During the last 6 months of 1955 the reported weekly num-
bers of infectious hepatitis cases remained approximately con-
stant, fluctuating for the most part between 400 and 500 for the
country as a whole. An increase in incidence usually occurs
during the winter months but as yet there is no indication of the
usual seasonal rise. This is also true for the individual States.

While large numbers of cases have been reported recently
in 3 States-California, New York, and Pennsylvania-with-
large populations, their incidence rates are lower than those
of many States with fewer inhabitants. The States with the
highest incidence rates are in the northern part of the United
States. In previous years the southeastern part of the country
has experienced a relatively high incidence. Unlike the con-
tinental United States, an increase in the incidence of the disease
was reported in Alaska during the latter part of 1955. Condi-
tions including lack of sanitary facilities in most communities
in Alaska are favorable for the spread of the infection. Since
July 1, 1955, more than 1 case has been reported for every
1,000 inhabitants of the Territory. This is the highest inci-
dence rate that Alaska has experienced for a comparable pe-
riod since the disease was made reportable in 1952.

For the current week, a total of 57 cases of diphtheria was
reported. Michigan reported 12 cases-the highest weekly in
more than a year-the usual number being less than 5. How-
ever, early in 1955 the State reported 10 cases in 1 week. Other
States reporting 4 cases or more are: California, 8; Texas, 6;
Florida, 5; and Louisiana and Georgia, 4 each.

Suspect smallpox

EPIDEMIOLOGICAL REPORTS

Dr. D. S. Fleming, Minnesota Department of Health, has
supplied additional information on the case of suspect smallpox
reported for the week ended December 24, 1955. A herpes
simplex virus has been isolated from vesicular fluid obtained
from the patient. This rules out a diagnosis of smallpox. No
secondary cases have been reported among the patient's con-
tacts.

Salmonellosis

Dr. F. Plotke, Public Health Officer in Illinois, has re-
ported an outbreak of salmonellosis involving 6 persons in an
institution. Epidemiologic evidence indicated that eggnog was
the vehicle of infection. Bacteriological examination revealed
the presence of Salmonella pullorum in frozen eggs used in the
preparation of the eggnog.

The Los Angeles County Department of Health has re-
ported an outbreak of salmonellosis among 10 persons in a
private household. Of these, 9 became ill with acute gastro-
intestinal symptoms from 5 to 15 hours after eating a meal.
A mixture of chopped beef liver and chicken served for dinner
was considered to be the vehicle of infection because the per-
son not ill ate none of it. Although never ill, this person was
later found to be a carrier of Salmonella Newport. There were
2 other persons (infant twins) in the household who did not eat
any of the dinner. Of the twins, one had diarrhea prior to the

outbreak. A stool specimen collected yielded S. alachua. The
other twin had had recurrent diarrhea since birth and had been
under treatment by a family pediatrician. However, at the time
of the dinner it was symptom free. A stool culture taken later
was negative for Salmonella.

The liver mixture was prepared with onions and fried in
chicken fat for about half an hour. It was left unrefrigerated
for about 6 hours, then transported from the place of prepara-
tion to the residence where it was served. Here, it remained
on a table for several hours with members of the family serv-
ing themselves from time to time. With one of the twins ill for
several days prior to this occasion, it is possible that in han-
dling the infant the infection may have been transferred to the
food. None of the food was available for bacteriological exami-
nation but a specimen of liver, from which the chopped meat
came, was negative for pathogens.

A special investigation was made in the household where
the liver mixture was prepared. The head of the household
had made a trip to Mexico about 2 months before the outbreak.
A few days after returning home, he developed acute diarrhea
which lasted about 3 days, but he did not seek medical attention.
No stool specimens were obtained until after the food infection
episode. Salmonella Newport was isolated from the first spec-
imen collected. A later specimen was negative, but a third
collected 2 months after the incident yielded S. alachua. The
first specimen collected from his wife was negative, and the
second was positive for S. typhimurium. From the clinical
cases S. Newport and S. alachua were isolated. Because sev-
eral types of Salmonella organisms were isolated, no definite
etiology could be assigned to this outbreak.

Dr. D. C. Poskanzer, New York State Health Department,
has reported an outbreak of salmonellosis among 60 persons
following a testimonial dinner in a restaurant. Of these, 34
became ill with nausea, chills, headache, malaise, vomiting,
and diarrhea, with a mean incubation period of 36 hours. Roast
beef was suspected to be the vehicle of infection, but this was
not definitely established. The source of infection was not found.
A strain of Salmonella typhimurium was isolated from speci-
mens obtained from 5 patients.

Gastro-enteritis

Dr. D. C. Poskanzer has reported 2 outbreaks of gastro-
enteritis involving a hotel in New York State. The chef, who
had gastro-enteritis prior to these outbreaks, was suspected
to be the source of infection. However, no laboratory exami-
nations were made to prove this supposition. The first was
among 75 persons following a luncheon. Twenty of these be-
came ill with abdominal cramps and diarrhea from 2 to 3 hours
later. The source of illness was probably ground beef loaf,
half of which was prepared the night before and left unrefrig-
erated. The second outbreak occurred about 2 weeks later.
In this instance the symptoms were identical with those of the
earlier outbreak, but the incubation period was from 10 to 20
hours. Epidemiologic evidence indicates that turkey was the
vehicle of infection, but none of the food was available for bac-
teriological examination.