A multiple-source method for studying the prevalence of developmental disabilities in children: the Metropolitan Atlanta Developmental Disabilities Study.

The Metropolitan Atlanta Developmental Disabilities Study is the first US, population-based epidemiologic study of the prevalence of mental retardation, cerebral palsy, hearing impairment, and visual impairment among school-age children. The study population consisted of children who were 10 years of age between 1985 and 1987 and whose mothers were residents of the five Georgia counties of Clayton, Cobb, DeKalb, Fulton, and Gwinnett at the time of the child's birth. Since children with developmental disabilities are identified by and receive services from various health, social service, and education systems, a multiple-source case identification method was used. This study is unique in that individual school records were used to identify children with the four disabilities. Use of a multiple-source method made it possible to confirm specific conditions and to classify subtypes of disabilities. About 95% of the children with one or more of these four disabilities were initially identified through the school systems. This approach is much less costly than conducting medical and psychologic assessments on populations of children. In addition, this method made it possible to estimate accurately the "administrative prevalence" of these disabilities (ie, the number of children previously identified with these disabilities for the purpose of providing services). The prevalence rates found in this study, per 1000 10-year-old children, were as follows: mental retardation, 10.3; cerebral palsy, 2.0; hearing impairment, 1.0; and visual impairment, 0.6.(ABSTRACT TRUNCATED AT 250 WORDS)

Population-based risk factors for neonatal group B streptococcal disease: results of a cohort study in metropolitan Atlanta.

To determine risk factors for neonatal group B streptococcal (GBS) disease, a cohort study was conducted in Atlanta of infants with invasive GBS disease during 1982 and 1983. Laboratory review detected 71 infants with early-onset disease (1.09 cases/1000 live births) and 37 infants with late-onset disease (0.57 cases/1000 live births). Compared with the 64,858 births in Atlanta in the same period, infants with early-onset GBS disease were more often black, less than 2500 g, and born to teenage mothers. A history of miscarriage increased a woman's risk of delivering an infant with early-onset disease. Black infants had 35 times the risk of late-onset disease that nonblack infants had. Thirty percent of early-onset disease and 92% of late-onset disease could be attributed to black race, independent of other risk factors. Most case-mothers (96%) received prenatal care, suggesting that prevention strategies such as prenatal screening or maternal immunization could reach nearly all the population at risk.

Recovery of hepatitis A virus from a water supply responsible for a common source outbreak of hepatitis A.

An outbreak of hepatitis A occurred in a north Georgia trailer park served by a private well. Of 18 residents who were serosusceptible to hepatitis A virus (HAV), 16 (89%) developed hepatitis A. Well water samples were collected 3 months after illness onset in the index case and 28 days after illness onset in the last trailer park resident. Hepatitis A virus antigen (HAVAg) was detected in the samples by enzyme immunoassay from three of the five cell lines following two 30-day passages and from a fourth cell line following a third passage of 21 days.

Magnitude and patterns of family and intimate assault in Atlanta, Georgia, 1984. Collaborative Working Group for the Study of Family and Intimate Assaults in Atlanta.

A sample of police incident reports was used to examine the magnitude and patterns of family and intimate assault involving weapon use or threat, bodily force, or verbal threat of assault in a defined urban population during 1984. More than half of the incidents involved partners (spousal and nonspousal), about a fourth involved prior or estranged partners, and the remainder involved family members and relatives. The 1984 rate of nonfatal family and intimate assault was estimated at 837 per 100,000 population--the fatal rate was 7 per 100,000 population. Fatal and nonfatal victimization rates for blacks and other races were three times the rates for whites. Fatal incidents predominantly involved handguns, and nonfatal incidents most often involved bodily force. Most nonfatal victims (66%) and some perpetrators (13%) suffered physical injuries. Data on prior police contacts suggest that family and intimate assaults occur within a context of repeated violence. Information about prior incidents might contribute to preventive efforts by identifying people at high risk of being victims or perpetrators.

Seroprevalence and risk factors for HTLV-I/II infection among female prostitutes in the United States.

We tested 1305 female prostitutes from eight areas of the United States for antibodies to human T-cell lymphotropic virus type I/II. Overall, 6.7% were human T-cell lymphotropic virus type I/II seropositive (with antibodies to both gag and env gene products). The seroprevalence rates ranged from 0% in southern Nevada to 25.4% in Newark, NJ. Human T-cell lymphotropic virus type I/II seropositivity was independently associated with race (odds ratio, 4.68), intravenous drug use (odds ratio, 2.94), hepatitis B seropositivity (odds ratio, 2.87), recruitment in Newark (odds ratio, 2.34), and more years of sexual activity (odds ratio, 1.08 per year of sexual activity). Groups with high rates included blacks, Hispanics, and American Indians, and the rates in these groups were significantly higher than among whites and Asian Americans for women both with and without a history of intravenous drug use. Among intravenous drug users, the only other independent associations were more years of sexual activity and recruitment in Newark; and in non-intravenous drug users, hepatitis B seropositivity. These data show that human T-cell lymphotropic virus type I/II infection is present among female prostitutes in some areas of the United States. Further studies are needed to evaluate patterns of transmission and long-term health effects.

Hepatitis B virus infection among children born in the United States to Southeast Asian refugees.

Since 1975 nearly 1 million persons have entered the United States from Southeast Asia, where infection with hepatitis B virus (HBV) is hyperendemic. To evaluate the prevalence and patterns of transmission of HBV infection among the children of refugees from Southeast Asia, we studied 196 refugee families with 257 children born in the United States. Of 31 children born in the United States to mothers with infectious disease, 17 (55 percent) had been infected with HBV. Of 226 children whose mothers did not have infectious disease, 15 had HBV infection--a prevalence of 6.6 percent (95 percent confidence interval, 4.1 to 10.7). The risk of infection was greatest (26 percent) among children living in households with children with infectious disease (relative risk, 5.5; confidence interval, 2.3 to 13.4). Exposure to fathers or other adults with infectious disease was not significantly associated with infection. Of children from households with no persons with infectious disease, 3.9 percent (confidence interval, 1.7 to 8.8) were infected. Nearly half (46 percent) the cases of HBV infection among the U.S.-born children of refugees were not attributable to perinatal transmission from a mother with infectious disease. We conclude that child-to-child transmission may be occurring within and between households. Current recommendations to immunize the newborns of mothers with infectious disease are not sufficient to protect all U.S.-born children of Southeast Asian refugees from HBV infection early in life, when the risk of chronic sequelae and premature death is highest. We recommend that the HBV vaccination policy be expanded to include all newborns of Southeast Asian immigrants.

The epidemiology of injuries in Atlanta day-care centers.

From June 1987 through May 1988, we collected reports of injuries among 5300 children who attended 71 day-care centers in Atlanta, Ga. One hundred forty-three injuries severe enough for the child to require medical or dental care were reported, including 63 lacerations (44.1%), 23 fractures (16.1%), 5 crush injuries (3.5%), 4 dislocations (2.8%), 2 human bites (1.4%), and 2 concussions (1.4%). The head was the site of 98 (68.5%) injuries. Peak hours for injuries were 11 AM and 4 PM, the peak day was Monday, and the peak season was summer. After adjustment for hours and dates of attendance, the rate was 1.77 injuries per 100,000 child-hours in day care; among preschool-aged children, infants had the lowest rate (0.77) and 2-year-old children had the highest rate (2.26). Almost 47% of injuries occurred on the playground; falls were involved in 70% of such injuries. Because 33% of all injuries resulted from falls on the playground, impact-absorbing playground surfaces may be a possible intervention to reduce injuries.

The health and economic burden of cigarette smoking in Georgia in 1985.

Using the estimated prevalence of current and former cigarette smoking among Georgians, death certificate data in 1985, and the available literature on smoking-related health risks, we estimated the health and economic impact of cigarette smoking in Georgia in a single year. We estimated, using relatively conservative assumptions, the mortality and years of life lost prematurely, as well as the costs of medical care for ill individuals, lost wages due to death, and lost wages due to illness attributable to smoking. In 1985, past or present smoking was the cause of death for more than 7,700 Georgians, accounting for over 120,000 years of expected life lost prematurely, and with an overall societal cost exceeding $1.5 billion dollars. Cardiovascular diseases were the major cause of all estimated deaths associated with smoking. The prevalence of current smokers is higher in Georgians than the national average; this approach to examining the risks may be useful in lowering that prevalence by influencing patient education in Georgia.

Trends in cause-specific infant mortality in Georgia.

We previously reported that almost one third of the potential for reduction (PFR) in infant mortality in Georgia would result from reduction in mortality of normal birthweight infants. To determine where reductions were made in the past and where gaps remain, we examined trends from 1960 to 1980-82 in cause-specific mortality for normal birthweight infants by race. In the neonatal period, mortality was reduced by 66% for white infants, 76% for black infants. In the postneonatal period, overall reductions were smaller than in the neonatal period, 50% for white and 71% for black infants. The majority of the remaining gap resulted from excess mortality in the infection, injury, and Sudden Infant Death categories. The widest gaps in infant mortality exists in the postneonatal period. There is a 12% potential for reduction in the black infant mortality rate if interventions directed at the normal birthweight infant in the postneonatal period are emphasized.

Day-care center attendance and hospitalization for lower respiratory tract illness.

To identify risk factors associated with hospitalization for acute lower respiratory tract illness, 102 children less than 2 years of age admitted to four Atlanta metropolitan area hospitals between December 1984 and June 1985 with the diagnosis of lower respiratory tract illness were studied. The most common causative agent associated with illness was respiratory syncytial virus, followed by other respiratory viruses, Haemophilus influenzae, and Streptococcus pneumoniae. The 102 case-patients were compared with 199 age- and sex-matched controls. A parent or guardian for each patient and control was interviewed by telephone regarding demographic data, care outside the home, breast-feeding, previous medical history, allergies, and smoking and illness in household members. Five factors were associated with lower respiratory tract illness in both a univariate analysis and a multiple logistic regression model (P less than .05). These factors were the number of people sleeping in the same room with the child, a lack of immunization the month before the patient was hospitalized, prematurity, a history of allergy, and regular attendance in a day-care center (more than six children in attendance). Care received outside of the home in a day-care home (less than or equal to six children in attendance) was not associated with lower respiratory tract illness. The suggestion made by our study and other studies was that for children less than 2 years of age, care outside of the home is an important risk factor for acquiring lower respiratory tract illness, as well as other infectious diseases, and that this risk can be reduced by using a day-care home instead of a day-care center.

Risk of adverse outcomes of pregnancy after human parvovirus B19 infection.

Human parvovirus B19 (B19) infection during pregnancy has been associated with fetal deaths. We conducted several studies to develop data needed to make recommendations for preventing fetal death associated with infection. In the first study, after an outbreak of B19 infection, specimens of cord blood from 47 infants with congenital anomalies, 10 with suspected intrauterine infection, and gestational age-matched controls were tested for IgG and IgM antibodies to B19. None had evidence of recent infection. Next, 192 women with unknown exposure to B19 who had stillbirths or spontaneous abortions were studied. Two patients and two controls had evidence of recent B19 infection. In a second case-control study of women who had stillbirths after outbreaks of erythema infectiosum in area schools, none of the 20 patients or 26 controls were IgM positive at the time of delivery. The rate of infection, as demonstrated by IgM positivity, among 267 pregnant control subjects was approximately 1%. These studies suggest that among pregnant women unselected for exposure to B19, neither infection nor stillbirths are common.