LEAD POISONING - Continued of that hazard, through scraping and repainting of walls or other measures. This improvement over the first quarter reduction index of 68.1 is due in part to reductions of hazards identified in earlier quarters. Chelation treatment was provided to 1,089 children in the second quarter. The ratio of chelations to number of children identified in Classes II, III, and IV is 12.5, a continuation of the downward trend in the rate of chelation. Reported by Environmental Health Services Div, Bur of State Services, CDC. TABLE 1. Results of screening in childhood lead poisoning control projects - United States, second quarter of fiscal year 1976, (October 1, 1975 to December 31, 1975) 1 Class II and Classes III & IV defined in CDC Statement, Increased Lead Absorption and Lead Poisoning in Y Epidemiologic Notes and Reports Follow-up on Botulism Associated with Commercial Cherry Peppers Three more persons who ate commercially processed cherry peppers at the Ramada Inn, Elk City, Oklahoma, have been clinically diagnosed as having botulism (MMWR 25[17]). This brings to 7 the total number of persons who contracted the disease in this manner. All 7 ate the peppers from April 13-18. The fifth ill person, from Prague, Oklahoma, was located during a CDC and State of Oklahoma telephone survey of individuals who had registered at the Ramada Inn April 622. The sixth patient, from Elk City, Oklahoma, was diagnosed by a local physician who had been alerted by CDC to the possibility of unidentified cases of botulism in persons who had eaten at the Inn. The last ill person, from Oklahoma City, suspected her illness might be botulism after reading press reports about the outbreak and contacted the Oklahoma City Health Department. The cherry peppers served at the Inn were manufactured by the Dreher Pickle Company, Denver, Colorado. Peppers produced by this company were sold under 16 brand names to commercial establishments; none were sold for home use. One of the following identification numbers is stamped on all containers packed on that day: MAR-1977, MAR-197, or MAR 1977D; this identification number may be preceded by a prefix number 1 through 8. As a precautionary measure, the company is voluntarily recalling all 1-gallon containers with these identification numbers. The Ramada Inn in Elk City, Oklahoma, is located on Interstate 40,* a major transcontinental route. Since a gallon of cherry peppers contains 125-150 peppers, there may be other persons from throughout the United States who have undiagnosed botulism. Reported by WG Husband, MD, Elk City; MJ Puiggari, MD, Okla- *In MMWR 25(17) it was incorrectly identified as U.S. 40. International Notes Chancroid Outbreak - Manitoba Twenty-one cases of chancroid were reported in Manitoba in December 1975 and January 1976. The disease has not been reported in Manitoba for many years. To date, laboratory confirmation has not been obtained for any of the cases; the diagnosis has been based solely on the clinical appearance of the disease. All of the reported cases form a single cluster of sexually related persons geographically concentrated in the northern part of Winnipeg. It is believed that the initial case came to Manitoba from another province where it may have been introduced from the Caribbean area. Intensive case finding and contact investigation are underway to eradicate the disease from the province. Reported by E Snell, MD, Dept of Health and Social Development, Manitoba, in Canada Diseases Weekly Report, 2(12):48, March 20, 1976. Editorial Note: The true incidence of chancroid, a venereal disease relatively common in the tropics but uncommon in temperate climates, is difficult to estimate, but in fiscal year 1975 only 811 cases were reported in the United States. Of these, 677 (83%) were male. In many settings the disease is traced to small groups of women who often have no evidence of infection. Consequently, prompt epidemiologic treatment of these high risk groups is important for controlling or eradicating the disease. In most environments sulfonamides, tetracyclines, or a combination of both provide effective therapy. In some areas where resistance has developed, such as in Southeast Asia, streptomycin, kanamycin, and intravenous cephalothin have been used effectively. Reported by Venereal Disease Control Div, Bur of State Services, 24 31 · ༅། 7 14 21 28 5 12 19 26 2 9 16 23 30 6 13 20 27 4 11 18 JUL. AUG. SEP. ONSET OCT. 1 8 15 22 291 Ages of confirmed cases were between 1 month and 20 years (Figure 2). There were no deaths. Three (10%) of the confirmed cases were fully immunized for their age, 15 (48%) were partially immunized for their age, and 13 (42%) had no history of pertussis immunization. Twenty-five confirmed cases were from Knox County. The other 6 were from parts of the Knoxville metropolitan area in adjacent counties. Immunization surveys conducted in Knox County found that in 1973 and 1975 90% of 2year-old children had received at least 4 doses of DiphtheriaTetanus-Pertussis vaccine (DTP) and that from 1973-1975, 98% of new school entrants were fully immunized. Most reported cases in the 1975 outbreak came from low income neighborhoods and housing projects. One housing project was chosen for an immunization survey. While most children in the project had received at least 1 injection of DTP, only 184 (41%) of 453 pre-school children had received the appropriate number of injections. < 2 3 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 >20 AGE sources of medical care for additional injections when indicated. In addition to the special clinics, the Knox County Health Department sponsored a mass media campaign to encourage parents to utilize routine health department immunization clinics. During July 1975, 1,750 DTP injections were given by these clinics, compared with 1,263 given during July 1974. A second cluster of cases occurred shortly after the special clinics were held (Figure 1), but thereafter only a few sporadic cases were reported. Age distribution and residences of patients in the second cluster were similar to those of patients in the first. Reported by MB Duffy, MD, Knox County Health Dept; EL Shipe, Editorial Note: Despite high overall immunization levels The Knox County Health Department sponsored 13 immunization clinics in the 13 identified high risk neighborhoods and administered approximately 600 DTP injections between July 3-11. One hundred thirty of the 184 susceptibles identified in the special survey received injections at these clinics. Children were referred to their usual U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVIC Pertussis - Continued Active surveillance by the Knox County Health Department identified the problem early and facilitated a focused attack on the population at risk. Surveillance was facilitated by the availability of FA staining as an aid in the diagnosis of whooping cough syndrome. Slides made from nasopharyngeal swabs can be heat-fixed and mailed to a Botulism A married couple from Seattle, Washington, contracted botulism after eating home-canned lamprey in early January 1976. The wife, a 55-year-old woman, died. The woman was hospitalized on January 3, 1976, in Seattle, with sudden onset of vomiting, blurred vision, and diplopia. By the next day facial paralysis, dysphonia, upper extremity weakness, and respiratory insufficiency were observed. On January 5, the patient's husband noted double vision and diplopia and was also hospitalized. Because of the similar illness in both patients, hospital physicians suspected botulism. Type A botulinal toxin and type A Clostridium botulinum were subsequently detected in stool samples from each patient and from unconsumed portions of homecanned lamprey that the woman and her husband had eaten on January 2. Both patients received trivalent ABE antitoxin on January 5. The husband fully recovered and was discharged on January 7. Cardio-respiratory arrest and sub central laboratory for this test which is quick, reliable, and inexpensive (2). References 1. Center for Disease Control: United States Immunization Survey: 1974. Issued April 1975 2. Kendrick PL, Eldering G, and Eveland WC: Fluorescent antibody techniques, methods for identification of Bordetella pertussis. Am J Dis Child 101:149-154, 1961 Washington sequent coma complicated the woman's hospital course, and she died April 9. The lamprey had been caught in the Columbia River in May 1975 and promptly cleaned, barbecued, and baked at 375-400°F for 30 minutes. The lamprey was then packed in jars and boiled in an open kettle for an additional 40 minutes. Only 1 of the 36 jars which had been prepared in May had been consumed, and then without incident. All other bottles were recovered; 5 were tested and found to be negative for botulinal toxin by the Washington State Department of Social and Health Services. Reported by JJ Cotesworth, MD, Virginia Mason Hospital, Seattle; AHB Pedersen, MD, HW Anderson, BS, PA Bonin, MA, E Tronca, MS, Seattle-King County Health Dept; TL Nghiem, MD, DrPH, State Epidemiologist, Washington State Dept of Social and Health Services; Enterobacteriology Br, Bacteriology Div, Bur of Laboratories, and Enteric Diseases Br, Bacterial Diseases Div, Bur of Epidemiology, CDC. |