Clinical and epidemiologic characteristics of nodding syndrome in Mundri County, southern Sudan.

BACKGROUND: Nodding syndrome (repetitive nodding and progressive generalized seizures) is assuming epidemic proportions in South Sudan, Tanzania and Uganda. OBJECTIVE: To describe clinical and epidemiological features of nodding syndrome in southern Sudan based on preliminary investigations conducted in 2001 and 2002. METHOD: Household surveys, clinical, electrophysiological (EEG) assessments, informant interviews and case-control studies were conducted in the town of Lui and the village of Amadi in southern Sudan. RESULTS: Nodding syndrome is characterized by involuntary repetitive nodding of the head, progressing to generalized seizures; mental and physical deterioration. The EEGs were consistent with progressive epileptic encephalopathy. Prevalence of Nodding syndrome in Lui and Amadi was 2.3% and 6.7% respectively. All case control studies showed a positive association between cases and Onchocerca volvulus. A history of measles was negatively associated with being a case: 2/13 of cases and 11/19 of controls had had measles: odds ratio 0.13 (95% CI 0.02, 0.76). Environmental assessment did not reveal any naturally occurring or manmade neurotoxic factors to explain Nodding Syndrome, although fungal contamination of food could not be ruled out. CONCLUSION: Nodding Syndrome was strongly associated with Onchocerca volvulus. There was no evidence to suggest an environmental pollutant, chemical agent, or other toxic factor.

Status of polio eradication in the seven countries of the Eastern Africa Epidemiological Block.

The progress that Burundi, Eritrea, Kenya, Rwanda, Tanzania, Uganda, and Zambia, the seven countries of the Eastern Africa Epidemiological Block (EAEB), have made toward polio eradication is summarized. Despite low per capita gross national product, poor infrastructure (especially for communication and transportation), and civil unrest, the EAEB has made significant progress toward polio eradication. Five of the seven countries have achieved high levels of routine coverage with at least three doses of oral polio vaccine. Virologic surveillance is established in Tanzania, Uganda, Zambia, and Kenya; will be established in Eritrea in 1997; and will be resumed in Rwanda as soon as civil unrest abates. Political support for polio eradication is strong in the region, and all of the EAEB countries, except Burundi, held either national or subnational immunization days in 1996.

Timeliness of national reporting of communicable diseases: the experience of the National Electronic Telecommunications System for Surveillance.

The timeliness of reporting four nationally notifiable diseases was examined using data reported via the National Electronic Telecommunications System for Surveillance. Timeliness of reporting varied by disease (bacterial meningitis: median 20 days; salmonellosis: median 22 days; shigellosis: median 23 days; and hepatitis A: median 33 days) and by state. These findings indicate a need to standardize surveillance definitions and to account for reporting differences between states in interpreting regional disease trends or detecting multistate disease outbreaks.

Reliability of ratings of anesthesia's contribution to adverse surgical outcomes.

The interrater reliability of physician ratings of anesthesia contribution to adverse outcomes was evaluated. A physician panel reviewed hospital records, anesthesia records, standard data collection forms, and, when available, autopsy reports for 28 patients experiencing severe morbidity or death within 48 hours following anesthesia for surgery. Consensus among reviewers about the contribution of anesthesia to adverse outcomes ranged from 82.1% to 92.9%. Kappa coefficients indicated excellent interrater reliability for the Edwards Scale and rating scale, and good interrater reliability for the percent scale.

The reporting of race and ethnicity in the National Notifiable Diseases Surveillance System.

The authors used 1987 data from the Epidemiologic Surveillance Project (ESP) of the Centers for Disease Control to examine the completeness of race-ethnicity reporting in the National Notifiable Diseases Surveillance System. And, to the extent possible, they used ESP to assess racial and ethnic disparities in the occurrence of selected notifiable infectious diseases. For the 30 reporting areas (29 States and the District of Columbia) that provided data to ESP for all of calendar year 1987, approximately 60 percent of case reports were accompanied by specified race-ethnicity for affected persons. This percentage varied widely by disease and State. In general, non-Hispanic whites had morbidity rates (cases per 100,000 population per year) that were among the lowest compared with rates for other groups, and Native Americans commonly had rates that were among the highest. The ranking of morbidity rates among blacks, Hispanics, and Asians and Pacific Islanders varied by disease, although the last group had strikingly higher rates for malaria and tuberculosis. The age distribution of persons with cases was often lower among minority groups than among non-Hispanic whites, but the authors were unable to calculate age-specific or age-adjusted rates. Potential biases that limit interpretation of the findings are reviewed. Efforts to eliminate racial-ethnic disparities in the occurrence of infectious diseases would be aided by effective surveillance data. For the ESP to meet its potential in this regard, however, substantial improvements in the reporting of race-ethnicity for notifiable diseases are needed.

The Widal slide agglutination test, a valuable rapid diagnostic test in typhoid fever patients at the Infectious Diseases Hospital of Jakarta.

The Widal slide agglutination test was evaluated as a rapid diagnostic test in typhoid fever patients at the Infectious Diseases Hospital, Jakarta, Indonesia from 1980-1982. The results of the test can be available within 45 minutes of patient admission. The study showed that, among 229 patients with Salmonella typhi-positive typhoid fever and 179 control fever patients, when the Widal O antibody titer was greater than or equal to 1:20 the sensitivity was 53%, the specificity 98%, the positive predictive value 96%, and the negative predictive value 68%. A negative Widal test (O antibody titer less than 1:20) does not provide useful information, but when the O antibody titer is greater than or equal to 1:20 the clinician at the Infectious Diseases Hospital of Jakarta can be 96% certain that the patient has typhoid fever.

Legionnaires' disease: the epidemiology of two outbreaks in Burlington, Vermont, 1980.

Eighty-five cases of Legionnaires' disease were diagnosed in two major outbreaks at a large regional medical center in Burlington, Vermont, in the summer of 1980. Cases in both outbreaks were positive for Legionella pneumophila, serogroup 1 by culture, serology, or direct fluorescent antibody tests. All cases had spent time in the city of Burlington in the 10 days before the onset of symptoms. Cases in both outbreaks were both hospital- and community-acquired. A case-control study identified no common in-hospital exposure, including shower use, that was associated with illness. Cases without previous exposure to the hospital were more likely to occur in persons with residences in neighborhoods just downwind of cooling tower A, but not throughout the municipal water system. Epidemiologic and environmental studies supported the association of this cooling tower, located 150 m from the hospital, with both outbreaks. Maintenance employees who worked with tower A had higher Legionella titers than those who worked with a comparison tower located 1.6 km away. Aerosolization of L. pneumophila by tower A and airborne spread to the hospital and community are postulated. The distance of airborne transmission of L. pneumophila in these consecutive outbreaks is greater than previously reported.

Comparison of an active and passive surveillance system of primary care providers for hepatitis, measles, rubella, and salmonellosis in Vermont.

Between June 1, 1980 and May 31, 1981, the Vermont Health Department telephoned a randomly chosen half of the state's primary care offices for surveillance reports of hepatitis, measles, rubella, and salmonellosis. No reports were actively solicited from the other half of the primary-care practices in the state. Active-surveillance units made more reports and more complete reports of diseases and had twice the number of reports per patient seen by the practice than did passive-surveillance units. (Am J Public Health 1983; 73:795-797.)

Ophthalmia neonatorum prophylaxis in Vermont.

Vermont birth certificates and hospital medical charts for 1979 were reviewed to determine whether infants born at home or in hospitals had documentation of prophylaxis against gonococcal ophthalmia neonatorum. Of the 139 home births recorded in 1979, 78 infants (54.0 percent) received no prophylaxis, compared with 97 (1.4 percent) of 7,156 infants born in hospitals (P less than 0.0001). Ophthalmic medications that have not been recommended for use for neonatal prophylaxis were being used in two hospitals in the State. A followup review of 7,668 Vermont birth certificates for 1980 indicated that hospital practices improved in that year, after the hospitals received a reminder on proper prophylactic procedures from the Vermont Department of Health.

[Experiences with the steroid narcotic alfaxalone/alfadolone (Aurantex) in emergency patients in rescue service]. / Erfahrungen mit dem Steroidnarkotikum Alfaxalon/Alfadolon (Aurantex) bei Notfallpatienten im Rettungsdienst.

Prehospital emergency patients, especially with polytrauma and/or severe head injury need sedation for intubation and transportation. The use of relaxant drugs is dangerous under these circumstances. The "ideal drug" for this indication should not have any harmful effects on respiration, circulation, intracranial pressure, and should facilitate intubation. Short action without cumulation is desirable to make an early neurological diagnosis possible. Althesin was studied in our rescue service (ambulance and helicopter) in 133 cases (trauma n = 91, neurologic n = 18, cardiologic n = 12, intoxication n = 12), Althesin facilitated intubation in 129 cases, and was generally sufficient for sedation. Negative side effects were not seen provided althesin was correctly used. The necessity of the preceding use of an antihistaminic drug is emphasized. Althesin should not be used in patients suffering from severe cardiac disease because of its possible negative influence on cardiocirculatory function.

Acute fluoride poisoning associated with an on-site fluoridator in a Vermont elementary school.

On August 30 1980, an outbreak of minor illnesses consisting of nausea and vomiting affected 22 individuals attending a farmers market at a school. Illness was associated with the consumption of beverages made from school water (Xc2 = 65.6, p less than .0001); analysis of the water showed high levels of fluoride (1,041 mg/l). The most likely source of the contamination was the school fluoridator, which had accidentally been left on continuous operation.

[Thiopental for the prevention of severe brain damage after carbon monoxide poisoning. Case report on 3 cases]. / Thiopental zur Vermeidung schwerer Hirnschädigung nach Kohlenmonoxidvergiftung. Kasuistische Mitteilung über 3 Fälle.

Three cases of severe carbon monoxide poisoning are described presenting with deep coma, generalised extensor spasms and myoclonia as symptoms of acute midbrain syndrome. Despite this poor prognosis all patients survived without essential neurological impairment. This favourable outcome is thought to be due to the administration of thiopentone for the amelioration of hypoxic brain damage in dosages commonly employed in anaesthesia.

Pseudomonas aeruginosa skin infections in persons using a whirlpool in Vermont.

Four guests at a ski resort in Vermont reported contracting a characteristic papular, pustular, or vesicular rash after using the resort's whirlpool. Pseudomonas aeruginosa serotype 1, bacteriophage type 86, was isolated from a pustule on one patient, water within the whirlpool, and the whirlpool diatomaceous earth filter. This appears to be the first outbreak of dermatitis associated with P. aeruginosa serotype 1. Previous reports of whirlpool-associated dermatitis outbreaks have identified serotype 9 and 11 isolates of P aeruginosa as the causative agents.

Pneumonic and nonpneumonic forms of legionellosis. The result of a common-source exposure to Legionella pneumophila.

Two male maintenance workers contracted legionellosis while cleaning the interior of a cooling tower contaminated with Legionella pneumophila. In one man severe, life-threatening Legionnaires' disease developed, whereas the other experienced a comparatively mild, self-limiting illness that was consistent with previous descriptions of cases of Pontiac fever. This report represents the first documentation of the development of both of these syndromes following exposure to a common source of the organism. The implications of this observation for the pathogenetic mechanisms that underly the different clinical manifestations of legionellosis are discussed.

An outbreak of xylene intoxication in a hospital.

On January 3, 1980 an outbreak of illness occurred in 15 employees of a small community hospital. Symptoms included headache, nausea, vomiting, and dizziness or vertigo; the duration of illness ranged from 2 to 48 hours. The employees who became ill all worked in areas of the hospital served by one central ventilation system. None of the 180 persons working in other parts of the hospital developed symptoms requiring medical care. Less than 1 hour before the outbreak occurred, 1 liter of liquid xylene had been discarded down a sink drain in the pathology laboratory. Simulation experiments confirmed that xylene vapor could have been drawn into the room that contained the fan unit of the ventilation system. This outbreak illustrates an unusual route of exposure to a widely used laboratory chemical.