During a 31-month period in 1979-1981, nine patients at a renal transplant center in Tennessee developed invasive infections with Aspergillus species. Despite an extensive search, no common environmental source of contamination was found. A matched case-control study of host risk factors showed that leukopenia, prior administration of antibiotics, and treatment with azathioprine and antilymphocyte serum were not significantly related to the development of aspergillosis. In contrast, the administration of high-dose corticosteroids posed a significant risk. An average daily dose of greater than or equal to 1.25 mg of prednisone/kg per day for the entire interval studied was the best predictor of subsequent invasive infection with Aspergillus.

From January to July 1991, an outbreak of mumps occurred in Maury County, Tennessee. At the primarily affected high school, where 98% of students and all but 1 student with mumps had been vaccinated before the outbreak, 68 mumps cases occurred among 1116 students (attack rate, 6.1%). Students vaccinated before 1988 (the first year mumps vaccination was required for school attendance in Tennessee) may have been at greater risk of mumps than those vaccinated later (65[6.1%] of 1001 vs. 2[2.2%] of 89; risk ratio, 2.9; 95% confidence interval, 0.7-11.6). Of 13 persons with confirmed mumps who underwent serologic testing, 3 lacked IgM antibody in well-timed acute- and convalescent-phase serum specimens. Vaccine failure accounted for a sustained mumps outbreak in a highly vaccinated population. Most mumps cases were attributable to primary vaccine failure. It is possible that waning vaccine-induced immunity also played a role.

The high rate of E. chaffeensis infection in community A resulted from its proximity to a wildlife reserve. When outdoor recreational activities are common and concentrations of ticks are high, outbreaks of arthropod-borne zoonoses can be anticipated.

A prevalence serosurvey was performed on an 11.7% sample of the 6,503 adult male inmates in Tennessee prisons. On the basis of the sample, 0.9% of the prisoners possessed hepatitis B surface antigen, and 29.5% had one or more serum markers for hepatitis B virus (HBV). Thirty-two possible risk factors were analyzed for association with possession of HBV serum markers. The significant risk factors for possession of HBV markers in this population were found to be age, intravenous drug use while not incarcerated, intravenous drug use while incarcerated, race, education, military service history, and duration of prior and current imprisonments, in that order of importance. Given the modest contribution of incarceration to overall risk, mass immunization of prisoners against HBV seems unwarranted. Prisoners with unusually long sentences or who use intravenous drugs in prison are subgroups at particularly high risk. The logistic model can be used to target a serological screening and immunization program.

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