<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20090101_19_1949"
                     title="Strep B Screening Guidelines Quickly Adopted"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/tb/14759?impressionId=1265786755710"
                     
      TORONTO, June 17 -- National guidelines for streptococcus B screening in pregnant women, issued in 2002, were rapidly adopted, researchers said.
              &lt;p&gt; 
              &lt;p&gt;In 2003 and 2004, 85% of women were screened before delivery, compared with just 48.1% in 1998 and 1999, according to Stephanie Schrag, DPhil, of the CDC, and colleagues.
              &lt;p&gt; 
              &lt;p&gt;The proportion of infants exposed to antibiotics in the delivery period also rose -- to 31.7% from 26.8% -- the researchers reported in the June 18 issue of the &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;The guidelines call for pregnant women to be screened for strep B colonization before delivery, followed by antibiotic prophylaxis in women positive for the bacteria.
              &lt;p&gt; 
              &lt;p&gt;The goal of the guidelines was to prevent early-onset strep B disease in infants -- a leading infectious cause of illness and death in the first week of life.
              &lt;p&gt; 
              &lt;p&gt;The adoption of the guidelines coincided with an observed 27% drop in the incidence of the disease, the researchers noted. In this study, the incidence of the disease was 0.32 per 1,000 births, they found.
              &lt;p&gt; 
              &lt;p&gt;But the researchers said there are opportunities to reduce the incidence still further, by better management of preterm deliveries and improved delivery of culture results.
              &lt;p&gt; 
              &lt;p&gt;The findings come from an analysis of data from the CDC&apos;s Active Bacterial Core surveillance, a 10-state, population-based system that monitors invasive strep B disease.
              &lt;p&gt; 
              &lt;p&gt;The researchers studied 254 births in which the infant had strep B disease and 7,437 births in which the infant did not.
              &lt;p&gt; 
              &lt;p&gt;They found:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;87.0% of women positive for strep B and who delivered at term received antibiotic prophylaxis, while antibiotics were only given in 63.4% of women with unknown colonization status who delivered early
                &lt;li&gt;incidence of disease was higher in preterm babies than in those delivered at term -- 0.73 cases per 1,000 live births compared with 0.26
                &lt;li&gt;Most cases of strep B disease -- 189 of 254, or 74.4% -- occurred in full-term infants
                &lt;li&gt;Among mothers who delivered at term, missed screening accounted for 34 cases of disease, or 13.4% of the total
                &lt;li&gt;61.4% of the full-term infants who had disease were born to mothers who had tested negative before delivery
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;The authors noted that &quot;in the case of any highly implemented prevention strategy, remaining cases of disease will often be the result of prevention failures; given the performance of the antenatal screening test for group B streptococcus as a predictor of intrapartum colonization status, some false negative results are expected to occur.&quot;
              &lt;p&gt; 
              &lt;p&gt;Mothers who delivered early were less likely to be screened than mothers who delivered at term, with a relative risk of 0.56 and a 95% confidence interval from 0.51 to 0.62.
              &lt;p&gt; 
              &lt;p&gt;In a univariate analysis, delivery at less than 34 weeks&apos; gestation was the only factor significantly associated with not being screened before delivery. The relative risk was 1.5, with a 95% confidence interval from 1.2 to 1.8.
              &lt;p&gt; 
              &lt;p&gt;Overall, however, lack of screening contributed only a small proportion of strep B disease, with only 18.0% of the cases occurring among infants of unscreened women.
              &lt;p&gt; 
              &lt;p&gt;Penicillin or ampicillin were the most common agents used for prophylaxis (employed in 76.7% of women for whom it was deemed necessary). Among those with a penicillin allergy, clindamycin was most commonly used.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The researchers reported no external support for the study. 
              &lt;p&gt;No potential conflicts were disclosed.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
        
    </recommendedItem>
    <recommendedItem id="20090101_19_4150"
                     title="H1N1 Testing, Positive Results on the Decline (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Pulmonology/URIstheFlu/tb/17614?impressionId=1265786755710"
                     
      &lt;p&gt;The end of the so-called second wave of pandemic H1N1 influenza may be in sight as testing rates  --  and the number of positive tests for the virus  --  show evidence of decline across the country, a report affirmed.&lt;/p&gt;
&lt;p&gt;From their peak in late October, diagnostic H1N1 testing rates dropped 75% by Dec. 9, back down to volumes seen in August, when the current wave of illness began, according to Quest Diagnostics.&lt;/p&gt;
&lt;p&gt;These findings reinforce surveillance findings from other sources, commented Anthony Fiore, MD, MPH, a medical epidemiologist with the CDC in Atlanta.&lt;/p&gt;
&lt;p&gt;&quot;Honestly, in a lot of areas of the country I don&apos;t know that people need us to tell them that rates are declining,&quot; Fiore told &lt;em&gt;MedPage Today&lt;/em&gt;. &quot;They clearly are in most parts of the country.&quot;&lt;/p&gt;
&lt;p&gt;Quest Diagnostics  --  one of the largest companies involved in H1N1 testing  --  said positive H1N1 tests dropped 60% or more in every region but one during the two weeks from Nov. 25 to Dec. 9 compared with the prior two weeks.&lt;/p&gt;
&lt;p&gt;The area comprising Colorado, Montana, Utah, North and South Dakota, and Wyoming saw only a 38% drop in test positivity.&lt;/p&gt;
&lt;p&gt;And, pandemic H1N1 is still plenty active, particularly in New England, Fiore noted.&lt;/p&gt;
&lt;p&gt;&quot;But this is very typical of influenza, and happens every season,&quot; he said in an interview, &quot;where you have very different pictures in different parts of the country at different times of the winter season.&quot;&lt;/p&gt;
&lt;p&gt;Nationally, Quest Diagnostics found falling rates of H1N1 in test specimens as well.&lt;/p&gt;
&lt;p&gt;The company&apos;s analysis was based on testing volume at five of the company&apos;s laboratories that perform diagnostic H1N1 testing. The company also markets two emergency use-authorized H1N1 test kits to other laboratories, but these weren&apos;t included in the report.&lt;/p&gt;
&lt;p&gt;In the two weeks from Nov. 25 to Dec. 9, only 21% of specimens tested positive for the pandemic influenza virus, compared with 44% throughout the earlier part of November.&lt;/p&gt;
&lt;p&gt;Altogether, about half of H1N1 tests performed since May 11  --  soon after the virus started circulating in the U.S.  --  have been positive for the virus, the report said.&lt;/p&gt;
&lt;p&gt;While H1N1 positivity rates dropped across age groups, children ages 5 to 14 years continue to have the highest proportion of positive results, at close to 40%.&lt;/p&gt;
&lt;p&gt;Though the H1N1 wave appears to be drawing to a close, seasonal influenza is expected to &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/17598&quot; mce_href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/17598&quot; target=&quot;_blank&quot;&gt;pick up as usual &lt;/a&gt;through the end of the month and begin to peak in the first months of the new year, Fiore said.&lt;/p&gt;
&lt;p&gt;But experts are divided over how widespread and virulent the seasonal flu will be this year: some believe it has already been &quot;crowded out&quot; by H1N1. Nor is there consensus on whether there&apos;s a third wave of H1N1 on the horizon for the spring, or how bad it will be.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was done entirely through Quest Diagnostics, which makes H1N1 laboratory testing kits and performs diagnostic H1N1 testing.&lt;/p&gt;&lt;p&gt;Fiore reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_2460"
                     title="States Work Toward Integrated Disease Surveillance"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/Surveillance/tb/15395?impressionId=1265786755710"
                     
      States are making progress in developing interoperable electronic disease surveillance systems -- which allow for electronic communication among stand-alone systems within the state and between states.
              &lt;p&gt; 
              &lt;p&gt;In a survey of all 50 states, 26% reported achieving interoperability among two or more surveillance modules, according to Lisa Dwyer, MPH, of the Council of State and Territorial Epidemiologists (CSTE) in Atlanta, which conducted the assessment in 2007.
              &lt;p&gt; 
              &lt;p&gt;Further, 14% had plans for interoperability, and 56% were acquiring the technology necessary to support interoperability, Dwyer and colleagues reported in the July 31 issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;&quot;As interoperability becomes the standard for electronic data sharing, more states will face customization costs and the need to hire more technical specialists who can manage health information and exchange,&quot; the researchers said.
              &lt;p&gt; 
              &lt;p&gt;To assess the status of state systems, the CSTE sent questionnaires to state managers.
              &lt;p&gt; 
              &lt;p&gt;Data were collected on five systems used by most states -- those for communicable human diseases in general, HIV/AIDS, lead exposure, sexually transmitted diseases other than HIV/AIDS, and tuberculosis -- as well as any state-level enhancements.
              &lt;p&gt; 
              &lt;p&gt;About one-third (32%) of states use the National Electronic Disease Surveillance System (NEDSS) base system as their general communicable disease surveillance system.
              &lt;p&gt; 
              &lt;p&gt;NEDSS is a web-based system developed by the CDC. It integrates disease surveillance systems so data can be transferred securely from clinicians to public health departments.
              &lt;p&gt; 
              &lt;p&gt;The rest of the states use some combination of off-the-shelf products, the CDC electronic system, and state-developed surveillance systems that were customized to suit their needs.
              &lt;p&gt; 
              &lt;p&gt;More than three-quarters (78%) said at least one part of their electronic surveillance system was under development or being planned.
              &lt;p&gt; 
              &lt;p&gt;Most HIV/AIDS and lead poisoning surveillance systems were standalones.
              &lt;p&gt; 
              &lt;p&gt;In an accompanying note, the &lt;em&gt;MMWR&lt;/em&gt; editors said, &quot;Several policy and ethical reasons require that some surveillance systems have a lower level of integration than others.&quot;
              &lt;p&gt; 
              &lt;p&gt;&quot;For example,&quot; they said, &quot;special needs for patient privacy and data security might explain why the HIV/AIDS surveillance modules are standalone in certain states.&quot; 
              &lt;p&gt; 
              &lt;p&gt;Of the 40 states that reported having a fully functional system for general communicable disease surveillance, 58% had an integrated system. Integration was defined as inclusion of separate data modules in one system.
              &lt;p&gt; 
              &lt;p&gt;Half of fully functional Web-based TB reporting systems was integrated.
              &lt;p&gt; 
              &lt;p&gt;According to the &lt;em&gt;MMWR&lt;/em&gt; editors, the results of the survey &quot;revealed substantial variation in how states developed their electronic disease surveillance systems, and also that they were strongly committed to making their surveillance systems interoperable.&quot;
              &lt;p&gt; 
              &lt;p&gt;&quot;States will need to upgrade or replace aging electronic surveillance systems to continue meeting public health needs and to conform to current information technology standards,&quot; they said.
              &lt;p&gt; 
              &lt;p&gt;The costs of these upgrades will be substantial, they said.
              &lt;p&gt; 
              &lt;p&gt;The survey revealed that the combined hardware and software costs ranged from $250,000 to $1 million.
              &lt;p&gt; 
              &lt;p&gt;&quot;Sufficient resources from surveillance and healthcare information technology stakeholders will be needed to support the growing electronic infrastructure and to improve the efficacy and quality of electronic disease surveillance systems,&quot; the editors said.
              &lt;p&gt; 
              &lt;p&gt;&quot;The ultimate vision,&quot; they said, &quot;is to increase the connectivity of federal and state surveillance systems that can transfer appropriate public health, laboratory, and clinical data efficiently and securely over the Internet.&quot;
              &lt;p&gt; 
              &lt;p&gt;They noted at least two limitations with the survey: the uncertainty over the actual number of information technology staff involved in the state surveillance systems and the use of self-reported data.
             
    </recommendedItem>
    <recommendedItem id="20090101_19_3007"
                     title="Panel Urges Increased Animal Surveillance"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/tb/16107?impressionId=1265786755710"
                     
      &lt;p&gt;With the pandemic H1N1 flu attacking from an unexpected quarter, the Institute of Medicine says the U.S. must take the lead in developing a widespread program aimed at disease surveillance in animals.&lt;/p&gt;
&lt;p&gt;The pandemic flu  --  which originated in pigs  --  is only the latest in an increasing number of diseases that have jumped the species barrier, the institute said in a new report.&lt;/p&gt;
&lt;p&gt;Such zoonotic pathogens have caused more than 65% of infectious disease outbreaks in the past 60 years, the institute said, and have caused more than $200 billion in economic losses worldwide over the past decade.&lt;/p&gt;
&lt;p&gt;&quot;Zoonotic diseases are like wildfires, which flare up unexpectedly and can take a significant toll on human and animal health and damage household livelihoods as well as national economies,&quot; said Marguerite Pappaioanou, DVN, PhD, executive director of the Association of American Veterinary Medical Colleges.&lt;/p&gt;
&lt;p&gt;&quot;All too often,&quot; she said, &quot;our reaction to these outbreaks has been to try containing a wildfire after it has gotten out of control.&quot;&lt;/p&gt;
&lt;p&gt;Pappaioanou, a co-chairman of the panel that developed the report, was formerly coordinator of the CDC&apos;s international response to H5N1 avian influenza and the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak.&lt;/p&gt;
&lt;p&gt;Experts on the flu say they had feared a pandemic would emerge from poultry and had made international efforts to ramp up surveillance of the birds. But they were blindsided by the swine-origin H1N1 flu, because pigs had not been under systematic surveillance. (See &lt;a href=&quot;http://www.medpagetoday.com/tbindex.cfm?tbid=16039&quot; mce_href=&quot;http://www.medpagetoday.com/tbindex.cfm?tbid=16039&quot; target=&quot;_blank&quot;&gt;Special Report: Surveillance Gap Slowed H1N1 Pandemic Response&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;The new IOM report was the result of a request two years ago from the U.S. Agency for International Development (USAID), which wanted to explore disease surveillance in animals, an institute official said.&lt;/p&gt;
&lt;p&gt;The goal should be to stop responding to the &quot;disease du jour&quot; and implement a sustained and integrated disease surveillance system that allows public health officials to be prepared for outbreaks, panel co-chair Gerald Keusch, MD, of Boston University told reporters.&lt;/p&gt;
&lt;p&gt;&quot;Developing an effective global system for detecting and responding to emerging zoonotic diseases is a tall order,&quot; Keusch said.&lt;/p&gt;
&lt;p&gt;But given the resources that are mustered to fight each individual outbreak, &quot;We believe it is possible to implement a sustainable, integrated human and veterinary disease surveillance system that is acceptable to all stakeholders,&quot; he said.&lt;/p&gt;
&lt;p&gt;Because the U.S. government leads in disease surveillance, the panel argued that it should lead efforts to build such a system.&lt;/p&gt;
&lt;p&gt;Their report urges that the Departments of Health and Human Services, Agriculture, Homeland Security, and the Interior work with the private sector and nongovernmental organizations  --  as well as USAID and international organizations  --  to spearhead a more effective global surveillance and response system.&lt;/p&gt;
&lt;p&gt;Among other things, the report said they should: &lt;ul&gt; &lt;li&gt; Immediately strengthen surveillance in human populations at high-risk for zoonotic diseases, such as livestock and poultry workers, in countries where animal disease surveillance is weak. &lt;/li&gt; &lt;li&gt;Develop and strengthen animal surveillance systems so that diseases are detected in animals, rather than through human outbreaks. &lt;/li&gt; &lt;li&gt;Help develop science-based criteria to pin down what drives disease.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_3337"
                     title="CDC: H1N1 Flu Still Hits the Young Hardest"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/16535?impressionId=1265786755710"
                     
      &lt;p&gt;ATLANTA  --  The pandemic H1N1 influenza virus continues to disproportionately attack the young, the CDC warned today.&lt;/p&gt;
&lt;p&gt;Children and adults under age 25 have accounted for 53% of hospitalizations for laboratory-confirmed H1N1 and 23.6% of related deaths since Sept. 1, the agency reported at a press briefing.&lt;/p&gt;
&lt;p&gt;Seniors, on the other hand, have accounted for just 7% of H1N1-confirmed hospitalizations and 11.6% of deaths from the virus based on data from 27 and 28 states, respectively.&lt;/p&gt;
&lt;p&gt;&quot;This is really, really different than what we see with seasonal flu,&quot; said Anne Schuchat, MD, director of the CDC&apos;s National Center for Immunization and Respiratory Diseases, who led the briefing.&lt;/p&gt;
&lt;p&gt;Seasonal flu typically causes 60% of its hospitalizations and 90% of fatalities in those 65 and older, she noted. &quot;It&apos;s almost completely reversed here,&quot; a pattern that matches what was seen in the spring.&lt;/p&gt;
&lt;p&gt;Schuchat reemphasized that physicians shouldn&apos;t take &quot;No&quot; as the answer when using the influenza rapid diagnostic test.&lt;/p&gt;
&lt;p&gt;&quot;You can&apos;t really rely on that. The accuracy of the rapid tests when they show up a negative is not that good,&quot; she said.&lt;/p&gt;
&lt;p&gt;Physicians should trust their clinical judgment in administering antivirals early to severely ill patients with flu-like symptoms or those with known risk factors for more severe disease, including pregnancy and asthma  --  without waiting for laboratory results or trusting a negative rapid result, Schuchat said.&lt;/p&gt;
&lt;p&gt;Pregnancy, in particular, has been a risk factor for which the CDC said it has met resistance in its recommendation to treat with antivirals.&lt;/p&gt;
&lt;p&gt;&quot;Completely healthy pregnant women have been coming down with horrible, horrible illnesses [with the pandemic H1N1, including the need for] intensive care unit courses, and, tragically, more deaths that we&apos;ve been hearing about recently,&quot; Schuchat said.&lt;/p&gt;
&lt;p&gt;Deaths in the young population were also more common in children with neurologic conditions, such a cerebral palsy and muscular dystrophy, although there have been some otherwise healthy children who have had the same grave outcome.&lt;/p&gt;
&lt;p&gt;One reason behind the &quot;overwhelmingly serious complications&quot; seen in some healthy young people is that the virus can cause pneumonia if the infection spreads to the lower respiratory tract, which is difficult to treat even with antivirals, Schuchat said.&lt;/p&gt;
&lt;p&gt;Another problem seen in some of the cases is that bacteria, particularly staph, can creep in after the influenza has weakened the immune system and cause serious pneumonia, she added.&lt;/p&gt;
&lt;p&gt;Already this fall, 292 deaths have been reported by the 28 states reporting laboratory-confirmed H1N1 cases to the CDC. Schuchat said the number of cases likely reflected under-reporting, but that the ages of affected patients was probably a good reflection of practice.&lt;/p&gt;
&lt;p&gt;The age breakdown was: &lt;ul&gt; &lt;li&gt;3.1% ages 4 and under&lt;/li&gt; &lt;li&gt;13.7% ages 5 to 18&lt;/li&gt; &lt;li&gt;6.8% ages 19 to 24&lt;/li&gt; &lt;li&gt;32.5% ages 25 to 49&lt;/li&gt; &lt;li&gt;32.2% ages 50 to 64&lt;/li&gt; &lt;li&gt;11.6% ages 65 and older&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Over the same Sept. 1 to Oct. 10 period, there were 4,958 laboratory-confirmed H1N1-related hospitalizations reported to the CDC by 27 states.&lt;/p&gt;
&lt;p&gt;The ages of those hospitalized were: &lt;ul&gt; &lt;li&gt;19% ages 4 and younger&lt;/li&gt; &lt;li&gt;25.3% ages 5 to 18&lt;/li&gt; &lt;li&gt;8.7% ages 19 to 24&lt;/li&gt; &lt;li&gt;24% ages 25 to 49&lt;/li&gt; &lt;li&gt;15% ages 50 to 64&lt;/li&gt; &lt;li&gt;7.2% ages 65 and older&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;These statistics support the CDC&apos;s recommendations targeting younger populations for vaccination efforts, Schuchat said.&lt;/p&gt;
&lt;p&gt;She noted that although the distribution of H1N1 vaccine still seems to be smaller than demand in most areas, the number of doses available for states to order rose from 9.8 million last week to 12.8 million, and the number actually ordered by the states roughly doubled.&lt;/p&gt;
&lt;p&gt;&quot;It probably feels like a slow start for a lot of people,&quot; Schuchat said. &quot;But we&apos;re still really at the beginning [of the flu season]. We&apos;re in it for the long haul.&quot;&lt;/p&gt;
&lt;p&gt;Based on the 1957/1958 pandemic flu, a second wave of infection might be expected in the spring, she noted. &quot;At CDC, we&apos;re planning a long response.&quot;&lt;/p&gt;

    </recommendedItem>
</recommendedContent>