Daniel B. Fishbein

An Outbreak of Thyrotoxicosis Caused by the Consumption of Bovine Thyroid Gland in Ground Beef

We report an outbreak of thyrotoxicosis without true hyperthyroidism that occurred between April 1984 and August 1985 among residents of southwestern Minnesota and adjacent areas of South Dakota and Iowa. One hundred twenty-one cases were identified through surveillance of medical clinics, laboratories, hospitals, and physicians offices. Investigation of the outbreak demonstrated an association between the occurrence of thyrotoxicosis and the consumption of ground beef prepared from neck trimmings processed by a single slaughtering plant (odds ratio, 19.0; P = 0.0001). The cause was confirmed by the findings of bovine thyroid tissue in samples of these trimmings and high concentrations of thyroid hormone in implicated samples of ground beef and the demonstration of prompt increases in serum thyroid hormone concentrations in volunteers who ate the implicated ground beef. Bovine thyroid tissue had been introduced into the neck trimmings inadvertently during the process of gullet trimming, a procedure that harvests muscles from the bovine larynx. The outbreak resolved after this procedure was discontinued at the plant. The clinical features of the illness suggested the diagnosis of silent thyroiditis, and it is possible that sporadic cases--or even outbreaks--of thyrotoxicosis factitia caused by this mechanism may have occurred in the past but were not recognized.

One-year study of the 2-1-1 intramuscular postexposure rabies vaccine regimen in 100 severely exposed Thai patients using rabies immune globulin and Vero cell rabies vaccine

The 2-1-1 rabies postexposure treatment schedule is an abbreviated regimen in which a tissue culture rabies vaccine is administered intramuscularly at two sites on day 0, and at one site on days 7 and 21. Compared to the standard five-dose intramuscular regimen, the 2-1-1 schedule reduces the number of clinic visits from five to three and the amount of vaccine used by 20%. One hundred Thai patients, who were severely exposed to rabies, were treated with rabies immune globulin and the 2-1-1 regimen using purified Vero cell rabies vaccine. They were followed for 1 year. Rabies antibody titres were measured in 10% of this group. All patients survived and adverse reactions were mild. A satisfactory antibody response (a titre greater than 0.5 IU ml-1) occurred in all ten patients studied at day 14, but persisted for 90 days in 80% and for 360 days in only 50%. The authors therefore do not recommend use of the 2-1-1 schedule in severely exposed patients who also need to receive rabies immune globulin.

Pre-exposure rabies prophylaxis for travellers: are the benefits worth the cost?

Pre-exposure rabies prophylaxis is recommended by the Immunization Practices Advisory Committee of the US Public Health Services (PHS) as a safe and effective method for reducing the risk of rabies in international travellers. The United States Peace Corps provides pre-exposure prophylaxis with human diploid cell rabies vaccine (HDCV) to over 2000 new volunteers each year going to rabies-endemic countries. During the year November 1987 through October 1988, 175 rabies exposures (and no deaths) were documented in Peace Corps Volunteers serving in 31 rabies-endemic countries, for an overall postexposure treatment rate of 43.6/1000 volunteers per year. Although PHS treatment protocols were strictly followed, the postexposure prophylaxis rate for these Peace Corps Volunteers was 550 times higher than that for the US general population, and 55 times higher than the average rate for 30 developing countries. The use of pre-exposure prophylaxis in travellers was not cost-effective and will not become so until the price of a dose of vaccine declines substantially to

Rabies control in the Republic of the Philippines : benefits and costs of elimination

7.00 for the Peace Corps, and even lower for groups with less rabies exposure. However, despite the high vaccine cost, pre-exposure prophylaxis continues to be recommended in the Peace Corps for important non-economic reasons which may also be applicable to other groups of travellers.

Human diploid cell rabies vaccine purified by zonal centrifugation: a controlled study of antibody response and side effects following primary and booster pre-exposure immunizations

We compared the benefits and costs of eliminating animal and human rabies in the Philippines. If rabies had been eliminated in 1988, economic benefits would total P52.8 (US

Community outbreak of thyrotoxicosis: Epidemiology, immunogenetic characteristics, and long-term outcome

2.5) million in 1989. These benefits would largely arise from the abolition of expenses associated with rabies prevention: P29.7 (US

Immunogenicity of rabies vaccines used during an urban epizootic of rabies in Mexico

1.4) million for animal vaccination, P21.6 (US

Deterioration in immunologic status of human immunodeficiency virus (HIV)-infected homosexual men with lymphadenopathy: prognostic implications.

1.0) million for human postexposure prophylaxis, and P0.3 (US

Pre-Exposure Rabies Immunization with Human Diploid Cell Vaccine: Decreased Antibody Responses in Persons Immunized in Developing Countries

0.02) million for animal rabies examinations. Benefits also included P1.2 (US

The Early Kinetics of the Neutralizing Antibody Response after Booster Immunizations with Human Diploid Cell Rabies Vaccine

0.06) million in additional earnings of humans whose death due to rabies would be prevented. Nationwide elimination was estimated to cost between P88.1 (US