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The article discusses research on monkeypox (mpox) and its implications for dermatologists, published in the journal"Cutis." Topics include the history of the virus, clinical presentation, complications, diagnosis, methods of transmission, infection control recommendations, indications for vaccination. It also mentions the increasing prevalence of mpox outbreaks, particularly in endemic regions of Africa, and the need for dermatologists to be prepared to recognize and manage this disease.

Objective  This study aimed to estimate the prevalence of measles immunity in a cohort of pregnant women in New York City and determine if there is a positive correlation of measles immunity with patient demographics, rubella immunity, number of measles, mumps, and rubella vaccine (MMR) doses received, and age at last vaccination. Study Design  This is a cross-sectional study of pregnant patients seen at a single institution from January 2019 to May 2019. Patients were classified as measles and rubella immune or nonimmune using commercial immunoglobulin G (IgG) tests. Patient characteristics were compared using t -tests, Chi-square tests, or Fisher's exact tests as appropriate. The association of age at last vaccination with immunity status was assessed using multivariable logistic regression adjusted for age at presentation. The utility of rubella IgG for distinguishing measles immunity was assessed using receiver operating characteristic curve analysis. Results  Serologic immunity for measles and rubella was obtained for 1,366 patients. Of these, 1,047 (77%) were measles immune and 1,291 (95%) were rubella immune. Patients born after 1989 were less likely to be immune to measles, while multiparity and private insurance were associated with increased measles immunity. Documentation of MMR vaccination was available for 140 (10%) patients. Of these, 44 (31%) were serologically nonimmune to measles and 9 (6.4%) were nonimmune to rubella. In patients known to have received one dose of MMR, 62% (24/39) were immune to measles with an improvement to 72% (69/96) among those who received two or more doses. Age at last vaccination was not associated with measles immunity. Rubella IgG level was a poor predictor of positive measles titer (area under the curve = 0.59). Conclusion  Approximately one of every four pregnant patients is serologically measles nonimmune, even among women with documented MMR vaccination or documented rubella immunity. These findings raise concerns that relying on vaccination history or rubella immune status may not be sufficient to assure protection from infection with measles. If further suggests that measles serology should be added to routine prenatal laboratory testing to identify nonimmune patients that may benefit from postpartum vaccination. Key Points Approximately one of every four pregnant patients were serologically measles nonimmune. Rubella immunoglobulin G was a poor predictor of measles immunity status. Measles serology should be added to routine prenatal laboratory testing. [ABSTRACT FROM AUTHOR]

Despite implementation of the Clostridium difficile Infection (CDI) algorithm in 2016, inappropriate testing remains an issue. To further reduce this problem, Mandatory Pre-Authorization (MPrA) or Hard Stop Order (HSO) was implemented in March 2017. MPrA/HSO requires the ordering physician to apply the criteria set in the algorithm and obtain approval from an Infectious Disease (ID) physician. The test is stopped if the criteria are not met and without approval. The objective of this review is to examine the effectiveness of the MPrA/HSO in our hospitals. An order set was built in the electronic medical record (EMR) identifying the ordering physician and ID attending approving the test. Educational sessions, posters and pocket size algorithm were provided. Orders without ID approval were referred back to the ordering physician or escalated to the Chief of Service or to the Director of Infection Prevention. Exclusion for the MPrA/HSO were Emergency Room patients suspected with CDI. National Healthcare Safety Network (NHSN) data from February 2016 to March 2018 were retrospectively analyzed. Comparison of Pre and Post implementation data showed a decline of 68% in CDI testing for Hospital A and 61% for Hospital B. The Hospital-Onset CDI dipped to 74% in Hospital A and 61% in Hospital B and inappropriate testing decreased by 75% and 100% respectively. >97% met testing criteria and ID approval. Pre and Post MPrA/HSO Standard Infection Ratio (SIR) were statistically significant. Testing stewardship accomplished a reduction of CDI testing without a corresponding increase in CDI, and without evidence of missed cases. Our goal of reducing inappropriate testing is achieved, thereby improving patient outcome as unnecessary isolation and exposure to antibiotics are avoided. Administrative support, interdisciplinary teamwork and integration of the MPrA/HSO in the EMR are essential in the success of this initiative. [ABSTRACT FROM AUTHOR]