Human immunodeficiency virus-associated cytomegalovirus infection with multiple small vessel cerebral infarcts in the setting of early immune reconstitution.

Cytomegalovirus (CMV) infection is an important cause of neurologic disease in the context of advanced human immunodeficiency virus (HIV) infection and is recognized as a cause of immune reconstitution inflammatory syndrome (IRIS) after initiation of highly active antiretroviral therapy (HAART). Central nervous system vasculitis secondary to CMV has only rarely been described in the context of HIV, despite the established ability of CMV to infect microvascular endothelial cells in the brain. However, we report a case that demonstrates the association between CMV and multiple small vessel cerebral infarct lesions after initiation of HAART.

Has the United States population been adequately vaccinated to achieve rubella elimination?

Mathematical models indicate that elimination of rubella virus transmission requires maintenance of approximately 90% rubella immunity among children. To evaluate whether rubella vaccination coverage among US preschool and school-age children is at levels consistent with rubella elimination, we reviewed data from 3 sources: (1) the Biologics Surveillance, which documents the net number of vaccine doses sold (1970-2004); (2) state immunization surveys of school entrants 5-6 years of age (1980-2005); and (3) the National Immunization Survey of children 19-35 months of age (1995-2004). Vaccine biologics data show that the net number of rubella vaccine doses sold was at least equivalent to the number of children born each year during 1970-2004. The average coverage for school-entrant surveys among reporting states was >95% for 1980-2004. National coverage among children 19-35 months of age was > or =90% overall for each year during 1995-2004. Three independent surveys suggest that childhood coverage with rubella-containing vaccine has been at sufficiently high levels to achieve elimination of rubella virus transmission.

Congenital rubella syndrome burden in Morocco: a rapid retrospective assessment.

BACKGROUND: WHO recommends that countries considering introduction of rubella vaccine into their immunisation programme assess their burden of congenital rubella syndrome, to determine whether vaccination is warranted. However, few guidelines exist for such assessments in developing countries. We retrospectively estimated the burden of congenital rubella syndrome in Morocco, and assessed our methods of rapid case finding. METHODS: We undertook case finding in the two cities with Morocco's main tertiary care referral centres, using medical records from births between Jan 1, 1990, and May 31, 2002, disability records from 1965 to 1997, and retinal examinations from deaf students born between 1985 and 1994, applying the WHO definition for a clinically confirmed case of congenital rubella syndrome. We also reviewed disability data for evidence of epidemic periodicity and estimated yearly incidence of the syndrome from congenital cataract data for births between 1990 and 2001. FINDINGS: We identified 62 clinically confirmed cases of congenital rubella syndrome from medical records, 148 from disability records, and 15 in deaf students. We noted no epidemic periodicity in disability data, and estimated a yearly incidence of the syndrome in Morocco of 8.1-12.7 cases per 100000 livebirths. INTERPRETATION: We show evidence of congenital rubella syndrome in Morocco and support the addition of rubella vaccination to the national programme. Various data sources can be explored to rapidly assess burden of the syndrome; ophthalmology departments and outpatient cardiology clinics could offer the most potential for such case finding, dependent on documentation practices.

Low postpartum rubella vaccination rates in high-risk women, Miami, Florida, 2001.

OBJECTIVE: To evaluate adherence to the Advisory Committee on Immunization Practices' recommendations on postpartum rubella vaccination in hospitals with a high proportion of foreign-born Latina mothers, the highest risk group for congenital rubella syndrome. METHODS: In four large hospitals in Miami-Dade County, maternal medical records for births in 2001 were randomly selected. Using demographic information from birth certificates, vaccination information from medical records, and policy information from a hospital survey, postpartum rubella vaccination rates were characterized among women eligible for vaccination (non-immune and not screened) through univariate and multivariable analyses. Data collection was performed in 2002-2003 and the analysis was completed in 2004-2005. RESULTS: Among 1991 women, 1209 (61%) were foreign born. Overall, 410 (21%) were eligible for vaccination, and of these 44 (11%) were vaccinated. Vaccination rates were not associated with maternal race/ethnicity or the existence of institutional standing-order vaccination policies. A vaccination order was recorded for 59% (240/410), but even in the presence of an order, only 17% (31/240) of those women were vaccinated. CONCLUSIONS: Despite policies and standing orders to vaccinate, postpartum rubella vaccination rates were very low among all racial/ethnic subgroups in a sample of hospitals caring for high-risk, foreign-born women. These findings suggest that additional system-level interventions, such as comprehensive operational guidelines, must accompany standing orders to vaccinate rubella non-immune women postpartum.

Inadequate syphilis screening among women with prenatal care in a community with a high syphilis incidence.

OBJECTIVES AND GOAL: This study was designed to evaluate the extent to which pregnant women in a community with a high syphilis incidence were screened for syphilis according to standard recommendations of twice during prenatal care and at labor and delivery. STUDY DESIGN: Labor and delivery records from 4 hospitals in Miami-Dade County, Florida, were abstracted to obtain maternal and prenatal care characteristics and syphilis screening practices. RESULTS: Of the 1991 women, records indicated that 1655 (83%) were screened at least once during prenatal care, 220 (11%) were screened twice during prenatal care before delivery, and 184 (9%) were screened twice during prenatal care and at delivery. Attending a private clinic, having more than adequate prenatal care and having private insurance were associated with not being screened at least twice before delivery. CONCLUSIONS: Few women were screened according to standard recommendations, and provider or institutional-related factors affected adequacy of screening.

Lack of SARS transmission among public hospital workers, Vietnam.

The severe acute respiratory syndrome (SARS) outbreak in Vietnam was amplified by nosocomial spread within hospital A, but no transmission was reported in hospital B, the second of two designated SARS hospitals. Our study documents lack of SARS-associated coronavirus transmission to hospital B workers, despite variable infection control measures and the use of personal protective equipment.