Measles outbreak in a fully immunized secondary-school population.

An outbreak of measles occurred among adolescents in Corpus Christi, Texas, in the spring of 1985, even though vaccination requirements for school attendance had been thoroughly enforced. Serum samples from 1806 students at two secondary schools were obtained eight days after the onset of the first case. Only 4.1 percent of these students (74 of 1806) lacked detectable antibody to measles according to enzyme-linked immunosorbent assay, and more than 99 percent had records of vaccination with live measles vaccine. Stratified analysis showed that the number of doses of vaccine received was the most important predictor of antibody response. Ninety-five percent confidence intervals of seronegative rates were 0 to 3.3 percent for students who had received two prior doses of vaccine, as compared with 3.6 to 6.8 percent for students who had received only a single dose. After the survey, none of the 1732 seropositive students contracted measles. Fourteen of 74 seronegative students, all of whom had been vaccinated, contracted measles. In addition, three seronegative students seroconverted without experiencing any symptoms. We conclude that outbreaks of measles can occur in secondary schools, even when more than 99 percent of the students have been vaccinated and more than 95 percent are immune.

A combined family and community medicine clerkship.

In 1973, the Eastern Virginia Medical School was established with a goal of producing primary care physicians. As part of this goal, a family practice clerkship experience was required for each medical student. An office based clerkship was developed with students spending five half-days a week in a volunteer family physician's office. To expand the clerkship so that students had contacts and experiences with community resources, several additional experiences were added in community medicine areas: a twice-a-week seminar series, public health agency visits, and an emergency room experience. After four years, using data from faculty and students, student evaluations, and the residency choices of graduates, the clerkship has met most of its objectives. This program shows that a community based educational program with volunteer faculty and few full-time faculty can be office based and still ensure similar experiences and learning through a community medicine focus and weekly seminar sessions.

Some estimates of the potential reduction in the U.S. infant mortality rate by family planning.

PIP: An objection is made to the use of 12-year-old National U.S. infant mortality data to relate the possible effects of local family planning programs occurring 10 years after the data events took place. Family planning techniques and practice as well as the methods of child care, the application of public health techniques for prevention of infant deaths, the causes of infant mortality, and the availability of prenatal care have changed extensively over the last 12 years. In addition, local infant mortality data should be refined because national infant mortality data lacks homogeneity. Graphs are presented which illustrate the data differences when progressing to smaller and smaller geographic areas. Thus, extrapolations based on old infant mortality rates are useful only if significant local variations of data within state areas are taken into account.^ieng