Millicent Eidson

L-tryptophan and eosinophilia-myalgia syndrome in New Mexico

On Oct 30, 1989, the New Mexico Health and Environment Department learned of 3 patients with eosinophilia and severe myalgia who had been taking L-tryptophan. Further review of these and similar cases led to the initial recognition of the eosinophilia-myalgia syndrome (EMS) epidemic. To elucidate the apparent association between L-tryptophan-containing products (LTCPs) and EMS a case-control study was done. The case definition was unexplained peripheral eosinophilia (2000/microliters or more) and incapacitating myalgia. Cases were found through review of white blood cell counts from May 1 to Oct 31, 1989, in nine medical laboratories in New Mexico. 11 cases and 22 matched controls were interviewed for information on symptoms and other clinical findings, on the use of LTCPs, and on potential confounding factors. All 11 cases (100%) used LTCPs compared with only 2 controls. These findings led to a ban on the sale of LTCPs in New Mexico, followed by a nationwide recall of such preparations in the United States.

Outbreaks of enteric disease associated with animal contact: not just a foodborne problem anymore.

In the past 10 years, an increasing number of outbreaks of enteric disease associated with animals in public settings, such as fairs and petting zoos, have been reported. Fifty-five of these outbreaks that occurred in the United States during 1991-2005 are reviewed in this article. Lessons learned from these outbreaks and recommendations for prevention are also discussed. Physicians should be aware of this important public health problem and play an active role in prevention of human illness associated with animals in public settings.

Salmonella Typhimurium outbreak associated with veterinary clinic.

A Salmonella enterica serovar Typhimurium outbreak was associated with a veterinary clinic. Confirmed cases were in one cat, two veterinary technicians, four persons associated with clinic patients, and a nurse not linked to the clinic. This outbreak emphasizes the importance of strong public health ties to the animal health community.

Public health impact of reemergence of rabies, New York.

This report summarizes the spread of a raccoon rabies epizootic into New York in the 1990s, the species of animals affected, and human postexposure treatments (PET). A total of 57,008 specimens were submitted to the state laboratory from 1993 to 1998; 8,858 (16%) animals were confirmed rabid, with raccoons the most common species (75%). After exposure to 11,769 animals, 18,238 (45%) persons received PET, mostly because of contact with saliva or nervous tissue. We analyzed expenditure reports to estimate the cost of rabies prevention activities. An estimated

Crow deaths caused by West Nile virus during winter.

13.9 million was spent in New York State to prevent rabies from 1993 to 1998. Traditional prevention methods such as vaccinating pets, avoiding wildlife, and verifying an animal’s rabies status must be continued to reduce costly PET. To reduce rabid animals, exposures, and costs, oral vaccination of wildlife should also be considered.

Dead crow density and West Nile virus monitoring, New York.

In New York, an epizootic of American crow (Corvus brachyrhynchos) deaths from West Nile virus (WNV) infection occurred during winter 2004–2005, a cold season when mosquitoes are not active. Detection of WNV in feces collected at the roost suggests lateral transmission through contact or fecal contamination.

VecTest as Diagnostic and Surveillance Tool for West Nile Virus in Dead Birds

Persons in counties with high dead crow densities had elevated risk for disease.

Spatial and temporal patterns of enzootic raccoon rabies adjusted for multiple covariates

The VecTest WNV assay is adequate for diagnostic and surveillance purposes in American Crows, Blue Jays, and House Sparrows.

Rabies Postexposure Prophylaxis, New York, 1995–2000

BackgroundWith the objective of identifying spatial and temporal patterns of enzootic raccoon variant rabies, a spatial scan statistic was utilized to search for significant terrestrial rabies clusters by year in New York State in 1997–2003. Cluster analyses were unadjusted for other factors, adjusted for covariates, and adjusted for covariates and large scale geographic variation (LSGV). Adjustments were intended to identify the unusual aggregations of cases given the expected distribution based on the observed locations.ResultsStatistically significant clusters were identified particularly in the Albany, Finger Lakes, and South Hudson areas. The clusters were generally persistent in the Albany area, but demonstrated cyclical changes in rabies activity every few years in the other areas. Cluster adjustments allowed the discussion of possible causes for the high risk raccoon rabies areas identified.ConclusionThis study analyzed raccoon variant rabies spatial and temporal patterns in New York that have not been previously described at a focal (census tract) level. Comparisons across the type of spatial analysis performed with various degrees of adjustment allow consideration of the potential influence of geographical factors for raccoon rabies and possible reasons for the highest risk areas (statistically significant clusters).

“Neon Needles” in a Haystack

Bats are now the leading source of rabies postexposure prophylaxis.