Intestinal immunity is a determinant of clearance of poliovirus after oral vaccination.

BACKGROUND: Response to challenge with live, attenuated, oral polio vaccine (OPV) is a measure of immunity induced by prior immunization. METHODS: Using stool samples from a study from Oman in which an initial schedule of inactivated polio vaccine (IPV) was followed by an OPV type 1 challenge, we quantitated virus shed, sequenced capsid proteins of recovered virus, and developed assays for neutralization of poliovirus and mucosal immunoglobulin A (IgA) detection. RESULTS: Neutralizing activity correlated with detection of polio-specific IgA in stool suspensions collected 7 days after OPV type 1 challenge. Both neutralization and IgA in stool were associated with cessation of virus shedding by day 7. Rapid development of an IgA response with cessation of shedding suggests that IPV primed for the early response to challenge. Correlation of neutralization activity and IgA detection provides evidence that polio-specific IgA intestinal antibody is a determinant of mucosal shedding/transmission and that IgA functions through neutralization of virus. In contrast, neither presence nor quantity of serum or intestinal antibody induced by IPV prior to challenge correlated with cessation of shedding. CONCLUSIONS: These assays provide an opportunity to study other immunization schedules to gain a broader understanding of the appearance and duration of a protective mucosal response to polio vaccination.

2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis.

BACKGROUND: WHO recommends routine use of rotavirus vaccines in all countries, particularly in those with high mortality attributable to diarrhoeal diseases. To establish the burden of life-threatening rotavirus disease before the introduction of a rotavirus vaccine, we aimed to update the estimated number of deaths worldwide in children younger than 5 years due to diarrhoea attributable to rotavirus infection. METHODS: We used PubMed to identify studies of at least 100 children younger than 5 years who had been admitted to hospital with diarrhoea. Additionally, we required the studies to have a data collection midpoint of the year 2000 or later, to be done in full-year increments, and to assesses diarrhoea attributable to rotavirus with EIAs or polyacrylamide gel electrophoresis. We also included data from countries that participated in the WHO-coordinated Global Rotavirus Surveillance Network (consisting of participating member states during 2009) and that met study criteria. For countries that have introduced a rotavirus vaccine into their national immunisation programmes, we excluded data subsequent to the introduction. We classified studies into one of five groups on the basis of region and the level of child mortality in the country in which the study was done. For each group, to obtain estimates of rotavirus-associated mortality, we multiplied the random-effect mean rotavirus detection rate by the 2008 diarrhoea-related mortality figures for countries in that group. We derived the worldwide mortality estimate by summing our regional estimates. FINDINGS: Worldwide in 2008, diarrhoea attributable to rotavirus infection resulted in 453,000 deaths (95% CI 420,000-494,000) in children younger than 5 years-37% of deaths attributable to diarrhoea and 5% of all deaths in children younger than 5 years. Five countries accounted for more than half of all deaths attributable to rotavirus infection: Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan; India alone accounted for 22% of deaths (98,621 deaths). INTERPRETATION: Introduction of effective and available rotavirus vaccines could substantially affect worldwide deaths attributable to diarrhoea. Our new estimates can be used to advocate for rotavirus vaccine introduction and to monitor the effect of vaccination on mortality once introduced.

Exposición humana a rabia animal en Puerto Rico, 1980-1983 / Human exposure to animal rabies in Puerto Rico, 1980-1983

El manejo apropiado de las heridas, y la administración correcta de profilaxis antirrábica son mandatorios para evitar un desenlace mortal en las personas que han sufrido mordeduras por animales. Una alta proporción de mangostas(Herpestes auropunctatus) capturadas en Puerto Rico alberga el virus de rabia. De 1980 a 1983 se encontraron mangostas con rabia en todas las regiones de la isla, y durante todas las estaciones del año. El hallazgo de rabia en perros y gatos ocurrió con mucho menor frecuencia que en las mangostas. Los roedores (ratas, ratones y hamsters) y lagomorfos (conejos y liebres) examinados en el laboratorio fueron todos negativos para rabia. La tasa general de tratamientos antirrábicos en Puerto Rico en 1983 fue 4.77 por cien mil habitantes y el costo de los agentes inmunológicos fue de $60,528. La tasa de tratamiento de varones fue mayor que la de mujeres (6.15 vs. 3.46 por cien mil habitantes). El manejo apropiado de mordeduras por animales se resume con el acróstico RATAS (R-abia, A-ntibióticos, T-étanos, AS-epsia). Para cada víctima de una mordedura hay que considerar la necesidad de profilaxis contra rabia; la necesidad de antibióticos para tratar heridas infectadas, sucias, o severas; la necesidad de inyectarle al paciente antitoxina o inmunoglobulina antitetánica; y la utilidad de limpiar la herida con jabón o desinfectantes