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Volume 18, Number 9—September 2012

Volume 18, Number 9—September 2012   PDF Version [PDF - 17.05 MB - 163 pages]

Perspective

  • Hepatitis E, a Vaccine-Preventable Cause of Maternal Deaths PDF Version [PDF - 202 KB - 4 pages]
    A. B. Labrique et al.
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    These deaths are substantial and could be prevented by commercial vaccine.

        View Abstract

    Hepatitis E virus (HEV) is a major cause of illness and of death in the developing world and disproportionate cause of deaths among pregnant women. Although HEV vaccine trials, including trials conducted in populations in southern Asia, have shown candidate vaccines to be effective and well-tolerated, these vaccines have not yet been produced or made available to susceptible populations. Surveillance data collected during 2001–2007 from >110,000 pregnancies in a population of ≈650,000 women in rural Bangladesh suggest that acute hepatitis, most of it likely hepatitis E, is responsible for ≈9.8% of pregnancy-associated deaths. If these numbers are representative of southern Asia, as many as 10,500 maternal deaths each year in this region alone may be attributable to hepatitis E and could be prevented by using existing vaccines.

Research

  • Medscape CME Activity
    Effectiveness and Timing of Vaccination during School Measles Outbreak PDF Version [PDF - 458 KB - 9 pages]
    A. Marinović et al.
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    Implementing a vaccination campaign during an outbreak can effectively reduce the outbreak size.

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    Despite high vaccination coverage in most European countries, large community outbreaks of measles do occur, normally clustered around schools and resulting from suboptimal vaccination coverage. To determine whether or when it is worth implementing outbreak-response vaccination campaigns in schools, we used stochastic outbreak models to reproduce a public school outbreak in Germany, where no vaccination campaign was implemented. We assumed 2 scenarios covering the baseline vaccination ratio range (91.3%–94.3%) estimated for that school and computed outbreaks assuming various vaccination delays. In one scenario, reacting (i.e., implementing outbreak-response vaccination campaigns) within 12–24 days avoided large outbreaks and reacting within 50 days reduced outbreak size. In the other scenario, reacting within 6–14 days avoided large outbreaks and reacting within 40 days reduced the outbreak size. These are realistic time frames for implementing school outbreak response vaccination campaigns. High baseline vaccination ratios extended the time needed for effective response.

  • Medscape CME Activity
    Evaluation of Diagnostic and Therapeutic Approaches for Suspected Influenza A(H1N1)pdm09 Infection, 2009–2010 PDF Version [PDF - 335 KB - 8 pages]
    V. Vijayan et al.
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    Variations between practice and national recommendations could inform clinical education in future influenza seasons.

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    To assess adherence to real-time changes in guidelines for influenza diagnosis and use of oseltamivir during the 2009 influenza A(H1N1) pandemic, we reviewed medical records of patients with confirmed or suspected influenza-like illness (ILI) and those with no viral testing in a large Los Angeles (California, USA) hospital. Of 882 tested patients, 178 had results positive for influenza; 136 of the remaining patients received oseltamivir despite negative or no results. Oseltamivir use was consistent with national recommendations in >90%. Of inpatients, children were less likely than adults to have ILI at testing and to receive oseltamivir if ILI was found. Of outpatients, children were more likely to have positive test results; 20% tested did not have ILI or other influenza signs and symptoms. Twenty-five of 96 test-positive patients and 13 of 19 with lower respiratory tract disease were, inappropriately, not treated. Variations between practice and national recommendations could inform clinical education in future influenza seasons.

  • Evaluation of Immigrant Tuberculosis Screening in Industrialized Countries PDF Version [PDF - 197 KB - 8 pages]
    M. Pareek et al.
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    Improvements are needed in current screening, which is insufficient and ineffective.

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    In industrialized countries, tuberculosis (TB) cases are concentrated among immigrants and driven by reactivation of imported latent TB infection (LTBI). We examined mechanisms used to screen immigrants for TB and LTBI by sending an anonymous, 18-point questionnaire to 31 member countries of the Organisation for Economic Co-operation and Development. Twenty-nine (93.5%) of 31 responded; 25 (86.2%) screened immigrants for active TB. Fewer countries (16/29, 55.2%) screened for LTBI. Marked variations were observed in targeted populations for age (range <5 years of age to all age groups) and TB incidence in countries of origin of immigrants (>20 cases/100,000 population to >500 cases/100,000). LTBI screening was conducted in 11/16 countries by using the tuberculin skin test. Six countries used interferon-γ release assays, primarily to confirm positive tuberculin skin test results. Industrialized countries performed LTBI screening infrequently and policies varied widely. There is an urgent need to define the cost-effectiveness of LTBI screening strategies for immigrants.

  • Trends in Meningococcal Disease in the United States Military, 1971–2010 PDF Version [PDF - 339 KB - 8 pages]
    M. P. Broderick et al.
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    When you consider the risks undertaken by US military personnel, do you include risk for disease? Public health officials do. Military personnel are at risk for infectious disease because of crowding, the rigors of physical training, and sometimes unhygienic field conditions. Meningococcal disease (usually manifested as bacterial meningitis or blood-borne infection) can be rapidly fatal. It has historically affected the military more than the general US population. One hundred years' worth of data support this trend from as long ago as World War I. However, in 1970, a policy requiring vaccination of military recruits started lowering the rate of infection, although the rate remained higher than that for the general population. Since 1982, improvements in vaccines have lowered rates even further. As a result of these vaccination efforts, the meningococcal disease rate among military personnel has reached a historic low, which now matches that of the general population.

        View Abstract

    Meningococci have historically caused extensive illness among members of the United States military. Three successive meningococcal vaccine types were used from 1971 through 2010; overall disease incidence dropped by >90% during this period. During 2006–2010, disease incidence of 0.38 (cases per 100,000 person-years) among members of the US military was not significantly different from the incidence of 0.26 among the age-matched US general population. Of the 26 cases in the US military, 5 were fatal, 15 were vaccine failures (e.g., illness in a person who had been vaccinated), and 9 were caused by Neisseria meningitidis serogroup Y. Incidences among 17- to 19-year-old basic trainees and among US Marines were significantly higher than among comparison military populations (p<0.05). No apparent change in epidemiology of meningococcal disease was observed after replacement of quadrivalent polysaccharide vaccine with conjugate vaccine in 2007. The data demonstrate that vaccination with meningococcal vaccine is effective.

  • Prevention and Control of Fish-borne Zoonotic Trematodes in Fish Nurseries, Vietnam PDF Version [PDF - 347 KB - 8 pages]
    J. Clausen et al.
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    Reducing snails and trematode eggs in nursery ponds lowered trematode transmission among fish.

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    Worldwide, >18 million persons were infected with fish-borne zoonotic trematodes in 2002. To evaluate the effectiveness of interventions for reducing prevalence and intensity of fish-borne zoonotic trematode infections in juvenile fish, we compared transmission rates at nurseries in the Red River Delta, northern Vietnam. Rates were significantly lower for nurseries that reduced snail populations and trematode egg contamination in ponds than for nurseries that did not. These interventions can be used in the development of programs for sustained control of zoonotic trematodes in farmed fish.

  • Surveillance for Influenza Viruses in Poultry and Swine, West Africa, 2006–2008 PDF Version [PDF - 258 KB - 7 pages]
    E. Couacy-Hymann et al.
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    West Africa might be an animal influenza–free zone.

        View Abstract

    To determine the extent of animal influenza virus circulation in Côte d’Ivoire, Benin, and Togo, we initiated systematic year-round active influenza surveillance in backyard birds (predominantly chickens, guinea fowl, and ducks) and pigs. A total of 26,746 swab specimens were screened by using reverse transcription PCR. Animal influenza prevalence was estimated at 0 (95% CIs for each of the 2 study years 0–0.04% to 0–1.48% [birds] and 0–0.28% to 0–5% [pigs]). In addition, 2,276 serum samples from the same populations were negative for influenza-specific antibodies. These data indicate that the environments and host populations previously identified as harboring high levels of influenza virus in Southeast Asia do not do so in these 3 countries. The combination of climate and animal density factors might be responsible for what appears to be the absence of influenza virus in the backyard sector of the 3 countries.

Policy Review

  • Medscape CME Activity
    Control of Fluoroquinolone Resistance through Successful Regulation, Australia PDF Version [PDF - 230 KB - 8 pages]
    A. C. Cheng et al.
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    Restricted Fluoroquinolone use in humans and food animals has result in low rates of resistance in human pathogens

        View Abstract

    Fluoroquinolone antimicrobial drugs are highly bioavailable, broad-spectrum agents with activity against gram-negative pathogens, especially those resistant to other classes of antimicrobial drugs. Australia has restricted the use of quinolones in humans through its national pharmaceutical subsidy scheme; and, through regulation, has not permitted the use of quinolones in food-producing animals. As a consequence, resistance to fluoroquinolones in the community has been slow to emerge and has remained at low levels in key pathogens, such as Escherichia coli. In contrast to policies in most other countries, this policy has successfully preserved the utility of this class of antimicrobial drugs for treatment of most infections.

Dispatches

Letters

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Etymologia

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