Controlled study of a new five-component acellular pertussis vaccine in adults and young children.

A new five-component acellular pertussis (AP) vaccine containing 10 micrograms of pertussis toxoid, 5 micrograms of filamentous hemagglutinin, 5 micrograms of combined agglutinogens 2 and 3, and 3 micrograms of pertactin was evaluated in adults and young children. AP vaccine was compared with saline placebo in 31 adults, and AP vaccine combined with diphtheria and tetanus toxoids (ADTP) was compared with whole cell DTP in 41 children, ages 16-20 months, who had received whole cell DTP during infancy. AP was mildly to moderately reactogenic in adults, with pain noted within 72 h and 5-8 days after immunization.

Circulating cytomegalovirus (CMV) neutralizing activity in bone marrow transplant recipients: comparison of passive immunity in a randomized study of four intravenous IgG products administered to CMV-seronegative patients.

Forty-two cytomegalovirus (CMV)-seronegative bone marrow transplant (BMT) recipients were randomized in a double-blind fashion to receive one of four commercially available intravenous Ig (IVIgG) products (Gamimmune N, Immune Globulin Intravenous, Gammagard, or Sandoglobulin) at a dose of 500 mg/kg every other week. The four treatment groups were similar in distribution of patient ages, weights, autologous versus allogeneic donor type, and underlying diseases. Every other week administration of IVIgG provided total serum IgG levels within the physiologic range for age.

Randomized double-blinded comparison of three intravenous immunoglobulin products in bone marrow transplantation.

We have used samples from the in vivo situation to compare antibody levels provided by the infusion of different IVIG products, a measure, albeit indirect, of potential therapeutic efficacy. The further correlation of in vivo antibody titers with functional activities of these antibodies (eg, opsonization and viral neutralization) would provide additive valuable information about the usefulness of this therapy.

Maternal immunization with the capsular polysaccharide vaccine for Haemophilus influenzae type b.

Maternal immunization with the capsular polysaccharide (PRP) vaccine of Haemophilus influenzae type b has been shown to extend the time that protective levels of maternal antibody are detected in infants. In a randomized, blinded trial, PRP or placebo was administered uneventfully to 213 women in the third trimester of pregnancy. Infants born to PRP recipients had significantly higher levels of antibody to PRP than did infants born to placebo recipients: 2.

Complications of measles during pregnancy.

Twelve pregnant women and one woman who had just given birth were hospitalized with measles in Houston between 1988 and 1990. The most common and serious maternal complication was pneumonitis (seven patients). Other maternal complications included hepatitis (seven patients), premature labor (four patients), spontaneous abortion (one patient), and death (one patient).

Acyclovir therapy in neonates.

Study Objective: To determine the pharmacokinetic parameters of acyclovir disposition in neonates with renal dysfunction.

Design: Prospective sequential open enrollment of neonates with presumed herpes group virus infections.

Setting: Neonatal intensive care units in the greater Minneapolis-St.

High dose-short duration ribavirin aerosol treatment--a review.

A high-dose, short-duration treatment with ribavirin aerosol consisting of a three-fold increase in concentration of drug (60 mg versus 20 mg of ribavirin per mL in the liquid reservoir of the generator administered for about one-third the time of the standard treatment) was as effective as the standard dosage in the treatment of experimental influenza A and B infections in mice and in the treatment of experimental respiratory syncytial virus infection in cotton rats. Despite some minor pulmonary intolerance, it was considered to be suitable for use in treatment of patients with severe chronic pulmonary disease, and it was well-tolerated and apparently effective in the treatment (by face mask and endotracheal tube) of infants with bronchiolitis principally caused by respiratory syncytial virus infection. Pharmacokinetic studies in mice revealed very high concentrations of drug in the lungs, about triple the level with the standard dose, with similar blood and brain concentrations.

Pharmacologic basis for high-dose oral acyclovir prophylaxis of cytomegalovirus disease in renal allograft recipients.

The incidence of cytomegalovirus disease, the most important infectious complication of renal transplantation, was reduced in renal allograft recipients by a regimen of prophylactic high-dose oral acyclovir. To analyze the pharmacologic aspects of our prophylactic approach, we evaluated safety, pharmacodynamics, and in vitro susceptibility data. One hundred four recipients of cadaveric renal allografts received either oral acyclovir (n = 53) in doses of up to 3,200 mg/day or a placebo (n = 51) for 12 weeks posttransplant.

Nosocomial transmission of respiratory syncytial virus in immunocompromised adults.

Respiratory syncytial virus (RSV) isolates obtained from nine infected immunocompromised adult patients hospitalized during two consecutive winters (January through April 1987 and 1988) were collected and analyzed against a panel of monoclonal antibodies by an enzyme immunoassay. The history of the patients' illness, onset of symptoms, and date of initial isolation of virus was correlated with the hospital ward and time of hospitalization. Three patients died of respiratory failure related to RSV infection acquired nosocomially.

Acyclovir treatment for varicella does not lower gpI and IE-62 (p170) antibody responses to varicella-zoster virus in normal children.

The varicella-zoster virus (VZV) membrane glycoprotein gpI elicits a major immunoglobulin G antibody response after naturally acquired VZV infection; antibody to a nonglycosylated immediate-early protein, IE-62 (p170), represents a response to a nonmembrane VZV component. We evaluated antibody response to VZV gpI and IE-62 (p170) at 28 days and 1 year following infection in 34 children (ages 5 to 16 years) enrolled in a randomized placebo-controlled study of oral acyclovir for the treatment of varicella. All children were VZV antibody negative at enrollment, were previously healthy, and had laboratory-documented varicella.

High-dose, short-duration ribavirin aerosol therapy in children with suspected respiratory syncytial virus infection.

Nine children (aged 6 weeks to 7 years) with suspected respiratory syncytial virus infection received aerosal treatment with ribavirin, 60 mg/ml for 2-hour periods three times daily for up to 5 days. Five children received treatment via an endotracheal tube and four via an oxygen hood. Blood samples (3 to 17 per patient) and respiratory secretions (4 to 23 per patient) were assayed for ribavirin with reverse-phase high-performance liquid chromatography.

Acyclovir treatment of varicella in otherwise healthy children.

Study Objective: To determine whether acyclovir administered orally affects the duration and severity of varicella in otherwise normal children.

Design: Randomized, placebo-controlled, double-blind trial.

Setting: Patients' residence and university hospital clinic.

Treatment of resistant herpes simplex virus with continuous-infusion acyclovir.

Two patients with acquired immunodeficiency syndrome who developed severe ulcerative proctitis caused by herpes simplex virus type 2 that was resistant to acyclovir were successfully treated with 6 weeks of high-dose, continuous-infusion acyclovir sodium (1.5 to 2.0 mg/kg per hour).

Herpes simplex virus resistant to acyclovir. A study in a tertiary care center.

Study Objective: To determine the sensitivity of herpes simplex virus isolates to acyclovir and the importance of resistant isolates in hospitalized patients.

Design: Retrospective incidence cohort study.

Setting: All herpes simplex virus isolates cultured over 1 year from patients followed at a tertiary care center.

Antiviral drugs in pediatrics.

Pediatricians are made familiar with antiviral drugs and are provided with specific recommendations for treatment of viral diseases. The antiviral drugs in clinical use today are discussed in terms of their doses, routes of administration, mechanisms of action, established and potential efficacies, and toxicities. These drugs include acyclovir, amantadine, trisodium phosphonoformate, ganciclovir, ribavirin, rimantadine, vidarabine, and zidovudine.

Respiratory syncytial virus-induced acute lung injury in adult patients with bone marrow transplants: a clinical approach and review of the literature.

Acute lung injury induced by respiratory syncytial virus (RSV) is a major cause of morbidity and mortality in patients who have undergone bone marrow transplantation. Twenty-nine of the 74 patients who received bone marrow transplants at the University of Minnesota during a 1-year period developed evidence of acute lung injury, and RSV was identified as the cause in 8. We discuss the clinical course of these 8 patients and offer a clinical approach to RSV infection occurring after bone marrow transplantation.

Continuous infusion of high-dose acyclovir for serious herpesvirus infections.

Thirteen patients with herpesvirus infections who were unresponsive to at least 72 h of intermittent acyclovir administration received high-dose continuous infusion. Steady-state concentrations were maintained at between 20 and 98 mumol/liter. Of 12 patients who had continuous infusion for greater than 5 days, 7 (58%) resolved their infections, as determined by clinical and virologic parameters, suggesting that continuous infusion may succeed in some patients who do not respond to conventional therapy.

Recovery of human immunodeficiency virus type 1 from supernatant fluid of routine viral cultures.

Peripheral blood mononuclear cell samples from human immunodeficiency virus (HIV) antibody-positive subjects were inoculated into cell cultures used for routine viral isolation to determine if HIV could survive in them. HIV was recovered from 5 (19%) of 26 day 1 supernatants and from four of the five samples in all three types of cell cultures. We conclude that HIV may survive for at least 24 h in standard virology cell culture systems and therefore is a potential risk for laboratory personnel.

Placebo-controlled trial of varicella vaccine given with or after measles-mumps-rubella vaccine.

A placebo-controlled study of varicella vaccine given either with or 6 weeks after measles-mumps-rubella (MMR) vaccine was undertaken in healthy children (mean age 16 months). A total of 101 varicella-zoster virus antibody-negative children completed the study. Serologic response to MMR vaccine was excellent (nearly 100%) and not significantly affected by the administration of varicella vaccine.

Respiratory syncytial virus infection in immunocompromised adults.

Respiratory syncytial virus disease was documented in 11 immunocompromised adults, aged 21 to 50. Underlying conditions included bone marrow transplant (6 patients), renal transplant (3 patients), renal and pancreas transplants (1 patient), and T-cell lymphoma (1 patient). Diagnosis of infection was based on specimens from bronchoalveolar lavage, sputum, throat, sinus aspirate, and lung biopsy.

Evaluation of centrifugation cultures of bronchoalveolar lavage fluid for the diagnosis of cytomegalovirus pneumonitis.

Cytomegalovirus (CMV) pneumonitis is one of the most severe manifestations of CMV disease among immunocompromised patients. The diagnosis of CMV pneumonitis traditionally has required the use of invasive procedures such as lung biopsy. In this retrospective study, we evaluated a centrifugation culture method in samples of bronchoalveolar fluid for the noninvasive diagnosis of CMV pneumonitis.