mmwrfeb161990

mmwrfeb161990 - .- — 7 ' -- . . " ' “.rMia-Iari'a...

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Unformatted text preview: .- — 7 ' -- . . " ' “.rMia-Iari'a trans-mission:inf the.-‘=U3nii:tedflStates'0ngts.;;:jinfrecwe_ntly: since 1950, 2.11 ' - Outbreaks of. :imroduced-..;ma.|aria;f ai.l"i98-fl$:ed' - bvit-Plé'ausmadiumfi vim? hm bee” ' - identified; H'Owevfer; 14=of these occurredLJn Caili'ffitnia (Sfivei'n --d:t!.ri-n9' 19355147]! 1933' ' ' . ,afi‘d'1'989').:qu3rbFflbreaks+3ohe.'ea-ch.i-nj‘3i936'11.)Cahid11988iénIWd-cin 1989f~+occurred ' - iLin-SansDie-96';.C.O-UDW~"-ThisI990rtdeSCfibeS'thé éutb-rea=k$~i'n San"Diergifi'EOH-W‘“ 1933'- arid 1.9892 _ August 11988.1“ ' 3 " '- _ On'Aggu-sti2.;_j1988,-;a. miii'gra-hgwmker‘who jivedifnfafcanYO-fi' Mair the-Lake Hodges res-.ervoi; ._ (25 “m_i'le*s_a;-:n'a_rit'h;i"of _'-=S'a=n.‘i'-Dié§1§=)” (Figure . 1'.) was Vfli‘agmse‘j P Viv“ ' s.infectioh.i-=TweIVeIche£ Wfirkers MIN? qtivéd- ifn. the-Same a;re'1a.-'.a-nd7.'.'ha‘diiwmfitoms-‘Sugr- 7 ag'eSti've of m'”a.l.ar.ia..._We-fiej .'r9ferrsd_ by d-pu'bl-i-c health nurse for: diaQ-h-o.s-i-s:gqn‘August 3', ' --A?n 'epiderfiéi-Qlfi figcgii-mzestigafion“ identzifia" aiit'fiatal ofI-30-nersons W'hOe.-h'ad' $¥mpt°m- - f 31:6 3‘ :vivaxf iihfe;¢tiah3'-With7f Onset. between 2.145: and; Se_ptembe'r"-13';.- Two cases " . .' y Lake- , 'ifodg-‘QSI reservoir»;iAl.:l3i?pafient$.'--.de:tietd'fistravims-'-malaria-5infectia‘hfiintravemus ._ - - in 13-V33'25- ’ ‘ ' ' " ' 792 i 7 ;_. MMWR‘ijT‘ *lr’Marar'ia 4'c5ohtir3ped’jfif .I _‘ _ _ _ . . 7 . ‘ 7{Nineteen'ofxth,e7rni-graint -WBrkefis”,.'i5ived Vin"ffiev‘canan-‘afeaguisaven lived «or. a-Afarm : direct-iv- sour-h fifth-e canydfi; ' gone .p reg nantgwomafi ~ worked-at “a tree? nursery adjacent s to the fa rm andrgwas‘ requiredfiioi be gutside at dawnah-d rduskamnd one migrant worker 3‘ ] hadron-set'bf'symptoms {Sf-tier mQV'inQ‘i-TITO'mr"the cahYofififiTh-e 'two. cases in local- ilopment adjagent-tothe ‘ I permanent freeidente occurred inra camp-[e who lived in; 'a dam farm." j._: . a --- ... ,. _. ' r " The migrant workers in therganyo-n had___d_iverted'water‘flQWfromr-a small channei' ' -zto_ their: camp: Some-df-i-their-I:éfielters:icerisistg-ng.;primaril-v;.9i-plastic mrpaui-ins and ' cardbOerdi Materials) were lobatedwi’t-"hi'n *5:._*§fe_e:ti' of _th=e9";;wate'r; Of the 39 migrant 1: ' workers (20 dehdm had; malaria) in thiec‘afnyen', questionnaires were administered ‘ J to. 731 (79%); ‘the remaining wdrk'e re could .n'ot belocéted. Cases and non-cases were ., similar instermls ‘ofitype OfSharer?needwfgr'fileeping' (op’e‘ers; e‘nciosed), average ._ ' ndmber of dail'yr'h-ours spentbyl open water (mg-gen, riVer,‘or caha-I), bathing site; and time offl-day't-returnifig"tq-the‘q‘amp; : jfi -- -- -,I , 7 7 ' _ *A‘ pd_s_s-ibi'ei_‘ i-ndiexieaise fbrfitihe.'qu'tbre-ekiwae ea? n1,;igrant;'-WOrker_withidocumented .' , P. viVax malaria Whoahéd spenfs'evemlj'n'ightsfifithe-canyon at theiend‘of June. Light" ' me caught ZS‘e'zdul-tgfemaie: Anopheles herinsi - traps-piacjednear theeanyon a'titha’rt‘ti ‘ mosquiipewa'icom'petent m‘alériervegtor. - . "On August 3', the San.;--Di-erb'.Ceu’nty Department of Health Services began : V '. _ > mm is; 1990" elmifipationgnq t.reat_'rhe'n‘t70f_'_ persons with-malaria;Chlorociui'ne prbphy'laxis‘ was ., ' administered to migralnt‘workers in the canyon._;aind on the farm_di.reCtiy scum of the 4 qanyo-n.‘0n_ AugUst .4,‘"t_;rap$“placed- in 'tzherqan-ypncamp-.area“caughtffrp-m One toV11 ' adult -fem-a.ie--A'n...:hermsi igpieirg flap; 1ch traps placed next to an irrigation pondo'h’the farm: south .bf~the:»_can'y0"" Gangbt'fl-BA‘ m-osq-uite’es, Vader-control efforts incitideq {the ‘ app.liqatiionsgfli,flafrViéides ii-‘ri‘s'eetici-d‘es'. i These-fefierte- resulted in. . -.-substantialreductione in mosqgiro pppuiation's, ‘ " ' * '- -' 174L'Locafioi1e Of im'ailarievputbrealsis. — _n California; August 51988 andqii‘lysand August. 1983 - ., _' , wigrenéwiarkm ' j _ ' i jflerme‘nem-nesidems, ‘ 1‘ e ; freeway-n ‘ «San Diego ; 4 county ' -"- ~ ' .' - _f'-M.ii_a.s r : ‘o " 0.5).? 1.6 1.5- mam _ 'Sani Die-99 Clo-until. " Vol. 39 I No. 6 ‘ MMWR 93 Malaria — Continued July 30; P. vivax parasites were detected in a blood smear. On August 22, a permanent resident of this area became ill; P. vivax parasites were identified. This resident had no history of foreign travel, lV-drug use, or blood transfusions. Twelve light traps placed in the open field in Rancho Penasquitos on July 26 caught six An. hermsi mosquitoes. On August 31, 36 An. hermsi mosquitoes were caught in eight light traps placed near the resident’s house. Control measures included treating infected persons and applying larvicides and adulticides. No further cases were reported from this area. August 1989 On August 6, a San Diego resident who lived north of the San Dieguito River (Figure 1) became ill with confirmed P. vivax infection. He had no history of foreign travel, lV~drug use, or blood transfusions. On August 10, a migrant worker who resided in a camp at the San Dieguito River (1 mile from the resident’s house) became ill, and P. vivax infection was diagnosed. On August 11, P. vivax infections were diagnosed in three of 40 migrant workers living in the area around the camp. On August 10, 27 An. hermsi mosquitoes were caught in five light traps in the area. Control measures included the application of larvicides and adulticides and the administration of chloroquine chemoprophylaxis to migrant workers in the area. No further cases were reported from this area. Reported by: 8 Hunt, 0 Maher, M Ginsberg, MD, M Mizrani, MS, C Peter, PhD, M Bartzen, M Thompson, DPH, D Flamras, MD, San Diego County Dept of Health Svcs, RR Roberto, MD, Infectious Disease Br, California Dept of Health Svcs. Div of Field Svcs, Epidemiology Program Office; Malaria Br, Div of Parasitic Diseases, Center for Infectious Diseases, CDC. Editorial Note: The outbreak of malaria in 30 persons in San Diego County in 1988 Carlsbad, 35 miles north'of San Diego (1). Common features of the 1986 outbreak and later instances of malaria transmission in San Diego County were 1) the limited access to medical care for migrant workers with malaria, resulting in delays in identification and treatment of parasitemic persons and in institution of control measures; 2) the lack of sanitary water and waste water disposal facilities and adequate shelter for the workers; and 3) the presence of an effective Anopheles mosquito vector and a susceptible population. Specific sources of infection for the mosquitoes could not be identified. However, in all of these outbreaks, agricultural workers from countries with endemic malaria had been present in the affected areas. Other clusters of introduced malaria in the San Diego area may have gone undetected because a diagnosis of malaria might not have been considered in symptomatic patients with no history of travel abroad and because malaria may be undetected in migrant workers and other populations who have limited access to medical care. Anopheline malaria vectors are found in many parts of California; therefore, locations that facilitate introduction and transmission of malaria cannot be readily predicted. 94 Malaria -- Continued disease surveillance, health education References 1. Maldonado YA, Nahlen BL, San Diego County, Californi 2. Brunetti R, Fritz RF, Hollister HC An outbreak of malaria ' _4 Med Hyg 1953;3:779—88. «:6le TABLE I. Summary — cases of specified notifiable diseases, United States N 6th Week Ending Feb. 10. Feb. 11. Median 1990 1989 1985-1989 Cumulative, 6th Week Ending Feb. 10, Feb. 11, Median 1990 1989 Disease 1985-1989 -' Acquired Immunodeficiency Syndrome (AIDS) 1.484 U’ 316 5,418 3,174 1,846 Aseptic meningitis 95 108 76 498 473 473 Encephalitis: Primary (arthropod-borne & unspeci 18 16 16 68 66 87 Post-infectious 6 - 1 12 7 7 Gonorrhea: Civilian 12,715 13,423 14,010 74,785 75,808 94,371 Military 198 315 254 1,188 1,303 1,529 ’- Hepatitis: Type A 590 702 500 2,694 3,466 2,575 Type B 363 416 454 1,829 2,062 2,451 Non A, Non B 28 48 48 196 261 324 Unspecified 30 66 89 177 245 386 ‘- Legionellosis 27 27 12 122 101 85 Leprosy 3 5 2 13 14 15 Malaria 27 33 14 106 115 72 Measles: Total* 129 107 51 756 402 153 Indigenous 57 101 50 554 376 146 Imported _ 72 6 3 202 26 24 Meningococcal infections 64 72 72 309 297 337 Mumps 81 101 90 541 579 482 Pertussis 102 54 47 276 250 220 Rubella (German measles) 1 4 4 35 20 24 Syphilis (Primary & Secondaryi: Civilian 758 836 625 4,683 4,319 3,810 Military 6 10 6 66 38 23 Toxic Shock syndrome 8 2 7 41 28 34 by M Tubercuiosis 245 276 348 1,872 1,780 1,733 " Tularemia — - 1 4 6 10 1 Typhoid Fever 5 12 7 32 45 28 '- Typhus fever, tick-borne (RMSF) 2 10 1 10 16 Rabies, animal 49 Cum. 1990?. Congenital syphilis, ages < 1 year Diphtheria Anthrax . Leptospirosis 3 Botulism: Foodborne - Plague - ? Infant 3 Poiiomyeiitis, Paralytic,s - Other (Ore. 1) ‘l Psittacosis (Calif. 1) 22 Brucellosis (Mass. 1, Iowa 1, Fla. 1) 5 Rabies, human - Cholera - Tetanus (Mich. 1) 5 Congenital rubella syndrome - Trichinosis 4 Because AIDS cases are not received weekly-from all reportin areas, comparison of weekly figures may be misleading. fThree of the 129 reported cases for this week were Imported ram 3 foreign country or can be directly traceable to a known internationally imported case within two generations. 5No cases of suspected poliomyelitis have been reported in 1990: none of 13 suspected cases in 1989 have been confirmed to date. Nine of 14 suspected cases In 1988 were confirmed and all were vaccine-associated. ' .. 3mm“! leaf "in ...
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This note was uploaded on 04/13/2008 for the course ABIO 308 taught by Professor Mackiewicz during the Spring '08 term at SUNY Albany.

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mmwrfeb161990 - .- — 7 ' -- . . " ' “.rMia-Iari'a...

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