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Biomedical subjects

D J Bregman

Publications and source records attributed to D J Bregman.

At least 19 recordsLinked to original sources
PubMed1990

Farr's law applied to AIDS projections.

Farr's Law of Epidemics, first promulgated in 1840 and resurrected by Brownlee in the early 1900s, states that epidemics tend to rise and fall in a roughly symmetrical pattern that can be approximated by a normal bell-shaped curve. We applied this simple law to the reported annual incidence of cases of acquired immunodeficiency syndrome in the United States from 1982 through 1987. The 6 years of incidence data closely fit a normal distribution that crests in late 1988 and then declines to a low point by the mid-1990s. The projected size of the epidemic falls in the range of 200 000 cases. A continuing incidence of endemic cases can be expected to emerge, but we believe it will occur at a low level.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Postmarketing surveillance for neurologic adverse events reported after hepatitis B vaccination. Experience of the first three years.

In 1982, the Centers for Disease Control, the Food and Drug Administration, and the manufacturer created a surveillance system to monitor spontaneous reports of adverse events occurring after inoculation with the new plasma-derived hepatitis B vaccine (Heptavax-B, Merck Sharp and Dohme, West Point, PA). In the three years between June 1, 1982 and May 31, 1985, an estimated 850,000 persons received the vaccine. During that period, a total of 41 reports were received for one of the following neurologic adverse events: convulsions (five cases), Bell's palsy (10 cases), Guillain-Barré syndrome (nine cases), lumbar radiculopathy (five cases), brachial plexus neuropathy (three cases), optic neuritis (five cases), and transverse myelitis (four cases). Half of these occurred after the first of three required vaccine doses. There were no deaths. Calculation of the relative risks of these illnesses after hepatitis B vaccination was highly dependent on diagnostic classification of the cases, estimates of the size of the vaccinated population, background incidence of the diseases, and the length and distribution of the hypothetical at-risk interval used in the analysis. Other factors important in judging the results of the study could not be measured, including underreporting. In some analyses, Guillain-Barré syndrome was reported significantly more often than expected (p less than 0.05, Poisson probability distribution). However, no conclusive epidemiologic association could be made between any neurologic adverse event and the vaccine. Even if such an association did exist, the preventive benefits of the vaccine in persons at high risk for hepatitis B would unequivocally outweigh the risk of any neurologic adverse event.

Evaluation Studies as Topic↗
PubMed1986

A model-based approach for estimating the mean incubation period of transfusion-associated acquired immunodeficiency syndrome.

The incubation period, representing the interval between the date of exposure and the date of diagnosis, can be firmly ascertained in transfusion-associated cases of acquired immunodeficiency syndrome (AIDS). However, because the observation period of all transfusion-infected persons may be short compared with the average incubation period for AIDS, many cases with long incubation periods have not yet been diagnosed. Thus, the simple average of 2.6 years tends to underestimate the true mean. To correct for this underestimation bias, we assumed that the underlying distribution of the incubation periods is a member of a broad class of probability densities. Then, by maximum likelihood techniques, the mean incubation period for transfusion-associated AIDS was estimated to be 4.5 years, with the 90% confidence interval ranging from 2.6 to 14.2 years. The long incubation period has important consequences for infected individuals and implications for public health intervention and prevention policy.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Sample size for individually matched case-control studies.

The standard formulas used to calculate sample size for an individually matched case-control study assume a constant probability of exposure throughout the pool of possible controls. We propose new formulas that allow for heterogeneity in the probability of exposure among controls in different matched sets. Since matching factors are suspected of being confounders, they are expected to divide the total population into subgroups with different proportions exposed. Thus, the assumption of homogeneity of exposure among controls, made by the currently used formulas, is inconsistent with the assumptions used to design a matched study. The proposed formulas avoid this inconsistency. We present an example to illustrate how heterogeneity can affect the required sample size.

Biometry↗
PubMed1985

Efficacy of influenza vaccine in nursing homes. Reduction in illness and complications during an influenza A (H3N2) epidemic.

From December 10, 1982, to March 4, 1983, when influenza A (H3N2) viruses circulated in Michigan, outbreaks of influenza-like illness were identified in seven nursing homes in Genesee County; 272 (27%) of 1,018 residents were affected. Unvaccinated residents were more likely than vaccinated residents to become ill (risk ratio [RR], 2.6; 95% confidence interval [Cl], 1.8-3.6) and were subsequently more likely to be hospitalized (RR, 2.4; 95% Cl, 1.2-4.8), develop roentgenographically proven pneumonia (RR, 2.9; 95% Cl, 1.6-5.3), or die (RR, 5.6; 95% Cl, 1.2-9.1). Similar observations were made during investigations in six of the eight remaining nursing homes in Genesee County, in which 57 (12%) of 458 residents became ill sporadically. These findings suggest that influenza vaccine can reduce the incidence and severity of influenza virus infections among the elderly and chronically ill and underscore the importance of vaccination programs for those in nursing homes and in the general community.

Disease Outbreaks↗
PubMed1985

Acquired immunodeficiency syndrome among patients attending hemophilia treatment centers and mortality experience of hemophiliacs in the United States.

The acquired immunodeficiency syndrome (AIDS) was first recognized among hemophiliacs in 1982. The authors have conducted investigations to determine the onset and incidence of AIDS among hemophiliacs and to determine trends in hemophilia mortality since the introduction of clotting-factor concentrates in the late 1960s. A survey of United States hemophilia treatment centers, supported by the Centers for Disease Control and the National Hemophilia Foundation, defined a population of hemophiliacs which was monitored for AIDS cases through June 1984. Death reports from the United States Vital Statistics System and from the hemophilia treatment center survey provided mortality trends for 1968-1979 and for 1978-1982, respectively. The results of these investigations demonstrate the following points. 1) The AIDS epidemic is a new and important cause of illness and mortality among hemophiliacs, although a very low incidence of AIDS among hemophiliacs prior to 1982 cannot be ruled out. 2) The AIDS cases who attended the surveyed hemophilia treatment centers were distributed throughout the United States and were older than hemophilia treatment center patients without AIDS. AIDS cases also used more lyophilized clotting-factor concentrate, but only a small number of cases were reported with this information. 3) Improved care for hemophilia, including the use of clotting-factor concentrates, dramatically reduced hemophilia mortality rates during the 1970s. 4) In 1982, hemorrhage was the major cause of death among hemophiliacs. Deaths from non-alcoholic liver disease were also increased. AIDS incidence among hemophilia treatment center attendees was stable at 0.6 cases per 1,000 hemophilia treatment center attendees per year during 1982 and 1983 but increased sharply to 5.4 cases per 1,000 during the first quarter of 1984.

Acquired Immunodeficiency Syndrome↗
PubMed1984

An epidemiologic and clinical evaluation of Guillain-Barré syndrome reported in association with the administration of swine influenza vaccines.

As a result of a court order, computerized summaries of approximately 1,300 cases reported as Guillain-Barré syndrome by state health departments to the Centers for Disease Control during the intensive national surveillance instituted following the swine influenza vaccination program in 1976-1977 became available for further study. Although the data were not uniformly adequate to confirm the diagnosis of Guillain-Barré syndrome, they were sufficient to enable classification according to extent of motor involvement. Vaccinated cases with "extensive" paresis or paralysis occurred in a characteristic epidemiologic pattern closely approximated by a lognormal curve, suggesting a causal relationship between the disease and the vaccine. Cases with "limited" motor involvement showed no such pattern, suggesting that this group included a substantial proportion of cases which were unrelated to the vaccine. The effect attributed to the vaccine lasted for at least six weeks and possibly for eight weeks but not longer. The relative risk of acquiring "extensive" disease over a six-week period following vaccination ranged from 3.96 to 7.75 depending on the particular baseline estimate of expected normal or endemic incidence that was chosen. Correspondingly, the number of cases that could be attributed to the vaccine over the six-week period ranged from 211 to 246, or very slightly higher over an eight-week period if the lowest baseline estimate was used. The total rate of Guillain-Barré syndrome cases attributed to prior use of the vaccine was 4.9 to 5.9 per million vaccinees.

Centers for Disease Control and Prevention, U.S.↗
PubMed1984

Safety of prolonged administration of rimantadine hydrochloride in the prophylaxis of influenza A virus infections in nursing homes.

We evaluated the safety of rimantadine hydrochloride (RH) prophylaxis in a double-blind, placebo-controlled trial in three nursing homes during a community epidemic of influenza A (H3N2). Although daily monitoring of the 35 participants revealed an association between RH administration (100 mg twice a day) and the development of nausea and anxiety (P less than 0.05), these and other potential side effects were transient and were rarely considered to be clinically significant. Serum RH levels measured at the end of the trial (mean, 1,159 ng/ml) were nearly three times higher than those measured previously in younger individuals, suggesting that lower dosages may be indicated for the elderly.

Adamantane↗
PubMed1983

Acquired immune deficiency syndrome in the United States: the first 1,000 cases.

Between June 1981 and February 1983, the Centers for Disease Control (Atlanta) received reports of 1,000 patients living in the United States who met a surveillance definition for the acquired immune deficiency syndrome (AIDS). Seventy-three percent of these patients were diagnosed after January 1, 1982. The 1,000 patients included 284 with Kaposi's sarcoma (KS), 497 with Pneumocystis carinii pneumonia (PCP), 83 with KS and PCP, and 136 with opportunistic infections other than PCP. The overall mortality has been 39.2%. Cases have been reported from 32 states and the District of Columbia; New York, California, New Jersey, and Florida account for 82.7% of the reports. All but 61 of the patients could be classified into one or more of the following groups: homosexual or bisexual men, intravenous drug abusers, Haitian natives, or patients with hemophilia. Epidemiologic trends in AIDS cases are consistent with the gradual extension of an infectious agent into new populations.

Acquired Immunodeficiency Syndrome↗
PubMed1982

Mortality data analysis using a multiple-cause approach.

Death certificates are the primary source for information used to define general mortality patterns in the United States. Analyses of mortality data generally are restricted to one of the conditions listed on the certificate--the underlying cause of dealth. We review principles related to the use of mortality data and describe a study using mortality tapes ("multiple-cause tapes") that list all conditions recorded on dealth certificates. Using multiple-cause tapes, we found that the number of deaths associated with seven infectious diseases in 1968, 1969, and 1970 was from 24% (diphtheria) to 81% (rubella) greater than that officially reported. Multiple-cause tapes also permitted a review of the association of deaths attributed to measles and varicella and known complications of these diseases. these observations confirm the usefulness of multiple-cause tapes in analyzing mortality data and emphasize the importance of examining all conditions listed on the death certificate.

Death Certificates↗
PubMed1982

Norwalk gastrointestinal illness: an outbreak associated with swimming in a recreational lake and secondary person-to-person transmission.

An outbreak of gastrointestinal illness in which headache, low grade fever and myalgia were common symptoms occurred among persons who visited a recreational park in Macomb County, Michigan, on July 13-16, 1979. The temporal clustering of onsets of 121 persons who were the first in their households to become ill suggested an incubation period ranging from 4-77 hours. A history of swimming in the park's lake was elicited with significantly greater frequency from these persons than from park visitors who were not ill (age standardized odds ratio = 4.8; 95% confidence interval, 1.8-12.7). One hundred twenty-six park visitors who became ill were household contacts of index patients who had swum in the lake; at least 62 of these 126 cases were probably due to secondary transmission. A secondary attack rate of 19% was observed in household contacts who had not visited the park. Serologic studies identified Norwalk virus as the etiologic agent. The source of the contamination of the lake could not be determined. Although some water samples collected just before and after the epidemic period had high coliform counts, the geometric mean coliform density of all samples collected on those days was within the limits established by the Environmental Protection Agency as acceptable for recreational contact water.

Adolescent↗
PubMed1982

Rocky Mountain spotted fever in the United States: use of age-specific incidence to determine public health policy for a vector-borne disease.

The increasing national and regional incidence of Rocky Mountain spotted fever (RMSF) during the past two decades led us to look at nationally collected epidemiologic data on reported cases of RMSF for 1975 through 1978, paying special attention to age-specific incidence in the states where the disease is most common. The group aged 5 to 9 years was the cohort at highest risk of contracting RMSF, but it was the 40- to 59-year age group that had the highest case fatality rate (CFR), 11.3%. Control efforts should include an educational program aimed at school-aged children and their parents, as well as instructions for physicians (particularly family practitioners and internists) on the early recognition and proper treatment of this illness.

Adolescent↗
PubMed1981

Guillain-Barré syndrome: its epidemiology and associations with influenza vaccination.

The epidemiology of Guillain-Barré syndrome (GBS) and the associations of GBS with influenza vaccination are described based on review of three types of epidemiological data: case-control studies, incidence rate studies of GBS in well-defined populations, and surveillance data from a sentinel neurologist surveillance system of GBS in the United States. These data indicate that the crude annual incidence rate of GBS per 100,000 people ranges from 0.6 to 1.9 in different populations in widely scattered areas of the world. In general, incidence rates are higher with advancing age until about 75 years, higher for men than women, and higher for whites than blacks. No specific HLA antigen has been significantly associated with GBS in general, although HLA AW 30 and AW 31 have been associated with chronic relapsing polyneuritis. Important trigger agents of GBS include nonspecific respiratory and gastrointestinal infections and cytomegalovirus infection. Influenza infection and influenza vaccinations are not generally important trigger agents. A major exception to this is the occurrence of just under 1 excess case of GBS per 100,000 A/New Jersey influenza vaccinations administered in the United States, 1976-1977. A significant excess risk of GBS was not observed after administration of influenza vaccine in 1978-1979 and 1979-1980. The differences between the contents of and immunological reaction to A/New Jersey influenza vaccine and the more recent influenza vaccines deserve further study.

Adolescent↗
PubMed1981

Comparative efficacy of injectable calcium and magnesium salts in the therapy of hydrofluoric acid burns.

Hydrofluoric acid (HF) causes severe skin burns which often progress in severity despite physiologic neutralization. The currently accepted therapy is the subcutaneous injection of calcium (Ca) gluconate to precipitate the residual free fluoride ion. Magnesium (Mg) also forms an insoluble fluoride salt and is less tissue irritating than Ca. This study compared the effects of subcutaneous injection of saline, Ca gluconate, Mg acetate (MgAc), and Mg sulfate (MgSO4) on lesions resulting from HF burns in rats. Burns treated with either Mg compound healed 3.7 +/- 1.7 days faster (p less than 0.05) developed less severe lesions (p less than 0.01) and exhibited left untreated or treated with saline. There was no difference in the incidence of infection between the study groups. The effects of burns treated with calcium were statistically similar to the control groups. This study suggests that Mg may be more effective than Ca in minimizing the duration, depth, and progression of dermal HF burns.

Animals↗
PubMed1980

Fatal Guillain-Barré syndrome after the national influenza immunization program.

Fifty-eight fatal cases of Guillain-Barré syndrome (GBS) were reported during the 1976 to 1977 National Influenza Program: Thirty-two (58%) of these patients had received the A/New Jersey influenza vaccine. The mean interval from vaccination to onset was 3.9 weeks, and the incidence of preceding illness in vaccinated or unvaccinated patients was similar. Fifty-eight percent had at least one chronic disease before onset. The clinical features were similar in vaccinated and unvaccinated patients. Most deaths followed medical complications of respiratory paralysis: Fifteen had pneumonia, 29 (83%) died suddenly, 15 had sudden arrhythmias or hypotension, and 7 had myocardial infarction or pulmonary embolus.

Adolescent↗
PubMed1980

An outbreak of varicella-zoster virus infection among cancer patients.

An outbreak of varicella-zoster infection occurred among patients of the Medicine Branch, National Cancer Institute, National Institutes of Health. Epidemiologic investigation suggested that the outbreak was due to two distinct types of disease. One type was acquired without previous exposure to other diseased patients and invariably associated with dermatomal lesions. The other, an a typical form, was associated with person-to-person transmission and equivocal initial dermatomal distribution and had an incubation period of approximately 11 to 25 days. Despite the diagnosis of zoster, the latter probably was varicella, occurring in patients who were immunodeficient because of disease, debility, and chemotherapy.

Adult↗
PubMed1979

Guillain-Barre syndrome following vaccination in the National Influenza Immunization Program, United States, 1976--1977.

Because of an increase in the number of reports of Guillian-Barre syndrome (GBS) following A/New Jersey influenza vaccination, the National Influenza Immunization Program was suspended December 16, 1976 and nationwide surveillance for GBS was begun. This surveillance uncovered a total of 1098 patients with onset of GBS from October 1, 1976, to January 31, 1977, from all 50 states, District of Columbia, and Puerto Rico. A total of 532 patients had recently received an A/New Jersey influenza vaccination prior to their onset of GBS (vaccinated cases), and 15 patients received a vaccination after their onset of GBS. Five hundred forty-three patients had not been recently vaccinated with A/New Jersey influenza vaccine and the vaccination status for 8 was unknown. Epidemiologic evidence indicated that many cases of GBS were related to vaccination. When compared to the unvaccinated population, the vaccinated population had a significantly elevated attack rate in every adult age group. The estimated attributable risk of vaccine-related GBS in the adult population was just under one case per 100,000 vaccinations. The period of increased risk was concentrated primarily within the 5-week period after vaccination, although it lasted for approximately 9 or 10 weeks.

Adolescent↗