This outbreak illustrates the high price exacted by the practice of modern medicine, particularly use of parenteral injections and surgery, without due attention to good medical practice. High priority must be given to education of medical staff in developing countries and to guidelines for safe operation of clinics and hospitals. Failure to do so will have far reaching, costly, and ultimately devastating consequences.

To estimate the burden of reptile- and amphibian-associated Salmonella infections, we conducted 2 case-control studies of human salmonellosis occurring during 1996-1997. The studies took place at 5 Foodborne Diseases Active Surveillance Network (FoodNet) surveillance areas: all of Minnesota and Oregon and selected counties in California, Connecticut, and Georgia. The first study included 463 patients with serogroup B or D Salmonella infection and 7618 population-based controls. The second study involved 38 patients with non-serogroup B or D Salmonella infection and 1429 controls from California only. Patients and controls were interviewed about contact with reptiles and amphibians. Reptile and amphibian contact was associated both with infection with serogroup B or D Salmonella (multivariable odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2; P<.009) and with infection with non-serogroup B or D Salmonella (OR, 4.2; CI, 1.8-9.7; P<.001). The population attributable fraction for reptile or amphibian contact was 6% for all sporadic Salmonella infections and 11% among persons <21 years old. These data suggest that reptile and amphibian exposure is associated with approximately 74,000 Salmonella infections annually in the United States.

Syndromic surveillance refers to methods relying on detection of individual and population health indicators that are discernible before confirmed diagnoses are made. In particular, prior to the laboratory confirmation of an infectious disease, ill persons may exhibit behavioral patterns, symptoms, signs, or laboratory findings that can be tracked through a variety of data sources. Syndromic surveillance systems are being developed locally, regionally, and nationally. The efforts have been largely directed at facilitating the early detection of a covert bioterrorist attack, but the technology may also be useful for general public health, clinical medicine, quality improvement, patient safety, and research. This report, authored by developers and methodologists involved in the design and deployment of the first wave of syndromic surveillance systems, is intended to serve as a guide for informaticians, public health managers, and practitioners who are currently planning deployment of such systems in their regions.

In July 1995, 40 Montana residents were identified with laboratory-confirmed Escherichia coli O157:H7 infection; 52 residents had bloody diarrhea without laboratory confirmation. The median age of those with laboratory-confirmed cases was 42 years (range, 4- 86); 58% were female. Thirteen patients were hospitalized, and 1 developed hemolytic-uremic syndrome. A case-control study showed that 19 (70%) of 27 patients but only 8 (17%) of 46 controls reported eating purchased (not home-grown) leaf lettuce before illness (matched odds ratio, 25.3; 95% confidence interval, 3.9-1065.6). Pulsed-field gel electrophoresis identified a common strain among 22 of 23 isolates tested. Implicated lettuce was traced to two sources: a local Montana farm and six farms in Washington State that shipped under the same label. This outbreak highlights the increasing importance of fresh produce as a vehicle in foodborne illness. Sanitary growing and handling procedures are necessary to prevent these infections.

Lassa fever has been estimated to cause 5,000 deaths annually in West Africa. Recently, war in the zone where Lassa fever is hyperendemic has severely impeded control and treatment. Vaccination is the most viable control measure. There is no correlation between antibody levels and outcome in human patients, and inactivated vaccines produce high titers of antibodies to all viral proteins but do not prevent virus replication and death in nonhuman primates. Accordingly, we vaccinated 44 macaques with vaccinia virus-expressed Lassa virus structural proteins separately and in combination, with the object of inducing a predominantly TH1-type immune response. Following Lassa virus challenge, all unvaccinated animals died (0% survival). Nine of 10 animals vaccinated with all proteins survived (90% survival). Although no animals that received full-length glycoprotein alone had a high titer of antibody, 17 of 19 survived challenge (88%). In contrast, all animals vaccinated with nucleoprotein developed high titers of antibody but 12 of 15 died (20% survival). All animals vaccinated with single glycoproteins, G1 or G2, died, but all those that received both single glycoproteins (G1 plus G2) at separate sites survived, showing that both glycoproteins are independently important in protection. Neither group had demonstrable antibody levels prior to challenge. We demonstrate that in primates, immune responses to epitopes on both glycoproteins are required to protect against lethal challenge with Lassa virus without having untoward side effects and that this protection is likely to be primarily cell mediated. We show that an effective, safe vaccine against Lassa virus can and should be made and that its evaluation for human populations is a matter of humanitarian priority.Lassa virus is endemic in rural West Africa. The prevalence of antibody to Lassa virus ranges from 5% in Guinea and 15 to 20% in Sierra Leone and Liberia to over 20% in Nigeria (7,30). Lassa fever has been estimated to cause from 100,000 to 300,000 infections a year and several thousand deaths (30). The fatality rate for hospitalized patients is about 17%, but in certain groups of patients, such as pregnant women in their third trimester, more than 30% may die, and fetal or neonatal loss is about 88% (34). Deafness is a common complication of Lassa fever, affecting as many as 15% of patients and rendering an estimated 1 to 2% of the population hearing impaired in areas with high rates of infection (11). Treatment with intravenous ribavirin has been shown to be effective; however, it is not widely available in the areas where the disease is endemic and must be administered in the first week of illness for optimal efficacy (28). Recently, social and economic conditions have deteriorated in areas of high endemicity of eastern Sierra Leone and Liberia, and incidence and mortality have increased (R. Allan, R. Ladbury, K. Skinner, and S. Mardel, Abstr. Int. Conf. Emerg. Infect. Dis., abstr. 16, p. 21, 1998).Lassa virus, an arenavirus, exhibits persistent, asymptomat...

Vibrio vulnificus infections are highly lethal and associated with consumption of raw shellfish and exposure of wounds to seawater. V. vulnificus infections were reported to the Centers for Disease Control and Prevention from 23 states. For primary septicemia infections, oyster trace-backs were performed and water temperature data obtained at harvesting sites. Between 1988 and 1996, 422 infections were reported; 45% were wound infections, 43% primary septicemia, 5% gastroenteritis, and 7% from undetermined exposure. Eighty-six percent of patients were male, and 96% with primary septicemia consumed raw oysters. Sixty-one percent with primary septicemia died; underlying liver disease was associated with fatal outcome. All trace-backs with complete information implicated oysters harvested in the Gulf of Mexico; 89% were harvested in water ú22ЊC, the mean annual temperature at the harvesting sites (P õ .0001). Control measures should focus on the increased risk from oysters harvested from the Gulf of Mexico during warm months as well as education about host susceptibility factors.Vibrio vulnificus is a gram-negative, halophilic bacterium to infections have not previously been studied, and a safe harvesting temperature has not been defined. that inhabits marine and estuarine environments and causes three syndromes of clinical illness in humans: gastroenteritis, Here we summarize data from the Centers for Disease Control and Prevention (CDC) Gulf Coast Surveillance System, wound infections, and primary septicemia [1]. Although gastroenteritis is self-limited and rarely reported, wound infections which has collected epidemiologic and clinical information about V. vulnificus infections in Florida, Alabama, Louisiana, and primary septicemia are highly lethal conditions that occur most often among persons with liver disease or other immunoand Texas since 1988. To assess the contribution of environmental factors in the epidemiology of V. vulnificus infections, compromising conditions [2 -4]. Primary septicemia with V. vulnificus is usually associated with the consumption of raw we also studied the association between reported infections and water temperature at oyster harvesting sites. The clinical and oysters; it is probably the leading cause of seafood-associated fatalities in the United States.environmental information described highlights potential control measures for reducing the number of V. vulnificus infecSince its first recognition as a pathogen in the 1970s [2,5], much has been learned about the effects of bacterial virulence, tions in the United States. host factors, and environmental conditions in the epidemiology of V. vulnificus infections. Vibrios proliferate in warm water Methods [6,7], and infections occur more commonly in warmer months [4,8]; however, the harvest site temperatures of oysters traced States participating in the Gulf Coast Vibrio Surveillance System were Florida, Alabama, Louisiana, and Texas; other states were also encouraged to report Vibrio infections to CDC. Investigators in state and c...

We provide a national perspective for HPIV activity during the 15-year study period and demonstrate distinct seasonal peaks in activity for HPIV-1, HPIV-2, and HPIV-3. In addition, our data suggest that there is an interaction between HPIV-3 and HPIV-1 activity, which may have implications in future prevention strategies.

To determine the incidence of cryptococcosis and its risk factors among human immunodeficiency virus (HIV)-infected persons, population-based active surveillance was conducted in four US areas (population, 12.5 million) during 1992-1994, and a case-control study was done. Of 1083 cases, 931 (86%) occurred in HIV-infected persons. The annual incidence of cryptococcosis per 1000 among persons living with AIDS ranged from 17 (San Francisco, 1994) to 66 (Atlanta, 1992) and decreased significantly in these cities during 1992-1994. Among non-HIV-infected persons, the annual incidence of cryptococcosis ranged from 0.2 to 0.9/100,000. Multivariate analysis of the case-control study (158 cases and 423 controls) revealed smoking and outdoor occupations to be significantly associated with an increased risk of cryptococcosis; receiving fluconazole within 3 months before enrollment was associated with a decreased risk for cryptococcosis. Further studies are needed to better describe persons with AIDS currently developing cryptococcosis in the era of highly active antiretroviral therapy.