The constant evolution of testing methodologies for the human retroviruses demands that periodic reviews of the capabilities of these methodologies used in the public health laboratories be conducted. To this end, the Association of State and Territorial Public Health Laboratory Directors (ASTPHLD) sponsored the Sixth Conference on Human Retrovirus Testing March 57, 1991, in Kansas City, Missouri. Approximately 285 conference participants viewed 36 poster presentations, heard 12 plenary session speakers discuss a variety of topics relevant to retrovirus testing, and participated in six panel sessions concentrating on the most relevant topics of human retrovirus testing.

Panel Session 1 was entitled ‘Testing for HIV-1.” Topics discussed included rapid testing methods, western blots, testing of nontraditional samples, surrogate markers, recombinant/synthetic-based assays, western blot interpretation criteria, indirect fluorescent antibody methods, and viral detection methods.

To assess the current status of testing for human retroviruses, a survey was sent to 54 state and territorial public health laboratories during the third quarter of 1990. The survey requested data for fiscal year 1990 (July 1989-June 1990). In previous years, calendar-year data were requested.

Previous studies on the bactericidal effects of ultraviolet (UV) lamps have focused on the effects of specific wavelengths and the time and intensity of exposure. Virtually all of these studies have used continuous wave UV. Exposure to UV can induce abnormal ion flow or increased membrane permeability, or it can depolarize the membrane, induce DNA, RNA, and protein alterations, and inhibit oxidative phosphorylation. Any periodic alteration in the modulation of the intensity alters the biological effectiveness. If the waveform and pulse repetition rate are chosen carefully, the bactericidal effects of the UV light may be greatly enhanced.

We tested a prototype UV-C lamp modulated by a series of complex waveforms designed to enhance bactericidal activity. These experiments evaluated the effectiveness of the modulated WC in a series of in vitro experiments on six serogroups of Salmonella.

The standards set by the Joint Commission on the Accreditation of Healthcare Organizations (ICAHO) and published annually in the Accrediting Manual for Hospitals (AMH) define the framework within which most hospitals conduct their quality assurance (QA) and utilization review (UR) activities. The process known as “monitoring and evaluation,” reviewed here in May, forms a central component of many of these standards. The monitoring and evaluation process, in turn, depends on the identification of “clinical indicators.” The JCAHO has stated that a clinical indicator is “a quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities. An indicator is not a direct measure of quality. Rather, it is a screen or flag that identifies or directs attention to specific performance issues that should be the subject of more intense review”.

Lyme borreliosis (also known as Lyme disease) has become the most commonly reported tick-transmitted disease in the United States.’ The diverse clinical manifestations of the disease make diagnosis difficult, but Lyme borreliosis is quite responsive to treatment if recognized in the early stages.

In the early part of the century, Afzelius in Sweden and Lipschutz in Austria described a distinctive skin lesion, erythema chronicum migrans (ECM), which developed at the site of a previous tick bite. Later, Garin and Bujadoux in France, Hellerström in Sweden, and Bannwarth in Germany described the association of ECM with neurological diseases, including neuropathies, radiculopathies, and cranial nerve palsies. Lyme disease was first recognized as a separate syndrome in the United States by Dr. Allen Steere and his colleagues in 1976, after a homemaker, MS Polly Murray, brought an outbreak of arthritis to their attention. Epidemiological studies of this unusual geographical clustering of children in Lyme, Connecticut, who were thought to have juvenile rheumatoid arthritis, suggested another process. The illness was eventually found to be caused by a vectorborne spirochete, Borrelia burgdorferi, which is capable of infecting the cardiovascular, dermatologic, neurologic, and musculoskeletal systems.