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An explosive outbreak of a febrile respiratory illness occurred among members of a college fraternity. The preponderant signs and symptoms were muscle aches, cough, and low-grade fever. All illnesses occurred within 1.3 to 13 hours of attendance at a party where there was a dense airborne dust from straw that had been laid on the floor. Of the 67 fraternity members who attended the party and answered a questionnaire, 55 became ill (attack rate, 82%). Risk of illness was higher for those who spent more time at the party. Duration of illness ranged from 4.5 hours to seven days. Results of serological studies did not demonstrate an allergic or viral cause for these illnesses. The clinical and epidemiologic features of this outbreak were characteristic of organic dust toxic syndrome, an acute respiratory illness caused by inhalation of molds growing on hay, silage, or other agricultural products.

One man died and four other persons required hospitalization following accidental exposure to carbon monoxide at a motel. In spite of prompt diagnosis of the index cases, a search for the source of exposure and for other possible victims was delayed more than ten hours. Subsequent investigation revealed that air conditioning units drew carbon monoxide from the gas heaters for the motel's indoor swimming pools into three adjacent guest rooms through structural defects in the walls. Emergency care providers must remember that in environmental exposures, other persons may continue to be at risk, and efforts must be made to identify them.

A serologic service for determining antibody levels due to prior rabies immunization was provided at an annual convention of the Tennessee Veterinary Medical Association in January 1977. A total of 26 veterinarians volunteered to participate, and only 2 had adequate serum levels of antibody related solely to a pre-exposure immunization. An additional six veterinarians had high titers of antibody—probably the result of post-exposure immunization after rabies-proved incidents. The level of protection for veterinarians appears to be low, which suggests a need for a re-emphasis on immunizations and for increased availability of the relatively new human diploid cell vaccine.

We designed a special surveillance system to detect health complaints of visitors to the 1982 World's Fair. Heat-related illness occurred during the first month of the Fair but was substantially reduced by public education, environmental modification, and provision of additional water fountains. There was no disruption of emergency health services in the communities surrounding the Fair. Advance planning and the provision of on-site medical services can minimize the public health impact of large gatherings.

In April 1981, an outbreak of hepatitis A occurred among state legislators in Tennessee. Although the number of cases was small, we traced the source to a food handler who served cold meats and cheese. This investigation demonstrates the value of rapid serologic testing using a radioimmunoassay technique and matched case-control analysis to identify small foodborne outbreaks of hepatitis A.

An outbreak of nosocomial varicella was traced to airborne spread from an immunocompromised child hospitalized from Nov 11-19, 1980. Seventy potentially susceptible children were hospitalized on the ward during that period. Although the index patient remained in strict room isolation throughout his hospital stay, eight of these patients contracted varicella. The afternoon of November 12 was the period of highest risk for acquiring varicella. Eight of 36 patients (22%) present that afternoon, compared to none of 34 patients not present that afternoon, acquired the infection. A patient's risk of contracting varicella was significantly related to how near he/she came to the index patient's room that afternoon. Airflow studies, using the tracer gas, sulfur hexafluoride (SF6), demonstrated that patient rooms on this ward were at positive pressure with respect to the corridor. Despite isolation procedures, SF6 released in the index patient's room achieved concentrations in the corridor as high as 10% of those inside the room. Airborne spread of varicella has rarely been reported, but it may be a common mode of transmission in hospitals. We suggest that patients hospitalized with varicella be placed in strict isolation in negative-pressure rooms to reduce the risk of nosocomial transmission.

The Tennessee Child Passenger Protection Act, mandating the use of child restraint devices for children younger than 4 years, took effect in 1978. In the years 1978 through 1983, eighty-one children younger than 4 years died in Tennessee traffic accidents; only two were in child restraint devices. During this period, as child restraint device use rose from 8% to more than 30%, the number of deaths among children younger than 4 years declined more than 50%. Analysis of supplemental accident reports filed in investigations of motor vehicle accidents involving children younger than 4 years during 1982 and 1983 showed that child restraint devices are highly effective in preventing death and in preventing or reducing injury. Children not in child restraint devices were 11 times more likely to die in an accident than children in child restraint devices. Children traveling in the arms of an adult were exposed to a risk of injury or death comparable to that of children left entirely unrestrained.

In 1970, the Tennessee state health department established a statewide system for collecting family planning data which are used by service providers and planners to manage the statewide program and evaluate ongoing program efforts. Teach-ins were held explaining the reasons for instituting the system, the potential use for clinic staff, and extensive directions on completing the data forms. The first form is a medical visit record, used principally for admission, medical followup, and annual return visits. The second form is a record for non-medical transactions as recruitment, resupply, or counseling. The forms are to be filled out by clerical, paramedical or nursing staff. Through the system, monthly reports of delinquent patients may be utilized for followup and each county can be ranked according to the proportion of estimated numbers in need of family planning services who have been served. 6 reports are sent to each county monthly, including: 1) a due list of those due to return for services over the next 6 weeks; 2) a missed list of patients who missed their scheduled return for service during the preceeding 2 months; 3) a dropped list of patients 2 or more months overdue; 4) a monthly listing of county rankings by the proportion of local target population currently receiving services; 5) a report on patient activity status by method of contraception; 6) a monthly report on number of visits showing which members of each county's clinic staff are delivering which types of services. A major reason for initiating a centralized record system was to stimulate interest in family planning at the county level, while giving each county a tool to evaluate its own performance and compare its program to other counties. County continuation rates vary from 40.1% to 77.6%. For the state as a whole 54.6% of the 46,950 pill patients were still active 1 year after their initial clinic visit.

The placental transmission of immune antibodies to the newborn had been inferred by clinical observation for some years before Ehrlich proved its occurrence experimentally in 1892. 1 Since that time the transplacental passage of humoral antibodies has claimed the interest of many investigators who have made highly significant contributions to the basic knowledge of placental physiology and immunology. Practical results of their work have come from a clearer understanding of the previously observed neonatal immunity of many infants to infections which attacked them later in life. The relatively short duration of the newborn's passively acquired immunity has been well established by many of these investigations, 2-17 and a pattern of artificial immunization for infants has been devised as a result. The practice of actively immunizing expectant mothers in order to protect newborn infants was advocated even in the pre-Ehrlich era 18 and has been proposed anew in more recent times.