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S L Cochi

Publications and source records attributed to S L Cochi.

68 records · Page 4Linked to original sources
PubMed1987

Acquired immunodeficiency syndrome in low-incidence areas. How safe is unsafe sex?

Serum specimens from the cohort of persons who attended sexually transmitted disease clinics in New Mexico during a two-month period were tested for human immunodeficiency virus (HIV) antibody. Twenty-seven (2.0%) of 1374 serum specimens had repeatedly low-positive reactions by enzyme-linked immunosorbent assay testing, and 22 (1.6%) had repeatedly high-positive reactions. All sera (sufficient for testing by Western blot) with low-positive reactions gave negative results, and all sera (sufficient for testing by Western blot) with high-positive reactions gave positive results. All persons whose serum had high-positive reactions were male. Most (86%) had been seen at the only urban sexually transmitted disease clinic in New Mexico, and most (72%) were openly gay or bisexual. Of all gay and bisexual men evaluated, 14% (16/112) had high-positive reactions. Rapid plasma reagin positivity was significantly associated with HIV enzyme-linked immunosorbent assay low (false) positivity. The relatively high rate of HIV seropositivity among gay men with other sexually transmitted diseases indicates that transmission of acquired immunodeficiency syndrome is continuing in this low-incidence area and documents the need for testing and counseling programs in sexually transmitted disease clinics.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Control of epidemic group A meningococcal meningitis in Nepal.

During the first six months of 1983, an epidemic of serogroup A meningococcal meningitis occurred in the Kathmandu valley of Nepal, resulting in 875 cases and 95 deaths. The annual attack rate was 103 cases per 100,000 population, with a peak attack rate occurring in April. Epidemic meningococcal disease had not been recognized previously in Nepal. Early in 1984, a review of hospital-based data on pyogenic meningitis in Kathmandu showed three times as many cases per month compared with the same period the previous year, suggesting that a recurrent epidemic was unfolding. Beginning in February 1984, a vaccination campaign directed at a high-risk target population of people aged 1-24 years was launched; over 329,000 doses of bivalent A/C meningococcal vaccine were given, achieving approximately 64% coverage of the target population. A dramatic decline in the number of new meningitis cases occurred coincident with the initiation of the mass vaccination campaign. This experience demonstrates that it is possible, with appropriate surveillance efforts, to detect an evolving epidemic of meningococcal disease early in its course and to institute control measures in advance of the expected epidemic peak.

Adolescent↗
PubMed1987

Preventing rubella: assessing missed opportunities for immunization.

Cases of rubella continue to occur among adults in the United States because 10-20 per cent of persons in this age group remain susceptible. To evaluate the potential preventability of these cases, we present a method for assessing missed opportunities for rubella immunization, based on immunization recommendations of the Immunization Practices Advisory Committee (ACIP) of the US Public Health Service (PHS). Immunization programs faced with limited resources can use analysis of missed opportunities to focus on those gaps in implementation contributing most to the remaining rubella cases.

Adolescent↗
PubMed1987

Childhood upper respiratory tract infections: to what degree is incidence affected by day-care attendance?

Risk factors for acute upper respiratory tract disease in childhood were evaluated in a population-based sample of the Atlanta metropolitan area. Mothers from 449 households containing 575 children less than 5 years of age were selected by random-digit dialing and questioned about upper respiratory tract infection and ear infection occurring in their children during the preceding 2 weeks. Household demographic and socioeconomic characteristics, maternal smoking history and child day-care attendance and breast-feeding information were also obtained. For children less than 5 years of age, the reported incidence of upper respiratory tract infection was 24%, and of ear infection, 6%. Controlling for the other variables measured, day-care attendance was associated with a significantly increased risk of both illnesses. For upper respiratory tract infection, increased risk was present for all children attending day care (P = .02, odds ratio = 1.6), whereas for ear infection, risk could be demonstrated only for full-time attendees (P = .005, odds ratio = 3.8). Maternal smoking was a second independent risk factor for a child's having upper respiratory tract infection (odds ratio = 1.7, P = .01). Thirty-one percent of all upper respiratory tract infection among day-care attendees and 66% of all ear infections among full-time day-care attendees were attributable to day-care attendance. Given the proportion of children in day care, 9% to 14% of the total burden of upper respiratory tract disease in this population was day care related.(ABSTRACT TRUNCATED AT 250 WORDS)

Child Day Care Centers↗
PubMed1986

Haemophilus influenzae b polysaccharide vaccine. Physician acceptance and use of a new vaccine.

The introduction of Haemophilus Influenzae type b (Hib) polysaccharide vaccine in 1985 provided an opportunity to study the extent to which physicians have adopted the use of the new vaccine in their routine practice behavior, the factors that predict Hib vaccine use by physicians, and how physicians have chosen to deal with differing recommendations for its administration. We surveyed all physicians providing primary care to children in New Mexico six to eight months after vaccine licensure to assess their knowledge of existing recommendations and their current behavior regarding use of the Hib vaccine. Of the 369 primary care physicians who responded, 100% of pediatricians, 98% of family practitioners, and 91% of general practitioners were aware that a vaccine against invasive Hib disease had been licensed. Sixty-three percent of physicians surveyed were currently using the vaccine. Vaccine usage varied significantly by specialty, with 86% of pediatricians reporting use compared with 61% of family practitioners and 31% of general practitioners. Physicians were significantly more likely to use Hib vaccine if they were young and if they worked in the private sector rather than the public sector. The three sets of recommendations for Hib vaccine use had been widely read; 85% of respondents had read at least one set. Practitioners confronted with differing recommendations had elected to give the vaccine permissively within existing guidelines. Our findings suggest that practitioners have adapted quickly to the introduction of Hib vaccine but that nonuse of the vaccine in the public sector remains an obstacle to full implementation of this prevention strategy.

Attitude of Health Personnel↗
PubMed1986

Primary invasive Haemophilus influenzae type b disease: a population-based assessment of risk factors.

We performed a population-based case-control study of risk factors for primary invasive Haemophilus influenzae type b (Hib) disease in metropolitan Atlanta from July 1, 1983, through June 30, 1984. Active surveillance identified 102 cases in children less than 5 years of age, 89 of whom lived in households with telephones. We used random digit dialing to select 530 controls who were postmatched to cases by age. Multivariate analysis showed a significant association between Hib disease and two independent exposure factors, household crowding (odds ratio (OR) 2.7, 95% confidence limits (CL) 1.3 to 5.6) and day-care attendance. For day-care attendance, relative risk was highest in 2- to 5-month-old infants (OR 17.7, 95% CL 5.8 to 54.4) and declined to 9.4 (4.3 to 20.9) at ages 6 to 11 months, 5.0 (2.7 to 9.3) at 12 to 23 months, 2.7 (1.3 to 5.5) at 24 to 35 months, and 1.4 (0.5 to 4.0) in 36- to 59-month-old children. Fifty percent of all invasive Hib disease that occurred during the study period was attributable to exposure to day-care; the attributable risk for household crowding was 18%. Dose-response effects were observed for hours per week of day-care attendance and extent of household crowding. Breast-feeding was protective for infants less than 6 months of age (OR 0.08, 95% CL 0.01 to 0.59). After controlling for socioeconomic and other confounding factors, we could demonstrate no effect of black race on cumulative risk of invasive Hib disease. Our study defines high-risk groups and provides a population-based model of the interrelationship between risk factors associated with invasive Hib disease.

Age Factors↗
PubMed1985

Secondary Haemophilus influenzae type b in day-care facilities. Risk factors and prevention.

The risk factors for acquisition of secondary day-care-associated Haemophilus influenzae type b disease were evaluated in a cohort of children in Seattle-King County, Washington; Atlanta; and the state of Oklahoma. During the study period, 129 primary cases were identified in children less than 5 years old who attended day-care facilities. In ten instances (8%), a secondary case occurred between one and 60 days after a primary case in the same classroom. Risk of secondary disease in classroom contacts was strongly age related: 2.4% in children 0 to 11 months old, 1.2% in children 12 to 23 months old, and 0.0% in children 24 to 59 months old. Controlling for age, children attending day-care more hours per week were more likely to transmit or acquire secondary disease. Risk of secondary disease for children in other classrooms at a center where a case had occurred was not significantly greater than risk of primary disease. Administration of rifampin to classroom contacts of a child with invasive H influenzae was effective in preventing secondary cases (95% confidence interval for rifampin efficacy, 47% to 100%). For children 0 to 23 months old not treated with rifampin, risk of secondary disease was 2.7% (95% confidence interval, 1.1% to 4.3%), a risk approaching that reported in household contacts.

Age Factors↗
PubMed1985

Pasteurized milk as a vehicle of infection in an outbreak of listeriosis.

Between June 30th and August 30th, 1983, 49 patients in Massachusetts acquired listeriosis. Seven cases occurred in fetuses or infants and 42 in immunosuppressed adults; 14 patients (29 per cent) died. Of 40 Listeria monocytogenes isolates available for testing, 32 were serotype 4b. Two case-control studies, one matching for neighborhood of residence and the other for underlying disease, revealed that the illness was strongly associated with drinking a specific brand of pasteurized whole or 2 per cent milk (odds ratio = 9, P less than 0.01 for the neighborhood-matched study; odds ratio = 11.5, P less than 0.001 for the illness-matched study). The association with milk was further substantiated by four additional analyses that suggested the presence of a dose-response effect, demonstrated a protective effect of skim milk, associated cases with the same product in an independent study in another state, and linked a specific phage type with the disease associated with milk. The milk associated with disease came from a group of farms on which listeriosis in dairy cows was known to have occurred at the time of the outbreak. Multiple serotypes of L. monocytogenes were isolated from raw milk obtained from these farms after the outbreak. At the plant where the milk was processed, inspections revealed no evidence of improper pasteurization. These results support the hypothesis that human listeriosis can be a foodborne disease and raise questions about the ability of pasteurization to eradicate a large inoculum of L. monocytogenes from contaminated raw milk.

Adult↗
PubMed1985

Immunization of US children with Hemophilus influenzae type b polysaccharide vaccine. A cost-effectiveness model of strategy assessment.

Hemophilus influenzae type b (HIB) is the leading cause of bacterial meningitis in the United States. Efforts are under way to develop vaccines immunogenic in children younger than 18 months, but clinical efficacy of a previously developed HIB polysaccharide vaccine has already been established in children aged 18 months or older. We developed a cost-effectiveness model to evaluate immunizing US children with this HIB polysaccharide vaccine pending development of a more immunogenic product. The model permitted comparison of the impact of alternative strategies for use of the vaccine, including universal use at 18 or 24 months of age, use of a second dose after primary immunization, and use in high-risk groups such as day-care-center attendees. Universal vaccination at 18 or 24 months of age resulted in similar estimates of disease prevented, as a consequence of the higher expected efficacy and duration of immunity for the vaccine when given at 24 months. Overall, the implementation of routine childhood immunization against HIB at 18 months of age was the most cost-effective strategy. Universal vaccination at 18 months of age combined with a second dose for day-care-center attendees would substantially increase the number of cases prevented, with a minimal increase in costs. Universal vaccination with a two-dose schedule beginning at 18 months of age could prevent the most disease.

Bacterial Capsules↗
PubMed1984

Overview of neonatal listeriosis.

Neonatal listeriosis accounts for the largest recognizable group of infections due to Listeria monocytogenes. Fetal wastage with early gestational infection is a recognized complication of maternal infection. Late gestational maternal infection or asymptomatic colonization may be associated with neonatal infection. Early-and late-onset clinical forms are recognized and the epidemiology, and clinical features of neonatal listeriosis resemble neonatal infections due to group B streptococci. The source of L. monocytogenes in most cases of neonatal listeriosis, particularly the late-onset form, remains obscure.

Adolescent↗
PubMedDate not supplied

Prevention of Haemophilus influenzae type b infections in day care: a public health perspective.

The availability of new data regarding the risk of invasive Haemophilus influenzae type b (Hib) among day care attendees allows the formulation of a practical public health approach to this problem. It is now clear that day care attendees are at significantly increased risk for development of primary invasive Hib disease. While the risk of secondary Hib disease for most is low, risk is substantially increased when young day care attendees are exposed to a primary case to a degree analogous to that of household contacts. Because risk for primary Hib disease is increased among day care attendees, immunization of these children with Hib polysaccharide vaccine is of the highest priority and may be appropriate for children as young as 18 months of age. In light of new data documenting the efficacy of rifampin in prevention of secondary disease, the use of this medication is indicated when unvaccinated day care attendees younger than two years old have had significant contact with a primary case.

Age Factors↗
PubMedDate not supplied

Vaccine prevention of Haemophilus influenzae type b disease: past, present and future.

In little more than half a century we have come a long way toward the eventual elimination of invasive Hib disease as a major threat to children in the United States. The Haemophilus b polysaccharide vaccine has provided the first tool for large scale public health intervention efforts in specific target groups of children older than 18 months of age who are likely to benefit from immunization. Immunization programs using the currently available vaccine represent an interim measure that is likely to be replaced within the next few years by new programs utilizing an improved vaccine with greater potential for preventing invasive Hib disease in susceptible infants and young children. Prospects appear good that an improved second generation vaccine that will provide protective efficacy in infants during the first year of life will become available in the near future.

Age Factors↗