Biomedical subjects
Publications and source records attributed to D J Bregman.
The preliminary results of the national surveillance for Guillain-Barré syndrome(GBS) are reported. In the first 6 months of 1978, 327 cases of GBS were reported to the Center for Disease Control (CDC). A statistically significant difference was observed between sex-specific attack rates, and a direct correlation also was observed between advancing age and increasing risk of GBS.
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Onset of maternal varicella up to 5 days before delivery is associated with in utero exposure to varicella and may result in severe infection in the newborn 5 to 10 days after delivery. Since up to 31% of these newborns may die, routine administration of varicella-zoster immunoglobulin to these infants is recommended. Little is known, however, about the risk of death in other infants with postnatal infection. Available epidemiologic data indicate an estimated death/case ratio for children less than 1 year of age 4 times that for 1- to 14-year-olds (8 in 100,000 vs. 2 in 100,000). Since the actual ages for the infant deaths were lacking, it has been impossible to know how many deaths were possibly related to maternal varicella contracted within the 5 days before delivery. Using National Center for Health Statistics data, we analyzed 92 deaths due to varicella in children less than 1 year old reported between 1968 and 1978 (median age, 5.5 months). Only five deaths occurred in newborns (ages 8 hours to 19 days). These data indicate that intrauterine infection accounts for few varicella deaths in infants. Since postnatal infection accounts for the observed increased risk of death in this age group, the need for preventing postnatal varicella in all infants merits further study. However, based on the small number of deaths occurring annually and the low relative risk compared to other high risk groups, routine postexposure administration of varicella-zoster immunoglobulin to all children less than 1 year of age does not seem warranted at this time.
To identify risk factors that determine the major manifestations of the acquired immunodeficiency syndrome (AIDS), the authors analyzed data from three epidemiologic studies conducted by the Centers for Disease Control. The authors compared patients by outcome of disease. Eighty-seven homosexual patients (47 with Kaposi's sarcoma, 20 with Pneumocystis carinii pneumonia, and 20 with both) had participated in the earlier studies, and their interviews and laboratory test results were available. Compared with patients who have Pneumocystis carinii pneumonia only, patients with Kaposi's sarcoma and those with both diseases reported more different sexual partners, more recreational drug use, higher incomes and higher rates of non-B hepatitis. Multivariate analysis showed that the variable most strongly associated with Kaposi's sarcoma was the use of large quantities of nitrite inhalants. A multifactorial model is postulated to explain the various disease manifestations of AIDS. This study suggests that the use of nitrite inhalants may be a cofactor in the development of Kaposi's sarcoma. By identifying other cofactors, investigators may be able to define additional opportunities for prevention of the development of AIDS.
During the period August 9--13, 1976, 21 of 89 residents of a nursing home in southeastern Florida had sudden onset of fever--temperature greater than 38.1 degrees C (100.6 degrees F) with no accompanying symptoms. Five residents, whose temperatures ranged from 39.4 degrees C (103 degrees F) to 41.3 degrees C (106.4 degrees F), died. No viral or bacterial pathogens were isolated. None of the nursing home's 123 employees and volunteers had similar illness. The air-conditioning system was shut down for repairs from August 9 through August 12, a time when recorded peak temperatures outdoors ranged from 30.6 degrees C (87 degrees F) to 32.2 degrees C (90 degrees F). The only recorded temperature inside the nursing home for that period was 31.7 degrees C (89 degrees F). Laboratory and epidemiologic data were consistent with the theory that the illness was due to hyperpyrexia, secondary to environmental conditions, rather than to an infectious agent. The episode was considered analogous to the nonspecific increased mortality of elderly and chronically ill persons during an urban heat wave. The episode points up the need for prompt recognition and intervention when there is the potential for heat stress in elderly and chronically ill patients. Buildings housing such patients must be designed so that alternative ventilation can be provided when the central air-conditioning system fails.
Serum HI and neuraminidase-inhibiting (NI) antibody measurements were made at 3, 32 and 50 weeks after inactivated influenza Hsw1N1 vaccination of 438 adults in 1976. Although the highest postvaccination geometric mean HI titers were observed in persons greater than or equal to 52 years of age, the rate of antibody decline was similar in adults of all ages. In 14 children who had a seroconversion following two doses of whole virus or split virus vaccine, the geometric mean HI antibody titer was lower after the second vaccine dose than the peak titer observed in adults, and the decrease in titer was also more rapid by 4 to 7 months. One year after influenza Hsw1N1 vaccination of adults, the prevalence of homologous HI antibody greater than or equal to 40 was 71% to 97%, whereas only two of the 14 children maintained similar titers at 5 to 7 months. Neuraminidase-inhibiting antibody titer formation occurred more frequently in those without prevaccination NI antibody, but the rate of decline was also greatest in this initially seronegative group. The rate of antibody decline at one year in the population with preexisting antibody was similar to that observed for HI antibody decline in a primed population. Heterologous influenza A/Victoria/3/75 (H3N2) HI antibody formation occurred in 22% of adults aged 25 to 51 after Hsw1N1 vaccination and in 12% of those over the age of 51, but the rate of heterologous antibody decline was more rapid than that observed for homologous antibody.
In the period 1970 through 1979, the Coxsackie B1, B2, B3, B4, and B5 viruses constituted 24 percent of more than 18,000 enteroviruses isolated and reported through national surveillance. Young children, especially males, were most frequently affected: 48 percent of the national surveillance population were less than 5 years of age, including 30 percent who were less than 1 year old. Among the most frequently reported clinical syndromes associated with B infection were meningitis (in 56 percent of patients with B1-B5 infections), encephalitis (in 15 percent), and respiratory tract disease (in 14 percent). Carditis, a well-known B syndrome, was reported with only 2 percent of B1-B5 infections. Like most enteroviral agents, Group B viruses were isolated primarily during the summer: 87 percent of all these isolations were made during the 5 months from June through October. Although B2, B3, and B4 viruses were isolated at relatively uniform levels each year, B1 and B5 viral illnesses occurred nationwide as explosive epidemics only in certain years. A separate population of B-infected patients, identified by the Nassau County Medical Center (NCMC) Virus Laboratory, East Meadow, N.Y., during the same 10-year period, was studied to compare epidemiologic characteristics and to evaluate in greater detail clinical and laboratory features of B infections. Because of more active solicitation of specimens for testing, ascertainment in the NCMC system was more complete. The most frequently reported clinical findings at NCMC included fever (97 percent of cases), which was biphasic in 27 percent; pharyngitis (85 percent); vomiting (56 percent); headache (49 percent); other respiratory signs and symptoms (44 percent); diarrhea (40 percent); abdominal pain (33 percent); rash (31 percent); and otitis (28 percent). Rash was more frequently associated with younger than with older age groups (P < .01) for all B agents. Overall, throat (T) and rectal (R) swabs had the highest B-positivity rates among known infected patients(83 percent for T and 78 percent for R). Only for T was the positivity rate correlated with the interval between onset of illness and obtaining the specimen (P < .05). B agents grew most quickly from T specimens, but most reliably from R specimens. On the basis of these data,the authors recommend that both T and R specimens be obtained from every patient for whom prompt and reliable laboratory diagnosis of B infection is sought.To the authors' knowledge, these results from 10 years of national surveillance represent the largest surveillance summary of Coxsackie B viruses to date in the literature. Comparison of these results with those reported over the same 10 years by NCMC reflects differences that arise mostly because of differences in ascertainment systems.