A crisis of community anxiety and mistrust: the Medfly eradication project in Santa Clara County, California, 1981-82.

Public anxiety of near panic proportions was created by the announcement of a plan to commence aerial application of malathion bait over a large urban area in California for the eradication of the Mediterranean fruit fly within four days. A risk assessment had reported the project entailed no significant risk to health but environmentalist groups and the media ignored the report. We describe the successful measures taken by State health workers to counteract the anxiety which itself constituted a serious public health problem. The most important measure was the rapid convening of a Health Advisory Committee composed of recognized experts and local professionals and leaders to provide an authoritative, respected and sympathetic voice to deal with the community's concerns. These experiences may be of value to other communities facing unwarranted anxiety over perceived environmental hazards.

Vitamin A--a pregnancy hazard alert.

Vitamin A is essential to human health, but concerns have arisen recently regarding its potential teratogenicity. Human and animal birth defects have been associated with the use of the vitamin A analogue, isotretinoin, or Accutane, for acne treatment, although the association of such defects with vitamin A itself is unclear. The federal Food and Drug Administration is evaluating the health issues surrounding vitamin A and, together with the manufacturer, has developed restrictions and label warnings to ensure the appropriate use of Accutane. We also have evaluated these issues, with concerns about the possible teratogenicity of high vitamin A intake during pregnancy. Practitioners should be familiar with the possible hazard of excessive dosages of vitamin A and its analogues. Vitamin A daily doses of higher than 8,000 IU for pregnant woman are not necessary for good health and are not recommended. Foods high in beta-carotene can provide the necessary amounts of vitamin A and, in contrast to the synthetic analogues, their use has not been associated with vitamin A toxicity or teratogenicity in humans or animals.

A communitywide outbreak of giardiasis with evidence of transmission by a municipal water supply.

Three hundred fifty residents of Rome, New York, had laboratory-confirmed cases of giardiasis between 1 November 1974 and 7 June 1975. A random household survey showed an overall attack rate for giardiasis (defined as a diarrheal illness of 5 days or more) of 10.6%. A significant association was discovered between having giardiasis and using city water and between having illness and drinking 1 or more glasses of water a day. The presence of human settlements in the Rome watershed area suggested that the water supply could have been contaminated by untreated human waste. The infectivity of municipal water was confirmed by producing giardiasis in specific pathogen-free dogs fed sediment samples of raw water obtained from an inlet of a city reservoir. A microscopic examination of the water sediments uncovered a Giardia lamblia cyst in one sample. This was the first time that a G. lamblia cyst has been found in municipal water in an epidemic and the first time that such water has been shown to infect laboratory animals.