T.M. Pollock

CONSEQUENCES OF CONFIRMED MATERNAL RUBELLA AT SUCCESSIVE STAGES OF PREGNANCY

Over a thousand women with confirmed rubella infection at different stages of pregnancy were followed up prospectively. Two-thirds of the women were multiparous. Pregnancy continued in 40%, and the infants were followed up after birth both clinically and serologically. The frequency of congenital infection after maternal rubella with a rash was more than 80% during the first 12 weeks of pregnancy, 54% at 13-14 weeks, and 25% at the end of the second trimester. The infection rate then rose again to reach a high figure in the last month. Follow-up was to 2 years of age--the findings in infected children being compared with those in children who had escaped infection. Rubella defects occurred in all infants infected before the 11th week (principally congenital heart disease and deafness) and in 35% of those infected at 13-16 weeks (deafness alone). No defects attributable to rubella were found in 63 children infected after 16 weeks. Continued surveillance of cases of confirmed rubella during pregnancy is recommended as an additional way of monitoring the effect of rubella vaccination.

CONTROLLED TRIAL OF INACTIVATED INFLUENZA VACCINE CONTAINING THE A/HONG KONG STRAIN DURING AN OUTBREAK OF INFLUENZA DUE TO THE A/ENGLAND/42/72 STRAIN

Abstract A trial of inactivated influenza vaccine containing the A/Hong Kong/68 strain was made in 800 boys in a boarding-school starting in 1970. The boys had serum samples withdrawn for antibody estimations and were allocated at random to vaccine and control groups. During an outbreak of influenza A due to the A/England/42/72 strain, all boys with clinical influenza reported to the medical officer and the diagnosis was confirmed by laboratory examination. The vaccine was shown to confer substantial protection against the new virus strain. The presence of haemagglutinating (H.I.) antibody to either strain 6 weeks before the outbreak was associated with protection against influenza. In boys with H.I. antibody to A/Hong Kong/68 virus the attack-rate was 6%, compared with 25% in boys with no H.I. antibody to either virus strain. No influenza occurred in boys known to have H.I. antibody to the A/England/42/72 strain. Three-quarters of the boys in whom A/Hong Kong/68 H.I. antibody had been naturally acquired developed A/England/ 42/72 H.I. antibody after vaccination. In contrast, the development of A/England/42/72 H.I. antibody was less frequent after revaccination of boys in whom the A/Hong Kong/68 H.I. antibody had been induced by vaccination. A vaccine prepared from the A/Hong Kong/68 strain conferred substantial protection despite the recent antigenic shift of the influenza virus.

INFLUENZA AT CHRIST'S HOSPITAL: MARCH, 1974

Boys in a boarding-school given inactivated influenza-A or influenza-B vaccine have been observed during a simultaneous outbreak of influenza due to A/Port Chalmers, B/Hong Kong, and B/Intermediate strains. Influenza-B vaccine conferred substantial protection, the attack-rates in boys given B vaccine being 24% compared with 45% in a control group. A/Hong Kong vaccine, by preventing infection during the previous influenza A/England outbreak, left the boys vulnerable to influenza A/Port Chalmers. Influenza-A haemagglutination-inhibiting (H.I.) antibody acquired by natural infection was associated with more protection than H.I. antibody induced by vaccination. This difference was not seen with influenza-B H.I. antibody.

SYMPTOMS AFTER PRIMARY IMMUNISATION WITH DTP AND WITH DT VACCINE

Symptoms after routine primary immunisation of 6004 infants with diphtheria/tetanus/pertussis (DTP) vaccine and 4024 infants with diphtheria/tetanus (DT) vaccine have been compared. After each dose, crying, screaming, and feverishness were more frequent with adsorbed DTP than adsorbed DT, but the difference was small. Attacks of high-pitched screaming, episodes of pallor or cyanosis with limpness, convulsions, and local reactions occurred with similar frequency after both vaccines. There was a considerable increase in local reactions after the 3rd dose with both vaccines. Over 1000 doses of plain DTP (with no aluminium hydroxide adjuvant) were given during the study. Post-vaccination symptoms were more common after the plain than after the 2 adsorbed preparations.

HUMAN ANTI-CHICKENPOX IMMUNOGLOBULIN IN THE PREVENTION OF CHICKENPOX

Human anti-chickenpox immunoglobulin (zoster immune globulin, ZIG) was largely ineffective in preventing infection in forty-three high-risk contacts of chickenpox. Twenty-nine of these non-immune infants and children who had been in close contact with cases of varicella became infected, and symptoms developed in twenty-four. Since ZIG may modify chickenpox it should continue to be given to high-risk contacts until the availability of a simple and sensitive test makes it possible to identify those who are susceptible. However, ZIG is not necesary for infants whose mothers have chickenpox or zoster five or more days before delivery, since all such infants (eleven) had varicella-zoster antibody at birth.

WHOOPING-COUGH VACCINATION AN ASSESSMENT

Abstract In considering the value of whooping-cough vaccine in the U.K., where the incidence of the disease is now extremely low, it is probable that the risks from stopping routine vaccination would be considerable. Whooping-cough vaccine, like other vaccines, must carry some risk, but whereas the potential dangers of abandoning vaccination are clear, those from using the vaccine as a routine procedure have not been adequately assessed. Vaccination against whooping-cough should not be discouraged until there is valid evidence that the risk from the vaccine outweighs the risk from the disease.

IMMUNOGLOBULIN FOR THE PREVENTION OF INFECTIOUS HEPATITIS IN PERSONS WORKING OVERSEAS

Abstract 1079 persons were each given 750 mg. of immunoglobulin to protect them against infectious hepatitis while working abroad. Only 1 case of the disease developed during the first seven months after inoculation, but cases occurred in subsequent months. Among 942 recruits who did not receive immunoglobulin, infectious hepatitis began to occur during the second month abroad. Ultimately the incidence of infectious hepatitis was similar in inoculated and uninoculated recruits. Despite the limitations of these data, the findings seem to corroborate the view that a single dose of immunoglobulin given to intending travellers protects for about six months; for longer periods of protection further doses would probably be required.

SURVEYS OF RUBELLA ANTIBODIES IN YOUNG ADULTS AND CHILDREN

22 000 serum samples from university students and young adult blood donors collected between 1969 and 1980 were tested for antibody to rubella virus. Of the women born in 1956 and after (i.e., those eligible for rubella vaccine at school) the proportions seronegative ranged from 3% to 6% in different years, compared with 12-20% in men of the same age groups. Serum samples from schoolchildren were also tested: 40-50% of girls and boys aged 10-11 years were seronegative--percentages similar to those before the introduction of vaccine. However, only 2-6% of 15-year-old girls (who would have been offered vaccine) were seronegative compared with 20-30% of 15-year-old boys. These results indicate that the rubella vaccination programme in the U.K. is having a significant impact on the immunological status of young women of childbearing age but that a large number of women remain potentially susceptible.

EFFECT OF RUBELLA VACCINATION PROGRAMME ON SEROLOGICAL STATUS OF YOUNG ADULTS IN UNITED KINGDOM

Antibody to rubella virus was measured in over 10,000 serum samples collected in 1976, 1977, and 1978 from young adult blood donors and university students. The incidence of seronegatives was lower (4--7%) among females born in 1956 and subsequently--i.e., among the age groups offered rubella vaccine at school--than among females born before 1654 (11--20%). The incidence of seronegatives among males in the 1977 and 1978 surveys had the opposite trend, with a higher proportion of seronegatives in younger males, born in 1956 and subsequently, than in older males. The findings provide evidence that the rubella vaccination programme in the U.K. is having a significant impact on the immunological status of young females of childbearing age. Nevertheless too high a proportion of young females remains potentially susceptible to rubella.

INTRADERMAL TEST AND SEROLOGICALTESTS IN SUSPECTED BRUCELLAINFECTION IN MAN

Abstract During the routine use of the brucellin skin-test in 211 hospital patients, reactions to the test were compared with the results of four serological tests. Weak or absent skin reactions were sometimes associated with high titres in the serological tests. On the other hand, strongly positive skin reactions were sometimes associated with low titres. Fourfold rises in paired specimens of sera may have been due to the performance of a skin-test and not to active infection. The skin-test should not be used in routine diagnosis when serological tests are available.