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The article discusses public health response to the initiation and spread of pandemic COVID-19 in the U.S. from February 24 to April 21, 2020. Topics discussed include continued importation of the virus by travelers infected elsewhere; attendance at professional and social events, resulting in amplification in the host locations and multistate spread; and challenges in virus detection, including limited testing, emergence during the peak months of influenza circulation.

The need for closer linkages between scientific and programmatic areas focused on addressing vaccine-preventable and acute respiratory infections led to establishment of the National Center for Immunization and Respiratory Diseases (NCIRD) at the Centers for Disease Control and Prevention. During its first 10 years (2006-2015), NCIRD worked with partners to improve preparedness and response to pandemic influenza and other emergent respiratory infections, provide an evidence base for addition of 7 newly recommended vaccines, and modernize vaccine distribution. Clinical tools were developed for improved conversations with parents, which helped sustain childhood immunization as a social norm. Coverage increased for vaccines to protect adolescents against pertussis, meningococcal meningitis, and human papillomavirus-associated cancers. NCIRD programs supported outbreak response for new respiratory pathogens and oversaw response of the Centers for Disease Control and Prevention to the 2009 influenza A(H1N1) pandemic. Other national public health institutes might also find closer linkages between epidemiology, laboratory, and immunization programs useful. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editors discuss the various articles published within the issue on topics including communication strategies in clinical trials, the Sierra Leone Trial to Introduce a Vaccine Against Ebola (STRIVE), and vaccine safety and efficacy.

The article presents the discussion on COVID-19 pandemic causing disruption, death, and despair. Topics include enduring personal illness and hospila]ization while attempting for teaching with various strains of virtual and hybrid instruction; and presenting to parents and staff, and reconciling conflicting assessments of the dynamic local situation.

The article focuses on global health and the global health strategy of the U.S. Centers for Disease Control and Prevention (CDC) as of July 2014. Topics discussed include the role of CDC in the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the CDC Option B+ approach to prevent mother-to-child transmission of Human Immunodeficiency Virus (HIV) in Malawi, and its collaboration with China's influenza scientists and public health authorities.

The challenges of the COVID-19 pandemic and the public health crisis of racism underscore how important it is for our nation to attract, develop, and retain a diverse public health workforce that can work in communities as well as local, state, and national levels. 3 This article is part of a I Pedagogy in Health Promotion: The Scholarship of Teaching and Learning i supplement, "Preparing the Future Public Health Workforce: Contributions of the CDC Undergraduate Public Health Scholars Program", which was supported by a cooperative agreement from the U.S. Centers for Disease Control and Prevention, Office of Minority Health and Health Equity to the Society for Public Health Education, entitled "Strengthening Public Health Systems and Services through National Partnerships to Improve and Protect the Nation's Health" (Contract Number 5 NU38OT000315-03-00). Keywords: public health; workforce development; public health pedagogy EN public health workforce development public health pedagogy 13S 14S 1 12/09/21 20211202 NES 211202 Hindsight may or may not be 2020, but beginnings look different from the end of a public health career. [Extracted from the article]

Objective : To determine levels of prenatal screening for several infections, intrapartum recognition of risk factors, and prophylaxis against mother-to-child transmission of group B streptococcus. Methods : Review of stratified random sample of hospital records for deliveries in Connecticut during 1996. SUDAAN analysis was used to adjust for the complex survey design, and weighting adjusted for the probability of being sampled and nonresponse. Results : Of 992 records requested, 868 (88%) were abstracted and analyzed. Thirty-six percent of women had prenatal screening for group B streptococcus and 26% had been tested for human immunodeficiency virus (HIV), while 97–99% of women had been screened prenatally for hepatitis B surface antigen, rubella, and syphilis. Of those women tested, 17% were detected as group B streptococcus carriers, and 78% of these received intrapartum antibiotic prophylaxis. Among women who were not screened for group B streptococcus prenatally, 22% met risk-based criteria for prophylaxis, but only 45% of these received intrapartum prophylaxis. Among unscreened women with a risk factor, those with shorter hospital stays prior to delivery, admitted on evening or night shifts, or who delivered on the weekend were significantly less likely to receive intrapartum prophylaxis. Conclusion : In 1996, the majority of women who delivered in Connecticut were not tested prenatally for group B streptococcus and the majority of those not tested in whom there was an indication for prophylaxis were not treated. Compliance with group B streptococcus prevention recommendations can be improved through increased prenatal testing and/or better recognition of risk-based criteria for intrapartum prophylaxis. [ABSTRACT FROM AUTHOR]

Cerebral palsy is the most common neuromotor developmental disability of childhood, affecting as many as 8,000 to 12,000 children born in the U.S. each year (corresponding to a prevalence rate of between 2 and 3 per 1000 children). Recent improvements in neonatal care have not resulted in a decline in the overall prevalence of cerebral palsy and, in fact, greater numbers of very preterm/very low birth weight infants are surviving with cerebral palsy and other developmental problems. Infection in pregnancy may be an important cause of the disorder. In preterm infants, there appears to be about a 2-fold increased risk for cerebral palsy from chorioamnionitis, and in term infants the estimated increased risk is about 4-fold. Provisionally, chorioamnionitis might account for 12% of spastic cerebral palsy in term infants and 28% of cerebral palsy in preterm infants. Studies of biochemical markers of fetal inflammation typically associated with infection also suggest that an inflammatory response may be an important independent etiologic factor. If a substantial proportion of cerebral palsy is attributable to acute amnionitis infection and/or neonatal sepsis, cerebral palsy should have decreased in the United States after administration of intrapartum antibiotics became widespread in response to publication of public health consensus guidelines for Group B streptococcus in 1996. However, failure to detect declines could have a number of explanations and these explanations illustrate the many public health challenges related to intrauterine infection and cerebral palsy. Given the gaps in our current knowledge about intrauterine infection and cerebral palsy, public health recommendations for timely and specific prevention activities are limited at this time. MRDD Research Reviews 2002;8:39–45. © 2002 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Active Bacterial Core surveillance (ABCs) is a collaboration between the Centers for Disease Control and Prevention and several state health departments and universities participating in the Emerging Infections Program Network. ABCs conducts population-based active surveillance, collects isolates, and performs studies of invasive disease caused by Streptococcus pneumoniae, group A and group B Streptococcus, Neisseria meningitidis, and Haemophilus influenzae for a population of 17 to 30 million. These pathogens caused an estimated 97,000 invasive cases, resulting in 10,000 deaths in the United States in 1998. Incidence rates of these pathogens are described. During 1998, 25% of invasive pneumococcal infections in ABCs areas were not susceptible to penicillin, and 13.3% were not susceptible to three classes of antibiotics. In 1998, early-onset group B streptococcal disease had declined by 65% over the previous 6 years. More information on ABCs is available at www.cdc.gov/ncidod/dbmd/abcs. ABCs specimens will soon be available to researchers through an archive. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study examined epidemiologic factors affecting mortality from pneumococcal pneumonia in 1995 through 1997. METHODS: Persons residing in a surveillance area who had community-acquired pneumonia requiring hospitalization and Streptococcus pneumoniae isolated from a sterile site were included in the analysis. Factors affecting mortality were evaluated in univariate and multivariate analyses. The number of deaths from pneumococcal pneumonia requiring hospitalization in the United States in 1996 was estimated. RESULTS: Of 5837 cases, 12% were fatal. Increased mortality was associated with older age, underlying disease. Asian race, and residence in Toronto/Peel, Ontario. When these factors were controlled for, increased mortality was not associated with resistance to penicillin or cefotaxime. However, when deaths during the first 4 hospital days were excluded, mortality was significantly associated with penicillin minimum inhibitory concentrations of 4.0 or higher and cefotaxime minimum inhibitory concentrations of 2.0 or higher. In 1996, about 7000 to 12,500 deaths occurred in the United States from pneumococcal pneumonia requiring hospitalization. CONCLUSIONS: Older age and underlying disease remain the most important factors influencing death from pneumococcal pneumonia. Mortality was not elevated in most infections with beta-lactam-resistant pneumococci. [ABSTRACT FROM AUTHOR]

ABSTRACT. Background. Early-onset group B streptococcal (GBS) prevention efforts are based on targeted use of intrapartum antibiotic prophylaxis (IAP); applicability of these prevention efforts to infections caused by other organisms is not clear. Methods. Multicenter surveillance during 1995 to 1996 for culture-confirmed, early-onset sepsis in an aggregate of 52 406 births; matched case-control study of risk factors for GBS and other sepsis. Results. Early-onset disease occurred in 188 infants (3.5 cases per 1000 live births). GBS (1.4 cases per 1000 births) and Escherichia coli (0.6 cases per 1000 births) caused most infections. GBS sepsis less often occurred in preterm deliveries compared with other sepsis. Compared with gestation-matched controls without documented sepsis, GBS disease was associated with intrapartum fever (matched OR, 4.1; CI, 1.2-13.4) and frequent vaginal exams (matched OR, 2.9; CI, 1.1-8.0). An obstetric risk factor--preterm delivery, intrapartum fever, or membrane rupture >/=18 hours--was found in 49% of GBS cases and 79% of other sepsis. IAP had an adjusted efficacy of 68.2% against any early-onset sepsis. Ampicillin resistance was evident in 69% of E coli infections. No deaths occurred among susceptible E coli infections, whereas 41% of ampicillin-resistant E coli infections were fatal. Ninety-one percent of infants who developed ampicillin-resistant E coli infections were preterm, and 59% of these infants were born to mothers who had received IAP. Conclusions. Either prenatal GBS screening or a risk-based strategy could potentially prevent a substantial portion of GBS cases. Sepsis caused by other organisms is more often a disease of prematurity. IAP seemed efficacious against early-onset sepsis. However, the severity of ampicillin-resistant E coli sepsis and its occurrence after maternal antibiotics suggest caution regarding use of ampicillin instead of penicillin for GBS prophylaxis. Pediatrics 2000:105:21-26; group B streptococcal,... [ABSTRACT FROM AUTHOR]

Addresses the adverse outcomes of pregnancy attributable to group B streptococcus (GBS) disease, through a multicenter study which confirmed the important role of heavy colonisation with GBS in pre-term low-birthweight deliveries. How the pathogen has continued to evolve; The proportion of clinical infections capsular serotypes are causing.

Presents a study in which researchers evaluated the epidemiologic features and risk factors for multiple cases of meningococcal disease in schools in the United States. Study design; Setting; Main outcome measures; Results, including the identification of 22 clusters of meningococcal disease; Benefits of rapid initiation of a chemoprophylaxis program; Vaccination in prevention; Other conclusions.

Evaluates the impact of prevention efforts against human listeriosis in the United States. Food-borne transmission as a major cause human listeriosis; Identification of cases in which Listeria monocytogenes was isolated from cultures or ordinarily sterile sites in an aggregate population of more than 19 million; Cases of perinatal and nonperinatal listeriosis.

Presents information on the outbreak of Meningococcal disease in the United States. Identifies the different disease stricken areas by reviewing related data from January 1980 to June 1993 and comprehend its trend; Effectiveness of the methods of prevention.

Presents strategies for prevention of neonatal group B streptococcal (GBS) disease. Screening for GBS carriage and selective intrapartum antibiotics; Epidemiologic risk factors; Maternal GBS vaccination; Cost-effectiveness, cost-benefit and sensitivity analyses; Impact on the population.

Presents a study that used population-based surveillance in New Jersey in 1986 to quantify the risk of invasive pneumococcal disease in persons with AIDS and in those who went to develop AIDS. Estimated size of the immunosuppressed HIV-infected population; Rates of pneumococcal disease; Number of patients expected to contract pneumococcal disease in areas with a high incidence of AIDS.

The article presents the Pieter Bruegel the Elder (c.1525-1569) the largest of the 41 surviving paintings ''The Wine of Saint Martin’s Day'' (1565-1568) presented at the Spanish national art museum Museo del Prado. According to the author, the masterwork could be interpreted as a metaphor for prevention of respiratory infections. Comments from art critic Michael Kimmelman are included.

The authors reflect on the efforts to protect the adult population against influenza, particularly in the U.S., as of mid-September 2012. They focus on the report by L. A. Jackson on the comparative immunogenicity of multiple formulations of A(H1N1) 09pdm influenza vaccine among adults. They cite a brief history of influenza vaccination in the country, including the recommendation by the U.S. surgeon general in 1960 and the studies by the National Institutes of Health in 2009.

The author discusses the role of scientific evaluation in integration of health care services. He says that coverage of intervention, quality of services, and acceptability of immunization are factors that are appropriate topics of scientific study when the integration of diverse interventions is being introduced. He states that by incorporating strong evaluation and operations research into the integration of services countries provide effective public health services for their populations.

The article discusses various factors related to haemophilus influenzae. Though the impact of influenzae can also be seen among adults, the vast majority of cases of haemophilus influenzae had concentrated among children. Though microbiologists have taken many positive steps toward creating effectives vaccines, the complete eradication of the disease is not possible without long-term monitoring of immunization programs.

This article focuses on the incidence and characteristics of invasive disease due to group B streptococci (GBS) among neonatal in Great Britain and Wales. Development and licensure of an adolescent or maternal GBS vaccine is likely the most effective and sustainable longterm prevention strategy for a wide range of hospital settings and countries. If immunity does not wane rapidly, a single vaccine series may be sufficient to protect women throughout their childbearing years. Although adolescent vaccination strategies would alleviate concerns about vaccination during pregnancy and might prevent adverse outcomes during early pregnancy.

This article discusses aspects of research, policy and practice concerning the spread and control of infectious diseases in the U.S. As of February 2000, a century ago, infectious diseases essentially defined public health, but more recently public health has defined infectious diseases through the very narrow terms of categorical funding. The categorical programs of the American Journal of Public Health address infectious diseases worthy of major public health emphasis. Individual categorical programs are often successful in achieving their goals. Yet the tremendous opportunities of integration are difficult to achieve as long as funding and infrastructure remain rigidly aligned with categorical problems. Vital statistics were created to count the rates at which the masses were succumbing to the leading causes of death during the past centuries. The gains of life expectancy reaped as a consequence of winning several battles against infectious diseases have not ended the larger war. Most people in industrialized countries survive the childhood illnesses that were so deadly during the first part of the 20th century. During the latter part of the century, however, the U.S. saw the longest sustained period of increasing deaths attributable to infectious diseases.

The authors comment on the opioid overdose epidemic in the U.S. and discuss proven strategies to manage chronic pain effectively without opioids to avoid overdoses and addiction. They discuss how reforming prescribing practices can help address the epidemic and improve conditions in communities through a coordinated public health initiative.

Presents information on a study which examined the incidence and clinical spectrum of group B streptococcus infection in adults. Materials and methods; Case-fatality rate; Characterization of groups at increased risk for infection.

Outbreaks and sporadic cases of meningococcal disease among college students have prompted consideration of a policy of routine vaccination for this group. Purchase and administration of the vaccine for routine vaccination would cost $56 million per year. Savings in medical care and indirect costs would not equal this amount unless the annual rate of disease among students is at least 6.5/100 000. The actual rate among students in unknown; however, surveillance data suggest it could not be more than 1.3/100 000. At rates near this estimate, the net cost of the program would be approximately $45 million annually. More cost-effective prevention strategies might be yielded by further studies to identify students at substantial risk of meningococcal disease, or by the development of a conjugate serogroup C vaccine that could be administered during infancy. [ABSTRACT FROM AUTHOR]

The authors offers updates on the Zika virus from January 2016 to July 2016. Topics covered include advisory issued by the U.S. Centers for Disease Control and Prevention against women traveling to areas with Zika virus in January 2016, the association between Zika infection and serious birth defects, and the use of insect repellent registered by the U.S. Environmental Protection Agency.

A review of the article "A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women" by Joura EA, Giuliano AR, Iversen O-E, et al in the current issue of the publication is presented.

The article focuses on hepatitis C virus (HCV) among injection drug users. HCV is transmitted through the sharing of needles and syringes, and the majority of HCV infections in the U.S. are associated with injection drug use. There is no vaccine for HCV, and the mutation rate of the virus will make it difficult to develop one. The treatments for HCV infection are expensive and uncomfortable, and they are effective in fewer than half the cases in which they are undertaken. The HCV epidemic provides a second chance for society to learn from the mistakes made with HIV/AIDS and to implement strategies that are effective, timely, and just and that transcend the politics of stigmatization.

Opinion. Focuses on the 1997 guidelines for the prevention of early-onset group B streptococcal (GBS) disease set by the American Academy of Pediatrics (AAP) and other medical associations. Approaches for the prevention of early-onset GBS disease; Limitations of the 1992 AAP guidelines; Clarification of the appraisal of the Academy policy published in 1992.

This author comments on an article by J. T. Redd and E. Susser on the value of hospital-based operational research in addressing challenges to the health care system. Background of the 19th-century maternity ward epidemics of childbed fever due to A streptococci is presented. The article states that economic factors are a driving force in decision making at the hospital level.

A strong evidence base provides the foundation for planning and response strategies. Investments in pandemic preparedness included support for research that aided early detection, response, and control of the 2009 influenza A (H1N1) (pH1N1) pandemic. Scientific investigations conducted during the pandemic guided understanding of the virus, disease severity, and epidemiologic risk factors. Field investigations also produced information that strengthened guidance for the use of antivirals, identification of target populations for monovalent pH1N1 vaccine, and refinement of recommendations for social distancing measures. Communication of this evolving evidence base was important to sustaining credibility of public health. Areas where substantial controversy emerged, such as the optimal approach to respiratory protection of healthcare workers, often suffered from gaps in the evidence base. Many aspects of the 2009–2010 pandemic influenza experience provide ongoing opportunities for additional study, which will strengthen plans for future pandemic response as well as control of seasonal influenza. [ABSTRACT FROM PUBLISHER]

A response by Christina Phares to a letter to the editor about her article “Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005,” in the 2008;299(17):2056- 2065 issue is presented.

A letter to the editor is presented in response to the article "A Controlled Trial of a Human Papillomavirus Type 16 Vaccine" in the November 21, 2002 issue.

A response by Stephanie J. Schrag, Anne Schuchat and Janet Mohle-Boetani to letters to the editor about their article focusing on the prevention of early onset of group B streptococcal disease in neonates published in the July 25, 2002 issue is presented.

Deals with the prevention of infections among pregnant women. Role of infectious agents in adverse consequences of pregnancy; Information on maternal immunization; Control of infectious diseases through breast-feeding.

The article focuses on the screening and prevention of neonatal group B streptococcal disease. Group B streptococcus became the leading cause of life-threatening infections in newborns during the 1970s. Infants with group B streptococcal disease have sepsis, meningitis, or pneumonia. Efforts to promote prevention in the U.S. culminated in the publication of a uniform set of recommendations by the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. The article refers to a study that describes a method for the detection of group B streptococcus by using two polymerase-chain-reaction techniques.

Background: Before the introduction of the conjugate vaccines, Haemophilus influenzae type b was the major cause of bacterial meningitis in the United States, and meningitis was primarily a disease of infants and young children. We describe the epidemiologic features of bacterial meningitis five years after the H. influenzae type b conjugate vaccines were licensed for routine immunization of infants. Methods: Data were collected from active, population-based surveillance for culture-confirmed meningitis and other invasive bacterial disease during 1995 in laboratories serving all the acute care hospitals in 22 counties of four states (total population, more than 10 million). The rates were compared with those for 1986 obtained by similar surveillance. Results: On the basis of 248 cases of bacterial meningitis in the surveillance areas, the rates of meningitis (per 100,000) for the major pathogens in 1995 were Streptococcus pneumoniae, 1.1; Neisseria meningitidis, 0.6; group B streptococcus, 0.3; Listeria monocytogenes, 0.2; and H. influenzae, 0.2. Group B streptococcus was the predominant pathogen among newborns, N. meningitidis among children 2 to 18 years old, and S. pneumoniae among adults. Pneumococcal meningitis had the highest case fatality rate (21 percent) and in 36 percent of cases was caused by organisms that were not susceptible to penicillin. From these data, we estimate that 5755 cases of bacterial meningitis were caused by these five pathogens in the United States in 1995, as compared with 12,920 cases in 1986, a reduction of 55 percent. The median age of persons with bacterial meningitis increased greatly, from 15 months in 1986 to 25 years in 1995, largely as a result of a 94 percent reduction in the number of cases of H. influenzae meningitis. Conclusions: Because of the vaccine-related decline in meningitis due to H. influenzae type b, bacterial meningitis in the United States is now a disease predominantly of adults rather than of infants and young children. (N Engl J Med 1997;337:970-6.) [ABSTRACT FROM AUTHOR]

Background: The effect of malaria infection on the immunogenicity of the recombinant vesicular stomatitis virus-Zaire Ebola virus envelope glycoprotein (GP) vaccine (rVSVΔG-ZEBOV-GP) (ERVEBO) is unknown.Methods: The Sierra Leone Trial to Introduce a Vaccine Against Ebola (STRIVE) vaccinated 7998 asymptomatic adults with rVSVΔG-ZEBOV-GP during the 2014-2016 Ebola epidemic. In STRIVE's immunogenicity substudy, participants provided blood samples at baseline and at 1, 6, and 9-12 months. Anti-GP binding and neutralizing antibodies were measured using validated assays. Baseline samples were tested for malaria parasites by polymerase chain reaction.Results: Overall, 506 participants enrolled in the immunogenicity substudy and had ≥1 postvaccination antibody titer. Of 499 participants with a result, baseline malaria parasitemia was detected in 73 (14.6%). All GP enzyme-linked immunosorbent assay (ELISA) and plaque reduction neutralization test (PRNT) geometric mean titers (GMTs) at 1, 6, and 9-12 months were above baseline, and 94.1% of participants showed seroresponse by GP-ELISA (≥2-fold rise and ≥200 ELISA units/mL), while 81.5% showed seroresponse by PRNT (≥4-fold rise) at ≥1 postvaccination assessment. In participants with baseline malaria parasitemia, the PRNT seroresponse proportion was lower, while PRNT GMTs and GP-ELISA seroresponse and GMTs showed a trend toward lower responses at 6 and 9-12 months.Conclusion: Asymptomatic adults with or without malaria parasitemia had robust immune responses to rVSVΔG-ZEBOV-GP, persisting for 9-12 months. Responses in those with malaria parasitemia were somewhat lower. [ABSTRACT FROM AUTHOR]

The article discusses the introduction of vaccines for the prevention of diseases from 1961-2011. It mentions that vaccines were received by children in the U.S. in 1961 for the prevention of various diseases including pertussis, poliomyelitis, and smallpox. It adds that a nationwide immunization program was established from 1961-1988.

Group B streptococci (GBS) emerged dramatically in the 1970s as the leading cause of neonatal infection and as an important cause of maternal uterine infection. We review the epidemiology, diagnosis, and therapy of GBS perinatal infection. In 1996, the first national consensus guidelines were released. Since then, there has been a 70% reduction in early-onset neonatal GBS infection, but no decrease in late-onset neonatal GBS disease. In 2002, new national guidelines were released recommending 1) solely a screen-based prevention strategy, 2) a new algorithm for patients with penicillin allergy, and 3) more specific practices in certain clinical scenarios. Yet many clinical issues remain, including implementation of new diagnostic techniques, management of preterm rupture of membranes, use of alternative antibiotic approaches, improvement of compliance, prevention of low birth weight infants, emergence of resistant organisms, and vaccine development. [ABSTRACT FROM AUTHOR]

We examined the peer-reviewed literature on the burden of bacterial pneumonia and the effectiveness of interventions for its prevention among HIV-infected adults in developed and developing countries. Bacterial pneumonia rates were up to 25-fold higher among HIV-infected adults than in the general community, with rates increasing as CD4+ T-cell count decreases. In developed countries, cohort studies showed that highly active antiretroviral therapy (HAART) had the most consistent effect on reducing pneumonia. In a prospective cohort and case-control studies from these regions, pneumococcal polysaccharide vaccine reduced pneumococcal disease in certain subgroups, particularly those with higher CD4+ T cells/μL. In patients with fewer than 200 CD4+ T cells/μL, antimicrobial prophylaxis was usually effective in reducing pneumonia. In sub-Saharan Africa, randomised controlled trials concluded that co-trimoxazole prophylaxis decreased rates of bacterial pneumonia, but pneumococcal polysaccharide vaccine prevented neither pneumonia nor invasive pneumococcal disease. Although not yet fully evaluated in Africa, based on experience in industrialised nations, use of HAART in Africa may have substantial potential to prevent bacterial pneumonia. [Copyright &y& Elsevier]

The article assesses baseline levels of awareness about perinatal Group B streptococcal (GBS) infection among women of childbearing age in the U.S. from 1999 to 2002. It informs that early-onset infections occur within 7 days of birth and are fatal in 4%-6% of cases. In the U.S., approximately 1600 cases of early-onset infections occur annually. GBS is a leading cause of sepsis, pneumonia, and meningitis among newborns in the U.S. During delivery, however, a woman may pass the bacterium to her newborn, with a 50% chance that the newborn will be colonized and a 2% chance that the newborn will develop invasive disease in the absence of intervention with antimicrobials. Intraparturn antimicrobial prophylaxis is highly effective in preventing GBS transmission; since implementation of prevention strategies in the United States, the incidence of early-onset CBS disease has deceased by 70%. Guidelines for testing pregnant women were issued in 1996 by the Centers for Disease Control and Prevention, American College of Obstetricians and Gynecologists, and American Academy of Pediatrics.

The Emerging Infections Programs (EIPs), a population-based network involving 10 state health departments and the Centers for Disease Control and Prevention, complement and support local, regional, and national surveillance and research efforts. EIPs depend on collaboration between public health agencies and clinical and academic institutions to perform active, population-based surveillance for infectious diseases; conduct applied epidemiologic and laboratory research; implement and evaluate pilot prevention and intervention projects; and provide capacity for flexible public health response. Recent EIP work has included monitoring the impact of a new conjugate vaccine on the epidemiology of invasive pneumococcal disease, providing the evidence base used to derive new recommendations to prevent neonatal group B streptococcal disease, measuring the impact of foodborne diseases in the United States, and developing a systematic, integrated laboratory and epidemiologic method for syndrome-based surveillance. [ABSTRACT FROM AUTHOR]

Sepsis occurring in the first week of life can be a devastating neonatal problem. Group B streptococci (GBS) and enterobacteriaceae are the main causes of early-onset sepsis in more developed countries. Intrapartum antimicrobial prophylaxis (IAP) has lowered the incidence of early-onset GBS sepsis by 50–80%. However, there are concerns that the use of IAP may select for infections caused by enterobacteriaceae, including some strains resistant to antimicrobials. We explored potential associations between IAP use and changes in the causes of early-onset sepsis. We concluded that there have been substantial declines in the incidence of early-onset infections due to GBS and, in some settings, other bacteria. Increases in the frequencies of non-GBS or antimicrobial-resistant early-onset sepsis have been limited to preterm, low-birthweight, or very-low-birthweight neonates. We propose systematic monitoring of early-onset sepsis, coupled with targeted research, to inform periodic reassessment of prevention strategies. [Copyright &y& Elsevier]

We compared the hypothetical effects of the 23-valent polysaccharide pneumococcal vaccine with new vaccines on preventing invasive and noninvasive pneumococcal disease in persons ≥65 years. We estimated how much disease would occur if no polysaccharide vaccine were in use and used this baseline to compare the polysaccharide, a 7-valent conjugate vaccine, and hypothetical common antigen vaccine. The polysaccharide, conjugate, and common antigen vaccines prevented 10.6, 10.7, and 17.7% of invasive disease and 4.3, 5.6, and 10.0% of pneumonia, respectively. Superior effectiveness of new vaccines was dependent upon a presumed longer duration of protection than the 23V-PPV and effectiveness against noninvasive pneumonia. Our results suggest that new vaccines could improve disease prevention. [Copyright &y& Elsevier]

We used population-based data to evaluate how often groups of randomly selected clinical laboratories accurately estimated the prevalence of resistant pneumococci and captured trends in resistance over time. Surveillance for invasive pneumococcal disease was conducted in eight states from 1996 to 1998. Within each surveillance area, we evaluated the proportion of all groups of three, four, and five laboratories that estimated the prevalence of penicillin-nonsusceptible pneumococci (%PNSP) and the change in %PNSP over time. We assessed whether sentinel groups detected emerging fluoroquinolone resistance. Groups of five performed best. Sentinel groups accurately predicted %PNSP in five states; states where they performed poorly had high between-laboratory variation in %PNSP. Sentinel groups detected large changes in prevalence of nonsusceptibility over time but rarely detected emerging fluoroquinolone resistance. Characteristics of hospital-affiliated laboratories were not useful predictors of a laboratory's %PNSP. Sentinel surveillance for resistant pneumococci can detect important trends over time but rarely detects newly emerging resistance profiles. [ABSTRACT FROM AUTHOR]

Interpretation: The adoption by Canadian obstetric care providers of neonatal GBS prevention practices recommended by expert groups was slow but improved significantly over time. These findings highlight the difficulties associated with achieving compliance with diverse and frequently changing recommendations. However, the associated incidence of neonatal GBS disease, which was low or declining, suggests that efforts to disseminate current GBS prevention guidelines have been moderately successful. [ABSTRACT FROM AUTHOR]