Jan C. Forfang

Norwalk gastroenteritis : A community outbreak associated with bakery product consumption

From 23 to 26 August 1982, a gastrointestinal illness occurred among 129 of 248 (52%) persons interviewed who had attended four social events in the Minneapolis-St. Paul area. The median incubation period was 36 hours, and symptoms included diarrhea, nausea, headache, and vomiting. Findings of a food-specific questionnaire given to attendants of the four events confirmed that consumption of cake and frosting was significantly associated with development of the illness (odds ratio, 7.9 to 48.3; p = 0.006 to 0.00001). All cake items were purchased from a single bakery, where the employee who had prepared the frosting had had onset of diarrhea and vomiting on August 20. Given an approximate 60% attack rate among persons who ate frosted items, we estimate that 3000 outbreak-associated cases occurred. Serologic analysis confirmed that 17 of 25 ill persons had fourfold or greater rises in their antibody titer to Norwalk virus. Thus, foodborne transmission of Norwalk virus can result from contamination by a single foodhandler.

An Outbreak of Foodborne Giardiasis

GIARDIA LAMBLIA is recognized as an important cause of acute illness in human beings. Community-wide waterborne outbreaks of giardiasis have been documented with increasing frequency, 1 2 3 4 5 and...

Toxic shock syndrome: Relation to catamenial products, personal health and hygiene, and sexual practices

In 1980, the discovery of an association between vaginal tampon use and toxic shock syndrome affected the lifestyles of menstruating women and the catamenial products industry. It made both the general public and the medical community more aware of all aspects of menstruation. The relation between developing toxic shock syndrome and tampon use is unclear; tampon fluid capacity (absorbency) remains the best predictive measure of that risk. No unique aspect of tampon use other than absorbency seems to increase the risk of developing toxic shock syndrome, and numerous hygiene and medical history factors do not seem to play a role in the pathogenesis of the disease. Studies in Minnesota, Wisconsin, and Iowa indicate that 70% to 75% of women between the ages of 15 and 24, the group with the highest risk of developing menstrual toxic shock syndrome, continued to use tampons after news media attention in 1980 on the association of the syndrome with tampon use. This rate of use is higher than the rate found for the general population by recent tampon market research.

Surveillance of Toxic Shock Syndrome in Minnesota: Comments on National Surveillance

In January 1980, the Minnesota Department of Health began the surveillance of toxic shock syndrome with epidemiologically defined active and passive components. The intensity of surveillance has been constant since its inception. As of 30 June 1981, 197 confirmed cases of toxic shock syndrome, 15% of all cases nationwide, have been identified in Minnesota. During the 18 months of active surveillance, the total cases reported per calendar quarter ranged from 20 to 24 cases, and the number of tampon-associated cases ranged from 15 to 21. There was no difference in the quarterly distribution of total (p greater than 0.2) or tampon-associated (p greater than 0.2) cases of toxic shock syndrome during the six quarters. Fifty-five tampon-associated cases had onset of illness during the 9 months of surveillance in which Rely tampons (Proctor & Gamble) were on the market; 59 tampon-associated cases had onset of illness during the 9 months after Rely tampons were removed from the market.

Tri-State Toxic Shock Syndrome Study: Evaluation of Case Definition and Prevention of Recurrence

Abstract The clinical and laboratory findings in 80 nonfatal cases of toxic shock syndrome were examined as part of the Tri-State Toxic-Shock Syndrome Study conducted by the state health department...