Immunization/prophylaxis clinics

Apart from animal studies, a large number of clinical studies have been carried out since the 1970s to demonstrate the efficacy of immune milk preparations in the prophylaxis or therapy of human GI diseases. These studies have been reviewed in several articles (Facon et al., 1993 Hammarstrom et al., 1994 Ruiz, 1994 Davidson, 1996 Weiner et al., 1999 Korhonen et al., 2000b Lilius and Mamila, 2001). Examples of immune milk trials carried out in humans are described in Table II. Clinical evidence obtained in most of these studies indicates that immune milk preparations are protective and, to some extent, also therapeutic against rotavirus infections in children (Ebina et al, 1985 Davidson et al., 1989 Mitra et al, 1995 Sarker et al, 1998). A protective or therapeutic effect of immune milk has also been demonstrated in humans against... 

Candidate vaccines under development are immunogenic and confer protection against lethal aerosol exposures. Recent animal studies have shown that either active immunization or passive prophylaxis may be effective against intravenous or intraperitoneal intoxication with ricin (Poh et al, 1994). In the case of inhalational exposure, active immunization or prophylactic administration of aerosolized specific anti-ricin antibody may also be effective (Poli et al, 1994). Unfortunately, these applications may not be clinically available since they are still under investigation. 

In a placebo-controlled study of chemoprophylaxis for malaria, 701 Tanzanian infants were assigned to intermittent pyrimethamine + sulfadoxine (under 5 kg, a quarter of a tablet 5-10 kg, half a tablet over 10 kg, one tablet each tablet contained pyrimethamine 25 mg plus sulfadoxine 500 mg) alongside routine childhood immunizations and iron supplementation at 2, 3, and 9 months of age (4). The combination was well tolerated, with no reported adverse events. Episodes of clinical malaria fell by 59% (95% Cl = 41, 72) and the incidence of severe anemia by 50% (95% Cl = 8, 73%) in the first year of life. Contrary to previous studies involving continuous prophylaxis in infants, there was no increase in the frequency of rebound episodes of malaria up to 18 months of age, suggesting that the development of malaria-specific immunity was unimpaired. Responses to vaccines were unaffected. 

Para MF, Finkelstein D, Becker S, Dohn M, Walawander A, Black JR. Reduced toxicity with gradual initiation of trimethoprim-sulfamethoxazole as primary prophylaxis for Pneumocystis carinii pneumonia AIDS Clinical Trials Group 268. J Acquir Immune Defic Syndr 2000 24(4) 337 3. 

Some of the clinical consequences in SS disease include megaloblastic erythropoiesis, aplastic crisis, stroke, bone pain crisis, proneness to infection particularly by Pneumococcus, Salmonella, and Haemophilus due to hypos-plenism and acute chest syndrome. Prophylactic use of penicillin and antipneumococcal and Haemophilus vaccines has aided in the management of life-threatening infectious complications of SS disease. Neonatal screening has been used in the identification of infants with sickle cell disease so that risk of infection can be modulated by appropriate immunizations and penicillin prophylaxis. The acute chest syndrome characterized by chest pain is due to clogged pulmonary capillaries in a small number of studies, patients have been treated with inhaled nitric oxide, which dilates blood vessels with clinical improvement. 

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