Rickey Wilson

ILLNESS CAUSED BY VIBRIO DAMSELA AND VIBRIO HOLLISAE

Vibrio damsela was isolated from six wound infections in otherwise healthy persons. In five of the six cases the wounds were known to have been exposed to salt or brackish water at the time of the injury. Vibrio hollisae was isolated from an index stool culture in nine cases in which no other enteric pathogen was identified. All nine patients had diarrhoea and abdominal pain; one patient had bloody diarrhoea. Six of the nine patients were known to have eaten raw seafood in the five days before they became ill. These data suggest that both V. damsela and V. hollisae can produce diseases with distinct clinical and epidemiological characteristics.

Non-O Group 1 Vibrio cholerae Gastroenteritis in the United States: Clinical, Epidemiologic, and Laboratory Characteristics of Sporadic Cases

Fourteen sporadic cases of non-O group 1 Vibrio cholerae gastroenteritis were identified through isolates submitted to the Centers for Disease Control in 1979. All the ill persons had diarrhea, 13 had abdominal cramps, 10 had fever, and three had vomiting; in four cases the patients had bloody diarrhea. Five patients had traveled outside the United States before they became ill. All nine domestically acquired cases were in patients who had eaten raw oysters within 72 hours of onset of illness; in a matched case-control study, illness in these patients was strongly associated with eating raw seafood (p less than 0.0001). Only one isolate produced heat-labile toxin by a Y-1 adrenal cell assay. All isolates were susceptible to tetracycline, chloramphenicol, kanamycin, and cephalothin.

Short Communication. Age at Onset of Necrotizing Enterocolitis: an Epidemiologic Analysis

Summary: We studied the epidemiologic interrelationships among birth weight, gestational age, and age at onset of necrotizing enterocolitis of the newborn. As birth weight increased, the range of ages at onset and the mean age at onset both decreased. Weekly birth weight-specific attack rates for necrotizing enterocolitis declined sharply in all birth weight groups when the equivalent of 35–36 wk gestational age was reached. Our data are consistent with the hypothesis that the risk period for necrotizing enterocolitis is determined primarily by the maturity of the gastrointestinal tract of the newborn.

1465 AGE AT ONSET FOR NECROTIZING ENTEROCOLITIS (NEC): EPIDEMIOLOGIC AND CLINICAL ANALYSIS

We examined the epidemiologic features of age at onset of NEC and studied infants of ≤1500 grams (gm) birthweight (BW) with NEC for factors predictive of early (<10 days) and late (>10 days) onset. For 1977-1978 NEC cases in Georgia, we found that mean age at onset of NEC increased as BW decreased; the proportion of infants with late onset illness declined from 66% for BW ≤1000 gm to 0% for BW >2500 gm (p<.0001, linear trend). BW specific weekly attack rates (AR) and mean gestational age (GA) for each BW group were:The AR declined significantly at 35-36 wks equivalent GA for each BW group. Only 4 of 62 infants with BW >1500 gm had late onset illness compared to 45 of 86 weighing ≤1500 gm. For infants with NEC weighing ≤1500 gm, no significant differences were found in Apgar scores, use of antibiotics, feedings, presence of 19 maternal and 14 neonatal risk factors or in outcome of illness between those of early and late onset. Our data support a major role for gut immaturity as a determinant of the risk period for development of NEC.

500 EPIDEMIOLOGIC CHARACTERISTICS OF NECROTIZING ENTEROCOLITIS (NEC) IN GEORGIA

The widely varied institutional reports of incidence rates and fatality ratios (FR) of NEC prompted a statewide epidemiologic study of this disease. We defined NEC using the criteria of Bell (J Pediatric Surg 1978;187:1), and identified all cases of NEC occurring in Georgia residents born during 1977 and 1978. Case finding included visits to tertiary-care centers, a telephone survey of smaller nurseries with follow-up visits when necessary, and contact of intensive-care nurseries in neighboring states. Hospital-chart review identified 148 cases; 78 infants were females and 70 males. Birth-weight and rate-specific incidence rates and FR were:NEC rates for infants weighing less than 2500 grams were higher for blacks than whites (p<.005). Weight-specific FR were not affected by transport. Weight-specific incidence rates and FR did not vary significantly among 6 tertiary centers. NEC deaths represented 15% of all post-hebdomadal deaths of infants weighing less than 1500 grams. Further evaluation of NEC in populations of different socioeconomic and ethnic makeup is needed.