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ISSN 1188-4169
Canada Communicable
Disease Report
Date of publication: 1 May 1992
Releve des maladies
transmissibles au Canada
Date de publication: 1 mai 1992
Vol. 18--8
Contenu du present numero:
Contained In this Issue:
Hospital Outbreak of Salmonella enteriditis Infection - Ontario
Cholera Associated with an International Airline Fligh~ 1992
Notifiable Diseases Summary . . . . . . . .
Increase in Invasive Meningococcal Disease, 1991-1992 New Zealand . . . . . . . . . . . .
Announcements . . . . . . . . . . . .
57
60
61
63
64
HOSPITAL OUTBREAK OF SALMONELLA ENTERIDITIS
INFECTION-ONTARIO
Flambee d'infectton aSalmonella enteriditis dans un hOpital de !'Ontario .
Cas de cholera lies un vol international en 1992 . . . . . . . .
Sommaire des maladies adeclara~on obligatoire . . . . . . . .
Augmentation du nombre de cas de meningococcie invasive, 1991-1992Nouvelle-Zelande . . . . . . . . . . . . . . . . .
Annonces
. . . . . .
. . . . . .
57
a
60
61
63
64
FLAMBEE D'INFECTION ASALMONELLA ENTERIDITIS DANS UN
H6PITAL DE L'ONTARIO
Between 18 September, 1991 and25 February, 1992, 95
laboratory-confinned cases of infection with Salmonella enJeriditis,
phage type 13, occurred among patients and staff of a regional health
centre in southern Ontario (Figure 1). This report summarizes the
results of the outbreak investigation.
Entre le 18 septembre 1991 et le 25 fevrier 1992, 95 cas confirrnes en
laboratoire d'infection a Salmonella enJeriditis, lysotype 13, se sont declares
parmi !es patients et le personnel d'un centre de sante regional du sud de
!'Ontario (figure 1). Le present rapport resume !es resultats de l'enquete
concemant cette flam bee.
The outbreak consisted of two phases. The first phase occurred
between 18 September and 14 October, 1991, and involved 38 cases.
Case symptoms included diarrhea, nausea and abdominal cramps.
Although 3 fatalities occurred among cases, none of the deaths were
directly attributable to Salmonella infection. Water, ice, food
specimens and environmental swabs obtained from the hospital
kitchen were culture negative for S. enteriditis. No foodhandler was
identified as the cause of the outbreak. Health inspectors identified
several poor foodhandling practices in the kitchen and appropriate
corrective measures were instituted. No further cases occurred until
November.
La flambee s'est produite en deux phases. Au cours de la premiere phase,
qui debute le 18 septembre et prend fin le 14 octobre 1991, 38 cas sont
signales. Les sujets atteints se plaignenl de diarrhee, de nausees et de crampes
abdominales. Trois deces sont signales parmi !es cas recenses, mais aucun
n 'est directement atiribuable a I'infection aSalmonella. L' analyse
d. echantillons d. eau, de glace et d. aliments et d. echantillons preleves par
ecouvillonnage dans la cuisine de l'hOpilal est negative pours. enteriditis.
Aucun des manipulateurs n'est reconnu comme etant a l'origine de la flambee.
Les inspecteurs hygienistes mettent ajour plusieurs mauvaises pratiques de
manipulation dans la cuisine et font appliquer les mesures correctives
appropriees. Aucun nouveau cas n' est signale jusqu 'en novembre.
The second phase of this outbreak began 19 November, 1991, and
involved 57 cases. Cases again had symptoms of diarrhea, nausea and
abdominal cramps. Five fatalities occurr-ed among cases during this
phase but none was directly attributable to Salmonella infection.
Again, no foodhandler was found to be the source of the outbreak.
Au cours de la seconde phase de la flambee, qui debute le 19 novembre, 57
cas sont recenses. Les personnes touchees presentent les memes symptomes
que precedemment: diarrhee, nausees et crampes abdominales. Aucun des cinq
deces signales ne peut etre directement rattache aI'infection aSalmonella.
Cette fois encore, les manipulateurs ne sont pas consideres comme etant a
l'origine de la flambee.
On 15 January, 1992, S. enJeriditis, phage type 13, was identified
in a sample of minced ham. Minced ham was prepared by grinding
fully cooked, deboned ham in a vertical food mixer. The mixer was
also used to prepare other sandwich fillings and to blend raw shelled
eggs that were used in custard and French toast. S. enleriditis, phage
type 13, was subsequently identified in samples of uncooked custard,
minced beef, turkey and tuna sandwiches that had been prepared in
the vertical mixer.
Le 15 janvier 1992, S. enJeriditis, lysotype 13, est isole clans un echantillon
de hachis de jambon. Un robot culinaire a ete utilise pour transformer du
jambon cuit desosse en hachis de jambon. Cet appareil a egalement servi a
preparer d. autres gamitures a sandwiches et a melanger les oeufs crus entrant
dans la fabrication de creme patissiere et de pain dore. s. enteriditis, lysotype
13, est decouvert par la suite dans des echantillons de creme patissiere non
cuite, de hachis de boeuf et de gamitures pour sandwiches a la dinde et au thon
prepares a !'aide du meme appareil.
A case-control study was conducted in which 15 persons with S.
enteriditis, phage type 13, infection were each matched by hospital
ward to 2 people who had not had positive S. enJeriditis cultures.
Dans le cadre d'une etude cas-temoin, chacun des membres d'un groupe de
15 sujets presentant une infection aS. enJeriditis, lysotype 13, est apparie par
le personnel de l 'hOpital a2 sujets trouves negatifs a I' egard des. enJeriditis.
Cette etude revele que la consommation de sandwiches prepares a I' aide du
robot culinaire presente un risque relatif eleve (risque relatif, 4; intervale de
confiance a95 %, 0,69-25), mais non significatif.
Consumption of sandwich types prepared in the vertical mixer had an
elevated odds ratio, (odds ratio, 4; 95% confidence interval, 0.69-25)
but was not significant.
I SOcond Oau Mal Roglshat'on No.
l "'*-1
""I'"
5670
Health and Welfare
Canada
I
Santo et Bien-lltre social
Canada
57
I Cour~or do lo dw>!Oma cklDO • EmJQ11ham0<1I n• 6670 I
l+I
C anada
Figure 1
Epidemic Curve:
HospItal Outbreak of
Salmonella enterlditls,
Ontario, September 1991
to February 1992
1" phase
1'" phase
Figure 1
Courbe epldemlologlque :
flambee d'lnfectlon a
Salmonella enterldltls dans
un hOpltal de !'Ontario
septembre 1991 afevder
1992
2•d phase
2•m• phase
15-.
en en
Q)
~Contact
Cl!
gi u
u Q)
c;-010-·
Visitor
Visiteur
Q; ~
•
EE
Employee
D Staff
.D .D
:J
0
zZ
~Patient
Week ending/Semaine se terminant
A swab taken from the shaft of the mixer blades on 15 January
and a sample of rinse water from the mixer bowl were both positive
for S. enteriditis, phage type 13. The shaft of the mixer blade had a
hollow core that was difficult to clean and disinfect. The mix.er was
removed from service on 15 January, 1992. A swab taken 24
January from material found on the base of the mix.er was also
positive for S. enteriditis, phage type 13. All other water, ice and
food samples and environmental swabs were negative for S.
enteriditis. Five other Salmonella serotypes were isolated from raw
poultry.
Un echantillon preleve par ecouvillonnage le 15 janvier sur le corps du
couteau du robot culinaire et un echantillon d'eau de rinyage provenant du
bol du meme appareil sont trouves positifs pour S. enteriditis, Iysotype 13.
Le corps du couteau est creux et difficile anettoyer et adesinfecter. On
cesse d'utiliser le robot culinaire le 15 janvier 1992. Un echantillon de
matiere preleve par ecouvillonnage le 24 janvier sur la base de l'appareil
est egalement trouve positif pour S. enteriditis, lysotype 13. Tous Jes autres
echantillons d'eau, de glace et d'alirnents et tousles echantillons preleves
par ecouvillonnage dans le milieu sont negatifs pour S. enteriditis. Cinq
autres serotypes de Salmonella sont isoles apartir d'echantillons de volaille
crue.
There was a dramatic reduction in the number of new cases of
S. enteriditis infection after use of the mixer was discontinued on
15 January. All cases with onset dates after 15 January could be
attributed to either in-hospital exposure prior to that date or
person-to-person spread.
Une reduction spectaculaire du nombre de nouveaux cas d'infection aS.
enleriditis est observee apres le 15 janvier 1992, date a laquelle on cesse
d 'utiliser le robot culinaire. Tous les cas qui se declarent par la suite sont
attribuables aune infection nosocomiale survenue avant cette date ou aune
transmission de personne apersonne.
Although the primary source of contamination of the mixer
could not be determined, the fact that raw eggs were beaten in the
mixer and the finding of yellow material resembling egg on its base
suggests that eggs may have been the original source of this
organism. In the United States and Britain, numerous outbreaks of
S. enteriditis infection have been linked to the consumption of
eggsCl,2,3,4.S>.
La source initiale de la contamination du robot n' a pas ete determinee,
mais le fait qu' on ait utilise cet appareil pour battre des oeufs crus et qu 'on
ait ensuite trouve sur la base du robot une matiere jaune ressemblant adu
jaune d'oeuf laisse croire que Jes oeufs auraient pu etre la source de la
contamination. Aux Etats-Unis et en Angleterre, de nombreuses flambees
d 'infection as. enteriditis ont ete associees ala consommation
d 'oeufsCl,2,3,4.Sl.
This outbreak emphasizes the need for thorough cleaning and
disinfection of equipment used in institutional kitchens, and
suggests that increased efforts may be required to alert foodhandlers
to the potential hazards associated with the use of whole fresh eggs
in institutions.
Cette flambee demontre aquel point il est important de nettoyer et de
desinfecter soigneusement !es appareils culinaires utilises dans !es
etablissements et fait ressortir le besoin de sensibiliser davantage Jes
manipulateurs d' aliments travaillant dans ces etablissements aux risques
potentiels qui se rattachent aI 'utilisation d' oeufs frais entiers.
Comment
Commentalres
S. enteritidis has become the most commonly reported
Salmonella serotype in the United States and Great BritainC406>. In
Canada, laboratory reports of human isolates of S. enteritidis have
increased since 1984 (Figure 2) (H. Lior, National Laboratory for
Enteric Pathogens, LCDC: personal communication, 1992). S.
enteritidis accounted for 12.4% of all human Salmonella isolates
reported in Canada in 1991 and was the second most commonly
reported Salmonella serotype.
S. enteriditis est devenu le serotype de Salmonella le plus courarnment
signale aux Etats-Unis et en AngleterreC4·6>. Au Canada, le nombre d'isolats
humains de S. enJeriditis signales par Jes laboratoires s 'est accru depuis
1984 (figure 2) (H. Lior, Laboratoire national pour les pathogenes
enteriques, LLCM: communication personnelle, 1992). Le nombre d'isolats
de S. enJeriditis representait 12,4 % de tous !es isolats humains de
Salmonella signales au Canada en 1991 et le deuxieme serotype de
Salmonella en importance.
58
Flgure2
Salmonella enterltldls:
Laboratory Isolates, Canada,
1979·1991
Figure 2
Salmonella enterltldls :
lsolats de laboratolre,
Canada, 1979-1991
1,200-
l:rn Number/Nombre
~%
-14
Vl
Vl
(ii
Q) -
(ii 0
-
0
Vl
~­
Vl "'O
: : Q)
0
...
.0
oE
zo
z
0
Year I Annee
Numerous large and small outbreaks have been attributed to the
consumption of S. enJeritidis contaminated eggs or egg products in
the United States and Great Britain<1•2•3•4•5>. Considerable publicity
has surrounded attempts to eliminate this serotype from egg-laying
flocks.
De nombreuses flambees importantes ou de faible envergure ont ete
attribuees ala consommation d 'oeufs OU de produits abase d' oeufs
contarnines par S. enJeriditis aux Etats-Unis et en Angleterren.2•3•4.s>. Une
publicite importante a entoure Jes initiatives visant aeliminer ce serotype
des bandes de poules pondeuses.
The evidence supporting eggs as the initial source of the
outbreak in this institution is circumstantial, but credible. The only
uncooked foods processed in the mixer were whole, fresh eggs, and
cabbage. Other potential common sources of Salmonella, such as
poultry, were not processed in the mixer. The raw chicken sampled
during the outbreak grew 5 Salmonella serotypes but no S.
enJeritidis. Various sandwich fillings that had been prepared in the
mixer during the days following the mixing of eggs were found to
be contaminated. While the case-control study was too small to
obtain a statistically significant result, the increased risk associated
with sandwich consumption was sufficient to demand attention if S.
enJeritidis had not been isolated. Identification of the organism on
the base of the mixer 9 days after it was removed from service
suggests that a single batch of egg mixture could have been the
initial and probably continuing source of infection.
Les preuves associant les oeufs ala contamination survenue dans cet
etablissement sont circonstancielles, mais credibles. Mis apart le chou, !es
oeufs frais entiers ont ete les seuls aliments crus qui ont ete transformes a
I' aide du robot culinaire. On n' a pas utilise cet appareil pour la
transformation d' autres sources potentielles frequentes de contamination par
Salmonella, par exemple, la volaille. Les echantillons de poulet cru preleves
durant la flambee contenaient cinq serotypes de Salmonella, mais non S.
enJeriditis. Diverses garnitures pour sandwiches preparees a!'aide du robot
dans les jours qui ont suivi le melange des oeufs ont ete trouvees
contaminees. Si l'etude cas-temoin n'avait pas l'envergure voulue pour
fournir des resultats statistiquement significatifs, la hausse du risque
associee ala consommation des sandwiches etait suffisarnment importante
pour qu'on examine le probJeme de plus pres et ce, meme si S. enJeriditis
n'avait pas ete isole. La decouverte de l'organisme sur la base du robot neuf
jours apres qu 'on ait cesse d'utiliser 1'appareil laisse croire qu 'un seul lot de
garniture aux oeufs a ete la source initiale de la contamination et est
probablement al 'origine des cas qui se sont declares par la suite.
Serving raw unpasteurized shell eggs in eggnog or protein
supplement drinks was associated with large Salmonella outbreaks
occurring in some institutions in the 1970sC7l, As a result, most
institutions, including the hospital reported in this article, do not
serve raw unpasteurized eggs. However, cooked shell eggs are
served by many institutions, including this hospital kitchen. This
outbreak serves as an important reminder of the possibility of cross
contamination occurring in institutional kitchens when raw and
ready-to-eat foods are prepared in the same machine.
La consommation d'oeufs crus non pasteurises sous forme de lait de
poule OU de supplements proteines a ete associee ad'importantes flambees
d'infection aSalmonella survenues dans des etablissements en 1970m.
Depuis, la plupart des etablissements, y compris l 'hopital mentionne dans le
present article, ont decide de ne plus servir d' oeufs crus non pasteurises. De
nombreux etablissements, notamment L'hopital en cause, continuent
cependant d'offrir des oeufs cuits au menu. Cette flambee nous rappelle de
fayon dramatique qu 'une contamination croisee peut survenir dans Jes
cuisines d'etablissements ou !'on prepare des aliments crus et des aliments
prets-a-manger a I' aided 'un seul et meme appareil.
59
References
1. Cowden JM, Chisholm D, O'Mahony M, et al. Two outbreaks
R6f6rences
1. Cowden JM, Chisholm D, O'Mahony M, et coll. Two outbreaks qf
Salmonella enteritljtis. ohage ~oe 4 infection associated with the
consffiftfon ~(fresh shell-egg oraducts. Epidemic! Infect
1989,1 3.47- 2.
2. Coyle EF, Palmer SR, Ribeiro CD, et coll. Salmonella enteriditis phage
4 infection· association with hens' e.ggs. Lancet 1988;2: 1295-96.
ofSalmonella enteritidis, phage type 4 infection associated
with the consumption offresh shell-egg products. Epidemic!
Infect 1989;103:47-52.
2. Coyle EF, Palmer SR, Ribeiro CD, et al. Salmonella enteritidis
phag~ ~ infection: association with hens' eggs. Lancet
1988,2.1295-96.
3. Lin FYC, Morris JG, Trump D, et al. Investigation ofan
outbreak ofSalmonella enteritidis gastroenteritis associated
with consumption ofeggs in a restaurant chain in Maryland.
Am J Epidemiol 1988; 128:839-44.
4. CDC. Update: Salmonella enteritidis infections and shell eggs
- UnitedStates, 1990. MMWR 1990;39:909-12.
5. Cowden JM. Salmonellosis and eggs: 2ublic health, food
2oisoning, andfood hygiene. Current Upinion in Infectious
Diseases 1990;3:246-9.
6. Salmonella infections, En$land and Wales: laboratory reports
weeks 91132-15. Commurucable Disease Report
1991;1(36):162.
7. Steere AC, Creaven PJ, Hall WJIII, et al. Person-to-person
spread ofSalmonella typhimurium after a hospital
common-source outbreak. Lancet 1915;1:319.
Source: Field Epidemiology Division, Bureau ofCommunicable
Disease Epidemiology and the National Laboratory for
Enteric Pathogens, Bureau ofMicrobiology, LCDC,
Ottawa; Laboratory Services Branch and Disease
Control Service, Public Health Branch, Ontario Ministry
ofHealth, Toronto; Bruce-Grey-Owen Sound Health
Onit, Owen Sound, Ontario.
7. Steere AC, Creaven PJ, Hall WJ ill, et coll. Pe.rson-to-pe.rson spre.ad qf
Salmonella W7himurjum qfte.r a hospital convnon-source. outbreak.
Lancet 1975;1:319.
Source : Division de I' epidemiologie regionale, Bureau de I' epidemiologie
des maladies transmissibles et Laboratoire national pour les
pathogenes enteriq_ues, Bureau de microbiologie, I.LCM, Ottawa;
Direction des services de laboratoire et Service de lutte contre la
maladie, Direction de la sante publique, Ministere de la sante de
I' Ontario, Toronto; Service de sante Bruce-Grey-Owen Sound,
Owen Sound (Ontario).
lnternatlonal Notes
Notes lnternatlonales
CHOLERA ASSOCIATED WITH AN INTERNATIONAL
AIRLINE FLIGHT, 1992
r
3. Lin FYC, Morris JG, Trump D, et coll.=~:~~ o~~ =~~
Salmonella enteriditis gastroe.ntiritis
~
fn a ~estauranl chain in MarylanrJ. Am J Epidemiol
e.§f
1
a: :t
:Ji
o:s (
8,128.839-44.
4. CDC. Update: Salmonella enteridjtis infections and she.II e.ggs - Unite.d
State.s 1990. MMWR 1990;39:909-12.
5. Cowden JM. Sa/monellosis and e.ggs ·~Uc he.a/th food poisoning.
and food hniene. Current Opinion in ectious Diseases 1990;3:246-9.
6. Salmonella infections Enffnd and Wales: laboratory re.ports wee.ks
91132-35. Communicable isease Report 1991;1(36):162.
CAS DE CHOLERA LIES AUN VOL INTERNATIONAL EN 1992
On 19 February, 1992, the Los Angeles County Health
Department and the California Department of Health Services
received reports that Vibrio cholerae 01 had been isolated from
stool cultures of 5 persons with diarrhea who became ill after
travelling on the same international airline flight. The flight,
Aerolinas Argentinas flight 386, departed from Buenos Aires,
Argentina, on the afternoon of 14 February; stopped in Lima, Peru,
for passengers to disembark and board; and landed in Los Angeles
later that evening. On arrival in Los Angeles, the flight had 336
passengers and 20 crew members.
Le 19 fevrier 1992, le Los An~eles County Health Department et le
California Department of Healtb Seryjces ont re~u des rapports indiquant
que la souche Vibrio cholerae 01 avait ete isolee dans !es selles de 5
personnes souffrant de diarrhee qui avaient emprunte le meme vol
international. Le vol en question, le vol 386 d'Aerolinas Argentinas, avait
quitte Buenos Aires (Argentine) l' apres-midi du 14 fevrier, avait fait escale
aLima (Perou) pour debarquer et embarquer des voyageurs et etait
finalement arrive a Los Angeles en fin de soiree. Ason arrivee a Los
Angeles, le vol comptait 336 passagers et 20 membres d 'equipage.
As of 26 February, 31 persons on the flight had cultureconfirmed V. cholerae infection: 10 in Los Angeles County, 8 in
other parts of California, 9 in Nevada, 3 in Japan, and 1 in
Argentina; 1 person died. Fifty-four other passengers have reported
diarrheal illness.
Le 26 fevrier, 31 personnes qui etaient abord de ce vol presentaient une
infection aV. cholerae confirmee par une culture : 10 dans le Comte de Los
Angeles, 8 ad'autres endroits en Californie, 9 au Nevada, 3 au Japan et 1 en
Argentine. Une personne est decedee. Cinquante-quatre autres passagers ont
signale avoir souffert de diarrhee.
Studies to determine the mode of transmission and to
characterize the strains are in progress.
Des etudes sont en cours pour determiner le mode de transmission et
caracteriser Jes souches en cause.
Editorial Note: Until this outbreak, only 20 cases of cholera in
the United States had been related to the Latin American epidemic
that began in January 1991. This outbreak demonstrates that
clinicians should suspect cholera in persons with severe watery
diarrhea and that this suspicion should be increased in persons
returning from areas with choleraC1l. An outbreak of cholera in
Australia in 1972 was also associated with an international airline
Note de la redaction: Avant cette poussee, 20 cas seulement de
cho!era aux Etats-Unis avaient ete lies al'epidemie qui a debute enjanvier
1991 en Amerique latine. Cette poussee montre que Jes cliniciens doivent
soup~nner le cholera lorsqu 'une personne presente une diarrhee aqueuse
severe, et qu 'ils doivenl etre encore plus vigilants lorsque la personne
revient d'un pays ou le cholera est endemiqueO>. Une poussee de cholera en
Australie en 1972 a egalement eti liee a un vol internationaJ<2>.
fligh~2>.
Culture of rectal swabs on thiosulfate-citrate-bile salts-sucrose
(fCBS) medium should be requested for any patient suspected to
have cholera. Patients with cholera have substantial ongoing fluid
losses that need to be replaced; frequent monitoring is necessary to
ensure that hydration is adequate. All but severely dehydrated
persons can be managed with oral rehydration solution (ORS)<!>. If
II faut demander une culture d' ecouvillons rectaux sur milieu
thiosulfate-citrate-sels biliaires-sucrose (TCBS) lorsqu'on soup~nne le
cholera chez un malade. Les malades souffrant du cholera perdent une
quantite importante de liquide qui doit etre remplacee, et ii faut Jes garder en
etroite surveillance pour verifier que l 'hydratation est adequate.
L'administration d'une solution de rehydratation par voie orale (SRO) suffit
Suite a la page 63
Continued on page 63
60
HEALTH AND WELFARE CANADA - SANTE ET BIEN-~TRE SOCIAL CANADA
Notifiable Diseases Summary · Sommaire des maladies adeclaration obligatoire
New Cases Reported for the Month (Mo) Ending 30 September 1991 - Nouveaux cas declares pour le mois se terminant le 30 6eptembre 1991
Disease
Maladle
AIDS·Slda
Amoeblasls • Arriblase
Botulsm · Botuisme
Brucellosis • Brucelose
Ca11'17fiobaeler1osls ·
C8Jllll'lobact6riose
Chanaold • Cha'!Cre rrou
Chickerpox • Vll'lceile
Chlatl!fdla, genital •
ChiaJTl{<lose g6nltale
Cholera· Cholllra
Diphtheria • Dipht6rie
Glardlasls • Glll'dase
Gonocoocal lnfecdons •
Infections gonococdqueslq
Gonococcal ~thalrria neonatorum.
~talrrle gonococdque du nouveau-116
Haemophlus lnfkJenzae B (all Invasive) •
Qnvaslve) aH. lnftuenzae Bl~
Hepatitis A · H6pattte A
Hepatitis B . H6paUle B
Hepatitis C • H6pattte C
Hepatitis non-A, non-8 •
H6pathe non-A. non-B
Hepatitis unspecified viral •
H6patlte ¥1rale, sans prlldslon
Herpes Slrrplex (oongenltalhleonatal) ·
Herp6s (congllrlltalh16onatal)
Leglooolosls • Leglonelose
Leprosy • Lbpre
Usterlosls (all types) •
Ust6riose (tous genres)
Malaria. Paludisme
Measles • Rougeole
Merlnglt!s, pneumococcal •
Mllrllnglte ii pneumocoques
Menlnghls, other bacterial
Autres m6nlnglles bact6rlemes"'''
Merlng111S/Encephal1Us viral •
MAnlnglle/enc&phallle viral~
Merlngococcal lnfecdons •
Infections a rnllrlngocoques
Mlmps • Orelllons
Paratyphoid • ParatyphoTde
Penussls • Coquelud'ie
Plague • Pesle
Pollorrtfelitls • Pollorrtf6llle
Rat:Aes ·Rage
Rubella · Rub6ole
Congenital Rubella • Rub6ole cong6nltale
Salmonellosls • Saimonellose"
stigellosls • Shlgellose
Syphilis:
Eariy, Symptoma11c •
Symptoma11que, r6cente
Other Syphilis • Aures sypiills
TetalllS • T6tanos
Tricllinosls · Tricllinose
Tuberwlosls • Tuberwose
Typhoid· TyphoTde
Verotoxigenic E. coll •
E. col v6ro1oxinogbnes
Yellow Fever • R6vre jaune
ICD-9
CIM-9
042·044
006
005.1
023
Canada
Mo
Mois
Cum.
91
Cum.
90
42
118
689
1287
5
9
8360
819
1537
3
14
8971
-
999
008.41"
099.0
052
099.81"
001
032
007.1
NeWfoundland
Terre-Neuve
2
1
562 10182 17333
1905 25366 27094
-1
819
871
2
1
5
5953 6336
9337 10631
Cum.
91
Cum.
90
Mo
Mols
Cum.
91
Cum.
90
Mo
Mols
Cum.
91
Cum.
90
1
1
2
5
3
78
-
12
10
-
49
11
11
82
-3
-
41
216
-
145
12
-
-
-
-
-
-
-7
-
4
-
-
105
-
402
221
1300
-
-
-
14
1
184
19
24
33
098
098.4
320.0,038.41"
070.0,070.1
070.2,070.3
027.0,771.22'
084
055
091
090,092-097
037
124
010·018
002.0
008.01"
060
-
54
-
-2
218
-
-
211
1590
830
1389
-
-
-
-
-
2
6
14
8
17
38
118
228
95
240
-
-
Mo
Cou.
Cum.
91
Cum.
90
13
7
31
-
-
..
182
92
41 1
95
3
Cum.
91
-
4
168
-
82
317
..
-
-
-
-
-
84
63
27
49
..
-
-
-
-
-
-
-
-
-
-
11
210
298
1
6
6
-
-
2
-
2
3
1
3
2
173
156
8
1586
3135
16
14
1412
3132
-
5
6
4
5
-
-
1
1
134
-
-
-
-
76
530
10
-
-
-
-
1
-
9
3
59
22
-
-
71
14
19
-
-
49
194
3
547
5561
79
351
504
84
-
3
1
3
-
8
64
215
-
66
210
190
1
11
270
312
-
22
283
17
1650
317
4
228
-
5
436
13
5877
2
-
-
-
-
1
-
3
2
34
5
48
-
-
-
-
1
-
-
-2
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1
48
-
-2
-
-
1
15
1
5
6
-
-
-
-
1
1
10
3
20
-
-
-
-
-
117
1
87
2
-
269
214
-
-
-
89
1
645
2
11
784
66
575
-
-
-
135
899
2
11
820
42
666
-
12
2
5
-
-
-
-
-
3
-
2
11
-
-4
21
-
-
-
-
57
3
-
-
-
-
1
1
-
-
-
-
12
-
-
-
-
-
-
-
40
-
-3
-2
-
-
-
187
4
251
12
14
5
-
-
-
-
-
5
3
19
-2
-
127
5
284
46
5
13
1
2
1
8
6
-
-
2
-
-
-
18
-1
-
-
-
-
-
-
-
1
-
6
1
-
-
9
17
-2
-8
•r -
-
..
36
1
503
-
-
10
29
3
267
-
-
11
93
-
1
-
..
90
-
9
17
-
-
11
5
-
27
3
-
..
-
2
9
181
1649
23
2
-
255
959
..
..
..
..
..
..
-
4
-
105
..
7
-
60
..
..
..
..
..
3
4
3
1
10
6
-
95
2
-
1
3
..
..
..
..
..
..
..
..
..
..
15
-
..
..
31
..
-
-
..
..
-
-
..
-
-
491
1446
12
1
73
-
-
269
796
1
5
7
-
-
6503 11571
7
-
-
-
-
-
-
1594
..
..
3
1
1031
..
1
3
-
-
1
1
-
3
89
1
21
7
3
51
2
11
19
1
2
6
-
765
75
-
-
-
322
1
6848
1273
49
-
1
2
1
-
3
5864
882
-
-
..
5
1
-
-
..
..
..
..
-
-
..
..
3
-
..
..
-
105
2
320.1
036
072
002.1-002.9
033
020
045
071
056
771.0
003
004
18
-
Quebec
Ou6bec
Cum.
90
Mo
Mols
-
771.21"
482.41
030
New Bnllswlck
Nowea11-8rlXlSWlck
Nova Scotts
Nowelle-~cosse
Mo
Mols
lndldes al 098 calogcries excepl 098.4
Includes boccal celUils a epiglollias 464.3 in a dild <5 years wilh no oher causative crgansms isolated
lrdides en<:ePialilis
Al olhor calogo1ies except Haemophius 320.2, Usteriosis 027.0, Meringococcal 036, Pneunoooccal 320.1
and Tlb«oJools 013.0
(5) Al categories excepl Measles 055, M11nps 072. Poiomye~as 045, RubeDa 056 and Yellow Fever 060
t6) Excludes Typhad 002.0 and Paratyphad 002.1lo002.9
• ICD·9 oodes used in lhe list may be incompete. Al 5 digit codes are l.Wlofficial and
are br LCOC suveilance purposes ooly.
t I.Uy not represent national total if dala ~om he povinces are incxmpele.
(1)
(2)
13)
(4)
Prince Edward Island
he-du-Prince-~douard
-
-
-
26
50
28
79
-
-
31
3
749
168
2
93
1609
336
18
27
77
122
-
-
-
1
-
-
5
-
11) Compood biles les nbriques 098, sauf 098,4
12) Compood celluite buccale ou llplglottite 464,3 chez un oofanl <5 '"'' dlez ql.i aue1Jn au~e microorganism• causal n'a 616 isol6
13) Compood enc6phalito
(4) Toules les autres rubriques sauf ii Haemoplilus 320.2. istllriose 027.0, ii m6ringocoques 006, A
pneumoc<XtlJes 320,1 et IUb.,.ruleuse 013,0
15) Toules les rubriques, sauf rougeole 055, oreilons 072. poiomylilile 045, rubl>cle 056 et fi9v!e jaune 060
(6) Saul typho!de 002,0 el paratypho!de 002,1 ii 002.9
• Les oodes de la CIM·9 figl.fanl dans la lisle ne son! peut-he pas pompets. Quant aux oodes l 5
chiffres, is ne soot pas offiaels, ayant 618 etabis l.fiquomenl aux fins de la surveilanc:e du LLCM.
t Use pool que c:e difie ne repr6senle pas lo total national si les donnhes povenanl das povinces son! incxmpleles.
61
Notifiable Diseases Summary (Concluded) - Sommaira des maladies adeclaration obligatoira (fin)
New Month (Mo) Ending 30 September 1991 - Periode sa terminant la 30 saptembre 1991
Disease
Maladle
IC0.9
CIM-9
Ontatlo
Mo
Mols
AIDS-Sida
Amooblasls - Arriblase
Botulsm - Botulsma
Brucellosis - Q-ucelose
Ca"ll'flobatterlosls Carrpy1obatt6rlose
Chana-old - Chancre mou
Chlcke~x - Varlcelle
ChlamJdla. genhal Chlamydlose g4nltale
Cholera - Choll)ra
Dlph1heria - Dlpht6rie
Glardlasls - Glardlase
Gonococcal Infections ln1ections gonococdques'~
Gonoooccal Clpllhalrrla neonatorum Ophtalrrle gonococdq.ie du notNeau-l'MI
Haemopilus 1nnienzae B (all Invasive) (Invasive) aH. lnfuenzae e<•
Hepatitis A - H6patite A
Hepatitis B - H6patita B
Hepatitis C - H6patlte C
Hepatitis non-A, non-B H6patite non-A, non-B
Hepatitis unspecified viral H6patite vlrale, sans JJ'8dslon
Herpes Sl~ex (congenital/neonatal) H~s (oong6nlt~onatal)
leglonellosls - leglonelose
l&JJ'OSy - l6JJ'8
Usterlosls (all types) Ust6riose (tous g811'es)
Malaria - Paludlsma
Measles - Rougeole
Meningitis, JJ'l&Umocoo:al M6nlnglte a JJ'l&Umocoques
MerlngiUs, other bacterial
Autres m6nlngltes battllliemeS'~
Menlngltis/Encepialitis viral •
M6nlngite/enoopiallte vlrale~
Menlngococcal ln1ections Infections a mllnlngoco<1Jes
Mumps - Orelllons
Para1yphold - Paratypiotde
Pei1USsls - Coqueluche
Plague - Paste
PollOITTf&lltls - PollOITTf61lte
Ral:ies - Rage
Rubella - Rub6ole
Congerltal Rlilella - Rub6ole cong6nitale
Salmonellosls - Salmooellose<•
Shlgellosls - Shlgellose
Syplills:
Eariy, Sy~omallcSymptomatique, rk:ente
Other Sypillls - Autres sylitllls
Tetanus - T4tanos
Trichinosis - Trichlnose
Tuberrulosls - Tubera.fose
TYi:llold - Typio!de
Verotoxlgenlc E. coll E. coll v6rotoxlnogllnes
Yellow Fever - R6vre Jaune
SYMBOLS
. Not reportable
.. No1 available
_ No cases reported
042-044
006
005.1
023
-
54
-
-
582
008.41'
099.0
052
-
Cum. Cum.
91
90
-
336
401
Saskatchewan
Mo Cum. Cum.
Mols
91
90
Mo Cum.
Mols
91
Cum.
90
9
4
43
7
45
-
-
-
201
575
166
844
2
6
17
28
4
41
-
-
-
-
-
- - 364 3414
-
3
4
4299 4473
2
-
-
979 10923 10780
099.81'
001
032
007.1
Manitoba
·-
3354
-
183
-
-
47 672
215 2189
320.0,038.41'
070.0,070.1
070.2,070.3
771 .21'
482.41
030
027.0,771.22'
084
055
091
090,092-097
037
124
010-018
002.0
008.01'
060
1320
-1
690
604
223
- -
19
-
-
673
-
-
-
-
-
15
32
2
6
227
31
12
184
-
-
-
-
-
-
81
-
13
9
86
67
597
1304
316
496
8
5
68
35
49
24
-
13
28
-
-
-
-
7
82
-
-
-
-
-
-
-
-
-
-
-
8
3
37
16
5
1
-
-
-
-
1
-
44
10
19
- - 3
- - -
-
-
38
104
1
283
5321
26
195
257
32
2
8
-
4
3
4
4
7
2
-
22
178
51
103
29
9
103
129
10
3
70
117
12
484
92
12
577
- 3
77
421 2605
-
-
-
11
1
-
-
-
-3
-
25
-
-
420 7646 11896
590
-
-
-1
42
-
59
97
-
92
858
5
-
65
90
957
-
-
68
115
128
-
Mo
Mols
9
14
-
320.1
036
072
002.1-002.9
033
020
045
071
056
771.0
003
004
227
- - - - 44353 468
098
098.4
-
Bl1tlsh Colurrtla
ColorrtleBl1timlque
Mo Cum. Cum.
Mols
91
90
-
1
2
2491 2701
4404 4850
1
-
32
Alberta
-
1
1
141 817
115 1035
-
Cum. Cum.
91
90
192
418
34
-
Yukon
140
408
-
3
1630 1416
-
-
-
-
1
-
-
-
3
36
47
-
24
16
10
12
m
217
82
-
231
604
1
450
730
-
34
60
1
14
-
-
89
- -
69
405
-
-
-
-
1
1
-
2
1472 1538
1010 1139
-
-
-
-
-1
-
24
16
15
18
17
11
8
2
2
194
57
26
95
79
36
11
4
8
1
-
-
2
1
24
46
-
1
-
1
9
5
2
5
4
- 278- . 252
314
- - - 11
41 33
66
90
32
215
-
-
-
-
1
1
6
11
1
-
1
21
4
1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
87
-
1
95
-
-
-
-
-1
-
1
-
-
-
-
340
1
1
3
13
16
-
4
2
-
-
-
-
2
1
2
14
12
-
16
23
3
15
48
4
23
30
-
1
3
-
10
25
-
9
10
-
3
7
-
18
27
2
22
17
-
-
3
4
1
1
52
2
3
5
11
6
77
95
1
1
-9
62
-
-
41
1
87
46
-
3
1
25
-
-
-
-
37
-
-
-
-
-
-
-
1
101
-
-
-
-
247
5
-
-
46
-
-
79
-
598 4303
38
53
2
-
153
-
-
24
5
149
27
260
27
29
11
375
84
241
186
66
5
611
63
608
83
146
15
896
152
16
220
145
-
-
2
5
8
-
2
17
-
10
9
66
723
1
577
1
3
13
7
30
70
692
23
401
578
46
533
75
4
42
-
1
1
-
10
77
4
49
-
1
5
11
2
14
15
-
35
4
76
-
47
1
6
-
13
1
59
-
-
27
-
-
-
-
-
-
-
-
-
-
-
SIGN ES
_ 'A declaration non obligatoire
.. Non disponible
Aucun cas declares
28
50
6
4
1
-9
14
2656
404
-
-
-
-1
3
376
-
-
-
6
38
-
-
Mo Cum. Cum.
Mols
91
90
3
66
1
758
172
-
7
-
-
-
-
-8
-
-
-
-
-
-
94
-
7
1
1
2
20
158
-
-
-
-
242
107
-
-3
21
1
889
949
105
Mo Cum. Cum.
Mols
91
90
-
871 1536
-
Nor1hwest Territories
Territolres du Nord-ouest
-
-
-
-
-
-
-
-
6
-
-
48
4
- -
-
-
-6
-
-
6
-
1
-
-
-
28
-
8
2
10
2
1
-
-
-
-
-
-
-
6
7
-
-
6
7
-
-
- - 1
-2 19- 27- - - 1
- - - 151 156
- - 30 172
- - -
-
SOURCE:
SOURCE:
Disease Surveillance Division
Labora1ory Centre for Disease Control
Health and Welfare Canada
Ottawa, Ontario K1A OL2
Tel.: (613) 957-0334
Division de la surveillance des maladies transmissibles
Labora1oire de lutte contra la maladie
Santa et Bien-Aire social du Canada
Ottawa (Ontario) K1 A OL2
Tel.: (613) 957-0334
62
26
Suite ck la page (J()
Continued from page (J()
a patient is severely dehydrated or if ORS is not available,
intravenous therapy with Ringer's lactate solution should be
administered. Antibiotics with demonstrated effectiveness in
reducing the duration of illness include doxycycline, tetracycline,
trimethoprim-sulfamethoxazole, and furazolidone. Because
secondary transmission in the United States is rare, prophylactic
antibiotic treatment of contacts is not advised. Household contacts
of persons with cholera should receive instructions about proper
handwashing and should seek medical care if they develop diarrhea
in the week following illness onset in the index patient. Public
health authorities should ensure that patients' feces are disposed of
through proper sewage treatment or a functioning septic tank.
habituellement, sauf chez Jes personnes gravement deshydratees(ll.
Lorsqu'un malade est gravement deshydrate ou qu'on ne dispose pas de
SRO, on doit adrninistrer une solution de lactate de Ringer par voie
intraveineuse. La doxycycline, la tetracycline, le trimethoprime/
sulfamethoxazole et la furazolidone sont des antibiotiques efficaces qui
reduisent la duree de la ma!adie. Etant donne que Jes cas de transmission
secondaire sont rares aux Etats-Unis, il n' est pas indique de prescrire un
traitement antibiotique prophylactique aux personnes qui sont entrees en
contact avec Jes malades. Les proches des personnes atteintes de cholera
doivent recevoir des instructions sur la fayon de se !aver Jes mains et
doivent consulter un medecin s'ils font une diarrhee dans la semaine suivant
le debut de la maladie chez Jes cas de reference. Les autorites sanitaires
doivent s' assurer que les selles des malades sont soumises aun traitement
d'epuration adequat OU sont evacuees dans une fosse septique en bon etat.
References
R6f6rences
1. CDC. Update: cholera - Western Hemisphere, and
recommendations for treatment ofcholera. MMWR
1991 ;40:562-5.
2. Sutton RO. An outbreak ofclwlera in Australia due to food
served inflighl on an international aircraft. Journal of Hygiene,
Cambridge, 1974;72:441-51.
Source: Morbidity and Mortality Weekly Report, Vol 41, No 8,
1992.
1. CDC. Update· cholera - Western Hemisphere and recommeruJations
for treatment efcholera. MMWR 1991 ;40:562-5.
lnternatlonal Notes
2. Sutton RO. An outbreak efcholera jnAuS(ralia <lue to foodseryed jn
fli~t on an jnternatjonal ajrcrqft. Journal of Hygiene, Cambridge,
19 4;72:441-51.
Source: Morbidity and Mortality Weekly Report, Vol 41, N" 8, 1992.
Notes lnternatlonales
INCREASE IN INVASIVE MENINGOCOCCAL DISEASE,
1991-1992- NEW ZEALAND
AUGMENTATION DU NOMBRE DE CAS DE MENINGOCOCCIE
INVASIVE, 1991-1992-NOUVELLE·ZELANDE
Following the epidemic years of 1985 and 1986, the incidence
of laboratory-confirmed invasive meningococcal disease declined
and remained low until mid-1991; however, since that time, there
has been an increase (Figure 1). This increase has been distributed
nationwide, with no apparent geographic clustering or demonstrated
epidemiologic link among most cases. Of note, the proportion of
cases that occurred in persons 5 years of age and older increased
from 42% of the total number of cases reported from January 1990
to June 1991, to 61 % of the total reported since that time.
Moreover, in contrast to the epidemic period of the mid-l 980s when
serogroup A was identified in nearly two thirds of cases, the
proportion of cases which have been attributable to serogroup B has
steadily increased since that time, accounting for around 60% of
cases in 1991 and almost 90% of cases in the first 2 months of 1992.
Suite aux annees d'epidemie 1985 et 1986, l'incidence des
meningococcies invasives confirmees en laboratoire a diminue, pour
demeurer faible jusqu 'au milieu de 1991. Depuis !ors, on a toutefois note
une augmentation du nombre de cas (figure 1). Cette augmentation est
repartie l'echel!e de tout Je pays, sans grappe geographique apparente OU
sans lien epidemiologique demontre entre la plupart des cas. Fait noter, la
proportion des cas survenus chez les personnes agees de 5 ans et plus est
passee de 42 % du nombre total de cas signa!es entre janvier 1990 et juin
1991, 61 % du total. En outre, si pres des deux-tiers des cas declares
pendant la periode d. epidemic du milieu des annees 80 ant ete attribue au
serogroupe A, la proportion de cas attribuables au serogroupe B n' a pas
cesse d'augmenter depuis !ors, et etait d'environ 60 % des cas en 1991 et de
pres de 90 % au cours des 2 premiers mois de 1992.
Figure 1
Invasive Menlngococcal
Disease Reported to the
New Zealand Communicable
Disease Centre,
January 1989 to January 1992
•
a
a
a
Actual number of lsoletoe per month
Nombfo r•el d'lsolau por mols
•
Moving overage number of lsofalos
Nombre d''80\at1 lmoyonne mobile)
• •
•
July
Juillet
1989
January
Janvier
January
Janvier
1990
1991
1990
Month and Year/Mois et ann~e
Source: CD - Communicable Disease New Zealand, Vol 92,No 2,
1992.
July
Juillet
Figure 1
Cas de menlngococcle Invasive
slgnales au Centre de lutte contra
les maladies de la
Nouvelle·Z61ande, Janvier 1989 a
Janvier 1992
July
Juillet
January
Janvier
1991
1992
I Source: CD - Communicable Disease New Zealand, Vol 92, N° 2, 1992.
63
Annonces
Announcements
SOMMAIRE ANNUEL DES MALADIES ADECLARATION OBLIGATOIRE
NOTIFIABLE DISEASES ANNUAL SUMMARY
The 1990 Notifiable Diseases Annual Summary is now
available. Copies may be obtained by writing to the Division of
Biometrics, Laboratory Centre for Disease Control, Tunney's
Pasture, Ottawa, Ontario, Kl A OL2, or by calling Carole Scott
(613) 957-0334. For those interested in the 1989 Summary, there
are a li.m.®d number of copies still available.
Le sonunaire annuel des maladies adeclaration obligatoire de 1990 est
maintenant pret. Pour s 'en procurer un exemplaire, ecrire ala Division de la
biometrie, Laboratoire de lutte contre la maladie, Pre Tunney, Ottawa (Ontario),
KlA OL2 ou contacter Carole Scott (613) 957-0334. Les interesses sont pries de
noter qu'il reste un nombrelimitt d'exemplaires du Sommaire de 1989.
GUIDES DE PREVENTION DES INFECTIONS
AVAILABILITY OF THE INFECTION CONTROL GUIDELINES
The series of Infection Control Guidelines, previously available
through Health and Welfare Canada, are now being distributed by
the Canada Communication Group. The following is a list of the
titles, catalogue numbers and prices:
Isolation & Precaution
Techniques
H30-11-6-1 E
$9.95
Occu~atlonal Health In Health
Care acilities
H30-11 ·6-2E
$10.95
Perinatal Care
H30-11 ·6·3E
$11.95
La serie de guides de prevention des infections, qu'on pouvait autrefois se
procurer aupres de Sante et Bien-etre social Canada, sont maintenant distribues
par Canada Communication Group. Voici la liste des titres, des numeros de
catalogue et des prix :
Techniques d'isolement et precautions
H30-11 ·6·1F
9,95 $
A!'Intention du personnel travalllant dans les
H30-11 ·6·2F
10,95 $
Solns perinatals
H30· 11-6-3F
11,95 $
etabllssements de sante
Parts I to V
H30-11-6-4E
$12.95
Sections I aIV
H30-11-6-4F
12,95 $
Organization of Hospital
Infection Control Programs in
Health Care Facilities
H30-11-6-5E
$8.95
Organisation des programmes de prevention
des infections dans les etablissements de
sante
H30-11-6-5F
8,95 $
Long Term Care Facilities
H30-11-6-6E
$9.95
Les etabllssements de soins prolonges
H30-11-6-6F
9,95 $
Antimicrobial Utilization In
Health Care Facilities
H39· 173·1990E
$9.95
L'utilisatlon des antimicrobiens dans les
etablissements de sante
H39· 173-1990F
9,95 $
All inquiries and orders should be directed to:
Toutes !es demandes de renseignements et les commandes doivent etre
acheminees a :
Canada Communication Group
Ottawa, Ontario
KlAOS9
Tel:
(819) 956-4802
Fax:
(819) 994-1498
Canada Communications Group
Ottawa (Ontario)
KlAOS9
(819)956-4802
Telephone :
Telecopleur: (819)994-1498
'Ibo Canada Communicablo Di<cuo Report (CCDR) P""'"'" cum:nt informatic:m cm infcctioua
and Olhot di<cuc1f..-111TYCillanoo pwpooe1 and ii av&ilablo through 1ub1Ctiption. Many of tho
a.rticlc1 contain pn:liminaiy information and further confirmation may bo obta.incd from tho
1owcc1 quomd. Tho Dcpartmont of National Health and Weir.,,, doe1 not UllUlDC "'IJ><X!Sibility
for accuracy or authonticity. Cc:mtributiooa aro welc:amc (in the olrw;ial Ianauaac of your choice)
&cm anyone worlr.ing in the be al th field and will not pn:cludc publication ebewbcre.
Scientific Advil..-y Board:
Bclitcr.
Alailtant Editor:
Dcaklop Publilhing
Dr. J. Spib.
Dr. K.Razce
FJcancr PuiJson
Nicole Beaudoin
Joanm Regnier
(613) 957-4243
(613) 957-1329
(613) 957-1788
(613) 957-0841
To sub1cribo to this publication, pica., contact.:
Tel. No.:
PAX:
comp16mcnl&irc1 pcuvcnt 2tre obtcnus 1uprC1 dc:1 IOW'CCI mcntionn6c1. Le miniJ~rc de la Sa.nt6 nationalo ct du
Bicn~8b'c IOCW m pcut 8tre 1c011rcspmuablodel1cxactitudc1 ni de l'authcnticit6 dc1 uticlc1. Toutc pcnormo
travaillant clans le domainc de la 11&Dt6 e11 invit6e l cdlabarer (clans la !quo officiclle de oon choix); la publicatic:m
d'un articlo dana le RMTC e'en emp&cho pu la publication ailleun.
Groupe de coDJCille11 1cicntifique1 :
R6dactrioo en chef:
R6dactrioo adjoinll> :
llditlquc :
Submiuiooa to the CCDR 1hould bo aen1 to tho Editor at tho following addre11: Labonitory Centre
forDilcuo Cmtrol, Twmcy'a Puturo, Ottawa, Ontario KIA OL2.
Canada Communicatiom Group - Publilhin&
Ottawa, Canada KIA OS9
Pow rcc:cvoir lo Rclcv6 des malailic1 trammiuib1c1 au Canada (R.MfC), qui p-61c:nto dc1 donn6c1 pcrtincntc1 tur IOI
maladie1 infcctieuae1 et lei auln:1 maladica clans lo but do Cacilil<:r lcur >UTYCillanoo, il .Wfit de 1'y abonncr. Un grand
nombrc dc1 articlc1 qui y am.t publ~1 nc cmt.icnncm quo dc1dotm6c11ommain:1, mail des rcmoigncmmtl
(819) 956-480'2
(819) 994-1498
Price per year. $60.00 + O.S.T. • in Canada; $72.00 (U.S.) • ou11ide Cllllda
C MinillCt oCNational Health and Wolf.,,, 1992
D' I . Spill
D'K.Rou:c
Blcan..-Paulson
Nk.olo Beaudoin
IOllDDC Regnier
(613) 957-4243
(613) 957-1329
(613) 957-1788
(613) 957-0841
Pour soumenro un article, vcuillcz. vou1 adrcucr l la ~dactrloo en chef, Laboratoiro de luttD c:ontM la mala.dic1 Pr6
Twmcy, Ottawa (Omario) KIA OL2.
Pour vous abcnmcr l cc.tic publication. vcu.illcz ccntactcr:
Groupe Communication Canada - lldition
N' do u!l6phono:
Ottawa (Canada) KIA OS9
T616copicur:
Prix par ann6e: 60 S + TPS au Canada; 72 $US l 1'6trangcr.
C Minilln: do la San16 nationalo et du Bicn-8tro 1ocial 1992
64
(819) 956-480'2
(819) 994-1498
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