Disease Prevention by Meningococcal Serogroup C Polysaccharide Vaccine in Preschool Children: Results After Eleven Months in Sao Paulo, Brazil

Abstract

Eleven c a s e s of SSPE from t h e r u r a l southeast were studied a t Duke from 1968-73. Eight p a t i e n t s had a h i s t o r y of measles immunization and 5 of these reportedly had antecedent n a t u r a l measles. The diagnosis was confirmed i n every case e i t h e r by t h e u l t r a s t r u c t u r a l demonstration of v i r u s nucleocapsids i n b a i n t i s s u e or t h e detection of anti-measles antibodies i n t h e CSF.Six of t h e p a t i e n t s had normal EEGs when f i r s t examined, an average of 6 months a f t e r t h e onset of i l l n e s s . This gmup d i d not d i f f e r from those with abnormal EEGs i n any important d e t a i l including age, sex, measles antibody t i t e r , s e v e r i t y o r duration of i l l n e s s o r t h e length of survival. A l l of t h e EEGs eventually became abnormal, 4 with t h e c l a s s i c a l suppression burst p a t t e r n considered d i a p o s t i c f o r SSPE. A t t h e time of t h e normal t r a c i n g , one patient had well developed mpclonus.These findings indicate t h a t a normal EEG i s common i n SSPE e v k when t h e c l i n i c a l disease is moderately advanced.This re-emphasizes the diagnostic importance& CSF measles antibcdies when other s t u d i e s a r e normal. Dept. of Ped. and Path., Univ. of Miami Sch. Med., Miami, Fla. COUNTERIMMUNELECTROPHORESISDuring a period of 18 months, 15 cases of S e r r a t i a s e p t icemia were i d e n t i f i e d i n the Neonatal I C U of a large county h o s p i t a l including two outbreaks of 5 and 4 cases each.Weight SurvivalfPatient Number Mortality Age a t Onset 2,500gm 5/13 61% 1 t o 15 days 2,500gm 112 8 days Both term infants were postoperative p a t i e n t s (TE-fistula).An epidemiologic survey of the Neonatal I C U (8 beds) and the adjacent premature nurseries (35 beds) revealed:Equipment: 51230 c u l t u r e s grew S e r r a t i a Personnel: 2/67 ( 2 nurse's hands) Infants : 91238 ( 5 NP,3 r e c t a l , 1 eye). Control measures included s t r i c t hand washing with change from hexachlorophene t o a povidone-iodine preparation, elimination of water i n i s o l e t t e s , and r i n s i n g of hands, i s o l e t t e s and other equipment with 2% a c e t i c acid. Gentamycin replaced kanamycin i n accordance with the s e n s i t i v i t i e s . Two premat u r e i n f a n t s with meningitis survived a f t e r treatment with systemic and i n t r a t h e c a l gentamycin.I n a nursery epidemic of s e p s i s and meningitis due t o S e r r a t i a marcescens, s i g n i f i c a n t morbidity and mortality was seen i n premature and ill neonates. This emphasizes t h e importance of considering any microorganism a s a p o t e n t i a l devastating pathogen i n susceptible populations. During an outbreak of serogroup C sulfonamide-resistant controls. All infections occurred in infants with high abnormal colonNeisseria meningitidis i n the c i t y of Sao Paulo, Brazil, ization and were due to the type of bacterium producing the high colserogroup C meningococcal polysaccharide was given t o...

Clinical evaluation of group A and group C meningococcal polysaccharide vaccines in infants.

“…The C vaccine has been demonstrated to be 75% protective in Brazilian children 24-35 mo of age under epidemic conditions (9). However, there was no protection apparent in infants 6-23 mo of age.…”

“…It remains to be determined whether the antibody levels achieved by infants in response to the meningococcal vaccines will be sufficient to protect them against meningococcal disease. Both naturally acquired and vaccine-induced antibody to the A and C vaccines have been shown to protect adults against disease (8,9). In addition, the A vaccine has been demonstrated to be 100% protective in Egyptian school children 6-15 yr of age, and such protection has lasted for at least 2 yr (10).…”

“…The mol wt of the A vaccine used in Egypt was 170,000, approximately twice as large as lot A-5 (10). While the minimal protective concentration of anti-A is not yet established, geometric mean anti-A concentrations of [9][10][11][12][13][14][15] Ag/ml were induced in the Eg-yptian children with a single dose of 50 ytg of vaccine. Similar anti-A concentrations have been achieved after primary immunization with lot A-5 of children over 2 yr of age in the United States (12,14).…”

“…Tlle groui) C vaccine lhais been showN-n to be safe andl effective in U. S. Army recruits (7,8). Field trials underway in Sao Paulo, Brazil, inidicate that the group C vaccine provides signlificant protectioni against disease in children over 2 yr of age (9). The efficacy of the group A vaccine in preveniting disease has been demonstratedI in Egyptian school children (10) and in a mlixed-age population in the Sudan (11).…”

Antibody response to serogroup A and C meningococcal polysaccharide vaccines in infants born of mothers vaccinated during pregnancy.

“…Milestones in the control of serogroups A and C outbreaks were reached with the licensing of meningococcal serogroups A and C polysaccharide vaccines (9). In field trials, serogroup C vaccines (10,11), This work was initiated while Dr. McCormick and Mr. Gorman were short-term advisors for the Pan American Health Organization.…”