Major expansions of select CD8+ subsets in acute Epstein-Barr virus infection: comparison with chronic human immunodeficiency virus disease.

CD8+ lymphocyte phenotypes were characterized during acute Epstein-Barr virus (EBV) infection, and a comparison was made to previous studies of human immunodeficiency virus (HIV). This was of interest because CD8+ cells contribute to immunologic control of both infections, but the usual outcome of EBV infection is benign, whereas untreated HIV infection is fatal. During acute EBV infection, CD8+ cells expressed elevated levels of the activation antigens CD38 and HLA-DR, similar to that during chronic HIV infection. Within 16 weeks, when EBV latency is established, CD8+ cell activation had resolved. In contrast, activation persists in HIV infection. Expression of CD38 and HLA-DR on CD8+ cells could be a marker for ongoing viral replication in both infections. Other CD8+ cell alterations observed in this study of acute EBV infection included increases in both CD62L- and CD62L+ CD8+ cells and unique kinetics in the expansion of the CD57+CD8+ cell subset.

Health care industry consolidation: implications for physician executive careers.

Corporate America is changing in ways never seen before. At the same time that stockholders are cheering the rise in many companies' profits, people within these organizations are struggling with new definitions of job and career. To satisfy Wall Street and presumably to be more successful, workers and managers are encouraged to become more entrepreneurial, more accountable, more efficient. If they are successful, they are told, they might get to keep their jobs, but there are no guarantees. Security, whether economic or emotional, is no longer part of the deal.

Health care use by human immunodeficiency virus-infected students at a California student health service.

We report characteristics of 16 college students with human immunodeficiency virus (HIV) infection but without the acquired immunodeficiency syndrome who received care at a student health center at a major university in California. Sociodemographic and clinical data and medical expenditures were obtained retrospectively from medical charts and computerized billing records. All 16 students were men who had sex with men, and 3 had also used intravenous drugs. Dermatologic conditions, upper respiratory tract infections, gastrointestinal conditions, anemia, lymphadenopathy, sexually transmitted diseases, and ophthalmologic conditions were more frequent among HIV-infected students than among the general student population using the health center. On average, HIV-infected students visited the student health service about 3 times more often and incurred charges about 10 times higher than the general population of students visiting the health center. Student health centers, which have been at the forefront of developing strategies for HIV prevention, education, and counseling, must also develop treatment programs for HIV-infected students.

A search for Bordetella pertussis infection in university students.

University students with persistent cough of greater than or equal to 6 days' duration were evaluated for evidence of infection with Bordetella pertussis. Of 130 students studied during a 30-month period, 34 (26%) were found to have evidence of recent infections with B. pertussis. Infection was identified by direct fluorescent antibody assay of a nasopharyngeal specimen in one student and serologically in 33 additional subjects. B. pertussis was not recovered on culture of nasopharyngeal specimens from any subjects. Students with B. pertussis infection were identified in seven of the eight 3-month periods in which students were enrolled during the 30-month investigation, suggesting an endemic rather than epidemic pattern of infection in this university population. Illnesses of students with pertussis were similar to the illnesses of students without pertussis. The findings in this study suggest that adult populations in which endemic illness occurs at a relatively constant rate may be the reservoirs for pertussis outbreaks in susceptible children. Immunization programs in the future will need to employ booster doses for adults if complete control of B. pertussis infection is our goal.

Cost-effectiveness evaluation of measles immunization strategies on a college campus.

Since live rubeola vaccine became available in 1963, routine immunization of children at age 15 months has been the recommended strategy for eliminating measles in the United States. However, due to increasing measles outbreaks, especially among previously immunized populations, the Immunization Practices Advisory Committee (ACIP) recently recommended modifying the one-dose measles vaccination policy to a two-dose schedule, one at 15 months and one at age 5 or 6 years. To address the present college population, ACIP recommended vaccinating all college students who lack proof of immunity. We used the methods of decision analysis to examine the cost effectiveness of implementing such a program in a specific college population, namely, students at the University of California at Los Angeles (UCLA). We developed a model to examine three possible vaccination strategies: "wait," "screen," and "vaccinate all." Estimates of probabilities and cost were derived from several outbreaks at UCLA as well as statewide data. In the baseline case, the least expensive strategy is to wait until an outbreak occurs before implementing a vaccination program. The additional cost incurred by screening per measles case avoided is $122,871. However, using sensitivity analysis, we found that the overall cost of elective vaccination strategies is driven by the cost of the vaccine itself. If vaccine could be provided at a nominal cost to the university, a strategy of vaccinating all students without proof of immunity (by either history of two vaccinations or positive titer) would provide the high level of immunity needed to prevent outbreaks and still be most cost effective ($16,644 per measles case avoided).

The challenge for women physician executives.

After half a century of constituting 5 percent of the physician population, women will soon make up more than one-third of U.S. physicians. Women now practice in virtually every specialty. This enormous change has created both opportunities and tensions. Within the broader context of the changing role of women in U.S. society, women physicians are exploring new career paths--paths that are both similar to and different from those of their male colleagues. A future challenge for women physicians will be achieving significant representation in the medical management ranks.

Evaluation of a tuberculosis screening and prophylaxis program for international students.

In many parts of the world, tuberculosis (TB) is still a major cause of morbidity and mortality. Because of the high rate of worldwide TB infection, the University of California, Los Angeles (UCLA), requires nonimmigrant foreign students to have a tuberculin skin test before completing registration for classes. Out of 589 students tested, 57.6% were positive (n = 339) at the level of 5 mm induration or greater. All positive reactors with no contraindications to isoniazid (INH) were urged to take INH chemoprophylaxis (n = 290). Several strategies designed to improve compliance were used with all students. In addition, some students attended a lecture and discussion prior to initiation of therapy. Completion rates were low for all students, including those who attended the lecture-discussion session. Implications of the results for future screening activities are discussed.

Screening and immunization of rubella-susceptible women. Experience in a large, prepaid medical group.

Four hundred and fifty childbearing-aged women were screened for rubella hemagglutination inhibition (HI) antibody after a clinical history of susceptibility was obtained. One hundred and forty-nine (33%) were found to be susceptible (titers less than 1:8), pointing out the need for a move active immunization program for susceptible young women and for routine vaccination of children. Clinical history correlated poorly with the level of HI antibody. One hundred percent of the patients were vaccinated and protective antibody titres developed in 97%. Since titers are higher after infection than after vaccination, periodic reevaluation of the vaccinated group may be indicated if immunity is to be ensured.