An outbreak of severe BCG axillary lymphadenitis in Saint Lucia, 1982-83

An epidemic of BCG auxillary lymphadenitis affected at least 37 children, primarily infants, in Saint Lucia in late 1982 and early 1983. Eleven infants had spontaneous rupture or required incision and drainage of supportive lymph nodes. Cases developed auxillary lymphadenitis from 1-22 weeks after immuniazation with Connaught BCG vacine, first introduced into the country in September, 1982. No single factor could be reliably implicated as the sole cause of the epidemic. More potent BCG vaccines, such as the Connaught product, give better protection but more reactions than weaker BCG vaccines and may reduce patient compliance with the Expanded Programme on Immunization in general. Those in BCG programmes should be alert to adverse reactions and scrupulous in storing, reconstituting, and administering the correct dose of BCG vaccine intradermally. Keeping good vaccination records and vials of each lot of vaccine used can help to determine whether epidemics of adverse reactions are occuring and what their cause might be. (AU)

An outbreak of typhoid fever in Paramin, Trinidad

Typhoid fever was recognized in four residents of Paramin, a community of market gardeners located in the rugged mountains near Port-of-Spain. Because of the community's poor water quality and sewage disposal, an immediate effort was made to investigate and control the outbreak. Eleven additional persons with S. typhi infection were found, all of whom had onset of illness before the investigation began and could be linked to three foci of infection. All tested isolates demonstrated an identical degraded Vi phage type. No source of outbreak was found, but spread of the infection appeared to be person-to-person rather than a common source such as food or water. Water samples and Moore swabs detected no S. typhi organisms, but did demonstrate widespread faecal contamination of the springs and streams used as water sources, suggesting the potential for a water-borne outbreak of S. typhi or other enteric disease. We worked with community leaders to protect the water supply by chlorinating the centrally located school water supply for community-wide use and reminding residents to boil water and maintain good hygienic habits (AU)