N.R. Grist

ECHOVIRUSES, CARDITIS, AND ACUTE PLEURODYNIA

Abstract Statistical analysis of 833 cases of echovirus infection showed a significantly greater association of type-6 infection with acute pleurodynia, and a suggestive association of type 19 and some other types with cardiac disease and pleurodynia. Published reports and international data from W.H.O. support the suggestion that echo type 6 and 19 viruses share the potentiality of type-B Cox-sackie viruses causing acute carditis and pleurodynia.

The Epidemiology of Enteroviruses

International and local Scottish data illustrate the epidemiology of enteroviruses in recent years. Polioviruses still predominate as causes of serious paralytic disease, except where controlled by vaccination and require continuing surveillance. Aseptic meningitis is the commonest reported illness due to enterovirus infection, but notable clinical manifestations of certain types (particularly coxsackie group A) involve the skin and mucous membranes and the respiratory tract. Gastrointestinal disturbance has been reported in some echovirus infections, and cardiac disease is particularly associated with group B coxsackie virus infections. Although most enterovirus infections are silent or trivial in severity, the trend towards periodic epidemicity of different enteroviruses involving older age-groups may entail the emergence of new disease problems of which heart disease may be one example.

Poliomyelitis: a gap in immunity.

Abstract Although there are now few cases of poliomyelitis in the U.K., a serological survey carried out in a municipal district in Glasgow revealed a disturbing lack of immunity to poliomyelitis in a proportion of preschool children. Only 49% of the children had antibody to all three types of polio-virus. 54% of those children with a history of immunisation lacked triple immunity.

Illness associated with a package holiday in Romania.

A study of 370 holidaymakers returning from Romania revealed that 279 (75%) reported illness. Alimentary symptoms predominated and were recorded either alone or along with other symptoms by 71 per cent of the tourists. The highest illness rate (82%) occurred in those under 39 years of age and those over 60 years had least illness (38%). Most of the tourists attributed their illnesses to the supply, handling or preparation of food and drink. Twenty-six (21%) tourists had serological evidence of typhoid immunisation out of 121 from whom blood samples were obtained. Most of the tourists studied (85%) were immune to poliomyelitis.

Viruses in diarrhoeal disease

SIR,-The paper by Professor W. J. H. Butterfield and his coworkers (2 December, p. 505) showing that the diagnosis of diabetes mellitus can be made in the absence of glycosuria is of especial importance in the field of geriatrics. I now have records of about 20 elderly patients presenting with neurological symptoms and signs where the diagnosis of diabetes mellitus has been previously dismissed because of the absence of glycosuria. Subsequent glucose tolerance tests have established the true aetiology, and appropriate treatment invariably results in satisfactory improvement.

Epidemic keratoconjunctivitis in the West of Scotland, 1967-72

Outbreaks of epidemic keratoconjunctivitis have occurred among workers in shipyards and other industrial concerns in the West of Scotland in 1956, 1967 and 1971-72. In the most recent episode 220 persons were known to be affected and those mainly involved were shipyard personnel working on the open decks of ships under construction; only a few non-industrial workers were affected. As in previous outbreaks adenovirus type 8 was shown to be the causal organism. It is likely that spread of the virus was probably facilitated in some of the patients by such procedures as first aid measures to remove foreign bodies from the eye. A survey of the family contacts of those affected in 1971-72 revealed that only 2% were secondarily infected. This was probably due to propaganda measures to discourage the use of communal face towels, etc.Despite close virological surveillance over a period of 6 years of patients attending opthalmic clinics in the West of Scotland, there is as yet no clue to the whereabouts of adenovirus type 8 during interepidemic periods. It is suggested that travellers might be responsible for the introduction of the infection into an area.

Immune status of children of immigrants to poliomyelitis.

Four ethnic groups of children from the Glasgow area--155 Asians, 85 Africans, 85 Chinese, and 93 Scots--were examined for neutralising to poliovirus types 1, 2, and 3. Only seven of the 418 children had no detectable antibody, and of these, four were aged less than 7 months; none had received polio vaccine. The best-protected children were the Chinese (93% with antibody to all three poliovirus types), followed by the African (81%), Scottish (78%), and Asian children (77%). We conclude that children of immigrants are no more vulnerable to poliovirus infection than their Scottish counterparts.

Letter: Epidemiology of poliomyelitis in Scotland.

SIR,-The excellent article by Wing Commander H F Oxer (20 September, p 692) has drawn attention to the problems involved in aeromedical flights. Having assessed a patient as suitable for transportation by air the doctor or hospital is often faced with the problem of organising a suitable flight. The St John Ambulance aeromedical service operates a unique voluntary 24-hour international emergency travel service by air ambulance charter or by airline scheduled flights for the escort of patients to or from any part of the world and within the UK. Air ambulance flights are particularly useful for seriously ill patients who may require considerable in-flight care. There is the additional advantage of being able to land at a much greater number of airports, the patient thus having to travel shorter road distances between airport and hospital. The St John aeromedical service charters the following aircraft: HS 125 jets, Cessna Golden Eagles, Navajo Chieftains, Islanders, Aztecs, and Senecas. Each aircraft has advantages and disadvantages compared with the others but with the range of aircraft available a comprehensive service is provided. On every flight a volunteer team of two or three air attendants (selected from a register of doctors, nurses, and lay members, all of whom have undergone additional aeromedical training) take standard medical packs which include oxygenation, automatic ventilation, resuscitation, intubation, and intravenous equipment. At present the service covers the whole of Western Europe and North and West Africa. When escorting cases on airline scheduled services the St John service makes the necessary booking arrangements for stretcher fittings or sitting patients and for dealing with customs and immigration, the Foreign Office, embassies, and consuls. All St John air attendants carry the necessary international health documents. Patients are escorted to or from any part of the world and the air attendant will, if necessary, accompany the patient from the hospital bed in Britain to the hospital bed in the destination country or vice versa. I should be pleased to supply further information on request.