Hospitalization of paediatric patients for methicillin-resistant Staphylococcus aureus skin and soft-tissue infection, 1998-2006.

Hospital discharge reports have provided data for studies of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infection (SSTI) studies. This analysis determined the sensitivity and positive predictive value of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code combinations to calculate hospitalization incidence rates, representativeness of a set of three ICD-9-CM codes to define MRSA SSTI, and hospitalization incidence rate trends for paediatric MRSA SSTIs in Los Angeles County (LAC). Using 133 cases from 31 hospitals, we found that the set of three ICD-9-CM codes used to define laboratory-confirmed cases had one of the highest positive predictive values (49%). There was no difference in age and race between those categorized using three codes vs. other code combinations. A dramatic increase in paediatric MRSA SSTI cases occurred in LAC during 1998-2006. We conclude that this combination of codes may be used to determine the rise of MRSA SSTIs in paediatric populations.

Surveillance of listeriosis in Los Angeles County, 1985-1986. A first year's report.

After a large food-borne outbreak of listeriosis in Los Angeles County, California, in 1985, the California State Department of Health Services instituted mandatory reporting of Listeria monocytogenes by clinical laboratories. From September 1, 1985, through August 31, 1986, 94 cases of listeriosis were reported in Los Angeles County for an annual crude incidence rate of 12 cases per million persons. Of the 94 cases, 37 (39%) were in neonates and/or their mothers and 57 (61%) were nonperinatal. The overall case fatality rate was 31%, with a perinatal case fatality of 16% (6 fetal and 23 nonperinatal); this compares with an epidemic perinatal case fatality rate of 32%. No significant differences were observed in age-adjusted, race-specific incidence rates among nonperinatal cases or race-specific incidence rates among perinatal cases. All but 2 of the nonperinatal patients had a known predisposing risk factor for the development of listeriosis, the most common of which was a prior history of steroid therapy. A clustering of cases was not identified. No common food sources were apparent. Patients presenting as perinatal cases were more likely to have ingested Mexican-style cheese, ice cream, and yogurt than those presenting as nonperinatal cases. Improved case ascertainment through mandatory reporting and laboratory-based surveillance will establish meaningful baseline levels of listeriosis.

Screening for HIV and hepatitis B virus in Los Angeles County prenatal clinics: a demonstration project.

A project designed to pilot voluntary screening for HIV antibody and hepatitis B virus antigen (HBsAg) in women using Los Angeles County Department of Health Services prenatal clinics is described. The purpose of the study was to demonstrate that HIV testing could be integrated into an existing prenatal health care system with minimal disruption. In an 8-month period, 9,069 women entered the project; 76% accepted HIV antibody testing. The rate of HIV antibody seropositivity was 144 per 100,000 (10 per 6,943), and the rate of HBsAg seropositivity was 253 per 100,000 (23 per 9,103). No difference in test acceptance rates was found using a sign-off versus a sign-on HIV antibody consent form although potential confounders were not controlled. Only five of the eight HIV antibody-positive women (63%) and eight of the 20 HBsAg-positive women (40%) who were interviewed reported behaviors considered high risk for HIV or HBsAg infection.

Listeriosis: an uncommon opportunistic infection in patients with acquired immunodeficiency syndrome. A report of five cases and a review of the literature.

Between January 1985 and March 1986, five cases of listeriosis were reported in Los Angeles County in patients with the acquired immunodeficiency syndrome (AIDS). All patients were homosexual men with no other risk factors for AIDS. Two patients had sepsis only, two patients had sepsis and meningitis, and one patient had sepsis and signs of meningitis. Sixty percent of the cases (three patients) had a prior or concurrent gastrointestinal illness. Eighty percent of the cases (four patients) also had no prior history of antibiotic administration. Both of these findings may have predisposed these AIDS patients to be at increased risk for listeriosis. Although listeriosis is an infrequent illness in AIDS patients, people with AIDS or human immunodeficiency virus infection should probably refrain from ingesting food items associated with listeriosis. These food items include improperly pasteurized dairy products, and raw fruits and vegetables not properly washed.

Varicella outbreaks after vaccine licensure: should they make you chicken?

In 1998, 3 years after vaccine licensure, child care centers (CCC) in Los Angeles County continued to report varicella outbreaks. We investigated outbreaks at 2 CCCs to determine the cause for them, such as low vaccination coverage levels or unexpected low vaccine effectiveness. We collected information on past history of varicella, illness during the outbreak, and prior varicella vaccination among CCC attendees. We found that CCC "H" had a vaccination coverage of 87% (34/39) compared with 30% (6/20) in CCC "L." The overall attack rate was lower in CCC "H" (31%) than in "L" (61%; P value =.03). Vaccine effectiveness for any varicella was 71% in "H" and 100% in "L." Vaccinated children with varicella had milder disease than unvaccinated. In conclusion, we found varicella outbreaks in CCCs with both high and low vaccination coverage. Vaccine effectiveness was within the range predicted by the literature. Vaccination led to a lower attack rate in the highly vaccinated CCC and appeared to protect from severe disease.

Biologic, foster, and adoptive parents: care givers of children exposed perinatally to human immunodeficiency virus in the United States. The Pediatric Spectrum of Disease Clinical Consortium.

Children born to human immunodeficiency virus (HIV)-infected mothers often do not live with a biologic parent because of drug use, illness, or death of the mother. Public health officials need to know the number and proportion of children who will require care by someone other than a biologic parent (alternative care giver). The Pediatric Spectrum of Disease project, conducted in six different geographic regions in the United States, assesses issues specific to HIV in children. Among the information being collected in this study are data regarding the primary care giver. Of 1683 children born to HIV-infected mothers and enrolled through 1990, 55% (937) were living with a biologic parent, 10% (169) with another relative, 28% (455) were in foster care, 3% (55) had been adopted, and 4% (67) lived in group settings or with other care givers. In all locations and for all racial/ethnic groups, children of mothers who used intravenous drugs were more likely to be living with an alternative care giver than were children of mothers who had not used intravenous drugs (odds ratio 4.15). However, there were striking variations by study location (odds ratio range 1.4 to 7.2). The data suggest that maternal drug use may be the most important factor determining whether a child lives with a biologic parent and that there are also regional differences in alternative care placement.

Natural history of human immunodeficiency virus disease in perinatally infected children: an analysis from the Pediatric Spectrum of Disease Project.

OBJECTIVE: To describe the progression of human immunodeficiency virus (HIV) disease through clinical stages from birth to death among a large number of perinatally infected children. METHODS: The Pediatric Spectrum of Disease (PSD) project, coordinated by the Centers for Disease Control and Prevention (CDC), has conducted active surveillance for HIV disease since 1988 in seven geographic regions. PSD data are collected from medical and social service records every 6 months through practitioners at each participating hospital clinic. We analyzed data from perinatally HIV-infected children born between 1982 and 1993. The natural history of HIV disease was divided into five progressive stages using the clinical categories in the CDC 1994 pediatric HIV classification system: stage N, no signs or symptoms; stage A, mild signs or symptoms; stage B, moderate signs or symptoms; stage C, severe signs or symptoms; and stage D, death. A five-stage Markov model was fitted to the PSD data. To compare the estimates from the PSD project with the published estimates, we also fitted an alternative Markov model using acquired immunodeficiency syndrome (AIDS; 1987 case definition) in place of stage C and also calculated standard Kaplan-Meier estimates. RESULTS: A total of 2148 perinatally HIV-infected children were included in the analysis. The estimated mean times spent in each stage were: N, 10 months; A, 4 months; B, 65 months; and C, 34 months. We estimated that a child born with HIV infection has a 50% (95% confidence interval [CI], 40%-60%) chance of severe signs or symptoms developing by 5 years of age and a 75% (95% CI, 68%-82%) chance of surviving to 5 years of age. For a child in stage B, there is a 60% (95% CI, 49%-71%) chance of severe signs or symptoms developing within the next 5 years and a 65% (95% CI, 56%-73%) chance of surviving 5 more years. The estimated mean time from birth to stage C was 6.6 (95% CI, 5.7-7.5) years, and the estimated mean survival time from birth was 9.4 (95% CI, 8.1-10.7) years. From the alternative Markov model, the estimated mean time from birth to AIDS was 4.8 (95% CI, 4.5-5.2) years. CONCLUSION: Markov modeling using the revised pediatric classification system allowed us to describe the natural history of HIV disease in children before diagnosis of AIDS. On average, children progress to moderate symptoms in the second year of life and then remain moderately symptomatic for more than half of their expected lives, underscoring their need for clinical care before the onset of AIDS. The results from the Markov model are useful in family counseling, health care planning, and clinical trial designs.

Progression of human immunodeficiency virus disease among infants and children infected perinatally with human immunodeficiency virus or through neonatal blood transfusion. Los Angeles County Pediatric AIDS Consortium and the Los Angeles County-University of Southern California Medical Center and the University of Southern California School of Medicine.

Using community-based surveillance data for pediatric human immunodeficiency virus (HIV) infection, we examined disease progression using survival analysis among perinatally HIV-infected children and children HIV-infected through a neonatal blood transfusion. As of December 31, 1991, 238 HIV-infected children (classified P-1 or P-2 according to the Centers for Disease Control and Prevention classification system) were identified. Median symptom-free survival time from birth to symptomatic infection (P-2) was different for perinatally acquired (n = 166) and neonatal transfusion-acquired (n = 72) infection (6.4 months vs. 17.8 months, respectively; P < 0.001). Survival after development of symptomatic infection (P-2) did not differ by transmission mode. Survival differences from birth to death were significant at P < 0.05 (75% of perinatally HIV-infected children survived 44 months vs. 71 months for transfusion-associated children). Although survival estimates improved for those receiving antiretroviral treatment, differences by mode were still observed. For perinatally HIV-infected children, mortality was highest in the first year of life (12%). Those remaining symptom-free beyond their first year demonstrated survival experiences similar to those for children with transfusion-associated infection.

Risk factors for invasive group A streptococcal infections in children with varicella: a case-control study.

OBJECTIVE: To identify characteristic clinical manifestations and potential risk factors for invasive group A streptococcal (GAS) disease in children with varicella. DESIGN AND PARTICIPANTS: A case-control study was conducted in Los Angeles and Orange Counties, CA. Cases were children with varicella who developed invasive GAS disease between January 1 and May 3, 1994 (n = 25). Controls were acquaintance, neighborhood or schoolmate children with uncomplicated varicella during the study period (n = 62). Cases were compared with controls with regard to underlying illness, child care practices, parental home health practices, health care-seeking behaviors, sociodemographic characteristics and clinical characteristics. RESULTS: Controlling for age we found that cases were more likely than controls: (1) to be cared for in the home vs. out-of-home child care (odds ratio (OR), 4.4 (95% confidence interval (95% CI), 1.1 to 17)); (2) to report having asthma (OR, 6.2 (95% CI, 1.2 to 41.0)) and to be taking albuterol (OR, 11.6 ((95% CI, 1.0 to 581)); (3) to be secondary varicella cases within a household (OR, 7.3 (95% CI, 2.2 to 25)); (4) to report fever after Day 2 of varicella; and (5) to have contacted their health care provider later than controls (Day 3.8 rather than Day 1.7, P < 0.001). CONCLUSIONS: To our knowledge this is the first case-control study exploring potential risk factors for invasive GAS disease in children with varicella. Both previously healthy children with varicella and those with underlying medical problems, including asthma, may be at increased risk for GAS complications. Interventions should be targeted to parents and health care providers to increase awareness of early signs and symptoms of invasive GAS disease in children with varicella. Additional studies are needed to confirm the associations suggested by this study between GAS complications of varicella and asthma, in-home child care, secondary vs. primary varicella household cases and delayed contact with medical care providers.

Protection provided by Haemophilus influenzae type b conjugate vaccines in Los Angeles County: a case-control study.

The objective was to assess the degree of disease control and to evaluate the protective efficacy of licensed Haemophilus influenzae type b (Hib) conjugate vaccines (HbOC, PRP-OMP, PRP-D) used routinely in children 2 to 35 months of age. We conducted a case-control study in Los Angeles County between January 1, 1991, and December 31, 1992, and a cohort analysis of Hib cases between 1983 and 1992. For the case-control study 105 cases of invasive Hib disease were identified and 767 geographically and age-matched controls were selected by random digit telephone dialing. Sixteen HbOC vaccine failures occurred > 14 days after a single dose of vaccine, 6 vaccine failures after 2 doses and 3 failures after 3 doses; 2 cases occurred 6 and 12 days, respectively, after an initial dose of HbOC. The protective efficacy of a single HbOC vaccine dose was 71.1% (95% confidence interval (CI), 37.5 to 87.2%). After 2 doses the efficacy was 88.8% (95% CI, 59.5 to 96.9%) and after 3 doses it was 94.4% (95% CI, 68.0% to 99.0%). Similar 95% CIs were seen for 1 and 2 doses of PRP-OMP vaccine. Adjustment of efficacy estimates for potential confounding variables did not significantly alter the results. Despite relatively low rates of immunization (20 to 60%) the rates of Hib disease decreased strikingly between 1990 and 1992 (from 24.2 to 4.4/100,000 children < 5 years of age). The HbOC conjugate vaccine, used predominantly but incompletely during this period, provided substantial protection against invasive Hib disease in children immunized between 2 and 35 months of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Investigation of an epidemic of invasive aspergillosis: utility of molecular typing with the use of random amplified polymorphic DNA probes.

When seven immunocompromised patients developed invasive aspergillosis during construction at a hospital, new methods were performed to compare fungal isolates and a case-control study was conducted to determine risks for infection. Typing of Aspergillus flavus with the use of restriction endonuclease analysis and restriction fragment length polymorphism using random amplified polymorphic DNA reactions to generate DNA probes revealed different patterns between isolates from two patients and a similar pattern among those from one patient, a health care worker, and an environmental source. Case patients were more likely than controls to have longer periods of hospitalization (median, 83 vs. 24 days; P < 0.01), neutropenia (median, 33 vs. 6 days; P < 0.05), and exposure to broad spectrum antimicrobials (median, 56 vs. 15 days; P = 0.08). No patients restricted to protected areas developed aspergillosis. Risk of exposure of immunocompromised patients to opportunistic organisms stirred up by construction activity may be decreased by admitting these patients to protected areas away from construction activity and by restricting traffic from construction sites to these areas. Although typing of A. flavus isolates did not reveal a single type or source of organism responsible for infection, this method may facilitate epidemiologic investigation of possible nosocomial sources and transmission in similar settings.

Human immunodeficiency virus-infected adolescents: a descriptive study of older children in New York City, Los Angeles County, Massachusetts and Washington, DC.

BACKGROUND: Children infected with HIV are entering adolescence with challenging and changing medical and social needs. Through chart review we describe certain medical and social characteristics of adolescents who acquired HIV as children. METHODS: HIV-infected children 12 years of age and older in 1995 were monitored through the Pediatric Spectrum of HIV Disease study from four US sites. In addition to standard 6-month medical chart reviews, a special chart abstraction in 1997 collected available psychosocial and sexual history information. RESULTS: A total of 131 adolescents HIV-infected as children were studied: 52 infected perinatally; 44 infected through a contaminated blood transfusion; 30 through receipt of contaminated blood products for hemophilia; and 5 with unknown transmission mode. Mean age at last medical contact was 15.5 years, 67% were Hispanic or African-American, 12% were employed, 66% attended regular school, 66% knew their HIV status and 48% (8% for the perinatally infected) lived with their biologic mother. Information on sexual activity showed that 18% had sexual relations, 28% did not and for 53% sexual activity was not recorded in the medical chart. Four percent used illicit drugs, which along with sexual activity showed a positive association with age. Forty-two percent had an AIDS-defining opportunistic infection, and 56% had a recent CD4+ lymphocyte count <200 cells/microl. CONCLUSIONS: Adolescents in this study represent a heterogeneous group of surviving HIV-infected children some of whom are sexually active and potential sources of HIV transmission. Clinicians who treat HIV-infected and high risk adolescents face the challenges of providing care and prevention services appropriate to adolescent development.

A survey of hospital postpartum and postabortion rubella vaccination policies in Los Angeles County, 1992.

OBJECTIVE: To determine the proportion of Los Angeles County (LAC) hospitals offering obstetrical services that have postpartum and postabortion rubella vaccination policies. DESIGN: A survey was sent to the infection control practitioners (ICPs) of all operational acute care hospitals (N = 133) in LAC in 1992. A remainder and second survey was mailed to ICPs who did not respond to the first mailing. RESULTS: Of 75 hospitals with obstetrical departments, 56 (75%) responded. Thirty-four (61%) of the 56 respondent hospitals had post-partum rubella vaccination policies. Of the 34 hospitals with policies, 30 (88%) accepted only a written record of rubella seropositivity as proof of immunity, 30 (88%) screened women with unknown immunity status before hospital discharge, and 32 (94%) vaccinated susceptible women before hospital discharge. Of the 32 hospitals that performed induced abortions, only two (6%) provided screening and vaccination services for these women. CONCLUSION: Only 61% of hospitals in LAC offering obstetrical services had postpartum rubella vaccination policies while only minimal screening and vaccination occurred in association with abortion services. Widespread implementation of postabortion screening and vaccination, and more stringent compliance with Advisory Committee on Immunization Practices recommendations for postpartum screening and vaccination in hospitals offering obstetrical services would reduce the number of rubella-susceptible women who have been missed by other prevention strategies.

Pyrogenic reactions associated with single daily dosing of intravenous gentamicin.

OBJECTIVE: To identify risk factors associated with an unexpected outbreak of pyrogenic reactions (PR) following intravenous gentamicin. DESIGN: We conducted two cohort studies. PRs were defined as chills, rigors, or shaking within 3 hours after initiating the gentamicin infusion during the preepidemic (December 1, 1997-January 15, 1998) or epidemic (May 1-June 15, 1998) periods. We tested gentamicin vials for endotoxin using the limulus amebocyte lysate assay. SETTING: Inpatient services of a large community hospital in Los Angeles, California. RESULTS: During the epidemic period, 22 (15%) of 152 patients developed documented PRs following intravenous gentamicin. PRs were more likely among patients receiving single daily dosing (SDD) than multiple daily dosing gentamicin (20/73 [27%] vs. 2/79 [3%]; relative risk, 10.8; 95% confidence interval, 2.6 44.7). Laboratory analysis of gentamicin vials found endotoxin levels that were higher among Fujisawa-brand gentamicin (implicated brand) than gentamicin used after the outbreak terminated (non-implicated brand). Although endotoxin levels in the vials did not exceed US Pharmacopeia limits (1.7 endotoxin units/mg gentamicin), the use of SDD gentamicin may place patients at greater risk of receiving doses of endotoxin above the threshold for PRs in humans. CONCLUSIONS: Reassessment of the acceptable amounts of endotoxin in gentamicin and other parenteral products should be considered when dosing intervals used in clinical practice change.

A survey of hospital infection control policies and employee measles cases during Los Angeles County's measles epidemic, 1987 to 1989.

BACKGROUND: Between December 1987 and December 1989, 74 adults employed in Los Angeles County acute care hospitals were found to have measles. To investigate measles infection control policies in Los Angeles County and to gain information on employee measles cases, two surveys were performed. METHODS: A survey of all infection control practitioners (N = 102) of acute care hospitals was conducted in July 1989. Reported employee measles cases were surveyed after initial case reports were reviewed. RESULTS: The survey of acute care hospitals revealed that only 17% had mandatory measles infection control policies requiring written proof of past measles vaccination, disease, or seropositivity. Only 4% of hospitals had policies affecting students or volunteers. A second survey of hospital employees with confirmed measles revealed that 46% (34/74) were working in hospitals without measles infection control policies, 43% (32/74) were born before 1957, and 31% (21/67) were working in jobs not traditionally considered to provide a high risk of measles exposure. One third of the sick employees were hospitalized. The standard of either birth date before 1957 or oral history of measles illness or vaccination would have classified 93% (39/42) of the employees with measles as immune. CONCLUSIONS: Effective infection control policies against measles and rubella should be adopted and enforced. Those policies should only allow written documentation as proof of measles immunity and should address all employees, regardless of age or job description.

A comparison of hospital policies for measles, mumps, and rubella infection control in Los Angeles County, 1989 and 1992.

BACKGROUND: A survey was conducted in 1992 in Los Angeles County, California, to assess changes since an earlier survey in 1989 in the numbers of acute care hospitals that had established policies on measles, mumps, and rubella infection control and the extent to which these policies were implemented. METHODS: A questionnaire inquiring about measles, mumps, and rubella infection control was sent to ICPs of 133 acute care hospitals in Los Angeles County. The results were compared with those of a similar survey conducted in 1989. The increase in the number of hospitals with such policies between 1989 and 1992 was analyzed. RESULTS: In 1989, 29 (28%), 9 (9%), and 65 (64%) of the 102 respondent hospitals had measles, mumps, and rubella infection control policies, respectively. Larger proportions of the 95 respondent hospitals in 1992 had measles (56, 59%), mumps (15, 16%), and rubella (69, 73%) infection control policies. CONCLUSIONS: The number of hospitals with infection control policies for measles, mumps, and rubella increased from 1989 to 1992. Efficiency and scope of such policies varied, however, and could be improved by making the policies mandatory, requiring written documentation of employee immunity, and extending policies to cover all employees. The most dramatic increase was in the number of hospitals with infection control policies for measles; this increase may have been caused by the 1987 to 1989 measles epidemic in Los Angeles County, by increased awareness of the Immunization Practices Advisory Committee recommendations, or by increased sensitivity to the issue of infection control triggered by the 1989 survey.

A cluster of coagulase-negative staphylococcal bacteremias associated with peripheral vascular catheter colonization in a neonatal intensive care unit.

BACKGROUND: A cluster of six neonatal cases of coagulase-negative staphylococcal bacteremias occurred in a Los Angeles County neonatal intensive care unit in March 1989. METHODS: A retrospective cohort study assessed the impact of host-and delivery-related variables, length of hospitalization, duration of antibiotic treatment, performance or duration of invasive procedures, and staffing variables on risk of coagulase-negative staphylococcal bacteremia. RESULTS: Unstratified analyses yielded eight risk factors with risk ratios greater than 2. After stratification by gestational age (less than 29 weeks) and low birth weight (less than 1500 gm), frequency of blood transfusions, duration of respiratory therapy, heparin lock and central vascular line placement, and hyperalimentation remained associated with elevated risk. Two species were identified, arguing against a common source of infection. Of four cohort months with more than 15 very low birth weight infants in the neonatal intensive care unit, an elevation of coagulase-negative staphylococcus-positive blood cultures and diagnosed bacteremias occurred in only two. CONCLUSIONS: This cluster of coagulase-negative staphylococcal bacteremia was probably caused by frequent manipulation of catheters in neonates who were at heightened risk because of low birth weight and prematurity.

Eradication of Haemophilus influenzae type b disease in southern California. Kaiser-UCLA Vaccine Study Group.

OBJECTIVE: To assess the effects of Haemophilus influenzae vaccination of infants. RESEARCH DESIGN: We evaluated H influenzae type b (Hib) disease rates in Los Angeles County, California (population, 9 million; 1983 through 1992), and in the Southern California Kaiser Health Plan (2.5 million enrollees; 1988 through 1992) during the past decade. Cases were obtained through active and passive disease surveillance in the two populations. The following vaccines were used during the study period (1983 through 1992): (1) Hib polysaccharide vaccine (polyribosyl ribitol phosphate) (used from 1985 through 1987 for children 24 through 60 months of age); (2) Hib polysaccharide-diphtheria toxoid conjugate, Hib polysaccharide CRM197 mutant diphtheria toxoid conjugate vaccine, and Hib polysaccharide outer-membrane protein of group B meningococcus conjugate vaccine in older children (1988 through 1990; ages 15 through 60 months); and (3) Hib polysaccharide CRM197 mutant diphtheria toxoid conjugate vaccine and Hib polysaccharide outer-membrane protein of group B meningococcus conjugate vaccine used in infants (1991 through 1992). MEASUREMENTS AND RESULTS: Between 1983 and 1988, the Hib disease incidence in Los Angeles County was unchanged (32.7 to 42.5/100,000 person-years in children younger than 5 years). In 1989 through 1990, before Hib conjugate licensure for infant use, Hib disease rates in all age groups declined. After licensure of Hib vaccines for infants in 1990, there was a further fivefold decrease in infants. More dramatic decreases occurred in the better-immunized Kaiser Health Plan children aged 0 through 60 months (53 cases in 1989, only two cases in 1992). CONCLUSIONS: The Hib disease has been nearly eradicated in a fully immunized population (Kaiser Health Plan), and significant reductions have also occurred in Los Angeles County.

Measles in pregnancy: a descriptive study of 58 cases.

OBJECTIVE: To describe the effects of measles in pregnancy using a large case series. METHODS: Pregnant women with measles were identified by county health department records, and their hospital and clinic records were reviewed. When available, records for the infants of case patients were also reviewed. RESULTS: Fifty-eight pregnant women with measles were identified. Thirty-five (60%) were hospitalized for measles, 15 (26%) were diagnosed with pneumonia, and two (3%) died of measles complications. Excluding three induced abortions, 18 pregnancies (31%) ended prematurely; five were spontaneous abortions and 13 were preterm deliveries. All but two of the 18 pregnancies that terminated early did so within 14 days of rash onset. Two term infants were born with minor congenital anomalies, but their mothers had measles late in the third trimester. No newborns were diagnosed with congenital measles. CONCLUSIONS: The incidence of death and other complications from measles during pregnancy may be higher than expected for age-comparable, nonpregnant women. Measles in pregnancy may lead to high rates of fetal loss and prematurity, especially in the first 2 weeks after the onset of rash.

Fatal listeria meningitis in an immunocompromised infant: therapeutic implications.

Infection with Listeria monocytogenes is rare in infants and children. Listeriosis has been made a notifiable condition in the State of California since 1985. From January 1985 to December 1990, only seven cases of listeriosis have been reported in children less than or equal to 13 years of age. This brief report summarises the features of a fatal case of listeria meningitis in an immunocompromised 4-month-old infant, discusses diagnostic and therapeutic implications, and describes the other six cases.