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Encephalitis Continued Reported by: AA Kindle, JE McJunkin, MD, JR Meek, MD, Charleston Area Medical Center; MM Tomsho, MD, Summersville; DL Holbrook, DL Smith, MD, Nicholas County Health Dept; BA Crowder, DM Rosenberg, MD, Kanawha County Health Dept; JA Burke, DC Newell, DO, Fayette County Health Dept; SL Sebert, MD, Greenbrier County Health Dept; JH Wright, DO, Logan County Health Dept; JW Brough, DrPH, DM Cupit, MS, LE Haddy, MS, RC Baron, MD, Acting State Epidemiologist, West Virginia Dept of Health. Div of Field Svcs, Epidemiology Program Office; Div of Vector-Borne Viral Diseases, Center for Infectious Diseases, CDC. Editorial Note: La Crosse virus, a bunyavirus in the California serogroup, and its mosquito vector, Aedes triseriatus, are widely distributed in the central and eastern United States (1,2). Central nervous system (CNS) infections from La Crosse virus have been recognized chiefly in the upper Midwest. However, reports of sporadic cases from other states suggest that the disease may be endemic in a broader geographic distribution (3,4). The focus of cases in West Virginia in 1987 illustrates the high levels of endemic transmission that may remain undetected unless specific diagnoses are sought.

CNS infections from La Crosse virus occur nearly exclusively among children. Of the 929 cases reported to CDC from 1971-1983, 833 (89.7%) involved children under 15 years of age. Boys are affected more often than girls, presumably because they spend more time outdoors where they are exposed to the vector. Boys accounted for 66.3% of the 833 reported cases involving children. Although the proportion of reported cases involving males in West Virginia in 1987 was higher than the proportion reported elsewhere, it was not significantly greater than expected (p>0.17, binomial distribution).

The incidence of La Crosse encephalitis in the five-county area of central West Virginia (20/100,000 children <15 years of age, 4.7/100,000 total population) was similar to rates reported from other locations where the disease is endemic. In 1978, active, hospital-based surveillance in 20 Wisconsin and Minnesota counties showed an incidence of 31.6/100,000 children under 15 years of age and 6.3/100,000 total population (5).

La Crosse encephalitis is infrequently recognized as a cause of childhood morbidity from CNS infection. Incidence rates for La Crosse encephalitis in endemic areas are similar to rates for Haemophilus influenzae meningitis, which range from 35 to 40/100,000 for children under 5 years of age and from 2.2 to 7.7/100,000 for the total population (6). The fatality rate for La Crosse encephalitis is <1%; however, during acute illness, convulsions occur in 50% of cases, and focal weakness, paralysis, or other localized signs occur in 25% (3). Residual convulsive disorders may persist in 10% of cases, and some recovered patients have impaired cognitive performance (3).

Public health measures to control La Crosse encephalitis have focused on eliminating breeding sites for Ae. triseriatus, but the importance of tree holes and breeding sites such as tires and other discarded containers in the spread of La Crosse encephalitis has not been well defined. The current case-control study addresses this issue; results of the study will help public health officials planning mosquito control programs to target breeding sites that pose the greatest risk. References 1. Calisher CH. Taxonomy, classification, and geographic distribution of California serogroup

bunyaviruses. Prog Clin Biol Res 1983;123: 1-16. 2. Craig GB Jr. Biology of Aedes triseriatus: some factors affecting control. Prog Clin Biol Res

1983;123:329-41. 3. Tsai TF, Monath TP. Viral diseases in North America transmitted by arthropods or from

vertebrate reservoirs. In: Feigin RD, Cherry JD, eds. Textbook of pediatric infectious diseases. Vol II. 2nd ed. Philadelphia: WB Saunders, 1987;1417-56.

Encephalitis Continued 4. Kappus KD, Monath TP, Kaminski RM, Calisher CH. Reported encephalitis associated with

California serogroup virus infections in the United States, 1963-1981. Prog Clin Biol Res

1983;123:31-41. 5. Hurwitz ES, Schell W, Nelson D, Washburn J, LaVenture M. Surveillance for California

encephalitis group virus illness in Wisconsin and Minnesota, 1978. Am J Trop Med Hyg

1983;32:595-601. 6. Fraser DW, Geil CC, Feldman RA. Bacterial meningitis in Bernalillo County, New Mexico: a

comparison with three other American populations. Am J Epidemiol 1974;100:29-34.

Epidemiologic Notes and Reports

Influenza Update

United States

The following are indicators of influenza activity in the United States for the weeks ending January 16, 23, 30, and February 6. Numbers and percentages in this table are provisional and may change as additional reports are received for the given weeks.

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*Sporadically occurring cases, no known outbreaks. *Outbreaks in counties whose total population comprises less than 50% of total state population. Outbreaks in counties whose total population comprises 50% or more of total state population. *Members of the American Academy of Family Physicians who submit weekly influenza surveillance reports based on their patient population. *States reporting isolates of influenza A(H3N2) to date: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Idaho, lowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Montana, New Mexico, North Dakota, New York, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, West Virginia, Wisconsin, and Wyoming. **States reporting isolates of influenza B to date: Arizona, Hawaii, Montana, Nevada, New York, Ohio, Tennessee, Washington, and Wisconsin.

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The Morbidity and Mortality Weekly Report is prepared by the Centers for Disease Control, Atlanta, Georgia, and available on a paid subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, (202) 783-3238.

The data in this report are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday. The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other public health problems of current interest to health officials. Such reports and any other matters pertaining to editorial or other textual considerations should be addressed to: Editor, Morbidity and Mortality Weekly Report, Centers for Disease Control, Atlanta, Georgia 30333. Director, Centers for Disease Control

Editor James O. Mason, M.D., Dr.P.H.

Michael B. Gregg, M.D. Director, Epidemiology Program Office

Managing Editor Carl W. Tyler, Jr., M.D.

Gwendolyn A. Ingraham

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Over the past 11 years, efforts to meet arthritis-related needs in Missouri have evolved through several stages: 1) development of an informal group of concerned citizens, 2) appointment of the Missouri Task Force on Arthritis, 3) passage of legislation regarding arthritis and funding of a State Arthritis Program, 4) creation of regional arthritis centers, and 5) collection of state data to target arthritis-related efforts in Missouri.

Missouri began working toward a state arthritis plan in 1976, when concerned citizens formed a coalition to address the state's needs regarding arthritis. The Missouri Task Force on Arthritis, officially appointed by the Missouri Board of Health in 1977, was asked to assess arthritis-related needs and formulate recommendations. Members were organized into several working groups focusing on health-care facilities, manpower needs, professional education, public education, research, and public affairs.

Public hearings were held in all regions of the state in 1979. Task force members, assisted by the Eastern and Western Missouri Arthritis Foundation chapters, mobilized local community leaders, regional news media, and concerned individuals to promote the hearings. From the public hearings and the findings of the working groups, the task force wrote a three-volume report that reflected a consensus of recommendations (1). These recommendations included establishing a statewide network of regional arthritis centers for diagnostic, treatment, and educational services; providing educational programs for physicians and allied health professionals; training and recruiting more rheumatologists for underserved areas; improving public education; and increasing research efforts.

A bill encompassing the recommendations of the State Arthritis Plan and modeled on congressional legislation that led to the enactment of the National Arthritis Act in 1976 was first submitted to the Missouri legislature in 1980. The bill, which was

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES / PUBLIC HEALTH SERVICE

BAR 2; 1981

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