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S L Cochi

Publications and source records attributed to S L Cochi.

At least 55 records · Page 3Linked to original sources
PubMed1991

Outbreak of paralytic poliomyelitis in Oman: evidence for widespread transmission among fully vaccinated children.

From January, 1988, to March, 1989, a widespread outbreak (118 cases) of poliomyelitis type 1 occurred in Oman. Incidence of paralytic disease was highest in children younger than 2 years (87/100,000) despite an immunisation programme that recently had raised coverage with 3 doses of oral poliovirus vaccine (OPV) among 12-month-old children from 67% to 87%. We did a case-control study (70 case-patients, 692 age-matched controls) to estimate the clinical efficacy of OPV, assessed the immunogenicity of OPV and extent of poliovirus spread by serology, retrospectively evaluated the cold chain and vaccine potency, and sought the origin of the outbreak strain by genomic sequencing. 3 doses of OPV reduced the risk of paralysis by 91%; vaccine failures could not be explained by failures in the cold chain nor on suboptimum vaccine potency. Cases and controls had virtually identical type 1 neutralising antibody profiles, suggesting that poliovirus type 1 circulation was widespread. Genomic sequencing indicated that the outbreak strain had been recently imported from South Asia and was distinguishable from isolates indigenous to the Middle East. Accumulation of enough children to sustain the outbreak seems to have been due to previous success of the immunisation programme in reducing spread of endemic strains, suboptimum efficacy of OPV, and delay in completing the primary immunisation series until 7 months of age. Additionally, the estimated attack rate of infection among children aged 9-23 months exceeded 25% in some regions, suggesting that a substantial proportion of fully vaccinated children had been involved in the chain of transmission.

Case-Control Studies↗
PubMed1991

Invasive group B streptococcal disease in adults. A population-based study in metropolitan Atlanta.

OBJECTIVE: To define the incidence and clinical spectrum of group B streptococcus infection in adults. To characterize groups at increased risk for infection. DESIGN: Retrospective population-based surveillance of group B streptococcus infections occurring in adults. Patients were identified by review of microbiology records at all surveillance area hospital laboratories. Demographic and clinical data were abstracted from patient medical records. SETTING: Metropolitan Atlanta, Ga, 1982 through 1983. PATIENTS: We identified 70 adult patients with invasive group B streptococcus infections; 14 infections occurred in pregnant women and 56 in nonpregnant adults. RESULTS: The annual incidence of group B streptococcus infection in men and nonpregnant women was 2.4 cases per 100,000 population. Incidence increased with age and was higher in blacks than in whites. The case-fatality rate was 32%. Group B streptococcus was most often isolated from blood (71%) and soft tissue (16%). Common clinical presentations included skin and soft-tissue infection (36%), bacteremia without focus (34%), pneumonia (11%), arthritis (9%), and endocarditis (9%). Compared with the general population's risk of infection, the risk of infection in persons with diabetes mellitus was increased 10.5-fold (95% confidence interval [CI], 7.8 to 14.4); in persons with cancer, it was increased 16.4-fold (95% CI, 11.5 to 23.3). CONCLUSIONS: Group B streptococcus infections cause serious disease in adults as well as in neonates, providing an additional rationale for vaccine development. Determining the incidence of adult disease and groups at greatest risk will help in focusing prevention efforts.

Female↗
PubMed1991

Mumps outbreak in a highly vaccinated population.

From October 1988 to April 1989, a large mumps outbreak occurred in Douglas County, Kansas. Of the 269 cases, 208 (77.3%) occurred among primary and secondary school students, of whom 203 (97.6%) had documentation of mumps vaccination. Attack rates were highest for students attending junior high school (8.0%), followed by high school (2.0%) and elementary school (0.7%). A retrospective cohort study conducted at one junior high school with an attack rate of 12.9% did not find age at vaccination or type of vaccine received (single or combined antigen) to be risk factors for vaccine failure. Students vaccinated more than 4 years before the outbreak appeared to have a higher attack rate than those vaccinated more recently (relative risk (RR) = 4.3; 95% confidence interval (CI) = 0.6, 30.0); however, this association did not exist when risk was evaluated based on number of vaccine doses received. Students who had documentation of receiving only one dose of vaccine were at greater risk than those who had received two doses (RR = 5.2; 95% CI = 1.0, 206.2). Overall, vaccine effectiveness among Douglas County junior high school students was estimated to be 83% (95% CI = 57%, 94%). These data suggest that mumps vaccine failure and the failure to vaccinate have contributed to the relative resurgence of mumps observed in the United States since 1986. The recent change in immunization policy to recommend a two-dose schedule of measles-mumps-rubella vaccine should help reduce the occurrence of mumps outbreaks in highly vaccinated populations.

Age Factors↗
PubMed1990

A profile of mothers giving birth to infants with congenital rubella syndrome. An assessment of risk factors.

To formulate strategies for elimination of congenital rubella syndrome, it is important to identify risk factors for delivering an infant affected by it. We analyzed cases of congenital rubella syndrome in infants born from 1970 to 1985 and reported to either one of two independent Centers for Disease Control surveillance systems. Mothers of infants with congenital rubella syndrome identified in both surveillance systems were disproportionately younger than mothers giving birth in the United States. The risk for delivering an infant with congenital rubella syndrome was approximately 2.5 times higher for blacks compared with whites for both reporting systems. A total of 18% of infants with congenital rubella syndrome born since 1979 were Hispanic (national population average, 7%). Both surveillance systems showed that, although primiparous mothers were at highest risk, 39% of women delivering infants affected by congenital rubella syndrome had had at least one previous live birth, suggesting that postpartum immunization could have prevented these congenital rubella syndrome cases. Young, black, and Hispanic primiparous women represent populations at elevated risk for delivering a congenital rubella syndrome-affected infant and should be specifically targeted for immunization.

Adolescent↗
PubMed1990

Assessment of vital statistics and surveillance data for monitoring tetanus mortality, United States, 1979-1984.

Reported tetanus cases and tetanus deaths have declined substantially since widespread implementation of tetanus immunization. However, preventable morbidity and mortality continue to occur. During 1979-1984, 74-95 cases of tetanus were reported annually to the Centers for Disease Control (CDC) and 20-31 deaths were reported annually by the National Center for Health Statistics (NCHS). To evaluate further the health impact of tetanus, the authors assessed the completeness of national tetanus mortality data. They reviewed tetanus case report forms received at CDC from the states and NCHS multiple-cause-of-death tapes for 1979-1984. CDC reports recorded 129 deaths and NCHS mortality tapes 197 deaths. Year of death, state, age, and sex were used to match CDC and NCHS deaths, identifying 78 deaths reported to both sources. Using the methodology of Chandra Sekar and Deming, the authors estimated the actual number of tetanus deaths for 1979-1984 to be 326 (95% confidence interval 291-361). Based on this estimate, the completeness of reporting to CDC was 40%, to NCHS 60%, and to the combined systems 76%. To evaluate the reasons for underreporting, the authors contacted 14 states that had reported greater than or equal to 10 cases of tetanus to CDC during 1979-1984 to obtain death certificates for all tetanus deaths and additional information on all tetanus cases. Thirteen states submitted 108 death certificates for review. Coding and other systematic errors did not explain the low reporting efficiency. Failure to list tetanus as a cause of death on the death certificate was the primary reason for nonreporting of tetanus deaths to NCHS. These results suggest that NCHS tetanus mortality data may not be as complete as previously assumed and that tetanus mortality, and probably morbidity, are higher than previous reports have indicated.

Aged↗
PubMed1990

Major subtypes of invasive Haemophilus influenzae from 1983 to 1985 in Atlanta, Ga.

We compared outer membrane protein (OMP) patterns of Haemophilus influenzae isolated in metropolitan Atlanta, Ga., from July 1983 to June 1985. Of 74 randomly selected H. influenzae serotype b, biotype I, isolates (24% of the total number of H. influenzae, and 32% of the total number of H. influenzae serotype b, biotype I, isolates), 66 (89.2%) had the same OMP pattern. Of the remaining eight, five (6.7%) had an identical OMP pattern. The other three isolates had separate and distinct patterns. A greater diversity of OMP patterns was found with H. influenzae serotype b, biotype II, and nonserotypeable H. influenzae. Of the 18 H. influenzae serotype b, biotype II, isolates (5.8% of the total number of H. influenzae isolates), 1 had an OMP pattern similar to that of the predominate biotype I OMP type, 6 (33% of the biotype II) had the same pattern, and 11 had heterogeneous patterns. Of the 19 recoverable, nonserotypeable biotype II isolates (6.8% of the total number of H. influenzae), 18 had different OMP patterns, and no pattern was similar to those observed with serotype b. These findings indicate that most H. influenzae strains isolated during this 2-year period were indistinguishable by serotype, biotype, or OMP patterns.

Bacterial Outer Membrane Proteins↗
PubMed1990

Mumps transmission in hospitals.

Although sporadic transmission of mumps within hospitals to patients and staff is well documented, outbreaks of mumps within hospitals have only rarely been reported. The widespread mumps outbreaks that occurred in Tennessee in 1986-1987 provided an opportunity to assess the extent of the problems caused by mumps in hospitals. Information was obtained from 146 (95%) of 154 infection control practitioners in the state. Infection control problems caused by mumps were reported from 17 (12%) of 146 hospitals. The 17 hospitals in which these incidents occurred were located in counties that accounted for 67% of the reported mumps cases statewide during this period. Although most cases of mumps in health care workers were community-acquired, six health care workers in three different hospitals developed mumps following nosocomial exposure. In two institutions, nine patients contracted mumps while hospitalized. Both were long-term-care facilities housing adolescents, who had substantial contact with a community where mumps outbreaks were ongoing. This study suggests that mumps poses a small but real risk to both patients and staff in hospitals, particularly in long-term-care facilities caring for adolescents and young adults. In communities where mumps activity is ongoing, hospitals should consider identifying potentially susceptible staff members at risk for infection and offering vaccine. Likewise, susceptible patients in long-term-care facilities should be immunized.

Cross Infection↗
PubMed1990

Measles, mumps, and rubella vaccines.

With widespread use of the live virus vaccines for measles, mumps, and rubella, there has been a dramatic decrease in the incidence of all three diseases. At the same time, an increasing proportion of the remaining cases are occurring in adolescents and adults. Thus, vaccinations for these three diseases of childhood must be included in a comprehensive program for adult immunization. The vaccines have a proven history of safety and efficacy and are usually administered together as combined measles-mumps-rubella (MMR) vaccine. Vaccination for measles, mumps, and rubella is particularly important for susceptible adults likely to come in contact with infected children. Adults at particularly high risk for exposure may include daycare center workers, teachers and other school employees, college students, medical personnel, and those planning to travel outside the United States.

Age Factors↗
PubMed1989

Congenital rubella syndrome in the United States, 1970-1985. On the verge of elimination.

The National Congenital Rubella Syndrome Registry, a passive surveillance system, and the Birth Defects Monitoring Program, a newborn hospital discharge data set, are used to monitor the incidence of congenital rubella syndrome in the United States. Reports to the registry contain clinical and laboratory data which allow cases to be classified into six categories according to the likelihood of having congenital rubella syndrome. The monitoring program records newborn discharge diagnoses, without detailed information, of a nonrandom sample of about one fourth of the births in the United States annually. To evaluate the two systems and to estimate the actual incidence of congenital rubella syndrome, the authors collected hospital discharge summaries on all cases as reported by the monitoring program from 1970-1985 and classified them by the registry criteria. Of the 392 cases reported to the monitoring program during 1970-1985, 24% (n = 93) could be classified as confirmed or compatible compared with 79% (n = 415) of the 526 cases reported to the registry (rate ratio = 3.3; 95% confidence interval (CI) 2.9-3.8). Diagnosis of congenital rubella syndrome was made during the neonatal period for 68% (263 of 389) registry cases for whom such data were available. When the Lincoln-Peterson capture-recapture method of estimating population size for independent surveillance systems was used, an estimated 1,064 confirmed and compatible cases (95% CI 668-1,460) diagnosed during the neonatal period occurred during 1970-1979, for an average of 106 cases per year. During 1980-1985, an estimate of 122 neonatal confirmed and compatible cases (95% CI 8-236) occurred, for an average of 20 cases per year. A downward secular trend in the incidence of congenital rubella syndrome beginning in 1980 was observed. The registry detected 22% of all neonatal confirmed and compatible cases, the monitoring program detected 8%, and the two systems combined detected a total of 28%. The results indicate that congenital rubella syndrome may be on the verge of elimination in the United States.

Age Factors↗
PubMed1989

A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases.

An epidemiologic classification of paralytic poliomyelitis cases (ECPPC) has been in use in the United States since 1976. In 1985, this classification system was reviewed because of recent changes in the epidemiology of paralytic poliomyelitis and improved laboratory capability to definitively characterize poliovirus strains. An alternative classification system was devised, the epidemiologic and laboratory classification of paralytic polio cases (ELCPPC), that incorporated virus isolation and strain characterization with epidemiologic information. Reported paralytic poliomyelitis cases for 1980-86 were classified by both the ECPPC and the ELCPPC classification systems. The new ELCPPC system classified 91 per cent of the reported cases as vaccine-associated, while the ECPPC system classified only 71 per cent of the reported cases as vaccine-associated. The proposed classification system provides more specific and useful information particularly concerning vaccine-associated paralytic poliomyelitis.

Epidemiologic Methods↗
PubMed1989

Changing epidemiology of mumps and its impact on university campuses.

The reported incidence of mumps has declined dramatically since licensure of the live attenuated mumps vaccine in the United States in 1967, particularly in young children. Because administration of the vaccine was not widely practiced during the first decade it was available, there is now a cohort of teenagers and young adults who are relatively underimmunized. Reported mumps cases in this cohort increased substantially during 1986 to 1987. Mumps outbreaks at three Illinois universities, from which 123 clinical cases were reported between September 1986 and May 1987, were investigated. Meningeal involvement was reported in 17% of case-patients, orchitis occurred in 19% of 64 men, 6% of patients were hospitalized, and direct health care costs were estimated at $264 per case and more than $32,000 for the three outbreaks combined. The risk of mumps illness was greater for students less than 20 years of age (relative risk [RR] = 2.1, 95% confidence interval [CI] = 1.4, 3.1); students residing in dormitories (RR = 2.7, 95% CI = 1.6, 4.6); and out-of-state students (RR = 1.8, 95% CI = 1.0, 3.0). Because the available data suggest that mumps in college-aged persons is due chiefly to a failure to vaccinate susceptible persons, colleges and universities should become one major focus of mumps prevention activities to reduce susceptibility in this high-risk population.

Adolescent↗
PubMed1988

Mumps in the workplace. Further evidence of the changing epidemiology of a childhood vaccine-preventable disease.

The first documented mumps outbreak in the workplace took place between August and December of 1987, when 119 cases of mumps occurred among employees at three Chicago futures exchanges and their household contacts. Twenty-one patients developed 23 complications, and nine persons were hospitalized. Total direct and indirect economic costs associated with the outbreak were $120,738; the cost per case was $1473. Only three patients had written documentation of mumps immunization. The outbreak is consistent with the recent changing epidemiology of mumps and the increase in reported cases in the adolescent and young adult populations. Mumps vaccine was licensed in 1967, but its distribution was limited until 1977 when the Immunization Practices Advisory Committee of the US Public Health Service recommended it for universal use. As a result, a cohort of adolescents and young adults under-immunized against mumps and underexposed to disease is now entering the work force. Vaccination of susceptible employees could prevent the substantial health impact of mumps.

Adult↗
PubMed1988

Perspectives on the relative resurgence of mumps in the United States.

Although the United States has enjoyed great success in the control of mumps since the licensure of live virus mumps vaccine in 1967, a relative resurgence of mumps during the 1986-1987 period has raised concerns about the long-term effectiveness of mumps vaccine. We received mumps surveillance data, historical information on mumps vaccine distribution and recommendations for its use, survey data on levels of mumps immunization in US children during the 1973-1985 period, the effect of mumps immunization school laws on the reported incidence of mumps among states with and without such laws, and studies of mumps vaccine effectiveness. Following licensure, a decade elapsed before mumps vaccine was endorsed as a routine immunization of childhood, while immunization survey and vaccine distribution data reflected only gradual acceptance of the vaccine. However, mumps incidence declined during this period, resulting in a relatively underimmunized cohort of children born between 1967 and 1977 who grew up during a period when the risk of exposure to mumps was rapidly declining. The resurgence of mumps since 1986 has been characterized by a selective increase in incidence and a shift in the age group at highest risk to middle and high school students in those states lacking comprehensive mumps immunization school laws. Postlicensure field evaluations of mumps vaccine effectiveness have not demonstrated waning vaccine-induced immunity. The data indicate that the relative resurgence of mumps in the United States is chiefly due to a failure to vaccinate all susceptible persons, especially those who are now between 10 and 19 years old. Mumps immunization school laws offer an approach to deal with the problem of continuing susceptibility in school-age populations.

Adult↗
PubMed1988

A large outbreak of mumps in the postvaccine era.

During a county-wide mumps outbreak in Nashville, Tennessee, 332 cases of mumps were identified at a public high school (attack rate, 18.8%). A pep rally 17 d before the peak of the outbreak at a single public high school may have provided an opportunity for point-source exposure. A case-control study demonstrated that vaccine efficacy was 75% (we used provider-verified records and excluded students with a history of mumps disease). Although school records were nonuniform, mumps immunization status was correct, compared with provider-verified records, in at least 85% of both cases and controls. Parental reports were much less reliable. The cost of the outbreak was estimated at $154/case. Receiving mumps vaccine at a vaccine clinic held after the outbreak had peaked was associated with a decrease in risk of mumps disease. Thus, these clinics may have a role in the control of such outbreaks.

Adolescent↗
PubMed1988

Current epidemiology of pertussis in the United States.

The incidence of pertussis in the United States decreased rapidly during the 20th century, with the most impressive decreases resulting from the widespread use of DTP vaccine since the late 1940's. As a result of immunization laws, vaccine coverage levels against pertussis at school entry have been greater than 95% since 1980. National surveillance for pertussis done by the Centers for Disease Control (CDC) consists of two parts: a weekly telephone reporting system and a written case report system providing more detailed demographic, clinical, and laboratory information. In addition, data on secondary spread of pertussis among household contacts of reported cases were available on a small proportion of reported cases during 1979-1983. During the period 1980-1986, a total of 17,396 cases of pertussis was reported to CDC by weekly telephone reports. The annual incidence of reported pertussis rose during this period from 0.5 cases per 100,000 population to 1.7/100,000. Infants less than 12 months of age had the highest average annual incidence, estimated at 32 cases per 100,000. Children 1-4 years of age accounted for 25% of all cases but had an average annual incidence only 1/7th that of infants. The incidence rates for all age groups increased consistently between 1982 and 1986. The most impressive relative increases occurred among older adolescents and persons 20 years of age and older. In 1986, 10% of reported cases were in this age group compared to only 5% in 1982. Rates of hospitalization and complications such as pneumonia, seizures, and encephalopathy associated with pertussis were highest in children less than 6 months of age and declined progressively with increasing age.(ABSTRACT TRUNCATED AT 250 WORDS)

Centers for Disease Control and Prevention, U.S.↗