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K J Bart

Publications and source records attributed to K J Bart.

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

Adverse events following immunization with DTP vaccine.

The Monitoring System for Adverse Events Following Immunization became fully operational in late 1978 in all 50 States, New York City and Washington, D.C. This system compiles information on adverse events temporally associated (within four weeks) to the administration of a vaccine. A total of 2,062 reports of adverse events following diphtheria and tetanus toxoids and pertussis vaccine (DTP) were received between 1979 and 1982. The number of reports received in 1979 was 387, increasing to 707 reports in 1982. The increase is predominantly in local reactions and fever. The number of persons with serious illnesses temporally associated with vaccine remained relatively constant over the four year period. The overall rate of reported adverse events following DTP (70.8 per million doses administered in the public sector) was about twice that of Td (33.5) or DT (38.4); however it was not substantially different from those following measles- or rubella-containing vaccines. Those who had convulsions (whether febrile or non-febrile) following receipt of DTP vaccine were substantially more likely to have had a personal history of convulsions than those who had a non-neurologic adverse event following DTP (p less than 0.0001). This information, along with data from the literature, has led to recent recommendations by advisory groups in the United States that any infant or child with a personal history of convulsions should be thoroughly evaluated before initiating or continuing immunization with pertussis vaccine.

Diphtheria Toxoid↗
PubMed1985

Health impact of measles vaccination in the United States.

As a result of intensive efforts to vaccinate children, measles and its attendant complications of encephalitis and death have declined more than 99% from the prevaccine era. Similarly, subacute sclerosing panencephalitis has declined markedly. Measles vaccine has been demonstrated to be extremely safe, as well as extremely effective. The health and resource benefits due to vaccination against measles during the first 20 years of vaccine licensure have been enormous. In this period it is estimated that vaccination against measles has prevented 52 million cases, 5,200 deaths, and 17,400 cases of mental retardation, achieving a net savings of $5.1 billion. These substantial health and resource benefits of measles vaccination will continue to accrue in the future.

Adolescent↗
PubMed1985

A benefit-cost analysis of a childhood varicella vaccination programme.

We examined the expected experience of normal individuals from a hypothetical birth cohort of 3.5 million persons followed from birth to their 30th birthday without and with a varicella vaccination programme. We assumed that one dose of vaccine would be given to 15-month-old children along with the measles, mumps and rubella vaccination to avoid a separate administration cost. It was also assumed that 90% of children would be vaccinated, that vaccine efficacy would be 90%, and that vaccine-induced immunity would be lifelong. Finally, it was assumed that the programme would have no effect on either the incidence rate or severity of zoster. For both disease and vaccine, we measured the direct medical costs and home care costs (i.e., costs associated with lost work time by someone other than the patient). Costs associated with death or forgone wages to the patient were not estimated. The reduction in costs would be 66% with a net savings of $262,050,392. The benefit:cost ratio would be 6.9:1. If the major assumptions in this analysis hold true, there may be substantial financial benefits from vaccinating all children against varicella.

Chickenpox↗
PubMed1984

Poliomyelitis in the USA: virtual elimination of disease caused by wild virus.

The average number of paralytic poliomyelitis cases per year in the United States has fallen from 16 000 just before vaccine was introduced in the 1950s to only 12 in 1978-83. 18 of the 69 cases (26%) reported in this 6-year period were not vaccine associated according to the epidemiological classification of paralytic poliomyelitis cases, established in 1975. The van Wezel antigenic differentiation test and oligonucleotide fingerprinting provide a laboratory basis for definitive characterisation of wild and vaccine-like poliovirus strains. Of the 69 cases, isolates from 42 have been analysed; 31 were vaccine-like poliovirus and 11 wild poliovirus. 7 of the wild poliovirus isolates are from cases in a 1979 outbreak caused by poliovirus imported from the Netherlands through Canada; 1 is from a single importation; and 3 are from isolated cases with no identified source. No indigenous wild strain has been isolated from any reported poliomyelitis case since 1981, when a wild strain was isolated from an immunodeficient individual.

Humans↗
PubMed1984

Outbreak of paralytic poliomyelitis, Taiwan.

Taiwan had been free of major poliomyelitis outbreaks since 1975, but from May 29 to Oct 26, 1982, 1031 cases of type 1 paralytic poliomyelitis were reported to the Taiwan health authorities. Before the outbreak approximately 80% of infants had received at least 2 doses of trivalent oral poliovaccine (OPV) by their first birthday. Of the 86% of poliomyelitis patients whose vaccination status was known 65% had not had poliovaccine, 19% had received one dose, 8% had received two doses, and 8% had received three or more doses. Vaccine efficacy was calculated to be 82% after one dose, 96% after two doses, and 98% after three or more doses. Failure to vaccinate rather than vaccine failure was the most important risk factor in this outbreak. A child who had not had any vaccine was 80 times more likely to become a case than one who had received three or more doses of poliovaccine, independent of sanitation facilities at home. A child was 5 times more likely to become a case if he received water from non-municipal rather than municipal sources. Furthermore, for children who received municipal water, the risk was doubled if the family shared a toilet with at least one other family. This outbreak shows that major epidemics can occur in areas that have high overall community vaccination levels. Identification and vaccination of subpopulations with low coverage is essential for the control of poliomyelitis.

Adolescent↗
PubMed1984

The opportunity and obligation to eliminate rubella from the United States.

The licensure of rubella vaccines in the United States in 1969 offered the opportunity to prevent the devastating consequences of congenital rubella infection, including miscarriages, therapeutic abortions, and congenital rubella syndrome (CRS), with its average lifetime cost of more than $220,000 per case. With the widespread use of vaccine, rubella transmission in the United States has been reduced to record low levels. Epidemics of rubella and CRS, previously reported every six to nine years, have not occurred, and since 1980, following decreases of rubella incidence rates in the postpubertal population, the endemic incidence rates of CRS have also begun to decrease. We have both the opportunity and the obligation to hasten elimination by (1) ensuring that susceptible females of childbearing age are vaccinated, (2) initiating and/or enforcing existing legislation requiring proof of rubella immunity for all children enrolled in schools, (3) intensifying surveillance for both acquired rubella and CRS, and (4) aggressively controlling rubella outbreaks.

Adolescent↗
PubMed1983

Rational strategy for rubella vaccination.

Current rubella vaccination programmes, devised when knowledge of vaccine characteristics was still incomplete, have not been fully successful in protecting those at maximum risk of the sequelae of rubella infection. Now that more is known of vaccine characteristics and the impact of the initially chosen strategies has been assessed, it is time to modify immunisation strategies, the priorities being first to protect women of childbearing age, and then to interrupt transmission of rubella.

Adolescent↗
PubMed1982

Imported measles in the United States.

In the period 1980-1981, two hundred nine imported measles cases were reported in the United States. These cases represent 1.3% of the total of 16,630 cases of measles reported to the Centers for Disease Control (CDC) during that period. An average of two imported measles cases were reported each week. The travelers with imported measles were United States citizens and foreign nationals who arrived from 47 different countries throughout the world. However, returning United States citizens have accounted for a rising proportion of imported measles cases. Approximately half (49.3%) of the imported cases were reported by four areas: California, New York State exclusive of New York City, New York City, and Florida. Seven measles outbreaks occurring following importations during the two-year period were identified. In addition to 114 imported measles cases reported to the CDC in 1981, 437 measles cases were reported to be caused directly or indirectly by those importations. The actual number of import-associated cases may have been considerably higher. Imported measles and associated cases together accounted for at least 17% (551/3,124) of reported measles cases in 1981.

Adolescent↗