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PubMed1998

Preconception care: who needs it, who wants it, and how should it be provided?

BACKGROUND: Preconception care (PC) aims to identify and reduce a number of modifiable factors that can adversely affect pregnancy outcome. AIM: To ascertain both knowledge of the attitudes towards PC among members of primary health care teams (PHCTs) and registered women of childbearing age in a representative sample of general practices in Harrow. METHOD: A questionnaire survey was conducted in a randomly selected group of nine general practices in the London borough of Harrow. Subjects included all relevant health professionals and female patients of childbearing age registered with the practices. RESULTS: A total of 62/88 (70.5%) health professionals and 811 women (1 in 20 of the entire target population) completed the questionnaires. Nurses' knowledge matched that of the doctors, except in the area of genetics. Over 85% of all health professionals believed that PC could be of benefit to both mother and baby. Women were generally well informed; Asian women, those born outside the UK, those who had never been pregnant, and those who had not undertaken education beyond the age of 18 years were significantly less well informed. Health professionals considered PC to be best delivered opportunistically by nurses, and this method appeared to be acceptable to most female patients of childbearing age, although it was significantly less acceptable among Asians. CONCLUSION: Among health professionals and women of childbearing age, there is generally a good level of knowledge of PC, although certain groups are less well informed than others and could benefit from a targeted education approach. Widespread agreement that PC is worthwhile was found among PHCT members, but this view is less strongly held by the female public, with the acceptability of providing PC opportunistically differing significantly between ethnic groups.

Adolescent↗
PubMed1993

Development of a population pharmacokinetic model and optimal sampling strategies for intravenous ciprofloxacin.

Data obtained from 74 acutely ill patients treated in two clinical efficacy trials were used to develop a population model of the pharmacokinetics of intravenous (i.v.) ciprofloxacin. Dosage regimens ranged between 200 mg every 12 h and 400 mg every 8 h. Plasma samples (2 to 19 per patient; mean +/- standard deviation = 7 +/- 5) were obtained and assayed (by high-performance liquid chromatography) for ciprofloxacin. These data and patient covariates were modelled by iterative two-stage analysis, an approach which generates pharmacokinetic parameter values for both the population and each individual patient. The final model was used to implement a maximum a posteriori-Bayesian pharmacokinetic parameter value estimator. Optimal sampling theory was used to determine the best (maximally informative) two-, three-, four-, five-, and six-sample study designs (e.g., optimal sampling strategy 2 [OSS2] was the two-sample strategy) for identifying a patient's pharmacokinetic parameter values. These OSSs and the population model were evaluated by selecting the relatively rich data sets, those with 7 to 10 samples obtained in a single dose interval (n = 29), and comparing the parameter estimates (obtained by the maximum a posteriori-Bayesian estimator) based on each of the OSSs with those obtained by fitting all of the available data from each patient. Distributional clearance and apparent volumes were significantly related to body size (e.g., weight in kilograms or body surface area in meters squared); plasma clearance (CLT in liters per hour) was related to body size and renal function (creatinine clearance [CLCR] in milliliters per minute per 1.73 m2) by the equation CLT = (0.00145.CLCR + 0.167).weight. However, only 30% of the variance in CLT was explained by this relationship, and no other patient covariates were significant. Compared with previously published data, this target population had smaller distribution volumes (by 30%; P < 0.01) and CLT (by 44%; P < 0.001) than weight- and CLCR- matched stable volunteers. OSSs provided parameter estimates that showed good to excellent estimates of CLT (or area under the concentrations-time curve [AUC]) were unbiased and precise (e.g., r2 for AUC for all data versus AUC for OSS2 was > 0.99) and concentration-time profiles were accurately reconstructed. These results will be used to model the pharmacodynamic relationships between ciprofloxacin exposure and response and to aid in developing algorithms for individual optimization of ciprofloxacin dosage regimens.

Adult↗
PubMed2004

[Study on the trend and disease burden of injury deaths in Chinese population, 1991 - 2000].

OBJECTIVE: The mortality and trend of injury in 1991 - 2000, the distribution of causes of injuries by areas as well as disease burden in Chinese population were discussed. METHODS: Data on mortality level and causes of injuries provided by National Disease Surveillance Program in 1991 - 2000, adjusted by under-reporting rate together with years of potential life lost (YPLL) and WPYLL of injuries and proportion of YPLL and WPYLL of total death, were calculated. RESULTS: The mortality of injury was kept at a stable level from 1991 to 2000. The adjusted average death rates were 66.56/100,000 with 81.41/100,000 in males, 51.17/100,000 in females, and 38.68/100,000, 74.63/100,000 in urban and rural populations respectively. Death rates of injury in the east, central and west rural areas were 1:1.14:1.21 respectively. Injury was the main cause of death among children and youths. Traffic accident, suicide, drowning, poisoning and fall were main causes of injury accounting for 70 percent of all the injury mortality. Since 1990's, the death rate of traffic accident had been obviously increasing, YPLL and WPYLL in injury 2132 years/10,000 and 1587 years/10,000, respectively. The YPLL and WPYLL were 24.56% and 26.51% of total deaths. CONCLUSION: The disease burden of injury was heavy and the death of injury caused more social and economic losses owing to premature death. The increasing death rate of traffic accident called for more attention. Different effective control strategies should be formulated based on different death causes of injury and different target populations.

Age Factors↗
PubMed2000

The law and ethics of the use of experimental medication in patients incapable of expressing consent: between a rock and a hard place.

In Australia, human research ethics committees approve clinical trials of drugs in accordance with federal regulations. Federal guidelines allow for the possible conduct of clinical trials in all populations. Within the State of New South Wales, persons unable to consent because of disability are subject to State legislation which, until 1998, regarded drug trials as Special Medical Treatment requiring consent of the Guardianship Tribunal. That consent could only be given if an anticipated individual benefit could be proved. As no such guarantee could be given prior to conduct of a clinical trial, it being unethical to trial an active substance against a placebo if potential individual benefit is already proven for the active substance, a conundrum resulted whereby the Tribunal could not give the required approval. Many argued that the New South Wales law resulted in some experimental medications, such as those being available to minimise tissue damage following stroke, or those being specifically developed for those with late stage dementia, not being made available to their target populations. Amendments were made to remove reference to clinical drug trials as Special Medical Treatment, and a new system established whereby such trials could proceed, including the use of a placebo, with the approval of an ethics committee and the Tribunal.

Clinical Trials as Topic↗
PubMed2006

Development of written information for antiretroviral therapy: comprehension in a Tanzanian population.

OBJECTIVE: To design and develop a simple, easily readable patient information leaflet (PIL) for a commonly used antiretroviral (ARV) regimen and to evaluate its readability and acceptability in a Tanzanian population. METHOD: A PIL incorporating simple text and pictograms was designed for the antiretroviral regimen of stavudine, lamivudine and efavirenz. The PIL was designed according to established good design guidelines, modified during a multi-stage iterative testing process and piloted in a South African Xhosa population. The PIL was made available in both English and Kiswahili. Sixty Tanzanian participants who were not taking ARVs were interviewed. They were asked to read the PIL in the language of their choice and were then asked a series of two-part questions; the first part required participants to locate the information in the PIL, after which they were asked to explain the information in their own words. Acceptability was assessed through close-ended questions and open-ended feedback. The influence of selected patient characteristics on comprehension of the PIL was investigated using one-way ANOVA and t-tests for independent samples with a significance level set at 0.05. MAIN OUTCOME MEASURE: Comprehension of the written information in an overall percentage understanding. RESULTS: The overall average percentage comprehension of the PIL was 95%. The target set by the EC guideline that at least 80% of participants correctly locate and understand the information was achieved for 19 of the 20 questions. Five of the six instructions illustrated by pictograms were correctly understood by all participants. The only patient characteristics significantly associated with comprehension were educational level and self-reported ease of reading the PIL. Acceptability of the PIL was high and positive comments were associated with simplicity, good design, easy readability and user-friendliness, the latter enhanced by the inclusion of pictograms. CONCLUSION: The PIL designed for this study was shown to be effective in communicating information about ARVs. Patient characteristics must be taken into account when developing written information, and the final document must be tested for comprehension in the target population.

Adolescent↗
PubMed2005

Interventions for preventing obesity in children.

BACKGROUND: Obesity prevention is an international public health priority. The prevalence of obesity and overweight is increasing in child populations throughout the world, impacting on short and long-term health. Obesity prevention strategies for children can change behaviour but efficacy in terms of preventing obesity remains poorly understood. OBJECTIVES: To assess the effectiveness of interventions designed to prevent obesity in childhood through diet, physical activity and/or lifestyle and social support. SEARCH STRATEGY: MEDLINE, PsycINFO, EMBASE, CINAHL and CENTRAL were searched from 1990 to February 2005. Non-English language papers were included and experts contacted. SELECTION CRITERIA: Randomised controlled trials and controlled clinical trials with minimum duration twelve weeks. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Twenty-two studies were included; ten long-term (at least 12 months) and twelve short-term (12 weeks to 12 months). Nineteen were school/preschool-based interventions, one was a community-based intervention targeting low-income families, and two were family-based interventions targeting non-obese children of obese or overweight parents. Six of the ten long-term studies combined dietary education and physical activity interventions; five resulted in no difference in overweight status between groups and one resulted in improvements for girls receiving the intervention, but not boys. Two studies focused on physical activity alone. Of these, a multi-media approach appeared to be effective in preventing obesity. Two studies focused on nutrition education alone, but neither were effective in preventing obesity. Four of the twelve short-term studies focused on interventions to increase physical activity levels, and two of these studies resulted in minor reductions in overweight status in favour of the intervention. The other eight studies combined advice on diet and physical activity, but none had a significant impact. The studies were heterogeneous in terms of study design, quality, target population, theoretical underpinning, and outcome measures, making it impossible to combine study findings using statistical methods. There was an absence of cost-effectiveness data. AUTHORS' CONCLUSIONS: The majority of studies were short-term. Studies that focused on combining dietary and physical activity approaches did not significantly improve BMI, but some studies that focused on dietary or physical activity approaches showed a small but positive impact on BMI status. Nearly all studies included resulted in some improvement in diet or physical activity. Appropriateness of development, design, duration and intensity of interventions to prevent obesity in childhood needs to be reconsidered alongside comprehensive reporting of the intervention scope and process.

Adolescent↗
PubMed1992

Evaluating the impact of a promotional campaign for screening mammography: who attends?

The Breast X-ray Programme of the Central Sydney Health Service is one of 11 pilot programs in Australia assessing the best methods of delivering population-based mammographic screening. The aim of this study was to determine the attendance rate and to describe sociodemographic predictors of attendance in an area serviced by the program. A well-defined population of approximately 4500 women aged 45 to 70 was identified within the Central Sydney area for intensive testing of recruitment strategies. After four visits (spanning two years) to the area by a mobile screening van, 48% of the women were screened. Women from non-English-speaking backgrounds were just as likely to attend as women from English-speaking backgrounds, probably because special attention was given to recruiting these women. Older women from English-speaking backgrounds were less likely to attend, whereas no age trend existed for women of non-English-speaking backgrounds. Sampled attendance data of women from English-speaking backgrounds showed that women with more education were more likely to attend screening. Women who were employed were just as likely to attend as those who were not. In order to screen 70% of the targeted population as set forth for a national mammography screening program, it appears that community recruitment efforts alone will not be sufficient. With special attention to recruitment coverage, older women and women from non-English-speaking backgrounds can be successfully recruited. Special attention will also need to be focused on encouraging attendance in women who have less formal education.

Age Factors↗
PubMed1993

Linking the delivery of health care to service population needs: the role of the epidemiologist on the health care management team.

Historically, in the United States, the practice of most epidemiologists has been oriented toward the public health needs of persons living in communities, and has focused on the determination of rates of disease, risk factors for disease, and evaluating prevention and screening efforts. Continuous profound changes in demographic patterns throughout the world, increases in the rates of many chronic and communicable diseases and disabling conditions, and payer constraints all test the ability of health systems managers to provide quality health care. Over time, managers of health systems will recognize that the most cost-effective strategies will be derived from a population-based perspective. With this viewpoint, the epidemiologist can be a pivotal link in assisting the management team to align the delivery of health care services more effectively with the needs of populations targeted for services, either those residing in communities or those currently receiving services by a system, organization, or an individual provider. This article will describe the increasing role of the epidemiologist in health care organizations and illustrate the functions of the epidemiologist on the health care management team based upon the author's own experience at Rush-Presbyterian-St. Luke's Medical Center, an academic health care center in Chicago, Illinois.

Delivery of Health Care↗
PubMed2005

["Penis angina" or the current revolution in erectile dysfunction (ED)].

Erectile dysfunction (ED) can no longer be neglected by the medical profession, as the presence of ED is never entirely benign, but is always a reliable marker of a sexual disorder but also (and sometimes especially) a non-sexual disorder (physical and/or mental). Its documented association with many chronic diseases and high-risk situations is in the process of extending the significance of ED beyond the purely sexual domain, as this symptom, easily detected by simple clinical interview, appears to be not only a barometer of health, but also a warning indicator of situations that can sometimes be dangerous for the patient's health. For example, in male populations with a high vascular risk, ED is as frequent as diabetes and metabolic syndrome, and must be considered, until proof to the contrary, to reflect angina of the penis, i.e. an exercise-induced vascular symptom, which has a double warning value: 1) marker of deterioration, 2) potential prodrome of acute vascular accidents. These close relations between ED and cardiovascular disease give a completely different dimension to ED, which now constitutes a potential candidate for a new clinical vascular marker and possibly, in some cases, a new marker of cardiovascular risk. These unexpected roles of revealing factor and clinical marker of multiple health states (cardiovascular or other) paradoxically contribute to "desexualization" of ED, as sexual health no longer appears to be the major risk involved. In particular, they open the realistic perspective of opportunistic and proactive detection of ED in well targeted populations for the purposes of primary prevention of cardiovascular disease, a public health priority. For all these reasons, the development of ED requires a minimal evaluation of the patient's state of health, regardless of the doctor's qualification, by clearly distinguishing quality of life and health objectives. This modern management of ED is part of an individual (humanistic) and social (civic and ethical) approach. This "revolution" complies with the requirements of a good quality scientific approach, which comprises the concepts of evidence-based medicine and a rational approach to the service rendered to the patient, as management of his sexual health (and not his sexuality) also comprises management of his general health.

Cardiovascular Diseases↗
PubMed2007

Use of diagnostic algorithms and new technologies to study the incidence and prevalence of viral upper respiratory tract infections and their complications in high risk populations.

PURPOSE OF REVIEW: Most studies on the natural history of viral upper respiratory tract infections and their complications rely for ascertainment on self-assessed cold/flu illness or the identification of presumed complications. The criteria for cold/flu definition, however, are variable within and between individuals and illness is not prerequisite for a viral upper respiratory tract infection. These factors bias estimates of the incidence and prevalence of viral upper respiratory tract infections and their complications. Here we review new methodologies that can be adapted for use in future studies to refine those estimates. RECENT FINDINGS: We present a theoretical basis for standardized assignment of cold/flu episodes using a minimal algorithm template that operates on a structured set of symptoms/signs. We emphasize the greater accuracy of information derived from longitudinal studies that incorporate identification algorithms and assay of nasal secretions for causal virus by polymerase chain reaction and for proinflammatory chemicals to confirm nasal inflammation. SUMMARY: The methodologies and sampling strategies that we describe hold promise for better characterizing the incidence of complications for symptomatic and asymptomatic expressions of a viral upper respiratory tract infection caused by specific viruses. These data can then be used to estimate the efficacy and efficiency in a specified target population of prophylactic or intercurrent treatments to prevent the complications.

Algorithms↗
PubMed2001

Immunological responses of Eurasian badgers (Meles meles) vaccinated with Mycobacterium bovis BCG (bacillus calmette guerin).

Wildlife species, such as the badger (Meles meles), may act as maintenance hosts for Mycobacterium bovis and contribute to the spread and persistence of tuberculosis in associated cattle populations. Targeted vaccination of badgers against tuberculosis is an option that, if successfully employed, could directly facilitate the advancement of bovine tuberculosis eradication in affected areas. In this study, the immunological responses of a group of badgers vaccinated subcutaneously with low doses of Mycobacterium bovis bacillus calmette guerin (BCG) were measured in vitro and compared with non-vaccinated control animals over a period of 42 weeks. Peripheral blood mononuclear cells (PBMC) from badgers which had received repeated booster injections of BCG proliferated in response to culture with PPD-bovine (purified protein derivative of tuberculin). The proliferation was significantly greater than that seen in the non-vaccinated control group. In contrast, the proliferative response of PBMC from vaccinated badgers to PPD-avian declined relative to the control group. These results demonstrate that repeated vaccination of badgers with M. bovis BCG induced a population of T-lymphocytes responsive to specific antigens in PPD-bovine. Throughout the course of the study, the sera from all animals were tested (BrockTest) by an enzyme-linked immunosorbent assay (ELISA) system for the presence of antibodies to MPB83, a serodominant antigen whose expression is high in M. bovis, but very low in BCG (Pasteur). No animals at any stage showed seroconversion to the antigen, consistent with the tuberculosis-free status of the badgers under study.

Animals↗
PubMed2003

Assessment of the accuracy of diagnostic tests: the cross-sectional study.

In diagnostic accuracy studies, the contrast of interest can be one of the following: one single test contrast; comparing two or more single tests; further testing in addition to previous diagnostics; and comparing alternative diagnostic strategies. The clinical diagnostic problem under study must be specified. Studies of "extreme contrasts" (as early phase evaluations) and studies in "clinical practice" settings (assessing clinical value) should be distinguished. Design options are (1) survey of the total study population, (2) case-referent approach, or (3) test-based enrollment. Data collection should generally be prospective, but ambispective and retrospective approaches are sometimes appropriate. In addition to determinants of primary interest [the test(s) under study] possible modifiers of test accuracy and confounding variables must be specified. The reference standard procedure should be independent from the test results. Applying a reference standard can be difficult in case of classification errors, lack of a clear pathophysiologic concept, incorporation bias, or invasive or complex investigations. Possible solutions are: an independent expert panel, and the delayed type cross-sectional study (clinical follow-up). Also, a prognostic criterion can be chosen. For studies to be relevant for practice, inclusion criteria must be based on "intention to diagnose" or "intention to screen." The recruitment procedure is preferably a consecutive series of presenting patients or a target population screening, respectively. Sample size estimation should be routine. Analysis has to be focused on the contrast of interest. Estimating test accuracy and prediction of outcome need different approaches. External (clinical) validation requires repeated studies in other, similar populations. Also, systematic reviews and meta-analysis have a role. To enable readers of diagnostic research reports to evaluate whether methodological key issues were addressed, authors are advised to follow the STARD guidelines.

Cross-Sectional Studies↗
PubMedDate not supplied

Experience of the Checkerboard Area Health System in planning for rural health care.

The design of rural health care delivery systems often is based on concepts obtained from urban models. The implicit planning premises of successful urban models, however, may be inappropriate for many rural systems. An alternative model planned and implemented in the checkerboard region of rural northwest New Mexico has proved to be successful. This experience may be helpful to health care policymakers and planners confronted with environments that are not congruent with typical urban settings. The checkerboard region presented a challenging health planning environment characterized by formidable geographic, population, economic, and health behavior constraints. The Checkerboard Area Health System (CAHS), designed to provide comprehensive services in an area dominated by these constraints, was formed around a central diagnostic and treatment facility with six satellite clinics. The CAHS used an innovative administrative structure, extended the productivity of traditional providers by extensive use of mid-level and ancillary personnel, and created an effective referral network. These features are distinctly different from those of urban health care models. Overall, the CAHS attained a high rate of inpatient use. Additionally, the performance of the outpatient program indicates that traditional ambulatory care can be integrated with other health services that are more oriented toward health promotion and disease prevention. Finally, the emergency room at the central facility has attained an impressive record that, like the inpatient and outpatient areas, is responsive to the needs of the target population.

Adolescent↗
PubMed1996

A population-based study of the coverage of cancer patients by hospice services.

The aims were to determine the proportion of terminal cancer patients in South Australia who had involvement with a programme of hospice care, to identify the predictors of hospice involvement, and to consider the influence of hospice services, along with other variables, on the place of death. A file of patients of the State's hospice services who died in 1990 was compiled and linked to the population-based Central Cancer Register. We found that 1561 (56%) of the 2800 cancer patients who died in 1990 had care from a hospice service. Patients were less likely to be involved with a hospice service if they were 80 years or older, lived in a rural region, or had a haematological malignancy, and more likely to have hospice care if they had a survival time of more than six months, or were born in the UK or Europe. Patients of hospice services were more likely than other patients to die at home or in an inpatient hospice, and less likely to die in a nursing home or private hospital. A range of other factors were also found to be associated with place of death. We conclude that there has been a rapid acceptance of hospice care in South Australia, with a majority of the target population of cancer patients covered by services. Epidemiological research methods are useful for identifying gaps in the provision of care, and for determining the impact of various factors on where people die. This research is, therefore, important for the formulation and evaluation of policy for the delivery of terminal care.

Adult↗
PubMed2002

National Hepatitis C Surveillance Day in the Veterans Health Administration of the Department of Veterans Affairs.

Hepatitis C is a major public health and financial issue in health care. On March 17, 1999, a Veterans Health Administration (VHA) Hepatitis C Surveillance Day (HepCSD) was undertaken as an administrative tool to estimate the prevalence of hepatitis C antibody positivity in the population served by the VHA for purposes of resource needs allocation and cost projections. This was accomplished using blood from patients who were to have blood drawn for any other purpose. Data were gathered using a national electronic data-extraction system. Of 26,102 tests for hepatitis C virus antibody (HCVAb) performed that day, 1,724 were positive for HCVAb (6.6%). The mean age was 53.8 years, 58.7% were from the Vietnam era, 46% reported as white non-Hispanic, 29% reported as black non-Hispanic, and 97.4% were male. Compared with those who agreed to be tested and who were not seropositive for HCVAb and all persons having contact with the VHA on HepCSD, those who were HCVAb positive were more likely to be younger, black non-Hispanic, and to have served during the Vietnam era. The VHA has identified a target population for further screening and intervention efforts for hepatitis C.

Female↗
PubMedDate not supplied

A community trial of ivermectin for onchocerciasis in Sierra Leone: clinical and parasitological responses to the initial dose.

A double-blind placebo-controlled trial of ivermectin was started in 1987 in 6 villages in southern Sierra Leone. 1625 villagers, 93% of the total population, were surveyed before treatment and allocated at random to the trial. Onchocerciasis was hyperendemic and of moderate intensity in the area. Typical onchocerciasis skin lesions were seen in most cases; the blindness rate was 1.5% and a further 4.3% had visual impairment. Six months after treatment 988 subjects (80%) were reassessed and microfilarial loads in the ivermectin group were found to be 10% of control levels. Additionally, blood eosinophil concentrations were reduced by one-quarter. The severity, but not the prevalence, of skin lesions was significantly reduced in the ivermectin group, with a particularly marked effect on papular eruptions. There had been no reduction in the prevalence of itching, nor had markers of general health shown improvement after ivermectin. Ivermectin is an effective microfilaricidal agent and may improve Onchocerca-related skin lesions after a single dose. However, the lack of obvious benefit to a target population after the first dose of ivermectin may reduce compliance with subsequent doses. This has implications for planned mass treatment initiatives in onchocerciasis endemic regions.

Animals↗
PubMed1996

Cervical cancer screening in an urban population in Taiwan: five-year results.

OBJECTIVE: To review the first five years of the educational and cervical cancer screening program (ECCSP) at twelve public health centers in the metropolitan area of Taipei and to measure whether the ECCSP had an impact on cancer patterns. METHODS: We used data for cervical cancers diagnosed between 1986 and 1991 from all hospitals in Taipei and from the national cancer registry. During this time period, 2 158 cervical cancers were diagnosed from thirty-nine hospitals in Taipei city, of which 5% were identified after referral from the ECCSP: RESULTS: The percentage of early cervical cancers, defined as stage 0 or Ia, was 70% in women referred from the ECCSP, compared with 20% for women who were not referred from the ECCSP (P < 0.001). All age groupings also demonstrated this similar difference. The case-fatality rate of cervical cancer was significantly lower for ECCSP referred patients (8 of 106, 7.5%) than for non-ECCSP referred patients (401 of 2 051, 19.6%) during this study period (P < 0.01). CONCLUSIONS: This information suggests that the ECCSP has had a remarkable impact on the early diagnosis of cervical cancer. It is expected that a well organized screening program will be applied to a large target population from young to old adults so that the program can be effective for reducing the mortality rate of cervical cancer in Taiwan.

Adult↗
PubMed1998

Efficacy of meningococcal vaccine and barriers to vaccination.

CONTEXT: Use of the quadrivalent meningococcal vaccine for control of outbreaks has increased in recent years, but the efficacy of meningococcal vaccine during mass vaccination campaigns in US civilian populations has not been assessed. OBJECTIVES: To evaluate the efficacy of the quadrivalent meningococcal vaccine against serogroup C meningococcal disease in a community outbreak setting and to evaluate potentially modifiable barriers to vaccination in an area with persistent meningococcal disease following immunization. DESIGN: Matched case-control study of vaccine efficacy using cases of serogroup C meningococcal disease in persons eligible for vaccination during mass vaccination campaigns. Control patients were matched by neighborhood and age. The control group was used to identify possible barriers to vaccination. SETTING: Gregg County, Texas, population 106076, from 1993 to 1995. PARTICIPANTS: A total of 17 case patients with serogroup C meningococcal disease eligible for vaccine and 84 control patients. MAIN OUTCOME MEASURES: Vaccine efficacy and risk factors associated with nonvaccination. RESULTS: Vaccine efficacy among 2- to 29-year-olds was 85% (95% confidence interval, 27%-97%) and did not change in bivariate analyses with other risk factors that were significant in univariate analysis. Among control patients, older age was strongly associated with nonvaccination; vaccination rates for 2- to 4-year-olds, 5- to 18-year-olds, and 19- to 29-year-olds were 67%, 48%, and 20%, respectively (chi2 for linear trend, P=.01). CONCLUSIONS: The meningococcal polysaccharide vaccine was effective against serogroup C meningococcal disease in this community outbreak. Although specific barriers to vaccination were not identified, older age was a risk factor for nonvaccination in the target population of 2- to 29-year-olds. In future outbreaks, emphasis should be placed on achieving high vaccination coverage, with special efforts to vaccinate young adults.

Adolescent↗