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Objective. To evaluate the safety and immunogenicity of the recombinant acellular pertussis-diphtheria-tetanus (aPDT) vaccine (C-aPDT, Chiron/Biocine®). Study design. This is a randomized blinded trial evaluating the safety and immunogenicity of the recombinant aPDT vaccine (C-aPDT, Chiron/Biocine®) in 2000 infant recipients compared with 498 controls who received whole cell diphtheria-pertussis-tetanus (wDPT; Connaught) vaccine at 2, 4 and 6 months of age. In addition the safety and immunogenicity of the same C-aPDT vaccine were evaluated as a booster dose in a subset of the same population when given at 15 to 18 months of age and compared with licensed Lederle aPDT vaccine. Results. The C-aPDT vaccine was associated with very few local or systemic reactions when compared with wDPT. In toddlers the local and systemic side effects observed were similar after either acellular vaccine. When the immunogenicity of the C-aPDT vaccine was compared with the wDPT (Connaught) in infancy, the vaccines were equivalent for anti-diphtheria response, the wDPT developed higher anti-tetanus response and the C-aPDT vaccine was significantly more immunogenic for all other antigens tested. In toddlers the C-aPDT acellular vaccine exhibited equal or improved immunogenicity for antigens tested as compared with Lederle aPDT except for a higher anti-filamentous hemagglutinin response with the Lederle aPDT vaccine. Conclusion. The Chiron/Biocine® aPDT vaccine offers an improved safety profile as well as improved immunogenicity when compared with a licensed wDPT product.

Although neonatal intensive care units are known to be expensive, much of what happens inside such units in managed care organizations is not known. One reason for this lack of knowledge is that existing database systems were not designed to capture information in modern critical care units. This article describes the development of a dedicated outcomes database and wide area network linking six level III intensive care nurseries in the Kaiser Permanente Medical Care Program's Northern California Region. This database can be considered a hybrid, in that it combines attributes of research and operational systems.

Background. Measurement of the severity of illness is a research area of growing importance in neonatal intensive care. Most severity of illness scales have been developed in tertiary care settings. Their applicability in community neonatal intensive care units has not been tested. Objectives. Our goal was to assess the operational characteristics of the score for neonatal acute physiology (SNAP): the relationship to birth weight, the length of total hospital stay, and in-hospital mortality. Methods. We assigned SNAP scores prospectively to all inborn admissions at three community neonatal intensive care units during an 11-month period. Data on other neonatal predictors (eg, birth weight and the presence of congenital heart disease) were also collected. We measured in-hospital mortality, the experience of interhospital transport to a higher level of care, and total hospital stay. Results. We found that the SNAP's relationship to birth weight was similar to previous reports. The SNAP's perinatal extension is a reliable predictor of newborn in-hospital mortality, with an area under the receiver operator characteristic curve of 0.95. The SNAP is also a good predictor of total hospital length of stay, whether by itself (by which it can explain 31% of the total stay) or in combination with other variables. Its predictive ability is better among infants of low birth weight ( Conclusion. Although it has definite limitations among infants who weigh 2500 g or more, the SNAP is a potent tool for outcomes research. Modification of some of its parameters could result in a multifunctional scale suitable for use with all birth weights.

Healthy children (N=609) 12 months to 23 months old were randomly assigned to one group(A) receiving MMRII, Tetramune and Varivax given separately and concomitantly and another group (B) receiving MMRII and Tetramune separately and concomitantly with Varivax given 6 weeks later. Subjects were followed for 42 days after each vaccination for local and systemic reactions. Serology was determined at day 42 for Group A and day 84 for Group B. No significant differences were noted between groups for local reactions, injection site rashes, fever≥102° F, or other systemic reactions as a group. There was a significant difference observed in GMTs for varicella(p=