- Email: [email protected]
Outbreak of anthrax in a border province of Northeastern Thailand, 1995
32s
PUBLIC
“IS THE EBOLA-RESTON VIRUS TIONALLY EXPOSED HUMANS?”
A THREAT
TO OCCUPA-
Ted&o Joselito A. Retuyn Jr., T. G. Ksiazek, A..?. Khan, A. Sanchez, M. C. Races, Filipino Field Epidemiology Training Program, Ma-
M. E. G. Miranda, and M. M. Dayrit. nila, Philippines. Introduction: There have been several outbreaks of Ebola-Reston (EBOR) virus infection among Philippine monkeys. Since the virus is lethal to monkeys and is closely related to the African Ebola subtypes (Zaire, Sudan, Ivory Coast) which cause fatal illness among humans, there has been concern rhar EBO-R may pose a risk to exposed humans. Following the recent detection of EBO-R virus in Philippine monkeys exported to the US, we were asked to re-assess the risk to occuparionally exposed persons. Methodology: Employees of all 5 export facilities and 2 holding facilities in trapping areas were interviewed. We gathered data on possible risk factors for infection (e.g., bites or scratches from monkeys) and history of any Ebolalike illness. Blood samples were collected and tested for EBO-R IgG antibody using the ELISA method. Liver function tests (LFT) were done on 2 previously antibody positive persons. Their family members were also interviewed and blood samples collected for testing. Results: Two hundred fifty persons (including 4 family members of previous seropositive) were included in the study. There were no signs of Ebola-like illness among them. All blood samples were negative for EBO-R antibody except for 1 animal handler from the facility where infected monkeys were found. This person was also antibody positive in 1993. The other known seropositive individual was now seronegative. LFr results were all normal. Discussion: Results of this and other investigations in the Philippines and US reveal that humans infected with EBO-R report no illness, suggesting rhat infection results in very mild or non-apparent illness. Transmission m humans has been infrequent and is mostly blood borne. Airborne transmission is unlikely as such mode would have resulted in more infections among exposed persons. Although transmissible ro humans, EBO-R does not pose a public health threat, unlike the African Ebola subtypes.
HEALTH
“OUTBREAK OF BORDETELLA PERTUSSIS IN CD. OBREGON SONORA, MEXICO.” Leon R. Sergio, 0. L. Martinez, L. Sapian, and Pablo f&i-M. Mexican Field Epidemiology Training Program, Comos de Plateros, Mexico. Objectives: The infections by B. pertussis (whooping cough) as a cause of infant mortality; approximately 35,000 children die due to this disease every year in the Americas; for this reason, our objective is to corroborate the existence of an outbreak of B. prtussis. Main Outcome Measure(s): A cross-sectional study was carried out in Cd. Obregon, Sonora, during May 1996. The clinical files from the General Hospital were reviewed, and a probable case of whooping cough was considered as “any person older than 3 months of age who requested medical attention or presented: with paroxysm of cough, wirh cyanosis or followed by laryngeal strider lasting 14 or more days, hemorrhage (conjunctival, petechiae, epistaxis), contact wirh similar cases in the last 4 weeks with blood count with leukocytosis and lymphocytosis.” A census in an a-block area was carried out around the residence of the probable cases or suspected cases which were defined as “anyone living near the case or any contact of any age, with cough lasting for any amount of time and rhat had the symptoms mentioned above.” Nasopharyngeal, blood, and virology samples were taken. The samples were sent and processed in Mexico, the CDC Atlanta, and to Canada, to carry out agglutination of specific antibodies and PCR tests. The vaccination coverage was analyzed. Results: 9 probable cases were found, belonging to 9 different localities in 3 municipalities of the state. The cases were studied and the samples were negative. Of the 9 children, 4 died (44%), all more or less 4 months old. The complication in 78% of the children was atelectasis. 2,881 houses were visited in the census. Besides the 9 probable cases in hospital, 28 suspected cases and a probable case were detected. Of the 121 samples for culture of B. pertussis raken in the community from all the probable cases, suspected cases, and contacts, rhree were positive (2.5%). In the census from the vaccination program a coverage of 76% in the age group of O-3 months, was focmd, with 69% in children of 4-5 months, 78% in that of 6-8 months and 99% in those of 9-l I months. Conclusions: The existence of an outbreak of B. prtussis was corroborated; although the causative agent was not isolated in the initial cases, an additional 3 cases were located, B. pertussis was isolated from a close contact of the cases. A low vaccination coverage in the O-5 months age groups probably contributed to this outbreak.
“THE RELATIONSHIP BETWEEN HEALTH BEHAVIORS AND HEALTH STATUS AMONG THE OFFICERS AND MEN OF A MILITARY POLICE BRIGADE IN TAIWAN.” I-Hong Shen “OUTBREAK OF ANTHRAX IN A BORDER PROVINCE OF NORTHEASTERN THAILAND, 1995.” Sunthorn Rheanpumikankit, P. Chumkasian, T. Nammuog, T. Smarksaman, and Chuchomkam. Thai Field Epidemiology Training Program, Nonthaburi, Thailand. Introduction: On Sep. 13, 1995, Division of Epidemiology was notified of an anthrax outbreak m Kabcherg district, Surin province. Thai FETP joined the epidemiological team and started to investigate source of outbreak in order to provide recommendation for prevention and control measures. Methodology: Active case finding was performed in 4 villages. A case was one who had onset during June l-August 31, 1995 and classified in any of the following three categories; cutaneous anthrax, intestinal anthrax, respiratory anthrax. Retrospective cohort study was conducted in one village to identify risk t&tors. We also surveyed grazmg areas, and local and border markets. Results: There were five reported dead cows from 4 nearby villages during June to August. All dead cows were dissected by villagers and distributed in the village for consumption. Attack rate for intestinal anthrax was 12% (44 cases) and cutaneous cases was 13%. In rhe analytic study village, there were 16 intestinal anthrax and 15 cutaneous anthrax. Among cutaneous anthrax, all cases had contact with beef from dead cows. Dissectors were 6.5 times likely to be infected than orhers (95% Cl = 2.5-17.2). Dissectors who had a body wound were 44 times likely to be infected than those who did not have a wound (95% Cl = 28-68). Eating uncooked beef was associated with intestinal anthrax (RR = 4.2, 95% Cl = 1.7-10.2). One month prior to the death of the first cow, the owner had gone to buy some cows at the Cambodian border market. Other dead cows were either herded in the same grazing area as the index cow or the dissected area. Local and border markets had poor sanitation. There was no quality control of imported meat. Conclusions: There was an outbreak of anthrax caused by Bacillus anthracis which was widely spread due to late diagnosis and control measures. Exposure to cows which had unnatural deaths either by dissecting or eating were confirmed risk factors. However we could not establish the mechanism for which the first cow was infected. Destructmn of carcass, vaccination of cartie, and education to avoid consuming uncooked meat were recommended. Cooperation between health office and livestock office was initiated.
and Kow-Tong Chen. Taiwanese Field Epidemiology Training Program, Taipei, Taiwan. Introduction: The purpose of this study was to examine the relationship between health behaviors, and physical and perceived health status among the study population. Healthy behaviors were classified as positive health indicators, while unhealthy behaviors were classified as risk factors. Methodology: A cross-sectional sttldy was conducted among a military police brigade m Taipei. We used a multiple stage sampling scheme to randomly select participants from each company in proportion to its size. Data were collected by means of self-completed sttucrured questionnaires. The total sample size was 498 and the response rate was 88.15%. A health behaviors index (HBI) was calculared by summing the scores of five individual health behaviors scores (smoking, chewing betel-nut, drinking, weight control, and exercise). A low HBI score indicates healthy behavior. Seven health indicators were examined (number of symptoms and number of medical visits during the past one month, number of diseases during the past one year, fatigue status after working every day [stamina], results of 5000-meter race, distance of throwing hand grenade, and health perceptions). The relationship between health behaviors index and 7 health indicators was examined by multiple regression analysis. Results: After controlling for rank, age, education, manta1 status, military service, and residence we found that the HBI had a positive correlatmn (p < 0.01) with number of symptoms, fatigue status, results of 5000-meter race and health perceptions; and a nonsignificant positive correlation (p > 0.05) with number of medical visits, and distance of throwing hand grenade. A nonsignificant inverse correlation between the HBI and number of diseases was also observed. Discussion: We found the officer and men with healthier behaviors had better physical and perceived health status. Potential limitations of this srudy include the following: (1) the number of medlcal visits and diseases (negative health indicators) may not reliably reflect the health status of young ad&s; (2) the relationship between health behaviors and acute condirions (the principal components of number of diseases) is not obvious; (3) recall bias for number of medical visits; (4) medical visits reflected not only health status hut also predisposing and enabling components; (5) distance of rhrowmg hand grenadea may reflect experience and skill.
PUBLIC
“IS THE EBOLA-RESTON VIRUS TIONALLY EXPOSED HUMANS?”
A THREAT
TO OCCUPA-
Ted&o Joselito A. Retuyn Jr., T. G. Ksiazek, A..?. Khan, A. Sanchez, M. C. Races, Filipino Field Epidemiology Training Program, Ma-
M. E. G. Miranda, and M. M. Dayrit. nila, Philippines. Introduction: There have been several outbreaks of Ebola-Reston (EBOR) virus infection among Philippine monkeys. Since the virus is lethal to monkeys and is closely related to the African Ebola subtypes (Zaire, Sudan, Ivory Coast) which cause fatal illness among humans, there has been concern rhar EBO-R may pose a risk to exposed humans. Following the recent detection of EBO-R virus in Philippine monkeys exported to the US, we were asked to re-assess the risk to occuparionally exposed persons. Methodology: Employees of all 5 export facilities and 2 holding facilities in trapping areas were interviewed. We gathered data on possible risk factors for infection (e.g., bites or scratches from monkeys) and history of any Ebolalike illness. Blood samples were collected and tested for EBO-R IgG antibody using the ELISA method. Liver function tests (LFT) were done on 2 previously antibody positive persons. Their family members were also interviewed and blood samples collected for testing. Results: Two hundred fifty persons (including 4 family members of previous seropositive) were included in the study. There were no signs of Ebola-like illness among them. All blood samples were negative for EBO-R antibody except for 1 animal handler from the facility where infected monkeys were found. This person was also antibody positive in 1993. The other known seropositive individual was now seronegative. LFr results were all normal. Discussion: Results of this and other investigations in the Philippines and US reveal that humans infected with EBO-R report no illness, suggesting rhat infection results in very mild or non-apparent illness. Transmission m humans has been infrequent and is mostly blood borne. Airborne transmission is unlikely as such mode would have resulted in more infections among exposed persons. Although transmissible ro humans, EBO-R does not pose a public health threat, unlike the African Ebola subtypes.
HEALTH
“OUTBREAK OF BORDETELLA PERTUSSIS IN CD. OBREGON SONORA, MEXICO.” Leon R. Sergio, 0. L. Martinez, L. Sapian, and Pablo f&i-M. Mexican Field Epidemiology Training Program, Comos de Plateros, Mexico. Objectives: The infections by B. pertussis (whooping cough) as a cause of infant mortality; approximately 35,000 children die due to this disease every year in the Americas; for this reason, our objective is to corroborate the existence of an outbreak of B. prtussis. Main Outcome Measure(s): A cross-sectional study was carried out in Cd. Obregon, Sonora, during May 1996. The clinical files from the General Hospital were reviewed, and a probable case of whooping cough was considered as “any person older than 3 months of age who requested medical attention or presented: with paroxysm of cough, wirh cyanosis or followed by laryngeal strider lasting 14 or more days, hemorrhage (conjunctival, petechiae, epistaxis), contact wirh similar cases in the last 4 weeks with blood count with leukocytosis and lymphocytosis.” A census in an a-block area was carried out around the residence of the probable cases or suspected cases which were defined as “anyone living near the case or any contact of any age, with cough lasting for any amount of time and rhat had the symptoms mentioned above.” Nasopharyngeal, blood, and virology samples were taken. The samples were sent and processed in Mexico, the CDC Atlanta, and to Canada, to carry out agglutination of specific antibodies and PCR tests. The vaccination coverage was analyzed. Results: 9 probable cases were found, belonging to 9 different localities in 3 municipalities of the state. The cases were studied and the samples were negative. Of the 9 children, 4 died (44%), all more or less 4 months old. The complication in 78% of the children was atelectasis. 2,881 houses were visited in the census. Besides the 9 probable cases in hospital, 28 suspected cases and a probable case were detected. Of the 121 samples for culture of B. pertussis raken in the community from all the probable cases, suspected cases, and contacts, rhree were positive (2.5%). In the census from the vaccination program a coverage of 76% in the age group of O-3 months, was focmd, with 69% in children of 4-5 months, 78% in that of 6-8 months and 99% in those of 9-l I months. Conclusions: The existence of an outbreak of B. prtussis was corroborated; although the causative agent was not isolated in the initial cases, an additional 3 cases were located, B. pertussis was isolated from a close contact of the cases. A low vaccination coverage in the O-5 months age groups probably contributed to this outbreak.
“THE RELATIONSHIP BETWEEN HEALTH BEHAVIORS AND HEALTH STATUS AMONG THE OFFICERS AND MEN OF A MILITARY POLICE BRIGADE IN TAIWAN.” I-Hong Shen “OUTBREAK OF ANTHRAX IN A BORDER PROVINCE OF NORTHEASTERN THAILAND, 1995.” Sunthorn Rheanpumikankit, P. Chumkasian, T. Nammuog, T. Smarksaman, and Chuchomkam. Thai Field Epidemiology Training Program, Nonthaburi, Thailand. Introduction: On Sep. 13, 1995, Division of Epidemiology was notified of an anthrax outbreak m Kabcherg district, Surin province. Thai FETP joined the epidemiological team and started to investigate source of outbreak in order to provide recommendation for prevention and control measures. Methodology: Active case finding was performed in 4 villages. A case was one who had onset during June l-August 31, 1995 and classified in any of the following three categories; cutaneous anthrax, intestinal anthrax, respiratory anthrax. Retrospective cohort study was conducted in one village to identify risk t&tors. We also surveyed grazmg areas, and local and border markets. Results: There were five reported dead cows from 4 nearby villages during June to August. All dead cows were dissected by villagers and distributed in the village for consumption. Attack rate for intestinal anthrax was 12% (44 cases) and cutaneous cases was 13%. In rhe analytic study village, there were 16 intestinal anthrax and 15 cutaneous anthrax. Among cutaneous anthrax, all cases had contact with beef from dead cows. Dissectors were 6.5 times likely to be infected than orhers (95% Cl = 2.5-17.2). Dissectors who had a body wound were 44 times likely to be infected than those who did not have a wound (95% Cl = 28-68). Eating uncooked beef was associated with intestinal anthrax (RR = 4.2, 95% Cl = 1.7-10.2). One month prior to the death of the first cow, the owner had gone to buy some cows at the Cambodian border market. Other dead cows were either herded in the same grazing area as the index cow or the dissected area. Local and border markets had poor sanitation. There was no quality control of imported meat. Conclusions: There was an outbreak of anthrax caused by Bacillus anthracis which was widely spread due to late diagnosis and control measures. Exposure to cows which had unnatural deaths either by dissecting or eating were confirmed risk factors. However we could not establish the mechanism for which the first cow was infected. Destructmn of carcass, vaccination of cartie, and education to avoid consuming uncooked meat were recommended. Cooperation between health office and livestock office was initiated.
and Kow-Tong Chen. Taiwanese Field Epidemiology Training Program, Taipei, Taiwan. Introduction: The purpose of this study was to examine the relationship between health behaviors, and physical and perceived health status among the study population. Healthy behaviors were classified as positive health indicators, while unhealthy behaviors were classified as risk factors. Methodology: A cross-sectional sttldy was conducted among a military police brigade m Taipei. We used a multiple stage sampling scheme to randomly select participants from each company in proportion to its size. Data were collected by means of self-completed sttucrured questionnaires. The total sample size was 498 and the response rate was 88.15%. A health behaviors index (HBI) was calculared by summing the scores of five individual health behaviors scores (smoking, chewing betel-nut, drinking, weight control, and exercise). A low HBI score indicates healthy behavior. Seven health indicators were examined (number of symptoms and number of medical visits during the past one month, number of diseases during the past one year, fatigue status after working every day [stamina], results of 5000-meter race, distance of throwing hand grenade, and health perceptions). The relationship between health behaviors index and 7 health indicators was examined by multiple regression analysis. Results: After controlling for rank, age, education, manta1 status, military service, and residence we found that the HBI had a positive correlatmn (p < 0.01) with number of symptoms, fatigue status, results of 5000-meter race and health perceptions; and a nonsignificant positive correlation (p > 0.05) with number of medical visits, and distance of throwing hand grenade. A nonsignificant inverse correlation between the HBI and number of diseases was also observed. Discussion: We found the officer and men with healthier behaviors had better physical and perceived health status. Potential limitations of this srudy include the following: (1) the number of medlcal visits and diseases (negative health indicators) may not reliably reflect the health status of young ad&s; (2) the relationship between health behaviors and acute condirions (the principal components of number of diseases) is not obvious; (3) recall bias for number of medical visits; (4) medical visits reflected not only health status hut also predisposing and enabling components; (5) distance of rhrowmg hand grenadea may reflect experience and skill.