Acute Rheumatic Fever in Los Angeles County

There was a general downward trend in the reported incidence of acute rheumatic fever in Los Angeles County during the years 1954-1963. A survey of hospital records in five large hospitals in 1962 revealed 100 cases diagnosed, 39 of which were reported. Diagnoses in the charts reviewed conformed to the Modified Jones Criteria. Most of the patients were born in Los Angeles County.Mortality rates for acute rheumatic fever during the same period were greatly in excess of those expected from the reported morbidity. The mean crude mortality rate for the period concerned was higher than for New York City, although not as high as for Boston.Acute rheumatic fever appears to constitute a health problem in need of review in Los Angeles County.     

Rheumatic fever in Southern California; problems related to diagnosis

Rheumatic fever occurs in native of Southern California and is a cause of death. The incidence of streptococcosis in Los Angeles is approximately equal to that in three other major cities in the United States where rheumatic fever is known to occur commonly. Manifestations of rheumatic fever may range from mild to severe. It is suggested that a greater percentage of patients in Southern California have symptoms of rheumatic fever that are more mild. Differentiation between prolonged, uncomplicated streptococcosis and rheumatic fever is a major problem. The judicious use of a battery of tests, acute phase reactants, on the same blood sample will frequently help to establish the diagnosis in borderline situations so common to Southern California.     

Modeling valley fever (coccidioidomycosis) incidence on the basis of climate conditions

Valley fever (coccidioidomycosis) is a disease endemic to arid regions within the Western Hemisphere, and is caused by a soil-dwelling fungus, Coccidioides immitis. Incidence data for Pima County, reported to the Arizona Department of Health Services as new cases of valley fever, were used to conduct exploratory analyses and develop monthly multivariate models of relationships between valley fever incidence and climate conditions and variability in Pima County, Arizona, USA. Bivariate and compositing analyses conducted during the exploratory portion of the study revealed that antecedent temperature and precipitation in different seasons are important predictors of incidence. These results were used in the selection of candidate variables for multivariate predictive modeling, which was designed to predict deviation from mean incidence on the basis of past, current, and forecast climate conditions. The models were specified using a backward stepwise procedure, and were most sensitive to key predictor variables in the winter season and variables that were time-lagged 1 year or more prior to the month being predicted. Model accuracy was generally moderate ( r(2) values for the monthly models, tested on independent data, ranged from 0.15 to 0.50), and months with high incidence can be predicted more accurately than months with low incidence.     

Climate controls on valley fever incidence in Kern County, California

Coccidiodomycosis (valley fever) is a systemic infection caused by inhalation of airborne spores from Coccidioides immitis, a soil-dwelling fungus found in the southwestern United States, parts of Mexico, and Central and South America. Dust storms help disperse C. immitis so risk factors for valley fever include conditions favorable for fungal growth (moist, warm soil) and for aeolian soil erosion (dry soil and strong winds). Here, we analyze and inter-compare the seasonal and inter-annual behavior of valley fever incidence and climate risk factors for the period 1980–2002 in Kern County, California, the US county with highest reported incidence. We find weak but statistically significant links between disease incidence and antecedent climate conditions. Precipitation anomalies 8 and 20 months antecedent explain only up to 4% of monthly variability in subsequent valley fever incidence during the 23 year period tested. This is consistent with previous studies suggesting that C. immitis tolerates hot, dry periods better than competing soil organisms and, as a result, thrives during wet periods following droughts. Furthermore, the relatively small correlation with climate suggests that the causes of valley fever in Kern County could be largely anthropogenic. Seasonal climate predictors of valley fever in Kern County are similar to, but much weaker than, those in Arizona, where previous studies find precipitation explains up to 75% of incidence. Causes for this discrepancy are not yet understood. Higher resolution temporal and spatial monitoring of soil conditions could improve our understanding of climatic antecedents of severe epidemics.     

Rheumatic Fever and Rheumatic Heart Disease in Barbados: Detection and Prophylaxis

The objectives of this study were to improve our methods of secondary prophylaxis of rheumatic fever and rheumatic heart disease in Barbados, to estimate the overall prevalence of these diseases and the relative load imposed by them on available health services, and to measure the yield, feasibility, and effectiveness of mass programmes for the detection and prophylactic management of rheumatic heart disease in schoolchildren.Improved methods of surveillance and follow-up resulted in 97% adherence to therapy by patients on prophylactic penicillin. Thirty-four children, 27 with a first attack, were admitted with acute rheumatic fever, representing a 7% occupancy of children''s medical beds during the 12-month period of the study. Out of a possible 3,942 schoolchildren aged 5-11 years, 3,882 (98%) were screened for rheumatic heart disease. Four cases (about 1 per 1,000) were discovered.     

Lewis W. Hackett and the early years of the International Health Board's Yellow Fever Program in Brazil, 1917-1924

Lewis W. Hackett joined the staff of the International Health Board (IHB) in 1914. He was sent to Brazil in 1916, where his original responsibility was hookworm control, but he was gradually and inevitably drawn into combating other diseases. Hackett had a strong influence on public health in Brazil. In 1922 he instituted grass-roots (local) health units and programs. The next year, he negotiated with the federal government a cooperative yellow fever control program, which was described in the IHB's 1923 annual report as the "new and final campaign against yellow fever" in Brazil. Eleven offices were established in northern Brazil, where it was expected that yellow fever would quickly be eradicated. Just as the new program got underway Hackett was reassigned to Italy, where he remained until the beginning of World War II. Nonetheless, Hackett had done a classic job of developing the IHB program in Brazil, moving carefully but authoritatively from the initial focus on hookworm, to the development of a more comprehensive public health program, and then to the strategic thrust toward yellow fever.     

Genetic diversity in a reintroduced swift fox population

Swift fox (Vulpes velox) were historically distributed in southwestern South Dakota including the region surrounding Badlands National Park (BNP). The species declined during the mid-1800s, largely due to habitat loss and poisoning targeted at wolves (Canis lupus) and coyotes (Canis latrans). Only a small population of swift foxes near Ardmore, which is located in Fall River County, South Dakota, persisted. In 2003, a reintroduction program was initiated at BNP with swift foxes translocated from Colorado and Wyoming. Foxes released in the years 2003, 2004 and 2005 were translocated from Colorado (BNP-Colorado) whereas in 2006, released foxes were translocated from Wyoming (BNP-Wyoming). Our objective was to evaluate genetic diversity and structure of the restored swift fox population in the area surrounding BNP compared to source fox populations in an area of Colorado and Wyoming, as well as the local swift fox population neighboring BNP near Ardmore in Fall River County, South Dakota. A total of 400 swift foxes (28 released in 2003, 28 released in 2004, 26 released in 2005, 26 released in 2006, 252 wild-born foxes, 40 individual foxes from the Ardmore area of South Dakota) was genotyped using twelve microsatellite loci. We report mean gene diversity values of 0.778 (SD = 0.156) for the BNP-Colorado population, 0.753 (SD = 0.165) for the BNP-Wyoming population, 0.751 (SD = 0.171) for the BNP population, and 0.730 (SD = 0.166) for the Fall River population. We also obtained F_st values ranging from 0.014 to 0.029 for pair-wise comparisons of fox populations (BNP, Fall River, BNP-Wyoming, BNP-Colorado). We conclude that the reintroduced fox population around BNP has high genetic diversity comparable to its source populations in Colorado and Wyoming. Although genetic diversity indicates that the reintroduction was successful, additional time is necessary to fully evaluate long-term genetic maintenance and interconnectivity among these populations.     

Q fever in Croatia: war-induced changes in epidemiological characteristics

The article describes the epidemiological characteristics of Q fever in Croatia, during the period before and after the Homeland War. In the ten years prior to the Homeland War (1983-1992) 1053 cases of Q fever were recorded, 16.2% (171) of which on islands and in coastal areas. In the period after the Homeland War (1995-2008), a total of 654 cases was recorded, 59.9% (392) of which on islands and in coastal areas. In addition to reduced incidence, geographic distribution of the disease also changed. Before the war, the highest morbidity rate was recorded in the Sisak-Moslavina County. After the war, the Split-Dalmatia County recorded the highest morbidity rate because in the post-war period sheep from Bosnia and Herzegovina went to this county for winter grazing. The disease might be relevant to the Croatian Army and other armed forces that stay in Croatia as part of NATO forces.     

Identification of a streptococcal octapeptide motif involved in acute rheumatic fever

Acute rheumatic fever is a serious autoimmune sequela of pharyngitis caused by certain group A streptococci. One mechanism applied by streptococcal strains capable of causing acute rheumatic fever is formation of an autoantigenic complex with human collagen IV. In some geographic regions with a high incidence of acute rheumatic fever pharyngeal carriage of group C and group G streptococci prevails. Examination of such strains revealed the presence of M-like surface proteins that bind human collagen. Using a peptide array and recombinant proteins with targeted amino acid substitutions, we could demonstrate that formation of collagen complexes during streptococcal infections depends on an octapeptide motif, which is present in collagen binding M and M-like proteins of different beta-hemolytic streptococcal species. Mice immunized with streptococcal proteins that contain the collagen binding octapeptide motif developed high serum titers of anti-collagen antibodies. In sera of rheumatic fever patients such a collagen autoimmune response was accompanied by specific reactivity against the collagen-binding proteins, linking the observed effect to clinical cases. Taken together, the data demonstrate that the identified octapeptide motif through its action on collagen plays a crucial role in the pathogenesis of rheumatic fever. Eradication of streptococci that express proteins with the collagen binding motif appears advisable for controlling rheumatic fever.     

A NOTE ON THE INCIDENCE OF RHEUMATIC FEVER IN LOS ANGELES

Nationwide campaigns to alert the public to the dangers of rheumatic heart disease carry the hazard that parents in some localities may become more alarmed than is warranted by the local rate of incidence of the disease; and the alarm of the parent may harm the child.In such circumstances physician and patient alike might be reassured if it could be ascertained that the incidence of rheumatic fever in a given community was relatively low.Application to the Los Angeles area of a statistical formula worked out from Coombs'' data on the incidence and death rate from the disease in England and from Ash''s data in Philadelphia, gave indication that the incidence of rheumatic fever in all age groups in Los Angeles is approximately 68 new cases a year—a relatively favorable figure in a population approaching two million.     

Incidence of Heart Disease in Children in the City of Toronto

A special registry of children with heart disease in the City of Toronto was set up (a) to provide for follow-up of all children with heart disease in that community, (b) to remove the “cardiac” label from children with functional murmurs, (c) to acquaint parents with facilities available for the management of children with heart disease, and (d) to record useful data regarding heart disease in children.The 1961-62 Cardiac Registry showed that 542 of 156,775 pre-school and school children had evidence of heart disease; 464 were congenital and 68 rheumatic in origin: 121 children with congenital heart defects had been treated surgically. Congenital cardiac disease ranked fifth in frequency among the causes of death in children. There was a diminution of acute rheumatic fever and rheumatic heart disease in children in 1961-62 when compared with data for previous years. Seventy-eight per cent of children in this series with a history of rheumatic fever were receiving continuous prophylaxis.     

Rheumatic fever and rheumatic heart disease; incidence in California

The statistics quoted in this and other published reports appear to substantiate the impression that rheumatic fever in California, although still an important public health problem which varies widely from one locality to another, is of lower incidence and perhaps of more benign character than in most other parts of the United States. It also appears that in California aortic insufficiency may be of higher relative incidence and occurs more frequently as a clinically diagnosable sequel of rheumatic fever than does classical mitral stenosis. Congenital defects of the heart constitute a large proportion of the cases of organic heart disease in children and young adults in this state.     

RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE—Incidence in California

The statistics quoted in this and other published reports appear to substantiate the impression that rheumatic fever in California, although still an important public health problem which varies widely from one locality to another, is of lower incidence and perhaps of more benign character than in most other parts of the United States. It also appears that in California aortic insufficiency may be of higher relative incidence and occurs more frequently as a clinically diagnosable sequel of rheumatic fever than does classical mitral stenosis. Congenital defects of the heart constitute a large proportion of the cases of organic heart disease in children and young adults in this state.     

White-tailed deer as hosts of cattle fever-ticks

A penned study for obtaining definitive information on the status of white-tailed deer (Odocoileus virginianus) as a host for cattle feverticks (Boophilus microplus) was conducted on St. Croix of the U.S. Virgin Islands. Four generations of fever-ticks were propagated on one deer during a six month period. Nine wild white-tailed deer also were collected from four insular estates to evaluate the carrier status of these animals on an island where cattle fever-ticks are indigenous. Two deer were infested with B. microplus where contact with domestic livestock had not occurred for 20 years; five deer were free of B. microplus where a vigorous cattle dipping program had been practiced for three years; and, two deer were infested with B. microplus where contact with fever-tick infested cattle occurred at irregular intervals. It was concluded that white-tailed deer constitute a host species for B. microplus and must be considered in future fever tick eradication endeavors. This study also suggested that, through routine dipping of cattle, fever ticks may be eradicated from an area where cattle and deer cohabit the same premises.     

Antigenic epitope mapping of the M24 protein of Streptococcus pyogenes: implications for serodiagnosis of rheumatic fever

Abstract Rheumatic fever continues to be a significant problem in Australian Aboriginal communities and developing countries worldwide. Early diagnosis could facilitate the institution of penicillin prophylaxis resulting in the prevention of recurrences of rheumatic fever. An overlapping biotinylated peptide bank of 82 peptides, based on the known sequence of Streptococcus pyogenes M24 protein, was used in a standard enzyme immunoassay. A total of 82 sera were tested from both aboriginal and non-aboriginal subjects with clinically proven rheumatic fever, rheumatic heart disease and matched controls. Two peptides with significant sequence homology at the C-terminal end were found to be discriminatory between aboriginal cases and controls. It is proposed that these peptides could be the basis of a serological test for rheumatic fever.     

Molecular epidemiology of Brucella abortus isolates from cattle, elk, and bison in the United States, 1998 to 2011

A variable-number tandem repeat (VNTR) protocol targeting 10 loci in the Brucella abortus genome was used to assess genetic diversity among 366 field isolates recovered from cattle, bison, and elk in the Greater Yellowstone Area (GYA) and Texas during 1998 to 2011. Minimum spanning tree (MST) and unweighted-pair group method with arithmetic mean (UPGMA) analyses of VNTR data identified 237 different VNTR types, among which 14 prominent clusters of isolates could be identified. Cattle isolates from Texas segregated into three clusters: one comprised of field isolates from 1998 to 2005, one comprised of vaccination-associated infections, and one associated with an outbreak in Starr County in January 2011. An isolate obtained from a feral sow trapped on property adjacent to the Starr County herd in May 2011 clustered with the cattle isolates, suggesting a role for feral swine as B. abortus reservoirs in Starr County. Isolates from a 2005 cattle outbreak in Wyoming displayed VNTR-10 profiles matching those of strains recovered from Wyoming and Idaho elk. Additionally, isolates associated with cattle outbreaks in Idaho in 2002, Montana in 2008 and 2011, and Wyoming in 2010 primarily clustered with isolates recovered from GYA elk. This study indicates that elk play a predominant role in the transmission of B. abortus to cattle located in the GYA.     

Acute rheumatic fever

While rheumatic fever is relatively uncommon except where there are poor and crowded living conditions, sporadic acute attacks continue to occur in a family or pediatric medical practice. The physician''s role in management of the sore throat in the diagnosis of suspected cases of rheumatic fever and in follow-up for continued prophylaxis is discussed. The frequency of admissions and presenting features of 159 patients with acute rheumatic fever is reviewed. Continued surveillance is required if we are to achieve a further reduction in attack rate and complications.     

Ethnic differences in mortality from acute rheumatic fever and chronic rheumatic heart disease in New Mexico, 1958-1982.

To examine time trends and differences in mortality rates from acute rheumatic fever and chronic rheumatic heart disease in New Mexico''s Hispanic, American Indian, and non-Hispanic white populations, we analyzed vital records data for 1958 through 1982. Age-adjusted mortality rates for acute rheumatic fever were low and showed no consistent temporal trends among the three ethnic groups over the study period. Age-adjusted and age-specific mortality rates for chronic rheumatic heart disease in Hispanic and non-Hispanic whites decreased over the 25-year period, although rates were higher among Hispanics than among non-Hispanics during most of the time period. In American Indians, age-adjusted mortality rates for chronic rheumatic heart disease increased between 1968 and 1977 to twice the non-Indian mortality rates during the same period. Despite this increase in mortality from chronic rheumatic heart disease among New Mexico''s American Indians from 1968 to 1977, the New Mexico data generally reflect national trends of decreasing mortality from chronic rheumatic heart disease.     

Yellow fever and dengue—the interactions of virus,vector and host in the re-emergence of epidemic disease

The incidence of the mosquito-borne flavivirus diseases, yellow fever, dengue and dengue hemorrhagic fever has increased dramatically in recent years. Both diseases are characterized by the emergence of explosive epidemics. Yellow fever outbreaks appear to have a periodicity dependent upon fluctuations in sylvatic (enzootic) transmission cycles and the ecological factors that influence these cycles. Spread of the virus from the sylvatic cycle to human settlements, ultimately with interhuman transmission by domestic Aedes aegypti is a repeating event in Africa, and presents a renewed threat in the Americas, where effective Ae. aegypti control collapsed in the 1970s. The incidence of dengue has also increased dramatically in recent years, with up to 80 million persons living in tropical regions of the world now affected annually—an attack rate of 4%. The severe form, dengue hemorrhagic fever (DHF) has become a leading health problem throughout Asia in the last 20 years and is emerging as an epidemic disease in the Americas. Unlike yellow fever, sylvatic dengue transmission cycles are not responsible for disease emergence. The major factors underlying dengue epidemics are changes in human ecology, increasing contact with Ae. aegypti, the co-circulation of multiple dengue serotypes, and a rising prevalence of immunity and immunopathological events that underlie the pathogenesis of DHF. In this review, the complex interplay of virus, host, vector, environment and weather in the ecology of yellow fever and dengue are explored.     

The Rural Health Program of Southern Monterey County

The Rural Health Project of Southern Monterey County is attempting to demonstrate that a private group of physicians with the collaboration of the County Medical Society can responsibly and efficiently conduct a program of providing comprehensive medical care to indigent patients.Within the purposes of P.L. 89-749, the Rural Health Project is experimenting with a new way of organizing indigent health care and at the same time is providing the basis for comprehensive health planning at the local level.