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E W Brink

Publications and source records attributed to E W Brink.

At least 19 recordsLinked to original sources
PubMed1992

Epidemiology of poliomyelitis in the United States one decade after the last reported case of indigenous wild virus-associated disease.

Poliomyelitis caused by wild poliovirus has been virtually nonexistent in the United States since 1980, and vaccine-associated paralytic poliomyelitis (VAPP) has emerged as the predominant form of the disease. We reviewed national surveillance data on poliomyelitis for 1960-1989 to assess the changing risks of wild-virus, vaccine-associated, and imported paralytic disease; we also sought to characterize the epidemiology of poliomyelitis for the period 1980-1989. The risk of VAPP has remained exceedingly low but stable since the mid-1960s, with approximately 1 case occurring per 2.5 million doses of oral poliovirus vaccine (OPV) distributed during 1980-1989. Since 1980 no indigenous cases of wild-virus disease, 80 cases of VAPP, and five cases of imported disease have been reported in the United States. Three distinct groups are at risk of vaccine-associated disease: recipients of OPV (usually infants receiving their first dose), persons in contact with OPV recipients (mostly unvaccinated or inadequately vaccinated adults), and immunologically abnormal individuals. Overall, 93% of cases in OPV recipients and 76% of vaccine-associated cases have been related to administration of the first or second dose of OPV. Our findings suggest that adoption of a sequential vaccination schedule (inactivated poliovirus vaccine followed by OPV) would be effective in decreasing the risk of VAPP while retaining the proven public health benefits of OPV.

Humans↗
PubMed1992

Epidemiological features of pertussis in the United States, 1980-1989.

From 1980 through 1989, 27,826 cases of pertussis were reported to the Centers for Disease Control, for an average annual crude incidence of 1.2 cases/100,000 population. The incidence of reported disease increased in all age groups during this period, but the increase was disproportionately large among adolescents and adults. Infants between 1 and 2 months of age were at highest risk for pertussis (average annual incidence, 62.8/100,000). Infants less than 2 months of age had the highest reported rates of pertussis-associated hospitalization (82%), pneumonia (25%), seizures (4%), encephalopathy (1%), and death (1%). Rates of complication were generally higher among unvaccinated children than among those who had received three or more doses of diphtheria-tetanus-pertussis vaccine; 64% of children 3 months to 4 years of age who had reported cases of pertussis had not been immunized appropriately for their age. Whereas control of pertussis in the United States may be further improved through increased levels of diphtheria-tetanus-pertussis vaccination among eligible infants and children, the use of acellular vaccines in adolescents and adults may also be needed to reduce the burden of pertussis in very young infants.

Age Factors↗
PubMed1990

Assessment of vital statistics and surveillance data for monitoring tetanus mortality, United States, 1979-1984.

Reported tetanus cases and tetanus deaths have declined substantially since widespread implementation of tetanus immunization. However, preventable morbidity and mortality continue to occur. During 1979-1984, 74-95 cases of tetanus were reported annually to the Centers for Disease Control (CDC) and 20-31 deaths were reported annually by the National Center for Health Statistics (NCHS). To evaluate further the health impact of tetanus, the authors assessed the completeness of national tetanus mortality data. They reviewed tetanus case report forms received at CDC from the states and NCHS multiple-cause-of-death tapes for 1979-1984. CDC reports recorded 129 deaths and NCHS mortality tapes 197 deaths. Year of death, state, age, and sex were used to match CDC and NCHS deaths, identifying 78 deaths reported to both sources. Using the methodology of Chandra Sekar and Deming, the authors estimated the actual number of tetanus deaths for 1979-1984 to be 326 (95% confidence interval 291-361). Based on this estimate, the completeness of reporting to CDC was 40%, to NCHS 60%, and to the combined systems 76%. To evaluate the reasons for underreporting, the authors contacted 14 states that had reported greater than or equal to 10 cases of tetanus to CDC during 1979-1984 to obtain death certificates for all tetanus deaths and additional information on all tetanus cases. Thirteen states submitted 108 death certificates for review. Coding and other systematic errors did not explain the low reporting efficiency. Failure to list tetanus as a cause of death on the death certificate was the primary reason for nonreporting of tetanus deaths to NCHS. These results suggest that NCHS tetanus mortality data may not be as complete as previously assumed and that tetanus mortality, and probably morbidity, are higher than previous reports have indicated.

Aged↗
PubMed1989

Family history of convulsions and use of pertussis vaccine.

To evaluate the risk of neurologic events after vaccination with diphtheria-tetanus-pertussis (DTP) vaccine, we used data from the Centers for Disease Control Monitoring System for Adverse Events Following Immunization to compare the family history of convulsions in persons reporting neurologic events with that in persons reporting nonneurologic events; these events have an onset within 3 days of immunization with DTP vaccine, given either alone or with oral poliovirus vaccine. Persons reporting neurologic events were 6.4 times more likely to report a prior personal history of convulsions than those reporting nonneurologic events (95% confidence interval 4.7 to 8.8), and were 2.4 times more likely to report a history of convulsions in first-degree family members, that is, siblings or parents (95% confidence interval 1.7 to 3.4). Similar risks were noted for subgroup analyses controlling for type of event (febrile vs nonfebrile convulsion), age at immunization, source of report, number of previous doses of DTP vaccine, and day of onset. Because the Centers for Disease Control monitoring system receives reports on a nonrandom sample of all adverse events after immunization, selection bias could not be ruled out. On the basis of these data, we conclude that children with a family history of seizures are at increased risk of neurologic events, primarily febrile convulsions, after DTP vaccination. However, this increase in risk may reflect a nonspecific familial tendency for convulsions rather than a specific vaccine effect. Considering the rare occurrence of neurologic events after DTP vaccination, the generally benign outcome of febrile convulsions (which make up the majority of these neurologic events), and the possible increased risk of pertussis in the general population if the estimated 5% to 7% of persons with a first-degree family history of convulsions were exempted from pertussis vaccination, we further conclude that a history of convulsions in siblings or parents should not be a contraindication to pertussis vaccination. Special care in the prevention of postvaccination fever may be warranted in children with a family history of seizures.

Centers for Disease Control and Prevention, U.S.↗
PubMed1989

A new epidemiologic and laboratory classification system for paralytic poliomyelitis cases.

An epidemiologic classification of paralytic poliomyelitis cases (ECPPC) has been in use in the United States since 1976. In 1985, this classification system was reviewed because of recent changes in the epidemiology of paralytic poliomyelitis and improved laboratory capability to definitively characterize poliovirus strains. An alternative classification system was devised, the epidemiologic and laboratory classification of paralytic polio cases (ELCPPC), that incorporated virus isolation and strain characterization with epidemiologic information. Reported paralytic poliomyelitis cases for 1980-86 were classified by both the ECPPC and the ELCPPC classification systems. The new ELCPPC system classified 91 per cent of the reported cases as vaccine-associated, while the ECPPC system classified only 71 per cent of the reported cases as vaccine-associated. The proposed classification system provides more specific and useful information particularly concerning vaccine-associated paralytic poliomyelitis.

Epidemiologic Methods↗
PubMed1988

Risk factors for community- and household-acquired pertussis during a large-scale outbreak in central Wisconsin.

To identify risk factors associated with community- and household-acquired pertussis, we studied 61 households (HHs) with members with culture-positive illnesses and compared their characteristics with 58 neighborhood control-HHs and 62 randomly selected control-HHs. Case-HHs were more likely than either control group to have members 12-18 y of age (P less than .01); these individuals accounted for 34% of all primary cases. A history of exposure outside the home was the most important predictor of community-acquired infection (P less than .001), with adolescents being at higher risk than other age-groups (odds ratio, 3.2; P less than .001). After known exposure to a culture-positive case in the same HH, the risk of illness was unrelated to age; lengthy delays in initiating erythromycin therapy and prophylaxis were the only factors associated with secondary spread (P less than .01). The risk of pertussis may be related more to the likelihood of exposure than to age-related increases in susceptibility, and the risk can be reduced with appropriate use of erythromycin.

Adolescent↗
PubMed1988

Live or inactivated poliomyelitis vaccine: an analysis of benefits and risks.

Using decision analysis we evaluated the benefits and risks of continued primary reliance on oral poliomyelitis vaccine (OPV) compared to use of inactivated poliovirus vaccine (IPV). We followed a hypothetical cohort of 3.5 million children from birth to age 30 assuming 95 per cent coverage with 98 per cent effective vaccine. Primary reliance on IPV would result in more cases of paralytic poliomyelitis as well as more susceptibles remaining in the population than would be expected with continuing OPV use (74.1 vs 10.0 cases and 5.9 per cent vs 1.1 per cent susceptibles, respectively). However, with OPV use, most cases of paralysis seen would be associated with the vaccine. Our analysis supports a continuation of current US policy placing primary reliance on OPV but the conclusion is heavily dependent on assumptions of risk of exposure to wild virus in the United States. Major declines in risk of exposure to wild virus could alter the balance significantly.

Adolescent↗
PubMed1988

Decision analysis and polio immunization policy.

Dr. Salk's comments on our paper fall into four major categories: our use of the techniques of decision analysis, the assumptions we used, the fact that we did not include individual and social values in the model, and the way in which vaccine policies are developed in the United States. We believe that the methods were used correctly, that the assumptions we used are defensible, and that our conclusions were both appropriate and appropriately worded. We explicitly did not include individual and social values since we were addressing the scientific and epidemiologic issues rather than ethical and moral issues. Vaccine policy development in the United States is carried out in public forums with opportunity for presentation of all sides of an issue.

Child↗
PubMed1988

Current epidemiology of pertussis in the United States.

The incidence of pertussis in the United States decreased rapidly during the 20th century, with the most impressive decreases resulting from the widespread use of DTP vaccine since the late 1940's. As a result of immunization laws, vaccine coverage levels against pertussis at school entry have been greater than 95% since 1980. National surveillance for pertussis done by the Centers for Disease Control (CDC) consists of two parts: a weekly telephone reporting system and a written case report system providing more detailed demographic, clinical, and laboratory information. In addition, data on secondary spread of pertussis among household contacts of reported cases were available on a small proportion of reported cases during 1979-1983. During the period 1980-1986, a total of 17,396 cases of pertussis was reported to CDC by weekly telephone reports. The annual incidence of reported pertussis rose during this period from 0.5 cases per 100,000 population to 1.7/100,000. Infants less than 12 months of age had the highest average annual incidence, estimated at 32 cases per 100,000. Children 1-4 years of age accounted for 25% of all cases but had an average annual incidence only 1/7th that of infants. The incidence rates for all age groups increased consistently between 1982 and 1986. The most impressive relative increases occurred among older adolescents and persons 20 years of age and older. In 1986, 10% of reported cases were in this age group compared to only 5% in 1982. Rates of hospitalization and complications such as pneumonia, seizures, and encephalopathy associated with pertussis were highest in children less than 6 months of age and declined progressively with increasing age.(ABSTRACT TRUNCATED AT 250 WORDS)

Centers for Disease Control and Prevention, U.S.↗
PubMed1988

Outbreaks of pertussis in the United States: the Wisconsin experience.

To identify risk factors for pertussis in older age groups and to examine the effectiveness of erythromycin therapy and prophylaxis in reducing secondary spread, epidemiologic investigations of two outbreaks involving teenagers and adults were conducted. The first outbreak occurred in 1984 among residents of a facility for developmentally disabled persons (median age 17 years). Rates of culture-and/or serologically confirmed infection ranged from 6% to 91% in exposed wards (42% overall), with transmission continuing over a five-month period. Although residents age 10-19 years experienced the highest rates of infection, they were also more likely to be exposed compared with residents in other age groups. Infection rates were significantly lower on wards where erythromycin treatment and prophylaxis were initiated less than 2 weeks after onset of illness in the index case (overall attack rate = 16% vs. 75% in wards where more than 4 weeks had elapsed; p less than .0001). Early treatment with erythromycin was also effective in reducing pertussis severity. The second outbreak occurred over a six-month period among residents of a 3-county area in central Wisconsin in 1985, with adults accounting for 38% of 161 culture-positive cases. Exposure outside the home was the most important predictor of community-acquired infection (p less than .001), with adolescents being at higher risk than persons in other age groups (odds ratio 3.2; p less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Infant mortality and childhood nutritional status among Afghan refugees in Pakistan.

In 1984 and again in 1985, systematic surveys were undertaken to evaluate infant mortality and childhood nutritional status among the Afghan refugee population in Pakistan. The entire Afghan refugee population under the administration of the United Nations High Commissioner for Refugees was sampled. Infant mortality rates were estimated to be 156 per 1000 for 1984 and 119 per 1000 for 1985. A decline was also suggested in neonatal mortality rates from 61 per 1000 for 1984 to 46 per 1000 for 1985. For neither infant nor neonatal mortality was the difference statistically significant. Improvements were seen in the percentage of children who died before their fifth birthday (22.5% in 1984 and 18.8% in 1985), in the percentage of children who were malnourished (3.5% in 1984 and 2.3% in 1985), and an increase in the percentage of children above the WHO/NCHS/CDC weight-for-height reference median (26% in 1984 and 35% in 1985). Diarrhoea was the most frequently reported cause of death for both years and was a particularly important cause of death among one-year-old children. In 1985, measles was related to 24% of the deaths and neonatal tetanus to 9% of the deaths, an increase from 8% for measles and 6% for tetanus in 1984.

Afghanistan↗
PubMed1987

The case for global eradication of poliomyelitis.

Global eradication of poliomyelitis can be achieved by a programme strategy that includes achievement and maintenance of high immunization levels, effective surveillance to detect all new cases, and a rapid vigorous response to the occurrence of new cases. Regional eradication targets have already been set in Europe and the Americas. Possible impediments to eradication include the necessity to generate political and social will; managerial constraints; issues of vaccine efficacy, stability, and cost; and adequacy of surveillance. We believe that the impediments can be overcome and that with intensified effort and increased international collaboration, global eradication could be achieved as early as 1995.

Costs and Cost Analysis↗