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MMWR
December 17, 1999

MMWR articles are embargoed until 4 p.m. Eastern time on Thursday.

MMWR Synopsis
  1. Infantile Hypertrophic Pyloric Stenosis Following Pertussis Prophylaxis with Erythromycin — Knoxville, Tennessee, 1999
  2. Carbon Monoxide Poisoning Associated With Use of LPG-Powered (Propane) Forklifts in Industrial Settings — Iowa, 1998
  3. Global Measles Control and Regional Elimination, 1998–1999
Fact Sheet: Pyloric Stenosis

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MMWR
Synopsis December 17, 1999

Infantile Hypertrophic Pyloric Stenosis Following Pertussis Prophylaxis with Erythromycin — Knoxville, Tennessee, 1999
Newborns taking oral erythromycin may experience an increased risk of pyloric stenosis.
PRESS CONTACT:
Margaret (Peggy) Honein, Ph.D., M.P.H.
CDC, National Center for Environmental Health
(770) 488–7160		 At least 157 babies born at one community hospital received the antibiotic erythromycin after they had been possibly exposed to pertussis (whooping cough). Over the next month, seven of these babies developed pyloric stenosis, a disorder in which a muscle at the bottom of the stomach enlarges causing obstruction of the outlet of the stomach; milk or other food cannot pass from the stomach to the small intestine. As a result, infants with pyloric stenosis have projectile vomiting and are treated surgically. The rate of pyloric stenosis in infants who received the antibiotic erythromycin was unusually high. All seven of these babies were less than 3 weeks old when they began taking erythromycin. It is important to prevent whooping cough in very young infants because it can lead to death; however, physicians should carefully evaluate the risks and benefits of erythromycin in newborns less than a month old.

  Carbon Monoxide Poisoning Associated With Use of LPG-Powered (Propane) Forklifts in Industrial Settings — Iowa, 1998
Internal combustion engines operating in enclosed environments increase the risk of carbon monoxide exposure.
PRESS CONTACT:
Patricia Quinlisk , M.D., M.P.H.
Iowa Dept of Public Health
(515) 281–4941
(Alternate: Russ Currier D.V.M., M.P.H. 515–281–4933)		 Iowa public health officials investigated three sequential outbreaks of carbon monoxide (CO) poisoning during a 6-month period, resulting from exhaust emissions from LP gas-powered forklifts operated in enclosed industrial settings. A combination of poorly tuned forklifts coupled with inadequate ventilation exacerbated subsequent exposures to persons working in these facilities. Recognition of CO poisoning was delayed. Diagnosis and treatment was inadequate and inappropriate when patients entered the health care system. The investigation clearly shows that businesses need to improve forklift maintenance and install monitoring equipment. Likewise the medical community needs to improve efforts to screen patients for suspect CO poisoning and refer affected patients to hyperbaric oxygen centers.

  Global Measles Control and Regional Elimination, 1998–1999
Measles remains an important cause of illness and death in many parts of the world.
PRESS CONTACT:
Dalya Guris, M.D., M.P.H.
CDC, National Immunization Program
(404) 639–8252		 With approximately 30 million cases and 1 million deaths attributed to measles in 1998, this disease remains one of the most important cause of illness and death — despite the widespread availability of an effective and safe vaccine. Failure to deliver at least one dose of measles vaccine to all infants remains the primary reason for this preventable illness and death burden. During 1997-1998, routine one-dose measles vaccination coverage has declined in some regions. Improving routine vaccination coverage to at least 90% in each country, and conducting supplementary vaccination campaigns in high-risk areas are key strategies to reduce deaths from measles. In countries or regions where measles is under control and elimination is targeted, achieving over 95% coverage in nationwide supplemental vaccination campaigns is important.

  Fact Sheet
 

Pyloric Stenosis

December 17, 1999
CDC, Division of Media Relations
(404) 639-3286

Pyloric stenosis is a disorder in which a muscle at the bottom of the stomach is enlarged, obstructing the outlet of the stomach so that milk or other food cannot pass from the stomach to the small intestine.
  • Infants with pyloric stenosis usually have projectile vomiting that begins at about 3 to 4 weeks of age.
  • Pyloric stenosis usually affects about 1 to 3 newborns per 1000 live born babies (0.1% to 0.3%)
  • Pyloric stenosis is much more common in boys than girls.
  • Surgical treatment of pyloric stenosis is safe and effective.
  • Approximately 90% of babies born in one hospital in February 1999 received the antibiotic erythromycin to prevent whooping cough following a whooping cough outbreak among newborns born at that hospital. The rate of pyloric stenosis among babies born at this hospital in February 1999 was nearly seven times higher than among babies born there during the previous 2 years.
  • Approximately 5% of the newborns in this investigation who received the antibiotic erythromycin for whooping cough prevention developed pyloric stenosis.
  • The seven babies in this investigation who took erythromycin and got pyloric stenosis were less than 3 weeks old when they began taking erythromycin.
  • All seven babies in this investigation who had pyloric stenosis were surgically treated and have recovered.
  • Gastrointestinal symptoms occur frequently in babies taking erythromycin. Among the newborns in this investigation who received erythromycin following the pertussis outbreak, over 20% had symptoms of excessive fussiness, and over 30% reported vomiting.
  • Oral erythromycin is the recommended treatment for newborns with whooping cough or chlamydia infections, and is used to prevent whooping cough in newborns who are exposed to persons with whooping cough. However, it is important to only give preventive treatment to newborns who have been exposed to a person with whooping cough symptoms.
  • The reported incidence of whooping cough in babies less than one year old is 50 per 100,000.
  • 72% of the babies less than six months old with whooping cough are hospitalized, and the case-fatality of whooping cough in this age group is 0.5%.

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