The authors concluded that the early administration of anti-WNV hyper immune high dose IVIG should be recommended for WNV encephalitis [ 34].
There are additional cases of WNV encephalitis mostly successfully treated with anti-WNV hyper immune high dose IVIG [ 36- 42], among them are several solid organ transplant patients [ 37, 39- 42].
When on the sixth day WNV was suspected, corticosteroids and plasmapheresis were discontinued, and anti-WNV hyper immune high dose IVIG at 0.4 grams per kilogram body weight each day for a seven day course was started instead.
Therefore, it is important to demonstrate as part of the nonclinical assessment the need to include the adjuvant such as the increased magnitude and/or breadth of the immune response, dose sparing effects, etc. Dr Martin Friede of the WHO added to the discussion emphasizing that use of adjuvant with each antigen is independently evaluated, and continues for the lifetime of the product.
The clinical findings, the fact that no patients responded to antibiotic therapy, that many of them were ANA positive and all responded to immune suppressive doses of prednisolone, indicate that the fever and other clinical signs in these dogs were immune-mediated.
Both vaccines elicited a strong specific immune response after Dose 2 and Dose 3 (Table 4).
In two cases antibodies against endplate proteins (SPA-HRPO) were identified.> Sixty-one of 77 of the cases were treated with immune-suppressive doses of corticosteroids either as a monotherapy (32/61) or in combination with other immunosuppressive treatments (29/61).
We used analysis of variance (ANOVA) to analyze immune responses by dose; when appropriate, linear regressions were used to determine dose response.
Nevertheless, for the key variables (cellular immune response and dose) we could perform conditional logistic regression grouped by study, thus adjusting varying vaccination protocols or response criteria.
The reason for the higher incidence risk in the pediatric population is not well understood, but could be due to differences in the pediatric and adult immune systems, viral dose, and/or exposure [38].
