CHILDHOOD LEUKAEMIA IN WEST BERKSHIRE

1248 ABSENCE OF HTLV-III ANTIBODY IN BLOOD DONORS AND RECIPIENTS IN INDIA

HTLV-I AND HTLV-III ANTIBODIES* IN PATIENTS WITH TROPICAL

SPASTIC PARESIS

SIR,-Although AIDS has not been reported in India, we have investigated the prevalence, in South-Central India, of HTLV-111 antibody in 216 blood donors and in 123 patients with renal failure or renal transplants who had received blood transfusions from 751 donors and had undergone 6046 sessions of haemodialysis (table). CHARACTERISTICS OF BLOOD DONORS AND RENAL PATIENTS TESTED FOR HTLV-III ANTIBODY *In ELISA tests"’’ a ratio of7 over background was used to define positivity for HTLV-I or HTLV-III antibody. Ratios between 4 and 7 were considered borderline positive, and ratios below 4 were negative. The percentage of borderline cases for HTLV-I in Jamaican sera was 17%, Colombian sera 0%, Jamaican CSF 11%, and Colombian CSF 14%; for HTLV-III in Jamaican sera it was 8%.

treponemal antigens, indicating previous infection with

yaws

or

syphilis. These high rates of ELISA antibodies to HTLV-1, not only in the

Martinique, but also in sera and cerebrospinal patients from Jamaica and Colombia, may be important, although cross-reactivity with other retroviruses and sera

of patients in

fluids of TSP

other infectious agents cannot be excluded. To evaluate the role, if any, of HTLV-1 in TSP we need detailed clinical, epidemiological, and laboratory studies in these and other high incidence foci in the developing world. Central Nervous System Studies, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA

PAMELA RODGERS-JOHNSON D. CARLETON GAJDUSEK

University of the West Indies, Kingston, Jamaica

OWEN ST C. MORGAN

Results as mean:!:SD *Number of donors from whom blood had been transfused.

Laboratory of

Neurology Clinic, Hospital Universitario del Valle, Cali, Colombia

VLADIMIR ZANINOVIC

Laboratory of Tumor Cell Biology, National Cancer Institute, Bethesda

PREM S. SARIN

Public

Kingston Hospital, Kingston, Jamaica 1 Cruickshank EK. A

DANIEL S. GRAHAM

neuropathic syndrome of uncertain

origin West Indian

Med J

1956, 5: 147-58. Biójo R, Barreto P Paraparesia espástica del Pacifico. Colombia Méd 1981, 12: 111-17. 3 Saxinger C, Gallo RC. Methods in laboratory investigation. Application ofthe indirect 2 Zaninovic V,

4.

enzyme-linked immonoabsorbent assay microtest to the detection and surveillance of human T-cell leukemia-lymphoma virus. Lab Invest 1983; 49: 371-77. Sarngadharan MG, Popovic M, Bruch L, Schutbach J, Gallo RC. Antibodies reactive with human T-lymphotropic retroviruses (HTLV-III) in serum of patients with AIDS Science 1984, 224: 506-07

WA, Kalyanaraman VS, Robert-Guroff M. The human type C retrovirus, HTLV, in Blacks from the Carribean region and relationship to adult T-cell leukemia/lymphoma. Int J Cancer 1982; 30: 257-64. 6. Rodgers PEB. The clinical features and aetiology of the neuropathic syndrome in Jamaica West Indian Med J 1965; 14: 36-47. 5. Blattner

ESTIMATING AIDS

(UK) SiR,—Dr Mortimer’s table (Nov 9, p 1065) may cause the reader to believe that Dr Tillett and I (Sept 7, p 541) estimated numbers of cases in the UK for the years 1981-85. In fact we estimated ranges of predictions for 1985-88 by a technique based on’numbers of cases presenting in previous years. We felt that it was inappropriate to make single predictions unaccompanied by ranges or to make use of data from the USA. It has not been shown that the proportions of homosexual men in the UK and US populations are similar, and its frequency and types of sexual practice which might cause British homosexual men to be exposed to HTLV-III infection’ differ from those described in surveys of homosexual men in the USA.2,3 Therefore, we felt that the major at-risk groups in the two countries were not

comparable.

PHLS Communicable Disease Surveillance Centre, London NW9 SEQ

MARIAN MCEVOY

TJ, McEvoy M. Epidemiology and behavior studies in homosexual men Paper presented at International Conference on AIDS (Atlanta, Georgia, April, 1985) 2. Bell N, Weinberg MS. Homosexuals. a study of diversity among men and women. London. Mitchell Beazley, 1982. 3. Jay K, Young A The gay report. New York Summitt Books, 1979. 1. McManus

Sera were lyophilised, refrigerated, and tested in one batch by enzyme-linked immunosorbent assay (’Virgo’; Electronucleonics), all positive sera being retested in duplicate by ’Bio-Enzabead’ (Bionetics) as well as the Electronucleonics kit. In the initial screen 334 sera were negative. 5 samples in group 3 were positive (0-100 or more absorbance units at 492 nm) but these were negative when retested in duplicate and are not thought to be truly positive. Thus 339 donors and patients tested were free from HTLV-III antibody. Since homosexuals or haemophiliacs who have received clotting factors and multiple transfusions were unavailable for investigation we chose blood donors and recipients as the most relevant groups to

explore for evidence of HTLV-III infection. Supported in part by the Indian Council of

Medical Research.

Departments of Virology and Nephrology, Christian Medical College Hospital,

ERIC SIMOES MESHACH KIRUBAKARAN

Vellore, Tamilnadu 632004, India;

T. JACOB JOHN

and National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health,

Bethesda, Maryland, USA

NANCY TZAN DAVID MADDEN JOHN L. SEVER

CHILDHOOD LEUKAEMIA IN WEST BERKSHIRE

SIR,-Since the establishment of

a

paediatric oncology

haematology clinic at the Royal Berkshire Hospital, Reading, in 19711 we have been concerned that we were seeing more children with acute leukaemia than might be expected in a population the size of our health district’s. Following the investigation of the incidence of childhood leukaemia near the nuclear complex at Sellafield,and because the West Berkshire health district contains two nuclear establishments-namely, the Atomic Weapons Research Establishment at Aldermaston and the Royal Ordinance Factory at Burghfield-and has two others as near neighbours, we decided to collate our figures. While doing so we learned that Yorkshire Television plans to show a documentary about childhood cancer in this area. We have not discussed our data with the media, but want to publish our preliminary findings before the programme is shown. For the years 1972-84, 49 children aged 0-9 years were newly diagnosed at the paediatric oncology/haematology clinic as having acute leukaemia. 45 were residents of West Berkshire at the time of diagnosis. The population of children at risk in West Berkshire during 1972-84 was estimated from age-specific mid-year population figures obtained from the population estimates department, Office of Population Censuses and Surveys (OPCS). The average annual incidence rate of leukaemia among children m

1249 INCIDENCE OF LEUKAEMIA AMONG CHILDREN AGED WEST BERKSHIRE

1972-84 AND

0-9 YEARS IN 1972-81

AGE-ADJUSTED AVERAGE ANNUAL DEATH RATES FOR LEUKAEMIA AND ALL CANCER PER

ENGLAND AND WALES

105 PERSONS

*ICD codes: 1972-78 8th revision codes 204-207, 1979-84 9th revision codes 204-208. 1972-81 OPCS series MBI (numerator) and PPl (denominator). Data for 1982-84 not yet available. :E & W rate x total person-years at risk in West Berkshire 1972-84. p values are two tailed.

tSource.

West Berkshire (1972-84) is compared with that in England and Wales (1972-81) in the accompanying table. The apparent statistical significance of the excess in children under 5 must be interpreted with caution because we were already suspicious that there was an excess in children and this was the reason for the analysis. Moreover, there are problems with using incidence data for England and Wales as the basis for calculating expected cases.2For example, registration of leukaemia may be more efficient in some parts of the country and there may be variations in leukaemia incidence due to factors such as socioeconomic class. Both factors could, if they operate in this district, artificially inflate the observed/expected difference. We have excluded non-resident cases; on the other hand, we know of some West Berkshire children with leukaemia who are being treated outside the district. The study is still in progress. Information about other time periods and age groups, the geographical and temporal distributions, and the incidence of other childhood cancers are being collected. Pathology Laboratory, Royal Berkshire Hospital, Reading, Berkshire RG1 5AN

CAROL J. BARTON

Epidemiological Monitoring Unit, London School of Hygiene and Tropical Medicine

EVE ROMAN

Royal Berkshire Hospital

HILARY M. RYDER ANN WATSON

VS, Weindling AM, Ryder HM, Barton CJ, Newman CL. Approach to the management of children with malignant disease in one district general hospital. Br MedJ 1981; 283: 366-67. 2. Investigation ofthe possible increased incidence of cancer in West Cumbria: Report of the Independent Advisory Group (chairman, Sir Douglas Black). London: HM Stationery Office, 1984. 1. Neil

CANCER NEAR A CALIFORNIA NUCLEAR POWER PLANT

effects on health of low-level radiation due to radioactive releases from nuclear power plants has stemmed from reports relating to the Sellafield (Windscale) plant in West Cumbria, UK. The San Onofre nuclear power plant on the coast of San Diego County in southern California is a plant about which similar concerns have been expressed. It is near Los Angeles and San Diego, and almost 1 million people live within 25 miles of San Onofre and over 5 million live within 50 miles. This plant began commercial operation in 1968 and generates up to 450 MW. There have not been any known significant radioactive releases affecting the population around San Onofre. To calculate death rates in counties and smaller areas surrounding San Onofre I used taped records summarising every death among Cahfornian residents from 1960 to 1983. The underlying cause of death was assigned by a State nosologist, and I examined death certificates for all childhood leukaemia deaths. Population data were obtained from the 1960, 1970, and 1980 censuses. For purposes of comparison before and since the plant began to operate commercially I used two time periods (1960-68 and 1969-83). Average populations at the midpoints of these intervals have been determined by interpolation, and standard procedures have been used to calculate age-adjusted average annual death rates. Comparisons have been made with data for the general population at

SIR,-Concern

over

possible

*Under 20 Figures in parentheses show numbers of deaths. f95% confidence limits for rates 2- 3-22 for 1960-68 and 0 - 2-6’ 1 for 1969-83

distances from San Onofre, using the surrounding three counties (Orange, Riverside, and San Diego), which cover a distance up to about 50 miles from the plant, and by using selected cities and census tracts within distances of about 25 and 10 miles. All white residents in the State of California provide an appropriate comparison since the three counties have over 90% white residents. Average annual age-adjusted death rates during the "before operation" period (1960-68) and "during operation" period (1969-83) for leukaemia, all cancer, and infant mortality were similar for the three counties and for California (table). Furthermore for leukaemia under age 20 there was no association with distance from the plant before or during the period of operating. By selectively grouping childhood leukaemia deaths by city of residence it is possible to construct four leukaemia clusters in cities 15-20 miles from San Onofre (of 3,3,3, and 5 deaths within periods of 18 months or less since 1960) giving death rates 10-100 times the average leukaemia rates of 2-4 deaths per 105 children. However, these clusters are statistical aberrations; the children had not lived near San Onofre or been exposed to radiation. Congenital malformation, fetal mortality, neonatal mortality, and perinatal mortality rates for six hospitals within 25 miles of the plant were, if anything, lower than those reported from other Californian

varying

hospitals. The San Onofre nuclear power plant has had no discernible impact on the health of the surrounding population. School of Public Health,

University of California, Los Angeles, California 90024, USA

JAMES E. ENSTROM

1. Enstrom JE. Cancer mortality patterns around the San Onofre nuclear power 1960-1978. Am JPublic Health 1983; 73: 83-92.

plant,

TREATMENT OF BACTERIAL ENDOCARDITIS

SIR,-The Working Party of the British Society for Antimicrobial Chemotherapy (Oct 12, p 815) recommends flucloxacillin plus or gentamicin for the treatment of endocarditis where Staphylococcus aureus is the infecting organism. The following case

fusidic acid

demonstrates that flucloxacillin in combination with fusidic acid may not be the treatment of choice in severe Staph aureus infection. An 11-year-old boy presented with fever, a painful, swollen left tibia, and palpable lymph nodes in the groin. Osteomyelitis was diagnosed and he was treated with intravenous erythromycin 500 mg 6-hourly and fusidic acid 500 mg 8-hourly. Subsequently Sraph aureus was isolated from blood cultures taken on admission. Because of difficulty in administering intravenous erythromycin this agent was discontinued and flucloxacillin was added to fusidic acid. Laboratory investigations at this stage showed that the minimum inhibitory concentration (MIC) of methicillin for the Staph aureus isolated was 31 mg/1, the mean bactericidal concentration being the