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Thomas Campbell Butler, at 63 years of age, is completing the first year of a 2-year sentence in federal prison, following an investigation and trial that was initiated after he voluntarily reported that he believed vials containing Yersinia pestis were missing from his laboratory at Texas Tech University. We take this opportunity to remind the infectious diseases community of the plight of our esteemed colleague, whose career and family have, as a result of his efforts to protect us from infection by this organism, paid a price from which they will never recover.

An enzyme-linked immunosorbent assay for the detection of rotavirus-specific immunoglobulin G (IgG), IgM, and IgA antibodies was used in a serological study of Traveler's diarrhea. The antigenically related simian rotavirus (SA-11) was used as antigen in this study. Serum was obtained from two groups of volunteers before travel (pre-travel) and at various times after arrival at their destination (post-travel). One group consisted of 47 American Peace Corps volunteers who traveled to Honduras, and the second group consisted of 66 Panamanian travelers who visited Mexico. An association between rotavirus and Traveler's diarrhea was found in each group with 36% of American Peace Corps volunteers and 30% of Panamanians with diarrhea demonstrating a greater than or equal to 4-fold increase in rotavirus antibody titers in the post- as compared to the pre-travel specimens. While no rotavirus-specific IgM antibody was detected in any serum tested, increases in specific antibody were found in both the IgG and IgA immunoglobulin classes.

We conducted a prospective study of travelers' diarrhea on 73 physicians and 48 family members attending a medical congress in Mexico City, in October, 1974. Fecal and blood specimens were collected before, during and after their visit and examined for enteric bacterial pathogens, viruses and parasites. In 59 (49 per cent) participants travelers' diarrhea developed. Median duration of illness was five days. Onset occurred a median of six days after arrival. An etiologic agent was found in 63 per cent of ill participants. Enterotoxigenic Escherichia coli of different, non-"enteropathogenic" serotypes was the most common cause; other responsible pathogens included salmonellae, invasive Esch. coli., shigellae, Vibrio parahaemolyticus, Giardia lamblia and the human reovirus-like agent. Consumption of salads containing raw vegetables was associated with enterotoxigenic Esch. coli infection (P = 0.014). Travelers' diarrhea in Mexico is a syndrome caused by a variety of pathogens, the most common of which is enterotoxigenic Esch. col.

Although oral glucose-electrolyte solutions containing 90 mmol of sodium per liter have been widely used in the treatment of acute diarrhea among under-nourished children in the developing world, they have rarely been studied in well-nourished children. We therefore conducted a controlled randomized study among well-nourished children three months to two years who were hospitalized with acute diarrhea (52 in the United States, and 94 in Panama), to compare the efficacy of this solution with that of one containing 50 mmol of sodium per liter and with standard intravenous therapy. Oral rehydration with both solutions according to protocol was successful in 97 of 98 children (one required unscheduled intravenous therapy), and in 87 (89 per cent) no intravenous therapy was required. All of six children admitted with hypernatremia were successfully treated with oral therapy alone. We conclude that glucose-electrolyte oral solutions containing either 50 or 90 mmol of sodium per liter are effective and safe in the treatment of well-nourished children hospitalized with acute diarrhea, and that they may completely replace the intravenous fluids in the majority of such children.

Approximately 8% of 240 isolates of Escherichia coli obtained from food of animal origin in the United States were found to be enterotoxigenic, as determined in adrenal cells, rabbit ileal loops, and assays in infant mice. These organisms were of diverse serotypes that are not included among the so-called enteropathogenic serotypes and would not have been identified by usual laboratory methods. These enterotoxigenic E. coli are of potential importance to public health.

Serum antibody titrations against the heat-labile enterotoxin (LT) of Escherichia coli were carried out on Panamanians, U.S. citizens resident in the Panama Canal Zone, Apache Indians living on the reservation in Whiteriver, Arizona, and Peace Corps volunteers before they traveled overseas. Antibody titers to Norwalk virus were also carried out on serum from Panamanian and Canal Zone residents. A high prevalence of low-titer LT antibodies was found in infants and adults from Panama, the Canal Zone, and Whiteriver. Panamanian children aged 1 to 5 years had the highest LT antibody titers. Peace Corps volunteers had a low prevalence and titer of LT antibodies. Prevalence and titer of antibodies to Norwalk virus were generally higher in Panamanians compared with Canal Zone residents of the same age. In the populations we studied, various modes of transmission and mechanisms of immunity likely explain the differences which we observed in antibody prevalence and titer to these two enteric pathogens.

Travelers' diarrhea was studied prospectively in a group of 39 American Peace Corps Volunteers (PCVs) during their first five weeks in Kenya. Twenty-seven developed diarrheal disease and 12 remained well. Multiple episodes were documented in 11 of the symptomatic volunteers. Enterotoxigenic Escherichia coli of many serotypes producing heat-labile and/or heat-stable enterotoxin were isolated from 17 of the 27 volunteers with diarrhea and from 1 of the 12 well volunteers. The enterotoxigenic E. coli were more likely to be antibiotic sensitive than the non-enterotoxigenic E. coli. A serum antibody rise to the heat-labile toxin (LT) was detected in six symptomatic volunteers, five of whom had a positive culture for LT-producing E. coli, and from one asymptomatic, culture negative volunteer. Salmonella cubana was isolated from two volunteers, and three volunteers had serologic evidence of infection with human reovirus-like (rotavirus) agent. This study confirms the role of enterotoxigenic E. coli as a major cause of travelers' diarrhea and suggests that the disease is similar in widely separated geographic areas.