Archive for August 21, 2008

West Nile Virus Update — United States, January 1–August 19, 2008

MMWR Weekly  August 22, 2008  V.57  N.33  p.901

West Nile Virus Update — United States, January 1–August 19, 2008

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August 21, 2008 at 5:48 pm Leave a comment

Syphilis Testing Algorithms Using Treponemal Tests for Initial Screening — Four Laboratories, New York City, 2005–2006

MMWR Weekly  August 15, 2008  V.57  N.32  p.872-875

Syphilis Testing Algorithms Using Treponemal Tests for Initial Screening — Four Laboratories, New York City, 2005–2006

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August 21, 2008 at 5:46 pm Leave a comment

Prognosis after West Nile Virus Infection

Annals of Internal Medicine  19 August 2008  V.149  N.4  p.232-241

Mark Loeb, MD, MSc; Steven Hanna, PhD; Lindsay Nicolle, MD; John Eyles, PhD; Susan Elliott, PhD; Michel Rathbone, MD; Michael Drebot, PhD; Binod Neupane, MSc; Margaret Fearon, MD; and James Mahony, PhD

From McMaster University, Hamilton, Ontario; University of Manitoba and the Public Health Agency of Canada, Winnipeg, Manitoba; and Ontario Provincial Laboratory, Toronto, Ontario, Canada

Background: The long-term prognosis of patients infected with West Nile virus is not well understood.

Objective: To describe the patterns of physical and mental function after infection with West Nile virus and to determine factors associated with recovery.

Design: Longitudinal cohort study.

Setting: Data were collected during home visits and from ambulatory clinics in 4 Canadian provinces.

Participants: 156 persons with West Nile virus infection.

Measurements: Scores on the Physical Component Summary and Mental Component Summary of the Short Form-36, Depression Anxiety Stress Scale, and Fatigue Severity Scale.

Results: Physical and mental function, as well as mood and fatigue, seemed to return to normal within 1 year of symptom onset. Participants with neuroinvasive disease took slightly longer to recover. Maximum predicted recovery or rate of recovery in any domain did not differ between participants with meningoencephalitis and those with encephalitis. Lack of preexisting comorbid conditions was associated with faster recovery of physical function, whereas lack of comorbid conditions and male sex were associated with faster recovery of mental function.

Limitations: The analysis excluded 7 patients who died shortly after diagnosis, so the study’s estimates of prognosis may be overoptimistic. The authors did not formally assess neuropsychological difficulties. The estimates of recovery are relative to the U.S. population, not to participants’ function levels before West Nile virus infection.

Conclusion: Physical and mental outcome measures seem to normalize within approximately 1 year in patients with West Nile virus. The presence of preexisting comorbid conditions is associated with longer recovery.


August 21, 2008 at 5:44 pm Leave a comment

Health and Economic Implications of HPV Vaccination in the United States

N Engl J of Medicine  Aug.21, 2008  V.359  N.8  p.821-832

Jane J. Kim, Ph.D., and Sue J. Goldie, M.D., M.P.H.


Background The cost-effectiveness of prophylactic vaccination against human papillomavirus types 16 (HPV-16) and 18 (HPV-18) is an important consideration for guidelines for immunization in the United States.

Methods We synthesized epidemiologic and demographic data using models of HPV-16 and HPV-18 transmission and cervical carcinogenesis to compare the health and economic outcomes of vaccinating preadolescent girls (at 12 years of age) and vaccinating older girls and women in catch-up programs (to 18, 21, or 26 years of age). We examined the health benefits of averting other HPV-16–related and HPV-18–related cancers, the prevention of HPV-6–related and HPV-11–related genital warts and juvenile-onset recurrent respiratory papillomatosis by means of the quadrivalent vaccine, the duration of immunity, and future screening practices.

Results On the assumption that the vaccine provided lifelong immunity, the cost-effectiveness ratio of vaccination of 12-year-old girls was $43,600 per quality-adjusted life-year (QALY) gained, as compared with the current screening practice. Under baseline assumptions, the cost-effectiveness ratio for extending a temporary catch-up program for girls to 18 years of age was $97,300 per QALY; the cost of extending vaccination of girls and women to the age of 21 years was $120,400 per QALY, and the cost for extension to the age of 26 years was $152,700 per QALY. The results were sensitive to the duration of vaccine-induced immunity; if immunity waned after 10 years, the cost of vaccination of preadolescent girls exceeded $140,000 per QALY, and catch-up strategies were less cost-effective than screening alone. The cost-effectiveness ratios for vaccination strategies were more favorable if the benefits of averting other health conditions were included or if screening was delayed and performed at less frequent intervals and with more sensitive tests; they were less favorable if vaccinated girls were preferentially screened more frequently in adulthood.

Conclusions The cost-effectiveness of HPV vaccination will depend on the duration of vaccine immunity and will be optimized by achieving high coverage in preadolescent girls, targeting initial catch-up efforts to women up to 18 or 21 years of age, and revising screening policies.



Human Papillomavirus Vaccination — Reasons for Caution

Charlotte J. Haug, M.D., Ph.D.


August 21, 2008 at 11:13 am Leave a comment

Large Community Outbreak of Streptococcus pneumoniae Serotype 5 Invasive Infection in an Impoverished, Urban Population

Clinical Infectious Diseases 15 September 2008  V.47  N.6  p.768–774 

Marc G. Romney,1,3 Mark W. Hull,2 Réka Gustafson,3,4 Jat Sandhu,4 Sylvie Champagne,1,3 Titus Wong,3 Anouf Nematallah,3 Sara Forsting,4 and Patricia Daly3,4

Departments of 1Pathology and Laboratory Medicine and 2Medicine, St. Paul’s Hospital, Providence Health Care, 3Faculty of Medicine, University of British Columbia, and 4Communicable Disease Control, Vancouver Coastal Health, Vancouver, Canada

Background.  Streptococcus pneumoniae is a common cause of sporadic invasive infections, but outbreaks of invasive pneumococcal disease are infrequent. In August 2006, a sudden increase in the number of patients presenting with invasive pneumococcal disease was noted at St. Paul’s Hospital (Vancouver, Canada). Most patients with severe disease resided in an area referred to as the Downtown Eastside, a neighborhood known for its high rates of poverty and illicit drug use.

Methods.  Prospective, laboratory-based surveillance for invasive pneumococcal disease was initiated, including on-site serotyping of S. pneumoniae isolates. A vaccination campaign using 23-valent polysaccharide pneumococcal vaccine was launched in the Downtown Eastside. Multiple logistic regression was used to examine the association of sociodemographic variables and medical risk factors with S. pneumoniae serotype status.

Results.  A single S. pneumoniae serotype (serotype 5) was responsible for 78% of invasive pneumococcal disease cases (137 of 175 cases) during the outbreak period of August 2006–July 2007. The outbreak strain, although fully susceptible to penicillin, caused significant morbidity and placed considerable strain on the acute care system within the Vancouver Coastal Health region. Crack cocaine use was found to be the main independent risk factor associated with invasive pneumococcal disease due to S. pneumoniae serotype 5 (odds ratio, 12.4; 95% confidence interval, 2.22–69.5).

Conclusions.  A targeted vaccination campaign using polysaccharide pneumococcal vaccine appeared to help control this outbreak. In urban centers with high rates of illicit drug use, vaccination strategies for preventing invasive pneumococcal disease may need to be refined to include individuals who use crack cocaine.


August 21, 2008 at 11:10 am Leave a comment

Campylobacter Bacteremia: Clinical Features and Factors Associated with Fatal Outcome

Clinical Infectious Diseases 15 September 2008  V.47  N.6  p.790–796 

Jérôme Pacanowski,1 Valérie Lalande,2 Karine Lacombe,1,6,8 Cherif Boudraa,1 Philippe Lesprit,10
Patrick Legrand,11 David Trystram,3 Najiby Kassis,12 Guillaume Arlet,4,6 Jean-Luc Mainardi,5,7
Florence Doucet-Populaire,9,7,13 Pierre-Marie Girard,1,6,8 and Jean-Luc Meynard,1 for the
CAMPYL Study Groupa

1Service des Maladies Infectieuses et Tropicales and 2Laboratoire de Microbiologie, Hôpital Saint-Antoine, 3Laboratoire de Bactériologie, Hôpital La Pitié-Salpétrière, 4Laboratoire de Bactériologie, Hôpital Tenon, 5Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Hôpital Européen Georges Pompidou, 6Université Paris VI Pierre et Marie Curie, 7Université Paris V René Descartes, 8INSERM UMR-S707, and 9Unité EA 4065, Paris, 10Unité Contrôle Epidémiologie et Prévention de l’Infection and 11Laboratoire de Microbiologie, Hôpital Henri Mondor, Créteil, 12Laboratoire de Microbiologie, Hôpital Paul Brousse, Villejuif, and 13Laboratoire de Microbiologie, Hôpital de Versailles, Le Chesnay, France

Background.  Campylobacter bacteremia is uncommon. The influence of underlying conditions and of the impact of antibiotics on infection outcome are not known.

Methods.  From January 2000 through December 2004, 183 episodes of Campylobacter bacteremia were identified in 23 hospitals in the Paris, France, area. The medical records were reviewed. Characteristics of bacteremia due to Campylobacter fetus and to other Campylobacter species were compared. Logistic regression analysis was performed to identify risk factors for fatal outcome within 30 days.

Results.  Most affected patients were elderly or immunocompromised. C. fetus was the most commonly identified species (in 53% of patients). The main underlying conditions were liver disease (39%) and cancer (38%). The main clinical manifestations were diarrhea (33%) and skin infection (16%). Twenty-seven patients (15%) died within 30 days. Compared with patients with bacteremia due to other Campylobacter species, patients with C. fetus bacteremia were older (mean age, 69.5 years vs. 55.6 years; P<.001) and were more likely to have cellulitis (19% vs. 7%; P=.03), endovascular infection (13% vs. 1%;  P=.007), or infection associated with a medical device (7% vs. 0%; P=.02). Independent risk factors for death were cancer (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.2–20.8) and asymptomatic infection (OR, 6.7; 95% CI, 1.5–29.4) for C. fetus bacteremia, the absence of prescription of appropriate antibiotics (OR, 12.2; 95% CI, 0.9–157.5), and prescription of third-generation cephalosporins (OR, 10.2; 95% CI, 1.9–53.7) for bacteremia caused by other species.

Conclusions.  Campylobacter bacteremia occurs mainly in immunocompromised patients. Clinical features and risk factors of death differ by infection species.


August 21, 2008 at 11:07 am Leave a comment


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