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October 2008
Vol. 18 No. 10
Patient Care and Science
In the IDSA Journals
Steve Baragona

Intradermal Shot Improves Influenza Vaccine Response in Older Adults

Adults over age 65 have the highest annual mortality from influenza and have decreased immune response to influenza vaccine, which is normally delivered intramuscularly. Researchers used a simple, reliable microinjection system to deliver trivalent influenza vaccine intradermally to more than 700 subjects with an average age of 70. Immune responses, as measured by antibody titers, seroprotection rates, and seroconversion rates, were superior in these individuals when compared to control subjects who received vaccine intramuscularly. The overall frequency of systemic adverse events was equivalent between intradermal and intramuscular immunization. Local reactions, e.g., erythema, swelling, induration, and pruritus, were more common in the intradermal group, but were mild. (Holland et al., J Infect Dis. 2008;198:650-658. Editorial commentary by McElhaney and Dutz, J Infect Dis. 2008;198:632-634.)

H5N1 Vaccines: Good News on Priming, Cross-reactivity, Dose Sparing

Two studies provide good news on influenza A H5N1 vaccines. In the first, 37 subjects previously vaccinated against a clade 0 strain of the virus (A/Hong Kong/156/1997) in studies conducted in 1997-1998 were given one dose of vaccine derived from a newer, clade 1 strain (A/Vietnam/1203/2004). Sixty-eight percent of these subjects had positive immune responses (4-fold increase in antibody level to a titer of 1:40 or greater), compared to 43 percent of 103 H5N1-naïve subjects given two doses of the clade 1 vaccine. (Goji et al., J Infect Dis. 2008;198:635-641). In the second study, an oil-in-water adjuvanted vaccine was safe and immunogenic at 1.9 µg of antigen, the lowest effective dose yet studied. This clade 1 vaccine also demonstrated cross-reactivity against clade 2 virus.  These studies advance our knowledge regarding potentially useful H5N1 vaccines and point to new strategies for pandemic influenza preparedness. (Levie et al., J Infect Dis. 2008;198:642-649. Editorial commentary discussing both studies by Poland and Sambhara, J Infect Dis. 2008;198:629-631.)

Increasing Legionellosis in the United States  

The authors analyzed all cases of legionellosis reported to the Centers for Disease Control and Prevention from 1990 through 2005. From 2002 through 2003, the number of reported cases increased by 70 percent, and the incidence of legionellosis has remained at 2003 levels since that time. Cases were concentrated on the East coast. The increases have been greatest among younger persons. (Neil and Berkelman, Clin Infect Dis. 2008;47:591-599.)

Single-day Famciclovir for Genital Herpes 

In this double-blind study, nearly 1200 adults with histories of recurrent genital herpes were randomized to receive either single-day famciclovir (1000 mg twice daily) or 3-day valacyclovir (500 mg twice daily). Patients initiated treatment within 6 hours after a recurrence of symptoms. The groups had similar treatment outcomes, with approximately one-third of patients in each group having aborted episodes, and minimal differences in time to healing of lesions. The overall incidence of adverse events was similar for both groups. (Abudalu et al., Clin Infect Dis. 2008;47:651-658.)

Internet-based Antimicrobial Stewardship  

The implementation of an internet-based antimicrobial stewardship program at Johns Hopkins Children's Medical and Surgical Center led to an almost 12 percent decrease in dispensed doses. The online system enhanced communication between prescribers, pharmacists, and pediatric infectious disease fellows and yielded a significant reduction in the number of missed and delayed doses. (Agwu et al., Clin Infect Dis. 2008;47:747-753.)

More from the literature: the IDSA Journal Club

Don’t miss this feature to help you stay up to date on the infectious diseases literature. Each month, the IDSA Journal Club features brief summaries of key infectious diseases studies in the previous month’s major journals chosen by the new IDSA Literature Review Panel.

In addition, the “In This Issue” section of each issue of Clinical Infectious Diseases (CID) highlights several important studies from that journal. (Click for October 1 or October 15.) For a review of other recent research in the infectious diseases literature, see “In the Literature,” by Stanley Deresinski, MD, in each issue of CID:

October 1      

  • Avian H7 Influenza Viruses with Adaptation to Human Airway Epithelial Cell Receptors
  • Spinal Facet Joint Infection
  • The Downs and Ups of Infection with Group B Streptococci (GBS)
  • Maybe Femoral Venous Catheterization Isn't So Bad after All
  • Multidrug-Resistant Staphylococcus aureus (MRSA) Infection among Men Who Have Sex with Men

October 15  

  • Ventilator-Associated Tracheobronchitis (VAT)
  • Bladder Catheters and Infection: We Can Do Better
  • Mumps is Back!

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