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American Journal of Epidemiology Vol. 130, No. 5: 935-949
Copyright © 1989 by The Johns Hopkins University School of Hygiene and Public Health

research-article

MULTIPLE SCLEROSIS IN KEY WEST, FLORIDA

CHARLES G. HELMICK1 2,, J. MICHAEL WRIGLEY3, MATTHEW M. ZACK1 2, WILLIAM J. BIGLER3, JANET I. LEHMAN3, ROBERT S. JANSSEN4, E. CHARLES HARTWIG3 and JOHN J. WITTE3

1Epidemiology and Surveillance Branch, Division of Chronic Disease Control, Center for Environmental Health and Injury Control, Centers for Disease Control Atlanta, GA
3Florida State Health Office, Florida Department of Health and Rehabilitative Services Tallahassee, FL
4Retrovirus Diseases Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control Atlanta, GA

Reprint requests to Dr. Charles G. Helmick, Epidemiological Research and Statistical Support Branch, Division of Chronic Disease Control and Community Intervention, Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, Mail Stop F42, 1600 Clifton Rd NE, Atlanta, GA 30333

In 1984, a press release by a Miami, Florida, neurologist described a possible cluster of persons with multiple sclerosis in Key West, Florida. The authors examined the cluster using prevalence rates, which are recognized as having a latitudinal gradient for multiple sclerosis, being generally high at high latitudes and low at low latitudes. Case ascertainment showed 32 definite or probable cases among residents of the study area (latitude, 24.5° N) on September 1, 1985, a prevalence rate of 70.1/100,000 population—14 times the rate estimated for this latitude by modeling techniques based on US and international data, 7-44 times the rate for areas at similar latitudes (Mexico City, Mexico; Hawaii; New Orieans, Louisiana; and Charles County, South Carolina), and 2.5 times the expected rate for all US latitudes below 37° N. This finding could not be explained by changes in diagnostic criteria, case ascertainment bias, immigration of people from high-risk areas, an unusual population structure, a large percentage of related cases, or better survival. Prevalent cases (n = 22) were more likely than general population controls (n = 76), matched by sex and 10-year age group, to have: lived longer in Key West, been a nurse, ever owned a Siamese cat, had detectable antibody titers to coxsackievirus A2 and poliovirus 2, and ever visited a local military base (Fleming Key). Key West has an unusually high prevalence of multiple sclerosis that may be related to these risk factors.

multiple sclerosis; space-time clustering

2Current address: Epidemiological Research and Statistical Support Branch, Division of Chronic Disease Control and Community Intervention, Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control Atlanta, GA


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