Showing papers by "Centers for Disease Control and Prevention published in 1978"

Epidemiological evidence for causal relationship between Epstein-Barr virus and Burkitt's lymphoma from Ugandan prospective study

Abstract: Results from a prospective sero-epidemiological study initiated in Uganda in 1971 indicate that children with high antibody titres to Epstein-Barr virus structural antigens are at high risk of developing Burkitt's lymphoma. These findings strongly support a causal relationship between the Epstein-Barr virus and Burkitt's lymphoma but suggest that the oncogenic potential of the virus is realised only in exceptional circumstances.

Pontiac fever an epidemic of unknown etiology in a health department: i. clinical and epidemiologic aspects

Abstract: In July 1968, an explosive epidemic of acute febrile illness occurred at a county health department facility in Pontiac, Michigan. Illness characterized principally by fever, headache, myalgia, and malaise affected at least 144 persons, including 95 of 100 persons employed in the health department building. The mean incubation period was approximately 36 hours. Illness was self-limited, generally lasting from two to five days. Secondary cases did not occur in family contacts and second attacks did not consistently follow re-exposure in the building. A defective air-conditioning system was implicated as the source and mechanism of spread of the causative factor. However, extensive laboratory and environmental investigations failed to identify the etiologic agent. Since these investigations a bacterium similar to or identical with the agent responsible for Legionnaires' Disease has been isolated from guinea pigs exposed to the Pontiac health department building in 1968 as well as from guinea pigs exposed to water from the evaporative condenser. Paired sera from 32 cases of Pontiac Fever showed seroconversion or diagnostic rises in antibody titers to this bacterium.

Epidemic Yersinia enterocolitica infection due to contaminated chocolate milk.

Abstract: In September and October, 1976, an outbreak of illness due to chocolate milk contaminated with Yersinia enterocolitica resulted in hospitalizaron of 36 children, 16 of whom had appendectomies. Infection with Y. enterocolitica serotype 0:8 was demonstrated in 38 ill persons. Sixty-one per cent of the persons who were infected had a titer greater than 1:160 OH agglutinins to serotype 8 yersinia, whereas 48 per cent of the hospitalized children had a fourfold change in agglutinin titer. An epidemiologic investigation demonstrated that illness was associated with drinking of chocolate milk purchased in school cafeterias, and Y. enterocolitica 0:8 was subsequently isolated from the milk. The investigation suggested that the bacterium was introduced at the dairy during the mixing by hand of chocolate syrup with previously pasteurized milk. (N Engl J Med 298:76–79, 1978)

Hepatitis B Infection in Physicians: Results of a Nationwide Seroepidemiologic Survey

Abstract: To define the epidemiologic features of occupationally acquired hepatitis B infection among physicians, we conducted a seroepidemiologic survey of physicians attending three American Medical Association conventions in 1975 and 1976. Of 1,192 participating physicians, 220 (18.5%) had serologic evidence of prior hepatitis B virus infection (positive hepatitis B surface antibody). The infection rate was higher among those practicing in urban communities; it increased with the number of years in practice; and among specialties, it was highest in pathologists (27%) and surgeons (28%). The serologic data demonstrated a changing pattern of viral hepatitis related to entry into the medical profession, with hepatitis B accounting for a majority of clinical hepatitis experienced after beginning medical practice. ( JAMA 239:210-212, 1978)

An outbreak in 1965 of severe respiratory illness caused by the Legionnaires' disease bacterium.

Abstract: In January 1977 an unsolved outbreak of infection at St. Elizabeth's Hospital (Washington, D.C.) that occurred in 1965 was linked with Legionnaires' disease. The link was made by fluorescent antibody testing with the bacterium isolated from tissues of persons with Legionnaires' disease in the 1976 outbreak in Philadelphia. In July and August 1965, an epidemic of severe respiratory disease characterized by abrupt onset of high fever, weakness, malaise, and nonproductive cough, frequently accompanied by radiographic evidence of pneumonia, affected at least 81 patients at St. Elizabeth's Hospital, a general psychiatric hospital. Fourteen (17%) of the affected patients died. Intensive epidemiologic and laboratory investigations in 1965 did not determine the etiology. The etiologic organism may have become airborne from sites of soil excavation.

Age, sex, and race effects on mortality from systemic lupus erythematosus in the United States.

Abstract: Nationwide rates of death from systemic lupus erythematosus (SLE) were estimated from National Center for Health Statistics mortality data for 1968 to 1972 according to age, sex, and race. The overall rates for females, 6.3 per million person-years (whites 5.2, blacks 14.8), were about four times that for males, 1.6 per million person-years (whites 1.5, blacks 2.2). The overall rate for blacks, 8.8, was 2.6 times that for whites, 3.4. An earlier rise in age-specific mortality rates for females than males produced higher age-specific female-to male sex ratios in the early adult years than in later years. Mortality generally increased with age in whites whereas the phenomenon of an accentuation and decline during the early and middle adult ages was seen in blacks, particularly females. Analysis of age-, sex-, race-specific rates using one measure of synergistic interaction, S, revealed substantial synergy between the effects of sex and race on mortality during the childbearing ages (S = 3.2, 95% confidence interval = 2.3--4.4).

Down syndrome, paternal age, maternal age and birth order

Abstract: Recent cytogenetic evidence has shown that trisomy 21 can arise, perphaps even in substantial proportion, from paternal nondisjunction. The statistical association between Down syndrome incidence and maternal age, paternal age and birth order has been studied in a sample of over 4000 cases. The size of this sample made it possible to control for the effect of maternal age by single years of age during the search for a paternal age effect and vice versa, and the importance of such stringent control is emphasized. The maternal age association was confirmed with an extremely high degree of statistical significance while no independent effect of paternal age was found; indeed, the rates at paternal ages over 45 years appear to be nearly constant. After adjusting for the effects of parental age, a significant inverse association of birth order with incidence was noted. It also appears that the incidence among very young mothers may be high: for maternal ages 15 years and less the rates seem to be equivalent to those found at 30 or 35 years. In order to help answer the question of whether the maternal age association is the result of increasing rates of nondisjunction or of some other mechanism (for example, an age related defect in a spontaneous abortion screening mechanism), the proportion of cases due to maternal and paternal nondisjunction at different parental ages must be determined.

In vitro activity of antimicrobial agents on Legionnaires disease bacterium.

Abstract: Six isolates of Legionnaires disease bacteria were tested for their susceptibility to 22 antimicrobial agents. The most active agent was rifampin (minimal inhibitory concentration,

Oral contraceptives, smoking, and other factors in relation to risk of venous thromboembolic disease

Abstract: Analysis of data from the Walnut Creek Contraceptive Drug Study showed a significant increase in risk of venous thromboembolic disease in the absence of surgery, trauma, malignancy, pregnancy, and the puerperium for women with a previous history of thromboembolism, hypertension, diabetes, varicose veins, gallbladder disease, and cigarette smoking. Education, marital status, parity, use of noncontraceptive estrogens, and obesity were not associated with an increase in risk of the disease. When only cases of the disease in the absence of all known predisposing causes (idiopathic cases) were analyzed, both oral contraceptive use and smoking remained as independent risk factors; there was no evidence of a positive interaction between them.

Classification of the Legionnaires' disease bacterium: An interim report

Abstract: Deoxyribonucleic acid (DNA) from strains of the Legionnaires' disease bacterium (LDB) was characterized in order to aid in the proper classification of this organism. The genome size of LDB DNA was estimated at 2.5×109 daltons by reassociation kinetics; a guanine-plus-cytosine content of LDB of 39% was established by optical thermal denaturation and buoyant density ultracentrifugation measurements. DNA relatedness studies on 12 strains of the LDB indicated that they were all members of the same species. DNA relatedness studies have thus far failed to show that the LDB is significantly related to any other organism, including all members of Enterobacteriaceae,Pasteurella multocida, Francisella tularensis, Rochalimaea quintana, Vibrio species,Staphylococcus epidermidis, andFlavobacterium meningosepticum.

Water hardness and cardiovascular mortality.

Abstract: Ever since Kobayashi,' in 1957, noted a parallel between the geographic distribution of the acidity of water in Japanese rivers and the distribution of what was then one of the major causes of mortality in Japan, apoplexy, an increasing number of investigators all over the world have attempted to elucidate and confirm a geographic relationship between quality of drinking water and mortality, particularly from cardiovascular causes. The now voluminous literature in this field has been subject to several comprehensive As remarkable as the geographic diversity of these studies is the great diversity of the hypotheses that have been favored by daerent investigators, both as regards the identity of the water-borne factor to which they impute a good or bad influence, and as regards the nature of the disease or pathologic process induced. Re~ently,~ we expressed regret at the lack of any emerging consensus among those who have contributed to the literature over the last 15 years, and at the failure of most studies to yield evidence capable of discriminating among any of 64 major classes of explanatory hypotheses that need to be considered. Kobayashi did not refer to any category other than apoplexy, but ecological studies, from Schroeder on, have usually tried several cause-specific death rates as dependent variables. Thus, even though most investigators continue to refer to the hazard of residing in soft-water areas as if it related specifically to cardiovascular disease, support for this view has been progressively weakened by the admission of a bronchitis effect lo and by the suggestion that there is also an infant mortality effect in England, Wales 11, l2 and possibly Canada,13 though not in the United States.14 Stocks l5 showed that whatever may be the environmental or genetic factor responsible for regional mortality patterns of cardiovascular disease in the United Kingdom, it would appear to have a pronounced effect also on the incidence of congenital malformation of the central nervous system, and to a lesser extent this would apply to nephritis and carcinoma of the stomach. In the United States, Sauer l6 found as strong a negative correlation of hardness with malignant neoplasm as with cardiovascular deaths, Canadian statistics l7 show that more than half the excess mortality in soft-water areas is certified to noncardiovascular causes of death. Uncertainty as to the real effect of the water factor has lead some investigators to discriminate between various components of cardiovascular mortality in the hope of identifying a more specific association. For example,

Antibiotic susceptibility of clinical isolates of Listeria monocytogenes.

Abstract: A broth microdilution method was used to measure the minimal inhibitory concentrations (MICs) of the antibiotics most often recommended for treatment of listeriosis. The MICs of ampicillin, penicillin, erythromycin, and tetracycline for 175 strains of Listeria monocytogenes were below the approximate MIC breakpoint for susceptible strains as recommended by the National Committee on Clinical Laboratory Standards. Inhibition diameters for 125 strains were measured by the standardized disk method (National Committee on Clinical Laboratory Standards) and compared with the appropriate MIC values. By both methods, strains were susceptible to the above four antibiotics, except for three strains, which were intermediate in susceptibility to penicillin by the disk method. Since the minimal bactericidal concentrations for ampicillin and penicillin significantly exceeded the MICs for these antibiotics, 45 strains were evaluated with ampicillin (5 μg/ml) and gentamicin (1 μg/ml) to compare the synergistic bactericidal effect of the two used in combination and singly. An increased kill of 100-fold was observed with the antibiotics combined in 19 strains after 4 to 6 h and in 40 strains after 24 h. A comparison of results with microdilution in Trypticase soy broth and agar dilution in Mueller-Hinton agar revealed that MICs for gentamicin, kanamycin, and streptomycin were strongly influenced by the media used. The MICs were consistently lower in Mueller-Hinton agar.

Phenol Poisoning Due to Contaminated Drinking Water

Abstract: Accidental spillage of 37,900 1 of 100% phenol (carbolic acid) in July 1974 caused chemical contamination of wells in a rural area of southern Wisconsin. Human illness characterized by diarrhea, mouth sores, dark urine, and burning of the mouth was subsequently reported by seventeen individuals who consumed the contaminated water; their estimated intake of phenol was 10 to 240 mg/person/day. Clustering of the illnesses in time and place, as well as the similarity of these cases to previously documented cases of phenol poisoning, suggest that phenol in water caused the illness. Physical and laboratory examinations 6 months after the exposure revealed no residual abnormality in exposed persons. Water testing and geologic evaluations indicate that contamination of the underground water system may persist for many years.

Prevalence of antibody to the Norwalk agent by a newly developed immune adherence hemagglutination assay.

Abstract: An immune adherence hemagglutination assay (IAHA) for the detection of antibody to the Norwalk agent of acute epidemic nonbacterial gastroenteritis was developed using as antigen virus purified from stool from an experimentally infected volunteer. The assay was sensitive and specific and was efficient for detecting Norwalk antibody seroresponses. The prevalence of Norwalk antibody in various groups in the United States was studied. Antibody to the Norwalk agent was acquired gradually, beginning slowly in childhood and accelerating in the adult period so that by the fifth decade 50% possessed antibody. This pattern of antibody acquisition contrasted sharply with that for the human rotavirus of infantile gastroenteritis. Rotavirus antibody was acquired during early childhood by almost all individuals in the pediatric groups studied. Antibody to the Norwalk agent was also found in rural Bangladesh; in a small prevalence survey of 39 children and adults 21% possessed Norwalk IAHA antibody, whereas 95% possessed antibody to the human rotavirus.

Botulism type b: epidemiologic aspects of an extensive outbreak

Abstract: Between March 31 and April 6, 1977, 59 individuals developed type B botulism. All ill persons had eaten at the same Mexican restaurant and all had consumed a hot sauce made with improperly home-canned jalapeno peppers, either by adding it to their food, or by eating a nacho that had had hot sauce used in its preparation. There was a highly significant association between illness and consumption of hot sauce when a comparison was made between ill persons and well controls: 4% of all restaurant patrons eating at the restaurant during the outbreak period became ill with botulism; however, approximately two-thirds of those actually exposed to the toxic hot sauce became ill. Disease severity was statistically correlated with incubation periods. No differences in disease severity were found between persons of different age groups. The full clinical spectrum (mild symptomatology with neurologic findings through life-threatening ventilatory paralysis) of type B botulism was documented.

The diagnosis of Legionnaires' disease

Abstract: Excerpt Laboratory methods to confirm the diagnosis of Legionnaires' disease are becoming more widely used, and the disease is proving to be sufficiently common so that all physicians attending pat...

Antimicrobial susceptibility patterns of Streptococcus pneumoniae.

Abstract: Fifty clinical isolates of Streptococcus pneumoniae received by the Streptococcus Laboratory of the Center for Disease Control from August 1976 through March 1977 and 50 pneumococcal strains retrieved from 13- to 16-year storage (originally isolated October 1961 through December 1964) were tested for susceptibility to 10 antimicrobial agents by disk-agar diffusion and agar dilution tests No appreciable differences in susceptibility patterns were apparent between the two groups, and, except for one isolate, all were highly susceptible to every drug tested except gentamicin This single isolate required higher drug concentrations to inhibit macroscopic growth and had corresponding decrements in zones of disk inhibition with penicillin, ampicillin, and cephalothin An additional 43 pneumococci recently received from various areas of the United States and Canada were screened by a disk agar diffusion method for penicillin resistance Four of these isolates had penicillin zone diameters <30 mm, and subsequent agar dilution test results showed that the penicillin minimum inhibitory concentrations were elevated with these organisms Antimicrobial susceptibility patterns of pneumococci to antimicrobials other than penicillin and its analogs have not changed substantially in over a decade However, due to the emergence of strains with decreased susceptibility to penicillin, the screening test for penicillin resistance in pneumococci, especially in isolates from spinal fluid and blood, could be clinically useful as an aid in selecting optimal therapy

Development and Evaluation of an Immunodiffusion Test for Diagnosis of Systemic Zygomycosis (Mucormycosis): Preliminary Report

Abstract: An antigen analysis with filtrate and homogenate precipitinogens of single isolates of the zygomycetes Absidia corymbifera, Mucor pusillus, Rhizopus arrhizus, and Rhizopus oryzae demonstrated the presence of common antigens among the three genera as well as antigens which permit their differentiation. Selected homogenate antigens were valuable in developing a diagnostic immunodiffusion (ID) test for systemic zygomycosis. When sera from 43 patients with various proven mycoses other than zygomycosis were tested against each of the antigens, none formed precipitin bands identical to those formed by A. cormybifera, M. pusillus, and the Rhizopus spp. rabbit reference antisera. Sera from 23 normal persons and 25 diabetics did not react with any of the antigens. Homogenate antigens detected antibody in 8 of the 11 sera (73%) from suspected or proven cases of zygomycosis, whereas ID tests with filtrate antigens detected antibody in only 2 of the 11 sera (18%). Of the eight sera that reacted with the homogenate antigens, five only reacted with a specific Rhizopus sp. antigen, two only reacted with a specific M. pusillus antigen, and one only reacted with a specific A. corymbifera antigen. Study results show the ID test with homogenate antigens to be more specific and sensitive than the ID test with filtrate antigens and indicate that the former is a promising technique for diagnosing human zygomycosis.

Identification of Saint Louis encephalitis virus mRNA.

Abstract: Saint Louis encephalitis (SLE) virus-specific RNA was recovered from infected HeLa cells by sodium dodecyl sulfate (SDS)-phenol-chloroform extraction, and the molecular species were resolved by SDS-sucrose gradient centrifugation and agarose gel electrophoresis. Sucrose gradient centrifugation revealed the presence of a 45S species, minor 20 to 30S heterogeneous species, and an 8 to 10 S RNA species in the cytoplasmic extract. Analysis of the same samples by electrophoresis on agarose gels, under both nondenaturing and denaturing conditions, revealed only two virus-specific RNA molecules, the 45S genome-sized RNA and an 8 to 10S species. Varying the gel concentration to facilitate analysis of nucleic acids with molecular weights ranging from 25,000 to 25 X 10(6) failed to reveal additional RNA species, although low levels of a putative double-stranded replicative form could conceivably have escaped detection. From our observations it appears that the heterogeneous RNA species and presumably the 20S RNase-resistant species reported in other investigations of flavivirus RNA are degradation products or conformers of the 45S molecule. Polysomes from SLE virus-infected cells were prepared and separated from contaminating nucleocapsid by centrifugation on discontinuous sucrose gradients. RNA extracted from these polysome preparations was analyzed by sucrose gradient centrifugation and agarose gel electrophoresis. The 45S SLE virus genome-size molecule was found to be the only RNA species associated with the polysomes. This molecule was sensitive to RNase digestion and was released from polysomes by EDTA and puromycin treatment. These findings provide direct evidence that the 45 S SLE virus RNA serves as the messenger during virus replication, in contrast to the 26S RNA species which functions as the predominant messenger during alphavirus replication.

Medical Economics Survey-Methods Study Cost-Effectiveness of Alternative Survey Strategies

Abstract: The Medical Economics Survey-Methods Study was conducted under contract for the National Center for Health Statistics during 1975–76. The objective was to determine the cost-effectiveness of a variety of strategies under consideration for application in a national survey in 1977. Detailed data on he