A school outbreak of Norwalk-like virus: evidence for airborne transmission.

An outbreak of gastroenteritis affected a school attended by children aged 4-11 years. Epidemiological features suggested this was due to Norwalk-like virus (NLV) and this was confirmed by polymerase chain reaction (PCR). Nucleotide sequence analysis of the PCR amplicons revealed identical strains in all five positive stool samples. Pupils were significantly more likely to become ill following an episode of vomiting within their classroom (adjusted odds ratio 4.1, 95% CI 1.8-9.3). The times from exposure to illness were consistent with direct infection from aerosolized viral particles where exposure to vomiting was high. Cleaning with quaternary ammonium preparations made no impact on the course of the outbreak. However, the outbreak stopped after the school closed for 4 days and was cleaned using chlorine-based agents. This study confirms the importance of vomiting in the transmission of NLV and provides evidence that direct infection with aerosolized viral particles occurs.

Use of hygiene advice and active immunisation to control an outbreak of hepatitis A.

A community outbreak of at least 16 cases of hepatitis A is described. Salivary antibody testing of 126 children within a school in that community showed only one case of undiagnosed previous infection. Three other children had received hepatitis A vaccine previously, and this was reflected in their antibody titres. For the schools serving the community control measures included advice on good hygiene (supervised handwashing and additional cleaning in the schools). All close contacts of cases (household and childminding contacts and all staff in one school) were given active immunisation, though two subsequently developed hepatitis A, 17 and 27 days after vaccination. The use of human normal immunoglobulin (HNIG) was fully discussed with contacts, but was declined in all cases. The low prevalence of previous infection found in the schoolchildren implies that, in future, few adults will be immune. Public concern about blood products after the recent Department of Health decision to stop using British-sourced plasma may be a factor in limiting the uptake of HNIG, especially as there is now a perceived safer alternative, namely hepatitis A vaccine. Lack of evidence of spread of disease within the schools involved demonstrates that good hygiene, especially handwashing, remains the most important element in the control of hepatitis A.

Evidence for airborne transmission of Norwalk-like virus (NLV) in a hotel restaurant.

An outbreak of gastroenteritis followed a meal in a large hotel during which one of the diners vomited. The clinical features of the illness suggested Norwalk-like virus (NLV, small round structured virus) infection, and this was confirmed by electron microscopy and reverse transcriptase polymerase chain reaction (RT-PCR) of stool samples. Further characterization of the virus by nucleotide sequence analysis of the PCR amplicons revealed identical strains in all the affected individuals. The foods served at the meal could not be demonstrated to be the cause of the outbreak. Analysis of attack rates by dining table showed an inverse relationship with the distance from the person who vomited. No one eating in a separate restaurant reported illness. Transmission from person-to-person or direct contamination of food seems unlikely in this outbreak. However, the findings are consistent with airborne spread of NLV with infection by inhalation with subsequent ingestion of virus particles.

Media management of a community outbreak of meningococcal meningitis.

Cases and, particularly, clusters of meningococcal meningitis often create high levels of public concern and attract the interest of news media. We describe below our experience of managing intense local and national media interest during a community outbreak of meningococcal disease in Derbyshire. Our learning is set out as ten key recommendations. Four of these are around managing the media, including using a proactive press release, providing detailed briefings, using a single spokesperson and coordination of the response by a press officer experienced in media management. Another four describe how to deliver an appropriate on-site response, often requested during community intervention programmes. The two final recommendations relate to ensuring good communication and supporting staff during what is an intensely stressful period. We hope our experiences may help others if faced with a similar problem.

Meningococcal disease in siblings caused by rifampicin sensitive and rifampicin resistant strains.

Two brothers presented with meningococcal infection in a five day period, the first with a rifampicin sensitive strain and the second, who had received rifampicin chemoprophylaxis, with a resistant strain. Secondary cases of meningococcal disease can occur despite chemoprophylaxis, and may be rifampicin resistant. Close contacts should be informed of the early symptoms of meningococcal disease and of the need to seek medical advice urgently if they occur.

Identifying and responding to physicians' needs ... a marketing priority.

Identifying and meeting physician needs is the focus of many hospital efforts today. Various informal and formal methods have been used in this endeavor. Surveys and focus groups are the traditional methodologies; and the responses have included various types of physician liaison programs. The author of this article reviews these methodologies and offers recommendations for securing accurate information and ensuring the success of programs to meet the needs thus identified.

Hospitals and physicians battle together for market share.

Physicians are facing the same competitive pressures as hospitals. As local distributors of health care, physicians need to compete on the basis of quality, price, convenience and access; however, they often do not have the requisite skills. This article details one hospital's strategies for mutually beneficial cooperative marketing.

Electron Spin Resonance of 2,2,6,6-Tetramethylpiperidine-1-Oxyl (TEMPO)-labeled Plant Leaves.

Temperature dependence for partitioning of 2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO) between aqueous and lipid components of whole leaf tissue was measured. TEMPO is an electron spin resonance nitroxide label that has been used in model systems to detect membrane phase separations. Measurements were made on chilling-sensitive tomato leaves, frost-sensitive potato leaves, and frost-hardy and supercooled wheat leaves. The results suggest a membrane phase separation at 11 C in tomato, 3 C in potato, and -11 C in wheat.

[Determination of connective tissue content of meat products using the hydroxyproline methods (author's transl)]. / Uber die Erfassung des Bindegewebsgehaltes von Fleischwaren mit der Hydroxyprolinmethode.

The amino acids of collagenous and elastic connective tissue of beef and pork and of commercial meat products were determined by gaschromatography. A correlation was established between hydroxyproline and glycine and also between hydroxyproline and proline. Thus the content of elastic connective tissue in meat products is quite constant and compared with the amount of collagenous material insignificant.--Determination of amount of connective tissue in meat products from the amount of hydroxyproline this is suitable for the needs of food control.