Morb Mortal Wkly Research Articles

Prevention and Control of Seasonal Influenza with Vaccines.

This report updates the 2015-16 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines (Grohskopf LA, Sokolow LZ, Olsen SJ, Bresee JS, Broder KR, Karron RA. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, United States, 2015-16 influenza season. MMWR Morb Mortal Wkly Rep 2015;64:818-25). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. For the 2016-17 influenza season, inactivated influenza vaccines (IIVs) will be available in both trivalent (IIV3) and quadrivalent (IIV4) formulations. Recombinant influenza vaccine (RIV) will be available in a trivalent formulation (RIV3). In light of concerns regarding low effectiveness against influenza A(H1N1)pdm09 in the United States during the 2013-14 and 2015-16 seasons, for the 2016-17 season, ACIP makes the interim recommendation that live attenuated influenza vaccine (LAIV4) should not be used. Vaccine virus strains included in the 2016-17 U.S. trivalent influenza vaccines will be an A/California/7/2009 (H1N1)-like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008-like virus (Victoria lineage). Quadrivalent vaccines will include an additional influenza B virus strain, a B/Phuket/3073/2013-like virus (Yamagata lineage).Recommendations for use of different vaccine types and specific populations are discussed. A licensed, age-appropriate vaccine should be used. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended product is otherwise appropriate. This information is intended for vaccination providers, immunization program personnel, and public health personnel. Information in this report reflects discussions during public meetings of ACIP held on October 21, 2015; February 24, 2016; and June 22, 2016. These recommendations apply to all licensed influenza vaccines used within Food and Drug Administration-licensed indications, including those licensed after the publication date of this report. Updates and other information are available at CDC's influenza website (http://www.cdc.gov/flu). Vaccination and health care providers should check CDC's influenza website periodically for additional information.

Influenza vaccination administration: When is it too early?

Each year, the Advisory Committee on Immunization Practices (ACIP) publishes recommendations on the appropriate use of influenza vaccine. Over the years, there have been concerns about the optimal time when the vaccine should be given owing to the possibility of waning immunity if administered too early in the influenza season. The ACIP recommendations for the 2015-2016 influenza season state that the vaccine should be given before the onset of influenza activity in the community and should be offered by October if possible. 1 Grohskopf L.A. Olsen S.J. Sokolow L.Z. et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2015-16 influenza season. MMWR Morb Mortal Wkly Rep. 2015; 64: 818-825 Crossref PubMed Scopus (244) Google Scholar The 2013-2014 recommendations had changed the wording to state that patients should be vaccinated “soon after vaccine becomes available and, if possible, by October.” 2 Centers for Disease Control and PreventionPrevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices—United States, 2013-14. MMWR Recomm Rep. 2013; 62: 1-43 Google Scholar The 2012-2013 guidelines were worded slightly differently, stating that the vaccine should be given “as soon as vaccine is available.” 3 Centers for Disease Control and PreventionPrevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2012-2013 influenza season. MMWR Morb Mortal Wkly Rep. 2012; 61: 613-618 PubMed Google Scholar The 1990 recommendations suggested November as the optimal time for organized clinics. 4 Centers for Disease Control and PreventionPrevention and control of influenza: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Recomm Rep. 1990; 39: 1-15 Google Scholar These changes in wording reflect the difficulty in deciding the optimal time, based on conflicting literature regarding the duration of protection after vaccination. With newer preparations of influenza vaccine (e.g., influenza high-dose, cell culture, live attenuated, or intradermal influenza vaccine) as well as improvements in vaccine production (vaccine manufacturers are shipping influenza vaccine to clinicians in late summer), vaccine is now available earlier than ever. Chasity M. Shelton, PharmD, BCPS, BCPPS, Assistant Professor, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN Brandon M. Ladd, Student Pharmacist, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN Stephan L. Foster, PharmD, FAPhA, Professor, College of Pharmacy, APhA Liaison Representative to the Advisory Committee on Immunization Practices, University of Tennessee Health Science Center, Memphis, TN

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2016

I October 2015, the Advisory Committee on Immunization Practices (ACIP) approved the Recommended Adult Immunization Schedule: United States, 2016. This schedule summarizes ACIP recommendations for the use of vaccines routinely recommended for adults in 2 figures (Figures 1 and 2), footnotes for each vaccine (Figure 3), and a table that describes primary contraindications and precautions for commonly used vaccines for adults (Table). Details on these updates and information on other vaccines recommended for adults can be found at www.cdc.gov/vaccines/schedules. The full ACIP recommendations for each vaccine are not included in the schedule owing to space limitations but can be found at www.cdc.gov/vaccines/hcp/acip-recs /index.html. The 2016 adult immunization schedule was reviewed and approved by the American College of Physicians, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and American College of Nurse-Midwives. Changes in the 2016 adult immunization schedule from the 2015 schedule include the following new ACIP recommendations: Y Interval change for 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) from “6 to 12 months” to “at least 1 year” for immunocompetent adults aged ≥65 years (1). Adults aged ≥19 years with anatomical or functional asplenia, cerebrospinal fluid leak, or cochlear implant or who are immunocompromised should receive PPSV23 at least 8 weeks after PCV13. Y Serogroup B meningococcal (MenB) vaccine series should be administered to persons aged ≥10 years who are at increased risk for serogroup B meningococcal disease (2). Those at increased risk include persons with anatomical or functional asplenia or persistent complement component deficiencies, microbiologists who are routinely exposed to isolates of Neisseria meningitidis, and persons identified at increased risk because of a serogroup B meningococcal disease outbreak. MenB vaccine series may be administered to adolescents and young adults aged 16 through 23 years (preferred age is 16 through 18 years) to provide short-term protection against most strains of serogroup B meningococcal disease (3). Y Nine-valent human papillomavirus (HPV) vaccine (9vHPV) was added to the 2016 adult immunization schedule. This vaccine can be used for routine vaccination against HPV as 1 of 3 HPV vaccines (bivalent HPV vaccine [2vHPV], quadrivalent HPV vaccine [4vHPV], and 9vHPV) recommended for females and 1 of 2 HPV vaccines (4vHPV and 9vHPV) recommended for males (4). Notable changes in Figures 1 and 2 are as follows: Y The row for “Meningococcal” was retitled to “Meningococcal 4-valent conjugate (MenACWY) or polysaccharide (MPSV4)” to indicate that there are 2 types of serogroup A, C, W, and Y meningococcal vaccines available for adults. Y A new row for “Meningococcal B (MenB)” was added. Y Additional text was added in several indication bars to describe reasons for alternate dosing schedules for vaccines where such designations were appropriate; for example, in the “Measles, mumps, and rubella (MMR)” indication bar that states “1 or 2 doses,” the clause “depending on indication” was added. Y The text in the “Hepatitis A” indication bar was revised from “2 doses” to “2 or 3 doses depending on vaccine” to account for the hepatitis A and hepatitis B combination vaccine that is administered in a 3-dose series. Additional clarifying changes in Figure 2 include: Y The text in the consolidated “Influenza” indication bar was simplified to “one dose annually”; readers should refer to the footnotes for additional information regarding which influenza vaccine types are recommended for different age and risk groups. Y The text in the “Pneumococcal polysaccharide (PPSV23)” indication bar was revised from “1 or 2 doses” to “1, 2, or 3 doses depending on indication” to account for the recommendation that adults aged ≥19

An acute gastroenteritis outbreak caused by GII.17 norovirus in Jiangsu Province, China.

Noroviruses are a common cause of acute gastroenteritis around the world; however, reports of outbreaks caused by GII.17 norovirus are rare. An outbreak caused by GII.17 norovirus in a senior high school in Wuxi, Jiangsu Province, China is reported here. An epidemiological investigation, pathogen detection, and case-control study were performed. Epidemiological data combined with the epidemic curve indicated that this outbreak was a point source type initially, followed by secondary transmission. The first case was identified as most likely the source of the outbreak. Risk analysis showed exposure to patients and sharing a communal water cooler to be associated with the spread of infection. Sequence analysis of GII-positive samples confirmed that the norovirus GII.17 variant was the etiological agent of this outbreak.

Epidemia do vírus Zika: a mais nova emergência internacional

Epidemia do vírus Zika: a mais nova emergência internacional

Communicable diseases as health risks at mass gatherings other than Hajj: what is the evidence?

Mass gatherings are characterized by the concentration of people temporally and spatially, and may lead to the emergence of infectious diseases due to enhanced transmission between attendees. This is well-demonstrated in the context of the Hajj and Umrah pilgrimages in Saudi Arabia. The goal of this review was to present the available evidence on outbreaks associated with a variety of pathogens, or also the lack thereof, as assessed by thorough surveillance at any mass gatherings with the exception of those in Saudi Arabia. A systematic search for relevant articles in the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sixty-eight studies were identified. Although outbreaks have not been reported frequently in or after mass gatherings outside the Hajj and Umrah pilgrimages, they have sometimes occurred at Muslim, Christian, and Hindu religious events, at sports events, and at large-scale open air festivals. In this review it was found that the most common outbreaks at these mass gatherings involved vaccine preventable diseases, mainly measles and influenza, but also mumps and hepatitis A. Meningococcal disease has rarely been recorded. Additionally it was found that the transmission of various communicable diseases that may not be prevented by vaccination has been recorded in association with mass gatherings. These were mainly gastrointestinal infections, caused by a variety of pathogens. It was also noted that some outbreaks occurring at mass gatherings have resulted in the international spread of communicable diseases.

Long-term surveillance of the effect of PCV13: the future challenge in Africa

Long-term surveillance of the effect of PCV13: the future challenge in Africa

Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola

© 2015 Elsevier Ltd. The west African Ebola epidemic that began in 2013 exposed deep inadequacies in the national and international institutions responsible for protecting the public from the far-reaching human, social, economic, and political consequences of infectious disease outbreaks. The Ebola epidemic raised a crucial question: what reforms are needed to mend the fragile global system for outbreak prevention and response, rebuild confidence, and prevent future disasters? To address this question, the Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine jointly launched the Independent Panel on the Global Response to Ebola. Panel members from academia, think tanks, and civil society have collectively reviewed the worldwide response to the Ebola outbreak. After difficult and lengthy deliberation, we concluded that major reforms are both warranted and feasible. The Panel's conclusions off er a roadmap of ten interrelated recommendations across four thematic areas: 1 Preventing major disease outbreaks All countries need a minimum level of core capacity to detect, report, and respond rapidly to outbreaks. The shortage of such capacities in Guinea, Liberia, and Sierra Leone enabled Ebola to develop into a national, and worldwide, crisis. Recommendation 1: The global community must agree on a clear strategy to ensure that governments invest domestically in building such capacities and mobilise adequate external support to supplement eff orts in poorer countries. This plan must be supported by a transparent central system for tracking and monitoring the results of these resource flows. Additionally, all governments must agree to regular, independent, external assessment of their core capacities. Recommendation 2: WHO should promote early reporting of outbreaks by commending countries that rapidly and publicly share information, while publishing lists of countries that delay reporting. Funders should create economic incentives for early reporting by committing to disburse emergency funds rapidly to assist countries when outbreaks strike and compensating for economic losses that might result. Additionally, WHO must confront governments that implement trade and travel restrictions without scientific justification, while developing industry-wide cooperation frameworks to ensure private firms such as airlines and shipping companies continue to provide crucial services during emergencies. 2 Responding to major disease outbreaks When preventive measures do not succeed, outbreaks can cross borders and surpass national capacities. Ebola exposed WHO as unable to meet its responsibility for responding to such situations and alerting the global community. Recommendation 3: A dedicated centre for outbreak response with strong technical capacity, a protected budget, and clear lines of accountability should be created at WHO, governed by a separate Board. Recommendation 4: A transparent and politically protected WHO Standing Emergency Committee should be delegated with the responsibility for declaring public health emergencies. Recommendation 5: An independent UN Accountability Commission should be created to do systemwide assessments of worldwide responses to major disease outbreaks. 3 Research: production and sharing of data, knowledge, and technology Rapid knowledge production and dissemination are essential for outbreak prevention and response, but reliable systems for sharing epidemiological, genomic, and clinical data were not established during the Ebola outbreak. Recommendation 6: Governments, the scientific research community, industry, and non-governmental organisations must begin to develop a framework of norms and rules operating both during and between outbreaks to enable and accelerate research, govern the conduct of research, and ensure access to the benefits of research. Recommendation 7: Additionally, research funders should establish a worldwide research and development financing facility for outbreak-relevant drugs, vaccines, diagnostics, and non-pharmaceutical supplies (such as personal protective equipment) when commercial incentives are not appropriate.

First Do No Harm: Prevention Strategies for Influenza Season

Influenza is a significant cause of morbidity and death in the United States and around the world. 1 Grohskopf LA Olsen SJ Sokolow LZ et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014–15 influenza season. MMWR Morb Mortal Wkly. 2014; 63 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6332a3.htm. Published August 15, 2014. Accessed May 31, 2015): 691-697 PubMed Google Scholar , 2 Reed C Kim IK Singleton JA et al. Estimated influenza illnesses and hospitalizations averted by vaccination—United States, 2013–2014 influenza season. MMWR Morb Mortal Wkly Rep. 2014; 63: 1151-1154 PubMed Google Scholar , 3 Boyle J Crilly J Keijzers G et al. Impact of influenza across 27 public emergency departments in Australia: a 5-year descriptive study. Emerg Med J. 2012; 29: 725-731 Crossref PubMed Scopus (4) Google Scholar , 4 Hiller KM Sullivan D Influenza vaccination in the emergency department: are our patients at risk?. J Emerg Med. 2009; 37: 439-443 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar , 5 Gasparini R Amicizia D Lai PL Panatto D Clinical and socioeconomic impact of seasonal and pandemic influenza in adults and the elderly. Hum Vaccin Immunother. 2012; 8: 21-28 Crossref PubMed Scopus (83) Google Scholar , 6 World Health Organization Influenza virus (seasonal). Fact sheet. http://www.who.int/mediacentre/factsheets/fs211/en/ Google Scholar Seasonal influenza circulates annually and is spread from person to person through contact with contaminated surfaces, coughing, and sneezing. For many people, influenza is an uncomfortable but recoverable illness, although in higher-risk populations such as the very young, the elderly, pregnant women, immunocompromised people, and people with chronic medical conditions, it can lead to serious complications including death. 6 World Health Organization Influenza virus (seasonal). Fact sheet. http://www.who.int/mediacentre/factsheets/fs211/en/ Google Scholar Anna Maria Valdez, Member, San Francisco Chapter, is Faculty, School of Nursing, Walden University, Minneapolis, MN.

Coccidioidomycosis Where It Shouldn't Be

Coccidioidomycosis — or valley fever — is caused by a fungus found in soil and is endemic in the southwestern U.S., Mexico, and Central and South America. In endemic areas of the U.S., reported cases increased eightfold between 1998 and 2012. Incidence has also increased in nonendemic areas (NEJM JW Infect Dis May 27 2014; [e-pub] and MMWR Morb Mortal Wkly Rep 2014; 63:450). Retrospective …

Rapid diagnostics for Ebola in emergency settings

Rapid diagnostics for Ebola in emergency settings

Commentary: On the use of quasi-experimental designs in public health evaluation.

tional business cycles. Business Rev 2006;Q1:11–24. 34. Christodoulou C, Douzenis A, Papadopoulos FC et al. Suicide and seasonality. Acta Psychiatr Scand 2012;125:127–46. 35. McKeown RE, Cuffe SP, Schulz RM. US suicide rates by age group, 1970–2002: an examination of recent trends. Am J Public Health 2006;96:1744–51. 36. Angrist JD, Pischke J-S. Mostly Harmless Econometrics: An Empiricist’s Companion. Princeton, NJ: Princeton University Press, 2009. 37. Shadish WR, Cook TD, Campbell DT. Experimental and QuasiExperimental Designs for Generalized Causal Inference. Boston, MA: Houghton Mifflin, 2001. 38. Carpenter C. Heavy alcohol use and youth suicide: evidence from tougher drunk driving laws. J Policy Anal Manage 2004; 23:831–42. 39. Carpenter C, Dobkin C. The effect of alcohol consumption on mortality: regression discontinuity evidence from the minimum drinking age. Am Econ J Appl Econ 2009;1:164–82. 40. Stevenson B, Wolfers J. Bargaining in the shadow of the law: divorce laws and family distress. Q J Econ 2006;121: 267–88. 41. Centers for Disease C, Prevention. Suicide among adults aged 35–64 years – United States, 1999–2010. MMWR Morb Mortal Wkly Rep 2013;62:321–5. 42. Luo F, Florence CS, Quispe-Agnoli M, Ouyang L, Crosby AE. Impact of business cycles on US suicide rates, 1928–2007. Am J Public Health 2011;101:1139–46. 43. Lester D, Yang B. Social and economic correlates of the elderly suicide rate. SuicideLife Threat Behav 1992;22:36–47. 44. Innamorati M, Tamburello A, Lester D et al. Inequalities in suicide rates in the European Union’s elderly: trends and impact of macro-socioeconomic factors between 1980 and 2006. Can J Psychiatry 2010;55:229–38. 45. Meara ER, Richards S, Cutler DM. The gap gets bigger: changes in mortality and life expectancy, by education, 1981–2000. Health Aff 2008;27:350–60. 46. Olshansky SJ, Antonucci T, Berkman L et al. Differences in life expectancy due to race and educational differences are widening, and many may not catch up. Health Aff 2012;31:1803–13. 47. Autor DH, Katz LF, Kearney MS. Trends in US wage inequality: Revising the revisionists. Rev Econ Stat 2008;90:300–23. 48. Anderson RN, Minino AM, Hoyert DL, Rosenberg HM. Comparability of cause of death between ICD-9 and ICD-10: Preliminary estimatesl. Natl Vital Stat Rep 2001;49:1–32. 49. Klugman J, Condran G, Wray M. The role of medicolegal systems in producing geographic variation in suicide rates. Soc Sci Quart. 2013;94:462–89. 50. Murphy SL, Xu J, Kochanek KD. Deaths: Final data for 2010. Hyattsville, MD: National Center for Health Statistics, 2013.

Can HIV Be Cured and Should We Try?

An estimated 35.0 million persons live with HIV; 2.1 million new infections occurred and 1.5 million persons died of HIV in 2013 (World Health Organization, http://www.who.int/hiv/data/epi_core_dec2014.png?ua=1). Despite effective combination antiretroviral therapy (cART), less than one-quarter of patients can access these life-prolonging medications; and despite its effectiveness, cART does not normalize life expectancy, as premature aging, metabolic complications and chronic inflammation complicate HIV therapy. HIV is incurable due to the presence of a latent viral reservoir. During the life cycle of the virus, HIV integrates into the host DNA. A subset of integrated HIV provirus remains transcriptionally silent, producing neither viral proteins nor viral progeny, until reactivation by various physiologic stimuli. This latency of HIV allows some infected cells to escape immune detection and elimination, and these latently infected cells constitute the viral reservoir. The latent viral reservoir allows viral rebound within weeks of interruption of cART, 1,2 where the magnitude of viral replication approaches that present pre-therapy. Although it was once thought that viral rebound occurred universally following therapy interruption, several recent reports challenge that paradigm. The “Berlin patient” successfully cleared HIV after two allogeneic transplants from a donor with homozygous CCR5Δ32 mutation,3 and he has not rebounded HIV after nearly seven years. This case likely represents a cure from HIV; yet other cases have been described where HIV rebound has been attenuated, or delayed. The “Mississippi” baby was a perinatally HIV-infected infant who initiated cART within hours of birth, and when interrupted eighteen months later, viremia remained undetectable for nearly two years.4 The Harvard BMT cases underwent allogeneic BMT, developed undetectable HIV DNA, yet rebounded viremia within only eight months after cART discontinuation.5 Together these cases demonstrate that control of viremia in the absence of cART is possible, if not durable.4 The VISCONTI cohort of 14 HIV-infected adults who initiated antiretroviral therapy during acute infection, and in whom high level rebound viremia had not occurred several years after cessation of therapy,6 similarly demonstrated that viral rebound following cART interruption can be attenuated. These cases have reinvigorated research toward finding a cure for HIV, which certainly will require an exceptional investment of time, talent and resources. Thus it is prudent to question whether such resources would be better devoted to more proximate needs with proven results (such as supplying cART to those without access to it, or supplying pre/post exposure prophylaxis to reduce the rate of new infections).

Shigella flexneri serotype 3a: the rise of a superbug

Shigellosis is a highly contagious acute gastrointestinal infection conferred by faeco-oral transmission of the pathogen Shigella spp. 1 Musher DM Musher BL Contagious acute gastrointestinal infections. N Engl J Med. 2004; 351: 2417-2427 Crossref PubMed Scopus (129) Google Scholar In low-income countries and high-risk regions, poor sanitation is responsible for about 165 million cases of shigellosis annually, with at least 1 million of these resulting in death. 2 Kotloff KL Winickoff JP Ivanoff B et al. Global burden of Shigella infections: implications for vaccine development and implementation of control strategies. Bull World Health Organ. 1999; 77: 651-666 PubMed Google Scholar In high-income countries and low-risk regions, shigellosis is typically associated with travel to high-risk regions (Africa, Asia, and Latin America). 3 Borg ML Modi A Tostmann A et al. Ongoing outbreak of Shigella flexneri serotype 3a in men who have sex with men in England and Wales, data from 2009–2011. Euro Surveill. 2012; 17: 1-5 Google Scholar Since 2000, shigellosis has also been reported as a sexually transmitted infection (STI) among men who have sex with men (MSM). 4 CDCShigella sonnei outbreak among men who have sex with men San Francisco, California, 2000–2001. MMWR Morb Mortal Wkly Rep. 2001; 50: 922-926 PubMed Google Scholar In most cases of shigellosis, treatment relies on replacement of fluids and salts lost due to severe diarrhoea, which usually lasts for less than a week. 5 US National Library of MedicineNational Institutes of Health http://www.nlm.nih.gov/medlineplus/ency/article/000295.htm Google Scholar However, severe infections in young children and old adults, or immunocompromised people, might require antibiotic treatment. 6 DuPont HL Approach to the patient with infectious colitis. Curr Opin Gastroenterol. 2012; 28: 39-46 Crossref PubMed Scopus (25) Google Scholar The emergence of Shigella spp strains with decreased antibiotic susceptibility is a growing public health concern. 7 Gu B Cao Y Pan S et al. Comparison of the prevalence and changing resistance to nalidixic acid and ciprofloxacin of Shigella between Europe-America and Asia-Africa from 1998 to 2009. Int J Antimicrob Agents. 2012; 40: 9-17 Summary Full Text Full Text PDF PubMed Scopus (106) Google Scholar Intercontinental dissemination of azithromycin-resistant shigellosis through sexual transmission: a cross-sectional studyWe identified transmission-facilitating behaviours and atypical course(s) of infection as precipitating factors in shigellosis-affected MSM. The intercontinental spread of antimicrobial-resistant shigella through established transmission routes emphasises the need for new approaches to tackle the public health challenge of sexually transmitted infections in MSM. Full-Text PDF

Invited Commentary

Invited Commentary

Widening Rural–Urban Disparities in Youth Suicide

A recent study (NEJM JW Pediatr Adolesc Med Apr 2015 and MMWR Morb Mortal Wkly Rep 2015; 64:201) documented increasing suicide rates among girls compared with boys. In a new study, investigators examined whether suicide rates among youth (ages 10 to 24 years) differed by rural versus urban residence from 1996 to 2010. They used data from the National Vital Statistics System in combination with …

What's trending in the infection prevention and control literature? From HIS 2012 to HIS 2014, and beyond

SummaryThis is an informal review of some of the trends in the infection prevention and control literature since the last Healthcare Infection Society (HIS) conference in late 2012. Google Trends was used to investigate how the volume of interest in various infection control topics had changed over time. Ebola trumped all the others in Google searches, reflecting a surge of publications in the literature. Aside from Ebola, other trends in the infection prevention and control literature covered in this article include Middle East Respiratory Syndrome (MERS) coronavirus, universal versus targeted interventions, faecal microbiota transplantation, whole genome sequencing, carbapenem-resistant Enterobacteriaceae, and some aspects of environmental science. The review ends with an attempt to predict some of the trends in the infection prevention and control literature between now and the next HIS conference in 2016.

Acute flaccid myelitis and enteroviruses: an ongoing story

Acute flaccid paralysis is a complex clinical syndrome defined by a rapid onset of weakness and has various differential diagnoses, including poliomyelitis characterised by lesions of the anterior horn cells of the spinal cord (anterior myelitis). 1 Marx A Glass JD Sutter RW Differential diagnosis of acute flaccid paralysis and its role in poliomyelitis surveillance. Epidemiol Rev. 2000; 22: 298-316 Crossref PubMed Scopus (130) Google Scholar On Sept 12, 2014, physicians notified the Centers for Disease Control and Prevention (CDC) about a cluster of acute limb weakness in children in Colorado, USA. 2 Pastula DM Aliabadi N Haynes AK et al. Acute illness of unknown etiology in children—Colorado, August–September 2014. MMWR Morb Mortal Wkly Rep. 2014; 63: 901-902 PubMed Google Scholar These cases coincided with a nationwide outbreak of enterovirus D68 infections associated with severe respiratory illnesses, especially in children. 3 Midgley CM Jackson MA Selvarangan R et al. Severe respiratory illness associated with enterovirus D68—Missouri and Illinois, 2014. MMWR Morb Mortal Wkly Rep. 2014; 63: 798-799 PubMed Google Scholar The unusual association of clusters of acute flaccid paralysis and the emergence of enterovirus D68 in the USA raised questions about the causal role of this serotype in patients with severe neurological manifestations. A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USAWe report the first geographically and temporally defined cluster of acute flaccid paralysis and cranial nerve dysfunction in children associated with an outbreak of enterovirus-D68 respiratory illness. Our findings suggest the possibility of an association between enterovirus D68 and neurological disease in children. If enterovirus-D68 infections continue to happen in an endemic or epidemic pattern, development of effective antiviral or immunomodulatory therapies and vaccines should become scientific priorities. Full-Text PDF

Assessment of Autism Across the Lifespan: A Way Forward

The prevalence of autism spectrum disorders (ASDs) is currently estimated at 1 in 68 individuals in the US (Centers for Disease Control and Prevention (Morb Mortal Wkly Rep 63:1–21, 2014)), and recommendations for screening and best practices for diagnostic evaluations have been formulated in scientific, clinical, and institutional venues, if not successfully implemented. As such, this article reviews the best practices in the field for toddler, school-age and adolescent/adult assessments, describes at-risk symptomatology in toddlers, reviews common co-morbidities to be aware of at each time point, discusses cultural issues with regard to diagnoses, and brings forth new research, particularly with regard to earlier screening and diagnosis.

Laundry Detergent Pod Ingestion in 2 Pediatric Patients

There is growing concern among poison control centers (PCCs) regarding pediatric ingestions of laundry detergent pods (LDPs). Also known as capsules, liquitabs, sachets, or packs, LDPs have been available in the United States since 2010. 1 Centers for Disease Control, Prevention Health hazards associated with laundry detergent pods—United States, May-June 2012. MMWR Morb Mortal Wkly Rep. 2012; 61: 825-829 PubMed Google Scholar These products are marketed to be more convenient than traditional laundry detergent but may be eye-catching to children because of LDPs’ visual similarities with candy packaging. 2 Forrester MA Comparison of pediatric exposures to concentrated “pack” and traditional laundry detergents. Pediatr Emerg Care. 2013; 29: 482-486 Crossref PubMed Scopus (29) Google Scholar The Centers for Disease Control and Prevention (CDC) released a recent report on health hazards associated with LDPs, stating that in just a 1-month period (May 17 to June 17, 2012), 1,008 laundry detergent exposures were reported to PCCs, with 485 (48%) of these exposures due to LDPs. 1 Centers for Disease Control, Prevention Health hazards associated with laundry detergent pods—United States, May-June 2012. MMWR Morb Mortal Wkly Rep. 2012; 61: 825-829 PubMed Google Scholar Of the LDP exposures, approximately 454 (94%) involved children aged 5 years or younger. Furthermore, LDP ingestions were associated with a significantly higher rate of vomiting (55% vs 34%, P < .001), drowsiness (7% vs 2%, P < .001), and coughing or choking (15% vs 11%, P = .048) compared with traditional laundry detergent exposures. Lauren I. Karel is Drug Information Pharmacy Resident, Jefferson University Hospitals, Philadelphia, PA. Michele C. Handzel is Critical Care Pharmacy Resident, Jefferson University Hospitals, Philadelphia, PA. Jamie M. Rosini is Clinical Pharmacy Specialist, Christiana Care Health System, Newark, DE.