Diphtheria serology in adults in Central Java and East Java, Indonesia: the importance of continuous diphtheria vaccination

Background: Vaccination increase immunity against diphtheria, yet will decrease by aging. Therefore, boosters are needed to be done regularly. Objectives: This study aims to determine the immunity to diphtheria for the population of 16 years old and above. Methods: The sample of study were 295 collected blood serums by Riskesdas project in 2013, the criteria was above 15 years of age and originating from the Provinces of Central Java or East Java inclusively. Immunity assessment was based on antibody titer (IgG) against diphtheria using Vero Cell cytotoxicity test. Statistical analysis was performed using the X2 test. Results: The full protective IgG titer (>0.1 IU/ml) at the age of 16-20 years included 75% sample with a geometric mean titer (GMT) of 0.19 IU/ml. Yet, at the age of 21-60 years and > 60 years, full protective IgG titers only cover 45.5% and 33.3% sample with GMT respectively 0.06 IU / ml. Statistical analysis showed the relationship between age and immune status with p-value 0.003. Otherwise, no relationship between the status of immunity with sex and residency with p-values of 0.16 and 0.43. Conclusions: The immune status against diphtheria at the age of above 15 years decreases with aging. Keywords: Adult; diphtheria; Indonesia; serology.

Early protection against measles infection in children Immunized with DPT-measles Vaccine at the Age of 4 Months

A study on early immunization with DPT-measles vaccine at the age of 4 months, was earned out during 1990 - 1991 on 348 babies at the Health Centre of Surabaya regency. Three hundred and forty eight babies were served as control. The results of the study reported here were : (a) By giving a mixture of DPT and measles at an early age (4 months of age) the coverage of measles immunization could be increased to 21% - 27%. (b) 1'wenty two percents of measles cases could be prevented. (c) The geometric mean titer using hemagglutination inhibition test of the babies who got a mixture DP7~measles vaccination at an early age was significantly higher than that of the GMT HI test of babies who got measles vaccination at the age of 9 months ( z test, p <0, 05 ) . The result of analysis of data showed that an early immunization program using a mixture of DPT-measles could protect babies under 9 months and thus prevent them from measles infection.

Respon Imun Itik Bali Pascavaksinasi Newcastle Disease

Penelitian ini bertujuan untuk mengetahui respon imun itik terhadap vaksinasi Newcastle Disease (ND), serta waktu yang diperlukan agar terbentuk titer antibodi yang protektif. Penelitian menggunakan rancangan acak lengkap (RAL) dengan waktu sebagai perlakuan. Objek penelitian menggunakan serum itik Bali. Pengambilan darah pravaksinasi dilakukan pada umur tiga minggu, pada umur empat minggu dilakukan vaksinasi secara sub kutan. Pengambilan darah pascavaksinasi dilakukan empat kali dengan interval waktu satu minggu, diambil dari vena tibialis cranial dengan spuite satu cc, dan serum dipindahkan ke dalam tabung Eppendorf. Titer antibodi diuji dengan uji Hemaglutination inhibition (HI), dan dinyatakan dalam Geometric Mean Titer (GMT) dengan satuan Log 2. Rerata titer antibodi pravaksinasi adalah 0,83±0,408 Log 2. Sedangkan rerata titer antibodi minggu ke-1,2,3 dan 4 pasca vaksinasi adalah 2±0,632 Log 2, 5,5±1,225 Log 2, 1,2±0,983 Log 2, dan 0,16±0,408 Log 2. Dapat disimpulkan titer antibodi protektif (?2?) pada minggu ke-2 pascavaksinasi.

Seroprevelensi Virus Avian Influenza SubTipe H5N1 Pada Unggas Domestik Peliharaan Masyarakat di Kawasan Cagar Alam Pulau Dua Serang Provinsi Banten

<p><em>Abstrak </em>- <strong>Unggas</strong><strong> </strong><strong>domestik</strong><strong> </strong><strong>di</strong><strong> </strong><strong>sekitar</strong><strong> </strong><strong>kawasan</strong><strong> </strong><strong>Cagar</strong><strong> </strong><strong>Alam</strong><strong> </strong><strong>Pulau</strong><strong> </strong><strong>Dua</strong><strong> </strong><strong>(CAPD)</strong><strong> </strong><strong>banyak</strong><strong> </strong><strong>berinteraksi</strong><strong> </strong><strong>dengan</strong><strong> </strong><strong>burung</strong><strong> </strong><strong>air liar yang terinfeksi virus H5N1. Oleh karena itu perlu diperoleh informasi terkait keberadaan Virus AI pada unggas domestik tersebut. Penelitian ini bertujuan untuk mengetahui prevalensi serologi Avian Influenza (AI) H5N1 pada unggas peliharaan masyarakat yang dipelihara dengan sistem <em>backyard </em>di sekitar kawasan CAPD. Pengamatan terhadap habitat dan perilaku bebek, ayam dan mentok dilakukan untuk menganalisa adanya interaksi dengan burung air liar di kawasan CAPD. Sebanyak 49 sampel serum yang terdiri dari 15 sampel serum bebek, 14 sampel serum mentok dan 20 serum ayam diperiksa keberadaan antibodi terhadap AI subtipe H5N1 melalui uji hambatan aglutinasi (<em>Haemaglutination</em><em> Inhibition</em>). Hasil pengamatan menunjukkan presentase seroprevalensi mencapai 100% dengan nilai <em>Geometric Mean Titer </em>sampel yang diperiksa sebesar 2</strong><strong>7,9 </strong><strong>untuk</strong><strong> </strong><strong>mentok,</strong><strong> </strong><strong>2</strong><strong>4,6 </strong><strong>untuk</strong><strong> </strong><strong>bebek</strong><strong> </strong><strong>dan</strong><strong> 2</strong><strong>77 </strong><strong>untuk</strong><strong> ayam. Terdapatnya antibodi membuktikan unggas peliharaan masyarakat di kawasan CAPD pernah terpapar virus AI subtipe H5N1.</strong></p><p><strong> </strong></p><p><strong><em>Kata Kunci</em></strong> - <em>Avian Influenza</em>, CAPD, Unggas Domestik, <em>Haemaglutination Inhibition</em></p><p><em> </em></p><p><em>Abstract</em> - <strong>Domestic birds around Pulau Dua Nature Reserve area (CAPD) interact with wild water birds infected with H5N1 virus. Therefore it is necessary to obtain information related to the presence of AI virus in domestic poultry. This study aims to determine the prevalence of Avian Influenza serology (AI) H5N1 in community poultry maintained by backyard system around CAPD area. Observation of habitat and duck, chicken and stuck behavior was done to analyze the interaction with wild water birds in CAPD area. A total of 49 serum samples consisting of 15 serum duck samples, 14 serum serum samples and 20 serum chickens examined the presence of antibodies against AI subtypes H5N1 through an agglutination inhibition test (Haemaglutination Inhibition). The observation result shows that seroprevalency percentage reaches 100% with Geometric Mean Titer value of examined sample is 27,9 for stool, 24,6 for duck and 277 for chicken. The presence of antibodies proves that community poultry in the CAPD region has been exposed to AI virus subtype H5N1</strong>.</p><p> </p><p><strong><em>Keywords</em></strong> - <em>Avian</em><em> Influenza</em>, CAPD, Unggas Domestik, <em>Haemaglutination Inhibition</em></p>

Immune Response to Seasonal Influenza Vaccine in Patients with Relapsing-Remitting Multiple Sclerosis Receiving Long-term Daclizumab Beta

Background: For patients with relapsing-remitting multiple sclerosis (RRMS) undergoing continuous immunomodulatory therapy, understanding whether vaccinations can be performed safely and effectively is important. We tested the immune response to inactivated seasonal influenza vaccine during long-term daclizumab beta treatment. Methods: In this prospective, open-label, single-arm extension SELECTED study, an optional vaccine substudy was performed on patients with RRMS who had already received daclizumab beta for 1 to 2 years in previous studies. Patients were administered the seasonal vaccine as a single intramuscular dose containing three inactivated influenza virus strains: A/California/7/2009 (A/H1N1), A/Texas/50/2012 (A/H3N2), and B/Massachusetts/2/2012 (B). Endpoints included proportion of patients achieving seroprotection, proportion of patients who seroconverted, geometric mean titer ratio before and after vaccination, and adverse events reported during 28-day follow-up. Results: Ninety patients received the influenza vaccine (mean previous daclizumab beta exposure, 49.6 doses). Seroprotection (anti–hemagglutination immunoglobulin G titer ≥40) was detected in 92% (95% confidence interval [CI], 85%–97%) of patients for A/H1N1, 91% (83%–96%) for A/H3N2, and 67% (56%–76%) for B. The proportion of patients who seroconverted was 69% (95% CI, 58%–78%) for A/H1N1, 69% (58%–78%) for A/H3N2, and 44% (34%–55%) for B. The anti–hemagglutination immunoglobulin geometric mean titer ratio was 7.7 for A/H1N1, 9.0 for A/H3N2, and 4.3 for B. There were no significant adverse events considered related to vaccination during 28-day follow-up. Conclusions: Patients with RRMS receiving long-term daclizumab beta treatment mounted an immune response to the seasonal influenza vaccine at levels considered to confer protection. No major or new safety issues were identified.

Imunogenisitas dan Keamanan vaksin Tetanus Difteri (Td) pada Remaja sebagai salah satu upaya mencegah Reemerging Disease di Indonesia

Latar belakang. Di Indonesia berpotensi terjadi reemerging disease difteri akibat belum ada program imunisasi ulang yang berkesinambungan pada remaja.Tujuan. Menilai imunogenisitas dan keamanan vaksin tetanus difteri (Td) yang diberikan sebagai imunisasi ulang pada remaja.Metode. Uji klinis randomized double-blind controlled dilakukan terhadap 296 pelajar remaja sehat di kota Bandung, usia 10–18 tahun, pada September 2007–September 2008. Didapatkan 296 remaja sebagai subjek penelitian, dibagi dalam 2 kelompok secara acak sederhana. Kelompok I mendapat vaksin Td 0,5 mL intramuskular. Kelompok II mendapat vaksin TT sebagai kontrol. Pemeriksaan kadar antibodi anti difteri dan anti tetanus dilakukan sebelum dan 1 bulan setelah imunisasi menggunakan teknik enzyme-linked immunosorbent assays (ELISAs). Data keamanan dikumpulkan sampai 1 bulan pasca imunisasi menggunakan buku harianHasil. Konsentrasi antibodi seroproteksi (>0,1 IU/mL) terhadap difteri dan tetanus mencapai 93,2% dan 100,0%. The geometric mean titer (GMT) terhadap difteri meningkat dari 0,0618 IU/mL menjadi 0,7583 IU/mL (p<0,001), dan terhadap tetanus meningkat dari 0,4413 IU/mL ke 14,4054 IU/mL (p<0,001). Nyeri pada tempat suntikan terjadi pada 20,3% kelompok Td dan 18,2% pada TT (p=0,028). Demam >37,5°C hanya terjadi pada sedikit subjek dari kedua kelompok (rentang Td: 0,7-4,7%; rentang TT: 3,4–6,7%). Tidak terdapat reaksi kejadian ikutan pasca imunisasi serius dan dapat ditoleransi dengan baik.Kesimpulan. Imunisasi ulang Td meningkatkan kadar antibodi protektif terhadap difteri dan tetanus, serta aman diberikan pada remaja.

Abstract 13741: Clinical Value of the Detection of Autoantibodies Against β1, β2 and α1 Adrenergic Receptors in Patients With Heart Failure

Background: Metoprolol and carvedilol are the β-blockers most often used in the management of patients with heart failure (HF), and the choice of drug is still unclear. Autoantibodies against β1, β2 and α1 adrenergic receptors (anti-β1-AR, anti-β2-AR and anti-α1-AR) participate in the pathology of HF. The purpose of the current study is to determine anti-β1-AR, anti-β2-AR and anti-α1-AR may be association with carvedilol treatment in HF patients. Methods: Synthetic β1, β2 and α1 adrenoreceptors peptides served as the target antigen. ELISA was used to screen the sera of 267 HF patients, which were divided into different groups based on their autoantibodies reactively. Echocardiography was performed between carvedilol therapy. Results: Final analysis covered 137 patients, including 65 patients with three autoantibodies and 72 negative. The frequency and geometric mean titer of anti-β1-AR, anti-β2-AR and anti-α1-AR were significantly lower in the positive group after 6 months of carvedilol (all P<0.01, from 100% to 57%, 50%, 49% and from 1:118, 1:138, 1:130 to 1:72, 1:61,1:67 respectively). Of these, 28 patients showed no autoantibodies. Both groups showed improvement left ventricular remodeling and function by carvedilol in combination with standard treatment regime for six months (all P<0.01). However, the 68 patients with three antibodies improved more obviously than 72 negative patients (P<0.01). Conclusion: Carvedilol treatment significantly decreased the frequency and geometric mean titer in patients with three autoantibodies, even to complete ablation, and with more improvement in cardiac function and remodeling. Three autoantibodies may be useful biomarker of over-activation of the sympathetic nerves system for clinical medication.

Effective Immune Response In Patients Who Have Hematologic Malignancies After Vaccination with Inactivated Influenza A (H1N1) 2009 Monovalent Vaccine

Abstract 1743 Introduction: Effective vaccinations against 2009 H1N1 have been reported in healthy individuals; however, the response of immunocompromised patients, particularly patients who have hematologic malignancies and who also may be taking cytotoxic myelosuppressive and immunosuppressive treatments, is unclear and is generally considered to be decreased. Methods: We conducted a prospective study to test the immunogenicity of H1N1 vaccination in patients with hematologic malignancies. We enrolled 22 patients, all of them received inactivated monovalent H1N1 2009 vaccine made by Sanofi. Antibody responses were measured by hemaglutination inhibition assay (HAI) at 4–6 weeks and 6–16 weeks. Results: Among the 22 patients, there were 15 males, 7 females, median age 61.5y (range 35–86y). Sixteen patients had active disease, with MGUS+MM (n=4), CLL+NHL (n=5), MDS+AML (n=4) and MPD (n=3), while the other 6 patients were in remission (within 3 years of initial diagnosis), including MM (n=1), CLL+NHL+HD (n=3), AML (n=1) and MPD (n=1). Eleven patients were receiving treatment (within 28 days before or after vaccination) with drugs that have myelosuppressive potential (91%), and 54.5% of the patients were also receiving drugs that have immunosuppressive potential. The median interval of treatment prior to vaccination was 6 days (range 0–84 d) and the median interval of treatment after vaccination was 14 days (0-28 d). At baseline, 23.0% (95% confidence interval [CI], 4–42%) patients had antibody titer ≥ 1:40, and the geometric mean titer was 18.2 (95%CI, 8.6–38.7); at 4–6 weeks, the geometric mean titer was 197.0 (95%CI, 86.5–448.4), and the geometric mean ratio was 12.1 (95%CI 5.28–27.9). The seroconversion rate (4 fold increase in the antibody titer and ≥1:40) was 75% (95%CI, 54–96%), and the post-vaccination seroprotection rate (titer ≥1:40) was 90% (95%CI, 77–100%). When re-tested at 6–16 weeks, the results were not significantly different. Among the 5 patients (25%) who did not show seroconversion, 2 had very high baseline protection titers, 2 did not attain seroprotective titers after vaccination, another one did not show protective titer at 6 weeks, but mounted a titer of 1:40 at 10 weeks. No serious adverse events or hospital admissions from H1N1 infection were documented at 6 months of follow up. Subgroup analyses were performed to evaluate the influence on seroconversion rates of potential factors including (1) the presence or absence of active disease, (2) lymphoproliferative disorders versus myeloid disorders, (3) myelosuppressive drugs, (4) immunosuppressive drugs, and none showed a significant difference. Three patients were treated with Rituximab based chemotherapy, 1 patient who had R-CHOP for NHL showed robust response at 4–6 weeks, while 1 patient who had CLL treated with FCR, and another one with NHL treated with R-Bendamustine failed to develop response. These are the only 2 patients who did not show seroconversion or seroprotective titers in this study. Conclusion: Patients with hematologic malignancies are able to generate an immune response to the H1N1 vaccine. The lower boundaries of CI of seroconversion rate (54%) and that of seroprotection rate (77%) are above what are recommended by the US FDA for an effective vaccine. Among the patients who developed an immune response, all but one demonstrated response within 4–6 weeks. Patients receiving Rituximab based treatment nevertheless can generate an effective immune response. Disclosures: No relevant conflicts of interest to declare.

Effects of Prior Polysaccharide Vaccination on Magnitude, Duration, and Quality of Immune Responses to and Safety Profile of a Meningococcal Serogroup C Tetanus Toxoid Conjugate Vaccination in Adults

ABSTRACT Extensive use of meningococcal AC polysaccharide (MACP) vaccines has raised concerns about induction of immunologic hyporesponsiveness to C polysaccharide. We investigated the immunogenicity and safety of a meningococcal C-tetanus conjugate (MCC-TT) vaccine in naïve adults and prior MACP vaccinees. Laboratory staff (n = 113) were recruited; 73 were naïve to meningococcal vaccination, and 40 had previously received ≥1 dose of MACP vaccine. Blood was taken prior to MCC-TT vaccination and 1 week, 1 month, and 6 months later. At each time point, proportions of subjects with serum bactericidal antibody (SBA) titers of ≥8 or ≥128 were similar (P > 0.46); >94% of subjects achieved titers of ≥128 at 1 month. However, the geometric mean titer (GMT) of SBA at 1 month was higher in the naïve (1,757; 95% confidence interval [95% CI], 1,102 to 2,803) than in the previously vaccinated (662; 95% CI, 363 to 1,207) group (P = 0.02), and similarly at 6 months (P < 0.001). Conversely, geometric mean concentrations (GMCs) of serogroup C-specific immunoglobulin G (IgG) were significantly higher in the previously vaccinated group pre-MCC-TT and at 1 week; the groups were similar at 1 month, and there was some evidence that the GMC for the previously vaccinated group was higher at 6 months. Qualitative differences in antibodies between groups were demonstrated by using the SBA/IgG ratio, though avidity measures were similar for the two groups throughout the study. MCC-TT was well tolerated, with similar safety profiles in the two groups. Pain in the arm and headache were the most frequently reported events following vaccination. The study shows that MCC-TT is safe and immunogenic in naïve and previously MACP-vaccinated adults, though the magnitude and persistence of postvaccination SBA responses in the latter group were lower.

Constitutive Expression of the Vi Polysaccharide Capsular Antigen in Attenuated Salmonella entericaSerovar Typhi Oral Vaccine Strain CVD 909

ABSTRACT Live oral Ty21a and parenteral Vi polysaccharide vaccines provide significant protection against typhoid fever, albeit by distinct immune mechanisms. Vi stimulates serum immunoglobulin G Vi antibodies, whereas Ty21a, which does not express Vi, elicits humoral and cell-mediated immune responses other than Vi antibodies. Protection may be enhanced if serum Vi antibody as well as cell-mediated and humoral responses can be stimulated. Disappointingly, several new attenuated Salmonella enterica serovar Typhi oral vaccines (e.g., CVD 908-htrA and Ty800) that elicit serum O and H antibody and cell-mediated responses following a single dose do not stimulate serum Vi antibody. Vi expression is regulated in response to environmental signals such as osmolarity by controlling the transcription oftviA in the viaB locus. To investigate if Vi antibodies can be stimulated if Vi expression is rendered constitutive, we replaced P tviA in serovar Typhi vaccine CVD 908-htrA with the constitutive promoter P tac , resulting in CVD 909. CVD 909 expresses Vi even under high-osmolarity conditions and is less invasive for Henle 407 cells. In mice immunized with a single intranasal dose, CVD 909 was more immunogenic than CVD 908-htrA in eliciting serum Vi antibodies (geometric mean titer of 160 versus 49, P = 0.0007), whereas O antibody responses were virtually identical (geometric mean titer of 87 versus 80). In mice challenged intraperitoneally with wild-type serovar Typhi 4 weeks after a single intranasal immunization, the mortality of those immunized with CVD 909 (3 of 8) was significantly lower than that of control mice (10 of 10,P = 0.043) or mice given CVD 908-htrA (9 of 10, P = 0.0065).