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.

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.

Hospital care of tuberculosis patients referred for directly observed therapy in New York City: identifying factors in prolonged stays.

Individuals hospitalized and treated for tuberculosis (TB) who were then enrolled into TB directly observed therapy at four study hospitals in New York City (NYC) were identified. Review of hospital medical records determined whether the hospitalizations were warranted and whether lengths of stay were prolonged. Most hospitalizations were appropriate but over 70 percent of cases analyzed had prolonged stays. Of these, almost half were to document bacteriologic response to anti-TB treatment. Some were prolonged due to misunderstanding of state recommendations. Focused educational efforts could significantly reduce lengths of stay and save up to $9.7 million annually in NYC hospitalization costs.

The descriptive epidemiology of pneumococcal meningitis in New York City.

A total of 348 cases of meningitis caused by Streptococcus pneumoniae were reported to and investigated by the New York City Department of Health during the six years 1973-1978. The descriptive epidemiology and completeness of reporting of this disease entity are presented. The total crude incidence was estimated at 1.46 cases per 100,000 population per year. The high-risk age categories were less than 5 years and greater than or equal to 65 years. The incidence of pneumococcal meningitis for blacks with sickle cell disease was much greater than that for other blacks, who, in turn, had a higher rate than whites. The overall case fatality ratio was 0.590. The case fatality increased with increasing age and was higher in nonwhites than in whites. Twenty-four per cent of all cases had predisposing chronic conditions which would have qualified them for the polyvalent pneumococcal vaccine under the present guidelines.

Rickettsialpox: report of an outbreak and a contemporary review.

Rickettsialpox is a mild illness characterized by the appearance of a primary eschar at the site of a mite bite followed by fever, headache, and a papulovesicular rash. It can be confused with a variety of illnesses including several other rickettsial diseases and chickenpox. R. akari, the etiologic agent, is a rickettsia belonging to the spotted fever group (SFG) of rickettsial illnesses. In spite of significant serologic cross-reactivity with other SFG agents, there is no convincing evidence of cross-immunity to these agents after recovery from rickettsialpox. Tetracyclinie is the drug of choice in the treatment of this disease.

Listeria and gram-negative bacillary meningitis in New York City, 1972-1979. Frequent causes of meningitis in adults.

In an eight year period (1972-1979), 158 cases of enteric gram-negative bacillary meningitis and 53 cases of Listeria meningitis were reported to the New York City Health Department. These two forms of bacterial meningitis were the fourth and fifth most common ones reported to the Department, respectively. The cumulative total of reported cases of gram-negative rod meningitis over this less than the reported cases due to Neisseria meningitis over this period. In contrast to most previous studies of Listeria and enteric gram-negative meningitides, the majority of cases occurred in adults. Listeria meningitis occurred more often in immunosuppressed hosts and the elderly than in the newborn; gram-negative bacillary meningitides were seen more often in elderly septic patients and in patients with traumatic skull fracture than in infants during the first months of life. The over-all mortality of Listeria meningitis was 62 percent; that of the combined gram-negative meningitides 71.3 percent. The mortality in adults with Escherichia coli and Klebsiella meningitis who were treated with chloramphenicol as the major antibiotic was 83 percent. In comparison, the only appreciable survival rates noted were in those with Listeria, Escherichia coli, Proteus mirabilis and Salmonella meningitis who were treated with ampicillin alone in whom the over-all mortality was 51 percent.

Meningococcal disease in New York City, 1973 to 1978. Recognition of groups y and W-135 as frequent pathogens.

In the period 1973 through 1978, the New York City Department of Health serogrouped 648 isolates of Neisseria meningitidis and investigated 259 cases if meningococcal meningitis and meningococcemia. Although meningitis and septicemia were mainly due to groups B and C, groups Y and W-135 caused nearly one third of the cases. There was no difference in mortalities when disease caused by the classic groups A, B, and C was compared with disease caused by the new serogroups X, Y, Z, W-135, and Z'. Most isolates from the respiratory tract were from the new serogroups, especially Z and Z' (some from patients with pneumonia), as were most of those from the genitourinary tract, anal canal, and miscellaneous sites. Group X was infrequently seen. Although most of the isolations of these groups of N meningitidis are apparently from asymptomatic carriers, Y and W-135 do cause a substantial number of acute symptomatic infections, in particular, septicemia.

Are air-conditioning maintenance personnel at increased risk of Legionellosis?

We surveyed by use of medical questionnaires and blood tests 21 maintenance workers involved with cleaning and servicing cooling towers and evaporative condensers at a large company to determine the frequency of pneumonia and antibody levels against Legionella pneumophila serogroup 1. The 21 high-risk workers were compared with 27 low-risk workers, persons who were not directly involved in service or maintenance for the company. The overall prevalence of titers greater than or equal to 128 for the 21 high-risk workers was 19.0% compared with 22.2% for the low-risk group. There were no significant differences in the history of pneumonia between these groups. Possible explanations for these findings are discussed.