Creutzfeldt-Jakob disease in pituitary growth hormone recipients in the United States

Article Abstract:

Human growth hormone (HGH, or somatotropin), a hormone made in the pituitary gland, is an effective treatment for growth failure due to insufficient pituitary activity; until the latter half of the 1980s, HGH was prepared from pituitary glands that had been removed from cadaver brains. However, the occurrence of Creutzfeldt-Jakob disease (CJD; a rare but fatal, degenerative nervous system disease) in three young patients who had received pituitary-derived HGH led to the suspicion that the cadaver tissue had contained infected pituitary glands. The distribution of this type of HGH was stopped, and an epidemiologic study of all patients who had received it was started. Eighty-four percent (5,288 people) of the group of 6,284 patients who received HGH were studied. They were interviewed by telephone and contacted again several months later if symptoms of the type associated with CJD were present. Data were also analyzed concerning patients' deaths and the distribution patterns of hormone lots. The average patient had started treatment with HGH at an age just younger than 10 and had continued for almost three years. Seven cases of CJD were identified in this group of patients, five of whom had been identified when the current study began. Clinical summaries are presented for these patients. One died in the early stages of the disease; the others developed poor balance and gait disturbances as their first signs. They then progressed to more severe disturbances of coordination, and dementia (cognitive loss). More commonly with CJD, mental aberrations appear first, then coordination disturbances. These seven patients had longer courses of treatment than the group as a whole (100 months versus 41 months, on average) and all had started treatment with HGH before 1970. No single lot of HGH could be identified as having been distributed to these patients, nor were the cases confined to any single treatment center. The average incubation period of CJD is 15 years, and only approximately one tenth of the group has been followed that long. Thus, an increasing number of deaths due to this cause seems likely, as the infected former HGH recipients become ill. On the other hand, the method of preparing HGH changed in 1977 to one more likely to reduce viral contamination, and infection rates may not be constant. In any event, it appears that longer durations of HGH treatment put patients at risk for CJD. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Quality management, Disease transmission, Somatotropin, Contamination, Creutzfeldt-Jakob disease

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Impact of free vaccine and insurance status on physician referral of children to public vaccine clinics

Article Abstract:

Physicians who care for uninsured children are likely to refer them to a free vaccination clinic, which could result in a delay in vaccination. A survey of 1,236 family physicians, general practitioners and pediatricians revealed that 58% used the child's insurance status to decide whether to vaccinate them or send them to a clinic. Physicians who received free vaccines from the Vaccines for Children program were much less likely to refer the child to a clinic than physicians who did not receive free vaccines. This program was set up specifically to provide free vaccination to those unable to afford it.

Surveys, Medical referral, Insurance

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Effect of a Monetary Sanction on Immunization Rates of Recipients of Aid to Families With Dependent Children

Article Abstract:

A financial penalty may encourage welfare parents to get their children vaccinated. In a study of 2,500 families who received Aid to Families with Dependent Children, 1,500 were told that they would not receive benefits for any preschool child who was not completely vaccinated. At 2 years of age, 72.4% of children in the penalty group were completely vaccinated compared to 60.6% of the children whose families were not penalized.

Evaluation, Economic sanctions, Sanctions (International law)

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