We report 5 patients with secondary vaccine failure (SVF) who were infected with natural measles 2, 5, 5, 7 and 12 years, respectively, after vaccination with further attenuated live measles vaccine during infancy. Their seroconversion had been confirmed after vaccination. Three of the 5 patients had mild (modified) measles, while the remaining 2 patients had typical measles. The hemagglutination inhibition antibody titers to measles virus in paired acute and convalescent sera showed a secondary response pattern in 4/5 patients, and a primary response pattern was present in the remaining patient. Measles IgM antibodies were present in all patients during the convalescent stage. The patient with the primary response pattern may have had a decrease in the B cell memory during the 5-year period between vaccination and infection. This may be the first SVF case report that confirms the existence of completely waning immunity in recipients of the further attenuated live measles vaccines.
We present six cases of diabetes insipidus (DI) complicating pregnancy. In three cases, DI was manifested during pregnancy and required the administration of desmopressin acetate (1-desamino-8-D-arginine vasopressin, DDAVP). All these cases exhibited abnormal laboratory data such as an elevation of liver enzymes or a decrease in serum antithrombin III. The remaining three cases had suffered from DI before pregnancy which was well controlled on DDAVP. The clinical courses of these pregnancies were all uneventful subsequent to therapy. If DI is first recognized during pregnancy, attention should be paid to the possibility of abnormal liver function and eclampsia.
An exceptionally high incidence of congenital rubella syndrome (CRS) has been noted in Ryukan children who were infants in utero during an extensive rubella epidemic in the Ryukyu Islands in 1964 through the spring of 1965. In 1965, the Congenital Rubella Study Group of Kyushu University registered in the Ryukyus 408 cases of CRS and an incidence of 20 cases of CRS per 1000 births. The nearby Amami Islands, on the other hand, had a low incidence of CRS. Seroepidemiologic studies indicated a high prevalence of antibodies in the Ryukyus but a low prevalence in the Amamis. Since CRS is uncommon throughout Japan, some investigators have hypothesized that Japanese strains of the virus are avirulent and that a virulent American strain caused the epidemic in the Ryukyus. However, retrospective seroepidemiologic studies reported here indicate that the high incidence of CRS in the Ryukyus was more probably due to low seropositivity and a resultant high attack rate of rubella among pregnant women, rather than to a hypothetical virulent teratogenic strain of rubella virus. Conversely, the data suggest that the low incidence of CRS in Japan may reflect the infrequency of rubella nonimmunes in women of childbearing age.
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