Pharmacotherapy: The Journal of Human Pharmacology and Drug TherapyVolume 34, Issue 12 p. 1227-1229 Editorial Lifting the Fog of Health Delivery and Costs Hershel Jick, Corresponding Author Hershel Jick Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington, MassachusettsAddress for correspondence: Hershel Jick, Boston Collaborative Drug Surveillance Program and Boston University School of Medicine, 11 Muzzey Street, Lexington, MA 02421; e-mail: hjick@bu.edu.Search for more papers by this author Hershel Jick, Corresponding Author Hershel Jick Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington, MassachusettsAddress for correspondence: Hershel Jick, Boston Collaborative Drug Surveillance Program and Boston University School of Medicine, 11 Muzzey Street, Lexington, MA 02421; e-mail: hjick@bu.edu.Search for more papers by this author First published: 23 December 2014 https://doi.org/10.1002/phar.1530Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume34, Issue12December 2014Pages 1227-1229 RelatedInformation

OBJECTIVES:To compare the usage and cost of antibiotics in the United States and United Kingdom in children younger than 10 years.METHODS:A follow up of some 160,000 young children enrolled in U.S. private health insurance companies and an equal number in general practices in the United Kingdom in 2009, based on two prospectively designed and documented electronic medical databases.MAIN RESULTS:Percentage of young children in each country prescribed an antibiotic together with the estimated total annual cost.PRINCIPAL CONCLUSIONS:In the United States, ~75% of privately insured children were prescribed one or more antibiotics compared with an estimated 50% in the United Kingdom. The annual cost was more than five times higher in the United States compared with the United Kingdom The usage and cost of antibiotics in young privately insured children is far higher in the United States than in the United Kingdom, where the government pays the cost of prescription drugs.

Background: Bone fractures in children represent a source of significant disability and morbidity. Are children with autistic spectrum disorder (ASD) at an altered risk of fractures compared with typically developing children? Methods: Using the General Practice Research Database, the authors assessed the prevalence of fractures in boys with ASD diagnosed between 2 and 8 years. A cross-sectional design was used to compare the prevalence of fractures among children with ASD and age-matched controls, conditional logistic regression to explore the relative risk of having a fracture in association with diagnosed ASD. Results: The study population comprised 3,219 boys with a first-time diagnosis of ASD and 12,265 matched controls. ASD was associated with a significantly decreased risk of developing a fracture at any time in childhood (odds ratio [OR], 0.68, 95% confidence interval [CI], 0.59-0.77, p <.0001). The relative risk estimates were lower for the time period after ASD diagnosis (OR, 0.56, 95% CI, 0.48-0.66, p <.0001) but were not different for the time period before ASD diagnosis (OR, 0.96, 95% CI, 0.78-1.18, p =.6866). Adjusting for use of different drugs did not change the estimates. Conclusion: The relative risk of experiencing a fracture at any time in childhood is lower for boys with ASD compared with healthy boys.

Objectives To update UK studies begun in the early 1990s on the annual prevalence and incidence rates of autism in children; undertaken in response to a March 2012 press release, widely covered by the media, from the US Centre for Disease Control (CDC) reporting that the autism prevalence rate in 2008 in 8-year-old US children was 1 in 88, a 78% increase from a CDC estimate in 2004. This finding suggested a continuation of the dramatic increase in children diagnosed as autistic, which occurred in the 1990s.Design Population study using the UK General Practice Research Database (GPRD).Methods Annual autism prevalence rates were estimated for children aged 8years in 2004-2010 by dividing the number diagnosed as autistic in each or any previous year by the number of children active in the study population that year. We also calculated annual incidence rates for children aged 2-8years, by dividing the number newly diagnosed in 2004-2010 by the same denominators.Results Annual prevalence rates for each year were steady at approximately 3.8/1000 boys and 0.8/1000 girls. Annual incidence rates each year were also steady at about 1.2/1000 boys and 0.2/1000 girls.Conclusions Following a fivefold increase in the annual incidence rates of autism during the 1990s in the UK, the incidence and prevalence rates in 8-year-old children reached a plateau in the early 2000s and remained steady through 2010. Whether prevalence rates have increased from the early 2000s in the USA remains uncertain.

Study ObjectiveTo compare the annual cost of proton pump inhibitors (PPIs) in the United States and in the United Kingdom.DesignMatched‐cohort cost analysis.Data SourcesU.K. General Practice Research Database (GPRD) and MarketScan Commercial Claims and Encounter Database, a large, U.S. self‐insured medical claims database.Study PopulationWe initially identified more than 1 million people in the GPRD who were younger than 65 years of age and who were prescribed at least one prescription drug in 2005. Each of these people was then matched by year of birth and sex to one person in the U.S. database. From the matched pool, we estimated that 280,000 people were aged 55–64 years from each country. Of these, an estimated 27,230 (9.7%) in the U.S. were prescribed a PPI compared with 22,560 (8.1%) in the U.K. After excluding patients who did not receive the PPI continuously or who switched PPIs during the year, there remained 11,292 people in the U.S. and 9923 in the U.K. who were prescribed a single PPI preparation continuously during 2005 (annual PPI users).Measurements and Main ResultsAnnual drug costs were determined by random sampling. The estimated annual cost/patient in the U.S. ranged from $901 for generic omeprazole to $1485 for lansoprazole. In the U.K., the annual costs were similar, approximately $400 for each PPI, irrespective of whether the agents were available in generic formulation. The total estimated annual cost of PPIs for 2005 in this study group was $14 million in the U.S. compared with $4.1 million in the U.K.ConclusionThe cost of continuous use of PPIs covered by private insurance companies in the U.S. in 2005 was more than 3 times the cost covered by the U.K. government. This result is consistent with the findings of an earlier study on relative costs of statins between the countries.

Study Objective To compare the annual cost of methylphenidate in the United States and the United Kingdom. Design Matched‐cohort cost analysis. Data Sources The U.K. General Practice Research Database ( GPRD ) and MarketScan Commercial Claims and Encounters Database, a large, U.S. self‐insured medical claims database. Study Population We initially identified 1.6 million people in the GPRD who were younger than 65 years of age in 2005. These people were then matched by year of birth and sex with 1.6 million people in the U.S. database. From this matched pool, we estimated that 98,000 boys aged 5–14 years from each country in 2005 were prescribed at least one drug. Of these, 6485 (6.6%) in the U.S. were prescribed methylphenidate compared with 1405 (1.4%) in the U.K. After excluding those who did not receive methylphenidate continuously, there remained 2298 boys in the U.S. and 939 in the U.K. who were prescribed methylphenidate continuously during 2005 (annual methylphenidate users). We estimated and compared drug costs (presented in 2005 U.S. dollars) for continuous users separately in the two countries. Measurements and Main Results Estimated drug costs were determined by random sampling. Estimated annual costs/patient in the U.S. ranged from $402 for doses of 5–10 mg to $821 for doses greater than 20 mg. In the U.K., costs ranged from $146 for doses of 5–10 mg to $661 for doses greater than 20 mg. The total annual cost of the continuous receipt of methylphenidate in the U.S. was $170,199 compared with $39,393 in the U.K. Conclusion The cost of methylphenidate for boys aged 5–14 years paid by private insurance companies in the U.S. was more than 4 times higher than comparable costs paid by the government in the U.K.

Pharmacotherapy: The Journal of Human Pharmacology and Drug TherapyVolume 32, Issue 11 p. 967-969 Editorial The Cost of Prescription Drugs: A Comparison of Two Countries Hershel Jick M.D., Hershel Jick M.D. Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington, MassachusettsSearch for more papers by this authorAndrew Wilson M.P.H., Andrew Wilson M.P.H. Heller School for Social Policy and Management, Brandeis University, Waltham, MassachusettsSearch for more papers by this author Hershel Jick M.D., Hershel Jick M.D. Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington, MassachusettsSearch for more papers by this authorAndrew Wilson M.P.H., Andrew Wilson M.P.H. Heller School for Social Policy and Management, Brandeis University, Waltham, MassachusettsSearch for more papers by this author First published: 01 November 2012 https://doi.org/10.1002/phar.1224Citations: 3 For questions or comments, contact Hershel Jick, M.D., Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, 11 Muzzey Street, Lexington, MA 02421; e-mail: [email protected]. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Squires DA. Explaining high health care spending in the United States: an international comparison of supply, utilization, prices, and quality. New York: The Commonwealth Fund, 2012. 2Jick H, Wilson A, Wiggins P, Chamberlin DP. Comparison of prescription drug costs in the United States and the United Kingdom, part 1: statins. Pharmacotherapy 2012; 32: 1–6. 3Jick H, Wilson A, Wiggins P, Chamberlin DP. Comparison of prescription drug costs in the United States and the United Kingdom, part 2: proton pump inhibitors. Pharmacotherapy 2012; 32: 489–92. 4Parkin L, Hagberg KW, Jick H. Comprehensive comparison of drug prescribing in the United States and United Kingdom. Pharmacotherapy 2011; 31: 623–9. 5Schultz D. Drug coupons: a good deal for the patient, but not the insurer. Available from http://www.kaiserhealthnews.org/Stories/2012/October/02/drug-coupons.aspx?p=1. Accessed October 9, 2012. 6Jick H, Wilson A, Wiggins P, Chamberlin DP. Comparison of presription drug costs in the United States and the United Kingdom, part 3: Methylphenidate. Pharmacotherapy 2012; 32: 970–3. Citing Literature Volume32, Issue11November 2012Pages 967-969 ReferencesRelatedInformation

Study ObjectiveTo compare the annual cost of statins in the United States and in the United Kingdom.DesignMatched‐cohort cost analysis.Data SourcesU.K. General Practice Research Database (GPRD), and MarketScan Commercial Claims and Encounters Database, a large, U.S. self‐insured medical claims database.Study PopulationWe initially identified 1.6 million people in the GPRD who were younger than 65 years of age in 2005. These people were then matched by year of birth and sex with 1.6 million people in the U.S. database. From this matched pool, we estimated that 280,000 people aged 55–64 years from each country in 2005 were prescribed at least one drug. Of these, 91,474 (33%) in the U.S. were prescribed a statin compared with 68,217 (24%) in the U.K. After excluding those who did not receive statins continuously or who switched statins during the year, there remained 61,470 in the U.S. and 45,788 in the U.K. who were prescribed a single statin preparation continuously during 2005 (annual statin users). We estimated and compared drug costs (presented in 2005 U.S. dollars) separately in the two countries.Measurements and Main ResultsEstimated drug costs were determined by random sampling. Estimated annual costs/patient in the U.S. ranged from $313 for generic lovastatin to $1428 for nongeneric simvastatin. In the U.K., annual costs/patient ranged from $164 for generic simvastatin to $509 for nongeneric atorvastatin. The total annual cost of the continuous receipt of statins in the U.S. was $64.9 million compared with $15.7 million in the U.K. In June 2006, after our study results were analyzed, the U.S. Food and Drug Administration approved generic simvastatin. We thus derived cost estimates for simvastatin use during 2006 and found that more than 60% of simvastatin users switched to the generic product, which reduced the cost/pill by more than 50%.ConclusionThe cost paid for statins in the U.S. for people younger than 65 years, who were insured by private companies, was approximately 400% higher than comparable costs paid by the government in the U.K. Available generic statins were substantially less expensive than those that were still under patent in both countries.

Study Objective. To compare the frequency of outpatient drug prescribing in the United States and United Kingdom according to individual drugs and therapeutic categories during 2004-2006.Design. Retrospective prescription record review.Data Sources. United Kingdom General Practice Research Database, and the MarketScan Commercial Claims and Encounters Database for U.S. data.Subjects. In the U.K. database, we identified 1.6 million people younger than 65 years who were prescribed at least one prescription drug in at least one of the calendar years during the study period (2004-2006). For comparison, for each U.K. person identified, we randomly identified one person of the same sex and year of birth in the U.S. database who was also prescribed at least one drug in the same calendar year.Measurements and Main Results. We compared the frequency of prescribing of individual drugs, as well as selected therapeutic categories. Substantially higher proportions of people in the United States were prescribed antibiotics, statins, and postmenopausal hormones, but asthma drugs were prescribed more frequently in the United Kingdom. In those younger than 20 years, antidepressants and antipsychotics were prescribed more than twice as frequently in the United States, and males in the United States were far more likely to be prescribed drugs for attention-deficit hyperactivity disorder than were their counterparts in the United Kingdom.Conclusion. This study provides documented quantification of differing patterns of drug use in the United States and United Kingdom during 2004-2006. The higher proportionate prescribing for most indications in the United States and the greater use of drugs under patent suggest that monetary costs are likely to be considerably higher in the United States than in the United Kingdom.

Background . Initially the course of the 2009 swine flu pandemic was uncertain and impossible to predict with any confidence. An effective prospective data resource exists in the United Kingdom (UK) that could have been utilized to describe the scope and extent of the swine flu outbreak as it unfolded. We describe the 2009 swine flu outbreak in the UK as recorded daily by general practitioners and the potential use of this database for real-time tracking of flu outbreaks. Methods . Using the General Practice Research Database, a real-time general practice, electronic database, we estimated influenza incidence from July 1998 to September 2009 according to age, region, and calendar time. Results . From 1998 to2008, influenza outbreaks regularly occurred yearly from October to March, but did not typically occur from April to September until the swine flu outbreak began in April 2009. The weekly incidence rose gradually, peaking at the end of July, and the outbreak had largely dissipated by early September. Conclusions . The UK swine flu outbreak, recorded in real time by a large group of general practitioners, was mild and limited in time. Simultaneous online access seemed feasible and could have provided additional clinical-based evidence at an early planning stage of the outbreak.

To the Editor: In 2001, we reported that the first-time (incident) diagnosis of autism in the United Kingdom increased nearly 4-fold among boys aged 2-5 years born between 1988 and 1993.1 Subsequently, we reported that the incidence of autism continued to rise for boys age 2-4 years old through the 1996 birth cohorts, and may have reached a plateau in 1997.2 To estimate the incidence of autism beyond the 1997 birth cohort, we updated the findings for additional birth cohorts of boys from 1998 through 2001. This study, as in our previous 2 studies,1,2 was derived from information in the population-based General Practice Research Database. These data have been shown to be of high quality and completeness.3 The diagnosis of autism has been confirmed from original clinical records.4 The specificity of these autism diagnoses have been found to be highly concordant with the DSM-IV definition of autism spectrum disorders.5 As in our previous studies,1,2 we identified boys who had a first-time diagnosis of autism. We required the identified boys (cases) to have at least 18 months of recorded information in the computerized practice record before the first recorded diagnosis of autism, to be born in 1988 to 2001, and to be age 2-4 years at the time of the first recorded diagnosis. We calculated the 3-year cumulative incidence (risk) of autism by dividing the number of cases of autism diagnosed in each birth cohort by the number of boys present in the birth cohort for the 3-year period. Each annual birth cohort (1988-2001) was analyzed separately. We identified 328 males with a first-time diagnosis of autism. As previously reported,1,2 the 3-year risk of autism rose consistently from about 4 per 10,000 in the 1988 birth cohort to about 25 per 10,000 in the 1997 birth cohort. The cumulative incidence remained fairly stable for birth cohorts 1998 through 2001 (Fig.).FIGURE.: Three-year cumulative incidence of diagnosed autism among boys age 2-4 years, by year of birth. Bars indicate 95% confidence intervals.Hertz-Picciotto and Delwiche6 recently published results on the incidence of autism in young children, based on the California Department of Developmental Services databases for birth cohorts from years 1990-2003.6,7 The authors concluded that there continued to be an increase in autism incidence over time that was not accounted for by changing age at diagnosis and by shifting diagnostic criteria. By contrast, in our study the incidence of diagnosed autism in the United Kingdom appeared to have reached a plateau for the last 5 birth cohorts (1997-2001) in young boys. We have suggested that a main cause of the apparent increase in the incidence of autism in the United Kingdom in the early 1990s was a change in criteria for diagnosing autism in children previously diagnosed as having only delayed development.8 The current study provides support for that proposition. The criteria for the diagnosis of autism seem to have become stable in the United Kingdom in young boys born in the late 1990s and early 2000s. Katrina W. Hagberg Hershel Jick Boston Collaborative Drug Surveillance Program Boston University School of Medicine Lexington, MA [email protected]

To the Editor: Influenza outbreaks in the United Kingdom typically occur seasonally from October through March. Data from the early 1990s show that outbreak size and virulence have varied substantially over age, calendar year, and geography.1,2 We estimated the rate of clinically diagnosed influenza according to age, calendar time, and region from July 1996 through June 2007. Monthly rates were calculated by dividing the number of cases of influenza recorded each month by the number of patients active in each of approximately 350 general practices in that month. The location of practices ranged from Belfast in the north to Southampton in the south. We also derived the frequency of influenza vaccination according to age and calendar time. The study was based on General Practice Research Database, which provides complete and accurate clinical information.3–6 We identified more than 40,000 persons diagnosed with “influenza” or “influenza-like symptoms” during the 11-year period of study. Because the database represents a representative sample of about 5% of the UK population,5 more than 800,000 cases of influenza were presumably diagnosed by general practitioners nationwide during this time. The monthly rates of influenza are shown in the Figure. Few cases were recorded during the spring and summer months (April–September) of any year. Higher-than-normal seasonal outbreaks occurred in 1996–1997 (6885 cases), 1998–1999 (7452 cases), and 1999–2000 (9005 cases)—mainly in December and January. Smaller outbreaks in 1997–1998 and 2000–2001 peaked in February. Rates of influenza fell on average more than 70% to background levels of less than 2700 cases per year from July 2001 through June 2007.FIGURE.: Monthly rate of influenza for July 1996 through June 2007. Categorization of seasonal activity from HPA Centre for Infections.7Rates of influenza were consistently highest in persons age 20–54 years and lowest in those age 70 or older. They were consistently higher in Wales and Northern Ireland and lowest in southern regions of the United Kingdom. The dramatic fall in influenza rates after 2001 was evident in all regions. A previously undetected influenza virus was identified in the 2001–2002 season; nevertheless, the level of diagnosed influenza was low. From 1996 through September 2000, the frequency of influenza vaccination was 35%–45% in persons age 70 or older, 18%–22% in those age 55–69, 5%–6% in those 40–54, 2%–3% in those age 20–39, and less than 2% in those under 20 years. Vaccination frequency rose by more than 75% in all age groups after October 2000, when the government initiated a policy to vaccinate the elderly and others at high risk for influenza. In the past 2 decades, outbreaks of influenza in the United Kingdom have been restricted to the fall and winter months of October through March.1–3,7 The severity, age, and geographic distribution have varied from season to season. The largest outbreak, considered “epidemic,” occurred in the 1989–1990 season.2 Three outbreaks in the 1996–1997, 1998–1999, and 1999–2000 seasons were described as “higher than seasonal average.”2 Other smaller outbreaks before 2001 are described as “normal seasonal activity.” Since October 2001, the seasonal rate of influenza has fallen by an average of more than 70% through June of 2007.2,7 The recent spring outbreak of A/H1N1 (swine) influenza was exceptional. Following a comprehensive review of published studies, Simonson et al8 concluded that the effectiveness of the influenza vaccine in the elderly is still under debate. In our descriptive study, a major increase in influenza vaccination frequency in October 2001 has been followed by a dramatic decrease in the rate of influenza in all age groups, and this decline has continued through June 2007. Whether this time-trend association is coincidental or, at least in part, due to increased influenza vaccination remains to be determined. Additional results are available as an eAppendix (https://links.lww.com/EDE/A361). Hershel Jick Douglas P. Chamberlin Katrina W. Hagberg The Boston Collaborative Drug Surveillance Program Boston University School of Medicine Lexington, MA

We identified all children in the UK General Practice Research Database diagnosed with measles from 1990 to 2008 and calculated annual incidence according to age and geographic region by dividing the number of cases per year by the number of children who were active in the population. We evaluated the effectiveness of the measles vaccines by comparing the vaccination histories of children who were diagnosed with measles (cases) to children who were not (controls). The annual incidence of measles fell after the introduction of the MMR vaccine in late 1988. However, a modest outbreak of measles occurred in 1994, leading to large nationwide programs to immunize children. Since 1996, the incidence of measles has fallen by more than 80%. Prior measles vaccination is highly effective and has substantially reduced the risk of measles.

Study Objective To estimate the effectiveness of influenza vaccination in people in the United Kingdom at low risk for influenza during an 11-year period from July 1996-June 2007Design Case-control studyData Source United Kingdom General Practice Research DatabaseSubjects A total of 4985 patients (aged < 80 yrs) who were considered to be at low risk for influenza, but were diagnosed with influenza or influenza-like illness from July 1996-June 2007, were identified as cases A total of 19,940 controls who were also low-risk individuals, who had no diagnosis of influenza, were matched to the cases by year of birth, sex, specific general practice, and date on which case patient was diagnosed with influenza (index date)Measurements and Main Results We identified previous vaccination status from the subjects' electronic medical records and evaluated the effect of timing of influenza vaccination and the number of previous annual vaccinations received We estimated the relative risk of influenza in those who received the influenza vaccination compared with those who did not, conditional on the matching variables Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated Age, sex, general practice, index date, and preexisting medical conditions were closely controlled for in the analysis Vaccination conferred an important protective effect (OR 0 74, 95% CI 0 60-0 91) when given within 4 months before seasonal influenza outbreaks This effect was similar for each calendar year and across all agesConclusion Seasonal influenza vaccination provided substantial protection against clinically diagnosed influenza when given within 4 months of annual seasonal outbreaks in people at low risk A review of the incidence of influenza over the 11-year period provides compelling indirect evidence that influenza vaccines were similarly effective in those who were at high risk These results provide a useful background to current and future influenza outbreaks whose course is uncertain

Study Objective. To estimate the rate of suicide in patients taking montelukast.Design. Population-based cohort studyData Source. United Kingdom General Practice Research Database.Patients. A total of 23,500 patients who had received at least one prescription for montelukast in the cumulative data from February 1998-March 2007.Measurements and Main Results. Rate of suicide was to be calculated as number of suicides divided by person-time at risk. Person-time of montelukast exposure was accrued for each patient as a cumulative duration of all prescriptions. The 23,500 patients had received 252,593 prescriptions for montelukast, representing 21,050 person-years at risk for suicide. We then sought to identify all cases that had a computer-recorded diagnosis of suicide; however, no cases of suicide were found in patients exposed to montelukast during our time frame.Conclusion. The risk of suicide attributable to montelukast, if present at all, is extremely low in users.

BACKGROUND:The United Kingdom (UK) underwent a massive epidemic of mumps from 2003 through 2006. The origin and spread was mapped in 350 general practices that used office computers to contribute comprehensive medical information on approximately 3 million patients to the General Practice Research Database (GPRD).METHODS:The continuous 3-month cumulative incidence of mumps (2003-2006) was estimated by dividing the number of diagnosed cases of mumps each 3 months by the population at risk according to age, region, practice, and calendar time. The effect of the measles, mumps, and rubella (MMR) vaccine was estimated by comparing vaccine exposure of those diagnosed with mumps and those who were not.RESULTS:There were 5683 cases of mumps recorded in the Database over the 4-year time period. As the Database represents about 5% of the UK population, we estimate that there were more than 100,000 cases of mumps diagnosed in the UK during these 4 years. The epidemic appears to have started in one practice in Wales in the first 6 months of 2003 and then spread slowly north and east, reaching a peak in 2005. Young adults aged 18-24 years were at the highest risk. There were 3 major MMR vaccination campaigns (1988-1989, 1997, and 2004-2005) that by 2006 provided more than 70% protection against mumps in children younger than 18 years of age. Protection was higher in those who had received 2 doses of the vaccine.CONCLUSION:A comprehensive program of medical information generated by selected general practitioners has provided a sound basis for the real-time recording of the origin, spread, and scope of an infectious disease.