Archive for July, 2009

Prevention and Control of Seasonal Influenza with Vaccines Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009

MMWR  Recommendations and Reports  July 31, 2009  V.58  N.RR-8  1-52

This report updates the 2008 recommendations by CDC’s Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine for the prevention and control of seasonal influenza. Information on vaccination issues related to the recently identified novel influenza A H1N1 virus will be published later in 2009. The 2009 seasonal influenza recommendations include new and updated information. Highlights of the 2009 recommendations include 1) a recommendation that annual vaccination be administered to all children aged 6 months–18 years for the 2009-10 influenza season; 2) a recommendation that vaccines containing the 2009–10 trivalent vaccine virus strains A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like, and B/Brisbane/60/2008-like antigens be used; and  3) a notice that recommendations for influenza diagnosis and antiviral use will be published before the start of the 2009-10 influenza season. Vaccination efforts should begin as soon as vaccine is available and continue through the influenza season.

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July 30, 2009 at 5:57 pm Leave a comment

Intensive-Care Patients With Severe Novel Influenza A (H1N1) Virus Infection — Michigan, June 2009

MMWR Weekly  July 17, 2009 V.58  N.27  p.749-752

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July 30, 2009 at 5:55 pm Leave a comment

Update: Novel Influenza A (H1N1) Virus Infections — Worldwide, May 6, 2009

MMWR Weekly May 8, 2009  V.58  N.17  p.453-458

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July 30, 2009 at 5:54 pm Leave a comment

Respiratory Syncytial Virus and Parainfluenza Virus

N Engl J of Medicine  June 21, 2001  V.344  N.25  p.1917-1928


Medical Progress

Caroline Breese Hall, M.D.



July 30, 2009 at 5:51 pm Leave a comment

A Randomized Trial of Diagnostic Techniques for Ventilator-Associated Pneumonia

N Engl J of Medicine  Dec.21, 2006  V.355  N.25  p.2619-2630

The Canadian Critical Care Trials Group

Background Critically ill patients who require mechanical ventilation are at risk for ventilator-associated pneumonia. Current data are conflicting as to the optimal diagnostic approach in patients who have suspected ventilator-associated pneumonia.

Methods In a multicenter trial, we randomly assigned immunocompetent adults who were receiving mechanical ventilation and who had suspected ventilator-associated pneumonia after 4 days in the intensive care unit (ICU) to undergo either bronchoalveolar lavage with quantitative culture of the bronchoalveolar-lavage fluid or endotracheal aspiration with nonquantitative culture of the aspirate. Patients known to be colonized or infected with pseudomonas species or methicillin-resistant Staphylococcus aureus were excluded. Empirical antibiotic therapy was initiated in all patients until culture results were available, at which point a protocol of targeted therapy was used for discontinuing or reducing the dose or number of antibiotics, or for resuming antibiotic therapy to treat a preenrollment condition if the culture was negative.

Results We enrolled 740 patients in 28 ICUs in Canada and the United States. There was no significant difference in the primary outcome (28-day mortality rate) between the bronchoalveolar-lavage group and the endotracheal-aspiration group (18.9% and 18.4%, respectively; P=0.94). The bronchoalveolar-lavage group and the endotracheal-aspiration group also had similar rates of targeted therapy (74.2% and 74.6%, respectively; P=0.90), days alive without antibiotics (10.4±7.5 and 10.6±7.9, P=0.86), and maximum organ-dysfunction scores (mean [±SD], 8.3±3.6 and 8.6±4.0; P=0.26). The two groups did not differ significantly in the length of stay in the ICU or hospital.

Conclusions Two diagnostic strategies for ventilator-associated pneumonia — bronchoalveolar lavage with quantitative culture of the bronchoalveolar-lavage fluid and endotracheal aspiration with nonquantitative culture of the aspirate — are associated with similar clinical outcomes and similar overall use of antibiotics.



July 26, 2009 at 9:56 pm Leave a comment

Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia

Am J of Respiratory and Critical Care Medicine  Feb 2005  V.171  N.4  p.388-416

American Thoracic Society Documents

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July 26, 2009 at 9:53 pm Leave a comment

Respiratory Syncytial Virus Infection in Elderly and High-Risk Adults

N Engl J of Medicine  Apr 28, 2005  V.352  N.17  p.1749-1759

Ann R. Falsey, M.D., Patricia A. Hennessey, R.N., Maria A. Formica, M.S., Christopher Cox, Ph.D., and Edward E. Walsh, M.D.

Background Respiratory syncytial virus (RSV) is an increasingly recognized cause of illness in adults. Data on the epidemiology and clinical effects in community-dwelling elderly persons and high-risk adults can help in assessing the need for vaccine development.

Methods During four consecutive winters, we evaluated all respiratory illnesses in prospective cohorts of healthy elderly patients (65 years of age) and high-risk adults (those with chronic heart or lung disease) and in patients hospitalized with acute cardiopulmonary conditions. RSV infection and influenza A were diagnosed on the basis of culture, reverse-transcriptase polymerase chain reaction, and serologic studies.

Results A total of 608 healthy elderly patients and 540 high-risk adults were enrolled in prospective surveillance, and 1388 hospitalized patients were enrolled. A total of 2514 illnesses were evaluated. RSV infection was identified in 102 patients in the prospective cohorts and 142 hospitalized patients, and influenza A was diagnosed in 44 patients in the prospective cohorts and 154 hospitalized patients. RSV infection developed annually in 3 to 7 percent of healthy elderly patients and in 4 to 10 percent of high-risk adults. Among healthy elderly patients, RSV infection generated fewer office visits than influenza; however, the use of health care services by high-risk adults was similar in the two groups. In the hospitalized cohort, RSV infection and influenza A resulted in similar lengths of stay, rates of use of intensive care (15 percent and 12 percent, respectively), and mortality (8 percent and 7 percent, respectively). On the basis of the diagnostic codes of the International Classification of Diseases, 9th Revision, Clinical Modification at discharge, RSV infection accounted for 10.6 percent of hospitalizations for pneumonia, 11.4 percent for chronic obstructive pulmonary disease, 5.4 percent for congestive heart failure, and 7.2 percent for asthma.

Conclusions RSV infection is an important illness in elderly and high-risk adults, with a disease burden similar to that of nonpandemic influenza A in a population in which the prevalence of vaccination for influenza is high. An effective RSV vaccine may offer benefits for these adults.



July 26, 2009 at 9:50 pm Leave a comment

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