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Biomedical subjects

G T Stewart

Publications and source records attributed to G T Stewart.

At least 37 records · Page 2Linked to original sources
PubMed1985

Whooping cough and pertussis vaccine: a comparison of risks and benefits in Britain during the period 1968-83.

Since 1975, acceptance of pertussis vaccine has fallen from over 70% to 50% or less in most parts of Britain. This permits evaluation of a continuing natural experiment in which the frequency and severity of whooping cough can be compared those of adverse events following injections of pertussis vaccine. National data show an increase in notifications of whooping cough in most parts of Britain since 1975. Hospital admissions show considerable variation between areas with relatively high rates in some areas of deprivation but very low rates in more affluent areas even where vaccine-acceptance is around 50%. Deaths of infants with whooping cough have decreased steadily since 1900, the rate since 1975 being the lowest ever. Active epidemiological surveillance in Glasgow, with a population of 216,000 children and 13,000 births annually, shows that outbreaks and severe cases requiring admission to hospital were concentrated consistently in a few areas of deprivation. There is a significant correlation between vaccine-acceptance and hospital admission by district of residence but analysis of variance shows this effect to be less than that of overcrowding in households and other deprivation variables. In each of three outbreaks studied prospectively (1974-5, 78-78 and 82) about 30% of cases occurred in children who had received three doses of pertussis vaccine. Such vaccination had a significant protective effect in children aged 1-4 years but not in older children. There was no evidence of a herd immunity sufficient to protect infants below age for vaccination. Admissions to hospital decreased during the period 1970-83. There were no deaths attributable to proven or suspected infections with Bordetella pertussis during the period 1972-1983. No cases of encephalopathy, permanent brain damage or lung damage were detected in a follow up of all cases notified, surveyed or admitted to hospital between 1975 and 1982. Collectively, these national and local data provided estimates of the frequency of infection, complications of infection, admission to hospital and death in children with whooping cough for comparison with local, national and published estimates of the frequency and severity of adverse reactions, encephalopathy, permanent brain damage and death after injections of pertussis vaccine. It is concluded that, in children living in non-deprived circumstances in Britain, the risk of pertussis vaccine during the period 1970-83 exceeded those of whooping cough. In some deprived sectors, the risks from whooping cough might have been marginally higher but there was no evidence that this was associated with any increase in deaths or permanent disabilities.

Adolescent↗
PubMed1984

Admission of children to hospitals in Glasgow: relation to unemployment and other deprivation variables.

Children living in deprived districts in Glasgow were on average about nine times (five to over a hundred times) more likely to be admitted to hospital for any reason than children in non-deprived districts. The deprivation variables most strongly correlated with admission rates were overcrowding in households and parental unemployment; in comparison with these the protective effect of vaccination against measles and whooping cough, for example, was less significant. The findings show possibilities of an immense saving in avoidable illness and health service costs by elimination of recognisable disadvantages. But they suggest also the presence of a less recognisable life-style factor which may be responsible for a substantial health-damaging effect in some relatively non-deprived environments.

Birth Rate↗
PubMed1981

Whooping cough in relation to other childhood infections in 1977-9 in the United Kingdom.

Estimates based upon notifications indicate that there was in the 1977-9 triennium in the United Kingdom the largest outbreak of whooping cough for 20 years or more. During this triennium there was also a sharp increase in other infections diseases of childhood, notably in non-notifiable respiratory infections. Isolates of certain respiratory viruses ran in parallel and collectively outnumbered those of Bordetella pertussis during the period of increase in notifications. There was highly significant positive correlation between isolates of B pertussis and of ECHO viruses, of Mycoplasma pneumoniae and rhinoviruses and, in Scotland only, of Coxsackie virus. Deaths in which whooping cough was certified as the immediate of underlying cause were lower than in previous outbreaks. Only a minority were bacteriologically confirmed. A closer study of the outbreak in Glasgow disclosed considerable variations in notification procedure and lack of correlation with isolates of B pertussis at the peak of the notification period. Attack rates calculated from notification were higher in deprived areas. Birth cohort studies showed a significantly higher proportion of notifications in unvaccinated children aged 1-4 and this was confirmed in family studies of clinical whooping cough in home contacts. But, overall, about 35% of reported cases were children who had received three injections of triple vaccine. Acceptance of pertussis vaccine fell sharply in 1975 but about 95% of unvaccinated children in age groups 0-5, including the 1977 and the 1977 and 1978 birth cohorts, either escaped infection or were not notified.

Adolescent↗