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The North Carolina Division of Health Services has received
reports of a
large outbreak of diarrheal disease among persons attending the
annual Rainbow
Family gathering, held this year at the Nantahala National Forest.
Most
participants attended the gathering between July 1 and July 7.
National Forest
Service personnel estimate a peak attendance, on July 4, of
approximately
12,000 persons. Attendees came from states throughout the country.
Anecdotal
reports from attendees suggest that the attack rate of acute
diarrheal illness
may have been greater than50%. Shigella sonnei has been isolated
from 25
persons from nine states (California, Georgia, Illinois,
Massachusetts,
Michigan, Ohio, North Carolina, Tennessee, and West Virginia)
following their
attendance at the gathering. Of those isolates with known
antimicrobial
resistance, 18/18 are resistant to ampicillin, 8/9 to trimethoprim-
sulfamethoxazole, and 5/5 to tetracycline. Poor hygiene,
insufficient potable
water, inadequate trench latrines, and frequent rainfall during the
event may
have contributed to the propagation and transmission of infection.
The
transmission of other enteric diseases has not been excluded.
Physicians
should be aware of the potential for diarrheal disease in
participants at this
gathering and should obtain appropriate diagnostic specimens.
Culture-confirmed cases of enteric diseases should be reported to
local and
state health departments.
Reported by: Communicable Disease Control Br, Div of Health Svcs,
North
Carolina Dept of Human Resources. Tennessee Dept of Health and
Environment.
Div of Field Svcs, Epidemiology Program Office; Enteric Diseases
Br, Div of
Bacterial Diseases, Center for Infectious Diseases, CDC.
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