Showing papers by "Timothy M. Uyeki published in 2006"

Severe Community-acquired Pneumonia Due to Staphylococcus aureus, 2003–04 Influenza Season

Abstract: During the 2003–04 influenza season, 17 cases of Staphylococcus aureus community-acquired pneumonia (CAP) were reported from 9 states; 15 (88%) were associated with methicillin-resistant S. aureus (MRSA). The median age of patients was 21 years; 5 (29%) had underlying diseases, and 4 (24%) had risk factors for MRSA. Twelve (71%) had laboratory evidence of influenza virus infection. All but 1 patient, who died on arrival, were hospitalized. Death occurred in 5 (4 with MRSA). S. aureus isolates were available from 13 (76%) patients (11 MRSA). Toxin genes were detected in all isolates; 11 (85%) had only genes for Panton-Valentine leukocidin. All isolates had community-associated pulsed-field gel electrophoresis patterns; all MRSA isolates had the staphylococcal cassette chromosome mec type IVa. In communities with a high prevalence of MRSA, empiric therapy of severe CAP during periods of high influenza activity should include consideration for MRSA.

Three Indonesian clusters of H5N1 virus infection in 2005.

Abstract: BACKGROUND Since 2003, the widespread ongoing epizootic of avian influenza A (H5N1) among poultry and birds has resulted in human H5N1 cases in 10 countries. The first case of H5N1 virus infection in Indonesia was identified in July 2005. METHODS We investigated three clusters of Indonesian cases with at least two ill persons hospitalized with laboratory evidence of H5N1 virus infection from June through October 2005. Epidemiologic, clinical, and virologic data on these patients were collected and analyzed. RESULTS Severe disease occurred among all three clusters, including deaths in two clusters. Mild illness in children was documented in two clusters. The median age of the eight patients was 8.5 years (range, 1 to 38). Four patients required mechanical ventilation, and four of the eight patients (50%) died. In each cluster, patients with H5N1 virus infection were members of the same family, and most lived in the same home. In two clusters, the source of H5N1 virus infection in the index patient was not determined. Virus isolates were available for one patient in each of two clusters, and molecular sequence analyses determined that the isolates were clade 2 H5N1 viruses of avian origin. CONCLUSIONS In 2005 in Indonesia, clusters of human infection with clade 2 H5N1 viruses included mild, severe, and fatal cases among family members.

Multistate surveillance for laboratory-confirmed, influenza-associated hospitalizations in children: 2003-2004.

Abstract: Background: Increasing use of rapid influenza diagnostics facilitates laboratory confirmation of influenza infections. We describe laboratory-confirmed, influenza-associated hospitalizations in a population representing almost 6% of children in the United States. Methods: We conducted population-based surveillance for influenza-associated hospitalizations between October 1, 2003, and March 31, 2004, in 54 counties in 9 states (4.2 million children) participating in the Emerging Infections Program Network. Clinical characteristics, predictors of intensive care unit admission and geographic and age-specific incidence were evaluated. Results: Surveillance identified 1,308 case-patients; 80% were <5 years and 27% were <6 months of age. Half of the patients and 4 of 5 pediatric deaths did not have a medical indication for influenza vaccination and were outside the 6- to 23-month age group. Twenty-eight percent of case-patients had radiographic evidence of a pulmonary infiltrate, 11% were admitted to intensive care and 3% received mechanical ventilation. The median length of hospital stay was 2 days. Community-acquired invasive bacterial coinfections (1% of patients) were associated with intensive care admission (adjusted odds ratio, 16.9; 95% confidence interval, 5.0-56.8). Thirty-five percent of patients ≥6 months old had received at least one influenza vaccine dose that season. The overall incidence of influenza-associated hospitalizations was 36 per 100,000 children (range per state, 10 per 100,000 to 86 per 100,000). Conclusions: Influenza was an important cause of hospitalizations in children during 2003-2004. Hospitalizations were particularly common among children <6 months of age, a group for whom influenza vaccine is not licensed. Continued surveillance for laboratory-confirmed influenza could inform prevention strategies.

Histopathologic and immunohistochemical features of fatal influenza virus infection in children during the 2003-2004 season.

Abstract: BACKGROUND The Centers for Disease Control and Prevention enhanced national surveillance for influenza-associated deaths among children because of early reports of pediatric deaths during the 2003-2004 influenza season. METHODS We studied lung and upper airway specimens from 47 case patients who died who had at least 1 positive result for influenza virus tests using hematoxylin and eosin, special stains for bacteria and fungi, and immunohistochemical (IHC) assays for influenza A and B viruses and other potential viral and bacterial respiratory pathogens. RESULTS Nineteen (40%) of the 47 patients were

Health benefits, risks, and cost-effectiveness of influenza vaccination of children.

Abstract: We estimated cost-effectiveness of annually vaccinating children not at high risk with inactivated influenza vaccine (IIV) to range from US $12,000 per quality-adjusted life year (QALY) saved for children ages 6-23 months to $119,000 per QALY saved for children ages 12-17 years. For children at high risk (preexisting medical conditions) ages 6-35 months, vaccination with IIV was cost saving. For children at high risk ages 3-17 years, vaccination cost $1,000-$10,000 per QALY. Among children notat high risk ages 5-17 years, live, attenuated influenza vaccine had a similar cost-effectiveness as IIV. Risk status was more important than age in determining the economic effects of annual vaccination, and vaccination was less cost-effective as the child's age increased. Thus, routine vaccination of all children is likely less cost-effective than vaccination of all children ages 6-23 months plus all other children at high risk.

Low Frequency of Poultry-to-Human H5N1 Transmission, Southern Cambodia, 2005

Abstract: To understand transmission of avian influenza A (H5N1) virus, we conducted a retrospective survey of poultry deaths and a seroepidemiologic investigation in a Cambodian village where a 28-year-old man was infected with H5N1 virus in March 2005. Poultry surveys were conducted within a 1-km radius of the patient's household. Forty-two household flocks were considered likely to have been infected from January through March 2005 because >60% of the flock died, case-fatality ratio was 100%, and both young and mature birds died within 1 to 2 days. Two sick chickens from a property adjacent to the patient's house tested positive for H5N1 on reverse transcription–PCR. Villagers were asked about poultry exposures in the past year and tested for H5N1 antibodies. Despite frequent, direct contact with poultry suspected of having H5N1 virus infection, none of 351 participants from 93 households had neutralizing antibodies to H5N1. H5N1 virus transmission from poultry to humans remains low in this setting.

Factors associated with nosocomial SARS-CoV transmission among healthcare workers in Hanoi, Vietnam, 2003

Abstract: In March of 2003, an outbreak of Severe Acute Respiratory Syndrome (SARS) occurred in Northern Vietnam. This outbreak began when a traveler arriving from Hong Kong sought medical care at a small hospital (Hospital A) in Hanoi, initiating a serious and substantial transmission event within the hospital, and subsequent limited spread within the community. We surveyed Hospital A personnel for exposure to the index patient and for symptoms of disease during the outbreak. Additionally, serum specimens were collected and assayed for antibody to SARS-associated coronavirus (SARS-CoV) antibody and job-specific attack rates were calculated. A nested case-control analysis was performed to assess risk factors for acquiring SARS-CoV infection. One hundred and fifty-three of 193 (79.3%) clinical and non-clinical staff consented to participate. Excluding job categories with <3 workers, the highest SARS attack rates occurred among nurses who worked in the outpatient and inpatient general wards (57.1, 47.4%, respectively). Nurses assigned to the operating room/intensive care unit, experienced the lowest attack rates (7.1%) among all clinical staff. Serologic evidence of SARS-CoV infection was detected in 4 individuals, including 2 non-clinical workers, who had not previously been identified as SARS cases; none reported having had fever or cough. Entering the index patient's room and having seen (viewed) the patient were the behaviors associated with highest risk for infection by univariate analysis (odds ratios 20.0, 14.0; 95% confidence intervals 4.1–97.1, 3.6–55.3, respectively). This study highlights job categories and activities associated with increased risk for SARS-CoV infection and demonstrates that a broad diversity of hospital workers may be vulnerable during an outbreak. These findings may help guide recommendations for the protection of vulnerable occupational groups and may have implications for other respiratory infections such as influenza.

Universal influenza vaccination in the United States: are we ready? Report of a meeting.

Abstract: Universal influenza vaccination has been proposed as one strategy to improve vaccination coverage and disease prevention. In October 2005, influenza and vaccination experts, public health practitioners, representatives from medical professional societies, influenza vaccine manufacturers, and managed care organizations met to assess whether current data were sufficient to support an expansion of universal influenza vaccination and to define information gaps and potential barriers to implementation. Presenters at the meeting documented the substantial burden of influenza disease among all age groups, the major role of children in transmission, and the effectiveness of vaccine, especially in healthy children and adults. Observational studies and a mathematical model suggested that indirect protection, or "herd immunity," resulting from vaccination of school-age children would substantially reduce the incidence of disease in other age groups. Economic analyses generally showed that vaccination of healthy children and adults is cost-effective and is sensitive to vaccine cost, population group, and season. Influenza vaccination received annually over several years is safe and effective, but data on long-term use are limited. Challenges to expanded recommendations include maintenance of the vaccine supply, implementation of a feasible and effective strategy for vaccine delivery, the burden on the public health infrastructure, public acceptability, and financing. Overall, meeting attendees favored incremental expansion of recommendations, potentially toward universal influenza vaccination. They preferred to expand recommendations among children first, because children have a higher risk of illness, compared with healthy adults; because there is greater feasibility of implementation of the recommendations among children; and because of the potential for herd immunity decreasing morbidity and mortality among adults.