Showing papers by "Joseph S. Bresee published in 1996"
TL;DR: Gammagard was the only IGIV product implicated in the transmission of HCV, and infection was associated with higher quantities ofHCV RNA in Gammagards produced from second-generation anti-HCV-screened plasma.
Abstract: Objective —To determine the risk of and risk factors for hepatitis C virus (HCV) infection among persons with immune deficiencies who had received intravenous immune globulin (IGIV) between March 1993 and February 1994 Design —Retrospective cohort study Setting —An immunology program in a tertiary care hospital Patients —Of 341 persons who had received IGIV between March 1,1993, and February 22,1994, 278 (82%) were enrolled The mean age for the enrolled persons was 9 years, and 99% had primary immune deficiencies Main Outcome Measures —Evidence of HCV infection by detection in sera of antibody to HCV and/or HCV RNA by reverse transcriptase polymerase chain reaction Results —Twenty-three (11%) of 210 persons who received the IGIV Gammagard (Baxter Healthcare Corporation, Deerfield, III) became infected compared with none of 52 persons who received exclusively other IGIV products (P=01) In a multivariate analysis, HCV infection was associated only with Gammagard produced from plasma screened by second-generation (multiantigen) anti-HCV tests (P=03) Hepatitis C virus RNA was detected in Gammagard, and the risk of transmission to recipients increased with increasing quantity of HCV RNA infused, from 0 for those who received no HCV RNA-positive lots to 29% for the quartile of patients receiving the greatest amount (P Conclusion —Gammagard was the only IGIV product implicated in the transmission of HCV Infection was associated with higher quantities of HCV RNA in Gammagard produced from second-generation anti-HCV-screened plasma Further studies are needed to determine reasons for the infectivity of Gammagard, and viral inactivation and removal steps are needed to ensure the safety of IGIV products
108 citations
TL;DR: If vitamin A has a beneficial effect on the course of RSV disease, it may be seen only in more severely ill children, and there was no significant benefit from vitamin A treatment for the overall group in duration of hospitalization, need for supplemental oxygen or time to resolve hypoxemia.
Abstract: Background Treatment with high dose vitamin A reduces complications and duration of hospitalization for children with measles. In respiratory syncytial virus (RSV) infection, as with measles, low serum vitamin A concentrations correlate with increased severity of illness. Methods To determine whether high dose vitamin A treatment is also effective for treating RSV disease, we conducted a randomized, double blind, placebo-controlled trial among 180 RSV-infected children between 1 month and 6 years of age at three hospitals in Santiago, Chile. Children with nasal washes positive for RSV antigen were given oral vitamin A (50 000 to 200 000 IU of retinyl palmitate, dosed according to age; n = 89) or placebo (n = 91) within 2 days of admission. Results There was no significant benefit from vitamin A treatment for the overall group in duration of hospitalization, need for supplemental oxygen or time to resolve hypoxemia. For the subgroup of children with significant hypoxemia on admission (room air oxygen saturation level ≤90%), those given vitamin A had more rapid resolution of tachypnea (P = 0.01) and a shorter duration of hospitalization (5.5 vs. 9.3 days, P = 0.09). No toxicities were seen, including excess vomiting or bulging fontanel. Conclusion If vitamin A has a beneficial effect on the course of RSV disease, it may be seen only in more severely ill children.
63 citations
Journal Article•
TL;DR: To characterize the clinical features of hepatitis C virus (HCV) infection associated with the administration of intravenous immunoglobulin (IVIG) in patients with varied immunodeficiencies, clinical and virologic data are collected in patients determined to have HCV exposure associated with Gammagard.
Abstract: Objective. To characterize the clinical features of hepatitis C virus (HCV) infection associated with the administration of intravenous immunoglobulin (IVIG) in patients with varied immunodeficiencies. Design. Prospective collection of clinical and virologic logic data in patients determined to have HCV exposure associated with Gammagard. Setting. Outpatient department of children9s Hospital tal, Boston. Patients. Twenty-one patients with evidence of HCV infection were identified during a screening program initiated to detect infection in exposed individuals. They ranged from 5 to 53 years of age; 14 were children under age 18. Results. Six patients presented with severe clinical hepatitis before detection by screening, 13 were detected by screening only, and 2 were first detected by screening and subsequently developed symptomatic hepatitis. Follow-up is available on 20 patients; 4 without viremia at identification have remained clinically well. Hepatitis and viremia have resolved in 2, 2 additional subjects have developed normal alanine aminotransferase (ALT) values with persistent viremia, and 13 have biochemical and/or virologic evidence of chronic hepatitis. Eight patients (7 children) have undergone liver biopsies; 7 have histologic findings of chronic hepatitis, 5 have mild fibrosis, and 2 have moderate fibrosis. HCV genotypes 1a and 1b were observed with equal frequency in this group. Conclusions. Some HCV infections associated with IVIG had a more severe, acute course than is ordinarily described. This may be attributable to host factors, such as immunodeficiencies, or virologic factors, such as inoculum or genotype. Although a large percentage (87.5%) of these individuals developed chronic infection, the natural history is not as yet completely defined.
36 citations
3 citations