Respuesta serológica por ELISA y MAT en voluntarios cubanos vacunados con vax SPIRAL® / Serological response by ELISA and MAT in Cuban volunteers vaccinated with vax SPIRAL@

Se estudió la seroconversión en 408 individuos vacunados y 135 placebo, incluidos en 2 ensayos clínicos de la vacuna cubana contra la leptospirosis humana. Se estudiaron 2 dosis vacunales y 5 esquemas. Seroconvirtieron de 38 vacunados (Fase I), 11 (29 por ciento) por MAT y 12 (32 por ciento) por ELISA, y de 33 placebo, 2 (6 por ciento) y 3( 9 por ciento) respectivamente. En la Fase II de 68 vacunados (dosis de 0,25 mL) y de 65 (dosis de 0,50 mL), seroconvirtieron 21 (31 por ciento) y 16 (25 por ciento) por ELISA respectivamente, por MAT 9 (13 por ciento) y 7 (11 por ciento) individuos fueron positivos. No hubo diferencias significativas entre las dosis utilizadas. La seroconversión por MAT, en 237 individuos vacunados con diferentes esquemas, fue de 22,4 por ciento, no existiendo diferencias significativas entre estos. En la mayoría de los individuos reactivos, se encontraron niveles de anticuerpos al menos a una de las cepas vacunales. Se recomendó, buscar y evaluar otros métodos para demostrar in vivo, el nivel de protección de esta vacuna(AU)

High levels of multiple antibiotic resistance among 938 Haemophilus influenzae type b meningitis isolates from Cuba (1990-2002).

OBJECTIVES: A national surveillance study to determine antimicrobial susceptibility in Haemophilus influenzae type b isolated from cerebrospinal fluid was carried out in Cuba from 1990 to 2002. METHODS: Susceptibility to ampicillin, co-amoxiclav, cefotaxime, ceftriaxone, co-trimoxazole, tetracycline, chloramphenicol and rifampicin was tested by the microdilution method according to the NCCLS guidelines. RESULTS: The 34 participating laboratories recovered 938 consecutive, non-identical isolates. All the isolates were retrieved from children aged <5 years. The mean number of isolates collected by year in the pre-vaccination era (1990-1998) was 93; after vaccination, 57 isolates were reported in 1999, 31 in 2000, four in 2001 and five in 2002. Resistance to ampicillin, co-trimoxazole, tetracycline and chloramphenicol was 46.3% (all beta-lactamase-positive), 51.3%, 33.2% and 44.0%, respectively. Ampicillin-resistant beta-lactamase-negative strains were not detected. All strains were susceptible to co-amoxiclav, cefotaxime, ceftriaxone and rifampicin. Ampicillin resistance was strongly associated with resistance to tetracycline, co-trimoxazole and chloramphenicol (P<0.001). Multidrug resistance was present in 43.8% of isolates. The most prevalent phenotype was resistance to ampicillin/chloramphenicol/tetracycline/co-trimoxazole, which was detected in 29.2% of strains overall. An increase in the prevalence of resistance to these antibiotics was observed from 1990 to 2000 in the range 40.7%-54.8% for ampicillin, 40.1%-51.6% for chloramphenicol, 45.4%-58.1% for co-trimoxazole and 23%-45.2% for tetracycline. CONCLUSIONS: In Cuba, the widespread vaccination against Haemophilus influenzae type b prevented a large number of meningitis cases in children caused by strains resistant to multiple antibiotics.

Antimicrobial susceptibility of Neisseria gonorrhoeae in Cuba (1995-1999): implications for treatment of gonorrhea.

BACKGROUND: Antibiotic-resistant strains of Neisseria gonorrhoeae, especially those resistant to penicillin and tetracycline, have spread with remarkable rapidity in many Caribbean countries. GOAL: The goal of the study was to survey the antibiotic susceptibilities of N gonorrhoeae strains isolated from 1995 to 1999 in Cuba and to discuss the impact of antimicrobial resistance on the management of gonorrhea in the country. STUDY DESIGN: Susceptibility of the strains to penicillin, tetracycline, cefuroxime, ceftriaxone, ciprofloxacin, spectinomycin, and azithromycin were determined by an agar dilution method. RESULTS: Penicillin and tetracycline resistance was noted in 60.8% and 54.2%, respectively, of the N gonorrhoeae strains tested. A total of 63.35 (76/120) of the N gonorrhoeae strains exhibited plasmid-mediated resistance to penicillin, tetracycline, or both. Strains with chromosomally mediated resistance to these antibiotics accounted for 10% (12/120) of the strains. The strains were susceptible to ceftriaxone, cefuroxime, spectinomycin, and ciprofloxacin. One strain's ciprofloxacin MIC was 0.125 mircog/ml. Of the 52 strains tested, 23.1% displayed intermediate resistance to azithromycin. CONCLUSIONS: N gonorrhoeae strains exhibited a high frequency of resistance and multiresistance to penicillin and tetracycline. Therefore, these antibiotics should no longer be used to treat gonococcal infections in Cuba and should be substituted with effective drugs such as third-generation cephalosporins, spectinomycin, and fluoroquinolones. The detection of intermediate resistance to azithromycin and ciprofloxacin underlines the importance of periodic surveillance for susceptibility of N gonorrhoeae strains to antimicrobials agents used as primary therapy for gonorrhea.