Tracy Gustafson - Academia.edu (original) (raw)

Papers by Tracy Gustafson

New England Journal of Medicine, 1987

This letter in response to an article about measles outbreak in a secondary school population sai... more This letter in response to an article about measles outbreak in a secondary school population said to be 99% immunized cites the present authors experience with measles outbreaks in a Texas school system. In this case there was a group of parents who held nonreligious views against immunization. Their children were faced with exclusion from school during the episode. The author said he had reason to believe that some of these parents may have presented falsified evidence such as baby books notes on pieces of papers with dates and health department records without official stamps. He cited these examples to advise the health officers be cautious in evaluating the validity of evidence of vaccination.

British Journal of Surgery, 2000

Background Although benchmarks and control charts are basic quality improvement tools, few surgeo... more Background Although benchmarks and control charts are basic quality improvement tools, few surgeons use them to monitor surgical site infection (SSI). Obstacles to widespread acceptance include: (1) small denominators, (2) complexities of adjusting for patient risk and (3) scepticism about their true purpose (cost cutting, surgical privilege determination or improving outcomes). Methods The application of benchmark charts (using US national SSI rates as limits) and control charts (using facility rates as limits) was studied in 51 hospitals submitting data to the AICE National Database Initiative. SSI rates were risk adjusted by calculating a new statistic, the standardized infection ratio (SIR), based on the risk index suggested by the Centers for Disease Control National Nosocomial Infection Surveillance Study. Fourteen different types of control chart were examined and 115 suspiciously high or low monthly rates were flagged. Participating hospital epidemiologists investigated and ...

Archives of Pediatrics & Adolescent Medicine, 1985

We conducted a telephone survey in Houston in March 1983 to assess the level of aspirin use among... more We conducted a telephone survey in Houston in March 1983 to assess the level of aspirin use among children during the influenza season. We completed interviews of 200 households with 346 children aged 12 years or younger. Fifty-two percent of the 346 children experienced at least one acute illness in the preceding three months. Fever was measured with a thermometer in 114 ill children, 103 of whom had at least one measured temperature of 37.7 degrees C or greater. Fourteen percent of these 103 children received aspirin only, 61% received acetaminophen only, and 20% received both. Among a subgroup of 44 children with temperatures of at least 39.4 degrees C, 11% received aspirin only, 59% received acetaminophen only, and 27% received both. Only 60% of the 200 parents interviewed had heard of Reye's syndrome. Forty-two percent knew of the association between Reye's syndrome and aspirin use. The survey suggests that acetaminophen has replaced aspirin as the major antipyretic used by children in Houston. If the decline in aspirin use in Houston is representative of the population in the United States, and if aspirin is causally related to Reye's syndrome, the incidence of Reye's syndrome may decline.

Annals of Internal Medicine, 1985

In July 1984, an outbreak of gastroenteritis occurred in a suburban community in Texas. A random ... more In July 1984, an outbreak of gastroenteritis occurred in a suburban community in Texas. A random telephone survey of 100 of 1791 households in the community identified an attack rate of 34%. The outbreak was traced to contamination of the community water supply, an artesian well. Fecal coliforms were identified in untreated drinking water from the well during July. Stool examinations and serologic tests identified Cryptosporidium as the etiologic agent. Cryptosporidium should be added to the list of waterborne organisms capable of causing outbreaks of gastroenteritis.

American Journal of Public Health, 1983

In April 1981, an outbreak of hepatitis A occurred among state legislators in Tennessee. Although... more In April 1981, an outbreak of hepatitis A occurred among state legislators in Tennessee. Although the number of cases was small, we traced the source to a food handler who served cold meats and cheese. This investigation demonstrates the value of rapid serologic testing using a radioimmunoassay technique and matched case-control analysis to identify small foodborne outbreaks of hepatitis A.

Archives of Pediatrics & Adolescent Medicine, 1985

An outbreak of diarrhea occurred in a day-care center in San Marcos, Tex, in August 1984. At the ... more An outbreak of diarrhea occurred in a day-care center in San Marcos, Tex, in August 1984. At the time of this study, the center was caring for 81 children aged 2 months through 5 years. A single stool specimen was collected from each of 50 children (62%). Cryptosporidium oocysts and Giardia lamblia cysts were each identified in stool specimens from 18 children. Three children had both parasites present in the same stool specimen. Echovirus 30 was identified in 19 of 25 stools cultured. Although three pathogens were circulating simultaneously in this group of children, only the presence of Cryptosporidium oocysts was associated with the occurrence of a diarrheal illness. Cryptosporidium may be a common cause of diarrhea in children who attend day-care centers.

Pediatrics, 1982

An outbreak of nosocomial varicella was traced to airborne spread from an immunocompromised child... more An outbreak of nosocomial varicella was traced to airborne spread from an immunocompromised child hospitalized from Nov 11-19, 1980. Seventy potentially susceptible children were hospitalized on the ward during that period. Although the index patient remained in strict room isolation throughout his hospital stay, eight of these patients contracted varicella. The afternoon of November 12 was the period of highest risk for acquiring varicella. Eight of 36 patients (22%) present that afternoon, compared to none of 34 patients not present that afternoon, acquired the infection. A patient's risk of contracting varicella was significantly related to how near he/she came to the index patient's room that afternoon. Airflow studies, using the tracer gas, sulfur hexafluoride (SF6), demonstrated that patient rooms on this ward were at positive pressure with respect to the corridor. Despite isolation procedures, SF6 released in the index patient's room achieved concentrations in the...

The American Journal of Tropical Medicine and Hygiene, 1985

Four cases of autochthonous human cutaneous leishmaniasis have been identified in south-central T... more Four cases of autochthonous human cutaneous leishmaniasis have been identified in south-central Texas since 1980. The patients presented with chronic ulcerating papules on the face, earlobe, and lateral thigh. In two patients, the infections healed without treatment. In the other two patients, the lesions healed following treatment with intramuscular sodium stibogluconate or topical antimony potassium tartrate. Serologic testing of family members, using four different techniques, indicates that asymptomatic infections may occur. These are the first reported cases of cutaneous leishmaniasis acquired in Texas since 1974. Organisms isolated from patients in 1974 and 1980 belonged to the Leishmania mexicana complex when tested by the isoenzyme technique. Although no animal reservoir or insect vector has been identified, six species of sand flies belonging to the genus Lutzomyia do inhibit this part of Texas. Accumulated evidence strongly suggests that cutaneous leishmaniasis is endemic in south-central Texas.

Infection Control, 1985

Between April 1982 and March 1983,10 of 26 (38.4%) allogeneic bone marrow transplant recipients h... more Between April 1982 and March 1983,10 of 26 (38.4%) allogeneic bone marrow transplant recipients housed on a newly opened bone marrow transplant unit developed invasive aspergillosis. By contrast, between September 1977 and March 1982, only 3 of 46 (6%) transplant recipients developed invasive aspergillosis. A case-control study to identify host factors related toAspergillusinfection found that aspergillosis was more common in patients with chronic myelogenous leukemia and aplastic anemia, older patients, patients having cytomegalovirus disease, patients who experienced prolonged granulocytopenia, patients conditioned with ara-C (100-200 mg/day), and patients who received longer duration of antimicrobial therapy. A series of logistic regression analyses revealed that underlying disease was the single best predictor ofAspergillusinfection. This study demonstrates that underlying disease is an important risk factor for aspergillosis and that special measures may be warranted when trans...

New England Journal of Medicine, 1987

An outbreak of measles occurred among adolescents in Corpus Christi, Texas, in the spring of 1985... more An outbreak of measles occurred among adolescents in Corpus Christi, Texas, in the spring of 1985, even though vaccination requirements for school attendance had been thoroughly enforced. Serum samples from 1806 students at two secondary schools were obtained eight days after the onset of the first case. Only 4.1 percent of these students (74 of 1806) lacked detectable antibody to measles according to enzyme-linked immunosorbent assay, and more than 99 percent had records of vaccination with live measles vaccine. Stratified analysis showed that the number of doses of vaccine received was the most important predictor of antibody response. Ninety-five percent confidence intervals of seronegative rates were 0 to 3.3 percent for students who had received two prior doses of vaccine, as compared with 3.6 to 6.8 percent for students who had received only a single dose. After the survey, none of the 1732 seropositive students contracted measles. Fourteen of 74 seronegative students, all of whom had been vaccinated, contracted measles. In addition, three seronegative students seroconverted without experiencing any symptoms. We conclude that outbreaks of measles can occur in secondary schools, even when more than 99 percent of the students have been vaccinated and more than 95 percent are immune.

Journal of the American Academy of Dermatology, 1985

This patient, an ll-year-old white male resident of Uvalde, TX, developed a red papule on his lef... more This patient, an ll-year-old white male resident of Uvalde, TX, developed a red papule on his left cheek in February 1980. The papule slowly grew to a size of 5 by 7 mm and ulcerated. A biopsy in May 1980 demonstrated Leishmania organisms in dermal macrophages. Cultures were reported as positive for organisms belonging to the Leishmania mexicana complex according to the isoenzyme profile. 4 The patient had not traveled outside of the United States with the exception of visiting the Mexican border city of Cuidad Acuna. Treatment was performed with two 10-day courses of intravenous sodium stibogluconate and the lesions healed quickly. Case 2 A 56-year-old white female resident of San Antonio, TX, was awakened from sleep one night in October 1982 by an apparent insect bite on her left earlobe. The 985 986 Nelson et al

Journal of Infectious Diseases, 1983

Journal of Infectious Diseases, 1983

During a 31-month period in 1979-1981, nine patients at a renal transplant center in Tennessee de... more During a 31-month period in 1979-1981, nine patients at a renal transplant center in Tennessee developed invasive infections with Aspergillus species. Despite an extensive search, no common environmental source of contamination was found. A matched case-control study of host risk factors showed that leukopenia, prior administration of antibiotics, and treatment with azathioprine and antilymphocyte serum were not significantly related to the development of aspergillosis. In contrast, the administration of high-dose corticosteroids posed a significant risk. An average daily dose of greater than or equal to 1.25 mg of prednisone/kg per day for the entire interval studied was the best predictor of subsequent invasive infection with Aspergillus.

Current Opinion in Infectious Diseases, 1991

Computer usage in hospital epidemiology has grown rapidly in recent years. In fact, among the dep... more Computer usage in hospital epidemiology has grown rapidly in recent years. In fact, among the departments concerned with measuring and improving quality, infection control leads the way in applying microcomputers to its information management needs. An obvious use of computers is to help manage surveillance databases. Other compelling reasons to collect and analyze data using computers include 1) newer methods to detect outbreaks; 2) classifying patient risks using indices specific to each type of infection; 3) decision analysis as a method of addressing cost-benefit questions; and 4) the future potential of expert computer systems.

Clinical Infectious Diseases, 1983

In November 1980, an outbreak of folliculitis due to Pseudomonas aeruginosa occurred in members o... more In November 1980, an outbreak of folliculitis due to Pseudomonas aeruginosa occurred in members of a health spa in Tennessee. The source of infection was traced to the health spa swimming pool, which had not been chlorinated for two days due to equipment malfunction. Thirty-seven (62%) of 60 members who used the swimming pool on these two days developed a papulopustular rash within eight hours to five days after swimming in the pool. The rash had a characteristic distribution, predominantly involving the buttocks, hips, and axillae. Other manifestations of infection included otitis externa (49%) and mastitis (11%). P. aeruginosa serogroup 0-11 was isolated from pustules of six people. A swab from the edge of the swimming pool also grew P. aeruginosa serogroup 0-11. With the rising popularity of home whirlpools and hot tubs, physicians may expect to encounter this disease with increasing frequency.

American Journal of Public Health, 1987

We designed a special surveillance system to detect health complaints of visitors to the 1982 Wor... more We designed a special surveillance system to detect health complaints of visitors to the 1982 World's Fair. Heat-related illness occurred during the first month of the Fair but was substantially reduced by public education, environmental modification, and provision of additional water fountains. There was no disruption of emergency health services in the communities surrounding the Fair. Advance planning and the provision of on-site medical services can minimize the public health impact of large gatherings.

The American Journal of Medicine, 1981

In August 1980, an outbreak of acute pulmonary histoplasmosis occurred among participants in a wa... more In August 1980, an outbreak of acute pulmonary histoplasmosis occurred among participants in a wagon train as it traveled through eastern Tennessee. Of the 85 people on the train 69 (81 percent) had evidence of infection with Histoplasma capsulatum. Fifty-four people had symptomatic disease. The source of infection was traced to the site of a former winter blackbird roost in Charleston, Tennessee, that had been partially cleared five years earlier to make a park. Fourteen of 25 soil samples from this site were culture-positive for H. capsulatum. This is the first reported outbreak to involve a large migrant group. The outbreak is unusual in that exposure occurred without excavation, construction or tree-cutting at the site.

Archives of Pediatrics & Adolescent Medicine, 1984

An outbreak of nosocomial varicella occurred in the neonatal intensive care unit of a west Texas ... more An outbreak of nosocomial varicella occurred in the neonatal intensive care unit of a west Texas hospital in 1982. Two health care workers and two infants were infected. The two infants acquired varicella following intimate exposures, although their mothers were shown to be seropositive. One of these infants had varicella-zoster antibody when exposed, received varicella-zoster immune globulin, and still had chickenpox develop. Thus, the presence of varicella-zoster antibody may not prevent infection in infants.

American Journal of Epidemiology

ABSTRACT

New England Journal of Medicine, 1987

This letter in response to an article about measles outbreak in a secondary school population sai... more This letter in response to an article about measles outbreak in a secondary school population said to be 99% immunized cites the present authors experience with measles outbreaks in a Texas school system. In this case there was a group of parents who held nonreligious views against immunization. Their children were faced with exclusion from school during the episode. The author said he had reason to believe that some of these parents may have presented falsified evidence such as baby books notes on pieces of papers with dates and health department records without official stamps. He cited these examples to advise the health officers be cautious in evaluating the validity of evidence of vaccination.

British Journal of Surgery, 2000

Background Although benchmarks and control charts are basic quality improvement tools, few surgeo... more Background Although benchmarks and control charts are basic quality improvement tools, few surgeons use them to monitor surgical site infection (SSI). Obstacles to widespread acceptance include: (1) small denominators, (2) complexities of adjusting for patient risk and (3) scepticism about their true purpose (cost cutting, surgical privilege determination or improving outcomes). Methods The application of benchmark charts (using US national SSI rates as limits) and control charts (using facility rates as limits) was studied in 51 hospitals submitting data to the AICE National Database Initiative. SSI rates were risk adjusted by calculating a new statistic, the standardized infection ratio (SIR), based on the risk index suggested by the Centers for Disease Control National Nosocomial Infection Surveillance Study. Fourteen different types of control chart were examined and 115 suspiciously high or low monthly rates were flagged. Participating hospital epidemiologists investigated and ...

Archives of Pediatrics & Adolescent Medicine, 1985

We conducted a telephone survey in Houston in March 1983 to assess the level of aspirin use among... more We conducted a telephone survey in Houston in March 1983 to assess the level of aspirin use among children during the influenza season. We completed interviews of 200 households with 346 children aged 12 years or younger. Fifty-two percent of the 346 children experienced at least one acute illness in the preceding three months. Fever was measured with a thermometer in 114 ill children, 103 of whom had at least one measured temperature of 37.7 degrees C or greater. Fourteen percent of these 103 children received aspirin only, 61% received acetaminophen only, and 20% received both. Among a subgroup of 44 children with temperatures of at least 39.4 degrees C, 11% received aspirin only, 59% received acetaminophen only, and 27% received both. Only 60% of the 200 parents interviewed had heard of Reye's syndrome. Forty-two percent knew of the association between Reye's syndrome and aspirin use. The survey suggests that acetaminophen has replaced aspirin as the major antipyretic used by children in Houston. If the decline in aspirin use in Houston is representative of the population in the United States, and if aspirin is causally related to Reye's syndrome, the incidence of Reye's syndrome may decline.

Annals of Internal Medicine, 1985

In July 1984, an outbreak of gastroenteritis occurred in a suburban community in Texas. A random ... more In July 1984, an outbreak of gastroenteritis occurred in a suburban community in Texas. A random telephone survey of 100 of 1791 households in the community identified an attack rate of 34%. The outbreak was traced to contamination of the community water supply, an artesian well. Fecal coliforms were identified in untreated drinking water from the well during July. Stool examinations and serologic tests identified Cryptosporidium as the etiologic agent. Cryptosporidium should be added to the list of waterborne organisms capable of causing outbreaks of gastroenteritis.

American Journal of Public Health, 1983

In April 1981, an outbreak of hepatitis A occurred among state legislators in Tennessee. Although... more In April 1981, an outbreak of hepatitis A occurred among state legislators in Tennessee. Although the number of cases was small, we traced the source to a food handler who served cold meats and cheese. This investigation demonstrates the value of rapid serologic testing using a radioimmunoassay technique and matched case-control analysis to identify small foodborne outbreaks of hepatitis A.

Archives of Pediatrics & Adolescent Medicine, 1985

An outbreak of diarrhea occurred in a day-care center in San Marcos, Tex, in August 1984. At the ... more An outbreak of diarrhea occurred in a day-care center in San Marcos, Tex, in August 1984. At the time of this study, the center was caring for 81 children aged 2 months through 5 years. A single stool specimen was collected from each of 50 children (62%). Cryptosporidium oocysts and Giardia lamblia cysts were each identified in stool specimens from 18 children. Three children had both parasites present in the same stool specimen. Echovirus 30 was identified in 19 of 25 stools cultured. Although three pathogens were circulating simultaneously in this group of children, only the presence of Cryptosporidium oocysts was associated with the occurrence of a diarrheal illness. Cryptosporidium may be a common cause of diarrhea in children who attend day-care centers.

Pediatrics, 1982

An outbreak of nosocomial varicella was traced to airborne spread from an immunocompromised child... more An outbreak of nosocomial varicella was traced to airborne spread from an immunocompromised child hospitalized from Nov 11-19, 1980. Seventy potentially susceptible children were hospitalized on the ward during that period. Although the index patient remained in strict room isolation throughout his hospital stay, eight of these patients contracted varicella. The afternoon of November 12 was the period of highest risk for acquiring varicella. Eight of 36 patients (22%) present that afternoon, compared to none of 34 patients not present that afternoon, acquired the infection. A patient's risk of contracting varicella was significantly related to how near he/she came to the index patient's room that afternoon. Airflow studies, using the tracer gas, sulfur hexafluoride (SF6), demonstrated that patient rooms on this ward were at positive pressure with respect to the corridor. Despite isolation procedures, SF6 released in the index patient's room achieved concentrations in the...

The American Journal of Tropical Medicine and Hygiene, 1985

Four cases of autochthonous human cutaneous leishmaniasis have been identified in south-central T... more Four cases of autochthonous human cutaneous leishmaniasis have been identified in south-central Texas since 1980. The patients presented with chronic ulcerating papules on the face, earlobe, and lateral thigh. In two patients, the infections healed without treatment. In the other two patients, the lesions healed following treatment with intramuscular sodium stibogluconate or topical antimony potassium tartrate. Serologic testing of family members, using four different techniques, indicates that asymptomatic infections may occur. These are the first reported cases of cutaneous leishmaniasis acquired in Texas since 1974. Organisms isolated from patients in 1974 and 1980 belonged to the Leishmania mexicana complex when tested by the isoenzyme technique. Although no animal reservoir or insect vector has been identified, six species of sand flies belonging to the genus Lutzomyia do inhibit this part of Texas. Accumulated evidence strongly suggests that cutaneous leishmaniasis is endemic in south-central Texas.

Infection Control, 1985

Between April 1982 and March 1983,10 of 26 (38.4%) allogeneic bone marrow transplant recipients h... more Between April 1982 and March 1983,10 of 26 (38.4%) allogeneic bone marrow transplant recipients housed on a newly opened bone marrow transplant unit developed invasive aspergillosis. By contrast, between September 1977 and March 1982, only 3 of 46 (6%) transplant recipients developed invasive aspergillosis. A case-control study to identify host factors related toAspergillusinfection found that aspergillosis was more common in patients with chronic myelogenous leukemia and aplastic anemia, older patients, patients having cytomegalovirus disease, patients who experienced prolonged granulocytopenia, patients conditioned with ara-C (100-200 mg/day), and patients who received longer duration of antimicrobial therapy. A series of logistic regression analyses revealed that underlying disease was the single best predictor ofAspergillusinfection. This study demonstrates that underlying disease is an important risk factor for aspergillosis and that special measures may be warranted when trans...

New England Journal of Medicine, 1987

An outbreak of measles occurred among adolescents in Corpus Christi, Texas, in the spring of 1985... more An outbreak of measles occurred among adolescents in Corpus Christi, Texas, in the spring of 1985, even though vaccination requirements for school attendance had been thoroughly enforced. Serum samples from 1806 students at two secondary schools were obtained eight days after the onset of the first case. Only 4.1 percent of these students (74 of 1806) lacked detectable antibody to measles according to enzyme-linked immunosorbent assay, and more than 99 percent had records of vaccination with live measles vaccine. Stratified analysis showed that the number of doses of vaccine received was the most important predictor of antibody response. Ninety-five percent confidence intervals of seronegative rates were 0 to 3.3 percent for students who had received two prior doses of vaccine, as compared with 3.6 to 6.8 percent for students who had received only a single dose. After the survey, none of the 1732 seropositive students contracted measles. Fourteen of 74 seronegative students, all of whom had been vaccinated, contracted measles. In addition, three seronegative students seroconverted without experiencing any symptoms. We conclude that outbreaks of measles can occur in secondary schools, even when more than 99 percent of the students have been vaccinated and more than 95 percent are immune.

Journal of the American Academy of Dermatology, 1985

This patient, an ll-year-old white male resident of Uvalde, TX, developed a red papule on his lef... more This patient, an ll-year-old white male resident of Uvalde, TX, developed a red papule on his left cheek in February 1980. The papule slowly grew to a size of 5 by 7 mm and ulcerated. A biopsy in May 1980 demonstrated Leishmania organisms in dermal macrophages. Cultures were reported as positive for organisms belonging to the Leishmania mexicana complex according to the isoenzyme profile. 4 The patient had not traveled outside of the United States with the exception of visiting the Mexican border city of Cuidad Acuna. Treatment was performed with two 10-day courses of intravenous sodium stibogluconate and the lesions healed quickly. Case 2 A 56-year-old white female resident of San Antonio, TX, was awakened from sleep one night in October 1982 by an apparent insect bite on her left earlobe. The 985 986 Nelson et al

Journal of Infectious Diseases, 1983

Journal of Infectious Diseases, 1983

During a 31-month period in 1979-1981, nine patients at a renal transplant center in Tennessee de... more During a 31-month period in 1979-1981, nine patients at a renal transplant center in Tennessee developed invasive infections with Aspergillus species. Despite an extensive search, no common environmental source of contamination was found. A matched case-control study of host risk factors showed that leukopenia, prior administration of antibiotics, and treatment with azathioprine and antilymphocyte serum were not significantly related to the development of aspergillosis. In contrast, the administration of high-dose corticosteroids posed a significant risk. An average daily dose of greater than or equal to 1.25 mg of prednisone/kg per day for the entire interval studied was the best predictor of subsequent invasive infection with Aspergillus.

Current Opinion in Infectious Diseases, 1991

Computer usage in hospital epidemiology has grown rapidly in recent years. In fact, among the dep... more Computer usage in hospital epidemiology has grown rapidly in recent years. In fact, among the departments concerned with measuring and improving quality, infection control leads the way in applying microcomputers to its information management needs. An obvious use of computers is to help manage surveillance databases. Other compelling reasons to collect and analyze data using computers include 1) newer methods to detect outbreaks; 2) classifying patient risks using indices specific to each type of infection; 3) decision analysis as a method of addressing cost-benefit questions; and 4) the future potential of expert computer systems.

Clinical Infectious Diseases, 1983

In November 1980, an outbreak of folliculitis due to Pseudomonas aeruginosa occurred in members o... more In November 1980, an outbreak of folliculitis due to Pseudomonas aeruginosa occurred in members of a health spa in Tennessee. The source of infection was traced to the health spa swimming pool, which had not been chlorinated for two days due to equipment malfunction. Thirty-seven (62%) of 60 members who used the swimming pool on these two days developed a papulopustular rash within eight hours to five days after swimming in the pool. The rash had a characteristic distribution, predominantly involving the buttocks, hips, and axillae. Other manifestations of infection included otitis externa (49%) and mastitis (11%). P. aeruginosa serogroup 0-11 was isolated from pustules of six people. A swab from the edge of the swimming pool also grew P. aeruginosa serogroup 0-11. With the rising popularity of home whirlpools and hot tubs, physicians may expect to encounter this disease with increasing frequency.

American Journal of Public Health, 1987

We designed a special surveillance system to detect health complaints of visitors to the 1982 Wor... more We designed a special surveillance system to detect health complaints of visitors to the 1982 World's Fair. Heat-related illness occurred during the first month of the Fair but was substantially reduced by public education, environmental modification, and provision of additional water fountains. There was no disruption of emergency health services in the communities surrounding the Fair. Advance planning and the provision of on-site medical services can minimize the public health impact of large gatherings.

The American Journal of Medicine, 1981

In August 1980, an outbreak of acute pulmonary histoplasmosis occurred among participants in a wa... more In August 1980, an outbreak of acute pulmonary histoplasmosis occurred among participants in a wagon train as it traveled through eastern Tennessee. Of the 85 people on the train 69 (81 percent) had evidence of infection with Histoplasma capsulatum. Fifty-four people had symptomatic disease. The source of infection was traced to the site of a former winter blackbird roost in Charleston, Tennessee, that had been partially cleared five years earlier to make a park. Fourteen of 25 soil samples from this site were culture-positive for H. capsulatum. This is the first reported outbreak to involve a large migrant group. The outbreak is unusual in that exposure occurred without excavation, construction or tree-cutting at the site.

Archives of Pediatrics & Adolescent Medicine, 1984

An outbreak of nosocomial varicella occurred in the neonatal intensive care unit of a west Texas ... more An outbreak of nosocomial varicella occurred in the neonatal intensive care unit of a west Texas hospital in 1982. Two health care workers and two infants were infected. The two infants acquired varicella following intimate exposures, although their mothers were shown to be seropositive. One of these infants had varicella-zoster antibody when exposed, received varicella-zoster immune globulin, and still had chickenpox develop. Thus, the presence of varicella-zoster antibody may not prevent infection in infants.

American Journal of Epidemiology

ABSTRACT