Irene L. Doto

The Prevention of Hepatitis B with Vaccine: Report of the Centers for Disease Control Multi-Center Efficacy Trial Among Homosexual Men

A randomized, double-blind, vaccine/placebo trial of the Merck 20-micrograms hepatitis B virus (HBV) vaccine was done among 1402 homosexual men attending venereal disease clinics in five American cities. Vaccination was followed by only minimal side effects. Two doses of vaccine induced antibody in 80% of vaccine recipients. A booster dose 6 months after the first dose induced antibody in 85% of recipients and markedly increased the proportion of recipients who produced high antibody titers. The incidence of HBV events was markedly less in the vaccine recipients compared to that in the placebo recipients (p = 0.0004). Between month 3 and 15 after the first dose, 56 more significant HBV events (hepatitis, or hepatitis B surface antigen positive, or both) occurred in the placebo group while only 11 occurred in the vaccine group. Ten of the 11 HBV events in the vaccine recipients occurred in hypo- or nonresponders to the vaccine. This vaccine appears to be safe, immunogenic, and efficacious in preventing infection with hepatitis B virus.

Occupational risk of hepatitis B infection in hospital workers.

To estimate the risk of hepatitis B virus (HBV) infection among hospital workers, we measured the prevalence of HBV infection in employees in five hospitals in different parts of the country and examined the effect of occupational and non-occupational factors on HBV prevalence. Among 5,697 persons studied, serologic markers of HBV infection were found in 807 (14%). Prevalence of infection was strongly related to race (Asian greater than Black greater than White), sex (male greater than female) and increasing age. Risk related to health occupation, studied by examining the change in HBV prevalence with duration in occupational group, was most strongly correlated with frequency of contact with blood during work. Workers having frequent blood contact had the highest estimated infection rate (1.05 per 100 person-years) and those with moderate contact an intermediate infection rate, compared to a negligible infection rate in workers with no blood contact. Frequency of needle accidents had an independent, positive effect on HBV infection rates, while degree of patient contact had no effect. Infection risk was uniform among all hospitals for groups with frequent blood contact. Among different occupation groups, risk of HBV infection also correlated closely with degree of blood-needle contact during daily work. This study provides a general approach to assessing risk of HBV infection in hospital personnel, and indicates that risk may be most easily estimated by quantitating degree of blood-needle contact during daily work.

Disseminated histoplasmosis: results of long-term follow-up. A center for disease control cooperative mycoses study.

Abstract Fifty-four cases of disseminated histoplasmosis were studied between 1947 and 1969 in eight hospitals in a cooperative study. Twenty-four patients received amphotericin B intravenously; of...

Chronic Pulmonary Coccidioidomycosis

Abstract Of 109 patients with proved coccidioidomycosis 20 had chest films and clinical findings indistinguishable from either chronic pulmonary histoplasmosis or chronic pulmonary tuberculosis. Many were thought to have tuberculosis for years before the fungal etiology of the lung disease was determined. Coccidioides immitis was cultured from sputums of 18 of 19 patients, and coccidioidin complement-fixation tests were positive in 14 of 15. Best therapeutic results were obtained with amphotericin B intravenously in a total dose of 30 mg per kilogram of body weight or more.

Epidemic Infection with Coxsackie Virus Group B, Type 5

A SEPTIC meningitis was a term coined in 1924 by Wallgren,1 who believed that he was describing a distinct etiologic entity. Since that time, aseptic meningitis has been shown to be due to varied c...

Clinical, X-ray, and serologic changes with histoplasma infection

AL TH O UGH considerable information about histoplasmosis has been accumulated since this f ungus infection was first described in 1906, much still needs to be learned about the frequency and severity of the disease accompanying primary infection. Following the classic work of Smith and his colleagues on Coccidioides infection in personnel of the U. S. Army (1), it was decided that such personnel, with their available medical care and complete records, would be an ideal group for a study of histoplasmosis. Consequently, in 1953 a study was initiated at Fort Leavenworth, Kans., by the U. S. Army Hospital on the post and the Public Health Service. Children of Army personnel participated. Trhe study was undertaken to determine the spectrum of illness accompanying Histoplasma infection. This was accomplished by observation of the clinical, X-ray, and serologic chaniges which accompanied conversion of the skin test from negative to positive. Its basic plan wvas to find a large number of children with a negative reaction to the histoplasmin skin test, observe these children over a period of time, and retest them to determine the infection, or conversion, rate. Clinical, X-ray, and serologic changes could thus be observed in a group who became infected and in a much larger group who did not and who therefore would serve as controls. Other interesting epidemiological information concerning infection was also collected.

The complement fixation antibody test in the diagnosis of chronic pulmonary histoplasmosis and blastomycosis

Abstract A review of the serologic data on 540 proven cases of chronic pulmonary histoplasmosis and 45 proven cases of chronic pulmonary blastomycosis revealed that 92 per cent of the histoplasmosis cases and 72 per cent of the blastomycosis cases had a positive CF test to one or more of the three antigens employed. Of the histoplasmosis cases, 90 per cent had a positive CF test for histoplasmosis. Among the 45 blastomycosis cases, only 36 per cent had a positive CF test for blastomycosis. When the homologous antigens were used, a titer of 1: 32 or greater was recorded for 68 per cent of the histoplasmosis cases, while only 9 per cent of the blastomycosis cases had titers of this magnitude. Ten per cent of the histoplasmosis cases and 64 per cent of the blastomycosis cases had negative tests. Cross reactions of CF antibodies between the antigens of H. capsulatum and B. dermatitidis present problems in diagnosis. The titers were greater for the homologous antigens for 84 per cent of the histoplasmosis cases and only 22 per cent of the blastomycosis cases. The best solution to the problem is to perform the CF test with the antigens of both fungi and also perform the test upon serial serum specimens.