Indochinese refugees in Ohio - 1980.
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Biomedical subjects
Publications and source records attributed to T J Halpin.
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Three patients with severe pneumonia at a community hospital in Columbus, Ohio, were found to have Legionnaires' disease in late August 1977. A subsequent serologic survey of patients with pneumonia at this hospital identified three additional cases. Among patients with pneumonia, hospital exposure in the 2 weeks before onset of illness was significantly associated with Legionnaires' disease (P = 0.003). Serosurveys of hospital employees with a recent history of upper respiratory illness, healthy employees, and workers at the hospital construction site showed that one of 101, one of 107, and none of 114, respectively, has a single reciprocal titer of greater than or equal to 256 to the Legionnaires' disease (LD) bacterium. Serosurveys of patients with pneumonia at three control hospitals identified five additional patients with Legionnaires' disease, three of them with pneumonia that was apparently hospital acquired in a single renal transplant unit. A fourth patient from that unit without clinical illness had a fourfold rise in titer to LD bacterium.
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A major purpose of a state-wide survey to document the vaccination status of 1,003 2-year-old children was to identify factors associated with failure to receive the recommended vaccinations. With a basic series of immunization defined as three doses of diphtheria-tetanus-pertussis (DTP), three oral polio vaccine (OPV), one measles, and one rubella, 72.5% of the children had completed the series. When the completed series was redefined to include a fourth DTP and mumps vaccine the rate of completion dropped to 40.8%. However, 59.1% of the children who had not completed this optimal series could be brought up-to-date with a single visit to their provider of medical care. Demographic variables independently associated with completion of the basic series were increased paternal education (P less than .001), increased maternal education (P less than .02), smaller family size (P less than .01) and higher socioeconomic status, as determined by census tract or rural town of residence (P less than .02). Race was not found to be a factor associated with vaccination rates when socioeconomic status was controlled. Patients who received their vaccinations from private physicians had a better vaccination rate than those who attended health department clinics. This difference persisted even when socioeconomic status was controlled by residence (P less than .02). The simultaneous comparison of parental education and family size demonstrated that a child having one parent with less than 12 years education or having at least three siblings has a fourfold greater risk of failure to complete his immunization than children whose parents are both college graduates. By using paternal and maternal education level and family size as screening variables, children at high risk for failure to complete their immunizations could be identified prospectively and made the target of intervention programs to improve compliance.
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During a large outbreak of measles in Ohio in 1976 it was possible to measure measles vaccine efficacy by age at time of vaccination and number of years since vaccination. Using a summed incidence method to control for the confounding variable introduced by mass immunization clinics held during the outbreak, vaccine efficacy was greater than 95% for children vaccinated at 12, 13, and 14 or more months of age. Vaccine efficacy for those vaccinated at 12 months of age was notably better than for those vaccinated at younger ages but not different from those vaccinated at older ages. Although recently administered vaccine appeared more efficacious than vaccine administered in the past, this difference was not significant when controlled for age at vaccination. Evaluation of the mass clinics held during the outbreak demonstrated that 59.6% of the inadequately immunized children attended the clinics, but this was not substantially different from the proportion of adequately immunized who attended (52.4%). Recommendations for measles revaccination need not include children previously vaccinated at 12 months of age or greater.
From April 1990 to April 1991, 278 cases of rubella were reported to the Ohio Department of Health. Of these, 276 (99 percent) were among the Amish of northeastern Ohio. The outbreak involved eight counties in an area that contains large settlements of Old Order Amish. Members of this community of Amish frequently take religious exemption from recommended immunization practices and are believed to represent a high proportion of Ohio's rubella-susceptible persons. Vaccination history was known only for 146 of the Amish people. Of those, only four had a positive history of rubella vaccination. Of the 276 Amish with cases of rubella, 65 (24 percent) were younger than age 5 years, 104 (38 percent) were ages 5-14, 46 (17 percent) were ages 15-19, 32 (12 percent) were ages 20-29, 6 (2 percent) were ages 30 or older, and age was not reported for 23 (8 percent). The ratio of males to females with rubella was 1:1. Five women of the Amish community were pregnant; four had been ill with symptoms consistent with rubella. Three were in their first trimester. Congenital rubella syndrome did not occur in any of the four live births. Serology was available for only the two non-Amish people, and both were acute phase serum-positive for Immunoglobulin M.