The role of the swimming pool in the transmission of pharyngeal-conjunctival fever.

AN EPIDEMIC of pharyngeal-conjunctival fever in Washington, D.C., in 1954 was recently reported by Bell' and co-workers at the National Institutes of Health, Bethesda, Maryland. The spread of this epidemic was largely associated with swimming pools, but direct transmission occurred readily in homes and in hospitals. From eye and throat washings, and stools from patients with the disease, the Type 3 APC (adenoidal-pharyngeal-conjunctival) virus was readily isolated in tissue cultures. Previously, Cockburn2 studied a similar epidemic in Greeley, Colorado, which occurred in August and September 1951, in which there was an "unusual combination of features consisting of acute conjunctivitis, vesicular pharyngitis, muscle pains, and pyrexia." In 13 out of 54 cases examined by the slit-lamp three weeks after onset, the corneae were found to have small, whitish plaques one mm. or less in size. The preauricular lymph nodes were not significantly enlarged but the lymph nodes in the neck were involved. Most patients had temperatures of 1020 F. to 1050 F., and many had pains in the back, legs or neck. In some instances a diagnosis of poliomyelitis was made, but spinal puncture did not reveal any increase in the cells in the C.S.F. It was estimated that from 25 to 50%o of children swimming in the pools developed the disease. In the 1954 Washington epidemic of pharyngeal-conjunctival fever due to Type 3 APC.virus, the symptoms described were similar to those of the Greeley epidemic, with the exception that no corneal opacities were seen in the affected eyes. The two epidemics were probably due to the same agent, however, since a study of eight paired sera from the Greeley epidemic showed a rise in antibody titre to the Type 3 virus. In Toronto, in the first six months of 1955, about 20 patients with viral conjunctivitis were