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Overall mortality from liver diseases may decrease over time. Researchers compared changing mortality data from death certificates with respect to underlying chronic liver disease between 1979 and 1989. Chronic liver disease was defined as alcohol-related liver disease, cirrhosis and hepatitis not linked to alcohol, and biliary cirrhosis. A total of 303,875 deaths from chronic liver disease occurred between 1979 through 1989. About 48.2% of the deaths were due to cirrhosis without alcohol, while 42.4% of all deaths were due to liver disease related to alcohol. African Americans had higher death rates from liver disease compared to other ethnic origins. The 1989 data represented a 21.7 percent decline in overall mortality. Geographic patterns indicated peak mortality rates due to chronic liver disease in the West and Northeast of the United States.

Kawasaki syndrome is characterized by an acute fever associated vasculitis (inflammation of the blood vessels), which can occur in infants and children. It is the primary cause of acquired heart disease in infants and children in the US and Japan. The cause of Kawasaki syndrome is not known. The largest outbreak of Kawasaki syndrome in the US occurred between October 1984 and January 1985. There were 62 cases of Kawasaki syndrome reported in the area from Colorado Springs, Colorado to Cheyenne, Wyoming. Fifty-two cases were diagnosed in the Denver, Colorado metropolitan area. These cases were examined, with particular emphasis on associated factors. Sixteen of 26 patients with Kawasaki syndrome compared with 10 of 49 control subjects had been exposed to shampooed or spot-cleaned rugs within 30 days of the onset of the condition. The reasons for this large outbreak are not clear, but an association between Kawasaki syndrome and exposure to rug or carpet cleaning was demonstrated. (Consumer Summary produced by Reliance Medical Information, Inc.)

With the increased use of day-care for children, there is concern about possible health-related risks. A study was undertaken to evaluate the risk of contracting respiratory illness in children of various ages who are cared for in day-care facilities. The age groups studied were six weeks through 17 months, 18 through 35 months, and 36 to 59 months. A day-care child (exposed child) was one who spent a minimum of 10 hours per week for the last four weeks with one or more unrelated child. A child was considered unexposed if neither he nor a sibling aged five or younger was receiving day care. A nationwide phone survey of 35,000 households was undertaken; 3,475 children of the right ages were identified, and 29 percent were classified as exposed while 60 percent were considered unexposed (the remaining 11 percent did not meet the criteria for either group). All age groups of exposed children showed an increased risk of respiratory illness, but this was statistically significant only in the youngest group, and in those aged 18 to 35 months with no older siblings. Children aged 18 to 35 months with older siblings were not at increased risk. The presence of older siblings in the home increased the risk of respiratory illness in the youngest age group, but provided older children some protection from respiratory illness. In each age group, increased duration of past day care was associated with a decreased risk of respiratory illness. It was estimated that about 10 percent of all respiratory illnesses that occurred in the United States during the period of this study in children of these age groups could be attributed to the child's being in a day-care setting. It is also suggested that smaller day-care centers involve a lower risk of respiratory illness for children in the 18- through 35-month age group than larger centers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Human parvovirus B19 causes erythema infectiosum, a contagious rash that is common among school children. Erythema infectiosum, sometimes referred to as fifth disease, has also been associated with arthritis and may cause serious reactions in persons with conditions such as sickle cell anemia. Previous studies have indicated that there is a link between parvovirus B19 infection during pregnancy and fetal death. While most women who become infected during pregnancy do not experience a miscarriage, the possibility has raised concerns. The transmission of the infection in adults and, in particular, to women of childbearing age, has received much attention. The precise mode of transmission of this virus is still unknown. A survey of 571 school and day-care workers was conducted during an outbreak of erythema infectiosum to assess their risk for B19 infection. Two classes of children were studied after the occurrence of an outbreak in the school. A questionnaire was given to the school personnel who were employed during the peak time of the outbreak of erythema infectiosum. Questions concerned amount of exposure to children, symptoms of B19 infection, and pregnancy. Serological tests were performed, which showed that 58 percent of the adults had been infected previously and were immune to the virus. Of those who were susceptible to B19 infection, 19 percent got the infection during the outbreak. Workers having contact with younger children and with larger numbers of children had higher rates of infection. In general, high rates of infection among teachers indicate that exposure to this illness occurs in these work environments. It was concluded that B19 infection is an occupational risk for day-care workers and school personnel. (Consumer Summary produced by Reliance Medical Information, Inc.)

The contamination of drinking water by cryptosporidium is probably not detected by the current methods of treating public water supplies. An outbreak of gastroenteritis effected an estimated 13,000 people in a county in western Georgia. A parasite, cryptosporidium oocyst, was found in the stools of 39 percent of the patients with gastroenteritis. Studies eliminated the presence of other parasitic pathogens. Inefficient flocculation and filteration may have allowed the parasite to pass into the water supply.

ABSTRACT: Data collected from the Public Health Service Main Study of Reye's Syndrome and Medications were analyzed to assess the relationship between the development of Reye's syndrome and the dose of aspirin received during the antecedent respiratory or chickenpox illness. Among those exposed to aspirin, case-patients were found to have received greater average daily and maximum daily doses of aspirin and greater doses of aspirin on the first four days of the antecedent illness (median, 25.1 mg/kg; 33.0 mg/kg; and 65.4 mg/kg; respectively) than did controls (median, 14.5 mg/kg; 19.0 mg/kg; and 27.0 mg/kg; respectively). The excess risk associated with increasing aspirin doses was due primarily to intermediate levels of dose (et, 15 to 27 mg/kg per day) rather than higher levels (>27 mg/kg per day). The dose difference between exposed case-patients and controls was greatest on days 3 and 4 of the antecedent illness.

Better implementation and newer methods may be needed to control hepatitis A (HAV) and hepatitis B (HBV) in daycare centers. HAV is transmitted through fecal-oral contamination. Few young children become jaundiced, making the disease difficult to diagnose. HAV is usually identified at daycare centers when parents or staff become ill. Although hygiene, surveillance, and gamma globulin treatment will control outbreaks, the percentage of cases where daycare was the source of exposure has not changed in a decade. This suggests prevention and control strategies are not being effectively implemented. A vaccine for HAV shows promise for controlling HAV in daycare centers, but more study is needed. HBV is transmitted through exposure to blood. Therefore, the risk of transmission is low. However, in places such as Japan, where HBV infection is highly prevalent, immunizing infants against HBV has markedly reduced infection rates in young children. The American Academy of Pediatrics and the American Academy of Family Physicians advocate universal HBV vaccination.

Abstract. The average annual incidence of Reye syndrome reported through national surveillance was lower during 1981 to 1984 than during the previous five surveillance years. This is accounted for by a decrease in cases among children younger than 10 years of age; the number of cases in 10- to 19-year-old persons remained relatively stable during this period. The overall decline in incidence and the differing age-specific incidence trends are apparent for both varicella-associated cases and for nonvaricella-associated cases. During 1985, the incidence has been much lower than during any previous year since surveillance was initiated; this most recent decrease includes children 10 to 19 years of age. Independently conducted surveys suggest that the prevalence of salicylate use for viral illnesses has decreased among children in recent years, particularly among children younger than 10 years of age. The changing epidemiology of Reye syndrome may reflect, in part, the declining use of salicylates among children and teenagers in the United States. Pediatrics 1986;77:598-602; Reye syndrome, surveillance, salicylate, influenza, varicella. [ABSTRACT FROM AUTHOR]

Abstract. National surveillance for Reye syndrome conducted during five years, including the period 1973-1974 and December 1976 through November 1980, has resulted in the reporting of more than 2,000 cases of Reye syndrome. The highest reported incidence of Reye syndrome occurred during years of primary influenza B and A (H1N1) activity; the reported incidence during one period of influenza A (H3N2) activity was somewhat lower. Regional outbreaks of Reye syndrome have been associated with influenza A (H1N1) and B but not with influenza A (H3N2). Cases of Reye syndrome in whites tend to be distributed throughout all age groups whereas a large percentage of cases in blacks have been reported in infants <1 year of age in three of the past four years. Nationally, there has been a decline in the case-fatality ratio in recent years. Pediatrics 70:895-900, 1982; Reye syndrome, influenza, varicella. [ABSTRACT FROM AUTHOR]

Abstract. In the spring of 1980, four confirmed and three possible cases of Reye syndrome, each associated with a chickenpox prodromal illness, were identified in Las Cruces, NM. One patient, a 5-year-old girl, died. Cases tended to occur in one section of the community, among children attending two of the 16 elementary schools. A telephone survey of parents with school-aged children (6 to 9 years old) suggested that a significantly greater attack rate of chickenpox occurred in children attending those two schools. Based upon this survey and the expected distribution of chickenpox among children less than 15 years of age, the incidence of Reye syndrome following chickenpox infection in the county in which Las Cruces is located was estimated to be 2.5/10,000 cases of chickenpox; these data reveal a four- to ninefold greater incidence of Reye syndrome than that following influenza B infections, which was previously estimated based upon a cluster of five cases in a county in Michigan. Additional investigations of Reye syndrome clusters are needed in an effort to identify and study suspected risk factors and to better define the relationship between Reye syndrome and viral infections. Pediatrics 70:901-906, 1982; Reye syndrome, chickenpox. [ABSTRACT FROM AUTHOR]

The most important recent development in our understanding of Reye's syndrome is the epidemiologic evidence linking this disease to aspirin in the United States. Assessment of epidemiologic issues of concern raised in prior studies did not explain the extremely high odds ratios observed in more recent studies. The observation of a dose-response relation between risk of Reye's syndrome and dose of aspirin ingested during the antecedent illness provides further supportive evidence for a causal link between Reye's syndrome and aspirin. Additional evidence for this association in the United States is provided by a marked decline in the use of aspirin among children in the United States, which has been accompanied by a dramatic decline in the incidence of Reye's syndrome. In contrast to experience in the United States, Reye's syndrome affecting primarily children aged 5-15 years has been relatively rare in Great Britain and Australia where acetaminophen rather than aspirin is the primary analgesic/antipyretic used. With the declining incidence of aspirin use in the United States, Reye's syndrome among children aged 5-15 years is becoming increasingly rare in the United States as well and, as in Great Britain and Australia, an increasing proportion of cases are being reported in children aged less than five years. Recent reports have suggested that many children younger than age five years who are thought to have the disease may be shown to have other metabolic disorders.(ABSTRACT TRUNCATED AT 250 WORDS) [ABSTRACT FROM AUTHOR]