Immunization roulette: influenza occurrence in five nursing homes.

Immunization with A/Bangkok 1/79 (H3N2) vaccine appeared to be protective for immunized nursing home residents during an influenza outbreak in 1983. All thirteen deaths during the 4-month period of the study were among residents of two of five nursing homes where influenza immunization was low or nonexistent. Death certificates included a diagnosis of I-ILI for only six of the 13 decedents, showing that I-ILI may be greatly underreported as a cause of death, and skewing statistical evaluation of the impact of influenza in nursing home populations. The cost of protection is only a small fraction of the cost to society of caring for seriously ill nursing home residents with I-ILI who must be admitted to a hospital.

Waterborne giardiasis: a communitywide outbreak of disease and a high rate of asymptomatic infection.

A communitywide outbreak of gastrointestinal illness due to Giardia lamblia infection occurred in the city of Berlin, New Hampshire, during April and May 1977. The clinical, epidemiologic, and laboratory aspects of this outbreak are described here. In 213 predominantly symptomatic cases of G. lamblia infection diagnosed at a local hospital laboratory in a 6-week period, illness was characterized by prolonged diarrhea (median duration 10 days) and 13% of symptomatic infections required hospitalization. Treatment with either quinacrine or metronidazole was generally followed by symptomatic improvement. A communitywide survey of the city residents revealed that the majority (76%) of G. lamblia infections occurring during the epidemic period were asymptomatic and ran a self-limited course without treatment. No significant secondary, person-to-person spread occurred and no enteric pathogens other than G. lamblia were implicated. Water was epidemiologically implicated as the most likely source of infection with Giardia cysts being demonstrated in samples of treated water as well as raw source water. Evidence supported the occurrence of two simultaneous outbreaks in this city which is supplied by two largely independent water supply systems. Inspection of the two water treatment facilities revealed several defects which permitted untreated (raw) water to mix with treated water. Human or beaver could have been responsible for contaminating source water with Giardia in this outbreak. A marked reduction in both clinical and subclinical giardiasis was apparent two months after onset of the outbreak, apparently as a result of measures applied to interrupt waterborne transmission of Giardia.

Hippocrates recycled.

Medical education in the United States has at least three serious deficiencies: its focus on medical under-graduate education rather than on medical education as a continuum throughout the career of a physician; its failure to recognize the basic incompatibility of highly sophisticated medical research and the education of the practicing physician; and its extremely high cost. The Hippocratic concept of preceptor education as an alternative has much to recommend it in replacing the present system, which underwrites the cost of student education through research grants and subsidies, but greatly neglects the continuing education of the practicing physician.