Published literature and events surrounding the outbreak are reviewed.

After the isolation of A/New Jersey/76 (Hsw1N1) influenza virus from five soldiers at Fort Dix, New Jersey, case finding was initiated by obtaining specimens for viral isolation from 95 patients with acute respiratory disease and determining antibody to influenza A/Mayo Clinic/103/74 (Hsw1N1) antigen in paired sera from 74 soldiers who had been hospitalized with acute respiratory disease. Influenza A/New Jersey virus was not isolated, but serologic studies identified eight additional soldiers as A/New Jersey influenza patients. Development of heterotypic antibody to A/Mayo Clinic antigen following infection and/or immunization with influenza A (H3N2) strains was studied and was found to occur infrequently. One of the 13 identified patients had died, and postmortem findings were consistent with viral pneumonia. Four of the 12 surviving patients had radiologic evidence of pneumonia, but clinical syndromes in all 12 were similar to those described for other influenza A infections.

The extent and duration of transmission of influenza A/New Jersey/76 virus at Fort Dix, New Jersey, was examined with use of titers of hemagglutination-inhibiting antibody to influenza A/Mayo Clinic/74 (HswN1) antigen as an index of infection. Five hundred ninety-three soldiers (a 9.3% sample) in basic combat training (BCT) were grouped in weekly cohorts by the date on which BCT was started. Cohorts with 11 of the 12 BCT cases of A/swine influenza began training on January 12, 19, and 26, 1976, respectively; 9%-19% of the trainees in these cohorts had titers of antibody to A/Mayo Clinic antigen of greater than or equal to 1:20. In five other cohorts without cases, which began training before January 12 or after January 26, 0-5% of trainees had titers of greater than or equal to 1:20. Titers observed in persons from military units not in BCT and in the civilian population of the post were not consistent with widespread transmission of the virus. Transmission of influenza A/New Jersey virus at Fort Dix probably occurred between mid-January and mid-February with little involvement of people outside of BCT units.

The clinical utility of selected brief cognitive screening instruments in detecting dementia in an elderly nursing home population was examined. One hundred twenty nursing home residents (mean age 87.9) were administered the Mini-Mental State Exam (MMSE) and the Modified Mini-Mental State Exam (3MS). The majority of the subjects (75%) were also administered the Dementia Rating Scale (DRS). Both clinically diagnosed demented (n = 57) and non-demented (n = 63) subjects participated in the study. Dementia was diagnosed in accordance with DSM-III-R criteria by physicians specializing in geriatric medicine. Using standard cutoffs for impairment, the 3MS, MMSE, and DRS achieved high sensitivity (82% to 100%) but low specificity (33% to 52%) in the detection of dementia among nursing home residents. Positive predictive values ranged from 52% to 61%, and negative predictive values from 77% to 100%. Higher age, lower education, and history of depression were significantly associated with misclassification of non-demented elderly subjects. Receiver Operating Characteristic (ROC) curve analyses revealed optimal classification of dementia with cutoff values of 74 for the 3MS, 22 for the MMSE, and 110 for the DRS. The results suggest that the 3MS, MMSE, and DRS do not differ significantly with respect to classification accuracy of dementia in a nursing home population. Elderly individuals of advanced age (i.e., the oldest-old) with lower education and a history of depression appear at particular risk for dementia misclassification with these instruments. Revised cutoff values for impairment should be employed when these instruments are applied to elderly residents of nursing homes and the oldest-old.