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The Center for Disease Control (CDC), Atlanta, Georgia implemented an eight-month prospective surveillance system in 24 hospitals distributed among states with and without public funding for abortion. Out of 3,157 visits for abortion-related complications, only 10 women gave a history of non-physician or self-induced abortion and none were Medicaid recipients. The small number of hospitals located in non-funded states and the smaller numbers of women served in these hospitals than in the funded states limited the power of out study. Women living along the Texas-Mexico border appeared more likely to have complications after illegal abortions than women from other areas of the country.

Asymptomatic infection with either Entamoeba histolytica or Giardia lamblia was found in 60 per cent of the residents in an institution for the mentally retarded one year after eradication of these parasites. The residents were then segregated into infected and noninfected groups and drug therapy was again successfully undertaken. The two groups remained separated except during periods of play. A one-year follow-up showed that both study and control groups were equally infected. The failure of segregation was confounded by patient age and infection with nonpathogenic parasites.

The Government of Senegal, in keeping with the priority given to women and children in its health programs, requested the assistance of the United Nations Development Program (UNDP) in identifying and executing a program to diminish maternal mortality in that country. A UNDP "Mission of Identification" was carried out in response to this initiative. The preliminary results of this mission confirm that the issue of maternal safety is of primary concern not only to the government but also to women in the Republic of Senegal. The methodology employed during this mission allowed the team of national and international experts to confirm the level of this concern and to identify four major potential areas of intervention. Quantitative goals for the program have been set and estimates for the efficacy of each of the intervention areas indicate that intervention through the timely provision of access to emergency surgical services and appropriate prenatal care will yield the largest reduction. The feasibility of providing interventions in each of the four areas was also addressed during the mission. This methodology will be applicable to other settings as Third World countries begin to address the problem of excessive maternal mortality.

Between August 7 and October 14, 1977, Clostridium perfringens organisms were isolated from endometrial and/or blood specimens from 3 women who had been hospitalized in McAllen, Texas, after having had illegal induced abortions. One of the women died of clostridial septicemia. A single abortionist was suspected in these 3 cases. The authors investigated the illnesses of these 3 women and those of 6 other women who were hospitalized at some time from January through October 1977 after having had illegal abortions but did not identify a common abortionist. The patient who died was a Medicaid-eligible woman who had had an abortion performed by a nonphysician after public funding of abortion was restricted in Texas as of August 5, 1977. The authors examined the medical records of all 230 women hospitalized in McAllen General Hospital with abortion complications from 1977 through January 1978. The local effect of restriction of public funds for abortion was to be studied. The incidence of women admitted to the hospital with febrile abortion complications after August 5, 1977, did not differ from that of women admitted from January 1 through August 4, 1977. However, the incidence of hospitalization of Medicaid-eligible women with abortion-related complications was greater after August 5 than it was in the earlier period.

Asymptomatic infection with either Entameba histolytica or Giardia lamblia was found in 61 per cent of the residents of a dormitory in an institution for the mentally retarded; two other dormitories had rates of 20 per cent and 22 per cent. Drug therapy was successfully undertaken in all three dormitories, and environmental improvements were introduced in the heavily infected dormitory. A one-year follow-up showed a reduction in parasitic disease in two dormitories but, in the most heavily infected dormitory, infection had returned to pretreatment levels.

Routinely collected sputum specimens from 100 adults hospitalized with pneumonia were frozen at -70 C until inoculation into Madin-Darby canine kidney, fetal tonsil, and esophageal epithelial cells. Six influenza A (H3N2) viruses, two respiratory syncytial viruses, three rhinoviruses, and nine herpes simplex viruses were recovered. Four patients with influenza virus and one with respiratory syncytial virus isolated had nosocomial pneumonia. Viral isolation from sputum specimens may aid the diagnosis of pneumonia of unclear etiology and merits further evaluation as a diagnostic tool and as an adjunct to influenza surveillance.

To determine risk factors for cholera in infants, a retrospective matched-pair study of 42 cases and their controls was undertaken during an outbreak of El Tor cholera in Bahrain in the autumn of 1978. The highest attack-rate of cholera (125/10 000) occurred in infants in the 6--11 month age-group, which corresponds to the weaning age in this community. Significantly more cases than controls were principally bottle fed (greater than 50% milk intake by bottle) than principally breast fed during the week before onset of illness (p=0.004). Analysis of various patterns of breast and bottle feeding did not determine whether the protection afforded by breast feeding was a negative effect (due to the lack of exposure to contaminated bottle feedings for breast fed infants) or a positive effect (due to protective functions of constituents of human breast milk). Cholera infection (with or without symptoms) among mothers of either case or control infants was uncommon (case mothers 3, control mothers 5), and mean serum vibriocidal and antitoxic antibody levels were similar for the two groups of mothers. These observations suggest that maternal infection did not affect the relative risk of infants having symptomatic cholera.

In the period 10 August 1978-23 January 1979, 913 culture-confirmed cases of cholera caused by Vibrio cholerae, biotype El Tor, serotype Ogawa, occurred in Bahrain. After discovery of the initial cases, others occurred sporadically, and the incidence reached a peak of 25-35 cases per day during the seventh week of the outbreak (16-22 September). The overall attack rate (27 per 10 000) was low and the outbreak subsided without mass immunization campaigns or rigorous border control of persons and imports. Investigation of 746 culture-confirmed cases that occurred in the period 10 August-13 October 1978, showed that cases occurred throughout most areas of the country and mainly affected infants, young children, and adult working-age males. Symptoms were very mild; fewer than 20% of patients required specific rehydration therapy. The highest attack rate (84 per 10 000) occurred in infants less than 1 year of age. No common vehicle or mode of transmission was identified. A matched-pair study of 35 cases and controls showed that adult cases were more likely than controls to have consumed food or beverage outside of the home before becoming ill. V. cholerae was isolated from stored drinking water in the houses of 8 cases but not from numerous samples of food and tap-water. It was presumed that cholera transmission occurred through a complex interaction of mild and asymptomatically infected persons with food, water, and the environment.

A passive disease report card (DRC) surveillance system failed to detect an epidemic of diarrheal disease caused by a newly identified drug-resistant strain of Shigella sonnei. The DRC system inaccurately described both the population at risk and the geographic location of cases. Specific limitations of the DRC system, including problems of underreporting and ascertainment bias, were complicated by the absence of timely data analysis and feedback to providers.

Pulmonary thromboembolism is an infrequent but serious complication of induced abortion. Of the 104 abortion-related deaths reported to the Center for Disease Control in 1972 through 1975, 10 (9.6 per cent) involved fatal pulmonary embolism; eight of these cases were proved at autopsy. All but one of the women had pre-existing risk factors for thromboembolic disease, including obesity, previous thrombophlebitis, use of oral contraceptives, or type A blood. All but one case occurred in women who had received general anesthesia. In addition, four of the eight women had undergone a concurrent sterilization procedure at the time of the abortion. Preventive efforts should focus on identifying women at high risk for thromboembolic events prior to the abortion procedure and then selecting the abortion procedure least likely to produce postoperative embolism.