Outbreak of acute gastroenteritis in young children with death due to rotavirus genotype G9 in Rio Branco, Brazilian Amazon region, 2005

BACKGROUND

An epidemic of acute gastroenteritis occurred in Rio Branco City, Acre State, in Brazil's Amazon region in 2005. An investigation was conducted to confirm the etiology and identify possible risk factors for death.

METHODS

Rio Branco municipality surveillance data for the period May to October 2005 were reviewed. In a case-control study, children who died following acute gastroenteritis were compared to age-matched controls with acute gastroenteritis who survived. Rotavirus A (RV-A) was investigated in 799 stool samples and genotyped by reverse transcription polymerase chain reaction (RT-PCR).

RESULTS

The cumulative incidence of diarrhea in children aged <5 years was 21%. A fatal outcome was significantly associated with uncovered household water storage containers. RV-A was identified in 88% of samples and G9 was the prevalent genotype (71%).

CONCLUSIONS

Oral rehydration solution and boiling or chlorinating drinking water likely limited mortality. This epidemic was caused by RV-A genotype G9. After the outbreak, a rotavirus vaccine was introduced into the official childhood immunization schedule in Brazil.

Epidemiological study of the claimed zinc phosphide intoxication in Kom Ombo district April 1996

INTRODUCTION

In April 1996, in Aswan Governorate, Egypt, an outbreak of vomiting without diarrhea, abdominal and leg pain was reported.

METHODS

A case-control study was conducted to determine the cause of the outbreak. 25 cases who had vomiting without diarrhea, abdominal and leg pain. Controls were randomly chosen from adjacent houses to cases and another village.

RESULTS

No occupational exposure was associated with the disease, 84% of cases lived in households where chemical rodenticide had been used for rat infestations compared to 22% of controls. Laboratory analysis and field investigation identified zinc phosphide intoxication as the probable cause of this outbreak.

Epidemic cholera during refugee resettlement in Malawi

BACKGROUND

In June 1988 a cholera epidemic occurred in a Mozambican refugee population resettling in southern Malawi.

METHODS

A case-control study was conducted to determine possible risk factors for disease. The characteristics of 48 refugee households with any member(s) hospitalized for suspected cholera were compared to 441 randomly sampled refugee households without hospitalizations.

RESULTS

Vibrio cholerae 01 was isolated from 50% (5/10) of case-patient stool cultures. Having any water containers with > or = 10 T capacity was associated with a significantly lower odds of suspected cholera in households (adjusted odds ratio [aOR] = 0.02, 95% confidence interval [CI] : 0.003-0.12), as was having metal cooking pots (aOR = 0.3, 95% CI : 0.12-0.7), after adjusting for length of residence and socioeconomic status (logistic regression model). Households with two or more children < 5 years old were at markedly increased odds of suspected cholera (P < 0.0001). These results suggest that water containers and cooking pots served important preventive functions during this cholera outbreak. Young children may have contributed to cholera transmission, but the reason(s) remains undetermined.

Profile of mortality from the 1989 Loma Prieta earthquake using coroner and medical examiner reports

Mortality patterns from earthquakes in the United States may differ from those observed in other parts of the world. We reviewed coroner and medical examiner records for all investigated deaths from seven California counties for 15 days following the Loma Prieta earthquake of October 17, 1989 (N = 327). Data on the circumstances surrounding death were used to classify each case as directly earthquake-related, indirectly earthquake-related, or not earthquake-related. Fifty-seven deaths were judged as directly earthquake-related. Six other deaths were indirectly related. Ten circumstances accounted for all directly earthquake-related deaths, with the collapse of an elevated freeway accounting for 40 of these deaths. Forty-six (80.8 per cent) of the 57 directly earthquake-related deaths occurred in motor vehicles on public roadways. Fifty-three (93.0 per cent) of the directly earthquake-related deaths occurred within seconds or minutes of injury. Future earthquake deaths in the United States may best be prevented by identifying and modifying seismic hazards in earthquake-prone regions, particularly transportation structures.

Reduced severity of eosinophilia-myalgia syndrome associated with the consumption of vitamin-containing supplements before illness

OBJECTIVE

To determine if the severity of subacute symptoms in eosinophilia-myalgia syndrome (EMS) was affected by medical history or use of nutritional supplements other than tryptophan before illness.

DESIGN AND STUDY POPULATION

A case-control study was conducted of EMS cases systematically sampled from all those reported to a statewide surveillance system in California in 1989. Excluding two previous EMS-related deaths, interviews were completed in 73% (57/78) of the eligible case patients sampled.

MAIN OUTCOME MEASURES

The severity of any myalgia(s), dyspnea, or walking impairment during each of the first 3 months of EMS was quantified by means of self-reported integer scores ranging from 0 (asymptomatic) to 10 (severe symptoms). Case patients in the top tercile of combined, unweighted monthly scores were defined as having severe symptoms.

RESULTS

All interviewees (57 of 57) had consumed supplemental tryptophan before illness; 89% (51/57) were female. The odds of severe symptoms were not significantly associated with gender, age, previous antidepressant use, or cumulative amounts of supplemental tryptophan consumed before or after EMS onset (P > .1). Previous consumption of any multivitamin(s), however, was associated with significantly lower odds of severe symptoms (adjusted odds ratio, 0.05; 95% confidence limits, 0.007, 0.4; P = .006).

CONCLUSIONS

The consumption of multivitamin-containing supplements before EMS appears to have modified the severity of subacute symptoms in this sample of cases from California.

Altered mammary responsiveness to estradiol and progesterone in mice exposed neonatally to diethylstilbestrol

Mammary glands from ovariectomised neonatally diethylstilbestrol (DES)-exposed (0.1 microgram daily for the first 5 days of life) mice seem morphologically indistinguishable from those of ovariectomised controls. However, administration of exogenous hormones reveals a differential response. In DES-exposed mice, estrogen implantation resulted in greater incidence of dilated ducts along with greater incidence of dilated ducts along with greater incidence and severity of terminal ductal hyperplasia and greater severity of cystic alveolar adenosis; combined estrogen and progestin treatment resulted in greater severity of terminal duct hyperplasia and less alveolar formation, and progestin treatment resulted in lower incidence and degree of lateral budding. Thus, mammary sensitivity to sex steroids is altered by early exposure of mice to DES.

The effective case management of childhood diarrhoea with oral rehydration therapy in the Kingdom of Lesotho

In Lesotho prior to 1986, diarrhoea was the leading cause of hospital mortality in children less than 5 years of age. At the Queen Elizabeth II Hospital, diarrhoea-related admissions as a proportion of all admissions in children less than 5 years of age declined from 23% in the year prior to the opening of the Oral Rehydration Therapy Unit (ORTU) to 13% in the first nine months of 1987 (p less than 0.05). In addition, the case-fatality ratio of children treated in the ORTU declined from 1.4% in the first quarter of 1986 to zero in the second and third quarters of 1987 (p less than 0.05). In a case-control study conducted to identify reasons for children failing ORTU treatment, factors associated with an increased risk of hospitalization included male gender (odds ratio [OR] = 4.9; 95% confidence limits [CL] = 2.0, 11.9), fever greater than or equal to 38.5 degrees C (OR = 2.0; CL = 1.2, 3.3), undernutrition (OR = 3.2; CL = 1.1, 9.4), and moderate dehydration (OR = 2.3; CL = 1.2, 4.4) or severe dehydration. (OR = 12.1; CL = 3.8, 38.5). Breastfed children less than 2 years of age were at decreased risk of hospitalization (OR = 0.4; CL = 0.2, 0.7). At this major hospital in Lesotho, the standardization of outpatient treatment for diarrhoea with oral rehydration salts (ORS) in the context of an ORTU resulted in a marked decrease in diarrhoea-associated hospitalization and deaths in children less than 5 years of age.

Delayed cerebrospinal fluid sterilization in infants with Hemophilus influenzae type b meningitis

Cerebrospinal fluid (CSF) sterilization after greater than 24 h of intravenous antibiotic therapy (delayed CSF sterilization) was noted in two infants treated with ceftizoxime and ceftazidime for bacterial meningitis. A case-control study was conducted of children between 6 w and 6 y of age treated between 1975 and 1985 at one institution for bacterial meningitis to determine risk factors for delayed CSF sterilization. Hemophilus influenzae type b was isolated from all children (n = 5) with delayed CSF sterilization, compared with only 78% of all children in the study (n = 83). In children with H. influenzae type b disease, children less than 6 mo of age were at higher risk than older children for delayed CSF sterilization (odds ratio = 7.5, 95% confidence limits = 1.4, 40.0). Factors not associated with delayed CSF sterilization included time of follow-up lumbar puncture, CSF total or differential white blood cell count, and CSF protein and glucose concentrations. Despite the in vitro antimicrobial susceptibility of H. influenzae type b to ceftizoxime and ceftazidime, delayed CSF sterilization may occur in infants receiving these antibiotics for bacterial meningitis.