(The following was reported by CBS Schofield, MD, and G Masterton, MD, Greater Glasgow Scotland] Health Board, in Communicable Diseases Scotland [38]:v, September 20, 1975.)

In a previous Special Report (1) it was noted that vestibular reactions associated with the use of minocycline appeared to be much less frequent in the United Kingdom than in the United States. We treated 349 male patients with either 300 or 400 mg of minocycline hydrochloride in a single oral dose, taken with water, for symptomatic gonorrhea (dysuria and urethral discharge). Of the 328 who returned after treatment, 5 complained of reactions, 2 (0.6%) of dizziness, and 3 (0.9%) of nausea (2). Of the returning treated patients, none complained of true vertigo, vomiting, or diarrhea, and 95.8% were cured with early symptomatic relief.

More recently, we have used this drug to treat female patients with predominantly asymptomatic gonococcal cervicitis and urethritis. One hundred and seventy-five were given 300 mg minocycline hydrochloride and 19 (10.9%) noted reactions. Fourteen (8.0%) complained of dizziness, 6 of whom also had gastrointestinal upsets. Another 5 complained only of gastrointestinal upsets. Of these 11 (6.3%), 6 complained of nausea and 5 of vomiting; 85 of these female patients received another 300 mg of minocycline 24 hours later, after which 5 (6%) complained of dizziness, of whom 3 (3.5%) also had gastrointestinal upsets-2 with nausea, 1 with vomiting. Seven patients who had reactions after the initial dose did not have any reaction after the second dose. There were no cases of true vertigo.

It appears that reactions following minocycline treatment are much more common in women than in men, not only from our own results but also from interpretation of the article in the Morbidity and Mortality Weekly Report (3). The 'family and acquaintance' group, presumably including both men and women, had a lower incidence of reactions than the hospital or college groups, all presumably women. Minocycline hydrochloride is the only member of the tetracycline group of drugs in which we found a higher incidence of side effects in women than in men-13 times the incidence of dizziness and 7 times the incidence of gastrointestinal upsets. We have not been able to correlate reactions with either the weight of the patients or the stage of the menstrual cycle when the drug was given.

The disparity between the incidence of reactions among the Americans and our patients still requires an explanation. This might be accounted for, not so much by differences in the production of the drug in various countries, but rather by differences in the observers. We do not ask patients who have taken a drug whether they have had a reaction to it, and we do not proffer any specific symptoms; we merely ask if they are all right, and whether they have noticed any change in their presenting symptoms. If there has been any drug reaction, then the patient has to make a positive statement, not just agree or disagree with the doctor.

The situation with the contacts of the fatal case of meningococcal meningitis in America (3) was quite different. The contacts knew that they were at risk of developing the same disease, and one might suspect that the participating health investigators would be checking to ensure that the contacts were not developing symptoms of meningitis, such as vertigo, dizziness, nausea, and vomiting. It is also possible that the apprehensive contacts themselves would be on the lookout for evidence of meningitis; it would be interesting to know how many complained of other suggestive symptoms such as headache, neck stiffness, and blurred vision.

Editorial Note

This interesting report prompted re-examination of data from the study previously reported by Altman in the MMWR (2). Analysis by sex of the reactions to minocycline among case contacts shows that women had a reaction rate of 85% and men 68% (Table 1), a statistically insignificant difference (x2 = 3.26; 1 d.f.). Reaction rates among both men and women were higher in the hospital group than among family and acquaintances. The fact that relatively more women were in the hospital group appears to have contributed to the slightly higher reaction rates in women. These results do not support the thesis that there are sex-specific differences in reaction rates to minocycline.

During July 1975 an outbreak of illness caused by Echo 9 virus occurred in a vacation colony in Dutchess County, New York.

All residents of the colony were surveyed, and blood, stool, and throat cultures were obtained on 15 individuals with recent illness. Results of this survey revealed that from June 30 through July 23, 88 (37.6%) of the 234 colony residents became ill. Typical symptoms and signs were headache (59%), fever (53%), stiff neck (36%), and rash (36%). Other less frequent manifestations included vomiting (18%), diarrhea (16%), and sore throat (13%). Age specific attack rates were highest in the 0-4 (81%) and 5-9 (46%) year groups. In persons under 21 years of age, attack rates were similar for both sexes, but in the 21 or older age group attack rates were significantly higher for females (41%) than for males (17%). The dates of onset suggested person-to

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person spread as the mode of transmission in this outbreak. Analysis of the intervals between primary and secondary household cases suggested an incubation period of 2-4 days. Echo 9 virus was isolated from 9 of 15 throat cultures and 11 of 13 stool specimens submitted to the New York Department of Health laboratory. Control measures taken to interrupt further transmission consisted of closure of the day camp, restriction of swimming pool use to post-convalescent persons, and temporary confinement of children to their quarters.

(Reported by A Blum, MD, Poughkeepsie; EB Donovan, SPHN, R Jeager, MD, S Redmond, MD, and M Zanna, MD, Dutchess County (New York) Health Dept; R Diebol, MD, D Lyman, MD, New York Dept of Health; and Viral Diseases Div, Bur of Epidemiology, CDC.)