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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 of yellow 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. [ABSTRACT FROM AUTHOR]

Background: Varicella vaccine was approved for use in Canada in 1998. A major goal of universal varicella vaccine programs is to reduce severe infection and associated complications. Baseline data are essential against which to judge the effectiveness of routine childhood immunization., Objective: To describe morbidity and mortality among children hospitalized for chickenpox. Methods. From January 1, 1991, to March 31, 1996, chickenpox admissions to 11 pediatric referral centers were actively identified. Patient and illness characteristics were compared for 3 subgroups defined by prior health: healthy; unhealthy but immunocompetent; immunocompromised., Results: Of 861 cases 488 (56.7%) were healthy, 75(8.7%) were unhealthy and 298 (34.6%) were immunocompromised. The immunocompromised children differed from healthy/unhealthy cases in mean age (6.4 vs. 4.0/4.6 years, respectively, P < 0.0001); median interval from rash onset to admission (2 vs. 5/5 days, P < 0.0001); complication rate (20% vs. 90%/79%; P = 0.001); and rate of acyclovir therapy (98% vs. 24%/39%; P = 0.001). Unhealthy vs. healthy cases had a higher frequency (P < 0.01) of intensive care (13.3% vs. 4.7%), ventilation (9.3% vs. 2.0%) and death (4% vs. 0.2%)., Conclusion: These data provide a baseline for morbidity/mortality resulting from chickenpox before varicella vaccine use in Canada.

Objective: To determine whether a population of pregnant women with group B streptococcal (GBS) vaginal colonization had an increased risk of specific epidemiological and intrapartum risk factors for early onset GBS disease., Setting: Tertiary university centre in Ottawa, Ontario., Design: Hospital-based retrospective cohort study., Methods: Pregnant women who gave birth during a four-month period in 1994 were included in the study. Potential GBS risk factors were obtained from a review of medical records. The prevalence of each risk factor in colonized and noncolonized women was examined using chi(2) or Fisher's exact test. Multiple logistic regression was performed., Results: A total of 986 women, including 94 (9.5%) women colonized with GBS, were studied. The proportion of women younger than 20 years of age in the colonized group was 2.1% (two of 94) versus 4.6% (41 of 891) in the noncolonized group (P=0.28). Similar rates of multiple births were observed among the colonized and noncolonized groups (2.1% [two of 94] versus 2.5% [22 of 891], respectively) (P=0.94). Likewise, there were no significant differences in either group in the prevalence of a previous pregnancy affected by GBS or diabetes mellitus (P=0.82 and P=0.79, respectively). Multivariable analyses indicated that women who were colonized with GBS were more than twice as likely to deliver prematurely (below 37 weeks' gestational age) (odds ratio [OR] 2.43, 95% CI 1.39 to 4.23). Similarly, colonized women were more likely to be febrile during labour (at least 38 degrees C) (OR 5.05, 95% CI 1.70 to 15.02)., Conclusion: GBS vaginal colonization was associated with premature labour and intrapartum pyrexia in the population studied. According to Canadian and American guidelines, women with GBS vaginal colonization qualify for intrapartum chemoprophylaxis. The study results suggest that the identification of women at risk of premature labour may be one advantage of early prenatal screening for GBS.

Objective: To determine the preferences of Canadian physicians for various strategies to prevent early-onset group B streptococcal (GBS) infection and the physicians' ratings of the effectiveness and feasibility of these strategies., Design: Questionnaire survey., Participants: Physicians working in primary or tertiary care settings in community-based and hospital-based practices., Materials and Methods: Questionnaires were sent to infectious diseases/microbiology (ID/MICRO) specialists, neonatologists and obstetricians (OBs) across Canada between December 1, 1994 and January 31, 1995. Responses were accepted up to March 31, 1995., Results: Responses were obtained from 257 physicians (37%), with the analyzable pool comprising 220 physicians. Significant differences in responses were documented. Antenatal GBS screening was indicated by 63% of 220 respondents. The majority of respondents (77%) indicated that antenatal screening occurred in the early third trimester at their centres. Seventy-two per cent of respondents (158 of 220) indicated that intrapartum penicillin was the standard of care for preventing GBS in their centres. ID/MICRO specialists and neonatologists were more likely to assign a top three preference ranking to the Canadian consensus option that involves screening at 26 to 28 weeks, compared with OB specialists (P<0.001, P=0.008, respectively). The three most preferred options were considered to have 'fair' effectiveness. The option with the highest score on the feasibility rating was the Canadian consensus option that involved no screening, but intrapartum prophylaxis for high risk women., Conclusion: Given the significant disparity in responses, further efforts at information sharing and consensus building regarding the prevention of early-onset GBS are needed.