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ObjectiveFrom January 29 through February 5, 2013, a school district outside metropolitan Denver, Colorado, was closed because of absenteeism related to influenza-like illness (ILI) among students and staff. We evaluated the consequences and acceptability of the closure among affected households.MethodsWe conducted a household survey regarding parent or guardian employment and income interruptions, alternative child care arrangements, interruption of noneducational school services, ILI symptoms, student re-congregation, and communication preferences during the closure.ResultsOf the 35 (31%) of 113 households surveyed, the majority (28 [80%]) reported that the closure was not challenging. Seven (20%) households reported challenges: 5 (14%) reported that 1 or more adults missed work, 3 (9%) reported lost pay, and 1 (3%) reported challenges because of missed subsidized school meals. The majority (22 [63%]) of households reported that a hypothetical 1-month closure would not represent a problem; 6 of 8 households that did anticipate challenges reported that all adults worked outside the home. The majority (58%) of students visited at least 1 outside venue during the closure.ConclusionsA brief school closure did not pose a major problem for the majority of the affected households surveyed. School and public health officials should consider the needs of families in which all adults work outside the home when creating school closure contingency plans. (Disaster Med Public Health Preparedness. 2015;9:4-8)

Introduction Scott Aarskog syndrome is an X-linked disorder characterised by short stature, hypertelorism, shawl scrotum in boys and brachydactyly. Syndrome is a genetic abnormality and the condition cannot be cured by optimal way. Aims The aim of this paper is to describe an extremely rare syndrome especially with mild mental retardation. Methods In two cases, the twin brothers and cousins girls where genetically established Scott Aarskog syndrome were made IQ tests in relation to the age of the children. Normally at this syndrome is very rare mental retardation. Results Boys with Scott Aarskog syndrome have had a rounded face with a broad forehead, but girls has no had. IQ test results showed that the twins, seven years old had IQ 69 or 71, a girl six years ald girl cousin 78. Affected twin brothers also have an abnormally long groove in the upper lip or philtrum and a broad nasal bridge. Tissue webbing between fingers and joint hypermobility with a pronounced hyperextension, flexion of the interphalangeal joints and brachydactyly in girl and both boys. The major signs of this X-linked condition are short stature. Musculoskeletal anomalies such as cervical vertebral anomalies, discrete spina bifida occulta, mild pectus excavatum, milder genu recurvatum, moderate joint restriction were presented in all three children relatives. Conclusions The prognosis of this disease is very bad with something shorter life, reduced everyday abilities for regular jobs, and in this case less severe retardation with disabilities to attend regular school and obtaining the title of the working capacity. Usually IQ in children is normal so this is a rare case that still occurs in Scott Aarskog syndrome.

Objective To determine if all-cause and cause-specific school absences improve predictions of virologically confirmed influenza in the community. Introduction School-based influenza surveillance has been considered for real-time monitoring of influenza, as children 5-17 years old play an important role in community-level transmission. Methods The Allegheny County Department of Health provided virologically confirmed influenza data collected from all emergency departments and outpatient providers in the county for 2007 and 2011-2016. All-cause school absence rates were collected from nine school districts within Allegheny County for 2010-2015. For a subset of these schools, in addition to all-cause absences, influenza-like illness (ILI)-specific absences were collected using a standard protocol: 10 K-5 schools in one school district (2007-2008), nine K-12 schools in two school districts (2012-2013), and nine K-12 schools from three school districts (2015-2016). We used negative binomial regression to predict weekly county-level influenza cases in Allegheny County, Pennsylvania, during the 2010-2015 influenza seasons. We included the following covariates in candidate models: all-cause school absence rates with different lags (weekly, 1-3 week lags, assessed in separate models using all other covariates) and administrative levels (county, school type, and grade), week and month of the year (assessed in separate models), average weekly temperature, and average weekly relative humidity. Separately, for the three districts for which ILI-specific and all-cause absences were available, we predicted weekly county-level influenza cases using all-cause and ILI-specific absences with all previously stated covariates. We used several cross- validation approaches to assess models, including leave 20% of weeks out, leave 20% of schools out, and leave 52-weeks out. Results Overall, 2,395,020 all-cause absences were observed in nine school districts. From the subset of schools that collected ILI-specific absences, 14,078 all-cause and 2,617 ILI-related absences were reported. A total of 11,946 virologically confirmed influenza cases were reported in Allegheny County (Figure 1). Inclusion of 1-week lagged absence rates in multivariate models improved model fits and predictions of influenza cases over models using week of year and weekly average temperature (change in AIC=-4). Using grade-specific all-cause absences, absences from lower grades explained data best. For example, kindergarten absences explained 22.1% of model deviance compared to 0.43% using 12 th grade absences in validation. Multivariate models of week-lagged kindergarten absences, week of year, and weekly average temperature had the best fits over other grade-specific multivariate models (change in AIC=-6 comparing K to 12 th grade). The utility of ILI-specific absences compared to total absences is mixed, performing marginally better, adjusting for other covariates, in 2 years, but markedly worse in 1 year. However, these results were based on a small number of observations. Conclusions Our findings suggest models including younger student absences improve predictions of virologically confirmed influenza. We found ILI-specific absences performed similarly to all-cause absences; however, more observations are needed to assess the relative performances of these two datasets.

Summary When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses. These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States — Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces). Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).

Introduction School closures, while an effective measure against the spread of disease during a pandemic, may carry unintended social and economic consequences for students and families. We evaluated these costs and consequences following a 4-day school closure in Mississippi's Harrison County School District (HCSD). Methods In a survey of all households with students enrolled in HCSD, we collected information on difficulties related to the school closure, including interruption of employment and pay, loss of access to subsidized school meals, and arrangement of alternative childcare. We analyzed this information in the context of certain demographic characteristics of the survey respondents and households, such as race, level of education, and income. We also estimated the average number of lost work days and documented the childcare alternatives chosen by households affected by the school closure. Results We received 2,229 (28.4%) completed surveys from an estimated 7,851 households eligible to participate. About half (1,082 [48.5%]) of the households experienced at least some difficulty during the closure, primarily in three areas: uncertainty about duration of the closure, lost income, and the effort of arranging alternate childcare. Adults working outside the home, particularly the major wage earner in the household, were more likely to suffer lost income while schools were closed, an effect mitigated by paid leave benefits. Difficulty arranging childcare was reported most frequently by respondents with lower levels of education and households with younger children. Beyond the top three concerns expressed by households in HCSD, the survey also shed light on the issue of food insecurity when subsidized school meals are not available. Reported by 17.9% of households participating in the subsidized school lunch program, difficulty providing meals during the closure was associated with higher numbers of dependent children, selection of "other" as the race of the household respondent, and lower levels of education. Conclusion To help prevent undue financial hardship in families of school children, public health authorities and school administrators should provide recommendations for childcare alternatives and paid leave or remote work options during prolonged school closures, particularly to households in which all adults work outside of the home.

Background The adequacy of communication and knowledge of donors and physicians regarding iron needs and the relationship between hemoglobin (Hb) and iron stores require evaluation to address donor iron deficiency. Study Design and Methods A prospective cohort study was performed on 550 successful donors and 50 donors deferred for low Hb (

We assessed risk groups for iron deficiency and the feasibility and efficacy of ferritin testing in a large blood center.Donors were informed of possible testing in the predonation pamphlet. Plasma ferritin was measured on retention samples (n = 12,595) from representative clinics. Low-ferritin donors (25 µg/L) were sent a letter and information sheet and not called for 6 months. Ferritin testing was repeated on 25% of donors; donor return rate and frequency were monitored.Low-ferritin donors represented 2.9% of first-time and reactivated (no donation in past 12 months) male donors, 32.2% of first-time and reactivated female donors, 41.6% of repeat male donors, and 65.1% of repeat female donors. A mean of 11.7 months after index donation, the return rate was 76% for normal and 58% for low-ferritin donors; returning low-ferritin donors had made approximately one fewer donation. Ferritin increased by 16.3 and 12.1 µg/L in male and female low-ferritin donors and decreased by 17 µg/L in male and female normal-ferritin donors.The minimum hemoglobin level will be increased to 130 g/L for male donors and the minimum interdonation interval changed to 84 days (four donations yearly) for female donors based on iron deficiency risk groups. Large-scale ferritin testing was feasible. Donors informed of low-ferritin results had a lower return rate, donated less often, and had an increase in ferritin on return, approximately 1 year after initial testing, compared to donors with normal ferritin results.

We compared tempOral patterns of respiratory illness-related unplanned school closures (USC) with influenza-like illness (ILI) data from outpatient provider visits to determine usability of these data for additional insight regarding ILI activity. We found significant correlation between USC and ILINet data (R= 0.54 with p-value

BACKGROUND Informing donors of their ferritin status is one possible mitigating strategy to reduce iron deficiency in donors. STUDY DESIGN AND METHODS We evaluated the impact of informing donors of their ferritin status on their donation frequency, understanding of iron needs, and actions to improve iron intake 2 years after their inclusion in a prospective observational cohort study. RESULTS Informing donors of low ferritin results decreased return rate in first-time and repeat donors, and the median number of donations declined from three to two donations/year in returning donors with low ferritin on index donation compared to an increase from 1.5 to 2.5 donations/year in donors with normal ferritin. An electronic questionnaire demonstrated that approximately 60% of low ferritin donors saw their primary medical practitioner, and half of this group started iron. Qualitative interviews revealed suboptimal understanding of iron needs and poor compliance with iron supplementation. CONCLUSION Providing donors with results of ferritin testing may reduce return rates and donation frequency in the 2 years after testing. Simply providing donors with ferritin results and an information sheet is often inadequate to improve donors' understanding of iron needs and may not lead to a substantive increase in iron intake over time.

A reactive school closure following high influenza-like illness-related student absenteeism in a Kentucky school district did not influence reported influenza-like illness transmission in student households., Background. School closures are an important mitigation strategy during influenza pandemic: if implemented early in a local outbreak, they can slow the disease spread in the surrounding community. During seasonal influenza epidemics, school closures may occur reactively, after the disease is already widespread in the community. Such reactive closures are often too late to reduce influenza transmission. However, they can provide data to determine under which circumstances they might be effective in reducing influenza-like illness (ILI) transmission. Methods. We conducted a household survey in a school district in Kentucky. District A closed after high student absenteeism due to influenza-like illness (ILI), whereas adjacent Districts B and C remained open. We collected data on self-reported ILI among household members in these 3 districts 2 weeks before the District A closure, during closure, and 2 weeks after reopening, and we evaluated economic and social consequences of school closure on student households in District A. The difference-in-differences method was applied to compare changes in ILI rates from before to after closure between districts. Results. Estimated average daily ILI rate decreased less in District A than in District B or C for the entire sample and when stratified by age groups (0–5 years old, 6–18 years old, and above 18 years old). Twenty-five percent of District A households reported ≥1 closure-related economic or social difficulty. Conclusions. Closing schools after a widespread ILI activity in District A did not reduce ILI transmission but caused difficulties for some households.

Introduction: Neuroimaging procedures and electroencephalography (EEG) are basic parts of investigation of patients with epilepsies. Aim: The aim is to try to assess relationship between bilaterally localized brain lesions found in routine management of children with newly diagnosed epilepsy and their interictal EEG findings. Patients and methods: Total amount of 68 patients filled criteria for inclusion in the study that was performed at Neuropediatrics Department, Pediatric Hospital, University Clinical Center Sarajevo, or its outpatient clinic. There were 33 girls (48,5%) and 35 boys (51,5%). Average age at diagnosis of epilepsy was 3,5 years. Results: Both neurological and neuropsychological examination in the moment of making diagnosis of epilepsy was normal in 27 (39,7%) patients, and showed some kind of delay or other neurological finding in 41 (60,3%). Brain MRI showed lesions that can be related to antenatal or perinatal events in most of the patients (ventricular dilation in 30,9%, delayed myelination and post-hypoxic changes in 27,9%). More than half of patients (55,9%) showed bilateral interictal epileptiform discharges on their EEGs, and further 14,7% had other kinds of bilateral abnormalities. Frequency of bilateral epileptic discharges showed statistically significant predominance on level of p

Background Social networks are increasingly recognized as important points of intervention, yet relatively few intervention studies of respiratory infection transmission have utilized a network design. Here we describe the design, methods, and social network structure of a randomized intervention for isolating respiratory infection cases in a university setting over a 10-week period. Methodology/principal findings 590 students in six residence halls enrolled in the eX-FLU study during a chain-referral recruitment process from September 2012–January 2013. Of these, 262 joined as “seed” participants, who nominated their social contacts to join the study, of which 328 “nominees” enrolled. Participants were cluster-randomized by 117 residence halls. Participants were asked to respond to weekly surveys on health behaviors, social interactions, and influenza-like illness (ILI) symptoms. Participants were randomized to either a 3-Day dorm room isolation intervention or a control group (no isolation) upon illness onset. ILI cases reported on their isolation behavior during illness and provided throat and nasal swab specimens at onset, day-three, and day-six of illness. A subsample of individuals (N = 103) participated in a sub-study using a novel smartphone application, iEpi, which collected sensor and contextually-dependent survey data on social interactions. Within the social network, participants were significantly positively assortative by intervention group, enrollment type, residence hall, iEpi participation, age, gender, race, and alcohol use (all P Conclusions/significance We identified a feasible study design for testing the impact of isolation from social networks in a university setting. These data provide an unparalleled opportunity to address questions about isolation and infection transmission, as well as insights into social networks and behaviors among college-aged students. Several important lessons were learned over the course of this project, including feasible isolation durations, the need for extensive organizational efforts, as well as the need for specialized programmers and server space for managing survey and smartphone data.

Background. In late October 2009, school-located pandemic vaccination was initiated in Maine before or concurrent with 2009 pandemic influenza A (H1N1) virus (pH1N1) peak activity. Methods. A case–control evaluation of 2009 H1N1 vaccine effectiveness was conducted in schools in Cumberland County, Maine. A case was a child who had an acute respiratory illness during 2 November–18 December 2009, and who tested positive for pH1N1 by real-time reverse-transcription polymerase chain reaction (rRTPCR). For each case, ≥4 event time-matched controls were sampled among classmates present in school during the study period who did not have an influenza-like illness. Vaccine effectiveness was calculated as (1 – adjusted odds ratio [aOR]) × 100%; aOR was estimated by using weighted logistic regression. Results. After adjusting for a diagnosis of asthma, 1 dose of 2009 H1N1 vaccine provided 69% protection (95% confidence interval (CI), 13–89) against rRT-PCR–confirmed H1N1 infection. Vaccine effectiveness estimates for live attenuated and inactivated vaccine were 81% (95% CI, −37 to 97), and 58% (95% CI: −39 to 87), respectively. Conclusions. One dose of monovalent pandemic vaccine provided substantial protection against pH1N1 infection among school-aged children.

BACKGROUND: Hemoglobin (Hgb) determination is an essential part of donor qualification. We assessed and implemented a new spectrophotometer for donor Hgb determination. STUDY DESIGN AND METHODS: Precision, accuracy, and ease of use were assessed on a prototype DiaSpect analyzer (DiaSpect Medical, GmBH, Sailauf, Germany). A protocol to qualify the analyzer was developed and executed preimplementation. Samples were developed for periodic quality control (QC). Postimplementation performance was assessed based on QC results and trending of deferral rates. RESULTS: Precision was excellent, with a coefficient of variation of 0.53%-1.14% per sample. The correlation coefficient between capillary DiaSpect and venous laboratory autoanalyzer measurements was 0.736. After 169 out of 223 analyzers failed to qualify on our initial protocol, all were successfully qualified with the use of a modified protocol, adjusted to avoid sources of variability. Because commercial controls proved inadequate, in-house samples were developed for periodic QC. Postimplementation, all analyzers had adequate QC results. Deferral rates decreased from 10.1 to 8.1% (p

In the United States, influenza season typically begins in October or November, peaks in February, and tapers off in April. During the winter holiday break, from the end of December to the beginning of January, changes in social mixing patterns, healthcare-seeking behaviors, and surveillance reporting could affect influenza-like illness (ILI) rates. We compared predicted with observed weekly ILI to examine trends around the winter break period. We examined weekly rates of ILI by region in the United States from influenza season 2003-2004 to 2012-2013. We compared observed and predicted ILI rates from week 44 to week 8 of each influenza season using the auto-regressive integrated moving average (ARIMA) method. Of 1,530 region, week, and year combinations, 64 observed ILI rates were significantly higher than predicted by the model. Of these, 21 occurred during the typical winter holiday break period (weeks 51-52); 12 occurred during influenza season 2012-2013. There were 46 observed ILI rates that were significantly lower than predicted. Of these, 16 occurred after the typical holiday break during week 1, eight of which occurred during season 2012-2013. Of 90 (10 HHS regions x 9 seasons) predictions during the peak week, 78 predicted ILI rates were lower than observed. Out of 73 predictions for the post-peak week, 62 ILI rates were higher than observed. There were 53 out of 73 models that had lower peak and higher post-peak predicted ILI rates than were actually observed. While most regions had ILI rates higher than predicted during winter holiday break and lower than predicted after the break during the 2012-2013 season, overall there was not a consistent relationship between observed and predicted ILI around the winter holiday break during the other influenza seasons.

Background Information on measles vaccine effectiveness (VE) is critical to help inform policies for future global measles control goals. Methods We reviewed results of VE studies published during 1960-2010. Results Seventy papers with 135 VE point estimates were identified. For a single dose of vaccine administered at 9-11 months of age and ≥12 months, the median VE was 77.0% (interquartile range [IQR], 62%-91%) and 92.0% (IQR, 86%-96%), respectively. When analysis was restricted to include only point estimates for which vaccination history was verified and cases were laboratory confirmed, the median VE was 84.0% (IQR, 72.0%-95.0%) and 92.5% (IQR, 84.8%-97.0%) when vaccine was received at 9-11 and ≥12 months, respectively. Published VE vary by World Health Organization region, with generally lower estimates in countries belonging to the African and SouthEast Asian Regions. For 2 doses of measles-containing vaccine, compared with no vaccination, the median VE was 94.1% (IQR, 88.3%-98.3%). Conclusions The VE of the first dose of measles-containing vaccine administered at 9-11 months was lower than what would be expected from serologic evaluations but was higher than expected when administered at ≥12 months. The median VE increased in a subset of articles in which classification bias was reduced through verified vaccination history and laboratory confirmation. In general, 2 doses of measles-containing vaccine provided excellent protection against measles.

A large measles outbreak occurred in Maroua, Cameroon during October 2008-April 2009; a nine-day outbreak response immunization (ORI) campaign was initiated 15 weeks after the start of the outbreak during high transmission season. To assess the impact of ORI, we described changes to case counts and characteristics before and after ORI, and the reporting efficiency of measles cases to the surveillance system. A sharp decrease in cases occurred from 555 cases during the period before ORI to 162 cases during the period after ORI; reporting efficiency was 79.5% before ORI and 93.0% after ORI. These findings highlight the potential benefits of rapid implementation of recommended ORI strategies during measles outbreaks in Africa.

Background. In Africa before the introduction of measles vaccination, measles primarily affected young children. To describe measles epidemiology in Africa since the start of accelerated measles control activities in 2001, we analyzed regional measles case-based surveillance data for 2002–2009.Methods. Country-years were grouped by 10-year moving average of routine measles vaccination coverage (aMCV1). Age was log transformed, and pair-wise comparisons of means were made. A χ 2 test was used to assess association between coverage and age groups. Cumulative percent curves and percentiles of age, dot plots with Loess curve, and Spearman rank correlation coefficient were calculated.Results. Of 180,284 suspected cases, 73,009 (41%) were confirmed as measles. Of these, the mean age was 79 months (median, 36 months; interquartile range, 16–96 months) and significantly younger in country-years with

Background Schools are purported to be primary venues of influenza transmission and amplification with secondary spread to communities. We assessed K—12 student absenteeism monitoring as a means for early detection of influenza activity in the community. Methods. We conducted a 3-year, prospective observational study of all-cause (a-TOT), illness-associated (a-I), and influenza-like illness-associated (a-ILI) absenteeism within the Oregon School District, Oregon, WI (OSD: enrollment = 3,900 students). Absenteeism reporting was facilitated by automated processes within OSD’s electronic student information system. Students were screened for ILI, and, if eligible, visited at home, where pharyngeal specimens were collected for influenza RT-PCR (IVD CDC Human Influenza Virus RT-PCR Diagnostic Panel) and multipathogen testing (Luminex NxTAG RPP). The study definition of a-ILI was validated for 700 children with acute respiratory infections using binomial logistic regression. Surveillance of medically attended laboratory-confirmed influenza (MAI) occurred in five primary care clinics in and adjoining OSD as part of the Wisconsin Influenza Incidence Surveillance Project using the same laboratory testing. Poisson general additive log linear regression models of daily counts of absenteeism and MAI were compared using correlation analysis. Results. Influenza A and B were detected in 54 and 51 of the 700 visited students, respectively. Influenza was significantly associated with a-ILI status (OR = 4.74; 95% CI: 2.78—8.18; P < 0.001). Of MAI patients, 371 had influenza A and 143 had influenza B. a-I was significantly correlated with MAI in the community (r = 0.472; P < 0.001) with a 15-day lead time. a-ILI was significantly correlated with MAI in the community (r = 0.480; P < 0.001) with a 1-day lead time. a-TOT performed poorly (r = 0.278; P < 0.001), following MAI by 9 days (Figure 1). Conclusion. Surveillance using cause-specific absenteeism was feasible to implement in OSD and performed well over a 3-year period marked by diverse presentations of seasonal influenza. Monitoring a-I and a-ILI can detect influenza outbreaks in the community, providing early warning in time for community mitigation efforts for seasonal and pandemic influenza. Disclosures All authors: No reported disclosures.

Background School closures may delay the epidemic peak of the next influenza pandemic, but whether school closure can delay the peak until pandemic vaccine is ready to be deployed is uncertain. Methods To study the effect of school closures on the timing of epidemic peaks, we built a deterministic susceptible-infected-recovered model of influenza transmission. We stratified the U.S. population into 4 age groups (0-4, 5-19, 20-64, and ≥ 65 years), and used contact matrices to model the average number of potentially disease transmitting, nonphysical contacts. Results For every week of school closure at day 5 of introduction and a 30% clinical attack rate scenario, epidemic peak would be delayed by approximately 5 days. For a 15% clinical attack rate scenario, 1 week closure would delay the peak by 9 days. Closing schools for less than 84 days (12 weeks) would not, however, reduce the estimated total number of cases. Conclusions Unless vaccine is available early, school closure alone may not be able to delay the peak until vaccine is ready to be deployed. Conversely, if vaccination begins quickly, school closure may be helpful in providing the time to vaccinate school-aged children before the pandemic peaks.

The difference between observed and predicted ILI rates during the winter holiday period varies across HHS region and influenza seasons. Most frequently, the last week in December had higher observed than predicted ILI rates, and the first week of January had lower observed than predicted ILI rates.

School closures implemented pre-emptively, before the peak of influenza activity, are an effective mitigation strategy to slow disease transmission during influenza pandemic. Prolonged school closures may impose unintended economic and social costs to students families. To better understand this unintended impact, we conducted household surveys in five different regions of the United States following school closures implemented for various reasons. One of the primary challenges for families during unplanned school closures is making emergency childcare arrangements. While the most frequently childcare is provided by a non-working household member, this option is not available for families where all adults are employed full-time. Although disruption of subsidized school lunch program did not appear as a difficulty for the majority of eligible families during these school closures, more research might be needed on closures that last longer than 7 days.

Background: The application of whole body vibration (WBV) as a warm-up scheme has been receiving an increasing interest among practitioners. Objectives: The aim of this study was to determine the effect of loaded and unloaded WBV on countermovement jump, speed and agility. Patients and Methods: Twenty-one healthy male college football players (age: 20.14 ± 1.65 years; body height: 179.9 ± 8.34 cm; body mass: 74.4 ± 13.0 kg; % body fat: 9.45 ± 4.8) underwent randomized controlled trials that involved standing in a half squat position (ST), ST with 30% of bodyweight (ST + 30%), whole body vibration at f = 50 Hz, A = 4 mm (WBV), and WBV with 30% bodyweight (WBV + 30% BW) after a standardized warm-up. Post measures of countermovement jump, 15-m sprint, and modified t-test were utilized for analyses. Results: One way repeated measures ANOVA revealed a significant difference in the countermovement jump performance, F (3, 60 = 9.06, η2 = 2.21, P = 0.000. Post-hoc showed that WBV + 30% BW posted significant difference compared to (P = 0.008), ST + 30% BW (P = 0.000) and WBV (P = 0.000). There was also a significant difference in the sprint times among interventions, F (3, 60) = 23.0, η2 = 0.865, P = 0.000. Post hoc showed that WBV + 30% BW displayed significantly lower time values than ST (P = 0.000), ST + 30% BW (P = 0.000) and WBV (P = 0.000). Lastly, there was a significant difference in the agility performance across experimental conditions at F(2.01, 40.1) = 21.0, η2 = 0.954, P = 0.000. Post hoc demonstrated that WBV have lower times than ST (P = 0.013). Also, WBV + 30% BW posted lower times compared to ST (P = 0.000), ST + 30% (P = 0.000) and WBV (P = 0.003). Conclusions: Additional external load of 30% bodyweight under WBV posted superior gains in countermovement jump, speed and agility compared to unloaded WBV, loaded non-WBV and unloaded non-WBV interventions.

High sequence diversity among TT virus (TTV) and TTV-like viruses (TTLVs) is an obstacle to PCR detection of the entire spectrum of existing genotypes. To determine which primers are needed to detect all know genotypes of these viruses, an alignment of commonly used primer sequences with sequences

To evaluate economic implications of conducting a “catch-up” measles vaccination campaign, we conducted an economic analysis of the 1996–1997 measles immunization campaign in two provinces of South Africa comparing the baseline two-dose routine immunization program to the combined vaccination strategy (routine two-dose immunization program, plus the 1996–1997 campaign). The study findings indicate that the 1996–1997 mass measles immunization campaign was cost-effective in both study provinces, and cost-saving in the province with higher pre-campaign disease incidence and lower routine vaccination coverage. An early investment in effective vaccination strategies that rapidly reduce disease burden apparently results in better returns, both epidemiologically and economically.

To contribute to the development of a rubella vaccination strategy, we conducted a study to determine age-specific susceptibility among women aged 15-39 years by testing for rubella-specific IgG antibodies. Of 964 women, 13% were found to be susceptible to rubella. Significantly higher susceptibility among women >25 years old was observed. Susceptibility data are important but are not sufficient to develop a vaccination strategy. After considering all available information, we suggested vaccination of women aged

In 1999 the Ministry of Health of Kyrgyzstan adopted the goal of measles elimination. This opportunity was used to launch a rubella and congenital rubella syndrome prevention program. Between January and August 2001 a rubella outbreak occurred in Bishkek City and Chui Oblast. Rubella surveillance data were reviewed for Kyrgyzstan (1981–2000) and rubella case-patient and laboratory information from Bishkek City and Chui Oblast during the outbreak. The data suggest that rubella is endemic in Kyrgyzstan with periodic epidemics every 3–5 years. From January to August 2001 1936 rubella case-patients were reported from Bishkek City and Chui Oblast; 242 were tested and 176 (73%) were laboratory confirmed. Most case-patients were 3–14 years old. However the incidence rate per 100000 among persons aged 15–35 years increased >/= 40-fold from 1 in 2000 to 41 in 2001. These findings highlight the importance of introducing rubella-containing vaccine in conjunction with measles elimination activities. (authors)

In 2000, Albania resolved to eliminate measles by 2007 by use of a four-step program: by conducting a "catch-up" vaccination campaign for all children aged 1-14 years, achieving and sustaining high coverage (>/=95%) among children aged 1 year with the first dose of a measles-containing vaccine, by introducing a routine second dose of measles-containing vaccine for children at age 5 years, and by improving measles surveillance. This catch-up campaign took place in November 2000: 867,000 doses of measles-rubella vaccine were administered for an estimated coverage of 99%. In all, 231 campaign-related adverse events were reported: syncope, 206; allergic reactions, 10; fever, 8; encephalitis/encephalopathy, 2; and aseptic meningitis, seizures, Guillain-Barre syndrome, anaphylaxis, and arthralgia, 1 each. All resolved without sequelae. This report describes the status of measles and rubella/congenital rubella syndrome control in Albania before 2000 and reports on implementation of the catch-up campaign.

Background: In South Africa as part of an effort to eliminate indigenous measles by 2002 vaccination campaigns were conducted in 1996–1997 targeting all children aged 9 months to 14 years; coverage was estimated at 85%. The impact of the campaigns on measles disease burden was evaluated in 1999. Methods: We analyzed routine measles surveillance data and undertook a retrospective review of hospital registers in two of South Africa’s nine provinces. Results: In Mpumalanga in the pre-campaign years (1992–1996) 4498 measles cases and 6 deaths were reported; 182 cases and no deaths were reported in 1997–1998. Hospital registers showed 1647 measles hospitalizations and 11 deaths in the precampaign period and 60 hospitalizations and no deaths after the campaign (1997–April 1999). In Western Cape in pre-campaign years (1992–1997) 5164 measles cases and 19 deaths were reported; 132 cases and no deaths were reported in 1998. Hospital registers showed 736 measles hospitalizations and 23 deaths in the pre-campaign period and 29 measles hospitalizations and no deaths postcampaign (1998–July 1999). Conclusions: Study findings indicate that reported measles cases measles-related hospitalizations and deaths were considerably reduced in both provinces after the campaign compared with the pre-campaign period. Longer observation is needed to evaluate the long-term impact of the campaigns. (author’s)

Introduction: Unilateral spastic cerebral palsy (US CP) is the second most common subtype of cerebral palsy. Aim: The aim of the study was to analyze neuroimaging findings in children with unilateral spastic cerebral palsy. Material and methods: The study was hospital based, which has included 106 patients with US CP (boys 72/girls 34, term 82/preterm 24). Neuroimaging findings were classified into 5 groups: Brain maldevelopment, predominant white matter injury, predominant gray matter injury, non specific findings and normal neuroimaging findings. Results: Predominant white matter lesions where the most frequent (48/106,45.28%; term 35/preterm 13), without statistically significant difference between term and preterm born children (x2=0.4357; p=0.490517). Predominant gray matter lesions had 32/106 children, 30.19%; (term 25/preterm 7, without statistically significant difference between term and preterm born children (x2=0.902; p=0.9862). Brain malformations had 10/106 children, 9.43%, and all of them were term born. Other finding had 2/106 children, 1.89%, both of them were term born. Normal neuroimaging findings were present in14/106 patients (13.21%). Conclusion: Neuroimaging may help to understand morphological background of motor impairment in children with US CP. Periventricular white matter lesions were the most frequent, then gray matter lesions.