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Biomedical subjects

C V Broome

Publications and source records attributed to C V Broome.

At least 37 records · Page 2Linked to original sources
PubMed1992

Epidemic meningococcal disease in Nairobi, Kenya, 1989. The Kenya/Centers for Disease Control (CDC) Meningitis Study Group.

An epidemic of meningococcal disease occurred in Nairobi, Kenya, during 1989, outside the "meningitis belt" of sub-Saharan Africa. About 3800 cases occurred between April and November (250/100,000 population). The case-fatality rate was 9.4% among hospitalized patients. Areas that included Nairobi's largest slums had particularly high attack rates. The epidemic displayed an unusual age distribution, with high attack rates among those 20-29 years old. A vaccination campaign was conducted. By early January, the weekly case count had fallen to 25 from a high of 272 (in September). A case-control study estimated the vaccine efficacy to be 87% (95% confidence interval, 67%-95%). A model estimated that the vaccination campaign reduced the number of cases by at least 20%. Multilocus enzyme electrophoretic typing demonstrated that the strain responsible for this large epidemic is closely related to strains that caused other recent epidemics, documenting further spread of what may be a particularly virulent clonal complex of group A Neisseria meningitidis.

Adolescent↗
PubMed1992

Comparative efficacy of oral rifampin and topical chloramphenicol in eradicating conjunctival carriage of Haemophilus influenzae biogroup aegyptius. Brazilian Purpuric Fever Study Group.

Persistent conjunctival carriage of the Haemophilus influenzae biogroup aegyptius (Hae) strain (BPF clone) responsible for Brazilian purpuric fever (BPF) has been documented. Topical chloramphenicol is routinely used to treat conjunctivitis in areas affected by BPF in Brazil. Although the BPF clone is susceptible to chloramphenicol, we observed a number of children treated with topical chloramphenicol for conjunctivitis who still developed BPF. During an investigation of an outbreak of BPF in Mato Grosso State, Brazil, we compared oral rifampin (20 mg/kg/day for 4 days) with topical chloramphenicol for eradication of conjunctival carriage of H. influenzae biogroup aegyptius among children with presumed BPF clone conjunctivitis. Conjunctival samples were taken for culture on the day treatment was initiated and a mean of 8 and 21 days later. At 8 days the eradication rates for oral rifampin and topical chloramphenicol were 100 and 44%, respectively (P = 0.003); at 21 days they were 100 and 50% (P = 0.01). Oral rifampin was more effective than topical chloramphenicol for eradication of the BPF clone and may be useful in prevention of BPF.

Administration, Oral↗
PubMed1992

Risk factors for deaths in children under 5 years old in Bagamoyo district, Tanzania.

We conducted a population based case control study of deaths in children < 5 years old from Bagamoyo District, Tanzania, to evaluate factors associated with death, and factors associated with not utilizing Government health care system. Six hundred and ten children who died between 1 July, 1986 and 30 June 1987 were enrolled as cases; 1,160 healthy control children were selected by multistage random cluster sampling. Twenty-five percent of deaths were ascribed to pneumonia based on "verbal autopsy"; 39% of acute respiratory deaths occurred in children < 6 months of age. In a multivariate analysis, significant independent associations were found with mother as sole decision maker for treatment (O.R = 0.13; 95% C:I. 0.07, 0.22); use of water from village well, pond, or river vs. tap water (O.R. = 11.86; 95% C.I., 5.46, 25.72); the child eating with others (O.R. = 9.42; 95% C.I. 5.68, 15.62) and the child sleeping in the room where cooking is done (O.R. = 2.78; 95% C.I. 1.79, 4.33). Overall only 45% of families utilized Government health care (village health worker, dispensary or health centre) during their child's terminal illness. Families utilizing Government health care were significantly more likely to say that the mother alone could make treatment decision (O.R. = 2.49, 95% C.I. 1.39, 4.46), and to be closer to a dispensary. The main reasons for not utilizing Government health care were 'traditional medicine is better' (41%) and 'no drugs available' (38%).

Age Factors↗
PubMed1991

Invasive group B streptococcal disease in adults. A population-based study in metropolitan Atlanta.

OBJECTIVE: To define the incidence and clinical spectrum of group B streptococcus infection in adults. To characterize groups at increased risk for infection. DESIGN: Retrospective population-based surveillance of group B streptococcus infections occurring in adults. Patients were identified by review of microbiology records at all surveillance area hospital laboratories. Demographic and clinical data were abstracted from patient medical records. SETTING: Metropolitan Atlanta, Ga, 1982 through 1983. PATIENTS: We identified 70 adult patients with invasive group B streptococcus infections; 14 infections occurred in pregnant women and 56 in nonpregnant adults. RESULTS: The annual incidence of group B streptococcus infection in men and nonpregnant women was 2.4 cases per 100,000 population. Incidence increased with age and was higher in blacks than in whites. The case-fatality rate was 32%. Group B streptococcus was most often isolated from blood (71%) and soft tissue (16%). Common clinical presentations included skin and soft-tissue infection (36%), bacteremia without focus (34%), pneumonia (11%), arthritis (9%), and endocarditis (9%). Compared with the general population's risk of infection, the risk of infection in persons with diabetes mellitus was increased 10.5-fold (95% confidence interval [CI], 7.8 to 14.4); in persons with cancer, it was increased 16.4-fold (95% CI, 11.5 to 23.3). CONCLUSIONS: Group B streptococcus infections cause serious disease in adults as well as in neonates, providing an additional rationale for vaccine development. Determining the incidence of adult disease and groups at greatest risk will help in focusing prevention efforts.

Female↗
PubMed1991

Efficacy of Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine in US children aged 18-59 months. Haemophilus Influenzae Vaccine Efficacy Study Group.

Vaccines prepared from the polyribosylribitol phosphate (PRP) capsule of Haemophilus influenzae b (Hib) have not consistently shown good efficacy in protecting children aged over 18 months from invasive Hib disease. To evaluate the efficacy of conjugate-PRP vaccines in this age-group, and to compare their effect with that of PRP vaccines, a post-marketing case-control study was conducted among 10,400,000 persons. Between Oct 1, 1988, and Feb 28, 1990, 75 patients with Hib disease and 161 control children between 18 and 60 months of age were enrolled. To minimise potentially confounding socioeconomic variables, controls were selected either from among patients' classmates at their day-care centre or from among family acquaintances. 9 of the 75 patients had received the diphtheria toxoid conjugate Hib vaccine more than 2 weeks before onset of illness. After adjusting for age and household crowding, the efficacy of PRP Hib vaccine was 64% (95% Cl = -20,89) and efficacy of the diphtheria toxoid conjugate Hib vaccine was 74% (95% Cl = 30,90). The study shows that the protective efficacy of this conjugate vaccine is less than ideal and highlights the need for additional post-licensing studies to confirm and expand understanding of the efficacy of these new products.

Analysis of Variance↗
PubMed1991

Use of surveillance for invasive pneumococcal disease to estimate the size of the immunosuppressed HIV-infected population.

We used population-based surveillance in New Jersey in 1986 to quantify the risk of invasive pneumococcal disease in persons with the acquired immunodeficiency syndrome (AIDS) and in those who went on to develop AIDS. Using pneumococcal surveillance, we also devised a method to estimate the size of the immunosuppressed population infected with the human immunodeficiency virus (HIV), the so-called pre-AIDS population. From rates of pneumococcal disease that occurred in areas with a low incidence of AIDS, we calculated the number of patients expected to contract pneumococcal disease in areas with a high incidence of AIDS. There were 59 more cases of pneumococcal disease observed than expected; 14 of these patients had AIDS by the time of pneumococcal infection. We attributed the remaining 45 cases to the increased risk of pneumococcal infection in pre-AIDS. The pre-AIDS pneumococcal cases and the attack rate of pneumococcal disease in pre-AIDS were used to estimate the size of the 1986 pre-AIDS New Jersey population as 8823 pre-AIDS cases (95% confidence interval, 7377 to 10,714) or 0.37% of the adult New Jersey population. Surveillance for marker diseases may provide a simple, independent method of estimating the pre-AIDS population.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The epidemiology of listeriosis in the United States--1986. Listeriosis Study Group.

To determine the morbidity and mortality due to listeriosis in the United States, the authors undertook an active surveillance project in 1986 to identify all cases in which Listeria monocytogenes was isolated from cultures of ordinarily sterile sites in a population of 34 million persons. The authors estimated that at least 1,700 cases of listeriosis and 450 deaths occurred in the United States in 1986; 27% of these cases occurred in pregnant women, with 22% of perinatal cases resulting in stillbirths or neonatal deaths. The risk of listeriosis in adults (0.5 per 100,000 population) was similar in all regions studied; the incidence of perinatal listeriosis was three times higher in Los Angeles County, California, than in the other areas (24.3/100,000 live births vs. 7.8/100,000 live births). Geographic variation may have resulted from underdiagnosis of perinatal listeriosis in five of the study areas. Multilocus electrophoretic enzyme typing was useful for elucidating the molecular epidemiology of L. monocytogenes; perinatal listeriosis was significantly associated with one group of related strains. Multilocus electrophoretic enzyme typing also identified three clusters representing possible common-source outbreaks. These findings document the substantial morbidity due to listeriosis in the United States; to the extent that sporadic listeriosis is foodborne, this morbidity could be reduced by appropriate preventive measures, particularly in persons known to be at increased risk of infection.

Adult↗
PubMed1991

Meningococcal disease in the United States--1986. Meningococcal Disease Study Group.

Active surveillance for invasive meningococcal disease was conducted during 1986 and 1987 in six areas of the United States with a total population of approximately 34 million persons. The incidence of meningococcal disease was 1.3:10(5). The highest incidence of disease among the surveillance areas was in Los Angeles County (1.65:10(5). Neisseria meningitidis serogroups B and C caused about equal amounts of disease, which reflects a recent increase in the incidence of group C disease. Group C caused more than half of the cases of meningococcal disease in Los Angeles and Tennessee but less than one-third of the cases in Missouri and Oklahoma. Multilocus enzyme electrophoresis demonstrated that a group of closely related isolates of N. meningitidis was prevalent in Los Angeles during the surveillance period and was associated with an increased incidence of meningococcal disease there.

Adolescent↗
PubMed1991

Toxic shock syndrome and tampons.

There has been a substantial reduction in the incidence of toxic shock syndrome in the 10 years since the association between tampons and toxic shock syndrome was first recognized. The decreased incidence is real, and not the result of decreased reporting to the passive surveillance system. The decreased incidence of menstrual toxic shock syndrome can primarily be explained by changes in the absorbency and composition of tampons available to the consumer. The reduction in the occurrence of menstrual toxic shock syndrome can be attributed to the withdrawal of Rely brand, which consisted of a unique composition, and subsequently to the lowering of absorbency of all brands of tampons. The conclusions of the early studies of toxic shock syndrome pointed the way to prompt public health interventions and resulted in the prevention of substantial morbidity.

Bacterial Toxins↗
PubMed1991

Outbreak of neonatal listeriosis associated with mineral oil.

In June, 1989, an outbreak of nosocomial listeriosis occurred in Costa Rica. Listeria monocytogenes was isolated from 9 ill infants 4 to 8 days old who were born after the delivery of an infant with early onset listeriosis. One nosocomial infection was fatal, 2 required mechanical ventilation and 1 resulted in hemiparesis. A higher proportion of cases than other infants born during the outbreak were delivered by cesarean section (55% vs. 24%, P = 0.04). Compared with the mothers of 36 random controls, case mothers were more often primiparous (odds ratio, 6.2, P = 0.03) or received general anesthesia before delivery (odds ratio, 4.4, P = 0.09). All infants were bathed with mineral oil from a multidose container. Culture of the oil by cold enrichment grew L. monocytogenes 4b with the same electrophoretic enzyme type as the outbreak strain. We hypothesize that aspiration of contaminated oil may have resulted in systemic listeriosis. General anesthesia may have increased the risk of aspiration. Lung tissue from the infant who died showed lipid-laden macrophages consistent with oil aspiration and had evidence of L. monocytogenes DNA detected by polymerase chain reaction. This is the first nosocomial outbreak of listeriosis in which a common source suggested epidemiologically was microbiologically confirmed. The high attack rate (greater than 200 times the United States rate of perinatal listeriosis) emphasizes the susceptibility of healthy neonates to L. monocytogenes. The results of our study led to the discontinuation of the use of mineral oil for bathing neonates in Costa Rica.

Case-Control Studies↗
PubMed1991

Comparison of cold enrichment and U.S. Department of Agriculture methods for isolating Listeria monocytogenes from naturally contaminated foods. The Listeria Study Group.

We compared the cold enrichment (CE) and U.S. Department of Agriculture (USDA) methods for isolating Listeria monocytogenes by examining 402 food samples. The food samples were collected from refrigerators of listeriosis patients as part of a multistate active surveillance project to determine the role of foods in sporadic listeriosis in the United States. L. monocytogenes was isolated from 51 food samples (13%). The USDA method was significantly better (P less than 0.001) than the CE method. The isolation efficiencies of the USDA and CE methods were 96 and 59%, respectively. Quantitation of L. monocytogenes in the food samples revealed that many food samples containing less than 0.3 CFU/g were negative as determined by the CE method but positive as determined by the USDA method.

Cold Temperature↗
PubMed1991

Epidemiology of human listeriosis.

During the 1980s, investigation of several large epidemics of listeriosis confirmed that transmission of L. monocytogenes in food causes human disease. Progress in laboratory detection and subtyping of the organism has enhanced our ability to compare human and environmental isolates of L. monocytogenes. Transmission by foodborne organisms is now recognized as causing both epidemic and sporadic listeriosis. Continued study of dietary risk factors associated with listeriosis is needed in order to develop dietary recommendations for the expanding population at increased risk of disease. Current research application of new molecular methods to the study of L. monocytogenes may improve the ability to diagnose pregnancy-associated disease and permit the rapid detection and control of L. monocytogenes in the food supply.

Animals↗
PubMed1991

Vaccine efficacy determination.

The "Gold standard" in vaccine testing is the randomized, placebo controlled, double-blind efficacy trial. Once a protective immune mechanism is defined, e.g., from an efficacy trial, vaccine performance can then be judged by serologic parameters. Although immunogenicity studies can provide important information, in many instances the answer has to come from efficacy trials. For rare diseases like meningococcal disease, these trials are expensive and difficult to conduct. It is therefore incumbent to learn as much as possible from each trial. Issues in pre-licensure studies include: vaccine selection, site selection, trial design, assignment to treatment and control groups, definition and surveillance for endpoints (cases, adverse reactions), identification of surrogate markers for protection, and utilization of monitoring committees.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

A cluster of meningococcal disease on a school bus following epidemic influenza.

An outbreak of meningococcal disease among children on a school bus offered the opportunity to study a proposed association between this infection and preceding influenza infection. Five students who rode the bus became ill with invasive group C meningococcus. Transmission was limited to the bus; there was no evidence for school transmission. All five students reported influenza-like symptoms within several weeks before the development of meningococcal disease. School absenteeism, principally due to upper respiratory tract illness, was higher during the 3 weeks before the outbreak of meningococcal disease than during any period in the preceding 3 1/2 years, suggesting an unusually severe outbreak of respiratory illness. A case-control study comparing students with and without influenza symptoms revealed that the outbreak of respiratory disease was due to B/Ann Arbor/1/86 influenza (geometric mean titers, 86 for 80 patients and 33 for 47 controls [P = .0007]). These data add to the evidence suggesting that influenza respiratory infection predisposes to meningococcal disease.

Absenteeism↗
PubMed1990

Respiratory viruses and mycoplasma as cofactors for epidemic group A meningococcal meningitis.

To investigate the role of coincident respiratory viral and mycoplasmal agents in the pathogenesis of meningococcal meningitis, we performed a matched case-control study of 62 patients with group A meningococcal meningitis during an epidemic in Chad. Case patients were more likely than controls to have nasal colonization or infection with respiratory viruses and Mycoplasma species (matched odds ratio, 23; 95% confidence interval, 3.1 to 170). Respiratory pathogens were found more commonly in older patients with meningitis (odds ratios were 2.9 for children under age 5 years and 46.5 in those over age 15 years), consistent with the increasing risk of meningitis with age during epidemics. In controls, the presence of respiratory pathogens increased the risk of upper-respiratory-tract symptoms but did not significantly increase meningococcal carriage.

Adolescent↗
PubMed1990

Borrelia burgdorferi: survival in experimentally infected human blood processed for transfusion.

The isolation of Borrelia burgdorferi from blood raises the possibility of bloodborne transmission of Lyme borreliosis through transfusions. To assess this possibility, the ability of B. burgdorferi to survive in human blood processed for transfusion was studied. Human blood was inoculated with B. burgdorferi type strain B-31 (ATCC 35210) at 0.2, 20, or 2000 viable cells/ml, processed by conventional blood banking procedures, stored at 4 degrees C, and cultured for B. burgdorferi at 12, 23, 36, and 48 days of storage. After processing, most B. burgdorferi were found in the packed cell fraction. At inoculum levels of 20 or 2000 viable cells/ml, B. burgdorferi survived in processed blood through 48 days of storage at 4 degrees C. B. burgdorferi was isolated from packed cells after 36 days of storage at 4 degrees C even when the initial inoculum level was as low as 0.2 cells/ml. The data demonstrate that B. burgdorferi can survive the blood processing procedures normally applied to transfused blood in the USA. Since hematogenous spread of the spirochete seems to occur early in the illness, primarily in symptomatic patients, the risk of transfusion-associated Lyme disease may be small. However, the possibility of survival of B. burgdorferi under blood banking conditions warrants a heightened awareness of this potential problem.

Blood Transfusion↗