EPIDEMIOLOGICAL BULLETIN by xumiaomaio

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									Canad. Med. Ass. J.                                                                                   PUBLIC HEALTH        889
Oct. 16, 1965, vol. 93




                                         EPIDEMIOLOGICAL BULLETIN
  DIPHTHERIA                                                     ing at the mouth. When the man struck it, the dog backed
  Saskatchewan                                                   off and then bit him again. A Labrador man who observed
                                                                 this incident suggested that this was not normal behaviour
  On June 3 and 5, two girls, aged 3 and 4 years, were           for an Indian dog.
admitted with suspected diphtheria to the Regina General            The dog was destroyed and the head sent by the U.S.
Hospital Infectious Disease Ward by their family physician.      Air Force hospital authorities at Goose Bay to the New
Following confirmation of the diagnosis by the isolation of      Jersey State Laboratories at Trenton for laboratory diag-
C. diphtheriae, the immediate family was placed in quaran-       nosis. Mouse inoculation tests confirmed the presence of
tine; neither the mother or the remaining nine children had      rabies virus. A course of anti-rabies vaccine was given to
any clinical symptoms at the time. On June 12, the eldest        the serviceman. All stray dogs in the area are being rounded
son, aged 20, developed a fever and sore throat and was          up and destroyed.
hospitalized that day. The same evening, the two girls              The Canadian Department of Agriculture, Health of
admitted the week previously died from complicating              Animals Division, has on record only one isolation of rabies
myocarditis; neither had received any diphtheria immuni-         for the Province of Newfoundland (Lewisporte, 1955, dog).
zation.                                                          The Island of Newfoundland is generally regarded as a
   During the quarantine period, the affected family dis-        rabies-free area.
obeyed the quarantine order, and as a result the entire
family was hospitalized. Despite a lack of clinical symp-          TICK PARALYSIS
toms, throat cultures were all positive except for that of
the mother. After the family had been treated in the hos-          British Columbia
pital for one week, the throat cultures became negative; the       A case of tick paralysis occurred in a 4-year-old girl from
home was disinfected and the family was discharged on            Montrose on June 25. Although she had been perfectly well
June 22.                                                         the night before, she woke up in the morning with

    TABLE I-PARALYTIC PoLIoMYRLITIs BY AGE GROUP AND INACTIVATED VACCINATION HISTORY, UNITED STATES, 1964
                                                  Doses of inactivated vaccine
                                                                                              Total
Age group                                0       lv      2V        3V       4+V      Unk.     cases      Per cent   Deaths
 0- 4.                                  28        1        3        4         1       1         38        41.8         3
 5- 9.                                   7        1        1        1         5       1         16         17.6        1
10 - 14.                                 2        0        0        2         3       0          7         7.7         1
15 - 19.                                 6        0        0        1         1       0          8         8.8         0
20 - 29.                                 2        1        1        0         0       0          4         4.4         0
30 - 39.                                 5        0        2        0         0       0          7         7.7         0
40+.                                     8        0        0        1         1       1         11        12.1         2
       Total.                           58        3        7        9        11       3         91       100.0         7
Per cent doses.                         65.9      3.4      8.0     10.2      12.5              100.0
                                                                                                                                                    Canad. Med. Ass. J.
890    PUBLIC HEALTH                                                                                                                                Oct. 16, 1965, vol. 93


      TABLE 11.-PARALYTIC POLIOMYELI'FIS BY AGE GROUP AND ORAL VACCINATION STATUS, UNITED STATES, 1964*
                                                                                      Doses of oral vaccine
                                                                                       Monovalent                                   Trivalent
                                                                                                                                                                     Total
Age group                                    Unvaccinated         1 type only            2 types       3 types                   1 dose            2 doses           cases
 0- 4.29                                                                  4(1)              1(1)            2                      2(1)                 0            38(3)
 5-9.9                                                                    1                 2(1)            2                      2                    0            16(1)
10-14.3                                                                   0                 0               4                      0                    0             7(0)
15-19.4                                                                   3(3)              0               1(1)                   0                    0             8(4)
20-29.3                                                                   1(1)              0               0                      0                    0             4(1)
30-39.4                                                                   0                 2(2)            0                      1(1)                 0             7(3)
40+.4                                                                     1(1)              1(1)            2 (2)                  3 (3)                0            11 ( 7)
      Total.56 (0)                                                       10 (6)             6 (5)          11(3)                  8 (5)                 0            91 (19)
       * <30 day cases are shown in parenthesis.

doses of trivalent vaccine. Of the eight cases, six had re-                       received three or more doses of oral vaccine and 59%
ceived three or more doses of inactivated vaccine in ad-                          had received three or more doses of inactivated vaccine
dition to the oral vaccine. From the six cases in which                           (Table IV). During the past three years, the proportion
virus isolation was attempted, two poliovirus isolates, both                      vaccinated with the oral vaccine has risen sharply. During
type I, were recovered.                                                           the same period of time the proportion of persons who
   Of the 91 paralytic cases, 19 occurred within 30 days of                       reported having received three or more doses of inactivated
the administration of oral poliomyelitis vaccine. Fifteen of                      poliomyelitis vaccine has remained essentially stable, al-
these 19 cases were in the 15-year and older age groups                           though with some decrease in the youngest age groups.
and constitute half of the total of 30 cases which had been                         With two immunizing agents available, an estimate of
reported in individuals of 15 years or older. These vaccine-                      the population presumably protected against poliomyelitis
associated cases were the subject of an inquiry in July                           would include both those who had received four or more
1964 by a special committee on oral poliomyelitis vaccine.                        doses of inactivated vaccine and those who received a

       TABLE 111.-FREQUENCY OF PoLIovIRus ISOLATES RECOVERED FROM PARALYTIC CASES, UNITED STATES, 1958-64
                                  Numbers of cases                                         Viruses identified                                         Per cent of
                                                      Per cent                                                                                      total specified
                                 Residual Specimens of cases                                        Type
Year                             paralysis submitted* studied                     I           II           III        Unk.   III               I            II
1958.3301                                   1479      44.8         898      29      194       10         80.1       2.6      17.3
1959.5472                                   2775      50.7        1881      10     228       23          88.8       0.5     10.8
1960.2218                                   1072      48.3         603       1     219         2         73.3 * 0.1         26.6
1961.829                                     481      58.0         231       6     145         0         60.5       1.6     37.9
1962.691                                     472      68.3         300       8     100         0         73.7       2.0     24.4
1963.336                                     242      72.0         160       6       31        0         81.2       3.0     15.7
1964.91                                       77      84.6          21       6       24        0         41.2      11.8     47.0
       *Includes all paralytic cases on which one or more fecal specimens were examined for virus isolation. State and local health
department laboratories and laboratories in academic centres reported these results through State epidemiologists to the Polio-
myelitis Surveillance Unit.

   Because of the small number of paralytic cases, special                        primary oral vaccine series. Although a primary oral vac-
efforts were made to obtain specimens for virus isolation                         cine series normally consists of three doses of monovalent
and serologic study from all cases. Isolates were obtained                        vaccine or two of the trivalent vaccine, it was possible
from 51 of 77 fecal specimens examined for virus. Of these,                       durin.g the survey to ascertain the numbers of doses but
24 (47.0%) were type III, 21 (41.2%) type I, and 6                                not the specific type of oral vaccine administered. A more
(11.9%) type II (see Table III). This contrasts with the                          detailed cross-classification for those 1-4 and 5-9 years of
distribution of isolates obtained during the period from                          age is presented in Table V. Based on the definitions above,
1958 to 1963, when type I isolates accounted for between                          63% of children 1-4 years of age and 81% of children
60 and 89% of the total each year and type III varied                             5-9 years of age have been "adequately immunized". Nine
from 10 to 38%. The proportional increase in type III
isolates reflects, in part, the lack of a major type I urban
epidemic.                                                                         TABLE V.-NUMBER (IN 000's) OF CHILDREN AGE 14 AND 5-9 RECEIVING
                                                                                  INACTIVATED AND OasL POLIOVAcCINE. NATIONAL IMMUNIZATION SURVEY-
   A survey of the poliomyelitis vaccination status of the                                                                      1964
U.S .popula.on, conducted by the Bureau of the Census                                                                           Number of OPV doses
in September 1964, reveals that 46% of the population had                              Number of IPV Total
                                                                                        inoculatton8 chiLdren          3               2            1          0    Unknown
TABLE IV.-NATIONAL IMMUNIZATION SURVEY FINDINGS, SEPTEMBER
                                                                                                                                                            Age 1-4
    1962. 1963, AND 1964: PoLIoMYELITIs VACCINATION STATUS
                                                                                      4 or more.         5342        2633              672         332       1694       ii
                                                                                                       3.4759        2175              646         332       1604        2
                                                                                                       2.1196         414              223         133        422        4
                    Oral poliovaccine          Inactivated poliovaccine                                   1.732       245              121          78        281        7
                                                                                                0.4450               2264           562             213      1411        0
                Per cent reporting 3 doses   Per cent reporting 3 or more             Uknown.       111                28             3               0        11       69
                                                         doses                           Total.  16.590              7759          2227            1088      5423       93
Age group        196S     1963      1964       1962      1968      1964               4or more.. 11,638              6692          1650             582      2699       15
 1- 4.           5.7      28.7      46.8       72.6     67.7      60.9                3.4632                         2643              774         232        965        18
 5- 9.           5.7      33.6      56.4       85.8     84.3      80.9                2.844                           396              181           87       177        3
10-14.           5.2      34.0      57.7       86.2     85.2      82.6                1.403                           146               81           55       115        6
15- 19.          4.1      28.2      49.8       79.2     78.8      77 7                0.2355                         1435              276          115       525        4
20 - 29.         3.7      21.4      38.4       55.0     55.4      54.9                Unknown.228                          18              8            5        6      191
30 -39.          4.3      23.1      41.9       44.7     43 8      43.5                   Total. 20.100              11.330         2970            1076      4487      237
40 - 49.         3.8      19.8      37.4       23.9     26.3      28.0
 1 -49.          4.6      26.4      46.2       81.3     00.7      59.8                   Source: U.S. Weekly Morbidity and Mortality Report, July 10, 1905.
Canad. Med. Ass. .*                                                                                   PUBLIC HEALTH           891
Oct. 16, 1965, vol. 93

per cent of the younger group and 3% of the older are               hours each, was given to the employees engaged in food
recorded as never having received poliomyelitis vaccine of          handling. When the premises were reopened, continuing
any type.                                                           checks brought to light the fact that 11 out of 63 food
                                                                    handlers, returning to work after two successive negative
  SALMONELLA GASTROENTERITI5-U.S.A.                                 rectal swabs, were again excreting Salmonella. The premi-
                                                                    ses were voluntarily closed for a second time and reopened
   A large outbreak of gastroenteritis due to Salmonelki            only after extensive further checks were negative and all
meleagridie is under investigation in the Metropolitan Area         food handlers had had an additional three successive
of Washington, D.C. Over 350 cases have been reported               negative rectal swabs. The primary source of contamination
with onsets of illness between May 11 and June 8. Cases             responsible for the outbreak remains unknown.
are known to have occurred in the District of Columbia,                Among the employees, only four out of a total of 115
Maryland, New Jersey, and Virginia. A total of 198 people           examined yielded serotypes other than S. meleagridis. Two
out of 580, who attended a series of catered parties during         had a dual infection with S. meleagridis and S. typhi-
a two-day period, are reported to have developed gastro-            murium; one had S. typhimurium only, and the fourth had
enteritis. The illnesses have been mild, only three persons         a dual infection of S. meleagridis and S. tennessee.
requiring hospitalization; there have been no deaths.
   Among ill persons, S. meleagridis has been recovered
from the stool cultures in over 80 instances. Investigation           ANNOTATIONS
indicated that a common source in this outbreak was a                 PROCEEDINGS OF THE NATIONAL CONFERENCE
large restaurant-delicatessen in Washington, D.C., emplo -            ON SALMONELLOSIS
ing 116 persons and offering restaurant facilities on tKe
premises, retail sale of food and home catering services.            WASHINGTON, D.C., MARCH 1964
   Salmonella meleagridis has been recovered from 17 out             In March 1964, a symposium on the problem of salmonel-
of 29 items of a variety of prepared foodstuffs. Of the 115       losis was held in Washington, attended by representatives
food handlers from whom specimens were taken. 64 were             of government and industry, to discuss aspects of epi-
excreting Salmonella; extensive environmental cultures have       demiology and control. The proceedings of this conference
been obtained within the establishment and S. meleagridis         have now been published and can be purchased from the
has been isolated from swabs of meat slicers and from a           Superintendent of Documents, Washington, D.C., for $1.50
food grinder.                                                     (U.S. funds).
   During a two-week voluntary closing of the premises, the                          Epidemiology Division, Department of
physical plant was extensively rechecked and a course of                                      National Health and Welfare
six lectures on sanitation and food hygiene, lasting two            Ottawa, July 1965




                            SUMMARY OF REPORTED CASES OF NOTIFIABLE DISEASES IN CANADA*
                         ISSUED BY THE PUBLIC HEALTH SECTION, DOMINION BUREAU OF STATISTICS
                                                                                                            Cumulative total
                                                                       Week ended (1965):                since beginning of year
Disease                                                   June 36      July 3     July 10   July 17         1965       1964
Brucellosis (Undulant fever).(044)                            1            1          1        -              17         32
Diarrhea of the newborn, epidemic.(764)                      -           -           5          2            63          48
Diphtheria..(055) -                                                      -          -          -              15         14
Dysentery..(045, 046, 048)                                   87          44         55         75          1686        1939
   (a) Amebic.(046) -                                                      7         5          2            39           4
   (b) Bacillary.(045) 21                                                 15        14         16           501         700
   (c) Other and unspeCified.(048)                           66          22         36         57          1146        1235
Encephalitis, infectious..(082.0)                            -             1        -          -               4          3
Food poisoning:.(049.0, 042.1, 049.2)                        23          33         20         38           712         824
   (a) Staphylococcus intoxication.(049.0)                   -           16         -          18            39           2
   (b) Salmonella with food as vehicle of infection. (042.1) 23           17        20         20           584         690
   (c) Unspecified.(049.2) -                                             -          -          -              89        132
Hepatitis, infectious
   (including serum hepatitis).(092, N998.5)                 78          78         59         96          3701        4883
Meningitis, viral or aseptic..(080.2, 082.1)                  5            1          1         4             85         79
   (a) Due to poliovirus..-                                              -          -          -              -           4
   (b) Due to Coxsackie virus.-                                          -          -          -               1         10
   (c) DuetoEcHovirus..-                                                 -          -          -               1          5
   (d) Other and unspecified.5                                             1          1         4             83         60
Meningococcal infections..(057)                               2            2         3          1             53         70
Pemphigus neonatorum (Impetigo of the newborn).. (766)       -           -          -           1              8          4
Pertussis (Whooping cough).(056)                             25           15        36         39          1313        2862
Poliomyelitis, paralytic.         .           (080.0, 080.1) -           -          -          -               1          7
Scarlet fever and Streptococcal sore throat.... (050, 051) 152          173        157        116          7632        5998
New active cases of tuberculosis for February.-                          -          -          -            281         257
                                       March.-                           -          -          -            307         348
Typhoid and Paratyphoid fever.(040, 041)                      6            1          1          1            74         87
Venereal diseases....341                                                404        397        405        12,019      12,091
   (a) Gonorrhea.(030-034)                          284                 355        365        361        10,637      10,480
   (b) Syphili.(020-021.3, 023, 024, 026-029)                57          49         32         44          1381        1611
   (c) Othert.(036-038)                                      -           -          -          -               1         -
        *Figures for the Yukon are received four-weekly and are, therefore, shown in the cumulative totals only.
        tIncludin. chaneroid, granuloma inguinale and lymphogranulom. venereum,

								
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