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Biomedical subjects

D W Fleming

Publications and source records attributed to D W Fleming.

At least 37 records · Page 2Linked to original sources
PubMed1994

A swimming-associated outbreak of hemorrhagic colitis caused by Escherichia coli O157:H7 and Shigella sonnei.

BACKGROUND: In the summer of 1991, simultaneous outbreaks of bloody diarrhea and hemolytic-uremic syndrome caused by Escherichia coli O157:H7 and of bloody diarrhea caused by Shigella sonnei were traced to a lakeside park near Portland, Oregon. METHODS: We identified cases primarily from routine surveillance reports. In case-control studies, the activities of persons with park-associated E. coli O157:H7 or S. sonnei infections were compared independently with those of three sets of controls. We also evaluated environmental conditions at the park and subtyped the bacterial isolates. RESULTS: We identified 21 persons with park-associated E. coli O157:H7 infections (all of them children; median age, six years) and 38 persons with S. sonnei infections (most of them children). These 59 people had visited the park over a 24-day period. Their illnesses were not associated with food or beverage consumption. All the case patients reported swimming, however, and in case-control studies swimming was strongly associated with both types of infection (P = 0.015 or less). The case patients were more likely than the controls to report having swallowed lake water, and they had spent more time in the lake. Numbers of enterococci indicative of substantial fecal contamination (geometric mean, > 50 per deciliter) were detected in the swimming area during some but not all of the outbreak period. Park-associated E. coli O157:H7 isolates were identical by pulsed-field gel electrophoresis and were distinguishable from other isolates in the Portland area. CONCLUSIONS: Lake water that was fecally contaminated by bathers was the most likely vehicle for the transmission of both the E. coli O157:H7 and the S. sonnei infections. The unusually prolonged outbreak suggests both the survival of these enteric organisms in lake water and a low infectious dose.

Case-Control Studies↗
PubMed1993

Vertical transmission of hepatitis A resulting in an outbreak in a neonatal intensive care unit.

Vertical transmission of hepatitis A virus (HAV) has not been reported. From 25 October to 15 November 1989, 10 cases of symptomatic HAV infection occurred among neonatal intensive care unit (NICU) staff. Testing of other NICU staff and patients identified 4 infected infants. Hepatitis A among staff was associated with caring for 1 of these infants, infant A (relative risk [RR], undefined; P = .05). Risk of illness was greater for staff who did not routinely wash their hands after treating infant A for apnea and bradycardia (RR = 4.9; P = .02). Staff, infants, visitors, and transfused blood products could not be implicated as a source of infant A's infection. Infant A's mother, however, was diagnosed with hepatitis A 10 days after premature labor and delivery. Evidence suggests that infant A was infected by his mother before or during birth. HAV then spread within the NICU because of breaks in infection control precautions. To prevent future outbreaks, NICU staff should adhere rigorously to body substance isolation measures.

Adult↗
PubMed1992

Pedestrian and hypothermia deaths among Native Americans in New Mexico. Between bar and home.

OBJECTIVE: To determine the nature of excess injury mortality among Native Americans in New Mexico. DESIGN: Retrospective review of death certificates for deaths from unintentional injuries. SETTING: The state of New Mexico. SUBJECTS: New Mexico residents who died of unintentional injuries between January 1, 1980, and December 31, 1989. MAIN OUTCOME MEASURE: Cause-specific mortality rates. RESULTS: Over half of the excess mortality from all unintentional injuries among Native Americans resulted from hypothermia and from pedestrian-motor vehicle crashes. New Mexico Native Americans were nearly eight times more likely to die in pedestrian--motor vehicle crashes and were 30 times more likely to die of hypothermia compared with other New Mexico residents. At death, 90% of those Native Americans tested were highly intoxicated (median blood alcohol concentrations of 0.24 and 0.18 g/dL [corrected] for pedestrian and hypothermia deaths, respectively). Despite the fact that most Native Americans in New Mexico live on reservations, most deaths occurred at off-reservation sites in border towns and on roads leading back to the reservation. CONCLUSIONS: The possession and sale of alcohol is illegal on many Native American reservations. This policy forces Native Americans who want to drink to travel long distances to obtain alcohol. These data suggest that this policy is also the likely explanation for the markedly increased risk of death from hypothermia and pedestrian-motor vehicle crashes in this population.

Accidents, Traffic↗
PubMed1991

Surveillance of attempted suicide among adolescents in Oregon, 1988.

In January 1988, Oregon became the first state to require hospital-based reporting of attempted suicide (AS) in all adolescents less than 18 years old. From January to December 1988, 644 cases of AS were reported (annual rate of 214 per 100,000 population, ages 10 to 17 years). We compared these 644 cases of AS with all 137 Oregon adolescents less than 18 years old who committed suicide in Oregon during the 10-year-period 1979 through 1988, and found that the strongest predictor of outcome was method used.

Adolescent↗
PubMed1990

Eosinophilia-myalgia syndrome associated with exposure to tryptophan from a single manufacturer.

Although eosinophilia-myalgia syndrome has been linked to use of tryptophan, it has been unclear whether tryptophan itself or a contaminant causes illness. In Oregon, we compared the brand and source of tryptophan used by 58 patients with eosinophilia-myalgia syndrome with the brand and source of tryptophan used by 30 asymptomatic controls identified through a random telephone survey and 63 asymptomatic controls who contacted the Oregon Health Division voluntarily. Although a single brand/retail lot of tryptophan was statistically associated with the development of eosinophilia-myalgia syndrome, there was no common importer, wholesaler, tablet maker, encapsulator, or distributor. However, 45 (98%) of 46 cases had taken a product made by one manufacturer, compared with three (30%) of 10 telephone survey controls and 15 (48%) of 31 volunteer controls. Retail lots of tryptophan from this manufacturer that were associated with cases were significantly more likely to have been produced from January through June 1989 than lots from this manufacturer that were taken by controls. These findings indicate that the recent epidemic of eosinophilia-myalgia syndrome was caused by a contaminant or an alteration in a subset of tryptophan manufactured by a single company in Japan shortly before the outbreak began.

Adult↗
PubMed1990

Partner notification: can it control epidemic syphilis?

STUDY OBJECTIVE: During 1987, the rate of syphilis among heterosexual adults in Oregon increased 159%, yet the number of cases of gonorrhea remained stable. Our study was done to evaluate why the same control measures contained gonorrhea but not syphilis in this population. DESIGN: Exploratory case-control study. SETTING: Public health clinics in Portland, and Salem, Oregon. PATIENTS: All 146 heterosexual adults with early syphilis and all 164 heterosexual adults with acute gonorrhea reported to the public health clinics during April to July 1988. INTERVENTION: A questionnaire was administered to all syphilis case-patients and control patients (those with gonorrhea) at the beginning of the routine, sexually transmitted disease (STD), investigative interview. MEASUREMENTS AND MAIN RESULTS: Syphilis case-patients had contact with an average of 5.0 sex partners for whom they could not supply locating information sufficient to initiate partner notification. In contrast, patients with gonorrhea had contact with an average of 0.4 sex partners for whom they could not supply locating information (P less than 0.005). The 28% (41 of 146) of syphilis case-patients who reported having exchanged sex for drugs or money accounted for 72% (527 of 729) of the unlocatable partners exposed to syphilis. In contrast, the 17% (28 of 164) of patients with gonorrhea who reported having exchanged sex for drugs or money accounted for 36% (25 of 69) of the unlocatable partners exposed to gonorrhea. CONCLUSIONS: Because patients infected with syphilis have relatively large numbers of anonymous sexual encounters, prevention strategies that supplement partner notification are urgently needed to control the syphilis epidemic among adults.

Adolescent↗
PubMed1989

HIV testing in prisoners: is mandatory testing mandatory?

We studied 977 newly incarcerated Oregon inmates to compare voluntary versus mandatory human immunodeficiency virus antibody (HIVAb) testing in the prison setting. All inmates were offered HIVAb counseling and testing. Blood drawn for routine syphilis serology from those who declined this offer was also tested for HIVAb after personal identifiers had been removed. Only 1.2 percent (12) prisoners were HIV positive. However, 62.5 percent (611) inmates were at risk for HIV infection by being an intravenous drug user, a male homosexual, or hepatitis B core antibody (HBcAb) positive. The ratio of at-risk, as yet uninfected inmates to those already HIV infected was 53 to 1. Two-thirds of all inmates including those at-risk chose to receive counseling and testing. In areas where most at-risk inmates are not yet infected, it may be more appropriate for HIV prevention activities in prison to focus on voluntary programs that emphasize education and counseling rather than mandatory programs that emphasize testing.

Adolescent↗
PubMed1987

Acquired immunodeficiency syndrome in low-incidence areas. How safe is unsafe sex?

Serum specimens from the cohort of persons who attended sexually transmitted disease clinics in New Mexico during a two-month period were tested for human immunodeficiency virus (HIV) antibody. Twenty-seven (2.0%) of 1374 serum specimens had repeatedly low-positive reactions by enzyme-linked immunosorbent assay testing, and 22 (1.6%) had repeatedly high-positive reactions. All sera (sufficient for testing by Western blot) with low-positive reactions gave negative results, and all sera (sufficient for testing by Western blot) with high-positive reactions gave positive results. All persons whose serum had high-positive reactions were male. Most (86%) had been seen at the only urban sexually transmitted disease clinic in New Mexico, and most (72%) were openly gay or bisexual. Of all gay and bisexual men evaluated, 14% (16/112) had high-positive reactions. Rapid plasma reagin positivity was significantly associated with HIV enzyme-linked immunosorbent assay low (false) positivity. The relatively high rate of HIV seropositivity among gay men with other sexually transmitted diseases indicates that transmission of acquired immunodeficiency syndrome is continuing in this low-incidence area and documents the need for testing and counseling programs in sexually transmitted disease clinics.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Childhood upper respiratory tract infections: to what degree is incidence affected by day-care attendance?

Risk factors for acute upper respiratory tract disease in childhood were evaluated in a population-based sample of the Atlanta metropolitan area. Mothers from 449 households containing 575 children less than 5 years of age were selected by random-digit dialing and questioned about upper respiratory tract infection and ear infection occurring in their children during the preceding 2 weeks. Household demographic and socioeconomic characteristics, maternal smoking history and child day-care attendance and breast-feeding information were also obtained. For children less than 5 years of age, the reported incidence of upper respiratory tract infection was 24%, and of ear infection, 6%. Controlling for the other variables measured, day-care attendance was associated with a significantly increased risk of both illnesses. For upper respiratory tract infection, increased risk was present for all children attending day care (P = .02, odds ratio = 1.6), whereas for ear infection, risk could be demonstrated only for full-time attendees (P = .005, odds ratio = 3.8). Maternal smoking was a second independent risk factor for a child's having upper respiratory tract infection (odds ratio = 1.7, P = .01). Thirty-one percent of all upper respiratory tract infection among day-care attendees and 66% of all ear infections among full-time day-care attendees were attributable to day-care attendance. Given the proportion of children in day care, 9% to 14% of the total burden of upper respiratory tract disease in this population was day care related.(ABSTRACT TRUNCATED AT 250 WORDS)

Child Day Care Centers↗
PubMed1986

Haemophilus influenzae b polysaccharide vaccine. Physician acceptance and use of a new vaccine.

The introduction of Haemophilus Influenzae type b (Hib) polysaccharide vaccine in 1985 provided an opportunity to study the extent to which physicians have adopted the use of the new vaccine in their routine practice behavior, the factors that predict Hib vaccine use by physicians, and how physicians have chosen to deal with differing recommendations for its administration. We surveyed all physicians providing primary care to children in New Mexico six to eight months after vaccine licensure to assess their knowledge of existing recommendations and their current behavior regarding use of the Hib vaccine. Of the 369 primary care physicians who responded, 100% of pediatricians, 98% of family practitioners, and 91% of general practitioners were aware that a vaccine against invasive Hib disease had been licensed. Sixty-three percent of physicians surveyed were currently using the vaccine. Vaccine usage varied significantly by specialty, with 86% of pediatricians reporting use compared with 61% of family practitioners and 31% of general practitioners. Physicians were significantly more likely to use Hib vaccine if they were young and if they worked in the private sector rather than the public sector. The three sets of recommendations for Hib vaccine use had been widely read; 85% of respondents had read at least one set. Practitioners confronted with differing recommendations had elected to give the vaccine permissively within existing guidelines. Our findings suggest that practitioners have adapted quickly to the introduction of Hib vaccine but that nonuse of the vaccine in the public sector remains an obstacle to full implementation of this prevention strategy.

Attitude of Health Personnel↗
PubMed1986

Primary invasive Haemophilus influenzae type b disease: a population-based assessment of risk factors.

We performed a population-based case-control study of risk factors for primary invasive Haemophilus influenzae type b (Hib) disease in metropolitan Atlanta from July 1, 1983, through June 30, 1984. Active surveillance identified 102 cases in children less than 5 years of age, 89 of whom lived in households with telephones. We used random digit dialing to select 530 controls who were postmatched to cases by age. Multivariate analysis showed a significant association between Hib disease and two independent exposure factors, household crowding (odds ratio (OR) 2.7, 95% confidence limits (CL) 1.3 to 5.6) and day-care attendance. For day-care attendance, relative risk was highest in 2- to 5-month-old infants (OR 17.7, 95% CL 5.8 to 54.4) and declined to 9.4 (4.3 to 20.9) at ages 6 to 11 months, 5.0 (2.7 to 9.3) at 12 to 23 months, 2.7 (1.3 to 5.5) at 24 to 35 months, and 1.4 (0.5 to 4.0) in 36- to 59-month-old children. Fifty percent of all invasive Hib disease that occurred during the study period was attributable to exposure to day-care; the attributable risk for household crowding was 18%. Dose-response effects were observed for hours per week of day-care attendance and extent of household crowding. Breast-feeding was protective for infants less than 6 months of age (OR 0.08, 95% CL 0.01 to 0.59). After controlling for socioeconomic and other confounding factors, we could demonstrate no effect of black race on cumulative risk of invasive Hib disease. Our study defines high-risk groups and provides a population-based model of the interrelationship between risk factors associated with invasive Hib disease.

Age Factors↗
PubMed1986

Methicillin-resistant Staphylococcus aureus: how reliable is laboratory reporting?

Microbiology laboratories in Oregon were surveyed in 1981 to determine how often methicillin-resistant Staphylococcus aureus (MRSA) was being reported to physicians in the state. Results of this survey were surprising in three respects. First, the mean percent of S. aureus isolates reported by laboratories as methicillin-resistant was 8.3%. Second, a significant inverse correlation was found between the percent of reported MRSA and laboratory size (p = 0.0001). Finally, laboratories which retested initially resistant isolates reported significantly less MRSA (mean 3.3%, median 1%) than those laboratories which accepted initial results (mean 20%, median 12%) (p = 0.0001). Independent testing by the Centers for Disease Control of isolates reported to be MRSA confirmed that some misidentification was occurring. Participating laboratories were notified of our initial findings and their potentially serious clinical ramifications. Laboratories were resurveyed in 1982, and a significant decrease in the reported MRSA to a mean percentage of 3.4% was observed (p = 0.002). It is unlikely that this situation is unique to Oregon, and similar misreporting of MRSA to physicians in other areas of the country may be compromising the safe and effective treatment of S. aureus infections.

Health Surveys↗
PubMed1986

Isolation of Listeria monocytogenes from raw milk.

During a recent outbreak of listeriosis, we examined 121 raw milk samples and 14 milk socks (filters). Listeria monocytogenes was recovered from 15 (12%) of 121 milk specimens and 2 (14%) of 14 milk socks. The optimal processing method consisted of cold enriching diluted milk for 1 month with culture to selective broth, followed by plating.

Agar↗
PubMed1986

Dermatitis in grocery workers associated with high natural concentrations of furanocoumarins in celery.

A vesicular, peeling rash characteristic of a phytophototoxic dermatitis developed on the hands and arms of 30 of 127 grocery workers. The rash subsequently healed with residual hyperpigmentation. Produce workers had the highest attack rate, 100% (8 of 8, p less than 0.0001). Although contact with celery had the highest relative risk for disease (relative risk, 6.3; 95% confidence interval, 2.6, 19.2) and the strongest dose-response effect, an association with celery alone could not be shown because workers were also exposed to other produce. However, anecdotal evidence also suggested that celery might be involved. The disease-resistant, high-quality brand of celery carried by these stores had higher levels of furanocoumarins, potent photosensitizers and a known cause of phytophotodermatitis, than other brands (p = 0.01). A randomly selected nationwide sample of stores in this chain showed dermatitis in 13 of 17 states and 26% of produce workers surveyed. Plant breeding to produce a more disease-resistant celery stock may lead to increased levels of endogenous furanocoumarins, resulting in phytophotodermatitis in grocery workers.

Dermatitis, Occupational↗
PubMed1985

Secondary Haemophilus influenzae type b in day-care facilities. Risk factors and prevention.

The risk factors for acquisition of secondary day-care-associated Haemophilus influenzae type b disease were evaluated in a cohort of children in Seattle-King County, Washington; Atlanta; and the state of Oklahoma. During the study period, 129 primary cases were identified in children less than 5 years old who attended day-care facilities. In ten instances (8%), a secondary case occurred between one and 60 days after a primary case in the same classroom. Risk of secondary disease in classroom contacts was strongly age related: 2.4% in children 0 to 11 months old, 1.2% in children 12 to 23 months old, and 0.0% in children 24 to 59 months old. Controlling for age, children attending day-care more hours per week were more likely to transmit or acquire secondary disease. Risk of secondary disease for children in other classrooms at a center where a case had occurred was not significantly greater than risk of primary disease. Administration of rifampin to classroom contacts of a child with invasive H influenzae was effective in preventing secondary cases (95% confidence interval for rifampin efficacy, 47% to 100%). For children 0 to 23 months old not treated with rifampin, risk of secondary disease was 2.7% (95% confidence interval, 1.1% to 4.3%), a risk approaching that reported in household contacts.

Age Factors↗