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1.
Pediatr Clin North Am ; 71(3): 469-479, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38754936

RESUMEN

This article examines lessons learned from previous pandemics, including the 2009 H1N1 influenza and the coronavirus disease 2019 pandemic. Pediatric providers have a unique and important role and strategies to improve collaboration and communication between public health and pediatric providers are essential during public health emergencies. A robust network of communication channels, effective public health messaging, and pediatric-focused disease related, and program outcome data are key to supporting a coordinated response to future pandemics. Critical issues include real-time communication with and engagement of pediatric providers as well as optimizing best evidence approaches for pediatric care while considering the distinct challenges facing children and their families.


Asunto(s)
COVID-19 , Salud Infantil , Pandemias , Pediatría , Salud Pública , Humanos , COVID-19/prevención & control , COVID-19/epidemiología , Niño , Pandemias/prevención & control , Gripe Humana/prevención & control , Gripe Humana/epidemiología , SARS-CoV-2
2.
Vaccines (Basel) ; 10(9)2022 Sep 19.
Artículo en Inglés | MEDLINE | ID: mdl-36146639

RESUMEN

This retrospective cohort analysis leveraged vaccination data for BNT162b2, mRNA-1273, and Ad26.COV2.S in the United States from the Komodo Healthcare Map database, the TriNetX Dataworks USA Network, and Cerner Real-World EHR (electronic health record) Data to evaluate rates of adherence to and completion of COVID-19 vaccination series (November 2020 through June 2021). Individuals were indexed on the date they received the first dose of a COVID-19 vaccine, with an adherence follow-up window of 42 days. Adherence/completion rates were calculated in the overall cohort of each database and by month of initiation and stratified by age, race/ethnicity, and urban/rural status. Overall adherence and completion to 2-dose COVID-19 mRNA vaccine schedules ranged from 79.4% to 87.4% and 81.0% to 89.2%, respectively. In TriNetX and Cerner, mRNA-1273 recipients were generally less adherent compared with BNT162b2 across sociodemographic groups. In Komodo, rates of adherence/completion between mRNA-1273 and BNT162b2 were similar. Adherence/completion were generally lower in younger (<65 years) versus older recipients (≥65 years), particularly for mRNA-1273. No other sociodemographic-based gaps in vaccine adherence/completion were identified. These data demonstrate high but incomplete adherence to/completion of multidose COVID-19 vaccines during initial vaccine rollout in the United States. Multidose schedules may contribute to challenges associated with successful global vaccination.

3.
Pediatrics ; 141(2)2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29358481

RESUMEN

Ensuring optimal health for children requires a population-based approach and collaboration between pediatrics and public health. The prevention of major threats to children's health (such as behavioral health issues) and the control and management of chronic diseases, obesity, injury, communicable diseases, and other problems cannot be managed solely in the pediatric office. The integration of clinical practice with public health actions is necessary for multiple levels of disease prevention that involve the child, family, and community. Although pediatricians and public health professionals interact frequently to the benefit of children and their families, increased integration of the 2 disciplines is critical to improving child health at the individual and population levels. Effective collaboration is necessary to ensure that population health activities include children and that the child health priorities of the American Academy of Pediatrics (AAP), such as poverty and child health, early brain and child development, obesity, and mental health, can engage federal, state, and local public health initiatives. In this policy statement, we build on the 2013 AAP Policy Statement on community pediatrics by identifying specific opportunities for collaboration between pediatricians and public health professionals that are likely to improve the health of children in communities. In the statement, we provide recommendations for pediatricians, public health professionals, and the AAP and its chapters.


Asunto(s)
Salud Infantil , Política de Salud , Promoción de la Salud , Colaboración Intersectorial , Pediatras , Rol del Médico , Costos de la Atención en Salud , Promoción de la Salud/economía , Humanos , Pediatras/educación , Guías de Práctica Clínica como Asunto , Estados Unidos
4.
BMJ Open ; 7(8): e017715, 2017 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-28851801

RESUMEN

OBJECTIVES: External validity, or generalisability, is the measure of how well results from a study pertain to individuals in the target population. We assessed generalisability, with respect to socioeconomic status, of estimates from a matched case-control study of 13-valent pneumococcal conjugate vaccine effectiveness for the prevention of invasive pneumococcal disease in children in the USA. DESIGN: Matched case-control study. SETTING: Thirteen active surveillance sites for invasive pneumococcal disease in the USA. PARTICIPANTS: Cases were identified from active surveillance and controls were age and zip code matched. OUTCOME MEASURES: Socioeconomic status was assessed at the individual level via parent interview (for enrolled individuals only) and birth certificate data (for both enrolled and unenrolled individuals) and at the neighbourhood level by geocoding to the census tract (for both enrolled and unenrolled individuals). Prediction models were used to determine if socioeconomic status was associated with enrolment. RESULTS: We enrolled 54.6% of 1211 eligible cases and found a trend toward enrolled cases being more affluent than unenrolled cases. Enrolled cases were slightly more likely to have private insurance at birth (p=0.08) and have mothers with at least some college education (p<0.01). Enrolled cases also tended to come from more affluent census tracts. Despite these differences, our best predictive model for enrolment yielded a concordance statistic of only 0.703, indicating mediocre predictive value. Variables retained in the final model were assessed for effect measure modification, and none were found to be significant modifiers of vaccine effectiveness. CONCLUSIONS: We conclude that although enrolled cases are somewhat more affluent than unenrolled cases, our estimates are externally valid with respect to socioeconomic status. Our analysis provides evidence that this study design can yield valid estimates and the assessing generalisability of observational data is feasible, even when unenrolled individuals cannot be contacted.


Asunto(s)
Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas , Clase Social , Cobertura de Vacunación , Vacunas Conjugadas , Estudios de Casos y Controles , Preescolar , Escolaridad , Humanos , Esquemas de Inmunización , Lactante , Seguro de Salud , Evaluación de Resultado en la Atención de Salud , Padres , Infecciones Neumocócicas/microbiología , Reproducibilidad de los Resultados , Características de la Residencia , Streptococcus pneumoniae , Estados Unidos
5.
Public Health Rep ; 132(1_suppl): 99S-105S, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28692391

RESUMEN

INTRODUCTION: Mass gatherings that attract a large international presence may cause or amplify point-source outbreaks of emerging infectious disease. The Los Angeles County Department of Public Health customized its syndromic surveillance system to detect increased syndrome-specific utilization of emergency departments (EDs) and other medical encounters coincident to the 2015 Special Olympics World Games. MATERIALS AND METHODS: We queried live databases containing data on ED visits, California Poison Control System calls, and Los Angeles County coroner-investigated deaths for increases in daily counts from July 19 to August 6, 2015. We chose syndrome categories based on the potential for disease outbreaks common to international travel and dormitory settings, morbidity amplified by high temperatures, and bioterrorism threats inherent to mass gatherings. We performed line-list reviews and trend analyses of total, syndrome-specific, and region-specific daily counts, using cumulative sum-based signals. We also piloted a novel strategy of requesting that ED registrars proactively tag Special Olympics attendees in chief complaint data fields. RESULTS: The syndromic surveillance system showed that the 2015 Special Olympics did not generate large-scale acute morbidities leading to detectable stress on local EDs. We recruited 10 hospitals for proactive patient tagging, from which 16 Special Olympics attendees were detected; these patients reported various symptoms, such as injury, vomiting, and syncope. PRACTICE IMPLICATIONS: As an enhancement to traditional syndromic surveillance, proactive patient tagging can illuminate potential epidemiologic links among patients in challenging syndromic surveillance applications, such as mass gatherings. Syndromic surveillance has the potential to enhance ED patient polling and reporting of exposure, symptom, and other epidemiologic case definition criteria to public health agencies in near-real time.


Asunto(s)
Aniversarios y Eventos Especiales , Brotes de Enfermedades , Servicio de Urgencia en Hospital/estadística & datos numéricos , Vigilancia en Salud Pública/métodos , Deportes , California , Hospitales , Humanos , Informática en Salud Pública/métodos , Análisis Espacial
6.
Pediatr Infect Dis J ; 35(10): 1132-6, 2016 10.
Artículo en Inglés | MEDLINE | ID: mdl-27622686

RESUMEN

BACKGROUND: Changes in herpes zoster (HZ) epidemiology are expected with childhood varicella vaccination. We reported previously that during 2000 to 2006 HZ incidence decreased 55% in children <10 years of age, while among 10- to 19-year olds it increased by 63%. We update the analysis with 4 additional years of data. METHODS: Population-based active surveillance was conducted for HZ in Antelope Valley, California. Structured telephone interviews and medical chart reviews collected data on demographics, varicella vaccinations, disease histories and clinical information. We calculated HZ incidence for 2007 to 2010 and assessed trends since 2000. RESULTS: Among children <10 years of age, HZ incidence continued the decreasing trend previously reported. During 2007 to 2010, the average incidence was 12.8 cases/100,000 children compared with 41.6 cases/100,000 children during 2000 to 2006, a 69% decline (P < 0.0001). For the 10- to 19-year olds, during 2007 to 2010 HZ incidence did not continue the increasing trend reported from 2000 to 2006; lower rates than in 2006 were observed in 3 of the 4 additional years evaluated. During 2007 to 2010 the average incidence was 78.2 cases/100,000 children compared with 68.0 cases/100,000 children during 2000 to 2006, a 13% increase (P = 0.123), with substantial fluctuation in annual rates throughout the 11 years of surveillance. CONCLUSIONS: During the mature varicella vaccination program, declines in HZ incidence among children <10 years of age continued through 2010. Among the 10- to 19-year olds, the increase reported through 2006 did not continue further and lower rates than in 2006 were observed through 2010. Widespread use of varicella vaccine could reduce HZ incidence among vaccinated populations. Ongoing monitoring of HZ incidence is needed to detect and understand changes in HZ epidemiology in the varicella vaccine era.


Asunto(s)
Vacuna contra la Varicela , Varicela/epidemiología , Varicela/prevención & control , Vacunación/estadística & datos numéricos , Adolescente , Adulto , California/epidemiología , Niño , Femenino , Humanos , Incidencia , Masculino , Vigilancia de la Población , Adulto Joven
7.
Emerg Infect Dis ; 22(7)2016 07.
Artículo en Inglés | MEDLINE | ID: mdl-27191253

RESUMEN

Many of the survivors of the 2014-2015 epidemic of Ebola virus disease (EVD) in western Africa were women of childbearing age. Limited clinical and laboratory data exist that describe these women's pregnancies and outcomes. We report the case of an EVD survivor who became pregnant and delivered her child in the United States, and we discuss implications of this case for infection control practices in obstetric services. Hospitals in the United States must be prepared to care for EVD survivors.


Asunto(s)
Trabajo de Parto , Parto , Complicaciones Infecciosas del Embarazo , Adulto , África Occidental/epidemiología , Femenino , Hospitales , Humanos , Control de Infecciones , Embarazo , Estados Unidos
8.
Pediatrics ; 137(4)2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26977081

RESUMEN

OBJECTIVES: We examined overall and incremental effectiveness of 2-dose varicella vaccination in preventing community transmission of varicella among children aged 4 to 18 years in 2 active surveillance sites. One-dose varicella vaccine effectiveness (VE) was examined in those aged 1 to 18 years. METHODS: From May 2009 through June 2011, varicella cases identified during active surveillance in Antelope Valley, CA and Philadelphia, PA were enrolled into a matched case-control study. Matched controls within 2 years of the patient's age were selected from immunization registries. A standardized questionnaire was administered to participants' parents, and varicella vaccination history was obtained from health care provider, immunization registry, or parent records. We used conditional logistic regression to estimate varicella VE against clinically diagnosed and laboratory-confirmed varicella. RESULTS: A total of 125 clinically diagnosed varicella cases and 408 matched controls were enrolled. Twenty-nine cases were laboratory confirmed. One-dose VE (1-dose versus unvaccinated) was 75.6% (95% confidence interval [CI], 38.7%-90.3%) in preventing any clinically diagnosed varicella and 78.1% (95% CI, 12.7%-94.5%) against moderate or severe, clinically diagnosed disease (≥50 lesions). Among subjects aged ≥4 years, 2-dose VE (2-dose versus unvaccinated) was 93.6% (95% CI, 75.6%-98.3%) against any varicella and 97.9% (95% CI, 83.0%-99.7%) against moderate or severe varicella. Incremental effectiveness (2-dose versus 1-dose) was 87.5% against clinically diagnosed varicella and 97.3% against laboratory-confirmed varicella. CONCLUSIONS: Two-dose varicella vaccination offered better protection against varicella from community transmission among school-aged children compared with 1-dose vaccination.


Asunto(s)
Vacuna contra la Varicela/administración & dosificación , Varicela/prevención & control , Infecciones Comunitarias Adquiridas/prevención & control , Inmunización Secundaria , Adolescente , California/epidemiología , Estudios de Casos y Controles , Varicela/epidemiología , Varicela/transmisión , Niño , Preescolar , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/transmisión , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Humanos , Masculino , Philadelphia/epidemiología , Vigilancia de la Población , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios
9.
Pediatr Infect Dis J ; 35(4): 440-5, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26658380

RESUMEN

BACKGROUND: Obesity emerged as a novel risk factor for severe disease during the 2009 H1N1 influenza pandemic. Murine studies indicate that obesity is associated with ineffective response to influenza vaccine, but few human studies exist. We aimed to determine if influenza vaccine is protective against laboratory-confirmed influenza in obese children. METHODS: Body mass index, vaccination status, and laboratory-confirmed influenza data were analyzed from a previously conducted prospective study in which active surveillance for influenza-like illness was conducted in 8 elementary schools in Los Angeles County during the 2010-2011 influenza season. Polymerase-chain reaction (PCR) was performed on combined nose/throat swabs collected from children with influenza-like illness at presentation to the school nurse or during absenteeism. RESULTS: Of 4260 children with height/weight data, 1191 (28.0%) were obese (body mass index ≥95th percentile). Respiratory specimens were obtained from 858 (20.1%) children. Unvaccinated obese compared with vaccinated obese children acquired 3 times more PCR-confirmed influenza (62 vs. 17 per 1000 children, P = 0.003) and missed more school days (4.6 vs. 3.2 per 100 school days, P < 0.001) during influenza season. Obese children with PCR-confirmed influenza were more likely to present with cough (86.2 vs. 72.4%, P = 0.030) and missed more school per episode (2.4 vs.1.9 days, P = 0.023) compared with nonobese children. Among vaccinated children, rates of PCR-confirmed influenza were similar in obese and nonobese children (17 vs. 20 per 1000 children, P = 0.77). CONCLUSIONS: Obese children with PCR-confirmed influenza suffered from more cough and missed more school days than their nonobese peers. Influenza vaccination protected obese children against PCR-proven influenza illness.


Asunto(s)
Vacunas contra la Influenza/inmunología , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Obesidad/epidemiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Virus de la Influenza A/clasificación , Virus de la Influenza A/genética , Gripe Humana/virología , Masculino , Vigilancia en Salud Pública , Factores de Riesgo , Estudiantes , Vacunación
10.
MMWR Morb Mortal Wkly Rep ; 64(44): 1256-7, 2015 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-26562570

RESUMEN

Since 2012, three clusters of serogroup C meningococcal disease among men who have sex with men (MSM) have been reported in the United States. During 2012, 13 cases of meningococcal disease among MSM were reported by the New York City Department of Health and Mental Hygiene (1); over a 5-month period during 2012­2013, the Los Angeles County Department of Public Health reported four cases among MSM; and during May­June 2015, the Chicago Department of Public Health reported seven cases of meningococcal disease among MSM in the greater Chicago area. MSM have not previously been considered at increased risk for meningococcal disease. Determining outbreak thresholds* for special populations of unknown size (such as MSM) can be difficult. The New York City health department declared an outbreak based on an estimated increased risk for meningococcal infection in 2012 among MSM and human immunodeficiency virus (HIV)­infected MSM compared with city residents who were not MSM or for whom MSM status was unknown (1). The Chicago Department of Public Health also declared an outbreak based on an increase in case counts and thresholds calculated using population estimates of MSM and HIV-infected MSM. Local public health response included increasing awareness among MSM, conducting contact tracing and providing chemoprophylaxis to close contacts, and offering vaccination to the population at risk (1­3). To better understand the epidemiology and burden of meningococcal disease in MSM populations in the United States and to inform recommendations, CDC analyzed data from a retrospective review of reported cases from January 2012 through June 2015.


Asunto(s)
Brotes de Enfermedades , Homosexualidad Masculina , Infecciones Meningocócicas/epidemiología , Adolescente , Adulto , Infecciones por VIH/epidemiología , Humanos , Masculino , Infecciones Meningocócicas/microbiología , Persona de Mediana Edad , Neisseria meningitidis/clasificación , Neisseria meningitidis/aislamiento & purificación , Estudios Retrospectivos , Serotipificación , Estados Unidos/epidemiología , Adulto Joven
11.
MMWR Morb Mortal Wkly Rep ; 64(39): 1123, 2015 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-26447803

RESUMEN

On February 14, 2015, patient A, aged 17 years, was seen in an emergency department for evaluation of reactive airway disease. In the waiting room at the same time were two siblings, aged 6 months, presenting with fever and rash; these two children (patients B and C) were later confirmed to have measles. Patient A began a 5-day course of oral prednisone (50 mg per day); however, symptoms continued, and patient A returned to the emergency department the next day and received 125 mg of intravenous (IV) methylprednisolone. Patient A had documentation of receipt of 2 doses of measles, mumps, and rubella (MMR) vaccine at ages 12 months and 4 years.


Asunto(s)
Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificación , Vacuna contra el Sarampión-Parotiditis-Rubéola/inmunología , Sarampión/diagnóstico , Sarampión/transmisión , Adolescente , Trazado de Contacto , Infección Hospitalaria , Brotes de Enfermedades/prevención & control , Servicio de Urgencia en Hospital , Humanos , Lactante , Los Angeles/epidemiología , Sarampión/epidemiología , Sarampión/prevención & control
12.
Influenza Other Respir Viruses ; 9(5): 255-62, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26073870

RESUMEN

BACKGROUND: School-located influenza vaccination (SLV) programs have the potential to mass-vaccinate all enrolled children, but parental consent is required. OBJECTIVE: To examine parental attitudes and determine predictors of parental consent for vaccination of schoolchildren through SLV programs. PATIENTS/METHODS: Surveys were distributed to parents of 4517 children during 2009-2010 (year 1) and 4414 children during 2010-2011 (year 2) in eight elementary schools in conjunction with a SLV program. RESULTS: Participants included 1259 (27·9%) parents in year 1 and 1496 (33·9%) in year 2. Parental consent for 2009 H1N1, 2009 seasonal, and 2010 seasonal influenza vaccines was obtained from 738 (70·8%), 673 (64·5%), and 1151 (77·2%) respondents, respectively. During the 2009 pandemic, respondents concerned about influenza severity were twice as likely to consent for the 2009 H1N1 vaccination compared to unconcerned respondents (OR 2·04, 95% CI:1·19-3·51). During year 2, factors that predicted parental consent were the perception of high susceptibility to influenza infection (OR 2·19, 95% CI:1·50-3·19) and high benefit of vaccine (OR 2·23, 95% CI:1·47-3·40). In both years, college-educated parents were more likely to perceive vaccine risks (year 1: 83·6 versus 61·5%, P < 0·001 and year 2: 81·1% versus 60·6%, P < 0·001) and less likely to consent for seasonal influenza vaccine (year 1: OR 0·69, 95% CI:0·53-0·89 and year 2: OR 0·61, 95% CI:0·47-0·78) compared to non-college-educated parents. CONCLUSIONS: Parents who appreciate the risks of influenza and benefits of vaccination are more likely to consent for SLV. More research is needed to determine how to address heightened safety concerns among college-educated parents.


Asunto(s)
Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Padres/psicología , Vacunación/psicología , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Programas de Inmunización , Subtipo H1N1 del Virus de la Influenza A/inmunología , Subtipo H1N1 del Virus de la Influenza A/fisiología , Gripe Humana/psicología , Gripe Humana/virología , Masculino , Percepción , Instituciones Académicas , Estados Unidos , Salud Urbana , Adulto Joven
13.
Clin Infect Dis ; 59(3): 325-32, 2014 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-24829215

RESUMEN

BACKGROUND: School-located influenza vaccination (SLV) programs can efficiently immunize large numbers of school-aged children. We evaluated the impact of SLV on laboratory-confirmed influenza and absenteeism. METHODS: Active surveillance for influenza-like illness (ILI) was conducted on 4455 children in 4 SLV intervention and 4 control elementary schools (grades K-6) matched for sociodemographic characteristics during the 2010-2011 influenza season in Los Angeles County, California. Combined nose/throat swabs were collected from febrile children with ILI at presentation to the school nurse or during absenteeism. RESULTS: In SLV schools, 26.9%-46.6% of enrolled students received at least 1 dose of either inactivated or live attenuated influenza vaccine compared with 0.8%-4.3% in control schools. Polymerase chain reaction for respiratory viruses (PCR) was performed on 1021 specimens obtained from 898 children. Specimens were positive for influenza in 217 (21.3%), including 2009 H1N1 (30.9%), H3 (9.2%), and B (59.9%). Children attending SLV schools, regardless of vaccination status, were 30.8% (95% confidence interval, 10.1%-46.8%) less likely to acquire influenza compared with children at control schools. Unvaccinated children were indirectly protected in the school with nearly 50% vaccination coverage compared with control schools (influenza rate, 27.1 vs 60.0 per 1000 children; P = .023). Unvaccinated children missed more school days than vaccinated children (4.3 vs 2.8 days per 100 school days; P < .001). CONCLUSIONS: Vaccination of at least a quarter of the school population resulted in decreased influenza rates and improved school attendance. Herd immunity for unvaccinated children may occur in schools with vaccination coverage approaching 50%.


Asunto(s)
Subtipo H1N1 del Virus de la Influenza A/inmunología , Virus de la Influenza A/inmunología , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/epidemiología , Vacunación , Absentismo , Adolescente , California/epidemiología , Niño , Preescolar , Femenino , Humanos , Gripe Humana/prevención & control , Masculino , Instituciones Académicas , Estudiantes/estadística & datos numéricos , Vacunas Atenuadas
14.
Emerg Infect Dis ; 20(2): 248-56, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24447640

RESUMEN

Fungal endophthalmitis is a rare but serious infection. In March 2012, several cases of probable and laboratory-confirmed fungal endophthalmitis occurring after invasive ocular procedures were reported nationwide. We identified 47 cases in 9 states: 21 patients had been exposed to the intraocular dye Brilliant Blue G (BBG) during retinal surgery, and the other 26 had received an intravitreal injection containing triamcinolone acetonide. Both drugs were produced by Franck's Compounding Lab (Ocala, FL, USA). Fusarium incarnatum-equiseti species complex mold was identified in specimens from BBG-exposed case-patients and an unopened BBG vial. Bipolaris hawaiiensis mold was identified in specimens from triamcinolone-exposed case-patients. Exposure to either product was the only factor associated with case status. Of 40 case-patients for whom data were available, 39 (98%) lost vision. These concurrent outbreaks, associated with 1 compounding pharmacy, resulted in a product recall. Ensuring safety and integrity of compounded medications is critical for preventing further outbreaks associated with compounded products.


Asunto(s)
Ceguera/microbiología , Endoftalmitis/microbiología , Infecciones Fúngicas del Ojo/microbiología , Soluciones Oftálmicas/efectos adversos , Colorantes de Rosanilina/efectos adversos , Triamcinolona Acetonida/efectos adversos , Anciano , Anciano de 80 o más Años , Ceguera/epidemiología , Ceguera/etiología , Ceguera/cirugía , Recall de Medicamento , Endoftalmitis/epidemiología , Endoftalmitis/etiología , Endoftalmitis/cirugía , Infecciones Fúngicas del Ojo/epidemiología , Infecciones Fúngicas del Ojo/etiología , Infecciones Fúngicas del Ojo/cirugía , Femenino , Fusarium/patogenicidad , Fusarium/fisiología , Humanos , Masculino , Persona de Mediana Edad , Retina/microbiología , Retina/patología , Retina/cirugía , Saccharomycetales/patogenicidad , Saccharomycetales/fisiología , Estados Unidos/epidemiología , Cuerpo Vítreo/microbiología , Cuerpo Vítreo/patología , Cuerpo Vítreo/cirugía
15.
Infect Control Hosp Epidemiol ; 35(1): 89-91, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24334805

RESUMEN

This report details an outbreak investigation conducted by the Los Angeles County Department of Public Health of 3 cases of bacterial infection among patients receiving hemodialysis who were treated at the same dialysis center in 2011. Improper disinfection of reusable dialyzers was hypothesized as the source of transmission.


Asunto(s)
Bacteriemia/epidemiología , Candidemia/epidemiología , Brotes de Enfermedades , Infecciones por Bacterias Gramnegativas/epidemiología , Riñones Artificiales/microbiología , Diálisis Renal/instrumentación , Stenotrophomonas maltophilia , Adulto , Anciano , Bacteriemia/microbiología , Candidemia/microbiología , Equipo Reutilizado , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Fallo Renal Crónico/terapia , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Diálisis Renal/efectos adversos
16.
Infect Control Hosp Epidemiol ; 34(11): 1215-7, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24113609

RESUMEN

An outbreak of methicillin-susceptible Staphylococcus aureus joint infections occurred at an outpatient radiology center. We identified 7 case patients; all had undergone magnetic resonance arthrograms with intra-articular joint injections. The outbreak was likely due to unsafe injection practices in preparation of contrast solution for intra-articular injection.


Asunto(s)
Medios de Contraste/efectos adversos , Brotes de Enfermedades , Artropatías/epidemiología , Imagen por Resonancia Magnética/efectos adversos , Infecciones Estafilocócicas/epidemiología , Adulto , Instituciones de Atención Ambulatoria , Artrografía/efectos adversos , Medios de Contraste/administración & dosificación , Femenino , Humanos , Inyecciones Intraarticulares , Artropatías/microbiología , Masculino , Persona de Mediana Edad , Staphylococcus aureus
17.
Pediatrics ; 132(5): e1134-40, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24101763

RESUMEN

OBJECTIVE: One-dose varicella vaccination for children was introduced in the United States in 1995. In 2006, a second dose was recommended to further decrease varicella disease and outbreaks. We describe the impact of the 2-dose vaccination program on varicella incidence, severity, and outbreaks in 2 varicella active surveillance areas. METHODS: We examined varicella incidence rates and disease characteristics in Antelope Valley (AV), CA, and West Philadelphia, PA, and varicella outbreak characteristics in AV during 1995-2010. RESULTS: In 2010, varicella incidence was 0.3 cases per 1000 population in AV and 0.1 cases per 1000 population in West Philadelphia: 76% and 67% declines, respectively, since 2006 and 98% declines in both sites since 1995; incidence declined in all age groups during 2006-2010. From 2006-2010, 61.7% of case patients in both surveillance areas had been vaccinated with 1 dose of varicella vaccine and 7.5% with 2 doses. Most vaccinated case patients had <50 lesions with no statistically significant differences among 1- and 2-dose cases (62.8% and 70.3%, respectively). Varicella-related hospitalizations during 2006-2010 declined >40% compared with 2002-2005 and >85% compared with 1995-1998. Twelve varicella outbreaks occurred in AV during 2007-2010, compared with 47 during 2003-2006 and 236 during 1995-1998 (P < .01). CONCLUSIONS: Varicella incidence, hospitalizations, and outbreaks in 2 active surveillance areas declined substantially during the first 5 years of the 2-dose varicella vaccination program. Declines in incidence across all ages, including infants who are not eligible for varicella vaccination, and adults, in whom vaccination levels are low, provide evidence of the benefit of high levels of immunity in the population.


Asunto(s)
Vacuna contra la Varicela/administración & dosificación , Varicela/epidemiología , Varicela/prevención & control , Brotes de Enfermedades/prevención & control , Programas de Inmunización/métodos , Adolescente , Adulto , California/epidemiología , Varicela/diagnóstico , Niño , Preescolar , Esquema de Medicación , Femenino , Humanos , Lactante , Masculino , Philadelphia/epidemiología , Adulto Joven
18.
Infect Control Hosp Epidemiol ; 34(2): 144-50, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23295560

RESUMEN

OBJECTIVE: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging multidrug-resistant pathogen associated with higher mortality, longer hospital stays, and increased costs. CRKP was thought to be sporadic in Los Angeles County (LAC); however, the actual incidence is unknown. To address this, LAC declared CRKP a laboratory-reportable disease on June 1, 2010. DESIGN: Laboratory-based community-wide surveillance. PATIENTS: Any individual who was identified as CRKP positive. CRKP was defined as a K. pneumoniae isolate resistant to all carbapenems by 2010 Clinical and Laboratory Standards Institute criteria. METHODS: Laboratory directors of 102 LAC acute care hospitals (ACHs) and 5 reference laboratories were to submit susceptibility testing results for all CRKP-positive specimens. Positive specimens from the same patient within the same calendar month of previous culture were excluded. RESULTS: A total of 814 reports were received from June 1, 2010, through May 31, 2011, from 69 laboratories; 675 (83%) met the case definition. Cases were reported from ACHs (387 [57%]), long-term ACHs (LTACs; 231 [34%]), and skilled nursing facilities (57 [8%]); an outbreak in 1 LTAC was identified. The pooled mean incidence rate in LAC ACHs and LTACs was 0.46 per 1,000 patient-days; the rate in LTACs (2.54 per 1,000 patient-days) was higher than that in ACHs (0.31 per 1,000 patient-days; P < .001). Sixty-five individuals had multiple incidences, accounting for 147 case reports. CONCLUSION: CRKP is more present in LAC than suspected. Rates were consistently higher in LTACs than in ACHs. Heightened awareness of this problem is needed in all LAC healthcare facilities, as patients access services along the continuum of care.


Asunto(s)
Carbapenémicos/uso terapéutico , Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae/efectos de los fármacos , Resistencia betalactámica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Continuidad de la Atención al Paciente , Servicio de Urgencia en Hospital , Femenino , Humanos , Incidencia , Lactante , Infecciones por Klebsiella/tratamiento farmacológico , Klebsiella pneumoniae/aislamiento & purificación , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Instituciones de Cuidados Especializados de Enfermería , Adulto Joven
19.
PLoS Negl Trop Dis ; 6(1): e1480, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22292097

RESUMEN

To assess the burden of neurocysticercosis (NCC) in California we examined statewide hospital discharge data for 2009. There were 304 cases hospitalized with NCC identified (incidence = 0.8 per 100,000). Cases were mostly Latino (84.9%), slightly more likely to be male than female (men 57.6%, women 42.4%) with an average age of 43.5 years. A majority of cases were hospitalized in Southern California (72.1%) and many were hospitalized in Los Angeles County (44.7%). Men were more likely than women to have severe disease including hydrocephalus (29.7% vs. 18.6%, p = 0.027), resulting in longer hospitalizations (>4 days, 48.0% vs. 32.6%, p = 0.007) that were more costly (charge>$40 thousand men = 46.9% vs. woman = 4.1%, p = 0.026). Six deaths were recorded (2.0%). The total of NCC-related hospital charges exceeded $17 million; estimated hospital costs exceeded $5 million. Neurocysticercosis causes appreciable disease and exacts a considerable economic burden in California.


Asunto(s)
Neurocisticercosis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , California/epidemiología , Niño , Preescolar , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Neurocisticercosis/economía , Factores de Riesgo , Adulto Joven
20.
Pediatrics ; 128(6): 1071-7, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22123875

RESUMEN

OBJECTIVE: To describe varicella disease in infants since implementation of the varicella vaccination program in the United States. PATIENTS AND METHODS: From 1995 to 2008, demographic, clinical, and epidemiologic data on cases of varicella in infants were collected prospectively through a community-based active surveillance project. We examined disease patterns for infants in 2 age groups: 0 to 5 and 6 to 11 months. RESULTS: Infant varicella disease incidence declined 89.7% from 1995 to 2008. Infants aged 0 to 5 months had milder clinical disease than those aged 6 to 11 months: ≥50 lesions, 49% vs 58% (P = .038); fever (body temperature > 38°C), 12% vs 21% (P = .014); and varicella-related complications, 6% vs 14% (P = .009), respectively. Age was an independent predictor of the occurrence of complications. CONCLUSIONS: The varicella vaccination program has resulted in substantial indirect benefits for infants, who are not eligible for vaccination. Presence of maternal varicella-zoster virus antibodies might explain attenuated disease in very young infants likely born to mothers with history of varicella. Although varicella disease incidence has declined, exposure to varicella-zoster virus continues to occur. Improving varicella vaccination coverage in all age groups will further reduce the risk of varicella exposure and protect those not eligible for varicella vaccination.


Asunto(s)
Vacuna contra la Varicela , Varicela/epidemiología , Varicela/prevención & control , Vacunación/estadística & datos numéricos , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios Prospectivos , Estados Unidos , Adulto Joven
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