Philip S. Brachman

Field Evaluation of a Human Anthrax Vaccine

IN A SERIES of papers published from 1951-1955,- Wright and colleagues, reported on the development of an anthrax vaccine. This vaccine was shown to be an effective immunizing agent for laboratory animals and its safety for human use was demonstrated by the successful injection of 600 scientific personnel at Fort Detrick. Its value for human immunization could be established through a field study of a susceptible industrial population known to be chronically exposed to anthrax. This communication reports the data collected in such a study over a fouryear period.

An epidemic of inhalation anthrax, the first in the twentieth century: I. Clinical features

Abstract Five cases of inhalation anthrax and four cases of cutaneous anthrax are presented. Three inhalation and two cutaneous cases were proved by culture or microscopic demonstration of the anthrax bacillus, and the others were clinically consistent with the diagnosis. These cases constituted an epidemic, for they all occurred within a ten-week period at a goat hair processing mill. The illnesses of the patients with inhalation anthrax began insidiously with mild fever, fatigue and malaise lasting several days. This mild initial phase was terminated by the sudden development of dyspnea, cyanosis and, in two cases, disorientation and coma. Four patients died within twenty-five hours of the onset of severe symptoms. The principal lesions found by pathologic examination of three patients were hemorrhagic mediastinitis and lymphadenitis, pleural effusion, acute splenitis and, in two cases, hemorrhagic meningitis. The pathogenesis, symptoms, diagnosis and treatment of inhalation anthrax are discussed. Physicians should consider this disease when faced with an acute febrile illness in a person occupationally exposed to anthrax spores.

Epidemic salmonellosis in hospitals and institutions. A five-year review.

Abstract During the period 1963–1967 the Salmonella Surveillance Report recorded 40 epidemics of salmonellosis in hospitals and institutions, involving 3025 patients and 43 deaths. Epidemics occurred in newborn nurseries, pediatric wards, general-hospital wards, nursing homes and mental institutions. Epidemics involving children were smaller and associated with higher case fatality ratios and more often spread by cross-infection than outbreaks affecting adults. Common-vehicle outbreaks were usually limited to adults and were most frequently due to eggs or egg products. Early detection of outbreaks requires an alert hospital surveillance system. In common-vehicle outbreaks, the contaminated vehicle must be identified and removed. In cross-infection outbreaks, a search for human excreters and contaminated environmental objects must be made. Cross-infection outbreaks are difficult to halt and require vigorous enforcement of hygienic technics, isolation of salmonella excreters and patients admitted with diarr...

Two Cases of Fatal Inhalation Anthrax, One associated with Sarcoidosis.

IN April, 1957, a twenty-eight-year-old man with a two-and-a-half-year history of confirmed sarcoidosis contracted fatal inhalation anthrax. The diagnosis was proved by pathological and bacteriologic studies. During the ensuing epidemiologic investigation, a previously proved case of fatal inhalation anthrax in a fifty-year-old housewife was uncovered. The woman may have been exposed to the same source of Bacillus anthracis as the man even though the cases occurred eight years apart. It is unusual to encounter cases of anthrax, either the cutaneous or the inhalation form, in which the source of the infecting organism is not obvious or readily discovered, for most .xa0.xa0.

Isolation from Animals of Human Strains of Staphylococci during an Epidemic in a Veterinary School

Antibiotic-resistant staphylococci of the same bacteriophage type were isolated from the external nares of asymptomatic domestic animals and from human beings during an epidemic of staphylococcal disease in veterinary students. Not all of the infections could be attributed to person-to-person contact; spread could be explained also by transmission of staphylococci from animals.

Francisella tularensis in New England.

Tularemia was first described by McCoy in 1911 as a plague-like disease of rodents; the etiologic agent was identified in the following year and named Bacterium tularense after Tulare County, California, the location of the initially observed epizootic among ground squirrels. Because the illness that it causes is clinically similar to plague, in both man and animals, the organism became known as Pasteurella tularensis. However, this organism is distinctly different from other pasteurella species, so that it has recently been renamed Francisella tularensis after Dr. Edward Francis, whose early work led to clarification of transmission cycles and etiologic and immunologic .xa0.xa0.