George K. Morris

Profiles of Airborne Fungi in Buildings and Outdoor Environments in the United States

ABSTRACT We examined 12,026 fungal air samples (9,619 indoor samples and 2,407 outdoor samples) from 1,717 buildings located across the United States; these samples were collected during indoor air quality investigations performed from 1996 to 1998. For all buildings, both indoor and outdoor air samples were collected with an Andersen N6 sampler. The culturable airborne fungal concentrations in indoor air were lower than those in outdoor air. The fungal levels were highest in the fall and summer and lowest in the winter and spring. Geographically, the highest fungal levels were found in the Southwest, Far West, and Southeast. The most common culturable airborne fungi, both indoors and outdoors and in all seasons and regions, were Cladosporium, Penicillium, nonsporulating fungi, and Aspergillus. Stachybotrys chartarum was identified in the indoor air in 6% of the buildings studied and in the outdoor air of 1% of the buildings studied. This study provides industrial hygienists, allergists, and other public health practitioners with comparative information on common culturable airborne fungi in the United States. This is the largest study of airborne indoor and outdoor fungal species and concentrations conducted with a standardized protocol to date.

Shigellosis in custodial institutions

Thirty-four high-risk children admitted to an institution with endemic Shigella flexneri 2a disease were given either streptomycin-dependent S. flexneri 2a or S. sonnei oral vaccine. Fourteen vaccinees in each group remained under surveillance for more than 12 months and one sonnei vaccinee for more than six months. There was no difference in attack rate for S. flexneri 2a diarrhea between the flexneri and sonnei vaccinees (9/14 vs. 9/15). All cases of symptomatic dysentery occurred within nine months after vaccination; despite clinical immunity thereafter, episodic asymptomatic excretion of shigella was observed in 10 of 28 children. The level of immunity induced by streptomycin-dependent S. flexneri 2a oral vaccine was insufficient to prevent disease in this institutional setting.

THREATS TO MEDICAL CONFIDENTIALITY

SIR,-As doctors and nurses, we write to express our concern about a number of threats to medical confidentiality. These are posed by certain extremist pressure groups and individuals who appear to be so convinced of the righteousness of their own dogmatic views that they are prepared to sacrifice the privacy to which all patients are entitled from their medical advisers. Confidentiality between patient and doctor has always been a fundamental tenet of good medical care, and is not something that the medical or nursing professions should allow to be eroded. The threats to confidentiality are occurring in three specific areas of medical practice: contraception for those aged under 16, late abortions, and the care of severely malformed newborn infants. These situations are difficult and distressing for all those involved. They require tact, understanding, compassion, sympathy, and, above all, an honest relationship based on mutual trust. This last is not possible if the patient has reason to believe that information freely passed in confidence is going to be revealed to third parties or the media. It is not sufficiently widely known that pressure groups have been attempting to recruit informers within hospitals and clinics. They seek out doctors, nurses, chaplains, and others whose privileged positions give them access to private medical information. The suffering of parents whose severely handicapped infant has died is grievous enough, even when decent conventions of privacy have been respected. It becomes quite unbearable when families are exposed to the fierce glare of television, radio, and press coverage. Sexual abuse of an under-age girl can be damaging in itself without being compounded by pregnancy. Late abortions carry their own traumas and publicity only adds to these. The wellbeing of patients is not best served by doctors and nurses continually having to look over their shoulders for informers, and their treatment should not be prejudiced by the opinions of a strident and well-organised minority. On these issues it may be that the majority of those in the caring professions should also ensure that its voice is heard. We would welcome it if those who share our concern would write to let us know. *