Acute Purulent Meningitis in Alaska Natives: Epidemiology,Diagnosis and Prognosis

During the period 1957-1964, 69 cases of purulent meningitis were treated at the U.S. Public Health Service Hospital in Bethel, Alaska, a 65-bed facility serving about 10,000 Eskimos and Indians in the remote Yukon-Kuskokwim Delta area. Nearly two-thirds of the patients were infants, among whom the case fatality rate was 37.2%, compared with the overall fatality rate of 30.4%. In 52% of the cases no causative organism could be demonstrated on smear or culture. Of the bacteriologically positive cases, one-third were due to pneumococci and one-third to meningococci. Prognosis was not affected by previous treatment or recovery of the organism. Since 1957, an annual average of one out of 74 infants in the area has had purulent meningitis; one out of 200 has died of the disease. Chronic otitis media, poor nutrition, a high incidence of respiratory disease and the relative inaccessibility of medical care are significant factors.     

Food-borne botulism in Canada, 1971-84

Sixty-one outbreaks of food-borne botulism involving a total of 122 cases, of which 21 were fatal, were recorded from 1971 to 1984 in Canada. Most occurred in northern Quebec, the Northwest Territories or British Columbia. Of the 122 victims 113 were native people, mostly Inuit. Most of the outbreaks (59%) were caused by raw, parboiled or “fermented” meats from marine mammals; fermented salmon eggs or fish accounted for 23% of the outbreaks. Three outbreaks were attributed to home-preserved foods, and one outbreak was attributed to a commercial product. The causative Clostridium botulinum type was determined in 58 of the outbreaks: the predominant type was E (in 52 outbreaks), followed by B (in 4) and A (in 2). Renewed educational efforts combined with a comprehensive immunization program would significantly improve the control of botulism in high-risk populations.     

Dental chipping in Aleuts, Eskimos and Indians

Analysis of dentitions belonging to 324 prehistoric and protohistoric Aleuts, Eskimos and northern Indians, all of whom were regularly meat-eaters, reveals a significant difference between Eskimos and Aleut-Indians for a little known type of tooth wear. This wear is characterized by severe crushing and/or flaking of the crown surface of one or more teeth (termed “pressure-chipping”). It occurs chiefly in dentitions of high arctic Eskimos of Alaska, Canada, and Greenland, and significantly less often in the teeth of Kodiak Island Eskimos, Aleuts and northern Indians. Sex differences do not exist but pressure-chipping occurs significantly more often in adult (21–x years) than in non-adult (0–20 years) Eskimos. The exact mechanism(s) responsible for pressure-chipping is unknown, although ethnographic accounts of Eskimo eating habits suggest that crushing of hard substances such as bone was involved. The severity of this wear could have contributed to the selection for, or preservation of, large and complex crowns in high arctic Eskimos. Pressure-chipping is offered as evidence favoring the view that tooth size (longevity) may have had in the past some adaptive value.     

Type A and type B botulism in the North: first reported cases due to toxin other than type E in Alaskan Inuit.

Botulism outbreaks shown to be due to type A and type B toxin occurred in Alaska, a region previously known for only type E botulism. The outbreak due to type A toxin involved three people, two of whom died. The outbreak due to type B toxin involved nine people, none of whom died. Both outbreaks were in Inuit villages, and native foods were incriminated. The occurrence of these outbreaks strongly suggests that Clostridium botulinum, types A and B are indigenous to Alaska. The outbreaks underscore the need for initial treatment of patients with antitoxin that is trivalent (ABE), even in Arctic regions.     

Acute myocardial infarction and sudden death in Sioux Indians.

While some Indian tribes have low rates of acute myocardial infarction, Northern Plains Indians, including the Sioux, have rates of morbidity and mortality from acute myocardial infarction higher than those reported for the United States population in general. In a review of diagnosed cases of acute myocardial infarction over a 3-year period in 2 hospitals serving predominantly Sioux Indians, 8% of cases were found misclassified, and 22% failed to meet rigorous diagnostic criteria, although the patients did indeed have ischemic heart disease. Patients had high frequencies of complications and risk factors and a fatality rate of 16% within a month of admission. Sudden deaths likely due to ischemic heart disease but in persons not diagnosed as having acute myocardial infarction by chart review occurred 3 times more frequently than deaths occurring within a month of clinical diagnosis.     

A global assessment of salmon aquaculture impacts on wild salmonids

Since the late 1980s, wild salmon catch and abundance have declined dramatically in the North Atlantic and in much of the northeastern Pacific south of Alaska. In these areas, there has been a concomitant increase in the production of farmed salmon. Previous studies have shown negative impacts on wild salmonids, but these results have been difficult to translate into predictions of change in wild population survival and abundance. We compared marine survival of salmonids in areas with salmon farming to adjacent areas without farms in Scotland, Ireland, Atlantic Canada, and Pacific Canada to estimate changes in marine survival concurrent with the growth of salmon aquaculture. Through a meta-analysis of existing data, we show a reduction in survival or abundance of Atlantic salmon; sea trout; and pink, chum, and coho salmon in association with increased production of farmed salmon. In many cases, these reductions in survival or abundance are greater than 50%. Meta-analytic estimates of the mean effect are significant and negative, suggesting that salmon farming has reduced survival of wild salmon and trout in many populations and countries.     

The genetic structure of populations of Chuckotka Peninsula Eskimos and Chuckchi based on study of 13 loci of serum and erythrocyte proteins and enzymes

The Eskimos and Chuckchi of the Chuckotka Peninsula were studied at 13 loci of serum and erythrocyte proteins and enzymes by electrophoresis. Six loci-including albumin, transferrin, carbonic anhydrase I and II, monoamine oxidase, and superoxide dismutase-were monomorphic in the studied populations. The mean frequencies of alleles in nine polymorphic loci of Chuckotka Eskimos and Chuckchi, Eskimos of Alaska, Canada, and Greenland, some Mongoloid populations of Siberia, American Indians, and Lapps of circumpolar areas of Western Europe were obtained. The genetic distances between these populations were calculated. The Eskimos of Chuckotka were closest to the Alaskan Eskimos. The relative heterozygosity of Chuckotka Eskimos was calculated and was the highest in Chuckchi. The average heterozygosity in Eskimo populations increased in the following order, from least to greatest: Chuckotka Eskimos, St. Lawrence Island Eskimos, Alaskan Eskimos, Greenland Eskimos, and Canadian Eskimos. The average heterozygosity of the Chuckchi was similar to that of Western Hemisphere Eskimos.     

Variation in the convexity of the human maxillary incisor labial surface

Labial surface convexity of the maxillary central incisors (ILC) is classified with a new five grade ranked scale. More than 2,000 individuals representing 20 worldwide populations were studied. Principle findings are 1) sexual dimorphism is not significant, 2) antimere asymmetry is moderate, 3) labial convexity is negatively associated (r = ?0.48) with labial surface double-shovelling, and 4) significant differences occur between several populations. Convexity is most marked in African and Asiatic Indian populations, particularly Bushmen. Europeans have intermediate degrees of convexity, and American Indians the least; Eskimos have the highest amount of convexity among Native Americans. Pacific Islanders are intermediate; Melanesians show the strongest expression of incisor labial convexity in the Pacific.     

Smallpox Control in Canada

During the period 1961 to 1963 there were 10 separate importations of smallpox cases by aircraft into England and Wales, Germany, Sweden, Poland and Canada. A feature of the resulting outbreaks was the number of cases and deaths of physicians and other health personnel. With the increasing volume of international air traffic there is a risk of importing incubating cases of smallpox into Canada, as occurred in 1962. Millions of Canadians have been protected against smallpox. Some complications of smallpox vaccination have occurred in Canada; such complications can be minimized by proper attention to contraindications to vaccination. The Food and Drug Directorate, Department of National Health and Welfare, has circularized all physicians in Canada to request their co-operation in reporting adverse reactions to drugs. This includes serious, unusual or unsuspected reactions to immunizing agents (vaccines, toxoids and antitoxins). The latter information will be shared with the Epidemiology Division, Department of National Health and Welfare, and the provincial epidemiologist and manufacturer concerned. The importance of maintaining the smallpox immunity of physicians, nurses and other hospital and health personnel in Canada is emphasized.     

A population study of the jugular foramen bridging of the human cranium

The author previously proposed a simple standard for diagnosing the jugular foramen bridging in man. The incidence of this bridging trait was investigated according to that standard in nine cranial series of East Indians, Micronesians, Japanese, Ainu, Mongols, Aleuts, Alaskan Eskimos, Canadian Eskimos, and Ontario Iroquois. No sex difference in incidence of the trait was recognized. Side difference in trait incidence was also slight but was statistically significant in the combined series of all the population samples examined. The bridging trait occurred more frequently on the right side than on the left side. Occurrences of the bridging trait were definitely associated between sides. Incidence of the trait was less in East Indians, Ontario Iroquois, and Micronesians, but greater in Alaskan Eskimos and Canadian Eskimos, the incidences in Japanese, Ainu, Aleuts, and Mongols being intermediate. The differences in trait incidence among the nine population samples were considered to reflect the differences in genetic compositions of these specific populations.     

Conditions of reproduction and population dynamics of Pacific salmons (<Emphasis Type="Italic">Oncorhynchus</Emphasis>): The northeast of Sakhalin Island

The efficiency of reproduction of Pacific salmon (Oncorhynchus) in the rivers of the northeastern Sakhalin coast is characterized based on long-term observations. The rivers of the northern, central, and southern parts differ in the type of their channel, faunistic composition of aquatic biota, and prevalent salmon species. The northern rivers have a plain type of channel with rather low spawning efficiency of salmons and relatively poor freshwater ichthyofauna. The central area houses the largest rivers (Tym’ and Nabil’ Rivers) running to the Nyiskii and Nabil’skii Gulfs; the rivers there have developed channels of a plain type, high diversity of resident ichthyofauna, low spawning efficiency of the pink salmon Oncorhynchus gorbuscha, and high (in the past) abundance of the fall chum salmon O. keta. Characteristic of the southern rivers with their prevalently mountain–foothill type of channels are poor fish population and high spawning efficiency of the pink salmon. The population dynamics of the salmonids in the northeastern coast of Sakhalin is described. The total number of breeders entering the rivers of the northeastern coast that provides an efficient reproduction is estimated as 3.5?9.0 million individuals for the pink salmon and 0.04–0.60 million individuals for the chum salmon (fall race).     

Patterns of genomic variation in Coho salmon following reintroduction to the interior Columbia River

Coho salmon were extirpated in the mid‐20th century from the interior reaches of the Columbia River but were reintroduced with relatively abundant source stocks from the lower Columbia River near the Pacific coast. Reintroduction of Coho salmon to the interior Columbia River (Wenatchee River) using lower river stocks placed selective pressures on the new colonizers due to substantial differences with their original habitat such as migration distance and navigation of six additional hydropower dams. We used restriction site‐associated DNA sequencing (RAD‐seq) to genotype 5,392 SNPs in reintroduced Coho salmon in the Wenatchee River over four generations to test for signals of temporal structure and adaptive variation. Temporal genetic structure among the three broodlines of reintroduced fish was evident among the initial return years (2000, 2001, and 2002) and their descendants, which indicated levels of reproductive isolation among broodlines. Signals of adaptive variation were detected from multiple outlier tests and identified candidate genes for further study. This study illustrated that genetic variation and structure of reintroduced populations are likely to reflect source stocks for multiple generations but may shift over time once established in nature.     

Study on the Floristic Composition Similarity of Mangrove Among Their Global Distribution Regions

Based on set theory, the similarity and disparity indices among plant distribution regions were defined with the Jaccard’s similarity index. The similarity among six mangrove distribution regions in the world was analysed. The results showed that the region most similar to the eastern coast of Africa was the coast of Oceania, the region most similar to the coast of Asia and the eastern Pacific Archipelago was the coast of Oceania, the region most similar to the western coast of America was the western coast of Africa, the region most similar to the western coast of Africa was the eastern coast of America. By cluster analysis of the six mangrove distribution regions, the western coast of Africa and the eastern coast of America, the coast of Asia and eastern Pacific Archipelago and the coast of Oceania, were merged into two large regions respectively. The six mangrove distribution regions were further merged into two large regions which were consistent with the east central group and the west central group.     

Causes of Blindness in Canada: An Analysis of 24,605 Cases Registered with The Canadian National Institute for the Blind

A survey of blind persons in Canada, based on registrations with The Canadian National Institute for the Blind (C.N.I.B.), is reported. This is the first study of its type having national scope and based on data registered in a central file. It covered 24,605 living registered blind persons ranging from premature infants to very elderly persons. Causes of blindness are broken down with respect to topography (site and type of lesion) and etiology. In terms of frequency, the principal causes were lesions affecting the globe (e.g. glaucoma, myopia), 36%; the retina, 23%; the lens, 16%; and the optic nerve, 11%. In this study, 32% of the blindness was due to prenatal causes. The prevalence of blindness per 100,000 persons in Canada, based on C.N.I.B. data, was 131, varying among the provinces from 108 to 376. Serious ocular disease was four times more prevalent than blindness; 101,436 such cases (the prevention group) were listed by the C.N.I.B.     

Opportunities with W.H.O

Available statistics were studied to define the extent of the lung cancer problem in Canada. Because of the low overall survival in treated and untreated cases at one year, mortality figures provide a rough index of morbidity from this disease.Male lung cancer death rates rose steadily from 3.0 to 24.6, and female rates from 1.6 to 4.0 per 100,000 population between 1931 and 1961. In males, the greatest increase occurred in the 70-74 year age group (eighteen-fold) and in females in the 80-84 year age group (seven-fold).Lung cancer caused 2774 deaths in Canada in 1961, and was the leading cause of cancer deaths for males in all age groups from 40 to 79 years. It accounted for approximately 1 in 5 of all cancer deaths in males and 1 in 26 in females.Lung cancer mortality in Canada has not increased to the same extent as in certain other countries, but to counter the rising trend, changes in the smoking habits of the population are required as well as community and industrial control of atmospheric carcinogens.     

Incidence of Clostridium botulinum Type E in Salmon and Other Marine Fish in the Pacific Northwest

Salmon, sole, cod, oysters, clams, and crabs from ocean waters along the coast of Oregon and Washington were examined for the presence of Clostridium botulinum type E. The organism was detected by identification of the type E toxin in enrichment cultures of the viscera of individual fish. Of 369 salmon specimens, 48 yielded cultures containing toxin lethal to mice, and almost half of the toxic cultures were shown to contain botulinal toxin, chiefly type E. Eighteen of 113 sole and cod specimens, 4 of 22 Dungeness crab specimens, 5 of 16 oyster specimens, and 27 of 115 clam specimens gave rise to cultures containing botulinal toxin which was usually type E, although types A and B were occasionally encountered.     

Relationship of drinking water quality (hardness-softness) to cardiovascular mortality in Newfoundland

The profile of mortality in Newfoundland was analysed for all deaths occurring in 1969 of persons 35 to 69 years of age, of whom the total was 1036. An exceptionally high cardiovascular mortality (793 deaths/100,000) was noted for St. John''s, the capital city of Newfoundland, a city which has an extremely soft drinking-water supply. This high rate corresponds to that observed in the “high mortality belt” reported for the east coast of the United States, and in conjunction with data from mainland Canada, extends the belt across the entire eastern aspect of North America. The proportion of cardiovascular deaths of men occurring outside the hospital was less within hard drinking-water areas in Newfoundland than in the soft water areas of the province. Thus, the statistics reported here of cardiovascular mortality confirm evidence reported elsewhere on “macro-geographic” variations in this disease(s) as well as “micro-geographic” regional variations which may be dependent upon local environmental factors.     

Clinical Manifestations and Case Management of Ebola Haemorrhagic Fever Caused by a Newly Identified Virus Strain,Bundibugyo, Uganda, 2007–2008

A confirmed Ebola haemorrhagic fever (EHF) outbreak in Bundibugyo, Uganda, November 2007–February 2008, was caused by a putative new species (Bundibugyo ebolavirus). It included 93 putative cases, 56 laboratory-confirmed cases, and 37 deaths (CFR = 25%). Study objectives are to describe clinical manifestations and case management for 26 hospitalised laboratory-confirmed EHF patients. Clinical findings are congruous with previously reported EHF infections. The most frequently experienced symptoms were non-bloody diarrhoea (81%), severe headache (81%), and asthenia (77%). Seven patients reported or were observed with haemorrhagic symptoms, six of whom died. Ebola care remains difficult due to the resource-poor setting of outbreaks and the infection-control procedures required. However, quality data collection is essential to evaluate case definitions and therapeutic interventions, and needs improvement in future epidemics. Organizations usually involved in EHF case management have a particular responsibility in this respect.     

Larval and juvenile Pacific herring Clupea pallasii are not susceptible to infectious hematopoietic necrosis under laboratory conditions

Infectious hematopoietic necrosis (IHN) leads to periodic epidemics among certain wild and farmed fish species of the Northeast (NE) Pacific. The source of the IHN virus (IHNV) that initiates these outbreaks remains unknown; however, a leading hypothesis involves viral persistence in marine host species such as Pacific herring Clupea pallasii. Under laboratory conditions we exposed specific pathogen-free (SPF) larval and juvenile Pacific herring to 10(3) to 10(4) plaque-forming units (pfu) of IHNV ml(-1) by waterborne immersion. Cumulative mortalities among exposed groups were not significantly different from those of negative control groups. After waterborne exposure, IHNV was transiently recovered from the tissues of larvae but absent in tissues of juveniles. Additionally, no evidence of viral shedding was detected in the tank water containing exposed juveniles. After intraperitoneal (IP) injection of IHNV in juvenile herring with 10(3) pfu, IHNV was recovered from the tissues of sub-sampled individuals for only the first 5 d post-exposure. The lack of susceptibility to overt disease and transient levels of IHNV in the tissues of exposed fish indicate that Pacific herring do not likely serve a major epizootiological role in perpetuation of IHNV among free-ranging sockeye salmon Oncorhynchus nerka and farmed Atlantic salmon Salmo salar in the NE Pacific.     

Human Prion Diseases in the United States

Background

Prion diseases are a family of rare, progressive, neurodegenerative disorders that affect humans and animals. The most common form of human prion disease, Creutzfeldt-Jakob disease (CJD), occurs worldwide. Variant CJD (vCJD), a recently emerged human prion disease, is a zoonotic foodborne disorder that occurs almost exclusively in countries with outbreaks of bovine spongiform encephalopathy.This study describes the occurrence and epidemiology of CJD and vCJD in the United States.

Methodology/Principal Findings

Analysis of CJD and vCJD deaths using death certificates of US residents for 1979–2006, and those identified through other surveillance mechanisms during 1996–2008. Since CJD is invariably fatal and illness duration is usually less than one year, the CJD incidence is estimated as the death rate. During 1979 through 2006, an estimated 6,917 deaths with CJD as a cause of death were reported in the United States, an annual average of approximately 247 deaths (range 172–304 deaths). The average annual age-adjusted incidence for CJD was 0.97 per 1,000,000 persons. Most (61.8%) of the CJD deaths occurred among persons ≥65 years of age for an average annual incidence of 4.8 per 1,000,000 persons in this population. Most deaths were among whites (94.6%); the age-adjusted incidence for whites was 2.7 times higher than that for blacks (1.04 and 0.40, respectively). Three patients who died since 2004 were reported with vCJD; epidemiologic evidence indicated that their infection was acquired outside of the United States.

Conclusion/Significance

Surveillance continues to show an annual CJD incidence rate of about 1 case per 1,000,000 persons and marked differences in CJD rates by age and race in the United States. Ongoing surveillance remains important for monitoring the stability of the CJD incidence rates, and detecting occurrences of vCJD and possibly other novel prion diseases in the United States.