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Biomedical subjects

A B Bloch

Publications and source records attributed to A B Bloch.

At least 37 records · Page 2Linked to original sources
PubMed1989

An outbreak of tuberculosis in rural Delaware.

A total of 35 patients diagnosed with tuberculosis in 1976-1984 were identified as part of a sustained outbreak involving five communities located in southern Delaware. The index case, a 25-year-old black female with sputum smear-positive, cavitary pulmonary tuberculosis, was a sexual partner of three other persons with cavitary pulmonary tuberculosis and a close contact of 10 other persons with tuberculosis. The median age of the 35 patients was 23 years (range 15 months to 77 years), and 13 (37%) were less than 15 years of age. Sixteen patients (46%) were male, and 34 (97%) were black. Pulmonary parenchymal disease was noted in 18 cases (51%), including nine (26%) with cavitary lesions; 11 (31%) had lymphatic disease (hilar and/or mediastinal); five (14%) had pleural disease; and one (3%) had a normal chest radiograph. Infection prevalence (per 100 tested) was 44.7 for close contacts of cases and 18.3 for other than close contacts, and disease prevalence (per 100 tested) was 8.9 and 1.4 for those two groups, respectively. This outbreak highlights several points: Outbreaks of tuberculosis may go undetected for several years; aggressive and complete surveillance and containment efforts are needed to control tuberculosis; and tuberculosis in children and minorities is still a problem in the United States.

Adolescent↗
PubMed1989

The epidemiology of tuberculosis in the United States. Implications for diagnosis and treatment.

Tuberculosis in the United States is primarily and increasingly a disease of minorities and the foreign-born. Tuberculosis among non-Hispanic whites is predominantly a disease of the elderly, whereas among minorities and the foreign-born, it is primarily concentrated in young adults. In the past few years, tuberculosis has increased among young adults, especially those who are black or Hispanic. Available data support the hypothesis that the spread of human immunodeficiency virus infection has increased the risk of tuberculosis. A substantial proportion of tuberculosis in the United States is potentially preventable through the administration of preventive therapy to high-risk populations.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The epidemiology of tuberculosis in the United States.

Tuberculosis (TB) in the United States is primarily and increasingly a disease of minorities and the foreign-born. TB among non-Hispanic whites is predominantly a disease of the elderly, while among minorities and the foreign-born, it is primarily concentrated in young adults. In the past few years, TB has increased among young adults, especially those who are black or Hispanic. Available data support the hypothesis that the spread of human immunodeficiency virus (HIV) infection has increased the risk of TB. A substantial proportion of TB in the United States is potentially preventable through the administration of preventive therapy to high-risk populations.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Tuberculosis and acquired immunodeficiency syndrome--Florida.

Florida reported 1858 cases of the acquired immunodeficiency syndrome (AIDS) and 8455 cases of tuberculosis from January 1, 1981, through October 31, 1986. Of the patients with AIDS, 159 (8.6%) also had tuberculosis, and 154 (1.8%) of the patients with tuberculosis also had AIDS. Among patients with both diagnoses, tuberculosis was diagnosed before AIDS by more than 1 month in 50%, was diagnosed within 1 month before or 1 month after the diagnosis of AIDS in 30%, and was diagnosed more than 1 month after the AIDS diagnosis in 20%. Compared with patients with AIDS only, patients with both diagnoses were also more likely to be Haitian, black (other than Haitian), or Hispanic. Compared with patients with tuberculosis only, patients with both diagnoses were more likely to be younger, male, Haitian, black (other than Haitian), and Hispanic, have extrapulmonary tuberculosis and negative tuberculin skin tests, and have noncavitary chest roentgenograms. These data suggest that patients with AIDS may have an increased risk of tuberculosis and that patients with both diagnoses differ in important demographic and clinical characteristics from patients with AIDS only or tuberculosis only.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Mycobacterial disease: epidemiology, diagnosis, treatment, and prevention.

TB is common in the setting of HIV-induced immunosuppression, especially among demographic groups with a high background prevalence of tuberculous infection. It is often the first (sentinel) infectious disease to appear, extrapulmonary and disseminated disease is common, the chest x-ray picture is frequently atypical, and the tuberculin skin test is often falsely negative. It therefore requires a high index of suspicion and an aggressive diagnostic approach to avoid missing HIV-related tuberculous disease, which is communicable from man to man by the aerosol route and which appears to be highly treatable with conventional anti-TB drugs. Identification and INH prophylaxis of tuberculous-infected, HIV-seropositive persons is likely to be very important in the prevention of tuberculous disease. MAI is also a very common pathogen that frequently produces extrapulmonary and disseminated disease among patients with AIDS. In contrast to TB, AIDS-related MAI disease occurs more uniformly among the AIDS risk groups, occurs late among the HIV-related infections, and is not effectively treated with current drug regimens.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Outbreaks of group A streptococcal abscesses following diphtheria-tetanus toxoid-pertussis vaccination.

Two outbreaks of group A streptococcal abscesses following receipt of diphtheria-tetanus toxoid-pertussis (DTP) vaccine from different manufacturers were reported to the Centers for Disease Control (CDC) in 1982. The clustering of the immunization times of cases, the isolation of the same serotype of Streptococcus from all cases in each outbreak, and the absence of reported abscesses associated with receipt of the same lots of vaccine in other regions of the country, suggest that each outbreak was probably caused by contamination of a single 15-dose vial of vaccine. The preservative thimerosal was present within acceptable limits in unopened vials from the same lot of DTP vaccine in each outbreak. Challenge studies indicate that a strain of Streptococcus from one of the patients can survive up to 15 days in DTP vaccine at 4 degrees C. Contamination of vials during manufacturing would have required survival of streptococci for a minimum of 8 months. Preservatives in multidose vaccine vials do not prevent short-term bacterial contamination. Options to prevent further clusters of streptococcal abscesses are discussed. The only feasible and cost-effective preventive measure now available is careful attention to sterile technique when administering vaccine from multidose vials.

Abscess↗
PubMed1985

Health impact of measles vaccination in the United States.

As a result of intensive efforts to vaccinate children, measles and its attendant complications of encephalitis and death have declined more than 99% from the prevaccine era. Similarly, subacute sclerosing panencephalitis has declined markedly. Measles vaccine has been demonstrated to be extremely safe, as well as extremely effective. The health and resource benefits due to vaccination against measles during the first 20 years of vaccine licensure have been enormous. In this period it is estimated that vaccination against measles has prevented 52 million cases, 5,200 deaths, and 17,400 cases of mental retardation, achieving a net savings of $5.1 billion. These substantial health and resource benefits of measles vaccination will continue to accrue in the future.

Adolescent↗
PubMed1985

Measles outbreak in a pediatric practice: airborne transmission in an office setting.

In February 1981, a measles outbreak occurred in a pediatric practice in DeKalb County, GA. The source case, a 12-year-old boy vaccinated against measles at 11 1/2 months of age, was in the office for one hour on the second day of rash, primarily in a single examining room. On examination, he was noted to be coughing vigorously. Seven secondary cases of measles occurred due to exposure in the office. Four children had transient contact with the source patient as he entered or exited through the waiting room; only one of the four had face-to-face contact within 1 m of the source patient. The three other children who contracted measles were never in the same room with the source patient; one of the three arrived at the office one hour after the source patient had left. The risk of measles for unvaccinated infants (attack rate 80%, 4/5) was 10.8 times the risk for vaccinated children (attack rate 7%, 2/27) (P = .022, Fisher exact test, two-tailed). Airflow studies demonstrated that droplet nuclei generated in the examining room used by the source patient were dispersed throughout the entire office suite. Airborne spread of measles from a vigorously coughing child was the most likely mode of transmission. The outbreak supports the fact that measles virus when it becomes airborne can survive at least one hour. The rarity of reports of similar outbreaks suggests that airborne spread is unusual. Modern office design with tight insulation and a substantial proportion of recirculated ventilation may predispose to airborne transmission.

Adult↗
PubMed1982

Imported measles in the United States.

In the period 1980-1981, two hundred nine imported measles cases were reported in the United States. These cases represent 1.3% of the total of 16,630 cases of measles reported to the Centers for Disease Control (CDC) during that period. An average of two imported measles cases were reported each week. The travelers with imported measles were United States citizens and foreign nationals who arrived from 47 different countries throughout the world. However, returning United States citizens have accounted for a rising proportion of imported measles cases. Approximately half (49.3%) of the imported cases were reported by four areas: California, New York State exclusive of New York City, New York City, and Florida. Seven measles outbreaks occurring following importations during the two-year period were identified. In addition to 114 imported measles cases reported to the CDC in 1981, 437 measles cases were reported to be caused directly or indirectly by those importations. The actual number of import-associated cases may have been considerably higher. Imported measles and associated cases together accounted for at least 17% (551/3,124) of reported measles cases in 1981.

Adolescent↗
PubMedDate not supplied

Impact of measles in the United States.

Measles has had a severe impact on children in the United States since colonial times. In the early decades of the 20th century, thousands of fatal measles infections were reported each year. During the 1950s an annual average of greater than 500,000 cases of measles and nearly 500 deaths due to measles were reported in the United States. Surveys indicated that 95% of the population had been infected with measles by the age of 15 years. The introduction of measles vaccine and its widespread use, which began in 1963, has had a major impact on the occurrence of measles in the United States. Reported numbers of cases, deaths due to measles, and complications of measles (e.g., encephalitis) have declined dramatically. Accompanying the decline in reported incidence of measles and following it by approximately seven years, has been a decline in the reported incidence of subacute sclerosing panencephalitis (SSPE). In recent years, the incidence of measles has dropped to levels that are less than 1% of those seen in the prevaccine era. In 1981, provisional figures indicated that only 10% of counties in the United States reported any cases of measles. The reported incidence in 1981 was 1.3 cases per 100,000 population, compared with an average incidence of 336.3 cases per 100,000 population in the decade 1950-1959. Thus, the impact of measles in the United States has been markedly reduced, and it is anticipated that indigenous transmission will be eliminated entirely from the country within the year.

Adolescent↗
PubMedDate not supplied

Estimating HIV levels and trends among patients of tuberculosis clinics.

Symptomatic tuberculosis (TB) can occur as an opportunistic disease in immunosuppressed persons who are infected with human immunodeficiency virus (HIV) and who have been previously infected with Mycobacterium tuberculosis. Increases in TB cases have occurred in areas which have reported large numbers of cases of the acquired immunodeficiency syndrome (AIDS), and a high proportion of these TB cases have been HIV seropositive. Therefore, increasing numbers of HIV-infected persons may be found in TB clinics and hospitals. HIV serologic surveys in TB clinics and hospitals providing clinical services to TB patients are needed to assess the local prevalence of HIV infection in TB patients and the consequent need for public health intervention to prevent further spread of HIV and TB infection. The Centers for Disease Control (CDC), in collaboration with State and local health departments, has initiated HIV surveillance of patients with confirmed and suspected TB in TB clinics and hospitals in the United States. Blinded (serologic test results not linked to identifiable persons) HIV seroprevalence surveys are conducted in sentinel TB clinics and hospitals that provide TB clinical services each year to obtain estimates of the level of HIV infection in TB patients and to follow trends in infection over time. Nonblinded (voluntary) surveys will also be conducted to evaluate behaviors that have placed TB patients at risk for or protected them against HIV infection. Data from these surveys will be used to target education and prevention and control programs for TB and HIV infection and to monitor changes in behavior in response to such programs.

AIDS Serodiagnosis↗
PubMedDate not supplied

Drug resistance among tuberculosis patients, New York City, 1991 and 1992.

The authors assessed drug susceptibility patterns among tuberculosis patients reported to the New York City Department of Health in the first quarters of 1991 and 1992. Resistance to one or more drugs was seen in 26 percent (137 divided by 520) in 1991 and 24 percent (122 divided by 517) in 1992. Resistance to isoniazid was seen in 22 percent and 19 percent of patients in 1991 and 1992, respectively; resistance to rifampin in 15 percent and 14 percent; and to both isoniazid and rifampin in 15 percent and 14 percent. Combined resistance to four first line drugs (isoniazid, rifampin, streptomycin, and ethambutol) was seen in 6 percent (1991) and 8 percent (1992). Patients with organisms resistant to both isoniazid and rifampin were as likely among U.S. born as among foreign born, and younger patients were more likely than older patients to have isoniazid and rifampin resistant organisms. These findings underscore the importance of obtaining susceptibility testing in all patients who have cultures positive for Mycobacterium tuberculosis.

Adolescent↗