A prospective, laboratory-based surveillance project obtained accurate data on meningitis in a population of 34 million people during 1986. Haemophilus inftuenzae was the most common cause of ...bacterial meningitis (45%), followed by Streptococcus pneumoniae (18%), and Neisseria meningitidis (14%). Rates of H. inftuenzae meningitis varied significantlybyregion, from 1.91100,000 in New Jersey to 4.0/100,000 in Washington state. The overall case fatality rates for meningitis were lower than those reported in several studies from the early 1970s, suggesting that improvements in early detection and antibiotic treatment may have occurred since that time. Concurrent surveillance was also performed for all invasive disease due to the five most common causes of bacterial meningitis. Serotypes of group B streptococcus other than type III caused more than halfof neonatal group B streptococcal disease and mortality, suggesting that an optimal vaccine preparation must be multivalent. Of the organisms evaluated, group B streptococcus was the second most common cause of invasive disease in persons >5 years old.
Active surveillance for toxic shock syndrome (TSS) was established in 1986 in Los Angeles County and in the states of Missouri, New Jersey, Oklahoma, Tennessee, and Washington. Case reports were ...solicited through biweekly contact with all acute-care hospitals. One hundred sixteen definite and 63 probable cases were reported; 85% of the cases occurred in female patients and 15% in male patients. Among cases in females, 83 (55%) were menstrual; the mean age of the patients with menstrual cases was 23 years (range, 12-46 years). The overall incidence of TSS was 0.53/100,000. The cumulative incidence varied significantly by region, ranging from 1.23/100,000 in Oklahoma to 0.22/100,000 in New Jersey (P = .0001); the incidence in all other areas ranged from 0.39/100,000 to 0.70/100,000. The incidence of menstrual TSS was 1.05/100,000 women 15-44 years of age and peaked in women between the ages of 15 and 19 years at 1.52/100,000. The incidence was higher in whites than in nonwhites for both menstrual TSS (1.21/100,000 vs. 0.34/100,000, P = .002) and nonmenstrual TSS (0.30/100,000 vs. 0.14/100,000, P = .031). Our data indicate that TSS continues to be a cause of morbidity. Although there is under-reporting in national passive surveillance, the proportion of menstrual cases reported through active surveillance was similar to that reported to the passive system in 1986.
For assessment of current risk factors for developing toxic shock syndrome (TSS) during menstruation, a case-control study was performed. Cases with onset between 1 January 1986 and 30 June 1987 were ...ascertained in six study areas with active surveillance for TSS. Age-matched controls were selected from among each patient's friends and women with the same telephone exchange. Of 118 eligible patients, 108 were enrolled, as were 185 "friend controls" and 187 telephone exchange-matched controls. Tampon use was a risk factor for developing TSS during menstruation (odds ratio = 29; 95% confidence interval = 7-120), and risk increased with increasing tampon absorbency (odds ratio = 1.34 per gram increase in absorbency; 95% confidence interval = 1.2-1.6). The role of tampon chemical composition could not be assessed because the number of cases was inadequate. Neither use of birth control pills for contraception nor use of medications for premenstrual or menstrual symptoms protected against or was a risk factor for the development of menstrual TSS.
This study was designed to determine whether residential proximity to waste incinerators might affect the respiratory health of young children, and to identify other risk factors for childhood ...respiratory illnesses. Participants were selected from two residential areas located near a hazardous waste industrial furnace (HWI) or a municipal waste incinerator (MWI), and two areas selected for comparison purposes. Data were collected through telephone interviews with a parent or guardian of each child-participant, beginning with a baseline interview, followed by ten biweekly interviews from September 1993 through March 1994. Retrospective data reported at baseline were analyzed with proportional hazards regression to compare rates of lower respiratory illness (LRI) in the incinerator areas with rates in the comparison areas. No difference was detected in the rate of LRI between the HWI area and its comparison area. However, the rate of LRI was significantly higher in the MWI area relative to its comparison area (adjusted rate ratio 2.88, 90% confidence interval (CI) 1.60-5.19), and additional analyses indicated that LRI rates were comparable between these areas before the incinerator began operating. Rates of upper respiratory illnesses (URI) were compared through analyses of longitudinal data collected during weekly interviews. No significant difference in the incidence of URI was detected between the HWI and comparison areas. Rates of URI were elevated in the MWI area related to its comparison area, with an adjusted incidence density ratio (IDR) ranging from 1.3 (95% CI 1.0-1.6) among children who spent most daytime hours within two miles from home, to 1.9 (95% CI 1.3-2.9) among children who spent most daytime hours farther than two miles from home. Data collected from the four areas were combined to examine independent risk factors for upper and lower respiratory illnesses while adjusting for confounding effects of the incinerators. Several risk factors identified (age of the child, history of LRI during the first year of life, larger day care or school class sizes) corroborate the results of other studies; other (use of a wood-burning fireplace in the home and age of housing) substantiate the importance of the indoor environment to childhood respiratory health.
Use of barrier contraceptives has been hypothesized to be a risk factor for nonmenstrual toxic shock syndrome (TSS). This association was evaluated in a case-control study of nonmenstrual TSS; cases ...were identified through an active surveillance system for TSS during 1986 and 1987. Potential risk factors for nonmenstrual TSS were compared for 28 patients and 100 age-matched controls. Use of barrier contraceptives was associated with a significantly increased risk of nonmenstrual TSS, with matched odds ratios of 10.5 and 11.7 for contraceptive sponge and diaphragm use, respectively. Use of nonbarrier contraceptive methods was unrelated to nonmenstrual TSS. Despite the elevated odds ratio, the incidence of nonmenstrual TSS in barrier contraceptives users and the risk of nonmenstrual TSS attributable to barrier contraceptive use are low. Clinicians and women who use barrier contraceptives should be aware of this rare but potentially fatal complication; however, other considerations, such as efficacy and complications associated with other types of contraception, may be more important in the choice of a contraceptive method.
To assess the efficacy of the Haemophilus b polysaccharide vaccine following licensure and to evaluate the risk of Haemophilus influenzae type b (Hib) disease in the week following vaccination, we ...conducted a day care-based case-control efficacy study using cases of invasive Hib disease ascertained through active surveillance in areas with a total population of 34 million. For each patient 18 to 59 months old, up to three 18- to 59-month-old controls were chosen from the same day care classroom. Using conditional logistic regression, the vaccine efficacy was estimated to be 45% (95% confidence interval = -1% to 70%) and did not change significantly after accounting for potential biases. In addition, three (3%) of 104 patients vs five (2%) of 207 controls were vaccinated within seven days before the patients' dates of admission (odds ratio = 1.8, 95% confidence interval = 0.3 to 10.2), which does not suggest an increased risk of Hib disease in the week following immunization. This study suggests that the efficacy of the currently used HBPV is less than expected from previous studies and points out the usefulness of case-control studies for monitoring vaccine efficacy following licensure.
The behavior of nine intact group-living adult female rhesus was observed for 30 min daily with each of four adult male rhesus across a verified ovulatory menstrual cycle. Blood samples collected ...from females daily or on alternate days were analyzed for estradiol, testosterone, and progesterone. Female patterns of approach, follow, and initiate proximity increased several days prior to the estradiol peak, peaked on the day of the estradiol peak, then declined completely or to very low frequencies. Mounts, intromissions, and ejaculations increased significantly on the day of the estradiol peak, remained elevated for 2 more days, then declined completely by the fifth day after peak estradiol. Ejaculations never occurred outside of a 10-day period starting 4 days before the estradiol peak and ending 5 days after the estradiol peak. During this period females initiated over 90% of all approaches. Female hand slap, threaten away, and stand up increased significantly on the first day of increased copulation, remained elevated while copulation was significantly elevated, then decreased along with the decline in copulation. Ten of eleven patterns of female behavior correlated significantly with estradiol level prior to the estradiol peak. All were significantly inversely correlated with progesterone level after the estradiol peak. No pattern of female behavior correlated significantly with testosterone either before or after the estradiol peak. Similarly, male patterns of behavior correlated with female levels of estradiol and progesterone, but not testosterone. These results demonstrate a relationship between increased serum estradiol and increased female initiation of sexual behavior. The finding that some patterns of female behavior increase several days prior to copulation, whereas other behaviors increase coincident with increased copulation suggests that the behavior of group-living rhesus females serves two functions. The first is to communicate sexual interest and the second is to maintain the consort pair and increase the probability that ejaculation will occur. In addition, the strong correlation between preovulatory female behavior and estradiol level suggests that the female's behavior provides precise information about her reproductive state and could thus coordinate copulation with maximal fertility.
The sexual behavior of six adult rhesus females was observed with each of four males prior to, during, and following a 90 day treatment with 20 micrograms/day of a gonadotropin releasing-hormone ...(GnRH) agonist (WY-40972). All females ovulated, approached males and copulated during an untreated cycle. No ovulations occurred during agonist treatment and all females showed reduced sexual interest during the last 25 treatment days. Three females showed elevated estradiol and copulated during the first 10 days of agonist treatment, but never showed similar levels of estradiol or copulation during the rest of treatment. Within 34 days after agonist treatment, all females initiated proximity to males, copulated, and ovulated. All females became pregnant on their second ovulation after agonist treatment. This demonstration that inhibition of ovulation with a GnRH agonist decreased rhesus female sexual initiation, demonstrates the importance of ovarian hormones to female sexual motivation and suggests that the changes in human female sexual interest should be evaluated during the development of agonist-based contraceptives.
The emergence and spread of new influenza virus variants and the impact of influenza on morbidity and mortality were examined between Oct 1988- May 1989. During the 1988-89 influenza season, ...influenza A and B viruses were identified in the US with essentially equal frequency overall, although both regional and temporal patterns of predominance shifted during the season.
