Evolution of the Control of Communicable Diseases Manual: 1917 to 2000.

For 84 years, The Control of Communicable Diseases Manual has provided public health practitioners with relevant and timely information on infectious diseases. An examination of the contents of the Manual's 17 editions provides insight into the changes in medical understanding of infectious diseases. This article provides an evolution of the manual and examines the diseases described in each edition.

A history of biological and chemical warfare and terrorism.

This article provides a brief history of biological warfare and terrorism. It contends that examining disease in history provides public health specialists with the knowledge necessary to improve our surveillance system for potential acts of bioterrorism.

Epidemiologic study of pulmonary obstruction in workers occupationally exposed to ethyl and methyl cyanoacrylate.

The association between pulmonary obstruction (e.g., asthma) and occupational exposure to methyl cyanoacrylate (MCA) and ethyl cyanoacrylate (ECA) was examined in an occupational cohort of 450 persons at an adhesive production facility in Puerto Rico. Employee medical records containing information on physical examinations and pulmonary function tests (PFTs), as well as occupational histories, on each employee over a period of about 17 yr and industrial hygiene measurements were evaluated. The cohort analysis was based on a Cox proportional hazards model. Workers exposed to ECA or MCA were compared to workers unexposed to these chemicals with respect to their risk of becoming an "incident case." An "incident case" was defined as any person whose PFTs were normal at the time of employment, but later demonstrated an obstructive pattern, which was defined as a decline in the ratio of forced expiratory volume exhaled in 1 s to forced vital capacity (FEV1/FVC) below 70%. A separate case-control analysis was also conducted that compared "suspected cases," defined as all those whose PFTs ever demonstrated an obstructive pattern (e.g., asthma), to persons whose PFTs remained within normal limits throughout their employment with respect to their past peak and cumulative exposures to cyanoacrylates. All of these analyses showed no evidence that exposure to average short-term concentrations of ECA or MCA of less than 0.5 ppm and occasional daily peak exposures of at least 1.5 ppm (usually 10 min or less), with occasional higher concentrations during spills, were associated with an increased risk of pulmonary obstruction. However, the study suggested that persons occupationally exposed to cyanoacrylates were more likely to have some reversible eye or upper airway irritation than persons who were unexposed.

Cancer in asbestos-exposed occupational cohorts: a meta-analysis.

OBJECTIVE: To examine existing asbestos-exposed occupational cohorts and apply a meta-analytic technique to determine the magnitude of association between exposure and lung cancer and to investigate other cancer sites that may be related to such an exposure. METHODS: We summarized the data from 69 asbestos-exposed occupational cohorts reporting on cancer morbidity and mortality. Data were extracted regarding numbers of deaths for each cancer, numbers of mesotheliomas, occupations and latency for respiratory, gastrointestinal, urinary and lymphohematopoietic cancers. For each cancer, we calculated a meta-SMR and examined heterogeneity of results using a chi-square test and by calculating a Z-statistic for each study. To examine the dose-response effect, we divided the studies into tertiles according to the percentage of mesothelioma deaths that served as a proxy estimation of asbestos exposure. RESULTS: Lung cancer data demonstrated meta-SMRs of 163 and 148 with and without latency, respectively, with significant heterogeneity of results even after stratification according to occupational groups. Stratification of lung cancer studies according to percentage of mesothelioma deaths showed a dose-response effect. Z-scores ranged from -12.21 to + 29.49. Analysis for laryngeal cancer yielded meta-SMRs of 157 and 133 with and without latency, respectively, demonstrating homogeneous results across studies but accompanied by no evidence of a dose-response effect. Data for gastrointestinal cancers showed no evidence of a significant association and no dose-response effect. Kidney cancer demonstrated statistically non-significant meta-SMRs of 120 (95% CI 88-160) and 111 (95% CI 94-131) with and without latency respectively. CONCLUSIONS: This meta-analysis demonstrates a wide variability of the association between occupational asbestos and lung cancer. There was a suggestion of an association between asbestos and laryngeal carcinoma and no clear association with other cancers.

Mycotoxins and public health: a review.

This article provides an overview of the public health implications of mycotoxins--including a review of mycotoxin-related diseases documented in humans and animals, recent associations between mycotoxin exposure and carcinogenicity, a catalogue of foodstuffs documented to have been contaminated by mycotoxins, and a description of the distribution of mycotoxins in both the United States and worldwide. The article also advocates that public health professionals utilize recent developments in the field of mycotoxicology to explore associations between these fungal metabolites and acute and chronic disease in humans.

A brief history and inventory of immunizations.

This article attempts to summarize succinctly the origins, past history, present armamentarium, and possible future directions of immunizing agents. Individual discoveries and governmental initiatives have led to large-scale immunization programs that have proven the success of this primary preventive tool. Examples of missed opportunities have been noted. Like previous vaccines, the newer vaccines will require scientific proof of efficacy and public acceptance. Unlike other primary preventive tools (chlorination of water, pasteurization of milk), future successful immunization programs will require active participation, of the public and continuous governmental education in order to protect its citizens.

Emerging pathogens--the white horse of the apocalypse?

The concept of emerging microbial disease is discussed both in a historical and contemporary perspective. Major factors contributing to emergence of viral, bacterial, rickettsial, and parasitic diseases over the last 25 years are discussed. Forty agents are listed in a table by year of recognition/emergence, mode of transmission, geographical distribution, and symptom complex. Public health prevention and control measures and long-term public health implications are also summarized. Suggestions are offered on how to retrieve appropriate information on newly emerging pathogens and to obtain authoritative and timely information on surveillance data using electronic mail access.