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Edward Rothstein: Edith has asked me to chair this session, 'The Ascendance of Science and Technology.' Traditionally, in gatherings of intellectuals and discussions about culture, science tends to be omitted--unless [...]

John Patrick Diggins: Welcome to the fourth session of 'Our Country, Our Culture.' I will introduce the speakers successively. We're going to start with Hilton Kramer, the editor of The [...]

Edith Kurzweil: Hilton Kramer is the moderator this morning. Next to him are Jules Olitski and Bob Brustein. Cynthia Ozick couldn't come, because she suddenly got very ill, but she [...]

The new Japanese and U.S. pertussis formulations of the diphtheria-tetanus-pertussis (DPT) vaccine appear to provide similar degrees of protection, and intramuscular injection seems to cause fewer adverse localized reactions than injections under the skin. The new whooping cough vaccines contain components of Bordetella pertussis instead of whole, killed cells, which causes fewer side effects. Researchers measured antibody levels and evaluated side effects in 189 Japanese and U.S. infants receiving their two-, four-, and six-month DPT series. Infants in both countries were randomly assigned to receive the Japanese or the U.S. version of the pertussis vaccine. No serious adverse reactions were seen. Infants given the vaccine under the skin were more likely to have local inflammation. Only minor differences in antibody levels were seen. These differences depended on formulation, nationality, and whether the vaccine was injected into the muscle or under the skin., Objective. We compared the diphtheria and tetanus toxoids and bicomponent acellular pertussis vaccine (DTaP) responses in Japanese and United States infants. Design. This was a double-blind, comparative study. Setting. Private pediatric practices in Japan and the U.S. participated. Subjects. One hundred eighty-nine healthy 2-month-old infants were tested. Interventions. Infants were immunized at 2, 4, and 6 months of age. The Japanese formulation (DTaP-J) contained 20 [mu]g of pertussis toxin (PT) and 20 [mu]g of filamentous hemagglutinin (FHA); the U.S. formulation (DTaP-US) contained 23.4 [mu]g of each antigen. Parents used a standard form to record adverse experiences. Serum was obtained before the first immunization, 2 months after the second immunization, and 1 month after the third immunization. Measurements. Differences in DTaP-J and DTaP-US were evaluated in Japanese infants immunized subcutaneously (SC). Differences due to ethnicity and to route of administration were compared in U.S. infants immunized with DTaP-US SC or intramuscularly (IM). An indirect enzyme-linked immunosorbent assay was used to determine immunoglobulin G antibody responses to PT, FHA, and tetanus toxoid. Neutralizing antibody to PT was measured by a Chinese hamster ovary cell assay. Diphtheria antitoxin was assayed by serum neutralization on VERO cells. Results. Statistical differences (P < 0.05) in adverse events included less fatigue after immunization with DTaP-US compared with DTaP-J. Erythema of more than 2.5 cm was more frequent, but erythema less than 2.5 cm was less frequent in Japanese infants compared with U.S. infants. Fewer Japanese infants were febrile (>38[degrees]C), tired, or irritable. Subcutaneous immunization resulted in a greater frequency of erythema and induration. The DTaP-US resulted in an equivalent response to PT and a greater response to FHA. More Japanese infants demonstrated at least a fourfold response over preimmunization antibody values to FHA. In U.S. infants, antibody responses to the contained pertussis antigens were equivalent after IM and SC administration. Compared with Japanese infants receiving DTaP-J SC, U.S. infants receiving DTaP-US IM had equivalent responses to PT and a greater response to FHA. Conclusions. United States infants receiving an IM injection of a U.S.-produced bicomponent DTaP vaccine produced antibody responses to the contained pertussis antigens at least equal to those of Japanese infants receiving a similar bicomponent DTaP vaccine shown to be effective in older Japanese children. Pediatrics 1996;97: 236-242; acellular pertussis vaccine, whole-cell pertussis vaccine, immunogenicity, reactogenicity, pertussis toxoid, filamentous hemagglutinin, intramuscular immunization, subcutaneous immunization., ABBREVIATIONS. DTP, diphtheria-tetanus-pertussis vaccine; DTaP, diphtheria and tetanus toxoids and acellular pertussis vaccine; FHA, filamentous hemagglutinin; PT, pertussis toxin; IM, intramuscular; SC, subcutaneous; DTaP-US, U.S. formulation of DTaP; Lf, limit [...]

A three-component acellular pertussis vaccine (DTaP) appears to be more effective and causes fewer adverse reactions than a whole-cell pertussis vaccine (DTwP). DTaP is a vaccine for diphtheria, tetanus and pertussis (whooping-cough) that includes three pertussis antigens. Of 165 infants from 15 to 20 months old who had already received three DTwP vaccinations on the recommended schedule, 110 received a booster shot of DTaP and 55 received a booster of DTwP. Pain and redness at the vaccination site were significantly less in infants who received DTaP than in those who received DTwP. Also, the infants vaccinated with DTaP experienced less fever, drowsiness, loss of appetite and fussiness than those vaccinated with DTwP. In addition, the DTaP vaccine caused greater immune response to the three pertussis antigens than the DTwP vaccine. This indicates that the DTaP vaccine safely and effectively provides protection against pertussis., Objective. To compare the immunogenicity and reactogenicity of a diphtheria and tetanus toxoids and three-component acellular pertussis vaccine (DTaP) with a diphtheria and tetanus toxoids and whole-cell pertussis vaccine (DTwP) when administered as a booster dose to infants 15 through 20 months of age. Design. Randomized, double-blind, comparative study. Setting. Three pediatric practices (two private; one hospital-based). Participants. One hundred and sixty-five healthy 15-through 20-month old infants. Selection procedures and interventions. Infants were randomly assigned in a 2:1 ratio to receive vaccine from a single lot of DTaP or from commercially available DTwP. DTaP contained 25 [micro]g of pertussis toxoid, 25 [micro]g of filamentous hemagglutinin, 8 [mu]g of pertactin (69-kilodalton outer membrane protein), 25 flocculating units of diphtheria toxoid, and 10 flocculating units of tetanus toxoid per 0.5-mL dose. DTwP contained one half the concentrations of diphtheria and tetanus toxoids compared with DTaP and a pertussis component with a potency of 4 U/0.5-mL dose. Serum samples were obtained on the day of immunization and 4 weeks later. Adverse reactions were recorded by parents for 7 days after immunization. An interval history was obtained 4 weeks after immunization. Measurements and results. IgG antibody to pertussis toxoid, filamentous hemagglutinin, pertactin, diphtheria toxoid, and tetanus toxoid was measured by an indirect enzyme-linked immunosorbent assay (ELISA) method. One month after immunization, the geometric mean antibody levels after DTaP compared with DTwP were: pertussis toxoid, 70.6 vs 28 ELISA U/mL (P = .003); filamentous hemagglutinin, 183.4 vs 43 ELISA U/mL (P < .001); pertactin, 216 vs 49.9 ELISA U/mL (P < .001); diphtheria, 14.1 vs 14.9 IU/mL (P = .74); and tetanus, 11.9 vs 14.8 IU/mL (P = .089). After immunization with DTaP, most local and systemic adverse experiences were significantly fewer compared with DTwP (P < .05). Conclusions. This three-component DTaP vaccine demonstrates significantly greater immune responses to pertussis toxoid, filamentous hemagglutinin, and pertactin, equivalent immune responses to diphtheria and tetanus toxoids, and significantly less reactogenicity compared with a licensed DTwP. Pediatrics 1994;93:656-659; acellular pertussis vaccine, whole-cell pertussis vaccine, immunogenicity, reactogenicity, pertussis toxoid, filamentous hemagglutinin, pertactin, 69-kilodalton outer membrane protein, immunization

A combined diphtheria, tetanus, pertussis (DTP) and Haemophilus influenzae type b (HbOC) vaccine may be effective and safe in young infants. Among 378 two-month-old infants, 189 were vaccinated with a combined DTP-HbOC vaccine and 189 were vaccinated with separate DTP and HbOC vaccines. The number of adverse events in infants who received the combined vaccine was similar to that in those who received separate vaccines. Children had a higher response to each of the vaccine components after three doses of the combined vaccine than after three doses of the separate vaccines. Enhanced response to Hemophilus influenzae B occurred after two doses of the combined vaccine.

Children who receive the live attenuated Oka-Merck varicella vaccine may develop a less severe form of varicella, or chickenpox, than unvaccinated children. Among 150 healthy children between 12 months and 17 years old who developed chickenpox, 58 had been vaccinated against chickenpox and 92 had not. The vaccinated children had received the live attenuated Oka-Merck varicella vaccine. The children who had been vaccinated had significantly fewer chickenpox lesions than those who had not. They were also less likely to have a fever, but the incidence of other symptoms was similar for the two groups of children. Vaccinated children recovered in a significantly shorter period of time.

* Objective.--To compare the safety and immunogenicity of Lederle Laboratories' (Pearl River, NY) diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine with diphtheria and tetanus toxoids and whole-cell pertussis (DTwP) vaccine when administered simultaneously with measles-mumps-rubella (MMR) vaccine and trivalent oral poliovirus (OPV) vaccine at 15 to 16 months of age. Design.--Randomized and double-blind. Setting.--Two general pediatric practices. Participants.--Ninety-seven infants, aged 15 to 16 months, who had received three previous DTwP immunizations. Selection Procedures and Interventions.--Healthy children received the DTaP or DTwP vaccine. Infants received the MMR vaccine at a separate site and the OPV vaccine concurrently. Blood was obtained on day 0 and at 6 weeks. Adverse events were recorded by parents at specified times after immunization. Measurements/Results.--Within 3 days of immunization, DTaP vaccine recipients had less fever, drowsiness, and ir-ritability (P=.01, .04, .01, respectively). They also experienced less tenderness, erythema, and induration (.001, .001, and .002, respectively). There was no difference in the frequency of adverse reactions 6 to 14 days after immunization. Enzyme-linked immunosorbent assays were used to determine all antibody values. Antibody responses to filamentous hemagglutinin and pertussis toxoid were significantly greater in the DTaP group (P=.0001 and .02, respectively). Immune responses to the other measured antigens were similar. Conclusions.--Simultaneous administration of the Lederle DTaP with MMR and OPV vaccines did not interfere with antibody response to pertussis antigens measured or measles, mumps, or rubella viruses and was associated with fewer local and systemic adverse events during the first 3 days following immunization when compared with the simultaneous administration of the DTwP, OPV, and MMR vaccines. We conclude that the DTaP vaccine can be administered at 15 months of age concurrently with the MMR and OPV vaccines. (AJDC 1993;147:854-857), The safety and immunogenicity of Lederle Laboratories' (Pearl River, NY) diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine with diphtheria and tetanus toxoids and whole-cell pertussis (DTwP) vaccine when administered simultaneously with measles-mumps-rubella (MMR) vaccine and trivalent oral poliovirus (OPV) at 15 to 16 months of age were compared. Ninety-seven infants who had received three previous DTwP immunizations and who were aged 15-16 months were used. Concurrent administration of vaccines increases the number of children appropriately vaccinated, particularly when the likelihood they will return for further immunization is in doubt. Lederle DTaP vaccine can be administered safely with the MMR and OPV vaccines without interfering with antibody responses to pertussis antigens contained in the vaccine or measles, mumps or rubella viruses. Simultaneous administration of the Lederle DTaP with the OPV and MMR vaccines is associated with fewer local and systemic adverse events when compared with the simultaneous administration of the DTwP, OPV and MMR vaccines.

* Objective.--To compare the safety and immunogenicity of three investigational lots of Haemophilus influenzae type b polysaccharide-tetanus toxoid (PRP-T) conjugate vaccine in infants. Design.--A multicenter, randomized immunogenicity trial. Infants were vaccinated at 2, 4, and 6 months of age with one of three lots of PRP-T. A control group received H influenzae type b oligomers conjugated to [CRM.sub.197] (HbOC). Serum was obtained before each injection and 1 month after the third dose, and assayed blindly for antibody in one laboratory. Subjects.--Four hundred eighty-four infants from private pediatric practices located in five geographic areas. Measurements and Results.--There were no significant differences in the number of adverse events reported for infants receiving PRP-T or HBOC, and the rates did not exceed those observed previously in infants given diphtheriatetanus-pertussis vaccine alone. Total serum anti-PRP antibody responses were analyzed in 336 infants who met strict inclusion criteria. After one, two, or three doses, the respective antibody responses to each of the three lots of PRP-T and to HbOC vaccine were similar. The only exception was one lot of PRP-T, which after one or two injections elicited significantly higher geometric mean antibody responses than the other two lots or the HbOC vaccine. After a third injection, there were no significant lot differences. Combining the data from the different lots, there were no significant differences in the geometric mean antibody concentration after three doses of PRP-T or HbOC (8.3 vs 7.7 [Mu]g/mL), and 95% and 91 %, respectively, of infants had greater than 1.0 [Mu]g/mL of antibody. There were no significant differences in the magnitudes of the respective IgG1-, IgG2-, and IgM-specific antibody concentrations between infants given PRP-T or HbOC. Conclusions.--The three investigational lots of PRP-T tested were safe and were as immunogenic as or more so than the licensed HbOC conjugate vaccine. (AJDC. 1993;147:832-836), A multicenter, randomized immunogenicity trial involving 485 infants from private pediatric practices in five geographic areas was carried out to compare the safety and immunogenicity of three investigational lots of Haemophilus influenzae type b polysaccharide-tetanus toxoid (PRP-T) conjugate vaccine. Each of the infants was vaccinated at 2, 4 and 6 months of age with one of three lots of PRP-T. All the infants received oral polio, DTP and Hib conjugate on the same visit, but adverse events did not surpass those expected from DTP vaccine alone. To compare the immunogenicity of the three lots of PRP-T and the HbOC vaccine, the data from the five study locations were combined. They showed that PRP-T and HbOC were immunologically similar. PRP-T was subsequently licensed in the U.S., France and other European countries.