Irene B. Hillary

Persistence of rubella antibodies 15 years after subcutaneous administration of Wistar 27/3 strain live attenuated rubella virus vaccine.

The rubella-specific antibody levels of children vaccinated with RA 27/3 rubella vaccine have been determined over the 15 years since vaccination. Over the period monitored, titres have declined at a comparable rate to those observed in children who had experienced natural rubella infection. In both cohorts the mean rate of decay was similar throughout the 15 years of the study. One in eleven vaccinated children monitored for the entire period of the study reverted to a state of susceptibility to rubella as judged by routine rubella antibody tests used in practice today. The implications of the findings for rubella prophylaxis are discussed.

MMR vaccination, measles epidemiology and sero-surveillance in the Republic of Ireland

OBJECTIVE Following the introduction of a national measles and subsequent MMR vaccination programme, to determine the susceptibility of 3-14-year-old children to measles, mumps and rubella and to relate the results to the epidemiology of measles and the need for vaccination policy changes. DESIGN Cross-sectional sero-survey and trends in measles notifications and mortality. SETTING Paediatric hospital outpatient departments in Dublin. SUBJECTS Sera were collected from 837 children attending the clinics in 1991 and 1992. RESULTS The prevalence of antibodies in children aged 3-6, 7-10 and 11-14 years was 84, 83 and 95% for measles; 48, 60 and 65% for mumps; and 78, 63 and 74% for rubella, respectively. The prevalence of mumps antibodies may be underestimated. Ninety-six per cent of girls aged 13-14 years had rubella antibodies. A widespread outbreak of measles occurred in 1993. Over recent years, an increasing proportion of measles notifications were in older children. CONCLUSION Given sub-optimal uptake of MMR vaccine, outbreaks of infection in pre- and primary school children are inevitable. In such circumstances, a 2-shot MMR vaccine programme with high uptake is essential to prevent a shift of disease into older age groups.

Trials of intranasally administered rubella vaccine.

No evidence of vaccine virus transmission was found in two studies where Wistar RA 27/3 rubella vaccine was administered intranasally. Vaccine was immunogenic in all of 23 vaccinated children in one study, while in the other only 5 of the 11 vaccinees developed antibody. The reduced seroconversion rate in the latter study appears to have been caused by one or a combination of factors, including the vaccination technique, the presence of infective nasal conditions in vaccinees and the titre of vaccine used.

Persistence of antibody induced by rubella vaccine (Wistar RA 27/3 strain) after six years

A total of 21 rubella seronegative children vaccinated subcutaneously with Wistar RA 27/3 strain live attenuated rubella vaccine in a family study of vaccine virus transmissibility were reviewed after 6 years. Haemagglutinating inhibiting (HAI) antibody titres of sera collected 46 days, 2 years and 6 years after vaccination were compared. Antibody titres in the vaccinated subjects were not significantly influenced by time, infection in susceptible siblings or revaccination.

Persistence of antibody after subcutaneous vaccination with Wistar RA 27/3 rubella vaccine.

After subcutaneous vaccination of rubella sero-negative children with Wistar RA 27/3 rubella vaccine, haemagglutination-inhibiting antibody titres were compared in sera taken 46 days and 2 years after vaccination. Antibody titres were well maintained in the absence of any known exposure to natural infection.

Mother-to-child transmission of human immunodeficiency virus (HIV) in Ireland: a prospective study.

Symptomatic HIV infection was first diagnosed in an Irish child in 1985. A prospective study was initiated to determine the vertical transmission rate (VTR) of HIV and the average age of infant seroreversion and to monitor clinical, immunologie and virologie evidence for HIV infection in seroreverters. Ninety three HIV positive infants have been prospectively identified since 1985. The predominant underlying maternal risk factor for HIV infection is intravenous drug use (IVDU) (96 per cent). Of 93 infants, median gestational age was 40 weeks and median birth weight 3125 grams. Ninety-four per cent of infants were bottle fed. Currently 72 (77 per cent) infants are uninfected, 12 (13 per cent) are infected, 4 (4.5 per cent) are indeterminate and 5 (5.5 per cent) have been lost to follow up. The intermediate estimate of vertical transmission rate (VTR) is 14.3 per cent. The median age at documented seroreversion was 12 months. There are no significant differences between infected and non-infected children in male/female ratio, gestational age, mode of delivery or birth weight. Strategies to reduce the transmission of HIV among drug users in combination with routine antenatal screening and antiretroviral prophylaxis of vertical transmission are all measures which can reduce HIV infection in our children.

Changes in incidence of hepatitis B in Ireland from 1970–1987

SummaryThis paper analyses data on 2,226 cases of Hepatitis B virus (HBV) infection detected during the years 1970 to 1987. Of those where information on risk-group was available (1,301), infection among intravenous drug-abusers accounted for the largest proportion (49%). Most became infected during and since an outbreak of hepatitis B and Delta hepatitis which originated in this group in 1980. A comparison of the data before and after the start of the outbreak among drug-abusers shows a marked increase in the number of HBV infections in nondrug users, including haemophiliacs, homosexuals and health-care staff, and a dramatic decrease in hepatitis B following blood transfusion. A larger group (165 cases), many of whom are long-term healthy hepatitis B surface antigen carriers, were patients in institutions for the mentally handicapped (IMH). Most were detected recently during pre-vaccination sampling programmes. Others affected included visitors to and from high-incidence areas, tattooed persons, dialysis patients, persons born to infected mothers, and members of the security forces dealing with drug-abusers.In all, 8.4% of the hepatitis B cases detected were found to be carriers and 67% of these remained carriers in 1987. The mean duration of carriage was 3.25 years. Intravenous drug-abusers and IMH patients constituted the two largest groups of carriers.The running-three-yearly mean incidence of new cases of hepatitis B has levelled off below the peak of 1981. Although the number of cases among drug-abusers has apparently decreased, the number of cases among non drugabusing groups has increased by 50%. The use of recently introduced vaccines in some risk groups should help to reverse this upward trend.

Acyclovir in the management of herpes virus infections in immunosuppressed children

SummarySix children, aged from 5 to 15 years who developed herpes virus infections while on chemotherapy for malignant disease were treated with systemic acyclovir (Acycloguanasine). Clinical response was evident in all patients with no adverse effects or toxicity. The mechanism of action of the drug, mode of administration and possible side effects are discussed and comparisons drawn with the already published data on its use in humans.

Q fever in the Republic of Ireland.

SummarySera from 1,587 patients received at the Department of Medical Microbiology, University College, Dublin during the years 1971 to 1974 for investigation of clinical syndromes including pyrexia of unknown origin, acute respiratory illness, brucellosis and infective cardiac conditions, were tested for antibody toCoxiella burnetii. Eighty-six were found to contain antibody to the Phase 2 antigen. Antibody to Phase 1C. burnetii antigen was found in five patients with valvular heart disease and in three other long standing illnesses. The relevance of such antibodies to the final clinical diagnosis in these patients is discussed. The occupation, age, sex and geographical location of the patients are recorded in an attempt to add to existing information on the epidemiology of the disease in the Republic of Ireland.

Rubella serological survey on Irish school children.

SummaryAserological survey of rubella antibody was carried out using the haemagglutination inhibition test on sera from school children aged 4 to 18 years, in the Republic of Ireland between November 1969 and May 1970. Five thousand four hundred and eighty-four sera were screened at a dilution of 1∶10 and the results indicate some immunity in 72 per cent of those tested. Some midland and western rural counties appear to have a higher proportion of children without antibodies. In one county 46 per cent had no demonstrable antibody.Five hundred and twenty sera were titrated and titres of 1∶80 or less were obtained in 24 per cent of these. The correlation between statements concerning a history of rubella and immune status was good in all ages tested only if the history statements were in the affirmative. As a result of this study it appears that vaccination is indicated at an early date.