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1. Shaughnessy, Megan K., Renee L. Micielli, Daryl D. Depestel, Jennifer Arndt, Cathy L. Strachan, Kathy B. Welch, and Carol E. Chenoweth. "Evaluation of Hospital Room Assignment and Acquisition of Clostridium Difficile Infection." Infection Control and Hospital Epidemiology 32.3 (2011): 201-206. Print. 2. Weber, David J., Deverick J. Anderson, Daniel J. Sexton, and Williams A. Rutala. "Role of the environment in the transmission of Clostridium difficile in health." American Journal of Infection Control 41 (2013): S105-10. Print. References Geographically associated cases Room Dates same room was occupied Date 1st C. difficile positive

A 55-year-old white female with a complex medical history including mixed connective tissue disease and peripheral vascular disease developed a group of red-purple papules on her proximal medial thigh that was followed, five months later, by the development of a large violaceous patch. She reported a history of radiation to this site (for melanoma) during her childhood. She was admitted to the hospital with a presumptive diagnosis of cellulitis, but failed to respond to antibiotics. A biopsy was performed and demonstrated a well-differentiated angiosarcoma arising in conjunction with reactive angioendotheliomatosis. Excision of the lesion was performed, and fifteen months of follow-up have shown no recurrence or metastasis.

Background Inappropriate use of antibiotics by individuals worried about biological agent exposures during bioterrorism events is an important public health concern. However, little is documented about the extent to which individuals with self-identified risk of anthrax exposure approached physicians for antimicrobial prophylaxis during the 2001 bioterrorism attacks in the United States. Methods We conducted a telephone survey of randomly selected members of the Pennsylvania Chapter of the American College of Emergency Physicians to assess patients' request for and emergency physicians' prescription of antimicrobial agents during the 2001 anthrax attacks. Results Ninety-seven physicians completed the survey. Sixty-four (66%) respondents had received requests from patients for anthrax prophylaxis; 16 (25%) of these physicians prescribed antibiotics to a total of 23 patients. Ten physicians prescribed ciprofloxacin while 8 physicians prescribed doxycycline. Conclusion During the 2001 bioterrorist attacks, the majority of the emergency physicians we surveyed encountered patients who requested anthrax prophylaxis. Public fears may lead to a high demand for antibiotic prophylaxis during bioterrorism events. Elucidation of the relationship between public health response to outbreaks and outcomes would yield insights to ease burden on frontline clinicians and guide strategies to control inappropriate antibiotic allocation during bioterrorist events.

We report a case of primary Actinomyces viscosus endocarditis, an unusual manifestation of actinomycosis, in a 43-year-old farmer with an indolent febrile illness. As has occurred in previous cases, diagnosis was delayed in part because blood isolates were misidentified. Months later when she required aortic valve and root replacement, histologic exam of the diseased valve revealed branching filamentous organisms and the original blood isolates were retrospectively confirmed to be Actinomyces viscosus.

ONGOING COMMUNICATION BETWEEN public health officials and clinicians facilitates recognition of and response to emerging infections and deliberate attacks with biological agents.1 However, little is known about sources of bioterrorism information used by frontline responders, particularly emergency physicians. During the 2001 anthrax attacks, official bioterrorism updates were communicated through Health Alert Networks, the Epidemic Information Exchange (Epi-X), and the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR).2–4 Additional information was shared through MMWR reprints in medical journals and through the websites of medical associations, the CDC, and state and local health departments.5 To allow rapid dissemination of Health Alerts to key partners, state health departments started to use media such as e-mail and broadcast fax to strengthen links with hospitals, clinicians, and laboratories. In Pennsylvania, the development of a Health Alert Network had started in summer 2001 with the creation of an electronic database of e-mail addresses and fax numbers of hospital directors, emergency physician directors, and professional medical societies. The first Pennsylvania Health Alert was disseminated on September 11, 2001, shortly after the terrorist attack on the World Trade Center.6 The frequency of Health Alerts remained low until after the CDC announced an investigation of the index case of the 2001 bioterrorismrelated anthrax outbreak.7–8 During October and November, 21 alerts about bioterrorism were sent through the Pennsylvania Health Alert Network. These alerts primarily shared information derived from Epi-X, the eight MMWR updates released during the same period,4 and announcements of the CDC’s four satellite broadcasts targeted to clinicians.9 Health Alerts were sent to more than 300 fax machines and approximately 200 e-mail addresses in the Health Alert Network contact database. Public health communication during the 2001 anthrax attacks relied heavily on Health Alert Networks and other newly developed channels such as websites. However, it was unclear whether clinicians received official public health information disseminated through these newly developed electronic media and other sources. Specifically, we sought to determine whether physicians had been exposed to official Health Alerts and MMWR updates. We also wanted to assess physician-initiated contacts with public health agencies and physicians’ knowledge about bioterrorism. We report here results from a study conducted among Pennsylvania emergency physicians during the 2001 bioterrorism attacks.

This report updates CDC's recommendations for using yellow fever vaccine (CDC. Yellow Fever Vaccine: Recommendations of the Advisory Committee on Immunizations Practices: MMWR 1990;39[No. RR-6]1-6). The 2002 recommendations include new or updated information regarding 1) reports of yellow fever vaccine-associated viscerotropic disease (previously reported as febrile multiple organ system failure); 2) use ofyellow fever vaccine for pregnant women and persons infected with human immunodeficiency virus (HIV); and 3) concurrent use of yellow fever vaccine with other vaccines. A link to this report and other information related to yellow fever can be accessed at the website for Travelers' Health, Division of Global Migration and Quarantine, National Center for Infectious Diseases, CDC, at http://www.cdc.gov/travel/index.htm, and through the website for the Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, CDC, at http://www.cdc.gov/ncidod/ dvbid/yellowfever/index.htm.

West Nile virus (WNV) can cause large outbreaks of febrile illness and severe neurologic disease. This study estimates the seroprevalence of WNV infection and assesses risk perception and practices regarding potential exposures to mosquitoes of persons in an area with intense epizootics in 1999 and 2000. A serosurvey of persons agedor = 12 years was conducted in southwestern Connecticut during October 10-15, 2000, using household-based stratified cluster sampling. Participants completed a questionnaire regarding concern for and personal measures taken with respect to WNV and provided a blood sample for WNV testing. Seven hundred thirty persons from 645 households participated. No person tested positive for WNV (95% CI: 0-0.5%). Overall, 44% of persons used mosquito repellent, 56% practicedor = two personal precautions to avoid mosquitoes, and 61% of households didor = two mosquito-source reduction activities. In multivariate analyses, using mosquito repellent was associated with age50 years, using English as the primary language in the home, being worried about WNV, being a little worried about pesticides, and finding mosquitoes frequently in the home (P0.05). Females (OR = 2.0; CI = 1.2-2.9) and persons very worried about WNV (OR = 3.8; CI = 2.2-6.5) were more likely to practiceor = two personal precautions. Takingor = two mosquito source reductions was associated with persons with English as the primary language (OR = 2.0; CI = 1.1-3.5) and finding a dead bird on the property (OR = 1.8; CI = 1.1-2.8). An intense epizootic can occur in an area without having a high risk for infection to humans. A better understanding of why certain people do not take personal protective measures, especially among those agedor = 50 years and those whose primary language is not English, might be needed if educational campaigns are to prevent future WNV outbreaks.

Background: Surgical site infections (SSIs) are the third most common nosocomial infection. An antimicrobial suture was approved recently by the FDA and its use to control SSIs is supported by the high incidence of SSIs localized to the incision, the juxtaposition of sutures with incisional wounds and efficacy in preclinical models of SSIs. However, the active agent in the suture, triclosan, has associated liabilities including limited coverage for certain SSI pathogens, ubiquitous use in consumer products and the potential for resistance. Therefore, substitution of more appropriate active agents in antimicrobial sutures is highly warranted. We have developed small nonpeptidic mimics of host defense proteins (HDP) as antimicrobial agents and examined their suitability versus triclosan as active agents for antimicrobial sutures.

An analysis of 2001 and 2002 West Nile virus (WNV) surveillance data shows that counties that report WNV-infected dead birds early in the transmission season are more likely to report subsequent WNV disease cases in humans than are counties that do not report early WNV-infected dead birds.

Lalit Kalra, MD, Fellow, Division of Infectious Diseases; Margaret Miller, MT(ASCP)M, CIC, Infection Prevention Coordinator; Ping Du, MD, PhD, Assistant Professor, Departments of Medicine and Public Health Sciences; Cynthia Whitener, MD, Crystal Zalonis, DO, MS, Assistant Professor of Medicine and Orthopedics, Division of Infectious Diseases and Epidemiology; Marissa Grifasi, PharmD, BCPS, Clinical Pharmacy Specialist, Infectious Diseases; Kathleen Julian, MD, Assistant Professor of Medicine, Division of Infectious Diseases, Associate Hospital Epidemiologist; Penn State Milton S. Hershey Medical Center, Hershey, PA