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S R Preblud

Publications and source records attributed to S R Preblud.

At least 19 recordsLinked to original sources
PubMed1991

Measles among the Amish: a comparative study of measles severity in primary and secondary cases in households.

An outbreak of measles among a predominantly unvaccinated and susceptible Amish population in Lebanon County, Pennsylvania, offered the opportunity to test the hypothesis that secondary cases in households are more severe than primary cases because the former have more intense exposure and receive a greater virus inoculum. Of 130 measles cases reported between April and June 1988, 119 (92%) constituted a study of disease severity. Severity was assessed by determining frequency and duration of symptoms, length of any hospitalization, and number of days in bed. In a univariate analysis, fewer secondary cases had conjunctivitis (relative risk [RR], 0.67; 95% confidence interval [CI], 0.48-0.96) and headache (RR, 0.37; CI, 0.15-0.86), but more had earache (RR, 9.69; CI, 1.8-202.9) compared with primary cases. Secondary cases had a shorter mean duration of coryza (4.0 vs. 5.0 days, Student's t test, P = .08). However, a logistic regression model that matched by family and controlled for age and sex indicated that there were no significant differences in measles severity among primary and secondary cases in households.

Adolescent↗
PubMed1991

A measles outbreak at a college with a prematriculation immunization requirement.

BACKGROUND: In early 1988 an outbreak of 84 measles cases occurred at a college in Colorado in which over 98 percent of students had documentation of adequate measles immunity (physician diagnosed measles, receipt of live measles vaccine on or after the first birthday, or serologic evidence of immunity) due to an immunization requirement in effect since 1986. METHODS: To examine potential risk factors for measles vaccine failure, we conducted a retrospective cohort study among students living in campus dormitories using student health service vaccination records. RESULTS: Overall, 70 (83 percent) cases had been vaccinated at greater than or equal to 12 months of age. Students living in campus dormitories were at increased risk for measles compared to students living off-campus (RR = 3.0, 95% CI = 2.0, 4.7). Students vaccinated at 12-14 months of age were at increased risk compared to those vaccinated at greater than or equal to 15 months (RR = 3.1, 95% CI = 1.7, 5.7). Time since vaccination was not a risk factor for vaccine failure. Measles vaccine effectiveness was calculated to be 94% (95% CI = 86, 98) for vaccination at greater than or equal to 15 months. CONCLUSIONS: As in secondary schools, measles outbreaks can occur among highly vaccinated college populations. Implementation of recent recommendations to require two doses of measles vaccine for college entrants should help reduce measles outbreaks in college populations.

Adolescent↗
PubMed1990

A profile of mothers giving birth to infants with congenital rubella syndrome. An assessment of risk factors.

To formulate strategies for elimination of congenital rubella syndrome, it is important to identify risk factors for delivering an infant affected by it. We analyzed cases of congenital rubella syndrome in infants born from 1970 to 1985 and reported to either one of two independent Centers for Disease Control surveillance systems. Mothers of infants with congenital rubella syndrome identified in both surveillance systems were disproportionately younger than mothers giving birth in the United States. The risk for delivering an infant with congenital rubella syndrome was approximately 2.5 times higher for blacks compared with whites for both reporting systems. A total of 18% of infants with congenital rubella syndrome born since 1979 were Hispanic (national population average, 7%). Both surveillance systems showed that, although primiparous mothers were at highest risk, 39% of women delivering infants affected by congenital rubella syndrome had had at least one previous live birth, suggesting that postpartum immunization could have prevented these congenital rubella syndrome cases. Young, black, and Hispanic primiparous women represent populations at elevated risk for delivering a congenital rubella syndrome-affected infant and should be specifically targeted for immunization.

Adolescent↗
PubMed1990

Measles antibody: reevaluation of protective titers.

A school blood drive before a measles outbreak permitted correlation of preexposure measles antibody titers with clinical protection using the plaque reduction neutralization (PRN) test and an EIA. Of 9 donors with detectable preexposure PRN titer less than or equal to 120, 8 met the clinical criteria for measles (7 seroconfirmed) compared with none of 71 with preexposure PRN titers greater than 120 (P less than .0001). Seven of 11 donors with preexposure PRN titers of 216-874 had a greater than or equal to 4-fold rise in antibody titer (mean, 43-fold) compared with none of 7 with a preexposure PRN titer greater than or equal to 1052 (P less than .02). Of 37 noncases with preexposure PRN titer less than 1052, 26 (70%) reported one or more symptoms compared with 11 (31%) of 35 donors with preexposure PRN titers greater than or equal to 1052 (P less than .002). By EIA, no case had detectable preexposure antibody; the preexposure geometric mean titer of asymptomatic donors (220) was not significantly higher than that of symptomatic donors who did not meet the clinical criteria for measles (153) (P = .10). The study suggests that PRN titers less than or equal to 120 were not protective against measles disease and illness without rash due to measles may occur in persons with PRN titers above this level.

Adult↗
PubMed1990

A school-based measles outbreak: the effect of a selective revaccination policy and risk factors for vaccine failure.

Persons who received measles vaccine between 12 and 14 months of age have been found to be at increased risk of measles compared with those vaccinated at greater than or equal to 15 months of age. Because of this, in 1987 the Immunization Practices Advisory Committee of the US Public Health Service recommended that, during measles outbreaks, revaccination of persons vaccinated at 12-14 months of age be considered. During a school-based outbreak in New Mexico in 1987, the authors evaluated the effect of a mandatory revaccination policy in affected schools. Before the effect of revaccination, the overall attack rate in persons vaccinated at greater than or equal to 12 months of age was 4.1 cases/1,000 students; afterward, the risk was significantly reduced by 73%, to 1.1/1,000 students. The attack rate among students targeted for revaccination declined 100%, compared with 41% among those not revaccinated. Overall, attack rates were significantly lower in schools conducting revaccination early compared with schools holding later revaccination. In a retrospective cohort study of single-dose vaccines in one school, age at vaccination was not associated with risk of disease; however, persons vaccinated greater than or equal to 10 years before the outbreak were at increased risk, independently of age at vaccination. Revaccination of persons whose most recent vaccination was between 12 and 14 months of age appeared to control transmission in this outbreak. Further studies are needed to confirm these observations and to evaluate the effect of other revaccination efforts during outbreaks.

Adolescent↗
PubMed1989

Patterns of transmission in measles outbreaks in the United States, 1985-1986.

Since the licensing of measles vaccine in 1963, the incidence of reported measles in the United States has declined to less than 2 percent of previous levels. To characterize the current epidemiology of measles in the United States, we analyzed measles outbreaks that occurred during 1985 and 1986. There were 152 outbreaks (defined as five or more cases related epidemiologically), which accounted for 88 percent of the cases reported during those two years. There were two major types of outbreaks: those in which most of the cases occurred among preschool-age children (those under 5 years of age) (26 percent) and those in which most of the cases occurred among school-age persons (those 5 to 19 years of age) (67 percent). The outbreaks among preschool-age children ranged in size from 5 to 945 cases (median, 13); a median of only 14 percent of the cases occurred in vaccinated persons, and a median of 45 percent of the cases were classified as preventable according to the current strategy. Outbreaks among school-age persons ranged in size from 5 to 363 cases (median, 25); a median of 60 percent of the cases occurred in vaccinated persons, and a median of only 27 percent of the cases were preventable. The outbreaks among preschool-age children indicate deficiencies in the implementation of the national measles-elimination strategy. However, the extent of measles transmission among highly vaccinated school-age populations suggests that additional strategies, such as selective or mass revaccination, may be necessary to prevent such outbreaks.

Adolescent↗
PubMed1989

Vaccine-preventable diseases on college campuses: the emergence of mumps.

Because of the adverse health impact of vaccine-preventable diseases, particularly measles and rubella, on college campuses, the American College Health Association (ACHA) Committee on Immunization and the House of Delegates issued position statements in 1983 and 1984 stating that colleges and universities should institute prematriculation immunity requirements. Since then, many colleges have implemented requirements and some states have passed comprehensive college laws requiring proof of immunity at the time of matriculation. No college rubella outbreaks have been reported to the Centers for Disease Control (CDC) since 1985. Measles outbreaks, however, have continued to be reported. In 1986-1987, 315 college measles cases were reported from 15 states, comprising over 3% of the total cases reported to CDC. Thirty-six percent of college measles cases could have been prevented through full implementation of prematriculation immunity requirements. Outbreaks of mumps were reported among students attending 16 colleges and universities in 3 states where active surveillance was undertaken during the 1986-1987 academic year. These mumps outbreaks, the first reported in colleges since vaccine licensure in 1967, were responsible for considerable health impact and disruption of activities. The outbreaks paralleled the increase in mumps reported nationally, which was largely a result of illness among unvaccinated adolescents and young adults not previously exposed to mumps. A lack of routine mumps vaccination in the past has allowed accumulation of susceptible unvaccinated persons in middle schools, high schools, and colleges. Outbreaks are likely to occur in those colleges that draw students who attended primary and secondary school in states without comprehensive laws requiring mumps vaccination.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Congenital rubella syndrome in the United States, 1970-1985. On the verge of elimination.

The National Congenital Rubella Syndrome Registry, a passive surveillance system, and the Birth Defects Monitoring Program, a newborn hospital discharge data set, are used to monitor the incidence of congenital rubella syndrome in the United States. Reports to the registry contain clinical and laboratory data which allow cases to be classified into six categories according to the likelihood of having congenital rubella syndrome. The monitoring program records newborn discharge diagnoses, without detailed information, of a nonrandom sample of about one fourth of the births in the United States annually. To evaluate the two systems and to estimate the actual incidence of congenital rubella syndrome, the authors collected hospital discharge summaries on all cases as reported by the monitoring program from 1970-1985 and classified them by the registry criteria. Of the 392 cases reported to the monitoring program during 1970-1985, 24% (n = 93) could be classified as confirmed or compatible compared with 79% (n = 415) of the 526 cases reported to the registry (rate ratio = 3.3; 95% confidence interval (CI) 2.9-3.8). Diagnosis of congenital rubella syndrome was made during the neonatal period for 68% (263 of 389) registry cases for whom such data were available. When the Lincoln-Peterson capture-recapture method of estimating population size for independent surveillance systems was used, an estimated 1,064 confirmed and compatible cases (95% CI 668-1,460) diagnosed during the neonatal period occurred during 1970-1979, for an average of 106 cases per year. During 1980-1985, an estimate of 122 neonatal confirmed and compatible cases (95% CI 8-236) occurred, for an average of 20 cases per year. A downward secular trend in the incidence of congenital rubella syndrome beginning in 1980 was observed. The registry detected 22% of all neonatal confirmed and compatible cases, the monitoring program detected 8%, and the two systems combined detected a total of 28%. The results indicate that congenital rubella syndrome may be on the verge of elimination in the United States.

Age Factors↗
PubMed1989

Vaccines of importance in the hospital setting. Problems and developments.

Hospital personnel may be exposed to or transmit certain vaccine-preventable diseases. Using immunizing agents optimally in hospitals will protect personnel as well as patients. Preventing illness in hospitals through comprehensive immunization policies can be more cost-effective than case management and outbreak control. Hospital-based immunization programs for patients provide an important strategy for immunizing high-risk patients. Immunizing patients protects them against preventable illnesses that may be acquired in the hospital or the community following discharge.

Cross Infection↗
PubMed1989

Measles outbreak among unvaccinated preschool-aged children: opportunities missed by health care providers to administer measles vaccine.

A measles outbreak in an inner-city area primarily involved preschool-aged children younger than 5 years of age. The reasons why 31 unvaccinated preschool children with measles disease had not been vaccinated were investigated. For some patients, health care providers missed opportunities to vaccinate eligible patients against measles. Of the 26 patients whose full immunization status was known, ten (38%) were vaccinated with diphtheria and tetanus toxoids and pertussis vaccine and/or oral poliovirus vaccine at a time when they could have received measles vaccine simultaneously, according to recommendations of the Immunization Practices Advisory Committee and the American Academy of Pediatrics. In addition, five of ten health care providers interviewed missed at least one opportunity to administer measles vaccine because of a minor illness that was not a contraindication to vaccination. Unvaccinated patients were more likely to receive health care in the public sector, have single mothers, and have parents who had no knowledge of existing vaccines; they were less likely to be age-appropriately immunized with other antigens. If measles immunization levels among preschool children in the United States are to be increased, education of both health care providers and parents, coupled with innovative strategies targeted to preschool children, particularly of low socioeconomic groups in inner cities, are needed.

Adolescent↗
PubMed1989

Changing epidemiology of mumps and its impact on university campuses.

The reported incidence of mumps has declined dramatically since licensure of the live attenuated mumps vaccine in the United States in 1967, particularly in young children. Because administration of the vaccine was not widely practiced during the first decade it was available, there is now a cohort of teenagers and young adults who are relatively underimmunized. Reported mumps cases in this cohort increased substantially during 1986 to 1987. Mumps outbreaks at three Illinois universities, from which 123 clinical cases were reported between September 1986 and May 1987, were investigated. Meningeal involvement was reported in 17% of case-patients, orchitis occurred in 19% of 64 men, 6% of patients were hospitalized, and direct health care costs were estimated at $264 per case and more than $32,000 for the three outbreaks combined. The risk of mumps illness was greater for students less than 20 years of age (relative risk [RR] = 2.1, 95% confidence interval [CI] = 1.4, 3.1); students residing in dormitories (RR = 2.7, 95% CI = 1.6, 4.6); and out-of-state students (RR = 1.8, 95% CI = 1.0, 3.0). Because the available data suggest that mumps in college-aged persons is due chiefly to a failure to vaccinate susceptible persons, colleges and universities should become one major focus of mumps prevention activities to reduce susceptibility in this high-risk population.

Adolescent↗
PubMed1988

Mumps in the workplace. Further evidence of the changing epidemiology of a childhood vaccine-preventable disease.

The first documented mumps outbreak in the workplace took place between August and December of 1987, when 119 cases of mumps occurred among employees at three Chicago futures exchanges and their household contacts. Twenty-one patients developed 23 complications, and nine persons were hospitalized. Total direct and indirect economic costs associated with the outbreak were $120,738; the cost per case was $1473. Only three patients had written documentation of mumps immunization. The outbreak is consistent with the recent changing epidemiology of mumps and the increase in reported cases in the adolescent and young adult populations. Mumps vaccine was licensed in 1967, but its distribution was limited until 1977 when the Immunization Practices Advisory Committee of the US Public Health Service recommended it for universal use. As a result, a cohort of adolescents and young adults under-immunized against mumps and underexposed to disease is now entering the work force. Vaccination of susceptible employees could prevent the substantial health impact of mumps.

Adult↗
PubMed1988

Perspectives on the relative resurgence of mumps in the United States.

Although the United States has enjoyed great success in the control of mumps since the licensure of live virus mumps vaccine in 1967, a relative resurgence of mumps during the 1986-1987 period has raised concerns about the long-term effectiveness of mumps vaccine. We received mumps surveillance data, historical information on mumps vaccine distribution and recommendations for its use, survey data on levels of mumps immunization in US children during the 1973-1985 period, the effect of mumps immunization school laws on the reported incidence of mumps among states with and without such laws, and studies of mumps vaccine effectiveness. Following licensure, a decade elapsed before mumps vaccine was endorsed as a routine immunization of childhood, while immunization survey and vaccine distribution data reflected only gradual acceptance of the vaccine. However, mumps incidence declined during this period, resulting in a relatively underimmunized cohort of children born between 1967 and 1977 who grew up during a period when the risk of exposure to mumps was rapidly declining. The resurgence of mumps since 1986 has been characterized by a selective increase in incidence and a shift in the age group at highest risk to middle and high school students in those states lacking comprehensive mumps immunization school laws. Postlicensure field evaluations of mumps vaccine effectiveness have not demonstrated waning vaccine-induced immunity. The data indicate that the relative resurgence of mumps in the United States is chiefly due to a failure to vaccinate all susceptible persons, especially those who are now between 10 and 19 years old. Mumps immunization school laws offer an approach to deal with the problem of continuing susceptibility in school-age populations.

Adult↗
PubMed1988

International measles importations United States, 1980-1985.

Between 1980 and 1985, 89-121 international measles importations were reported annually in the US, accounting for 0.7-6.9% of the annual number of reported measles cases. These measles cases were acquired in more than 70 different countries. Three countries accounted for over one third of all imported cases: Mexico, the UK and the Philippines. Thirty-six states reported importations. However, over half of all importations were reported from only six states: California, New York, Maryland, Florida, Texas and Hawaii. Most measles importations did not cause transmission in the US. In 1982 and 1985 only 16% and 29% of importations resulted in any spread cases. Until there is better control of measles worldwide, high immunization levels are crucial for continued measles control in the US.

Adolescent↗