Biomedical subjects
Publications and source records attributed to S R Preblud.
Three algorithms have been prepared that should permit a rational and consistent assessment of the likelihood of acute rubella infection in the pregnant woman whose previous rubella immune status is unknown, and the attendant risks, if any, to her unborn child.
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In the period April to October, 1977, an epidemic of pertussis in the outpatient population of a large metropolitan hospital involved 115 cases that were diagnosed by culture or direct fluorescent antibody tests. A study of secondary cases in household contacts showed attack rates of 81% in children under one year of age; attack rates decreased with increasing age to 8% in persons over 20 years of age. Vaccine efficacy was estimated to be 63%. There was no evidence of decreased efficacy with increasing time after vaccination. Fourteen asymptomatic FA-positive individuals were identified; four of these were also culture positive. Four were adults and ten were children. Nine of the ten children had received three or more vaccinations, compared to only 29 of 78 symptomatic children (P = 0.002).
Previous estimates of the age-specific risks of varicella-associated encephalitis and death (the only two varicella complications for which national data are available) have been based on age data for varicella cases from only three reporting areas. In an attempt to estimate more accurately the age-specific risks, 1978, age data for varicella cases were solicited from state epidemiologists. These age-specific data were compared to those from the three original reporting areas and from the National Center for Health Statistics Health Interview Survey (HIS) for the time period 1972 to 1978. The age distribution of state and HIS cases was then compared with that of encephalitis cases and deaths reported between 1972 and 1978 to the Centers for Disease Control and the National Center for Health Statistics, respectively. Despite differences in the number and distribution of varicella cases, both sources clearly identified those greater than or equal to 20 years of age as having the greatest risk of varicella encephalitis or death. Young children also were at increased risk. A number of problems with the reliability and accuracy of the data indicate that more specific data are needed to delineate further the groups most at risk of varicella complications who might benefit most from vaccination, and to evaluate accurately the effects the vaccine might have.
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Investigation of an outbreak of rubella on a college campus provided an opportunity to study the occurrence of orchitis, or testalgia, in male adolescents and young adults. Of 68 subjects with rubellla infection, five reported pain without swelling in one or both testicles lasting up to three days. Two of them had laboratory-confirmed rubella infection. Since the majority of all currently reported cases of rubella in the United States occur in persons 15 years of age and older, an increased awareness of rubella as a possible cause of testicular pain, and perhaps of orchitis, in postpubertal boys and men result in further characterization of this symptom.
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