Outbreak of variant influenza A(H3N2) virus in the United States.

BACKGROUND: Variant influenza virus infections are rare but may have pandemic potential if person-to-person transmission is efficient. We describe the epidemiology of a multistate outbreak of an influenza A(H3N2) variant virus (H3N2v) first identified in 2011. METHODS: We identified laboratory-confirmed cases of H3N2v and used a standard case report form to characterize illness and exposures. We considered illness to result from person-to-person H3N2v transmission if swine contact was not identified within 4 days prior to illness onset. RESULTS: From 9 July to 7 September 2012, we identified 306 cases of H3N2v in 10 states. The median age of all patients was 7 years. Commonly reported signs and symptoms included fever (98%), cough (85%), and fatigue (83%). Sixteen patients (5.2%) were hospitalized, and 1 fatal case was identified. The majority of those infected reported agricultural fair attendance (93%) and/or contact with swine (95%) prior to illness. We identified 15 cases of possible person-to-person transmission of H3N2v. Viruses recovered from patients were 93%-100% identical and similar to viruses recovered from previous cases of H3N2v. All H3N2v viruses examined were susceptible to oseltamivir and zanamivir and resistant to adamantane antiviral medications. CONCLUSIONS: In a large outbreak of variant influenza, the majority of infected persons reported exposures, suggesting that swine contact at an agricultural fair was a risk for H3N2v infection. We identified limited person-to-person H3N2v virus transmission, but found no evidence of efficient or sustained person-to-person transmission. Fair managers and attendees should be aware of the risk of swine-to-human transmission of influenza viruses in these settings.

HIV prevalence and related behaviors among sex workers in Jamaica.

BACKGROUND: The aims of the study were to estimate HIV prevalence among sex workers (SWs) in Jamaica and to identify risk factors associated with HIV infection. METHOD: Face to face interviews and HIV testing of 450 SWs across Jamaica were conducted in 2005. Participants were identified by key informants. RESULTS: About 9% of SWs were HIV-positive. HIV-positive SWs tended to be older, less educated, have a history of crack/cocaine use, and were less likely to be aware of the Ministry of Health's prevention programme. More than 90% of SWs reported having easy access to condoms and using condoms at last sex with local and tourist clients. However, 30% of SWs used condoms with nonpaying partners. Knowledge of HIV prevention methods was high but only 38.6% of SWs appropriately rejected myths about HIV transmission by mosquito bites and meal sharing. CONCLUSION: Prevention programmes targeting SWs must emphasize the risk associated with both paying and nonpaying sexual partners while providing knowledge about HIV prevention. Increased access to prevention programmes is likely to reduce HIV prevalence among this population.

Cardiometabolic disease in human immunodeficiency virus-infected children.

Cardiometabolic problems in children with human immunodeficiency virus (HIV) infection have recently begun to emerge as distinct clinical problems that require monitoring and often intervention. The cardiometabolic issues that face HIV-infected children include high rates of unfavorable lipid profiles, insulin resistance, cardiovascular inflammation, and vascular stiffness as well as the phenotypic features of truncal adiposity and facial/extremity wasting. Children differ from adults in that many have been exposed to both HIV and antiretroviral therapies even before birth. The future risk of adverse cardiovascular outcomes is poorly defined yet warrants close tracking because a number of risk factors are present in early childhood. Preventive care and interventions that include surveillance of nutrition and body composition, dietary counseling, exercise programs, and drug therapy should be considered standard care for all HIV-infected children.