Clinical efficacy of meningococcus group A capsular polysaccharide vaccine in children three months to five years of age.

We performed field trials in the course of an epidemic in Finland to learn whether Group A memingococcal capsular polysaccharide vaccine protects infants and young children from meningitis. The first trial involved 130,178 children between the ages of three months and five years; 49,295 children received the vaccine, 48,977 received a control Haemophilus influenzae Type b polysaccharide vaccine, and 31.906 remained unvaccinated. No cases of meningitis or sepsis caused by Group A meningococci were seen in the first year of observation among the children vaccinated with meningococcal vaccine whereas six occurred among those vaccinated with the H. influenzae vaccine and 13 among those not vaccinated. In the second trial 21,007 children of the same ages received the meningococcal vaccine. No cases caused by Group A occurred among those vaccinated, although five to seven would have been expected within the year. Meningococcal Group A vaccine appears efficacious in young infants and children.

Uriglox and quantitative urine microscopy in diagnosis of urinary tract infection.

The aim of this study was to find an alternative to the sole use of abundant cultural findings as a basis for the diagnosis of urinary tract infection (UTI). For this purpose, the results obtained from the bacteriological culture of daytime urine specimens from 154 students by the dip slide method were checked against the findings from the quantitative culture, microscopy and Uriglox testing of the first morning urines voided later at home. As a diagnostic criterion, the finding of 10(5) or more bacteria/ml urine in two successive cultures had an error of 19%. For the simultaneous occurrence in the morning urine of abundant bacteria (larger than or equal to 10(5)/ml) and a subnormal glucose concentration (as revealed by the Uriglox test), this error was 1.5%. Only the latter combination showed, therefore, the presence of UTI at the confidence level of larger than or equal to 95%, or was "clinically significant". The specificity indices for the Uriglox test and the quantitative culture were 0.99 and 0.97, respectively. Microscopy of the morning urine showed 10(3) or more bacteria/ml in all the subjects with infection but the number of leucocytes was normal in a fifth of them. The specificity indices for microscopic counts of 10(3) or more organisms/ml and 10 or more leucocytes/mm3 were 0.74 and 0.94, respectively. For higher counts, i.e. 10(5) or more bacteria/ml and 50 or more leucocytes/mm3, the specificity index of positive microscopy was 1.0. This specificity level was, however, attained at the expense of the sensitivity, which for 10(5) or more organisms/ml was 0.67 and for 50 or more leucocytes/mm3 0.53. It is concluded that abundant bacterial contamination of specimens often decisively complicates the diagnostic use of urine culture, and therefore the combined use of quantitative culture, microscopy and the Uriglox test is recommended as the principal tool for the diagnosis of UTI in ordinary hospital and ambulatory health services.