A communitywide outbreak of hepatitis A occurred in Portland, OR, from 1983 through 1986. At the peak of the outbreak, the age- and sex-specific annual incidence rate approached 400 cases per 100,000 population among men ages 25 to 34, the highest risk group. The community incidence rate was nearly 10 times the relevant national incidence rate. A review of the records concerning cases of hepatitis A reported in the last 6 months of 1985 revealed that about half the number of young adults whose cases were investigated during that time reported a history of intravenous (IV) drug use--a proportion about 50 times greater than expected among persons in that age range. A simultaneous epidemic of overdose deaths from heroin and a concomitant increase in hepatitis B incidence rates led to the suspicion that this was a drug-abuse-associated epidemic of hepatitis among new IV drug users. Control of this outbreak was difficult because the population most at risk was distrustful of public health officials. Increased surveillance in food service establishments and schools might have prevented outbreaks from a common source in the general population; however, an increase of sporadic cases in the nondrug-using population clearly occurred.

Adolescent↗

PubMedDate not supplied

A preliminary comparison between local public health units in the Canadian Province of Ontario and in the United States.

This comparison between public health departments in the United States and in the Canadian Province of Ontario addresses the funding and staffing and the size and program content of local health departments after Canada's national health reform provided universal access to personal health services. Ontario's local health departments are required to provide a uniform set of public health services. In the United States, there is substantial variation among jurisdictions in kinds and amounts of services delivered. Ontario health units have staff sizes and budget levels that increase in proportion to population served, like those in the United States. But in Ontario, per capita expenditures increase with decreasing population, while the reverse is true in the United States. This anomaly may be attributed to lack of critical staff or elimination of key programs in small U.S. departments. Medical care of indigents probably accounts for the increased per capita costs seen in very large U.S. health departments. An estimated price for uniform public health services meeting the Ontario requirements in all U.S. jurisdictions as they were organized in 1989 is $5.8 billion per annum (not adjusted for inflation). If smaller health departments were consolidated, a savings of more than $1 billion could be realized. Even with this reorganization, average expenditures in smaller U.S. health departments would need to be doubled, and staff sizes increased by about 50 percent to meet Ontario's uniform public health program standards.

Data Collection↗