Updates by Carol A Kemper
Updates
By Carol A. Kemper, MD, FACP, Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center, Section Editor, Updates Section Editor, HIV, is Associate Editor for Infectious Disease Alert.
Study Confirms Men Are Dirtier
Lauran Neergaard, USA Today, September 21, 2005.
Following an educational campaign promoting hand washing in public places, and observing 6300 people using public restrooms at various locations across the United States, researchers report slow but steady improvement in rates of hand washing. But men are still not as rigorous as women about their personnel hygiene.
Researchers observed that 92% of women but only 64% of men washed their hands following use of the toilets at Penn Station in New York City. Similar rates of hand washing were observed at Grand Central Station. The worst statistics were observed at a ballgame at the Atlanta stadium, where 84% of women and 63% of men washed their hands. The best figures came from the Ferry Building in San Francisco (where they have the best farmers market on Saturday morning) and Chicago’s Shedd Aquarium and Museum of Science, where only 12% forgot to wash up.
These figures are in contrast to a recent Harris telephone poll of 1000 adults, 91% of who claimed they always washed after using a public restroom. Only one-third admitted to washing their hands after coughing or sneezing. Another example of how people over estimate their good behavior.
Yaws in the United States?
MMWR 2005;54(37);933-934.
In October 2004, the CDC received reports of positive syphilis tests in refugee children from Liberia and Somalia. Positive treponemal and non-treponemal tests can not differentiate between the various treponemal diseases, which include T. pallidum subsp. pallidum (true venereal syphilis) or one of the endemic non-venereal subspecies, such as T. pallidum subsp. pertenue (yaws), T. pallidum subsp. endemicum (bejel or endemic syphilis), and T. carateum (pinta). All 3 of these latter infections are transmitted by skin contact, are more prevalent in children, and could be endemic in group housing or refugee situations. In contrast, true venereal syphilis is transmitted only sexually or vertically. Thus, a positive test in the mothers of these children, if available for testing, would suggest congenital transmission of T. pallidum subsp. pallidum. On the other hand, a negative test in the mother would suggest either consensual or non-consensual sexual transmission - or yaws.
The non-venereal endemic treponemal infections cause progressive skin lesions with severe destructive gummatous changes of skin, ones, and cartilage. Yaws typically starts as a maculopapular rash with regional lymphadenitis, and secondary lesions commonly appear at the mucocutaneous junction ("framboesiform lesions"). Hyperkeratosis of hands and feet, with deep erosions, can occur. The face and the long bones, especially the tibia, are common sites for infection, with periosteal changes and slow bone destruction ("sabre tibia"). In the Middle East, this condition is known as bejel. Following mass eradication campaigns with penicillin in the 1950s, yaws became quite rare in the tropics. Ongoing war and famine in parts of Africa may be contributing to its resurgence. On the other hand, pinta, which is endemic to the New World, and is still occasionally seen in Mexico, Columbia, Ecuador, and Venezuela, causes small papules and slowly expanding plaques, which gradually coalesce and, in the late stages, are often depigmented.
Further information regarding clinical signs or symptoms in the children was not available. The CDC recommends screening of all refugee and immigrant children from areas endemic for non-venereal treponemal infection (including most of Africa, Indonesia, Pakistan, Sri Lanka, Cambodia, India, and the West Pacific Islands).
SARS—Just Another 21st Century Plague
"Twenty-first Century Plague: The Story of SARS", by Thomas Abraham (Johns Hopkins University Press, 2005); Lau SK, et al, Severe Acute Respiratory Syndrome Coronavirus-Like Virus in Chinese Horseshoe Bats. Proc Natl Acad Sci USA. 2005;102:14040-14045; Poon LL, et al. Identification of a Novel Coronavirus in Bats. J Virol. 2005;79:2001-2009.
Abraham’s book is an exciting must read for anyone in infectious disease, infection control and public health, with good pointers on managing health care crisis. It underscores Truman Capote’s contention that "well written non-fiction is more exciting than any fiction." Barely before this book got to press and SARS was declared the plague of the new millennium, avian influenza, swoops down on Europe and Turkey from the steps of Russia. Meanwhile, we have CCU nurses in revolt at our hospital, refusing to receive influenza vaccine this year, and a floor nurse who is still out on disability from severe airways disease following influenza infection, contracted on the medical wards in April 2005 (she refused vaccination and failed to pick up her gratis prescription of Tamiflu in a timely fashion). Why is the next threat always worse than the present danger?
The origins of SARS are still being investigated, but experts in the field are increasingly skeptical that civets are the reservoir for infection. In surveillance studies of non-caged animals from non-urban areas, researchers at Hong Kong University have identified a SARS--like corona virus from 23 (39%) of 59 anal swabs of wild Chinese horseshoe bats (Rhinolopus sinicus). Sequencing analysis showed that bat-SARS-CoV is closely related to human and civet SARS CoV, and phylogenetic analysis suggest that bat virus forms a distinct cluster within group 2b viruses. The most significant difference between the bat and human corona viruses lay in genes encoding for cellular binding of virus to host cells, leaving open the question of how bat-SARS virus may have jumped species to humans. An insertion sequence found in bat-SARS-CoV, which is not found in humans virus, but was found in civet virus, suggests that the two species may share a common ancestor virus. This may be somewhat belated but happy news to civets—10,000 of which were killed following initial reports fingering them as the suspect reservoir. Neutralizing antibody to human SARS virus was found in some of the horseshoe bats, suggesting thatcare should be taken when handling these animals.
The group also found a novel group 1 coronavirus isolated from 63% of the fecal samples from 3 different wild bat species from the genus Miniopterus, suggesting that coronaviruses may commonly circulate among bat species in mainland China.
Guillain-Barré Syndrome Following Meningococcal Vaccination
FDA and CDC Alerts, Press Release, October 1, 2005; and proMED-mail post dated October 1, October 2, and October 7, 2005. www.promedmail.org.
Five teenagers have developed Guillain-Barré Syndrome (GBS) following administration of Menactra vaccine (meningococcal conjugate vaccine A, C, Y, W135, Sanofi Pasteur). A sixth possible case just reported on October 4th is being investigated. Menactra was licensed by the United States in January 2005 and, in February, the Advisory Council on Immunization Practices (ACIP) recommended the routine use of vaccine for adolescents aged 11-2 years, at entry to high school, and for first year college students living in dormitories or otherwise at high risk. No cases of GBS were reported in pre-licensing clinical trials of about 7000 patients. Thus far, about 2,500,000 dose of vaccine have been used, suggesting a lower than anticipated rate of GBS than that estimated for the general population (annual incidence estimates 0.4 to 4 per 100,000 population). Because additional cases may be underreported, the FDA and CDC are requesting any information about possible cases (www.vaers.hhs.gov or by telephone at 800-822-7967).
All 5 cases occurred in teens aged 17-18 that received vaccine between June 10 and July 25th, and developed symptoms within 14-31 days of vaccination. The 5 patients received vaccine from 4 different lots, and lived in 4 different states on the East Coast. Interestingly, only one of the teens was completely healthy. One of the cases had a history of 2 prior episodes of GBS, following receipt of other vaccines as a child; one had a mother with a history of GBS; and another had sore throat 6 days before the onset of symptoms.
Three different but similarly conjugated vaccines have been used in the United Kingdom (conjugated to either a non-toxic diphtheria toxoid or tetanus toxoid). Following administration of these vaccines, 5 cases of GBS have also been reported in the United Kingdom, which is also a lower than anticipated rate of illness for the general population.
GBS can occur either spontaneously or following any number of viral or bacterial infections, as well as a number of bacterial and viral vaccines. About 20-40% of cases occur following bacterial gastroenteritis from Campylobacter jejuni (an IDA Board question). Dr. Steve Berger from Tel Aviv Medical Center assembled a list of 18 vaccines that have been associated with GBS to date, including DT, DtaP, DTP, HbOC-DTP, HbOC, PRP-D, Hepatitis A, Inactivated Influenza, Japanese encephalitis, MMR, MR, pneumococcal conjugate, oral poliomyelitis, rabies, rubella, rubella-mumps, tetanus toxoid, and varicella vaccines, the most notable of which was the 1976 swine flu influenza vaccine.
Following an educational campaign promoting hand washing in public places, and observing 6300 people using public restrooms at various locations across the United States, researchers report slow but steady improvement in rates of hand washing. But men are still not as rigorous as women about their personnel hygiene.Subscribe Now for Access
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