A low-cost intervention for cleaner drinking water in Karachi, Pakistan.

Objective: To pilot test an inexpensive, home-based water decontamination and storage system in a low-income neighborhood of Karachi.

Methods: Fifty households received a 20-L plastic water storage vessel with a high-quality spout and a regular supply of diluted hypochlorite solution. Twenty-five control households were recruited.

Microbiologic effectiveness of hand washing with soap in an urban squatter settlement, Karachi, Pakistan.

We conducted a study in a squatter settlement in Karachi, Pakistan where residents report commonly washing their hands to determine if providing soap, encouraging hand washing, and improving wash-water quality would improve hand cleanliness. We allocated interventions to 75 mothers and collected hand-rinse samples on unannounced visits. In the final model compared with mothers who received no hand-washing intervention, mothers who received soap would be expected to have 65% fewer thermotolerant coliform bacteria on their hands (95% CI 40%, 79%) and mothers who received soap, a safe water storage vessel, hypochlorite for water treatment, and instructions to wash their hands with soap and chlorinated water would be expected to have 74% fewer (95% CI 57%, 84%).

Processes for obtaining nonmedical exemptions to state immunization laws.

Objectives: This study sought to determine the specific processes required for obtaining religious and philosophical exemptions to school immunization laws.

Methods: State health department immunization program managers in the 48 states that offer nonmedical exemptions were surveyed. Categories were assigned to reflect the complexity of the procedure within a state for obtaining an exemption.

Health consequences of religious and philosophical exemptions from immunization laws: individual and societal risk of measles.

Context: All US states require proof of immunization for school entry. Exemptions are generally offered for medical, religious, or philosophical reasons, but the health consequences of claiming such exemptions are poorly documented.

Objectives: To quantify the risk of contracting measles among individuals claiming religious and/or philosophical exemptions from immunization (exemptors) compared with vaccinated persons, and to examine the risk that exemptors pose to the nonexempt population.

Impact of anti-vaccine movements on pertussis control: the untold story.

To assess the impact of anti-vaccine movements that targeted pertussis whole-cell vaccines, we compared pertussis incidence in countries where high coverage with diphtheria-tetanus-pertussis vaccines (DTP) was maintained (Hungary, the former East Germany, Poland, and the USA) with countries where immunisation was disrupted by anti-vaccine movements (Sweden, Japan, UK, The Russian Federation, Ireland, Italy, the former West Germany, and Australia). Pertussis incidence was 10 to 100 times lower in countries where high vaccine coverage was maintained than in countries where immunisation programs were compromised by anti-vaccine movements. Comparisons of neighbouring countries with high and low vaccine coverage further underscore the efficacy of these vaccines.

Trends in hospitalizations for diarrhea in United States children from 1979 through 1992: estimates of the morbidity associated with rotavirus.

Objectives: To examine trends in the hospitalizations of children for diarrheal disease in the U.S. and to provide estimates for the burden of disease associated with rotavirus diarrhea.

Observations on the ecology of Salmonella waycross and Salmonella typhimurium on Guam.

A period of high incidence of human Salmonella infections on the island of Guam saw the emergence of S. waycross as the most commonly isolated serotype as well as a concurrent decreasing proportion of isolates due to S. typhimurium.

Day-care center attendance and hospitalization for lower respiratory tract illness.

To identify risk factors associated with hospitalization for acute lower respiratory tract illness, 102 children less than 2 years of age admitted to four Atlanta metropolitan area hospitals between December 1984 and June 1985 with the diagnosis of lower respiratory tract illness were studied. The most common causative agent associated with illness was respiratory syncytial virus, followed by other respiratory viruses, Haemophilus influenzae, and Streptococcus pneumoniae. The 102 case-patients were compared with 199 age- and sex-matched controls.

Effect of urban versus rural residence and of maternal education on infant health in South Lebanon.

A sample of 253 women from rural and urban areas of south Lebanon were visited for 18 months after delivery. Information was collected on patterns of reproduction, infant feeding, and use of the health services. The findings indicate that educated women and women living in urban areas were better off in terms of family formation patterns, immunisation, and well-baby care.

Bottled beverages and typhoid fever: the Mexican epidemic of 1972-73.

A chloramphenicol resistant strain of S. typhi which caused a very large epidemic of typhoid fever in Mexico in 1972-73 survived in opened bottles of one carbonated drink with a pH of 4.6 for two weeks and in another such drink with a pH of 5.

Clinical features of types A and B food-borne botulism.

Medical records of 55 patients with type A and type B food-borne botulism reported to the Centers for Disease Control during 2 years were reviewed to assess the clinical features and severity of illness, diagnostic test results, nature of complications, amd causes of death. Some patients had features not usually associated with botulism including paresthesia (14%), asymmetric extremely weakness (17%), asymmetric ptosis (8%), slightly elevated cerebrospinal fluid protein values (14%), and positive responses to edrophonium chloride(26%). Several observation suggest that type A was more severe than type B disease.

Handwashing to prevent diarrhea in day-care centers.

Diarrhea has been recognized as a frequent health problem among children enrolled in day-care centers. Thus, we evaluated the effect of a handwashing program in two day-care centers (HWC) on the incidence of diarrhea among children when compared to children in two control centers (CC). After the program was begun, the incidence of diarrhea at the HWC began to fall and after the second month of the study was consistently lower than that at the CC.

Gastrointestinal Illness Associated with Consumption of a Soy Protein Extender .

In July and August 1976, an outbreak of acute gastrointestinal illness occurred among persons who had consumed a commercially marketed soy protein tunafish salad extender. After a public warning of a possible product contamination, representatives of 350 households reported 508 persons ill with an afebrile gastrointestinal syndrome that occurred usually within 1 h after the salad-extender was eaten. Interviews of randomly selected reported ill persons (cases) showed that the principal symptoms were nausea (91%), abdominal cramps (71%), diarrhea (53%), headache (42%), difficulty breathing (36%), and vomiting (22%).

Role of Norwalk virus in outbreaks of nonbacterial gastroenteritis.

Twenty-five separate outbreaks of nonbacterial gastrointestinal illnesses were studied serologically for evidence of infection with the Norwalk virus and the rotaviruses that affect humans. Eight of 25 outbreaks appeared to be related to the Norwalk virus. In one of the 25 outbreaks, there was evidence of rotavirus infection.

Non-cholera vibrio infections in the United States. Clinical, epidemiologic, and laboratory features.

Non-cholera vibrios are organisms that are biochemically indistinguishable from Vibrio cholerae but do not agglutinate in vibrio 0 group 1 antiserum. Since 1972 there has been a dramatic increase in the number of these organisms referred to the Center for Disease Control for identification. Clinical, epidemiologic, and laboratory data were analyzed for 26 of 28 patients with isolates identified between January 1972 and March 1975.

Epidemiology of Escherichia coli in the United States.

Current evidence suggests that diarrheagenic E. coli are not important causes of disease in the sanitized urban centers of the United States at this time. However, enterotoxigenic E.

Raw hamburger: an interstate common source of human salmonellosis.

An interstate common-source outbreak of salmonellosis was first detected in the United States in September and October, 1975, when a tenfold increase in Salmonella newport isolates was noted through routine salmonella surveillance by the Colorado Department of Health. Eighteen primary cases with a distinctive antibiotic resistance pattern (tetracycline, streptomycin, and sulfonamides) were evaluated in a case-control study, and illness was found to be associated with eating raw hamburger (p less than .001) from any store of one grocery chain (p less than .