Seasonal respiratory syncytial virus prophylaxis based on predetermined dates versus regional surveillance data.

BACKGROUND: In Ontario, Canada, the respiratory syncytial virus (RSV) prophylaxis period onset is defined by a fixed-date set provincially each year and offset by local hospital RSV admission activity. Inaccurate timing can result in inadequate or more costly prophylaxis. METHODS: RSV positivity (2002/03 to 2010/11) was obtained from a local database. RSV activity was described: season start/end dates, duration and optimum number of palivizumab doses required compared with doses administered for the final 4 RSV seasons (2007 to 2011). Three prophylaxis period-setting methods were evaluated for seasons 2007/08 to 2010/11: 1) the provincial method currently in use, 2) a local fixed-date method based on laboratory data accrued from the previous 5 seasons and 3) an exploratory prospective method based on surveillance of laboratory data. These were compared with the observed RSV seasons. RESULTS: The local RSV pattern closely reflects provincial seasonality. The local median season duration was 125 days (range 90-181). Median season onset and offset dates were December 19 and April 16, respectively. The prophylactic period definitions corresponded similarly, but the provincially set and local fixed-date methods provided longer immunity periods than required for the actual RSV season and involved the administration of more than 5 palivizumab doses compared with the prospective method. CONCLUSIONS: The provincial prophylactic period aligned with the local fixed-date and prospective methods. However, the adoption of any of the first 2 strategies merits close observation to minimize excess healthcare expenditure. The prospective surveillance of laboratory isolates should be further explored as a preferred option to better define prophylactic periods.

Tuberculosis prevention and treatment.

Tuberculosis (TB) is one of the oldest known diseases and has claimed more lives than any other Today, about one-third of the world's population is infected with TB. In 2003, 1,379 cases of new, active and relapsed TB were reported in Canada. TB is caused by Mycobacterium tuberculosis. Only 10 per cent of infected individuals will develop active TB. Pulmonary TB can be spread by an infectious person through the aerosolization of droplets when coughing, talking, spitting, sneezing or singing. Symptoms of pulmonary TB are a cough with or without sputum production lasting at least three weeks, chest pain, hemoptysis, fever, night sweats, weight loss, lack of appetite, chills and weakness. Extrapulmonary TB is generally not associated with person-to-person spread. Common sites include the throat, lymph nodes, abdomen, intestines, long bones of the legs, spine, kidneys, bladder, skin, eyes and meninges. The risk factors for TB infection and disease include close contact with an active pulmonary TB case, HIV infection or AIDS, inactive disease not adequately treated, low income, underlying medical condition, homelessness, alcoholism, injection drug use, aboriginal background or occupation in health care. Risk settings include travel or residence in an endemic area or work or residence in a correctional facility, shelter, rooming house, residential facility, hospital or long-term care facility. Nurses need to advocate for the prompt diagnosis and isolation of suspected and confirmed TB cases. Knowing when to institute such measures as isolation in a negative pressure room, using respirator masks and limiting interpersonal contacts is vital to the nursing care of TB patients. In addition, the role of the public health department needs to be understood; for example, all jurisdictions have legislated requirements for reporting new positive TB skin tests to public health.