Guillain-Barré syndrome and Bell's palsy in Hawaii in 1981.
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Adult↗
Biomedical subjects
R L Vogt
Publications and source records attributed to R L Vogt.
Isolation of Campylobacter jejuni from milk during an outbreak of campylobacteriosis.
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Animals↗
Legionnaires' disease: the epidemiology of two outbreaks in Burlington, Vermont, 1980.
Eighty-five cases of Legionnaires' disease were diagnosed in two major outbreaks at a large regional medical center in Burlington, Vermont, in the summer of 1980. Cases in both outbreaks were positive for Legionella pneumophila, serogroup 1 by culture, serology, or direct fluorescent antibody tests. All cases had spent time in the city of Burlington in the 10 days before the onset of symptoms. Cases in both outbreaks were both hospital- and community-acquired. A case-control study identified no common in-hospital exposure, including shower use, that was associated with illness. Cases without previous exposure to the hospital were more likely to occur in persons with residences in neighborhoods just downwind of cooling tower A, but not throughout the municipal water system. Epidemiologic and environmental studies supported the association of this cooling tower, located 150 m from the hospital, with both outbreaks. Maintenance employees who worked with tower A had higher Legionella titers than those who worked with a comparison tower located 1.6 km away. Aerosolization of L. pneumophila by tower A and airborne spread to the hospital and community are postulated. The distance of airborne transmission of L. pneumophila in these consecutive outbreaks is greater than previously reported.
Cross Infection↗
Pontiac fever associated with a whirlpool spa.
In March 1981, an outbreak of 34 cases of Pontiac fever occurred among 74 members of a social club who visited an inn in south-central Vermont. Environmental and epidemiologic investigations were done to identify the causes of the illness. The outbreak of Pontiac fever was most likely caused by L. pneumophila, serogroup 6, which was identified in a whirlpool spa at the inn. This is the first reported instance of an outbreak of Pontiac fever associated with a whirlpool spa.
Adult↗
Salmonellosis outbreak at a Vermont hospital.
An outbreak of gastrointestinal illness occurred at a hospital in northern Vermont during September 1981. Of the 292 hospital employees surveyed, 43 had diarrheal illness; 12 of them had positive cultures for Salmonella, serotypes chester, tennessee, or habana. In addition, three individuals who were culture-positive but did not have diarrhea were counted among the cases. Illness was related to eating roast beef or cold cuts (P less than .01) in the month of September. One food specimen, an unopened package of precooked roast beef supplied by a New York processor, was found to be contaminated by Salmonella, serotypes chester, tennessee, and livingston. Cold cuts were believed to be secondarily contaminated by a meat slicer. Three of 80 patients whose charts were reviewed had nosocomial diarrhea; two of them had positive cultures for Salmonella, serotype chester. Secondary transmission of Salmonella from hospital staff was the likely source for at least two of the patients.
Animals↗
Serotyping and serology studies of campylobacteriosis associated with consumption of raw milk.
A community outbreak of 15 cases of gastroenteritis was traced to consumption of unpasteurized milk produced at one commercial dairy. Using two different testing schemes, we found that a Campylobacter jejuni isolate from an ill patient and an isolate from a sick cow were the same serotype. Bacteriological studies suggested that a single epidemic strain of Campylobacter jejuni caused this outbreak.
Animals↗
Investigation of a waterborne outbreak of giardiasis using serologic testing by IFA.
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Disease Outbreaks↗
National survey on outbreaks associated with whirlpool spas.
A national survey of state epidemiologists sought information on reported outbreaks of illness associated with non-residential whirlpool spas for the period April 1972-July 1, 1982. Reports were received from 49 states. Of the 74 whirlpool-associated outbreaks reported, 72 were characterized as having patients with papular or pustular rash and two were associated with cases of Pontiac fever.
Bacterial Infections↗
Drinking-water-induced copper intoxication in a Vermont family.
Three of four family members reported recurrent episodes of gastrointestinal illness while residing in a house in a small northwestern Vermont village. The father and two daughters repeatedly experienced episodes of emesis and abdominal pain after drinking water drawn from their kitchen faucet. One early-morning water sample taken from the family household contained a copper level of 7.8 mg/L, which is above the standard for drinking water (1.0 mg/L). Values for the second daughter's copper in hair analysis (1,200 micrograms/g) and copper in nail analysis (100 micrograms/g) were elevated (normal range 11 to 53 micrograms/g). The household was at the end of a 3/4-in (19.05-mm) copper main, and it is suspected that copper levels increased in water when the water remained stagnant in the main. All symptoms of the family resolved when they stopped drinking water in their home. This is the first report of copper-induced gastrointestinal illness attributable to a public supply of drinking water.
Adult↗
Comparison of an active and passive surveillance system of primary care providers for hepatitis, measles, rubella, and salmonellosis in Vermont.
Between June 1, 1980 and May 31, 1981, the Vermont Health Department telephoned a randomly chosen half of the state's primary care offices for surveillance reports of hepatitis, measles, rubella, and salmonellosis. No reports were actively solicited from the other half of the primary-care practices in the state. Active-surveillance units made more reports and more complete reports of diseases and had twice the number of reports per patient seen by the practice than did passive-surveillance units. (Am J Public Health 1983; 73:795-797.)
Hepatitis↗
An outbreak of xylene intoxication in a hospital.
On January 3, 1980 an outbreak of illness occurred in 15 employees of a small community hospital. Symptoms included headache, nausea, vomiting, and dizziness or vertigo; the duration of illness ranged from 2 to 48 hours. The employees who became ill all worked in areas of the hospital served by one central ventilation system. None of the 180 persons working in other parts of the hospital developed symptoms requiring medical care. Less than 1 hour before the outbreak occurred, 1 liter of liquid xylene had been discarded down a sink drain in the pathology laboratory. Simulation experiments confirmed that xylene vapor could have been drawn into the room that contained the fan unit of the ventilation system. This outbreak illustrates an unusual route of exposure to a widely used laboratory chemical.
Dizziness↗
Acute fluoride poisoning associated with an on-site fluoridator in a Vermont elementary school.
On August 30 1980, an outbreak of minor illnesses consisting of nausea and vomiting affected 22 individuals attending a farmers market at a school. Illness was associated with the consumption of beverages made from school water (Xc2 = 65.6, p less than .0001); analysis of the water showed high levels of fluoride (1,041 mg/l). The most likely source of the contamination was the school fluoridator, which had accidentally been left on continuous operation.
Adolescent↗
Campylobacter enteritis associated with contaminated water.
Approximately 3000 people in Bennington, Vermont, 19% of the population, had a diarrheal illness during the first and second weeks of June 1978. Persons affected reported abdominal cramps (86%), diarrhea (82%), malaise (73%), and headache (47%). The mean duration of illness was 4.6 days. The illness was associated with drinking unboiled water from the town water system. Investigation showed that the entire water system was probably contaminated and the source of contamination was the main unfiltered water source. Bolles Brook. Campylobacter fetus subspecies jejuni was cultured from 15 of 42 rectal swabs obtained from persons who had been ill, but not from swabs obtained from 23 persons who served as controls. No environmental samples of water and no specimens from wild or domestic animals were positive for Campylobacter. This appears to be the first waterborne outbreak of gastroenteritis associated with C. fetus subspecies jejuni.
Adult↗
Pneumonic and nonpneumonic forms of legionellosis. The result of a common-source exposure to Legionella pneumophila.
Two male maintenance workers contracted legionellosis while cleaning the interior of a cooling tower contaminated with Legionella pneumophila. In one man severe, life-threatening Legionnaires' disease developed, whereas the other experienced a comparatively mild, self-limiting illness that was consistent with previous descriptions of cases of Pontiac fever. This report represents the first documentation of the development of both of these syndromes following exposure to a common source of the organism. The implications of this observation for the pathogenetic mechanisms that underly the different clinical manifestations of legionellosis are discussed.
Anti-Bacterial Agents↗
From the Vermont State Health Department. Salmonella enteritidis serotype derby and consumption of raw milk.
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Adolescent↗
The Vermont epidemic of Legionnaires' disease.
Sixty-nine laboratory-documented cases of Legionnaires' disease occurred in Vermont between 1 May and 31 December 1977. Clinical manifestations were similar to those in the 1976 Philadelphia epidemic. Case-control studies suggested that Legionnaires' disease patients were more likely to present with headache or diarrhea than were patients with pneumonia of presumed nonbacterial cause. The case-fatality ratio for patients treated with erythromycin was 4%, compared with 17% in patients not treated with erythromycin. Thirteen patients had been hospitalized throughout the 10 days preceding onset of illness, equaling the maximal known incubation period. This suggests either acquisition or reactivation of infection in the hospital. However, even during the week of peak disease activity, cases occurred in patients with no recent hospital contact. The only community factor possibly associated with acquisition was home air conditioning. This prevalence of seroreactivity to the Legionnaires' disease bacterium in various community populations was as high as 26%, suggesting a possible endemic area.
Adolescent↗
Morbidity on Kauai before and after Hurricane Iniki.
BACKGROUND: On September 11, 1992, Hurricane Iniki, a Class III/IV storm, passed directly over Kauai. This study is the first attempt to measure increases in injuries and other health outcomes among an entire population in the impact zone of a hurricane. METHODS: Medical chart data were abstracted from all facilities providing primary and emergency care on Kauai. Incidence of injury, cardiovascular disease, and asthma for the 2-week period following Hurricane Iniki were compared to those for the 2-week period preceding Iniki. RESULTS: A total of 1,584 injuries were treated in the post-Iniki period compared with 231 injuries treated in the pre-Iniki period (relative risk = 6.86, 95% confidence interval 5.98-7.87). Open wounds constituted over half of these injuries. Physician visits for asthma and cardiovascular disease were also significantly increased in the post-Iniki period (relative risks, respectively: 2.81, 95% confidence interval 1.93-4.09; 2.73, 95% confidence interval 1.51-4.94). CONCLUSIONS: Significant increases in the incidence of injuries, asthma, and cardiovascular disease occurred following Hurricane Iniki. Although no changes occurred in the proportion of patients needing hospitalization, additional injuries and illnesses after a natural disaster can burden existing medical facilities in a rural community with limited resources. Disaster preparedness plans need to include methods to increase services and supplies at existing medical facilities.
Adolescent↗