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Biomedical subjects

P A Brunell

Publications and source records attributed to P A Brunell.

At least 19 recordsLinked to original sources
PubMed1995

Measles control in the United States: problems of the past and challenges for the future.

Elimination of indigenous measles from the United States has been a public priority since 1978. To assess the progress made toward this goal, we review the epidemiology of measles from 1963 to the present. From the 1970s through early into the recent measles epidemic, the majority of measles cases were in highly vaccinated, school-age children. This was due primarily to a 1 to 5% primary measles-mumps-rubella vaccine failure rate and nonrandom mixing patterns among school-age populations. To eliminate susceptible individuals in the school-age populations, a second dose of measles vaccine is now recommended between 5 and 6 years or 11 and 12 years by both the Advisory Committee on Immunization Practices and the American Academy of Pediatrics. Later in the epidemic, measles cases surged among unimmunized preschool children, especially among the poor in inner-city areas. Immunization rates have been documented to be low among preschool populations because of missed opportunities to administer vaccines at all health visits and barriers to access to immunizations. To raise immunization rates, the age for the first measles-mumps-rubella immunization was lowered to 12 to 15 months of age, federal immunization funding has increased, and new standards for immunization delivery have been developed and promulgated.

Child↗
PubMed1995

Unrecognized human immunodeficiency virus type 1 infection in a cohort of transfused neonates: a retrospective investigation.

OBJECTIVE: To retrospectively identify unrecognized human immunodeficiency virus type 1 (HIV-1) infection among a cohort of children transfused as neonates before donated blood was routinely screened for HIV-1 antibody. METHODS: Records at a large, private, metropolitan hospital were reviewed to identify children who were transfused as neonates between January 1980 and March 1985 and discharged alive from the hospital. Multiple data sources were used to locate these children. Parents or guardians were contacted, and their children were offered HIV-1 antibody testing and physical examination. RESULTS: Of the 775 children identified as having received transfusions during the project period, 644 (83%) were located, and 443 (69%) were evaluated for HIV-1 infection. Among those evaluated, 33 (7%) had antibody to HIV-1, including 14 whose infections had not been previously diagnosed. At the time of enrollment, 13 children infected with HIV-1 were asymptomatic an average of 63 months after transfusion. CONCLUSION: HIV-1 antibody testing should be considered for all children, regardless of clinical status, who were transfused before routine blood donor screening was implemented in March 1985, particularly in areas with a high incidence of acquired immunodeficiency syndrome during those years.

Cohort Studies↗
PubMed1993

Clinical manifestations of varicella-zoster virus infections in human immunodeficiency virus-infected children.

OBJECTIVE: To study the clinical course of varicella-zoster infection in children infected with human immunodeficiency virus type I. DESIGN AND SETTING: A clinical and laboratory study of human immunodeficiency virus-infected children was undertaken at Cedars-Sinai Medical Center, Los Angeles. PARTICIPANTS: Twenty-seven human immunodeficiency virus-infected children aged 1 to 13 years who were treated between 1987 and 1992. Twenty-one children had acquired the infection through blood transfusion, 18 during the neonatal period and three during their early years of life. Six infants had acquired the infection perinatally. RESULTS: Seventeen children have developed varicella, of whom 10 had an uncomplicated course and seven suffered from chronic, recurrent, or persistent varicella. Uncomplicated or recurrent varicella was a relatively benign illness that did not require antiviral therapy except in one child. In contrast, patients with persistent varicella required antiviral therapy as they were sicker and had a prolonged course. One had pneumonia, and another patient developed hyperkeratotic lesions that were refractory to therapy. They had lower CD4 counts (P < .01) and had a more advanced stage of the human immunodeficiency virus disease than the other children. Three patients who were receiving regular intravenous immunoglobulin developed their initial attack of varicella despite the presence of the varicella-zoster antibody. Four patients, three of whom had uncomplicated varicella, developed zoster involving one or two dermatomes. One patient developed zoster while receiving acyclovir therapy. CONCLUSIONS: Children infected with human immunodeficiency virus type 1 may suffer unusual manifestations of varicella-zoster infection. The incidence of zoster in these children is higher than in the general population and is close to that in patients with leukemia. The effectiveness of antiviral therapy in these patients was difficult to evaluate.

Acyclovir↗
PubMed1992

Meningoencephalitis in a neonate congenitally infected with human immunodeficiency virus type 1.

A newborn infant born to a mother infected with human immunodeficiency virus type 1 had acute meningoencephalitis on the second day of life. Human immunodeficiency virus type 1 was isolated from the plasma, cerebrospinal fluid, and peripheral blood mononuclear cells. Specific IgM for human immunodeficiency virus type 1 was detected by an enzyme-linked immunosorbent assay antibody-capture technique in cord blood and in serum obtained 3 weeks later. We believe that the meningoencephalitis was caused by human immunodeficiency virus type 1 acquired in utero.

Adult↗
PubMed1992

Varicella in pregnancy, the fetus, and the newborn: problems in management.

As many as 9000 pregnancies annually may be complicated by varicella, which creates management problems for the woman and her fetus or newborn. Estimates on risk to the fetus and to neonates vary widely, making counseling difficult. Likewise, the efficacy of passive immunization of pregnant women or their exposed newborns is not precisely known. In addition to these problems in clinical management, questions remain about the developmental immunology of varicella-zoster virus infection. For example, why do infants exposed in utero to the virus get zoster at an early age and why does passive immunization of newborns appear to be less effective than immunization of older individuals?

Acyclovir↗
PubMed1991

Virus burden in human immunodeficiency virus type 1-infected children: relationship to disease status and effect of antiviral therapy.

The human immunodeficiency virus type 1 (HIV-1) was isolated from the plasma and peripheral blood mononuclear cells (PBMCs) from each of 21 infected children. The mean titers in plasma were 7 and 165 tissue culture-infective doses per milliliter in 9 children with asymptomatic (P-1) and 12 with symptomatic (P-2) infection, respectively (P = .0013). Significantly higher viral titers were found in PBMCs obtained from P-2 compared with P-1 children: 1920 vs 25 tissue culture-infective doses per 10(6) PBMC (P = .0018). In symptomatic patients at least 1 in 520 circulating mononuclear cells harbored HIV-1. No correlation was found between the viral burden and CD4+ lymphocyte counts. A decrease in the HIV-1 titers was noted both in PBMCs and plasma of symptomatic patients treated with zidovudine for 2 to 7 months. It is concluded that symptomatic children harbor a higher amount of the virus in plasma and PBMCs than asymptomatic children. Zidovudine treatment for 2 months or more decreased the amount of HIV-1 in PBMCs and plasma.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Measles vaccine.

Administration of measles vaccine has sharply reduced the occurrence of measles. However, "mini epidemics" occurring at increasing intervals through 1989 brought about the need for a routine two-dose schedule of measles vaccination. The prevention of preschool cases and school-based cases are two major goals of this new schedule. A two-dose schedule will address the latter goal, however, it will not affect the more difficult problem of measles among preschoolers, a group with lower immunization rates than school-age children. The use of Edmonston-Zagreb measles vaccine in developing countries offers the promise of reducing worldwide disease rates in young infants in the future. However, the major goal in the United States and other developed countries is to increase levels of measles immunity.

Adolescent↗
PubMed1989

Transmission of chickenpox in a school setting prior to the observed exanthem.

An epidemic of chickenpox in a class is described. Four children were able to transmit infection prior to the time their rash was observed by their parents. A fifth child was known to have attended school while he had localized varicelliform lesions that were present for 2 days prior to the appearance of the generalized exanthem. It cannot be ascertained whether some of the other children may have had similar lesions that were not observed at the time they attended school. The first classroom case was observed prospectively so that the time of rash was fairly well established. Although he apparently transmitted infection prior to the onset of rash, virus could not be isolated from the respiratory secretion of this child on the day he presumably infected his classmate. Virus was not found in his respiratory secretions or those obtained from his two siblings before or after the onset of rash, although it was recovered from vesicular fluid.

Chickenpox↗
PubMed1988

Herpes zoster in children with acute lymphocytic leukemia.

Herpes zoster (HZ) occurred in 25% (28/88) of a population of children with acute lymphocytic leukemia (ALL) who were seropositive for varicella zoster virus antibody before its onset; 16.5% (33/199) of the total group of children with ALL developed HZ. There were no deaths and only one significant complication, cutaneous disseminated disease, as a result of HZ. The small number of patients studied may have accounted for the failure to find a significant association between the occurrence of HZ and the type of ALL or chemotherapy protocol employed. Although HZ seemed to be more common in those patients who experience relapses of their leukemia, it did not portend a poor outcome for ALL.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Establishment by enzyme-linked immunosorbent assay of seronegative range for herpes simplex virus and cytomegalovirus antibodies and evaluation of heterologous responses to live varicella vaccine.

Cord serum samples treated with staphylococcus protein A and an immune affinity column to remove immunoglobulin G were used to establish a seronegative range for herpes simplex virus and cytomegalovirus. No seroconversions or increased heterologous antibody levels to herpes simplex virus or cytomegalovirus were found in live varicella vaccine recipients.

Adult↗
PubMed1988

Combined vaccine against measles, mumps, rubella, and varicella.

A combined measles, mumps, rubella, and varicella vaccine produced seroconversions for all four components similar to that found if measles, mumps, and rubella vaccine or live varicella vaccine were given separately. In addition, those exposed to varicella were completely protected or had only a mild rash. Moreover, the reaction rates were not increased if the vaccines were combined. The somewhat lower and delayed serologic response to live varicella vaccine as compared with the combined measles, mumps, rubella, and varicella may have been due to the small amount of varicella vaccine virus used or to its degree of attenuation. Persistence of antibody was observed 1 year postimmunization.

Antibodies, Viral↗