Neonatal chlamydial infections in Massachusetts, 1992-1993.

INTRODUCTION: An increase in the numbers of babies reported with Chlamydia trachomatis infections in Massachusetts prompted a review of the medical records of both infants and mothers to evaluate the clinical presentation, the maternal epidemiologic profile, risks of transmission, and the screening practices of health care providers. METHODS: Medical records of 44/47 infants reported with a chlamydial infection in 1992-1993 were analyzed, as were 40 of the maternal records. RESULTS: Almost all of the infants (39, or 89%) had conjunctivitis, despite the fact that ocular prophylaxis with erythromycin was documented at birth for 34 infants. Five other infants presented with respiratory tract infections without conjunctivitis, and they had all received prophylaxis at birth either with erythromycin (3) or silver nitrate instillation (2). More than one fifth (10, or 22.7%) had a respiratory tract infection. Seventy percent of the mothers were younger than 25. More than 85% were receiving prenatal care by the end of the second trimester. Twenty-five (62.5%) were screened for chlamydia. Nine women tested positive, seven of whom were tested beyond the first trimester. Seventy-five percent of the women who tested negative were tested in the first trimester. DISCUSSION: This case series supports previous data documenting that ocular prophylaxis can fail to prevent neonatal chlamydial conjunctivitis, and does not prevent colonization or infection at other sites. This study reinforces the importance of primary prevention of neonatal infections through prenatal screening in the third trimester, treatment of infected mothers and their sexual partner(s), and active follow-up.

An epidemiologic study of gypsy moth rash.

In 1981, outbreaks of itchy skin rashes were reported accompanying the heavy infestation of gypsy moths (GM) in the Northeastern United States. The rash problem was widespread and a considerable public annoyance. In the spring of 1982, during the period of greatest contact with the caterpillars, a telephone survey was carried out in a highly infested community (HI) and a minimally infested community (LO). Information was collected from 1,000 persons, representing more than 90 per cent of those selected for study. The one-week risk of rash was 10.4 per cent in the HI area and 1.6 per cent in the LO area, for a risk ratio (RR) of 6.5. The occurrence of rash was strongly related to a history of having had a rash in the previous year or having had a caterpillar crawl on the affected area. The combination of both factors additively increased the risk of rash. Hay fever and hanging the wash outside were other related variables. History of allergies other than hay fever since childhood and the use of insecticides were unrelated to rash occurrence.

The gypsy moth caterpillar: a significant new occupational and public health problem.

Seventeen workers in a laboratory where research with the gypsy moth was being performed were subjected to a questionnaire and to skin tests in an attempt to clarify the extent of allergy-like reactions in these workers. Ten of 17 reported dermatologic and/or pulmonary reactions associated with exposure to the caterpillar. Of the subjects with reactions, seven (70%) had reactions to allergens in the past. When all the workers were skin tested with various extracts, there was a strong relationship between reactions to the skin tests and clinical symptoms. The documentation of this problem helps to explain the outbreak of cutaneous reactions seen in the general population during the massive gypsy moth outbreak in spring 1981 in the Northeast.