{[ promptMessage ]}

Bookmark it

{[ promptMessage ]}

Trichinella Spiralis Infection

Trichinella Spiralis Infection - lilOTiCE This that ii.2...

Info iconThis preview shows pages 1–4. Sign up to view the full content.

View Full Document Right Arrow Icon
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Background image of page 2
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Background image of page 4
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: lilOTiCE: This that ii} .2, lifBiECin .hv Cami-9m lax; l3 I S (initial February 1, 1991 lVol. 40 I No. 4 57 Trichr'nella spiralis Infection — United MORBIDITYAND M.RTAUTY '50 ESE; Lgfig—BBt-zfore Age 65 — U S WEEKLY REPOR' 62 Smokailxg-Attributabie Mortality and YPLL - U.S.. 1988 72 Change of Dosing Regimen for Malaria Prophylaxis with Mefloquine Printed and distributed by the Massachusetts Medical Society. - - - - - {Jubilshers 01 The New England Journal of Medicine 73 Epsdermology m Action Course Epidemiologic Notes and Reports Trichinellaispiralis infection -— United States, 1990- Since 1947, when the Public Health Service began to record statistics on trichino— sis, the number of cases reported by state health departments each year has declined: in the late 19405, health departments reported an average of 400 cases and 10—15 deaths each year; from 1982 through 1986, the number declined to an average of 57 per year (Figure 1) and atotal of three deaths (1,2). Although this trend reflects a decline in the number of cases related to commercially purchased pork, recent outbreaks of trichinosis in lowa and Virginia emphasize the continuing need for education about the dangers of eating inadequately cooked pork. ‘ Des Moines, Iowa. From July 21 through September 3 1990 90 (36%) of 250 persons who attended or ate food taken from a wedding in Des Moines on July 14 FIGURE 1. Reported trichinosis cases — United States, 19474990“ 'Cases §§§§§§§ 150 100 8 O 1950 1955‘ 1960 1965 1970' 1975 1980 1995 1990 Year ' *Data for 1987—1990 are preliminary. 53 MMWR ' _ . February 1,1991 Trichinella spiralis ‘ .- Continued developed trichinosis*; most (approximately 95%) of the 250 persons had immi- grated to the United States since 1975 from Southeast Asian countries. Of those Who became ill, 52 (58%) were treated by physicians: one of the 52 was hospitalized. Detailed case histories were obtained from 39 ill and 13 well persons who attended the wedding. Of the 39 ill persons, 34 (87%) ate uncooked pork sausage, compared with four {31%) of the 13,,weli persons lp<0.01, Mantel-Haensiel test); no other foods were associated with illness. The sausage had been prepared from 120 lbs of commercially purchased pork and Was served uncooked, as is customary for that food item in Southeast Asian culture. No pork was available for analysis at the time of investigation. The meat could not be traced back to the source farm because the meatepacking company that supplied the pork slaughters 14,000—15,000 hogs a day from hundreds of farms, and the exact date the hogs were slaughtered was unknown. Only four (4%) of 107 persons who attended the wedding and were interviewed knew about trichinosis or about the potential hazards of eating undercooked pork. - The lowa Refugee Health -P-rograrn, Iowa Department of Health, prepared a brief information sheet describing trichinosis and ways to avoid infection and translated this information into the three major languages (Laotian, Cambodian, and Vietnam- ese) of the Southeast Asian Community in laws; the information sheet is being - distributed by the Bureau of Refugee Programs. Staunton, Virginia. in November and December 1990, 15 cases oftrichinosis* were reported by eight local physiciansin Augusta, Page, Rockingham, and Shenandoah counties to the Central Shenandoah Health District, Virginia Department of Health. Six cases were confirmed by muscle biopsy, five had positive serology by bentonite flocculation, and four were epidemiologically linked. Nine of these persons required hospitalization. All patients had fever, myalgia, and periorbital edema: all nine patients for whom eosinophil counts were available had elevated levels. Detailed case histories were available for all ill persons. Fourteen (93%) persons The 14 persons who had consumed sausage had purchased bulk pork sausage from several local retail grocery stores; the stores had'purchased this sausage from a local processing plant. No pork was available for analysis at the time of investigation. During the 6 weeks before the outbreak, the plant purchased hogs from two brokers who had obtained hogs from multiple producers in Virginia and surrounding states. The plant produces 1500 lbs of sausage per week, which is distributed throughout eight counties in the Shenandoah Valley. - 7 The health department issued an areawide alert to physicians and hospitals and a news release to all area newspapers that included information on proper cooking and handling of raw pork. ' ' *The CDC case definition-for trichinosis is 1) a TrichinelIa—positive mus’cle biopsy or positive serologic test for trichinosis in a patient with eosinophilia, fever, myalgia, and/or periorbital edema; or 2) in an outbreak, at least one person must meetthe first criterion: associated cases Vol. 40/No.4 ' MMWR -' - 59 Trichinella spiralis — Continued Reported by: V Phabmixay, LA Wintermeyer, MD, State Epidemiologist, lowa Dept of Public Health. D Kiser, T Overby, MD, Rockingham Memorial Hospital; 5 Landry, MS, C Caplen, MD, Central Shenandoah Health District; 3 Mays, Lord Fairfax Health District; L Branch, Office of ' Epidemiology; GB Miller, Jr, MD, State Epidemiologist, Virginia Dept of Health. Parasitic Diseases Br, Div of Parasitic Diseases, Center for infectious Diseases, CDC. Editorial Note: Since 1975, the proportion of trichinosis cases associated with Consumption of contaminated commercial pork has declined in the United States. This decline probably reflects a combination'of factors, including laws prohibiting the feeding of offal to hogs, the increased use of home freezers, and the practice of thoroughly cooking pork. in recent years the relative importance of consumption of wild game (including bear, wiid boar. and walrus) (2,3) as a cause of trichinosis has increased. Consumption of meat from any carnivorous animal that has fed on trichina-infested flesh poses a risk (Figure 2). In addition to the two multiple-case outbreaks in this report, 15 other cases were'reported in 1990-. At least three cases were sporadic; information on the remaining 12 is unavailable. _ The outbreak in Iowa is thefourth since 1975 that occurred among the 900,000 Southeast Asian refugees who have immigrated to the United States (4,5). The three previous outbreaks were related to consumption of undercooked pork that was not obtained from a commercial producer (4). This outbreak is consistent with previous reports indicating that recent immigrants/from Southeast Asia are at particular risk for developing trichinosis because of their dietary habits (4). FIGURE 2. Life cycle of Trichinella spiralis in humans Larvae Encysted _ in Muscle ' ' i _ ‘ Flesh with infective larvae is eaten by humans or other animals. The larvae become adult worms in the intestine of the host and in turn release new larvae, which penetrate the intestinal wall and encyst in striated muscle. Cannibalism, scavenging for meat scraps, and consumption of farm rats may be important sources of infected flesh. Feeding raw garbage to pigs is illegal in the United States. Wild game. especially bear and boar. are often sources of infection in humans. so ' MMWR February 1,1991 ' Trichinella spiralis — Continued Based on serologic examination of hogs at abattoirs, the prevalence of Trichinella infection in commercial pork ranges from 0 to 0.7% (6,7). Approximately 80 million hogs are slaughtered commercially each year in the United States. About 40% of the pork produced is sold as “ready to eat" pork products;_such,p_red.u.c.t§,.mlé§l.Pe made with trichina-free pork or pork adequatelycooked orhtreated to kill trich'i_naml"arva‘e. Trichinella larvae in pork are killed by freezing at 5 F {—15 leor '21 dayslor longer if meat is >15 cm thick); however, Trichinella larvae present in wild game are often relatively resistant to freezing (8 ). Cooking is one of the, most common methods of assuring that Trichinella are destroyed; a temperature of 170 F (77 C) substantially exceeds the thermal death point andris usually achieved if the meat is cooked until it is W l. - Public health officials in areas with large populations of immigrants from South- east Asia should consider education programs directed at the prevention of trichino- sis. Physicians need to be aware of the continued presence of T. spire/is in com: mercial pork in the United States and should consider the diagnosis in any patient with an illness compatible with trichinosis and whose dietary preferences put than; at risk for infection. ‘ " References 1. Schantz PM. Trichinosis in the United States, 1947—1981. Food Technol 1983;37:83—6. 2. Bailey TM, Schantz PM. Trends in the incidence and transmission patterns of human trichinosis in the United States, 1982—4986. Rev Infect Dis 1990;12:5—11. 3. CDC. Trichinosis surveillance, United States, 1986. MMWR 1988:37lno. SS-S):1—~8. 4. Stehr-Green JK, Schantz PM. Trichinosis in Southeast Asian refugees in the United States. Am J Public Heaith 1986:76:1238-9. 5. US Department of Heaith and Human Services.'Fleport to the Congress: Refugee Resettle- ment Program. Washington, DC: US Department of Health and Hum-an Services, January 31, 1990. - - 6. Duffy-CH, Schad GA, Leiby DA, at al. Slaughterhouse survey for swine triChinosis in Northeast United States. In: Kim CW, ed. Trichinellosis, proceedings of the Sixth international Confer- ence on Trichinosis. Albany, New York: State University of New York Press, 1985. 7. Hill R0, Spencer PL, Doby KD, et al. Illinois swine trichinosis epidemiology project. in: Kim CW, ed. Trichineliosis, proceedings of the Sixth international Conference on Trichinosis. Albany, New York: State University of New York Press, 1985. _ 8. Dick TA, Chadee K. Bioiogical characterization of some North American isolates of Trichinella spiralis. ln: Kim CW, Ruitenberg EJ, Teppema TS, eds. Trichinellosis, proceedings of the Fifth International Conference on Trichinosis. Surrey, England: Reedbooks, 1981. 9. Leighty JC. Control I public-health aspects (with special reference to the United States). in: Campbell WC. ed. Trichinelia and trichinosis. New York: Plenum Press, 1983. Current Trends Update: Years of Potential Life Lost“ Before Age 65 —- United States, 1988 and 1989 Final" mortality data from CDC's National Center for Health Statistics (NCHS) indicate that in 1988 deaths in the United States accounted for 12,278,554 years of potential life lost before age 65 (YPLL) (Table 1l—a total consistent with provisional data reported previously (12,281,741 YPLL {1 I). Provisional data indicate that for 1989 there were 12,370,499 YPLL. - - ...
View Full Document

{[ snackBarMessage ]}