TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending
November 3, 1984 and November 5, 1983 (44th Week)

TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending November 3, 1984 and November 5, 1983 (44th Week)

Mortality data in this table are voluntarily reported from 121 cities in the United States, most of which have populations of 100.000 or more A death is reported by the place of its occurrence and by the week that the death certificate was filed Fetal deaths are not included.

** Pneumonia and influenza

+ Because of changes in reporting methods in these 4 Pennsylvania cities, these numbers are partial counts for the current week Complete counts will be available in 4 to 6 weeks.

tt Total includes unknown ages

§ Data not available Figures are estimates based on average of past 4 weeks.

Diabetic Nursing-Home Residents - Continued

between hospital and home. With DRGs, the greatest outcome of improved diabetes policies and procedures in nursing homes, particularly in the areas of care during acute illness and patient education, may be in preventing readmission to the hospital, thus affecting the number of hospitalizations, as well as the hospital-days rate.

Several factors affect nursing-home care that make established policies and procedures essential for safe, consistent, quality care. First, there is a high turnover rate among the nursing staff, particularly among nonlicensed nurse's aides. In Denver-area nursing homes, the estimated nursing turnover rate was 172% in 1980, 178% in 1981, and 114% in 1982. Second, many nursing homes employ part-time or temporary personnel, resulting in multiple persons providing nursing care for each resident. Third, the ratio of patient-to-licensed nursing staff is high. Licensed nursing personnel must delegate many tasks to minimally trained personnel.

Dietary departments are usually staffed by a food-service supervisor who generally has 90 hours of training in food service; cooks and dietary aides, however, only have on-the-job training. Most registered dietitians are employed on a consulting basis for as few as 4 hours per month. Finally, many nursing homes do not routinely offer diabetes education programs to their staff. In a survey of 444 nursing and dietary nursing-home personnel attending educational programs offered by the Colorado DCP in 1979 and 1980, the median number of diabetes education hours during the previous 5 years reported was less than one-half hour, with 43% reporting having no diabetes education during that time. Established policies and procedures can serve as a resource for all personnel and should be used as a basis for orientation and ongoing inservice education programs.

References

1. National Center for Health Statistics. The national nursing home survey: 1977 summary for the United States. Hyattsville, Maryland: National Center for Health Statistics, 1979; DHEW publication no. (PHS)79-1794. (Vital and health statistics; series 13, no. 143).

2. American Diabetes Association, American Association of Diabetes Educators. Guidelines for diabetes care in skilled nursing facilities. In: Guidelines for diabetes care. New York: American Diabetes Association, American Association of Diabetes Educators, 1981;40-4.

3. Colorado Department of Health, Division of Health Policy, Planning and Statistics. 1984 addenda to the 1982 state health plan. Denver, Colorado: Department of Health (in press).

Current Trends

Influenza Activity - Nevada

Isolation of two influenza viruses from persons in Las Vegas, Nevada, during late October 1984 has been reported. They have been preliminarily identified as related to A/Philippines/2/82(H3N2). The first isolate was from a 63-year-old woman who developed fever of 39.4 C (103 F), headache, and myalgias on October 24 and was admitted to a local hospital for 6 days. The second was from a 77-year-old man with chronic obstructive pulmonary disease, who was hospitalized on October 29 following onset of fever (38.9 C [102 F]), headache, myalgias, and nausea. No influenza outbreaks have been reported in Nevada. Reported by J Clark, P Reichelderfer, PhD, J Oparnico, Sunrise Hospital, N Venger, MD, K Fazekas, MD, Las Vegas, J Constantino, O Ravenholt, MD, Clark County Health Dept, GE Reynolds, MD, State Epidemiologist, Nevada State Dept of Human Resources; WHO Collaborating Center for Influenza, Influenza Br Div of Viral Diseases, Center for Infectious Diseases, CDC.

Influenza - Continued

Editorial Note: It is common for sporadic isolates of influenza to be reported at this time of year in the United States, indicating low-level spread of virus in the population. Both patients in Nevada were hospitalized, illustrating the potential benefit of administering influenza vaccine annually to those persons at greatest risk of complications from influenza infections. The Immunization Practices Advisory Committee (ACIP) has recommended that priority be given to develop special programs for administration of vaccine to two of the groups at high risk: (1) adults and children with chronic disorders of the cardiovascular or pulmonary systems severe enough to have required regular medical follow-ups or hospitalization during the preceding year; (2) residents of nursing homes and other chronic-care facilities (e.g., institutions housing patients of any age with chronic medical conditions) (1).

Influenza vaccine, although normally given in the fall, should continue to be administered to persons in the above high-priority groups, as well as to persons in other groups recommended to receive it (1), up to the time influenza epidemics are occurring. Physicians and administrators of facilities providing care for persons at high risk are also encouraged to evaluate the organization and outcome of present vaccination activities to determine whether changes could improve the delivery of vaccine to high-priority groups during the 1985-1986 season.

CDC will make available to health-care organizations and public health or voluntary agencies camera-ready copies of a revised brochure, "What You Should Know About 'Flu and 'Flu Shots," suitable for reprinting locally. Requests should be sent to the Centers for Disease Control, Influenza Branch, Division of Viral Diseases, Building 7, Room 111, Atlanta, Georgia 30333. In addition, a limited number of printed brochures is available from the above address. Requests for these should include a preaddressed, adhesive label to facilitate mailing the brochures.

Reference

1. ACIP. Prevention and control of influenza. MMWR 1984:33:253-60, 265-6.

Epidemiologic Notes and Reports

Poultry Giblet-Associated Salmonellosis - Maine

In November 1982 and October 1983, two unrelated outbreaks of foodborne salmonellosis caused by improperly cooked poultry giblets occurred in Maine. The two restaurants involved were located 50 miles apart but were part of the same restaurant chain. Reports of the outbreaks follow.

Outbreak 1: One hundred twelve culture-confirmed cases of Salmonella enteritidis serotype enteritidis were identified following exposure to this restaurant over the Thanksgiving weekend, November 25-27, 1982. A univariate analysis was unable to differentiate five of 42 foods associated with illness (roasted turkey, chef's dressing, giblet gravy, mashed potatoes, and apple cider) (p = 0.0001). Further analyses of food histories associated the giblet gravy most strongly with illness (p < 0.0001). All items served with the turkey dinner had been used by the time the investigation was initiated. Food from five "doggy" bags was retrieved following the outbreak, but the contents contained a nonsegregated mixture of the turkey dinner. Nevertheless, turkey from two bags was positive for Salmonella, as were mashed potatoes from the third bag.