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D B Fishbein

Publications and source records attributed to D B Fishbein.

85 records · Page 5Linked to original sources
PubMed1986

The early kinetics of the neutralizing antibody response after booster immunizations with human diploid cell rabies vaccine.

Persons immunized in developing countries were recently shown to have low titers after pre-exposure immunization with human diploid cell rabies vaccine (HDCV). An investigation into the response to HDCV boosters was conducted to determine if immunologic sensitization had occurred and if there was a response difference in persons immunized in and outside of the United States. Intramuscular (im) booster doses of vaccine were administered to 113 persons previously immunized outside the United States and 47 persons immunized in the United States. The post-exposure booster regimen of a single 1.0-ml im booster, as recommended by the World Health Organization for all but the most severe bites, produced a one-dilution (5-fold) rise in antibody titer in 14 (11%) of 123 persons tested 5 days after booster and in 56 (89%) of 63 persons studied 7 days after booster. Persons immunized in the United States and those immunized outside the United States had similar responses. Persons with low pre-booster titers were more likely to exhibit a 5-fold rise in antibody titer 5 days after booster (P = 0.03) than persons with higher pre-booster titers. The post-exposure booster regimen of 2 1.0-ml im doses (one each on days 0 and 3), recommended in the United States, produced a more rapid response than the single booster regimen in only some persons; a 5-fold response occurred in 6 (50%) of 12 persons 5 days after booster.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Viral↗
PubMed1986

Rabies in rodents and lagomorphs in the United States, 1971-1984: increased cases in the woodchuck (Marmota monax) in mid-Atlantic states.

A review of surveillance data on animal rabies from the Centers for Disease Control revealed 104 cases of rabies in rodents and lagomorphs for 1971 through 1984 in the United States; 80% of these were reported between 1980 and 1984. Woodchucks (Marmota monax) accounted for 64% of the cases. Most of the cases of rabies in woodchucks were associated with an epizootic of rabies in raccoons (Procyon lotor) in the mid-Atlantic states. In rabies endemic areas, humans exposed to woodchucks should receive rabies postexposure prophylaxis if the animal is not available for testing. The decision to administer postexposure prophylaxis to humans exposed to other rodents and lagomorphs should take into consideration the epidemiology of rabies in the exposing species.

Animals↗
PubMed1985

Unexplained lymphadenopathy in homosexual men. A longitudinal study.

In January 1982, the Centers for Disease Control began a prospective study of unexplained generalized lymphadenopathy syndrome in 78 homosexual or bisexual men. As of Aug 1, 1984, the median durations of lymphadenopathy and enrollment were 29.5 months and 20 months, respectively. Antibodies to human T-cell lymphotropic virus type III/lymphadenopathy-associated virus were present in 75 (96%) of the study patients. Five (6%) of the patients were diagnosed as having the acquired immunodeficiency syndrome five to 25 months after the onset of lymphadenopathy. At the time of their initial visit, these five patients had lower T-helper cell counts, hematocrits, lymphocyte counts, and pokeweed mitogen stimulation ratios and were more likely to report severe symptoms than patients who did not develop the acquired immunodeficiency syndrome. During 318 follow-up visits, except for the development of the acquired immunodeficiency syndrome in five patients, there has been little change in the initial laboratory and clinical measures of this cohort. Within the follow-up period of this study, the features of lymphadenopathy syndrome have been unremitting for the majority of patients.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Immune complexes in the acquired immunodeficiency syndrome (AIDS): relationship to disease manifestation, risk group, and immunologic defect.

Immune complex assays (and other immunologic tests) were performed on sera from 162 patients with the acquired immunodeficiency syndrome (AIDS) and 275 AIDS-related subjects. Immune complexes were detected in 89% of AIDS patients and 93% of homosexual men with lymphadenopathy. Immune complex levels in AIDS patients were not associated with a particular risk group or with types of opportunistic infection or malignancy; however, they correlated with other laboratory features of the immune defect (depression in T helper cells and T helper/suppressor-cell ratio, and IgG levels). Immune complexes were also detected in a lesser proportion of risk-group controls (homosexual men, hemophiliacs, Haitians). In risk-group controls, immune complex levels were associated with certain features reflecting sexual practice, blood product exposure, or infection, but these features did not account for the higher levels found in AIDS patients. In appropriate situations, immune complex assays may be of value as screening tests or, possibly, as prognostic indicators for AIDS or AIDS-related syndromes.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Pre-exposure rabies immunization with human diploid cell vaccine: decreased antibody responses in persons immunized in developing countries.

In November 1982, a U.S. Peace Corps volunteer in Kenya completed pre-exposure rabies prophylaxis with a standard 3 dose intradermal (ID) series of human diploid cell rabies vaccine (HDCV). In May 1983, she was bitten by a dog and died of rabies 3 months later. An initial investigation revealed that the patient, as well as 9 of 11 others immunized at the same time, had no rabies antibody titers (less than 1:5). We therefore instituted investigations into the immunogenicity of pre-exposure HDCV both in the United States and in developing countries. A serosurvey revealed unexpectedly low rabies titers in both Peace Corps volunteers and others immunized in developing countries. Antibody titers measured 2-3 weeks after ID immunization were compared in 9 groups totaling 271 persons in the United States and Kenya. There was no statistically significant difference in antibody titers in the 6 U.S. groups immunized from 1980-1984 (P greater than 0.15); however, groups immunized in the United States had significantly higher titers than a group of Kenyan nationals (P less than or equal to 0.0001), and the Kenyans had significantly higher titers than 2 Peace Corps groups immunized in Kenya (P less than or equal to 0.0001). No single hypothesis proposed (laboratory error, vaccine potency, vaccination technique, or specific immune suppression) accounted for the observed differences. Although we cannot fully explain the poor response to HDCV, it is probably due to multiple factors. We conclude that persons immunized with ID pre-exposure HDCV in developing countries should have rabies antibody titers determined to ensure their seroconversion; for persons immunized in the United States, such titers need not be routinely determined.

Adult↗
PubMed1985

Rabies in the United States and Canada, 1983.

Primarily as a result of organized canine rabies vaccination, leash laws, and other preventive procedures aimed at the canine population, the number of rabid dogs decreased markedly in the last thirty years (Figure 10). This decrease was accompanied by a similar marked reduction in human rabies (Table 2, Figure 11). As domestic animal rabies declined, rabies in wildlife increased. Since 1958 the number of cases of rabid wildlife surpassed domestic rabies cases, and today they account for over 85% of all reported rabies cases. In 1983, a total of 5,880 laboratory-confirmed cases of rabies in the United States and its territories were reported to CDC-a decline of 398 cases compared with 1982 (7) (Table 1). The total number of cases decreased for the second consecutive year. The 13% decline in 1982 was followed by a 6.4% decline in 1983. This decrease in cases, however, was not reported by all states. The four Mid-Atlantic states--Maryland, Pennsylvania, Virginia, and West Virginia--and the District of Columbia actually experienced an 83% increase in cases. These states and the District of Columbia reported 1,903 cases in 1983 (compared with 1,040 cases in 1982) which accounted for approximately one-third (32.4%) of all rabies cases nationally.

Adult↗
PubMed1984

Surveillance of Rocky Mountain spotted fever in the United States, 1981-1983.

Surveillance of Rocky Mountain spotted fever (RMSF) in the United States has revealed a stable incidence of the disease from 1981 to 1983, with a median of 0.48 cases/100,000 population per year (range, 0.42-0.52). During this three-year period an increase in both the number and the percentage of total cases reported from the West South Central states was observed when compared with previous three-year periods. An expanded case report form, which was introduced in 1981 for use by state health departments, was received for 2,850 (87%) of the 3,294 cases reported in 1981-1983. Of these 2850 cases, 1375 (48%) were laboratory confirmed. Death from RMSF was more common in persons greater than or equal to 30 years of age (case-fatality ratio of 8.4%) than in persons less than 30 years (2.2%, P less than .001). Fatality was also associated with failure to obtain a history of a tick bite within 14 days before onset of illness (P less than .05) and with lack of treatment with tetracycline or chloramphenicol (P less than .01).

Adolescent↗
PubMed1984

Surveillance of Rocky Mountain spotted fever, United States, 1981-1983.

The increase in the incidence of RMSF observed in the 1970s appears to have plateaued at a median of 0.49 cases/100,000 for the 6-year period 1978-1983. In 1981-1983, for the first time, Oklahoma had the highest incidence of RMSF in the United States (4.10 cases/100,000/year); increased numbers of cases were also reported from two of the other three West South Central states-Texas and Arkansas. Texas, which reported 217 cases in the 3-year period, had an average incidence of 0.47 cases/100,000/year. This apparent regional increase in RMSF activity may reflect multiple factors, including increased recognition and reporting of cases and environmental factors that may be associated with a true increase in RMSF. Simultaneously, a decrease in the number of cases reported and in the incidence of RMSF have been observed in the South Atlantic states, although these states still account for most (51%) of the cases in the United States. The slight decrease in the case-fatality ratio observed over the last 9 years is unexplained. It may reflect increased awareness of RMSF and result in appropriate and timely treatment. The increasing number and percentage of cases that are laboratory confirmed suggest that the more sensitive and specific laboratory tests now required for serologic confirmation are being more widely used and are contributing to an increased accuracy of reporting of RMSF in this country.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1981

Bacterial meningitis in the absence of CSF pleocytosis.

Two cases of acute bacterial meningitis occurred with an absent CSF WBC response. To determine the incidence and clinical characteristics of such patients, 50 consecutive cases of meningitis were reviewed retrospectively. In addition to the two initially noted cases, five additional cases were found. In the seven cases, there were six or fewer cells, but bacteria were detected in the CSF. A distinctive clinical and laboratory syndrome emerged. All seven patients were either old or had Hodgkin's disease or severe alcoholism. All patients had evidence of an overwhelming infection with confusion or nuchal rigidity. As compared with the remaining 45 patients with meningitis and CSF pleocytosis, no fever (less than 38 degrees C), a lower peripheral WBC count, and near-normal CSF glucose and protein concentrations were common. Organisms involved were EScherichia coli in three patients, Pneumococcus in three patients, and mixed anaerobes in patient. A fatal outcome ensued in six of seven patients. Despite the correct choice of an antibacterial agent, doses were late and suboptimal for meningitis. This syndrome is surprisingly common in host-defective cases, has an ominous prognosis, and must be treated expectantly with antimicrobial agents that enter the CSF.

Adult↗
PubMedDate not supplied

A cluster of tick-borne infections: association with military training and asymptomatic infections due to Rickettsia rickettsii.

During the spring of 1989, 86 members of a military unit from the state of Maryland, USA, participated in two-week-long training manoeuvres in the states of Arkansas (location FC) and Virginia (location FAPH). Acute febrile illnesses due to infections with two tick-borne pathogens, Rickettsia rickettsii and Ehrlichia sp., were confirmed serologically in 2 initial cases who were admitted to the hospital. A seroepidemiological investigation among unit members found an additional 17 of 109 individuals (16%) with elevated post-exposure indirect immunofluorescent antibody (IFA) titres to R. rickettsii (16 cases) and/or E. canis (2 cases). The seropositivity rate of personnel who trained at FC was 38% (15 of 40), compared to only 13% (4 of 31) and 8% (3 of 38) of personnel who trained at FAPH or who did not train in the field, respectively (P < 0.001). Seropositivity was associated with symptoms suggestive of a tick-borne illness. Only 4 (22%) and 6 (33%) of the 18 personnel seropositive for R. rickettsii reported an erythematous or petechial type of rash or a febrile illness, respectively, within 4 weeks of exposure; 5 of 18 (28%) personnel infected with R. rickettsii reported no symptoms and only 8 of 18 (44%) received medical treatment. Mild infections with R. rickettsii, or a closely related spotted fever group agent, may have accounted for the high infection rate experienced by this group.

Antibodies, Bacterial↗
PubMedDate not supplied

Q fever: current concepts.

Persons with Q fever usually present with severe retrobulbar headache, a fever to 104 degrees F or higher with shaking chills, general malaise, myalgia, chest pain, and sometimes pneumonia and hepatitis. Cattle, sheep, goats, and ticks are the primary reservoirs of the etiologic agent, Coxiella burnetii. Humans are usually infected by inhaling infectious aerosols. Because C. burnetii can survive for long periods in the environment, it poses a continuing health hazard once it is disseminated. Q fever usually occurs sporadically, but large outbreaks are frequently observed throughout the world, particularly among abattoir workers and personnel working in research centers. Q fever endocarditis follows a chronic course and is frequently fatal. Tests for antibodies to C. burnetii are required for confirmation of the diagnosis. Tetracyclines remain the mainstay of treatment for acute Q fever, and tetracyclines in combination with other antibiotics have been advocated for patients with Q fever endocarditis. Vaccines for Q fever have been proven effective in clinical trials.

Animals↗