Aetiology and epidemiology of viral croup in Glasgow, 1966-72

Two chemoattenuated PfSPZ malaria vaccines induce sterile hepatic immunity

The global decline in malaria has stalled1, emphasizing the need for vaccines that induce durable sterilizing immunity. Here we optimized regimens for chemoprophylaxis vaccination (CVac), for which aseptic, purified, cryopreserved, infectious Plasmodium falciparum sporozoites (PfSPZ) were inoculated under prophylactic cover with pyrimethamine (PYR) (Sanaria PfSPZ-CVac(PYR)) or chloroquine (CQ) (PfSPZ-CVac(CQ))-which kill liver-stage and blood-stage parasites, respectively-and we assessed vaccine efficacy against homologous (that is, the same strain as the vaccine) and heterologous (a different strain) controlled human malaria infection (CHMI) three months after immunization ( https://clinicaltrials.gov/ , NCT02511054 and NCT03083847). We report that a fourfold increase in the dose of PfSPZ-CVac(PYR) from 5.12 × 104 to 2 × 105 PfSPZs transformed a minimal vaccine efficacy (low dose, two out of nine (22.2%) participants protected against homologous CHMI), to a high-level vaccine efficacy with seven out of eight (87.5%) individuals protected against homologous and seven out of nine (77.8%) protected against heterologous CHMI. Increased protection was associated with Vδ2 γδ T cell and antibody responses. At the higher dose, PfSPZ-CVac(CQ) protected six out of six (100%) participants against heterologous CHMI three months after immunization. All homologous (four out of four) and heterologous (eight out of eight) infectivity control participants showed parasitaemia. PfSPZ-CVac(CQ) and PfSPZ-CVac(PYR) induced a durable, sterile vaccine efficacy against a heterologous South American strain of P. falciparum, which has a genome and predicted CD8 T cell immunome that differs more strongly from the African vaccine strain than other analysed African P. falciparum strains.

Clinical courses of croup caused by influenza and parainfluenza viruses

Influenza viruses have occasionally been associated with severe manifestations of croup, but no comparative studies of different viral etiologies are available. In a retrospective study we compared the clinical courses of croup caused by influenza and parainfluenza viruses in hospitalized children. By several indicators the clinical picture of croup caused by influenza viruses was significantly more severe than that caused by parainfluenza viruses.

Cyclical patterns and predictability in infection

Many infections, especially viral infections, show a certain periodicity which can be wholly or partly predictable. It is important to be able to recognize these patterns because anticipating changes in incidence should lead to better diagnosis, treatment and control of infection. In this review patterns of some viral and other infections in England and Wales which have been observed from laboratory reports over a period of 21 years, from 1967 to 1987, are described.

Effect of weather conditions on acute laryngotracheitis

The aim of the study was to examine the incidence of croup in the Swansea area and to determine whether meteorological factors have any effect on the incidence of acute laryngotracheitis requiring hospitalization. 447 patients with a diagnosis of acute viral croup were admitted to the Ear, Nose and Throat Department of Singleton Hospital, Swansea, between January 1st 1980 and December 31st 1984. There was no significant difference between days with and without croup admissions, with respect to barometric pressure or relative humidity. Maximum and minimum temperatures were significantly lower on days with croup admissions (p less than 0.001). Wind direction appeared to influence the number of admissions, which were increased when the wind was from the south-east (p less than 0.01).

Advances and controversies in the management of supraglottitis and laryngotracheobronchitis

Recent advances in pediatric airway intubation and the introduction of pharmacotherapeutic agents, active within the larynx and tracheobronchial tree, have created significant controversies in the treatment of acute obstructive inflammatory laryngeal disease. Although the etiology, pathophysiology, and clinical patterns of supraglottitis and laryngotracheobronchitis are no longer confused, decisions concerning their medical management and method of airway control remain controversial. Both inflammatory disorders are critically examined, with a reveiw of current concepts regarding the choice between endotracheal intubation and tracheotomy. Specific problems of anesthetic technique, criteria for extubation or decannulation, and the rationale for the use of corticosteroids, antibiotics, or racemic epinephrine are evaluated. If mechanical airway control is required, careful attention to initial intubation with a relatively small, cuffless polyvinyl chloride endotracheal tube and precise surgical technique when employing tracheotomy will minimize the overall morbidity. Short term intubation in acute obstructive inflammation of the larynx appears to be well tolerated. Tracheotomy is reserved for the few patients with laryngotracheobronchitis who demonstrate persistent significant subglottic edema.

Parainfluenza viral infections in children: correlation of shedding with clinical manifestations

Children presenting with acute respiratory disease to a private group practice in the fall of 1975 were studied to: (1) evaluate the efficacy in a pediatric office of a simple technics of obtaining nasal washes for the diagnosis of parainfluenza virus infections and (2) to determine the quantities of virus shed in relation to clinical characteristics. The nasal wash technic proved feasible for an office or clinic. Parainfluenza virus type 1 was recovered from 26 (74%) of 35 children with croup and from 40 (56%) of the total 72 children presenting with any form of respiratory illness. Virus was recovered significantly more often from children with croup and from those of younger age. The mean quantity of virus in 26 nasal washes was 2.97 log10 TCID50/ml. The shedding of greater quantities was correlated with younger age and the more frequent occurrence of laryngitis, pharyngitis, and fever.