Challenges in Interpretation of Diagnostic Test Results in a Mumps Outbreak in a Highly Vaccinated Population.

In spite of a greatly reduced incidence rate due to vaccination, mumps outbreaks continue to occur in several areas of the world, sometimes in vaccinated populations. This article describes an outbreak in a highly vaccinated population in southwestern Ontario, Canada, and the challenges encountered in interpreting the results of diagnostic tests used in the outbreak. During the outbreak, patients were interviewed and classified according to the outbreak case definition, and specimens were collected for diagnostic testing according to Ontario guidelines. Twenty-seven individuals were classified as confirmed cases (n = 19) or suspect cases (n = 8) according to the case definition, only 9 of which were laboratory-confirmed cases: 7 confirmed by reverse transcriptase PCR (RT-PCR) and 2 by IgM serology. All 19 confirmed cases represented patients who were associated with secondary schools in the local area and had been vaccinated against mumps with one (n = 2) or two (n = 17) doses of the measles-mumps-rubella (MMR) vaccine. This is the first published report of an outbreak of mumps in Ontario in which all confirmed cases had been vaccinated against the disease. It highlights the limitations of and difficulties in interpreting current mumps diagnostic tests when used in vaccinated individuals.

Public Health Follow-up of Suspected Exposure to Echinococcus multilocularis in Southwestern Ontario.

In the 3 years since the first report of canine alveolar echinococcosis (AE) in Ontario, three additional cases have been diagnosed in the province. Of the four cases reported to date, three have had no known history of travel outside the province. It is possible that this development is an indication of previously unrecognized environmental contamination with Echinococcus multilocularis eggs in some areas of the province. If so, there is the potential for an emerging threat to human health. This article describes a local public health department's investigation of the possible exposure to E. multilocularis of a number of individuals who had had contact with the latest of the four cases of canine AE, and summarizes a comprehensive decision process that can be used by public health departments to assist in the follow-up of such exposures.

Measurement of hepatic sterol synthesis in the Mongolian gerbil in vivo using [3H]water: diurnal variation and effect of type of dietary fat.

The hepatic synthesis of sterol was measured in the male Mongolian gerbil (Meriones unguiculatus) in vivo following the administration of [3H]water by monitoring the incorporation of radioactivity into digitonin-precipitable sterol. A diurnal rhythm in cholesterol synthesis was exhibited under conditions of ad libitum feeding with alternating 12-hour periods of light (0200 to 1400 hr) and dark (1400 to 0200 hr). The zenith was reached between 1500 and 2100 hr and the nadir approximately 10-12 hours later between 0200 and 0400 hr, which provided a zenith/nadir ratio of 9.6 to 1.0. The in vivo rates of hepatic sterol synthesis and plasma cholesterol levels were measured in gerbils fed semi-purified diets containing either 19.5% beef tallow + 0.5% safflower, 20% lard, or 20% safflower oil and widely differing ratios of polyunsaturated: saturated fatty acids. All diets were equalized to contain 0.01% cholesterol and 0.05% plant sterol. After 3 days on the experimental diets, the mean rates of cholesterol synthesis (nmol/g liver per hr) were 41.5, 26.6, and 13.8 for animals fed the diets containing beef tallow, lard, and safflower oil, respectively. After 7 and 14 days, synthetic rates were lowest in the gerbils fed safflower oil as were also the plasma cholesterol levels. These results indicate that the type of dietary lipid can significantly influence the in vivo rate of sterol biosynthesis in gerbil liver. This response may contribute, at least in part, to the observed differences in plasma cholesterol levels.