Detection Of Disease Outbreaks Research Articles

Watershed protection for New York City's supply

New York City is making every effort to protect its watershed to assure water quality and maintain filtration avoidance.Since 1987, New York City has enhanced its comprehensive watershed monitoring program (including pathogen monitoring), developed a disease surveillance and outbreak detection program, and implemented a watershed protection program that has improved water quality. The city recognized that high‐quality source water and effective watershed protection are the foundation of filtration avoidance under the federal Surface Water Treatment Rule (SWTR). Accordingly, the city applied for and received filtration avoidance determinations for the Catskill and Delaware portions of its system. This article summarizes the city's water quality data and watershed monitoring and protection programs in the context of the SWTR. A Watershed Memorandum of Agreement, signed Jan. 21, 1997, provides for land acquisition, updated watershed regulations, and partnership programs. As part of the watershed agreement, USEPA issued a four‐month interim filtration avoidance and will issue a revised filtration avoidance later in 1997. Provided the city meets certain provisions, this will allow it to avoid filtering the Catskill and Delaware supplies until at least Apr. 15, 2002.

Panel Calls E coli Screening Inadequate

HOPING TO REDUCE unnecessary medical treatment and strengthen the detection of disease outbreaks, an expert panel has recommended widespread culturing of laboratory specimens for Escherichia coli O157:H7. The panel, sponsored by the American Gastroenterological Association Foundation, met last month in Washington, DC. After hearing testimony from experts in medicine, public health, the food industry, and federal regulatory agencies, the panel produced a report with recommendations to stem "a major national problem." Who's Getting Sick, and Why? From 1982, when the virulent O157:H7 strain was identified as a human pathogen, through 1992, only two to three outbreaks were investigated each year in the United States. The figure jumped to 16 in 1993; 11 outbreaks during the first half of this year are being studied. Some of the increase is attributed to growing awareness, but the panel said the actual number of infections appears to be rising. It is estimated that E

Rapid detection of parainfluenza virus type 3 RNA in respiratory specimens: use of reverse transcription-PCR-enzyme immunoassay.

Parainfluenza virus type 3 (PIV-3), an important lower respiratory tract pathogen in young children and immunocompromised individuals, may be underdiagnosed because of the insensitivity of available culturing systems and delay in identification of virus in cell culture. We developed a reverse transcription-PCR-enzyme immunoassay (RT-PCR-EIA) for PIV-3, using primers specific for a highly conserved region of the hemagglutinin-neuraminidase gene. Testing of nasal washes spiked with PIV-3 or other respiratory viruses showed that this assay detected seven strains of PIV-3 but not other respiratory viruses. Of 103 respiratory tract samples obtained from children experimentally infected with a liver PIV-3 vaccine or naturally infected with wild-type PIV-3, 51 were positive by culture and 48 were positive by RT-PCR-EIA. Eleven of the culture-positive samples were negative by RT-PCR-EIA; however, none of these grew virus upon reinoculation into cell culture, indicating that virus was lost or was present at a very low titer. Eight of the culture-negative samples were positive by RT-PCR-EIA: two were obtained from a subject who was culture negative but had a serologic response to PIV-3, four were obtained 7 to 9 days after the first positive culture, and two were obtained 1 day prior to the first positive culture. Thus, this RT-PCR-EIA for PIV-3 is sensitive and specific and can detect viral RNA in samples from which virus cannot be cultivated. This assay could be used for diagnosis late in the course of PIV-3 infection and for accurate detection of disease outbreaks.

Active Morbidity Surveillance After Hurricane Andrew—Florida, 1992

<h3>Objective.</h3> —To describe the health status of and to detect disease outbreaks in the population affected by Hurricane Andrew in south Dade County, Florida. <h3>Design.</h3> —The Florida Department of Health and Rehabilitative Services and the US Army conducted active surveillance for gastrointestinal illness, respiratory illness, injury, and other index conditions by monitoring civilian and service member visits to care sites (civilian and military free care sites and hospital emergency departments) from August 30 (1 week after the hurricane's landfall) through September 30, 1992. <h3>Setting.</h3> —South Dade County, Florida. <h3>Main Outcome Measures.</h3> —Proportional morbidity: the number of daily visits for each index condition divided by the total number of visits, expressed as a percentage. Morbidity rate: the total number of daily visits by service members divided by the total number of service members, expressed as a percentage. <h3>Results.</h3> —Six index conditions accounted for 41.3% of visits to civilian free care sites: diarrhea (4.7%), cough (4.7%), other infection (9.6%), rash (5.4%), animal bite (1.2%), and injury (15.7%). At military free care sites, five index conditions accounted for 75.7% of civilian visits: injury (23.7%), dermatologic illness (12.4%), respiratory illness (9.9%), gastrointestinal illness (5.3%), and other medical conditions (24.4%). Two index conditions accounted for 54.1% of service member visits: injury (36.2%) and dermatologic illness (17.9%). During the 5 weeks after the hurricane, proportional morbidity from injury decreased; proportional morbidity from respiratory illness increased; and proportional morbidity from diarrhea was stable. No infectious disease outbreaks occurred. <h3>Conclusions.</h3> —Injuries were an important source of morbidity throughout the surveillance period, especially among service members. Enteric and respiratory agents did not cause disease outbreaks, despite alarming rumors to the contrary. (<i>JAMA</i>. 1993;270:591-594)

Active morbidity surveillance after Hurricane Andrew--Florida, 1992.

To describe the health status of and to detect disease outbreaks in the population affected by Hurricane Andrew in south Dade County, Florida. The Florida Department of Health and Rehabilitative Services and the US Army conducted active surveillance for gastrointestinal illness, respiratory illness, injury, and other index conditions by monitoring civilian and service member visits to care sites (civilian and military free care sites and hospital emergency departments) from August 30 (1 week after the hurricane's landfall) through September 30, 1992. South Dade County, Florida. Proportional morbidity: the number of daily visits for each index condition divided by the total number of visits, expressed as a percentage. Morbidity rate: the total number of daily visits by service members divided by the total number of service members, expressed as a percentage. Six index conditions accounted for 41.3% of visits to civilian free care sites: diarrhea (4.7%), cough (4.7%), other infection (9.6%), rash (5.4%), animal bite (1.2%), and injury (15.7%). At military free care sites, five index conditions accounted for 75.7% of civilian visits: injury (23.7%), dermatologic illness (12.4%), respiratory illness (9.9%), gastrointestinal illness (5.3%), and other medical conditions (24.4%). Two index conditions accounted for 54.1% of service member visits: injury (36.2%) and dermatologic illness (17.9%). During the 5 weeks after the hurricane, proportional morbidity from injury decreased; proportional morbidity from respiratory illness increased; and proportional morbidity from diarrhea was stable. No infectious disease outbreaks occurred. Injuries were an important source of morbidity throughout the surveillance period, especially among service members. Enteric and respiratory agents did not cause disease outbreaks, despite alarming rumors to the contrary.

Guidelines for the epidemiologic assessment of occupational asthma: Report of the Subcommittee on the Epidemiologic Assessment of Occupational Asthma, Occupational Lung Disease Committee

Physician reporting of cases of communicable disease has played an important role in detection and control of disease outbreaks.’ A similar expectation exists for physician reporting of occupational diseases, including occupational asthma. The diagnosis of a single case of occupational asthma may be a sentinel event that reveals the need to search for other cases, as well as remediable underlying causes.’ As stated by Rutstein et al.,3 such an occurrence may: “(1) provide the impetus for epidemiologic or industrial hygiene studies, or (2) serve as a warning signal that materials substitution, engineering control, personal protection, or medical care may be required.” Also, other purposes may be served by consequent epidemiologic and industrial hygiene studies. An epidemiologic survey may be needed to convince responsible parties that a health problem exists that is in some measure attributable to workplace exposures. An epidemiologic survey will be needed to quantitate the magnitude of a work-related health problem, whether the magnitude is expressed as disease prevalence, incidence, or some other measure. An epidemiologic study may identify personal risk factors that explain why certain persons have manifested a disease as a consequence of their occupational exposure(s). Resultant recommendations for control of exposures in the workplace may facilitate management of the index case and affected co-workers, and help prevent the occurrence of additional cases.