Max Bader

Venereal Transmission of Shigellosis in Seattle-king County

In the past, shigellosis in Seattle-King County has been primarily a disease of children, their parents, and foreign travelers. During the 18 months beginning in July 1975, an outbreak of shigellosis in Seattles community of gay men involved both Shigella flexneri and Shigella sonnei. They accounted for nearly 30% of all cases of shigellosis reported to the health department. Fellatio and/or oral-anal contact was reported by 90% of the infected homosexual men; this was probably the mechanism of transmission of most infections. Intercity spread was determined by case histories and by the finding of S. flexneri 3, a previously unusual organism in Seattle.

Normal Thyroxine Levels in Sudden Infant Death Syndrome

To the Editor.— In the QUESTIONS AND ANSWERS section (1982;248:593), the association between sudden infant death syndrome (SIDS) and elevated triiodothyronine (T 3 ) levels found at autopsy was discussed. The answer indicated that there was no proved causative association between elevated T 3 levels and the later development of SIDS. It might be worth noting that all of 30 consecutive Oregon SIDS infants had essentially normal thyroxine levels at the time of newborn screening for congenital hypothyroidism. In addition, none of 66 infants found to have congenital hypothyroidism at the time of newborn screening subsequently died of SIDS.

Needle-stick exposure and hepatitis.

To the Editor.— In response to the question as to what action should be taken after accidental needle-stick exposure when the contact patient is not known to have hepatitis (240:2325, 1978), the Seattle-King County Health Departments viral hepatitis case survey results may be helpful. All patients whose cases were reported were contacted by a nurse and asked about possible exposure sources. These sources included work in the health professions and needle exposures. During a two-year period, only one patient recalled an accidental needle-stick exposure. It had occurred eight months before her illness, and she was given standard immune serum globulin at the time. Her hepatitis was not type B. Although only an estimated 40% to 50% of hepatitis cases were reported in the metropolitan Seattle area (1.2 million people) during that period, it seems safe to infer that while needle-stick exposures to serum from persons with unknown hepatitis antigen status