Typhoid fever remains a serious problem in developing countries. Current vaccines are licensed for individuals who are 5 years old or older. A conjugate of the capsular polysaccharide (CP) of Salmonella enterica serovar Typhi (Vi) bound to recombinant exoprotein A of Pseudomonas aeruginosa (Vi-rEPA) enhanced Vi immunogenicity and protected 2-to 5-year-olds in Vietnam. In this study, Vi-rEPA was evaluated for use in infants. A total of 301 full-term Vietnamese infants received Expanded Program on Immunization (EPI) vaccines alone or with Vi-rEPA or Haemophilus influenzae type b-tetanus toxoid conjugate (Hib-TT) at 2, 4, and 6 months and Vi-rEPA or Hib-TT alone at 12 months. Infants were visited 6, 24, and 48 h after each injection to monitor adverse reactions. Maternal, cord, and infant sera were assayed for IgG anti-Vi and for IgG antibodies to Hib CP and the diphtheria, tetanus, and pertussis toxins at 7, 12, and 13 months. No vaccinerelated serious adverse reactions occurred. In the Vi-rEPA group, the IgG anti-Vi geometric mean (GM) increased from the cord level of 0.66 to 17.4 enzyme-linked immunosorbent assay units (EU) at 7 months, declined to 4.76 EU at 12 months, and increased to 50.1 EU 1 month after the 4th dose (95% of infants had levels of >3.5 EU, the estimated protective level). Controls had no increase of the IgG anti-Vi GM. Infants with cord anti-Vi levels of <3.5 EU responded with significantly higher IgG anti-Vi levels than those with levels of >3.5 EU. Anti-diphtheria, -tetanus, and -pertussis toxin levels were similar in all groups. Vi-rEPA was safe, induced protective anti-Vi levels, and was compatible with EPI vaccines, and it can be used in infants. High cord IgG anti-Vi levels partially suppressed infant responses to Vi-rEPA.Typhoid fever remains a common, serious, and difficult-totreat disease throughout the world, including Vietnam (6,20). In the Mekong Delta region, the incidence of typhoid in 2-to 4-year-olds is similar to that in school-age children (20). Similar findings have been reported in other Asian countries (4,24,30). Typhoid is still a difficult diagnosis to make. Affected infants are often unrecognized because of atypical presentations, and it is often difficult to obtain adequate amounts of blood for culture, the most reliable available diagnostic test, which still identifies only 50% of cases diagnosed by bone marrow culture (the most sensitive assay) (9, 11). Lastly, it has not been possible to mobilize personnel and vaccines to immunize the population during outbreaks of typhoid (22,34). These data indicate that effective vaccination for typhoid should be administered as part of the routine immunization of infants.The three licensed typhoid vaccines (parenteral inactivated whole-cell vaccine, oral attenuated Salmonella enterica serovar Typhi Ty21a, and parenteral Vi polysaccharide) confer approximately 70% protection to older children and adults and do not protect young children (1,13,18). We planned to develop a typhoid vaccine to administer to infants as part of their ...

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In the CNS, serotonin, an important neurotransmitter and trophic factor, is synthesized by both mast cells and neurons. Mast cells, like other immune cells, are born in the bone marrow and migrate to many tissues. We show that they are resident in the mouse brain throughout development and adulthood. Measurements based on capillary electrophoresis with native fluorescence detection indicate that a significant contribution of serotonin to the hippocampal milieu is associated with mast cell activation. Compared to their littermates, mast cell deficient C57BL/6 KitW-sh/W-sh mice have profound deficits in hippocampus-dependent spatial learning and memory and in hippocampal neurogenesis. These deficits are associated with a reduction in cell proliferation and in immature neurons in the dentate gyrus, but not in the subventricular zone – a neurogenic niche lacking mast cells. Chronic treatment with fluoxetine, a selective serotonin reuptake inhibitor, reverses the deficit in hippocampal neurogenesis in mast cell deficient mice. In summary, the present studies demonstrate that mast cells are a source of serotonin, that mast cell deficient C57BL/6 KitW-sh/W-sh mice have disrupted hippocampus-dependent behavior and neurogenesis, and that elevating serotonin in these mice, by treatment with fluoxetine, reverses these deficits. We conclude that mast cells contribute to behavioral and physiological functions of the hippocampus and note that they play a physiological role in neuroimmune interactions, even in the absence of inflammatory responses.

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