Major infectious diseases causing excess morbidity in the Hispanic population.

Current data indicate that there are a number of infectious diseases, ie, acquired immunodeficiency syndrome/human immunodeficiency virus infections, cysticercosis, hepatitis A, syphilis, tuberculosis, and typhoid fever, among others that cause disproportionately increased morbidity in Hispanics. The greater rate of poverty with its associated socioenvironmental problems, increased barriers to health care, and importation of infectious diseases endemic in the mother country are some of the major reasons that probably account for this disparity in disease burden in Hispanics. This formidable health problem can be addressed by targeting efforts at improving health education of family units and communities, environmental improvements, elimination or reduction of barriers to health care management and disease prevention, and appropriate screening programs. A comprehensive and uniform assessment of the impact of infectious diseases on Hispanics (and other minorities) in this country remains elusive, but is of paramount importance in establishing priorities and effective/efficient strategies to address this issue.

Epstein-Barr virus antibodies in multiple sclerosis.

Serum antibody titers to Epstein-Barr virus (EBV), an agent that persists in a latent form after the initial infection, were determined in 157 patients with multiple sclerosis and in 81 control subjects. Two patients (1.3%) and five control subjects (6.2%) lacked antibodies to EBV. In the subjects with antibodies, the prevalence of high titers (greater than or equal to 1:160) was significantly greater in patients, 69 (44.5%), than in control subjects, 22 (28.9%). The geometric mean titer of antibodies to EBV was significantly higher in patients, 107.0, than in control subjects, 77.1. There was no association between antibody titers and duration or activity of the disease. These findings further support the contention that patients with multiple sclerosis have a general aberration of the immunological system.

A heterophile system in human renal transplantation. IV. Natural immunity and its genetic implications.

Natural heterophile immunity was studied in 949 individuals including 41 recipients and donors of renal transplants and 141 families. The prevalence and strength of the natural immunity was at its maximum during the first two decades of life and declined thereafter. The population could be divided into three groups: one with natural immunity to heterophile transplantation antigens (HT-A), one with a heterophile immunity which was not (anti-HT-A) (i.e., anti-HX-A), and one group which had no heterophile immunity. Transplantation among these groups yielded results which along with family studies and mathematical considerations suggest that the HT-A system is controlled by a single genetic locus comprised of one dominant and one recessive allele.

Primary Epstein-Barr virus infections in children.

During a serioepidemiologic survey of a community, 13 (6.2%) of 209 children were found to be experiencing a current or recent primary Epstein-Barr virus (EBV) infection. The sera contained elevated antibody titers to viral capsid antigen of EBV, antibodies to early antigen (EA) of EBV, and specific IgM. The frequency of primary infections was highest in the first decade of life. The primary EBV infections were usually asymptomatic. The antibody to EA was directed predominantly to the R component. A heterophil antibody response was not detected.

Epstein-Barr virus infectious mononucleosis in children. I. Clinical and general laboratory findings.

Between 1976 and 1982, 113 children aged 6 months to 16 years with documented Epstein-Barr virus-induced infectious mononucleosis were studied prospectively, and in most instances serially. An unexpected finding was the large number of young children, less than 4 years old, with this disease. Children with infectious mononucleosis, in particular the very young, tended to have more rashes, significant neutropenia, abdominal pain (older children only), and possible hepatosplenomegaly than have been reported in adult patients. The intensity of the characteristic relative atypical lymphocytosis found in peripheral blood was age-related; it was less in the very young. Findings of failure to thrive, otitis media, and episodes of recurrent tonsillopharyngitis appeared to be unique or more closely associated with childhood disease. Complications such as thrombocytopenia with hemorrhagic manifestations, significant airway obstruction, and neurologic problems occurred more frequently whereas jaundice occurred less frequently than noted in adult patients. Six children, all less than 4 years old, developed pneumonia during the disease course. The increased availability of Epstein-Barr virus-specific testing should continue to expand our knowledge of this disease in children of all ages.

Epstein-Barr virus infectious mononucleosis in children. II. Heterophil antibody and viral-specific responses.

An investigation was performed to address the need to establish the rate of positive heterophil antibody responses, oropharyngeal isolation of Epstein-Barr virus (EBV), and the evolving pattern of EBV-specific antibody responses among children with documented EBV-infectious mononucleosis. Findings showed that the rate of heterophil antibody responses appeared to increase progressively with advancing age from infancy up to 4 years, after which the rates approached values similar to that reported in young adult patients. The rapid slide test detected a heterophil antibody response as frequently as the Paul-Bunnell-Davidsohn horse cell test, except in children less than 4 years old. The decreased sensitivity found with the rapid slide test in the very young was associated with their less intense heterophil response. The younger group of children also developed a lower acute mean titer and, as a result, a decreased persistence of immunoglobulin M antibody to EBV-capsid antigen, whereas they had more frequent responses to EBV-early antigen directed to restricted component than both the older subjects and adults reported elsewhere. Antibodies to EBV-nuclear antigen, characteristically a late-onset antibody, tended to develop earlier than noted in adult patients. In contrast, the prevalence and continued excretion of EBV from oropharyngeal secretions was similar to that reported in adult patients. It is speculated that these age-related differences in host responses are associated with the ontogeny of the immunologic system.

Persistence of antibody after the administration of influenza vaccine to children with cancer.

Children with cancer who received an intramuscular injection of inactivated split or whole bivalent (A/New Jersey/76-A/Victoria/75) influenza virus vaccine during the fall of 1976 were tested up to 18 months later for the persistence of antibody. Titers of antibody greater than of equal to 10 to influenza A/New Jersey/76 virus were present in the sera of 34 children two weeks after immunization. The geometric mean titer was 40.0. Eighteen months later a titer greater than or equal to 10 was present in 13 (38%) children; the geometric mean titer was 8.5. Of 36 children with a titer of antibody greater than or equal to 10 to A/Victoria/75 virus two weeks after immunization, 34 still had a detectable titer in the later examination. The geometric mean titer declined from 65.3 to 25.6. Titers of antibody to B/Hong Kong/72 virus (not included in the vaccine) remained relatively stable. In 11 children the usual chemotherapy was discontinued during the study. The shorter persistence of antibody to A/New Jersey/76 virus, in contrast to that of the other two influenza viruses tested, was associated with a lack of prior exposure to the virus and the absence of subsequent natural infection with this virus or an antigenically related subtype. The potential effect of cancer chemotherapy on the persistence of antibody levels is unclear.

The rapid diagnosis of infectious mononucleosis using an ELISA that detects IgM antibody to a peptide component of Epstein-Barr virus nuclear antigen.

An enzyme-linked immunosorbent assay (ELISA) that detects IgM antibody to a peptide component of the Epstein-Barr virus (EBV) nuclear antigen (EBNA-1) was compared with a conventional rapid heterophil antibody method for the rapid diagnosis of infectious mononucleosis. Discrepancies between the two methods were further analyzed using an indirect immunofluorescence assay to detect antibodies to EBV antigens. We evaluated 298 cases of suspected infectious mononucleosis. The ELISA was very sensitive (98.7%) and able to detect some cases (seven (9%) of 75 confirmed positives) that were negative by the rapid heterophil antibody test, but confirmed by immunofluorescence. However, approximately 17% of all positive tests could not be confirmed by EBV-specific immunofluorescence; thus, the overall positive predictive value was 83%; negative predictive value was 99.5%; and specificity was 93%. The high rate of false-positive tests makes this rapid ELISA unsuitable for the diagnosis of infectious mononucleosis.

HRSA's strategies to combat family violence.

This paper discusses the efforts of the Health Resources and Services Administration (HRSA) to work with a broad constituency to combat and ultimately prevent family violence. In partnership with states and communities, HRSA implements programs to strengthen health care infrastructure, support direct community-based service delivery, and educate health care providers. Soliciting and incorporating community input are critical steps in designing innovative training approaches to deal with pressing health concerns, such as the efforts of family violence in a community. This type of collaboration is evident in HRSA's programs such as the Area Health Education Centers, the Geriatric Education Centers, and the AIDS Education and Training Centers. Health care delivery systems and special health interventions must respond to the far-reaching effects of family violence. HRSA is devising a comprehensive strategy to guide program development in violence intervention. This strategy would build on successful models of education, prevention, and service delivery, as well as identification of critical areas for collaboration between community activists, researchers, epidemiologists, health care providers, policymakers, academicians, survivors, philanthropists, representatives from state and local government, and the faith community.

Serologic and virologic epidemiology of Epstein-Barr virus: relevance to chronic fatigue syndrome.

Patients considered to have chronic fatigue syndrome (CFS) have been reported to exhibit an increased antibody response to Epstein-Barr virus (EBV) early antigen complex and capsid antigen, findings that suggest some relationship between EBV and CFS. However, the serologic findings have not been totally consistent among different study groups, and the antibody patterns in asymptomatic individuals may be similar. Moreover, patients with symptomatology indicative of CFS do not appear to have an abnormal burden of EBV in body fluids and manifest only a variable, mild degree of EBV-specific cell-mediated responses. The evidence is growing that the serologic findings of an enhanced EBV state in individuals with CFS-like manifestations, as well as the subsequent reports of increased antibody titers to other viruses, reflect a generalized underlying immunologic dysfunction in these patients. Future studies with criteria-defined CFS study groups in which determinations are made of antibody responses to newly identified EBV-associated nuclear antigen components and distinct EBV proteins in addition to specific virologic and immunologic analyses of EBV may be worthwhile as a means of clarifying the association between EBV and CFS.

Epidemiologic study of a leukocyte-transforming agent in a general population.

Studies by others have demonstrated a leukocyte-transforming agent(s) (LTA) in the oropharyngeal secretions of a significant number of individuals with Epstein-Barr virus-associated infectious mononucleosis, cancer, and, to a lesser extent, an outpatient population. This present study determines by systematic sampling the prevalence of LTA in 27 families of a semirural community. Throat swab inoculums from three of 54 adults and none of 44 children induced transformation of umbilical cord lymphocytes. Complement-dependent Epstein-Barr virus nuclear antigen was detected in two of the three transformed cell cultures. The three LTA-positive individuals were characterized by the absence of serologic evidence of a recent Epstein-Barr virus infection and the lack of elevated antibodies against the viral capsid antigen of Epstein-Barr virus.

Endogenous reactivation of Epstein-Barr virus infections.

In a prior systematic community survey, 20 adults were found to have antibodies to viral capsid antigen (VCA) and early antigen (EA) OF Epstein-Barr virus (EBV) in serum. The presence of the latter antibody suggested a recent response to EBV. In the present study the significance of antibody to EA was more extensively evaluated by examination of the sera of these adults for the presence of EBV-specific IgM antibodies (EBV-IgM) and antibodies to EBV nuclear antigen (EBVNA). Sera of a matched group of adults with antibodies to VCA but without antibodies to EA were compared with those of the 20 adults with antibodies to EA (anti-EA-positive). In the anti-EA-positive group, 19 specimens of serum contained EBV-IgM, 16 contained elevated titers of antibodies to VCA, and 20 contained antibodies to EBVNA. The sera of the matched group had neither detectable EBV-IgM nor elevated titers of antibodies to VCA; however, all sera had antibodies to EBVNA. None of the individuals gave a history of an infectious mononucleosis-like illness. It was suggested that the majority, if not all, of the anti-EA-positive group were manifesting a host immune response to endogenous reactivation of latent EBV. It is of interest that the presence of EBV-IgM was part of this response.