Outbreak of boils in an Alaskan village: a case-control study

Objective To determine whether taking steam baths was associated with furunculosis and to evaluate possible risk factors for the occurrence of boils during a large outbreak in Alaska. Design A cohort study of village residents, a case-control study and assessment of environmental cultures taken from steam baths. Setting. Village in southwestern Alaska. Participants 1 adult member From 77 of the 92 households in the village was interviewed; 115 residents with at least one boil occurring between January 1 and December 12, 1996 were considered to be cases; 209 residents without a boil acted as the control group. All 459 village residents were included in the cohort study. Main outcome measure Rate of infection among all residents and residents who regularly took steam baths, risk factors for infection, and relative risk of infection. Results 115 people (25%) had had at least one boil. Men were more likely to have had a boil than women (relative risk 1.5; 95% confidence interval 1.1 to 2.2). The highest rate of infection was among people ages 25-34 years (32/76; 42%). No children younger than 2 years had had boils. Boils were associated with using a steam bath (odds ratio 8.1; 3.3 to 20.1). Among those who used a steam bath, the likelihood of developing bails was reduced by routinely sitting on a towel while bathing, which women were more likely to do, and bathing with fewer than 8 people. Of the 93 samples taken from steam baths, one Staphylococcus aureus isolate was obtained from a bench in an outer dressing room. Conclusion Using a steam bath was associated with developing boils in this outbreak in a village in Alaska. People should be advised to sit on towels while using steam baths.