Archive for March, 2010

Recommended Childhood and Adolescent Immunization Schedules—United States, 2010

PEDIATRICS  Jan 2010  V.125  N.1  p.195-196

Committee on Infectious Diseases

The 2010 recommended childhood and adolescent immunization schedules have been approved by the American Academy of Pediatrics, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and the American Academy of Family Physicians. There are 3 schedules: one for children 0 through 6 years of age, one for people 7 through 18 years of age, and a catch-up immunization schedule for children and adolescents who start late or fall behind. These schedules reflect current recommendations for the use of vaccines licensed by the US Food and Drug Administration and include the following changes from last year….



March 30, 2010 at 6:10 pm Leave a comment

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents Dec. 2009

Developed by the DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents – A Working Group of the Office of AIDS Research Advisory Council (OARAC) 168 pags.

December 1, 2009


March 29, 2010 at 6:30 pm Leave a comment

ARGENTINA – Situación del Dengue Actualización 26/03/2010

ARGENTINA – Situación del Dengue

Actualización 26/03/2010

Parte Nº 17 del Ministerio de Salud de la Nación

Desde diciembre de 2009 hasta la fecha, se ha confirmado la circulación de virus dengue serotipo 1 (DEN-1) en Argentina por parte del Laboratorio Nacional de Referencia (LNR) INEVH “Julio I. Maiztegui”. Se ha confirmado un caso de dengue serotipo 4 (DEN-4) en la ciudad de Rosario, sin antecedentes de viaje previo a zona afectada.  Hasta el momento no se confirmó la enfermedad por este serotipo en otros pacientes.

Se ha confirmado también la infección por dengue serotipo 2 (DEN-2) en pacientes con antecedentes de viaje a zonas afectadas fuera del país.

Se registraron en el país desde el 1º de enero de 2010 hasta la fecha, un total de 759 enfermos compatibles con dengue 1.

Provincia de Buenos Aires

En la provincia se registraron hasta la fecha 16 enfermos compatibles con dengue. Como se consignó en partes anteriores, en 2 de ellos se ha confirmado la infección (uno en la localidad de Tornquist y el otro en La Plata). Ambos con antecedentes de viaje reciente a zona afectada (Perú y Brasil).

En los restantes 14 enfermos no se ha confirmado aún la infección y continúan en estudio; los mismos se distribuyen en 13 localidades.


March 27, 2010 at 1:26 pm Leave a comment

2009 Pandemic Influenza A (H1N1) in Pregnant Women Requiring Intensive Care — New York City, 2009

MMWR Weekly March 26, 2010  V.59  N.11  p.321-326

Pregnant women are at increased risk for severe illness and complications from infection with seasonal influenza (1–3) and 2009 pandemic influenza A (H1N1) (4–6). To characterize the severity of 2009 H1N1 infection in pregnant women, the New York City Department of Health and Mental Hygiene (DOHMH) conducted active and passive surveillance for cases of 2009 H1N1 infection in pregnant women requiring intensive care. This report summarizes the results of that surveillance, which found that, during 2009, 16 pregnant women and one who was postpartum were admitted to New York City intensive-care units (ICUs). Two women died. Of the 17 women, 12 had no recognized risk factors for severe influenza complications other than pregnancy (7). All 17 women received antiviral treatment with oseltamivir; however, treatment was initiated ≤2 days after symptom onset in only one woman and was begun ≥5 days after symptom onset in four women. Because initiation of antiviral treatment ≤2 days after onset is associated with better outcomes (5,6), pregnant women should be encouraged to seek medical care immediately if they develop influenza-like symptoms, and health-care providers should initiate empiric antiviral therapy for these women as soon as possible, even if >2 days after symptom onset. Health departments and health-care providers should educate pregnant and postpartum women regarding the risks posed by influenza and highlight the effectiveness and safety of influenza vaccination. Obstetricians and other health-care providers should offer influenza vaccination to their pregnant patients….

Full Text


March 25, 2010 at 6:13 pm Leave a comment

Switching Gears for an Influenza Pandemic: Validation of a Duplex Reverse Transcriptase PCR Assay for Simultaneous Detection and Confirmatory Identification of Pandemic (H1N1) 2009 Influenza Virus

Journal of Clinical Microbiology  1 Dec 2009  V.47  N.12  p.3805-3813

Jason J. LeBlanc,1* Yan Li,3 Nathalie Bastien,3 Kevin R. Forward,1,2 Ross J. Davidson,1,2 and Todd F. Hatchette1,2

Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia, Canada,1 Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada,2 National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada3

Rapid methods for the detection and confirmatory identification of pandemic influenza A virus (also known as pandemic [H1N1] 2009) are of utmost importance. In this study, a conventional reverse transcriptase PCR (RT-PCR) assay for the detection of influenza A virus and the hemagglutinin of swine lineage H1 (swH1) was designed, optimized, and validated. Nucleic acids were extracted from 198 consecutive nasopharyngeal, nasal, or throat swab specimens collected early in the outbreak (127 negative specimens, 66 specimens with pandemic [H1N1] 2009 influenza virus, 3 specimens with seasonal [H1N1] influenza A virus, and 2 specimens with seasonal [H3N2] influenza A virus). The performance characteristics of the duplex RT-PCR assay were assessed and compared to those of various detection methods: a monoplex RT-PCR assay at the National Microbiology Laboratory, a real-time RT-PCR assay using a Centers for Disease Control and Prevention protocol, an in-house multiplex RT-PCR assay (targeting influenza A virus, influenza B virus, and respiratory syncytial virus), and a rapid antigen test (the Binax Now Influenza A & B assay). The sensitivity of the duplex RT-PCR assay for influenza A virus detection was 97.2%, whereas the sensitivities were 74.6%, 71.8%, 47.8%, and 12.7% for the other four assays, respectively. The duplex RT-PCR assay was also able to identify swH1 in 94% of the cases, thereby reducing the number of specimens forwarded to reference laboratories for confirmatory identification. Only a limited number of specimens that contained influenza A virus had amounts of virus that fell below the limit of detection of the assay with the swH1 primers. Overall, the duplex RT-PCR assay is a reliable method for the simultaneous detection and confirmatory identification of pandemic (H1N1) 2009 influenza virus and would be particularly attractive to laboratories without real-time RT-PCR capabilities.



March 24, 2010 at 6:51 pm Leave a comment

Mutability in the Matrix Gene of Novel Influenza A H1N1 Virus Detected Using a FRET Probe-Based Real-Time Reverse Transcriptase PCR Assay

Journal of Clinical Microbiology  1 Feb 2010 V.48 N.2 p.677-679

Neelam Dhiman, Mark J. Espy, Cole Irish, Patty Wright, Thomas F. Smith, and Bobbi S. Pritt

Influenza A viruses are well known for their genetic diversity. They are constantly evolving through point mutations in their hemagglutinin (H) and neuraminidase (N) genes and through genetic reassortment of their segmented RNA genome (2). The current pandemic/2009/novel H1N1 influenza A virus (called novel H1N1 herein) is a product of antigenic shift resulting from triple reassortment of human, avian, and swine viruses….


March 24, 2010 at 6:45 pm Leave a comment

Effect of Influenza Vaccination of Children on Infection Rates in Hutterite Communities

JAMA 10 March 10  2010  V.303 N.10  p.943-950

A Randomized Trial

Mark Loeb, MD, MSc; Margaret L. Russell, MD, PhD; Lorraine Moss, BSc; Kevin Fonseca, PhD; Julie Fox, PhD; David J. D. Earn, PhD; Fred Aoki, MD; Gregory Horsman, MD; Paul Van Caeseele, MD; Khami Chokani, MD; Mark Vooght, MD; Lorne Babiuk, PhD; Richard Webby, PhD; Stephen D. Walter, PhD

Departments of Pathology and Molecular Medicine (Dr Loeb and Ms Moss), Medicine (Dr Loeb), and Clinical Epidemiology and Biostatistics (Drs Loeb, Earn, and Walter), Michael G. DeGroote Institute for Infectious Disease Research (Drs Loeb and Earn), and Department of Mathematics and Statistics (Dr Earn), McMaster University, Hamilton, Ontario; Department of Community Health Sciences (Dr Russell) and Provincial Laboratory for Public Health and Department of Microbiology and Infectious Diseases (Drs Fonseca and Fox), University of Calgary, Calgary, Alberta; Departments of Medicine, Medical Microbiology and Pharmacology, and Therapeutics, University of Manitoba, Winnipeg (Dr Aoki); Saskatchewan Disease Control Laboratory, Regina (Dr Horsman); Cadham Provincial Laboratory, Winnipeg, Manitoba (Dr Van Caeseele); Saskatchewan Health, Cypress Health Region, Swift Current (Dr Chokani); Saskatchewan Health, Five Hills, Moose Jaw (Dr Vooght); and University of Alberta, Edmonton (Dr Babiuk), Canada; and St Jude Children’s Research Hospital and WHO Collaborating Center, Memphis, Tennessee (Dr Webby).


Children and adolescents appear to play an important role in the transmission of influenza. Selectively vaccinating youngsters against influenza may interrupt virus transmission and protect those not immunized.


To assess whether vaccinating children and adolescents with inactivated influenza vaccine could prevent influenza in other community members.

Design, Setting, and Participants

A cluster randomized trial involving 947 Canadian children and adolescents aged 36 months to 15 years who received study vaccine and 2326 community members who did not receive the study vaccine in 49 Hutterite colonies in Alberta, Saskatchewan, and Manitoba. Follow-up began December 28, 2008, and ended June 23, 2009.


Children were randomly assigned according to community and in a blinded manner to receive standard dosing of either inactivated trivalent influenza vaccine or hepatitis A vaccine, which was used as a control.

Main Outcome Measures

Confirmed influenza A and B infection using a real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay and by measuring serum hemagglutination inhibition titers.


The mean rate of study vaccine coverage among eligible participants was 83% (range, 53%-100%) for the influenza vaccine colonies and 79% (range, 50%-100%) for the hepatitis A vaccine colonies. Among nonrecipients, 39 of 1271 (3.1%) in the influenza vaccine colonies and 80 of 1055 (7.6%) in the hepatitis A vaccine colonies had influenza illness confirmed by RT-PCR, for a protective effectiveness of 61% (95% confidence interval [CI], 8%-83%; P = .03). Among all study participants (those who were and those who were not vaccinated), 80 of 1773 (4.5%) in the influenza vaccine colonies and 159 of 1500 (10.6%) in the hepatitis A vaccine colonies had influenza illness confirmed by RT-PCR for an overall protective effectiveness of 59% (95% CI, 5%-82%; P = .04). No serious vaccine adverse events were observed.


Immunizing children and adolescents with inactivated influenza vaccine significantly protected unimmunized residents of rural communities against influenza.



March 24, 2010 at 6:39 pm Leave a comment

Curbing Methicillin-Resistant Staphylococcus aureus in 38 French Hospitals Through a 15-Year Institutional Control Program

Archives of Internal Medicine March 22, 2010  V.170  N.6  p.552-559

Vincent Jarlier, MD, PhD; David Trystram, MD; Christian Brun-Buisson, MD, PhD; Sandra Fournier, MD; Anne Carbonne, MD; Laurence Marty, MD; Antoine Andremont, MD, PhD; Guillaume Arlet, MD, PhD; Annie Buu-Hoi, MD; Jean Carlet, MD, PhD; Dominique Decré, PharmD, PhD; Serge Gottot, MD, PhD; Laurent Gutmann, MD, PhD; Marie-Laure Joly-Guillou, MD, PhD; Patrick Legrand, MD; Marie-Hélène Nicolas-Chanoine, MD, PhD; Claude-James Soussy, MD, PhD; Michel Wolf, MD, PhD; Jean-Christophe Lucet, MD, PhD; Michelle Aggoune; Gilles Brücker, MD, PhD; Bernard Régnier, MD, PhD; for the Collégiale de Bactériologie-Virologie-Hygiène des Hôpitaux Universitaires de l’Île de France

Laboratoire de Bactériologie-Hygiène, Université Pierre et Marie Curie–Paris 6 and Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France (Drs Jarlier and Trystram); Réanimation Médicale (Dr Brun-Buisson) and Bactériologie-Virologie-Hygiène (Drs Legrand and Soussy), Hôpital Henri Mondor (AP-HP), Créteil, France; Direction de la Politique Médicale (AP-HP), Paris (Drs Jarlier and Fournier); Centre de Coordination de la Lutte Contre les Infections Nosocomiales Paris-Nord (C-CLIN Paris-Nord), Paris (Dr Carbonne and Ms Aggoune); Bactériologie-Virologie-Hygiène, Hôpital de Lagny, Lagny, France (Dr Marty); Bactériologie (Dr Andremont), Santé Publique (Dr Gottot), Unité d’Hygiène (Dr Lucet), and Réanimation Médicale (Drs Wolf and Régnier), Hôpital Bichat–Claude Bernard (AP-HP), Paris; Bactériologie-Virologie-Hygiène, Hôpital Tenon (AP-HP), Paris (Dr Arlet); Bactériologie-Virologie-Hygiène, Hôpital Européen Georges Pompidou (AP-HP), Paris (Dr Buu-Hoi and Gutmann); Direction Médicale, Haute Autorité de Santé, Saint-Denis-La-Plaine, France (Dr Carlet); Bactériologie-Virologie-Hygiène, Hôpital Saint Antoine, Paris (Dr Decré); Bactériologie-Virologie-Hygiène, Centre Hôpitalier Universitaire (CHU) d’Angers, Angers, France (Dr Joly-Guillou); Bactériologie-Virologie-Hygiène, Hôpital Beaujon (AP-HP), Paris (Dr Nicolas-Chanoine); and Direction Médicale, Public Interest Group ESTHER (Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau), Paris (Dr Brücker).


The Assistance Publique–Hôpitaux de Paris (AP-HP) institution administers 38 teaching hospitals (23 acute care and 15 rehabilitation and long-term care hospitals; total, 23 000 beds) scattered across Paris and surrounding suburbs in France. In the late 1980s, the proportion of methicillin resistance among clinical strains of Staphylococcus aureus (MRSA) reached approximately 40% at AP-HP.


A program aimed at curbing the MRSA burden was launched in 1993, based on passive and active surveillance, barrier precautions, training, and feedback. This program, supported by the strong commitment of the institution, was reinforced in 2001 by a campaign promoting the use of alcohol-based hand-rub solutions. An observational study on MRSA rate was prospectively carried out from 1993 onwards.


There was a significant progressive decrease in MRSA burden (–35%) from 1993 to 2007, whether recorded as the proportion (expressed as percentage) of MRSA among S aureus strains (41.0% down to 26.6% overall; 45.3% to 24.2% in blood cultures) or incidence of MRSA cases (0.86 down to 0.56 per 1000 hospital days). The MRSA burden decreased more markedly in intensive care units (–59%) than in surgical (–44%) and medical (–32%) wards. The use of ABHR solutions (in liters per 1000 hospital days) increased steadily from 2 L to 21 L (to 26 L in acute care hospitals and to 10 L in rehabilitation and long-term care hospitals) following the campaign.


A sustained reduction of MRSA burden can be obtained at the scale of a large hospital institution with high endemic MRSA rates, providing that an intensive program is maintained for a long period.



March 24, 2010 at 12:33 pm Leave a comment

Detection of multiple respiratory pathogens during primary respiratory infection: nasal swab versus nasopharyngeal aspirate using real-time polymerase chain reaction

European Journal of Clinical Microbiology & Infectious Diseases Apr 2010 V.29 N.4 p.365-371

T. J. Meerhoff1 , M. L. Houben2, F. E. J. Coenjaerts3, J. L. L. Kimpen2, R. W. Hofland2, F. Schellevis1, 4 and L. J. Bont2

(1)  NIVEL: Netherlands Institute for Health Services Research, Utrecht, The Netherlands

(2)  Department of Paediatrics, University Medical Centre Utrecht, Utrecht, The Netherlands

(3)  Department of Virology, University Medical Centre Utrecht, Utrecht, The Netherlands

(4)  Department of General Practice/EMGO Institute, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands


In this study, we present the multiple detection of respiratory viruses in infants during primary respiratory illness, investigate the sensitivity of nasal swabs and nasopharyngeal aspirates, and assess whether patient characteristics and viral load played a role in the sensitivity. Healthy infants were included at signs of first respiratory tract infection. Paired nasopharyngeal aspirates and nasal swabs were collected. Real-time polymerase chain reaction (PCR) was carried out for 11 respiratory pathogens. Paired nasopharyngeal aspirates and nasal swabs were collected in 98 infants. Rhinovirus (n = 67) and respiratory syncytial virus (n = 39) were the most frequently detected. Co-infection occurred in 48% (n = 45) of the infants. The sensitivity of the nasal swab was lower than the nasopharyngeal aspirate, in particular, for respiratory syncytial virus (51% vs. 100%) and rhinovirus (75% vs. 97%). The sensitivity of the nasal swab was strongly determined by the cycle threshold (CT) value (p < 0.001). The sensitivity of the swab for respiratory syncytial virus, but not rhinovirus, was 100% in children with severe symptoms (score ≥11). It is concluded that, for community-based studies and surveillance purposes, the nasal swab can be used, though the sensitivity is lower than the aspirate, in particular, for the detection of mild cases of respiratory syncytial virus (RSV) infection.



March 21, 2010 at 4:37 pm Leave a comment

The Modified APACHE II Score Outperforms Curb65 Pneumonia Severity Score as a Predictor of 30-Day Mortality in Patients With Methicillin-Resistant Staphylococcus aureus Pneumonia*

Chest February 1, 2008  V.133  N.2  p.363-369

Katherine E. Kollef, Richard M. Reichley, RPh, Scott T. Micek, PharmD and Marin H. Kollef, MD, FCCP

From the Division of Pulmonary and Critical Care Medicine (Dr. Kollef and Ms. Kollef), Washington University School of Medicine; Center for Quality and Effectiveness (Mr. Reichley), BJC Healthcare; and Department of Pharmacy Practice (Dr. Micek), St. Louis College of Pharmacy, St. Louis, MO.



To compare the predictive accuracy for 30-day mortality of the CURB65 score adopted by the British Thoracic Society and the simpler CRB65 score to APACHE (acute physiology and chronic health evaluation) II in patients with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.


A retrospective, single-center, observational cohort study.


Barnes-Jewish Hospital, a 1,200-bed urban teaching hospital.


Adult patients requiring hospitalization identified to have MRSA pneumonia.


Retrospective data collection from automated hospital, microbiology, and pharmacy databases.

Measurements and main results

Two hundred eighteen patients with MRSA pneumonia were identified over a 3-year period. Forty-four patients (20.2%) died during hospitalization. All three prediction rules had high negative predictive values but relatively low positive predictive values at most cut-off points examined. APACHE II had the greatest area under the receiver operating characteristic curve (0.805; 95% confidence interval [CI], 0.743 to 0.866) compared to CURB65 (0.634; 95% CI, 0.541 to 0.727) and CRB65 (0.643; 95% CI, 0.546 to 0.739) [p < 0.05 for both comparisons]. Similar results were obtained when the subgroups of community-acquired MRSA pneumonia and health-care–associated MRSA pneumonia were examined separately.


APACHE II outperformed CURB65 and CRB65 for initial prognostic assessment in MRSA pneumonia.



March 20, 2010 at 10:17 pm Leave a comment

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