especially during the early stage of the disease, when the test is likely to be negative (2-4). The diagnosis of early Lyme disease remains primarily clinical, and physicians should be aware of the limitations of current tests. Sensitivities of the IFA and the ELISA are relatively low during stage one (2-4), and the antibody response can be curtailed or aborted by early treatment with antibiotics (3). In contrast, some research laboratories have reported sensitivities >95% for tests of patients with stage two or three Lyme disease (2,4,5). Test specificities approaching 100% have also been reported (2,6); however, considerable variability may occur among laboratories because the tests are not standardized and are difficult to perform. The sensitivities and lack of standardization of the tests preclude their use alone for routine disease reporting and reinforce the need to develop a reliable and practical case definition for surveillance that is not dependent on serologic test results. Lyme disease is a problem of increasing national and international concern that merits continual and improved surveillance. Clinical studies to further define complications of the disease and to evaluate treatment regimens are needed. Public health education can help alert people to the symptoms of Lyme disease and to the importance of avoiding tick bites. The development of other effective primary preventive measures, particularly vector control, is essential. References 1. Steere AC, Broderick TF, Malawista SE. Erythema chronicum migrans and Lyme arthritis: epidemiologic evidence for a tick vector. Am J Epidemiol 1978;108:312-21. 2. Craft JE, Grodzicki RL, Steere AC. Antibody response in Lyme disease: evaluation of diagnostic tests. J Infect Dis 1984;149:789-95. 3. Shrestha M, Grodzicki RL, Steere AC. Diagnosing early Lyme disease. Am J Med 1985;78:235-40. 4. Wilkinson HW. Immunodiagnostic tests for Lyme disease. Yale J Biol Med 1984;57:567-72. 5. Craft JE, Grodzicki RL, Shrestha M, Fischer DK, García-Blanco M, Steere AC. The antibody response in Lyme disease. Yale J Biol Med 1984;57:561-5. 6. Magnarelli LA, Anderson JF, Johnson RC. Cross-reactivity in serological tests for Lyme disease and other spirochetal infections. J Infect Dis 1987;156:183-8. Suspected Nosocomial Influenza Cases in an Intensive Care Unit Georgia. During November 1987, CDC received reports of three patients and one nurse with suspected influenza infections in a 15-bed medical-surgical intensive care unit (MSICU). The index case occurred in a 71-year-old female with diabetes mellitus who was admitted to the MSICU on October 29 and subsequently required mechanical ventilation. Influenza A was identified by fluorescent antibody (FA) staining of tissue culture cells inoculated with an endotracheal aspirate collected on November 11. The patient died on November 14, and influenza virus was identified in lung tissue collected postmortem. The second patient, an intubated 60-year-old woman with chronic obstructive lung disease, had been hospitalized since October 26. Influenza A was identified by FA staining of cell culture inoculation of a lung biopsy specimen obtained on November 23. The same procedure was used to identify influenza A in an endotracheal aspirate specimen collected on November 26 from an intubated 76-year-old man who had been hospitalized since September 28. Further investigation revealed that a nurse who had cared for all three patients was absent from work during the last week of November because of an influenza-like illness. Neither the three patients nor the nurse had received the 1987-88 influenza vaccine. Isolates were not available for confirmation and subtype identification. Influenza - Continued Other reports. For the report week ending January 2, four states* reported regional outbreaks of influenza-like illness. Fifteen states have reported isolates of influenza A(H3N2), which is the predominant subtype so far this season. Influenza A, subtype pending, has been reported from Hawaii, Louisiana, Utah, and Washington. Reported by: P Patterson, D Smith, RK Sikes, DVM, MPH, State Epidemiologist, Georgia Dept of Human Resources. Univ Hygienic Laboratory, Univ of lowa. Participating State and Territorial Epidemiologists and State Laboratory Directors. WHO Collaborating Center for Influenza, Influenza Br, Div of Viral Diseases, Center for Infectious Diseases, CDC. Editorial Note: In the past, hospital laboratories have had to send specimens to reference laboratories for virus isolation and identification. Now, many hospital laboratories are able to rapidly identify influenza A or B viruses by using monoclonal antibodies for typing virus antigens produced in cell culture. Results can usually be obtained within 24 to 72 hours after inoculation of the specimen. *Alabama, South Dakota, Utah, and Wisconsin. *California, Colorado, Florida, lowa, Kansas, Minnesota, Missouri, Montana, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming. TABLE II. Notifiable diseases of low frequency, United States One of the 9 reported cases for this week were imported from a foreign country or can be directly traceable to a known internationally imported case within two generations. TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending January 9, 1988 and January 10, 1987 (1st Week) |