Geographically widespread outbreaks involving commonly isolated organisms and where the vehicles of infection are commonly eaten foodstuffs pose particular difficulties at a technical and organizational level. An outbreak of Salmonella typhimurium infection, affecting 39 people, spread over a wide area in North West England and North Wales in April and May 1991, was detected thanks to the practice of sending specimens to the national reference laboratory where phage typing and characterizing of antibiotic resistance patterns enabled the identification of a cluster of distinctive isolates (S. typhimurium DT193 resistant to sulphonamides, trimethoprim and furazolidone). An investigation, involving twenty environmental health departments in addition to health authorities and the Public Health Laboratory Service, showed an association between the illness and eating loose sliced cooked ham (P = 0.004). Detailed tracing of the chain of supply of the ham showed this to be particularly cooked ham originating from a single small local producer (P = 0.00003). Further investigation of that producer revealed that a batch of ham distributed on one day in early April was undercooked due to a malfunction in cooking equipment.
SUMMARYFollowing an episode of water contamination with sewage in a rural Irish town, a community-wide survey of gastrointestinal-associated illness and health service utilization was conducted. Random sampling of households yielded residents who were surveyed using a self-administered questionnaire. Of 560 respondents from 167 (84%) households, equal proportions lived in areas known to have been exposed and unexposed to the contaminated water, although 65% of subjects reported using contaminated water. Sixty-one percent of subjects met the case definition. The most common symptoms among cases were abdominal cramps (80%), diarhoea (75%), appetite loss (69%), nausea (68%) and tiredness (66%).Mean duration of illness was 7-4 days. Only 22 % of cases attended their general practitioner. Drinking unboiled water from the exposed area was strongly associated with being a case. A substantial degree of community illness associated with exposure to contaminated water was observed. The episode ranks as one of the largest reported water-borne outbreaks causing gastrointestinal illness in recent times.
the clinical department. Whether on this side or on tlhat, a beginning meanS much and could not fail to issue in larger ambitions.Again, the clinical laboratory oughlt to be made a cenitre ef practical interest to tlle practitioner, and the ideal scheme would enable him to attend in order actuallv to see for himself the results of tlle tests applied in connexion with cases for which lhe was responsible. Too many of us are content in this matter to iccept reports for whiclh -we -can supply no personal verification, and it may perhaps 'be asked whether such a proceeding is capable of ethical defence, seeing that in, the relation between practitioner and patient there is implied on the part of the practitioner the guarantee of a personal responsibility.A
SU3MIMARY.To sulm up my suggestions in brief formi I would say,:(1) That the general efficiency of tlle profession may be promoted by the organization of co-operative clinical study; (2) that for such organization appropriate centres already exist in thle shape of our local hospitals and kindred institutions; (3) that an effective sclheme of this order demands tlle co-ordination of tlle worli of the lhospital with the interests of the local profession; and (4)
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