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Objectives. —To assess health care providers' identification of human immunodeficiency virus (HIV)—exposed infants, to ascertain the prevalence of transplacental or oral zidovudine treatment among infants exposed to HIV, and to estimate the impact of zidovudine use on perinatal transmission in rural and urban North Carolina. Design. —Survey of North Carolina newborns tested for HIV infection in 1993 and 1994 compared with the number of anonymous HIV-positive childbearing women. Setting. —North Carolina hospitals, public health clinics, and private physicians' offices. Main Outcome Measures. —Rates of identification of HIV-exposed infants and of perinatal HIV-1 transmission, determined by HIV culture and polymerase chain reaction testing in the infants. Results. —The proportion of HIV-exposed children in North Carolina who were identified and tested increased from 60% in 1993 to 82% for all of 1994, and to more than 90% for the last quarter of 1994. The HIV-exposed infants born in rural counties were more likely to be recognized than those born in urban counties (P Conclusions. —Health care providers in North Carolina are identifying most of the state's HIV-seropositive pregnant women, treating them with zidovudine, and testing their infants soon after birth for HIV infection. The use of zidovudine in pregnant women and their infants has reduced perinatal HIV transmission in the state. (JAMA. 1996;275:1483-1488)

The nation has experienced a marked increase in measles cases during 1989 and 1990. Almost one half of all cases have occurred in unvaccinated preschool children, mostly minorities. The principal cause for the epidemic is failure to provide vaccine to vulnerable children on schedule. Major reasons for the low vaccine coverage exist within the health care system itself, which creates barriers to obtaining immunization and fails to take advantage of many opportunities to provide vaccines to children. Ideally, immunizations should be given as part of a comprehensive child health care program. However, immunization cannot await the development of such an ideal system. Essential changes can and should be made now. Specific recommendations include improved availability of immunization; improved management of immunization services; improved capacity to measure childhood immunization status; implementation of the two-dose measles vaccine strategy; and laboratory, epidemiologic, and operational studies to further define the determinants of decreased vaccine coverage and to develop new combinations of vaccines that can be administered earlier in life. The measles epidemic may be a warning flag of problems with our system of primary health care. (JAMA. 1991;266:1547-1552)

Dr Finley's comments are appreciated. The 50 patients whose records were reviewed were selected in a completely random manner. The appraisal of the antibiotic management was accomplished individually by three physicians prior to the assignment of the terms "inappropriate" or "appropriate." Examples of the criteria employed are (1) no evidence of infection and no indicated reason for prophylaxis, and (2) no bacterial cultures obtained, or an organism isolated but resistant to the drug employed. Antibiotics are one of the most frequently prescribed groups of drugs, and in the best interests of patient management, we must continue to use antimicrobial agents wisely to achieve effective therapy, to try to minimize the development of resistant organisms, and to reduce costs of treatment if two equally effective antimicrobial agents are available. These problems have been carefully considered in the report by Kunin et al.1In 1977 the ad hoc

• An 8-month-old male infant with severe combined immunodeficiency syndrome was admitted to the hospital with pneumonitis and, subsequently, died at 21 months of age. During his lengthy hospitalization, parainfluenza virus type 3 (PIV-3) was isolated from respiratory secretions and unusual sites, such as pericardial fluid, CSF, and WBCs. A postmortem examination showed apparent viral pancreatitis, and PIV-3 was isolated from the lung, brain, and pericardial fluid. To our knowledge, this is the first reported case of disseminated parainfluenza infection identified during life. We speculated that a mutant fusion protein may have been elaborated by the virus, allowing dissemination beyond the respiratory tract. (Am J Dis Child1983;137:1172-1174)

A 15-month-old infant observed at Duke University Medical Center for his final six months of life died with infectious complications of lymphopenic agammaglobulinemia. Parainfluenza virus type II was present in four specimens of respiratory secretions obtained during the terminal three months of life. Autopsy findings disclosed multinucleate giant cells in his lungs.

A study of antibiotic use at Duke University Medical Center in June 1973 showed that 34.2% of all patients received antibiotics (43.6% surgical, 21.4% medical patients). Cephalothins were most frequently ordered for surgical patients, ampicillin sodium and penicillin G or penicillin V with potassium for other patients. A retrospective analysis of 50 randomly selected patients, according to the Kunin's categories of use, showed 64% of total antibiotic therapy as not indicated or inappropriately administered in terms of drug or dosage. These results are similar to previous reports of antibiotic surveillance and further establish the need for continuing education of prescribing physicians. ( JAMA 237:2819-2822, 1977)

A prospective study of 70 mother-infant pairs was designed to evaluate vertical transmission of group B Streptococcus (GBS) in relation to the use of intrauterine fetal monitors (IUFMs). Multiple-site cultures obtained from mothers during the intrapartum interval and those obtained from infants on day 1 and at discharge or day 4 were plated on a selective medium. Thirteen (27.1%) of 48 IUFM-exposed women vs seven (31.8%) of 22 non-IUFM-exposed women had GBS at one or more sites. The GBS colonization with maternally concordant serotypes occurred in eight (61.5%) of 13 infants born to GBS-colonized, IUFM-exposed women vs two (28.6%) of seven infants born to GBS-colonized, non-IUFM-exposed women. While this suggests that vertical transmission of GBS is enhanced by IUFM placement, the differences in these infant rates were not statistically significant. ( JAMA 242:42-44, 1979)

Echovirus 14 was isolated from the liver of a newborn infant with fatal hepatic necrosis. It appeared likely that the infection was acquired in utero. Ultrastructurally, the findings in the liver cells were consistent with a viral infection. In cell cultures the viral isolate was found to produce crystalline inclusions in the nucleus and cytoplasm. Negative stained virions measured approximately 30.3 mμ in diameter. To our knowledge, the electron microscopy of echovirus 14 has not been previously reported.