Manual 18140476

Manual 18140476
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ISSN 0382-232X
Rapport hebdomadalre des
maladies au Canada
Canada Diseases
Weekly Report
Date of publication: 1oAugust 1991
Vol. 17·32
Date de publication: 10 aoOt 1991
Contenu du present numero:
Contained In this Issue:
Japanese Encephalitis Vaccine and Adverse Effects
Among Travellers
. . . . . . . .
Notifiable Diseases Summary
Announcements . . . . . . . . . .
173
175
178
JAPANESE ENCEPHALITIS VACCINE AND ADVERSE EFFECTS
AMONG TRAVELLERS
Le vaccin contra l'encephalite japonaise Bet ses effets indesirables
chez las voyageurs • . • • . . . .
Sommaire des maladies adeclaration obligatoire
Annonces . . . . . . . . . . . .
173
175
178
LE VACCIN CONTRE L'ENCEPHALITE JAPONAISE B ET SES EFFETS
INDESIRABLES CHEZ LES VOYAGEURS
lntroducUon
Introduction
Japanese encephalitis Bis a conunon cause of encephalitis
throughout Asia where the disease occurs in both epidemic and
endemic form. While no vaccine against Japanese encephalitis (JE) is
licensed in Canada at the present time, both the National Advisory
( <:onunittee on Immunization (NACLl989) ancJ."the World Health
1
:ganization (WHO, 1990) reconunend that at-risk trav~llers to
'- ..ndemic or epidemic areas should be v.aC'.cinated and inStructed in
personal protective measures. to avoid mosqu~tp bite~.
· Le virus de I' encephalite japonaise B (EJB) est une cause courante
d 'encephalite dans toute I' Asie, OU la maladie sevit aI' etat
endemo-Cpidemique. Bien qu'aucun vaccin contre ce type d'encephalite ne
soit autorise au Canada aI'heure actuelle, le Comite consultatif national de
l'iinmunisation (CCNI, 1989) et I' Organisation mondiale de la sante (OMS,
1990) reconunandent tous 2 que les voyageurs vulnerables qui prevoient se
rendre dans des regions OU sevit une endemie OU une epidemie soient vaccines
et informes de la maniere de se proteger des piqiires de moustiques.
Accordingly, since August 1989, physicians at the University of
Calgary International Travel Clinic (ITC) hav~ been providing
formalin inactivated Japanese encephalitis vaccine (JEV-Biken) to
travellers who meet the appropriate criteria. The vaccine is obtained
through the Bureau of Biologics, Health and Welfare Canada, on
condition that adverse effects temporally associated with the vaccine
are reported to the Bureau.
En consequence, depuis le mois d'aout 1989, les medecins de la clinique
des voyages intemationaux de 1'Universite de Calgary offrent un vaccin
inactive ala formaline contre I' encephalite japonaise (<lit JEV-Biken) aux
voyageurs qui repondent aux criteres. On I' obtient aupres du Bureau des
produits biologiques de Sante et Bien-8tre social Canada, a condition de
s'engager asignaler acelui-ci Jes effets indesirables relies dans le temps au
vaccin.
A prospective cohort study of adverse events temporally associated
to administration of JEV-Biken was conducted between August 1989
and October 1990.
L'etude prospective par cohortes de tels effets a ere faite d'aout 1989 a
octobre 1990.
Methods
Meth odes
All clients attending this ITC were asked to complete a standard,
self-administered questionnaire containing demographic information
and details of their proposed trips along with information about their
present health status and previous and concurrent inununizations. This
information was reviewed during the clinic visit and JEV-Biken was
made available to all clients whO were travelling to rural areas of
endemic countries for more than 3 weeks. The client was provided
with information about the disease, the vaccine and the vaccination
protocol, including documentation of symptoms following
inununization. The client was also advised on personal protective
measures to avoid mosquito bites. Following written consent, up to 3
doses of vaccine were administered 1 week apart. Each client was
given a standard form on which to document symptoms occurring in
the 7 days following vaccination, which was reviewed by the
physician prior to administration of the next dose of vaccine ..
Tous les clients de la clinique precitee ont ete pries de repondre a un
questionnaire normalise portant sur leurs p&rametres demographiques, les
details du voyage projete, leur etat de sante actuel, fours antecedents vaccinaux
et les inununisations faites OU a faire vers le temps de la visite. Une fois ces
renseignements passes en revue, on offrait le JEV-Biken atous ceux qui
devaient ~joumer plus de 3 semaines en regions rurales de pays OU la maladie
est endemique. On leur expliquait la maladie, le vaccin, le protocole de
vaccination et la maniere de consigner Jes symptomes survenant iqrres celle-ci.
On leur disait aussi conunent se proteger des piqiires de moustiques. Apres
consentement ecrit, on leur administrait jusqu 'a 3 doses de vaccin aune
semaine d'intervalle. On leur remettait 'ln formulaire normalise sur lequel
noter les sympt8mes survenant dans les 7 jours suivant la vaccination,
formulaire dont le medecin prenait connaissance avant l 'administration de la
dose suivante.
(
I Secald Ooa Mal llaqflral!on No.
I.I
6670
Health and Welfare
Canada
I Courlar de la dacodllma claslS • Er<ag!s1remant n•
I
Santa et
Canada
Bien~tre
social
173
6670
ll•B
Canada
I
Results
R~sultats
One hundred clients received a total of240 doses of JEV-Biken
during the study period. Information on the presence or absence of
adverse events following inununization was available for 96 of
these individuals following 229 (95.4%) doses of vaccine. There
were 56 females and 44 males in the study population ranging in
age from 6 months to 63 years.
On adonne 240 doses de JEV-Biken a100 clients. Pour 96 d'entreeux,
on sait s'il est survenu des reactions indesirables suivant la vaccination, ce
qui rend compte de 229 (95,4 %) des doses. II s'agit de 56 sujets feminins
et de 44 masculins; l'age varie de 6 mois a63 ans.
Overall, 62 ( 64.6%) individuals experienced some form of local
or systemic adverse reactions. Local reactions were experienced by
46 individuals following 72 doses. The frequency was highest
following the first dose and decreased following subsequent doses
(Table 1). The most common local reactions were redness,
tenderness and induration, with the majority of these effects
occurring during the first 24 hours following inununization. Other
local effects included itching and urticaria. Systemic reactions were
experienced by 44 individuals following 71 doses. The most
conimon systemic reaction was headache followed by irritability,
fever, and drowsiness. Other systemic reactions reported included
nausea, vomiting, abdominal pain, diarrhea, wealmess, chills,
malaise, fainting, visual blurring, and neurologic and
musculoskeletal symptoms. Eighty-five percent of these reactions
began in the first 24 hours following inununization. The probability
of experiencing a local or systemic reaction with the second or third
dose was significantly higher if an individual experienced a reaction
with the first dose.
Soixante-deux personnes (64,6 %) ont presente une forme quelconque
de reaction locale OU generale. 0n a observe des reactions locales chez 46
personnes apres 72 doses; leur frequence est le plus elevee apres la
premiere dose (tableau 1). II s'agit le plus souvent de rougeur, d'induration ·
et de douleur ala pression, survenant surtout au cours des 24 heures suivant
I' injection. Notons aussi les demangeaisons et l'urticaire. II est survenu des
reactions generales chez 44 sujets apres 71 doses. La plus courante est la
cephalee; viennent ensuite l 'irritabilite, la fievre, la somnolence. On a aussi
fait etat de nausee, de vomissements, de douleur abdominale, de diarrhee,
de faiblesse, de frissons, de malaises, d'evilnouissement, de vue
embrouillee, de symptomes se rapportant au systeme nerveux et al 'appareil
locomoteur. Dans 85% des cas, ces reactions sont apparues dans les 24
heures. La probabilite de survenue de reactions locales et generales ala
deuxieme OU ala troisieme dose est significativement plus elevee Chez le
sujet ayant reagi ala premiere.
.
".-;
Table 1/Tableau 1
Frequency of Adverse Reactions Following Vaccination with JEV-Biken
Fraquence des reactions indasirables par suite de la vaccination par VEJ-Biken
Adverse Reaction
Reaction indesirable
,f'
Any reaction/Quelconque
Local only
Locale seulement
."
,
.;._
"
.•
.,
'
'
Systemic only
Generale seulement
.
Dose 1
Dose2
Dose3
All Doses
Toutes doses
n=96
n=89
n=44
n=229
48
(50.0%)
41
(46.1%)
22
(50.0%)
111
(48.5%)
34
(35.4%)
25
(28.1%)
13
(29.5%)
72
(31.4%)
27
(28.1%)
27
(30.3%)
(38.6%)
17
71
(31.Clo/o)
(
Six individuals experienced musculoskeletal symptoms
following inununization including myalgias and swelling. For one
of these individuals the symptoms experienced were suggestive of a
flare-up of previously diagnos~d fibrpmyalgia, resulting in
discontinuation of the vaccine s'eries. Four individuals experienced
neurologic symptoms including increased salivation and taste,
emotional instability, difficulty concentrating and local numbness.
Six personnes ont presente des symptomes se rapportant al' appareil
locomoteur, y compris des myalgies et des tumefactions; chez l'une d'elles,
les symptOmes evoquant le reveil d'une "fibromyalgie" dont le diagnostic
avait ere pose anterieurement, la vaccination a ete interrompue.
Quatre personnes ont presente des symptOmes neurologiques: sialorrhee et
exacerbation du gout, instabilite affective, difficulte de concentration,
engourdissements localises.
Six clients had their series of inununizations discontinued due to
adverse reactions following inununization. In addition to the client
described in the above paragraph, 2 others experienced severe local
reactions following the second dose of vaccine. A fourth client had
a marked local reaction to the second dose accompanied by fever,
fluctuating headache, drowsiness and lack of concentration which
lasted for approximately 4 days following inununization. The fifth
client developed a moderate local reaction on day 3 following the
first dose of JEV-Biken, followed by nausea, malaise, myalgia,
Six clients ont vu leur serie de vaccins interrompue pour cause de
reactions indesirables. Le cas de l'un d'eux est decrit ci-dessus; 2 autres ont
montre de graves reactions locales la deuxieme dose. Un quatrieme sujet
a presente une reaction locale marquee ala seconde dose, accompagnee de
fievre, de cephalee fluctuante, de somnolence et d'un manque de
concentration qui ont <lure environ 4 jours. Le cinquieme client a eu une
reaction locale de gravite moyenne 3 jours apres la premiere injection; au
bout de 6 jours survenaient nausee, malaise, myalgie, syncopes,
(
somnolence et cephalee; le tout diaparaissant dans les 48 heures suivantes.
a
Continued on page 177
Suited la page 177
174
HEALTH AND WELFARE CANADA· SANTE BIEN·~TRE SOCIAL CANADA
Not1Habl11 Dla11as1111 Summary-Somm11lre d11111 maladl1111 ~ d~laratlon obllg11to!r111
New Cases Rep<ll111d fllf the Month Ending 31 March 111111
Nouveau caa d~lari11 pour le mo!111111tumlnant11131 mare 1991
Disease
Malarua
(
''
-"
Queboo
New Brunswick
Nova Scotia
Prince Edward Island
ICD·9 Canada
Newfoundland
Queboo
Nouveau Brunewlck
Nouvella-EC09se
lie-du-Prince-Edouard
CIM·9
Terra-Neuve
Cum. Cum.'
Cum. Cum.' Curr.
Curr. Cum. Cum.' Curr. Cum. Cum.' Curr. Cum. Cum.' Curr. Cum. Cum.' Curr.
111
90
Cou.
90
91
00 Cou.
Cou.
91
91
90
Cou.
COil.
91
90
91
90
Cou.
131
1
6
2
4
428
1
90
13
042·044
3
3
3
2
426
205
006
136
005.1
2
1
023
2
34
111
61
21
17
48
3
13
17
20
30
008.41.
1809
4
545
521
-
AIDS-Sida
Amoebiasia • Amiblase
·Botulism· Botulisms
Brucellosis· Brucellose
Campylobacteriosia •
Campylobacttlriose
099.0
Chancroid. Chancre mou
052
Chickenpox· Varicelle
099.81.
Chlamydia, genttal •
Clamydiose genitala
001
Cholera· Cholera
032
Diphtheria· DiphtMe
007.1
Glardlasia • Glardlase
098
Gonocoooal Infections·
Infections gonococciquea<•J
098.4
Gonococcal Ophthalmla neonatorum
• Ophtalmle gonococclque du
nouveau-ne ·
320.0,038.41.
Haemophllua lnfluenzae B
(all Invasive) •
(Invasive) a H. lnfluenzae B c>J
070.0,070.1
Hepatttla A· Htlpattte A
070.2,070.3
Hepatttia B • Htlpattte B
Hepatttia C • Hepatite C
Hepatttls non·A, non·B •
Htlpattte non-A, non·B
m.21·
Herpes Simplex (congenttaVneonatal)
·Herpes (congtlnttaVneonatal)
482.81
Legionellosis • Legionellose
030
Leprosy· Lepre
027.0,771.22·
Listerloal1 (all types) •
Listerloee (tou1 genres)
084
Malaria· Paludiame
055
Measlea. Rougeole
320.1
Meningitis, pneumocoooal •
1P~iogtte il pneumocoques
If
lit, other bacterial
i, / meningites bacltlriennea ,...,
Me-nlngitis/Encephalttis viral·
Mtlningtt&'encephaltte viraJe<'l
036
MeningooocoaJ Infections·
Infections il mtlnlngocoquea
072
Mu1J1)1 • Oreillons
002.1-002.9
Paratyphoid· Paratyphoide
033
Pertussis • Coqueluche
020
Plague· Peale
045
Poliomyelttis. Poliomyeltte
071
Rablea • Rage
056
Rubella· RubOole
771.0
Congenttal Rubella·
Rlbeola congtlnttale
003
Salmonellosls • Salmonellose<IJ
004
Shlgellosl&. Shlgellose
091
Syphilis:
Early, Symptomatic·
Syl!lllomatique, nloente
090,092-097
Other Syphilis • Autres syphllls
037
Tetanus- Tetanos
124
Trichinosis - Trlchinose
010-018
Tuberouiosis • Tuberculeuse
Typhoid· TyphoTde
..~,o
oos.01·
Verotoxigenlo E.coli~
E. ooliverotoxinoglmes
060
Yellow Fever • Flllvre jaune
(1)
(2)
(3)
(4)
(5)
(6)
•·
I\
\
-
-
-
1259
1890
3623
6223
5716
1611
54
46
133
93
284
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
.
..
-
..
-
27
-
1
130
55
611
104
450
19
57
-
-
11
-
-
-
-
32
15
65
23
114
8
4
38
13
25
19
-
.
.
..
.
.
.
.
5
4
15
11
14
18
-
3
2
3
-3
-
-
-
-
-
-
-
-
-
-
-
-
-
.
57
35
1
1
1
-
-
-'
-
1
2
1
1
1
..
129
525
1
3
399
941
2
14
344
344
-2
1
4
-1
-
-
-
-
-
4
11
25
-
-
.
..
.
-
-
-
-
-
14
3
-
-
12
346
15
66
743
29
632
885
1909
2872
5
1084
1578
-
-
16
4
2
18
51
28
,('
11
26
10
j
20'
,4
'30
16
,\59
;
32
1
;:'82
I
4
. 637
)839
-
-
99
-
.
-
6
21
6
69
-
-
.,
1
1
-
-
-
-
-
-
-
1
2
7
1
66
1
1
7
-
-
-
-
-
-
-
-
46
1
1286
262
98
683
155
25
99
241
52
-
-
-
-
35
356
51
33
-
-
1
-
46
4
8
3
165
10
60
1
114
5
5
-
-
-
-
-
-
7
-
1
26
3
-
2
25
-
-
-
-
1
-
-2·
-
1
-6
-
-
-
-
-
-
Includes all 098 categories except 098.4
Includes bucoal cellulttis or eplglottitls 464.3 In a child <5 years with no other cauaative
organisms isolated
Includes encephalitis
All other categories except Haemophilua 320.2, Uateriosis 027.0,
MenlngococcaJ 036, Pneumoooccal 320.1 and Tuberculosis 013.0
All categorlea except Measles 055, Mumps 072, Poliomyelitis 046, Rubella 056
and Yellow Fever 060
Excludes Typhoid 002.0 and Paratyphoid 002.1 to 002.9
·--0.9 codes used in the list may be lnoorrplete. All 5 digit codes are unofficial and
1for LCOC surveillance purposes only.
-
-
-
-
-
2
-
-
-
-
-
-
-
-
-
3
-
-
-
-
-
-
-
-
-
-
-
-
1
2
1
4
-
-
-
5
2
43
-
4
23
-
-
-
1
-
-
-
..
-
-
-
-
-
-
.
.
.
-
-
-
-
1
3
3
-
5
-
1
-
9
-
-
-
-
1
-
-
-
1
4
1
4
-
.
2
-
-
-
-
-
-1
-
-
-
-
..
-
-
-
13
14
7
-
7
-
-
-
-
-
1
-
-
-
-
-
-
-
-
-
8
-
-
1
-
-
40
1
1
32
15
3
-
-
·3
-
-
-
-
2
-
1
-
-
48
-
1
5
-
.
.
-
2
-
-
.
.
-
-
-
-
50
4
3
53
1
7
-
1
1
-
1
-
-
-
-
-
-
-
-
-
-
..
..
..
2
2
..
..
4
6
-
..
..
.
.
.
..
..
..
.
.
..
.
.
..
..
.
.
.
.
.
..
.
.
..
..
.
..
.
..
..
.
.
..
..
..
..
..
..
..
.
.
.
.
..
..
..
..
..
..
.
.
..
..
.
.
..
..
..
..
..
.
Corrprend toutes laa rubrlquee 096, eauf 098,4
Comprend cellulite buocale ou liplglottlte 464,3 chez un enfant < 5 an• ohez qui
aucun autre miC100rganl1me oaueal n'a 61618016
(3) Comprend eno6phallte
(4) Toutes les autres rubriquGG aauf a Haemoph1Uu1320,2, U1terloae 027,0,
ameningoooquee 038, apneumoooquea 320, 1 et tuberouleuae 013,0
(5) Toutes lea rubrlquee, aauf rougeole 066, oreUlon• 072. poliomy811te 045, rubOola 056
et fievre jaune 060
16) Saul typholde 002,0 et paratypho!de 002, 1 a 002,9
Lea codea de la CIM·g flgurant dane la lisle ne 1ont peut41tre pas porrplet1. Quant aux codes l 6
chlffres, ii• ne aont pas offlclels, ayant 616 61abU1 unlquement aux fine de la 1urvelllanoe du LLCM.
(1)
(2)
175
-
-
-
-
-
-
-
1
Notlfl11ble Dl11111a1H111 Summ11ry(Concludud)·Sommalre dH m11ladlee ii d!Wl11r11llon obllg11tolre(fln)
Month Ending 31 March 1991 • P6rlod111111 termln11nt le 31 mlll''il 1991
ICD·9 Ontario
CIM-9
Disease
Maladie
Saskatchewan
Manitoba
Yukon
BrlUah Columbia
Cclomble-BrltannlqlH
Aberta
Curr. Cum. Cum' Curr. Cum. Cum.• Curr. Cum. Cum.' Curr. Cum. Cum.' Curr. Cum.
91
90
91
90
91
91
90
91
90
Cou.
66
38
26
9
4
3
166
2
149
23
62
37
18
24
7
7
10
2
211
3
58
-
042-044
AIDS-Sida
008
Amoeblaale • Amibiase
005.1
Botullem • Botullsme
1
023
1
Bruoelloeiil • Bruoelloae
008.41' 261 1081
Ca!rpylobaaterioals •
C&Jlllylobaattlrloee
099.0
1
Chancrold • Chancre mou
062
Chloksnpox • Varicelle
099.81' 1029 3598
Chlamydia, genital·
Clamyd.loee g6nllale
001
Cholera-Cholera
032
Diphtheria· Dlphterle
866
202
007.1
Giardiasie • Giardiase
098 429 1543
GonococcaJ Infections·
lnfeotlone gonooocciquea< 1l
098.4
GonococcaJ Oph!ha.lmia noonatorum
• Ophtalmie gonococoique du
nouveau·ne
26
320.0,038.41'
4
Haemophilua lnfluenzae B (a.II
Invasive)·
(invasive) H. lnfluenzae B Ill
135
070.0,070.1
46
Hepatltla A· H&patlte A
648
070.2,070.3 404
Hepatltla B • H&pattte B
Hepatltla C • H&patlle C
13
3
Hepathl1 non·A, non·B •
H&patlte non·A, non·B
771.21'
Herpes Si01>lex (oongenltaVneonataJ)
·Herpes (oong8nltaVn'°'1atal)
11
482.81
Leglonelloeis - legionellose
3
030
Leproay • Lepre
027.0,771.22'
Llsteriosls (all types) •
Lleteriooe (toua genres)
54
084
9
Malaria· Paludlame
703
055 333
Measles· Rougeole
8
4
320.1
Meningitis, pneumocoooal •
Mllnlnglte pneumoooques
13
6
Menlngitla, other bacterial
Autres menlngltes bactenenneu 1>.•J
1
1Q
Menlngitis\En~a.llti1 viral·
Mllnlngltelen ha.lite virafel~
·.10
40
036
Menlngoooocal Infections·
lnfecllon1 menlngocoques
072
8
3,6'
MUITflll • Orelllona
002.1-002.9
,4
1
Paratyphoid· Paratypholde
205
033
34
Pertunle • Coqueluche
020
Plague· Peata
045
Poliomyelltle • Pollomyllllte
071
Rabies • Rage
6
20
056
Rubella· Rubeole
771.0
Congenital Rubella·
RlilOole oongenltale
136 621
003
Salmonellotl1 • SalmoneffosellJ
142
26
004
Shigellosis • Shigellose
89
091
31
Syphlll1:
Early, $yrrptomallo •
SylTlJtomatlque. recoote
000,002·097
86
219<
other $yphllle • Autres ayphille
037
Tetanus· T'tanoe
124
Trlchlnoala • Trichlnoae
01Q--018
126
31
Tuberouloele • Tuberouleuse
6
002.0
2
Typhoid· Typllolde
69
008.01'
8
Verotoxigenlo E. coll·
'h
E. coll verotoxinogenes
060
Yellow Fever· FJevre jaune
-
-
-
-
a
-
a
a
,,,
"
,\
-
-
SYMBOLS
Not reportable
Not available
No cases reported
-
-
..
-
-
-
-
-
-
36
-
41
66
838
-
-
-
189
-
1
180
-
140
-
371
Northwest Territories
Terrltolreo du
Nord-Ouest
Cum.' Curr. Cum. Cum.' Curr. Cum. Cum.
90
91
9;
91
90
'•
1
80
•
1
1
143
-
~
-
220
-
11
1138
1161
167
283
167
833
669
-
46
71
168
167
277
-4
335
-
100
-
- 178
74 303 339
199
228
98
340
359
146
390
499
346
-
-
-
-
-
-
-
-
-
-
-
-
-
2
3
6
-
-
1
6
9
15
1
-
21
2
36
8
19
10
14
8
68
18
58
10
28
9
101
30
69
24
-
-
-
-
g
383
-
-
-
-
-
-
-.,
-
-
-
-
2
-
-
1
-
-
-1
-
6
§_
1
-
2
2
4
-
-
-
-
2
-
-
3
12
46
7
-
-
\....
-
-
19
4
19
4
-
-
-
-
1
-
9
15
25
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-1
4
3
1
-
2731
-
-
-
-
-
-
3
-
-
4078
1
1
-
4
2
3
7
3
14
6
6
1
1
3
162
-
342
626
477
-1
6
-
-
-
1
2
4
21
89
58
196
192
244
-
16
-
-
-
-
-
-
-1
-
-
-
-
-
-
-
2
B
5
9
28
11
8
34
-
-
2
5
8
1
2
-
3
11
2
4
8
6
16
28
30
7
16
16
-
-
-
-
- 38- 7416
-
6
17
1
-
5
-
-
8
-
-
-
4
21
-
1~
-
22
-
-
-
-
-
-
82
7
1
17
3
2
62
29
3
85
88
68
1
214
26
81
18
-
-
236
54
2
198
35
-
212
21
14
3
2
23
1
6
26
-
-
40
11
-
-
11
-
-
-
-
1
1
-2
-3
-
-
6
-
-
-
-
-1
1
-
-
-
-
-
-
-
-
-
-
-
-
-
. Adeclaration non obligatoire
-
-
-
-
-
1
1
-
-
-
SOURCE:
Division of Biometrics
.
Laboratory Centre for Disease Control
Health and Welfare Canada
Ottawa, Ontario K1A OL2
Tel.:(613)957-0334
-
1
-
-
-
14
9
-
-
-
-
7
-
-7
-
1
-
-7
-
2
1663
-
-
-
13
-
130
-
5
301
-
-1
118
-
-
1
25
60
20
-
-
-
2
14
19
9
-1
12
2
28
20
-1
-
12
1
6
-8
-2
7
14
1
-
-
3
1
2
-
-
13
27
-
SIGN ES
.. Non disponible
_ Aucun cas declares
-
-
-
-
-
-
3
29
3
-
-
-
-
-
-
-
-
-
-
-
1
-
10
145
-
-
-
-
-1
-
-
1
1
-
-
(
-
1
2
-
-
3
-
-
-
1
1
3
3
21
-
-
-
-
-
5
-
-
-
-
-.
-
1
3
6
3
10
3
2
-
-
-
-
-
-
-
-
-
-
-
-
-3
-
-
-
-1
2
7
1
8
-
-
-
-
-
-
-
-
-
-
SOURCE:
Division de la Biometrie
Laboratoire de lutte contre la maladie
Santa et Bien-6tre social du Canada
Ottawa(Ontario) K1A OL2
Tel.:(613)957-0334
((
'-
176
\
syncopal attacks, drowsiness and headaches on the sixth day after
vaccination, which resolved within 48 hours. The sixth individual
developed symptoms of cholecystitis 12-24 hours after the second
dose, which was not felt to be directly related to the vaccine;
however, the patient declined a third dose of vaccine.
La sixieme personne ayant presente des symptlimes de cholecystite de 12 a
24 heures apres la deuxieme injection, mais sans que l'on pfit avec certitude
Jes attribuer au vaccin, elle a toutefois refuse la troisieme dose.
Systemic reactions were significantly more common in the 14
clients under 20 years of age; this appears to be due to a higher rate
of fever reported in this age group.
Les reactions generales, particulierement la fievre, ont ete beaucoup plus
frequentes chez les 14 personnes agees de mains de 20 ans.
There was no evidence of an increase in frequency of either
local or systemic adverse effects in individuals who had received
yellow fever, typhoid or cholera vaccinations either prior to this
particular trip or at any time during the previous 10 years.
Rien n'indique que la frequence des reactions locales OU generales soit
plus grande chez les personnes qui ont ete vaccinees contre la fievre jaune,
la typhoi:de ou le cholera soit en prevision du voyage projete, soit au cours
des 10 annees precedentes.
Recent authors have noted an increase in adverse events related
to specific vaccine lots. Two lots of vaccine were used in this
study: EJN 013 and EJN 032. Adverse events were observed
following 56.5% of doses using EJN 013 and 72.3% of doses using
EJN 032. This difference is statistically significant using a
one-tailed Fisher's exact test (p=0.016).
Certains auteurs ont releve recemment que certains lots de vaccin ·
donnent lieu a une frequence particulierement elevee de reactions
indesirables. Deux lots de vaccins ont ete utilises dans le present travail:
EJN 013 et EJN 032. Nos taux de reactions sont de 56,5 % EJN 013 et de
72,3 % EJN 032. Cette difference est statistiquement significative selon la
methode unilaterale de Fisher (p=0,016).
One individual who presented to a local physician with
generalized urticaria 2 days following the third dose of JEV-Biken
(EJN 032) had also received a second dose of typhoid vaccine 6
hours prior to the rash developing.
Un sujet, qui a consulte un medeein pour une urticaire generalisee 2
jours apres I' administration de la troisieme dose d'EJN 032, avait reyu une
deuxieme dose de vaccin anti-typhique 6 heures avant !'apparition des
demangeaisons.
Discussion
Analyse
The rates of both systemic and local reactions reported by
participa,tJts f.;t this study are higher than those previously
reported\l,2, ' .S>. However, this study used an active follow-up
protocol and was carried out among a typical travel clinic
popul~tion rather than an endemic or military population. Sanchez
et al. observed higher rates of soreness, fever, and headaches
among individuals who had received yellow fever vaccine in the
preceding 10 years but this was not observed in this study.
Les taux de reactions generales et locales signalees par les ~~:!mmts a
cette etude sont plus eleves que ceux qui Ont deja ete rapportes ' ' ;_)}•
Toutefois, le present travail comportait un protocole de suivi actif et portait
sur une population typique de clinique de voyage pl8~t que sur une
population endemique ou militaire. Sanchez et coll. ont observe des taux
eleves de douleur, de fievre et de cephalee chez les personnes qui avaient
re~u un vaccin contre la fievre jaune dans Jes 10 annees precedentes, ce qui
n'a pas ete le cas chez nous. .
The report of genc;iralized urticaria supports the findings of
Andersen and RonneP) and this, along with the observed lot effect,
is an area of particular concern which req~es further investigation.
Also of interest in the study were the reports of muskuloskeletal
. ' symptoms and aggravation of previously di~gnosed ;flbromyalgia.
This is an area where further research is required and may be a
consideration when deciding whether or nqt to administer the
vaccine, especially in cases where the risk of infection is relatively
low.
·
Le
d'urticaire generalisee vient etayer les trouvailles d' Andersen et
Ronne etne laisse pas d'inquieter. Vu les differences observees entre Jes
lots, ii ya lieu de pousser l'enquete plus loin. Un autre element interessant
du present travail est I'existence de symptlimes se rapportant a l' appareil
locomoteur, y compris l' aggravation d'une fibromyalgie deja connue. II y a
la une autre raison de poursuivre l' enquete. II se pourrait que de tels faits
dussent etre pris en consideration quand on decide d'administrer ou non le
vaccin, notamment dans Jes cas ou le risque d'infection est relativement ·
faible.
This study is ongoing and, as more subjects are recruited, the
power of the study to detect relationships with other vaccines will
improve. In the meantime, it is hoped that the data presented here
will enable other travel clinics to predict the rated of adverse events
that they could expect in their clinic population, and advise their
clients appropriately.
Ce travail se poursuit done, d'autres sujets sont recrutes. On arrivera
ainsi a mieux etablir Jes rapports entre les effets indesirables du vaccin
contre l'EJB et ceux d'autres vaccins. Entre temps, nous croyons que les
donnees presentees.ici permettront aux medecins d'autres cliniques de
voyage de prevoir les taux de reactions indesirables auxquels ils peuvent
s' attendre dans leur population et de conseiller leurs clients en consequence.
References
1. Poland JS, Cro:ep CB, Craven RB, et al. Evalua.tion of.the
References
1. Poland JS, Cropp CB, Craven RB, et coll.~~~ Ol!d
potency and sa1ety of inactivated Japanese encephalitis
·
vaccine in US inhabitants. J Infect Dis 1990; 161 :878-82.
2. Sanchez JL, Hoke CH, McCowan J, et al. Further experience
with Japanese encephalitis vaccine. Lancet 1990;335:972-3.
Letter.
3. Hoke CH, Nisalak A, San~awhipaN, et al. Protection against
Japanese encephalitis by inactivated vaccines. N Engl J Med
"' 1988;319:608-14.
4. Henderson A. Immunization against Japanese encephalitis in
Nepal: experience of I I52 subjects. J Royal Army Med Corps
1984;130:188-91.
5. Andersen MM, Ronne T. Side-effects with Japanese
encephalitisvaccine. Lancet 199"1;337:1044.
Source: Hilary C Robinson, MB, ChB, Regional Community
Medicine Specialist, Indian and Northern Health
Services, Medical Services Branch, Atlantic Region,
Health and Welfare Canada, Halifax, Nova Scotia;
Margaret L Russell, MD, Director, University of Calgary
InternationalTravel Clinic, WilliamM Csokonay, MD,
Assistant Professor, Department of Community Health
Sciences, University of Calgary, Calgary, Alberta.
f5f
sgfezy tjnactiyatedJffganese encephalitis;
= =:
8. J
Infect is 1990;161:8 8-82.
·
2. Sanchez JL, Hoke CH, Mccowan J, et coll. Further experience with
Japanese encephalitjsyaccine. Lancet 1990;335:972-3. Lettre.
3. Hoke CH, Nisalak A, Sangawhi:pa, et coll. Protection qfiainstJapanese
encephqlitis 1zy jnactiyated yacc1nes. N Engl J Med 198;319:608-14..
4. Henderson A. Immunization "fcinst Japanese encephqlitis in Nepal.·
experience qf 1152 suqiects. J oyal Army Med Corps
·
1984;130:188-91.
5. Andersen MM, Ronne T. Side-tdfects with Japanese enceehqlitis
~.Lancet 1991;337:1044.
Source : Ir Hilary C Robinson, specialiste en hygiene publique regionale
des Services de Sante des Indiens et des populations du Nord la
Direction generate des services medicaux pour la ref3ion de ·
a
l' At/antique, Sante et Bien-etre social Canada, Halifax
(Nouvelle-Ecosse); Dr Margaret L Russell, directrice de
l' University of Calgazy International Trayel Clinic, Ir William M
Csokonay, professeur adjoint au Departement des sciences de la
sante publ1que, Uniyersjty of Calgazy. Calgary (Alberta).
·
177
An nonces
Announcements
SYMPOSIUM ON
HEALTH OF INTERNATIONAL TRAVELLERS
COLLOQUE SUR LA
SANTE DES VOYAGEURS INTERNATIONAUX
The 4th symposiwn on the health of international travellers will
beheld 17-18 October, 1991, in Montreal. Topics such as
immunization for travellers, tropical diseases and travellers'
diarrhea will be discussed. (The program will be presented in
French with the exception of the 3 sessions on the prevention and
treatment of certain infections acquired while travelling).
Registration fee is $250. For more information, contact the
Departement de san~ communautaire, H6pital Saint-Luc, 1001
rue Saint-Denis, Montreal, Quebec, H2X 3H9, telephone (514) .
281·4004 or by FAX (514) 281·4099.
Le 4e colloque sur la sante des voyageurs internationaux aura lieu les 17 et 18
octobre 1991, aMontreal. Des sujets comme I' immunisation des voyageurs, les
maladies tropicales et la diarrhee du voyageur seront abordes. (Le progranune
sera presente en franyais, sauf les 3. seances sur.la prevention et le traitement de
certaines infections coniractees par des voyageurs). Les droits d'inscription sont
de 250 $.Pour de plus amples renseignements, s'adresser au Departementde
sante communautaire de l'H6pital Saint-Luc, 10-01, rue Saint-Denis,
Montreal (Quebec), H2X 3H9; telephone (514) 281-40-04, ou Ulecopieur
(514) 281-4099.
SYMPOSIUM 'ON
CELLULAR FATTY ACID ANALYSIS
BY GAS LIQUID CHROMATOGRAPHY AND ITS
APPLICATION IN MICROBIOLOGY
25--26 October, 1991
London, Ontario
COLLOQUE SUR
L' ANALYSE DES ACIDES GRAS CELLULAIRES
PAR CHROMATOGRAPHIE GAZ-LIQUIDE ET SON APPLICATION
ALA MICROBIOLOGIE
Les 25 et 26octobre1991
London (Ontario)
This 2-day symposiwn, presented by the Microbiology
Department of Victoria Hospital, will focus on anaerobic
organisms; coagulase-negative staphylocci; aerobic Gram-positive
and Gram-negative rods; and hospital epidemiology. The list of
speakers includes experts in the fields of microbiology and
epidemiology from University Hospital, Colwnbus, Ohio;
Laboratory Centre for Disease Control, Ottawa, Ontario; University
ofBritish Colwnbia, Vancouver, B.C., and Virginia Ptilytechnic
Institute and State University, Blacks1>urg, Virginia. :·
Ce colloque de 2 jours, presente par le Service de microbiologie de l 'h8pital
Victoria, portera Sur les microorganismes anaobies, les staphylocoques a
coagulase negative, les bacilles aerobies Gram positif et Gram negatif ainsi que
sur l 'epidemiologie en milieu hospitalier. La liste des conferenciers comprend
des specialistes de la microbiologie et de l' epidemiologie du Uniyersity Ho§llital.
Colwnbus (Ohio); du Laboratoire de lutte contre la maladie, Ottawa (Ontario);
de l'Universire de la Colombie-Britannique, Vancouver (C.-B.) et de YiI&inuv--·
Polytechnic Institute and State University, Blacksburg (Virginie).
\
'
Registration fee is $120, including lunch~~. To'register or
obtain additional information, contact Luba,'Stoakes at (519)
1
685-8212 or FAX (519) 685-8203.
:
The Canada Diseuea WcC;idy Rpportprcscms c:urrcnl Information en infi:ctious and othor cfuouea
for """"'nwiO. purpo<e1 mfi.t available fico of charge uponrcquolt. Many of tho artlcl..
ooriWn ~limilwy infotm:ation and further cooJimatlcnmAy bo obtainod from tho soorce1
quokld. 'Tho J)cpartmont of Health md W01,f.uo_doo1 not U1UinO reapom!bilily for w:uncy or
authontlcity. Ccntributicns arc wclcomod(in tho offici.tl language of your choU:c) from any<me
wcnkln& in tho boalth f10ld and will not JXCCludo publication o110wbcrc.
Sciont!ficAdvi.tory Boord:
Dr.J.Spika
Dr.K.Rozee
Bditm:
momor Paul1on
Ani.ttmtl!ditor:
Nicole Beaudoin
JoanmRognier
Clortrudo Tanliff
Deaktop Publilbing
Circulation:
(613) 9574243
(613) 957·1329
(613) 957·1788
(613) 957.()841
(613)957·7845
(613) 957.()842
Les droits d'inscription sont de 120 $, dejeuners compris. Pour s'inscrire ou
se renseigner, s 'adresser aLuba Stoakes par telephone (519-685-8212) OU par
relecopieur (519-685-8203).
r.e Rappmbebdoowllire dot maiadiol ru Cmada. qui foumit c1oo dmm6caportill:>D11>• 1ur 101 mahdlo• mmctio111ot ct
1.. 1utrca maladiol dam lo but do faclliwr lour iurveillancc, poutetrc oblow gratuilomont 1111' dcmando. Un wand
nombre d'articl01 no ccntlomom quo dos doon60l IOIJlllaircl mai.t dos mnsoipmontl compl6montairel pouYCill 8trc
obtzmUJ on 1'addre11ant aux 110Uite1 cil6<os. Lominiltrc do 11 Sanlll naticmlo ct du Bion-atrc IOCil! no pout&trc
rcapomth!o dol'onctitudo, ni dol'autbonticWS do. artlclos. ToUID pommoo oouvnntdma lo cbnaino doll mnl6 o.i
invit6o l callaboror (dam l&languo officlollo d01on cholx) ctll publicaticn d'un artiolo dam loprWolll Rapportn'on
emp8cbepulapublicaticnailloun.
<lroupo do C0010illo1111Clontifiquoa:
R6da<lricc on chef:
R6dactrice adjointo:
l'!ditiquo:
Diltributlcm:
Buroru of Ccmmunicablo Diseuo Epidemiology
Laboratory Omtrc for Diseuo Contra!
Twmoy'• Putnm
fYITAWA, Ontario
Bureau d'6pid6mialogio dos maladlo1 tnn1mi11ib!01
Laba:atoire do iullD conlro 11 maladio
Pr6Tunnoy
Cmada
Canada
K!A<L2
K1A<L2
OITAWA(Ontuio)
178
D'J. Spika
D'K.Rozco
moaner Paulsen
Nicolo Bollldoin
Jommo Regnier
Clortrudo Tlldiff
(613) 9574243
(613) 957-1329
(613) 957-1788
(613) 957.()841
(613) 957·7845
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(
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