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Clinical features and complications associated with group A streptococcal infections changed significantly between 1985 and 1990 in one Arizona county studied. Previously unconfirmed studies reported an increase in the rate and severity of group A streptococcal infections since the mid-1980s. Of 128 patients in Pima County, AZ, with group A streptococcal infections examined over the five-year period, the proportion of patients with low blood pressure, kidney impairment, skin problems, vomiting and diarrhea increased significantly. The elderly and children under age five were more likely to die from infection as were patients with low blood pressure and multi-organ system involvement. Overall, the streptococcal infection rate was 4.3 per 100,000 people, but the rate among Native Americans was 46.0 per 100,000. After 1988, 8% of the cases were associated with toxic shock-like syndrome, but before 1988, none were. Patients with toxic shock-like syndrome tended to be younger and were less likely to have underlying medical illnesses such as diabetes., Objective.--To determine disease incidence and changes in the epidemiology of invasive group A streptococcal infections in a community in Arizona. Design and Setting.--We retrospectively surveyed microbiology records from all 10 hospitals in Pima County Anzona, to identify patients who had Streptococcus pyogenes isolated from blood, sterile body fluid, or tissue biopsy specimens between April 1985 and March 1990. Demographic and clinical information was abstracted from the medical records of these patients. Patients.--A total of 128 patients with a median age of 53.5 years (range, 6 months to 96 years). Outcome Measures.--Racial/ethnic differences in disease incidence; mortality and changes in the clinical spectrum of disease over the study period. Results.--The annual age-adjusted incidence was 4.3 per 100 000 but was 46.0 per 100 000 among Native Americans. Advanced age, age less than 5 years, hypotension, and multi-organ system involvement were significantly associated with increased mortality. From 1985 to 1990, the proportion of infections with hypotension, rash, desquamation, renal impairment, and gastrointestinal involvement increased significantly ((X.sub.2) for trend P Conclusions.--Significant changes occurred in the spectrum of invasive group A streptoco.ccal infections in Pima County, Anzona, between 1985 and 1990. Native Americans were at increased risk of acquiring these infections. Patients with the streptococcal toxic shock-like syndrome had epidemiologic features that distinguished them from patients with other invasive infections, including younger age and less underlying illness. (JAMA. 1993;269:384-389)

The protozoan organism Giardia lamblia causes fever, diarrhea, cramps, weakness, and other symptoms, and is becoming increasingly common in day care centers, especially those that care for infants and toddlers. Whether infected children with no symptoms (asymptomatic) pass on the infection is not documented. Three different control strategies of controlling the spread of infection were tried at various day care centers. One group of day care centers treated symptomatic and asymptomatic children, and readmitted them after two negative stool tests, according to the existing policy. The second and third groups of centers treated symptomatic infections only, but the third group also treated asymptomatic children at the center. At the two groups of centers where both symptomatic and asymptomatic children were treated, there were significant reductions in Giardia prevalence, and a smaller reduction was found in the group of centers where only symptomatic children were treated. Part of the immediate reduction in prevalence occurred because asymptomatic children moved to other day care centers. At six months, none of the prevention strategies produced significantly fewer infections, but all three groups had lower prevalences than at the beginning of the study. Although it is not possible to draw general conclusions based on this study, the findings suggest that testing of all toddlers should be considered if there is an outbreak of diarrhea at a day care center. (Consumer Summary produced by Reliance Medical Information, Inc.)

The purpose of this study was to evaluate the impact of anonymous testing availability on human immunodeficiency virus (HIV) test demand in Arizona. Testing patterns before and after the introduction of anonymous testing were compared, Client knowledge of new test policy and delay in testing until an anonymous option was available were assessed. Test numbers among men who have sex with men showed a statistically significant increase after introduction of an anonymous testing option. Arizona continues to maintain anonymous testing availability. Public health agencies should consider how test policy may influence people's HIV test decisions. (Am J Public Health. 1994;84:2008-2010), Homosexual men may be more likely to undergo HIV testing if they can remain anonymous. County health departments in Arizona experienced a significant increase of 16.1% in HIV tests during the five months following a policy change to anonymous testing. Men who have sex with other men appeared more likely to wait until confidential testing was available than other groups, such as injection drug users. This testing increase continued over a 20-month period. Persons at high risk for HIV infection may be more likely to seek anonymous testing for privacy reasons. However, in order to secure public funding for HIV care and to continue communication with an infected patient, named reporting also needs to be integrated into a comprehensive health policy.

Absbract: Interviews conducted during outbreaks of group A meningococcal disease in skid row communities suggested that heavy alcohol use was associated with increased risk of disease. Frequent moving within skid row and from one skid row to another was characteristic of a subpopulation with increased risk of disease and may have facilitated spread within and between skid roars. The observations discussed herein have important implications for control of communicable diseases in and near skid rows. (Am J Public Health 1984; 74:253-254) [ABSTRACT FROM AUTHOR]

On July 28, 2014, the Cincinnati Health Department was notified of suspected cases of foodborne botulism in two women admitted to the same hospital 12 days apart. Patient A had been treated for 12 days for suspected autoimmune disease. When patient B, the roommate of patient A, was evaluated at the same medical center for similar symptoms, it was learned that on July 13, patient A and patient B had shared a meal that included prepackaged pesto from a jar; clinicians suspected botulism and notified the local health department. The pesto had been purchased from company A's farm stand in San Clemente, California. Laboratory testing detected botulinum toxin type B by enzyme-linked immunosorbent assay (ELISA) in leftovers of pasta with pesto. A culture of these food samples yielded Clostridium spp. that produced botulinum toxin type B; polymerase chain reaction (PCR) testing also was positive for type B toxin gene. Environmental assessment of company A identified improper acidification and pressurization practices and lack of licensure to sell canned products commercially, including products in hermetically-sealed jars. On July 30, the vendor voluntarily recalled all jarred products, and the California Department of Public Health (CDPH) warned the public not to consume company A's jarred foods. This report describes the two cases and the public health investigation that traced the source of the outbreak.