Reduction in the Incidence of Acute Bronchitis by an OralHaemophilus influenzaeVaccine in Patients with Chronic Bronchitis in the Highlands of Papua New Guinea

Abstract

Following the administration of a standardized questionnaire, 62 adult patients with chronic bronchitis were enrolled into a double-blind controlled trial of an oral killed Haemophilus influenzae vaccine in the highlands of Papua New Guinea. A 3-day course of vaccine or placebo was given monthly for 3 consecutive months. Participants were monitored weekly over 12 months for acute exacerbations; early morning sputum specimens were collected monthly and during acute exacerbations. Density of colonization by H. influenzae and H. parainfluenzae was determined by standard quantitative and semiquantitative techniques, and the latter method (quadrant score) was used to determine the density of growth of pneumococci. A total of 30 patients received vaccine and 32 placebo. The incidence rate of acute bronchitis in the vaccine group (0.011 episodes/person-weeks) was significantly lower than that in the placebo group (0.021 episodes/person-weeks), but there was no difference between the two groups in the incidence rates of more severe disease. Vaccine efficacy was maximal at times of peak incidence of disease. There was no evidence of a decline in vaccine efficacy for acute bronchitis over the 12-month follow-up period. The number of viable H. influenzae in the sputum declined in both vaccine and placebo groups over the 12-month follow-up period. The average concentration of H. influenzae in the vaccine group fell below that in the placebo group within 1 to 2 months after first immunization and remained so for 12 months, although the difference between the two groups narrowed during the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquisition and invasiveness of different serotypes of Streptococcus pneumoniae in young children

“…The PNG situation is similar to that found in Africa [19]. Papua New Guinean children may have deficiencies in bactericidal capacity based on specific or nonspecific deficiencies in cell-mediated immunity [20] or on the load of new infections transmitted from adults living in the same households [21]. Such serotypes though highly immunogenic may also have more efficient 38 T. SMITH AND OTHERS mechanisms for evading the destructive immune mechanisms of the host once they have invaded.…”

Incidence and Spread of <i>Mycobacterium tuberculosis</i>-associated Infection among Aba Federal Prison Inmates in Nigeria

“…Mitsos et al observed that only a small proportion of individuals infected with M. tuberculosis develop clinical TB (4), and even then, a wide clinical spectrum of severity of disease is observed in such individuals. A lifestyle, such as tobacco/cigarette smoking, could increase the chances of developing clinical TB four-fold (5-7) due to the various effects of smoking on components of both innate and adaptive immunity (8)(9)(10)(11). Exposure to indoor air pollution has been associated with TB among other broncho-pulmonary diseases (12).…”

Safety and Immunogenicity of an Oral Inactivated Whole-CellPseudomonas aeruginosaVaccine Administered to Healthy Human Subjects

“…In a preliminary study of nine bronchiectasis patients, oral immunization with an enteric coated whole-cell killed P. aeruginosa vaccine resulted in the detection of circulating antigen-reactive peripheral blood leukocytes, as well as a significant reduction in the levels of P. aeruginosa in the sputum (8). Further evidence to support the development of a whole-cell killed vaccine and an oral immunization strategy for P. aeruginosa comes from previous studies of nontypeable Haemophilus influenzae (NTHi), where patients with recurrent acute exacerbations of chronic bronchitis were orally immunized with a whole-cell killed NTHi vaccine (4,5,6,20,28). A recent Cochrane review of six NTHi trials of 440 subjects reported that oral immunization significantly reduced the number and severity of acute exacerbations (13).…”