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A study was conducted to evaluate and describe the changes that have taken place in health care-associated invasive methicillin-resistant staphylococcus aureus (MRSA) infections among residents of the U.S. during the period 2005 to 2008. Results indicated that the rates of such infections decreased over a four-year period.

A study is conducted to evaluate the efficacy of prevention guidelines in helping reduce the incidence of invasive Group B Streptococcal disease in the U.S. from 1999 to 2005. Results indicate a reduction in mortality among children from invasive Group B Streptococcal disease while on the other hand it had no effect on adults with the same disease.

The study presents the incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) disease in the U.S. The results show that invasive MSRA infections affect certain populations disproportionately and are no longer restricted to medical settings only.

A test was conducted to determine the rates of invasive pneumococcal disease (IPD) in young infants before and after pneumococcal conjugate vaccine (PCV7) was incorporated into the childhood immunization schedule. It was seen that since PCV7 introduction, rates of IPD in young infants have decreased significantly, providing evidence that vaccinating children aged 2-23 months has led to change in pneumococcal carriage in infants too young to receive PCV7.

An examination among adults aged 50 years or older on whether incidence of invasive pneumococcal disease, disease characteristics, or the spectrum of patients acquiring these illnesses have changed over the 4 years since pneumococcal conjugate vaccine licensure is presented. Results indicate that use of conjugate vaccine in children has substantially benefited older adults.

The Africans in the United States are more prone to invasive pneumococcal disease than the Americans. There is a decline in invasive disease among the younger children because of the introduction of a new protein polysaccharide pneumococcal conjugate vaccine.

People infected with both human T-cell lymphotropic virus type I (HTLV-I) and HIV appear to have more advanced disease than people infected with HIV only, despite higher CD4 cell counts. HTLV-I is a virus that destroys immune cells of the lymph system. CD4 cells are immune system cells that are depleted during HIV infection. Researchers evaluated the disease stage, CD4 cell counts and other laboratory measures of 27 HIV-positive, HTLV-I-positive patients (coinfection) and 99 HIV-positive, HTLV-I-negative (single infection) comparison subjects. Twenty-three percent of coinfected patients and 5% of singly infected patients acquired their infections by injection drug use or blood transfusion. Of coinfected patients, 44% were in the late stages of HIV infection, compared to only 21% of singly infected individuals. Coinfected individuals had higher average total lymph cell, white blood cell and CD4 cell counts than HIV-infected counterparts., Objectives.--To study the effect of human T-cell lymphtropic virus type I (HTLV-I) on markers of human immunodeficiency virus (HIV) disease progression. Design.--A retrospective, nested case-control study. Setting.--A university hospital outpatient HIV clinic in Rio de Janeiro, Brazil. Participants.--Human immunodeficiency virus--seropositive adults participating in a prospective HIV cohort study. Main Outcome Measures.--The HIV clinical stage, [CD4.sup.+] lymphocyte counts, and other laboratory parameters in 27 individuals infected with HIV and HTLV-I (coinfection) and 99 age-matched, HIV-seropositive, HTLV-seronegative controls (single infection). Results.--Variables independently associated with coinfection included higher [CD4.sup.+] lymphocyte count (odds ratio [OR], 2.3; 95% confidence limits [CL], 1.3,4.1), higher [CD4.sup.+] percentage (OR, 2.0; 95% CL, 1.3, 3.2), [[beta].sub.2]-microglobulin level of 254 nmol/L or more (OR, 6.8; 95% CL, 1.3, 35.4), World Health Organization stages 3 and 4 (OR, 4.4; 95% CL, 1.1, 18.0), and reporting a parenteral risk factor (OR, 7.4; 95% CL, 1.4, 38.9). When stratified by p24 antigenemia, coinfection was associated with an estimated 82% higher [CD4.sup.+] lymphocyte count (P

It appears that worldwide elimination of meningococcal infections will take some time due to a variety of factors including the lack of an effective vaccine. Infection with the organism Neisseria meningitidis can kill a healthy adult within hours. Infection with the organism is the primary cause of bacterial meningitis and bacteremia in the United States. Though the incidence of meningococcal infections has declined in the U.S., the emergence of a newer, more virulent strain of group C meningococcus in Canada and the Atlantic region indicates that the organism has not been eradicated. Though group C infections are more common in North America, group A infections are more common in developing countries. Vaccines are not used routinely because they are ineffective in children and ineffective against group B infections. Until more effective vaccines are developed, meningococcal infections will continue to be a public health threat.

Colonization by Streptococcus pneumoniae (S. pneumoniae) may lead to an outbreak of pneumococcal disease in children at child-care centers. Colonization occurs when an organism is present in the body but does not invade tissues or cause damage. The case of six children in a child-care facility in a family home is discussed. Three children developed fevers and evidence of S. pneumoniae in the blood. A fourth child developed an eye infection with discharge that when cultured indicated infection with S. pneumoniae. Samples from the noses and throats of the two other healthy children in the child care facility also tested positive for S. pneumoniae. DNA analysis indicated that all children were infected with the same strain of the organism. All of the children and their immediate families were treated with rifampin. Three weeks after treatment the three children colonized with S. pneumoniae were still colonized., Objective. - To investigate a cluster of invasive pneumococcal disease in children 8 to 26 months of age, using standard microbiological procedures and ribosomal DNA gene-restriction patterns to characterize the outbreak strain. Design. - Outbreak investigation. Setting. - A family child-care home with six children in Baltimore, Md. Results. - During an 8-day period, three of the six children in the family child-care home had febrile illnesses with pneumococcal bacteremia, and a fourth had purulent pneumococcal conjunctivitis. Type 12F Streptococcus pneumoniae was isolated from the four ill children and from the nasopharynges of the two healthy children. Ribotyping revealed all outbreak isolates had an identical ribotype pattern. Administration of rifampin to the children did not eradicate carriage of the organism. Conclusions. - Our data demonstrate that child care provides an opportunity for outbreak of invasive pneumococcal disease in young children. This observation suggests a need for increased alertness for clusters of pneumococcal disease in young children in child-care facilities and underscores the necessity for a pneumococcal vaccine that is effective in infants and young children. (JAMA. 1994;271:695-697)

The number of cases of meningococcal infection in teenagers and young adults in Maryland increased in the early 1990s but then began decreasing in 1998. The infection was much more likely to be fatal than a similar infection in young children and 83% of the infections could have been prevented by vaccination.

College students who live on-campus appear to have a higher risk of meningococcal infection than the general population. Meningococcal infection is caused by a bacterium called Neisseria meningitidis. Researchers analyzed the incidence of meningococcal infection in Maryland between 1992 and 1997. Of 228 people who developed this infection, 11 attended a four-year college and 3 attended a two-year college. The rate of meningococcal infection was 1.74 per 100,000 people among college students and 1.44 per 100,000 among the general population of the same age. However, among on-campus residents the rate was 3.24 per 100,000 compared to 0.96 per 100,000 in off-campus residents.

In August 1987, an outbreak of group A meningococcal meningitis occurred during the annual pilgrimage of Mecca, Saudi Arabia, resulting in an attack rate among American pilgrims of 640 per 100 000. To determine risk factors for carriage, throat cultures were taken from passengers arriving on four consecutive flights from Saudi Arabia to the United States. Pilgrims were more likely to be group A meningococcal carriers than were nonpilgrims (relative risk, 11.1; 95% confidence interval, 3.7 to 33.1). Smoking, crowding, and meningococcal vaccination were not significantly associated with group A carriage. Pilgrims complaining of recent fever or sore throat, however, were more likely to be group A carriers, consistent with previous reports linking carriage and disease to preceding viral infections. Serogrouping of invasive meningococcal isolates can be used to monitor for indigenous transmission of this unusual strain in the United States, and we recommend routine vaccination of pilgrims to prevent future outbreaks of miningococcal disease.

ABSTRACT: To assess the efficacy of the Haemophilus b polysacchaide vaccine following licensure and to evaluate the risk of Haemophilus influenzae type b (Hib) disease in the week following vaccination, we conducted a day care--based case-control efficacy study using cases of invasive Hib disease ascertained through active surveillance in areas with a total population of 34 million. For each patient 18 to 59 months old, up to three 18- to 59-month-old controls were chosen from the same day care classroom. Using conditional logistic regression, the vaccine efficacy was estimated to be 45% (95% confidence interval = - 1% to 70%) and did not change significantly after accounting for potential biases. In addition, three (3%) of 104 patients vs five (2%) of 207 controls were vaccinated within seven days before the patients' dates of admission (odds ratio = 1.8, 95% confidence interval=0.3 to 10.2), which does not suggest an increased risk of Hib disease in the week following immunization. This study suggests that the efficacy of the currently used HBPV is less than expected from previous studies and points out the usefulness of case-control studies for monitoring vaccine efficacy following licensure.

Context The duration of protection from tuberculosis of BCG vaccines is not known. Objective To determine the long-term duration of protection of a BCG vaccine that was previously found to be efficacious. Design Retrospective record review using Indian Health Service records, tuberculosis registries, death certificates, and supplemental interviews with trial participants. Setting and Participants Follow-up for the period 1948-1998 among American Indians and Alaska Natives who participated in a placebo-controlled BCG vaccine trial during 1935-1938 and who were still at risk of developing tuberculosis. Data from 1483 participants in the BCG vaccine group and 1309 in the placebo group were analyzed. Main Outcome Measures Efficacy of BCG vaccine, calculated for each 10-year interval using a Cox regression model with time-dependent variables based on tuberculosis events occurring after December 31, 1947 (end of prospective case finding). Results The overall incidence of tuberculosis was 66 and 138 cases per 100 000 person-years in the BCG vaccine and placebo groups, respectively, for an estimate of vaccine efficacy of 52% (95% confidence interval, 27%-69%). Adjustments for age at vaccination, tribe, subsequent BCG vaccination, chronic medical illness, isoniazid use, and bacille Calmette-Guérin strain did not substantially affect vaccine efficacy. There was slight but not statistically significant waning of the efficacy of BCG vaccination over time, greater among men than women. Conclusion In this trial, BCG vaccine efficacy persisted for 50 to 60 years, suggesting that a single dose of an effective BCG vaccine can have a long duration of protection. [ABSTRACT FROM AUTHOR]

This editorial comments on a study in this issue testing a multivalent conjugate vaccine for the prevention of meningococcal disease in infants. The author says the study appears to offer suggestion of the vaccine's value in children but longer term studies are needed to assess side effects, any interaction with the heptavalent pneumonia vaccine which uses the same protein carrier and duration of protection.

Responds to a letter to the editor of the 'Journal of the American Medical Association' about polysaccharide Haeomophilus vaccine's provision of protective efficacy in children.