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Human cytomegalovirus (HCMV) causes retinitis and is the leading cause of blindness in patients infected with the human immunodeficiency virus (HIV). While most patients with HIV are HCMV seropositive, not all will develop clinical complications from it. The immune responses that can prevent the development of HCMV retinitis are unknown. The levels of anti-HCMV antibodies, including responses to the two major envelope proteins, gpUL55 (gB) and gpUL75 (gH), which are the targets of neutralizing antibody (NA), were examined in HIV-infected patients with and without retinitis. No specific deficiency in the antibody response of retinitis patients was observed. However, higher levels of NA were associated with a more favorable clinical course. These results indicate that antibodies may modulate progression of disease, and they suggest a possible role for the exogenous administration of NA in patients who develop HCMV retinitis.

Recombinant baculoviruses were used to produce human B19 parvovirus empty capsids composed of only VP2 and VP2 capsids containing 4%, 25%, 35%, or 41% VP1 protein. Immunogenicity of the purified capsids, formulated with or without adjuvant, was evaluated in mice, guinea pigs, and rabbits. Sera were analyzed for total anti-B19 parvovirus antibodies, antibodies specific to the region unique to the VP1 capsid protein, and virus neutralizing antibodies. A relationship was observed between the development of antibodies specific to sequences unique to the VP1 protein and virus neutralization. The polypeptide composition of the empty capsid immunogens appeared to be important for elicitation of potent virus neutralizing activity. VP2 capsid immunogens devoid of VP1 protein, or consisting of only 4% VP1, the composition of naturally occurring virions, were generally poor at eliciting high levels of virus neutralizing activity. Capsids consisting of > or = 25% VP1 protein efficiently and consistently provoked vigorous B19 virus neutralizing responses. Recombinant empty capsids enriched for the VP1 protein should serve as the basis for a human B19 parvovirus vaccine.

The purpose of this study was to assess whether labor and delivery events were risk factors for sudden infant death syndrome (SIDS). A nested case-control design was used. From the 1974 cohort of live births for Upstate New York (exclusive of New York City), resident mothers (n = 132,948), SIDS cases, and living controls were selected. Data were abstracted from hospital delivery and vital records for 148 autopsied cases and 355 frequency-matched controls. With the use of unconditional logistic regression, no increase in SIDS risk was observed for artificial rupture of membranes, medication use during labor, induction/augmentation of labor, or anesthesia for delivery. An increased risk of SIDS was observed for labor 16 hours or more (odds ratio (OR) = 2.6, 95% confidence interval (CI) 1.1-6.5) and vaginal breech delivery (OR = 7.2, 95% CI 0.7-72.2). Significant inverse trends were observed for Apgar scores and risk of SIDS.

In order to assess the influence of secular effects and gravidity on the incidence rate of ectopic pregnancy, information from reproductive history questionnaires was obtained for 7804 gravid females identified through the Norwegian Twin Panel. The overall ectopic pregnancy incidence rate was 5.6 per 1000 estimated conceptions, with rates increasing for women born after 1950. Women experiencing their first pregnancy were at lowest risk for that pregnancy being ectopic. When women were stratified by whether they were born before or after 1950, gravidity still had an effect on the incidence rate of ectopic pregnancy. Conversely, year of birth was influential when stratifying by gravidity. The results obtained here suggest that the recent increase in the incidence of ectopic pregnancy is unrelated to the number of prior pregnancies.

Several investigators have noted an increase in the rate of congenital dislocation of the hip shortly after the initiation of neonatal screening procedures. This increase has been attributed to the detection of temporarily unstable hips which require no corrective treatment. To test whether neonatal screening had low specificity, the authors obtained data on 17,145 offspring of 7,896 twins from the Norwegian Twin Panel. Information from maternal reproduction history questionnaires was available on the presence or absence of congenital dislocation of the hip, type of obstetric delivery, and parity. The reported prevalence of the disorder did indeed begin to rise sharply during the late 1950s, at which time neonatal screening started in Norway. Infants were then grouped by year of birth (born before or after 1960), and odds ratios were calculated for breech delivery and early (first or second) parity. For the pre-screening group, the odds ratio of congenital dislocation of the hip was 7.7 among children delivered by breech presentation and 2.6 among those of early parity. These values are similar to those found in other studies. In the post-screening group, the odds ratios for breech delivery and early parity were 1.5 and 1.2, respectively. Breech delivery and early parity have been consistent risk factors for congenital dislocation of the hip. Their diminished influence in the post-screening group, as well as sharply increased rates of the disorder, suggests that in Norway neonatal screening programs may have had low specificity in detecting cases that required treatment.

The purpose of this study was to assess whether intrauterine growth retardation was associated with an increased risk of sudden infant death syndrome (SIDS). A total of 148 SIDS cases were identified from the Upstate New York (exclusive of New York City) live birth cohort for 1974 (n = 132,948). Dead controls represented all other sudden deaths (n = 114). Live controls were randomly selected and matched to cases on mother's age, race, parity, and residence and infant's birth date (n = 355). Data were collected from vital certificates (response, 97%), medical records (89%), and autopsy reports (100%). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with the use of logistic regression techniques to control for confounding. With live controls, significant risks were observed for gestations less than 37 weeks (OR = 2.2, CI 1.2-4.1), birth weights less than 2,500 g (OR = 2.5, CI 1.3-5.0) and birth lengths less than or equal to 47.0 cm (OR = 3.4, CI 1.8-6.4). Birth length less than or equal to 47.0 cm was the only significant risk factor observed when dead controls were used (OR = 2.9, CI 1.3-6.8). Risk decreased with increasing gestation and birth size. Postterm infants (greater than or equal to 42 weeks) were at lowest risk (live controls OR = 0.9, CI 0.5-1.6; dead controls OR = 0.6, CI 0.3-1.1). When gestational age was controlled for, SIDS infants were found to have reductions in both weight and length; this suggests that responsible mechanisms begin early in pregnancy.