An outbreak of head lice infestation (pediculosis) occurred in elementary school children in Barrow County, Georgia, in January 1974. An investigation was initiated to define the magnitude of the outbreak, determine factors that contribute to transmission, and disseminate information on control. All elementary school children in the county were examined for head lice and answered a questionnaire. Fifty-three (3%) of 1,783 white pupils were infested, but none of the 500 black pupils was infested. Distribution of infestation in the white pupils was influenced by grade, bed-sharing, socioeconomic status, infestation of other family members, crowding in the home, and family size; distribution was not influenced by hair length or the sex of the pupil. Recommendations for control based on the results of the investigation included procedures for identifying and processing cases, distributing free pediculicides, continuing surveillance, educating school personnel and parents on how to control the parasite.

HUMAN RABIES in the United States decreased from 20-25 cases per year in the late 1940s to 1-3 cases a year in the early 1970s (1-4). This trend was influenced by a similar decline in the incidence of rabies in domestic animals after the introduction and widespread use of improved animal vaccines and the establishment of more effective animal control programs. During the same period, however, the incidence of wildlife rabies increased; it now accounts for most reported animal cases, and it has become the most serious source of exposure for man. Despite the decline in rabies in domestic animals, there is still a threat of the disease for man because of the great numbers of animal bites that continue to be reported (57). Medical management of persons bitten by animals includes specific antirabies treatment, about which a quick decision must be made. When the offending animal is available, quarantine or laboratory studies, or both, provide the obvious answer. However, frequently the animal is not immediately available, and usually the decision is to treat the patient. Since the treatment-whether vaccine alone or vaccine and hyperimmune serum-is not without hazards, the decision to treat is difficult for the physician.

PUBLIC HEALTH officials have long con¬ sidered refrigeration essential to the safe handling of perishable foods. In recent years the application of this time-honored procedure has been challenged by a rapidly expanding food industry specializing in the production of wrapped sandwiches. Sandwiches are pre¬ pared almost entirely by hand from a variety of perishable foods known to support bacterial growth. Following fabrication they are transported in panel trucks and displayed for sale on the shelves of filling stations, grocery stores, fruit stands, and similar establishments at ambient air temperatures. Previous investigation has shown that exposure frequently ranges up to 48 hours and may sometimes approach 96 hours from the time that the sandwich was made. Although one would expect numerous food poisoning outbreaks as a result of the industry's apparent disregard for acceptable food han¬ dling practices, very few are definitively re¬ ported in the literature (1-3). In addition, reported incidents have not increased in pro¬ portion to expanded production. In Georgia, only 1 of more than 60 manufacturers has ever come under suspicion in a reported foodborne outbreak. This recent episode involved a box lunch which contained two kinds of wrapped sandwiches in addition to several other items. Circumstances were such that neither the exact food nor the etiological agent could be specif¬ ically identified. However, if one chooses to review the food poisoning history of sandwiches in general, an entirely different impression is gained. Ac¬ cording to the Morbidity and Mortality Weekly Report published by the Public Health Service, between the years of 1951 and 1963 sandwiches of various kinds served as vehicles in 133 food¬ borne outbreaks involving approximately 5,947 persons. Almost without exception incriminated sandwiches were prepared by caterers or restaurateurs using ingredients of uncertain age and condition.ingredients which if consumed prior to being incorporated into sandwiches could have engendered food poisoning, as has been demonstrated on occasion (h, 5). Closer examination of the situation will reveal that practically all data adduced as favoring refrigeration of wrapped sandwiches are based upon experiments with various sandwich ingredients. Uniformly these ingredients have been divorced from an actual ecological situa¬ tion, sterilized by autoclaving, inoculated with a million or more food-poisoning organisms per gram, and held at incubation temperatures for several hours. Although such an approach unquestionably demonstrates the ability of these organisms to multiply rapidly in certain perish¬ able foods under ideal growth conditions, it would seem somewhat unrealistic. In the absence of a body of epidemiologic evidence condemnatory of wrapped sandwiches as causes of food poisoning despite a continuing effort to find such evidence, considerable doubt

(1) Communicable Disease Center: Morbidi-by and Mortality Weeklly Report 11: 112, Apr. 13, 1962. (2) Thatcher, P. S., and Montford, J.: Egg p:roducts as a source of sialmonellae in processed foods. Clanad J Public Health 53: 61-69 (1962). (3) Quist, K. D.: Salmonella in poultry as related to human health. U.S. Dept. of Agriculture, Report of National Plans Conference, November 1962, pp. 24-30. (4) Biester, H. E., and Schwarte, L. H.: Diseases of poultry. Ed. 4. Iowa State University Press, Ames, 1959, pp. 202-248. (5) Morehouse, L. G., and Wedman, E. E.: Salmonella and other disease-producing organisms in animal by-products. A survey. J Ameir Vet Med Assoc 139: 989-995 (1961). (6) Young, G. A.: Sipecific pathogen-free pigs. J Amer Vet Med Assoc 137: 561-562 (1960). (7) Chute, H. L.: Establishment ;of poultry diseasefree areas. U.S. Department o'f Agricultu:re, Report of National Plians Conference, November 1962, pp. 39-40.

SummaryOf 214 children with hookworm infection in Lowndes County, Georgia, 80 were treated with tetrachloroethylene, 95 with one, two, or three doses of bephenium, and 39 were not treated. Following treatment, percentage reductions in mean egg counts were approximately 99, 89, 84, 64 and 50, respectively; and percentages of children completely cleared were 81, 29, 30, 16 and 26, respectively. It was concluded that bephenium possessed some anthelmintic activity but that tetrachloroethylene was superior. Side effects were more commonly produced by the bephenium preparation than by the tetrachloroethylene.

spotted fever is unique among the arthropod-borne dis- eases of man now or formerly endemic in the southeastern United States in that no reservoir lhost other than the tick vector appears to be re- quired.Transovarian transmission occurs, and larvae, nymphs, and adults are all potentially capable of transmitting the infection.Presumably even the egg might infect if it were crushed on the unprotected skin.Nevertheless, extensive research on rickettsial spotted fever over many years has revealed no naturally infected animal in the United States.When the disease is experimentally transmitted to dogs and other mammals, the infection is frequently silent, and the only indication of inoculation is the develop-

SummaryOne case of human infection with Isospora belli and two with I. hominis are described from two counties in Georgia. All of the infections appear to have been acquired locally and two of them were apparently related to an infection in the family dog. Morphologically the species of Isospora found in the human cases was similar to that recovered from the dog, suggesting that two of the human infections might have originated from the dog. However, it is suggested that further investigation is needed to determine if humans can be infected with the Isospora obtained from dogs and if a common source of infection exists for both man and dogs. Since clinical symptoms subsided following the administration of bismuth salicylate in one of the cases, it is suggested that this drug may have value in controlling symptomatic Isospora infection in man.