In 1982, the Centers for Disease Control, the Food and Drug Administration, and the manufacturer created a surveillance system to monitor spontaneous reports of adverse events occurring after inoculation with the new plasma-derived hepatitis B vaccine (Heptavax-B, Merck Sharp and Dohme, West Point, PA). In the three years between June 1, 1982 and May 31, 1985, an estimated 850,000 persons received the vaccine. During that period, a total of 41 reports were received for one of the following neurologic adverse events: convulsions (five cases), Bell's palsy (10 cases), Guillain-Barré syndrome (nine cases), lumbar radiculopathy (five cases), brachial plexus neuropathy (three cases), optic neuritis (five cases), and transverse myelitis (four cases). Half of these occurred after the first of three required vaccine doses. There were no deaths. Calculation of the relative risks of these illnesses after hepatitis B vaccination was highly dependent on diagnostic classification of the cases, estimates of the size of the vaccinated population, background incidence of the diseases, and the length and distribution of the hypothetical at-risk interval used in the analysis. Other factors important in judging the results of the study could not be measured, including underreporting. In some analyses, Guillain-Barré syndrome was reported significantly more often than expected (p less than 0.05, Poisson probability distribution). However, no conclusive epidemiologic association could be made between any neurologic adverse event and the vaccine. Even if such an association did exist, the preventive benefits of the vaccine in persons at high risk for hepatitis B would unequivocally outweigh the risk of any neurologic adverse event.
A serosurvey for antibodies to Legionella pneumophila was conducted among 206 employees of a power-generating plant. L. pneumophila serotype 6 and a non-typable L. pneumophila organism were isolated from cooling-tower water specimens at the plant, and antibody titers in workers were measured using homologous antigens prepared from these isolates. For the serotype 6 water isolate, none of workers with low cooling tower exposure, 4.6% with intermediate exposure, and 7.6% with high exposure levels had titers equal to or greater than 1:128 (P less than .05, Kruskal-Wallis test). For the non-typable L. pneumophila isolate, a similar trend was observed, but differences among workers in the three exposure groups were not statistically significant. No association was observed between antibodies to L. pneumophila serotypes isolated from cooling water and workers' age, race, smoking status, or duration of job assignment. None of the study employees had findings suggesting the occurrence of L. pneumophila pneumonia since the plant had been in operation. Use of respiratory protection devices by workers exposed to aerosols from cooling towers was not recommended.
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