A multiple sclerosis cluster associated with a small, north-central Illinois community.

The authors investigated a reported incidence cluster of multiple sclerosis (MS) cases in a small, north-central Illinois community to determine validity and statistical significance. DePue, Illinois--a small, north-central Illinois community--has previously been the site of significant environmental heavy-metal exposure from a zinc smelter. Significant contamination of soil and water with zinc and other metals has been documented in this community during the time period of interest. In the mid-1990s, several cases of MS were reported to the Illinois Department of Public Health within the geographic limits of this community. Available medical records from purported MS cases reported to the Illinois Department of Public Health were reviewed, and living individuals were seen and examined. Statistical analyses were conducted with clinically definite MS cases; onset dates were determined by first symptom, and expected incidence rates were determined from published epidemiologic studies. Nine new cases of clinically definite MS occurred among residents of DePue, Illinois, during the period between 1971 and 1990. Seven of the 8 living subjects included in the final analyses were examined by one author (RS). The computed incidence rate deriving from these cases within DePue Township, Illinois, represented a statistically significant excess of new MS cases over expected. During the period from 1971 through 1990, a significant excess of MS cases occurred within the population of DePue, Illinois. Significant exposure of this population to mitogenic trace metals, including zinc, was also documented during this time period.     

Decreasing prevalence of Q fever in Illinois.

There were 858 (37.7 percent) Q fever-infected dairy herds among the 2,277 tested in Illinois in 1963. The percentage decreased to 19.2 percent (380 of 1,975) in 1967. Reaction rates (complement-fixation test titer of 1:8 or greater) in serum samples from veterinarians decreased from 13.3 percent in 1956 to 3.9 percent in 1964 and from 3.6 percent in 1966 to 0 percent in 1968, 1970, 1972. There were 14 (2.7 percent) reactive serum samples among 526 abattoir workers tested in 1966; reaction rates were higher among workers having contact with swine (8.2 percent) than among workers having contact with cattle (1.8 percent). Two (0.1 percent) of 1,432 serum samples collected from 1967 to 1971 during preemployment examinations at another abattoir were reactive. Only two clinical cases of Q fever were reported to the Illinois Department of Public Health in the period 1963-80. All evidence evidence points to a decreasing prevalence of Q fever in Illinois.     

Lyme disease incidence in Wisconsin: a comparison of state-reported rates and rates from a population-based cohort

Few studies have assessed the accuracy and completeness of Lyme disease surveillance systems. Lyme disease cases were identified through review of medical records for residents of the Marshfield Epidemiologic Study Area (MESA), a population-based cohort of nearly 80,000 in north-central Wisconsin for which comprehensive medical care data are available through the Marshfield Clinic. These cases were compared with cases reported to the Wisconsin Division of Public Health to estimate the completeness of reporting. Annual incidence rates were calculated for MESA using the cases identified from chart review. Division of Public Health data were used to calculate statewide reported incidence rates, as well as rates for an eight-county region that surrounds and includes the MESA region. Of Lyme disease cases meeting the national case definition identified in MESA, 34% were reported to the state. The average incidence of Lyme disease (1992-1998) was 19.1 per 100,000 per year in MESA, 17.0 in the surrounding eight-county region, and 9.0 statewide. Trends in reported incidence across time, gender, and age in the surrounding eight-county region were generally comparable with those observed in MESA. These findings suggest that the passive surveillance system monitored trends in Lyme disease incidence reasonably well despite underreporting of cases.     

Children in Illinois with elevated blood lead levels, 1993-1998, and lead-related pediatric hospital admissions in Illinois, 1993-1997

OBJECTIVE: This study uses screening and hospitalization data to describe the prevalence of childhood lead poisoning in Chicago and the rest of the state of Illinois. METHODS: The authors used aggregate data published by the Illinois Department of Public Health on blood lead testing of children ages 0-6 years and data on lead-related hospital admissions of children ages 0-6 years, drawn from an administrative dataset compiled as part of a state initiative. RESULTS: No clear time trends in the percentage of children with elevated blood lead levels (defined as >15 micrograms per deciliter [microg/dL] or >45 microg/dL) were evident in either Chicago or the rest of Illinois. The proportions of children with elevated blood lead levels in Chicago and in the rest of Illinois did not decline at the dramatic rate seen in the US as a whole during the 1990s. Over a five-year period, in-hospital charges of $7.7 million were generated for the care of lead-poisoned children ages 6-16 in Chicago alone. CONCLUSION: Surveillance data, analyzed at the appropriate geographic level, can be used to focus resources on high-risk areas and to evaluate prevention efforts.     

Notes from the field: outbreaks of rotavirus gastroenteritis among elderly adults in two retirement communities--Illinois, 2011

In February 2011, three residents of a retirement community in Illinois were hospitalized for acute gastroenteritis. The admitting physicians ordered testing of stool specimens for several pathogens, including rotavirus. The hospital laboratory detected rotavirus antigen in specimens from each patient, and the hospital infection control practitioner reported that information to the Cook County Department of Public Health. Two additional residents were hospitalized for rotavirus gastroenteritis shortly thereafter. The health department sent stool specimens from the five patients to CDC for testing for rotavirus and norovirus. Rotavirus was detected in each specimen; norovirus was not detected. During a subsequent investigation, all available residents were queried regarding recent diarrheal symptoms. Preliminary data indicated that 22% of residents had confirmed or probable rotavirus disease and 10 residents were hospitalized. In May 2011, another outbreak of rotavirus gastroenteritis was detected at a second retirement community in the county. On preliminary analysis, the overall attack rate in the second retirement community was 11%, and 20 residents were hospitalized. No deaths were identified in either outbreak. Based on preliminary results of the investigations and general knowledge of rotavirus transmission, within each community, rotavirus likely was transmitted from person to person via contaminated hands or fomites (e.g., environmental surfaces). The outbreaks lasted ≥4 weeks.     

Mumps in the region of Rijeka

Compulsory vaccination against mumps at 15 months of age in the region of Rijeka, Croatia (340,467 inhabitants in 1990) started in 1976. The incidence and distribution of reported mumps cases during the period from 1976 to 1990 are presented. Two epidemics were reported during this period. The first was in 1977 with an incidence of 434.7 per 100,000 inhabitants. The second lasted throughout 1981 (incidence 432.5) and 1982 (incidence 552.1). An eight-year period, 1983--1990, followed with a low reported incidence. The highest incidence was among the 5 to 9-year old during the first post-vaccination period (1976--1982), while it shifted to the 15 to 19-year old during the second post-vaccination period (1983--1990). Mumps remains a spring-time disease with highest incidence in April. Registered cases were more frequent in males (55%) than in females (45%).     

Fear of bioterrorism and implications for public health preparedness

After the human anthrax cases and exposures in 2001, the Illinois Department of Public Health received an increasing number of environmental and human samples (1,496 environmental submissions, all negative for Bacillus anthracis). These data demonstrate increased volume of submissions to a public health laboratory resulting from fear of bioterrorism.     

Pertussis outbreak among adults at an oil refinery--Illinois,August-October 2002

On September 16, 2002, the Crawford County Health Department (CCHD) reported to the Illinois Department of Public Health (IDPH) four cases of cough illness among workers at an oil refinery (total worker population: 750) in Crawford County, Illinois. On August 14, a worker aged 39 years reported to the plant's health unit with a cough lasting 14 days. On the same day, the worker's supervisor aged 50 years visited the health unit for a paroxysmal cough of 3 days' duration and an incident of cough syncope. Both patients were referred to private health-care providers; blood samples from both patients had serologic test results suggestive of recent Bondetella pertusis infection, and CCHD was contacted. On September 18, IDPH and CCHD initiated active surveillance and case investigations. This report summarizes the results of that investigation, which found that during August 1-October 9, pertussis was diagnosed in 15 (10%) of 150 oil refinery workers from two separate operations (n=95) and maintenance (n=55) complexes, who were linked by contact with the ill supervisor. Through enhanced case finding, 24 cases of pertussis, 21 (88%) of which occurred in adults aged > or = 20 years, were identified in this outbreak, underscoring the need to recognize this highly infectious disease in adults and to improve national diagnostic and preventive strategies.     

Meningococcal disease in Louisiana 1978–1985

Data were analyzed from 729 meningococcal cases reported to the Epidemiology Section, Office of Preventive and Public Health Services, Louisiana Department of Health and Human Resources from 1978 through 1985. A total of 122 deaths (16.8%) occurred from these cases, with the highest case fatality rate (23.7%) noted in 1981. The eight-year average incidence rate per 100,000 population was 2.1. For individual years, the incidence rate was highest (3.6) in 1978 and lowest (0.8) in 1985. Although incidence rates per 100,000 population were greater for males during all years except 1978 and 1985 and greater for nonwhites in 1978, 1980, 1981, 1983 and 1984, the eight-year average incidence rates by sex and race were almost the same. Incidence rates were found to be highest in the less than one, and one to four-year age groups. For all eight years, over half of the cases were in the four years and under age group; the same was true for deaths, except in 1982 (46.7%). February was found to be the month with the highest frequency of reported case onset and death. The mean difference between date of disease onset and death for all fatal cases was 2.716 days (S.D.=6.48). Ten of the 64 Louisiana parishes reported no meningococcal disease cases from 1978–1985. There were 25 parishes with an eight-year average incidence rate of greater than 2.1. The overall incidence rates in Louisiana were greater than rates in the United States for the time periods reviewed.John B. Vaughn, D.V.M., M.P.H. Chairman and Professor, Department of Applied Health Sciences, Tulane University School of Public Health and Tropical Medicine, Theresa J. Forti, B.S.N., M.S. Hyg., Dr. P.H. Associate Professor, Department of Applied Health Sciences, Tulane University School of Public Health and Tropical Medicine. James E. Banta, M.D., M.P.H. Dean and Professor Tulane University School of Public Health and Tropical Medicine, Louise McFarland, M.P.H., Dr. P.H. is Chief, Epidemiology Section State of Louisiana Department of Health and Human Resources, and Karen Y. Kelso, C.R.N., B.S. is Nurse Epidemiologist State of Louisiana Department of health and Human Resources.The authors extend thanks to Mrs. Audrey P. Collins, Biostatistician, Louisiana Department of Health and Human Resources, and Barbara H. Denton, Demographer, Louisiana Tech University for their assistance in providing population data. Gratitude is also expressed to Dr. Charles T. Caraway for help with review of data.     

The presentation and incidence of paratrachoma in adults.

Thirteen definite and 3 probable cases of chlamydial eye infection were diagnosed in young adults attending the Bristol Eye Hospital between June 1978 and May 1980, and incidence of about 1 case per 44000 per year in the 15 to 44-year-old community served by this hospital, and 1 per 100000 in the total population of this community. These patients presented with a sub-acute follicular conjunctivitis or kerato-conjunctivitis, which had usually been present for several weeks and had often failed to respond to topical chloramphenicol treatment before presentation. Sera obtained from 14 patients, all had chlamydial antibody titres of 64 or more. Over the same period of time, an estimated 2500 patients per year from the same community attended the Venereology Department at the Bristol Royal Infirmary with genital chlamydial infections. These figures suggest that chlamydial infection of the eye complicates no more than 1 in 300 chlamydial infections of the genital tract in adults.     

Taxi Drivers: A Target Population for the Prevention of Transmissible Disease?

We set out to assess the feasibility and uptake of an on-site influenza vaccination campaign targeting taxi drivers in airport taxicab lots in Chicago, Illinois. Influenza vaccine was provided by the Chicago Department of Public Health as this event aligned with ongoing efforts to provide influenza vaccinations throughout the city. Clinicians and clinic support staff were volunteers recruited from the University of Chicago Medicine and incorporated nursing staff, physicians, physician residents, and administrative support. Together, this allowed for a cost-effective approach to provide free influenza vaccines to the primarily uninsured taxi driver population. During these events, 545 taxi drivers received influenza vaccine in 2012 while 354 drivers were immunized in 2013. Nearly all drivers reported uninsured or under-insured status. The ability to use volunteers and healthcare organization’s desires to meet the needs of the community, in collaboration with often under-staffed but highly dedicated local health departments have the potential to offer valuable public health services to underserved members of the community. Educational initiatives targeting vaccine hesitancy and misinformation may be necessary to improve immunization coverage among this population.     

Childhood leukemia in the vicinity of the Geesthacht nuclear establishments near Hamburg, Germany

BACKGROUND: During 1990-1991 a childhood leukemia cluster was observed in the sparsely populated region surrounding two nuclear establishments southeast of Hamburg, Germany. Since then, several new cases have been reported. Recently a possible accidental release of radionuclides in 1986 was hypothesized. OBJECTIVE: The objective of this study was to analyze the childhood leukemia incidence in this area since 1990. METHODS: All incident cases (< 15 years of age) were ascertained during 1990-2005 within a 5-km radius of the Krümmel nuclear power plant. We derived standardized incidence ratios (SIRs) using county and national leukemia incidence rates as referents. We stratified analyses by calendar period and attained age, and by subdividing the study region into areas north versus south of the Elbe river. RESULTS: Fourteen cases were ascertained in the study area, whereas 4.0 were expected based on national referent rates [1990-2005: SIR = 3.5; 95% confidence interval (CI), 1.9-5.9]. The excess was not confined to the early 1990s; for the more recent time period 1999-2005, the SIR is still elevated (SIR = 2.7; 95% CI, 0.9-6.2). SIRs of greatest magnitude were observed for children 0-4 years of age (SIR = 4.9; 95% CI, 2.4-9.0) and for residents south of the Elbe (SIR = 7.5; 95% CI, 2.8-16.4). CONCLUSIONS: The incidence in this region is significantly higher than the childhood leukemia incidence for Germany as a whole. To date, no unique hazards have been identified in this population. The fact that the elevated rates have persisted in this community for > 15 years warrants further investigation.     

Trichinosis surveillance, United States, 1987-1990.

Since the Public Health Service began recording statistics on trichinosis in 1947, the number of cases reported by state health departments each year has declined. In the late 1940s, health departments reported an average of 400 cases and 10-15 deaths each year; from 1982 through 1986, the number declined to an average of 57 cases per year and a total of three deaths for the period. From 1987 through 1990, 206 cases of trichinosis from 22 states, including 14 multiple-case outbreaks, were reported to CDC. In 1990, two large outbreaks associated with commercial pork accounted for 106 cases. In the 192 instances in which a suspect food item was identified, pork was implicated in 144 (75%) cases, walrus meat in 34 (18%), and bear meat in 14 (7%). Sausage, the most frequently implicated pork product, was associated with 128 of the 139 cases for which a form of ingested pork was specified. Before 1990, the proportion of cases of trichinosis attributable to consumption of commercial pork had declined steadily. This decline was probably due to a combination of factors, including laws prohibiting the feeding of garbage to hogs, the increased use of home freezers, and the practice of thoroughly cooking pork. Although the incidence of trichinosis has decreased substantially since national reporting was initiated in 1947, a dramatic increase in 1990, resulting from two large outbreaks, emphasizes the need for further education and control measures.     

Pertussis surveillance--United States, 1989-1991.

The licensure of whole-cell pertussis vaccine combined with diphtheria and tetanus toxoids as DTP in the 1940s--and its widespread use in infants and children--led to a dramatic decline in the incidence of reported pertussis. In the prevaccine era, the average annual incidence and mortality for reported pertussis were 150 cases and six deaths per 100,000 population, respectively. From 1989 to 1991, pertussis cases were reported by state and local health departments to CDC through two distinct national surveillance systems: the National Notifiable Diseases Surveillance System (NNDSS) and the Supplementary Pertussis Surveillance System (SPSS). During the period 1989-1991, 11,446 pertussis cases were reported to the NNDSS (4,157 in 1989; 4,570 in 1990; and 2,719 in 1991), for an unadjusted annual incidence of 1.7, 1.8, and 1.1 cases per 100,000 population in 1989, 1990, and 1991, respectively. For the period 1989-1991, case reports were received through the SPSS on 9,480 (83%) of the 11,446 patients reported to the NNDSS. Age-specific incidence and hospitalization rates were highest among children < 1 year of age and declined with increasing age. Long-term trends suggest an increase in the reported incidence of pertussis in the United States since 1976. The peak in reported pertussis cases in 1990 represents the highest annual incidence of pertussis since 1970. However, the incidence of pertussis declined 41% from 1990 through 1991. Whether the long-term increase in reported pertussis is a true increase in incidence is unclear; the observed increase may be a function of improved surveillance.(ABSTRACT TRUNCATED AT 250 WORDS)     

Capacity-building influences on Illinois local health departments.

Illinois local health departments (LHDs) were surveyed in 1992 and again in 1994 in order to assess changes in, influences on, and results of practice performance during this two-year period. Illinois LHDs serving both small and large populations were found to have greatly increased the extent to which they carry out practice measures related to public health's core functions. The Assessment Protocol for Excellence in Public Health (APEXPH) and its Illinois adaptation were cited as the most positive influences on practice performance. LHDs viewed the most significant consequences of participation in needs assessment and planning processes as increased understanding of internal strengths and weaknesses and of community health problems. These findings and implications suggest that significant improvements in LHD practice performance can result from widespread implementation of APEXPH and its derivatives.     

Investigation of a cluster of multiple sclerosis in two elementary school cohorts

The authors investigated a cluster of multiple sclerosis (MS) among people who had attended two elementary schools in El Paso, Texas, from 1948 through 1970. The community was concerned about the possibility of childhood exposure to heavy metals from a large nearby smelter because historical environmental and biological sampling data demonstrated the potential for study cohort members to have been exposed to heavy metals during their pre-adolescent years. One cohort had no reported cases of MS. In the second cohort, 22 members self-reported a diagnosis of MS, and 16 of these cases were confirmed as MS by an independent board-certified neurologist. The crude MS prevalence estimate was 411 per 100,000 (95 percent confidence interval [CI] = 197-603), Prevalence estimates from four different populations were used for calculation of standardized morbidity ratios (SMRs). At the extremes, the study cohort represents a deficit of cases (SMR= 0.9; 95 percent CI = 0.51-1.44) or a four-fold excess (SMR = 4.0; 95 percent Cl = 2.29-6.5).     

Illinois health officials move to mandate HIV reporting by name

The Illinois Department of Public Health plans to ask health care providers to report the names of people who test positive for HIV to the State. The new rules, scheduled to be published on February 27, extend name-based surveillance to HIV cases as well as AIDS cases. The AIDS Foundation of Chicago advocates the use of unique identifiers based on the unpublished University of California at San Francisco study that found that the fear of name disclosure had diminished. However, another study conducted in 1996 in California found 86 percent of those questioned would not seek HIV testing if their names were reported. The public health director believes the time has come to treat HIV like other sexually transmitted diseases and use proven public health solutions for preventing the spread of the virus.     

Electronic Public Health Registry of Extensively Drug-Resistant Organisms,Illinois, USA

In response to clusters of carbapenem-resistant Enterobacteriaceae (CRE) in Illinois, USA, the Illinois Department of Public Health and the Centers for Disease Control and Prevention Chicago Prevention Epicenter launched a statewide Web-based registry designed for bidirectional data exchange among health care facilities. CRE occurrences are entered and searchable in the system, enabling interfacility communication of patient information. For rapid notification of facilities, admission feeds are automated. During the first 12 months of implementation (November 1, 2013–October 31, 2014), 1,557 CRE reports (≈4.3/day) were submitted from 115 acute care hospitals, 5 long-term acute care hospitals, 46 long-term care facilities, and 7 reference laboratories. Guided by a state and local public health task force of infection prevention specialists and microbiologists and a nonprofit informatics entity, Illinois Department of Public Health deployed a statewide registry of extensively drug-resistant organisms. The legal, technical, and collaborative underpinnings of the system enable rapid incorporation of other emerging organisms.     

A population-based evaluation of the impact of interventions for improving care to cancer patients in the home setting.

A federally-funded demonstration project was conducted by the Illinois Cancer Council and the Illinois Department of Public Health to determine if the introduction of modest changes in the home health system would effect certain cancer patient patterns of care and outcomes. Certified home health agencies in two health planning regions of Illinois were randomized into one of three study groups, two of which received an intervention (oncology nurse specialist with continuing education on cancer, or continuing education on cancer alone), and the third was an "observation only" group. The pre/post differences of a number of evaluation parameters were investigated. Overall, the group which received the services of the oncology nurse specialist and continuing education on cancer demonstrated the largest percentage increase in cancer patient referrals to home care, and experienced a significant decrease in cancer patient mortality. No significant difference among cancer patients in the three study groups was noted for hospitalization rate or incidence of physiologic complications while on agency caseload.     

Surveillance of diarrhoeal diseases in Thailand

To provide information for prevention and control activities at national and local levels, Thailand's Ministry of Public health has monitored trends for diarrheal diseases since 1970. Data for the 1978-83 period obtained from the national epidemiological surveillance system are reported. The data were collected largely through a passive surveillance network in each province of Thailand. After preliminary analysis and tabulation at the local level, data were sent to the Ministry of Public Health for further analysis. Details on each case of diarrheal disease included the age, sex, place of residence, date of onset, and place of treatment. 5 categories of diarrheal diseases were distinguished: cholera, enteric fever, food poisoning, dysentery, and acute diarrhea. The causative agents of diarrheal diseases generally were isolated and identified in provincial hospital laboratories or at a government regional laboratory. During the 1978-83 period, 1,979,118 cases of diarrheal diseases were reported to the Thai Ministry of Public Health through the national surveillance system. The annual number of cases increased from 175,411 in 1978 to 537,972 in 1983, and this is reflected in an increase in the annual incidence from approximately 400/100,000 population in 1978 to over 1000/100,000 population in 1983. The average annual incidence of diarrheal diseases reported over this period was 694/100,000 or approximately 330,000 cases per annum. The number of cases of all categories of diarrheal disease increased, except cholera, which fluctuated from year to year. Acute diarrhea exhibited the highest average annual incidence (537/100,000), followed by that of dysentery (85), food poisoning (43), and enteric fever (25). Cholera had the lowest incidence (4/100,000). Over the 6-year study period, the majority of cases reported were acute diarrhea (77.4%), followed by dysentery (12.2%), food poisoning (6.3%), and enteric fever (3.5%). Cholera accounted for 0.6% of cases. A total of 3300 deaths from diarrheal diseases were reported over the study period. Deaths in each disease category, except cholera, decreased, and the annual number of deaths declined from 911 in 1978 to 370 in 1983. Acute diarrhea was the most common category leading to death. For acute diarrhea, the highest age-specific mortality rate was among children aged 0-4 years. Age-specific mortality rates for the remaining disease categories were much lower. The highest mean incidence rate for reported cases of acute diarrhea occurred in the central region of Thailand (608/100,000).