Two hundred and eighty-five cases of TEF/EA occurring in North Carolina from 1952–1978 were reviewed. Except for a greater incidence of low-birth-weight infants and hydramnios during pregnancy, the cases appeared to be representative of the population. Clustering of cases over time was statistically confirmed. The cyclic variation suggested an association with an infectious agent. The variation of reported infectious hepatitis cases during the period of this study resembled the variation of TEF/EA cases that had no other documented congenital malformations.