dmcanzi@watdcsu.waterloo.edu (David Canzi) (09/30/89)
Volume 2, Number 35 September 25, 1989
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Medical News
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Medical News for Week Ending September 25, 1989
Copyright 1989 - USA TODAY/Gannett National Information Network
Reproduced with Permission
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Sept. 15-17, 1989
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ACTIVISTS BLAST AZT COST:
AIDS activists and health experts want the cost of the AIDS drug AZT to be
more reasonable. On Thursday, they took aim at drug maker Burroughs Wellcome
Company. Researchers from Montefiore Medical Center in New York City charged
the price tag for fighting AIDS could be much lower if the company charged
fairer prices. (From the USA TODAY Life section.)
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Sept. 19, 1989
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AZT PRICE COMES DOWN:
The price for the drug AZT is coming down. Boroughs Wellcome Company is
cutting the price to $1.20 a capsule, down from $1.50. The price of the drug
raised concern last month when it was reported that AZT would cost $8,000 a
year retail. Studies have shown that the drug could postpone AIDS in some
infected people. (From the USA TODAY Money section.)
AIDS PATIENTS OUT ON A LIMB:
In an attempt to get well, a survey of 144 AIDS patients of the University
Clinic San Francisco found that 39, or 28 percent used treatments not approved
by the U.S. Food and Drug Administration in addition to those prescribed by
their physicians. Unapproved drugs used: Megadose vitamin C, dextran, AL-721
and fetal sheep blood injections.
FIRM INVESTS IN AIDS RESEARCH:
New York Life said Monday it would invest up to $20 million in a program
with Biogen, Inc., Cambridge, Mass., to jointly fund research, development and
clinical trials of AIDS therapeutic products. Biogen said it planned to study
the use of Receptin to treat AIDS.
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Sept. 20, 1989
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STRAIN ON HEALTH CARE SEEN:
Early detection and treatment of patients infected with the HIV virus will
severely strain the U.S. health care systems, says a study in the Journal of
the American Medical Association. The economic impact will be greatest in
urban areas but can be managed if the federal government takes a greater
financial responsibility, the authors say.
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Sept. 21, 1989
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MALE PROSTITUTES HARBORING AIDS:
One of the first studies of AIDS in male prostitutes, done in Atlanta from
July 1988 to March 1989, shows 27 percent of 152 tested positive for
antibodies to the virus. The study in Thursday's New England Journal of
Medicine also reports that 40 percent were intravenous drug abusers, 22
percent tested positive for syphillis and 58 percent for hepatitis B.
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Center for Disease Control Reports
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Varicella Outbreak in a Women's Prison -- Kentucky
During January and February 1989, three cases of varicella (chickenpox)
occurred among inmates at the Federal Correctional Institution in Lexington,
Kentucky. This all-women prison is a 1200-bed facility with an onsite
hospital. At the time of the outbreak, 1276 inmates were housed in the
facility; approximately one fourth were Hispanic (primarily from Central and
South America); 36 (3%) were pregnant. Thirty-two (3%) inmates were
seropositive by enzyme-linked immunosorbent assay (EIA) and Western blot for
human immunodeficiency virus (HIV) infection, including six persons with
acquired immunodeficiency syndrome (AIDS).
The first case of varicella developed on January 8 in a 25-year-old U.S.-
born black woman who had been on furlough in New Jersey with her 8-year-old
daughter who had chickenpox. The second case occurred on February 1 in a 23-
year-old Central American woman; she had given a hair permanent to the first
case-patient within 24 hours before the first patient developed a rash. The
third case was identified on February 19 in a 19-year-old U.S.-born Hispanic
woman who also has severe juvenile rheumatoid arthritis. The latter two women
attended the same class during late January.
The third case-patient lived in the chronic-care unit of the prison
hospital with 17 other women, including two with AIDS and one receiving low-
dose steroids for treatment of systemic lupus erythematosis. She potentially
exposed two groups of contacts. The first group comprised other inmates in the
chronic-care unit, the unit's medical staff, and inmate workers. To prevent
further transmission, persons with uncertain histories of previous chickenpox
infection were not permitted to enter the unit. Three nurses who were
uncertain of their histories were excluded from the unit pending results of
their varicella-zoster (VZ) antibody titer tests. In addition, 12 patients and
four inmate workers from the chronic-care unit were identified from histories
as possibly not immune.
The second group of contacts comprised all other identifiable social and
classroom contacts of the third case-patient and included greater than 200
inmates who attended the same programs or classes during the 3 days before she
developed symptoms. Of this group, 100 were uncertain about histories of
previous varicella infection, including 40 with self-identified risk behaviors
for HIV infection and one who may have been pregnant. Serum specimens were
obtained from 116 of these inmates and three staff members to measure VZ
antibody titers. Because of the time required to process the specimens, all
potentially susceptible inmates in this second group of contacts were
quarantined in a separate unit within the prison until their serologic results
became available.
Overall, 115 (99%) of the 116 persons with evaluative results* were immune
to VZ (immunity defined as titers greater than or equal to 1:8 by
immunofluorescent antibody (IFA) measurement); the one person who was
confirmed susceptible to VZ after duplicate IFA testing remained asymptomatic.
All pregnant women, AIDS patients, and staff were immune. In addition, all 40
persons reportedly at risk for HIV infection were negative for HIV antibody on
EIA testing. No cases of varicella have occurred since the third case.
Reported by: JB Williams, S Fawkes, Federal Correctional Institution,
Lexington, Kentucky. Div of Immunization, Center for Prevention Svcs, CDC.
Editorial Note: In the United States, exposure to and infection with the
highly communicable VZ virus is virtually unavoidable (1). VZ virus causes
both varicella (the manifestation of primary infection in a susceptible
person) and zoster (the result of reactivation of latent virus); patients with
either disease may transmit the virus to susceptible persons (1-3). An
estimated 3.5 million cases of varicella and 300,000 cases of zoster occur in
the United States annually (2).
Varicella can be life threatening, particularly in adults, pregnant women,
neonates, and immunocompromised persons. VZ infection in pregnancy may also
produce fetal infection and an array of congenital abnormalities characterized
as "congenital varicella syndrome" (4). Zoster occurs and can be severe in
HIV-infected persons (5). Persons from rural tropical and subtropical regions
are less likely than persons from temperate zones to be infected as children,
leaving them susceptible as adults (6). Thus, in this prison population,
increased risk existed for transmission and severe health effects.
In this investigation, the estimated level of immunity for the inmate
population was at least 99%. Based on this nonrandom sample from the
population of 1267 inmates, at most, 13 persons were possibly susceptible to
varicella before the onset of disease in the first case-patient. Nonetheless,
the close confines and extensive socialization in a prison maximize the
potential spread of a highly contagious disease, such as varicella, despite
high levels of immunity.
Introduction and subsequent transmission of the VZ virus among patients
and staff can be reduced in health-care settings such as in this prison. CDC
has developed isolation precautions for hospitalized patients who either have
active disease or have been exposed to varicella or zoster (7). CDC has also
issued recommendations to minimize virus transmission to and from hospital
personnel (8); in institutions where varicella is prevalent or where there are
many high-risk patients, it may be useful to screen those personnel who have a
negative or equivocal history of varicella for the presence of serum
antibodies to VZ virus to document susceptibility or immunity (persons with a
positive history can be considered immune). In the absence of a licensed
vaccine against VZ, efforts should be taken to maximize the effectiveness of
existing recommendations for control of VZ virus infections.
References
1. Weller TH. Varicella and herpes zoster: changing concepts of the natural
history, control, and importance of a not-so-benign virus. N Engl J Med
1983;309:1362-8,1434-40.
2. Preblud SR. Varicella: complications and costs. Pediatrics
1986;78(suppl):728-35.
3. Ragozzino MW, Melton LJ III, Kurland LT, Chu CP, Perry HO. Population-
based study of herpes zoster and its sequelae. Medicine 1982;61:310-6.
4. Preblud SR, Cochi SL, Orenstein WA. Varicella-zoster infection in
pregnancy (Letter). N Engl J Med 1986;315:1416-7.
5. Melbye M, Grossman RJ, Goedert JJ, Eyster ME, Biggar RJ. Risk of AIDS
after herpes zoster. Lancet 1987;1:728-31.
6. Gershon AA. Varicella-zoster virus infections. In: Spittell JA Jr, ed.
Clinical medicine. Vol 3. Philadelphia: Harper and Row, 1985.
7. Garner JS, Simmons BP. Guideline for isolation precautions in hospitals.
Infect Control 1983;4(suppl 4):245-325.
8. Williams WW. Guideline for infection control in hospital personnel.
Infect Control 1983;4(suppl 4):326-49.
*Three women had "interfering substances" in their serum preventing a
determination of VZ antibody presence, but subsequent interviews with family
members established a childhood history of chickenpox in all three cases.
--
David Canzi