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S R Preblud

Publications and source records attributed to S R Preblud.

At least 37 records · Page 2Linked to original sources
PubMed1987

The effect of a school entry law on mumps activity in a school district.

Sixty-three cases of clinical mumps occurring in a New Jersey school district presented an opportunity to determine compliance with the state's 1978 mumps "new entrants" school immunization law, investigate the effect of the law on the pattern of the outbreak, estimate the efficacy of mumps vaccine, and quantitate the economic impact of the outbreak. Only students in kindergarten (K) through grade 5 would have been affected by the immunization law. Students in the sixth grade were nearly seven times more likely to develop mumps than students in grades K through 5. The observed differences between the sixth graders and those in grades K through 5 most likely reflect the fact that sixth graders were not covered by the school law. Vaccine efficacy was estimated to be 91% (95% confidence interval = 77% to 93%). The total direct cost of the outbreak was $10,937 (clinic costs plus total cost to households). This outbreak demonstrates the significant impact of appropriate school vaccination laws on limiting the morbidity and economic and social costs of mumps.

Adolescent↗
PubMed1987

A persistent outbreak of measles despite appropriate prevention and control measures.

From January 4 to May 13, 1985, an outbreak of 137 cases of measles occurred in Montana and persisted for 12 generations of spread. A total of 114 cases occurred on the Blackfeet Indian reservation in northwest Montana. Of the 137 cases, 82 (59.9%) were in school-aged children (aged 5-19 years). Of the 114 cases on the reservation, 108 (94.7%) were classified as programmatically nonpreventable. A total of 64 (82.1%) of the 78 patients on the reservation who were born after 1956 and were above the recommended age at vaccination had a history of adequate measles vaccination. Additionally, an audit of immunization records at the schools in Browning, Montana, where most of the cases occurred, showed that 98.7% of students were appropriately vaccinated. A retrospective cohort study in the Browning schools failed to identify age at vaccination or time since vaccination as significant risk factors for vaccine failure. Overall vaccine efficacy was 96.9% (95% confidence interval = 89.5-98.2%). None of 80 Browning students who were vaccinated at less than 12 months of age and revaccinated at 15 months of age or older became infected. A case-control study showed a significant association between attendance at Browning basketball games and infection early in the outbreak. This outbreak suggests that measles transmission may persist in some settings despite appropriate implementation of the current measles elimination strategy.

Adolescent↗
PubMed1987

A cost-effectiveness analysis of measles outbreak control strategies.

This study compares the cost-effectiveness of six vaccination strategies during a measles outbreak: vaccination of all susceptibles 15 months of age or older and born after 1956 (the current routine strategy); lowering the recommended age at vaccination from 15 to 12 months (plus current routine strategy); lowering the recommended age at vaccination to six months (plus current routine strategy); revaccination of those vaccinated at 12-14 months of age (plus current routine strategy); vaccination of all students in school regardless of immune status; and vaccination of all residents 15 months to 28 years of age in the community regardless of immune status. The analysis is based on the hypothetical, early application of these strategies to a 1985 measles outbreak in Montana, which occurred despite appropriate application of current prevention and control recommendations. Although the results are applicable only to this particular outbreak, this analysis provides an approach which can be used in other settings to assess measles outbreak control strategies. Similar studies would need to be performed in a variety of settings to determine the most cost-effective measles outbreak control strategies overall.

Child↗
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

Measles hospitalizations, United States, 1977-84: comparison with national surveillance data.

Trends in measles discharges from hospitals participating in the Commission on Professional and Hospital Activities, Professional Activities Study (CPHA-PAS) from 1977 to 1984 reflected the rapid decline in measles morbidity indicated by national surveillance data with an 88 per cent decrease in hospitalizations and a 95 per cent decrease in reported cases from 1977 to 1984. Overall trends in number, age, and seasonal distribution were also generally similar. Thirty-four per cent of the hospitalizations listed respiratory complications, 8.5 per cent otitis media, and 3.4 per cent neurologic complications.

Adolescent↗
PubMed1986

Transmission of measles in medical settings. 1980 through 1984.

For the five-year period 1980 through 1984, a total of 241 persons with measles in 30 states were identified as probably having acquired their infection in a medical facility. The proportion of all measles cases acquired in medical settings increased from 0.7% for 1980 through 1982 to 2.9% for 1983 and 1984. Seventy-six percent of cases were found in patients or visitors, and 24% in personnel at the medical facility where transmission occurred. The highest proportion of cases occurred in children less than 5 years of age (54.3%), followed by persons 25 to 29 years of age (14.7%). Of spread (50.0%) and patient-to-staff spread (36.7%) were most common. Medical personnel rarely transmitted disease to others. More attention needs to be given to methods of preventing spread of measles in medical facilities, such as isolation precautions, postexposure prohylaxis of potential contacts (vaccination or immune globulin), and ensuring that medical personnel are immune to measles.

Adult↗
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

Varicella: complications and costs.

Varicella (chickenpox) has long been considered a benign, inevitable disease of childhood. Complications are generally mild and rarely severe, and virtually every individual is infected by adulthood. Infection is associated, however, with a high risk of serious complications in certain high-risk groups, such as leukemic children. Concerns about the severity of varicella in this population have led to the development and testing of a live, attenuated vaccine. Because of the favorable results thus far available, the vaccine may soon be licensed for use in high-risk individuals. The fact that a vaccine may soon be available has led to an increased interest in the potential benefits of a childhood varicella vaccine program. The costs associated with varicella infection in normal persons without a varicella vaccination program have been estimated to be approximately $400 million, 95% of which is the cost of caring for a child at home. Vaccination of normal 15-month-old children with a safe and effective vaccine with long-lasting immunity could reduce the cost by 66% and result in a savings of $7 for every dollar spent on the vaccination program. This assumes that vaccine would be administered only once with measles, mumps, and rubella vaccine, that there would be no increase in the number of varicella cases in older persons who are at increased risk for complications, and that there would be no deleterious effect on the occurrence and severity of herpes zoster.(ABSTRACT TRUNCATED AT 250 WORDS)

Chickenpox↗
PubMed1986

Appropriate age for measles vaccination in the United States.

The appropriate age for measles vaccination is determined by weighing the risk of measles disease and complications at a given age with vaccine efficacy at that age. In the United States, measles vaccine was initially used in children as young as 9 months of age because the disease was common and complications were greatest in persons less than 1 year of age. In 1965, when it became apparent that vaccine failure was unacceptably high in children less than 1 year and when epidemiologic analysis indicated that children greater than or equal to 1 year, particularly schoolchildren, were the primary focus of measles transmission, the vaccination age was raised to 12 months. In 1976, further studies showed efficacy was slightly higher at 15 months of age versus 12 months or 12-14 months of age. Because the risk of acquiring measles in children less than 15 months was low, the age for routine vaccination was increased to 15 months. This age recommendation may be appropriate for developed countries where the epidemiology of measles may be similar to the epidemiology in the United States. However, this age is inappropriate for many countries in the developing world where the risks of measles and complications from measles are high in young preschool children. In those countries, the recommended age for routine vaccination against measles is generally 9 months.

Age Factors↗
PubMed1985

Some current issues relating to rubella vaccine.

At the time of licensure in 1969, available data indicated that rubella vaccines were safe, noncommunicable, and effective. Since vaccine virus could cross the placenta and infect the fetus, cautious use of the vaccines in childbearing-age women was recommended. Over the past 15 years, additional information about the vaccines has been accumulated. This article provides an update of data on (1) the risk and degree of joint symptoms following vaccination and revaccination, (2) the duration of vaccine-induced immunity, (3) the protective effect of low levels of vaccine-induced antibody, and (4) the risks to the fetus following maternal vaccination. The data support continued vaccination of all young children as well as increased efforts to vaccinate susceptible adolescents and young adults, especially women. Only by more effective vaccination of the latter can elimination of congenital rubella syndrome be hastened.

Abnormalities, Multiple↗
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↗