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TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending February 6, 1988 and February 7, 1987 (5th Week)

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measles only, imported cases includes both out-of-state and international importations. notifiable U: Unavailable *International "Out-of-state

TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending February 7, 1988 and February 6, 1987 (5th Week)

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Del.

Md.

D.C.

Va.

W. Va.

N.C.

S.C.

Ga.

Fla.

E.S. CENTRAL

Ky.
Tenn.
Ala.

Miss.

W.S. CENTRAL

Ark.
La.
Okla.
Tex.

MOUNTAIN

Mont.
Idaho

Wyo.
Colo.

N. Mex.

Ariz.
Utah
Nev.
PACIFIC

Wash.

Oreg. Calif. Alaska

Hawaii

Guam

50

16

290

70

2

645

14

627

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*Mortality data in this table are voluntarily reported from 121 cities in the United states, most of which have populations of 100,000 or more. A death is reported by the place of its occurrence and by the week that the death certificate was filed. Fetal deaths are not included.

**Pneumonia and influenza.

† Because of changes in reporting methods in these 3 Pennsylvania cities, these numbers are partial counts for the current week. Complete counts will be available in 4 to 6 weeks.

ttTotal includes unknown ages.

§ Data not available. Figures are estimates based on average of past 4 weeks.

Exposure - Continued

Exposure to or contact with H by any route-respiratory, skin, or oral-should be limited to the extent practicable. This can be accomplished by use of appropriate engineering controls, personal protective equipment, and work practices. Concentrations in the workplace and surrounding air should be measured and verified by instruments that can reliably detect concentrations at or below the control limits. At this time, the most sensitive monitors can reliably measure 0.003 mg/m3 of H and L in the workplace air. Because of dispersion and dilution, this level would be adequate protection for the general population.

The members of the working group also considered DOD's proposal for agent stack emission levels during incineration. These limits should be 1) attainable by a well-designed, constructed, and operated incineration facility, 2) capable of offering an early indication of disturbed operating conditions, and 3) able to be accurately measured in a timely manner. The allowable stack concentrations proposed by DOD meet these criteria and appear to restrict emissions to concentrations well below those that would endanger health. They must be evaluated by air dispersion modeling of credible worst-case events and conditions specific to each site to ensure that they will not result in emissions exceeding the permissible level for the general population and the workplace.

On the basis of the evidence reviewed, members of the working group concluded that human health will be adequately protected from exposure to the chemical agents at the recommended concentrations in this report. Even long-term exposure to these concentrations would not create adverse health effects. The relatively short duration of the disposal program provides an additional margin of safety.

Epidemiologic Notes and Reports

La Crosse Encephalitis in West Virginia

Between July 6 and September 1, 1987, in central West Virginia, 19 cases of La Crosse encephalitis were serologically confirmed (Figure 1). After a cluster of meningo-encephalitis cases was reported from a referral pediatric service in Charleston, active hospital-based surveillance was undertaken in 15 counties in central and southern West Virginia, where La Crosse encephalitis had previously occurred. Cases were identified in five of these counties.

Eleven (58%) of the 19 patients were diagnosed as having viral encephalitis. Four (21%) had symptoms of meningitis alone, and four (21%) had meningo-encephalitis. The patients ranged in age from 1 to 14 years (mean = 7 years). Fifteen (79%) patients were male; the male-to-female ratio was 3.8:1. Eighteen (95%) children were hospitalized, and one child was treated as an outpatient. One patient, a 9-year-old boy with cerebral edema, died despite intensive supportive care.

All patients lived in rural areas of central West Virginia, a region with thick hardwood forests conducive to mosquito breeding. Attack rates varied by the patients' sex and place of residence (Table 1). Males were at much greater risk of becoming ill than females. The attack rate among children under 15 years of age in Nicholas County was over four times the rate in any other county. A case-control study is under way to test hypotheses regarding possible behavioral and environmental risk factors.

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For six (32%) of the patients, diagnosis was based on compatible clinical findings and a single immunofluorescent antibody (IFA) titer >128 during the convalescent stage of illness. For the other 13 (68%), a fourfold rise in antibody titer was demonstrated between the acute and convalescent stages of illness.

In the past, few cases of La Crosse encephalitis have been reported in West Virginia. Of 223 cases of encephalitis reported to the West Virginia Department of Health from 1980 through 1986, only eight (4%)-six in 1984 and two in 1985-were attributed to a California serogroup virus. Much of the increase in reported incidence in 1987 may be the result of intensive case-finding efforts. A change in the state laboratory's serologic procedure for La Crosse virus diagnosis may also have contributed to the increase in the number of identified cases. Previously, serologic diagnoses were made by measuring complement-fixing antibodies. The more sensitive IFA was adopted in 1987.

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FIGURE 1. Reported cases of LaCrosse encephalitis, by week of onset West Virginia, 1987

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TABLE 1. Attack rates of La Crosse encephalitis, by sex and county of residence West Virginia, July 6-September 1, 1987

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number of patients <15 years of age per 100,000 population of the same age.

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