— begin part 2 of 4 cut here —
100-fold: 6.1 in the Mid-Atlantic region, 3.7 in New England, 0.7 in the North
Central states, 0.6 in the Pacific states (1987 data only), 0.2 in 16
Southeast and Southwest states, and less than 0.1 in the Mountain region (2).
Reported by: State and local health departments. Div of Vector-Borne
Infectious Diseases, Center for Infectious Diseases, CDC.
Editorial Note:
National surveillance for LD relies on states for reports. Since 1982,
when national surveillance began, state surveillance systems for LD have
changed considerably. LD has been made a reportable disease in 31 states and
the District of Columbia, and surveillance for LD has intensified, especially
in areas where the disease is endemic.
Since 1982, 13,825 cases of LD have been reported. From 1982 through 1987,
the number of cases increased nearly fivefold from 492 to 2368; in 1988,
reported cases doubled (4572 cases) (Figure 2). LD is the most commonly
reported vectorborne disease in the United States (Figure 3).
>From 1983 through 1987, LD accounted for 50% of the vectorborne infections
reported to CDC. Tickborne diseases (e.g., LD, Rocky Mountain spotted fever
(RMSF)) accounted for 95% of these infections; fleaborne typhus and plague and
mosquitoborne arboviral infections accounted for the remaining 5%.
The increased incidence of reported LD probably is due to improved
Health InfoCom Network News Page 11
Volume 2, Number 37 October 9, 1989
awareness and recognition of the disease, as well as to an actual increase in
incidence and geographic spread. Other factors may also contribute to the
increase. For example, because the clinical and laboratory diagnosis of LD may
be imprecise (3), other conditions possibly may be misdiagnosed and reported
as LD. In addition to differences in clinical interpretation of erythema
migrans (EM), misdiagnosis may also result from the lack of standardization of
serologic testing and from cross-reactivity with Treponema and with other
Borrelia (3). In areas with endemic LD, persons with illnesses other than LD–
but who previously have been infected with B. burgdorferi (the causative agent
for LD)–also may be misdiagnosed (4). Conversely, several factors may be
responsible for failure of a case of LD to be diagnosed and/or to meet the
case definition. These include early treatment of symptoms resulting in
abrogation of the specific antibody response (3), the low sensitivity of
serologic tests in early LD (3), and the failure of approximately 25% of LD
patients to manifest EM (4,5). The extent of underreporting of LD is unknown.
Until more sensitive and specific laboratory diagnostic tests become
available, diagnosis of LD relies predominantly on clinical features.
Serologic testing may be of greatest diagnostic utility in patients who have
symptoms compatible with late-stage LD. The validity of serologic test results
depends largely on the experience of the diagnostic laboratory and its
quality-control procedures. No published data exist on the diagnostic utility
of antigen-detection assays in the laboratory diagnosis of LD. A comparative
study of licensed LD diagnostic kits is planned by the Association of State
and Public Health Laboratory Directors.
State- and community-based epidemiologic studies have documented an
increase in human cases and an expansion of affected areas (5-8).
Entomologic surveys have detected local increases of Ixodes dammini, the
principal tick vector in northeastern and central states, and its spread to
new areas (7-10). However, because the risk for acquiring LD varies widely by
locality, the disease appears to be of public health consequence only in
certain regions–specifically, coastal counties on both seaboards and in
certain counties in the upper Midwest. In the southeastern, southwestern, and
Mountain states, RMSF remains the leading vectorborne disease: from 1983
through 1987, 3160 RMSF and 658 LD cases were reported from the Southeast and
Southwest, and 37 RMSF and seven LD cases were reported from the Mountain
states.
Data concerning risk factors for acquiring LD are limited. In suburban
areas where LD is endemic, infection may be acquired principally around
patients’ residences (11,12), and risk of exposure may be continuous during
the transmission season. Under these circumstances, certain personal
protection measures (e.g., the daily application of repellents) may not be
practical. Further efforts are needed to evaluate the effectiveness of
environmental modifications and focal application of acaricides (chemicals
effective against ticks) for the control of vector ticks in these
circumstances. Where LD is transmitted sporadically through occasional or
brief exposures during recreation or work, personal protection measures are
most appropriate for prevention.
Measures recommended to reduce exposure to ticks include avoiding areas
endemic for LD; using repellents; wearing long-sleeved shirts and long pants,
and tucking pants into the top of socks; wearing light-colored clothing; and
Health InfoCom Network News Page 12
Volume 2, Number 37 October 9, 1989
inspecting clothing and skin frequently for ticks. Animal studies suggest that
I. dammini may not efficiently transmit infection until after 48 hours of
attachment and that prompt removal of attached ticks may limit transmission
(13). However, it is unknown how long a tick must attach to human hosts before
infection occurs.
N,N-diethyl-m-toluamide (DEET) is effective in repelling I. dammini and
other vector ticks. In view of the possible risk for toxicity (14), the use of
DEET-containing repellents solely to prevent LD may be inappropriate in areas
without endemic LD. Permethrin (0.5%) sprayed onto clothing also is effective
in reducing the numbers of adherent ticks, including I. dammini and others
(15,16). However, permethrin aerosols are available only in certain states
that have obtained Environmental Protection Agency approval for their
distribution.
References
1. Schmid GP, Horsley R, Steere AC, et al. Surveillance of Lyme disease in
the United States, 1982. J Infect Dis 1985;151:1144-9.
2. Tsai TF, Bailey RE, Moore PS. National surveillance of Lyme disease, 1987-
1988. Conn Med 1989;53:324-6.
3. Barbour AG. The diagnosis of Lyme disease: rewards and perils. Ann Intern
Med 1989;110:501-2.
4. Steere AC. Lyme disease. N Engl J Med 1989;321:586-96.
5. Cartter ML, Mshar P, Hadler JL. The epidemiology of Lyme disease in
Connecticut. Conn Med 1989;53:320-3.
6. Steere AC, Taylor E, Wilson ML, Levine JF, Spielman A. Longitudinal
assessment of the clinical and epidemiological features of Lyme disease in a
defined population. J Infect Dis 1986;154:295-300.
7. Lastavica CC, Wilson ML, Berardi VP, Spielman A, Deblinger RD. Rapid
emergence of a focal epidemic of Lyme disease in coastal Massachusetts. N
Engl J Med 1989;320:133-7.
8. Hanrahan JP, Benach JL, Coleman JL, et al. Incidence and cumulative
frequency of endemic Lyme disease in a community. J Infect Dis 1984;150:489-
96.
9. Spielman A, Wilson ML, Levine JF, Piesman J. Ecology of Ixodes dammini-
borne human babesiosis and Lyme disease. Annu Rev Entomol 1985;30:439-60.
10. Davis JP, Schell WL, Amundson TE, et al. Lyme disease in Wisconsin;
epidemiologic, clinical, serologic and entomologic findings. Yale J Biol Med
1984;57:685-96.
11. Falco RC, Fish D. A survey of tick bites acquired in a Lyme-disease
endemic area in southern New York State. Ann N Y Acad Sci 1988;539:456-7.
12. Falco RC, Fish D. Prevalence of Ixodes dammini near the homes of Lyme
disease patients in Westchester County, New York. Am J Epidemiol 1988;127:826-
Health InfoCom Network News Page 13
Volume 2, Number 37 October 9, 1989
30.
13. Piesman J, Mather TN, Sinsky RJ, Spielman A. Duration of tick attachment
and Borrelia burgdorferi transmission. J Clin Microbiol 1987;25:557-8.
14. CDC. Seizures temporally associated with use of DEET insect repellent–New
York and Connecticut. MMWR 1989;38:678-80.
15. Schreck CE, Snoddy EL, Spielman A. Pressurized sprays of permethrin or
DEET on military clothing for personal protection against Ixodes dammini
(Acari: Ixodidae). J Med Entomol 1986;23:396-9.
16. Mount GA, Snoddy EL. Pressurized sprays of permethrin and DEET on clothing
for personal protection against the Lone Star tick and the American dog tick
(Acari: Ixodidae). J Econ Entomol 1983;76:529-31.
*The surveillance case definition for LD varies among states and between
states and CDC. Some states use the CDC case definition adopted in 1988, i.e.,
physician-diagnosed erythema migrans (EM) in a person who acquired infection
in a county with endemic LD or, for persons who acquired infection in a county
without endemic LD, laboratory evidence of infection in addition to the
presence of EM. Other states (e.g., New York, Wisconsin, Connecticut) use a
previous, more inclusive, CDC case definition for LD, which counts as cases
persons with appropriate systemic manifestations and laboratory evidence of
infection (1).
Differences in the case definitions used by states must be considered when
state and regional incidences are compared.
Health InfoCom Network News Page 14
Volume 2, Number 37 October 9, 1989
International Notes
Lyme Disease — Canada
From 1977 through May 1989, 30 cases of Lyme disease (LD (Lyme
borreliosis)) were reported to Canada’s Laboratory Centre for Disease Control
(LCDC). Ontario is the only province in which LD is a reportable condition;
however, active laboratory surveillance for LD is conducted in other
provinces. In Ontario, the diagnosis of LD is based on recognition of erythema
migrans (EM), with involvement of at least two of the three organ systems
usually affected by LD (joints, nervous system, and cardiovascular system), or
EM and an indirect immunofluorescence antibody titer greater than or equal to
1:128 or an enzyme-linked immunosorbent assay optical density greater than or
equal to 0.40, or EM and isolation of Borrelia burgdorferi. Without EM,
diagnosis is based on involvement of at least one organ system and positive
serology or isolation (C. LeBer, Ontario Ministry of Health, personal
communication, 1989).
For 25 (83%) of the 30 cases, exposure probably occurred in Canada. Four
patients had a documented history of tick bite during travel to the
southeastern United States before onset of symptoms; one case was acquired in
Germany. Seventeen (68%) of the 25 indigenous cases were reported in Ontario,
and five (20%), in Manitoba (Figure 1). The areas in Canada with the highest
number of cases border on the American states with the highest reported
incidence of LD.
Sixteen (53%) of the 30 cases occurred in 1988. Of the 25 cases for which
month of onset was reported, cases occurred most commonly in July (28%) and
June (16%). The mean age of LD patients was 40 years (range: 18 months to 70
years). Males accounted for 53% of all cases.
A tick bite was documented for 47% of the patients; the remainder had
either no history of a bite or no available information. For 48% of LD
patients, EM was documented. The most frequently documented presenting symptom
was rash (38%), followed by arthralgia/arthritis (28%) and influenza-like
illness (13%). Most had multiple symptoms; five patients had neurologic
involvement. Five (17%) of the 30 LD patients were hospitalized.
Comment: In several provinces, studies are being planned to determine the
prevalence of infected vectors in Canada. The Department of Entomology,
University of Manitoba, identified, and the Smithsonian Institution in
Washington, D.C., confirmed, two female Ixodes dammini ticks collected in
Gunton and Winnipeg, Manitoba, in May and June 1989. These are the first
reports of this vector species in Manitoba. The only other Canadian reports
are from Long Point, Ontario. Intensive sampling efforts for I. dammini in
other regions of Manitoba in 1989 found only Dermacentor variabilis (American
dog tick).
To acquire more complete incidence data for Canada, LCDC is interested in
receiving reports of any additional cases through provincial/territorial
epidemiologists.
Adapted from: Canada Diseases Weekly Report 1989;15:135-7 and 1989;15:185, as
reported by: MJ Todd, MHSc, AO Carter, MD, Disease Surveillance, Bureau of
Communicable Disease Epidemiology, Laboratory Centre for Disease Control,
Health InfoCom Network News Page 15
Volume 2, Number 37 October 9, 1989
Ottawa, Ontario; TD Galloway, PhD, Dept of Entomology, Univ of Manitoba,
Winnipeg.
Health InfoCom Network News Page 16
Volume 2, Number 37 October 9, 1989
Epidemiologic Notes and Reports
Seizures Temporally Associated with Use of DEET Insect Repellent — New
York and Connecticut
In August 1989, epidemiologists from the New York State Department of
Health (NYSDH) investigated five reports of generalized seizures temporally
associated with topical use of N,N-diethyl-m-toluamide (DEET). Three of the
case-patients, one from New York and two from Connecticut, were reported by a
pediatric neurologist who practices in both states. One case was reported
initially to an entomologist in New York, and one was reported directly to the
NYSDH. The cases occurred in June through August 1989.
The patients, four boys aged 3-7 years and one 29-year-old man, had few
prodromal symptoms and recovered quickly. All five had unremarkable medical
histories, and none had had a previous seizure or neurologic event. All had
normal nonfocal neurologic examinations after their seizures, and four had
normal complete laboratory examinations and normal computerized tomography
and/or magnetic resonance imaging examinations. Each had had topical cutaneous
exposure to varying concentrations of DEET; four had had fewer than three
applications. The interval between last use of DEET and onset of seizures
ranged from 8 to 48 hours. One patient developed urticaria before his seizure;
he was one of two patients who developed an urticarial reaction to phenytoin
administered to control seizures.
While reinforcing the importance of DEET in preventing Lyme disease (LD
(Lyme borreliosis)), health officials in New York, Connecticut, and New Jersey
issued a health alert on August 22 advising caution in the use of DEET-
containing repellents. The NYSDH is planning to conduct epidemiologic studies
to evaluate the association between DEET and neurologic events.
Reported by: S Oransky, MD, Hudson Valley Poison Control Center, Nyack; B
Roseman, MD, Pediatric Neurologic Associates, White Plains; D Fish, PhD,
Medical Entomology Laboratory, New York Medical College, Valhalla; T Gentile,
MS, Center for Environmental Health, J Melius, MD, State Environmental
Epidemiologist, New York State Dept of Health. ML Cartter, MD, JL Hadler, MD,
State Epidemiologist, Connecticut State Dept of Health Svcs. Div of
Environmental Hazards and Health Effects, Center for Environmental Health and
Injury Control; Div of Vector-Borne Infectious Diseases, Center for Infectious
Diseases; Div of Field Svcs, Epidemiology Program Office, CDC.
Editorial Note: For health officials in New York and Connecticut, two of the
states where LD is of growing concern, inquiries about the potential adverse
effects of insect repellents have increased. Recent anecdotal reports of
seizures temporally associated with the use of DEET have heightened public
awareness of DEET’s potential adverse effects.
DEET has been marketed in the United States since 1956 and is used by an
estimated 50-100 million persons each year. Since 1961, at least six cases of
toxic systemic reactions from repeated cutaneous exposure to DEET have been
reported (1-6). Six girls, ranging in age from 17 months to 8 years, developed
behavioral changes, ataxia, encephalopathy, seizures, and/or coma after
repeated cutaneous exposure to DEET; three died. Another six systemic toxic
reactions have been reported following ingestion of DEET (7). Additionally,
episodes of confusion, irritability, and insomnia have been reported by
Everglades National Park employees following repeated and prolonged use of
Health InfoCom Network News Page 17
Volume 2, Number 37 October 9, 1989
DEET (8).
DEET is partially absorbed through the skin and has been used to enhance
dermal delivery of other drugs (9). Adverse reactions include allergic
responses, direct neurotoxicity, and dermatitis. One of the girls who died
after dermal exposure was partially deficient in the enzyme ornithine
carbamoyltransferase (3); DEET may interfere with the urea cycle metabolic
pathway (10).
Anecdotal reports of seizures are difficult to interpret. None of the
recent cases in New York and Connecticut have been clearly established as DEET
toxicity. In contrast to cases described in the medical literature, the New
York and Connecticut patients were all male, DEET exposure was less intense,
few prodromal symptoms or encephalopathy were seen, and recovery was more
rapid and complete. With the dramatic increase in the prevalence of DEET use
in areas with endemic LD, the reported cases of seizures temporally related to
DEET use may be coincidental. However, these cases may represent a different,
previously unreported spectrum of toxic reactions. Careful toxicologic and
epidemiologic studies must be conducted, including adequate documentation of
DEET levels in affected and unaffected persons.
Clinicians evaluating patients with unexplained seizures should consider
the possibility of exposure to DEET. However, since the exact circumstances
under which DEET-related neurotoxicity may occur are unclear, DEET should not
be accepted as the cause of a seizure until appropriate evaluation has
reliably excluded other possible etiologies.
The optimal concentration of DEET for prevention of tick bites is unknown.
However, repellents containing 20%-30% DEET applied to clothing are
approximately 90% effective in preventing tick attachment (11). To minimize
the possibility of adverse reactions to DEET, the following precautions are
suggested:
– Apply repellent sparingly only to exposed skin or clothing.
— Avoid applying high-concentration products to the skin, particularly of
children.
— Do not inhale or ingest repellents or get them into the eyes.
— Wear long sleeves and long pants, when possible, and apply repellent
to clothing to reduce exposure to DEET.
— Avoid applying repellents to portions of children’s hands that are
likely to have contact with eyes or mouth.
— Never use repellents on wounds or irritated skin.
— Use repellent sparingly; one application will last 4-8 hours.
Saturation does not increase efficacy.
— Wash repellent-treated skin after coming indoors.
— If a suspected reaction to insect repellents occurs, wash treated
skin, and call a physician. Take the repellent can to the
physician.Specific medical information about the active ingredients
in insect repellents is available from the National Pesticide
Telecommunications Network, telephone (800) 858-7378.
References
1. Edwards DL, Johnson CE. Insect-repellent-induced toxic encephalopathy in a
child. Clin Pharm 1987;6:496-8.
Health InfoCom Network News Page 18
Volume 2, Number 37 October 9, 1989
2. Gryboski J, Weinstein D, Ordway NK. Toxic encephalopathy apparently
related to the use of an insect repellent. N Engl J Med 1961;264:289-91.
3. Heick HMC, Shipman RT, Norman MG, James W. Reye-like syndrome associated
with use of insect repellent in a presumed heterozygote for ornithine
carbamoyl transferase deficiency. J Pediatr 1980;97:471-3.
4. de Garbino JP, Laborde A. Toxicity of an insect repellent: N-N-
diethyltoluamide. Vet Hum Toxicol 1983;25:422-3.
5. Roland EH, Jan JE, Rigg JM. Toxic encephalopathy in a child after brief
exposure to insect repellents. Can Med Assoc J 1985;132:155-6.
6. Zadikoff CM. Toxic encephalopathy associated with use of insect repellant.
J Pediatr 1979;95:140-2.
7. Tenenbein M. Severe toxic reactions and death following the ingestion of
diethyltoluamide-containing insect repellents. JAMA 1987;258:1509-11.
8. McConnell R, Fidler AT, Chrislip D, NIOSH. Everglades National Park health
hazard evaluation report. Cincinnati, Ohio: US Department of Health and Human
Services, Public Health Service, 1986; NIOSH health hazard evaluation report
no. HETA-83-085-1757.
9. Windheuser JJ, Haslam JL, Caldwell L, Shaffer RD. The use of N,N-diethyl-
m-toluamide to enhance dermal and transdermal delivery of drugs. J Pharm Sci
1982;71:1211-3.
10. Heick HMC, Peterson RG, Dalpe-Scott M, Qureshi IA. Insect repellent, N,N-
diethyl-m-toluamide, effect on ammonia metabolism. Pediatrics 1988;82:373-6.
11. Schreck CE, Snoddy EL, Spielman A. Pressurized sprays of permethrin or
DEET on military clothing for personal protection against Ixodes dammini
(Acari: Ixodidae). J Med Entomol 1986;23:396-9.
Health InfoCom Network News Page 19
Volume 2, Number 37 October 9, 1989
Deaths Associated with Hurricane Hugo — Puerto Rico
At 9 a.m. eastern daylight time on Monday, September 18, 1989, the eye of
Hugo, the North Caribbean’s strongest hurricane (a category four on a scale of
five) in a decade, struck the northeast corner of Puerto Rico. Hugo’s path
extended from the Lesser Antilles and the Virgin Islands (where it struck on
September 17) to South Carolina and areas of North Carolina (where it came
ashore during the late evening and early morning of September 21-22). Wind
velocities in San Juan were measured at up to 100 mph; wind gusts elsewhere
measured as high as 140 mph. These winds damaged nearly 25% of homes on
Puerto Rico, left approximately 75% of the island without power, and created
30-foot swells off the east coast. Heavy rains accompanying the hurricane
caused some flash flooding.
From September 18 to September 29, the medical examiner in Puerto Rico
investigated nine deaths considered to be related to the hurricane. One death
(case 1) occurred before the storm (preimpact phase); two (cases 2 and 3),
during the storm (impact phase); and six (cases 4-9), after the storm
(postimpact). The medical examiner categorized the manner of death for all
cases as "accident."*
Case 1. A 57-year-old man was electrocuted while trying to remove an
outside television antenna before the storm.
Case 2. A 94-year-old woman drowned while waiting out the storm in her
home.
Case 3. A 60-year-old man drowned on his boat during the storm.
Cases 4-8. Five electric company workmen, ages 28, 30, 35, 37, and 42
years, were electrocuted in five separate incidents while attempting to repair
downed power lines after the storm.
Case 9. A 35-year-old man was electrocuted when he contacted an electric
cable lying on the ground where he was chopping a tree.
Reported by: P Rechani, PhD, Director, Instituto de Sciencias Forenses de
Puerto Rico, San Juan; JV Rullan, MD, State Epidemiologist, Div of
Epidemiology, Puerto Rico Dept of Health. Div of Field Svcs,
Epidemiology Program Office; Div of Environmental Hazards and Health Effects,
Center for Environmental Health and Injury Control; Div of Safety Research,
National Institute for Occupational Safety and Health, CDC.
Editorial Note: In the past, hurricane-related mortality has occurred
primarily as a result of drownings during the impact phase. Most of these
drownings have been associated with storm surges rather than heavy rains (1).
For most parts of the world, however, this pattern may be changing. This
decrease in impact-phase drownings may be a consequence of improved
forecasting and early warnings about approaching hurricanes, as well as
increased compliance of persons potentially at risk with effective evacuation
programs.
The principal public health response to Hurricane Hugo was early warning
and a coordinated evacuation plan. By the evening of Sunday, September 17,
Health InfoCom Network News Page 20
Volume 2, Number 37 October 9, 1989
Puerto Rican officials had evacuated greater than 18,000 persons who were
residing in low-lying, flood-prone areas. Cases 2 and 3 were the only impact-
phase deaths in Puerto Rico. Despite repeated pleas from government
authorities, these persons refused to leave their property and move to
temporary shelters.
The contribution to mortality of causes other than impact-phase drownings
was highlighted by Tropical Storm Isabelle, which struck Puerto Rico in 1985.
Of the 95 deaths investigated by the medical examiner, 21 (22%) resulted from
drowning; the rest resulted from other traumatic injuries, primarily
associated with a landslide and collapsed bridges (CDC, unpublished data,
1987).
Public health officials and health-care providers must recognize that the
mortality and morbidity risks associated with hurricanes extend beyond the
impact phase. Efforts to minimize injury and other health risks for both
disaster-relief workers and the general population are crucial. These risks
include electric hazards, floodwaters, lacerations from storm debris and
unfamiliar equipment (e.g., chain saws), operation of motorized vehicles, use
of sump pumps and generators in confined spaces, and exacerbation of existing
or unknown medical conditions as a result of fatigue, stress, or unavailable
medical support.
CDC and other Public Health Service agencies are providing assistance to
the Virgin Islands, Puerto Rico, South Carolina, and other areas affected by
Hurricane Hugo. At least five of the seven electrocutions reported here were
work-related. A Fatal Accident Circumstance and Epidemiology (FACE) team from
the National Institute for Occupational Safety and Health, CDC, has arrived in
Puerto Rico to assist local health officials in the investigation of the
occupational fatalities that occurred during the postimpact phase.
Reference
1. French J. Hurricanes. In: Gregg MB, ed. Public health consequences of
disasters. Atlanta: US Department of Health and Human Services, Public Health
Service (in press).
*"Manner of death" and "accident" are medicolegal terms used on death
certificates that refer to the circumstances under which a death occurs;
"cause of death" refers to the injury or illness responsible for the death.
When a death occurs under "accidental" circumstances, the preferred term
within the public health community for the cause of death is "unintentional
injury."
Health InfoCom Network News Page 21
Volume 2, Number 37 October 9, 1989
===============================================================================
Dental News
===============================================================================
News from the National Institute of Dental Research
DENTAL PROJ NOW ONLINE
DENTALPROJ is now online. The file contains summaries of ongoing dental
research projects funded in the current fiscal year. NIDR developed the
database and collaborated with the National Library of Medicine in adding it
to MEDLINE. The file consists of active dental projects supported by DHHS,
and some projects (as many as could be collected) sponsored by the Veterans
Administration and the Department of Defense. The new database can be
accessed through MEDLINE by entering the command: FILE DENTALPROJ.
The purpose of DENTALPROJ is to expedite the transfer of information about
ongoing dental research projects. DENTALPROJ allows the scientific community
to access information while research is in progress–before results are
published, indexed, and otherwise available.
DENTALPROJ has approximately 1300 research projects listed. It will be
updated bi-annually and replaced annually. Included in its listing are:
grants and contracts administered by NIDR, career awards and the Institute’s
intramural (on-campus research). The file does not contain training or
fellowship awards.
UPDATE ON LONG RANGE RESEARCH PLAN FOR THE 1990S
As part of the planning process to develop the NIDR Long-Range Research Plan
for the 1990s, NIDR recently sponsored two special meetings involving private
industry and representatives of minority groups. On May 16, NIDR hosted a
session on "Dental Research–Industry Collaboration." Twenty-three
representatives from industry, joined by six dental scientists from academia
and 26 NIDR staff members, discussed the potential for collaborative
arrangements between academic dental research institutions and private
industry. On May 22, NIDR convened a session to discuss Dental Research and
Minority Group Issues. The meeting considered the oral health needs of
— end part 2 of 4 cut here —