Gary R. Noble

A nationwide outbreak of Reye's syndrome: Its epidemiologic relationship to influenza B

Between December 15 and June 30, 1974, 379 cases of confirmed Reyes syndrome were reported to the Center for Disease Control. Of these, 316 occurred during February and March 1974. A simultaneous surveillance system for influenza B indicated that this clustering of cases of Reyes syndrome correlated both temporally and geographically with influenza B outbreaks. The incidence of Reyes syndrome was higher in rural than in urban centers. Epidemiologically, two groups of cases of Reyes syndrome emerge: those which occur in older children (median age 11 years), cluster in time and geographic region, and are associated with antecedent influenza B infection; and those which occur sporadically thoughout the year, are isolated in occurrence, occur in younger children (median age 6 years), and are associated with a wide variety of antecedent viral illnesses.

Isolation of Swine Influenza Virus from Autopsy Lung Tissue of Man

Swine influenza virus, or an antigenically closely related virus, has been considered to be the etiologic agent of the 1918 influenza pandemic.1 2 3 4 Influenza in swine has continued to occur in t...

Swine influenza viruses isolated in 1976 from man and pig contain two coexisting subpopulations with antigenically distinguishable hemagglutinins

Abstract Hsw1N1 viruses isolated from recruits at Fort Dix, New Jersey, in 1976 were compared by hemagglutination inhibition (HI) and neuraminidase inhibition (NI) tests with HswlN1 viruses isolated from pigs from 1930 to 1976. Viruses isolated in 1976 from pigs and man were found to consist of two subpopulations with antigenically distinguishable hemagglutinins (HA). The HA of one subpopulation of 1976 viruses is similar to that of A/swine/Wisconsin/1/67 and has been identified on virus isolates dating back to at least 1957. The HA of the other subpopulation of 1976 viruses is similar to that of several other viruses isolated from 1971 to 1976, but has not yet been found on any North American isolate from before 1971 although it exhibits a significant cross-reactivity with the early isolate A/swine/Cambridge/39. Evidence is presented that the two antigenically distinguishable subpopulations coexisted in some cases in the infected host, including recruits at Fort Dix, a farmhand in Wisconsin, and an infected pig to which the Wisconsin farmhand was exposed. The results strongly support the likelihood that an influenza-infected pig was the initial source of virus containing the hemagglutinin genes present in the viruses ultimately isolated from recruits infected at Fort Dix, New Jersey.

Influenza vaccine in unprimed children: Improved immunogenicity with few reactions following one high dose of split-product vaccine†‡

Thirty-one unprimed children and young adults received an influenza A/USSR/77 vaccine containing 43 microgram of hemagglutinin. Their HAI antibody response was compared to that in 92 age-matched individuals from the 1978 national influenza immunization trial who received 10 and 4 microgram HA vaccines. A dose-related antibody response was observed after the first vaccine doses in the 7- to 12- and 13- to 25-year-old groups. An HAI titer greater than or equal to 40 was present in 81% and 93% of 43 microgram HA recipients, in 38% and 43% of 10 microgram HA recipients, and in 24% and 12% of 4 micrograms HA recipients respectively. The antibody response to the 43 microgram HA dose was significantly higher than was the response to the 10 and 4 microgram HA doses. The local and systemic side effects were not significantly different among the three vaccine groups and the placebo group. Thus, a high dose of influenza A/USSR/77 split-product vaccine given to unprimed children and young adults stimulated presumably protective levels of antibody and was free of a significant incidence of side effects.

Epidemic Intelligence Service Investigations of Respiratory Illness, 1946–2005

Infectious respiratory pathogens were the suspected cause of 480 outbreaks investigated by the Centers for Disease Control and Preventions Epidemic Intelligence Service officers during 1946-2005. All epidemic-assistance investigation reports and associated articles from scientific journals were reviewed. Investigations identified 25 different infectious respiratory pathogens including, most frequently, tuberculosis, influenza, and legionellosis. Other bacterial-, viral-, and fungal-related pathogens also were identified. Epidemic-assistance investigations were notable for first identifying Legionnaires disease and Pontiac fever, hantavirus pulmonary syndrome, and new strains of human and avian influenza, as well as emerging challenges (e.g., multidrug-resistant tuberculosis and pneumococcus). The investigations provided clinical insights into such diseases as pulmonary anthrax and identified high risks of serious respiratory illnesses for persons infected with human immunodeficiency virus, other immunocompromised persons, and persons with diabetes. They identified settings placing persons at high risk of acquiring disease, including nursing homes, prisons, homeless shelters, and hospitals. Travel also placed persons at risk. Key environmental factors related to spread of diseases and occupational risks for brucellosis and psittacosis were identified. The outbreak investigations constitute a wealth of prevention experience and provide the basis for recommendations to mitigate outbreaks and reduce future risks.