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Objective: Maryland became the first state to pass a vaccination law requiring college and university students living on campus to obtain a meningococcal vaccination or to sign a waiver refusing vaccination because college students are at increased risk for disease. The authors sought to identify how Maryland colleges addressed the law and determine whether schools were in full compliance. Participants: The authors surveyed 32 college/university administrators via a self-administered questionnaire. Methods: The authors calculated vaccination and waiver rates and assessed compliance with the law overall and with specific law components. Results: Among 28 participating schools, annual vaccination rates and waiver rates among students during 2000-2004 ranged from 66%-76% and 12%-17%, respectively. Two (7%) schools were compliant with all components of the law. Conclusions: Mandatory vaccination laws do not ensure compliance at the college and university level. Mandatory reporting, increased education, and collaboration between colleges and universities and public health agencies are needed. Keywords: college health, meningococcal disease, students, university, vaccination, Infection with Neisseria meningitides (N. meningitides), the organism responsible for meningococcal disease, can lead to life-threatening illnesses (eg, bacteremia and meningitis). The incidence of meningococcal disease is highest among children [...]

Background: Adults infected with HIV have high rates of invasive pneumococcal disease. Introduction of pneumococcal conjugate vaccine for children could affect disease among HIV-infected adults. Objective: To compare invasive pneumococcal disease among HIV-infected adults before and after the introduction of a pediatric conjugate vaccine. Design: Active laboratory-based surveillance in an adult population of 10.8 million, including 38 314 living with AIDS. Setting: 7 Active Bacterial Core surveillance areas in the United States. Patients: All surveillance-area residents 18 to 64 years of age with Streptococcus pneumoniae isolated from a sterile site between 1998 and 2003. Measurements: Ratio of the number of cases of invasive pneumococcal disease among HIV-infected adults to the estimated number of adults 18 to 64 years of age living with AIDS; serotype-specific subset analyses; and comparison of periods before and after introduction of conjugate vaccine by using exact tests. Results: Of 8582 cases of invasive pneumococcal disease in adults, 2013 (24%) occurred among persons infected with HIV. Between baseline (1998 to 1999) and 2003, the ratio of invasive pneumococcal disease in HIV-infected adults to the number of adults living with AIDS in the surveillance areas decreased from 1127 to 919 cases per 100000 AIDS population, a reduction of 19% (P = 0.002). Among HIV-infected adults, the ratio for disease caused by pneurnococcal serotypes included in the conjugate vaccine decreased 62% (P < 0.001), although the ratio for disease caused by nonvaccine serotypes increased 44% (P < 0.001). Limitations: Ratios are proxy measures of incidence rates. The denominator of surveillance-area residents living with HIV infection was not available. Conclusions: Introduction of the pediatric conjugate vaccine was associated with an overall decrease in invasive pneumococcal disease among HIV-infected adults, despite increased disease caused by nonvaccine serotypes.

Background and Objectives: Few data are available on the prevalence of and risk factors for sexually transmitted diseases (STDs) other than HIV in Brazil. Goal: The goal of this study was to determine the prevalence of HIV infection and other STDs in Brazilian women who seek HIV testing, investigate risk factors for these infections, and assess feasibility of screening in HIV test clinic settings. Study Design: We conducted a cross-sectional study of 200 women, aged 14 to 29 years, who attended an HIV testing site in central Rio de Janeiro. Participants completed a questionnaire and received testing for HIV, syphilis, chlamydia, and gonorrhea. Results: HIV and other STDs were common (HIV 8%, syphilis 6.5%, chlamydial infection 8%, and gonorrhea 9.5%). HIV was significantly associated with lower education and with having an HIV-infected partner. Other STDs were significantly associated with younger age at first intercourse, heavy alcohol consumption, and marijuana use. Conclusion: STDs appear to be substantial health problems among young Brazilian women seeking HIV testing. HIV testing sites in Brazil should consider offering screening and treatment for STDs and substance abuse as part of their HIV prevention services.

Background: The effect of antiretroviral therapy on seminal HIV shedding in the community remains unknown. Objective: To evaluate the effect of antiretroviral therapy on HIV shedding in semen. Design: Prospective cohort study. Setting: University hospital in Rio de Janeiro, Brazil. Patients: 93 HIV-infected men. Intervention: Antiretroviral therapy as prescribed by each patient's physician. Measurement: HIV RNA in semen and blood plasma before and after introduction of therapy. Results: At baseline, HIV RNA was detected in 69 semen samples (74%) and 89 blood samples (96%). Six months after introduction of therapy, HIV RNA was detected in 29 semen samples (33%) and 33 blood samples (38%). The mean reduction in levels of HIV RNA in semen at 6 months was 1.65 log(sub 10) units. Conclusions: Antiretroviral therapy reduces shedding of HIV in semen, which probably in turn reduces HIV transmissibility. However, a substantial proportion of patients may still be infectious and may have drug-resistant strains of the virus.

Brazilian women with AIDS may have a poorer prognosis than men. Researchers studied survival rates among 617 HIV-infected Brazilians, of whom 124 developed AIDS during the study. Ninety-one were men and 33 were women. Although men and women were equally likely to receive treatment, women had shorter life spans. More research is needed to determine why these women die sooner than men.

Patient coinfected with HIV and human T-cell lymphotrophic virus type 1 (HTLV-1) may have 146% higher CD4+ white blood cell levels in the blood than patients infected with HIV alone. In coinfection, the higher CD4+ level does not indicate better immune function, and HIV viral load may remain a better measure of disease status in coinfected patients.

A common cause of repeated group B streptococcal infections in adults may be a return of the same strain of the organism. Researchers surveyed a metropolitan area over a two-year period and identified 395 surviving adult patients and 241 surviving infant patients with group B streptococcal infection. Fifty-three adult patients with a non-recurring group B streptococcal infection served as controls. Group B streptococcal infections recurred in 22 of the adult patients but only one infant patient. Thirteen of these 22 adult patients had recurring infections with the same strain of the organism as their first infection. The time between the first and second infection was nearly three times shorter in the adult patients re-infected with the same streptococcal strain. The medical conditions associated with the recurring infections tended to be more severe.

People older than 65 or those with an identifiable risk factor may be appropriate populations to initially target with a future vaccine developed against group B streptococcal disease. Researchers surveyed 3 urban areas with a total population of 6.6 million people and identified 219 adult cases of group B streptococcal infection. They compared the characteristics of these infected patients with 645 hospital patients admitted for other conditions (controls). Twenty-two percent of the infections were acquired in the hospital. Patients with group B streptococcal infection over the age of 65 were nearly twice as likely to die from the infection as infected patients younger than 65 years of age. Nearly all of the infected patients (93%) had at least one of the identified risk factors including diabetes, breast cancer, stroke, liver cirrhosis, bladder dysfunction, or bed sores.