Biomedical subjects
O Levine
Publications and source records attributed to O Levine.
Evaluation of vaccines for the prevention of pneumonia in children in developing countries.
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Efficacy of meningococcal vaccine and barriers to vaccination.
CONTEXT: Use of the quadrivalent meningococcal vaccine for control of outbreaks has increased in recent years, but the efficacy of meningococcal vaccine during mass vaccination campaigns in US civilian populations has not been assessed. OBJECTIVES: To evaluate the efficacy of the quadrivalent meningococcal vaccine against serogroup C meningococcal disease in a community outbreak setting and to evaluate potentially modifiable barriers to vaccination in an area with persistent meningococcal disease following immunization. DESIGN: Matched case-control study of vaccine efficacy using cases of serogroup C meningococcal disease in persons eligible for vaccination during mass vaccination campaigns. Control patients were matched by neighborhood and age. The control group was used to identify possible barriers to vaccination. SETTING: Gregg County, Texas, population 106076, from 1993 to 1995. PARTICIPANTS: A total of 17 case patients with serogroup C meningococcal disease eligible for vaccine and 84 control patients. MAIN OUTCOME MEASURES: Vaccine efficacy and risk factors associated with nonvaccination. RESULTS: Vaccine efficacy among 2- to 29-year-olds was 85% (95% confidence interval, 27%-97%) and did not change in bivariate analyses with other risk factors that were significant in univariate analysis. Among control patients, older age was strongly associated with nonvaccination; vaccination rates for 2- to 4-year-olds, 5- to 18-year-olds, and 19- to 29-year-olds were 67%, 48%, and 20%, respectively (chi2 for linear trend, P=.01). CONCLUSIONS: The meningococcal polysaccharide vaccine was effective against serogroup C meningococcal disease in this community outbreak. Although specific barriers to vaccination were not identified, older age was a risk factor for nonvaccination in the target population of 2- to 29-year-olds. In future outbreaks, emphasis should be placed on achieving high vaccination coverage, with special efforts to vaccinate young adults.
Haemophilus influenzae type B infection.
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Cholera control among Rwandan refugees in Zaire.
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Association between specific plasmids and relapse in typhoid fever.
We studied isolates from 73 patients hospitalized with typhoid fever in Lima, Peru. Of these 73 patients, 11 (15%) suffered a clinical relapse, with fever and positive blood cultures, within 3 months of their original illness. Using plasmids as epidemiologic markers, we found that three patients who subsequently relapsed were initially infected with more than one strain of Salmonella typhi. There was a highly significant association between relapse and isolation of a strain containing either a 24- or a 38-kilobase plasmid at the time of the original infection; however, we were unable to show any evidence of homology between these two plasmids. Our data indicate that infection with multiple strains is not uncommon in this endemic area and suggest that relapse may be partly strain dependent.
Ridge at internal edge of cataract incision.
A white ridge that resembled an inverted snowbank and protruded into the anterior chamber from the region of the internal lips of the cataract incision was visualized gonioscopically during and after cataract operation. Its clinical apearance and course are delineated and documented, and its importance in relation to the formation of postoperative peripheral anterior synechiae, vitreous adhesions, and hyphemas is discussed.
Further studies on the ridge at the internal edge of the cataract incision.
A pathologic and experimental study of the etiology and morphology of the ridge, visible gonioscopically in the region of the internal lips of the cataract incision during and after the cataract operation, is described. The ridge observed clinically cannot be reproduced in human eye-banks eyes but can be reproduced in vivo in the eye of the owl monkey. Histopathology and ultramicroscopic studies of these experimental eyes, together with evidence derived from histopathologic slides of postmortem human eyes, suggest that the ridge is probably the result of immediate edematous swelling of the deeper layers of the corneal stroma after the incision transects corneal endothelium and the Descemet membrane. While internal wound lip malapposition may be a contributing factor to formation of the ridge, it is probably not an essential component. The ridge is not caused by the incision-closing sutures for it is already present prior to suturing of the wound. The role in ridge formation of mechanical stress alterations produced immediately by the incision is considered but is not known.