Although disease was mostly mild, the outbreak lasted for approximately 2 months, suggesting that varicella in vaccinated persons was contagious and that 99% varicella vaccination coverage was not sufficient to prevent the outbreak. This investigation highlights several challenges related to the prevention and control of varicella outbreaks with the 1-dose varicella vaccination program and the need for further prevention of varicella through improved vaccine-induced immunity with a routine 2-dose vaccination program. The challenges include: 1-dose varicella vaccination not providing sufficient herd immunity levels to prevent outbreaks in school settings where exposure can be intense, the effective transmission of varicella among vaccinated children, and the difficulty in the diagnosis of mild cases in vaccinated persons and early recognition of outbreaks for implementing control measures. The efficacy of 2 doses of varicella vaccine compared with 1 dose was assessed in a trial conducted among healthy children who were followed for 10 years. The efficacy for 2 doses was significantly higher than for 1 dose of varicella vaccine. This higher efficacy translated into a 3.3-fold lower risk of developing varicella >42 days after vaccination in 2- vs 1-dose recipients. Of the children receiving 2 doses, 99% achieved a glycoprotein-based enzyme-linked immunosorbent assay level of > or =5 units (considered a correlate of protection) 6 weeks after vaccination compared with 86% of children who received 1 dose. The 6-week glycoprotein-based enzyme-linked immunosorbent assay level of > or =5 units has been shown to be a good surrogate for protection from natural disease. Ten years after the implementation of the varicella vaccination program, disease incidence has declined dramatically, and vaccination coverage has increased greatly. However, varicella outbreaks continue to occur among vaccinated persons. Although varicella disease among vaccinated persons is mild, they are contagious and able to sustain transmission. As a step toward better control of varicella outbreaks and to reduce the impact on schools and public health officials, in June 2005, the Advisory Committee on Immunization Practices recommended the use of a second dose of varicella vaccine in outbreak settings. Early recognition of outbreaks is important to effectively implement a 2-dose vaccination response and to prevent more cases. Although the current recommendation of providing a second dose of varicella vaccine during an outbreak offers a tool for controlling outbreaks, a routine 2-dose recommendation would be more effective at preventing cases. Based on published data on immunogenicity and efficacy of 2 doses of varicella vaccine, routine 2-dose vaccination will provide improved protection against disease and further reduce morbidity and mortality from varicella.

Increased awareness could lead to appropriate diagnosis, prompt treatment, and better patient outcomes.

No abstract

OBJECTIVES-To study the association between amount of social contact and mortality after hip fracture in elderly participants. DESIGN-Prospective cohort.SETTING-Community residents of Baltimore, Maryland. PARTICIPANTS-Six hundred seventy-four elderly participants.MEASUREMENTS-Amount of telephone and direct personal contact between participants and their relatives and friends and mortality up to 2 years after fracture. RESULTS-Nosocial contact with friends during the 2 weeks before the fracture was associated with a five times greater risk of death over 2 years than daily contact with friends during the 2 weeks before the fracture (hazard ratio (HR) = 5.04, 95% confidence interval (CI) = 2.75-9.23). Participants with less than daily contact were also at greater risk of dying, although the CI spanned 1 (HR = 1.76, 95% CI = 0.99-3.13). Participants who had no contact with family members prefracture were more than twice as likely to die as those who communicated daily during the 2 weeks before fracture (HR = 2.26, 95% CI = 1.36-3.77). Participants who had less than daily contact were also more than twice as likely to die (HR = 2.55, 95% CI = 1.65-3.94).CONCLUSION-This study suggests that lower social contact before hip fracture is associated with poorer survival after 2 years. Conflict of Interest:The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that none of the authors have any financial or any other kind of personal conflicts with this manuscript. There is evidence that social interaction is associated with better survival in elderly persons, 10-14 even after myocardial infarction or stroke. [15][16][17][18] Other evidence suggests that social interaction is associated with better likelihood of functional recovery, which may indirectly improve the prospect of survival, [19][20][21][22] but what is not known is whether social interaction is associated with greater survival in frail elderly participants who have suffered hip fracture-a condition associated with high mortality. Because some of the risk factors for fracture differ from those for other conditions, it is important to understand whether social interaction is associated with recovery.The aim of this study was to evaluate whether frequent social contact is associated with greater likelihood of survival after hip fracture. It is a novel approach to examine the relationship between pre-and postfracture social support and mortality. Also, it extends previous work by examining the association between social network interaction and survival from hip fracture in a large cohort of patients, providing better adjustment for potentially confounding risk factors and by doing so over 2 years after fracture. METHODS ParticipantsParticipants in this study were subjects in the second Baltimore Hip Study cohort, which examined changes in physical capacity and quality of life in patients aged 65 and older who were admitted from the community to one of eight Baltimore-area hospitals in 1990 and 1991 for ...