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Objectives. Our goal was to determine whether school-level variability in implementation of immunization requirements is associated with the likelihood of a child having received an exemption to school immunization requirements. Methods. We surveyed 1000 school immunization personnel in Colorado, Massachusetts, Missouri, and Washington. We explored associations between school implementation of immunization requirements and the likelihood of a child having an exemption using logistic regression models. Results. School policies associated with an increased likelihood of children having exemptions included lack of provision of written instructions for completing the school immunization requirement before enrollment, administrative procedures making it easier to claim an exemption, and granting of philosophical exemptions. In the 2 states we surveyed where philosophical exemptions are not authorized (Massachusetts and Missouri), 17.0% and 18.1% of schools reported permitting philosophical exemptions. Conclusions. Inconsistencies in the interpretation and implementation of school immunization laws contribute to variability in rates of exemptions. School policies should be reviewed to ensure consistency with the intent of state laws.

The National Immunization Program of the Centers for Disease Control and Prevention is responsible for controlling infectious diseases through vaccination, but the program also plays a key role in postlicensure vaccine safety assessment. The time has come to separate postlicensure vaccine safety assessment from vaccine risk management as recommended by the National Research Council of the National Academy of Sciences. The National Transportation Safety Board offers a useful model for developing an independent National Vaccine Safety Board that would have the authority to leverage resources and expertise of various government agencies, academia, and industry to oversee postlicensure vaccine safety investigations. Such a board would have been useful in recent vaccine safety concerns, and its independence from government programs would ensure optimal vaccine safety and enhance public confidence in vaccines.

BCG vaccine efficacy persisted on a patient for 50 to 60 days which suggests that a single dose of an effective BCG vaccine can have a long duration of protection.

The behavioral impact, acceptability and incidence of HIV infection in persons with easy access to post-sexual exposure prophylaxis (PEP) to prevent HIV is studied. Studies revealed that PEP was safe and did not appear to be associated with increases in reported high-risk behavior and ready access to it did not effect HIV transmission.

The drug albendazole may benefit patients who have seizures because they have tapeworm infection in their brain, according to a study of 120 patients. The tapeworm causes scars inside the brain, and it is these scars that cause seizures. Albendazole is a drug that kills parasites.

The authors studied a community of 753 HIV-uninfected gay males between the ages of 18 and 50 for an average of 1.5 years in Rio de Janeiro. Of this group, 34 became infected, an annual rate of 3.1% overall, and for those under 20 years old, a rate of 8.4%.

Vitamin A supplementation of populations of vitamin A-deficient preschool-age children has been shown to reduce childhood mortality, but the primary preventive effects of such supplements on childhood infectious diseases have not been carefully evaluated. We conducted an individually randomized, placebo-controlled, double-masked trial among 1,407 Indonesian preschool-age children, to measure the effects of high dose vitamin A on acute respiratory and diarrheal illnesses. Signs and symptoms of morbidity were monitored using every other day home surveillance by trained interviewers. High dose vitamin A supplements increased the incidence of acute respiratory illnesses (ARI) by 8%, and acute lower respiratory illnesses (ALRI) by 39%. These detrimental effects on acute lower respiratory illnesses were most marked in children with adequate nutritional status (rate ratio 1.83, 95% confidence interval 1.257-2.669). In contrast, vitamin A tended to be protective of ALRI in chronically malnourished children (rate ratio 0.71, 95% confidence interval 0.375-1.331). There was no overall effect of high-dose vitamin A supplements on the incidence of diarrheal disease (rate ratio 1.06, 95% confidence interval 0.920-1.225). However, we found a significant interaction between supplementation and age: vitamin A increased the incidence of diarrhea in children INDEXING KEY WORDS: vitamin A deficiency, vitamin A supplementation, preschool children, acute respiratory illness, diarrheal diseases

Statistical analyses based on data provided by the National Health Interview Survey have shown that the demand for alcohol is responsive to price. The study, which was carried out using several regression models, also indicates that both light and heavy drinkers are considerably less price elastic than moderate drinkers and are more likely to feel the effects of alcohol taxes designed to curtail heavy or abusive drinking.

People infected with both human T-cell lymphotropic virus type I (HTLV-I) and HIV appear to have more advanced disease than people infected with HIV only, despite higher CD4 cell counts. HTLV-I is a virus that destroys immune cells of the lymph system. CD4 cells are immune system cells that are depleted during HIV infection. Researchers evaluated the disease stage, CD4 cell counts and other laboratory measures of 27 HIV-positive, HTLV-I-positive patients (coinfection) and 99 HIV-positive, HTLV-I-negative (single infection) comparison subjects. Twenty-three percent of coinfected patients and 5% of singly infected patients acquired their infections by injection drug use or blood transfusion. Of coinfected patients, 44% were in the late stages of HIV infection, compared to only 21% of singly infected individuals. Coinfected individuals had higher average total lymph cell, white blood cell and CD4 cell counts than HIV-infected counterparts., Objectives.--To study the effect of human T-cell lymphtropic virus type I (HTLV-I) on markers of human immunodeficiency virus (HIV) disease progression. Design.--A retrospective, nested case-control study. Setting.--A university hospital outpatient HIV clinic in Rio de Janeiro, Brazil. Participants.--Human immunodeficiency virus--seropositive adults participating in a prospective HIV cohort study. Main Outcome Measures.--The HIV clinical stage, [CD4.sup.+] lymphocyte counts, and other laboratory parameters in 27 individuals infected with HIV and HTLV-I (coinfection) and 99 age-matched, HIV-seropositive, HTLV-seronegative controls (single infection). Results.--Variables independently associated with coinfection included higher [CD4.sup.+] lymphocyte count (odds ratio [OR], 2.3; 95% confidence limits [CL], 1.3,4.1), higher [CD4.sup.+] percentage (OR, 2.0; 95% CL, 1.3, 3.2), [[beta].sub.2]-microglobulin level of 254 nmol/L or more (OR, 6.8; 95% CL, 1.3, 35.4), World Health Organization stages 3 and 4 (OR, 4.4; 95% CL, 1.1, 18.0), and reporting a parenteral risk factor (OR, 7.4; 95% CL, 1.4, 38.9). When stratified by p24 antigenemia, coinfection was associated with an estimated 82% higher [CD4.sup.+] lymphocyte count (P