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Biomedical subjects

E D Shapiro

Publications and source records attributed to E D Shapiro.

At least 73 records · Page 4Linked to original sources
PubMed1991

The epidemiology and prevention of disease caused by Haemophilus influenzae type b.

Disease caused by H. influenzae type b is a world-wide problem of major proportions that affects both developed and developing countries. Young children are at particularly high risk of developing serious invasive infections. There has been tremendous recent progress in the development of vaccines that are immunogenic even in young infants. Clinical trials have demonstrated the efficacy of these polysaccharide-protein conjugate vaccines in infants. Two of these vaccines have been licensed in the United States for use in infants, and licensure of a third conjugate vaccine is expected soon. Many questions still remain to be answered. Are there significant differences in the efficacy for infants of the different licensed conjugate vaccines? Are the differences in the recommended schedules of immunization for the different vaccines justified? Would a combination of an initial dose of PRP-OMP (which is the most immunogenic vaccine in 2-month-old children) followed by subsequent doses of HbOC or PRP-T provide better overall protection than a schedule that uses only a single vaccine? Although much more research remains to be done, these vaccines, which have been recommended for routine universal immunization of infants in the United States, give us the capability of effectively preventing this potentially devastating infection of children.

Adolescent↗
PubMed1991

Bacterial respiratory infections and otitis media.

Bacterial infections of the respiratory tract are an important potential problem for children who attend group day care. Immunization (for Hib) or chemoprophylaxis, when appropriate, should lessen the risk and help to control or prevent the problem in many instances.

Child Day Care Centers↗
PubMed1990

New vaccines against Haemophilus influenzae type b.

Recently, great progress has been made in the development of vaccines against Hib. Four polysaccharide-protein conjugate vaccines are actively being tested. Three of these (PRP-D, HbOC, and PRP-OMP) are currently licensed for use in children at 15-18 months of age. Clinical trials of these vaccines in infants are currently being conducted in the United States. If these show the vaccines to be efficacious, licensure for infants will follow. Although much work remains to be done, it seems likely that the effective prevention of serious Hib infections in infants, as well as in older children, is a goal that may be within our reach in the next several years.

Bacterial Capsules↗
PubMed1990

Protective efficacy of Haemophilus influenzae type b polysaccharide vaccine.

There has been uncertainty and controversy about the protective efficacy of Haemophilus influenzae type b polysaccharide vaccine almost since it first was licensed in the United States. This article will briefly review the available epidemiologic data about the protective efficacy of this vaccine in children with no recognized underlying illnesses. H influenzae type b polysaccharide vaccine was licensed in the United States in April 1985, based on the results of a randomized clinical trial that was conducted in Finland. That study indicated that the vaccine's protective efficacy was 90% against invasive disease caused by H influenzae type b in children 18 to 71 months of age. Authorities recommended that all children receive the vaccine at 2 years of age and that it be administered to children up to the age of 60 months. The Immunization Practices Advisory Committee also recommended that children at increased risk (such as those who attend group day care) receive the vaccine at 18 months and again at 24 months of age because of its inconsistent immunogenicity when administered to 18-month-old children. Soon after its licensure, however, reports of vaccine failures began to appear. In some instances the vaccine failure could be attributed to an identifiable immune deficiency. However, Granoff et al reported 54 apparently normal children who had received the H influenzae type b polysaccharide vaccine but subsequently developed invasive disease caused by H influenzae type b. The majority of these children had normal serum concentrations of total immunoglobulins, IgG2, hemolytic complement, and antibody to tetanus toxoid (a T-cell-dependent antigen).(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Capsules↗
PubMed1989

New epidemiologic evidence confirming that bias does not explain the aspirin/Reye's syndrome association.

To determine the validity of the aspirin/Reye's syndrome association, we developed an epidemiologic investigation to assess the effects of five potential sources of bias. A case-control study incorporated procedures to avoid temporal precedence and susceptibility bias. These included classifying cases as having monophasic or biphasic patterns of illness and matching for severity of symptoms at zero-time. To evaluate the effect of a potential recall bias, an "alternate-condition" control group was enrolled. A medical record review study was conducted to assess the potential for diagnostic bias, and a blanket surveillance of all hospitals in a region was conducted to evaluate reporting bias. Twenty-four case subjects and 48 matched controls were enrolled. Eight-eight percent of case subjects and only 17% of controls had received aspirin prior to the onset of Reye's syndrome (matched odds ratio, 35; 95% confidence interval, 4.2 to 288). Further analyses demonstrated that the association could not be attributed to the five potential sources of bias.

Adolescent↗
PubMed1989

Blood cultures in the management of febrile outpatients later found to have bacteremia.

To determine the value of using blood cultures in the detection and prevention of serious focal infections in young febrile outpatients, we reviewed the records of all patients with positive blood cultures for Streptococcus pneumoniae, Haemophilus influenzae type b, or Neisseria meningitidis from January 1971 to June 1983. Of the 482 episodes of bacteremia, 164 (34%) were in children initially managed as outpatients. Of these 164 patients, 20 (12%) either had a serious focal complication subsequently or had persistent bacteremia at follow-up. However, 9 of these 20 children with complications were returned by their parents for reevaluation because of persistent symptoms and signs before the results of the blood cultures were known to clinicians. During the 12 years of the study, four cases of meningitis were detected directly as a result of the positive blood culture. Careful clinical follow-up is critical in the management of febrile outpatients.

Child, Preschool↗
PubMed1989

The immunogenicity of Hemophilus influenzae type B polysaccharide-Neisseria meningitidis group B outer membrane protein complex vaccine in infants and young children.

Hemophilus influenzae type b polysaccharide-Neisseria meningitidis group B outer membrane protein complex vaccine was administered in a single dose to 38 children ages 24-53 mo (group 1) and to 78 children ages 12-23 mo (group 2) and in two doses to 84 children ages 2-11 mo (group 3). The geometric mean concentration of the capsular antibody before and after the vaccine regimen, respectively, were 0.35 microgram/ml and 12.59 micrograms/ml in group 1, 0.18 microgram/ml and 4.79 microgram/ml in group 2, and 0.15 microgram/ml and 3.80 micrograms/ml in group 3. After completing the vaccine regimen, concentrations of capsular antibody were greater than or equal to 0.15 microgram/ml in 199 (99.5%) of the 200 children and greater than or equal to 1.0 microgram/ml in 168 (84%) of the children. There were no serious and few minor adverse reactions to the vaccine. This vaccine is immunogenic in infants and young children.

Antibodies, Bacterial↗
PubMed1989

Epidemiology of pharyngeal colonization of infants with aerobic gram-negative rod bacteria.

By using a selective medium, pharyngeal colonization with gram-negative rod (GNR) bacteria was determined in a cohort of 49 normal infants monitored from birth to 6 months of age. Culture swabs were diluted in 1 ml of saline for quantitation. The prevalence of GNR in the first 72 h of life was 8% and rose to 29% during the first month, 52% at 2.5 months, 67% at 4.5 months, and 62% at 6 to 7 months. Colonization was with substantial numbers of organisms, generally greater than 100 colonies per ml and frequently greater than 1,000 colonies per ml. The most common species were Klebsiella species, Escherichia coli, Enterobacter species, and Acinetobacter anitratus. Fewer infants who were breast fed rather than formula fed at the time of culture harbored GNR (26 versus 45%, P less than 0.05). The point prevalence of pharyngeal GNR colonization in our special care nursery was 12 of 47 (26%), which was found to be similar to that of age-matched normal infants. GNR carriage in normal infants does not appear to be a residual of organisms acquired at birth, and interpretations of GNR carriage in ill or hospitalized infants should be evaluated by comparison with these data in healthy infants.

Age Factors↗
PubMed1988

The protective efficacy of Haemophilus b polysaccharide vaccine.

To assess the protective efficacy of the Haemophilus b polysaccharide vaccine, a case-control study was conducted in Connecticut, Dallas County, and greater Pittsburgh. Seventy-six children 24 to 72 months of age who had H influenzae type b isolated from normally sterile sites from August 1985 through July 1987 were enrolled. For each case two controls, matched by age and place of residence, were randomly selected from the records of all live births in the area. Antecedent receipt of the Haemophilus b polysaccharide vaccine was ascertained from the records of all physicians and clinics at which the subjects received medical care. Overall, 12% of the cases and 39% of the controls had received the vaccine. The estimate of the protective efficacy of the vaccine was 88% overall (95% confidence interval, 74% to 96%) and 91% (95% confidence interval, 71% to 99%), 92% (95% confidence interval, 76% to 99%), and 81% (95% confidence interval, 45% to 96%) in Connecticut, Dallas County, and greater Pittsburgh, respectively. The estimates were not substantially affected by adjusting with logistic regression for differences between the cases and controls in race and the attendance of group day care. We conclude that the Haemophilus b polysaccharide vaccine is highly effective in these areas among children who receive the vaccine when they are 24 months of age or older.

Age Factors↗
PubMed1988

Bacteremia with group A streptococci in childhood.

Medical records of 60 patients with bacteremia caused by group A streptococci who were treated at the Yale-New Haven (Conn) Hospital from 1973 to 1986 and the Boston Children's Hospital Medical Center from 1977 to 1984 were reviewed. Seven children (12%) were immunocompromised, seven (12%) had varicella, and two (3%) had cavernous hemangiomas. Fifty-two children (87%) had an identifiable focus of infection. The most commonly documented sources of bacteremia were in the skin (22 children) and the respiratory tract (19 children). Metastatic foci of infection included osteomyelitis (nine children), septic arthritis (eight children), and meningitis (three children). Seven episodes were nosocomial (four were catheter related and three occurred postoperatively). Four patients (7%) died: two were severely immunocompromised, one of whom had extensive hemorrhagic varicella; the third had widespread hemorrhage into a large cavernous hemangioma of the skin; the fourth had an initial diagnosis of sudden infant death syndrome. Bacteremia with group A streptococci, although uncommon, continues to cause serious infections in children during the antibiotic era.

Adolescent↗