{'fraction_non_alphanumeric': 0.018916913946587538, 'fraction_numerical': 0.018916913946587538, 'mean_word_length': 5.5144927536231885, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Nosocomial Measles Persists Despite Sharp Decline in Total Cases

Outbreak of Shigellosis Aboard Commercial Airline An international foodborne outbreak of shigellosis was identified after the occurrence of an index outbreak involving a professional football team. Twentyone (32%) of 65 football players and staff developed shigellosis associated with consuming cold sandwiches prepared at the airline flight kitchen of a Minnesota-based airline. An intensive investigation identified 240 passengers with confirmed or probable shigellosis on 219 flights to 24 states, the District of Columbia, and four countries between September 14 and October 13,1988. An outbreak-associated strain of S/zig& sonnei was isolated from football players and staff, airline passengers, and flight attendants. It was believed that cold food items were contaminated during processing by one or more foodhandlers who acquired S soneii infection in the community. Several foodhandlers admitted to working while they had diarrhea. Employees did not always wash their hands before beginning work, after eating or using the toilet facilities, or as often as necessary. The authors noted that inadequate cleaning and sanitizing of equipment produced conditions that were conducive to the transmission of S sonnei and an apparent failure of adequate training and supervision of food handlers contributed to this outbreak. The authors recommend that all establishments that massproduce cold food items should perform aggressive surveillance for diarrhea1 illness, exclude ill employees from handling food, and provide strict supervision of handwashing practices. Further, prevention of such outbreaks may require reduction of hand contact in the preparation of cold food items. The potential for outbreaks of shigellosis associated with cold food served on commercial airlines is increased because of the lack of onboard refrigeration facilities, inadequate handwashing sinks, and faucet designs that require one hand to hold the faucet open while rinsing the other hand. Only 23 outbreaks of foodborne illness associated with commercial airline flights have been reported worldwide from 1947 through 1984. Recognition of these outbreaks was facilitated by one of three factors: 1) attack rates exceeding 20% of the passengers or crew; 2) incubation periods short enough that passengers became ill during or shortly after the flight; or 3) the occurrence of an illness, such as cholera or typhoid fever, that is likely to be investigated by public health officials. FROM: Hedberg CW, Levine WC, White KE, et al. An international foodborne outbreak of shigellosis associated with a commercial airline. JAMA 1992;268:3208-3212.