine was in reducing meningitis and blood infections, it has done a phenomenal job," said Shah, whose study was supported by the National Institutes of Health.
While Pfizer said Prevnar is not licensed to prevent pneumonia in the U.S., it stressed the new study's design might be shrouding possible effects of the vaccine on the disease.
Source: Reuters Health, 16th February 2011.
For the past four months, KPBS and the Watchdog Institute have tracked the whooping cough epidemic across California and other affected states. In an effort to better understand who is getting sick, we examined data from San Diego County Health and Human Services agency that contained immunization history for each person diagnosed with pertussis. In September, KPBS reported that almost two-thirds of the people diagnosed with pertussis in San Diego County had been up to date on their immunizations. The figure surprised local health officials.
The institute then requested similar information from the California Department of Public Health. Each local health jurisdiction is responsible for reporting detailed information on probable pertussis cases to the state health department. The department keeps track of the information electronically and submits it to the Centers for Disease Control and Prevention (CDC).
In September, we received the states data on pertussis cases, and found it was not up to date and was missing information. For example, the immunization history was marked unknown for more than 60 percent of the cases. The states figures for San Diego County also didnt match what the county had given us. We asked the state about the discrepancies, and officials responded that if we wanted timely and accurate information, we should ask each countys health department.
Within days, we began requesting immunization history information from counties that reported high numbers of cases of pertussis. Of the 19 contacted, nine responded with immunization information. Officials from the other counties said they either didnt have the data, or they cited patient privacy in withholding it.
The institutes analysis of the data provided showed that in cases where immunization history is known between 44 and 83 percent of the people diagnosed with whooping cough had been vaccinated.
A more recent set of data from the state showed the California Department of Public Health still does not have immunization history information for almost 70 percent of the reported cases. However, in cases where immunization history is known, 83 percent of the people diagnosed with pertussis had been immunized.
To better understand the current epidemic, reporters for KPBS and the Watchdog Institute traveled to Los Angeles, Sacramento and the Netherlands to interview the worlds leading experts on pertussis, health officials and vaccine experts. They also reviewed recent studies done on pertussis, interviewed local families about their experiences with the disease and filed California Public Records Act and federal Freedom of Information Act (FOIA) requests for information on the epidemic and efforts to respond to it.
The CDC recently stopped answering questions about ongoing studies of whooping cough and its response to outbreaks nationwide. The CDC still has not produced records in response to a FOIA request the institute filed in September for information relating to past whooping cough epidemics.
Source: Watchdog Institute, 17th December 2010.
Background: This multicenter study was undertaken to investigate the serologic evidence of antibodies to Bordetella pertussis toxin (IgG-PT) in children and adolescents.
Methods: IgG-PT value in a single serum collected from 1616 children and adolescents was measured by enzyme-linked immunosorbent assay in the Food and Drug Administration (FDA)-units per milliliter from November 2008 to October 2009. The relationship between time since infection and IgG anti-PT levels were analyzed and the estimated age-specific incidences of infection were calculated.
Results: The sera IgG-PT geometric mean concentrations of the samples were 1.7 FDA-U/mL. The sera protective rates of all the subjects were 6.6% (95% confidential interval [CI]: 5.4%, 7.8%). The rates in the group aged 2 years was 9.2% (95% CI: 3.5%, 14.9%), which was significantly higher than in those aged >=3 years ([chi]2 = 1615, P = 0.000). In the group aged >=3 years, 4.0% (95% CI: 3.0%, 5.0%) of the individuals tested showed an IgG-PT level >=40 FDA-U/mL, which was equivalent to an estimated incidence of B. pertussis infection of 7000 (95% CI: 5300, 8800) per 100,000 population per year in the year before serum sampling. There were 2 peaks of estimated incidence. One peak incidence of 9100 (95% CI: 4300, 14000) per 100,000 population per year was found in the population aged >6 to 8 years. Another peak was in the population of 12- to 20-year olds with the estimated incidence of 14,600 (95% CI: 9100, 20100) per 100,000 per year.
Conclusions: The levels of protective antibodies against pertussis were very low in the immunized children aged 2 to 20 years. A booster dose of immunization for older children or adolescents should be an urgent priority. Moreover, using enzyme-linked immunosorbent assay to determine the efficiency of vaccines and even to obtain the serodiagnosis would be beneficial in controlling pertussis.
Source: Pediatric Infectious Disease Journal:
POST AUTHOR CORRECTIONS, 18 March 2011
An immunocompetent health care worker with no known history of varicella-zoster virus (VZV) disease was exposed to a patient with herpes zoster and was immunized 2 days later. Twenty-seven days after receiving the varicella vaccine, while hospitalized, she developed a disseminated rash. This exposure and subsequent development of symptoms posed infection control challenges. A polymerase chain reaction analysis of her vesicular fluid was positive for vaccine-type VZV, and a blood specimen collected before vaccination demonstrated a positive VZV titer by the fluorescent antibody to membrane antigen test. To the best of our knowledge, there have been no previous reports of an immunocompetent seropositive person developing vaccine-type VZV after receiving the vaccine.
Source: American Journal of Infection Control
Volume 39, Issue 3 , Pages 247-249, April 2011.
The aim of this study was to determine the level of anti-HBsAg (hepatitis B surface antigen) in vaccinated high risk group. We measured anti-HBsAg concentration in blood sera of adult students aged from 19 to 37 years old. Five milliliters (5 ml) of blood sample was taken from 210 cases four months after the second dose and 126 out of 210 cases three months after the third dose of hepatitis B vaccination. All blood samples were analyzed for anti-HBsAg by ELISA method. 125 out of 210 samples (59.5%) showed anti-HBsAg concentrations higher than 20 mIu/ml and considered immune after the second dose of hepatitis B vaccination. Also, 99.2% of samples had anti-HBsAg higher than 20 mIu/ml three months after the third dose of the vaccination. Non-immune cases in males were more than females (41.2% vs.40.1%). In conclusions, our results reinforce the importance of hepatitis B vaccine in adolescents and suggest that three dose of hepatitis B vaccine is necessary to increase the seropositive rate of anti-HBsAg in adults.
Source: Vaccine,Volume 29, Issue 15, 24 March 2011, Pages 2727-2729
AN INVESTIGATION into a mumps outbreak at Oban has revealed concerning figures indicating some waning local immunity to the Measles Mumps and Rubella (MMR) vaccine.
The outbreak mainly affected young people in their teens and 20s.
It is thought to have spread initially through social mixing over the Christmas and New Year period when local young people were visiting their families.
The investigation shows that of the 140 cases recorded during the outbreak between December and February, 44% had received two doses of MMR, 28% had received one dose and 25% had not been immunised with MMR.
The figures will be discussed at the NHS Highland Board meeting in Inverness next Tuesday.
A report to the board states: This suggests some waning mumps immunity from MMR vaccine. Our work has now been published in Eurosurveillance (the European scientific journal devoted to the epidemiology, surveillance, prevention and control of communicable diseases).
Oban councillor Elaine Robertson, who is also a board member of NHS Highland, said: It does have to be investigated because these figures are not what we would have expected.
This obviously raises concerns and is worthy of greater investigation.
When this comes up I will be asking how we take this forward. Obviously they have done a thorough investigation into the background.
It is of interest and concern to everyone, not just the locality of Oban. This is something which would be looked into across the whole of the UK and also the world really.
Source: The Press and Journal, 30th March 2011.
We report the uncommon clinical course of tetanus in a completely immunized 14-year-old boy. His initial symptoms, which included a flaccid paralysis, supported a diagnosis of botulism. Preliminary mouse-test results with combined botulinum antitoxins A, B, and E, obtained from tetanus-immunized horses, backed this diagnosis. The change in his clinical course from paralysis to rigor and the negative, more specific, botulinum mouse test with isolated botulinum antitoxins A, B, and E, obtained from nonvaccinated rabbits, disproved the diagnosis of botulism. Tetanus was suspected despite complete vaccination. The final results of a positive mouse test performed with isolated tetanus antitoxin confirmed the diagnosis. Adequate treatment was begun, and the boy recovered completely.
Source: Pediatrics Vol. 120 No. 5 November 1, 2007 pp. e1355 -e1358
Full paper here: http://pediatrics.aappublications.org/content/120/5/e1355.full#sec-2
According to reports, a nurse and father of two, Kevin Hall, 43-years-old, passed away in arms of his wife Jennifer on Christmas Day, just two months after having the swine flu vaccination, as he was later confirmed to be killed by the H1N1 virus.
Also, a new breath test is being investigated to assist in identifying people infected with the H1N1 flu virus, and the test, which measures the immune response to the H1N1 flu virus, can assist in curbing future vaccine shortages by identifying people who have been infected with the flu virus and preventing irrelevant vaccinations.
However, the researchers, from Cleveland Clinic and Syft Technologies investigated the fast-acting, non-invasive breath test to rate biomolecules that are brought together responding to the H1N1 strain. Hence, the breath test analyzed the exhaled nitric oxide a biomolecule, that its previous production has been connected to influenza, viral infection and presumed to have a favorable role in the elimination of the viral infection.
Moreover, the results revealed a rise in nitric oxide levels in all subjects on the third day after vaccination and there were no major differences in the levels on any of the other days.
The health authorities have discovered that more than 78 per cent of confirmed polio cases in Pakistan involved children who had been administered polio drops.
According to a report compiled by polio eradication section of the National Institute of Health, out of 136 polio cases reported this year, 107 children had been administered polio drops on several occasions under a prescribed schedule.
The data available on the website of the World Health Organisation also indicated that Pakistan had registered the highest number of polio cases in a decade this year.
Officials in the National Polio Control Programme said that the number of polio cases had increased during the last three years after going down for the previous seven years.
They suspected that the vaccine might have lost its efficacy after not having been stored at the required temperature, especially in far-flung areas where electricity supply is disrupted for long hours.
Prof Athar Niaz Rana, head of allergy and immunology department at the Shifa International Hospital, told Dawn: Vaccine failure and failure to vaccinate are two important factors which have affected the national polio campaign.
He insisted that security situation in Khyber-Pakhtunkhwa is also one of the factors which has led to the failure of vaccine in that region.
Dr Rana pointed out that the problem of vaccine storage in areas where refrigeration facilities are not available or power supply is discontinued very frequently also affects the efficacy of polio vaccine.
A health ministry official told Dawn: It is a WHO-tested vaccine and we have no doubt about its efficacy, although we have a few issues at the district level related to management.
He said the vaccine was not being used in Pakistan alone but also in several other countries.
A surge in polio cases in a few areas is because of security reasons and the ministry has developed a comprehensive plan for 2011 to meet the challenge.
Source: Dawn.com, 22nd December 2010 - http://www.dawn.com/2010/12/22/incidence-of-polio-among-vaccinated-children-alarms-govt.html
Three new outbreaks of circulating vaccine-derived polioviruses were identified and three previously identified outbreaks continued through late 2010 or into 2011. These new outbreaks highlight the importance of trivalent oral poliovirus vaccination campaigns to prevent both wild-type and vaccine-derived poliovirus outbreaks, according to the CDC.
The three new outbreaks of circulating VDPVs (cVDPVs) ranged in size from six to 16 cases and were reported in Afghanistan, Ethiopia and India. The previously reported outbreaks in Nigeria, Democratic Republic of Congo (DRC) and Somalia continued through late 2010 or into 2011 and resulted in a total of 405 cases. In addition, two countries experienced importations of cVDPVs from Nigeria, and nine people living in seven middle-income and developing countries who were newly identified as paralyzed were found to excrete VDPVs. VDPVs were also found among people and environmental samples in 15 countries. The emerging cVDPVs were type 2 in all but one country, according to a report in Morbidity and Mortality Weekly Report.
Source: Pediatric Supersite, 5th July 2011 -
Measles is the most transmissible disease known to man. During the 1980s, the number of measles cases in the United States rose dramatically. Surprisingly, 20% to 40% of these cases occurred in persons who had been appropriately immunized against measles. In response, the United States adopted a two--dose universal measles immunization program. We critically examine the effect of vaccine failure in measles occurring in immunized persons.
We performed a computerized bibliographic literature search (National Library of Medicine) for all English-language articles dealing with measles outbreaks. We limited our search to reports of US and Canadian school-based outbreaks of measles, and we spoke with experts to get estimates of vaccine failure rates. In addition, we devised a hypothetical model of a school where measles immunization rates could be varied, vaccine failure rates could be calculated, and the percentage of measles cases occurring in immunized students could be determined.
We found 18 reports of measles outbreaks in very highly immunized school populations where 71% to 99.8% of students were immunized against measles. Despite these high rates of immunization, 30% to 100% (mean, 77%) of all measles cases in these outbreaks occurred in previously immunized students. In our hypothetical school model, after more than 95% of schoolchildren are immunized against measles, the majority of measles cases occur in appropriately immunized children.
The apparent paradox is that as measles immunization rates rise to high levels in a population, measles becomes a disease of immunized persons. Because of the failure rate of the vaccine and the unique transmissibility of the measles virus, the currently available measles vaccine, used in a single-dose strategy, is unlikely to completely eliminate measles. The longterm success of a two-dose strategy to eliminate measles remains to be determined.
Source: Arch Intern Med. 1994;154:1815-1820. http://archinte.ama-assn.org/cgi/content/abstract/154/16/1815
A toddler from Wythenshawe has died from meningitis despite being vaccinated against the disease.
Lewis Taylor, two, was struck down by meningococcal C so rare that only a handful of people die from the strain each year. He was rushed to hospital by his parents but doctors could not save him.
Now his devastated parents Darren Taylor, 25, and Rebecca Weedon, 27, have told of their heartache. They want to warn other families of the symptoms to try to stop anyone else going through a similar ordeal.
Lewis, who died on September 12, had been immunised against meningococcal C. He had received three doses of the vaccine in line with standard immunisation programmes.
Source: Manchester Evening News, September 20, 2011.
The whooping cough vaccine given to babies and toddlers loses much of its effectiveness after just three years -- a lot faster than doctors believed -- and that could help explain a recent series of U.S. outbreaks among children who were fully vaccinated, a study suggests.
The study is small and preliminary, and its authors said the results need to be confirmed through more research. Nevertheless, the findings are likely to stir debate over whether children should get a booster shot earlier than now recommended.
"I was disturbed to find maybe we had a little more confidence in the vaccine than it might deserve," said the lead researcher, David Witt, chief of infectious disease at the Kaiser Permanente Medical Center in San Rafael, Calif. Dr. Witt presented his findings Monday at a conference in Chicago.
Source: Post-Gazette.com, 20 September 2011.
Hundreds of UC Berkeley students and employees lined up outside the campus health center Thursday for free vaccinations after a mumps outbreak infected up to 20 students.
A spokeswoman for the health center said the university and state public-health officials expected to vaccinate more than 1,000 people by the time the clinic closed at 6 p.m. The university will hold another free clinic from noon to 6 p.m. Oct. 14.
The state Department of Public Health was monitoring the rare outbreak this week. A department spokesman said he had no update on the number of students infected. Seven cases had been confirmed and 13 other students were being tested.
Although health officials initially wondered whether the outbreak started with students who had not been vaccinated, a spokeswoman for the city of Berkeley said all the patients had received the two recommended doses before becoming ill. Three vaccinations are recommended for people living and working on college campuses, a city health official said.
Source: Contra Costa Times, 7th October 2011.
DeVries et al. (June 16 issue)1 describe a patient with vaccine-derived poliomyelitis. We were unable to clear chronic, asymptomatic, neurovirulent poliovirus infection in a similarly antibody-deficient patient despite the use of antiviral therapy, breast milk, and oral immune globulin.2 In our patient, the mean IgG trough levels were 1000 mg per deciliter, and paralysis did not develop during an estimated 29 years of poliovirus infection. Neutralizing antibodies against his own poliovirus isolates were detected in his replacement immune globulin by the National Institute for Biological Standards and Control.3 In the patient described by DeVries et al., the IgG trough levels were 438 and 648 mg per deciliter before the onset of paralysis, and the immune globulinreplacement product had recently been changed. Since immunity to enteroviruses is primarily antibody-mediated,4 adequate immune globulin replacement is key for the prevention of paralysis in immunodeficient poliovirus carriers. Where possible, replacement immune globulin should be tested for antiviral activity against poliovirus isolates from such carriers until new antiviral agents that can cure this condition are available.5
Source: N Engl J Med 2011; 365:1355October 6, 2011.
Subacute sclerosing panencephalitis is a rare neurologic disorder of childhood and adolescence. We describe a 16-year-old boy who manifested the disease despite proper vaccinations. He was hospitalized because of bedwetting, involuntary limb movements, abnormal speech, and balance disturbances. Immunoglobulin G antibodies against measles were strongly positive, with a high relative cerebrospinal fluid/serum ratio. Polymerase chain reaction for measles produced negative results. Electroencephalography registered slow activity with high voltage discharges every few seconds, and with triphasic complex morphology. Magnetic resonance imaging revealed diffuse white matter changes, mostly around the posterior regions and lateral ventricles. Treatment with valproic acid, levetiracetam, carbamazepine, and intravenous immunoglobulin G was ineffective. Inosiplex and interferon-β-1a were also administrated. The patient became comatose, with generalized myoclonic jerks, and died 1 year later. An autopsy was not performed. This patient illustrates that subacute sclerosing panencephalitis should be suspected among young vaccinated subjects.
Source: Pediatr Neurol. 2011 Jun;44(6):467-70. http://www.ncbi.nlm.nih.gov/pubmed/21555060
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