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Volume 18, Number 8—August 2012
Volume 18, Number 8—August 2012 PDF Version [PDF - 5.45 MB - 183 pages]
Medscape CME Activity
Vaccination of Health Care Workers to Protect Patients at Increased Risk for Acute Respiratory Disease PDF Version [PDF - 379 KB - 10 pages]G. P. Dolan et al.View SummaryView Abstract
Evidence is limited but sufficient to sustain current vaccination recommendations.
Health care workers (HCWs) may transmit respiratory infection to patients. We assessed evidence for the effectiveness of vaccinating HCWs to provide indirect protection for patients at risk for severe or complicated disease after acute respiratory infection. We searched electronic health care databases and sources of gray literature by using a predefined strategy. Risk for bias was assessed by using validated tools, and results were synthesized by using a narrative approach. Seventeen of the 12,352 identified citations met the full inclusion criteria, and 3 additional articles were identified from reference or citation tracking. All considered influenza vaccination of HCWs, and most were conducted in long-term residential care settings. Consistency in the direction of effect was observed across several different outcome measures, suggesting a likely protective effect for patients in residential care settings. However, evidence was insufficient for us to confidently extrapolate this to other at-risk patient groups.
VIM-2–producing Multidrug-Resistant Pseudomonas aeruginosa ST175 Clone, Spain
PDF Version [PDF - 237 KB - 7 pages]
E. Viedma et al.View SummaryView Abstract
This clone is a major public health problem because it limits antimicrobial drug therapy.
A total of 183 patients were colonized or infected with multidrug-resistant Pseudomonas aeruginosa isolates at a hospital in Spain during 2007–2010; prevalence increased over this period from 2.8% to 15.3%. To characterize these isolates, we performed molecular epidemiologic and drug resistance analysis. Genotyping showed that 104 (56.8%) isolates belonged to a single major clone (clone B), which was identified by multilocus sequence typing as sequence type (ST) 175. This clone was initially isolated from 5 patients in 2008, and then isolated from 23 patients in 2009 and 76 patients in 2010. PCR analysis of clone B isolates identified the blaVIM-2 gene in all but 1 isolate, which harbored blaIMP-22. ST175 isolates were susceptible to only amikacin (75%) and colistin (100%). Emergence of the ST175 clone represents a major health problem because it compromises therapy for treatment of P. aeruginosa nosocomial infections.
Outbreak of Extended-Spectrum β-Lactamase–producing Klebsiella oxytoca Infections Associated with Contaminated Handwashing Sinks
PDF Version [PDF - 344 KB - 6 pages]
C. Lowe et al.View SummaryView Abstract
Sinks are a potential reservoir for environment-to-patient and patient-to-patient transmission.
Klebsiella oxytoca is primarily a health care–associated pathogen acquired from environmental sources. During October 2006–March 2011, a total of 66 patients in a hospital in Toronto, Ontario, Canada, acquired class A extended-spectrum β-lactamase–producing K. oxytoca with 1 of 2 related pulsed-field gel electrophoresis patterns. New cases continued to occur despite reinforcement of infection control practices, prevalence screening, and contact precautions for colonized/infected patients. Cultures from handwashing sinks in the intensive care unit yielded K. oxytoca with identical pulsed-field gel electrophoresis patterns to cultures from the clinical cases. No infections occurred after implementation of sink cleaning 3×/day, sink drain modifications, and an antimicrobial stewardship program. In contrast, a cluster of 4 patients infected with K. oxytoca in a geographically distant medical ward without contaminated sinks was contained with implementation of active screening and contact precautions. Sinks should be considered potential reservoirs for clusters of infection caused by K. oxytoca.
Population Diversity among Bordetella pertussis Isolates, United States, 1935–2009
PDF Version [PDF - 365 KB - 8 pages]
A. J. Schmidtke et al.View SummaryView Abstract
Resurgence of pertussis was not directly correlated with changes in vaccine composition or schedule.
Since the 1980s, pertussis notifications in the United States have been increasing. To determine the types of Bordetella pertussis responsible for these increases, we divided 661 B. pertussis isolates collected in the United States during 1935–2009 into 8 periods related to the introduction of novel vaccines or changes in vaccination schedule. B. pertussis diversity was highest from 1970–1990 (94%) but declined to ≈70% after 1991 and has remained constant. During 2006–2009, 81.6% of the strains encoded multilocus sequence type prn2-ptxP3-ptxS1A-fim3B, and 64% were multilocus variable number tandem repeat analysis type 27. US trends were consistent with those seen internationally; emergence and predominance of the fim3B allele was the only molecular characteristic associated with the increase in pertussis notifications. Changes in the vaccine composition and schedule were not the direct selection pressures that resulted in the allele changes present in the current B. pertussis population.
Solid Organ Transplant–associated Lymphocytic Choriomeningitis, United States, 2011
PDF Version [PDF - 273 KB - 7 pages]
A. MacNeil et al.View SummaryView Abstract
Lymphocytic choriomeningitis virus (LCMV) is carried by rodents. In very rare instances, it has been transmitted from person-to-person by organ transplantation. In 2011, a total of 14 organ recipients were infected with the virus, of which 11 died in the United States. The 4 most recent patients received organs from the same donor, which resulted in 2 deaths. Only after these 4 organ recipients became sick was it discovered that the donor had been exposed to rodents. Had this exposure been known before transplantation, the organ recipients may have been more closely monitored. Early diagnosis and treatment might have improved their chances of survival. Although organ donor screening reduces the risk for transmission of some viruses, it is not possible to screen for all possible viruses, including LCMV. For patients who get severely ill after receiving a transplant, clinicians should add LCMV infection to their list of possible causes.
Three clusters of organ transplant–associated lymphocytic choriomeningitis virus (LCMV) transmissions have been identified in the United States; 9 of 10 recipients died. In February 2011, we identified a fourth cluster of organ transplant–associated LCMV infections. Diabetic ketoacidosis developed in the organ donor in December 2010; she died with generalized brain edema after a short hospitalization. Both kidneys, liver, and lung were transplanted to 4 recipients; in all 4, severe posttransplant illness developed; 2 recipients died. Through multiple diagnostic methods, we identified LCMV infection in all persons, including in at least 1 sample from the donor and 4 recipients by reverse transcription PCR, and sequences of a 396-bp fragment of the large segment of the virus from all 5 persons were identical. In this cluster, all recipients developed severe illness, but 2 survived. LCMV infection should be considered as a possible cause of severe posttransplant illness.
Medscape CME Activity
Paragonimus kellicotti Flukes in Missouri, USA PDF Version [PDF - 213 KB - 5 pages]M. A. Lane et al.View SummaryView Abstract
You don’t have to be a contestant on Fear Factor to eat unusual things. An investigation of 9 new cases of lung fluke infection in Missouri found that in all cases, patients had eaten raw crayfish while on rafting or camping trips and most had been drinking alcohol. Although all patients recovered after treatment, a few whose diagnosis was delayed had unnecessary procedures and serious illness. Physicians should consider lung fluke infection in patients with nonspecific cough and fever, especially patients who have recently returned from a recreational river trip. Crayfish in Missouri rivers often carry lung flukes and should not be eaten raw.
Paragonimiasis is an infection caused by lung flukes of the genus Paragonimus. In Asia, P. westermani infections are relatively common because of dietary practices. However, in North America, cases of paragonimiasis, which are caused by P. kellicotti flukes, are rare. Only 7 autochthonous cases of paragonimiasis were reported during 1968–2008. In 2009, we reported 3 new case-patients with paragonimiasis who had been seen at our medical center over an 18-month period. Six additional case-patients were identified in St. Louis, Missouri, USA, and treated at Washington University–affiliated health centers in 2009–2010. We report detailed descriptions of these case-patients, which includes unusual clinical manifestations. We also describe public health interventions that were undertaken to inform the general public and physicians about the disease and its mode of transmission.
Hepatitis E Virus Genotype 3 in Wild Rats, United States
PDF Version [PDF - 328 KB - 6 pages]
J. B. Lack et al.View SummaryView Abstract
Rodents infected with this virus may be a serious threat to public health.
The role of rodents in the epidemiology of zoonotic hepatitis E virus (HEV) infection has been a subject of considerable debate. Seroprevalence studies suggest widespread HEV infection in commensal Rattus spp. rats, but experimental transmission has been largely unsuccessful and recovery of zoonotic genotype 3 HEV RNA from wild Rattus spp. rats has never been confirmed. We surveyed R. rattus and R. norvegicus rats from across the United States and several international populations by using a hemi-nested reverse transcription PCR approach. We isolated HEV RNA in liver tissues from 35 of 446 rats examined. All but 1 of these isolates was relegated to the zoonotic HEV genotype 3, and the remaining sequence represented the recently discovered rat genotype from the United States and Germany. HEV-positive rats were detected in urban and remote localities. Genetic analyses suggest all HEV genotype 3 isolates obtained from wild Rattus spp. rats were closely related.
Hepatitis E Virus Strains in Rabbits and Evidence of a Closely Related Strain in Humans, France
PDF Version [PDF - 383 KB - 8 pages]
J. Izopet et al.View SummaryView Abstract
The host range of HEV in Europe is expanding, and zoonotic transmission of HEV from rabbits is possible.
Hepatitis E virus (HEV) strains from rabbits indicate that these mammals may be a reservoir for HEVs that cause infection in humans. To determine HEV prevalence in rabbits and the strains’ genetic characteristics, we tested bile, liver, and additional samples from farmed and wild rabbits in France. We detected HEV RNA in 7% (14/200) of bile samples from farmed rabbits (in 2009) and in 23% (47/205) of liver samples from wild rabbits (in 2007–2010). Full-length genomic sequences indicated that all rabbit strains belonged to the same clade (nucleotide sequences 72.2%–78.2% identical to HEV genotypes 1–4). Comparison with HEV sequences of human strains and reference sequences identified a human strain closely related to rabbit strain HEV. We found a 93-nt insertion in the X domain of open reading frame 1 of the human strain and all rabbit HEV strains. These findings indicate that the host range of HEV in Europe is expanding and that zoonotic transmission of HEV from rabbits is possible.
Hepatitis E Virus in Pork Production Chain in Czech Republic, Italy, and Spain, 2010
PDF Version [PDF - 332 KB - 8 pages]
I. Di Bartolo et al.View SummaryView Abstract
Processing does not substantially abate endogenous virus.
We evaluated the prevalence of hepatitis E virus (HEV) in the pork production chain in Czech Republic, Italy, and Spain during 2010. A total of 337 fecal, liver, and meat samples from animals at slaughterhouses were tested for HEV by real-time quantitative PCR. Overall, HEV was higher in Italy (53%) and Spain (39%) than in Czech Republic (7.5%). HEV was detected most frequently in feces in Italy (41%) and Spain (39%) and in liver (5%) and meat (2.5%) in Czech Republic. Of 313 sausages sampled at processing and point of sale, HEV was detected only in Spain (6%). HEV sequencing confirmed only g3 HEV strains. Indicator virus (porcine adenovirus) was ubiquitous in fecal samples and absent in liver samples and was detected in 1 slaughterhouse meat sample. At point of sale, we found porcine adenovirus in sausages (1%–2%). The possible dissemination of HEV and other fecal viruses through pork production demands containment measures.
Medscape CME Activity
Factors Related to Increasing Prevalence of Resistance to Ciprofloxacin and Other Antimicrobial Drugs in Neisseria gonorrhoeae, United States PDF Version [PDF - 311 KB - 8 pages]E. Goldstein et al.View SummaryView Abstract
What would you do if you had a sexually transmitted disease that was untreatable with antibiotics? That is the situation we may be heading toward. In the United States, gonorrhea is the second most common reportable infection. Over the years, the organism that causes it, N. gonorrhoeae, has acquired resistance to several classes of antibiotics including, most recently, the fluoroquinolones. In fact, widespread resistance led CDC to stop recommending fluoroquinolones for gonorrhea treatment in 2007. Today, cephalosporin-based combination therapy is the last remaining option currently recommended for gonorrhea treatment. Understanding of the causes of drug resistance is needed so that control measures can be improved and the effectiveness of the few remaining drugs can be maintained. This article investigates possible causes for the emergence of fluoroquinolone-resistant N. gonorrhoeae that occurred several years ago. Fluoroquinolone-resistant strains spread in the United States in the late 1990s and spread more rapidly among men who have sex with men (MSM) than among heterosexual men. One possible explanation for the rise in drug resistance, especially among heterosexuals, is acquisition of resistant gonorrhea through travel. Certain drug-resistant strains of N. gonorrhoeae, particularly the multidrug resistant strains (also resistant to penicillin and tetracycline) circulating among MSM, seemed to be able to reach high prevalence levels through domestic transmission, rather than through frequent importation. After resistance emerged in a geographic area, resistant strains appeared among MSM and heterosexuals within several months. When resistance is detected in either MSM or heterosexuals, prevention efforts should be directed toward both populations.
Using data from the Gonococcal Isolate Surveillance Project, we studied changes in ciprofloxacin resistance in Neisseria gonorrhoeae isolates in the United States during 2002–2007. Compared with prevalence in heterosexual men, prevalence of ciprofloxacin-resistant N. gonorrhoeae infections showed a more pronounced increase in men who have sex with men (MSM), particularly through an increase in prevalence of strains also resistant to tetracycline and penicillin. Moreover, that multidrug resistance profile among MSM was negatively associated with recent travel. Across the surveillance project sites, first appearance of ciprofloxacin resistance in heterosexual men was positively correlated with such resistance for MSM. The increase in prevalence of ciprofloxacin resistance may have been facilitated by use of fluoroquinolones for treating gonorrhea and other conditions. The prominence of multidrug resistance suggests that using other classes of antimicrobial drugs for purposes other than treating gonorrhea helped increase the prevalence of ciprofloxacin-resistant strains that are also resistant to those drugs.
Comparison of Enzootic Risk Measures for Predicting West Nile Disease, Los Angeles, California, USA, 2004–2010
PDF Version [PDF - 305 KB - 9 pages]
J. L. Kwan et al.View SummaryView Abstract
The best model comprised enzootic surveillance data from avian, mosquito, and climate sources.
In Los Angeles, California, USA, 2 epidemics of West Nile virus (WNV) disease have occurred since WNV was recognized in 2003. To assess which measure of risk was most predictive of human cases, we compared 3 measures: the California Mosquito-Borne Virus Surveillance and Response Plan Assessment, the vector index, and the Dynamic Continuous-Area Space-Time system. A case–crossover study was performed by using symptom onset dates from 384 persons with WNV infection to determine their relative environmental exposure to high-risk conditions as measured by each method. Receiver-operating characteristic plots determined thresholds for each model, and the area under the curve was used to compare methods. We found that the best risk assessment model for human WNV cases included surveillance data from avian, mosquito, and climate sources.
Molecular Epidemiologic Investigation of an Anthrax Outbreak among Heroin Users, Europe
PDF Version [PDF - 209 KB - 7 pages]
E. P. Price et al.View SummaryView Abstract
Heroin may have been accidentally contaminated by an animal-derived source along a major drug trafficking route.
In December 2009, two unusual cases of anthrax were diagnosed in heroin users in Scotland. A subsequent anthrax outbreak in heroin users emerged throughout Scotland and expanded into England and Germany, sparking concern of nefarious introduction of anthrax spores into the heroin supply. To better understand the outbreak origin, we used established genetic signatures that provided insights about strain origin. Next, we sequenced the whole genome of a representative Bacillus anthracis strain from a heroin user (Ba4599), developed Ba4599-specific single-nucleotide polymorphism assays, and genotyped all available material from other heroin users with anthrax. Of 34 case-patients with B. anthracis–positive PCR results, all shared the Ba4599 single-nucleotide polymorphism genotype. Phylogeographic analysis demonstrated that Ba4599 was closely related to strains from Turkey and not to previously identified isolates from Scotland or Afghanistan, the presumed origin of the heroin. Our results suggest accidental contamination along the drug trafficking route through a cutting agent or animal hides used to smuggle heroin into Europe.
Escherichia coli O104 Associated with Human Diarrhea, South Africa, 2004–2011
PDF Version [PDF - 371 KB - 4 pages]
N. P. Tau et al.View Abstract
To determine the origin of >4,000 suspected diarrheagenic Escherichia coli strains isolated during 2004–2011 in South Africa, we identified 7 isolates as serotype O104; 5 as enteroaggregative E. coli O104:H4, and 2 as enteropathogenic E. coli O104:non-H4. Pulsed-field gel electrophoresis showed that these isolates were unrelated to the 2011 E. coli O104:H4 outbreak strain from Germany.
Vertical Transmission of Babesia microti, United States
PDF Version [PDF - 299 KB - 4 pages]
J. T. Joseph et al.View Abstract
Babesiosis is usually acquired from a tick bite or through a blood transfusion. We report a case of babesiosis in an infant for whom vertical transmission was suggested by evidence of Babesia spp. antibodies in the heel-stick blood sample and confirmed by detection of Babesia spp. DNA in placenta tissue.
Klebsiella pneumoniae in Gastrointestinal Tract and Pyogenic Liver Abscess
PDF Version [PDF - 238 KB - 4 pages]
C. Fung et al.View Abstract
To determine the role of gastrointestinal carriage in Klebsiella pneumoniae liver abscess, we studied 43 patients. Bacterial isolates from liver and fecal samples from 10 patients with this condition and 7 healthy carriers showed identical serotypes and genotypes with the same virulence. This finding indicated that gastrointestinal carriage is a predisposing factor for liver abscess.
Third-Generation Cephalosporin–Resistant Vibrio cholerae, India
PDF Version [PDF - 302 KB - 3 pages]
J. Mandal et al.View Abstract
Vibrio cholerae resistance to third-generation cephalosporins is rarely reported. We detected a strain that was negative for extended-spectrum β-lactamase and positive for the AmpC disk test, modified Hodge test, and EDTA disk synergy test and harbored the blaDHA-1 and blaNDM-1 genes. The antimicrobial drug susceptibility profile of V. cholerae should be monitored.
Seroprevalence and Cross-reactivity of Human Polyomavirus 9
PDF Version [PDF - 176 KB - 4 pages]
J. Nicol et al.View Abstract
Many humans have antibodies against simian lymphotropic polyomavirus (LPyV), but its DNA has not been found in humans. Identification of human polyomavirus 9 (HPyV9) led us to compare the seroprevalence and cross-reactivity of LPyV and HpyV9. Results could indicate that humans who have antibodies against LPyV are infected by HPyV9.
Lack of Evidence for Schmallenberg Virus Infection in Highly Exposed Persons, Germany, 2012
PDF Version [PDF - 175 KB - 3 pages]
T. Ducomble et al.View Abstract
Schmallenberg virus, a novel orthobunyavirus, is spreading among ruminants, especially sheep, throughout Europe. To determine the risk for human infection, we conducted a survey among shepherds to assess possible exposure and symptoms. We also performed serologic and molecular assays. No evidence of transmission to humans was detected.
Capsular Switching in Invasive Neisseria meningitidis, Brazil
PDF Version [PDF - 146 KB - 3 pages]
T. Castiñeiras et al.View Abstract
During the 1990s, an epidemic of B:4 Neisseria meningitidis infections affected Brazil. Subsequent increase in C:4 disease suggested B→C capsular switching. This study identified B→C switches within the sequence type 32 complex. Substantial disease related to capsular switching emphasizes the need for surveillance of circulating meningococcal strains to optimize disease control.
Avian Influenza and Ban on Overnight Poultry Storage in Live Poultry Markets, Hong Kong
PDF Version [PDF - 147 KB - 3 pages]
Y. Leung et al.View Abstract
We analyzed ≈12 years of surveillance data on avian influenza in Hong Kong live poultry markets. A ban on keeping live poultry overnight in these markets reduced virus isolation rates by 84% in chickens (p = 0.006) and 100% (p = 0.01) in minor poultry.
Drug-Resistant Tuberculosis Transmission and Resistance Amplification within Families
PDF Version [PDF - 250 KB - 4 pages]
J. A. Seddon et al.View Abstract
Drug-resistant tuberculosis is caused by transmission of resistant strains of Mycobacterium tuberculosis and by acquisition of resistance through inadequate treatment. We investigated the clinical and molecular features of the disease in 2 families after drug-resistant tuberculosis was identified in 2 children. The findings demonstrate the potential for resistance to be transmitted and amplified within families.
Chloroquine-Resistant Malaria in Travelers Returning from Haiti after 2010 Earthquake
PDF Version [PDF - 183 KB - 4 pages]
M. Gharbi et al.View Abstract
We investigated chloroquine sensitivity to Plasmodium falciparum in travelers returning to France and Canada from Haiti during a 23-year period. Two of 19 isolates obtained after the 2010 earthquake showed mixed pfcrt 76K+T genotype and high 50% inhibitory concentration. Physicians treating malaria acquired in Haiti should be aware of possible chloroquine resistance.
New Variants of Porcine Epidemic Diarrhea Virus, China, 2011
PDF Version [PDF - 240 KB - 4 pages]
W. Li et al.View Abstract
In 2011, porcine epidemic diarrhea virus (PEDV) infection rates rose substantially in vaccinated swine herds. To determine the distribution profile of PEDV outbreak strains, we sequenced the full-length spike gene from samples from 9 farms where animals exhibited severe diarrhea and mortality rates were high. Three new PEDV variants were identified.
Severe Human Granulocytic Anaplasmosis Transmitted by Blood Transfusion
PDF Version [PDF - 321 KB - 4 pages]
M. Jereb et al.View Abstract
A 36-year-old woman acquired severe human granulocytic anaplasmosis after blood transfusion following a cesarean section. Although intensive treatment with mechanical ventilation was needed, the patient had an excellent recovery. Disease caused by Anaplasma phagocytophilum infection was confirmed in 1 blood donor and in the transfusion recipient.
Hepatitis E Virus in Pork Food Chain, United Kingdom, 2009–2010
PDF Version [PDF - 150 KB - 3 pages]
A. Berto et al.View Abstract
We investigated contamination by hepatitis E virus (HEV) in the pork production chain in the United Kingdom. We detected HEV in pig liver samples in a slaughterhouse, in surface samples from a processing plant, and in pork sausages and surface samples at point of sale. Our findings provide evidence for possible foodborne transmission of HEV during pork production.
Autochthonous Infections with Hepatitis E Virus Genotype 4, France
PDF Version [PDF - 269 KB - 4 pages]
P. Colson et al.View Abstract
During January–March 2011, diagnoses of hepatitis E virus (HEV) infection increased in Marseille University hospitals in southeastern France. HEV genotype 4, which is described almost exclusively in Asia, was recovered from 2 persons who ate uncooked pork liver sausage. Genetic sequences were 96.7% identical to those recently described in swine in Europe.
Putative Novel Genotype of Avian Hepatitis E Virus, Hungary, 2010
PDF Version [PDF - 258 KB - 4 pages]
K. Bányai et al.View Abstract
To explore the genetic diversity of avian hepatitis E virus strains, we characterized the near-complete genome of a strain detected in 2010 in Hungary, uncovering moderate genome sequence similarity with reference strains. Public health implications related to consumption of eggs or meat contaminated by avian hepatitis E virus, or to poultry handling, require thorough investigation.
Novel Hepatitis E Virus in Ferrets, the Netherlands
PDF Version [PDF - 216 KB - 2 pages]
V. Raj et al.
Epidemic Clostridium difficile Ribotype 027 in Chile
PDF Version [PDF - 196 KB - 3 pages]
C. Hernández-Rocha et al.
Zoonotic Pathogens among White-Tailed Deer, Northern Mexico, 2004–2009
PDF Version [PDF - 164 KB - 3 pages]
C. Medrano et al.
KIs Virus and Blood Donors, France
PDF Version [PDF - 157 KB - 2 pages]
P. Biagini et al.
Usefulness of School Absenteeism Data for Predicting Influenza Outbreaks, United States
PDF Version [PDF - 178 KB - 3 pages]
J. R. Egger et al.
Rhodococcus erythropolis Encephalitis in Patient Receiving Rituximab
PDF Version [PDF - 175 KB - 2 pages]
S. R. Bagdure et al.
Factors Influencing Emergence of Tularemia, Hungary, 1984–2010
PDF Version [PDF - 214 KB - 3 pages]
M. Gyuranecz et al.
Klebsiella pneumoniae Carbapenemase-producing Enterobacteria in Hospital, Singapore
PDF Version [PDF - 165 KB - 3 pages]
I. Venkatachalam et al.
bla–positive Klebsiella pneumoniae from Environment, Vietnam
PDF Version [PDF - 225 KB - 3 pages]
R. Isozumi et al.
Rickettsia felis in Fleas, Southern Ethiopia, 2010
PDF Version [PDF - 156 KB - 2 pages]
O. Mediannikov et al.
Identification of Cause of Posttransplant Cachexia by PCR
PDF Version [PDF - 149 KB - 3 pages]
J. Guitard et al.
Murine Typhus in Drug Detoxification Facility, Yunnan Province, China, 2010
PDF Version [PDF - 191 KB - 3 pages]
W. Yang et al.
Carpal Tunnel Syndrome with Paracoccidioidomycosis
PDF Version [PDF - 188 KB - 3 pages]
F. von Glehn et al.
Books and Media
About the Cover
Peer Reviewed Report Available Online OnlyInfectious Disease Transmission during Organ and Tissue TransplantationM. A. Greenwald et al.View SummaryView Abstract
Transplantation of organs and tissues (bone, tendon, skin, cornea) will always be associated with some risk for transmission of infectious diseases from donor to recipient. Understanding and minimizing this risk is difficult for many reasons: donor screening processes vary, screening for every infectious organism is not possible, and assessment of recipient health after transplantation to determine possibility of disease transmission is often not adequate. In May 2010, the US Food and Drug Administration held a meeting to address these challenges and establish a research agenda for minimizing these transplant transmission risks. Attendees agreed that the focus should be on standardizing donor screening, compiling disease transmissibility data, monitoring of transplant recipients’ health, and assessing effectiveness of measures to minimize disease transmission. Collaboration and sharing of perspectives, experiences, and resources of all stakeholders in the transplantation process (government, private industry, and health care providers) can improve the safety of organ and tissue transplantation.
Infectious disease transmission through organ and tissue transplantation has been associated with severe complications in recipients. Determination of donor-derived infectious risk associated with organ and tissue transplantation is challenging and limited by availability and performance characteristics of current donor epidemiologic screening (e.g., questionnaire) and laboratory testing tools. Common methods and standards for evaluating potential donors of organs and tissues are needed to facilitate effective data collection for assessing the risk for infectious disease transmission. Research programs can use advanced microbiological technologies to define infectious risks posed by pathogens that are known to be transplant transmissible and provide insights into transmission potential of emerging infectious diseases for which transmission characteristics are unknown. Key research needs are explored. Stakeholder collaboration for surveillance and research infrastructure is required to enhance transplant safety.
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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- Page created: October 19, 2012
- Page last updated: October 19, 2012
- Page last reviewed: October 19, 2012
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