An outbreak of salmonellosis among children attending a reptile exhibit at a zoo.

OBJECTIVE: In January 1996, an outbreak of diarrhea caused by Salmonella Enteritidis occurred in children attending a Komodo dragon exhibit at a metropolitan zoo. We sought to determine the extent of the outbreak and mode of transmission. STUDY DESIGN: A case-control study was conducted. Controls were randomly selected from zoo membership lists and matched to patients by age group and date of exhibit visit. RESULTS: Of 65 patients identified, 39 had confirmed and 26 had suspected cases. The median age was 7 years (range, 3 months to 48 years); 55% were enrolled in the case-control study. No patients and two (4%) controls reported touching a dragon; however, 83% of patients but only 52% of controls touched the wooden barrier that surrounded the dragon pen (odds ratio = 4.0, 95% CI 1.2 to 13.9). Washing hands at the zoo after visiting the dragons was highly protective (OR = 0.14, 95% CI 0.03 to 0.7). Cultures from the patients, one dragon, and the exhibit barriers yielded Salmonella Enteritidis, phage type 8. On the basis of an attack rate of 4.3% among exhibit attendees under 13 years old on whom data were collected, we estimate that 315 additional cases of salmonellosis occurred among visitors in this age group. CONCLUSION: This large outbreak demonstrates the importance of environmental contamination in the transmission of Salmonella from reptiles, and the protective value of hand washing. Recommendations regarding reptile exhibits and reptilian pets should emphasize this indirect route.

Risk factors for victimization during the 1980 riot at the Penitentiary of New Mexico.

The New Mexico Penitentiary riot of February 2, 1980, resulted in death for 33 inmates at the hands of their fellow prisoners, and the hospitalization of 62 inmates for treatment of drug overdose or trauma. A case-control study of dead and hospitalized inmates was conducted to determine risk factors for victimization. Twelve (12.5%) of the 96 inmates housed in the protective custody unit were killed, compared with an overall penitentiary death rate of 2.9% (p = 0.0003). These 12 individuals were similar to the general inmate population with respect to age, race, years of education, crimes, time served, and prison rule infractions committed. In contrast, the 21 homicide victims housed in other areas were younger and had committed significantly greater numbers of rule infractions during incarceration. Prisoners hospitalized for drug overdose, but not those hospitalized for traumatic injuries, could be differentiated from the remaining prison population by increased convictions for homicide and higher prison infraction rates. Inmates in protective custody were targeted selectively for death; other subgroups of victims of violence appear to share characteristics often associated with perpetrators of violence.

Assessment of immunoglobulin use for hepatitis A control in New Mexico.

Community control of hepatitis A (HA) requires improvement of sanitation and timely use of immune globulin (IG) for selected contacts of ill persons. A marked increase in reported HA cases in New Mexico in late 1978 and early 1979 prompted aggressive evaluation of morbidity trends and of control efforts. This evaluation provided an opportunity to study the practices in disease reporting and IG administration in the State. In the 6-months study period January-June 1979, 596 cases of HA were reported in New Mexico (an annualized incidence rate of 95.9 cases per 100,000 population). Nearly three-fourths of the cases were reported within 14 days of onset of illness. IG was administered to the household contacts of 89 percent of the index patients; it was not indicated for the household contacts of 9 percent. Reasons for the failure to administer IG to the household contact of the other 2 percent of the index patients were not ascertained. Overall, 93 percent of the eligible household contacts received IG, and 80 percent of these contacts received it within 14 days of the onset of illness in the index patient. Differences in the relationship of physicians and health offices in the only metropolitan area in the State and in the rest of the State in respect to case reporting and IG administration were observed. The benefits from health department surveillance and control exceeded the costs by approximately fivefold. The reporting practices and the IG use of the physicians who reported HA cases were good; to improve further HA surveillance and control in the State, the focus needs to be on physicians who fail to report HA cases.

Increased incidence and prevalence of multiple sclerosis in Los Alamos County, New Mexico.

The incidence and prevalence of multiple sclerosis (MS) in Los Alamos County, New Mexico, were investigated because the number of reported cases appeared to have increased. The point prevalence on November 1, 1979, was 75.7 per 100,000, and average annual incidence rates for the period 1960-1969 and 1970-1979 were 3.4 and 3.7 per 100,000, respectively. The rates of MS in Los Alamos County were greater than expected from previous epidemiologic surveys of North America. The unusual ethnic composition and high socioeconomic level of the population probably contributed to the increases.

The advent of human diploid cell rabies vaccine: impact on vaccine utilization in New Mexico.

Three months' experience with the newly licensed human diploid cell rabies vaccine in the New Mexico comprehensive consultation-biologics system was reviewed. Comparison with the same period in 1978 and 1979 showed no increase in vaccine utilization despite the advent of this simpler-to-use, safer rabies vaccine. Anti-rabies treatments appear to be minimally influenced by new vaccine technology when a comprehensive consultation system is available to support and guide the private physician.