immunologie parameters specifically is not recommended in
the evaluation of the individual patient.2,4 Physicians caring for these patients have a difficult enough task in maintaining an appropriate focus: ensuring the careful exclusion of alternative, treatable diagnoses; providing contin¬ uous and occasionally exhausting support for these often diffi¬ cult patients; and entering and treating patients diagnosed by strict clinical criteria into much needed clinical protocols. The (potentially lucrative) commercial marketing of irrelevant lab¬ oratory tests, performed outside of approved investigator pro¬ tocols, is useless to both physicians and patients, expensive, and distracting. I exhort physicians who care for these patients to critically consider the need for such an elaborate and expensive serologie and immunologie evaluation. David P. Dooley, MD Wilford Hall Air Force Medical Center Lackland AFB, Tex
opinions or assertions herein are the private views of the author and as reflecting the views of the US Department of the Air Force, the US Department of the Army, or the US Department of Defense. 1. Chronic Fatigue and Immune Dysfunction Syndrome. Santa Monica, Calif: Specialty Laboratories Inc; January 1992. Promotional flier. 2. Straus SE. The chronic mononucleosis syndrome. J Infect Dis. 1988;157:405-412. 3. Klimas NG, Salvato FR, Morgan R, Fletcher MA. Immunologic abnormalities in chronic fatigue syndrome. J Clin Microbiol. 1990;28:1403-1410. 4. Buchwald D, Komaroff AL. Review of laboratory findings for patients with chronic fatigue syndrome. Rev Infect Dis. 1991;13(suppl 1):S12-S18. 5. Palca J. On the track of an elusive disease. Science. 1991;254:1726-1728. 6. Holmes GP, Kaplan JE, Gantz NM, et al. Chronic fatigue syndrome: a working case The
are
not to be construed
definition. Ann Intern Med. 1988;108:387-389.
American Indians, African Americans: Their Common Histories To the Editor.\p=m-\Thearticle by Blum et al1 prompted me to consider the many similarities in the health risks of African Americans and American Indians. Both groups exhibit a high risk of death among young men, a pervasive sense of low self-esteem and hopelessness, and the absence of a complete nuclear family.2 Perhaps these attributes, which appear to be less common in many other ethnic communities, are related to historical parallels in the experiences of African Americans and American Indians. Neither group entered white America out of choice. Both groups were forced into white society by white settlers, either as slaves or as conquered nations. Further study of the unique position of American Indians and African Americans and how this relates to and affects the similarity of their health risks could be important, particularly as policymakers and health care providers try to identify the health care and other needs of different ethnic communities. Deborah Chase United Health Care Corporation Minneapolis, Minn
1. Blum RW, Harmon B, Harris L, Bergeisen L, Resnick MD. American Indian\p=m-\ Alaskan Native youth health. JAMA. 1992;267:1637-1644. 2. Schor LB, Schor D. Within Our Reach: Breaking the Cycle of the Disadvantaged. New York, NY: Doubleday & Co Inc; 1988.
This letter was shown to the
author, who declined to reply.—Ed.
in Lyme Disease: A Correction To the Editor.\p=m-\Theillustration of a "characteristic erythema migrans lesion" used in the article by Kaslow1 first appeared in my 1984 article on Lyme disease.2 The "dark papular lesion at the periphery" represents a fibroepithelial polyp, not the site of a possible tick bite. The erythema migrans lesion appeared on the left hip, measured 8 by 9 cm, and had been present for 7 days.
1. Kaslow RA. Current perspective on Lyme borreliosis. JAMA. 1992;267:1381-1383. 2. Berger BW. Erythema chronicum migrans of Lyme disease. Arch Dermatol.
1984;120:1017-1021.
In Reply.\p=m-\Iam most grateful to Dr Berger for pointing out the erroneous attribution of the photograph as well as the precise nature and location of the lesion depicted in my recent article. His contributions to our knowledge of the early cutaneous expression of Lyme borreliosis are much
appreciated.
Richard A. Kaslow, MD National Institutes of Health Bethesda, Md
Poor Response to Rabies Vaccination by the Intradermal Route To the Editor.\p=m-\Serologicconfirmation of antibody titer is no longer recommended following primary rabies pre-exposure and postexposure vaccination with human diploid cell vaccine, except for immunosuppressed persons.1 The foundation for this practice is the previous Centers for Disease Control experience that all persons receiving such vaccination have demonstrated an adequate antibody response
(\m=ge\0.5IU).
On special request, the New York State Department of Health has continued to perform rabies serology for New York residents who have received preexposure rabies vaccination. During the period January 1,1990, through December 31, 1991, this laboratory tested serum from 201 patients vaccinated by the intradermal route. We identified 15 individuals in this group with rabies antibody titers of less than 0.5 IU in serum samples collected from 1 to 7 months following primary vaccination. All persons tested during the period who were vaccinated by the intramuscular route (N=11) and sampled within a comparable period of time had antibody titers of at least 0.5 IU. Titers were determined by a serum neutralization test similar to the rapid fluorescent focus in¬ hibition test performed at the Centers for Disease Control. These data are not the result of a scientific study, and therefore, important data on the patients are not available. Nevertheless, these results suggest the need for further study of the effectiveness of intradermal vaccination with human diploid cell vaccine, specifically regarding the recommenda¬ tion that adequate antibody conversion can be assumed fol¬ lowing primary intradermal vaccination, without serologie confirmation. This is especially significant in view of the growing popularity of intradermal vaccination because of its cost
advantage.
Charles V. Trimarchi Morris Safford, Jr New York State Department of Health
Albany
1. Centers for Disease Control. Rabies prevention\p=m-\UnitedStates, 1991: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR.
1991;40(No. RR-3):1-19.
Erythema Migrans
Bernard W. Berger, Southampton, NY
Incorrect Lower Limit for the Odds Ratio. \p=m-\Anerror occurred in the Original Contribution entitled "Lymphocytic Choriomeningitis Outbreak Associated With Nude Mice in a Research Institute," published in the March 11,1992, issue of The Journal (1992;267:1349\x=req-\ 1353). In Table 2 on page 1351, the exact 95% lower limit for the odds ratio for "Cleaning Cages" should be 6.72 [not 3.69].
MD
Downloaded From: http://jama.jamanetwork.com/ by a New York University User on 06/09/2015
the evaluation of the individual patient.2,4 Physicians caring for these patients have a difficult enough task in maintaining an appropriate focus: ensuring the careful exclusion of alternative, treatable diagnoses; providing contin¬ uous and occasionally exhausting support for these often diffi¬ cult patients; and entering and treating patients diagnosed by strict clinical criteria into much needed clinical protocols. The (potentially lucrative) commercial marketing of irrelevant lab¬ oratory tests, performed outside of approved investigator pro¬ tocols, is useless to both physicians and patients, expensive, and distracting. I exhort physicians who care for these patients to critically consider the need for such an elaborate and expensive serologie and immunologie evaluation. David P. Dooley, MD Wilford Hall Air Force Medical Center Lackland AFB, Tex
opinions or assertions herein are the private views of the author and as reflecting the views of the US Department of the Air Force, the US Department of the Army, or the US Department of Defense. 1. Chronic Fatigue and Immune Dysfunction Syndrome. Santa Monica, Calif: Specialty Laboratories Inc; January 1992. Promotional flier. 2. Straus SE. The chronic mononucleosis syndrome. J Infect Dis. 1988;157:405-412. 3. Klimas NG, Salvato FR, Morgan R, Fletcher MA. Immunologic abnormalities in chronic fatigue syndrome. J Clin Microbiol. 1990;28:1403-1410. 4. Buchwald D, Komaroff AL. Review of laboratory findings for patients with chronic fatigue syndrome. Rev Infect Dis. 1991;13(suppl 1):S12-S18. 5. Palca J. On the track of an elusive disease. Science. 1991;254:1726-1728. 6. Holmes GP, Kaplan JE, Gantz NM, et al. Chronic fatigue syndrome: a working case The
are
not to be construed
definition. Ann Intern Med. 1988;108:387-389.
American Indians, African Americans: Their Common Histories To the Editor.\p=m-\Thearticle by Blum et al1 prompted me to consider the many similarities in the health risks of African Americans and American Indians. Both groups exhibit a high risk of death among young men, a pervasive sense of low self-esteem and hopelessness, and the absence of a complete nuclear family.2 Perhaps these attributes, which appear to be less common in many other ethnic communities, are related to historical parallels in the experiences of African Americans and American Indians. Neither group entered white America out of choice. Both groups were forced into white society by white settlers, either as slaves or as conquered nations. Further study of the unique position of American Indians and African Americans and how this relates to and affects the similarity of their health risks could be important, particularly as policymakers and health care providers try to identify the health care and other needs of different ethnic communities. Deborah Chase United Health Care Corporation Minneapolis, Minn
1. Blum RW, Harmon B, Harris L, Bergeisen L, Resnick MD. American Indian\p=m-\ Alaskan Native youth health. JAMA. 1992;267:1637-1644. 2. Schor LB, Schor D. Within Our Reach: Breaking the Cycle of the Disadvantaged. New York, NY: Doubleday & Co Inc; 1988.
This letter was shown to the
author, who declined to reply.—Ed.
in Lyme Disease: A Correction To the Editor.\p=m-\Theillustration of a "characteristic erythema migrans lesion" used in the article by Kaslow1 first appeared in my 1984 article on Lyme disease.2 The "dark papular lesion at the periphery" represents a fibroepithelial polyp, not the site of a possible tick bite. The erythema migrans lesion appeared on the left hip, measured 8 by 9 cm, and had been present for 7 days.
1. Kaslow RA. Current perspective on Lyme borreliosis. JAMA. 1992;267:1381-1383. 2. Berger BW. Erythema chronicum migrans of Lyme disease. Arch Dermatol.
1984;120:1017-1021.
In Reply.\p=m-\Iam most grateful to Dr Berger for pointing out the erroneous attribution of the photograph as well as the precise nature and location of the lesion depicted in my recent article. His contributions to our knowledge of the early cutaneous expression of Lyme borreliosis are much
appreciated.
Richard A. Kaslow, MD National Institutes of Health Bethesda, Md
Poor Response to Rabies Vaccination by the Intradermal Route To the Editor.\p=m-\Serologicconfirmation of antibody titer is no longer recommended following primary rabies pre-exposure and postexposure vaccination with human diploid cell vaccine, except for immunosuppressed persons.1 The foundation for this practice is the previous Centers for Disease Control experience that all persons receiving such vaccination have demonstrated an adequate antibody response
(\m=ge\0.5IU).
On special request, the New York State Department of Health has continued to perform rabies serology for New York residents who have received preexposure rabies vaccination. During the period January 1,1990, through December 31, 1991, this laboratory tested serum from 201 patients vaccinated by the intradermal route. We identified 15 individuals in this group with rabies antibody titers of less than 0.5 IU in serum samples collected from 1 to 7 months following primary vaccination. All persons tested during the period who were vaccinated by the intramuscular route (N=11) and sampled within a comparable period of time had antibody titers of at least 0.5 IU. Titers were determined by a serum neutralization test similar to the rapid fluorescent focus in¬ hibition test performed at the Centers for Disease Control. These data are not the result of a scientific study, and therefore, important data on the patients are not available. Nevertheless, these results suggest the need for further study of the effectiveness of intradermal vaccination with human diploid cell vaccine, specifically regarding the recommenda¬ tion that adequate antibody conversion can be assumed fol¬ lowing primary intradermal vaccination, without serologie confirmation. This is especially significant in view of the growing popularity of intradermal vaccination because of its cost
advantage.
Charles V. Trimarchi Morris Safford, Jr New York State Department of Health
Albany
1. Centers for Disease Control. Rabies prevention\p=m-\UnitedStates, 1991: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR.
1991;40(No. RR-3):1-19.
Erythema Migrans
Bernard W. Berger, Southampton, NY
Incorrect Lower Limit for the Odds Ratio. \p=m-\Anerror occurred in the Original Contribution entitled "Lymphocytic Choriomeningitis Outbreak Associated With Nude Mice in a Research Institute," published in the March 11,1992, issue of The Journal (1992;267:1349\x=req-\ 1353). In Table 2 on page 1351, the exact 95% lower limit for the odds ratio for "Cleaning Cages" should be 6.72 [not 3.69].
MD
Downloaded From: http://jama.jamanetwork.com/ by a New York University User on 06/09/2015
