A nationwide outbreak of Reye's Syndrome. Its epidemiologic relationship of influenza B

Between December 15 and June 30, 1974, 379 cases of confirmed Reye's syndrome were reported to the Center for Disease Control. Of these, 316 occurred during February and March 1974. A simultaneous surveillance system for influenza B indicated that this clustering of cases of Reye's syndrome correlated both temporally and geographically with influenza B outbreaks. The incidence of Reye's syndrome was higher in rural than in urban centers. Epidemiologically, two groups of cases of Reye's syndrome emerge: those which occur in older children (median age 11 years), cluster in time and geographic region, and are associated with antecedent influenza B infection; and those which occur sporadically thoughout the year, are isolated in occurrence, occur in younger children (median age 6 years), and are associated with a wide variety of antecedent viral illnesses.

Pressure monitoring devices. Overlooked source of nosocomial infection

Contaminated pressure monitoring devices recently have been implicated as a source of epidemic organisms in three outbreaks of nosocomial bacteremia, one outbreak of candidemia, and one outbreak of hepatitis. Measures necessary to prevent monitoring-related infections have not always been appreciated or taken. As a minimum, pressure monitoring devices should be sterilized between use with different patients; strict aseptic technique should be employed when setting up and using monitoring systems; and each patient's monitoring tubing, fluid, and monitoring devices should be changed at regular intervals.

Serum neutralizing antibody after rabies postexposure prophylaxis

One hundred seventy-seven persons submitted specimens for serum neutralizing antibody titer detreminations 30 to 90 days after starting postexposure rabies prophylaxis. Ninety-two percent of those who received duck embryo vaccine alone developed adequate antibody titers. However, 23% of those who received equine antirabies serum plus duck embryo vaccine failed to develop an adequate antibody titer; one of these inadequate responders subsequently died of rabies. Factors that increased the risk of a poor antibody response included the receipt of steroids during the course of postexposure prophylaxis, and the use of more than 55 lu/kg of equine antirabies serum. Many persons receiving postexposure rabies prophylaxis fail to develop adequate humoral immunity and may have an increased risk of developing rabies. We suggest that persons receiving postexposure rabies prophylaxis should have serum neutralizing antibody determinations 30 to 40 days after starting treatment.

Live, attenuated influenza A/England/42/72 (H3N2) virus vaccine: a field trial

Two doses of a live, attentuated influenza A/England/42/72 (H3N2) vaccine virus (inhibitor-insensitive Alice strain) were administered intranasally to 130 university students, and placebo was given to 134 students. Fourfold or greater rises in titer of hemagglutination-inhibiting antibody occurred in 68% of all vaccine recipients and in 88% of those with initial titers of less than 1:8; the geometric mean titer of hemagglutination-inhibiting antibody increased from 1:15 to 1:77. A 3.2-fold rise in titer of neuraminidase-inhibiting antibody occurred in 24% of the students. Side effects produced by administration of the vaccine include mild rhinitis and sore throat, which were found only during the first four days after administration of the first dose. Inhibitor-insensitive virus was shed only by three of 31 intensively studied vaccine recipients; these three subjects all had initial serum titers of hemagglutination-inhibiting antibody of less than 1:8. No transmission of vaccine virus to spouses was detected. During a 12-month interval after vaccination, the geometric mean titer of hemagglutination-inhibiting antibody in serum and the prevalence of antibody decreased minimally among the 47 vaccine recipients still available for study.

Clinical use of human globulin immune to rabies virus

Studies of human globulin immune to rabies virus before licensure showed that it suppressed active antibody responses when individuals received 16 doses of duck embryo vaccine but not when they received 23 doses of duck embryo vaccine. Prospective surveillance of use of human globulin immune to rabies virus since licensure in 1974 has revealed that 40% of persons who receive 14-16 doses of duck embryo vaccine have low or undetectable antibody responses 30-90 days after initiation of the series. Ten percent of individuals receiving 21-23 doses of duck embryo vaccine have inadequate antibody responses, a percentage not significantly different from that found in recipients of 14 doses of vaccine alone. Human globulin immune to rabies virus has also been used for treatment of one case of clinical human rabies; this use was based on the observation that antibodies to rabies virus in serum do not develop until after the seventh day of clinical illness, and antibodies are absent from spinal fluid as long as 19 days after onset of symptoms. Intracranial pressure and neurological function remained stable after administration of human globulin immune to rabies virus, but two days after initiation of therapy, the patient died of progressive pulmonary dysfunction and tension pneumothorax.

Dealing with possible rabies exposure

When a patient has come in contact with a domestic or wild animal that may be rabid, the physician must decide whether postexposure rabies prophylaxis is warranted. Among the factors that must be weighed are the animal species involved, the epizootiology of rabies, and the circumstances surrounding the exposure.

HBs-Ag-negative hepatitis in a hemodialysis unit: relation to Epstein-Barr virus

Eleven of 40 patients in a hemodialysis unit had clinical or biochemical evidence of hepatitis during a five-week period. The clinical disease was mild, being limited solely to dialysis patients. Epidemiologic investigation indicated that the incubation period was between 17 and 35 days and that 10 of 11 patients had been exposed to a single venous-pressure monitor before onset. Dried blood and evidence of blood reflux up the venous-pressure gauge suggested that cross-contamination of the blood of successive patients probably resulted in transmission of disease. No association with the hepatitis B surface antigen or anti-hepatitis B antibody was demonstrated, but 10 of the 11 patients with elevated transaminase levels had evidence of recent exposure, to Epstein-Barr virus as manifested either by Ox-cell hemolysin titers or rises in titers to viral capsid antigen.

Treatment of persons exposed to rabies

Several clinical and epidemiologic criteria have been formulated by the Center for Disease Control in advising physicians on the treatment of persons exposed to possibly rabit animals. When deciding whether or not to institute rabies prophylaxis, the physician must consider (1) the type of exposure, (2) the animal species involved in the exposure and the regional epidemiology of rabies, (3) the circumstances surrounding the exposure, and (4) the treatment alternatives and complications.