Counseling the international traveler. Update '93.

The itinerary of international travelers will largely determine the amount of pretravel counseling, number of immunizations and type of malaria prophylaxis they will need. The countries visited are also the best predictor of traveler's diarrhea. Only yellow fever and cholera vaccines are required for entry into certain countries; the latter generally given only to satisfy entry requirements. Polio vaccine is important for some areas and is frequently neglected. For most malarious areas, chloroquine once per week is recommended. Mefloquine should be prescribed weekly for travelers going to chloroquine resistant malarious areas. Traveler's diarrhea is best prevented by avoiding high risk foods and beverages. Antibiotics, generally not recommended for prophylaxis, are very effective in treatment. Travelers should be reminded to advise physicians of their travel history during future medical encounters so that otherwise exotic tropical diseases, possibly contracted during travel, may be considered in diagnoses.

Thallium poisoning: an outbreak in Florida, 1988.

In October 1988, five of seven members of a Florida family were poisoned with thallium, constituting the largest outbreak of acute thallium poisoning in the United States since thallium was banned as a rodenticide in 1972. Three patients had an acute severe neuropathy with respiratory depression; one died. The other two had no symptoms. No cases were identified among nonhousehold relatives or friends, or in the community. Of the more than 100 environmental specimens collected at the family household and tested by atomic spectroscopy, three empty and four unopened glass soft drink bottles of the same lot number yielded thallium in a concentration fatal to humans. All family members who consumed the soft drink were poisoned (5/5) as compared with none of those who did not (0/2). Because poisoning was clustered to the family and police investigators provided evidence that the poisoning was deliberately targeted to the family, it was assumed that no other soft drink bottles contained thallium, and it was decided not to recall all soft drink bottles with the same lot number. A year later a neighbor of the family was arrested and convicted of the murder.

The protective effect of alcohol on the occurrence of epidemic oyster-borne hepatitis A.

Limited data indicate that drinking alcoholic beverages along with eating food contaminated with Shigella or Salmonella decreases the risk and/or the severity of illness. No such study has been reported following exposure to a viral pathogen. During an oyster-borne outbreak of hepatitis A, we studied the effect of ingestion of alcoholic beverages concomitant with consumption of contaminated oysters. The analysis was restricted to 51 cases and 33 controls who had consumed the implicated raw oysters. After controlling for potential confounders, we found a protective effect for beverages that have an alcohol concentration of greater than or equal to 10% (odds ratio = 0.1, 95% confidence interval = 0.02-0.9), but not for beverages with an alcohol concentration of less than 10% (odds ratio = 0.7, 95% confidence interval = 0.2-2.9).

A multistate outbreak of hepatitis A caused by the consumption of raw oysters.

BACKGROUND: In August 1988 we investigated a multistate outbreak of hepatitis A caused by Panama City, Florida, raw oysters. METHODS: Cases of hepatitis A (HA) with onset in July-August 1988 were identified among persons who ate seafoods harvested in the coastal waters of Panama City, Florida. We conducted a case-control study, using eating companions of case-patients, and calculated attack rate (AR) per 1000 dozen raw oysters served. Enzyme immunoassay (EIA) and a polymerase chain reaction (PCR) technique were performed on samples of raw shellfish obtained from Panama City coastal waters. RESULTS: Sixty-one case-patients were identified in five states: Alabama (23), Georgia (18), Florida (18), Tennessee (1), and Hawaii (1). We found an increased risk of HA for raw oyster eaters (odds ratio = 24.0; 95% confidence interval = 5.4-215.0; P less than .001). The AR of HA in seafood establishments was 1.9/1000 dozen raw oysters served. The EIA and PCR revealed HA virus antigen and nucleic acid in oysters from both unapproved and approved oyster beds, in confiscated illegally harvested oysters, and in scallops from an approved area. CONCLUSIONS: The monitoring of coastal waters and the enforcement of shellfish harvesting regulations were not adequate to protect raw oyster consumers. More emphasis should be placed on increasing public awareness of health hazards associated with eating raw shellfish.

Mycobacterium tuberculosis transmission in a health clinic.

Between January 1 and June 30, 1988, 30 (39.5%) of 76 staff members tested at a health clinic in Florida had positive tuberculin skin test reactions. This case-control study showed that people whose skin test converted were more likely than those whose skin test did not convert to have been present while patients were being treated with aerosolized pentamidine (odds ratio = 15.0; 95% confidence interval = 1.4 - 730.0) and to have worked on the first floor of the clinic (odds ratio = 9.3; 95% confidence interval = 1.1 - 420). The clinic building was poorly ventilated, and aerosolized pentamidine treatments were given in a room from which the air tended to flow into the hallway. Aerosolized pentamidine should be administered in a well-ventilated area from which the air is exhausted directly outside. All persons who are given such treatments should first be screened for tuberculosis. Use of trade names is for identification only and does not constitute endorsement by the Public Health Services or the U.S. Department of Health and Human Services.

Counseling the international traveler.

The itinerary of international travelers will largely determine the amount of pretravel counseling number of immunizations and type of malaria prophylaxis they will need. The countries visited are also the best predictor of traveler's diarrhea. Only yellow fever and cholera vaccines are required for entry into certain countries; the latter generally given only to satisfy entry requirements. Polio vaccine is important for some areas and is frequently neglected. For most malarious areas, chloroquine once per week is recommended. Fansidar should be prescribed weekly for very few travelers. Traveler's diarrhea is best prevented by avoiding high risk foods and beverages. Antibiotics, generally not recommended for prophylaxis, are very effective in treatment. Travelers should be reminded to advise physicians of their travel history during future medical encounters so that diseases, possibly contracted during travel, may be considered in diagnoses.

An outbreak of influenza A/Taiwan/1/86 (H1N1) infections at a naval base and its association with airplane travel.

In late October 1986, an outbreak of influenza-like illness was detected at the Naval Air Station in Key West, Florida. Between October 10 and November 7, 1986, 60 active duty personnel reported experiencing a respiratory illness characterized by fever, cough, sore throat, and myalgia. Influenza A/Taiwan/1/86 (H1N1) virus was recovered from three symptomatic patients. Forty-one (68%) of 60 case-patients belonged to a 114-person squadron that had traveled to Puerto Rico for a temporary assignment from October 17-28, 1986. Among squadron members, the attack rate for persons previously vaccinated with the 1986-1987 trivalent influenza vaccine and for those unvaccinated was the same (37%). Transmission of infection among squadron personnel appeared to have commenced in Key West and continued in a barracks in Puerto Rico and aboard two DC-9 aircraft that transported the squadron back to Key West on October 28. There was no evidence that the outbreak spread to the surrounding civilian communities in Puerto Rico or Key West. This was the first reported outbreak of respiratory illness due to influenza A/Taiwan/1/86 (H1N1) in the continental United States in the 1986-1987 influenza season.

Hepatitis A outbreak on a floating restaurant in Florida, 1986.

In April and May 1986, the largest reported foodborne outbreak of hepatitis A in Florida state history occurred among patrons and employees of a floating restaurant. A total of 103 cases (97 patrons and six employees) were identified. The exposure period lasted 31 days (March 20-April 19), making this the most prolonged hepatitis A outbreak to occur in a restaurant that to date has been reported to the Centers for Disease Control. The exposure period was divided into time intervals (peak, early, late, and total) for calculation of food-specific attack rates. The authors showed that green salad was an important vehicle of transmission for each phase of the exposure period, with the highest adjusted odds ratio for the three-day peak exposure interval (March 28-30), 6.8 (p = 0.001). Non-salad pantry items and mixed bar drinks were also identified as vehicles of transmission; both were more important during the early interval of the exposure period than during the late interval. Two of six infected employees worked in the pantry and may have sequentially infected patrons. Though rare, this outbreak suggests that hepatitis A infection among employees may allow for transmission to patrons for prolonged periods of time. Prevention of such outbreaks requires prompt reporting of ill patrons with rapid identification of infected employees and correction of food handling practices.

Disability days, United States, 1971.

Data are presented in this report on the total number and annual rates per person for disability days experienced by the civilian, noninstitutionalized population for 1971. Disability days included are restricted-activity days, bed days, work-loss days, and school-loss days. A day of restricted activity is defined as a day on which a person reduced his normal activities for the entire day because of illness or injury. Bed days, work-loss days, and school-loss days are included in the total number of restricted-activity days. Demographic characteristics used to described the persons with disability days are age, sex, place of residence, geographic region, famiIy income, usual activity, color, employment status, and for the currently employed population, industry and occupation. Previous reports of data from the Health Interview Survey on disability days are pubIished for July 1961-June 1962, July 1963-June 1964, July 1965-June 1966, and January-December 1968 in Vital and Health Statistics, Series 10, Numbers 4, 24, 47, and 67. Data on work-loss days for the currently employed during 1968 are discussed in Series 10, Number 71. Summary data from July 1965-June 1966 and January-December 1968 are also shown in this report for comparative purposes.

Prevalence of chronic skin and musculoskeletal conditions, United States-1969.

During 1969 the prevalence of chronic skin ,and musculoskeletal diseases among members of the civilian noninstitutionalized population was measured in the Health Interview Survey. Prevalence estimates and measures of impact of these conditions on the population covered by the Survey are presented in this report. This is the first report on the prevalence of chronic skin and musculoskeletal conditions based on data collected in health interviews to be published in the series, Vital and Health Statistics, and is one in a series of reports on specific condition groups (Series 10, Nos. 83,84, and 94). Methodological studies have shown that chronic conditions are generally underreported in interview surveys. Respondents in health interviews can report only those conditions of which they are aware and which they are willing to report to the interviewer. Reporting is better for those conditions which have made an impact on the affected individual and his family. Conditions that are severe, costly, or require treatment tend to be better reported than conditions having lesser impact. For instance, a condition which has caused hospitalization, limitation of activity, visits to the doctor, or days in bed is more likely to be reported in the interview than a condition which has little or no impact on the person.

Characteristics of persons with corrective lenses, United States -1971.

This report from the Health Interview Survey presents data on the use of corrective lenses for persons 3 years of age and over. Estimates are derived from a survey during 1971 of the civilian, noninstitutionalized population of the United States. Corrective lenses include eyeglasses and contact lenses. The term "corrective Ienses" is limited to visual aids worn to correct or improve vision and therefore excludes sunglasses worn only to filter light, safety glasses worn only for protection of the eyes, hand magnifying glasses, and other such devices. However, if the safety glasses are worn also for correction or improvement of vision, they are considered corrective lenses, as are prescription glasses. This report analyzes use of corrective Ienses by various demographic characteristics. An earlier report from the Health Interview Survey presented data on corrective lenses based on the July 1965-June 1966 survey. It contained information on age at which persons first obtained corrective lenses, type of prescription, usage, and the source of the optical examination if the individual was examined during the 2-year period prior to interview ("Characteristics of Persons with Corrective Lenses: United States, July 1965-June 1966," Vital and Health Statistics, Series 10, Number 53). A later section of the present report compares demographic differences in the proportion of the population with corrective lenses for the two time periods.

Disability days, United States-1968.

Included in this report are data on the total number and annual rates per person for disability days experienced by the civilian, noninstitutional population for data year 1968. Disability days included are restricted-activity days, beddays, and school-loss days. A day of restricted activity is defined as a day on which a person reduced his normal activities for the entire day because of illness or injury. Bed days, school-loss days, and work-loss days are included in the total number of restricted-activity days. Demographic characteristics used to describe the persons with disability days are age, sex, place of residence, geographic region, family income, usual activity, and color. Previous reports of data from the Health Interview Survey on disability days are published for July 1961-June 1962, July 1963-June 1964, and July 1965-June 1966 (vital and Health Statistics, SerieslO, Numbers 4,24, and 47).