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Biomedical subjects

E A Mortimer

Publications and source records attributed to E A Mortimer.

18 recordsLinked to original sources
PubMed1992

Epidemiology of pertussis and reactions to pertussis vaccine.

It remains clear that pertussis is a dangerous infectious disease that is well-controlled in industrialized countries by widespread immunization. In the developing world, it remains a source of high morbidity and mortality because of previously inadequate immunization programs. However, because of the intense efforts of the World Health Organization's Expanded Programme on Immunization, the effects of pertussis have already been ameliorated and show promise of being within a decade of approximating the situation in the developed world. Pertussis can be controlled only by immunization; other measures such as antimicrobial therapy offer negligible benefit. A problem that has been addressed in recent years is the excessive reactivity of whole-cell pertussis vaccine, which undoubtedly includes components of the organism that are irrelevant to the induction of immunity and are excessively reactive. Although epidemiologic studies appear to have largely, if not completely, absolved pertussis vaccine of responsibility for inducing death or permanent neurologic disability, a less reactive vaccine is highly desirable, not only to promote acceptance of a full course of immunization for the world's children but also for simple humanitarian reasons. Additionally, it has become evident that, because of waning immunity, pertussis increasingly occurs in adults. A less reactive vaccine would offer opportunity for reinforcement of immunity beyond childhood. The development of better, though as yet incomplete, understanding of the biology of Bordetella pertussis and its relation to humanity offers the opportunity for the production of less reactive vaccines free of irrelevant components. Acellular pertussis vaccines have been used exclusively in Japan for more than 10 years, and one such preparation, combined with diphtheria and tetanus toxoids, was licensed in the United States in late 1991 for use as the fourth and fifth doses of DTP, given at 15 months and prior to school entry. Field trials of this and other acellular DTP preparations are currently under way to determine their clinical efficacy in infants. It is probable that, within a very few years, whole-cell pertussis vaccine will be replaced by these newer preparations and that, in addition, the acellular product will be combined with other antigens, such as Haemophilus influenzae type b vaccine.

Bordetella pertussis↗
PubMed1979

Long-term prognosis of ulcerative colitis with onset in childhood or adolescence.

From 1955 through 1974, 336 patients with ulcerative colitis diagnosed before age 21 years were studied. In 93 patients (29%), a blood relative had ulcerative colitis, one case of Crohn's disease being found. The total colon was involved in 63% of patients; the entire colon or all but the rectal stump was removed in 35%. Eighteen patients died, nine of carcinoma of the colon. Sixty-five percent of patients had symptoms for longer than 6 months before the diagnosis of ulcerative colitis. If the diagnosis was delayed more than 24 months, there was a statistically significant correlation with increased rate of operations and complications and less good quality of life. When the 20-year study period was divided into two 10-year periods, the operative and complication rates were significantly different. Early diagnosis and treatment appear to improve the long-term prognosis of young patients with ulcerative colitis.

Acute Disease↗
PubMed1978

Immunization against infectious disease.

Mortality and morbidity from infectious diseases in the United States have declined more than 90 percent since 1900. Factors believed to be responsible for this decline include changes in the natural history of disease, sanitation, quarantine measures, control of nonhuman vectors, antibacterial drugs, and immunization. The contributions of each of these factors differ among the various infectious diseases; except for smallpox and diphtheria control, immunization had little effect until after World War II. The success of present and future immunization programs is endangered by public and physician complacency and by complex legal and ethical problems related to informed consent and responsibility for rare, vaccine-related injury.

Adolescent↗
PubMed1977

Reduction in mortality from coronary heart disease in men residing at high altitude.

In New Mexico, where inhabited areas vary from 914 to over 2135 m above sea level, we compared age-adjusted mortality rates for arteriosclerotic heart disease for white men and women for the years 1957-1970 in five sets of counties, grouped by altitude in 305-m (1000-foot) increments. The results show a serial decline in mortality from the lowest to the highest altitude for males but not for females. Mortality rates for males residing in the county groups higher than 1220 m in order of ascending altitude were 98, 90, 86 and 72 per cent of that for the county group below 1220-m altitude (P less than 0.0001). The results do not appear to be explained by artifacts in ascertainment, variations in ethnicity or urbanization. A possible explanation of the trend is that adjustment to residence at high altitude is incomplete and daily activities therefore represent greater exercise than when undertaken at lower altitudes.

Acclimatization↗
PubMed1976

Descriptive epidemiology of neural tube defects, Rochester, New York, 1918-1938.

This study examines the secular distribution of births, sex, and age at death of 330 cases of anencephaly and spina bifida and 62 cases of "monstrosity" recorded on City of Rochester death certificates between 1918 and 1938. The results show that death certificates may be used as a source of data (with inherent biases) and that persons diagnosed as monstrosity had similar epidemiologic characteristics to those diagnosed as anencephalic during this period. In Rochester the rise in prevalence at birth of neural tube defects was similar to, and occurred at approximately the same years as, the rises reported in Boston and Providence.

Abnormalities, Severe Teratoid↗
PubMed1976

The relationship of supplemental iodine to neural tube defects in Rochester, New York, 1924-1932.

The geographic distribution of infants born with anencephaly and spina bifida in Rochester, New York, in 1924-1932, was examined to test the hypothesis that iodine supplemented water may have reduced the prevalence of these defects. During this period the region had a high prevalence of iodine deficiencies. Comparing the prevalence of neural tube defects in an area with iodine supplemented water to one without iodine supplementation, we found no significant difference in prevalence at birth of neural tube defects. Because the prevalence rates for these defects in children of foreign-born parents (except the Irish) was low, we reexamined the data, excluding these cases. There remained no differences in rates. Iodine supplemented water thus appears to have had no effect on the occurrence of neural tube defects.

Adult↗
PubMedDate not supplied

An evaluation of pertussis vaccine.

Infant mortality from pertussis in the United States was 4.5 deaths/1,000 in 1900 but decreased to 0.003 deaths/1,000 by 1974. The attribution of this decrease in mortality to the widespread use of pertussis vaccine, which began in the 1940s, has been questioned because death rates from pertussis in infants steadily declined by 70% between 1900-1904 and 1935-1939. Thes doubts are compounded by the uncertain frequency and significance of untoward reactions to the vaccine. An attempt was made to clarify this issue by statistical analysis. Because most deaths from pertussis occur in the young, death rates were determined for consecutive five-year periods from 1900 through 1974 among children younger than one year of age (infants) and among those from one to four years of age. there was an accelerated decline in mortality beginning in 1940, especially among infants (P < 0.01 vs. mortality in 1930-1939). On the basis of the rate of decline before 1940, 4,000-8,000 deaths from pertussis would be expected to hve occurred in 1970-1974; however, only 52 such deaths occurred. It is unlikely that factors other than pertussis vaccine caused this decline in mortality. Therefore, the vaccine's benefit-risk ratio probably is high.

Central America↗