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Biomedical subjects

C S Peckham

Publications and source records attributed to C S Peckham.

At least 37 records · Page 2Linked to original sources
PubMed1996

Neonatal herpes simplex virus infection in the British Isles.

This study was set up to estimate the incidence of neonatal herpes simplex virus (HSV) infection in the British Isles, and to document the outcome of neonatal infection. Paediatricians reported cases of neonatal HSV through the active reporting scheme of the British Paediatric Association Surveillance Unit. Over a 5 1/2 year period (1986-91) 76 infants with neonatal HSV infection were reported, an incidence of recognised infection in the British Isles of 1.65/100000 livebirths. Twenty-five infants had HSV-1 infection, 24 HSV-2 and in 27 virus type was unknown. Twenty-seven had disseminated infection, 23 herpes encephalitis and 26 localised infection. Nineteen infants (25%) died in the neonatal period, and a further 25 (33%) have subsequently died or have long-term sequelae. At least half of the infants had been discharged home before symptoms became apparent. For 21 women there was evidence of a maternal genital herpes infection at some time, but this was reported or diagnosed retrospectively after neonatal HSV was suspected in 19 cases, and antenatally in only two. Neonatal HSV is rare in the British Isles and routine antenatal screening for genital herpes infection during pregnancy is not justified. A high proportion of infected infants present with non-specific signs and symptoms and without mucocutaneous involvement; furthermore, there is rarely a history of maternal infection. As early diagnosis and prompt treatment is essential, there must be a high level of awareness of the serious nature of neonatal HSV infection.

Confidence Intervals↗
PubMed1996

Vertical transmission of HIV-1: maternal immune status and obstetric factors. The European Collaborative Study.

OBJECTIVE: To estimate the effect of maternal factors and events around the time of delivery on HIV-1 vertical transmission risk. DESIGN: Prospective study. SETTING: Twenty-two obstetric and paediatric clinics in seven European countries. PATIENTS OR OTHER PARTICIPANTS: Mothers identified as HIV-infected before or at delivery and their children. MAIN OUTCOME MEASURE: Paediatric HIV infection. RESULTS: By November 1995, 1846 mothers with 1945 children had been enrolled. The vertical transmission rate was 16.4% (95% confidence interval, 14.5-18.3). Parity, maternal age, race, mode of HIV acquisition, injecting drug use and sex of infant were not statistically significantly associated with risk of transmission. Children delivered vaginally were more likely to be infected than those delivered by Caesarean section. However, in vaginal deliveries the procedures used, duration of ruptured membranes or length of second-stage labour were not related to transmission. Transmission increased almost linearly with decreasing CD4 cell count, but there was no such trend for CD8 cell count. Women with CD4 cell counts below 200 x 10(6)/l were significantly more likely to deliver early (chi 2 for trend, 14.02; P < 0.001). Very premature infants were at increased risk of infection, but after about 35 weeks gestation the transmission rate remained stable, with no increase in late pregnancy. This trend was confirmed after allowing for maternal CD4 cell count. CONCLUSIONS: The rate of vertical transmission increases linearly with decreasing maternal CD4 cell count. Women with fewer than 200 x 10(6) CD4 cells/l have an increased risk of premature delivery, which would affect timing of interventions. The stable transmission rate after 35 weeks gestation suggests little acquisition of infection during late pregnancy.

Europe↗
PubMed1994

Use of anonymous newborn serosurveys to evaluate antenatal HIV screening programmes.

OBJECTIVE: To evaluate the extent to which antenatal HIV screening programmes identify HIV infected women who go to term. DESIGN: Comparison of results of two surveillance systems. An anonymous neonatal HIV serosurvey was used to estimate the numbers of HIV infected women giving birth; reporting by obstetricians was used to assess the proportion who had been identified. SETTING: Three Thames regions. RESULTS: 729,105 neonatal blood samples were tested, of which 484 were HIV seropositive. Newborn HIV seroprevalence is increasing, at different rates, in inner London, suburban London, and in non-metropolitan districts. During the past four years the proportion of infected women who have been identified before delivery is 16.9%, but less than half of these were diagnosed during pregnancy. In 1993 only five of the 128 (4%) previously undiagnosed infected women delivering babies were identified by antenatal screening. CONCLUSION: Despite increased emphasis on antenatal testing for HIV in areas of higher prevalence the number of undiagnosed women delivering babies continues to increase. Consideration should be given to alternative strategies for offering antenatal HIV testing. Antenatal screening programmes should be monitored continuously by comparing anonymous neonatal seroprevalence with clinical reports from obstetricians.

Confidence Intervals↗
PubMed1993

Vertically transmitted HIV infection in the British Isles.

OBJECTIVE: To describe the epidemiology of vertically acquired HIV infection in the British Isles, the level of underreporting, the vertical transmission rate, and clinical spectrum of paediatric AIDS. DESIGN: Confidential, linked registers based on reporting from obstetricians and paediatricians; anonymous unlinked neonatal HIV serosurveys. SETTING: British Isles. SUBJECTS: Children born to mothers with HIV infection. MAIN OUTCOME MEASURES: Trends in HIV infection and vertical transmission rate. RESULTS: In Scotland and the Irish Republic, where most maternal HIV infection is related to drug misuse, the annual number of reports of children born to infected mothers has fallen since 1989. In England and Wales nearly half of maternal infections have been acquired overseas, and the number of children born to these women, and to women who became infected in Britain, is increasing. In south east England the proportion of live births to women whose infection was identified before delivery was only 17% (50/287), compared with 68% (26/38) in Scotland. The vertical transmission rate was 13.7% (23/168), and 23% of infected children developed AIDS in the first year of life. 41% (38/92) of children born to infected mothers who were ascertained after delivery were breast fed, compared with 5% (12/236) of those ascertained before delivery. CONCLUSIONS: The incidence of vertically transmitted HIV infection is increasing in England and Wales. More extensive antenatal testing would enable infected women to be counselled against breast feeding, which could prevent a substantial proportion of vertical transmission in some areas, and would increase opportunities for early diagnosis and treatment of infected children.

AIDS-Related Opportunistic Infections↗
PubMed1993

Rubella surveillance to December 1992: second joint report from the PHLS and National Congenital Rubella Surveillance Programme.

The high uptake of measles/mumps/rubella vaccine since October 1988 has had a major impact on rubella susceptibility in children under five years of age, with interruption of the epidemic cycle and reduction in incidence to a low endemic level. The number of infections in pregnancy reported in England and Wales to the PHLS Communicable Disease Surveillance Centre fell to 23 in 1990, and to 12 and two, respectively, in 1991 and 1992. The reduction was greatest in parous women, a group who were previously at risk through exposure to their own children. During 1991, however, susceptibility in parous antenatal women rose from 0.7% to 1%, suggesting that post-partum immunisation rates may have declined recently. If continued, this could give rise to outbreaks of congenital rubella in the future during the brief periods of rubella resurgence expected before disease elimination is achieved. Susceptibility among Asian women was four times higher than among non-Asians. Of the total of 94 births of congenitally infected infants since January 1987, only 19 occurred during 1990-92 (but this may increase due to late diagnoses). Factors contributing to the continuing occurrence of congenital rubella include missed opportunities for immunisation at school or post-partum, maternal reinfection, and recent immigration into the United Kingdom. Twenty-two (24%) of the women giving birth to congenitally infected infants since 1987 were Asian or Oriental women, of whom at least three acquired their infections abroad. Imported cases will be distinguished in future surveillance reports.

Abortion, Eugenic↗
PubMed1993

Maternal prevalence of Toxoplasma antibody based on anonymous neonatal serosurvey: a geographical analysis.

A total of 12,902 neonatal samples collected on absorbent paper for routine metabolic screening were tested anonymously for antibodies to toxoplasma. Seroprevalence varied from 19.5% in inner London, to 11.6% in suburban London, and 7.6% in non-metropolitan districts. Much of this variation appeared to be associated with the proportions of livebirths in each district to women born outside the UK. However, additional geographical variation remained and seroprevalence in UK-born women was estimated to be 12.7% in inner London, 7.5% in suburban London, and 5.5% in non-metropolitan areas. These estimates are considerably lower than any previously reported in antenatal sera in the UK. The wide geographical variation highlights a need for further research to determine the relative importance of different routes of transmission.

Antibodies, Protozoan↗
PubMed1993

Screening for HIV infection in pregnancy.

Antenatal HIV screening policies throughout the British Isles were surveyed and results linked to data on HIV-infected pregnant women notified through the Royal College of Obstetricians and Gynaecologists. Units offering HIV testing to all pregnant women were compared with those offering it only to women considered to be at risk, and in both situations fewer than 50% of infected women were identified as HIV infected for the first time in antenatal clinics. Based on laboratory reports of HIV infection in women of childbearing age, paediatric reports of children born to HIV positive women and unlinked anonymous neonatal screening programmes, there was evidence of under-recognition of HIV infection in pregnancy, particularly in England and Wales.

AIDS Serodiagnosis↗
PubMed1993

Birth weight and body mass index in childhood, adolescence, and adulthood as predictors of blood pressure at age 36.

STUDY OBJECTIVE: The purpose of this study was to investigate the relation between blood pressure at age 36, and birth weight and body mass index (BMI) in childhood, adolescence and adulthood. DESIGN: Prospective longitudinal survey over a period of 36 years in England, Scotland, and Wales. PARTICIPANTS: A nationally representative sample consisting of 3332 men and women born in one week in March 1946. Altogether 82% of these subjects had complete data for the present analysis. MAIN RESULTS: There was an inverse linear relation between birth weight and blood pressure at age 36. The relation between BMI and blood pressure at age 36 was initially inverse and became increasingly positive throughout life. Weight gain in childhood was positively associated with adult blood pressure, although less important than weight change in later life. The associations between blood pressure and birth weight, and blood pressure and adult BMI were independent, and together they accounted for no more than 4% of the variation in adult blood pressure. Both low birth weight (birth weight < or = 2.5kg) and high BMI at age 36 (BMI > 30kg/m2) were associated with hypertension (> 140/90mmHg), but the per cent population risk of hypertension attributable to low birth weight was less than 5%, and to high BMI less than 12%. CONCLUSIONS: Low birth weight and high BMI at age 36 were independently related to high blood pressure. A reduction in the percentage of low birthweight babies born in the fourth decade of this century would only have a negligible effect on the incidence of adult hypertension 30-40 years later.

Age Factors↗
PubMed1993

Long-term psychosocial sequelae of chronic physical disorders in childhood.

OBJECTIVE: This study was designed to examine the long-term psychosocial sequelae of chronic physical disorders that begin during childhood. DESIGN: We analyzed data from a national birth cohort. 12,537 children were followed until age 23 years--76% of all born in Britain during one week in 1958. Of these, 1667 had a chronic disorder before age 16 and 1279 were included in the 23-year follow-up. MEASURES: Outcome measures included self-reported psychological disturbances between ages 16 and 23, scores on the Malaise Inventory, social class, educational qualifications, unemployment, and social activities. RESULTS: The total cumulative incidence rate before 16 years was 109.5 per 1000. Demographic comparisons showed that the group with chronic physical disorders was similar to those free of chronic disorders in all respects except the sex ratio. Men with chronic physical disorders had significantly higher relative risks for abnormal scores on the Malaise Inventory (1.52, confidence interval [CI] 1.13, 2.05); specialist psychological care (1.43, CI 1.00, 2.03); poor educational qualifications (1.26, CI 1.08, 1.47); periods of unemployment (1.20, CI 1.03, 1.41); and less social drinking (1.36, CI 1.15, 1.60). In contrast, women only had a significantly elevated risk for having seen a mental health specialist (1.32, CI 1.02, 1.71). Among the men some of the risks were further elevated for those in specific diagnostic groups. These findings are examined in the light of postulates about the impact of chronic physical disorders as a whole and in an attempt to explain the striking sex differences. For clinicians they provide further reason to justify concern about the psychosocial aspects of care for children with chronic disorders.

Affective Symptoms↗
PubMed1992

Risk of human immunodeficiency virus type 1 transmission through breastfeeding.

Detection of human immunodeficiency virus type 1 (HIV-1) in breast milk by culture and polymerase chain reaction does not necessarily mean that breastfeeding is a route of transmission, although evidence from several case-reports points in that direction. We undertook a systematic review of published studies meeting criteria that allowed determination of quantitative risk of transmission via breastfeeding. Based on four studies in which mothers acquired HIV-1 postnatally, the estimated risk of transmission is 29% (95% Cl 16-42%). Analysis of five studies showed that when the mother was infected prenatally, the additional risk of transmission through breastfeeding, over and above transmission in utero or during delivery, is 14% (95% Cl 7-22%). Where there are safe alternatives to breastfeeding, universal named testing of pregnant women would provide an opportunity to advise more infected women not to breastfeed and might thereby reduce the number of vertically infected children. Since breastfeeding protects against infant deaths from infectious diseases, breastfeeding is still recommended where infectious diseases are a common cause of death in childhood, despite the additional risk of HIV transmission.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Two methods for assessing the risk-factor composition of the HIV-1 epidemic in heterosexual women: southeast England, 1988-1991.

OBJECTIVE: The prevalence of HIV-1 in the heterosexual population in southeast England between 1988 and 1991 was examined using two methods. DESIGN AND METHODS: First, district neonatal seroprevalence was compared on a geographical basis to social and demographic variables reflecting risk-factor prevalence. Second, over the same period eight children who developed AIDS within the first 12 months of life were born. RESULTS: The differences in seroprevalence between districts could be explained by the proportion of livebirths to women born in parts of Africa. An estimated 92% of neonatal seropositives could be associated with this demographic variable. The proportions of livebirths to women born in other countries, the prevalence of notified injecting drug use, and area measures of social deprivation, were only poorly related to HIV seroprevalence, and had no additional explanatory value. Seven of the eight (87.5%) children who developed AIDS in the first year were born to black women from Africa. CONCLUSIONS: Both methods suggest that a high proportion of heterosexually transmitted HIV in southeast England has been imported.

Adult↗
PubMed1992

Cytomegalovirus prevalence in pregnant women: the influence of parity.

Over 20,000 women attending for antenatal care at three London hospitals were prospectively studied to determine the prevalence of cytomegalovirus (CMV) antibodies; 54.4% of these women were CMV seropositive. Ethnic group was strongly associated with CMV status: 45.9% of white women were seropositive, 88.2% of Asian, and 77.2% of black women (African/Caribbean ethnic origin). Among 12,159 white women born in the British Isles, seropositivity was independently associated with increasing parity, older age, lower social class, and being single at antenatal booking. The findings are consistent with the hypothesis that, in the UK, child to mother transmission of infection plays a significant part in the acquisition of CMV infection in adult life.

Africa↗
PubMed1992

Evaluation of five commercial assays for screening antenatal sera for antibodies to Toxoplasma gondii.

AIMS: To evaluate the suitability of five commercial assays (Toxoreagent, DA, Captia Toxo IgG, Toxenz-G, Toxonostika-G) for screening large numbers of sera for antibodies to Toxoplasma gondii. METHODS: Sera from 1000 pregnant women booking for antenatal care at a London hospital were screened in parallel by each test. Sera giving discordant results were retested. RESULTS: The Captia Toxo IgG enzyme immune assay gave the best specificity on initial screening, with 0/773 false positives and only 2/218 false negatives. The Toxoreagent latex agglutination test performed well provided sera were tested at several dilutions to prevent prozone effects; 0/218 false negatives (greater than 12 IU/ml). Only one evidently false positive result was seen in the 1000 samples tested. The DA test gave no false negative results but produced 23/773 false positives. After repeat testing there were 9/1000 sera which gave equivocal results which were negative by the Captia Toxo IgG test (less than 12 IU/ml) but with low titres of 16 in the Toxoreagent test or 4 IU/ml in the DA test. In this situation women would have been asked for a follow up sample for repeat testing. Only 300 sera were tested by Toxenz-G; initial screening produced 4/58 false negative results and 4/242 false positives. CONCLUSIONS: The Captia Toxo IgG test gave the fewest discordant results on initial screening. Results could be readily expressed in international units using a programmable plate reader, and this may be useful for epidemiological studies. The Toxoreagent test is considerably cheaper, and is a simple and reliable method for screening provided that at least two dilutions are used.

Agglutination Tests↗
PubMed1991

Rubella vaccination in pregnancy.

Ninety-two pregnancies complicated by rubella vaccination were reported to the Rubella Vaccination in Pregnancy Study between 1981 and 1990. These pregnancies resulted in 87 live births, 3 stillbirths and two spontaneous abortions. One infant had serological evidence of congenital rubella infection but was healthy and normal with no indication of rubella damage at the age of two and half years. These findings suggest that the risk of rubella-associated damage following inadvertent rubella vaccination in pregnancy or shortly before is low, and support the current advice that termination of pregnancy should not be routinely recommended in these circumstances.

Antibodies, Viral↗