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BackgroundSince the introduction of Haemophilus influenzae serotype b (Hib) conjugate vaccines in the United States, invasive H. influenzae disease epidemiology has changed, and racial disparities have not been recently described.MethodsActive population- and laboratory-based surveillance for H. influenzae was conducted through Active Bacterial Core surveillance at 10 US sites. Data from 2008–2017 were used to estimate projected nationwide annual incidence, as cases per 100 000.ResultsDuring 2008–2017, Active Bacterial Core surveillance identified 7379 H. influenzae cases. Of 6705 patients (90.9%) with reported race, 76.2% were White, 18.6% were Black, 2.8% were Asian/Pacific Islander, and 2.4% were American Indian or Alaska Native (AI/AN). The nationwide annual incidence was 1.8 cases/100 000. By race, incidence was highest among AI/AN populations (3.1) and lowest among Asian/Pacific Islander populations (0.8). Nontypeable H. influenzae caused the largest incidence within all races (1.3), with no striking disparities identified. Among AI/AN children aged ConclusionsWhile nontypeable H. influenzae causes the largest H. influenzae burden overall, AI/AN populations experience disproportionately high rates of Hia and Hib, with the greatest disparity among AI/AN children aged

Background Haemophilus influenzae serotype a (Hia) can cause invasive disease similar to serotype b; no Hia vaccine is available. We describe the epidemiology of invasive Hia disease in the United States overall and specifically in Alaska during 2008–2017. Methods Active population- and laboratory-based surveillance for invasive Hia disease was conducted through Active Bacterial Core surveillance sites and from Alaska statewide invasive bacterial disease surveillance. Sterile-site isolates were serotyped via slide agglutination or real-time polymerase chain reaction. Incidences in cases per 100 000 were calculated. Results From 2008 to 2017, an estimated average of 306 invasive Hia disease cases occurred annually in the United States (estimated annual incidence: 0.10); incidence increased by an average of 11.1% annually. Overall, 42.7% of cases were in children aged Conclusions Incidence of invasive Hia disease has increased since 2008, with the highest burden among AI/AN children. These data can inform prevention strategies, including Hia vaccine development.

Background. Group A Streptococcus (GAS) is an important bacterial cause of life-threatening illness among the elderly. Public health officials investigated a protracted GAS outbreak in a skilled nursing facility in Georgia housing patients requiring 24-hour nursing or rehabilitation, to prevent additional cases. Methods. We defined a case as illness in a skilled nursing facility resident with onset after January 2009 with GAS isolated from a usually sterile (invasive) or nonsterile site (noninvasive). Cases were “recurrent” if >1 month elapsed between episodes. We evaluated infection control practices, performed a GAS carriage study, emm-typed available GAS isolates, and conducted a case-control study of risk factors for infection. Results. Three investigations, spanning 36 months, identified 19 residents with a total of 24 GAS infections: 15 invasive (3 recurrent) and 9 noninvasive (2 recurrent) episodes. All invasive cases required hospitalization; 4 patients died. Seven residents were GAS carriers. All invasive cases and resident carrier isolates were type emm 11.0. We observed hand hygiene lapses, inadequate infection documentation, and more frequent wound care staff turnover on wing A versus wing B. Risk factors associated with infection in multivariable analysis included living on wing A (odds ratio [OR], 3.4; 95% confidence interval [CI], .9–16.4) and having an indwelling line (OR, 5.6; 95% CI, 1.2–36.4). Cases ceased following facility-wide chemoprophylaxis in July 2012. Conclusions. Staff turnover, compromised skin integrity in residents, a suboptimal infection control program, and lack of awareness of infections likely contributed to continued GAS transmission. In widespread, prolonged GAS outbreaks in skilled nursing facilities, facility-wide chemoprophylaxis may be necessary to prevent sustained person-to-person transmission.

Chlamydia (Chlamydophila) pneumoniae is an obligate intracellular bacterium commonly associated with both upper and lower respiratory tract infections including pharyngitis, bronchitis, and pneumonia. First described in 1986, C. pneumoniae infections generally consist of low-grade fever, prolonged cough, coryza, headache, myalgias, and laryngitis [1, 2]. Macrolides are a common first-line treatment; however, tetracyclines and fluoro-quinolones are also effective. Symptoms may resolve without antibiotics and asymptomatic infection can occur [3–5]. Chlamydia pneumoniae is endemic world-wide. Outbreaks occur periodically and without a clear seasonal pattern, primarily in close-contact settings among high-risk populations such as in long-term care facilities [6–8]. Chlamydia pneumoniae is frequently detected alongside other respiratory pathogens, making its role as a primary disease-causing pathogen unclear [9–11]. The diagnosis of C. pneumoniae infection is commonly made through commercially available serological assays, despite poor sensitivity and specificity due to high background seroprevalence and potential cross-reaction with other Chlamydia species [12]. More recently, real-time polymerase chain reaction (qPCR) assays are being used to identify C. pneumoniae from respiratory specimens that are highly sensitive and specific for acute C. pneumoniae infection but are unable to provide a retrospective diagnosis [13–15]. During November 2009–February 2010, an outbreak of pneumonia was identified in a male federal correctional institution in Texas. Symptoms included low-grade fever, dry cough, and body aches, and illness appeared to occur in previously healthy inmates. Four inmates were hospitalized. Sputum and blood cultures, sputum testing for acid-fast bacilli, and urine testing for Legionella and Histoplasma were negative. This report describes the outbreak’s laboratory and epidemiological investigation, and illustrates the challenges of implementing outbreak control interventions in this setting.