CENTER FOR DISEASE CONTROL September 21, 1979 / Vol. 28 / No. 37

Surveillance Summary

437 Brucellpsjs^Umied States, 1978

, lntar(foti0nal'fl«e^Nv439 YeftovV Fever ^ Trinidad, Colombia

Epjdemiologic Notes and Reports

445/staphylococcal Food Penning —/(Delaware £ r iQjo \ > \

\ J ^Current Trerwis44Q^ajrvejllance of Chilo-hoodJLead

MORBIDITY AND MORTALITY WEEKLY REPORT AfP'soning - Unitedjtatfw/

Surveillance Summary xjc>/ q .

Brucellosis - United States, 1978

In 1978, 172 cases of brucellosis were reported to the Center ToT"BTSBclS^WTtrol.

This is a decrease of 69 cases from the 241 reported in 1977, and it is also the lowest

number of cases reported in any year since 1927, when brucellosis was first recognized as

a common cause of human illness.

Of these 172 cases, surveillance reports were received on 161 (94%); 127 (79%) of

these were classified as initial infections, and 15 (9%) were recrudescent.* No reinfections

were reported with onset in 1978. There were also no fatal cases.

Onset of illness was specified as acute or insidious in 104 brucellosis cases: acute

in 57 (55%) and insidious in 47 (45%). In 136 cases the month of onset was specified.

Onset of illness was reported to occur more frequently in the spring and summer than

in the fall and winter-a pattern observed for the period 1965-1974 (/).

As in the past, brucellosis predominantly affected adult males. Of 160 cases for which

sex was specified, 134 (84%) were in males; 116 (82%) of 142 cases for which age was

given were in persons between 20 and 60 years of age. This is the age category of the

work force in the United States and the population at greatest risk of acquiring brucello

sis in the meat-packing and livestock industries. Indeed, 58 (46%) of the 127 cases for

which information was available were in individuals working in the meat-processing

industry (Figure 1).

Thirty-eight states reported cases last year (Figure 2) compared with 37 states, Puerto

Rico, and Guam in 1977. Two states, Iowa and Texas, reported more than 15 cases

each and together accounted for 22% of the 1978 total. Idaho reported the greatest

increase in total cases (5), while Virginia reported the greatest decrease (33). Virginia's

marked decline was because of a reduction in swine-associated cases in abattoir workers.

The majority of the Idaho cases were associated with cattle.

As in the period 1975-1977, cattle were the most common source of human infection

last year. Contact with infected cattle resulted in 54 (34%) human cases in 1978. Swine-

associated cases were markedly reduced, due primarily to Virginia's decrease in such

cases. Contact with infected domestic swine was responsible for 16 cases (10%), and

*A confirmed case was defined as 1). a clinical specimen culture-positive for Brucella, or 2). clinical

symptoms compatible with brucellosis, such as any combination of fever, sweats, chills, undue fatigue,

anorexia, weight loss, arthralgia, lymphadenopathy, and splenomegaly,and a >4-fold change in Brucella

agglutination titer between acute and convalescent serum specimens obtained 2 or more weeks apart

and studied at the same laboratory. A presumptive case was defined as clinical symptoms compatible

with brucellosis with either a Brucella agglutination titer positive at a >1:160 dilution on a single

serum specimen obtained after the onset of symptoms or a stable Brucella agglutination titer positive

at a >1:160 dilution in serum specimens obtained after the onset of symptoms. A recrudescent case

is a confirmed or presumptive case in a person who, within the preceding 3 years, had an illness

diagnosed as brucellosis followed by a period of apparent recovery.

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE

MMWR September 21, 1979

Brucellosis - Continued

feral swine for 2 cases in hunters. An additional 18 (11%) cases resulted from contactwith cattle and swine. Three cases were associated with contact with dogs. Fourteen (9%)

cases were attributed to the ingestion of unpasteurized dairy products-9 of these to

milk produced in the United States. Five cases were attributed to foreign dairy products,

including raw milk or cheese from Mexico (3 cases), Iran (1 case), and an unspecified

Latin American country (1 case). Accidental injection of strain 19 Bruce/la vaccine was

listed as the cause in 3 cases, all in veterinarians, and laboratory accidents resulted in2 cases.

Reported by the Bacteria/ Zoonoses Br, Bacterial Diseases Div, Bur of Epidemiology, CDC.

Editorial Note: A review of brucellosis cases in the United States from 1967 to 1978

emphasizes the importance of abattoirs in the epidemiology of brucellosis. In 7 of the last10 years, more than half of reported cases occurred in people associated with the meat-processing industry (Figure 2). Of 2,063 cases on which reports were received in this10-year period, 1,171 (57%) were in abattoir workers.

Reference

1. Fox JD, Kaufmann AF: Brucellosis in the United States, 1965-1974. J Infect Dis 136- 312-3161977

A A copy of the surveillance report from which these data were summarized is available on requestfrom CDC, Attn: Bacterial Zoonoses Br, Bacterial Diseases Div, Bur of Epidemiology, CDC.

FIGURE 1. Total brucellosis cases and proportion associated with abattoirs * UnitedStates, 1967-1978

TOTAL REPORTS RECEIVED

— ABATTOIR-ASSOCIATED ANON-ABATTOIR

o 250-UJ

2 150-Ui

K

UICO

< I00-

I967 68 69 '70 '71 '72 '73 '74 '75 '76 '77 '78

'Includes packinghouse employees, government meat insDectors. and renrierinn nlant

September 21, 1979 MMWR

Brucellosis — Continued

FIGURE 2. Human brucellosis cases, by state, United States, 1978

International Notes

Yellow Fever — Trinidad, Colombia

Trinidad: On September 11, the Ministry of Health, Trinidad and Tobago, officially

notified the Pan American Health Organization and the World Health Organization (WHO)

that an outbreak of jungle yellow fever had been confirmed in howler monkeys from the

Mamural Forest of central Trinidad. In addition, 7 suspected human cases—all sylvatic-

were under investigation.

A similar outbreak of jungle yellow fever in the Guayaguayare Forest of southeast

Trinidad occurred in the fall of 1978 and spring of this year (1-3). As a result of that

outbreak, more than 75% of the population of Trinidad was immunized in a mass im

munization program in the spring of 1979.

Control measures for Aedes aegypti and surveillance for suspected human cases are

continuing throughout the island.

The island of Tobago remains free of yellow fever infection.

Colombia: A recently reported outbreak of yellow fever (4) appears to be spreading

north from Valledupar toward the more populated coastal areas. Several cases have

been reported in Fundacion and Cienaga, about 40 miles east of Barranquilla on the

coast. Health officials are vaccinating persons in the Fundacion area and other coastal

areas to the west. Although it has not been determined that the A. aegypti vector is in

volved in the outbreak, this species is known to be prevalent throughout the affected area.

440 MMWR September 21, 1979

Yellow Fever — Continued

Currently, the following areas of Colombia are officially included in those listed by

WHO as being infected with jungle yellow fever: Caqueta Intendencia, Cesar Department,

Magdalena Department, Meta Intendencia, Norte de Santander Department, Santander

Department, and Vaupes Comisaria.

Reported by the Pan American Health Organization; Office of Foreign Disaster Assistance, U.S. De

partment of State; Quarantine Div, Viral Diseases Div, Bur of Epidemiology, CDC.

Editorial Note: Because of the official declaration that the island of Trinidad is infected

with yellow fever, CDC now recommends yellow fever vaccination for all travelers to the

island of Trinidad. There is no evidence of risk for visitors who limit their activities to

urban areas, such as cruise ship passengers visiting Port of Spain. Nevertheless, even

visitors with such limited travel in Trinidad may be subject to quarantine restrictions in

other Caribbean and Central American ports of entry in view of Trinidad's "yellow fever

infected" status.

In view of the current yellow fever activity in Colombia, all travelers to the northern

coast of that country should be vaccinated against yellow fever. Travelers to other areas

of Colombia listed as infected with yellow fever should be vaccinated, unless their acti

vities are limited to urban areas.

References

1. MMWR 27:509, 1978

2. MMWR 28:72, 1979

3. MMWR 28:279, 1979

4. MMWR 28:371, 1979

TABLE I. Summary — cases of specified notifiable diseases. United States

[Cumulative totals include revised and delayed reports through previous weeks.]

nioc ACrUldEMdE

Aseptic meningitis

Brucellosis

Chickenpox

Diphtheria

Encephalitis: Primary (arthropod-borne & unspec.)

Post-infectious

Hepatitis, Viral: Type B

Type A

Type unspecified

Malaria

Measles (rubeola)

Meningococcal infections: Total

Civilian

Military

Mumps

Pertussis

Rubella (German measles)

Tetanus

Tuberculosis

Tularemia

Typhoid fever

Typhus fever, tick-borne (Rky. Mt. spotted)

Venereal diseases:

Gonorrhea: Civilian

Military

Syphilis, primary & secondary: Civilian

Military

Rabies in animals

37th WEEK ENDING

September

23

1979

367

6

252

—

3i

6

29?

586

234

10

<»2

21

21

—

70

36

36

3

497

7

IS

23

»211

381

*95

10

90

15, September 16,

1978*

293

2

240

—

67

3

272

497

139

19

200

29

28

1

58

41

140

-

56 7

1

<i

23

20,955

52 5

475

4

63

MEDIAN

1974-1978*

171

6

248

1

63

3

2 72

599

158

1 2.

107

29

28

—

183

41

78

1

58B

1

10

27

21,331

525

410

5

59

CUMULATIVE, FIRST 37 WEEKS

. September 15,

1979

4.535

110

171,292

62

595

170

10*215

20,638

7,358

4-70

12,135

1,933

1.923

10

11,189

968

10,660

50

19,928

148

335

857

699,722

19.494

17,115

224

3.503

TABLE II. Notifiable diseases of low frequency. United State;

Anthrax

Botulism (Wash. 1, Calif. 1)

Cholera (Calif. 1)

Congenital rubella syndrome

Leprosy t

Leptospirosis (Va. 1)

Plague

"Delayed reports received for calendar year 1978 are u

"Medians for gonorrhea and syphilis are based on data

tThe following delayed reports will be reflected in

CUM. 1979

- Poliomyel

17

1 Psittacosis

36 Rabies in i

114 Trichinosi

32 Typhus fe\9

sed to update last year's weekl

for 1976 1978.

next w eek's cumulative totals

tis: Total

Paral

(Colo. 1)

nan

t (Upst. t

er, flea-bo

i and cum

Leprosv:

«ic

J.Y. 1, N.J. 1, La. 1

me (endemic, murin

jlative totals.

P.R. +1: Trichinos

September 16,

1978*

3.820

126

124,132

59

802

162

10,671

20,311

5,892CIA

23,944

1.823

1,800

23

13.425

1,488

16,874

59

20,687

88

364

874

703,068

18.363

14,776

204

2.261

. Tex. 1)

e) (Tex. 7)

is: Mo. +1. N.Me

MEDIAN

1974-1978"

2,364

164

124,132

126

802

198

10,580

24,081

5,900

23.944

1,158

1,141

23

32,698

1.098

14,826

59

21,769

105

281

737

703,068

19,235

14,776

209

2.099

CUM. 1979

23

20

76

2

113

♦2

x. +3.

September 21, 1979

TABLt 111 (Cont.'d). Cases of specified notifiable diseases. United States, weeks ending

September 15, 1979, and September 16,1978 (37th week)

REPORTING AREA

MEASLES(RUBEOLA) MENINGOCOCCAL INFECTIUNS

TOTALPERTUSSIS RUBELLA TETANUS

CUM. CUM.

1979 1979

UNITED STATES

NEW ENGLAND

Maine

N.H.

MID. ATLANTIC

Upstate N.Y.

N.Y. City

N.J.t

E.N. CENTRAL

Ohiot

Ind.

36 13,660 50

1,

3,

1.

1,

1,

287

17

32

119

13

102

4

513655

756

57

45

14 3

264

204

•'.06

82 3

*46

733

214

16

420

20

2

1,961

1.314

46

25

241

a

32 7

2,165

1.390

346

74

S5S

10.8U

191

1,078

7.606

1.467

387

36

57

9

193_

—

-

1

-

-

4

2

1

-

1

B

-

3

1

3

3

4

-

_

1,

1,

2.

I,

122

397

481

93

255

899

259

322

264

M4j

135

726

179

192

252

447

52

—

—

3

-

1

9

3

4

1

1

3

2

-

-

1

-

2

—

_

E.S. CENTRAL

Ky.

Tenn.

Ala.

W.S. CENTRAL

Ark.

MOUNTAIN

Mont

Idaho

Wyo.

Colo.

N. Mex. t

269

54

112

151

450

768

201

37

56

84

24

900

9

247

22

622

318

57

21

36

2,

1,

1,

1.

B24

042

117

1 97

2H

7 5(,

407

119

943

101

244

051

16

343

13

6 7S

2 50

106

1_

2,

1,

220

61

951

837

165

146

519

146

29

41

36

40

311

26

143

28

35

45

35

2 6 9

21

I

1

1—

-

9—

1.323

1,088

98

22

115

1.342

480

2

2

-

-

-

1_

41

3

4

3

7

J 5

5

4

243

40

1

-

-

_

-

-

-

1

10_

2t>5

10

8

75

12

53

94

13

686

186

P.R. t

V.I.

Pac. Trust Terr, t

NA: Not available.

"Delayed reports received for 1978 are not sho

tThe following depay

Mo. +5, Md. -1, N.Mex. +1, Calif. +1, P.R.+1; Mumps: Mo.+4, Calif.+4, Gua

Mo. M.Calif.+3.

mlative totals.

-3, Mo. -7, Calif. +4, Guam +4; Men. inf.: Mich. +1,

H: Pertussis: Mo. +6, Calif. +3; Rubella: Conn. +1, N.J. -1.

September 21, 1979

TABLE III (Cont.'d). Cases of specified notifiable diseases. United States, weeks ending

September 15,1979, and September 16, 1978 (37th week)

REPORTING AREA

TYPHUS FEVER

(Tick-borne) H

(RMSF)

VENEREAL DISEASES (Civilian)

SYPHILIS (Pri. & Si

UNITED STATES 497 19,928 148

NEW ENGLAND 10 546 3

857 23.211

MID. ATLANTIC 73 3,103

Upstate N.Y. 24 595

N.Y. Cityt 15 1.138

N.J. 20 568

Pat 14 802

EN. CENTRAL

Ohiot

Ind.

III.

Mich.t

Mb.

W.N. CENTRAL

Minn.

lawn

Mo. t

N. Dak.

& Dak.

Nebr.t

Kans.t

& ATLANTIC

Del.

Md.t

D.C.

Va.

W. Va.

N.C.t

S.C.

Ga.

Fla. t

E.a CENTRAL

Ky.

Tenn.

Ala.

Miss

W.S. CENTRAL

Ark.

La.

Okla.

Tex.t

MOUNTAIN

Mont

Idaho

Wyo.t

Colo.

N. Mex.t

Ariz.

Utah

Nm

PACIFIC

Wash.

Oreg.

Calif, t

Alaska t

Hawaii

M

12

6

H9

24

3

22

2

2

15

—

-

z

I

93

—

6

-

26

i

13

4

14

27

55

12

12

21

10

56

3

>t

11

38

19-

_

2

2

I

11

1

2

B9

4

4

73

l.

2,949

532

373

1,168

744

132

688

109

56

370

14

41

16

82

4,540

36

586

217

540

174

724

326

712

1,225

1,832

477

517

4 30

40S

2,411

208

t84

263

1,456

60 7

29

10

6

8 9

104

297

25

47

3.252

190

137

2,635

52

6 2.605

2 317

1 1,163

5 107

8 1,013

108.041

29,873

9,272

33.547

25,552

9,798

106,971

27,963

11, 148

33,458

24,759

9,643

53 2,2«7

17 442

X 166

25 1.282

6 329

98 4,093

21

10 273

8 319

13 3*7

37 1,130

23 1,431

28 1.118

6 122

8 472

5 208

133 3,145

2 102

55 7 75

89 2,979

153

4 126

84 2,610

3.150 232

173

111 11

2.830 219

NYC -14, Pa. +17, Mich. -1, Mo. -8, Kans. -1, N.C. -3, Fl,

ner: Mo. +1, Md. -1, Calif. +5; RMSF: Mo. +1, N.C. -1, N.Me>

September 21, 1979

TABLE IV. Deaths in 121 U.S. cities,* week ending

September 15, 1979 (37th week)

REPORTING AREA

NEW ENGLAND

Boston, Mass.

Bridgeport, Conn.

Cambridge, Mass.

Fall River, Mass.

Hartford, Conn.

Lowell, Mass.

Lynn, Mass.

New Bedford, Mass.

New Haven, Conn.

Providence, R.I.

Somerville, Mass.

Springfield, Mass.

Waterbury, Conn.

Worcester, Mass.

MID. ATLANTIC 2,

Albany, N.Y.

Allentown, Pa.

Buffalo, N.Y.

Camden, N.J.

Elizabeth, N.J.

Erie, Pa.t

Jersey City, N.J.

Newark. N.J.

N.Y. City, N.Y. I,

Paterson, N.J.

Philadelphia. Pa.t

Pittsburgh, Pa. t

Reading, Pa.

Rochester, N.Y.

Schenectady, N.Y.

Scranton, Pat

Syracuse, N.Y.

Trenton N.J.

Utica. N.Y.

Yonkers, N.Y.

E.N. CENTRAL 2,

Akron, Ohio

Canton, Ohio

Chicago, III.

Cincinnati, Ohio

Cleveland. Ohio

Columbus, Ohio

Dayton, Ohio

Detroit, Mich.

Evansville, Ind.

Fort Wayne, Ind.

Gary, Ind.

Grand Rapids, Mich.

Indianapolis, Ind.

Madison, Wis.

Milwaukee, Wis.

Peoria, III.

Rockford, III.

South Bend, Ind.

Toledo. Ohio

Youngstown, Ohio

W.N. CENTRAL

Des Moines, Iowa

Duluth, Minn.

Kansas City, Kans.

Kansas City, Mo.

Lincoln, Nebr.

Minneapolis. Minn.

Omaha. Nebr.

St. Louis, Mo.

St. Paul, Minn.

Wichita. Kans.

ALL CAUSES, BY AGE (YEARS

ALL

AGES

605

161

tt

23

25

SO

2/

16

23

56

66

4

4j

20

45

644 1

52

22

117

47

28

19

38

53

'ill

22

396

74

38

106

20

24

83

3o

2b

31

197 I

56

51

528

133

191

141

92

248

51

34

19

53

L«9

23

143

35

32

46

123

49

734

38

26

32

109

27

93

106

170

66

67

'Mortality data in this table are

reported by the place

t Because of changes in

of itsoc

-S5

394

B8

33

14

22

30

IV

11

18

34

4")

3

34

14

29

639

27

17

76

26

18

16

25

24

8 76

15

244

34

33

62

11

18

55

22

17

23

345

35

35

30V

90

97

80

61

152

32

19

12

32

91

15

95

20

20

39

ao

31

441

27

15

14

57

21

56

It

89

42

44

45-64

140

46

IC

8

3

11

3

4

3

1Z

I 7

1

5

5

12

647

16

5

27

15

7

3

8

12

32 1

5

111

29

5

28

5

5

21

13

6

5

526

16

10

125

25

61

34

21

65

13

10

-

10

36

5

28

8

6

6

33

14

168

7

7

7

52

4

1 7

17

43

17

17

25-44

34

13

2

1_

3

3

1

2

4

2

-

1

1

1

203

4

-

8

3

3

2

6

124

2

29

2

-

10

2

-

3

1

1

3

151

-

1

43

11

20

13

2

19

3

3

4

4

9

2

7

3

—

-

5

2

43

2

—

4

7

I

10

3

10

3

i

voluntarily reported from

currenc ■ and by th i week t

<1

17

5

-

-

_

2

-

—

-

4

1

-

2

-

3

78

4

-

3

2

_

3

7

43

—

6

3

-

3

-

1

2

1

-

104

4

3

26

4

7

8

5

6

1

-

1

6

10

1

12

3

4

2

1

46

-

2

5

6

—

1

9

15

1

1

121 cities

hat the de

P&l"

TOTAl

37

12

5

—

1

1

3

1

1

-

7

—

2

2

2

ioa

-

i

6

2

-

I

3

45

1

27

4

4

5

1

-

2

2

2

2

51

—

-

13

3

3

4

3

7

2

-

-

6

4

1

1

-

1

1

1

1

26

2

3

_

1

—

2

3

5

—

10

in the U

REPORTING AREA

& ATLANTIC

Atlanta, Ga.

Baltimore, Md.

Charlotte, N.C.

Jacksonville, Fla.

Miami, Fla.

Norfolk, Va.

Richmond, Va.

Savannah, Ga.

St Petersburg, Fla.

Tampa, Fla.

Washington, D.C.

Wilmington. Del.

E.S. CENTRAL

Birmingham, Ala.

Chattanooga, Tenn.

Knoxville, Tenn.

Louisville, Ky.

Memphis, Tenn.

Mobile, Ala.

Montgomery, Ala.

Nashville, Tenn.

W.S. CENTRAL

Austin, Tex.

Baton Rouge, La.

Corpus Christi, Tex.

Dallas, Tex.

El Paso, Tex.

Fort Worth, Tex.

Houston, Tex.

Little Rock, Ark.

New Orleans, La.

San Antonio, Tex.

Shreveport, La.

Tulsa, Okla.

MOUNTAIN

Albuquerque, N. Men

Colo. Springs, Colo.

Denver, Colo.

Las Vegas, Nev.

Ogden, Utah

Phoenix, Ariz.

Pueblo, Colo.

Salt Lake City, Utah

Tucson, Ariz.

PACIFIC

Berkeley, Calif.

Fresno, Calif.

Glendale, Calif.

Honolulu, Hawaii

Long Beach, Calif.

Los Angeles, Calif.

Oakland, Calif.

Pasadena, Calif.

Portland, Oreg.

Sacramento, Calif.

San Diego, Calif.

San Francisco, Calif.

San Jose, Calif.

Seattle. Wash.

Spokane, Wash.

Tacoma, Wash.

TOTAL

nited States, most of

ALL

AGES

1,270

119

2 74

76

131

113

46

91

30

81

7U

180

51

649

84

55

49

120

160

49

31

101

1,067

62

43

37

162

52

8 0

124

53

171

143

50

82

600

61

27

121

77

21

141

21

45

86

If 697

15

72

25

46

80

491

61

20

152

52

153

164

135

136

55

40

11, 463

which have

ath certificate was filed. Fetal deaths are

reporting methods in these 4 Pennsylvania cities, these numbers are parti al counts f

ALL CAUSES, BY AGE (YEARS)

>65

738

69

169

37

64

70

30

55

16

64

4<J

90

25

398

46

29

30

n103

31

23

57

614

37

25

20

96

29

54

69

22

92

83

32

55

358

26

18

76

38

15

91

11

22

61

1,048

9

42

21

27

57

279

4C

16

91

32

98

109

71

87

41

28

6,975 2.

populations

not included

3r the currer

45-64

339

32

73

20

38

27

11

21

9

Lj>

1 7

62

13

157

24

16

13

23

38

a

5

30

285

12

15

is

42

10

20

4)

21

31

15

21

134

15

6

27

22

4

2i

7

12

18

378

5

17

3

11

17

103

15

4

39

10

32

34

39

28

8

8

774

25-44

97

11

14

10

15

9

3

6

4

2

6

14

3

51

9

o

4

6

15

6

2

3

8':

8

1

2

12

7

6

7

5

1 8

14

2

2

47

9

2

10

7

-

11

-

5

3

129

1

5

-

3

3

52

1

-

11

6

7

11

13

13

1

2

839

of 100,000 or mo

t week

<i

47

1

8

4

8

1

1

i

1

-

2

li

9

19

1

1

1

/

1

3

1

4

35

-

1

1

4

2

6

1

3

9

6

1

1

28

3

1

3

2

1

11

-

5

2

69

—

5

-

I

21

5

-

8

2

10

4

j

3

4

2

443

' p&r*TOTAL

36

5

-

2

3

4

3

7

-

3

2

4

3

29

1

-

1

13

5

4

3

2

29

5

3

-

I

3

2

3

5

3

1

3

19

6

6

1

3

2

1

—

-

-

45

—

4

1

1

1

14

I

2

-

1

I

5

2

6

5

1

380

re. A death is

mms will be

September 21, 1979

Epidemiologic Notes and Reports

Staphylococcal Food Poisoning — Delaware

On March 10, 1979, 64 cases of acute gastrointestinal disease occurred among 107

guests at a wedding reception in Sussex County, Delaware.

Symptoms included vomiting (85%), nausea (74%), abdominal cramps (61%), and diar

rhea (39%). Thirty-eight of those affected sought emergency room attention, although

none were hospitalized. Incubation periods of the illness ranged from 1.6 to 6.5 hours,

with a median of 3.5 hours.

Food histories, obtained from 103 of the guests, implicated chicken salad as the

food associated with illness. The attack rate among those who ate chicken salad was

76% (62/82), while only 9% (2/21) of those not eating this salad became ill (p<.001).

Coagulase-positive Staphylococcus aureus was subsequently isolated from the chicken

salad and the food grinder used to prepare it. No skin lesions were evident on any of

the 6 food handlers, but S. aureus was cultured from nasal swabs of 3. Phage typing,

performed at CDC, demonstrated that the isolates from the chicken salad, the food

grinder, and the nasal swab from the chicken salad preparer were all type 95.

The food was mostly prepared in private homes. The chicken for the salad was cooked

and deboned on March 8 and refrigerated in a large, plastic washtub. The following day

the chicken was ground in a meat grinder with celery and onions, mixed with mayonnaise,

and then refrigerated in the same tub. On the day of the reception, the salad was not

refrigerated during transport or before or during the reception—a total time period of

approximately 7 hours. During serving, it was noted that the chicken salad from the

central portion of the container felt warmer than that from the top, indicating uneven

refrigeration.

Reported by E Connors, RN, J Tobin, MD, Naticoke Hospital; GE Bender, MD, H Chaski, P Johnson,

M Shull, RN, R Tator, D Wasson, Sussex County Health Unit; B Kaza, PhD, ES Tierkel, VMD, State

Epidemiologist, MP Verma, PhD, Delaware Dept of Health and Social Services; Bacteriology Div, Bur

of Laboratories, Bacterial Diseases Div, Bur of Epidemiology, CDC.

Editorial Note: This classic staphylococcal outbreak underscores the need for continuing

public education in proper food handling, particularly with regard to prompt and ade

quate refrigeration of prepared foods. Staphylococcal food poisoning has been recognized

since 1914, when an outbreak in the Philippines, caused by inadequate refrigeration of

milk from a cow with a chronic staphylococcal infection, was described (7). This type of

food poisoning remains a major cause of outbreaks of acute gastrointestinal disease,

constituting approximately 25% of all foodborne outbreaks of known etiology reported

to CDC between 1972 and 1977.

The illness is caused by the presence of a heat-stable enterotoxin produced by only

a few strains of S. aureus, often from phage group 3; phage typing alone, however, can

not determine whether a given strain will produce enterotoxin.

The vehicle of transmission in staphylococcal food poisoning is almost always a pro

tein-containing food. Ham is the most common vehicle in the United States, where it is

implicated in 28% of outbreaks. Contamination, as in this case, is usually assumed to

be from food handlers; use of improper holding temperatures allows multiplication of

the staphylococci and elaboration of the toxin. After ingestion, the incubation period

may range from 30 minutes to 8 hours, with vomiting the predominant symptom. The ill

ness produced may be quite severe, although short-lived; a few fatal cases have been

reported (2).

Bacillus cereus may cause a similar clinical syndrome mediated by a heat-stable emetic

toxin; the median incubation period is less than 6 hours, with illness characterized by vom-

MMWR September 21, 1979

Food Poisoning — Continued

iting and abdominal cramps (3). B. cereus is also capable of producing a heat-labile diar-

rheal toxin, which may mimic Clostridium perfringens (4).

References

1. Barber MA: Milk poisoning due to a type of Staphylococcus albus occurring in the udder of a

healthy cow. Philippine Journal of Science 98:515-519, 1914

2. Currier RW, Taylor A, Wolf FS, Warr M: Fatal staphylococcal food poisoning. South Med J 66:

703-705,1973

3. Terranova W, Blake PA: Bacillus cereus food poisoning. N Engl J Med 298:143-144, 1978

4. Turnbull PCB, Kramer JM, Jorgensen K, Gilbert RJ, Melting J: Properties and production charac

teristics of vomiting, diarrheal, and necrotizing toxins of Bacillus cereus. Am J Clin Nutr 32:219-

228. 1979

Current Trends

Surveillance of Childhood Lead Poisoning — United States

In the second quarter of fiscal year 1979, 64 programs reported the screening of

103,230 children; 5,802 of these required additional diagnostic tests for lead toxicity

(Table 1). This represents a 17.8% increase over the number screened in the equivalent

time period in fiscal year 1978. The number of children identified with lead toxicity

increased 41.1%. Of these children, 29.8% were in screening risk classifications III and

IV;* this is an increase from the 15.1% reported in the same time period of the last fiscal

year. A total of 4,024 children were referred for care for iron deficiency.

During the second quarter 17,602 children were reported to be under pediatric man

agement for lead toxicity. Of these, 18.3% (3,216) were determined to be at reduced risk

when compared to the last time they were clinically evaluated; however, 3.2% (557)

children who were re-evaluated had increased risk.

Reported by the Environmental Health Services Div, Bur of State Services, CDC.

•Screening Class II and Classes III & IV are defined in CDC Statement "Preventing Lead Poisoning in

Young Children," April 1978.

TABLE 1. Results of screening in childhood lead poisoning control projects, United

States, second quarter fiscal year 1979 (January 1—March 31, 1979)

Programs

Bridgeport. Conn.

Waterbury. Conn.

Boston, Mass.

Chelsea. Mass.

Lawrence, Mass.

Lynn, Mass.

Worcester, Mass.

Rhode Island State

REGION 1 TOTAL

Cumulative FY 79

Atlantic City. N.J.

Camden. N.J.

East Orange. N.J.

Jersey City. N.J.

Newark. N.J.

Paterson, N.J.

Plainfield. NJ.

N.J. (other local programs)]:

Erie Co.. N.Y.

Monroe Co.. N.Y.

New York City

Onondaga Co., N.Y.

Westchester Co., N.Y.

REGION II TOTAL

Cumulative FY 79

Screened

1,165

272

5.218

502

1.350

825

994

1.322

11.648

22.331

195

386

383

221

748

1.030

248

776

1.559

1.749

21.906 S

1.276

609

31.086

Nu

Wit

Requiring pvuijnrtc

Total Class II

25

18

136

33

62

30

42

80

426

1.204

20

41

101

48

175

81

44

80

95

173

1.096!)

76

30

2.060

4.466

19

13

93

33

48

29

26

4b

306

960

6

37

59

33

121

55

41

f»B

79

157

810

60

23

1,5393.143

mber of childri

h laad toxicity

management

Classes

III 8, IV

6

5

43

0

14

1

16

35

120

244

14

4

42

15

54

26

3

22

16

16

286

16

7

521

1.323

■n

Receiving

pediatric

managemantT

79

162

1.516

35

278

145

298

533

3,046

—

64

381

54

167

844

580

258

NA

288

418

875

472

130

4,531

-

Identified

deficiency

26

46

63

24

13

15

35

14

236

596

27

97

40

20

125

214

7

NA

20

160

1,360

27

58

2.155

4.572

Number

to

1

Inspected

26

28

51

16

58

10

32

53

274

657

21

65

7

65

108

93

34

NA

65

85

176

101

14

824

1.770

of dwellings i

children with

bad toxicity

Found

with

lead

14

20

49

1G

M

1032

33

228

533

11

40

7

52

88

67

20

NA

46

BO103

60

3

582

1.256

related

Reduced

14

10

S3

B•11

4

24

26

178

440

14

25

3

2861

51

19

NA

3841

103

5

14

399

816

September 21, V

Lead Poisoning — Continued

3 0001 061280751TABLE 1. Results of screening in childhood lead poisoning control projects, United

States, second quarter fiscal year 1979 (January 1—March 31, 1979) — Continued

Programs

Delaware State

Washington, D.C.

Baltimore, Md.

Allentown-Bethlehem, Pa.

Chester, Pa.

Philadelphia, Pa.

Wilkes-Barre, Pa.

York, Pa.

Lynchburg, Va.

Norfolk, Va.

Portsmouth, Va.

Richmond, Va.

REGION III TOTAL

Cumulative FY 79

Augusta, Ga.

Louisville, Ky.

South Carolina State

Memphis, Tenn.

REGION IV TOTAL

Cumulative FY 79

Chicago, III.

Illinois State

Rockford, III.

Fort Wayne, Ind.

Detroit, Mich.

Grand Rapids, Mich.

Wayne Co., Mich.

Akron, Ohio

Cincinnati, Ohio

Cleveland, Chio

Kenosha, Wis.

Milwaukee. Wis.

Racine, Wis.

REGION V TOTAL

Cumulative FY 79

Arkansas State

New Orleans, La.

Houston, Texas

REGION VI TOTAL

Cumulative FY 79

Cedar Rapids-Linn

Co., Iowa

Davenport-Scott Co.,

Iowa

Kansas City, Kans.

St. Louis, Mo.

Springfield, Mo. tOmaha-Douglas Co., Neb.

REGION VII TOTAL

Cumulative FY 79

Alameda Co.. Calif.

Los Angeles, Calif.

REGION IX TOTAL

Cumulative FY 79

U.S. TOTAL

Cumulative FY 79

Screened

955

3,240

4,348

0

719

4,755

396

414

616

1.016

619

1,517

18,595

34,705

749

1,883

478

666

3,776

8.605

10,212

1,728

257

376

2,870

421

435

1,036

1.992

3,439

35

354

403

23.558

49,822

1,984

2,764

2,062

6.810

12,594

142

369

1.852

2,863

3

588

5.817

12,580

749

1,191

1.940

3.405

103.230

206,870

Requiri

Total

54

85

112

0

12

757

19

11

29

22

23

10

1,134

2,782

17

93

46

14

170

459

555

62

3

10

128

11

13

42

64

636

1

26

8

1,559

3,661

34

121

20

175

486

6

7

7

208

1

4

233

762

31

14

45

141

5.802

13,911

Nu

Wit

lg pediatric

Class II

39

64

68

0

3

56CI

IE10

17

14

16

9

815

1,927

14

68

43

11

136

373

38747

25

75

3

8

37

55

3300

13

5

967

2,349

23

90

12

126

338

4

7

5

141

1

3

161

462

18

7

25

91

4,074

9,633

mber of childr<

h lead toxicity

management

Classes

III & IV

15

21

44

0

9

197

4

1

12

8

7

1

319

855

3

25

3

3

34

86

168

15

1

5

53

8

5

5

9

306

1

13

3

592

1,262

11

31

8

50

148

2

0

2

67

0

1

72

310

13

7

20

50

1.728

4,278

n

Receiving

pediatric

management t

309

225

279

11

310

1,295

109

51

41

289

130

310

3.359—

173

459

347

216

1.195

—

NA

88

583

18

391

12

94

194

948

288

7

231

43

2,897

—

198

1,347

654

2.199

—

16

106

29

NA

2

96

249

—

51

79

130—

17.606

—

Identified

with iron

deficiency

41

210

67

0

5

0

25

33

56

16

18

31

502

874

16

56

5

36

113

211

49

64

16

0

9

2

30

110

136

135

2

3

6

562

1,333

26

94

87

207

421

6

10

0

148

NA

9

173

236

16

60

76

221

4,024

8,464

Number

to

k

Inspected

22

122

107

0

14

199

32

15

53

36

24

59

683

1,676

8

128

25

43

204

468

320

19

23

10

95

1

7

38

137

109

8

85

5

857

2,431

58

34

107

199

378

8

27

10

477

2

16

540

1,263

8

37

45

94

3.626

8.737

of dvw

childn

ad to

Foi

wi

le

Hup

n wit

(icity

nd

th

d

20

24

;;h

0

14

194

9

13

34

23

14

41

474

1,222

7

98

19

21

145

354

123

17

21

9

49

1

7

1921

57

8

62

1

395

1,213

52

31

45

128

273

8

24

6

313

2

5

358

813

7

36

43

87

2,353

5,751

related

h

Reduced

5

17

56

0

7

146

3

13

1

29

10

17

304

665

7

41

11

87

146

339

239

13

4

4

163

0

16

19

15

B65

36

1

570

1,229

18

19

46

83

134

1

16

2

1982

2

221

675

3

39

42

77

1,943

4,375

The Morbidity and Mortality Weekly Report, circulation 87,803, is published by the Center for

Disease Control, Atlanta, Georgia. The data in this report are provisional, based on weekly tele

graphs to CDC by state health departments. The reporting week concludes at close of business on

Friday; compiled data on a national basis are officially released to the public on the succeeding Friday.

The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other

public health problems of current interest to health officials. Send reports to: Center for Disease

Control, Attn: Editor, Morbidity and Mortality Weekly Report, Atlanta, Georgia 30333.

Send mailing list additions, deletions, and address changes to: Center for Disease Control, Attn:

Distribution Services, GSO, 1-SB-36, Atlanta, Georgia 30333. When requesting changes be sure to

give your former address, including zip code and mailing list code number, or send an old address label.

September 21, 1979

U.S. DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE / CENTER FOR DISEASE CONTROL

ATLANTA, GEORGIA 30333 OFFICIAL BUSINESS

Director, Center for Disease Control

William H. Foege, M.D.

Director, Bureau of Epidemiology

Philip S. Brachman, M.D.

Editor

Michael B. Gregg, M.D.

Managing Editor

Anne D. Mather, M.A.

Postage and Fees Paid

U.S. Department of HEW

HEW 396

68178CARJEJ-L0383627900AXXX

CREIGHTON

Z^UU *-«£■.*' wVq1 7 AOMAHAt NE 68178

HEW Publication No. (CDC) 79-8017