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An outbreak of hepatitis A occurred in a north Georgia trailer park served by a private well. Of 18 residents who were serosusceptible to hepatitis A virus (HAV), 16 (89%) developed hepatitis A. Well water samples were collected 3 months after illness onset in the index case and 28 days after illness onset in the last trailer park resident. Hepatitis A virus antigen (HAVAg) was detected in the samples by enzyme immunoassay from three of the five cell lines following two 30-day passages and from a fourth cell line following a third passage of 21 days.

Human parvovirus B19 (B19) infection during pregnancy has been associated with fetal deaths. We conducted several studies to develop data needed to make recommendations for preventing fetal death associated with infection. In the first study, after an outbreak of B19 infection, specimens of cord blood from 47 infants with congenital anomalies, 10 with suspected intrauterine infection, and gestational age-matched controls were tested for IgG and IgM antibodies to B19. None had evidence of recent infection. Next, 192 women with unknown exposure to B19 who had stillbirths or spontaneous abortions were studied. Two patients and two controls had evidence of recent B19 infection. In a second case-control study of women who had stillbirths after outbreaks of erythema infectiosum in area schools, none of the 20 patients or 26 controls were IgM positive at the time of delivery. The rate of infection, as demonstrated by IgM positivity, among 267 pregnant control subjects was approximately 1%. These studies suggest that among pregnant women unselected for exposure to B19, neither infection nor stillbirths are common.

A serosurvey for antibodies to Legionella pneumophila was conducted among 206 employees of a power-generating plant. L. pneumophila serotype 6 and a non-typable L. pneumophila organism were isolated from cooling-tower water specimens at the plant, and antibody titers in workers were measured using homologous antigens prepared from these isolates. For the serotype 6 water isolate, none of workers with low cooling tower exposure, 4.6% with intermediate exposure, and 7.6% with high exposure levels had titers equal to or greater than 1:128 (P less than .05, Kruskal-Wallis test). For the non-typable L. pneumophila isolate, a similar trend was observed, but differences among workers in the three exposure groups were not statistically significant. No association was observed between antibodies to L. pneumophila serotypes isolated from cooling water and workers' age, race, smoking status, or duration of job assignment. None of the study employees had findings suggesting the occurrence of L. pneumophila pneumonia since the plant had been in operation. Use of respiratory protection devices by workers exposed to aerosols from cooling towers was not recommended.

In October, 1977, an outbreak of toxoplasmosis occurred in patrons of a riding stable in Atlanta, Georgia; 37 became ill with toxoplasmosis or had serologic evidence by indirect fluorescent-antibody test of acute infection with Toxoplasma gondii (titer ≥1:4096 or a positive fluorescent-antibody test for toxoplasma antibodies). Forty-nine additional patrons did not become ill. Two of the three adult cats from the stable were seropositive for toxoplasma, which was also recovered from the tissues of two kittens and four mice trapped near the stable. Patrons who spent most of their time at the end of the stable where a cat had defecated had the highest incidence of infection. Patrons who attended the stable daily had a higher attack rate than those who attended less frequently. No common meals were consumed, and dietary history eliminated meat as the source of infection. The data suggest that toxoplasma oocysts were the source of the infection. (N Engl J Med 300:695–699, 1979)

In 1979 the infant mortality rate (IMR) dropped nearly 50% in a rural health district in southeast Georgia, and this lower rate continued during the next two years. For infants born during 1979 to 1981, the IMR was 12.4 as compared with 21.6 for those born from 1974 to 1978. Using linked birth and infant death records to identify shifts in the components of infant mortality in this district, we found that the change in IMR primarily reflected a decrease in neonatal and postneonatal deaths among infants with birth weight greater than or equal to 2,500 gm, rather than a change in the distribution of birth weights. Although the IMR was approximately twofold higher in white than in black infants, a similar relative decline in mortality was observed in both racial groups. For infants weighing greater than or equal to 2,500 gm, approximately half of the lower death rate was due to fewer deaths caused by infections. The decline in mortality in this district was greater than declines in neighboring districts and accompanied efforts to improve services for medically indigent mothers and infants. The findings suggest that in areas with high infant mortality, initial efforts to lower mortality should focus on primary care programs rather than more specialized interventions.

In 1980-1981, 158 motorcycle-associated fatalities occurred in Georgia, accounting for an estimated 6,113 lost years of productive life. Death ratios were highest for men 20 to 29 years of age, and motorcycle-associated fatalities occurred most frequently during summer months, on weekends, and during afternoon and evening hours. Forty-six percent of motorcycle-associated fatalities did not involve another vehicle, and head injuries alone or in combination with other injuries were responsible for death in approximately half. Helmet use, an effective measure for preventing motorcycle-associated fatalities, is required in Georgia; additional injury prevention strategies are discussed.

nervous system with certain time-honored epidemiologic, clinical, and laboratory characteristics. Epidemiologically, it exists in 2 forms: urban, propagated chiefly by unimmunized domestic dogs, and sylvatic, propagated in skunks, foxes, wolves, mongooses, other carnivores, and bats [1]. In the United States, infection in domestic animals usually results from a "spillover" of sylvatic reservoirs of infection, and man can be infected by either. Clinically, rabies has been considered to be invariably fatal, and therapy during clinical disease is directed at sedation and symptomatic treatment of seizures [2]. In the laboratory, positive results with any of 3 techniques?^histologic staining for Negri bodies, fluorescent antibody staining for rabies viral antigen, and mouse inoculation tests?confirm the diagnosis; negative results in all 3 together are generally believed to rule out rabies [3]. The case of human rabies presented here con

Human-derived rabies immune globulin (HRIG) was administered intramuscularly to 24 male volunteers according to two dose schedules: either 20 ml (equivalent to the World Health Organization [WHO] recommendation of 40 internation units/kg for equine-derived antiserum) or one-fourth of the WHO recommendation (10 IU/kg). The 10-IU/kg dose gave barely detectable antirabies antibody titers and is not considered of therapeutic value. The 20-ml dose gave higher, longer lasting titers of antirabies antibody than the comparable doses of equine antiserum currently in use. There were no untoward reactions. Before administration of HRIG, all 24 volunteers had IgG class anti-IgG antibodies (mean titer, 114μg/ml); 22 of 24 had IgA class anti-IgG antibodies (mean titer, 65μg/ml); and none of the 24 had IgM class anti-IgG antibodies. Administration of HRIG caused no significant change in these titers.

Five patients developed acute hepatitis B (HB) within four months after major operations by the same obstetric-gynecologic surgeon. Investigation documented that the surgeon was HB surface antigen and HB e antigen positive; all five patients had an HB subtype matching that of the surgeon and no other identifiable risk factors for HB viral infection. A seroprevalence study comparing exposed surgical and obstetric patients with a control group showed no significant additional subclinical HB transmission. The surgeon resumed his surgical practice but was required to obtain written informed consent from patients, to double-glove, and to employ appropriate surgical techniques to avoid self-injury. Seven months later, acute HB occurred in a patient two months after a cesarean section, resulting in exclusion of the surgeon from major operations. This is the fifth outbreak of nosocomial HB linked to an obstetric-gynecologic surgeon, and it reinforces the need for health care workers to receive preexposure prophylaxis with HB vaccine to prevent such occurrences. ( JAMA 1986;255:934-937)

Human rabies immune globulin (HRIG) was given in doses of 10,15, and 40 international units (IU)/kg of body weight to groups of volunteers. It was administered alone and in combination with 16 or 23 injections of duck embryo rabies vaccine (DEV). Administration of HRIG resulted in the early appearance of antibody but inhibited the development of active antibody in all groups receiving DEV. Forty-six percent of persons receiving HRIG at 40 IU/kg and 16 doses of DEV had serum rabies-neutralizing antibody titers of less than 1:5 at 70 days. This immunosuppression was overcome in the groups receiving 23 doses of DEV. Based on these data, post-exposure rabies prophylaxis series should consist of HRIG between 15 and 40 IU/kg plus a 23-dose course of DEV.