Effective vaccination against rabies in puppies in rabies endemic regions.

In rabies endemic regions, a proportionally higher incidence of rabies is often reported in dogs younger than 12 months of age, which includes puppies less than 3 months of age; this presents a serious risk to public health. The higher incidence of rabies in young dogs may be the effect of low vaccination coverage in this age class, partly as a result of the perception that immature immune systems and maternal antibodies inhibit seroconversion to rabies vaccine in puppies less than three months of age. Therefore, to test this perception, the authors report the virus neutralising antibody titres from 27 dogs that were vaccinated with high quality, inactivated rabies vaccine aged three months of age and under as part of larger serological studies undertaken in Gauteng Province, South Africa, and the Serengeti District, Tanzania. All of these dogs seroconverted to a single dose of vaccine with no adverse reactions reported and with postvaccinal peak titres ranging from 2.0 IU/ml to 90.5 IU/ml. In light of these results, and the risk of human beings contracting rabies from close contact with puppies, the authors recommend that all dogs in rabies endemic regions, including those less than three months of age, are vaccinated with high quality, inactivated vaccine.

Evaluation of program performance and expenditures in a report of performance measures (RPM) via a case study of two Florida county tuberculosis programs.

Health Department (HD) managers at both state and local levels are in desperate need of tools to assist in monitoring and evaluating programs. The purpose of this study is to assess the feasibility and utility of linking program performance scores and expenditures into a Report of Performance Measures (RPM). We analyzed secondary data on performance indicators, selected by HD staff, and expenditures, related to six surveillance activities, from two, similar, high-incidence, tuberculosis (TB) programs in Florida from 2002 to 2003. We compared the findings between the county HDs as an illustration of basic cost-effectiveness benchmarking, based on the cost-effectiveness grid. Data included here provide examples of: (1) two instances in which one county was operating relatively inefficiently compared to the other; (2) two instances in which performance and expenditures were similar for the counties; and (3) two instances in which one county spent more for higher performance scores than the other. These data illustrate how the RPM can be used to facilitate benchmarking, a basic evaluation tool. They also demonstrate ways to identify potential operational inefficiencies in a single time period and ultimately over time. It is thus likely to be a feasible and useful management tool.

Establishment of public health security in Saudi Arabia for the 2009 Hajj in response to pandemic influenza A H1N1.

Mass gatherings of people challenge public health capacities at host locations and the visitors' places of origin. Hajj--the yearly pilgrimage by Muslims to Saudi Arabia--is one of the largest, most culturally and geographically diverse mass gatherings in the world. With the 2009 pandemic influenza A H1N1 and upcoming Hajj, the Saudi Arabian Ministry of Health (MoH) convened a preparedness consultation in June, 2009. Consultants from global public health agencies met in their official capacities with their Saudi Arabian counterparts. The MoH aimed to pool and share public health knowledge about mass gatherings, and review the country's preparedness plans, focusing on the prevention and control of pandemic influenza. This process resulted in several practical recommendations, many to be put into practice before the start of Hajj and the rest during Hajj. These preparedness plans should ensure the optimum provision of health services for pilgrims to Saudi Arabia, and minimum disease transmission on their return home. Review of the implementation of these recommendations and their effect will not only inform future mass gatherings in Saudi Arabia, but will also strengthen preparedness efforts in other settings.

Effect of spinal flexion on the conus medullaris: a case series using magnetic resonance imaging.

Anatomy textbooks state that the conus medullaris moves cephalad when the vertebral column is flexed. This could confer protection against spinal cord damage during dural puncture, but has not been demonstrated in vivo. We therefore imaged the spine of 10 volunteers using magnetic resonance imaging to determine if such movement occurs with the spine in the neutral and flexed positions. The position of the conus medullaris in relation to the superior endplate of the L1 vertebra was determined. On spinal flexion, the conus medullaris moved cephalad in three subjects and caudad in three subjects, with no change in the remaining four. The median overall movement (95% CI [range]) was 0 mm (4 mm caudad to 1 mm cephalad [3 mm caudad to 1 mm cephalad]; p = 1.0). Whilst spinal flexion may facilitate needle insertion during dural puncture, it is unlikely to confer extra protection against spinal cord damage.

Epidemic investigation of diphtheria in the Republic of Armenia, 1990-1996.

While incidence rates of diphtheria steadily declined in Armenia after World War II, reemergence of the disease in 1990 brought about changes in public health practices and identified resource needs. The Armenian Ministry of Health (MOH) routinely collected diphtheria case reports, as a reportable health outcome. Diphtheria incidence rates increased from 0.02/100,000 in 1993 to 1/100,000 (36 cases) in 1994. The distribution of cases showed that the greatest number of illnesses and deaths occurred among persons 5-14 years old, yet incidence rates among persons 1-4 and 5-14 years old were similar (4. 4 cases/ and 4.3 cases/100,000, respectively). During 1990-1996, 9 (75%) of 12 cases who died and 18 (21%) of 84 cases who survived had not been vaccinated. The diphtheria epidemic in Armenia was an important, serious, and signal public health event. The Armenian MOH responded by revising immunization practices (1994), improving epidemic control measures (1995), and soliciting international resources (1992-1996).

Epidemic investigation of diphtheria, Republic of Kazakhstan, 1990-1996.

The diphtheria epidemic that began in Russia in 1990 reached Kazakhstan in 1992 when 45 case-patients (a 50% increase over 1991) were reported. In 1993, 82 case-patients were reported, and 489 were reported in 1994. The epidemic peaked in 1995 when 1105 case-patients were reported (incidence rate=6.7/100,000 population). In 1996, after public health practice modifications and several mass vaccinations, 455 case-patients were reported. From 1990 to 1996, children

Cluster headache-like disorder in childhood.

This paper reviews the diagnostic features of cluster headache-like disorder and describes its presentation in childhood. Case note summaries of patients with this condition are presented in the context of a brief summary of the literature. Four patients (two girls; aged 12 to 15 years) with cluster headache-like disorder were seen over a period of four years in the paediatric neurology department of Birmingham Children's Hospital. Their histories and clinical courses are described. All had a history of "thrashing around" or bizarre behaviour during attacks, which had distracted attention from the headache and seemed to contribute to delay in diagnosis. It appears that cluster headache-like disorder does occur in childhood but is not common and can be mistaken for other conditions. A history of thrashing around accompanied by headache is very suggestive. Recognition of the symptoms in the general paediatric clinic would allow rapid diagnosis.

The hormonal coordination of behavior and physiology at adult ecdysis in Drosophila melanogaster.

In insects, ecdysis is thought to be controlled by the interaction between peptide hormones; in particular between ecdysis-triggering hormone (ETH) from the periphery and eclosion hormone (EH) and crustacean cardioactive peptide (CCAP) from the central nervous system. We examined the behavioral and physiological functions of the first two of these peptides in Drosophila melanogaster using wild-type flies and knockout flies that lacked EH neurons. We used ETH from Manduca sexta (MasETH) to induce premature ecdysis and compared the responses of the two types of flies. The final release of EH normally occurs approximately 40 min before ecdysis. It is correlated with cyclic guanosine monophosphate (cGMP) production in selected neurons and tracheae, by an elevation in the heart rate and by the filling of the new tracheae with air. Injection of developing flies with MasETH causes all these events to occur prematurely. In EH cell knockouts, none of these changes occurs in response to MasETH, and these flies show a permanent failure in tracheal filling. This failure can be overcome in the knockouts by injecting them with membrane-permeant analogs of cGMP, the second messenger for EH. The basis for the 40 min delay between EH release and the onset of ecdysis was examined by decapitating flies at various times relative to EH release. In flies that had already released EH, decapitation was always followed within 1 min by the start of ecdysis. Immediate ecdysis was never observed when the EH cell knockout flies were decapitated. We propose that EH activates both ventral central nervous system elements necessary for ecdysis (possibly the CCAP cells) and descending inhibitory neurons from the head. This descending inhibition establishes a delay in the onset of ecdysis that allows the completion of EH-activated physiological processes such as tracheal filling. A waning in the inhibition eventually allows ecdysis to begin 30-40 min later.

Prophylactic coronary artery revascularization for elective vascular surgery: study design. Veterans Affairs Cooperative Study Group on Coronary Artery Revascularization Prophylaxis for Elective Vascular Surgery.

This article describes the design of an ongoing randomized trial intended to test whether patients who require elective vascular surgery would benefit from preoperative coronary artery revascularization prior to the vascular procedure. The primary objective is to determine whether coronary artery revascularization reduces long-term mortality (mean 3.5 years) in patients undergoing vascular surgery. The study design calls for 620 patients to be randomized and followed for a mean of 3.5 years following vascular surgery. Secondary endpoints include measures of quality of life and cost-effectiveness. Patients with coronary artery disease in need of an elective vascular operation are considered candidates for the study. Anatomic exclusion criteria include ejection fraction <20%, severe aortic stenosis (valve area <1.0 cm2), left main stenosis > or =50%, nonobstructive coronary artery disease (stenosis <70%), and coronary arteries that are not amenable to revascularization. Prior to the vascular surgery, the trial randomizes eligible patients to coronary artery revascularization (either bypass surgery or angioplasty) versus medical therapy. The trial stratifies the randomization by hospital and type of vascular surgery (intraabdominal versus infrainguinal) because of differences in long-term prognosis in those patients. A 1-year feasibility trial involving five Veterans Affairs (VA) medical centers of variable vascular surgical loads has been completed. The results showed that over 90% of expected patients could be randomized. As a result, a larger VA Cooperative Study involving 18 centers will begin recruitment of patients. The findings should help determine the best strategy for managing patients with coronary artery disease in need of elective vascular surgery.

Disruption of a behavioral sequence by targeted death of peptidergic neurons in Drosophila.

The neuropeptide eclosion hormone (EH) is a key regulator of insect ecdysis. We tested the role of the two EH-producing neurons in Drosophila by using an EH cell-specific enhancer to activate cell death genes reaper and head involution defective to ablate the EH cells. In the EH cell knockout flies, larval and adult ecdyses were disrupted, yet a third of the knockouts emerged as adults, demonstrating that EH has a significant but nonessential role in ecdysis. The EH cell knockouts had discrete behavioral deficits, including slow, uncoordinated eclosion and an insensitivity to ecdysis-triggering hormone. The knockouts lacked the lights-on eclosion response despite having a normal circadian eclosion rhythm. This study represents a novel approach to the dissection of neuropeptide regulation of a complex behavioral program.

The alcohol dehydrogenase gene is nested in the outspread locus of Drosophila melanogaster.

This report describes the structure and expression of the outspread (osp) gene of Drosophila melanogaster. Previous work showed that chromosomal breakpoints associated with mutations of the osp locus map to both sides of the alcohol dehydrogenase gene (Adh), suggesting that Adh and the adjacent gene Adhr are nested in osp. We extended a chromosomal walk and mapped additional osp mutations to define the maximum molecular limit of osp as 119 kb. We identified a 6-kb transcript that hybridizes to osp region DNA and is altered or absent in osp mutants. Accumulation of this RNA peaks during embryonic and pupal periods. The osp cDNAs comprise two distinct classes based on alternative splicing patterns. The 5' end of the longest cDNA was extended by PCR amplification. When hybridized to the osp walk, the 5' extension verifies that Adh and Adhr are nested in osp and shows that osp has a transcription unit of > or = 74 kb. In situ hybridization shows that osp is expressed both maternally and zygotically. In the ovary, osp is transcribed in nurse cells and localized in the oocyte. In embryos, expression is most abundant in the developing visceral and somatic musculature.

Deaths related to Hurricane Andrew in Florida and Louisiana, 1992.

BACKGROUND: Information about circumstances leading to disaster-related deaths helps emergency response coordinators and other public health officials respond to the needs of disaster victims and develop policies for reducing the mortality and morbidity of future disasters. In this paper, we describe the decedent population, circumstances of death, and population-based mortality rates related to Hurricane Andrew, and propose recommendations for evaluating and reducing the public health impact of natural disasters. METHODS: To ascertain the number and circumstances of deaths attributed to Hurricane Andrew in Florida and Louisiana, we contacted medical examiners in 11 Florida counties and coroners in 36 Louisiana parishes. RESULTS: In Florida medical examiners attributed 44 deaths to the hurricane. The mortality rate for directly-related deaths was 4.4 per 1 000 000 population and that for indirectly-related deaths was 8.5 per 1 000 000 population. In Louisiana, coroners attributed 11 resident deaths to the hurricane. Mortality rates were 0.6 per 1000 000 population for deaths directly related to the storm and 2.8 for deaths indirectly related to the storm. Six additional deaths occurred among non-residents who drowned in international waters in the Gulf of Mexico. In both Florida and Louisiana, mortality rates generally increased with age and were higher among whites and males. CONCLUSIONS: In addition to encouraging people to follow existing recommendations, we recommend emphasizing safe driving practices during evacuation and clean-up, equipping shelters with basic medical needs for the population served, and modifying zoning and housing legislation. We also recommend developing and using a standard definition for disaster-related deaths, and using population-based statistics to describe the public health effectiveness of policies intended to reduce disaster-related mortality.

Correlates of gun-carrying among adolescents in south Louisiana.

In the majority of episodes of fatal interpersonal violence, the weapon used is a firearm. Amid frequent reports of youths carrying weapons, including firearms, we conducted a case-control study to identify risk factors for being charged with gun-carrying and gun-carrying, per se, among adolescents in Jefferson Parish, Louisiana. Cases were defined as incidents of gun-carrying among adolescents < 19 years of age, legally charged in the Jefferson Parish, Louisiana, juvenile court from January 1, 1992, through April 15, 1993. For each case, we randomly drew three age-, gender-, and school-matched control subjects from the enrollment rosters of the Jefferson Parish public schools and administered a questionnaire. The data set comprised 38 case subjects and 103 matched control subjects. Thirty (29%) control subjects reported gun-carrying. Both case subjects and gun-carrying control subjects reported self-defense (40%) as the main reason for gun-carrying. Most case subjects (25 [66%]) were African Americans, but only 8 (27%) gun-carrying and 27 (37%) non-gun-carrying control subjects were African Americans. Case subjects were significantly more likely than gun-carrying control subjects to report being African American (odds ratio [OR] = 5.3, 95% confidence intervals [CI] = 1.6, 17.5). In crude analyses, case subjects were more likely than non-gun-carrying control subjects to report adult-male unemployment among households with adult men, to foresee a likelihood to be shot in school, to have seen a shooting, to use marijuana, to watch television > 6 hours per day, and to be African American. After the effect estimates were adjusted in conditional logistic regression modeling, case subjects were more likely than non-gun-carrying control subjects to report adult-male unemployment among households with adult men, using marijuana, and watching television > 6 hours per day (OR = 8.6, 95% CI = 1.2, 61,2; OR = 11.7, 95% CI = 2, 70.2; and OR = 6.5, 95% CI = 0.8, 51.9, respectively). Gun-carrying control subjects were significantly more likely than non-gun-carrying control subjects to report their school not safe, having seen a shooting, using marijuana, and having fired a gun (OR = 9, 95% CI = 1, 82.1; OR = 7, 95% CI = 1.3, 38.2; OR = 6.8, 95% CI = 1.8, 25.5; and OR = 17, 95% CI = 1.8, 156.6, respectively). We found that gun-carrying was very common, and that adolescent youths who carry guns were more likely to have familiarity with guns and experience with or perception of an unsafe environment. Together, these lead to the conclusion that gun-carrying is a common response of youths who live in a risky environment, who do not have the social support to learn how to deal effectively with that risk, and who have access to guns, which they think may provide them with some protection.

Hurricane Andrew-related injuries and illnesses, Louisiana, 1992.

To determine the extent and types of injuries and illnesses in Louisiana associated with or related to Hurricane Andrew, we gathered data from hospital emergency departments and coroner's offices on demographic variables, institution, nature and cause of the injury or illness, body part affected, location, and date and time of the event. A hurricane-related injury or illness was defined as one that occurred from noon on August 24, 1992, through midnight on September 21, 1992, as a direct or indirect result of the preparation for (preimpact), the impact of, or the clean-up after the hurricane (postimpact). Nineteen parishes in south-central Louisiana that were most affected by Hurricane Andrew provided data from patients seen in emergency departments and reports from coroner's offices. Active, advance surveillance of this type promotes and facilitates the reporting of disaster-related health outcomes. Future planning for hurricanes should take into account the high rate of cuts, lacerations, and puncture wounds, particularly during the postimpact phase.

Injuries to international petroleum drilling workers, 1988 to 1990.

Nonfatal work-related injury (NFI) rates are 49% higher among oil and gas field workers than among workers in all US industries combined, and these injuries are more severe (the rate of lost workdays in the oil and gas field services industry is 2.8 times that of all US industries combined). We analyzed the 1988 to 1990 incident reports submitted by drilling companies to the International Association of Drilling Contractors, an industry-wide international trade association representing 95% of the world's oil and gas drilling companies. We determined geographic and occupation-specific incidence rates by full-time equivalents, calculated per job category and year. Of the 5,251 reports, 5,218 (99.4%) were of NFI and 33 (0.6%) of fatal work-related injuries (FI). The overall NFI rate was 1.2/100 full-time equivalents and the overall FI rate was 7.5/100,000 full-time equivalents. Reported NFI in US territory was 4 times more common than in non-US territory. Reported FI in US and non-US waters were 4 and 5 times more common than on land, respectively. Three job categories--floormen, roustabouts, and derrickmen--accounted for 74% of the NFI and 64% of FI, with a rate ratio, compared with rates for all other occupations, of 10.5, 8.5, and 7.0 for NFI and 5.0, 9.4, and 4.0 for FI. Among all occupations, the body part most frequently injured was the upper extremity (1,631/5,218 [31%]). The four key NFI types and circumstances identified included the upper extremities "caught in" (857/5,218 [16%]),the back "strained" (592/5,218[11%]), the lower extremities "struck by" (538/5,218 [10%]), and the lower extremities injured while "slipping" (402/5,218 [8%]). Results of these analyses revealed several high-risk occupations in this industry and identified high-risk activities that can be targeted for further study.

Population-based nutritional risk survey of pensioners in Yerevan, Armenia.

Armenia, a republic of the former Soviet Union, currently suffers from hyperinflation of its currency, a five-year country-wide blockade, and a war with Azerbaijan. Pensioners 60 years of age or older may be at high risk for significant nutritional deficits. We drew a stratified systematic sample (with a random starting point) of 456 pensioner names from all eight administrative regions in Yerevan, the capital of Armenia. We administered a questionnaire that gathered data including self-reported weight and height, demographic characteristics, living conditions, medical and dietary history, income, and aid received from various sources. The survey yielded 381 of 456 (84%) completed interviews. Ninety-one percent reported their diet had gotten worse during the past six months, including less variety (83%) and quantity (85%) of food. Seventy-six percent reported they did not have enough money to buy food, and 91% had cut the size of their meals or skipped meals. Forty-five percent reported a weight loss of > or = 5 kg in the previous year. After we adjusted for potential confounders, weight loss of > or = 5 kg was associated with illness affecting eating (adjusted odds ratio [OR] = 2.2, 95% confidence intervals [CI] = 1.4, 3.4), not having received aid (adjusted OR = 2.2, 95% CI = 1.1, 4.1), and cutting the size of or skipping meals (OR = 2.7, 95% CI = 1.1, 6.7).(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of a method for detecting outbreaks of diseases in six states.

A new statistical method, developed for detection of changes in reporting, has proved useful in analysis of provisional data reported by state health departments to the National Notifiable Diseases Surveillance System (NNDSS). In this system, data from the current four-week period can be compared with data from the previous, same, and subsequent four-week periods from each of the preceding five years, and reports exceeding historical limits are highlighted in a horizontal bar graph. To evaluate the usefulness of this method at the state level, we applied it to weekly reports of seven notifiable diseases in six states over a four-month period. Participating state health departments investigated all events exceeding historical limits and reported known outbreaks that were not identified by the method. During the four-month period, the method identified 27 episodes of disease reports exceeding historical limits. Of these, 14 (52%) represented outbreaks. None was detectable by analysis of aggregate national surveillance data. Five outbreaks known to state health department officials were not identified by the method, because of increased disease activity during the baseline period or lack of timely provisional reporting of outbreak-related cases. Methods for detection of increases in reporting at the state level may identify events of public health importance that are obscured in aggregate national data and may supplement other local sources of information available to state health departments in the recognition of significant public health events.

Tularemia pneumonia in Oklahoma, 1982-1987.

OBJECTIVE: We assessed the incidence, risk factors, and prognostic implications of tularemia pneumonia in Oklahoma from 1982 through 1987. DESIGN: We retrospectively reviewed all reported case-patients over the six-year period 1982-1987. SETTING: Department of Health in Oklahoma, where tularemia is known to be endemic. PATIENTS: Of 128 patients with tularemia who entered the study, 32 had pulmonary involvement. MAIN RESULTS: Compared to patients without pulmonary involvement, those with tularemia pneumonia were older (52 vs 32, p less than .0001), less likely to give a history of vector exposure (25% vs 7%, p less than .05), more likely to present with typhoidal illness (56% vs 15%, p less than .0001), hospitalized longer (11.6 vs 4.7 days, p less than .001), more likely to have a positive culture (9 vs 7, p less than .01), and more likely to die (4 vs 1, p less than .01). CONCLUSIONS: Patients with tularemia pneumonia often present without historical or physical examination findings that suggest the diagnosis; thus, tularemia pneumonia often cannot be distinguished from other cases of community-acquired pneumonia. Therefore, especially in areas where the disease is endemic, tularemia must be considered in patients with pneumonia.