The epidemiology of chronic fatigue in San Francisco.

Despite considerable research on chronic fatigue syndrome (CFS) and conditions associated with unexplained chronic fatigue (CF), little is known about their prevalence and demographic distribution in the population. The present study describes the epidemiology and characteristics of self-reported CF and related conditions in a diverse urban community. The study used a cross-sectional telephone screening survey of households in San Francisco, followed by interviews with fatigued and nonfatigued residents. Respondents who appeared to meet case definition criteria for CFS, based on self-reported fatigue characteristics, symptoms, and medical history, were classified as CFS-like cases. Subjects who reported idiopathic chronic fatigue (ICF) that did not meet CFS criteria were classified as ICF-like cases. Screening interviews were completed for 8,004 households, providing fatigue and demographic information for 16,970 residents. Unexplained CF was extremely rare among household residents <18 years of age, but was reported by 2% of adult respondents. A total of 33 adults (0.2% of the study population) were classified as CFS-like cases and 259 (1.8%) as ICF-like cases. Neither condition clustered within households. CFS- and ICF-like illnesses were most prevalent among women and persons with annual household incomes below $40,000, and least prevalent among Asians. The prevalence of CFS-like illness was elevated among African Americans, Native Americans, and persons engaged in clerical occupations. Although CFS-like cases were more severely ill than those with ICF-like illness, a similar symptom pattern was observed in both groups. In conclusion, conditions associated with unexplained CF occur in all sociodemographic groups but appear to be most prevalent among women, persons with lower income, and some racial minorities.

Sex of the parental donor and cellular rejection of renal allografts in children.

The survival of renal allografts of maternal and paternal origin has been assumed to be identical, and in reports concerning graft survival the outcome of parental transplants is not analyzed by sex of the donor. Fifty-five children received a parental kidney between January 1973 and March 1987 at one institution. There were 6 technical failures. Analysis of renal graft survival in the remaining 49 children indicates a disparity between maternal and paternal graft survival, with an increased propensity for loss of paternal grafts from cellular rejection. Nine of 22 parental grafts are no longer functioning; 7 were lost from cellular rejection. In comparison, cellular rejection resulted in the loss of only 2 of 27 maternal grafts. This disadvantage of paternal grafts is most conspicuous in patients followed for 2 or more years; 7 of 15 paternal but only 1 of 20 maternal grafts were lost because of cellular rejection (P = 0.01). With causes of graft loss other than cellular rejection treated as withdrawal, actuarial survival of the 27 maternal grafts at 1 and 5 years is 96% and 91%, respectively, while that of the 22 paternal grafts is 83% and 58% (P = 0.017). Analysis of data from other centers will help determine whether our observation is of clinical significance.

A field evaluation in Mexico of four baits for oral rabies vaccination of dogs.

We evaluated four baits for the delivery of oral rabies vaccines to dogs. In a controlled study in a town in rural Mexico, 177 randomly selected dogs were assigned to receive one of four experimental baits (two of which were developed by the Denver Wildlife Research Center [DWRC]): one of two cylindrical polyurethane sponges with a corn meal coating (one fried in corn oil [DWRC-corn], the other in fish oil [DWRC-fish]), a fish-flavored polymer bait, or a wax bait. Each dog was also offered a commercial dog biscuit. We recorded whether or not the bait was completely consumed, and used the following measures to estimate the amount of oropharyngeal contact with each bait: total chewing time, presence of pieces of bait on the ground following administration, the total area of ground surrounding the location of ingestion that was covered with green dye contained in each bait, and condition of ampules that contained the dye. The dog biscuits were completely consumed significantly more often than the baits (155 of 176 [88%] for the biscuits versus 89 of 176 [50.5%] for the four baits; P less than 10(-6)), but were chewed for a significantly shorter time than the baits (mean time 34 sec for the biscuit versus 60-82 sec for the four baits: P less than 0.001). The ideal bait would probably combine the attractiveness of the commercial biscuit and the ability of the sponge baits to promote contact with the mucous membranes.

Prevention of canine rabies in rural Mexico: an epidemiologic study of vaccination campaigns.

We compared three vaccination strategies in three rural communities in Mexico to determine the factors associated with the success of vaccination programs in areas where canine rabies is poorly controlled. In town A, intensive publicity and community participation were used; owners were instructed to bring their dogs to temporary centralized clinics for vaccination. In town B, only brief precampaign publicity was used, followed by vaccination at a centralized site. Minimal publicity was also used in town C, but the vaccination campaign was conducted house to house. A total of 5,426 residents and 1,597 dogs were counted in the three towns (mean human:dog ratio 3.4:1). In Town A, 70.1% (472 of 673) of the dogs were vaccinated; the campaign required 40 person-minutes per dog. Significantly greater proportions were vaccinated in town B (262 of 318 [82.4%]; P less than 0.001) and town C (483 of 561 [86.1%]; P less than 0.00001); each of these latter campaigns required 10 person-minutes per dog. The following factors were positively associated (by multivariate analyses) with vaccination of individual dogs: non-intensive publicity, house-to-house vaccination, dogs owned by a single member of the household, and dogs acquired greater than 15 days after birth. Intensive publicity did not increase the overall success of the vaccination program; the efficiency of centralized versus and house-to-house vaccination was comparable.

An epidemiologic study of fatigue with relevance for the chronic fatigue syndrome.

We surveyed households in four rural Michigan communities to confirm a reported cluster of cases resembling chronic fatigue syndrome (CFS) and to study the epidemiology of fatigue in a rural area. Data were collected from 1698 households. We did not confirm the reported cluster. The prevalence of households containing at least one fatigued person was similar between communities thought to harbor the cluster and communities selected for comparison. Symptoms and features of generic forms of fatigue were very similar to those often attributed to CFS.

Fatiguing illness among employees in three large state office buildings, California, 1993: was there an outbreak?

UNLABELLED: The objective was to determine if a cluster of chronic fatigue syndrome (CFS)-like illness had occurred among employees in two large state office buildings in northern California, and to identify risk factors for and features of fatiguing illness in this population. DESIGN: case-control study. POPULATION AND SETTING: Over 3300 current employees in two state office buildings and employees in a comparable "control" building. Information was collected on demographic and occupational variables, the occurrence of fatiguing illness for at least one month in the previous year, and the presence of 36 symptoms. A total of 3312 (82%) of 4035 employees returned questionnaires. Overall, 618 (18.7%) persons reported fatigue lasting at least one month; including 382 (11.5%) with fatigue of at least six months' duration and 75 (2.3%) with symptoms compatible with a CFS-like illness. Independent risk factors for fatigue lasting one month or longer were found to be Native American ethnicity (OR 2.4, CI 1.1,5.3), Hispanic ethnicity (OR 1.7, CI 1.3,2.3), female sex (OR 1.5, CI 1.2,1.9), gross household incomes of less than $50,000 (OR 1.3, CI 1.1,1.6), and less than a college education (OR 1.3, CI 1.1,1.6). Similar risks were observed for persons who reported fatigue lasting six months or longer. Female sex (OR 3.2, CI 1.7, 6.4) was the only independent risk factor found for those persons classified as having a CFS-like illness. Case prevalence rates for all three categories of fatigue, as determined by multivariate analysis, were not significantly different among buildings. Despite finding a substantial number of employees with fatiguing illness in the two state office buildings, the prevalence was not significantly different than that for a comparable control building. Previously unidentified risk factors for fatigue of at least one month and at least six months identified in this population included Hispanic ethnicity, not having completed college, and income below $50,000.

Seroprevalence and incidence of sexually transmitted diseases in a rural Ugandan population.

The aim of the study was to determine in a rural population the age- and sex-specific prevalence and incidence rates of serological reactivity of 5 common sexually transmitted diseases (STDs) and their association with HIV-1 antibody status. Of the adult population of two villages (529 adults aged 15 years or more) 294 provided an adequate blood specimen both on enrollment and at 12 months. The sera were tested at 3 collaborating laboratories for antibodies against HIV-1, Treponema pallidum, Haemophilus ducreyi, Chlamydia trachomatis and herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). A sample of 45 children were tested for HSV-1 and HSV-2. Seroprevalence rates in adults on enrollment were 7.8% for HIV-1, 10.8% for active syphilis, 10.4% for H. ducreyi, 66.0% for C. trachomatis, 91.2% for HSV-1 and 67.9% for HSV-2. Males were significantly more likely than females to be seropositive for H. ducreyi (15.6% versus 6.6%), but less likely to be HSV-2 antibody positive (57.0% versus 74.4%). Reactivity to H. ducreyi, C. trachomatis and HSV-2 rose with increasing age. In contrast, active syphilis showed no age trend. All STDs tended to be more common in those HIV-1 seropositive. Incidence rates over the 12 months were nil for HIV-1, 0.5% for syphilis, 1.2% for H. ducreyi, 11.3% for C. trachomatis, and 16.7% for HSV-2. The results of this exploratory study indicate that all STDs included are common in this rural population. The high HSV-2 prevalence rate among adolescents suggests that HSV-2 may be an important risk factor for HIV-1 infection.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: A seroprevalence survey conducted in rural Uganda revealed a high potential for interaction between sexually transmitted diseases (STDs) such as herpes simplex virus type 2 (HSV-2) and human immunodeficiency virus (HIV). Venous blood samples were collected at baseline and one year later from 294 randomly selected adults aged 15 years or over from two neighboring villages. At baseline, 23 (7.8%) adults were HIV-positive; no seroconversion occurred during the one-year study period. STD prevalence rates were 10.8% for syphilis, 10.4% for Hemophilus ducreyi, 66.0% for Chlamydia trachomatis, and 91.2% for HSV-1 and 67.9% for HSV-2. More females (74.4%) than males (57.0%) were HSV-2 antibody-positive. Reactivity to H. ducreyi, C. trachomatis, and HSV-2 rose with increasing age, but there was no such trend for syphilis. HIV prevalence rates were 0.0% among those with no serologic evidence of previous STDs, 2.6% among those with one or two prior STDs, and 20.0% among those with three or four STD markers. Of particular concern was the high rate of HSV-2 prevalence among adolescents (85% among females aged 20-24 years and 82% in males aged 25-29 years). It is suggested that age-specific HSV-2 seroprevalence can provide an accurate marker of premarital sexual activity among Ugandan adolescents since it lacks the potential for bias associated with self-reporting in this population.

Cytomegalovirus seroprevalence in women bearing children in Jefferson County, Kentucky.

Symptomatic congenital cytomegalovirus (CMV) disease occurs almost exclusively in infants born to seronegative mothers who acquire the virus during pregnancy. This study sought to determine patterns of CMV immunity in women of childbearing age at one center participating in a national study. Cord blood specimens from 100 consecutive deliveries at each of three hospitals were tested for CMV-specific IgG. Mean age of women in this sample was 25.7 years; 76% were white, 60% were from middle and upper socioeconomic status, 64% were married, and 57% had other living children. Overall seroprevalence rate was 62%. Univariate analysis showed strong associations between seropositivity and lower socioeconomic status, non-white race, and age younger than 25 years (odds ratios, 4.4, 3.9, and 2.5, respectively). Stratification by socioeconomic status and race eliminated the effect of age. Stratification by socioeconomic status markedly reduced the effect of race, whereas stratification by race only moderately reduced the effect of lower socioeconomic status, which was the strongest predictor of seropositivity (odds ratio, 3.4). Seroprevalence was lowest among older white women of middle and upper socioeconomic status (47% seropositive). Development of longitudinal regional seroprevalence data will facilitate interpretation of data generated by the National CMV Registry.

Rabies surveillance in the United States during 1989.

In 1989, 4,808 cases of rabies in animals other than human beings were reported to the Centers for Disease Control, 1.8% more (4,724 to 4,808) than in 1988. Eighty-eight percent (4,224/4,808) of those affected were wild animals and 12% (584/4,808) were domestic animals. Cases were reported from 49 states, the District of Columbia, and Puerto Rico; Hawaii remained rabies-free. Skunks (1,657) continued to be the most commonly reported rabid wild animal. For the second consecutive year, more cats (212) were reported to be infected with rabies virus than any other domestic species. Compared with their 1988 reports, 5 states reported increases of greater than 100% (Alaska, 109%; New Jersey, 233%; Ohio, 133%; Oklahoma, 168%; and Washington, 125%), and 5 states reported decreases of greater than 50% (Connecticut, 63%; Mississippi, 56%; Montana, 67%; Nevada, 55%; and West Virginia, 53%) in 1989.

Life expectancy in an aboriginal Malaysian population.

A life table for an aboriginal Malaysian population, the Semelai, living in West Malaysia, was constructed using censuses from 1965, 1969, and 1974; and interview data from 1974. The life expectancy at birth for this population, 54.0 years, was compared to that of other Malaysian populations and selected Asian populations. This comparison indicated that the Semelai were at a disadvantage compared to the Malaysian populations, but in a favorable position when compared with the other Asian populations.

Regulation and the use of "negative" results from human reproductive studies: the case of ethylene dibromide.

This paper examines the regulatory usefulness of five studies of the reproductive effects of occupational exposure to ethylene dibromide. None of the studies found a statistically significant adverse effect. Results from an epidemiologic study can find no adverse effect either because there is in fact no association between the outcome and the exposure being studied or because the study was not powerful enough to detect an association between the two. This distinction is especially important when "negative" studies are offered as evidence that a chemical is not harmful to workers. General reasons for low power in reproductive studies are discussed, and each of the studies is examined to see if the results were in fact negative and what factors were operating to affect the power of each study. Four of the studies showed potential reproductive impairments that were not large enough to be judged statistically significant by the authors. The power of all of these studies was then examined and found to be low for a number of reasons. These studies therefore do not represent evidence that ethylene dibromide is harmless; on the contrary, they may indicate the opposite. In general, when regulating potentially harmful chemicals in a low-power situation, power should be raised by raising the alpha level of the study, especially when animal data show a strong positive effect.

Surveillance of congenital cytomegalovirus disease, 1990-1991. Collaborating Registry Group.

In January 1990, a registry was initiated for surveillance of infants with the often severe symptoms of congenital cytomegalovirus (CMV) disease. In the first 2 years, 100 cases were reported to the registry. Petechiae, the most commonly noted clinical sign, were reported for approximately 50% of infants, usually accompanied by hepatomegaly and splenomegaly. Of the various severe neurologic conditions that can result from congenital CMV infection, the most frequent was intracranial calcifications, which were noted in 43% of the cases. The most common laboratory abnormality was low platelet count, which was observed in 52% of the cases. Infants with severe neurologic damage were about twice as likely as infants with less severe damage to have most other clinical signs and laboratory abnormalities. Databases will be developed to facilitate comparisons among symptomatically infected infants and asymptomatically infected as well as noninfected infants.

Occupational exposures and brain cancer mortality: a preliminary study of east Texas residents.

The relationship between various occupational exposures and brain cancer was investigated in a case-control study using mortality data from 202 males who died in East Texas from gliomas in 1969-1978 and 238 male controls randomly selected from all deaths in East Texas in 1969-1978. Using the occupational classification scheme of the U.S. Bureau of the Census, the risk for brain cancer was significantly increased for male workers employed in the transportation, communication, and utilities industries [odds ratio (OR) = 2.26, confidence intervals (CI) = 1.18-4.32]. Further examination of this finding showed that male workers employed in occupations associated with electricity or electromagnetic (EM) fields had an elevated risk for brain cancer (OR = 3.94, CI = 1.52-10.20). In addition, there was a linear relationship between the probability of exposure to EM fields and brain cancer. Significantly elevated risk for brain cancer was also found among male workers in the trucking industry.

Surveillance for congenital cytomegalovirus disease: a report from the National Congenital Cytomegalovirus Disease Registry.

A national surveillance program for congenital cytomegalovirus (CMV) disease was initiated in 1990. In 4 years 285 cases were reported without seasonal patterns. Mean birth statistics were as follows: gestational age, 36 weeks; weight, 2,224 g; length, 45 cm; and head circumference, 30 cm. Of the infants 68% had CNS involvement, which was significantly (P < .005) associated with a direct bilirubin level of > or = 3 mg/dL, petechiae, an alanine aminotransferase level of > 100 U/L, a platelet count of < or = 75,000/mm3, hepatomegaly, and splenomegaly (P < .05). Maternal demographics revealed that the mean age was 23 years (range, 13-38 years), 59% were white, 33% were black, 47% had low incomes (receiving Medicaid), and 45% were primiparous. Compared with 1990 birth statistics in the United States, mothers of infants with congenital CMV disease were younger, and a greater percentage of these mothers were black. Two distinct maternal groups were identified on the basis of age, socioeconomic status, and parity. This finding may reflect different modes of transmission and suggest target populations for future CMV vaccine initiatives.

Incidence rates of firearm injuries in Galveston, Texas, 1979-1981.

Firearm injury mortality rates have been characterized in various settings, but little is known of the total magnitude of firearm injury, including morbidity. The authors determined population-based incidence rates of firearm injury among residents of Galveston, Texas, from 1979-1981 by using police, emergency department, hospital, emergency medical services, medical examiner, and vital records to identify 239 firearm injury cases. Vital records, medical examiner, and police records each identified more than 95% of the fatalities, but police records (sensitivity = 98%) were better than emergency department or hospital records (sensitivity = 82% and 28%, respectively) for identifying all nonfatal cases. The annual age-adjusted incidence rate of firearm injury was 128 per 100,000 persons. Black males, with the highest firearm injury rate (459 per 100,000 persons), were injured at 46 times the rate of white females (10 per 100,000 persons). The overall case fatality rate was 30%, including 25% of the assaults/homicides, 81% of the parasuicides/suicides, and 0% of the unintentional injuries. On the basis of the case fatality rates, an estimated 140,000 firearm injuries occur in the United States annually. The case fatality rate for penetrating head injuries was 80% versus 48% for chest injuries and 6% for all other parts of the body. The results are discussed with respect to policy recommendations for reducing firearm injuries.

The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group.

The complexities of the chronic fatigue syndrome and the methodologic problems associated with its study indicate the need for a comprehensive, systematic, and integrated approach to the evaluation, classification, and study of persons with this condition and other fatiguing illnesses. We propose a conceptual framework and a set of guidelines that provide such an approach. Our guidelines include recommendations for the clinical evaluation of fatigued persons, a revised case definition of the chronic fatigue syndrome, and a strategy for subgrouping fatigued persons in formal investigations.

Rabies surveillance, United States, 1988.

The primary purpose of the annual report on rabies surveillance is to assist local and state public health officials in the planning of rabies control programs and to guide health professionals in evaluating the need for rabies postexposure prophylaxis in patients who are exposed to animals that may be rabid. In 1988, a total of 4,724 cases of animal rabies were reported by 47 states, the District of Columbia, and Puerto Rico, similar to the total (4,729) for 1987. No human cases of rabies were reported. The South Atlantic, South Central, North Central, and Middle Atlantic states reported 81% of the cases. Pennsylvania, Texas, California, Maryland, and Virginia each reported over 300 rabid animals. Delaware (61 cases), New Mexico (15), Alaska (34), Connecticut (8), and South Carolina (127) each reported an increase in animal rabies cases greater than or equal to 100% in 1988 compared with 1987. Smaller but significant increases also were reported from Florida (66% increase), Pennsylvania (68%), and Georgia (40%). Eighty-eight percent of rabies cases were in wild animals, and 12% were in domestic animals. Skunks, raccoons, and bats accounted for 82% of all rabid animals. Cats became the most commonly reported domestic species for the first time since reporting to CDC began in 1960. The most effective methods of reducing the number of people exposed to rabies are to educate the public to avoid unfamiliar, especially wild, animals and to vaccinate susceptible pets against rabies. Rabies vaccination programs should target cats as well as dogs. Two cases of imported canine rabies emphasized the need to educate travelers of the risk of canine rabies in developing countries. Caution should be used when pets are imported from these countries.