diagnoses of hypertension-related diseases; improved containment of these conditions may prevent mortality but may require hospitalization for treatment.

While the increased number of hospitalizations for hypertension-related diseases was unexpected, it was accompanied by parallel increases in the number of total hospital discharges in the state. For example, in 1978, cerebrovascular disease represented 1.3% of the total discharges; in 1981, this proportion had increased by 1.8%. Similar increases were observed for the other related disease categories.

From the data presented, it appears that some positive changes have occurred in the control of high blood pressure in South Carolina since 1978. Although this assessment cannot document the specific causal relationships effecting these changes, it is possible to describe needs, develop intervention-targeted strategies, and assess subsequent change by using a systematic approach through which objective data are collected, analyzed, and evaluated Editorial Note: High blood pressure is one of the most prevalent chronic conditions affecting U.S. citizens (4). It is a major risk factor for cardiovascular disease (including cerebrovascular disease) and renal disease (5,6). In South Carolina, mortality rates for high blood pressurerelated diseases are significantly higher than those reported in other states (7).

The DHEC has had state funding for high blood pressure screening, education, and followup services since 1973. South Carolina was the second state, following Georgia, to designate state funding for high blood pressure control activities. To augment these efforts, in 1976 federal funds became available for expansion of community-based services.

While the SCHBPCP was involved in documenting the status of high blood pressure control in South Carolina since 1978, it must be acknowledged that the control of high blood pressure is a complex process. Positive improvements may have occurred, but direct causeand-effect relationships cannot be attributed solely to the SCHBPCP. However, the project did establish a comprehensive network of public, private, professional, and voluntary groups involved in blood pressure control activities, including screening and follow-up services, as well as public, patient, and professional education. A complete description of the programmatic aspects of the project is available from the Special Projects Section, Division of Chronic Disease, South Carolina DHEC, 2600 Bull Street, Columbia, South Carolina 29201.

Reported in Preventive Medicine Quarterly 1984;8 (Summer): 8-11, by DM Shepard, MAT, South Carolina Dept of Health and Environmental Control, Aiken, FC Wheeler, PhD, Special Projects Section, Div of Chronic Disease, South Carolina Dept of Health and Environmental Control, MC Weinrich, PhD, Dept of Epidemiology, School of Public Health, University of South Carolina, Columbia, E Devlin, project coordinator, staff and members, South Carolina Medical Association, South Carolina Affiliate, American Heart Association.

References

1. Lam JJ, Weinrich MC. A new sampling plan for the Carolina Health Survey. Proc Survey Research Methods. JASA 1981:81;385-6.

2. McClure G, Weinrich MC, Shepard DM. Carolina Health Survey (1979): a summary report. South Carolina Department of Health and Environmental Control, 1982.

3. McClure G, Weinrich MC, Shepard DM. Carolina Health Survey (1982): a summary report. South Carolina Department of Health and Environmental Control, 1983.

4. Rowland M, Robert J. Blood pressure levels in persons 6-74 years: United States 1976-1980. Vital and Health Statistics, Advance Data No. 84, 1982. National Center for Health Statistics, U.S. Department of Health and Human Services.

5. Kannel WB Some lessons in cardiovascular epidemiology from Framingham. Am J Cardiol 1976,37:269-82.

6. Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA 1979;242:2562-71.

7. Keil JE, Lackland DT, Hudson MB, et al. Coronary heart disease and stroke mortality in South Carolina geographical and temporal trends. J SC Med Assoc 1983;79:65-9.

Epidemiologic Notes and Reports

Campylobacter Outbreak

Associated with Certified Raw Milk Products

California

On May 31, 1984, 28 kindergarten children and seven adults from a private school of 240 students in Whittier, California, visited a certified raw milk (CRM) bottling plant in southern California, where they were given ice cream, kefir, and CRM. Three to 6 days later, several of the group began to experience fever and gastroenteritis. Ultimately, nine children and three adults became ill, and most of them were absent from school. Studies on stools from these 12 individuals for routine bacterial pathogens showed nine positive and three negative for Campylobacter jejuni. Stools were obtained from nine non-ill children in another kindergarten class; these stools did not yield C. jejuni. The only common foods these children (ill and nonill) ate were hamburgers, which are provided every Thursday to their school by a fast-food hamburger chain. No one else in the school became sick.

Reported in Public Health Letter 1984;6, Los Angeles County Dept of Human Svcs, California Morbidity (June 15, 1984), California Dept of Health Svcs; Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note: Other Campylobacter outbreaks have been linked to consumption of raw milk, including CRM (1). In June 1984, 17 members of a kindergarten class on Vancouver Island, British Columbia, Canada, visited a raw milk dairy; 13 drank raw milk. Nine persons became ill a median of 4 days after visiting the dairy. Stools from 10 persons were cultured, three yielded C. jejuni; four did not; the results of three are still pending (2). During 1983, two outbreaks of campylobacteriosis followed consumption of raw milk on school-sponsored outings in Pennsylvania (3). Similar outbreaks also occurred in 1981 and 1982 in Michigan, Minnesota, and Vermont. Technology does not presently exist to prevent contamination of raw milk supplies by Campylobacter, which is present in the intestinal tracts of about 40% of dairy cattle (4). Although infection may be more common than recognized, episodes of illness often are not well documented.

References

1. Potter ME, Blaser MJ, Sikes RK, Kaufmann AF, Wells JG. Human Campylobacter infection associated with certified raw milk. Am J Epidemiol 1983;117:475-83.

2. Kindergarten field trip to a farm, June 25, 1984, Vancouver Island. Disease Surveillance, British Columbia 1984;5:201-3.

3. CDC. Campylobacteriosis associated with raw milk consumption-Pennsylvania. MMWR 1983. 32:337-8, 344.

4. Martin WT, Patton CM, Morris GK, Potter ME, Puhr ND. Selective enrichment broth medium for isolation of Campylobacter jejuni. J Clin Microbio 1983;17:853-5.

Notice to Readers

Workshop on Occupational Diseases

The National Institute for Occupational Safety and Health (NIOSH) will sponsor a workshop entitled, "State-Based Reporting of Occupational Diseases." It will be held November 7-9, 1984, in Cincinnati, Ohio. For further information, contact Robert J. Mullan, M.D., Robert A. Taft Laboratories, Mail Stop R-21, 4676 Columbia Parkway, Cincinnati, Ohio 45226.

Addendum: Vol. 33, No. 36

p. 506. In the article, "Outbreaks of Respiratory Illness among Employees in Large Office Buildings - Tennessee, District of Columbia," the following persons should be added to the credits on page 507: J Simon, MPH, T Waters, PhD, Health Svcs, Tennessee Valley Authority, Chattanooga, Tennessee.

The Morbidity and Mortality Weekly Report is prepared by the Centers for Disease Control, Atlanta, Georgia, and available on a paid subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, (202) 783-3238.

The data in this report are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday.

The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other public health problems of current interest to health officials. Such reports and any other mat ters pertaining to editorial or other textual considerations should be addressed to: ATTN: Editor, Morbidity and Mortality Weekly Report, Centers for Disease Control, Atlanta, Georgia 30333.

1

1

Evaluation of Drought-Related Acute Undernutrition

Mauritania, 1983BLIC HEALTH LIBRARY

In August 1983, the government of the Islamic Republic of Mauritania requested emergency food assistance from several international agencies to relieve major food shortages resulting from the worst drought since the early 1970s. The various donors were asked to accept responsibility for providing food and emergency health services in different segments of the country's 12 regions, which have a combined population of 1.6 million persons. The U.S. Agency for International Development (USAID) accepted responsibility for three of the most severely affected regions: Adrar (population 55,000), Tagant (population 70,000), and Trarza (population 235,000). Using CDC methodology for nutritional assessment in emergency situations (1), surveys were performed in these three regions between September 1983 and November 1983.

A total of 300 children in Adrar, 360 in Tagant, and 870 in Trarza who were between the ages of 6 months and 5 years were included in the survey. Levels of acute undernutrition, defined as greater than two standard deviations below median weight-for-height using National Center for Health Statistics/Centers for Disease Control/World Health Organization standards (2), exceeded 10% in all three regions (Table 1); normally, 3% or less of children fall below this weight-for-height level, due to reasons other than food deprivation. These levels of undernutrition were equal to or higher than those reported for Mauritania in surveys done during the 1969-1974 Sahelian drought (3). However, little overt marasmus and no kwashiorkor were seen. Scurvy was observed in two of the regions, and xerophthalmia was observed in two of the regions at levels high enough to warrant widespread vitamin A prophylaxis. History of recent diarrhea was common. In the two regions where immunization status was assessed, only one-third of eligible children had been immunized against measles. Food aid had been received by a majority of families, but often the rations were incomplete or were not delivered frequently enough to ensure minimum recommended daily caloric intake (4). Furthermore, although protein intake exceeded daily requirements, the diet contained negligible amounts of both vitamins A and C.

Reported by the Government of the Islamic Republic of Mauritania; U.S. Agency for International Development, Nouakchott, Mauritania; Office of Foreign Disaster Assistance, US Agency for International Development, Washington, DC; International Health Program Office, Div of Reproductive Health, Div of Nutrition, Center for Health Promotion and Education, CDC.

Editorial Note: The goals of the nutrition surveys performed in Mauritania were: (1) to determine the magnitude of nutrition-related health problems; (2) to determine which groups in the population were at greatest risk; (3) to determine the prevalence of other health conditions that could exacerbate the health status of an already malnourished population; and

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES/PUBLIC HEALTH SERVICE