Low secondary transmission of 2009 pandemic influenza A (H1N1) in households following an outbreak at a summer camp: relationship to timing of exposure.

Following an outbreak of 2009 pandemic influenza A (H1N1) at a residential summer camp for boys aged 10-16 years, we assessed secondary household transmission of the novel virus after their return home. Of 212 study participants who attended camp, 49 had confirmed or probable influenza for a primary attack rate of 23%. Of 87 exposed household contacts who did not attend camp, only three instances of probable transmission were observed, for a household secondary attack rate of 3·5%. All secondary cases occurred in households where the ill camp attendee returned home 1 day after onset of illness, with an attack rate of 14·3% in household contacts in this category. Returning home after peak infectivity to others and advanced warning prior to reintegration of sick individuals into the household probably contributed to the overall low secondary attack rate observed.

Cholera toxin and pertussis toxin substrates and endogenous ADP-ribosyltransferase activity in Drosophila melanogaster.

Cholera toxin- and pertussis toxin-catalyzed ADP-ribosylation were used to identify and localize G protein substrates in Drosophila melanogaster and in Manduca sexta. Cholera toxin catalyzes ADP-ribosylation of 37 kDa and 50 kDa polypeptides, but these polypeptides are also substrates for an ADP-ribosyltransferase (EC 2.4.2.30) activity endogenous to the Drosophila extracts. Pertussis toxin modifies 37 kDa and 39 kDa polypeptides in Drosophila homogenates. The pattern of proteolysis of the 39 kDa pertussis toxin substrate is similar to that of mammalian Go and is influenced by guanyl nucleotide binding. The 39 kDa Go-like Drosophila and Manduca pertussis toxin substrates are found primarily in neural tissues. These studies provide further evidence that G proteins are present in Drosophila and that this organism can therefore be used to investigate the physiological roles of these enzymes using advanced genetic manipulations.

Failure of cooking to prevent shellfish-associated viral gastroenteritis.

BACKGROUND: In January 1995, Florida experienced the largest outbreak of oyster-associated gastroenteritis ever reported. METHODS: We interviewed both the cohort of persons from 38 gatherings where illness was reported and a sample of harvesters and harvest-area residents. Oysters were traced by means of tags and dealer records, and water quality measures in harvest areas were reviewed. We examined stool specimens for small round structured viruses by means of electron microscopy and amplification of RNA by reverse-transcriptase polymerase chain reaction. We also tested serum specimens for antibodies to Norwalk virus. RESULTS: Of 223 oyster eaters, 58% (129/223) became ill, compared with 3% (2/76) of non-oyster eaters (relative risk, 22; 95% confidence interval, 5.6-87.0). Most oyster eaters (67% [149/223]) ate only cooked (grilled, stewed, or fried) oysters. Oyster eaters who reported eating only thoroughly cooked oysters were as likely to become ill as those who ate raw oysters (relative risk, 0.68; 95% confidence interval, 0.45-1.0; P = .1). In 29 clusters, implicated oysters were from Apalachicola Bay, Florida. A community outbreak occurred in 2 bayside communities before the oyster harvest, leading to an increase in the reportedly common practice of overboard dumping of feces. Small round structured viruses were identified in the stool specimens of 2 harvest-area residents and 9 persons from 8 clusters. Results of water quality tests for fecal coliforms were within acceptable limits. CONCLUSIONS: This large outbreak of gastroenteritis associated with oysters may have resulted from overboard dumping of feces during a community outbreak of diarrheal illness. Our findings of acceptable water quality measures for fecal contamination and the lack of appreciable protective effect from cooking leave the consumer with no assurance of safety.

Guillain-Barré syndrome in Larimer County, Colorado: a high-incidence area.

During the period 1981-1983, 19 cases of Guillain-Barré syndrome (GBS) occurred in residents of Larimer County, Colorado, for an incidence of 4.0 cases per 100,000 population per year, compared with 1.2 cases per 100,000 per year in 1975-1980 (p less than 0.05). The higher incidence of GBS in 1981-1983 may represent an unusual chance occurrence, since no patient characteristics or predisposing events could be found to explain the increase. Nevertheless, the findings demonstrate that over a period of as long as 3 years, the crude average annual incidence of GBS in a large, well-defined population may exceed by twofold the upper limit of the previously reported range (0.6 to 1.9 cases per 100,000 per year).

Outbreak of Kawasaki syndrome in Denver, Colorado: association with rug and carpet cleaning.

Between October 1984 and January 1985, the largest outbreak of Kawasaki syndrome reported to date in the continental United States (62 cases) occurred in the Front Range of the Rocky Mountains, extending from Colorado Springs, Colorado, to Cheyenne, Wyoming. Fifty-two (84%) of these Kawasaki syndrome patients lived in the Denver metropolitan area. A case-control study revealed that 16 (62%) of 26 Kawasaki syndrome patients compared with 10 (20%) of 49 matched control subjects had a history of exposure to shampooed (19%) or spot-cleaned (81%) rugs or carpets within 30 days of the Kawasaki syndrome onset date (odds ratio = 5, P less than .01). The time of exposure to shampooed or spot-cleaned rugs or carpets for 9 of 10 Kawasaki syndrome patients who had a single exposure and for all 6 Kawasaki syndrome patients who had multiple exposures were clustered within an interval 13 to 30 days before the onset of illness. Although the reason for this unusually large outbreak remains obscure, it is the third in which a statistically significant association between Kawasaki syndrome and rug or carpet cleaning has been found.

Consumer product-related injuries in Athens, Ohio, 1980-85: assessment of emergency room-based surveillance.

Using the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission, I computed the average annual rates per 1,000 population of consumer product-related injuries in residents of Athens County, Ohio, and seem at one hospital. These rates do not include intentional injuries or injuries to occupants of motor vehicles, to pedestrians hit by motor vehicles, or those occurring on the job or in house fires. Average annual rates for all injuries combined ranged from 102 per 1,000 boys 10-14 years of age to 11.7 per 1.000 men 65-74 years of age. For all males, the annual rate was 53 per 1,000 and for all females, 32 per 1,000. The most common parts of the body injured were the fingers (accounting for 15% of visits), face (12%), ankle (8.5%), hands (8%), and head (7.9%). The most common injury types were lacerations (33%), contusions and abrasions (22%), sprains (16%), and fractures (13%). Hospital admission rates varied by age, sex, type of injury, and part of body injured. Comparison of a sample of NEISS records to emergency room records showed that data were abstracted by clerical personnel with a high degree of accuracy. Review of fractures of the lower leg identified a cluster of injuries in young girls from playground merry-go-rounds. Review of burn injuries identified problems with scald injuries in young adult women and with eye injuries from welding in young men. The system can be used to evaluate injury control measures taken on a local level.

The relative effectiveness of sanctions applied to first-time drunken driving offenders.

We selected for study drivers who were sentenced either to jail or a certified driver intervention program (DIP) in Franklin County, Ohio, in 1987 after their first drunken driving (DUI) conviction. Because each drunken driving charge was assigned to one of a pool of 15 judges with widely varying sentencing patterns, there was no apparent bias in subject allocation to the two treatments. For the jailed (n = 124) and DIP (n = 218) cohorts, we compared the likelihood of subsequent impaired driving, as evidenced by rearrest for a new alcohol-related driving offense or involvement in a car crash after drinking in the 4 years following the study-selected event. After controlling for potentially important covariates, such as gender, age, race, blood alcohol concentration, additional charges filed at the time of arrest, and driving history, we derived logistic regression results indicating that DIP attendees had significantly lower rates of subsequent impaired driving. Drivers who had no prior history of at least one non-DUI alcohol-related offense were significantly more likely to display additional impaired driving when jailed as opposed to those enrolled in a DIP (odds ratio [OR] = 2.53, confidence interval [CI] = 1.44, 4.45), while those with previous alcohol-related offenses may have fared better in jail (OR = .56, CI = .11, 2.76). Drivers younger than 21 years of age were also at elevated risk for repeat offenses (OR = 2.46, CI = 1.13, 5.35). DIPs appear most effective when used for persons who have not had previous alcohol-related crashes or driving offenses.

Campylobacter jejuni infection in Colorado: unexplained excess of cases in males.

Between January 1, 1981, and December 31, 1982, the Colorado Department of Health received reports of 1,185 culture-confirmed cases of Campylobacter jejuni infection. Incidence rates were highest among infants less than 1 year old and among persons aged 20-29 years. The distribution of cases by sex showed a predominance among males at all ages except 40-59 years, the most marked predominance occurring in infants under 1 year. The higher rates for males were also significant for all ages combined, for ages 10-19 years, and for ages 5-9 years. Neither Salmonella nor Shigella infections reported in Colorado during the same period showed the preponderance among males found for C. jejuni infections. Giardia infections, however, showed a weak male predominance, especially among children less than 10 years old. The preponderance of C. jejuni cases among males disclosed by this study was remarkable. The reasons for this phenomenon are not clear and need further research.

Follicular dermatitis outbreak caused by Pseudomonas aeruginosa associated with a motel's indoor swimming pool.

Fourteen cases of pustular dermatitis occurred in members of a snowmobile club who swam in a motel pool in West Yellowstone, Mont., in February 1978. Survey questionnaires identified seven additional cases in guests at the motel the same weekend. All those with rashes had used the swimming pool and dry sauna on February 17 or 18. Among 56 survey respondents, swimming pool and sauna use were significantly associated with illness (P = .0002 by Fisher's exact test). Pseudomonas aeruginosa serotype 0:11 was isolated from a pustule on the skin of one club member and from four samples of the indoor-outdoor carpet that surrounds the pool. A specific precipitating event for the outbreak was not identified, but disinfection practices at this facility (a single daily chlorination, no measurement of chlorine levels, toleration of grossly cloudy water, soggy poolside carpet) may have established conditions in which P. aeruginosa could grow intermittently and cause disease. These cases are the first documented outbreak of P. aeruginosa dermatitis in which a whirlpool bath has not been implicated.

Using YPLL in health planning.

OBJECTIVE: The measurement of years of potential life lost before age 65 (YPLL) is one of the Health Outcome Indicators defined by the state of Florida to measure progress toward Healthy People 2000 objectives. The authors describe the outcomes of their work with county health agencies to encourage use of the YPLL statistic. METHODS: Calculations of the 1993 YPLL rates for Florida counties with populations greater than 50,000 and of inter-county variability in YPLL rates were used to train county health agencies in the use of YPLL. RESULTS: Sixty-eight percent of all years of potential life lost in Florida in 1993 were attributed to 10 causes. While the total YPLL rates ranged from 3500 per 100,000 to 7000 per 100,000 across Florida counties, the leading causes differed substantially across counties. The YPLL measure was found to be useful in helping county health agencies plan programs to reduce premature mortality. CONCLUSIONS: Federal, state, and county health units can use YPLL rates to help guide activities toward Healthy People 2000 and to help identify new health problems that require forming new community alliances, but staff members must be trained to use the YPLL statistic appropriately. Causes that vary little across counties enable the implementation of statewide prevention approaches while causes that differ greatly by county will require locally designed interventions.

Fatal incident risk factors in recreational boating in Ohio.

To identify risk factors predicting the involvement of boat operators in incidents resulting in at least one fatality, the authors obtained data from a mail survey of registered boat owners in the State of Ohio and from the Boating Accident Report (BAR) files for 1983-86 compiled by the Ohio Department of Natural Resources. Additionally, they reviewed Ohio death certificates for those years to identify cases missed by the BAR system. Forty percent of the fatal incidents would have been missed by a search of death certificates alone. During the period studied, 107 boating incidents resulted in 124 deaths. There were 0.9 fatal incidents per million boat-operator hours. Factors found to be associated with an increased risk of a fatal boating incident were the operator being younger than 30 years, having fewer than 20 hours of boat operating experience, and lacking formal boat safety training. Canoes, kayaks, rowboats, and inflatables were associated with a higher rate of fatal incidents per million hours of use than were motorboats. Young age and lack of experience were associated independently with increased risk, explaining some of the effects associated with types of boats and with lack of training. The findings suggest that supervised experience, safety training programs aimed at young operators, and interventions specific to certain types of boats are likely to reduce boating fatalities.

Prevalence of Giardia lamblia and risk factors for infection among children attending day-care facilities in Denver.

A sample of children in the toddler age group was surveyed in Denver, CO, to determine the prevalence of Giardia lamblia and to identify risk factors for the intestinal disease. The sample consisted of 236 children attending day-care centers (DCC) and 79 who were not attending. Thirty-eight children (16 percent) attending DCCs and 7 (9 percent) who had not were positive for G. lamblia in stool samples. Risk factors for those attending DCC facilities included increasing duration of attendance, time per week attending DCCs, low family income, and large family size. The only risk factor for those not attending DCC facilities was travel to Colorado mountains. Multivariate analysis showed that risk factors for all children in the sample included travel to Colorado mountains, large family size, and attending DCC facilities. Infection was not associated with symptoms.

Measles outbreaks in religious groups exempt from immunization laws.

State immunization laws which exempt religious groups present difficult problems in disease control in measles epidemics. Two outbreaks are described, 136 cases in a college for Christian Scientists, and 51 cases associated with a camp attended by Christian Scientists. Control measures at the college included immunization and quarantine. An alternative strategy at the camp consisted of dispersal of exposed persons from the camp and their being quarantined in their home States. Three deaths (case-fatality ratio = 2.2 percent) were reported at the college; no serious complications were reported from the camp-associated epidemic. No transmission into the general community occurred in either epidemic. Public health officials are encouraged to be aware of the legal rights and obligations of religiously exempt groups so that outbreaks in these groups can be effectively controlled, even if standard immunization strategies are not possible. Early reporting and rapid case identification, investigation, and quarantine or vaccination procedures by public health workers are necessary for disease control in these settings.

Outbreaks of noroviral gastroenteritis in Florida, 2006-2007.

Noroviruses are an important cause of sporadic cases and outbreaks of acute gastroenteritis. During 2006-2007, widespread increases in acute gastroenteritis outbreaks consistent with norovirus were observed in the United States. We conducted a statewide survey to characterize norovirus outbreak activity in Florida during a 1-year period. From July 2006 to June 2007, 257 outbreaks of norovirus gastroenteritis were identified in 39 of Florida's 67 counties. About 44% of outbreaks were laboratory confirmed as norovirus and 93% of these were due to genogroup GII. About 63% of outbreaks occurred in long-term care facilities and 10% of outbreaks were classified as foodborne. The median number of ill persons per outbreak was 24, with an estimated total of 7880 ill persons. During the study period, norovirus outbreak activity in Florida was widespread, persistent, and consistent with increased activity observed in other parts of the country.

Cannabis-induced psychosis-like experiences are associated with high schizotypy.

OBJECTIVE: Recent studies have suggested that cannabis use is a risk factor for developing schizophrenia. We tested the hypothesis that cannabis use increases the likelihood of psychosis-like experiences in non-clinical participants who scored highly on a measure of schizotypy. METHOD: The psychological effects of cannabis were assessed in 137 healthy individuals (76% female, mean age 22 years) using a newly developed questionnaire concerned with subjective experiences of the drug: the Cannabis Experiences Questionnaire. The questionnaire has three subscales: Pleasurable Experiences, Psychosis-Like Experiences and After-Effects. Respondents also completed the brief Schizotypal Personality Questionnaire. RESULTS: Cannabis use was reported by 72% of the sample. Use per se was not significantly related to schizotypy. However, high scoring schizotypes were more likely to report both psychosis-like experiences and unpleasant after-effects associated with cannabis use. The pleasurable effects of cannabis use were not related to schizotypy score. CONCLUSION: High scoring schizotypes who use cannabis are more likely to experience psychosis-like phenomena at the time of use, and unpleasant after-effects. Our results are consistent with the hypothesis that cannabis use is a risk factor for full psychosis in this group.

Insurance coverage and usage of preventive health services.

The 1991 Florida Behavioral Risk Factor Survey which included 2,246 respondents to a random-digit-dial telephone survey, showed that 19.2% of Florida residents aged 18 and older reported they had no health insurance, and 24.7% reported they had no insurance covering outpatient services. Lack of insurance coverage was reported more frequently by younger adults (70% under age 40 vs 93% over age 60), by those with less than a high-school education (69% vs 85% for those with some college), by members of racial-ethnic minority groups (Hispanics 67.5%, Blacks 71.5%, whites 85%), and by residents of southeastern Florida. Persons without insurance coverage were less likely to report having had a check-up by a physician in the last year, more likely to report they needed to see a physician but could not because of cost (37% vs 9%), and less likely to have received a mammogram (33% vs 56%) or Pap smear (51.6% vs 67.8%) in the last year. These findings support the need for health-care reform to include assurance that health insurance covers preventive services.

Farm equipment injuries in a rural county, 1980 through 1985: the emergency department as a source of data for prevention.

Incidence rates of injury related to farm machinery were estimated for Athens County, Ohio, using data generated as part of the National Electronic Injury Surveillance System (NEISS) of the Consumer Product Safety Commission. The study period was 1980 through 1985. The service area of the principal hospital in the county, which participates in NEISS, closely approximates the population of the county. The population of the entire county and the rural farm population, based on US Census data, were used as denominators in calculation of rates. There were 147 injuries related to farm machinery over a six-year period, 14 of which were coded as occupational. One hundred twelve (84.2%) of these injury victims were men. The annual incidence rate per 1,000 rural farm resident population was 25.6 per 1,000 for children under the age of 14 years and was 55.6 per 1,000 for adults age 25 to 34 years. Annual rates for adults age 35 and up ranged from 13 to 19 per 1,000 rural farm residents. The annual number of tractor rollover injuries decreased during this study period, while the annual numbers of other tractor injuries did not change. Hospital emergency department visits can be used to document the need for and to evaluate injury prevention measures.

Assessment of a school exclusion policy during a chickenpox outbreak.

Two Ohio schools experienced an outbreak of over 200 cases of chickenpox during the period from October 5 to December 21, 1988, despite adherence to the 1986 American Academy of Pediatrics' recommendation that children be excluded from school for 1 week or until all lesions have crusted. In grades kindergarten through four, the attack rate for susceptibles was 51% (167/329). With the use of person-time analysis, classmates of a child with chickenpox in grades kindergarten through four were 3.6 times more likely to become a case 12-17 days (the range of one incubation period) after the last day the child with subsequent chickenpox was in class than at any other time during the 2.5-month study period (95% confidence interval (Cl) 2.4-5.4). This was even more pronounced during the first half of the outbreak (relative risk (RR), 10.8; 95% Cl 4.4-26.5). Cases were not more likely to aggregate 12-17 days after a child returned to school after having chickenpox (RR, 0.9; 95% Cl 0.5-1.5). No cases occurred in classmates 12-17 days after the 15 children absent less than 5 days returned to class. Because substantial chickenpox transmission may occur before rash onset, exclusion practices may have a limited effect on outbreak control and increase the indirect costs associated with chickenpox.

Acute giardiasis: an improved clinical case definition for epidemiologic studies.

In June 1983, an outbreak of waterborne giardiasis occurred in a group of 93 university students and faculty participating in a geology field course in Colorado. All cases occurred in one subgroup of persons who were heavily exposed to untreated stream water on a field trip, and the risk of illness was strongly related to the amount of untreated stream water consumed. The median incubation period from a brief exposure to the first symptom was 7 days. The authors compared symptoms and stool sample results among 31 Giardia-positive persons in the exposed group and 36 Giardia-negative participants in an unexposed group to assess several case definitions for acute giardiasis. Diarrhea, abdominal cramps, flatulence, foul-smelling stools, nausea, excessive tiredness, bloating, anorexia, and chills were each significantly more common in the first group than in the second. A giardiasis case definition of 5 days or more of diarrhea--the definition used in many epidemiologic studies of giardiasis--had a specificity of 100 percent but a sensitivity of only 32.2 percent compared with a definition based on results of stool examinations. When a case was defined as an illness lasting 7 days or more, with a combination of two or more of six symptoms (diarrhea, flatulence, foul-smelling stools, nausea, abdominal cramps, and excessive tiredness), sensitivity rose to 73 percent, with a specificity of 88 percent. Such a case definition may be an improvement over that of 5 days of diarrhea, especially in outbreaks where there is good laboratory documentation that Giardia is the etiologic agent. The definition should be validated in other outbreaks and in situations where giardiasis must be distinguished from gastrointestinal disease caused by other agents.

Breast cancer screening in Florida. Opportunities for prevention.

Records of 705 women age 40 years and over interviewed by the Florida Behavioral Risk Factor Surveillance System in 1990 were used to identify gaps in mammography utilization in Florida. Data were weighted to the 1990 age and race composition of the population. Of the women 55.8% received a mammogram in the last two years and 33.4% reported they had never had one. The percentage reporting a mammogram in the last two years was 61.9% for those who had a check-up in the last year and 68.7% for those who had a breast examination in the last year. The reason 34% gave for not having a mammogram was "not recommended by doctor." Cost or lack of insurance was the reason for 10.6% of all women and 15.2% of women from households below $15,000 annual income. Data were further stratified by age and race/ethnicity. Significant missed opportunities for mammography are occurring among women in the health-care system. Interventions to increase mammography need to address providers' attitudes and behaviors as well as potential patients.