Reactogenicity and immunogenicity of a single dose of typhoid Vi polysaccharide vaccine in children aged between 4 and 14 years.

BACKGROUND: The current study evaluated the reactogenicity and immunogenicity of Typherix, a new typhoid Vi polysaccharide vaccine, in children aged between 4 and 14 years. METHODS: This phase III, open, single-group study was conducted at a single centre in South Africa. Healthy children aged between 4 and 14 years received a single 0.5ml dose containing typhoid Vi polysaccharide vaccine 25 microg via intramuscular injection in the left deltoid. Safety and reactogenicity were assessed from solicited and unsolicited signs and symptoms reported during the 5- and 28-day postvaccination follow-up periods. Seropositivity rates against Vi were calculated at 28 days and 6 months after vaccination, and geometric mean titres (GMTs) were also calculated. RESULTS: A total of 199 children received the vaccine. The according-to-protocol immunogenicity analysis included 185 subjects and showed seropositivity rates of 99.5% [GMT of 2578 enzyme-linked immunosorbent assay (ELISA) units/ml] at day 28 and 94.5% (GMT of 1022 EL.U/ml) at 6 months. Of the 199 subjects included in the reactogenicity analysis, 52.8% reported clinical symptoms, 50.3% reported general symptoms, and 4.0% local symptoms. Solicited symptoms were reported in 46.7% of subjects. Local symptoms and signs were mild and involved mainly swelling. General solicited symptoms were most frequently fever (31.7% of subjects) and headache (14.1%). All general solicited symptoms were mild or moderate except for four reports of fever >39 degrees C. Unsolicited symptoms (mild or moderate) were recorded in 25.1% of subjects, and were most frequently abdominal pain and coughing. No serious adverse events were reported. CONCLUSIONS: Typherix typhoid Vi polysaccharide vaccine proved to be well tolerated and immunogenic when administered parenterally to children aged between 4 and 14 years.

Spinal infarction. A follow-up study.

BACKGROUND AND PURPOSE: Ten patients with spinal cord infarction were followed up after 1 to 27 (median, 3) years to establish the sequelae of the disease in the long term. SUMMARY OF REPORT: Eight surviving patients were interviewed about mobility, pain, and activities of daily living. All 8 patients had residual weakness in the legs; 7 of them were able to live at home without professional help. All but 1 suffered from continuous pain, which was not dependent on the degree of weakness. CONCLUSIONS: Motor function had improved to some extent in all patients, but pain is a disabling feature in the long term.

Prevalence of Helicobacter pylori antibodies in children in Bloemfontein, South Africa.

BACKGROUND: An association of H. pylori infection with chronic gastritis, peptic ulceration and gastric cancer is known. METHODS: Prevalence of IgG antibodies to Helicobacter pylori in children in the Bloemfontein, South Africa area was studied. Children attending the general pediatric outpatient department at Pelonomi Hospital in Bloemfontein were grouped according to age. A minimum of 100 children was investigated in each age group. Baseline demographic and socioeconomic data were collected. RESULTS: The study showed a high prevalence of H. pylori antibodies. Prevalence increased with age: 13.5% in children 3 months-2 years, 48.5% at 2-5 years, 67.3% at 5-10 years and 84.2% at 10-15 years. Investigation of the socioeconomic data in relation to the prevalence of H. pylori was inconclusive. CONCLUSIONS: This high prevalence needs further study.

Early thyroidectomy for medullary thyroid carcinoma in children and young adults with the multiple endocrine neoplasia type 2A (MEN 2A) syndrome.

A South African family, at risk for the multiple endocrine neoplasia type 2A (MEN 2A) syndrome, was identified. The Bloemfontein MEN Study Group was founded, inter alia, to study the effects of early detection of medullary carcinoma of the thyroid (MTC) and treatment by total thyroidectomy in children and young adults with MEN 2A. Genotypes were identified by DNA probe and MTC diagnosed by basal and stimulated calcitonin levels. Between 1986 and 1989, 10 members of the family underwent total thyroidectomy and central lymph node dissection for MTC. There were 6 female and 4 male patients (mean age 22,0 years; range 10 - 35 years). Histological examination of the resected thyroid revealed MTC in all patients; 8 had bilateral disease and 2 unilateral. Lymph nodes were negative for MTC in all patients. None of the patients suffered injury to the recurrent nerve, while 1 experienced transient hypoparathyroidism postoperatively. Replacement therapy is maintaining thyroid hormone levels in all patients. Screening should probably begin at the age of 1 year, and total thyroidectomy should be performed when an elevated calcitonin level is observed.

Experience with a provocative test of calcitonin release as a prospective screening for preclinical medullary thyroid carcinoma in MEN type 2A family members.

We report our experience with a provocative test of calcitonin (CT) release using a combined stimulus of intravenous 10% CaCl2 solution and pentagastrin on 34 normal adults (15 females: age 41 +/- 12.3 years and range 22-65 years; and 19 males: age 43 +/- 9.1 years and range 23-60 years) and in 44 family members of three proven multiple endocrine neoplasia type 2A syndrome (MEN 2A) patients. A commercial radioimmunoassay was used to determine the serum CT levels. Peak CT levels were reached within 2 to 5 minutes after administration of the stimulus in all subjects tested. In the group of normal subjects there was no significant difference in the mean basal CT levels between males (54.8 +/- 21.7 pg/ml) and females (56.5 +/- 34.8 pg/ml), whilst the mean peak response values for males was 146.3 +/- 120.6 pg/ml, which was significantly different from the mean value of females, namely 71.6 +/- 39.0 pg/ml. We did not find significant correlations between the basal CT level, peak CT response, and age. Of the 44 family members tested, 9 showed an exaggerated CT response to the combined stimulus and subsequently had a total thyroidectomy. Histological examination confirmed C-cell hyperplasia (CCH) in one and medullary thyroid carcinoma (MTC) in the other 8. Three of the 9 had high basal plasma CT levels. The 9 patients were retested postoperatively and all showed a flat response to the combined stimulus. Those family members with histological proof of MTC or CCH were screened for genetic linkage to the disease gene for MEN 2A using probe MCK2, and showed correlation in each instance.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of a family at risk for the multiple endocrine neoplasia type 2A (MEN 2A) syndrome.

A multidisciplinary group was formed to advise on strategy and to co-ordinate the management of a family at risk for the multiple endocrine neoplasia type 2A (MEN 2A) syndrome. A proposed strategy is outlined in which DNA analysis and provocative calcitonin testing is central.