Active surveillance and risk factors for leptospirosis in Hawaii.

A clinic-hospital-based leptospirosis surveillance program was conducted to determine the morbidity and risk factors in nonepidemic settings. The study was conducted on two islands, Kauai and Hawaii (Big Island), in the state of Hawaii for one year during 1988 and 1989. An active, more comprehensive case detection system was used on the Big Island that enabled us to determine the incidence of clinical disease. Subjects from both islands were used to conduct a case-control study for risk factors. One hundred seventy-two subjects from the Big Island (who presented with any two of the following symptoms: fever, headache, myalgia, or nausea/vomiting) were enrolled in the study. Twenty cases were diagnosed by culture, serology, or fluorescent antibody tissue staining at autopsy. Six cases required hospitalization and two succumbed to fatal infections. We estimated that these cases represented an annual incidence rate of 128 per 100,000 person-years in our target population. For 33 cases, 77 controls were matched for island, age, sex, and time of onset of illness. Interviews were conducted retrospectively in a double-blinded fashion with cases and controls and evaluated approximately 30 risk factors. Factors that were associated most strongly with development of leptospirosis were household use of rainwater catchment systems (P = 0.003), presence of skin cuts during the incubation period (P = 0.008), contact with cattle or the urine of cattle (P = 0.05 and P = 0.03, respectively), and handling of animal tissues (P = 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical and laboratory findings implicating palytoxin as cause of ciguatera poisoning due to Decapterus macrosoma (mackerel).

A near fatal case of ciguatera-related intoxication following consumption of smoked Decapterus macrosoma is documented. In addition to some of the hallmark symptoms of ciguatera poisoning, the patient exhibited acute respiratory distress and severe muscle spasms. Laboratory results showed large elevations in a number of blood enzymes, indicative of muscle damage. The responsible agent was extracted from corresponding fish samples and identified as palytoxin.

The hepatitis B immunization campaign for children in the Federated States of Micronesia.

Hepatitis B has long been recognized as hyperendemic among persons residing in the western Pacific. Effective control strategies have not been described. From December 1988 through October 1989, the Federated States of Micronesia (FSM) conducted a campaign to immunize children through age 6 years with three doses of hepatitis B (HB) vaccine. In addition, HB vaccination was incorporated into the routine immunization schedule for all children born in FSM, with the first dose given to newborns. Between December 1988 and October 1989, a total of 64,085 doses of HB vaccine were administered to the children. After the start of the campaign, the subject group was enlarged to include children through 15 years of age in the States of Yap and Kosrae. Fifty-nine percent of the enlarged group in all States received a complete series of HB vaccinations. During each client encounter, individual immunization records were examined and diphtheria-pertussis-tetanus, oral polio vaccine, and measles-mumps-rubella antigens were administered to children who were not adequately immunized. The annual immunization assessment for 1990 showed coverage improved significantly from previous years in every FSM State.

"KITS" for improved immunization of Kauai children.

Kauai physicians and District Health Office staff established a computerized tracking system in 1993 to improve immunization rates in Kauai-born infants. Comparison of 1995 and 1996 audit results of 1993- and 1994-born children showed completion rates for 9 antigens rose from 76% to 86%. Evolution and improvement of the tracking system are discussed. Recommendations for physicians are offered.

Clinical and epidemiological observations regarding the 1998 Kauai murine typhus outbreak.

Five cases of murine typhus occurring on southwestern Kauai in 1998 are described, following an investigation by the Department of Health. Two cases also had concurrent leptospirosis. Recent habitat changes of peridomestic animals and their fleas may have increased the risk for developing murine typhus. Increased suspicion of typhus by island physicians and more aggressive rodent control activities are recommended.

Leptospirosis on Kauai: investigation of a common source waterborne outbreak.

During the summer of 1987, a common source waterborne outbreak of leptospirosis occurred on the island of Kauai in the state of Hawaii. Eight leptospirosis cases were identified using the microscopic agglutination test. Methodologic weaknesses in this technique were responsible for the initial missed diagnosis on six of the eight cases. All cases had repeated exposure to the Waimea River. A wide array of animal reservoirs and optimal water conditions may have been factors in this outbreak.