Kenneth J. Bart

Measles seroconfirmation using dried capillary blood specimens in filter paper.

Because the incidence of measles has declined in recent years, the potential for confusion of measles with other morbilliform rashes has increased. Routine serologic testing of suspected cases of measles is recommended but it has been hampered, particularly in young infants and children, by the requirement of performing venipuncture. We have compared measles hemagglutination inhibition antibody testing performed on dried capillary whole blood collected on filter paper strips with testing of serum specimens obtained simultaneously by venipuncture. We assessed overall comparability, diagnostic sensitivity and specificity and acceptability and practicality for field use. Of the 125 capillary-venous sets compared, there was a 4-fold difference in hemagglutination inhibition titer between the two types of specimens in only one set (0.8%). Diagnostic sensitivity using capillary blood was 100% and specificity was 96%. Immunoglobulin M assessments on six capillary-venous sets were in complete agreement (three positive in both, three negative in both). In a pilot program of field use, filter paper blood collection was associated with a 97% (36 of 37) success rate in obtaining specimens from individuals with suspected cases of measles. This method of blood collection and testing is an accurate, feasible and acceptable means for seroconfirmation of measles.

History of convulsions and use of pertussis vaccine

Data on 2062 reports from the Monitoring System for Adverse Events Following Immunization, Centers for Disease Control (CDC), were analyzed to compare the risk of a personal or family history of convulsions in children who had a neurologic adverse event after receipt of diphtheria-tetanus-pertussis (DTP) vaccine with those who had a nonneurologic adverse event. Children with a neurologic event after DTP vaccine had a 7.2 times higher risk for personal history of convulsions (95% confidence limits 4.5 to 11.5) and a 4.5 times higher risk for family history of convulsions (95% confidence limits 3.1 to 6.7) than did children with an adverse event that did not affect the nervous system. Children with either a febrile or nonfebrile convulsion after receipt of DTP were significantly more likely to have a personal history of convulsions than children with a nonneurologic adverse event (P less than 0.0001). Children with a febrile convulsion after receipt of DTP but not children with nonfebrile convulsions were significantly more likely to have a family history of convulsions than those with a nonneurologic adverse event. It is recommended that pertussis vaccination be deferred in children with a personal history of a convulsion until it can be determined that an evolving neurologic disorder is not present. If such disorders are found, these children should be given the combined pediatric diphtheria and tetanus toxoids (DT) vaccine to complete the series.

Measles on Campus

Abstract Campus outbreaks and campus-associated cases together accounted for 51.1% of all reported measles cases in the first 26 weeks of 1983. This proportion is of particular concern because measles is a more serious disease in adults than in schoolchildren. For a substantial number of highly mobile young adults, college may be the last opportunity to ensure protection against measles and other preventable infections. Unfortunately, immunization levels on campuses are difficult to assess because very few institutions require immunization records. Nevertheless, colleges and universities have an obligation to their students to provide a safe and healthy learning environment; they also have a need to avoid costly and disruptive outbreaks on their campuses. To break the remaining chains of measles transmission on campus, colleges and universities should require all students born after 1956 to present a complete and up-to-date immunization record for matriculation and registration. Incoming freshmen should b...

Eliminating Rubella From the United States-Reply

In Reply.— We are gratified that Dr Kindrachuk made the efforts he did to try to ensure mothers of children were immune to rubella. We would like to clarify some points that should facilitate assessing the immunity status of mothers and offering vaccine. Several courses of action are available to physicians in well-baby clinics to determine immunity to rubella and to offer vaccine. Acceptable evidence of rubella immunity should be considered either documentation of receipt of rubella vaccine on or after the first birthday or documentation of a serological test demonstrating rubellaspecific antibodies. 1 Women lacking such evidence can be vaccinated without serological screening (the preferred course), screened by serological tests and offered vaccine at a later date if the test indicates susceptibility, or referred to their own physician for evaluation. All alternatives are acceptable but vaccinating without screening saves the patient the cost of the serological test and avoids