Jerry J. Eller

The association of viral and bacterial respiratory infections with exacerbations of wheezing in young asthmatic children

The relationship between exacerbations of wheezing and infection of the respiratory tract was studied prospectively in 32 young hospitalized asthmatic children. Of 139 episodes of wheezing, 58 (42 per cent) were associated with identifiable viral infections. There were 25 respiratory syncytial virus infections; wheezing occurred in 24 of these and pneumonia in 13. Parainfluenza type 2 infection appeared to be next most likely to be associated with wheezing, followed by coronavirus infection. Influenza A. (Hong Kong) was not associated with wheezing in any of the children. Infection with “pathogenic” bacteria was not statistically associated with wheezing.

Altered reactivity to respiratory syncytial virus: Description of atypical RSV illness and prospective four year follow-up of children previously immunized with an inactivated vaccine

Beginning in July 1966, 424 children ranging from 6 months to 7 years of age were immunized. Mild RSV illness was documented to occur later upon natural exposure to the wild virus in all age groups. Nineteen children in the youngest age group immunized (6–23 mos) were hospitalized with an atypical illness due to RSV. Eleven were hospitalized in 1966–67, 6 in 1967–68, and 2 in 1968–69. Two children had recurrent atypical illness during separate years. The illness was characterized by high fever adn pneumonia with marked bronchiolitic wheezing. Chest films showed prominent multi-segmental infiltrates usually in several lobes. Associated lung complications included: lobar atelectasis, pneumothorax, pneumomediastinum, pneumopericardium, subcutaneous emphysema, and pleural effusions. A diffuse maculopapular rash was present on the neck, trunk and proximal extremitities of 8 (42%) vaccinees in contrast to 1 of 31 (3.2%) control with hospitalized RSV illness (X2 = 9.57, p < 0.01). Of 9 hospitalized vaccinees avilable for prosepective follow-up for 4 years from the time of immunization, 5 (55.6%) were diagnosed by allergists, independently of the investigators, as having either asthma (4) or allergic rhinitis (1). This was in contrast to a diagnosis of an atopic disorder made in 7 of 46 (15.2%) age-matched controls prespectively followed (X2 = 5.01, p < 0.10).

Pathogenesis and Immunity in Pertussis

This is a 482-page authoritative text with 31 contributors who are among the most active investigators in the field of pertussis from six countries including the United Kingdom (16), Canada (2), France (2), Norway (1), Japan (5), and the United States (5). In 21 chapters the authors comprehensively present relevant new information concerning all aspects of pertussis. Each chapter begins with a brief introduction for the nonspecialist and concludes with a bibliography that contains the most recently published literature and often key historical references. There is an excellent blending of scientific information with practical clinical and vaccine applications. The first half of the book reviews the microbiology of Bordetella pertussis , including growth characteristics of the microorganism and its products. The combined technologies of transposon mutagenesis and recombinant DNA technology have catapulted our understanding of both the pathogenesis of pertussis and the molecular organization of the genes determining virulence. Most of

Altered reactivity to respiratory syncytial virus: Antibody response to RSV antigens and studies of the pathogensis of atypical RSV illness in recipients of inactivated vaccine

The vaccine, in contrast to natural infection, failed to produce significant serum IgA antibody. Kinetic experiments revealed no defect in the quality of IgG antibody produced by the vaccine. Arthus and precipitating antibodies were not demonstrable in post-vaccine sera. The mean percent blastoid formation and uptake of radiouridine were greater in vaccinees than in controls in vitro lymphocyte stimulation tests. A delayed dermal hypersensitivity reaction could be demonstrated in guinea pigs and African Green monkeys after multiple injections of adjuvanted RSV vaccine. Immediate wheal and flare reactions were not detected. A positive delayed skin test was still present in the monkeys 12 months after immunization. An African Green monkey previously immunized developed a temperature elevation above 106° and rales in the lungs, but no wheezing, lasting about 48 hours, beginning 9 days after intranasal challenge with live 11th MK passage RSV. The vaccine was shown to contain a disproportionate amount of soluble, CF antigens compared to surface, viral antigens. Evidence indicates that the vaccine overstimulated delayed hypersensitivity and IgE in young atopic children. Enhanced delayed hypersensitivity may account for the high fever, rash and some pulmonary infiltration, and the IgE-mediated response for the marked wheezing seen in atypical illness.