surveillancesummary xjc>/q. brucellosis -unitedstates, 1978
TRANSCRIPT
CENTER FOR DISEASE CONTROL September 21, 1979 / Vol. 28 / No. 37
Surveillance Summary
437 Brucellpsjs^Umied States, 1978
, lntar(foti0nal'fl«e^Nv439 YeftovV Fever ^ Trinidad, Colombia
Epjdemiologic Notes and Reports
445/staphylococcal Food Penning —/(Delaware £ r iQjo \ > \
\ J ^Current Trerwis44Q^ajrvejllance of Chilo-hoodJLead
MORBIDITY AND MORTALITY WEEKLY REPORT AfP'soning - Unitedjtatfw/
Surveillance Summary xjc>/ q .
Brucellosis - United States, 1978
In 1978, 172 cases of brucellosis were reported to the Center ToT"BTSBclS^WTtrol.
This is a decrease of 69 cases from the 241 reported in 1977, and it is also the lowest
number of cases reported in any year since 1927, when brucellosis was first recognized as
a common cause of human illness.
Of these 172 cases, surveillance reports were received on 161 (94%); 127 (79%) of
these were classified as initial infections, and 15 (9%) were recrudescent.* No reinfections
were reported with onset in 1978. There were also no fatal cases.
Onset of illness was specified as acute or insidious in 104 brucellosis cases: acute
in 57 (55%) and insidious in 47 (45%). In 136 cases the month of onset was specified.
Onset of illness was reported to occur more frequently in the spring and summer than
in the fall and winter-a pattern observed for the period 1965-1974 (/).
As in the past, brucellosis predominantly affected adult males. Of 160 cases for which
sex was specified, 134 (84%) were in males; 116 (82%) of 142 cases for which age was
given were in persons between 20 and 60 years of age. This is the age category of the
work force in the United States and the population at greatest risk of acquiring brucello
sis in the meat-packing and livestock industries. Indeed, 58 (46%) of the 127 cases for
which information was available were in individuals working in the meat-processing
industry (Figure 1).
Thirty-eight states reported cases last year (Figure 2) compared with 37 states, Puerto
Rico, and Guam in 1977. Two states, Iowa and Texas, reported more than 15 cases
each and together accounted for 22% of the 1978 total. Idaho reported the greatest
increase in total cases (5), while Virginia reported the greatest decrease (33). Virginia's
marked decline was because of a reduction in swine-associated cases in abattoir workers.
The majority of the Idaho cases were associated with cattle.
As in the period 1975-1977, cattle were the most common source of human infection
last year. Contact with infected cattle resulted in 54 (34%) human cases in 1978. Swine-
associated cases were markedly reduced, due primarily to Virginia's decrease in such
cases. Contact with infected domestic swine was responsible for 16 cases (10%), and
*A confirmed case was defined as 1). a clinical specimen culture-positive for Brucella, or 2). clinical
symptoms compatible with brucellosis, such as any combination of fever, sweats, chills, undue fatigue,
anorexia, weight loss, arthralgia, lymphadenopathy, and splenomegaly,and a >4-fold change in Brucella
agglutination titer between acute and convalescent serum specimens obtained 2 or more weeks apart
and studied at the same laboratory. A presumptive case was defined as clinical symptoms compatible
with brucellosis with either a Brucella agglutination titer positive at a >1:160 dilution on a single
serum specimen obtained after the onset of symptoms or a stable Brucella agglutination titer positive
at a >1:160 dilution in serum specimens obtained after the onset of symptoms. A recrudescent case
is a confirmed or presumptive case in a person who, within the preceding 3 years, had an illness
diagnosed as brucellosis followed by a period of apparent recovery.
U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE
MMWR September 21, 1979
Brucellosis - Continued
feral swine for 2 cases in hunters. An additional 18 (11%) cases resulted from contactwith cattle and swine. Three cases were associated with contact with dogs. Fourteen (9%)
cases were attributed to the ingestion of unpasteurized dairy products-9 of these to
milk produced in the United States. Five cases were attributed to foreign dairy products,
including raw milk or cheese from Mexico (3 cases), Iran (1 case), and an unspecified
Latin American country (1 case). Accidental injection of strain 19 Bruce/la vaccine was
listed as the cause in 3 cases, all in veterinarians, and laboratory accidents resulted in2 cases.
Reported by the Bacteria/ Zoonoses Br, Bacterial Diseases Div, Bur of Epidemiology, CDC.
Editorial Note: A review of brucellosis cases in the United States from 1967 to 1978
emphasizes the importance of abattoirs in the epidemiology of brucellosis. In 7 of the last10 years, more than half of reported cases occurred in people associated with the meat-processing industry (Figure 2). Of 2,063 cases on which reports were received in this10-year period, 1,171 (57%) were in abattoir workers.
Reference
1. Fox JD, Kaufmann AF: Brucellosis in the United States, 1965-1974. J Infect Dis 136- 312-3161977
A A copy of the surveillance report from which these data were summarized is available on requestfrom CDC, Attn: Bacterial Zoonoses Br, Bacterial Diseases Div, Bur of Epidemiology, CDC.
FIGURE 1. Total brucellosis cases and proportion associated with abattoirs * UnitedStates, 1967-1978
TOTAL REPORTS RECEIVED
— ABATTOIR-ASSOCIATED ANON-ABATTOIR
o 250-UJ
2 150-Ui
K
UICO
< I00-
I967 68 69 '70 '71 '72 '73 '74 '75 '76 '77 '78
'Includes packinghouse employees, government meat insDectors. and renrierinn nlant
September 21, 1979 MMWR
Brucellosis — Continued
FIGURE 2. Human brucellosis cases, by state, United States, 1978
International Notes
Yellow Fever — Trinidad, Colombia
Trinidad: On September 11, the Ministry of Health, Trinidad and Tobago, officially
notified the Pan American Health Organization and the World Health Organization (WHO)
that an outbreak of jungle yellow fever had been confirmed in howler monkeys from the
Mamural Forest of central Trinidad. In addition, 7 suspected human cases—all sylvatic-
were under investigation.
A similar outbreak of jungle yellow fever in the Guayaguayare Forest of southeast
Trinidad occurred in the fall of 1978 and spring of this year (1-3). As a result of that
outbreak, more than 75% of the population of Trinidad was immunized in a mass im
munization program in the spring of 1979.
Control measures for Aedes aegypti and surveillance for suspected human cases are
continuing throughout the island.
The island of Tobago remains free of yellow fever infection.
Colombia: A recently reported outbreak of yellow fever (4) appears to be spreading
north from Valledupar toward the more populated coastal areas. Several cases have
been reported in Fundacion and Cienaga, about 40 miles east of Barranquilla on the
coast. Health officials are vaccinating persons in the Fundacion area and other coastal
areas to the west. Although it has not been determined that the A. aegypti vector is in
volved in the outbreak, this species is known to be prevalent throughout the affected area.
440 MMWR September 21, 1979
Yellow Fever — Continued
Currently, the following areas of Colombia are officially included in those listed by
WHO as being infected with jungle yellow fever: Caqueta Intendencia, Cesar Department,
Magdalena Department, Meta Intendencia, Norte de Santander Department, Santander
Department, and Vaupes Comisaria.
Reported by the Pan American Health Organization; Office of Foreign Disaster Assistance, U.S. De
partment of State; Quarantine Div, Viral Diseases Div, Bur of Epidemiology, CDC.
Editorial Note: Because of the official declaration that the island of Trinidad is infected
with yellow fever, CDC now recommends yellow fever vaccination for all travelers to the
island of Trinidad. There is no evidence of risk for visitors who limit their activities to
urban areas, such as cruise ship passengers visiting Port of Spain. Nevertheless, even
visitors with such limited travel in Trinidad may be subject to quarantine restrictions in
other Caribbean and Central American ports of entry in view of Trinidad's "yellow fever
infected" status.
In view of the current yellow fever activity in Colombia, all travelers to the northern
coast of that country should be vaccinated against yellow fever. Travelers to other areas
of Colombia listed as infected with yellow fever should be vaccinated, unless their acti
vities are limited to urban areas.
References
1. MMWR 27:509, 1978
2. MMWR 28:72, 1979
3. MMWR 28:279, 1979
4. MMWR 28:371, 1979
TABLE I. Summary — cases of specified notifiable diseases. United States
[Cumulative totals include revised and delayed reports through previous weeks.]
nioc ACrUldEMdE
Aseptic meningitis
Brucellosis
Chickenpox
Diphtheria
Encephalitis: Primary (arthropod-borne & unspec.)
Post-infectious
Hepatitis, Viral: Type B
Type A
Type unspecified
Malaria
Measles (rubeola)
Meningococcal infections: Total
Civilian
Military
Mumps
Pertussis
Rubella (German measles)
Tetanus
Tuberculosis
Tularemia
Typhoid fever
Typhus fever, tick-borne (Rky. Mt. spotted)
Venereal diseases:
Gonorrhea: Civilian
Military
Syphilis, primary & secondary: Civilian
Military
Rabies in animals
37th WEEK ENDING
September
23
1979
367
6
252
—
3i
6
29?
586
234
10
<»2
21
21
—
70
36
36
3
497
7
IS
23
»211
381
*95
10
90
15, September 16,
1978*
293
2
240
—
67
3
272
497
139
19
200
29
28
1
58
41
140
-
56 7
1
<i
23
20,955
52 5
475
4
63
MEDIAN
1974-1978*
171
6
248
1
63
3
2 72
599
158
1 2.
107
29
28
—
183
41
78
1
58B
1
10
27
21,331
525
410
5
59
CUMULATIVE, FIRST 37 WEEKS
. September 15,
1979
4.535
110
171,292
62
595
170
10*215
20,638
7,358
4-70
12,135
1,933
1.923
10
11,189
968
10,660
50
19,928
148
335
857
699,722
19.494
17,115
224
3.503
TABLE II. Notifiable diseases of low frequency. United State;
Anthrax
Botulism (Wash. 1, Calif. 1)
Cholera (Calif. 1)
Congenital rubella syndrome
Leprosy t
Leptospirosis (Va. 1)
Plague
"Delayed reports received for calendar year 1978 are u
"Medians for gonorrhea and syphilis are based on data
tThe following delayed reports will be reflected in
CUM. 1979
- Poliomyel
17
1 Psittacosis
36 Rabies in i
114 Trichinosi
32 Typhus fe\9
sed to update last year's weekl
for 1976 1978.
next w eek's cumulative totals
tis: Total
Paral
(Colo. 1)
nan
t (Upst. t
er, flea-bo
i and cum
Leprosv:
«ic
J.Y. 1, N.J. 1, La. 1
me (endemic, murin
jlative totals.
P.R. +1: Trichinos
September 16,
1978*
3.820
126
124,132
59
802
162
10,671
20,311
5,892CIA
23,944
1.823
1,800
23
13.425
1,488
16,874
59
20,687
88
364
874
703,068
18.363
14,776
204
2.261
. Tex. 1)
e) (Tex. 7)
is: Mo. +1. N.Me
MEDIAN
1974-1978"
2,364
164
124,132
126
802
198
10,580
24,081
5,900
23.944
1,158
1,141
23
32,698
1.098
14,826
59
21,769
105
281
737
703,068
19,235
14,776
209
2.099
CUM. 1979
23
20
76
2
113
♦2
x. +3.
September 21, 1979
TABLt 111 (Cont.'d). Cases of specified notifiable diseases. United States, weeks ending
September 15, 1979, and September 16,1978 (37th week)
REPORTING AREA
MEASLES(RUBEOLA) MENINGOCOCCAL INFECTIUNS
TOTALPERTUSSIS RUBELLA TETANUS
CUM. CUM.
1979 1979
UNITED STATES
NEW ENGLAND
Maine
N.H.
MID. ATLANTIC
Upstate N.Y.
N.Y. City
N.J.t
E.N. CENTRAL
Ohiot
Ind.
36 13,660 50
1,
3,
1.
1,
1,
287
17
32
119
13
102
4
513655
756
57
45
14 3
264
204
•'.06
82 3
*46
733
214
16
420
20
2
1,961
1.314
46
25
241
a
32 7
2,165
1.390
346
74
S5S
10.8U
191
1,078
7.606
1.467
387
36
57
9
193_
—
-
1
-
-
4
2
1
-
1
B
-
3
1
3
3
4
-
_
1,
1,
2.
I,
122
397
481
93
255
899
259
322
264
M4j
135
726
179
192
252
447
52
—
—
3
-
1
9
3
4
1
1
3
2
-
-
1
-
2
—
_
E.S. CENTRAL
Ky.
Tenn.
Ala.
W.S. CENTRAL
Ark.
MOUNTAIN
Mont
Idaho
Wyo.
Colo.
N. Mex. t
269
54
112
151
450
768
201
37
56
84
24
900
9
247
22
622
318
57
21
36
2,
1,
1,
1.
B24
042
117
1 97
2H
7 5(,
407
119
943
101
244
051
16
343
13
6 7S
2 50
106
1_
2,
1,
220
61
951
837
165
146
519
146
29
41
36
40
311
26
143
28
35
45
35
2 6 9
21
I
1
1—
-
9—
1.323
1,088
98
22
115
1.342
480
2
2
-
-
-
1_
41
3
4
3
7
J 5
5
4
243
40
1
-
-
_
-
-
-
1
10_
2t>5
10
8
75
12
53
94
13
686
186
P.R. t
V.I.
Pac. Trust Terr, t
NA: Not available.
"Delayed reports received for 1978 are not sho
tThe following depay
Mo. +5, Md. -1, N.Mex. +1, Calif. +1, P.R.+1; Mumps: Mo.+4, Calif.+4, Gua
Mo. M.Calif.+3.
mlative totals.
-3, Mo. -7, Calif. +4, Guam +4; Men. inf.: Mich. +1,
H: Pertussis: Mo. +6, Calif. +3; Rubella: Conn. +1, N.J. -1.
September 21, 1979
TABLE III (Cont.'d). Cases of specified notifiable diseases. United States, weeks ending
September 15,1979, and September 16, 1978 (37th week)
REPORTING AREA
TYPHUS FEVER
(Tick-borne) H
(RMSF)
VENEREAL DISEASES (Civilian)
SYPHILIS (Pri. & Si
UNITED STATES 497 19,928 148
NEW ENGLAND 10 546 3
857 23.211
MID. ATLANTIC 73 3,103
Upstate N.Y. 24 595
N.Y. Cityt 15 1.138
N.J. 20 568
Pat 14 802
EN. CENTRAL
Ohiot
Ind.
III.
Mich.t
Mb.
W.N. CENTRAL
Minn.
lawn
Mo. t
N. Dak.
& Dak.
Nebr.t
Kans.t
& ATLANTIC
Del.
Md.t
D.C.
Va.
W. Va.
N.C.t
S.C.
Ga.
Fla. t
E.a CENTRAL
Ky.
Tenn.
Ala.
Miss
W.S. CENTRAL
Ark.
La.
Okla.
Tex.t
MOUNTAIN
Mont
Idaho
Wyo.t
Colo.
N. Mex.t
Ariz.
Utah
Nm
PACIFIC
Wash.
Oreg.
Calif, t
Alaska t
Hawaii
M
12
6
H9
24
3
22
2
2
15
—
-
z
I
93
—
6
-
26
i
13
4
14
27
55
12
12
21
10
56
3
>t
11
38
19-
_
2
2
I
11
1
2
B9
4
4
73
l.
2,949
532
373
1,168
744
132
688
109
56
370
14
41
16
82
4,540
36
586
217
540
174
724
326
712
1,225
1,832
477
517
4 30
40S
2,411
208
t84
263
1,456
60 7
29
10
6
8 9
104
297
25
47
3.252
190
137
2,635
52
6 2.605
2 317
1 1,163
5 107
8 1,013
108.041
29,873
9,272
33.547
25,552
9,798
106,971
27,963
11, 148
33,458
24,759
9,643
53 2,2«7
17 442
X 166
25 1.282
6 329
98 4,093
21
10 273
8 319
13 3*7
37 1,130
23 1,431
28 1.118
6 122
8 472
5 208
133 3,145
2 102
55 7 75
89 2,979
153
4 126
84 2,610
3.150 232
173
111 11
2.830 219
NYC -14, Pa. +17, Mich. -1, Mo. -8, Kans. -1, N.C. -3, Fl,
ner: Mo. +1, Md. -1, Calif. +5; RMSF: Mo. +1, N.C. -1, N.Me>
September 21, 1979
TABLE IV. Deaths in 121 U.S. cities,* week ending
September 15, 1979 (37th week)
REPORTING AREA
NEW ENGLAND
Boston, Mass.
Bridgeport, Conn.
Cambridge, Mass.
Fall River, Mass.
Hartford, Conn.
Lowell, Mass.
Lynn, Mass.
New Bedford, Mass.
New Haven, Conn.
Providence, R.I.
Somerville, Mass.
Springfield, Mass.
Waterbury, Conn.
Worcester, Mass.
MID. ATLANTIC 2,
Albany, N.Y.
Allentown, Pa.
Buffalo, N.Y.
Camden, N.J.
Elizabeth, N.J.
Erie, Pa.t
Jersey City, N.J.
Newark. N.J.
N.Y. City, N.Y. I,
Paterson, N.J.
Philadelphia. Pa.t
Pittsburgh, Pa. t
Reading, Pa.
Rochester, N.Y.
Schenectady, N.Y.
Scranton, Pat
Syracuse, N.Y.
Trenton N.J.
Utica. N.Y.
Yonkers, N.Y.
E.N. CENTRAL 2,
Akron, Ohio
Canton, Ohio
Chicago, III.
Cincinnati, Ohio
Cleveland. Ohio
Columbus, Ohio
Dayton, Ohio
Detroit, Mich.
Evansville, Ind.
Fort Wayne, Ind.
Gary, Ind.
Grand Rapids, Mich.
Indianapolis, Ind.
Madison, Wis.
Milwaukee, Wis.
Peoria, III.
Rockford, III.
South Bend, Ind.
Toledo. Ohio
Youngstown, Ohio
W.N. CENTRAL
Des Moines, Iowa
Duluth, Minn.
Kansas City, Kans.
Kansas City, Mo.
Lincoln, Nebr.
Minneapolis. Minn.
Omaha. Nebr.
St. Louis, Mo.
St. Paul, Minn.
Wichita. Kans.
ALL CAUSES, BY AGE (YEARS
ALL
AGES
605
161
tt
23
25
SO
2/
16
23
56
66
4
4j
20
45
644 1
52
22
117
47
28
19
38
53
'ill
22
396
74
38
106
20
24
83
3o
2b
31
197 I
56
51
528
133
191
141
92
248
51
34
19
53
L«9
23
143
35
32
46
123
49
734
38
26
32
109
27
93
106
170
66
67
'Mortality data in this table are
reported by the place
t Because of changes in
of itsoc
-S5
394
B8
33
14
22
30
IV
11
18
34
4")
3
34
14
29
639
27
17
76
26
18
16
25
24
8 76
15
244
34
33
62
11
18
55
22
17
23
345
35
35
30V
90
97
80
61
152
32
19
12
32
91
15
95
20
20
39
ao
31
441
27
15
14
57
21
56
It
89
42
44
45-64
140
46
IC
8
3
11
3
4
3
1Z
I 7
1
5
5
12
647
16
5
27
15
7
3
8
12
32 1
5
111
29
5
28
5
5
21
13
6
5
526
16
10
125
25
61
34
21
65
13
10
-
10
36
5
28
8
6
6
33
14
168
7
7
7
52
4
1 7
17
43
17
17
25-44
34
13
2
1_
3
3
1
2
4
2
-
1
1
1
203
4
-
8
3
3
2
6
124
2
29
2
-
10
2
-
3
1
1
3
151
-
1
43
11
20
13
2
19
3
3
4
4
9
2
7
3
—
-
5
2
43
2
—
4
7
I
10
3
10
3
i
voluntarily reported from
currenc ■ and by th i week t
<1
17
5
-
-
_
2
-
—
-
4
1
-
2
-
3
78
4
-
3
2
_
3
7
43
—
6
3
-
3
-
1
2
1
-
104
4
3
26
4
7
8
5
6
1
-
1
6
10
1
12
3
4
2
1
46
-
2
5
6
—
1
9
15
1
1
121 cities
hat the de
P&l"
TOTAl
37
12
5
—
1
1
3
1
1
-
7
—
2
2
2
ioa
-
i
6
2
-
I
3
45
1
27
4
4
5
1
-
2
2
2
2
51
—
-
13
3
3
4
3
7
2
-
-
6
4
1
1
-
1
1
1
1
26
2
3
_
1
—
2
3
5
—
10
in the U
REPORTING AREA
& ATLANTIC
Atlanta, Ga.
Baltimore, Md.
Charlotte, N.C.
Jacksonville, Fla.
Miami, Fla.
Norfolk, Va.
Richmond, Va.
Savannah, Ga.
St Petersburg, Fla.
Tampa, Fla.
Washington, D.C.
Wilmington. Del.
E.S. CENTRAL
Birmingham, Ala.
Chattanooga, Tenn.
Knoxville, Tenn.
Louisville, Ky.
Memphis, Tenn.
Mobile, Ala.
Montgomery, Ala.
Nashville, Tenn.
W.S. CENTRAL
Austin, Tex.
Baton Rouge, La.
Corpus Christi, Tex.
Dallas, Tex.
El Paso, Tex.
Fort Worth, Tex.
Houston, Tex.
Little Rock, Ark.
New Orleans, La.
San Antonio, Tex.
Shreveport, La.
Tulsa, Okla.
MOUNTAIN
Albuquerque, N. Men
Colo. Springs, Colo.
Denver, Colo.
Las Vegas, Nev.
Ogden, Utah
Phoenix, Ariz.
Pueblo, Colo.
Salt Lake City, Utah
Tucson, Ariz.
PACIFIC
Berkeley, Calif.
Fresno, Calif.
Glendale, Calif.
Honolulu, Hawaii
Long Beach, Calif.
Los Angeles, Calif.
Oakland, Calif.
Pasadena, Calif.
Portland, Oreg.
Sacramento, Calif.
San Diego, Calif.
San Francisco, Calif.
San Jose, Calif.
Seattle. Wash.
Spokane, Wash.
Tacoma, Wash.
TOTAL
nited States, most of
ALL
AGES
1,270
119
2 74
76
131
113
46
91
30
81
7U
180
51
649
84
55
49
120
160
49
31
101
1,067
62
43
37
162
52
8 0
124
53
171
143
50
82
600
61
27
121
77
21
141
21
45
86
If 697
15
72
25
46
80
491
61
20
152
52
153
164
135
136
55
40
11, 463
which have
ath certificate was filed. Fetal deaths are
reporting methods in these 4 Pennsylvania cities, these numbers are parti al counts f
ALL CAUSES, BY AGE (YEARS)
>65
738
69
169
37
64
70
30
55
16
64
4<J
90
25
398
46
29
30
n103
31
23
57
614
37
25
20
96
29
54
69
22
92
83
32
55
358
26
18
76
38
15
91
11
22
61
1,048
9
42
21
27
57
279
4C
16
91
32
98
109
71
87
41
28
6,975 2.
populations
not included
3r the currer
45-64
339
32
73
20
38
27
11
21
9
Lj>
1 7
62
13
157
24
16
13
23
38
a
5
30
285
12
15
is
42
10
20
4)
21
31
15
21
134
15
6
27
22
4
2i
7
12
18
378
5
17
3
11
17
103
15
4
39
10
32
34
39
28
8
8
774
25-44
97
11
14
10
15
9
3
6
4
2
6
14
3
51
9
o
4
6
15
6
2
3
8':
8
1
2
12
7
6
7
5
1 8
14
2
2
47
9
2
10
7
-
11
-
5
3
129
1
5
-
3
3
52
1
-
11
6
7
11
13
13
1
2
839
of 100,000 or mo
t week
<i
47
1
8
4
8
1
1
i
1
-
2
li
9
19
1
1
1
/
1
3
1
4
35
-
1
1
4
2
6
1
3
9
6
1
1
28
3
1
3
2
1
11
-
5
2
69
—
5
-
I
21
5
-
8
2
10
4
j
3
4
2
443
' p&r*TOTAL
36
5
-
2
3
4
3
7
-
3
2
4
3
29
1
-
1
13
5
4
3
2
29
5
3
-
I
3
2
3
5
3
1
3
19
6
6
1
3
2
1
—
-
-
45
—
4
1
1
1
14
I
2
-
1
I
5
2
6
5
1
380
re. A death is
mms will be
September 21, 1979
Epidemiologic Notes and Reports
Staphylococcal Food Poisoning — Delaware
On March 10, 1979, 64 cases of acute gastrointestinal disease occurred among 107
guests at a wedding reception in Sussex County, Delaware.
Symptoms included vomiting (85%), nausea (74%), abdominal cramps (61%), and diar
rhea (39%). Thirty-eight of those affected sought emergency room attention, although
none were hospitalized. Incubation periods of the illness ranged from 1.6 to 6.5 hours,
with a median of 3.5 hours.
Food histories, obtained from 103 of the guests, implicated chicken salad as the
food associated with illness. The attack rate among those who ate chicken salad was
76% (62/82), while only 9% (2/21) of those not eating this salad became ill (p<.001).
Coagulase-positive Staphylococcus aureus was subsequently isolated from the chicken
salad and the food grinder used to prepare it. No skin lesions were evident on any of
the 6 food handlers, but S. aureus was cultured from nasal swabs of 3. Phage typing,
performed at CDC, demonstrated that the isolates from the chicken salad, the food
grinder, and the nasal swab from the chicken salad preparer were all type 95.
The food was mostly prepared in private homes. The chicken for the salad was cooked
and deboned on March 8 and refrigerated in a large, plastic washtub. The following day
the chicken was ground in a meat grinder with celery and onions, mixed with mayonnaise,
and then refrigerated in the same tub. On the day of the reception, the salad was not
refrigerated during transport or before or during the reception—a total time period of
approximately 7 hours. During serving, it was noted that the chicken salad from the
central portion of the container felt warmer than that from the top, indicating uneven
refrigeration.
Reported by E Connors, RN, J Tobin, MD, Naticoke Hospital; GE Bender, MD, H Chaski, P Johnson,
M Shull, RN, R Tator, D Wasson, Sussex County Health Unit; B Kaza, PhD, ES Tierkel, VMD, State
Epidemiologist, MP Verma, PhD, Delaware Dept of Health and Social Services; Bacteriology Div, Bur
of Laboratories, Bacterial Diseases Div, Bur of Epidemiology, CDC.
Editorial Note: This classic staphylococcal outbreak underscores the need for continuing
public education in proper food handling, particularly with regard to prompt and ade
quate refrigeration of prepared foods. Staphylococcal food poisoning has been recognized
since 1914, when an outbreak in the Philippines, caused by inadequate refrigeration of
milk from a cow with a chronic staphylococcal infection, was described (7). This type of
food poisoning remains a major cause of outbreaks of acute gastrointestinal disease,
constituting approximately 25% of all foodborne outbreaks of known etiology reported
to CDC between 1972 and 1977.
The illness is caused by the presence of a heat-stable enterotoxin produced by only
a few strains of S. aureus, often from phage group 3; phage typing alone, however, can
not determine whether a given strain will produce enterotoxin.
The vehicle of transmission in staphylococcal food poisoning is almost always a pro
tein-containing food. Ham is the most common vehicle in the United States, where it is
implicated in 28% of outbreaks. Contamination, as in this case, is usually assumed to
be from food handlers; use of improper holding temperatures allows multiplication of
the staphylococci and elaboration of the toxin. After ingestion, the incubation period
may range from 30 minutes to 8 hours, with vomiting the predominant symptom. The ill
ness produced may be quite severe, although short-lived; a few fatal cases have been
reported (2).
Bacillus cereus may cause a similar clinical syndrome mediated by a heat-stable emetic
toxin; the median incubation period is less than 6 hours, with illness characterized by vom-
MMWR September 21, 1979
Food Poisoning — Continued
iting and abdominal cramps (3). B. cereus is also capable of producing a heat-labile diar-
rheal toxin, which may mimic Clostridium perfringens (4).
References
1. Barber MA: Milk poisoning due to a type of Staphylococcus albus occurring in the udder of a
healthy cow. Philippine Journal of Science 98:515-519, 1914
2. Currier RW, Taylor A, Wolf FS, Warr M: Fatal staphylococcal food poisoning. South Med J 66:
703-705,1973
3. Terranova W, Blake PA: Bacillus cereus food poisoning. N Engl J Med 298:143-144, 1978
4. Turnbull PCB, Kramer JM, Jorgensen K, Gilbert RJ, Melting J: Properties and production charac
teristics of vomiting, diarrheal, and necrotizing toxins of Bacillus cereus. Am J Clin Nutr 32:219-
228. 1979
Current Trends
Surveillance of Childhood Lead Poisoning — United States
In the second quarter of fiscal year 1979, 64 programs reported the screening of
103,230 children; 5,802 of these required additional diagnostic tests for lead toxicity
(Table 1). This represents a 17.8% increase over the number screened in the equivalent
time period in fiscal year 1978. The number of children identified with lead toxicity
increased 41.1%. Of these children, 29.8% were in screening risk classifications III and
IV;* this is an increase from the 15.1% reported in the same time period of the last fiscal
year. A total of 4,024 children were referred for care for iron deficiency.
During the second quarter 17,602 children were reported to be under pediatric man
agement for lead toxicity. Of these, 18.3% (3,216) were determined to be at reduced risk
when compared to the last time they were clinically evaluated; however, 3.2% (557)
children who were re-evaluated had increased risk.
Reported by the Environmental Health Services Div, Bur of State Services, CDC.
•Screening Class II and Classes III & IV are defined in CDC Statement "Preventing Lead Poisoning in
Young Children," April 1978.
TABLE 1. Results of screening in childhood lead poisoning control projects, United
States, second quarter fiscal year 1979 (January 1—March 31, 1979)
Programs
Bridgeport. Conn.
Waterbury. Conn.
Boston, Mass.
Chelsea. Mass.
Lawrence, Mass.
Lynn, Mass.
Worcester, Mass.
Rhode Island State
REGION 1 TOTAL
Cumulative FY 79
Atlantic City. N.J.
Camden. N.J.
East Orange. N.J.
Jersey City. N.J.
Newark. N.J.
Paterson, N.J.
Plainfield. NJ.
N.J. (other local programs)]:
Erie Co.. N.Y.
Monroe Co.. N.Y.
New York City
Onondaga Co., N.Y.
Westchester Co., N.Y.
REGION II TOTAL
Cumulative FY 79
Screened
1,165
272
5.218
502
1.350
825
994
1.322
11.648
22.331
195
386
383
221
748
1.030
248
776
1.559
1.749
21.906 S
1.276
609
31.086
Nu
Wit
Requiring pvuijnrtc
Total Class II
25
18
136
33
62
30
42
80
426
1.204
20
41
101
48
175
81
44
80
95
173
1.096!)
76
30
2.060
4.466
19
13
93
33
48
29
26
4b
306
960
6
37
59
33
121
55
41
f»B
79
157
810
60
23
1,5393.143
mber of childri
h laad toxicity
management
Classes
III 8, IV
6
5
43
0
14
1
16
35
120
244
14
4
42
15
54
26
3
22
16
16
286
16
7
521
1.323
■n
Receiving
pediatric
managemantT
79
162
1.516
35
278
145
298
533
3,046
—
64
381
54
167
844
580
258
NA
288
418
875
472
130
4,531
-
Identified
deficiency
26
46
63
24
13
15
35
14
236
596
27
97
40
20
125
214
7
NA
20
160
1,360
27
58
2.155
4.572
Number
to
1
Inspected
26
28
51
16
58
10
32
53
274
657
21
65
7
65
108
93
34
NA
65
85
176
101
14
824
1.770
of dwellings i
children with
bad toxicity
Found
with
lead
14
20
49
1G
M
1032
33
228
533
11
40
7
52
88
67
20
NA
46
BO103
60
3
582
1.256
related
Reduced
14
10
S3
B•11
4
24
26
178
440
14
25
3
2861
51
19
NA
3841
103
5
14
399
816
September 21, V
Lead Poisoning — Continued
3 0001 061280751TABLE 1. Results of screening in childhood lead poisoning control projects, United
States, second quarter fiscal year 1979 (January 1—March 31, 1979) — Continued
Programs
Delaware State
Washington, D.C.
Baltimore, Md.
Allentown-Bethlehem, Pa.
Chester, Pa.
Philadelphia, Pa.
Wilkes-Barre, Pa.
York, Pa.
Lynchburg, Va.
Norfolk, Va.
Portsmouth, Va.
Richmond, Va.
REGION III TOTAL
Cumulative FY 79
Augusta, Ga.
Louisville, Ky.
South Carolina State
Memphis, Tenn.
REGION IV TOTAL
Cumulative FY 79
Chicago, III.
Illinois State
Rockford, III.
Fort Wayne, Ind.
Detroit, Mich.
Grand Rapids, Mich.
Wayne Co., Mich.
Akron, Ohio
Cincinnati, Ohio
Cleveland, Chio
Kenosha, Wis.
Milwaukee. Wis.
Racine, Wis.
REGION V TOTAL
Cumulative FY 79
Arkansas State
New Orleans, La.
Houston, Texas
REGION VI TOTAL
Cumulative FY 79
Cedar Rapids-Linn
Co., Iowa
Davenport-Scott Co.,
Iowa
Kansas City, Kans.
St. Louis, Mo.
Springfield, Mo. tOmaha-Douglas Co., Neb.
REGION VII TOTAL
Cumulative FY 79
Alameda Co.. Calif.
Los Angeles, Calif.
REGION IX TOTAL
Cumulative FY 79
U.S. TOTAL
Cumulative FY 79
Screened
955
3,240
4,348
0
719
4,755
396
414
616
1.016
619
1,517
18,595
34,705
749
1,883
478
666
3,776
8.605
10,212
1,728
257
376
2,870
421
435
1,036
1.992
3,439
35
354
403
23.558
49,822
1,984
2,764
2,062
6.810
12,594
142
369
1.852
2,863
3
588
5.817
12,580
749
1,191
1.940
3.405
103.230
206,870
Requiri
Total
54
85
112
0
12
757
19
11
29
22
23
10
1,134
2,782
17
93
46
14
170
459
555
62
3
10
128
11
13
42
64
636
1
26
8
1,559
3,661
34
121
20
175
486
6
7
7
208
1
4
233
762
31
14
45
141
5.802
13,911
Nu
Wit
lg pediatric
Class II
39
64
68
0
3
56CI
IE10
17
14
16
9
815
1,927
14
68
43
11
136
373
38747
25
75
3
8
37
55
3300
13
5
967
2,349
23
90
12
126
338
4
7
5
141
1
3
161
462
18
7
25
91
4,074
9,633
mber of childr<
h lead toxicity
management
Classes
III & IV
15
21
44
0
9
197
4
1
12
8
7
1
319
855
3
25
3
3
34
86
168
15
1
5
53
8
5
5
9
306
1
13
3
592
1,262
11
31
8
50
148
2
0
2
67
0
1
72
310
13
7
20
50
1.728
4,278
n
Receiving
pediatric
management t
309
225
279
11
310
1,295
109
51
41
289
130
310
3.359—
173
459
347
216
1.195
—
NA
88
583
18
391
12
94
194
948
288
7
231
43
2,897
—
198
1,347
654
2.199
—
16
106
29
NA
2
96
249
—
51
79
130—
17.606
—
Identified
with iron
deficiency
41
210
67
0
5
0
25
33
56
16
18
31
502
874
16
56
5
36
113
211
49
64
16
0
9
2
30
110
136
135
2
3
6
562
1,333
26
94
87
207
421
6
10
0
148
NA
9
173
236
16
60
76
221
4,024
8,464
Number
to
k
Inspected
22
122
107
0
14
199
32
15
53
36
24
59
683
1,676
8
128
25
43
204
468
320
19
23
10
95
1
7
38
137
109
8
85
5
857
2,431
58
34
107
199
378
8
27
10
477
2
16
540
1,263
8
37
45
94
3.626
8.737
of dvw
childn
ad to
Foi
wi
le
Hup
n wit
(icity
nd
th
d
20
24
;;h
0
14
194
9
13
34
23
14
41
474
1,222
7
98
19
21
145
354
123
17
21
9
49
1
7
1921
57
8
62
1
395
1,213
52
31
45
128
273
8
24
6
313
2
5
358
813
7
36
43
87
2,353
5,751
related
h
Reduced
5
17
56
0
7
146
3
13
1
29
10
17
304
665
7
41
11
87
146
339
239
13
4
4
163
0
16
19
15
B65
36
1
570
1,229
18
19
46
83
134
1
16
2
1982
2
221
675
3
39
42
77
1,943
4,375
The Morbidity and Mortality Weekly Report, circulation 87,803, is published by the Center for
Disease Control, Atlanta, Georgia. The data in this report are provisional, based on weekly tele
graphs to CDC by state health departments. The reporting week concludes at close of business on
Friday; compiled data on a national basis are officially released to the public on the succeeding Friday.
The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other
public health problems of current interest to health officials. Send reports to: Center for Disease
Control, Attn: Editor, Morbidity and Mortality Weekly Report, Atlanta, Georgia 30333.
Send mailing list additions, deletions, and address changes to: Center for Disease Control, Attn:
Distribution Services, GSO, 1-SB-36, Atlanta, Georgia 30333. When requesting changes be sure to
give your former address, including zip code and mailing list code number, or send an old address label.
September 21, 1979
U.S. DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE
PUBLIC HEALTH SERVICE / CENTER FOR DISEASE CONTROL
ATLANTA, GEORGIA 30333 OFFICIAL BUSINESS
Director, Center for Disease Control
William H. Foege, M.D.
Director, Bureau of Epidemiology
Philip S. Brachman, M.D.
Editor
Michael B. Gregg, M.D.
Managing Editor
Anne D. Mather, M.A.
Postage and Fees Paid
U.S. Department of HEW
HEW 396
68178CARJEJ-L0383627900AXXX
CREIGHTON
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HEW Publication No. (CDC) 79-8017