TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending November 24, 1984 and November 26, 1983 (47th 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 Analysis of Trace Metals - Continued a separate sample-preparation procedure and, consequently, a separate sample. As a result, developing a profile of occupational exposure for a worker or group of workers was expensive and time-consuming. Now, however, a method combining new analytic instrumentation and techniques for sample preparation has been developed and is described below. This method, called inductively coupled plasma-atomic emission spectroscopy (ICP-AES), allows simultaneous, multi-element analysis and has been successfully applied to industrial hygiene samples collected from workplace atmospheres (2). The technique has also been adapted and extended for biologic monitoring by the National Institute for Occupational Safety and Health (NIOSH). Trace metals are first extracted from urine samples with a polydithiocarbamate resin (3). This resin is well-suited for such extractions because of its unique characteristic of complexing with trace metals while showing little significant affinity for the alkali or alkaline earth elements (e.g., sodium, potassium, and calcium), which occur in large quantities as dissolved salts in urine. After extraction, the resin is digested; the metals are dissolved in a small volume of acid; and ICP-AES analysis is conducted. This procedure allows the simultaneous quantitative measurement from a single sample of 17 elements-aluminum, barium, cadmium, chromium, copper, iron, lanthanum, lead, manganese, molybdenum, nickel, platinum, silver, strontium, tin, titanium, and zinc). Reported by Methods Research Br, Div of Physical Sciences and Engineering, National Institute for Occupational Safety and Health, CDC. Editorial Note: In addition to the 4 million workers occupationally exposed to elements or their alloys, a significantly larger number is exposed to the salts and aerosols of these metals. This new methodology provides a means for readily establishing baseline data for trace metals in urine samples of both exposed and nonexposed workers. With quantitation of several elements from a single sample, these biologic monitoring data can be collected considerably more efficiently than with traditional analytic methods. In addition to establishing baseline data, the methodology can also be used in screening to determine whether unsafe levels of toxic metals exist. The methodology developed from this work is included in the NIOSH Manual of Analytical Methods, Third Edition (4). References 1. Department of Health, Education, and Welfare. Occupational diseases—a guide to their recognition. Cincinnati, Ohio: Department of Health, Education, and Welfare, 1977; DHEW publication no. (NIOSH)77-181. 2. Hull RD. Multielement analysis of industrial hygiene samples. Paper No. 68, presented at the American Industrial Hygiene Conference, Portland, Oregon (1981). 3. Barnes RM, Genna JS. Concentration and spectrochemical determination of trace metals in urine with a polydithiocarbamate resin and inductively coupled plasma-atomic emission spectrometry. Anal Chem 1979;51:1065. 4. CDC. Availability of NIOSH Manual of Analytical Methods, Third Edition. MMWR 1984;33:467-8. Epidemiologic Notes and Reports Streptococcal Foodborne Outbreaks Puerto Rico, Missouri Two large outbreaks of foodborne group A streptococcal pharyngitis have been reported to CDC during 1984 in Puerto Rico and Missouri. Puerto Rico: On August 3, 1984, an outbreak occurred among guests attending a party in a private home in San Juan, Puerto Rico. During that weekend, numerous party attendees became ill with sore throat, myalgia, cervical adenopathy, and fever. Many were seen by physicians and had exudative pharyngitis. One was hospitalized. Streptococcal Foodborne Outbreaks - Continued The Puerto Rico Department of Health was notified of the outbreak on August 8. Because of the high attack rate and the clustering of cases, the outbreak was presumed to be foodborne. Self-administrated questionnaires were received from 45 (96%) of the 47 party attendees, and 25 questionnaires were received from their household contacts. Throat cultures were obtained from 44 (94%) of party attendees. Four persons were excluded from the questionnaire analysis-three because of onset of pharyngitis before the party, and one, because of an incomplete questionnaire. Of the 41 remaining persons, 23 (56%) had illness meeting the case definition. The attack rate for persons who ate carrucho, a conch salad, was 70%, compared with 29% for persons who did not eat carrucho (p = 0.013). No other food showed significantly different attack rates. No doseresponse effect for persons eating carrucho was demonstrated, nor was a difference in attack rates observed between persons who ate early in the evening and those who ate later in the evening. That carrucho was the vehicle for transmission was further supported by the fact that two of four persons who did not attend the party but who ate carrucho that had been brought home to them became ill with pharyngitis. The secondary attack rate for household contacts who did not eat carrucho was 4%. The incubation period was 12-60 hours (median 24 hours). Throat cultures from 11 party attendees grew group A streptococci, as did a small sample of carrucho remaining from the party. All cultures were of the same serotype (M nontypable. T12, SOR+). The carrucho was prepared in a small beachside restaurant outside San Juan. The conch used to make the carrucho came in a torn, unlabeled plastic bag and was allegedly imported from Santo Domingo. None of the uncooked conch remained for testing, but the method of salad preparation, which reportably included boiling the conch for 21⁄2 hours, should have been adequate to kill any streptococci. Seventy pounds of carrucho was made the afternoon of the party. The 25 pounds purchased by the party's host was left in an automobile at ambient temperature for 3 hours before delivery to the party. Approximately 2,000 persons who ate in the restaurant that weekend were potentially exposed to the 45 pounds of remaining carrucho. Because there was no way to identify individuals who might have eaten there that weekend, four clinical microbiology laboratories serving the San Juan area were surveyed in an attempt to determine if the number of positive throat cultures in August was higher than the number during the same time the previous year; no increase was observed. All foodhandlers at the restaurant were interviewed and examined for skin lesions, and cultures (pharyngeal, nasal, and hand) were obtained. No cultures were positive, and no histories were obtained of recent pharyngitis or skin lesions. Food prepared at the restaurant, including carrucho, during the week after the party was cultured; all was negative for group A streptococci. Because party attendees were potentially exposed to streptococci, the Puerto Rico Department of Health recommended that all attendees who developed symptoms of pharyngitis, regardless of culture results, receive antibiotic therapy effective against group A streptococci. Missouri: Another outbreak occurred among participants from seven states at a meeting held at a Kansas City, Missouri, hotel from May 31, to June 1, 1984. On June 6, the Kansas City Health Department was notified of three cases of group A beta-hemolytic streptococcal pharyngitis occurring in three technicians from one blood bank who had attended the meeting. Other cases were subsequently reported among persons who attended the meeting Clustering of cases and a high attack rate suggested a foodborne source. |