Envenenamento com o gás sarin-tókio

prednisolone daily and chlorpheniramine 8 mg 8-hourly orally. His symptoms resolved over the ensuing 4 days and he had no recurrence. A 20-year-old student received a single dose of JE vaccine (Biken, batch EJN 094A). After 24 hours she developed dizziness, nausea, and described influenza-like symptoms. 4 days after immunisation she developed a widespread urticarial rash affecting all limbs, trunk, face, and lips, with angio-oedema of the limbs. She was admitted to her local hospital and the rash subsided over 5 days. Photographs of both subjects showed the rashes to be very similar in distribution and morphology. One estimate. suggests that severe adverse events occur with a frequency of 1-104 per 10000 vaccinees. In the UK, of an estimated 35 120 JE immunised travellers, 8 severe cutaneous reactions (including our 2 patients) have been reported (P Murray, Cambridge Selfcare Diagnostics, personal communication), giving an incidence of 0-02%. The numbers of cases reported to the vaccine distributor by passive surveillance may be a considerable underestimate. The vaccine predominantly used in the UK is produced by the Research Institute of Osaka University (Biken) and is an inactivated virus derived from infected mouse brain. The total number of cases of JE disease in travellers, summarised by Wittesjo and colleagues, is around 25 cases in 14 years in several million European and North American visitors to Asia. This risk should be weighed against that of severe vaccine reactions occurring in about 1 per 4000 vaccinees. To propose any wider use of JE vaccine in this context could be hazardous. JE vaccine should be offered to travellers with high-risk itineraries." Typically, these will be those spending a month or more in rural or agricultural areas of Asia where transmission of JE is known to take place.
Alec Bonington, Marcus Harbord, Robert N Davidson, Ian Cropley, *Ron H Behrens
Department of Infection and Tropical Medicine, Northwick Park and *Hospital for