Vaccination of patients with diabetes mellitus--a retrospective study.

402 subjects with diabetes mellitus have been vaccinated of the total of 34,000 vaccinees immunized during the study period of 9 and half months. Altogether 229 diabetic patients (56.97%) have been vaccinated'against tick-borne encephalitis (TBE) and 74 (18.4%) against viral hepatitis (41 types A+B, 30 type A, 3 type B). The average age in four most commonly administered vaccines (FSME IMMUN 0.5 ML, Twinrix Adult, Typhim Vi, and Havrix 1440) was 65, 52, 56, and 54 years, respectively. Live attenuated vaccines have been given to 6 patients with diabetes (1.49%)--- 5 travellers to endemic countries received the yellow fever vaccine Stamaril (1 female, 4 male) and one male patient varicella vaccine Varilrix. Among the least common vaccines in diabetic patients were those against invasive pneumococcal and meningococcal infections. Not a single unexpected side effect has been observed following the vaccination procedure in any diabetic patient. Based on the results of this retrospective study we can conclude that vaccination in diabetic patients is free of any ri-k- provided that there are no other contraindications, e.g. allergy to vaccine components or severe acute febrile illness. In the case of unstable glycaemia and significantly impaired immune system due to diabetes mellitus, vaccination with live attenuated vaccines should be carefully considered and measured against the risks of exposure to each and every specific infectious agent. There is no reason to be afraid of vaccination in diabetic patients provided that general contraindications are respected. On the contrary, this risk group can benefit from vaccination more remarkably since it may have some life-saving potential.

High seroprevalence of granulocytic ehrlichiosis distinguishes sheep that were the source of an alimentary epidemic of tick-borne encephalitis.

A sheep herd from which contaminated cheese was produced, causing 21 cases of alimentary tick-borne encephalitis (TBE) in human beings, was tested serologically for the presence of specific antibodies against both the TBE virus (TBEV) and Anaplasma phagocytophilum, the cause of tick-borne fever (TBF) in ruminants, and compared with three other herds variously exposed to tick bites but without any TBE history. Virus-neutralisation (VN) with the TBEV strain Hypr and CV-1 cells was used in TBE tests, and indirect immunofluorescence assay (IFA) with neutrophils from goats experimentally infected with A. phagocytophilum was used for TBF testing. In 13 sheep from the incriminated herd (N =41), VN titres ranging from 1/4 to 1/128 traced previous TBE infection and all sheep had elevated titres of A. phagocytophilum antibodies ranging from 1/80 to 1/5120 in IFA, whereas two other herds (N = 8 and 9) were seronegative for TBEV and had significantly lower levels of A. phagocytophilum antibodies, corresponding to a lesser challenge from TBF. A control herd (N = 10) that was grazed on tick-free meadows in north Norway was completely seronegative. The respective distributions of positive titres of A. phagocytophilum and TBEV antibodies in the incriminated herd were not mutually random; the animals with higher anti-A. phagocytophilum titres tended to have lower anti-TBEV titres and vice versa (Spearman correlation coeff. =-0.86, p< or =0.01). The authors hypothesize that the immunosuppressive effect of TBF co-infection in sheep could be a contributory cause of TBE-virus contamination of milk, an aspect of TBE epidemiology that has not been considered thus far.