COSTAR--The stethoscope of the 1980s.
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Information Systems↗
Biomedical subjects
M A Hattwick
Publications and source records attributed to M A Hattwick.
A historical prospective mortality study of workers in copper and zinc refineries.
Earlier health studies of workers in electrolytic refinery operations have raised concern that workers may experience excess morbidity and premature death as a result of hazardous occupational exposures. This study was designed to determine if the refinery operation is associated with any excess mortality patterns. A cohort of 4,802 male workers exposed for at least one year during 1946-1975 was assembled from nine U.S. zinc and copper refineries. Vital status was ascertained for 4,241 (88%) of the cohort. Death certificates were obtained for 84% (355/423) of the deceased. Overall standard mortality ratios (SMRs) were calculated to be 92 for the cohort, 97 for the subgroup of copper refinery workers, and 83 for the subgroup of zinc refinery workers. Significantly high cause-specific SMRs were as follows: (1) cerebrovascular disease (CBVD) for the cohort; (2) all cancers, cancer of the digestive tract, and CBVD for the copper subgroup; (3) all cancers, cancer of the respiratory tract, and CBVD for one plant that demonstrated a significantly high overall SMR (133). The significant excess of cancer deaths among the study cohort is largely due to the plant that exhibited the significantly high overall mortality rate, but lack of smoking data qualifies this finding. The significant excess of CBVD seems to be consistent across plants and further research seems warranted to verify the finding.
Adolescent↗
Illness after influenza vaccination reported through a nationwide surveillance system, 1976-1977.
In 1976, the Center for Disease Control coordinated nationwide surveillance for illnesses after influenza vaccination as part of an effort to vaccinate the nation against influenza A/New Jersey/76. For the 48,161,019 persons vaccinated in 1976, a total of 4733 reports of illness were received which included reports of 223 deaths. When Guillain-Barré syndrome was reported in vaccine recipients, an investigation was begun to examine this possible association. Other than the Guillain-Barré syndrome and rare cases of anaphylaxis, no serious illnesses were causally associated with influenza vaccination by this type of surveillance. Widespread underreporting of illness and death in the passive phase of this surveillance system, however, impaired the ability to draw conclusions about reactions to vaccine from the reports of illness received.
Adolescent↗
The epidemiology of influenza B in a rural setting in 1977.
An epidemic of influenza B began in January, 1977, in two rural parishes in northeastern Louisiana and quickly spread to involve 29% of their population with clinical influenza. This epidemic was investigated using a standard questionnaire and a random sample of 4.2% of the population. The clinical illness was typical of influenza, with predominant fever, cough, malaise and headache. Gastrointestinal symptoms were part of the clinical syndrome. Rhinitis and diarrhea were significantly more common in children aged five years or less. Clinical attack rates increased with larger household size. The youngest age groups had clinical attack rate of 40--55%, but the elderly had very low attack rates. The direct cost of influenza-like illness during the epidemic averaged almost $30.00 per case. Knowledge of the cost of influenza-like illness and age-specific attack rates should be useful in planning future control efforts for influenza B.
Adolescent↗
Fatal Rocky Mountain spotted fever.
Forty-four fatal cases of Rocky Mountain spotted fever (RMSF) occurring in 1974 were compared with 50 nonfatal cases of similar age, sex, date of onset, and place of occurrence. Diagnosis and initiation of treatment in fatal cases were substantially delayed compared with nonfatal cases. Several reasons for this delay were identified: (1) the rash appeared later in the course of illness in the fatal cases, often not until the patient was terminal, (2) a history of tick bite was less often obtained during life or obtained late in the clinical course in fatal cases, and (3) initial nonspecific symptoms or unexpected symptoms led to an initial diagnosis of more common diseases. Only two fatal cases were treated with either tetracycline or chloramphenicol before the sixth day of illness. Presumptive diagnosis of RMSF and initiation of tetracycline therapy before onset of rash may be necessary to reduce mortality.
Adolescent↗
Excess mortality and influenza surveillance in Taiwan.
Excess mortality has proven to be a useful epidemiologic tool for influenza surveillance in the temperate zone. A retrospective analysis of the epidemiology of influenza in Taiwan was undertaken to explore the usefulness of this technique in the tropical--subtropical zone. Excess mortality similar to that observed during influenza epidemics in the temperate zone was noted during periods of previously recognized influenza epidemics in Taiwan. For the very young and the elderly excess mortality was observed to be even higher than in the temperate zone. Virus isolations, increased school absenteeism, and high clinical attack rates were also noted during influenza epidemics. Use of these epidemiologic techniques in Taiwan proved to be a useful approach to describe the impact of influenza.
Absenteeism↗
A comparison of a WI-38 vaccine and duck embryo vaccine for preexposure rabies prophylaxis.
Two types of rabies vaccine, WI-38 vaccine (WRV) and Duck Embryo Vaccine (DEV) were compared in rabies preexposure prophylaxis. Once group of veterinary students received four doses of DEV, a second group received four doses of WRV, and a third group received two doses of WRV. Adverse reactions were found to be similar for all three gorups. The antibody responses, however, differed markedly: the mean neutralizing titer after four doses of DEV was 1:75, after four doses of WRV was 1:1517, but was only 1:164 after two doses of WRV. All students who received three or four doses of WRV developed high titers of rabies antibody, making this vaccine very desirable for preexposure prophylaxis.
Adult↗
Lassa fever: response to an imported case.
In February, 1976, a Peace Corps worker returned to the United States from Sierra Leone with an undiagnosed illness later recognized as Lassa fever. To assess the risk of transmission and to contain a potential outbreak, we identified 552 contacts as having had exposure to the patient before the start of strict isolation procedures, and maintained intensive surveillance on these contacts for 21 days. At the end of the surveillance period, no illness had developed in contacts. One month later, a serologic survey among 29 of the contacts judged to be at high risk gave no evidence of infection. In response to the importation of this communicable and highly fatal disease, procedures for the isolation of the patient, the identification, surveillance and management of contacts and the handling of laboratory specimens were developed and implemented. These procedures could be adapted to future introductions of highly contagious diseases.
Adult↗
Influenza B-associated Reye's syndrome: incidence in Michigan and potential for prevention.
Prospective surveillance for Reye's syndrome in Michigan revealed the occurrence of 46 cases between December 15, 1973 and June 1, 1974. In an attempt to determine the incidence of influenza B-associated Reye's syndrome, a randomized point-prevalence survey of 1,041 schoolchildren was done in a county in Michigan where there had been simultaneous outbreaks of influenza B and Reye's syndrome. Of the children tested, 20% had titers of hemagglutination-inhibiting antibody to influenza virus B/Hong Kong/5/72 of greater than or equal 1:20. Based upon this countywide survey, the incidence of Reye's syndrome following influenza B was estimated as between 30.8 and 57.8 cases of Reye's syndrome per 100,000 cases of influenza B. A detailed epidemiologic investigation of the patients who developed Reye's syndrome indicated that the syndrome occurred four times more frequently in children living in rural areas than in children in the urban areas of the state. These studies indicate that, in addition to antecedent viral infections such as influenza B, factor(s) that are most likely extrinsic or environmental also play a role in the pathogenesis of Reye's syndrome.
Adolescent↗
Swine influenza virus infections in humans.
Influenza in swine was first recognized as an epizootic disease in 1918. During that same year influenza virus in humans caused the worst pandemic on record. The virus of swine influenza was isolated in 1930. Swine influenza virus was first isolated from humans in 1974. Since then, including the cases at Fort Dix, there have been a total of nine viral isolations from humans in the United States. Serologic evidence of infections with swine influenza virus in humans has also been obtained. Evidence for transmission of swine influenza virus to humans before 1974 is minimal and circumstantial. Recent recognition of infections with swine influenza virus may be the result of better surveillance, increased numbers of susceptible humans, or increased viral infectivity for humans. Nevertheless, the apparent frequency of human infections and the declining levels of antibodies to swine influenza virus in the human population suggest that influenza viruses of swine may be a potential sources of epidemic disease for humans.
Adolescent↗
Swine-like influenza virus infection in a Wisconsin farm family.
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Animals↗
Reye's syndrome: clinical progression and evaluation of therapy.
The hospital course and therapy of 369 patients with Reye's syndrome were evaluated. Eighty-three percent of patients had deepening coma during hospitalization. Stage of coma on admission, evidence of increased intracranial pressure, and blood ammonia levels greater than 300 microgram/100 ml were all significantly associated with increasing mortality. Among survivors of Reye's syndrome, 30% of those who developed either decerebrate posturing or seizures during hospitalization had serious neurologic sequelae upon discharge. When analyzed by (1) stage of coma during admission (2) progression of coma during hospitalization, (3) degree of blood ammonia level elevation, and (4) presence of increased intracranial pressuring, no significant differences were noted between patients receiving intensive supportive care and those receiving exchange transfusions and/or peritoneal dialysis.
Ammonia↗
A nationwide outbreak of Reye's Syndrome. Its epidemiologic relationship of influenza B.
Between December 15 and June 30, 1974, 379 cases of confirmed Reye's syndrome were reported to the Center for Disease Control. Of these, 316 occurred during February and March 1974. A simultaneous surveillance system for influenza B indicated that this clustering of cases of Reye's syndrome correlated both temporally and geographically with influenza B outbreaks. The incidence of Reye's syndrome was higher in rural than in urban centers. Epidemiologically, two groups of cases of Reye's syndrome emerge: those which occur in older children (median age 11 years), cluster in time and geographic region, and are associated with antecedent influenza B infection; and those which occur sporadically thoughout the year, are isolated in occurrence, occur in younger children (median age 6 years), and are associated with a wide variety of antecedent viral illnesses.
Adolescent↗
Dealing with possible rabies exposure.
When a patient has come in contact with a domestic or wild animal that may be rabid, the physician must decide whether postexposure rabies prophylaxis is warranted. Among the factors that must be weighed are the animal species involved, the epizootiology of rabies, and the circumstances surrounding the exposure.
Animals↗
Clinical use of human globulin immune to rabies virus.
Studies of human globulin immune to rabies virus before licensure showed that it suppressed active antibody responses when individuals received 16 doses of duck embryo vaccine but not when they received 23 doses of duck embryo vaccine. Prospective surveillance of use of human globulin immune to rabies virus since licensure in 1974 has revealed that 40% of persons who receive 14-16 doses of duck embryo vaccine have low or undetectable antibody responses 30-90 days after initiation of the series. Ten percent of individuals receiving 21-23 doses of duck embryo vaccine have inadequate antibody responses, a percentage not significantly different from that found in recipients of 14 doses of vaccine alone. Human globulin immune to rabies virus has also been used for treatment of one case of clinical human rabies; this use was based on the observation that antibodies to rabies virus in serum do not develop until after the seventh day of clinical illness, and antibodies are absent from spinal fluid as long as 19 days after onset of symptoms. Intracranial pressure and neurological function remained stable after administration of human globulin immune to rabies virus, but two days after initiation of therapy, the patient died of progressive pulmonary dysfunction and tension pneumothorax.
Adult↗
Rocky Mountain spotted fever: epidemiology of an increasing problem.
Reported cases of Rocky Mountain spotted fever in the United States have been increasing since 1960 and reached an all-time high of 754 cases in 1974. Detailed clinical and epidemiologic information was obtained on 1522 (55%) of the 2757 cases reported in the 5-year period 1970 through 1974. Fifty-one percent of cases were confirmed by one or more laboratory test. The increase has occurred predominantly in the southeastern part of the United States. A comparison of laboratory-confirmed and unconfirmed cases suggests that a variety of febrile exanthems may be confused with Rocky Mountain spotted fever. Neither a history of tick bite nor rash was universally present, and both were significantly less frequent in fatal cases. The overall death-to-case ratio during this period was 6.8%. Death-to-case ratios were significantly higher for nonwhites (13.9) than whites (5.8), for male patients (8.2) than female patients (4.5), and for person older than 30 (13.9) than persons younger than 30 (5.4).
Adolescent↗
Serum neutralizing antibody after rabies postexposure prophylaxis.
One hundred seventy-seven persons submitted specimens for serum neutralizing antibody titer detreminations 30 to 90 days after starting postexposure rabies prophylaxis. Ninety-two percent of those who received duck embryo vaccine alone developed adequate antibody titers. However, 23% of those who received equine antirabies serum plus duck embryo vaccine failed to develop an adequate antibody titer; one of these inadequate responders subsequently died of rabies. Factors that increased the risk of a poor antibody response included the receipt of steroids during the course of postexposure prophylaxis, and the use of more than 55 lu/kg of equine antirabies serum. Many persons receiving postexposure rabies prophylaxis fail to develop adequate humoral immunity and may have an increased risk of developing rabies. We suggest that persons receiving postexposure rabies prophylaxis should have serum neutralizing antibody determinations 30 to 40 days after starting treatment.
Adolescent↗
Pandemic influenza and the swine influenza virus.
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Antibodies, Viral↗