Whooping cough in relation to other childhood infections in 1977-9 in the United Kingdom.

Estimates based upon notifications indicate that there was in the 1977-9 triennium in the United Kingdom the largest outbreak of whooping cough for 20 years or more. During this triennium there was also a sharp increase in other infections diseases of childhood, notably in non-notifiable respiratory infections. Isolates of certain respiratory viruses ran in parallel and collectively outnumbered those of Bordetella pertussis during the period of increase in notifications. There was highly significant positive correlation between isolates of B pertussis and of ECHO viruses, of Mycoplasma pneumoniae and rhinoviruses and, in Scotland only, of Coxsackie virus. Deaths in which whooping cough was certified as the immediate of underlying cause were lower than in previous outbreaks. Only a minority were bacteriologically confirmed. A closer study of the outbreak in Glasgow disclosed considerable variations in notification procedure and lack of correlation with isolates of B pertussis at the peak of the notification period. Attack rates calculated from notification were higher in deprived areas. Birth cohort studies showed a significantly higher proportion of notifications in unvaccinated children aged 1-4 and this was confirmed in family studies of clinical whooping cough in home contacts. But, overall, about 35% of reported cases were children who had received three injections of triple vaccine. Acceptance of pertussis vaccine fell sharply in 1975 but about 95% of unvaccinated children in age groups 0-5, including the 1977 and the 1977 and 1978 birth cohorts, either escaped infection or were not notified.

A mathematical model of a heroin epidemic: implications for control policies.

An exponential model based on the infectious disease model of Kermack and McKendrick has been simplified to illustrate how the use of heroin spreads in epidemic fashion. A numerical simulation is arranged to show how the dynamics of spread are influenced by the original number of users, rates of conversion, and time of removal from the drug scene of those secondarily affected. The spread is significantly increased by small increases of those originally affected, in which case reduction of spread requires a large increase in rate of removal. The model indicates a strategy for intervention which is discussed in relation to policies for control of drug abuse.

Community medicine in the medical curriculum: a statistical analysis of a professional examination.

This paper analyses the examination results of two cohorts of medical students at the University of Glasgow. It discusses the usefulness of Scottish higher grades as predictors of ability to pass examinations in medicine. Further correlations are made between the results from community medicine and other fourth- and fifth-year medical school examinations.

AIDS: safety, regulation and the law in procedures using blood and blood products.

The purpose of this paper is to examine issues of regulation of the market for, and use of, blood and blood products. The situation has changed since the discovery of the Human Immune Deficiency Virus (HIV), the presumed cause of AIDS, because it was recognized that some haemophiliacs were infected with HIV from transfused blood and blood products before 1985. When the danger was realized in that year, regulations were introduced internationally to prevent this, but meanwhile some haemophiliacs developed AIDS. In several countries, governments have accepted responsibility, without liability, for possible transmission of infection, and paid compensation to victims. In France three health service officials have been convicted of fraud and criminal negligence. In March 1997 a trial began in Japan of three drugs company executives accused of promoting the sale of HIV-contaminated blood products. Since then there has been a class action in the USA resulting in awards. Further issues have arisen with regard to the outcome and treatment of asymptomatic infection with HIV. The implications for public safety, and for medical and legal practice, are far reaching and reveal a need for more effective monitoring of the existing procedure for supply and clinical use of blood and blood products.

Infection and immunization.

Herd infections, especially in children, are strongly influenced epidemiologically by social and demographic factors which have contributed favorably to a general decline in incidence and mortality during the past 50 years or more. Intervention procedures such as immunization cannot be evaluated or planned realistically except against these background factors. Assessed in this way, immunization against diphtheria and poliomyelitis was unequivocally effective in reducing incidence and morbidity of these diseases. By comparison, pertussis vaccine has a very limited protective effect, the value of which, as morbidity decreases, may be offset by the intrinsic toxicity of the vaccine and by the possibility of infrequent but severe brain damage in some children.

Effectiveness of one-to-one health education in the home.

HEALTH education conventionally takes one of two forms, a mass campaign to the whole population using the media, or an approach to members of chosen at-risk groups, through individual or small group sessions. The following study explores the efficacy of one-to-one education of the whole adult population, at risk or not, by visiting a random sample of them in their homes and giving them information on one of four relevant topics, adapting the style and content to the individual's needs and interests. The survey therefore tests the technique of a flexible, person-orientated approach to health education.

Knowledge of health information and services in a random sample of the population of Glasgow.

A RANDOM sample of adults in Glasgow was surveyed by trained interviewers to determine public knowledge on four topics chosen specifically for each of four age groups. The topics were: Welfare rights and services; Coronary Heart Disease (CHD) and individual action that can reduce risk; The dangers of smoking in pregnancy; and fluoride and its functions and the connections between good health and habitual behaviour.

The epidemiology and transmission of AIDS: a hypothesis linking behavioural and biological determinants to time, person and place.

Epidemiologically, the Acquired Immune Deficiency Syndrome, AIDS, is transmitted and distributed in the USA and Europe almost entirely in well-defined subsets of populations engaging in, or subjected to, the effects of behaviours which carry high risks of genital and systemic infections. The persons predominantly affected are those engaging in promiscuous homosexual and bisexual activity, regular use of addictive drugs, and their sexual and recreational partners. In such persons and in subsets of populations with corresponding life-styles, the risk of AIDS increases by orders of magnitude. Because of continuity of risk behaviour and of associated indicator infections, the incidence of AIDS over 3-5 year periods is predictable to within 10% of actual totals of registered cases in the USA and UK. Secondary transmission of AIDS beyond these groups is minimal or, in many locations, absent. There is no indication of appreciable spread by heterosexual transmission to the general population. The Human Immunodeficiency Virus, HIV, is transmissible to some extent in general populations, and more so among promiscuous persons. It may cause viraemia, lymphadenopathy and latent infection (HIV disease) in anyone. In persons engaging in risk behaviours which themselves alter or suppress immune responses, it can interact with MHC, antibodies to other organisms and to semen, and other allogenic antigens to initiate a programmed death of CD4 lymphocytes and other defensive cells, as in graft-host rejections. This occurs also in haemophiliacs receiving transfusions of blood products, and is more pronounced in persons with reactive HLA haplotypes. The susceptibility of particular subsets of populations to AIDS is thereby largely explained. But these changes occur in the absence of HIV, and so do Kaposi's sarcoma, lymphadenopathies and opportunistic infections which are regarded as main indicators of AIDS. The hypothesis that HIV-1 can do all this by itself and thereby cause AIDS is falsifiable on biological as well as epidemiological grounds. An alternative hypothesis is proposed, linking the incidence of AIDS to the evolution of contemporary risk behaviour in particular communities and locations in the USA, UK and probably in most of Europe. It does not pretend to explain the reported incidence of AIDS in Africa and other developing regions where data are insufficient to provide validation of the pattern of disease and contributory variables. The immediate, practical implication of this alternative hypothesis is that existing programmes for the control of AIDS are wrongly orientated, extremely wasteful of effort and expenditure, and in some respects harmful.

Scientific surveillance and the control of AIDS: a call for open debate.

This paper reviews some of the history of AIDS in order to put into perspective the claim that AIDS is or will be the pandemic plague of the twentieth century. It is concluded that AIDS shows a relatively stable and predictable pattern in the developed world, and that open and unbiased debate about AIDS is long overdue.

Medicine and health: What connection?

In most countries resources for the health services are allocated, increasingly and often overwhelmingly, to hosptial-oriented medical care and drug-dependent therapy. The assumption that community health will thereby be improved remains questionable even in developed countries, and is insupportable in developing countries. Technical advances and specialisation in medical sciences are now counterproductive by pre-empting limited resources and obscuring basic needs. To re-establish proportionality, priority should be accorded to: (a) application of proven preventive procedures for hazards of high prevalence, including excessive population growth; (b) improvements in housing and sanitation; and (c) extension of primary care by medical and other staff specially trained in the early recognition and management of personal complaints and of family and community problems.