Epidemiologic investigation of culture-proven cases of typhoid reported from 4 states has implicated food served in a New York City restaurant on December 13, 1975.

In mid-December, a group of 39 high school students, alumni, teachers, and friends from a Boston suburb traveled to New York City for the weekend. On December 13, at their evening meal in the downtown Manhattan branch (12 East 49th Street) of the Patricia Murphy's Candlelight Restaurant chain, they were joined by another alumnus who lived in New York City.

Six members of this group subsequently developed culture-proved typhoid. The first, the alumnus residing in New York City, had onset of weakness and malaise on December 27, and was hospitalized with fever and chills on January 1, 1976; Salmonella typhi, phage type B3, was isolated from cultures of his blood. The second was hospitalized with a febrile illness in New Hampshire on January 2, and blood cultures subsequently grew Salmonella Group D. The third patient had onset of symptoms on December 24. On January 10, when blood cultures grew S. typhi, he was hospitalized at a metropolitan Boston referral hospital. Information regarding the other 3 cases is still incomplete.

Three women from Connecticut, who were not part of the tour group, also ate dinner at the same restaurant on the evening of December 13; 1 developed fever, chills, and diarrhea on December 28, and was hospitalized January 4. Subsequently, S. typhi was isolated from her blood. Another has had a febrile illness; the third has remained well.

Investigators in New York City, Massachusetts, and Connecticut are attempting to identify the vehicle of transmission and the source of the infection. The restaurant is closed. (Reported by FP Tally, SL Gorbach, MD, New England Medical Center, Boston, Mass; M Fitzpatrick, RN, Waltham High School, Waltham, Mass; HP Harris, Jr, MD, MPH, Town of Fairfield Health Dept, Fairfield, Conn; NJ Fiumara, MD, State Epidemiologist, Massachusetts Dept of Public Health; JS Marr, MD, New York City Epidemiologist, Bur of Infectious Disease Controi, New York City; V Kaupas, MD, State Epidemiologist, New Hampshire Dept of Health and Welfare, Concord; DR Snydman, MD, Acting State Epidemiologist, Connecticut Dept of Health, Hartford; Field Services Div, Enteric Diseases Branch, Bacterial Diseases Div, Bur of Epidemiology, CDC.)

Frequent informal reports of individual cases and outbreaks of human scabies received by the Center for Disease Control have suggested a rising incidence of the disease in the last 2 years. In an attempt to determine any change in the frequency of scabies diagnoses and to assess socioeconomic factors and regional differences in disease occurrence, CDC conducted a telephone survey of practicing dermatologists throughout the United States during the week of December 12, 1975.

Three hundred nine dermatologists were selected at random to be surveyed from those registered as diplomates of the American Board of Dermatology; 280 (91%) were contacted. Of the 264 who had seen a case of scabies in the last 2 years, 249 (94%) had noted increasing numbers of patients with scabies in their practices. This observation was independent of the setting (i.e., rural, urban, or suburban), geographic location, or socioeconomic composition of the practice.

One-fourth of the physicians noting an increase in scabies identified 1973 as the year in which this increase began; one-half pointed to 1974 as the year that the disease began to rise. Half of the dermatologists estimated that scabies incidence had already peaked, but half said it was still on the rise. The number of dermatologists who noted a peak incidence of scabies over the past 5 years has risen dramatically (Table 1). Most respondents in the New England, South Atlantic, Mountain, and Pacific regions stated that the disease probably has reached its maximum incidence, whereas physicians in other areas of the United States observed that the increase was continuing. At the time of the survey, scabies patients represented from 0 to 18% (mean, 2.6%) of the dermatologists'

practices. Infestations were occurring in all socioeconomic groups, and dermatologists often were aware of case clusters in schools and recent outbreaks in hospitals and nursing homes in their communities.

(Reported by Parasitic Diseases Branch, Parasitic Diseases and Veterinary Public Health Div, Bur of Epidemiology, CDC.) Editorial Note

Although this survey was based on physicians' estimates rather than formal record searches, it illustrates the marked rise in the incidence of scabies over the past several years. Infestations are quite easily spread from person to person; however, transmission occurs principally during close physical contact. Individuals with no previous exposure to the mite may remain asymptomatic for several weeks, providing an unwitting source of spread of this parasitic disease to close (Continued on page 15)