for use with measles vaccine (0-4-0-8 IU/kg body weight; Blood Products Laboratory) was given in the opposite arm with a separate syringe immediately after the vaccine was injected. The measles haemagglutination inhibition antibody response was estimated in the paired sera by MC as described previously.4
ResultsAntibody response- Figure 2 shows the haagglutination inhibition antibody responses at eight weeks. One child (given Rimevax) failed to respond (titre <4) and two children had a minimal response (4), one after Attenuvax and one after Mevilin.Clinical reactiowns-Two reactions were reported after Rimevax. One child with left hemiplegia and a porencephalic cyst associated with dilatation of the right lateral-ventricle had a fit five days after vaccination. This was not associated with fever and lasted for a few minutes during which his eyes rolled and he twitched; there had been no similar occurrence. He recovered immediatelywith nofurther episodes. Another child with microcephaly and cerebral palsy, became febrile and irritable with a cough five days after vaccination but the next day was afebrile. Two children given Attenuvax were reported to have had rashes, one accompanied by coryza. No other reactions were reported.
DiscussionThe 45 children in this study undoubtedly required protection from measles and because of their personal history were considered at risk of having a convulsion from a febrile response to the vaccine given alone. The one fit reported was not associated with fever and occurred in a child with a grossly abnormal brain. Clearly in this small study no unacceptable reactions occurred despite the increased risk.Since it is not justifiable to take two blood samples from children routinely given measles vaccine any comparison of antibody response must be made with results from an earlier study. In a Medical Research Council trial in 1964, 75 children aged 10 months to 2 years were bled before and after being given Schwarz strain vaccine. The response to the vaccine without immunoglobulin was significantly higher (5% level or beyond), confirming that the antibody response is modified by immunoglobulin. All but one of the children in our study, however, produced a response; only clinical follow up will determine protection.Modifying possible febrile reactions to further attenuated vaccines by using immunoglobulin is not considered necessary outside Britain. Nevertheless, if the current recommendation results in the vaccination ofchildren such as these it seems justified, since without it they would have remained unvaccinated and at risk. Prednisolone was given in doses of 0-2, 04, and 0-6 mg/kg body weight daily for two weeks in a double blind randomised order (equivalent to 14, 28, and 42 mg of prednisolone daily in a person weighing 70 kg). Patients developing an exacerbation recorded peak expiratory flow rate twice daily for two days before starting and two weeks during treatment. A dose response was shown that was significant for the difference between the peak flows, low dose
Patients with chronic airflow obstruction were given a three-week course of prednisolone 40 mg per day. The (HPA) function in these patients. MethodsAll the patients studied had chronic airflow obstruction. None had received corticosteroids within three months of the study and none had cver been on long-term treatment with corticosteriods. In the first part of the study a short tetracosactrin test3 was used to assess adrenal function in eight patients before and after a three-week course of prednisolone 20 mg twice daily. In the short tetracosactrin test a basal plasma cortisol level is measured and followed immediately by an intramuscular injection of 250 jug of synthetic corticotrophin (tetracosactrin). Thirty minutes after the injection of tetracosactrin a blood sample is taken for measurement of plasma cortisol. The Address for reprint requests: Dr J Webb, Respiratory Laboratory, Brook General Hospital, Shooter's Hill Road, London SE18. 22 first tetracosactrin test was performed on the day before starting prednisolone and the second test performed on the first day after the three-week course of prednisolone 20 mg twice daily.The results of the first experiment confirmed that both the basal cortisol and the response to tetracosactrin were suppressed, and we went on to investigate the time course of the recovery of the basal cortisol and ACTH levels after a three-week course of prednisolone 40 mg daily (20 mg bd) in a further seven patients. In this second experiment basal cortisol and ACTH levels were measured on two occasions during the week before treatment and again on days 1, 2, 3, 4, and 5 after treatment with prednisolone.
Nineteen patients with chronic airflow obstruction measured their morning and evening peak expiratory flow (PEF) daily for 28 days. A placebo was taken for the first week and prednisolone 20 mg twice daily was taken for the last three weeks. The mean PEF in 13 patients who responded to prednisolone reached a maximum after eight days' treatment. The majority of the 19 patients had asthma and were thought to represent a typical cross section of patients who would be considered for a trial of oral corticosteroids. Most responsive patients will achieve a maximum response within eight days. Differences in response to treatment at different times of day and over the four-week period of the trial were investigated using an analysis of vari-18 on 11 April 2019 by guest. Protected by copyright.
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