A causal relationship between Bordetella pertussis and Bordetella parapertussis infections

Bordetella parapertussis is isolated during the late stages of pertussis outbreaks and occasionally from patients infected with pertussis. The relationship between Bordetella pertussis and B. parapertussis was investigated in mice with monoinfections and mixed infections. Four groups of 10 2-week-old suckling mice were studied: mice born to mice vaccinated against pertussis during pregnancy and unvaccinated controls consequently did and did not receive antipertussis toxin (PT) antibody transcolostrally. The mice were infected transnasally with B. parapertussis strain 422 and 2 identical groups were infected transnasally with B. parapertussis strain 422 and B. pertussis strain 18-323. Bacterial colonization of the lungs and trachea was studied at 1, 2, and 3 weeks after challenge. No persistent colonization by B. parapertussis of the lungs or trachea of monoinfected suckling mice were observed. Persistent colonization by B. parapertussis was observed when suckling mice that received anti-PT antibody transcolostrally were infected with both species. These findings are consistent with the clinical characteristics of B. parapertussis. The results of this study demonstrate that B. pertussis infection facilitates B. parapertussis infection.

Evaluation of pertussis treatment with erythromycin ethylsuccinate and stearate according to age

Although erythromycin estolate has been fully assessed for pertussis treatment, the evaluation of erythromycin ethylsuccinate and stearate, the main erythromycin preparations used in Japan and the US, is inadequate. We evaluated these preparations to establish an appropriate treatment for pertussis according to age. Sixty-six patients with culture-confirmed pertussis were treated with erythromycin administered at a dosage of 40-50 mg/kg/day (maximum, 1.2 g/day). Negative culture was obtained in 39% (15/38) of patients aged 0-2 years within one week and in 71% (27/38) within two weeks, in 78% (7/9) of those aged 3-15 years within one week and in 100% (9/9) within two weeks. All 12 adult patients had a negative culture within one week. The efficacy of erythromycin for the eradication of B. pertussis was significantly lower in children aged 0-2 years than in older children. In conclusion, it is desirable to administer erythromycin for three weeks to children aged 0-2 years, two weeks to those aged 3-15 years and one week to adults.

Efficacy of acellular pertussis vaccine in young infants

A prospective study of a pertussis outbreak in a residential facility was done. Among 19 residents aged < or = 2 years, 10 children were unimmunized and 9 were immunized with acellular pertussis vaccines. Of the 10 unimmunized children, 7 acquired laboratory-confirmed pertussis (four-fold titer rise, positive culture, or both); of these, 6 developed typical symptoms. Eight of the 9 immunized children acquired laboratory-confirmed infections, and 1 of these developed typical symptoms. No difference in infection was noted between the unimmunized and immunized groups (7/10 vs. 8/9, respectively), but a significant difference was observed in the development of symptoms (6/10 vs. 1/9, P < .05). Also, the isolation rate of Bordetella pertussis seemed to differ between the two groups (6/10 vs. 2/9, P = .12). In this population, acellular pertussis vaccine did not prevent infection with B. pertussis but protected most young infants from the onset of clinical symptoms.

Pertussis in adults

A survey was conducted of 89 households in each of which at least one patient with culture-confirmed pertussis had been detected. The source of infection was found to be an adult in 10 (11.2%) of the 89 households, and the rate of secondary attack was 19 (10.3%) of 185. Furthermore, a laboratory study disclosed 17 adults with subclinical pertussis; the subclinical infection rate was 17 (25.0%) of 68. When compared with pertussis in young children, the adult illness was generally less severe and had different clinical features. Adult pertussis showed neither leukocytosis nor lymphocytosis, but it produced anti-pertussis toxin antibody more quickly and higher levels of anti-filamentous hemagglutinin and agglutinin antibodies, and showed stronger growth inhibition of Bordetella pertussis. Although adult pertussis is usually unrecognized because of its different clinical and laboratory features, it is a significant health threat that requires some measures for disease control.

[Pharmacokinetics and the time course of pharmacodynamics of recombinant human erythropoietin (SNB-5001)]

Pharmacokinetics and the time course of pharmacodynamics of recombinant erythropoietin (SNB-5001) were investigated. The plasma concentration of SNB-5001 reached Cmax at 6-7 hr after the subcutaneous injection and gradually decreased. Most of the SNB-5001 in plasma disappeared at 48 hr. Serum erythropoietin activity changed similarly to plasma SNB-5001 concentration. It was indicated that SNB-5001 moves into the plasma and organs having intact bio-activity after its injection. The decrease in serum iron and increase in unsaturated iron binding capacity (UIBC) began at 8 hr after the injection. Both the trough point of serum iron decrease and the peak point of UIBC increase were 24 hr after the injection. Each value recovered to the initial level at 72 hr. Total iron binding capacity did not change. Increase in reticulocytes began at 24 hr and reached the peak at 72-96 hr after the injection of SNB-5001. Reticulocytes count recovered to the initial level at 120 hr. The pharmacodynamics time course after the subcutaneous injection of SNB-5001 was the same as that after the intravenous injection. It was indicated that SNB-5001 reached an effective plasma level at the earlier absorption phase after the subcutaneous injection.

[Molecular epidemiology of Vibrio cholerae O-1 from outbreak and sporadic patients in Nagoya in 1989]

Enterotoxigenic strains of Vibrio cholerae O-1 biotype eltor, isolated from three sporadic cases of cholera in Nagoya in 1989 and an outbreak of cholera in Nagoya in 1989 were analyzed for their similarities. All isolates of V. cholerae O-1 were indistinguishable in bacteriophage types, serovars, biovars and drug resistance patterns. Because the epidemiological investigation based on a primary structure of chromosomal DNA is more reliable, we isolated chromosomal DNA from these isolates and compared electrophoretic patterns of restriction endonuclease-digested DNA fragments. Furthermore, Southern hybridization of the cholera toxin gene was performed. Since no difference among six strains in these sporadic was observed, it was strongly suggested that both the independent cases and the outbreak of cholera were caused by the same strain.

[Simple and efficient method for clinical isolation of Bordetella pertussis]

Commercially available Amies transport medium with charcoal and three isolation media were tested to assess their efficiency in the clinical isolation of B. pertussis. First, the isolation rates of B. pertussis were compared between direct inoculation of nasopharyngeal specimens and inoculation after stored in Amies transport medium for 8 hours or less. The comparative isolation rates were 81% both (35 of 43 specimens from 29 patients) for direct inoculation and transport medium. Second, nasopharyngeal specimens were incubated for 5 days at 35 degrees C on the three media; Bordet-Gengou Medium (BG) with 5 micrograms of CEX per ml, Cyclodextrin Solid Medium (CSM) with 5 micrograms of CEX per ml, and Charcoal Agar with 40 micrograms of CEX per ml. The organism was detected from 44 nasopharyngeal specimens from 20 patients on at least one of the three tested media. The comparative isolation rates were 91% (40 of 44) on BG with 5 micrograms of CEX per ml, 93% (41 of 44) on CSM with 5 micrograms of CEX per ml, and 91% (40 of 44) on CA with 40 micrograms of CEX per ml. Although no differences in the isolation rates were observed among the three media, the appearance of the colonies was earlier by one day on BG than the rest of the two media. The detection of B. pertussis was occasionally easier on CA than the rest of the two because of its higher suppression for nasopharyngeal flora. CSM has its advantage in that it does not need any blood and can be prepared at anytime. Also, the shelf life of these three media proved to be at least one month when stored at 10 degrees C. We conclude that the clinical isolation of B. pertussis was highly successful with the following simple procedure: nasopharyngeal specimens stored in Amies transport medium and inoculated on one of the three media, BG, CSM, or CA, and then incubated for 5 days at 35 degrees C.

[Diphtheria antitoxin levels in Japanese adults (10-20 years after the last vaccination)]

The serum diphtheria antitoxin levels in Japanese adults were investigated and the persistence of diphtheria toxoid effect was evaluated. The subjects consisted of 56 volunteers (20-31 years of age) who had received regular inoculations of diphtheria and pertussis vaccine (I and II or III phases). They had been immunized according to the Vaccination Law (old version) revised in 1958. The length of time after the last inoculation of diphtheria toxoid was speculated to range from 10 to 20 years. Serum diphtheria antitoxin was determined by passive hemagglutination method. Antitoxin level was 0.025 HAU/ml in 1 subject (1.8%), 0.05 in 2 (3.6%), 0.1 in 2 (3.6%), 0.2 in 8 (14.3%), 0.4 in 7 (12.5%), 0.8 in 12 (21.4%), 1.6 in 7 (12.5%) and more than 1.6 in 17 (30.4%). Results indicated that 55 of 56 (98.2%) possessed a higher level than the prophylaxis standard (0.05 HAU/ml). Since the current Vaccination Law prescribes a lower amount and fewer inoculations than the old law, the number of adults possessing prophylactic antitoxin level may decrease in the future. Further investigation of antitoxin level in adults needs to be continued.

[Efficacy of acellular pertussis vaccine]

An outbreak of pertussis occurred in one room of a residential facility where 19 children aged 5 to 36 months were residing. They were prospectively surveyed to estimate the efficacy of acellular pertussis vaccine. Among the 19 residents, 9 were immunized with acellular pertussis vaccine. Among the 19 residents, 9 were immunized with acellular DTP vaccine and 10 were unimmunized. The spread of pertussis was surveyed bacteriologically and serologically for 2 months. Among the 9 immunized, 7 children acquired the laboratory-confirmed pertussis and 1 of the 7 developed the typical symptoms (whooping or paroxysmal coughing attack lasting for 14 days or more). Among the 10 unimmunized, 7 children acquired the laboratory-confirmed pertussis and 6 of the 7 developed the typical symptoms. There was no difference in the rate of secondary infection (7/9:7/10), but there was a significant difference in the rate of development of the typical symptoms (1/7:6/7 p less than 0.05). The point estimate of protective efficacy of the acellular DTP vaccine against typical pertussis was (6/10 - 1/9)/(6/10) x 100 = 81%. It was concluded from these findings that acellular DTP vaccine could not prevent the infection of Bordetella pertussis, but could prevent the development of the typical symptoms.

[Effects of transfer factor on chronic hepatitis B in childhood]

Nine children, 1 to 13 years of age, with HBeAg positive chronic hepatitis B received transfer factor (T.F.) monotherapy for 3 to 17 months, and were monitored by check-ups every six months from serum HBeAg, anti-HBe and GPT. In 12 months, 4 subjects became HBeAg negative and had normal serum GPT. In 22 to 48 months, 6 of the nine subjects had negative HBeAg and normal GPT, 2 had positive HBeAg and high GPT values. The remaining 1 subject who was observed for six months after T.F. therapy remained HBeAg positive with a high GPT values. No side effects were observed. These preliminary observations may indicate beneficial effects of T.F. on the natural course of chronic hepatitis B in childhood, though the ultimate effects awaits longer and well controlled clinical trials.

Heart rate and metabolic responses to participation in golf

Five healthy middle-aged men were asked to perform 18 holes of golf. Heart rate was measured throughout the play, and blood samples were compared before and after play. Oxygen uptake during play was estimated from their heart rate response during a treadmill-walking test. Mean heart rate was 108 (range 92-121) beats/min, which corresponded to 38 (range 35-41) %VO2max. Caloric cost of golf is 4-6 kcal/min and total energy expenditure was estimated more than 960 kcal during 18 holes. Blood glucose decreased and FFA increased following 18 holes of play. Golfing seems to be a suitable sport for middle-aged and elderly persons to enhance energy expenditure.

Efficacy and immunogenicity of acellular pertussis vaccine by manufacturer and patient age

Acellular pertussis vaccines, which have been used in Japan since 1981, vary in antigenic constituents among manufacturers. First, to assess the immunogenicity by manufacturer and patient age, 161 children aged 3 months to 2 years were immunized by acellular pertussis vaccine from one of three Japanese manufacturers, Biken, Takeda, or Kitasato. Anti-pertussis toxin antibody responses for children immunized with Takeda and Kitasato vaccines were comparable with patients with pertussis in the convalescent stage, and anti-pertussis toxin antibody response for Biken vaccine was far higher than those of convalescing patients. Anti-filamentous hemagglutinin antibody responses for the children given the three vaccines were far higher than those of the patients. Weak serotype 1.3 agglutinin responses were observed only in children administered the Takeda vaccine. Comparing these antibody responses among various age groups, the immunogenicity of acellular vaccines in children aged 3 to 6 months was comparable with children aged 2 years. Second, to assess the manufacturer-specific efficacy, 495 households of patients with pertussis were surveyed from 1981 to 1988. The estimated efficacy of the acellular pertussis vaccines in children aged 2 to 8 years was 82%, and there were no major differences in the secondary attack rates among children immunized with acellular pertussis vaccine from each manufacturer, ie, 12.5% (1/8) for Biken, 11.1% (2/18) for Takeda, and 5.9% (1/17) for Kitasato. We conclude from these two studies that similar efficacy was observed in children aged 2 years or older for acellular pertussis vaccines from the three manufacturers, which produced anti-pertussis toxin antibody responses comparable with patients with pertussis and far higher antifilamentous hemagglutinin antibody responses than in the convalescing patients, and that age did not affect the immunogenicity of acellular vaccines.

Type-specific efficacy of acellular pertussis vaccine

Two types of acellular pertussis vaccine have been used in Japan since their introduction in 1981. They are different in their antigen content and immunogenicity. To assess the type-specific efficacy of acellular pertussis vaccine commercially available in Japan, 442 households of patients with pertussis were surveyed from 1981 to 1987. The secondary attack rates in children 2 through 8 years of age were 61.3% (46/75) in unimmunized children, 7.5% (4/53) in children fully immunized by the filamentous hemagglutinin predominant type acellular pertussis vaccine, 14.3% (1/7) in children fully immunized by the pertussis toxin-filamentous hemagglutinin type vaccine, and 13.5% (7/52) in children given whole-cell pertussis vaccine. The estimated efficacy was 87.7% for the filamentous hemagglutinin predominant type vaccine and 76.7% for the pertussis toxin-filamentous hemagglutinin type vaccine in children aged 2 through 8 years. Both types of acellular pertussis vaccine were similarly effective, without any statistically significant differences, and their efficacy was not different from that of whole-cell vaccines. This survey also indicated that adults are a major source of infection, with a high secondary attack rate of 7.8%.

[Synthesis and metabolism of estriol conjugates]

As an indicator of fetal well being, the urinary estriol value is widely utilized. But the discrepancy between the results of NST and urinary estriol value has recently been pointed out. The estimation of plasma estriol is also recommended as a more reliable means of fetal assessment than that of urinary estriol. The purpose of the study is to clarify the patterns of estriol conjugates in maternal blood, retroplacental blood and cord blood, and further to elucidate the metabolism and secretion of each conjugate in organs and to determine the most useful conjugate as a source of fetal information. In normal pregnancy urine, estriol glucosiduronate is the dominant component of urinary estriol. In preeclampsia, the percentage of G decreased and that of G-S increased. In retroplacental blood, G-S is the main conjugate. On the other hand in cord blood, S is the dominant conjugate. The placental perfusion experiment revealed that the placenta hydrolyzed each conjugate to a free form and did not convert one conjugate to another. Periodical determination of plasma estriol conjugates in pregnant women revealed that the G-S fraction fluctuated most during parturition. The importance of liver as a possible site for estriol conjugation and the role of kidney in selective clearance of estriol conjugates are discussed.

Adverse reactions and antibody responses to acellular pertussis vaccine

Two types of acellular pertussis vaccine are used in Japan: the filamentous hemagglutinin (F-HA) predominant type and the pertussis toxin (PT)-F-HA type. We tested one lot of vaccine from each of three manufacturers (lots A and B, F-HA predominant type; lot C, PT-F-HA type). One hundred fifteen healthy children between the ages of 3 months and 23 months were immunized with one of the three lots of acellular pertussis vaccine to assess adverse reactions and antibody responses. The incidence of fever (temperature greater than or equal to 38 degrees C) was 2.6% for lot A, 1.2% for lot B, and 2.5% for lot C. The incidence of local reactions greater than 5 cm in diameter was 1.9% for lot A, 2.4% for lot B, and 3.3% for lot C. Thus no significant differences in adverse reaction were observed. The anti-PT antibody responses in the tested vaccines were equal to or greater than those in patients with pertussis in the convalescent stage, and the anti-F-HA antibody responses were far higher than those of convalescing patients. Lot C produced the highest anti-PT antibody, and Lot A the highest anti-F-HA antibody.

Comparison of blood-free medium (cyclodextrin solid medium) with Bordet-Gengou medium for clinical isolation of Bordetella pertussis

Cyclodextrin solid medium (CSM) developed by us was evaluated to be a suitable synthetic medium for the clinical isolation of Bordetella pertussis when compared with Bordet-Gengou (BG) medium. The addition of 5 micrograms of cephalexin (CEX) per ml to CSM not only supported the good growth of B. pertussis but also sufficiently suppressed the growth of nasopharyngeal flora. During period 1 of this study, nasopharyngeal specimens from 60 patients with clinical pertussis were inoculated on CSM supplemented with 5 micrograms of CEX per ml. The isolation rate was 70% (42 of 60). To confirm the efficacy of CSM, another study was performed. During period 2 of this study, nasopharyngeal specimens were cultured on both CSM and BG medium, each with 5 micrograms of CEX per ml. The comparative isolation rates were 100% (40 of 40 specimens from 29 patients) on CSM with 5 micrograms of CEX and 65% (26 out of 40) on BG medium with 5 micrograms of CEX. The excellent efficacy of CSM as measured by the isolation rate was thought to be due to the poor nutrition of this medium for the growth of nasopharyngeal bacteria. CSM retained its efficacy in clinical isolations even after 3 months of storage in a refrigerator. These data led us to conclude that CSM with 5 micrograms of CEX was much better than BG medium with 5 micrograms of CEX, determined by both the isolation rate and preservativity considerations, and that CSM with 5 micrograms of CEX per ml can be successfully used instead of BG medium as a medium for the clinical isolation of B. pertussis.

[Studies on meconium-like substances in the urine of mother and neonate during perinatal period]

It is well known that the entry of amniotic fluid into the mother's circulation may result in the occurrence of amniotic embolism, and aspiration of meconium by the neonate may cause meconium aspiration syndrome. To study meconium-like substances detected in the urine of mother and neonate during the perinatal period, the authors carefully assayed the Urinary Meconial Index (UMI) in subjects including 100 pregnant women, 171 parturient women, 171 neonates and 68 samples of amniotic fluid. Through the UMI assay, the frequency of the appearance of high UMI, the mode of delivery at high UMI and its effect upon both mother and neonate were studied and the following findings obtained. The entry of meconium into the mother's circulation occurs during labor pains and may be excreted into the mother's urine (6.4%). Labor pains enhance the entry of meconium into the mother's circulation and the entry takes place even in the absence of any clinical signs of rupture of the membranes (p less than 0.01). The entry of meconium into both mother and neonate occurs at a higher rate in dystocia and in cases with meconium-stained amniotic fluid (p less than 0.05). Even in the absence of marked symptoms such as those in meconium aspiration syndrome, the aspiration of meconium affects postnatal course of the newborn (positive CRP, early appearance of bilirubinemia: p less than 0.05).