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The association between the replacement disease and the overall decline in invasive pneumococcal disease among Alaska Native children is investigated. The results have shown that Alaska Native children are experiencing replacement invasive pneumococcal disease with serotypes not covered by heptavalent pneumococcal conjugate vaccine.

Objective. In 1993-1996, we conducted a nested case-control study to determine risk factors for hospitalization with respiratory syncytial virus (RSV) infection among Alaska Native infants and young children. In the current study, we returned to former RSV case-patients and their control subjects during 1999-2001 to determine whether children who are hospitalized with RSV at Methods. For each former RSV case-patient and control subject from remote villages in southwest Alaska, we reviewed medical records, interviewed parents, performed physical examinations and spirometry, collected sera, and analyzed chest radiographs. Case-patients were identified through surveillance for RSV hospitalization, and matched control subjects without lower respiratory infection (LRI)-related hospitalization were identified. Results. Hospitalization for RSV infection was associated with a significant increase in wheezing, LRIs, and asthma diagnosis during the first 4 years of life. The association decreased with age and was no longer significant by 5 years of age. However, hospitalization for RSV infection was associated with increased respiratory symptoms and increased chronic productive cough at 5 to 8 years of age. Children who were hospitalized with RSV were not more likely at follow-up to have allergies, eczema, or a positive family history of asthma. Conclusions. Severe RSV infection in infancy may produce airway injury, which is manifested in chronic productive cough with or without wheezing and recurrent LRIs. Although the association of RSV infection with wheezing seems to be transient, children remain at higher risk for chronic productive cough at 5 to 8 years of age. RSV prevention modalities may prevent sequelae that occur early and later in childhood. Alaska Native, respiratory syncytial virus, asthma., ABBREVIATIONS. RSV, respiratory syncytial virus; YK, Yukon-Kuskokwim; ISAAC, International Study on Asthma and Allergies in Children; LRI, lower respiratory infection; RR, relative risk; CI, confidence interval; OR, odds ratio. Respiratory [...]

The biological attacks with powders containing Bacillus anthracis sent through the mail during September and October 2001 led to unprecedented public health and law enforcement investigations, which involved thousands of [...]

After public notification of confirmed cases of bioterrorism-related anthrax, the Centers for Disease Control and Prevention's Emergency Operations Center responded to 11,063 bioterrorism-related telephone calls from October 8 to November [...]

In October 2001, the first inhalational anthrax case in the United States since 1976 was identified in a media company worker in Florida. A national investigation was initiated to identify [...]

Smokers and people exposed to passive smoking have a higher-than-normal risk of developing invasive pneumococcal disease. Invasive pneumococcal disease is an infection caused by Streptococcus pneumoniae that is present in blood or cerebrospinal fluid. In a study of 228 patients with invasive pneumococcal disease, 58% were smokers compared to 24% of 301 healthy volunteers. This translates to a four-fold greater risk of invasive pneumococcal disease. Nonsmokers exposed to environmental cigarette smoke were twice as likely to develop invasive pneumococcal disease as people not exposed to passive smoke.

Research findings show that pneumococcal capsular polysaccharide vaccines are effective in protecting 94% of the vaccinated preschool-age children with pneumococcal disease., To estimate the effectiveness of pneumococcal polysaccharide vaccine, we serotyped isolates submitted to the Pneumococcal Sentinel Surveillance System from 1984 to 1996 from 48 vaccinated and 125 unvaccinated children 2 [...]

All nursing home residents should be vaccinated against pneumococcal pneumonia. In a 1996 outbreak in an Oklahoma nursing home, 11 residents developed pneumococcal pneumonia, and 3 died. A strain of Streptococcus pneumoniae that was resistant to several drugs was found in blood and sputum samples from 7 residents with pneumonia, 23% of the other residents and 3% of the staff members. All of the strains were identical, indicating that they were transmitted from one person to another. Only 4% of the residents had been vaccinated with pneumococcal vaccine.

Pneumococcal vaccine appears to be cost-effective in preventing infection with Streptococcus pneumoniae in elderly people. Researchers estimated the costs and benefits of vaccinating all elderly residents in three US communities. Vaccination saved about $8 per capita in future medical expenses and added about one quality-adjusted day of life per person. If extended to all elderly Americans, pneumococcal vaccine would have saved $194 million in health care costs in 1993 and added 78,000 years of life to the population. The vaccine would not be cost-effective if its effectiveness was less or the vaccine cost twice as much., Context.--Clinical, epidemiologic, and policy considerations support updating the cost-effectiveness of pneumococcal vaccination for elderly people and targeting the evaluation only to prevention of pneumococcal bacteremia. Objective.--To assess the implications for medical costs and health effects of vaccination against pneumococcal bacteremia in elderly people. Design.--Cost-effectiveness analysis of pneumococcal vaccination compared with no vaccination, from a societal perspective. Setting and Participants.--The elderly population,aged 65 years and older in the United States in 3 geographic areas: metropolitan Atlanta, Ga; Franklin County, Ohio; and Monroe County, New York. Main Outcome Measures.--Incremental medical costs and health effects, expressed in quality-adjusted life-years per person vaccinated. Results.--Vaccination was cost saving, ie, it both reduced medical expenses and improved health, for all age groups and geographic areas analyzed in the base case. For people aged 65 years and older, vaccination saved $8.27 and gained 1.21 quality-adjusted days of life per person vaccinated. Vaccination of the 23 million elderly people unvaccinated in 1993 would have gained about 78 000 years of healthy life and saved $194 million. In univariate sensitivity analysis, the results remained cost saving except for doubling vaccination costs, including future medical costs of survivors, and lowering vaccination effectiveness. With assumptions most unfavorable to vaccination, cost per quality-adjusted life-year ranged from $35 822 for ages 65 to 74 years to $598 487 for ages 85 years and older. In probabilistic sensitivity analysis, probability intervals were more narrow, with less than 5% probability that the ratio for ages 85 years and older would exceed $100 000. Conclusions.--Pneumococcal vaccination saves costs in the prevention of bacteremia alone and is greatly underused among the elderly population, on both health and economic grounds. These results support recent recommendations of the Advisory Committee on Immunization Practices and public and private efforts under way to improve vaccination rates. JAMA. 1997;278:1333-1339

The incidence of drug-resistant pneumococcal pneumonia infections appears to be increasing nationwide. Drug resistance occurs when an organism is no longer susceptible to a drug once able to eradicate it. Thirteen hospitals from 12 states submitted pneumococcal isolates from 544 patients between Oct 1, 1991, and Sep 30, 1992. More than 5% of all isolates showed resistance to penicillin, erythromycin and trimethoprim-sulfamethoxazole. High-level penicillin resistance was detected in 1.3% of the isolates. A total of 16.4% of the isolates were resistant to one or more of the following antimicrobials: penicillin, erythromycin, trimethoprim-sulfamethoxazole and chloramphenicol. Eighty-five percent of the drug-resistant strains were members of six serotypes. The growing incidence of drug-resistant pneumonia has created the need for new conjugate pneumococcal vaccines and for effective use of currently available vaccines., Objective. - To estimate drug susceptibility patterns of Streptococcus pneumoniae in selected hospitals in the United States and to characterize the epidemiology of invasive drug-resistant pneumococcal infections. Design. - Minimum inhibitory concentrations (MICS) for a variety of commonly used antimicrobial drugs were determined for pneumococcal isolates submitted to the Centers for Disease Control and Prevention (CDC). Risk factors for drug-resistant pneumococcal infection were evaluated. Setting. - Hospital laboratories in the United States submitting pneumococcal isolates to the CDC between October 1, 1991, and September 30, 1992. Participants. - A total of 544 persons with pneumococci isolated from normally sterile sites. Results. - A total of 13 hospitals in 12 states actively participated in an ongoing pneumococcal surveilliance study. Resistance to penicillin was detected in 6.6% of isolates, including 1.3% of isolates with MICs of 2.0 [micro]g/ml or more (compared with

Hantavirus pulmonary syndrome is a serious, often fatal illness involving respiratory distress caused by an accumulation of fluid in the lungs. The first cases of hantavirus pulmonary syndrome occurred in the southwestern US in 1993. Among the first 18 patients, 14 died. Researchers reviewed the medical records of 17 of these patients to characterize the disease. All 17 patients experienced fever and muscle pain before the onset of respiratory distress. Other common symptoms were headache, cough, and nausea, vomiting or diarrhea. The average duration of symptoms before hospitalization was 5.4 days. At hospital admission, all the patients were breathing rapidly and 94% also had a rapid heart rate. Fifty percent had lower than normal blood pressure. Blood tests showed elevated white cell counts, elevated hematocrit and reduced platelet counts. The average length of illness before death was eight days.

The pneumococcal polysaccharide vaccine may be more effective in certain patient populations than in others. The pneumococcal vaccine is given to at-risk individuals to prevent community-acquired pneumonia and meningitis. Researchers examined the the effectiveness of the vaccine in 2,837 patients over five years old with an infection of the blood or cerebrospinal fluid between May 1978 and Apr 1992. The vaccine was 57% effective in preventing infections caused by the serotypes of Streptococcus pneumoniae included in the vaccine. It was 84% effective for patients with diabetes mellitus, 73% for those with coronary vascular disease, 69% for those congestive heart failure and 65% for those with chronic pulmonary diseases. The time since vaccination did not affect efficacy of the vaccine significantly.

Low blood levels of retinol (vitamin A) may be associated with a more severe form of measles. Treatment with vitamin A should be considered for children who are hospitalized for measles. Blood levels of vitamin A were measured within five days of onset of a measles rash in 114 children who were five years old or younger. Seventy-two percent of the children had low blood levels of vitamin A. Average blood levels of vitamin A were lower in children who were hospitalized or who had pneumonia. Children with otitis media, or inflammation of the middle ear, had higher blood levels of vitamin A. Decreased blood levels of vitamin A has been associated with measles deaths among children in developing countries.

Objectives. A large number of children with measles were hospitalized at a children's hospital during a metropolitan measles outbreak. In this study we addressed the appropriateness of those admissions. Methods. Charts of all 634 patients with a diagnosis of measles who were treated between August 1989 and April 1990 were reviewed. Determination of the appropriateness of hospital admission was based on severity of illness and presence of severe of complications of measles. Results. Of 564 patients with clinical measles or serologic evidence of recent infection, 252 were inpatients (median age 1.5 years) and 312 were outpatients (median age 2.1 years). Fifty-nine (23.4%) of the inpatients had been inappropriately admitted. Inpatients were significantly more likely than outpatients to have physiologic instability or a clinical complication. Chidren 15 months of age or younger were more likely to be hospitalized, as were children evaluate in the first 3 months of the outbreak period, even if admission was not appropriate on the basis of physiological instability or complications. Conclusions. Younger patients with measles and patients evaluated earlier in the epidemic were more likely to be admitted to the hospital even when admission was inappropriate as assessed by degree of physiologic instability or presence of complications. (Am J Public Health. 1993;83:379-384), Younger children or those who develop measles earlier in a measles outbreak may more likely to be admitted inappropriately to the hospital for treatment than other measles patients. Among 564 children suffering from measles who were treated at Children's Hospital of Wisconsin between Apr 1989 and Apr 1990, 312 were treated as outpatients and 252 were treated as inpatients. While most admissions were appropriate, 59 children treated as inpatients were admitted to the hospital inappropriately. Children under 15 months old were more likely to be admitted to the hospital for treatment than older children, regardless of severity of illness. Patients who were treated during the first three months of the measles outbreak were also more likely to be admitted to the hospital than those treated later, reflecting doctors' initial unfamiliarity with diagnosing and treating measles. Children treated as inpatients were more likely to be physiologically unstable or have some type of complication.

Snakes on a Plane was poised to be the blockbuster movie of the 2006 summer season. It featured reptiles smuggled onto an airplane as an unusual bioweapon of mass destruction. [...]

The pneumococcal conjugate vaccine would be cost-effective in babies if the cost of the vaccine was less than $50 per dose. This was the conclusion of researchers who evaluated the cost-effectiveness of the vaccine on a hypothetical group of 3.8 million babies. Vaccination would prevent more than 53,000 cases of pneumonia, 1 million cases of otitis media, and 116 deaths from pneumococcal infection.

To the Editor.-- We read with great interest the article by Cabrera et al[1] regarding hemolytic uremic syndrome (HUS) associated with invasive Streptococcus pneumoniae infection. The authors carried out a [...]

OBJECTIVE. Before 1991, Alaska Native children experienced one of the highest rates of invasive Haemophilus influenzae type b disease. H influenzae type b vaccine has led to a near-elimination of invasive H influenzae type b disease in the United States. We describe challenges encountered in controlling H influenzae type b disease in Alaska and update the current status of H influenzae disease and carriage in Alaska as lessons to other populations. PATIENTS AND METHODS. We reviewed data from statewide H influenzae disease surveillance conducted during 1980-2004. Vaccine coverage data were based on audits from tribal facilities and the National Immunization Survey. H influenzae type b colonization data were based on 6 carriage studies. RESULTS. After universal infant vaccination in 1991, H influenzae type b disease among Alaska Native and non-Native children CONCLUSIONS. H influenzae type b vaccination has resulted in a dramatic decrease in invasive H influenzae type b disease in Alaska; however, despite high rates of H influenzae type b vaccine coverage, H influenzae type b disease rates among rural Alaska Native children KEYWORDS. Haemophilus influenzae type b, vaccine, Alaska Native children., URL: www.pediatrics.org/cgi/doi/10.1542/peds.2006-0287 Rosalyn Singleton, MD MPH, Laura Hammitt, MD, Thomas Hennessy, MD, MPH, Lisa Bulkow, MS, Carolynn DeByle, BS, Alan Parkinson, PhD, Tammy E. Cottle, BA, Helen Peters, RN, Jay [...]

People who receive a second vaccination with pneumococcal polysaccharide vaccine (PPV) may be more likely to develop a minor reaction to the vaccine than those receiving it for the first time. PPV immunizes people against Streptococcus pneumoniae, which can cause serious infections. Researchers compared the rate of reactions at the injection site among 901 people who received their first PPV dose and 513 people who received a booster shot. Those receiving a booster shot were three times more likely to develop a reaction at the injection site. The reaction lasted an average of three days.