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Deaths, severe reactions after DTP not due to vaccine, says study team. Adverse reactions in Kazakhstan.
VACCINE AND IMMUNIZATION NEWS. 1996 Jun; (1):1-2.Kazakhstan's ministry of health recently notified UNICEF of the deaths of 4 children under age 6 months which occurred within 24 hours to 6 days following immunization with diphtheria/pertussis/tetanus (DPT) vaccine. Thinking that the vaccine may have caused the deaths, the ministry was considering halting its national children's immunization program. Within 1 week of the report of the third death, a joint WHO-UNICEF team of experts arrived in Kazakhstan to investigate. Although the team strongly suspected that the deaths were due to defective vaccine, vaccination was quickly ruled out as the cause of death due to a number of reasons. The WHO-UNICEF team instead believes that failure to observe proper immunization procedure may have caused the deaths. Visits to 2 health centers in which 2 of the children were immunized produced no evidence in support of this latter hypothesis. Kazakhstan officials also reject poor immunization practices as a possible cause. Kazakhstan's ministry of health plans to investigate all of the cases, while WHO and UNICEF have recommended a review of the national immunization program and are waiting to see if the recommendation is followed up.
Ann Arbor, Michigan, UMI Dissertation Services, 1996. , viii, 336 p. (UMI No. 9631613)This dissertation presents a social history of oral contraceptives (OCs) in the US during the period 1950-70. Chapter 1 examines the factors which combined to give birth to the OC. These include the state of scientific knowledge, sexual mores, women's role and status, interest in population control, and the influence of Margaret Sanger and Katherine McCormick, the role of the pharmaceutical industry, clinical trials, and US Food and Drug Administration (FDA) approval. Chapter 2 covers the introduction of the OC and its reception by physicians, Planned Parenthood, patients, and the media (by examining coverage on health effects, moral effects, the Roman Catholic debate, and population control). The third chapter relates ways the popular press cloaked the OC in social and moral terms during the mid-1960s by reviewing sociological research on premarital sex, demographic research on contraceptive unsafe, the role of the media, and the effect of the OC on population control efforts. Chapter 4 discusses medical controversy and public concern surrounding side effects and complications associated with OC use. Specific topics include early reports on blood clotting and on cancer, reports of the World Health Organization, FDA, and American Medical Association, and responses of physicians and patients to these reports. The final chapter follows the OC into the political arena by reporting on hearings held on "competitive problems in the drug industry" and on the OC. The response of the media, Planned Parenthood, patients, physicians, and feminists is presented, and debates over informed consent and the package insert are noted. The dissertation concludes that the unresolved medical controversies did not compel women to abandon the OC but caused women to worry about their health while taking it. Thus, informed consent procedures were given serious consideration, and the percentage of married women taking the OC dropped from 36 in 1973 to 20 in 1982. The OC's legacy to women is the belief in their right to simple, safe, and reliable contraception.
CONTRACEPTION REPORT. 1996 Nov; 7(4):4-9.Two recent studies provide confirmation of the safety of low-dose oral contraceptives (OCs) with respect to stroke. The first study (Petitti et al.) investigated all strokes that occurred in 1991-94 among women 15-44 years of age who were members of the Kaiser Permanente Medical Care Programs of Northern and Southern California. A total of 408 confirmed strokes occurred among 1.1 million women during 3.6 million women-years of observation. There was no increased risk of ischemic or hemorrhagic stroke among current low-dose OC users. The adjusted odds ratio (OR) for ischemic stroke among current users compared to former users and never users was 1.2 (95% confidence interval (CI), 0.5-2.6). The adjusted OR for hemorrhagic stroke was 1.1 (95% CI, 0.6-2.2). Past users had a significantly decreased ischemic stroke risk compared to never users (OR, 0.5; 95% CI, 0.3-0.98). For subarachnoid hemorrhage, the OR was 1.5 (95% CI, 0.6-3.6) for current users compared to former and never users. The second study (World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception) investigated 3792 cases of stroke, myocardial infarction, and venous thromboembolism and 10,281 hospitalized controls. Current OC use significantly increased the risk of ischemic stroke in both Europe (OR, 3.0; 95% CI, 1.7-5.4.0) and developing countries (OR, 2.9; 95% CI, 2.1-4.0). Current OC use was associated with hemorrhagic stroke in developing countries (OR, 1.8; 95% CI, 1.3-2.3), but not in Europe (OR, 1.4; 95% CI, 0.8-2.3). European users of low-dose OCs showed no excess risk of stroke. Both smoking and hypertension were independent risk factors for stroke.