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Date: Fri, 15 Apr 94 21:52:26 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR 1 Apr 94] E. coli Outbreak Linked to Home-Cooked Hamburger
Message-ID: <4DZukc2w165w@stat.com>

                  Emerging Infectious Diseases
   Escherichia coli O157:H7 Outbreak Linked to Home-Cooked Hamburger
                     - California, July 1993 -

     Although outbreaks of Escherichia coli O157:H7 have been linked to
consumption of contaminated ground beef, the organism is rarely isolated from
the implicated meat. In addition, most epidemiologic investigations of illness
associated with E. coli O157:H7 infections have been directed at
restaurant-associated outbreaks, and the sources of infection for sporadic
cases rarely have been identified. In July 1993, three cases of
culture-confirmed E. coli O157:H7 infection among persons residing in a small
community in California were traced to consumption of hamburger purchased from
a local grocery store; E. coli O157:H7 was isolated from that meat. This
report summarizes the investigation of these cases by local and state public
health officials.
     On July 12, 1993, a hospital laboratory in Fort Bragg, California,
reported a case of E. coli O157:H7 infection in a 13-year-old girl to the
Mendocino County Public Health Department (MCPHD). The patient had had onset
of bloody diarrhea on July 7 and recovered. Members of her family reported
having eaten home-cooked hamburgers on July 5 made from meat purchased from a
local market (market A) on July 3; the hamburgers had been cooked "medium
rare." All five family members who ate the hamburgers reported diarrhea; the
index patient and her mother had bloody diarrhea. E. coli O157:H7 was isolated
from leftover ground beef from the same package used to make the hamburgers.
     Two additional cases of culture-confirmed E. coli O157:H7 infection
occurred in persons residing in the same community: an 18-year-old man who had
onset of bloody diarrhea on July 18 and an 84-year-old woman with diabetes
mellitus and chronic uremia who developed nonbloody diarrhea on July 10. Both
persons reported having eaten hamburger purchased at market A on July 3. Two
family members of the man and one family member of the woman also developed
nonbloody diarrhea after eating the hamburger. Although no patients developed
hemolytic uremic syndrome (HUS), the elderly woman died 3 weeks after
hospitalization; her death was attributed to her chronic renal disease.
     Media announcements from MCPHD requested persons who had experienced
bloody diarrhea during July to contact the department. Of five persons who
reported having had bloody diarrhea, four submitted stool for culture.
Although all were negative, the cultures had been obtained 11-26 days after
onset of diarrhea. Reviews of the emergency department log of the district
hospital for July 1-22 did not identify additional cases of bloody diarrhea.
     Environmental health staff from MCPHD and staff from the U.S. Department
of Agriculture (USDA) inspected market A and the other two markets in the
community that sold ground meat (markets B and C) but did not identify
violations in meat storage or grinding procedures. Shelf samples of ground
beef from all three markets were obtained for testing. The owner of market A
also initiated a voluntary recall of all ground beef purchased at that market
during June 25-July 19; as a result, 91 packages of ground beef were returned.
     Of the 15 samples of ground beef obtained from market A and tested, four
were positive for E. coli O157:H7. All positive samples had been placed on the
shelves on July 3. Of 16 samples from market B, one was positive for E. coli
O157:H7. None of seven samples obtained from market C were positive. The
packages placed on the shelf of market A on July 3 were obtained from "chubs,"
which are large tubes of ground beef purchased from an outside supplier. The
market often reground the meat in its own grinder and sometimes added "trim
meat" from other sources. A traceback of the meat was not performed.
     Because the isolates produced an uninterpretable pattern by pulsed-field
gel electrophoresis, selected isolates were further characterized by phage
typing at the National Laboratory for Enteric Pathogens, Laboratory Center for
Disease Control, in Ottawa. Phage type 31 was identified in the three patient
isolates, the leftover ground beef obtained from the freezer of the index
patient's family, and the two isolates selected for testing from market A. The
sample from market B (which was not implicated in the outbreak) was phage type
4.
     Following the investigation, MCPHD provided information to all county
meat markets about optimal meat-grinding procedures and issued a press release
advising consumers to cook ground beef thoroughly.

Reported by: C Turney, M Green-Smith, Microbiology Dept, Mendocino Coast
District Hospital; M Shipp, MD, C Mordhorst, C Whittingslow, MPH, L Brawley,
MPH, D Koppel, E Bridges, G Davis, J Voss, R Lee, MS, Mendocino County Public
Health Dept, Fort Bragg; M Jay, DVM, S Abbott, MS, R Bryant, MS, K Reilly,
DVM, SB Werner, MD, L Barrett, DVM, RJ Jackson, MD, GW Rutherford, III, MD,
State Epidemiologist, California Dept of Health Svcs. H Lior, MSc, National
Laboratory for Enteric Pathogens, Laboratory Center for Disease Control,
Health and Welfare Canada, Ottawa. Foodborne and Diarrheal Diseases Br, Div of
Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC.

Editorial Note: E. coli O157:H7 was first described as a pathogen in humans in
1982 following the investigation of two outbreaks of illness that were
associated with consumption of hamburger from a fast-food restaurant chain
(1). Since then, more than 12 outbreaks have been reported in the United
States (2). Although other investigations have implicated consumption of
undercooked ground beef, less commonly identified sources of E. coli O157:H7
infection have included roast beef, unpasteurized milk, apple cider, and
municipal water (2,3). Person-to-person transmission in child day care centers
also has been documented (4).
     E. coli O157:H7 infection causes diarrhea (often bloody) and abdominal
cramps; fever is infrequent. Infection with E. coli O157:H7 is a relatively
common cause of sporadic diarrheal illness: in prospective studies of patients
with diarrhea, E. coli O157:H7 has been isolated more frequently than Shigella
(2). Children and the elderly are at highest risk for clinical manifestations
and complications. Although illness usually resolves within 1 week, 5%- 10% of
patients develop HUS, which is characterized by hemolytic anemia,
thrombocytopenia, and renal failure. HUS is a common cause of acute renal
failure in children, and the case-fatality rate is 3%-5%.
     Sporadic cases and small outbreaks of E. coli O157:H7 infection similar
to the cluster described in this report probably occur throughout the United
States but are not recognized. Many clinical health-care providers do not
routinely order stool cultures for patients with diarrhea. Even when stool
cultures are ordered, clinicians may not be aware that most laboratories do
not culture stools for E. coli O157:H7 using sorbitol-MacConkey medium unless
specifically requested (5).
     The findings in this report illustrate the usefulness of subtyping in
distinguishing outbreak strains of E. coli O157:H7 from those present in the
community but unassociated with an outbreak. There are at least 62 known phage
types of E. coli O157:H7. In Canada, where phage typing is the predominant
subtyping method used, phage type 31 accounts for 9% of isolates tested (6).
     E. coli O157:H7 may be present in the intestines of healthy cattle and
may contaminate meat during slaughter. The process of grinding beef may then
transfer pathogens from the surface of the meat to the interior.
     Because of the publicity generated by large restaurant-associated
outbreaks, many persons associate infections caused by E. coli O157:H7 with
restaurant-served ground beef. However, the outbreak in Mendocino County
emphasizes that home-cooked hamburgers can be a source of infection and
underscores the need to cook ground beef until the interior is no longer pink
and juices run clear; thorough cooking kills E. coli O157:H7. On March 28,
1994, the USDA Food Safety and Inspection Service published regulations
mandating that safe handling instructions be included on all raw meat and
poultry product labeling.* These regulations include instructions to cook meat
thoroughly.
     In June 1993, the Council of State and Territorial Epidemiologists (CSTE)
passed a resolution that reporting of E. coli O157:H7 infections should be
required in all states. As of October 1, 1993, however, only 17 states
required E. coli O157:H7 infection to be reported to state health departments
(G.S. Birkhead, M.D., CSTE, personal communication, 1994). CDC is working with
state health departments to establish national surveillance for E. coli
O157:H7 infections. National surveillance and increased laboratory testing for
E. coli O157:H7 will assist in defining the public health impact of this
emerging pathogen.

References
1. Riley LW, Remis RS, Helgerson SD, et al. Hemorrhagic colitis associated
with a rare Escherichia coli serotype. N Engl J Med 1983;308:681-5.
2. Griffin PM, Tauxe RV. The epidemiology of infections caused by Escherichia
coli O157:H7, other enterhemorrhagic E. coli, and the associated hemolytic
uremic syndrome. Epidemiol Rev 1991;13:60-98.
3. Besser RE, Lett SM, Weber JT, et al. An outbreak of diarrhea and hemolytic
uremic syndrome from Escherichia coli O157:H7 in fresh-pressed apple cider.
JAMA 1993;269:2217-20.
4. Belongia EA, Osterholm MT, Soler JT, Ammend DA, Braun JE, MacDonald KL.
Transmission of Escherichia coli O157:H7 infection in Minnesota child day-care
facilities. JAMA 1993; 269:883-8.
5. CDC. Laboratory screening for Escherichia coli O157:H7-- Connecticut, 1993.
MMWR 1994; 43:192-4.
6. Khakhria R, Duck D, Lior H. Extended phage-typing scheme for Escherichia
coli O157:H7. Epidemiol Infect 1990;105:511-20.

* 59 CFR 14528-40.





------------------------------

Date: Fri, 15 Apr 94 21:53:33 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR] Prevalence of Penicillin-Resistant Streptococcus pneumoniae
Message-ID: <yFZukc3w165w@stat.com>

                  Emerging Infectious Diseases
    Prevalence of Penicillin-Resistant Streptococcus pneumoniae
                    Connecticut, 1992-1993

     Streptococcus pneumoniae is an important cause of community-acquired
bacterial pneumonia, meningitis, acute otitis media, and other infections (1).
Infants, young children, and the elderly are most severely affected by
pneumococcal disease (2). Although S. pneumoniae was once considered to be
routinely susceptible to penicillin, since the mid-1980s the incidence of
resistance of this organism to penicillin and other antimicrobial agents has
been increasing in the United States (1-4). National surveillance for
drug-resistant S. pneumoniae (DRSP) is limited to testing invasive isolates
from sentinel hospitals in 13 states. To determine the extent of antimicrobial
susceptibility testing of S. pneumoniae and the prevalence of penicillin
resistance among pneumococcal isolates from July 1992 through June 1993, in
August 1993 the Connecticut Department of Public Health and Addiction Services
(DPHAS) surveyed all 44 hospitals with clinical microbiology laboratories in
Connecticut. This report summarizes the results of that survey.
     Hospital laboratories were asked whether pneumococcal isolates were
tested for resistance to penicillin, which isolates were tested, which tests
were used, the number of isolates tested from different body sites from July
1992 through June 1993, and the minimal inhibitory concentrations (MICs) for
any resistant isolates. Forty-three (98%) of 44 hospital laboratories
responded.
     Of the 43 hospital laboratories, 33 reported performing antimicrobial
susceptibility tests on pneumococcal isolates, nine sent pneumococcal isolates
to other laboratories for testing, and one neither performed such tests on
pneumococcal isolates nor sent isolates to other laboratories for testing.
     In 15 of the 33 laboratories, penicillin susceptibility testing was
limited to qualitative disk diffusion (using an oxacillin disk). Nine
laboratories screened pneumococcal isolates by disk diffusion, then confirmed
penicillin resistance by determination of a quantitative MIC. Nine
laboratories determined the penicillin MIC for all pneumococcal isolates.
     MIC data were provided by 14 of the 18 laboratories that performed such
tests for pneumococcal isolates. MICs were reported for 846 isolates collected
during July 1992-June 1993. Penicillin resistance was defined as MIC greater
than or equal to 0.1 ug/mL, and high-level resistance was defined as MIC
greater than or equal to 2.0 ug/mL (5). Penicillin-resistant isolates were
reported from four of 14 hospitals. Eighteen isolates (2.1%) from any body
site were penicillin resistant, including five (1.3%) of 400 isolates from
usually sterile sites. Overall, three isolates (one each from blood, sputum,
and nasal fluid) were highly resistant. Two of these isolates had penicillin
MICs greater than or equal to 4.0 ug/mL.

Reported by: EH Simpson, ML Cartter, MD, JL Hadler, MD, State Epidemiologist,
Connecticut Dept of Public Health and Addiction Svcs. Child and Adult
Immunization Br, National Immunization Program; Nosocomial Pathogens and
Laboratories Br, Hospital Infections Program, Childhood and Respiratory
Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for
Infectious Diseases, CDC.

Editorial Note: The spread of DRSP strains may increase the public health
impact of S. pneumoniae infections because of increased morbidity and
reductions in the effectiveness of antimicrobial treatment for pneumococcal
disease. Of special concern is resistance to extended-spectrum cephalosporins,
which are often used as empiric therapy for meningitis (3).
     During 1979-1987, only one (0.02%) of 4585 pneumococcal sterile-site
isolates submitted to CDC's sentinel hospital surveillance system were highly
resistant to penicillin; in comparison, during 1992, seven (1.3%) of 544 such
isolates were highly resistant (4,6). In some pediatric populations, up to 30%
of pneumococcal isolates are penicillin resistant at some level, with a
substantial proportion of strains resistant to multiple drugs (3). Although
information regarding resistance to other antimicrobial drugs was unavailable
in the Connecticut survey, the overall prevalence of penicillin-resistant
strains in Connecticut was low through June 1993. However, resistant
pneumococcal strains can spread rapidly in communities (7,8), and DPHAS is
conducting surveillance for antimicrobial resistance.
     Because penicillin susceptibility cannot be assumed, pneumococcal
isolates associated with disease should be screened routinely for penicillin
resistance by disk diffusion using a 1-ug oxacillin disk (9), which is highly
sensitive--although not 100% specific--for penicillin resistance. Screening
cannot reliably quantify the degree of penicillin resistance; therefore,
pneumococcal isolates with oxacillin zone sizes less than or equal to 19 mm
should be further tested by determination of MICs for penicillin (9), as well
as for other drugs likely to be used in treatment. Some pneumococci with
either intermediate or high-level penicillin resistance also may be resistant
to extended-spectrum cephalosporins; therefore, penicillin-resistant isolates
should be tested by MIC for susceptibility to either ceftriaxone or cefotaxime
(3,5).
     To optimize empiric regimens and initial therapy for pneumococcal
infections, clinical health-care providers must be informed about the
prevalence and patterns of drug resistance among isolates in their
communities. Statewide surveillance for DRSP as a notifiable condition has
been initiated in Colorado, Connecticut, and New Jersey. CDC, in collaboration
with the Council of State and Territorial Epidemiologists and the Association
of State and Territorial Public Health Laboratory Directors, is developing
strategies for collecting information on pneumococcal drug resistance in other
states and for preventing morbidity and death associated with infection with
resistant strains (3). Because antimicrobial susceptibility testing should be
conducted routinely on invasive pneumococcal isolates, emphasis must be placed
on developing methods to compile and analyze results, alerting health-care
providers in communities in which resistant pneumococcal strains are
prevalent, and identifying areas requiring more intensive epidemiologic
assessment.
     In areas where pneumococci resistant to extended-spectrum cephalosporins
are prevalent, empiric therapy with vancomycin and an extended-spectrum
cephalosporin should be considered for cases of life-threatening infection
(e.g., meningitis) potentially caused by S. pneumoniae until results of
culture and susceptibility testing are known. The emergence of drug-resistant
pneumococcal infections underscores the need for adherence to recommendations
of the Advisory Committee on Immunization Practices that persons aged greater
than or equal to 2 years with medical conditions placing them at increased
risk for serious pneumococcal infection and all persons aged greater than or
equal to 65 years should receive 23-valent pneumococcal capsular
polysaccharide vaccine (10); no pneumococcal vaccine is licensed for children
aged less than 2 years.

References
1. Lederberg J, Shope RE, Oaks SC Jr, eds. Emerging infections: microbial
threats to health in the United States. Washington, DC: National Academy
Press, 1992.
2. Chesney PJ. The escalating problem of antimicrobial resistance in
Streptococcus pneumoniae. Am J Dis Child 1992;146:912-6.
3. CDC. Drug-resistant Streptococcus pneumoniae--Kentucky and Tennessee, 1993.
MMWR 1994;43:23-5,31.
4. Butler JC, Breiman RF, Facklam RR, the Pneumococcal Working Group.
Emergence of drug- resistant pneumococci in the United States [Abstract no.
1182]. In: Program and abstracts of the 33rd Interscience Conference on
Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for
Microbiology, 1993:336.
5. National Committee for Clinical Laboratory Standards. Methods for dilution
antimicrobial susceptibility tests for bacteria that grow aerobically--third
edition; approved standard. Villanova, Pennsylvania: National Committee for
Clinical Laboratory Standards, 1993; NCCLS document no. M7-A3 (vol 13, no.
25).
6. Spika JS, Facklam RR, Plikaytis BD, Oxtoby MJ, the Pneumococcal
Surveillance Working Group. Antimicrobial resistance of Streptococcus
pneumoniae in the United States, 1979-1987. J Infect Dis 1991;163:1273-8.
7. Kristinsson KG, Hjalmarsdottir MA, Axelsson A, Gudnason Th. Invasion and
spread of penicillin resistant pneumococci in Iceland [Abstract no. 1180]. In:
Program and abstracts of the 33rd Interscience Conference on Antimicrobial
Agents and Chemotherapy. Washington, DC: American Society for Microbiology,
1993:335.
8. Dagan R, Yagupsky P, Wasas A, Klugman K. Penicillin-resistant Streptococcus
pneumoniae (PenRSP): an increasing problem in pediatric invasive infections
and otitis media in southern Israel [Abstract no. 1181]. In: Program and
abstracts of the 33rd Interscience Conference on Antimicrobial Agents and
Chemotherapy. Washington, DC: American Society for Microbiology, 1993:336.
9. National Committee for Clinical Laboratory Standards. Performance standards
for antimicrobial disk susceptibility tests-- fifth edition; approved
standard. Villanova, Pennsylvania: National Committee for Clinical Laboratory
Standards, 1993; NCCLS document no. M2-A4 (vol 13, no. 24).
10. ACIP. Pneumococcal polysaccharide vaccine. MMWR 1989;38:64- 8,73-6.



------------------------------

Date: Fri, 15 Apr 94 21:54:33 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR] Progress Toward Poliomyelitis Eradication
Message-ID: <mHZukc4w165w@stat.com>

                  International Notes
    Progress Toward Poliomyelitis Eradication -- Egypt, 1993

     Since 1990, the Ministry of Health in Egypt has directed efforts toward
achieving poliomyelitis eradication by the end of 1994. To achieve this goal,
the Egyptian Expanded Program on Immunization (EPI) has progressively
implemented each of four World Health Organization (WHO)-recommended
strategies: 1) increasing and sustaining routine coverage with oral poliovirus
vaccine (OPV); 2) conducting National Immunization Days (NIDs); 3) developing
surveillance for acute flaccid paralysis (AFP), including laboratory
confirmation of cases; and 4) instituting "mopping-up" vaccination (i.e.,
house-to-house administration of two doses of OPV at an interval of 4-6 weeks
to all children aged less than 3 years who reside in areas where risk for wild
poliovirus transmission is highest). This report summarizes the poliomyelitis
eradication effort in Egypt based on a program review conducted during
November 20-30, 1993, by the Egyptian Ministry of Health; Cairo University;
the High Institute for Public Health in Alexandria, Egypt; WHO; Rotary
International; and CDC.
     Routine vaccination coverage with all EPI target disease vaccines
(bacille Calmette-Guerin [BCG], diphtheria and tetanus toxoids and pertussis
vaccine [DTP], measles, and OPV) increased substantially following the
acceleration of activities in 1984, and coverage has remained high. The
routine OPV vaccination schedule consists of doses at ages 2, 4, 6, 9, and 18
months. Reported vaccination coverage with three doses of OPV in children aged
less than 1 year increased from 67% in 1984 to 90% in 1989 and has ranged from
87% to 89% during 1990-1993 (Figure 1). From 1984 to 1990, routine vaccination
coverage with the other EPI target disease vaccines also increased (BCG: 53%
to 89%; three doses of DTP: 57% to 87%; and measles vaccine: 41% to 87%), and
since 1990, coverage with these vaccines has remained high.
     In addition to the routine vaccination program, supplemental vaccination
activities have been used to achieve poliomyelitis eradication goals. NIDs
have been conducted intermittently since 1976, and the level of activity
increased from 1990-1991, when a single dose of OPV was administered annually
to approximately 8.5- 8.7 million children aged less than 5 years, to
January-February 1993, when 17 million doses were administered in two separate
rounds to approximately 8.4-8.6 million children (Figure 1). Mopping-up
vaccination activities also have been used since 1991 (Figure 1). High-risk
districts are designated on the basis of low vaccination coverage and
confirmed poliomyelitis cases during the preceding 5 years. During 1991-1992,
6 million doses of OPV were administered during more than 100 districtwide
mopping-up operations.
     AFP surveillance was initiated in August 1990, and a policy of regular
zero reporting (i.e., reporting even if no cases occurred) from all reporting
sites was instituted in January 1992. In April 1992, AFP case investigation
was intensified with emphasis on proper collection of two stool specimens for
virus isolation. Despite increased surveillance, the reported number of cases
of confirmed poliomyelitis decreased from 619 cases in 1991 to 115 cases in
1993 (Figures 1 and 2). In 1993, the seasonal variation in AFP incidence,
which reflects the occurrence of poliomyelitis and usually peaks in Egypt
during August-October, decreased substantially (Figure 2).
     The geographic distribution of confirmed poliomyelitis cases remained
widespread in 1992, with cases reported from 24 of 26 governorates. However,
during 1993, poliomyelitis was focally distributed and reported in 17 of 26
governorates.

Reported by: Expanded Program on Immunization, Ministry of Health, Cairo.
Eastern Mediterranean Regional Office, World Health Organization, Alexandria,
Egypt; Expanded Program on Immunization, World Health Organization, Geneva.
International Health Program Office; Div of Viral and Rickettsial Diseases,
National Center for Infectious Diseases; Polio Eradication Activity, National
Immunization Program, CDC.

Editorial Note: Because of its location between the emerging
poliomyelitis-free zones of the Mahgreb Union and Arab states of the Persian
Gulf, Egypt is particularly important to the goal of global eradication of
poliomyelitis by the year 2000 (1). As a result of the implementation of
large-scale supplementary vaccination activities and efforts to strengthen the
poliomyelitis disease surveillance system, Egypt has made substantial progress
toward eradicating poliomyelitis by the end of 1994. The incidence of
poliomyelitis has decreased despite improvements in the poliomyelitis
surveillance system. In addition, supplemental vaccination activities with OPV
have not adversely affected the routine vaccination program or coverage levels
with vaccines for the other EPI target diseases (i.e., diphtheria, measles,
pertussis, tetanus, and tuberculosis).
     Since 1991, the epidemiologic pattern of poliomyelitis in Egypt has
changed from widespread endemic disease to a problem of more limited focal
distribution. This change may be attributed to the combination of NIDs and
focused mopping-up vaccination in high-risk districts. The Ministry of Health
in Egypt plans to continue two rounds of NIDs each in 1994 and 1995 to ensure
interruption of transmission of wild poliovirus. Decisions to conduct
additional NIDs will be made following reassessment of the epidemiologic
situation during 1995.

Reference
1. World Health Assembly. Global eradication of poliomyelitis by the year
2000. Geneva: World Health Organization, 1988. (Resolution WHA41.28).



------------------------------

Date: Fri, 15 Apr 94 21:56:15 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Drexel Univ Journal of Undergraduate Biological Research
Message-ID: <gkZukc6w165w@stat.com>

                      ===============================
                       CALL FOR UNDERGRADUATE PAPERS
                                ----------
    [] [] [] THE DREXEL UNIVERSITY JOURNAL OF UNDERGRADUATE [] [] []
         [] [] [] [] [] [] BIOLOGICAL RESEARCH [] [] [] [] [] []


Requirements:

[] Papers are limited to topics in biology.
[] You must be an undergraduate at least assisting with the research on which
you plan to write.
[] You must use the American Psychological Association (APA) format of
citing literature.  [see American Scientist for guide].

Due:

All papers are due by May 5.

If possible, submit papers in MacWrite II compatible format. Submitted
materials cannot be returned.

   ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
   :::::::::::| FOR  MORE  INFORMATION  OR  TO  SUBMIT  A  PAPER |:::::::::::
   ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
        [] write Journal of Undergraduate Research at

                     The Journal of Undergraduate Research
                     Department of Bioscience and Biotechnology
                     Drexel University
                     32nd and Chestnut Streets
                     Philadelphia, Pennsylvania 19104

        [] send e-mail to martinpf@dunx1.ocs.drexel.edu
   ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::



------------------------------

Date: Fri, 15 Apr 94 21:56:59 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Armed Forces Institute of Pathology Continuing Education Courses
Message-ID: <oLZukc7w165w@stat.com>

                ARMED FORCES INSTITUTE OF PATHOLOGY
        POSTGRADUATE SHORT COURSES ON CONTINUING EDUCATION

                            SPRING 1994

      8-13 May  Orthopedic Pathology            Harbourtown Resort
                                                St. Michaels, MD

        16 May  Selected Topics on              AFIP
                Oxygen Research                 Washington, DC

     21-23 May  Radiation & Cancer              Sheraton Premiere
                Chemotherapy                    @ Tyson's Corner
                                                Vienna, VA

     May31-3Jun Descriptive Veterinary          AFIP
                Pathology                       Washington, DC

      6-10 Jun  Exfoliative & Fine Needle       Hyatt Regency
                Aspiration Cytology             Bethesda, MD

      8-10 Jun  Methods & Advanced Techniques   USUHS
                in Human Identification         Bethesda, MD

     20-24 Jun  Forensic Anthropology           USUHS
                                                Bethesda, MD

     25-26 Jun  Hepatopathology 94'             Radisson Resort
                                                Vail, CO

     27-28 Jun  Gastrointestinal Surgical       Radisson Resort
                Pathology                       Vail, CO

                               FALL 1994

      3- 5 Aug  Histopathology                  AFIP
                                                Washington, DC

      8-12 Aug  Pathology of Laboratory         USUHS
                Animals                         Bethesda, MD

     19-21 Aug  Environmental Pathology         AFIP
                                                Washington, DC

     27-28 Aug  Anatomy, Histology & Electron   Georgetown University
                Microscopy of the Eye, Orbit    Conference Center
                and Ocular Adnexa               Washington, DC

     Aug29-2Sep Ophthalmic Pathology`for        Georgetown University
                Ophthalmologists                Conference Center
                                                Washington, DC

     12-16 Sept Pathology of Congenital Heart   AFIP
                                                Washington, DC

     17-18 Sept Pulmonary & Mediastinal         Menger Hotel
                Radiology                       San Antonio, TX

     19-22 Sept Morphologic Findings in         Ramada Inn
                Renal Disease                   Bethesda, MD

     26-30 Sept Advances in Diagnostic          Radisson Park Terrace
                Pathology of Infectious         Washington, DC
                Diseases

      3- 7 Oct  Basic Forensic Pathology        Holiday Inn Crowne Plaza
                                                Rockville, MD

     10-14 Oct  4th Annual Radiologic           Disney Contemporary Hotel
                Pathologic Correlation          Lake Buena Vista, FL

     12-14 Oct  Future Technologies for DNA     Red Lion y Posada Resort
                Analysis                        Scottsdale, AZ

     29-30 Oct  Hyperbaric Chamber Awareness    AFIP
                                                Washington, DC

      4- 5 Nov  DNA Databanks & Repositories    Sheraton Midway
                                                St. Paul, MN

     19-20 Nov  Interpretation of Prostatic     AFIP
                Biopsy                          Washington, DC

                                SPRING 1995

      4-8  Jan 95 Telemedicine I                Disney Contemporary Hotel
                  (Didatic)                     Lake Buena Vista, FL


     10-11 Jan 95 Telemedicine II               Disney Contemporary Hotel
                  (Interactive)                 Lake Buena Vista, FL

      9-10 Jan 95 Oral Pathology                Disney Contemporary Hotel
                                                Lake Buena Vista, FL

     22-27 Jan 95 Neuropathology Review         Hyatt Regency
                                                New Orleans, LA

     23-28 Jan 95 Uropathology                  Holiday Inn Crowne Plaza
                                                Rockville, MD

     13-17 Feb 95 Controversies & Recent        Disney Contemporary Hotel
                  Advances in Surgical          Lake Buena Vista, FL
                  Pathology

     17-19 Feb 95 Respiratory Tract &           Marriott Rivercenter
                  Mediastinum                   San Antonio, TX

     May 31-3 Jun Controversias y Adelantos     Caribe Hilton & Casino
                  Nuevos en Pathologia          San Juan, Puerto Rico
                  Quirurgica

     Press releases will be published as information becomes available.
     For additional information or clairification you may write:
     AFIP?ARP, Educ. Div.(I), Washington, DC 20306-6000; Telephone
     301/427-5231; Fax 301/427-5001; or INTERNET:
     LOWTHER@email.afip.osd.mil



------------------------------

Date: Fri, 15 Apr 94 21:57:58 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: CancerNet Update
Message-ID: <BNZukc8w165w@stat.com>

            *************************************************
            *       NATIONAL           INSTITUTE            *
            *               C A N C E R                     *
            *  INTERNATIONAL           INFORMATION          *
            *               C E N T E R                     *
            *************************************************
                   *   Cancernet@icicb.nci.nih.gov  *
                   **********************************




The National Cancer Institute has a new Information Associates Program
which provides one-stop, easy access to all of NCI's scientific
information resources, including online access to the PDQ database
via the Internet or by dialing toll-free to NCI using just a
modem and personal computer.  Request news article cn-400035
(U.S. Residents) or cn-400036 ( International) for details.


CancerNet has been updated for April.  The following statements
were modified.


Changed state-of-the-art  physician  statements:

Adult non-Hodgkin's lymphoma                                  cn-100066
Bladder cancer                                                cn-101206
Breast cancer                                                 cn-100013
Cervical cancer                                               cn-100103
Childhood acute myeloid leukemia                              cn-101081
Childhood brain tumor                                         cn-100047
Childhood Hodgkin's disease                                   cn-103043
Childhood non-Hodgkin's                                       cn-100915
Childhood rhabdomyosarcoma                                    cn-100759
Childhood soft tissue sarcoma                                 cn-103085
Chronic lymphocytic leukemia                                  cn-101003
Gestational trophoblastic tumor                               cn-101163
Hairy cell leukemia                                           cn-101651
Malignant mesothelioma                                        cn-101071
Malignant thymoma                                             cn-101248
Nonsmall cell lung cancer                                     cn-100039
Ovarian epithelial cancer                                     cn-100950
Ovarian low malignant potential tumor                         cn-104155
Pancreatic cancer                                             cn-100046
Prostate cancer                                               cn-101229
Rectal cancer                                                 cn-100076
Retinoblastoma                                                cn-100993
Small cell lung cancer                                        cn-100040
Vaginal cancer                                                cn-101055


Changed patient information statements:


Breast cancer                                                 cn-200013
Cervical cancer                                               cn-200103
Hairy cell leukemia                                           cn-201651
small cell lung cancer                                        cn-200040
Vaginal cancer                                                cn-201055


Changed cancer screening statements:

Screening for breast cancer                                   cn-304723


Changed supportive care statements:

No changes.


Changed drug information statements:

No changes.


Changed CancerNet News and PDQ database information:

The following news items were added:

AHCPR Clinical Practice Guidelines on Management of Cancer
Pain Overview                                                cn-400015

NCI Statement on Falsified Data in NSABP Trials              cn-400018
Breast Cancer BMT Trials Encourage Accrual                   cn-400019
NCI Update on Falsified Data in NSABP Trials (3/29/94)       cn-400026

The following news items were changed:

Information About PDQ                                         cn-400001
PDQ Distributors                                              cn-400003
CANCERLIT Distributors                                        cn-400006
NCI High Priority Clinical Trials                             cn-400007

The following News Articles were deleted:


Referral Information for the BCPT ( complete list)             cn-400020
        BCPT Referral (partial list)-Alabama to Georgia        cn-400021
        BCPT Referral (partial list)-Hawaii to Michigan        cn-400022
        BCPT Referral (partial list)-Minn to North Carolina    cn-400023
        BCPT Referral (partial list)-North Dakota to Texas     cn-400024
        BCPT Referral (patial list)-Utah to Wisc. plus Canada  cn-400025


NCI Fact Sheets:
----------------

The following new fact sheets were added:

NCI-Funded Study Evaluates Risk of Uterine Cancer
from Tamoxifen                                               cn-600333
Q & A: Fecal Occult Blood Test                               cn-600515


The following fact sheets were changed:

Community Clinical Oncology Program                          cn-600013
NCI's Clinical Trials Cooperative Group Program              cn-600014


The following fact sheets were deleted:

Updating the Guidelines for Breast Cancer Screening          cn-600055
Fecal Occult Blood Test Reduces Colorectal Cancer
Mortality                                                    cn-600058

Q & A: Breast Cancer Prevention Trial                        cn-600041

Breast Cancer Prevention Trial ( in spanish)                 cn-600044


CANCERLIT Citations and Abstracts:
----------------------------------

Citations and Abstracts from CANCERLIT were added for the following new
topics:

Acute lymphocytic leukemia -- Diagnosis, histopathology,
pathogenesis                                                cn-7__290
Acute lymphocytic leukemia -- Therapy                       cn-7__291
Acute myeloid leukemia -- Diagnosis, histopathology,
pathogenesis                                                cn-7__300
Acute myeloid leukemia -- Therapy                           cn-7__301
Cervical cancer -- Diagnosis, histopathology, and
pathogensis                                                 cn-7__180
Cervical cancer -- Therapy                                  cn-7__181
Endometrial cancer                                          cn-7__190
Gestational trophoblastic tumor                             cn-7__200
Non-Hodgkin's lymphoma -- Therapy                           cn-7__371
Ovarian cancer -- Diagnosis, histopathology, and
pathogensis                                                 cn-7__210
Ovarian cancer -- Therapy                                   cn-7__211
Vaginal/Vulvar cancer                                       cn-7__225
Thyroid cancer                                              cn-7__165


Search output is available for the months of October - December 1993 and for
January - March 1994.  Selected Citations and Abstracts added to CANCERLIT in
April will be available in CancerNet on April 7, 1994.


Request the Monthly PDQ Statement Changes ( cn-405001) for a description of
the changes in the statements listed above.

Request Changes to CancerNet (cn-400000) for a complete listing of changes to
CancerNet content for the current month.

Instructions:

To request the CancerNet Instructions and Contents List, send a
mail message, and in the body of the message, enter HELP.
Address the mail message to:

          cancernet@icicb.nci.nih.gov

To request the modified statements, follow the above directions,
and in the body of the mail message, enter the statement code.
When requesting more than one statement, enter each code on a
separate line.

CancerNet statements are available in Spanish. To request the
Instructions and Contents List in Spanish, enter SPANISH in the
body of the mail message. If you would like to request the statements
in Spanish, substitute the prefix "cs-" in front of the number
e.g., cs-100022 to receive the statement on anal cancer in Spanish.
 .
All of the physician and patient statements are available in Spanish.
Supportive care statements are now available in Spanish.
News items that are available in Spanish have a # next to the statement
title. Although both the English and Spanish are updated at the same
time each month, the Spanish statements do not reflect the changes made
in the English statements until the following month to allow time for
translation. If you are interested in requesting CancerNet statements
or news articles in Spanish, it is suggested that you request an updated
Contents List.

If you are redistributing the PDQ information you retrieve from
CancerNet to others at your location, or are interested in redistributing
the information from CancerNet, request the news article, Redistribution
of Cancernet (cn-400030), to find out about conditions that apply when
redistributing the information.  This article also has information on
other sites providing access to CancerNet information.


Please send comments or questions to:

Cheryl Burg
NCI International Cancer Information Center
Internet: cheryl@icicb.nci.nih.gov



------------------------------

Date: Fri, 15 Apr 94 21:58:47 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Univ of Pennsylvania Online Multimedia Oncology Resource
Message-ID: <ooZukc9w165w@stat.com>

OncoLink - The University of Pennsylvania Multimedia Oncology Resource.

We would like to announce "OncoLink", a Wide World Web-server and gopher
server oriented to CANCER. This resource is directed to physicians,
health care personnel, social workers, patients and their supporters.

THIS RESOURCE CAN BE REACHED AT: cancer.med.upenn.edu

This cancer information server is currently under development, with changes
made daily. Gopher can reach this resource using Port 80.

With a WWW-client (e.g. Mosaic), use:   http://cancer.med.upenn.edu/
With a gopher client (e.g. gopher) use: gopher cancer.upenn.edu 80

The current subject headings are:

     pediatric oncology
     radiation oncology
     medical oncology
     surgical oncology
     medical physics
     psychosocial support for oncology patients & families ****
     links to other oncology centers in the world

In the pediatric oncology section, there is a "Case of the Month" paper, as
well as a manuscript entitled: "Primitive Neuroectodermal Tumors of the Pineal
Gland (Pineoblastomas): Patterns of Presentation and Relapse, Survival and
Treatment Recommendations", by J.W. Goldwein, P.C. Phillips, L.N. Sutton, L.B.
Rorke, R.J. Pakcer and G.J.D'Angio of the University of Pennsylvania Medical
Center and The Children's Hospital of Philadelphia.

In addition to the surveys in the pediatric oncology section, there are also
surveys in the psychosocial section addressing cancer survivor's issues.

We shall be exploring interactive BBS and other means of disseminating cancer
information throughout the world on the Internet. The maintainer of this
resource can be contacted at: BUHLE@XRT.UPENN.EDU

--
Dr. E. Loren Buhle, Jr.  INTERNET: BUHLE@XRT.UPENN.EDU
University of Pennsylvania School of Medicine         Phone: 215-662-3084
Rm 440A, 3401 Walnut St., Philadelphia, PA 19104-6228   FAX: 215-349-5978

--
Dr. E. Loren Buhle, Jr.  INTERNET: BUHLE@XRT.UPENN.EDU
University of Pennsylvania School of Medicine         Phone: 215-662-3084
Rm 440A, 3401 Walnut St., Philadelphia, PA 19104-6228   FAX: 215-349-5978



------------------------------

Date: Fri, 15 Apr 94 21:59:37 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Post-Traumatic Stress Disorder Electronic Conference
Message-ID: <3PZukc10w165w@stat.com>

**********************************************************************
ANNOUNCING A NEW UNMODERATED DISCUSSION FORUM DEALING WITH ALL ASPECTS
                  OF POST-TRAUMATIC STRESS DISORDER
**********************************************************************
To join send the message:
join traumatic-stress firstname lastname
to: mailbase@mailbase.ac.uk

'Traumatic-stress' has been established to promote the investigation,
assessment, and treatment of the immediate and long-term psychosocial,
biophysiological, and existential consequences of highly stressful
(traumatic) events. Of special interest are efforts to identify
a "cure" of PTSD (Post-traumatic Stress Disorder).

**********************************************************************
Comments and suggestions should be addressed to:
Prof. Charles Figley <cfigley@garnet.acns.fsu.edu> or <traumatic-
stress-request@mailbase.ac.uk>
**********************************************************************



------------------------------

Date: Fri, 15 Apr 94 22:00:28 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: World Health Organization Worldwide AIDS Statistics
Message-ID: <HRZukc11w165w@stat.com>

*The World Health Organization, Global Programme on AIDS granted
permission to CDC to post the following AIDS Global Statistics to LPIES.
The statistics were taken from the Weekly Epidemiological Record, Vol. 69,
No. 2, p. 5-6 (January 14, 1994).


1994, Vol. 69, Pages 5-6
 No. 2

                          World Health Organization, Geneva
                      Organisation mondiale de la Sante, Geneve

                            WEEKLY EPIDEMIOLOGICAL RECORD
                         RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE

14 January 1994 - 69th Year                               69 Annee - 14
Janvier
 1994


                      ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)
                             DATA AS AT 31 December 1993

                     SYNDROME D'IMMUNODEFICIENCE ACQUISE (SIDA)
                             DONNEES AU 31 Decembre 1993

                                          NUMBER                DATE OF
                                        OF CASES                REPORT
COUNTRY/AREA -                            NOMBRE                DATE
        PAYS/TERRITOIRE                   DE CAS                DE
                                                                NOTIFI-
                                                                CATION
AFRICA - AFRIQUE

Algeria - Algerie                            138                08.08.93
Angola                                       608                26.05.93
Benin - Benin                                566                10.12.93
Botswana                                   1,151                30.08.93
Burkina Faso                               2,886                31.12.92
Burundi                                    7,225                10.12.93
Cameroon - Cameroun                        2,870                10.12.93
Cape Verde - Cap-Vert                        143                10.12.93
Central African Republic -
        Republique centrafricaine          3,730                30.11.92
Chad - Tchad                               1,523                08.12.93
Comoros - Comores                              3                31.05.93
Congo                                      5,267                31.12.92
Cote d'Ivoire                             14,655                05.07.93
Djibouti                                     419                08.11.93
Egypt - Egypte                                88                14.11.93
Equatorial Guinea -
        Guinee equatoriale                    31                31.05.93
Eritrea - Erythree                           372                31.12.92
Ethiopia - Ethiopie                        8,376                30.09.93
Gabon                                        472                10.12.93
Gambia - Gambie                              240                10.06.93
Ghana                                     11,044                30.04.93
Guinea - Guinee                              655                10.12.93
Guinea-Bissau - Guinee-Bissau                380                11.06.93
Kenya                                     38,220                09.07.93
Lesotho                                      479                10.12.93
Liberia - Liberia                            191                10.12.93
Libyan Arab Jamahiriya -
        Jamahiriya arabe libyenne             10                01.02.93
Madagascar                                     4                31.05.93
Malawi                                    29,194                20.08.93
Mali                                       1,874                25.11.93
Mauritania - Mauritanie                       40                25.07.93
Mauritius - Maurice                           17                30.06.93
Morocco - Maroc                              156                15.07.93
Mozambique                                   826                27.07.93
Namibia - Namibie                            311                31.03.90
Niger                                        921                15.06.93
Nigeria - Nigeria                            722                02.06.93
Reunion - Reunion                             65                20.03.92
Rwanda                                    10,138                10.12.93
Sao Tome and Principe -
        Sao Tome-et-Principe                  24                10.12.93
Senegal - Senegal                            911                31.05.93
Seychelles                                     2                10.12.93
Sierra Leone                                  95                07.07.93
Somalia - Somalie                             13                01.01.91
South Africa -
        Afrique du Sud                     1,803                01.02.93
Sudan - Soudan                               834                03.11.93
Swaziland                                    248                19.01.93
Togo                                       2,381                10.12.93
Tunisia - Tunisie                            136                21.05.93
Uganda - Ouganda                          34,611                01.11.92
United Republic of Tanzania -
        Republique-Unie de
        Tanzanie                          38,719                07.01.93
Zaire - Zaire                             21,008                10.06.93
Zambia - Zambie                         2  9,734                20.10.93
Zimbabwe                                  25,332                30.09.93

TOTAL                                    301,861


AMERICAS - AMERIQUES

Anguilla                                       5                30.09.93
Antigua and Barbuda -
        Antigua-et-Barbuda                    36                30.09.93
Argentina - Argentine                      2,767                30.06.93
Bahamas                                    1,329                30.09.93
Barbados - Barbade                           397                30.09.93
Belize                                        53                30.09.92
Bermuda - Bermudes                           223                30.06.93
Bolivia - Bolivie                             60                31.03.93
Brazil - Bresil                           43,455                02.10.93
British Virgin Islands -
        Iles Vierges
        britanniques                           6                30.09.93
Canada                                     8,640                30.09.93
Cayman Islands - Iles Caimanes                15                30.09.93
Chile - Chili                                805                30.09.93
Colombia - Colombie                        3,870                30.09.93
Costa Rica                                   525                30.09.93
Cuba                                         204                30.06.93
Dominica - Dominique                          12                30.06.90
Dominican Republic -
        Republique dominicaine             2,179                30.09.93
Ecuador - Equateur                           265                30.06.93
El Salvador                                  514                30.06.93
French Guiana -
        Guyane francaise                     232                30.09.90
Grenada - Grenade                             51                30.09.93
Guadeloupe                                   353                31.03.93
Guatemala                                    520                30.09.93
Guyana                                       359                31.03.93
Haiti - Haiti                              3,086                31.12.90
Honduras                                   2,865                30.06.93
Jamaica - Jamaique                           576                30.09.93
Martinique                                   266                30.09.93
Mexico - Mexique                          16,091                30.09.93
Montserrat                                     1                30.09.93
Netherlands Antilles and Aruba -
        Antilles neerlandaises et
        Aruba                                110                30.06.92
Nicaragua                                     51                30.09.93
Panama                                       582                30.09.93
Paraguay                                      62                30.09.93
Peru - Perou                                 883                30.06.93
Saint Kitts and Nevis -
        Saint-Kitts-et-Nevis                  39                30.09.93
Saint Lucia - Sainte-Lucie                    59                30.09.93
Saint Vincent and the
        Grenadines - Saint-
        Vincent-et-Grenadines                 54                30.09.93
Suriname                                     146                30.06.93
Trinidad and Tobago -
        Trinite-et-Tobago                  1,404                30.09.93
Turks and Caicos Islands -
        Iles Turques et
        Caiques                               39                30.09.93
United States of America -
        Etats-Unis d'Amerique            339,250                30.09.93
Uruguay                                      389                30.06.93
Venezuela                                  3,150                30.09.93

TOTAL                                    435,978


ASIA - ASIE

Afghanistan                                  ---                15.02.92
Armenia - Armenie                              2                30.04.93
Azerbaijan - Azerbaidjan                     ---                30.09.93
Bahrain - Bahrein                             11                04.05.93
Bangladesh                                     1                30.11.93
Bhutan - Bhoutan                             ---                30.11.93
Brunei Darussalam -
        Brunei Darussalam                      3                17.05.93
Cambodia - Cambodge                          ---                06.09.93
China(a) - Chine(a)                           14                07.08.93
Cyprus - Chypre                               28                03.11.93
Democratic People's Republic
        of Korea -  Republique
        populaire democratique
        de Coree                             ---                30.11.93
Georgia - Georgie                              2                30.04.93
Hong Kong                                     89                21.09.93
India - Inde                                 494                30.11.93
Indonesia - Indonesie                         42                30.11.93
Iran (Islamic Republic of) -
        Iran (Republique
        islamique d')                         73                28.08.93
Iraq                                          18                09.10.93
Israel - Israel                              253                30.09.93
Japan - Japon                                621                31.10.93
Jordan - Jordanie                             29                01.11.93
Kazakhstan                                   ---                30.09.93
Kuwait - Koweit                               10                10.08.93
Kyrgyzstan - Kirghizistan                    ---                30.04.93
Lao People's Democratic Republic -
        Republique democratique
        populaire lao                          3                10.09.93
Lebanon - Liban                               55                19.08.93
Macao                                          5                01.09.93
Malaysia - Malaisie                           90                05.10.93
Maldives                                     ---                30.11.93
Mongolia - Mongolie                          ---                30.11.93
Myanmar                                      133                30.11.93
Nepal - Nepal                                 24                30.11.93
Oman                                          31                05.11.93
Pakistan                                      37                01.11.93
Philippines                                  107                15.11.93
Qatar                                         34                31.01.93
Republic of Korea -
        Republique de Coree                   13                30.04.93
Saudi Arabia - Arabie saoudite                55                30.08.93
Singapore - Singapour                         60                26.08.93
Sri Lanka                                     33                30.11.93
Syrian Arab Republic -
        Republique arabe syrienne             23                22.08.93
Tajikistan - Tadjikistan                     ---                30.04.93
Thailand - Thailande                       3,001                30.11.93
Turkey - Turquie                             118                31.10.93
Turkmenistan - Turkmenistan                    1                30.04.93
United Arab Emirates - Emirats
        arabes unis                            8                12.02.93
Uzbekistan - Ouzbekistan                       2                30.06.93
Viet Nam                                      28                23.09.93
Yemen - Yemen                                  8                07.11.93

TOTAL                                      5,559



EUROPE

Albania - Albanie                            ---                30.09.93
Austria - Autriche                         1,087                30.11.93
Belarus - Belarus                             10                30.09.93
Belgium - Belgique                         1,486                30.09.93
Bulgaria - Bulgarie                           20                30.06.93
Croatia - Croatie                             53                30.06.93
Czech Republic(b) -
        Republique tcheque(b)                 46                30.09.93
Denmark - Danemark                         1,296                30.09.93
Estonia - Estonie                              2                30.06.93
Finland - Finlande                           141                30.09.93
France                                    26,970                30.09.93
Germany - Allemagne                       10,447                30.09.93
Greece - Grece                               845                30.09.93
Hungary - Hongrie                            139                30.09.93
Iceland - Islande                             29                30.09.93
Ireland - Irlande                            362                30.09.93
Italy - Italie                            18,832                30.09.93
Latvia - Lettonie                              4                30.06.93
Lithuania - Lituanie                           4                30.09.93
Luxembourg                                    70                30.09.93
Malta - Malte                                 29                30.09.93
Monaco                                        24                30.09.93
Netherlands - Pays-Bas                     2,783                30.09.93
Norway - Norvege                             349                30.11.93
Poland - Pologne                             156                30.11.93
Portugal                                   1,575                30.11.93
Republic of Moldova -
        Republique de Moldova                  4                30.09.93
Romania - Roumanie                         2,545                30.09.93
Russian Federation - Federation
        de Russie                            128                30.09.93
San Marino - Saint-Marin                       1                30.09.92
Slovak Republic(b) -
        Republique slovaque(b)                 6                30.09.93
Slovenia - Slovenie                           30                30.09.93
Spain - Espagne                           21,205                30.09.93
Sweden - Suede                               904                30.09.93
Switzerland - Suisse                       3,415                30.09.93
Ukraine                                       22                30.09.93
United Kingdom - Royaume-Uni               8,115                30.09.93
Yugoslavia(c) - Yougoslavie(c)               268                31.12.92

TOTAL                                    103,402



OCEANIA - OCEANIE

American Samoa - Samoa americaines           ---                31.08.93
Australia - Australie                      4,258                09.11.93
Cook Islands - Iles Cook                     ---                27.09.93
Fiji - Fidji                                   6                01.10.93
French Polynesia - Polynesie francaise        33                13.10.93
Guam                                          18                03.09.93
Kiribati                                     ---                02.07.93
Mariana Islands - Iles Mariannes               4                10.09.93
Marshall Islands - Iles Marshall               2                30.09.93
Micronesia (Federated States of) -
        Micronesie (Etats federes de)          2                09.09.93
Nauru                                        ---                26.08.93
New Caledonia and Dependencies -
        Nouvelle-Caledonie et
        Dependances                           31                29.09.93
New Zealand - Nouvelle-Zelande               413                30.09.93
Niue                                         ---                14.05.93
Palau                                          1                19.07.93
Papua New Guinea - Papouasie-
        Nouvelle-Guinee                       55                29.10.93
Samoa                                          1                23.04.93
Solomon Islands - Iles Salomon               ---                15.05.93
Tokelau                                      ---                20.09.93
Tonga                                          4                15.03.93
Tuvalu                                       ---                26.07.93
Vanuatu                                      ---                31.07.93
Wallis and Futuna Islands - Iles
        Wallis et Futuna                     ---                24.05.93

TOTAL                                      4,828


WORLD TOTAL -
        TOTAL MONDIAL                    851,628

(a) Does not include the Province of Taiwan which has reported 48 cases. --
A l'exclusion de la Province de Taiwan qui a notifie 48 cas.

(b) Previously reported under Czechoslovakia. -- Notifies anterieurement sous
Tchecoslovaquie.

(c) Refers to states/areas of the former Socialist Federal Republic of
 Yugoslavia
not otherwise listed separately. -- Concerne les Etats/territoires de
l'ancienne
Republique federale socialiste de Yougoslavie qui ne sont pas cites
separement.
------------------------------

End of HICNet Medical News Digest V07 Issue #11
***********************************************


---
Editor, HICNet Medical Newsletter
Internet: david@stat.com                 FAX: +1 (602) 451-1165
Bitnet  : ATW1H@ASUACAD


-------------------------------------------------------------------------------
