1 Rubella - Texas A case of rubella in a Texas high school senior was reported to the City of Houston Department of Public Health in late March 1976. After serologic confirmation, a survey was conducted in the high school to detect other cases. Any student or teacher with a 3-day illness characterized by rash and either fever or arthralgia in the 2 preceding weeks was considered to have rubella. One hundred forty three additional cases were identified, with the highest attack rate in the senior class. Review of school immunization records revealed declining immunization levels with each increasing grade (Table 2). All senior and junior high schools in the district were then surveyed in similar fashion for rubella-like illness. A total of 659 cases were identified, 378 in junior high school students and 281 in senior high school students. Cases were found in all but 1 of the junior and senior high schools in the district. There was 1 case in a female teacher. There were no reported cases among elementary school children. The health department instituted an educational program to inform post-pubertal females of their risk and to suggest appropriate precautionary measures. Surveillance Summary 2252 940 41.7 144 6.4 Total Reported by R McLean, MD, A Randall, MD, City of Houston Dept of Public Health; Field Services Div, Bur of Epidemiology, CDC. Editorial Note: In 1969 the City Health Department had launched a rubella immunization campaign aimed at students in kindergarten through third grade. Since 1971 Texas law has required rubella immunization for all school children up to age 12 years. This may explain the higher immunization levels and lower attack rates among students in the lower grades. This outbreak illustrates the continuing need to immunize susceptible, nonpregnant women of childbearing age as an adjunct to routine immunization in early childhood. Brucellosis - United States, 1975 In 1975, 328 cases of human brucellosis were reported to the Center for Disease Control, an increase of 82 cases over the 246 reported in 1974 and the largest number recorded since 1964 (Figure 2). Sixty percent of the cases occurred in people working in the meat processing industry. For the first year since 1959, the number of cases acquired from cattle exceeded the number acquired from swine. The increase in cattle-associated cases continues a trend which first became apparent in 1972. Thirty-six states reported cases in 1975 compared with 35 states and the District of Columbia in 1974. Five states, Florida, Georgia, lowa, Texas, and Virginia, each reported more than 20 cases and together accounted for 56% of the 1975 total. Iowa reported the greatest increase in total cases (33), while Illinois reported the greatest decrease (18). Brucellosis cases by state for the decade 1965-1974 indicate : that only 2 states, Delaware and Nevada, recorded no cases : for this period. Signs and symptoms were specified for 272 confirmed and presumptive cases reported in 1975. Fever, malaise, chills, sweating, weakness, body aches, headache, weight loss, and anorexia were most commonly reported. Therapy data were received on 258 (83%) of 309 cases for which reports were received. Tetracycline was administered alone or in combination with streptomycin to 240 (93%) of the 258 patients. While onset of illness was more commonly reported in the summer months, the seasonal variation was not striking. As in the past, brucellosis predominantly affected adult males. Of 308 cases in which sex was specified, 261 (85%) were in males. Of 293 cases in which age was given, 260 (89%) were in persons between 20 and 60 years of age -- 100 1947 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 the age category of the working force in the United States and the population at greatest risk of acquiring brucellosis in the meat packing and livestock industries. Contact with infected cattle resulted in 104 human cases (34%) and replaced swine as the most common source of infection for the first time since 1959 (Table 3). Contact with infected domestic swine was responsible for 94 cases (30%), and 4 cases occurred in hunters who killed and butchered feral swine. An additional 53 cases (17%) res CLASSIFICATION from contact with either cattle or swine. Of 24 cases (8%) attributed to the ingestion of unpasteurized dairy products, 8 were traced to milk produced in the United States and consumed by farm families. Sixteen cases were attributed to foreign dairy products, including raw milk or cheese from Mexico (10 cases), Greece (2 cases), Italy (2 cases), India (1 case), and Thailand (1 case). There were no human Brucella canis infections reported in 1975. In 1975, 185 (60%) of the 309 cases on which reports were received were in individuals working in packing plants. The source of infection was swine in 79 (43%) and cattle in 53 (29%) of these cases; in 49 cases (26%) the source was either cattle or swine. Of 90 cases for which work location was specified, 58 persons (64%) worked in the "kill" area, 12 (13%) worked in finished product preparation areas, 8 (9%) performed maintenance work, 8 (9%) worked in rendering areas, and 4 (4%) worked in non-processing areas. Infection in 4 of the 185 cases was recrudescent. A review of brucellosis cases in the United States from 1966 to 1975 emphasizes the importance of abattoirs in the epidemiology of brucellosis. In 7 of the last 10 years more than half of reported cases occurred in people associated with the meat-processing industry. Of 2,132 cases on which reports were received in the 10-year period, 1,155 (54%) were in abattoir personnel. Reported by the Bacterial Zoonoses Br, Bacterial Diseases Div, Bur of Epidemiology, CDC. ▲ A copy of the report from which these data were derived is avail- Table 3 Deer Caribou Swine Feral 1 Domestic Foreign Strain 19 Vaccine Laboratory Unknown Total 170 1 4 55.2 % of Total An outbreak of psittacosis occurred in employees of a Nebraska poultry processing plant in June 1976. Twentyeight of the plant's 98 employees were affected; 9 were hospitalized. The outbreak was associated with processing turkeys that had been raised in Texas. All the patients had varying combinations of fever (up to 107 F), chills, diaphoresis, headache, body aches, anorexia, and a feeling of weakness. Less frequently reported were cough (usually dry and nonproductive), photophobia, and epistaxis. Of 19 patients who had chest X-rays, 13 had evidence of pulmonary infiltrates consistent with psittacosis. The mean duration of illness was 9 days, and the mean hospital stay for 7 of the 9 hospitalized patients was 8 days. Acute and convalescent serum specimens, obtained 2 to 3 weeks apart from 27 of the patients, were tested for complement fixing antibody to chlamydia group antigens. Twenty had 4-fold or greater titer rises; 3 had titers >1:16 which were stable or had less than a 4-fold change, and 4 had titers <1:8. The cases occurred June 21-30, suggesting exposure over a short period of time. Both turkeys and chickens are slaughtered at the plant. Turkeys were slaughtered on 5 days in June before the outbreak (Figure 1). Since the incubation period for psittacosis is generally 4-15 days, those turkeys processed June 14 and 15 were suspected as the source. All 28 patients had worked the week of June 14, and all but 1 had worked on June 14 or 15. Four patients were new employees who first started working that week. None of 15 employees who worked the week before or the week after June 14 reported illness. The attack rate in employees who worked the week of June 14 was significantly greater than in employees who did not. (Fisher's exact test, 1-tailed p<0.01). All the turkeys processed on these dates were retired breeder birds from a single Texas flock. Before shipment, the implicated flock had been inspected for clinical signs of psittacosis; 15 of 6,000 hens and 5 of 500 toms were tested by direct complement fixation of chlamydial antibodies. No evidence of psittacosis infection was found. Serologic testing on July 9 of 38 birds used to replace the breeder stock also failed to detect infection. However, 2 hens which had not been shipped with the group of breeders processed on June 14-15 were seropositive (1:32 titers), and chlamydia were isolated from their tissues by mouse inoculation. Follow-up on Respiratory Infection The attack rate by work department was not significantly different in the group of 95 employees who worked on the 2 days June 14-15. There was no correlation with degree or duration of direct exposure to turkey tissue, suggesting that the infections were the result of aerosal transmission. Since the evisceration department was under positive air-pressure in relation to other plant areas, an out-flow of air to all other departments resulted. Reported by WH Northwall, MD, Good Samaritan Hospital, Kearney, Nebraska; G Hosek, PA Stoesz, MD, State Epidemiologist, Nebraska Dept of Health; JE Grimes, PhD, Texas A&M University, College Station, Texas; CR Webb, Jr, MD, Acting State Epidemiologist, Texas Dept of Health Resources; and Bacterial Zoonoses Br, Bacterial Diseases Div, Bur of Epidemiology, CDC. Editorial Note: This is the second turkey-associated psittacosis outbreak at this plant. In June 1974, 20 of 117 employees had illnesses clinically compatible with psittacosis; 12 of these cases were serologically confirmed (1). The 1974 outbreak also was associated with processing of retired breeder turkeys from Texas. Following outbreaks in 1974 of psittacosis in employees of 5 turkey processing plants, including that in Nebraska, the U.S. Department of Agriculture and state and local agriculture and health personnel implemented a pre-slaughter screening and control program for turkeys in Texas (2). No further human cases associated with birds from Texas occurred in 1974, and the program was discontinued in August of that year. The program was reimplemented in the period May-December 1975 following the diagnosis of psittacosis in a Texas veterinary diagnostician and in 5 Texas turkey flocks. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE Psittacosis - Continued Although the control program was not officially operative in 1976, the turkey flock implicated as the source of infection in the current outbreak was inspected and serologically screened on a voluntary basis. Whether the failure to detect infection in the flock was due to the small number of birds serologically screened or some other factor is uncertain. References: 1. Durfee PT, Pullen MM, Currier RW, Parker RL: Human psittacosis associated with commercial processing of turkeys. J Am Vet Med Assoc 167:804-808, 1975 2. Report of the Committee on Transmissible Diseases of Poultry, in Proceedings of the U.S. Animal Health Association, 2-7 Nov 1975. Portland, 1976, pp 226-234 Shigella flexneri Type 2 Foodborne Outbreak - Washington An epidemiologic investigation was initiated in Seattle when a woman reported that she and her sister had been ill for a week with diarrhea and related symptoms; the sister had been hospitalized for several days. Investigation revealed a total of 13 cases of shigellosis, all traced to food eaten 11 days earlier at a Polynesian luau, prepared for a social club by an unlicensed caterer at his home. Histories from 46 persons who attended the luau revealed that 13 (28%) had become ill. All 13 had severe diarrhea, 6 had abdominal pain, 6 headache and fever, 5 chills, and 1 myalgia and bloody stools. The incubation period ranged from 11 to 96 hours with a median of 64 hours. The duration of illness was 3 to 10 days. One patient was hospitalized. Stool specimens from 5 patients were submitted on July 9 to the local health department laboratory; all yielded Shigella flexneri 2. DISEASE The caterer, who had prepared approximately 20 types of meats, salads, fruits, and vegetable dishes in his home, denied any gastrointestinal illness and was not cultured. A stool specimen taken from an 11-year-old child in the caterer's home, however, grew Shigella flexneri 2. The majority of the club members eating at the luau indicated either that they had eaten some of every type of food available or that they could not recall what they had eaten. No food was available for culture. The water supply was from the municipal system. The caterer was ordered by the health department to discontinue preparation of food for public consumption. Reported by HW Anderson, BS, RS, M Bader, MD, MPH, Epidemiologist, Seattle-King County Dept of Public Health, Seattle, Washington; S Paine, RS, and TL Nghiem, MD, DrPh, Washington State Dept of Social and Health Services; Enteric Diseases Br, Bacterial Diseases Div, Bur of Epidemiology, CDC. Aseptic meningitis 2,556 173 117,319 2.650 139 -80 127 1,032 Post-Infectious 3 4 4 206 242 221 6,652 37,013 Type unspecified Malaria Measles (rubeola) Meningococcal infections, total 25 1,047 26 55.857 66 68 Tuberculosis Tularemia 1 21,564 651 515 9 84 |