Annual influenza vaccination of persons aged 65 years or older has been
shown to have both health and economic benefits. To study the clinical efficacy
and cost-effectiveness of annual influenza vaccination of younger, working
adults, Bridges and coauthorsArticle conducted a trial of influenza vaccine among
healthy employees of a US manufacturing company, aged 18 to 64 years, during
2 consecutive influenza seasons. In the 1997-1998 influenza season, when the
vaccine virus differed from the predominant circulating viruses, rates of
influenzalike illnesses and associated physician visits and work absenteeism
were higher in the vaccination group than in the placebo group. In the 1998-1999
season, when the vaccine and predominant circulating viruses were well-matched,
rates of influenzalike illnesses, lost work days, and physician visits were
significantly reduced in the vaccination group compared with placebo. However,
vaccination did not provide overall economic benefit in either season—the
net cost per person was $65.59 in 1997-1998; $11.17 in 1998-1999. In an editorial,
MontoArticle points out that because vaccine availability is expected to be limited
this coming influenza season, these findings support current recommendations
to give first priority to immunizing elderly and high-risk patients, and their
In some cases, amyotrophic lateral sclerosis may be familial. It may
also occur concurrently with other neurodegenerative syndromes. In a set of
families in which persons develop both amyotrophic lateral sclerosis and frontotemporal
dementia or either alone, Hosler and colleagues identified a new genetic locus
linked to familial amyotrophic lateral sclerosis with frontotemporal dementia
located on chromosome 9.
About 4 years ago, the Health Care Financing Administration began a
program to measure and track the quality of medical care provided to fee-for-service
Medicare beneficiaries. Jencks and colleagues describe the initial 24 process-of-care
quality indicators used in the program and report the performance of each
state on these measures and their relative rank between 1997 and 1999. Performance
rates for each measure varied widely by state; and for all measures, the percentage
of patients receiving appropriate care in the median state ranged from 11%
Young children in day care are at high risk for influenza infection
and appear to be more likely than school-aged children to transmit respiratory
illnesses to their household contacts. In this randomized trial during the
1996-1997 influenza season, Hurwitz and colleagues administered inactivated
influenza vaccine or hepatitis A vaccine as a control to children aged 24
to 60 months in day care centers. Febrile respiratory illnesses were significantly
reduced among unvaccinated household contacts of day care children in the
vaccination group, as was respiratory illness–related morbidity among
unvaccinated household contacts aged 15 to 17 years, compared with the control
Mycobacterium tuberculosis is usually transmitted
directly from person to person when aerosolized by coughing or sneezing. Johnson
and colleaguesArticle report an investigation of tuberculosis (TB) transmission to
3 workers at a medical waste treatment facility exposed during processing
of infectious medical waste from a laboratory. In an editorial, SepkowitzArticle
stresses the importance of conducting research on occupationally acquired
infections in non–health care workers.
"Intimidated and confused, never before had I sat so close to one who
was dying. Never had I listened to thoughts of how the path to death might
unfold, or heard the desire to seek not more life but less suffering." From
"Dare We Go Gently."
Experts debate the need for new federal regulatory measures to control
the spread of tuberculosis in health care facilities.
Reasons to consider drug dependence as a chronic medical illness, rather
than a social problem or an acute, curable condition, and implications for
treatment, insurance coverage, and outcomes evaluation.
Koplan and Fleming from the Centers for Disease Control and Prevention
outline 10 public health challenges for the next century.
Patient-centered medical care: Benefits and opportunities.
For your patients: A primer on influenza vaccination.
This Week in JAMA. JAMA. 2000;284(13):1615. doi:10.1001/jama.284.13.1615