A study of the association between seasonal influenza vaccines and the increased risk of Guillain-Barré syndrome using Vaccine Adverse Event Reporting System, 2018-2019

The aim of this study was to investigate the association between the incidence of Guillain-Barré syndrome (GBS) and seasonal influenza vaccines using the United States Vaccine Adverse Event Reporting System. Using multiple logistic regression analysis, we calculated the adjusted reporting odds ratio (ROR) of GBS cases associated with seasonal influenza vaccines administered from August 2018 to July 2019. Additionally, we analyzed the time-to-onset profile. The total number of adverse events reported following vaccination during this period was 43,235. Most of the GBS patients received a cell culture-based quadrivalent inactivated influenza vaccine (42.2%), quadrivalent inactivated influenza vaccine (26.6%), or high-dose trivalent inactivated influenza vaccine (15.6%). The adjusted ROR of seasonal influenza vaccines for GBS was 3.44 (2.40-4.95). The adjusted ROR of sex (male) (as reference female) and 0.5-59 years (as reference ≥ 60 years) were 1.90 (0.73-4.95) and 1.57 (0.88-2.78). Male sex and advanced age were not risk factors for GBS. The median duration of GBS was 9.5 (4.0-21.5) days. GBS following seasonal influenza vaccination developed mainly within 14 days and 42 days at most. In sex-stratified analyses, the median durations of GBS in females and males were 12.0 (8.3-28.5) and 5.0 (3.0-15.5) days (P = 0.050). Therefore, our findings indicate that the incidence of GBS is associated with seasonal influenza vaccines, and careful monitoring of GBS is required for up to 42 days, especially in the first 14 days. Moreover, GBS may occur slightly earlier in males than in females.

[Sarcoidosis with pulmonary cavitation and calcification]

A 38-year-old man was seen at another hospital because of bilateral reticulo-nodular shadows on a chest X-ray film at the time of a regular health check-up. Pulmonary tuberculosis was diagnosed, and the patient was treated with antituberculous chemotherapy. The shadow did not improve, and the patient was transferred to our hospital. Bacteriological studies for pyogenic bacteria, mycobacteria, and fungi were all negative. Serum levels of angiotensin-converting enzyme and lysozyme were abnormally high. Examination of a specimen obtained by transbronchial lung biopsy revealed noncaseating epithelioid-cell granuloma associated with severe hyalinization. Sarcoidosis was diagnosed. Chest CT showed multiple nodular opacities, some of which were calcified. Oral steroids were given because the lesion was progressing rapidly. Cavitary lesions appeared during tapering of steroid therapy. Bacteriological and fungal studies were negative and transbronchial lung biopsy showed noncaseating epithelioid-cell granuloma. Therefore, the cavitation within the granuloma with hyalinization may have developed because of steroid therapy, and the calcification may have been caused by postorganizing dystrophy.

[Digital analysis of pulmonary nodules--potential usefulness of computer-aided diagnosis for differentiation of benign from malignant nodules]

Digital analysis of 80 plain chest radiographs was done to differentiate benign from malignant pulmonary nodules. Each of 80 radiographs had a solitary pulmonary nodule, of which 40 were benign and the other 40 were malignant. Radiographic features of nodules were visually evaluated. Frequencies of the radiographic features described below were significantly different between benign and malignant nodules: irregular shape, vague density, well-defined contour, spicular formation, and vascular convergene. To digitally evaluate the density characteristics, two kinds of concentric circular windows were used, to allow analysis of intra-nodular, marginal and surrounding regions of the nodules. Seventeen digital parameters were obtained by computerized analysis with the windows. There were significant differences in six digital parameters; three of density gradient (one of intra-nodular and two of marginal regions), one DCF-N (directional contrast filter for nodule) output of intra-nodular region, and two of density entropy values of intra-nodular and surrounding regions. Density gradient parameters of marginal regions are believed to represent the features of nodular shape and spicula formation. With these six parameters, 70% of benign nodules and 85% of malignant nodules were correctly discriminated. These results suggest that computer-aided diagnosis may be used to differentiate benign from malignant nodules.

Absence of nonpercutaneous transmission of hepatitis C virus in a colony of chimpanzees

Transmission of hepatitis C virus (HCV) was studied in a colony of 85 chimpanzees using assays for anti-HCV and HCV-RNA. Thirteen of the 85 sera were positive for anti-HCV, and 12 of the 13 were also positive for HCV-RNA. All of the anti-HCV positive sera except one were obtained from chimpanzees which had been inoculated with non-A, non-B hepatitis virus. On the other hand, only one of 63 sera of chimpanzees without history of experimental infection of the virus was positive for anti-HCV. Transmission to this chimpanzee was thought to be a needle contaminated with HCV. All 39 samples of chimpanzees born in the center were negative for both anti-HCV and HCV-RNA. Sixteen of their mothers had undergone experimental infection, and 6 of them were positive for both anti-HCV and HCV-RNA. These results suggest that nonpercutaneous transmission, including sexual and mother-to-infant transmissions, is not an important mode of transmission. If these findings apply to humans, definition of inapparent sources of the infection is needed.

[A case of pulmonary eosinophilic granuloma with involvement of the ocular fundus]

A 37-year-old man was admitted to our hospital because of abnormal shadows on chest X-ray film at routine medical examination. The chest X-ray showed diffuse granular shadows in the bilateral upper and middle lung fields. Chest CT showed multiple cystic lesions and nodular lesions. Bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) were performed. Electron microscopic examination of BAL fluid revealed Langerhans' cells, and lung tissue specimen obtained by TBLB showed granuloma with infiltration of histiocytes and eosinophils. During the clinical course, the patient complained of cough and decrease of right visual acuity in association with an increase of abnormal shadows on chest X-ray. The lung disease gradually resolved after the cessation of smoking in spite of no therapy. In the right eye, an exudative lesion with retinal elevation was noted in the ocular fundus. Corticosteroid administration was effective for the treatment of this lesion. There was no pathological evidence of the right ocular lesion. However, the correlation of its clinical course with the lung disease suggests a relationship between the ocular lesion and pulmonary eosinophilic granuloma.

[A case of pulmonary sarcoidosis with B lymphocytosis in peripheral blood]

A 24-year-old man was admitted on October 14, 1988, with bilateral cotton-like shadows on chest X-ray film. Chest CT demonstrated multiple nodular shadows in bilateral lung fields. Laboratory data on admission showed peripheral blood lymphocytosis and slight decrease of serum IgG and IgA. ACE was within normal limits, and BALF findings showed no increase of lymphocytes. Surface marker analysis of peripheral blood lymphocytes showed an increase of B lymphocytes of antibody independent stage (B1, B4, J5, OKB7, sIgM, and sIgD positive cells were increased). Southern blot analysis of peripheral blood showed no rearrangement of immunoglobulin chains (H chain and L chain). In order to differentiate sarcoidosis from lymphoproliferative disorder, open lung biopsy was performed. Pathologic study revealed multiple epithelial granulomas without caseation. Immunohistochemical study demonstrated no accumulation of B cells of the lung. This patient was pathologically diagnosed as having pulmonary sarcoidosis. The abnormal chest shadows gradually improved without therapy; however, B cell lymphocytosis and slight decrease of serum IgG and IgA persisted. In general, lymphocytopenia of peripheral blood is usual in sarcoidosis. We report a rare case of pulmonary sarcoidosis with polyclonal B lymphocytosis of antibody independent stage in peripheral blood.

[Personal computer-based interpretation experiment system for digital chest images]

We have developed a system of nodule detection interpretation experiment on personal computers. This system is composed of three subsystems: practice, experiment and check modes. In the practice and experiment modes, chest radiographic images, each with or without a nodule, are shown in a random order on the monitor. The reader is then asked to point a location of nodule and to give a confidence rating. In the check mode, a subsystem shows locations of the real nodules and false positive foci on a figure of a chest radiograph. It also shows receiver operating characteristics of each reader. This system can precisely and easily perform an interpretation experiment. Then reader performance in detection of nodules can be accurately and promptly evaluated. This system, therefore, is very useful to perform a large-scale interpretation experiment in a constant reading condition.

Orosomucoid typing of apes (family Pongidae) by isoelectric focusing: among primates do only humans have two functional orosomucoid loci?

It has been demonstrated that human orosomucoid (ORM) is controlled by more than one functional loci, while Macaca ORM is controlled by one locus. To examine the time when the ORM gene was duplicated in the evolution of primates, plasma samples from 118 apes (family Pongidae) belonging to 4 genera and 12 species were investigated for ORM polymorphism using isoelectric focusing followed by immunoprinting. The band patterns of ORM in the subfamily Ponginae showed quantitatively different products as in humans. A pedigree study of common chimpanzees supported the two-locus model for ORM. Gibbons (subfamily Hylobatinae) displayed highly variable band patterns, but the number of loci was not determined unequivocally. Thus, this study shows that duplication of the ORM gene in primates occurred either before or after the divergence of Hylobatinae and Ponginae, consistent with a previous prediction from the molecular evolutionary rate of ORM.

[Clinical evaluation of S 6472 granule preparation (sustained-release cefaclor) in chronic bronchitis]

S 6472 granule preparation, a sustained-release cefaclor, was orally administered to 20 acutely exacerbated cases of chronic bronchitis at a daily dosage of 750 mg (titer) in 2 divided doses for a duration of 7-15 days and its clinical usefulness was evaluated. Clinical efficacies were good in 17 cases and fair in 3 cases, with a rate of efficacy of 85.0%. Organisms isolated from 13 patients were totalling 14 strains, i.e., 5 strains of Streptococcus pneumoniae, 3 strains of Branhamella catarrhalis, 2 strains of Streptococcus sp., 2 strains of Klebsiella oxytoca, 1 strain of Haemophilus influenzae and 1 strain of Staphylococcus aureus. All these strains, except the strains of Streptococcus sp., disappeared upon the administration of the drug. With regard to the safety, no side effects nor abnormal laboratory test values were encountered.