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Biomedical subjects

G F Grady

Publications and source records attributed to G F Grady.

At least 37 records · Page 2Linked to original sources
PubMed1984

A multivariate analysis of risk factors for hepatitis B virus infection among hospital employees screened for vaccination.

Previous studies of risk factors for hepatitis B virus infection among hospital employees have been based on surveys in single institutions or have been analyzed with univariate techniques. From November 1980 through August 1981, the authors performed a multi-institutional seroepidemiologic survey of hospital employees screened for entrance into a hepatitis B vaccine trial who represented groups at high risk for hepatitis B infection. Using a logistic regression model for the analysis of risk factors, the investigators determined the relative odds and 95% confidence intervals for risk of hepatitis B infection to be as follows: race (nonwhite/white: 3.4; 2.4-4.8) (p less than 0.001); history of acute viral hepatitis of an unspecified type (3.6; 2.2-5.9) (p less than 0.001); and employment at hospitals 1 through 5 as compared with hospital 6 (1.8; 1.1-2.9) (p = 0.015). In addition, certain job categories and the duration of employment within some of these categories were associated with increasing risk for hepatitis B infection over time. Laboratory workers (1.4; 1.2-1.7), surgical staff (1.2; 1.1-1.4), and medical staff (1.3; 1.1-1.5) had significant (p less than 0.05) increased risk of prior infection with longer duration of employment. Such time-job interaction was not demonstrable for nursing staff, anesthesiology staff, dental personnel, pathology staff, or ancillary personnel. The logistic regression model also shows that the highest gradient of risk for laboratory workers, surgeons, and medical staff occurs during the first five years of employment. An effective preventive strategy, such as the use of hepatitis B vaccine, should be targeted for these groups at the time of initial employment.

Adult↗
PubMed1984

Preparation of human hyperimmune globulin to Haemophilus influenzae b, Streptococcus pneumoniae, and Neisseria meningitidis.

As a first step in exploring the feasibility of passive antibody prophylaxis and therapy of serious infections caused by common encapsulated bacteria, we have immunized healthy adults with Haemophilus influenzae type b vaccine, 14-valent pneumococcal vaccine, and meningococcal group A and C vaccine; collected plasma by repeated pheresis; and purified a hyperimmune globulin termed bacterial polysaccharide immune globulin by the cold-ethanol fractionation method of Cohn and Oncley. Specific antibacterial antibody concentrations were measured in individual donors before and after immunization. In addition, antibody concentrations were measured in plasma pools prepared from immunized donors and from unimmunized controls and in the immunoglobulin-containing Cohn-Oncley fractions II and III derived from the respective plasma pools. A comparison of Cohn-Oncley fractions II, which contain primarily immunoglobulin G and which are used therapeutically as immune globulin, revealed that antibody to H. influenzae type b was enriched 15.3-fold and that antibody to meningococcal serogroups and pneumococcal types was enriched a mean of 4.4-fold (range, 1.2- to 9.9-fold). Enrichment of antibacterial antibody in Cohn fraction III, which contains substantial amounts of immunoglobulin M and immunoglobulin A in addition to immunoglobulin G, closely paralleled that in fraction II. Only antibodies to pneumococcal types 1 and 7 were increased disproportionately in fraction III. Based on the clinical experience that conventional immune serum globulin at a dose of 100 mg/kg protects agammaglobulinemic patients for ca. 1 month, we estimate that bacterial polysaccharide immune globulin, in similar dosage, will provide protection from systemic H. influenzae type b infection for 4 to 6 months and from pneumococcal and meningococcal infections for 3 to 4 months.

Antibodies, Bacterial↗
PubMed1984

Hepatitis B vaccine in health care personnel: safety, immunogenicity, and indicators of efficacy.

In a double-blind trial, we randomly assigned 1330 high-risk health care personnel to receive three 20-micrograms doses of hepatitis B vaccine or placebo. Among vaccine recipients 58% responded within 1 month and 97% within 9 months; there was no difference in immune response to the vaccine between men and women. Efficacy was evaluated after a mean follow-up of only 13.2 months, just before the vaccine was released commercially. Five hepatitis B infections were identified in placebo recipients and one in a vaccine recipient. Although the number of infections was too small to allow confident conclusions about protective efficacy of the vaccine, we saw a 67% reduction in the need for hepatitis B immune globulin after accidental hepatitis B inoculation in the vaccine group (relative risk, 5.08; 95% confidence intervals, 1.3 to 19.9). Minor side effects occurred with equal frequency after vaccine (28.7%) and placebo (27.2%) injections; no participant had a severe adverse reaction. Vaccination with the 20-micrograms hepatitis B vaccine was highly immunogenic and safe in health care workers.

Adult↗
PubMed1982

Hepatitis B immunity in hospital staff targeted for vaccination. Role of screening tests in immunization programs.

To estimate how many hospital workers might be exempted from immunization with newly available but expensive hepatitis B vaccine, baseline serum samples were analyzed to determine prevalence and titer of hepatitis B (HB) surface antibody (anti-HBs) and prevalence of core antibody (anti-HBc). Among 1,370 persons tested, anti-HBs was present in 279 (20.4%), including 192 (14.0%) with titers of 10 ratio units or greater. In a subset of 746 subjects who denied recent exposures, and who were tested for anti-HBc and anti-HBs, at least one of the two antibodies was found in 172 (23.1%). There were 47 (6.3%) who had anti-HBs alone and 27 (3.6%) with anti-HBc alone. Prevalence was related more closely to clinical service (eg, renal dialysis or surgery) than to title (eg, physician or technician).

Antibodies, Viral↗
PubMed1982

Accidental hepatitis-B-surface-antigen-positive inoculations. Use of e antigen to estimate infectivity.

We assessed the ability of radioimmunoassay for hepatitis B e antigen (HBeAg) to predict infectivity in exposed medical personnel by analyzing 390 samples of sera positive for hepatitis B surface antigen (HBsAg) that were implicated in accidental inoculations of known outcome. The radioimmunoassay detected HBeAg or its antibody (anti-HBe) in 91% of the donor sera. The incidence of hepatitis B was 19% (44 of 234) in recipients of HBeAg-positive sera but was only 2.5% (three of 121) in recipients of sera positive for anti-HBe, and nil (none of 35) in recipients of sera negative for HBeAg and anti-HBe. The known relation of HBeAg and infectivity was quantified by radioimmunoassay as a risk ratio of 10:1 (HBeAg-positive to HBeAg-negative) for this type of exposure. The sensitivity of the radioimmunoassay also showed that a large proportion (55%) of donor sera not producing hepatitis were positive for HBeAg; therefore, even the most flagrant needlestick exposures to HBsAg-positive sera often must involve subthreshold amounts of infective material.

Hepatitis B↗
PubMed1979

Relation of Mycoplasma pneumoniae seroreactivity, immunosuppression, and chronic disease to Legionnaires' disease. A twelve-month prospective study of sporadic cases in Massachusetts.

From April 1977 through March 1978, 28 presumptive cases of Legionnaires' disease were identified among 432 consecutive candidates having paired sera or tissue samples submitted to the Massachusetts Public Health Laboratories. Among the subgroup of 209 candidates with documented diffuse pneumonia and temperature of 39 degrees C or above, 24 (11.5%) had Legionnaires' disease whereas the diagnostic yield was only four of 223 (1.8%) among the remainder. The case-fatality rate was two of 28 (7%). Patients with Legionnaires' disease when compared to the entire group of candidates were similar in mean age (49 versus 48 years) and frequency of immunosuppressant therapy (15% versus 12%) but were more often male (64% versus 47%) with underlying chronic illness (46% versus 22%). Complement fixation tests against Mycoplasma pneumoniae (whole organisms) showed seroreactivity in 81% of Legionnaires' disease (LD) cases (22 to 27) compared to 13% of non-LD cases; conversely, 29% of all cases seropositive for M. pneumoniae (22 of 75) were seropositive for the LD bacterium compared to only 1% (five of 357) of the remainder. The coincidence of seroreactivity for M. pneumoniae and the LD bacterium is unexplained but suggests that M. pneumoniae seropositive cases should be evaluated for the possibility of Legionnaires' disease.

Adolescent↗
PubMed1978

Hepatitis B immune globulin: final report of a controlled, multicenter trial of efficacy in prevention of dialysis-associated hepatitis.

In a randomized, double-blind multicenter trial, 284 patients and 282 staff members of renal dialysis units who lacked detectable hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs) were randomly assigned to receive two 3-ml injections of immune serum globulin with high, intermediate, or low titers of anti-HBs four months apart. The incidence of infection with hepatitis B and of development of HBsAg was significantly lower in both patients and staff who received the high-titer material than in subjects who received the low-titer preparation eight but not 12 months after randomization (P less than 0.01 for patients and P less than 0.04 for staff, low-titer vs. high-titer at eight months). The high-titer hepatitis B immune globulin preparation did not appear to affect the severity of the cases of hepatitis that did occur, the proportion of subjects who developed persistent antigenemia, or the magnitude or timing of primary anti-HBs responses.

Antibodies, Viral↗
PubMed1978

A practical method for preparation of varicella-zoster immune globulin.

Outdated blood from blood banks in Massachusetts was screened for complement-fixing antibody to varicella-zoster virus (VZV). Approximately 15% of the plasma units had a titer greater than or equal to 16, and one-half of these had a titer of greater than or equal to 32. Plasma units with titers of CF antibody to VZV of greater than or equal to 16 were pooled. This pool had a CF antibody titer of 32 and a titer of fluorescent antibody of 64. Varicella-zoster immune globulin was prepared from the selected plasma pool by alcohol fractionation and analyzed for VZV-specific antibody. Varicella-zoster immune globulin had a fluorescent antibody titer of 2,048 and a neutralizing antibody titer of 1,024. This antibody concentration is equivalent to that in preparations of zoster immune globulin made from plasma of donors recovering from recent VZV infection.

Antibodies, Viral↗
PubMed1978

Eastern equine encephalitis in Massachusetts, 1957-1976. A prospective study centered upon analyses of mosquitoes.

Reappearance of eastern equine encephalitis (EEE) in Massachusetts residents in the 1970's provided an opportunity to assess the predictive value of data on rainfall, EEE in horses, and carriage of EEE virus (EEEV) by mosquitoes, factors which had been studied annually since the last EEE outbreak in 1955-1956. The cycle of multiple cases during 1973-1975 started in a second consecutive year of rainfall that exceeded the annual mean by more than 20 cm, conditions recapitulating the 1955-1956 experience. In 1973, widespread EEE fatalities in horses presaged human cases, another recapitulation of the 1955-1956 experience. However, in 1974, when horses were immunized extensively, no equine cases were seen even though three human fatalities occurred. An unseasonably early appearance of EEEV in mosquitoes was the only basis upon which the threat to humans could have been recognized. These changes in the recognition and distribution of EEEV activity from season to season illustrate the difficulty in making rational decisions regarding widespread aerial insecticide applications for mosquito control.

Animals↗