rwa PoLIoMYELITIs 367 por el Dr. Lenette de un virus parecido en una jirafa del Parque ZooMgico de San Diego, hizo pensar en la posibilidad de que exista en el sur de California una forma de rabia no transmitida por perros, con características similares a la rabia de los vampiros. AIgunos investigadores han sugerido la existencia de rabia en los roedores, que pudieran haber originado los dos casos citados. Sin embargo, esta teoría necesita aun de mayores investigaciones.
POLIOMYELITIS-SAN ANTONIO AREA-
A report by the Epidemiologid Committee, Sun Antonio City Health Department
The “Fiesta de San Jacinto,” a festival week devoted to indoor and outdoor entertainment, was held in San Antonio, Texas, from April 22 to April 27, 1946. Following this festival there appeared an abrupt outbreak of poliomyelitis. From the first of January to the 6rst of May only one case of poliomyelitis had been reported to the City Health Department in San Antonio. This case was reported early in January. On May 6, the first case of this outbreak was reported to the City Health Department. For the week ending May 11, ten cases were reported for the City and Bexar County; three of these died-two residents of t.he City and one of the county. On May ll, the Board of Health placed a ban on the City, prohibiting public gathermgs for those under the age of twenty-two years. On May 12, members of the State Department of Health and the City Board of Health met and discussed the entire situa- tion in the City of San Antonio and Bexar County. Following this meeting an Epidemiological Committee was set up to aid and advise in the clean-up and attempted control of the disease.
The Committee, in formulating its recommendations for the preven- tion of poliomyelitis, carefully considered the known faets relating to the characteristics of the virus causing the disease and the available data regarding its possibIe methods of transmission. Briefly stated, the following were considered:
1. The virus is destroyed by pasteurisation, i.e., by exposurc to a temperature of 55” C. for 30 minutes.
2. It resista drying for at least one month.
3. It survives in gastro-intestinal secretions for at lesst two houra.
4. It sur-vives in butter for at lea& three months; in milk for at lea& thirty-one days at room temperature; and in vrater for st lea&, three months at room tempera- ture.
5. Break point chlorination of water destroys the virus.
368 PAN AMERICAN SANITARY BUREAU [ApriZ 7. A toxic factor which produces lethal effects in animals has been isolated from
the stools and urine of human cases.
8. The virus has been demonstrated in the compon house fly and various other filth flies and the disease has been produced in monkeys from parenteral injection of emulsions of filth flies. The virus has been recovered from the fecal and vomit spots of the fly.
The committee considered all of the possible methods of transmission of poliomyelitis that have been advocated by various authorities, i.e., transmission by direct or indirect contact with individuals suffering from the infection, convalescents therefrom, or with “carriers” or those having subclinical attacks; by droplet infection through the respiratory tract in crowded places, as in schools, theatres, etc.; through contamination of food or drink by foodhanders, or by Bies or other insects; through con- taminated milk or water and through contaminated swimming pools.
All of these suggested methods of transmission have some experimen- tal and epidemiological evidente in support of them but their relative importance is still unproven In view of this fact, the committee felt that, insofar as possible, its recommendations should cover them all, and should be based upon the proven facts enumerated above.
Reasoning further, the following measures were outlined for the pro- tection of the public:
1. The ban on public gatherings, pienics, etc. to prevent contact with those in the incubation stage of the disease. This ban was placed on those persons under twenty-two years of age, because in the earlier cases the 12-21 age group was having the greatest incidence of cases. Later, this was modified to apply to the age group under 14 years since the character of the outbreak changed and those under 14 years of age were having practically all of the cases.
2. The closing of swimming pools, because of crowding and the possibility of infectious nasal secretions and intestinal organisms being in these pools.
3. The pasteurization of all milk and milk products, because of the possibility of infection from raw milk.
4. The spraying and fogging of the City with D.D.T. to kill flies, mosquitoes and other insects.
5. The improvement in removal of garbage and the covering of all garbage cans to eliminate the feeding and possible breeding of flies.
6. The proper disposal of garbage at city dumps to eliminate flies and fly breeding and the spread of flies from there.
7. The inspection, spraying, oiling and fly proofing of the pit of the box-seat, open privy.
8. D.D.T. spraying of garbage trucks on arrival and leaving the dumps, so that transportation of flies from one area to another would be prevented.
9. A general clean-up of the city with closer inspection of restaurants and eating places to discover possible sanitary defects with the object of correcting such defects and improving sanitation in general.
W81 POLIOMYELITIS 369 work of these divisions, and, in addition, called upon the Chamber of Commerce for their cooperation and help. The Chamber of Commerce furnished an unbiased, trained statistician to review and tabulate the data on individual case reports. The manager of the Chamber of Com- merce performed one of the most important jobs-that of CoordZnator. He personally attended meetings of the Epidemiological Committee and aided through his contacts with business people, the Chamber of Com- merce, the Rotary and other clubs, the City Board of Health, the City government generally, and contact with other cities. The stimulation and cooperation of personal and public interest in the problem were con- sidered outstanding. The Bexar County Health Depatiment, the News- papers, and the various Army Post Commanders, with their medical personnel, cooperated in every respect during the outbreak.
The nurses of the City Health Department visited each family and completed the case report requested by the Texas State Department of HeaIth. These reports were reviewed and additional information was acquired where necessary by visits to the family of the cases by members of the Epidemiological Committee, or through contact with the physi- cian treating the case.
The Sanitation Division of the City Health Department, inspected all the pit-toilets for defects. Al1 toilet boxes not fly-proof were corrected by closing aI1 openings. In addition, one quart of kerosene was sprayed over fecal contents as a larvicide. The box and the inside of the house were sprayed with 5 yo D. D. T. No attempt was made to fly-proof the house; all efforts were directed to covering of the pit and the use of a larvicide. A pamphlet in English and Spanish was distributed to aid in the correction of defects. This pamphlet stated in simple terms the method to be used. FoIIow-up inspections were made to see that de- fects mere properly corrected.
The cost of materials and labor for the entire season, (through Octo- ber), was approximately $40,000. This included sprayers and a fogging machine which cost $1625.40, and are considered permanent City equip- ment.
STATISTICAL TAE3L?LATION
370 PAN AMERICAN SANITARY BUREAU
original ban. In the next seven weeks of declining incidence of
cases
the whole complexion of the outbreak changed. Of forty-five additionalcases, only eleven were over 15 years of age, one of whom died. For the next four weeks, one case was reported and this case had been out of the City prior to the onset.
The fifty-eight cases among individuals under 15 years of age included one death. In the high school group, aged 15 to 17, there were eleven
cases
with five deaths. Among twenty-nine cases aged 18 and over, there were six deaths. The high proportion of older persons and the fatality rate in the high school age group were unusual features observed in this outbreak. No cases were reported among the colored race. A total of 17 or about 17ye of the cases were Latin Ameritan, (who com- prise about 43% of total population) ; of these, thirteen cases were under15, none over 18 years. The disease showed a preferente for blondes, according to hospital reports and home investigators, but complete figures are not available. There were 98 cases during the outbreak and 114 cases during the year of 1946.
DISCUSSION
Despite criticism, from some sources, of the use of DDT in an ef- fort to control an outbreak of poliomyelitis in a City, it is believed by this committee that discr2m2nate fogging and spraying, along with the general clean-up measures taken, may have been an important factor in bringing this outbreak to an earlier termination. The incidence of cases fe11 off abruptly from June 1 through August 31. In the three weeks prior to June 1, the control measures mentioned above were placed in effect. The peak incidence was reached in the state of Texas on the week ending JuIy 20; whereas, the outbreak in San Antonio and Bexar County reached its peak during the latter part of May.
The use of DDT is also believed to have been an important factor in reducing the number of cases of Typhus from 116 in 1945 to 26 cases in 1946 and in the reduction of infant diarrhea cases from 613 in 1945 to 479 in 1946, (deaths decreased from 208 in 1945 to 120 in 1946).
CONCLUSION
mV PoLIoMIELrrIs 371 POLIOMIELITIS-ZONA DE SAN ANTONIO-1946 (Sumario) DespuOs de una semana de festival (Fiesta de San Jacinto), celebrado en San Antonio, Texas, del 22 al 27 de abril, 1947, ocurrió repentinamente un brote de poliomielitis. El 12 de mayo se reuni6 una Comlsi6n Epidemlológica que estudió todo lo que se conoce con respecto al virus y los posibles métodos de transmisión de la poliomielitis, acordándose los siguientes métodos de control: (1) prohibición de reuniones pdblicas, (2) clausura de las piscinas de nataci6n, (3) pasteurización de la leche y sus derivados, (4) pulverización y atomización de Ia ciudad con DDT, (5) mejoramiento en la recolecci6n de basuras y en las tapas de los envases, junto con (6) disposición apropiada de la basura en los basureros de la ciudad, (7) inspección, pulverización y acondicionamiento a prueba de moscas de los excusa- dos, (8) pulverización con DDT de los camiones que conducen la basura al llegar a o salir de los basureros, (9) limpieza general de la ciudad con la cooperacibn de todas las agencias, por medio de petición del Departamento de Educación PGblica. Las enfermeras del Depto. de Sanidad, con la cooperación de los médicos particu- lares, informaron de todos los casos ocurridos. Se presenta información que demuestra una brusca disminución en el número de casos del 10 de junio al 31 de agosto. No se comunicaron casos entre la gente de color y ~610 17% entre latino- americanos (el 40% de la pobIaci6n de San Antonio es latinoamericana). No se ha comprobado que las medidas expuestas hubieran terminado con la epidemia.
