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April 25, 2002 Vol. 346 No. 17
In a randomized, single-blind study, 680 healthy, previously unvaccinated adults were inoculated intradermally with undiluted vaccinia virus vaccine, a 1:5 dilution, or a 1:10 dilution. The success rates were similarly high in all three groups: 97.2 percent, 99.1 percent, and 97.1 percent, respectively. Local and systemic symptoms were common, and 14 percent of subjects had rash at another site, including erythema multiforme in two subjects.
The administration of undiluted vaccinia vaccine led to vesicle formation in 19 of 20 healthy volunteers. With a 1:10 dilution, the success rate was 70 percent. With a 1:100 dilution the success rate was only 15 percent. The appearance of vaccinia vesicles correlated well with vigorous cytotoxic T-cell responses and with interferon-γ T-cell responses.
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Pulmonary dead space, the fraction of ventilation that is wasted, is greater than normal in patients with the acute respiratory distress syndrome who are undergoing mechanical ventilation. This study found that when the dead-space fraction was measured early in the course of the syndrome, higher values were independently associated with an increased risk of death.
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There is some concern about whether medical care of similar quality is offered by for-profit and nonprofit health maintenance organizations (HMOs). This study analyzed assessments of medical care by enrollees in for-profit and nonprofit HMOs. It found that although there were few overall differences, for-profit HMOs were rated less favorably than nonprofit HMOs by patients with self-reported fair or poor health.
A 19-year-old woman is brought to the emergency room because of the acute onset of dyspnea, wheezing, vomiting, and generalized flushing. She has well-controlled asthma as well as a history of atopic dermatitis as an infant and urticaria after ingesting peanut butter at the age of five years. According to friends she ate a chocolate-chip cookie from a vending machine just before her symptoms developed. The ingredients listed on the cookie wrapper do not include peanuts. Nevertheless, how should this patient's condition be treated?
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In the wake of the September 11, 2001, terrorist attacks, the Centers for Disease Control and Prevention proposed a model act for the states that specifies steps to be taken to contain an epidemic resulting from a bioterrorist attack. The act would grant broad powers to the states in the event of public health emergencies arising from bioterrorism. Annas discusses the trade-off between civil liberties and the need to protect the health of the public in the event of bioterrorism. His underlying premise is that the model act, despite being revised in December 2001, goes too far.
