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Incidence of acute rheumatic fever. A suburban community hospital experience during the 1970s.

The incidence of acute rheumatic fever has declined remarkably in the past three decades, but the disease has not been eradicated, as some physicians believe. This study documents the diagnosis of the disease in 23 middle-class children from Fairfax County, Virginia, during the 11-year-period from 1970 through 1980. This county has one of the highest median family incomes in the United States. The annual age-adjusted incidence rate of initial attacks of acute rheumatic fever per 100,000 Fairfax County children declined from 3.0 in 1970 to 0.5 in 1980. In six of the 23 children, carditis accompanied by monarticular arthritis or arthralgia was present. Another seven children had carditis plus polyarthritis. Two patients had Sydenham's chorea. None of the children had erythema marginatum or rheumatoid nodules. In two children, symptoms of acute rheumatic fever developed two weeks after they finished a 10-day course of penicillin for Group A streptococcal pharyngitis. The remaining 21 children had not been considered ill enough to be brought to medical care prior to development of symptoms of acute rheumatic fever.

Acute Disease↗

Should all children receive two measles vaccinations? A study of measles susceptibility in a suburban New Jersey private practice.

Because of the rising incidence of rubeola, we tested all our patients who were vaccinated prior to 15 months of age and those vaccinated after 15 months, if requested, for susceptibility to measles (IgG, ELISA). Those found to be susceptible were revaccinated. Of 1,228 tested, 264 (21.5%) were susceptible. In the group vaccinated before 1980, 237 of 901 (26.3%) were susceptible, whereas only 27 of 327 (8.3%) vaccinated after 1980 were not immune. Susceptibility was sharply divided by month of age at vaccination at the 14-month mark. Less than 5% of those vaccinated after age 15 months in the 1980s (one of 22, or 4.5%) were susceptible. Waning immunity (secondary vaccine failure) was not found to be a factor in our patients. Despite outbreaks of measles in surrounding communities and in our area, none of our patients developed measles. Identification of high-risk groups and selective measles revaccination should be considered as an alternative to universal revaccination in populations such as ours, since it is more cost-effective and may prove equally successful.

Analysis of Variance↗

Genetically distant American Canine distemper virus lineages have recently caused epizootics with somewhat different characteristics in raccoons living around a large suburban zoo in the USA.

BACKGROUND: Mortality rates have differed during distemper outbreaks among free-ranging raccoons (Procyon lotor) living around a large Chicago-area zoo, and appeared higher in year 2001 than in 1998 and 2000. We hypothesized that a more lethal variant of the local Canine distemper virus (CDV) lineage had emerged in 2001, and sought the genetic basis that led to increased virulence. However, a more complex model surfaced during preliminary analyses of CDV genomic sequences in infected tissues and of virus isolated in vitro from the raccoons. RESULTS: Phylogenetic analyses of subgenomic CDV fusion (F) -, phosphoprotein (P) -, and complete hemagglutinin (H) - gene sequences indicated that distinct American CDV lineages caused the distemper epizootics. The 1998 outbreak was caused by viruses that are likely from an old CDV lineage that includes CDV Snyder Hill and Lederle, which are CDV strains from the early 1950's. The 2000 and 2001 viruses appear to stem from the lineage of CDV A75/17, which was isolated in the mid 1970's. Only the 2001 viruses formed large syncytia in brain and/or lung tissue, and during primary isolation in-vitro in Vero cells, demonstrating at least one phenotypic property by which they differed from the other viruses. CONCLUSIONS: Two different American CDV lineages caused the raccoon distemper outbreaks. The 1998 viruses are genetically distant to the 2000/2001 viruses. Since CDV does not cause persistent infections, the cycling of different CDV lineages within the same locale suggests multiple reintroductions of the virus to area raccoons. Our findings establish a precedent for determining whether the perceived differences in mortality rates are actual and attributable in part to inherent differences between CDV strains arising from different CDV lineages.

Amino Acid Sequence↗

Organophosphorus pesticide exposure of urban and suburban preschool children with organic and conventional diets.

We assessed organophosphorus (OP) pesticide exposure from diet by biological monitoring among Seattle, Washington, preschool children. Parents kept food diaries for 3 days before urine collection, and they distinguished organic and conventional foods based on label information. Children were then classified as having consumed either organic or conventional diets based on analysis of the diary data. Residential pesticide use was also recorded for each home. We collected 24-hr urine samples from 18 children with organic diets and 21 children with conventional diets and analyzed them for five OP pesticide metabolites. We found significantly higher median concentrations of total dimethyl alkylphosphate metabolites than total diethyl alkylphosphate metabolites (0.06 and 0.02 micro mol/L, respectively; p = 0.0001). The median total dimethyl metabolite concentration was approximately six times higher for children with conventional diets than for children with organic diets (0.17 and 0.03 micro mol/L; p = 0.0003); mean concentrations differed by a factor of nine (0.34 and 0.04 micro mol/L). We calculated dose estimates from urinary dimethyl metabolites and from agricultural pesticide use data, assuming that all exposure came from a single pesticide. The dose estimates suggest that consumption of organic fruits, vegetables, and juice can reduce children's exposure levels from above to below the U.S. Environmental Protection Agency's current guidelines, thereby shifting exposures from a range of uncertain risk to a range of negligible risk. Consumption of organic produce appears to provide a relatively simple way for parents to reduce their children's exposure to OP pesticides.

Agriculture↗

Diabetic ketoacidosis in a community of suburban Osaka. Analysis of 39 episodes of ketoacidosis and related conditions.

Thirty-nine episodes of hyperglycemia and disturbance of acid-base equilibrium were classified according to the result of nitroprusside test for serum (or urine) ketones, serum electrolytes, glucose, lactate, beta-hydroxybutyrate and arterial blood pH and gas analysis into the following 6 groups; (1) diabetic ketoacidosis (DKA), (2) mild DKA, (3) DKA with mixed acid-base disturbance, (4) DKA with lactic acidosis, (5) lactic acidosis with mild ketonemia, (6) lactic acidosis. Their clinical manifestations, laboratory findings, insulin and i.v. fluid requirement in the early phase of therapy were surveyed and compared with those reported from Western countries. The fundamental problems of groups (1) to (4) were hyperglycemia and acid-base disturbance. Groups (5) and (6) were characterized by underlying serious medical illness, accompanied by lactic acidosis and hyperglycemia. All patients in groups (1) to (4) recovered but 7 of 10 patients in groups (5) and (6) died within the first 7 days. DKA with or without lactic acidosis and lactic acidosis with or without mild ketonemia appeared as two separate conditions from the standpoint of management and prognosis and were differentiated only by nitroprusside test for serum ketones. DKA with lactic acidosis and DKA without it could not be differentiated by routine blood chemistries and therapy for the two did not differ so that they were thought to be in the same spectrum of metabolic alteration.

Blood Chemical Analysis↗

[Occurrence and biology of Rhodnius neglectus Lent, 1954 in palm trees of suburban areas of Belo Horizonte, Minas Gerais].

Eighty-one "macaubeiras" palm-trees (Acrocomia sclerocarpa) from the periphery of Belo Horizonte city were cut down and dissected between April 1979 and July 1980. 60.5% of the trees were positive for R. neglectus and 463 specimens of this insect were collected, providing a mean rate of 9,45 individuals for positive palm-trees. R. neglectus seems to present a single annual generation in this region, but evidence was obtained that two generations may occur. Its spawn period is related to the hot months of the year, when younger insects prevail over the adults. This observation suggests that higher population densities are related to better feeding conditions and to minor densities of specific predators such as Telenomus sp., ants, spiders, hemipters, scorpions and pseudo scorpionidae. The Trypanosoma cruzi infection index was 15,9%, suggesting that R. neglectus is a very important vector of silvatic infections in the region. Marsupials are the main vertebrate source of T. cruzi infection. R. neglectus is strongly associated with palm-trees in the area, and with the various species of birds that haunt them. So far, there is no evidence suggesting R. neglectus to be an important vector of human Chagas' disease in the region.

Animals↗

Evaluation of an oral disease control program administered to a clinic population at a suburban dental school.

This study included 99 patients. Seventy-four of these participated in the Oral Disease Control program at Emory University School of Dentistry and 25 control patients did not. Those who completed the Oral Disease Control program were examined and scored from 2 to 24 months afterward. The Patient Hygiene Performance Scoring was used. It was found that there was no significant difference in levels of plaque between subjects who completed the Oral Disease Program and those who did not participate. Also, the patient's knowledge of the causes of dental caries and gingival disease bore no significant relationship to the amount of plaque present. Further, certain selected hygiene habits had no significant effect on plaque level. The patients studied were enthusiastic about the control program and developed an increased awareness of oral disease control. However, this study confirms others that demonstrate the need for repeated professional reinforcement in any effective oral disease control program.

Adolescent↗