Prevention of Vibrio vulnificus infections. Assessment of regulatory educational strategies.

CONTEXT: Vibrio vulnificus-related disease caused by eating contaminated raw oysters prompted California to implement regulatory educational initiatives in 1991. OBJECTIVE: To assess California guidelines and education efforts with regard to the prevention of V. vulnificus infections in Los Angeles County and to evaluate compliance with state regulations mandating posting of warning signs concerning risks of eating raw oysters. DESIGN: Review of epidemiologic investigations of V. vulnificus infections in Los Angeles County between 1993 and 1995; telephone interviews of patients or surrogates; and a survey of restaurants serving raw oysters in Los Angeles County. SETTING: General community. MAIN OUTCOME MEASURES: Prior warning of patients and posting of warning signs in restaurants. RESULTS: Recent cases of V. vulnificus infections in Los Angeles County suggest that a unique, vulnerable group (uninsured Hispanic men with viral or alcoholic liver disease) has not been reached through education efforts. Of a total of 11 cases, information regarding being warned about the hazard of eating raw shellfish was available for 8; of these, only 1 case was reported as having been warned, but he had misunderstood the preventive message. Warning signs were not posted adequately in more than 50% of restaurants surveyed and one third of these establishments had signs in English only. Warnings were never located on dining tables and rarely included in menus. CONCLUSION: A more effective strategy is required to prevent V.vulnificus infections in Los Angeles County.

Food-borne disease in hospitals: prevention in a changing food service environment.

The results of an investigation into an outbreak of food-borne disease at a hospital in Los Angeles County are reported. The outbreak occurred at a luncheon buffet for nonpatient visitors attending an event at the hospital, which was catered by the hospital. The food source and etiologic agent(s) responsible for the outbreak were not identified by our investigation. However, several issues relating to the changing character of hospital food provision and their implications for prevention of food-borne disease in hospitals were conspicuous. Two trends apparent in hospital food service are toward increased use of foodstuffs prepared by wholesale food manufacturers and more frequent invitation to community groups to meet within hospital facilities and use hospital catering services. We found that (1) hospital kitchens in Los Angeles County are undersurveyed with respect to frequency of sanitary inspections; (2) hospitals have no mechanism whereby to assess the sanitary inspection record of wholesale food manufacturers from whom they purchase foodstuffs; and (3) crossover of food items prepared for nonpatient hospital visitors, including catered foods, to the inpatient menu occurs. The potential risks for a food-borne disease outbreak among compromised inpatients resulting from these factors are discussed, and measures to reduce such risk are proposed.

Heterosexual and perinatal transmission of human immunodeficiency virus in a low prevalence community.

Six previously unidentified cases of human immunodeficiency virus (HIV) infection were found during an investigation and follow-up of three clusters of heterosexually and perinatally transmitted HIV infections. The investigations were to identify those infected, to interrupt the transmission of HIV, to attempt to reduce the likelihood of the development of the acquired immunodeficiency syndrome among those found to be seropositive, and to show the usefulness of traditional disease control strategies during this epidemic. Our findings indicate the value of contact tracing for HIV infections and the need to provide and evaluate educational activities regarding the transmission of HIV in low prevalence populations.