Robert A. Pollard

Campylobacter Enteritis in the United States: A Multicenter Study

During a 15-month study, 8097 fecal specimens submitted to clinical microbiology laboratories at eight hospitals in different parts of the United States were examined. Campylobacter jejuni was isolated from 4.6%, Salmonella from 2.3%, and Shigella from 1.0%. Isolation rates for each pathogen were highest from stool specimens that were watery, bloody, or contained leukocytes. The peak isolation rate for C. jejuni was in persons ages 10 to 29 years; for Salmonella, in children younger than age 10 years; and for Shigella, in children ages 5 to 9 years. The clinical features of the three infections were nearly identical. In contrast, abdominal pain, bloody diarrhea, fever, tenesmus, and abnormal sigmoidoscopy findings were present significantly more often in patients infected with C. jejuni than in a control group of patients with diarrhea. Of patients with leukocytes in their stools and a history of fever, 45.9% were infected with one of the three pathogens. Use of laboratory and clinical findings defined groups with high or low risk of these three infections but could not accurately predict isolation. Fecal cultures had the highest yields when obtained from patients within 7 days from the onset of symptoms.

National Trends in the Initial Hospitalization for Heart Failure

OBJECTIVES: Heart failure is a major health care burden among older adults, but information on recent trends has not been available. We compare rates, sociodemographic characteristics, and discharge outcomes of the initial hospitalization for heart failure in the Medicare populations of 1986 and 1993.

The Shifting Stroke Belt Changes in the Geographic Pattern of Stroke Mortality in the United States, 1962 to 1988

BACKGROUND AND PURPOSE The factors that contribute to the Stroke Belt--a concentration of high stroke mortality rates in the southeastern United States--remain unidentified. Previous hypotheses that focused on physical properties of the area have not been confirmed. This study describes changes in the locations of areas with the highest rates of stroke mortality and the implications for new hypotheses regarding the Stroke Belt. METHODS We calculated annual, age-adjusted stroke mortality rates for black women, black men, white women, and white men for the years 1962 to 1988 using a three-piece log-linear regression model. Maps were produced with the state economic area (SEA) as the unit of analysis. The baseline Stroke Belt was defined as the area with the largest concentration of high-quintile SEAs in 1962. RESULTS The concentration of high-rate SEAs tended to shift away from the Piedmont region of the Southeast and toward the Mississippi River valley. For example, whereas among black women in 1962, 72% of SEAs in the baseline Stroke Belt were in the highest quintile, by 1988 this percentage had dropped to 48%. Similar patterns were observed for the other race/sex groups. CONCLUSIONS Temporal changes in the location of areas with the highest stroke mortality rates suggest that new hypotheses for understanding the geographic pattern of stroke mortality should consider temporal trends in a variety of medical, socioeconomic, and behavioral factors.

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.

A large outbreak of foodborne salmonellosis on the Navajo Nation Indian Reservation, epidemiology and secondary transmission.

In September 1974, the largest outbreak of foodborne salmonellosis ever reported to the Center for Disease Control--affecting an estimated 3,400 persons--occurred on the Navajo Nation Indian Reservation. The responsible agent was Salmonella newport and the vehicle of transmission was potato salad served to an estimated 11,000 persons at a free barbecue. The cooked ingredients of the potato salad had been stored for up to 16 hours at improper holding temperatures. The magnitude of the outbreak allowed us to study secondary transmission by calculating the rates of diarrheal illness during the 2 weeks following the outbreak in persons who did not attend the barbecue and by examining the results of stool cultures obtained after the outbreak. We found no secondary transmission. We conclude that a health official should monitor food preparation and service at large social gatherings and that person-to-person transmission of salmonellosis probably does not normally occur even in settings considered highly conductive to cross-infection.

ACUTE WATER SHORTAGE AND HEALTH PROBLEMS IN HAITI

During a severe drought Port-au-Prince, Haiti, lost hydroelectric power for 10 weeks. This led to water shortages in areas of the city dependent on water supplied from electrically driven pumps. In a study of the impact of water restriction on disease, 400 families were randomly selected from two urban areas differentially affected by the water shortage. Disease in children was found to be related to quantity of water used, socioeconomic status, employment of head of household, and family size. The methods used in this study are recommended for the investigation of the relationship between water quantity and health.