EPIDEMIOLOGICAL REPORTS-Continued

in food containers, purchased especially for this occasion, and allowed to stand for 5 hours until time for delivery to the 2 plants. Each container consisted of a thermos bottle jacket in which 3 aluminum inserts were placed. An inspection of the kitchen of the diner revealed that the bakery area was insani tary, garbage was stored unsatisfactorily, and the utensils were very dirty. Of 3 turkey specimens collected, 1 was positive for staphylococci and proteus species. Stool specimens collected from 4 individuals who were associated with the diner and who became ill were negative for salmonella and shigella organisms.

Dr. Mason Romaine, Virginia Department of Health, has reported an outbreak of gastro-enteritis among persons who ate cream filled pastries from a local bakery. Seven persons are known to have been affected. Bacteriological examination of samples of cream filling revealed staphylococci. The source of contamination is believed to be one of the "fillers" who had cuts on his hand.

February 10, 1956

Vol. 5, No. 5

Influenza

EPIDEMIOLOGICAL REPORTS

The following reports have been received by the WHO Influenza Information Center, National Institutes of Health.

Dr. E. H. Lennette, California State Department of Public Health, reports the serological diagnosis of one case of influenza A occurring in Sonoma County, California. The onset of the illness was December 18. No other serological diagnoses have been made thus far in the civilian population in California.

The Preventive Medicine Division, OSG, U. S. Air Force, has reported a mild epidemic of influenza A among school children of an Air Force Base in the United Kingdom. The outbreak began on December 8, 1955, lasted approximately 10 days, and was limited to the age group 13 through 18. Clinically, the disease was mild with fever lasting not longer than 72 hours. Specific diagnosis was made by complement fixation tests on 15 pairs of sera, all of which showed a rise in titer of influenza A antibody. No new cases have occurred since December 19 at this installation.

The Ministry of Health of the United Kingdom reports a localized outbreak of influenza A in South East Suffolk, which has subsided. Sporadic cases of influenza A continue to be reported from other parts of the United Kingdom.

Dr. C. H. Andrewes, World Influenza Center, reports that while there are no signs at all of a widespread epidemic in England, there is some serologic evidence of the occurrence of influenza A recently. Only one strain of influenza A has been isolated. This resembles the Scandinavian strains of 1950 and 1951. There are also reports of a little clinical influenza in Portugal and Holland.

Rabies in man

Dr. Henry A. Holle, Texas Department of Health, reports a fatal case of rabies in an entomologist who had been actively engaged in research on bat rabies in Texas. The mode of transmission is unknown. No history of an animal bite was obtained. A postulated portal of entry was an atopic dermatitis on the posterior aspect of the neck which was present for about 2 months preceding the illness, and had only recently healed. Accidental inoculation may have occurred while handling infected bats. Rabies was suspected from the history and typical clinical course. Post-mortem examination of the brain tissue failed to reveal Negri bodies. The diagnosis of rabies was confirmed by animal inoculation with Negri bodies demonstrated in the brain tissue of all the injected mice.

Rabies in animals

During January, 32 cases of rabies in animals were reported in 6 counties in California. Most of these (27) were in 3 contiguous southern counties. Of the total, 26 cases were in dogs, all from the 3 southern counties. The remaining cases were in skunks, only 1 being in the southern group of counties.

Psittacosis

The Washington State Department of Health reported a case of psittacosis for the last week of January. This case was in a 29-year-old teacher, who is also a farmer. The patient

became ill and developed symptoms of pneumonia 4 days later. A complement fixation test, performed at the Rocky Mountain Laboratory in Hamilton, Montana, on the patient's sera was positive for psittacosis in a titer of 1:128. The source of infection was not definitely determined. However, an effort is being made to obtain blood samples from turkeys and chickens on the farm for laboratory examination.

Diphtheria

Dr. R. L. Wenzel, Columbus Department of Health in Ohio, has given information on a recent outbreak of diphtheria in an institution. The outbreak began during the last week of November 1955, with the death of a 6-year-old boy, followed in 2 days by the death of his 4-year-old sister. The last death occurred January 11 in a 5-year-old boy whose onset of illness was early in December, and at present is believed to have died of diphtheritic myocarditis. There were 6 classical cases with 4 deaths, 3 less severe cases, and 13 persons who were asymptomatic healthy carriers. One case, not included, developed in a child discharged to another area.

The first 2 children who died had been temporary residents of the institution 1 week prior to onset of the disease. All but one of the other cases have been contacts of children who had been in the institution. Approximately 55 children had been discharged in the 1-week interval between the time of discharge of the first 2 cases and the time the first was reported as having died from the illness. Most of these children were discharged to residences within the city, but some went to homes outside the city limits in the county, others to different cities in the State, and 1 to another State. Health commissioners in these areas were notified.

All organisms tested were extremely virulent and of the "gravis" strain. None of the children who died had any previous immunization against diphtheria. The milder cases had a primary series of immunizations 6 to 10 years before, but no stimulating doses.

Throat cultures have always been taken on children admitted to the institution, but none prior to the outbreak had been positive for diphtheria. This was not considered significant. A 10-year-old child detected in the institution as a healthy carrier after the outbreak, has still retained diphtheria organisms in his throat for 2 months. He has been given a series of penicillin injections twice and one course of chloromycetin. Sensitivity tests indicated that the organism was sensitive to both of these drugs. Tonsillectomy is now being considered. None of the personnel working in the institution were found to be carrying the organism, and the source of the outbreak was not found.

Infectious hepatitis

The California Department of Public Health has reported an outbreak of infectious hepatitis in a housing area. Nine cases have occurred in 4 households and 1 suspect case in a fifth household. The first case occurred in the fall of 1955. The patient was in contact with a 6-year-old boy who was ill about that time, but his family has moved and no other information about him is available. With the exception of 1, all the cases were in families who were either neighbors or friends. The spread was probably person to person.

Chemical food poisoning

Dr. James Scatterday, Florida State Board of Health, has reported 2 cases of nitrite poisoning in children from the ingestion of raw wieners. The cases were in siblings, ages 3 years and 15 months, and death occurred in the 3-year-old child. Dr. John M. Sims, local physician who made the diagnosis, reported that the symptoms were sudden onset and consisted chiefly of cyanosis and shock from anoxia within 30 minutes to 1 hour after ingestion. Analysis of post-mortem blood from the one child revealed a methemoglobin concentration of 30 percent. Raw wieners found in gastric aspirate and vomitus of both children, on chemical analysis, showed concentrations of nitrite 3 to 5 times greater than the maximum allowable concentration of 200ppm. The wieners were prepared in a local packinghouse and a review of their procedure showed considerable laxity in measuring the nitrite and nitrate salts added to the meat as a preservative. Necessary steps were taken to withdraw their products from the market pending establishment of proper plant controls.

Typhoid fever

Dr. D. S. Fleming, Minnesota Department of Health, has given preliminary information on the 7 cases of typhoid fever

report ed. last week. In addition, there were 4 suspect cases. The diagnoses were confirmed by isolation of S. typhosa from specimens (blood or stool) obtained from the patients. In the suspect cases, clinical symptoms were compatible with typhoid, and high Widal reactions were suggestive of typhoid. Preliminary information has not revealed any common source and cases seem to be unrelated epidemiologically. The distribution of the cases, including the suspect, were as follows: two in girls under 10 years of age, 5 in the 10 to 19 year age group, and 4 in persons aged 30 and over.

Salmonellosis

Dr. R. H. Hutcheson, Tennessee Department of Health, has reported an outbreak of salmonellosis in a hospital nursery. Of 10 infants in the nursery, 3 developed diarrhea in a period of 3 days. Immediate isolation was established for the control of the disease. Stool specimens collected from the patients yielded Salmonella newington. Stool specimens were obtained from the nurses and nurse aides, and a nurse aide was found to be a carrier of the organism. She gave no history of recent gastro-enteritis. Her duties included the preparation of the forContinued on page 8