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Biomedical subjects

A R Pelletier

Publications and source records attributed to A R Pelletier.

6 recordsLinked to original sources

Tuberculosis in a correctional facility.

BACKGROUND: After the identification of five suspected cases of tuberculosis (TB) in a Nassau County (New York) jail during a 3-week period, an epidemiologic investigation was begun to document the number of cases of TB infection and disease associated with the jail, the characteristics of current or former inmates with TB disease, and the factors contributing to TB transmission in the jail. METHODS: The county TB register was matched against the inmate files of the jail. Medical records from hospitals, the health department, and the jail were then reviewed. All inmates in the jail were skin tested during a mass screening. RESULTS: From January 1, 1988, through March 16, 1990, of 205 TB cases in the county, 49 (24%) were associated with the jail. Forty of the cases occurred among current or former inmates, one in a corrections officer, and eight among community contacts of inmates. The 40 inmates with TB were predominantly nonwhite (75%), unmarried (80%) men (90%), with a median age of 32 years. Twenty-three (58%) had a history of injecting drug use, and 14 (35%) were known to be seropositive for the human immunodeficiency virus. Thirty (75%) of the inmates had culture-confirmed pulmonary TB. Five (29%) of 17 Mycobacterium tuberculosis isolates had the same phage type and DNA fingerprint, which was consistent with transmission of infection within the jail. The mass screening revealed that 374 (20%) of 1855 inmates were tuberculin positive. CONCLUSIONS: Without an effective program of TB control, jails can act as reservoirs of disease for inmates and staff, and for the community into which the inmates are released.

Adult

Shigellosis in Kentucky, 1986 through 1989.

A marked increase in the number of cases of shigellosis was reported in Kentucky in 1988. To examine reasons for this increase, we reviewed the 389 cases of shigellosis reported from 1986 through 1989. Ninety-three percent (285/305) of cases due to known species were due to Shigella sonnei. Sixty-two percent (243/389) of cases occurred in children less than 10 years of age. The annual incidence for blacks (6.8 cases per 100,000) was nearly four times that for whites (1.8 per 100,000). The increased number of cases in 1988 was due to outbreaks in five areas of the state, which accounted for 85% (200/234) of the cases. Three of the five outbreaks involved day-care centers. The primary mode of transmission appeared to be person-to-person; there was no evidence of a common source of infection from food or water. To prevent future outbreaks, cases of shigellosis need to be reported promptly to ensure appropriate investigation and control by local health departments.

Adolescent

The epidemiology of Lyme disease in Kentucky, 1985-1990.

Lyme Disease has become the most common vector-borne disease in the United States. To assess the extent of the disease in Kentucky, all case reports were reviewed for 1985-1990. A total of 51 cases met the current case definition. Epidemiologic features were similar to those reported nationally. Although the recognized tick vectors for Lyme Disease have still not been identified in Kentucky, physicians should educate their patients on the risk of Lyme Disease and measures to prevent tick bites. Reporting cases of Lyme Disease will continue to be important so that trends in the disease's occurrence in Kentucky can be monitored.

Adolescent

Age-specific incidence of chickenpox.

Because licensure of a chickenpox (varicella) vaccine is likely soon, it is important to ascertain the age-specific incidence of chickenpox. Increasing vaccine coverage and a resulting decrease in transmission may result in an accumulation of susceptible adults, followed by a shift of incidence into those older age groups in future years. Valid baseline age-specific incidence will make it possible to detect this phenomenon. Two studies were conducted in Kentucky to assess age-specific incidence of chickenpox. The first assessed chickenpox occurrence in two consecutive school-year cohorts of children from a geographically representative sample of Kentucky primary schools. The second gathered information from household members of those persons interviewed in the Behavioral Risk Factor Surveillance System telephone survey. The age-specific rates are remarkably similar between studies. Rates peak during the preschool and kindergarten years (ages 3-6). Approximately 20 percent of children remain susceptible to chickenpox after age 8 in both studies. The results from these two surveys will be valuable baselines for comparison with findings in incidence studies that will be performed after vaccine licensure.

Adolescent