Differentiating the wild from the attenuated during a measles outbreak.

In the midst of a local measles outbreak, a recently immunized child was investigated for a new-onset measles-type rash. Nucleic acid testing identified that a vaccine-type measles virus was being shed in the urine. Clinically differentiating measles from a nonmeasles rash is challenging, but can be supported by a thorough medical history evaluation. Rashes are expected to occur after immunization; nucleic acid testing can be used when it is difficult to differentiate between wild and attenuated strains.

Pendant une flambée locale de rougeole, un enfant récemment vacciné a subi des examens en raison d'une éruption rougeoleuse de novo. Le test d'acide nucléique a établi qu'un virus rougeoleux de type vaccinal était excrété dans l'urine. Il est difficile d'obtenir la différenciation clinique de la rougeole et d'une éruption non rougeoleuse, mais on peut l'étayer par une évaluation approfondie des antécédents médicaux. Des éruptions peuvent se produire après la vaccination. Le test d'acide nucléique peut être utile lorsqu'il est difficile de différencier les souches sauvages des souches atténuées.

Bacteremic pneumococcal pneumonia: a prospective study in Edmonton and neighboring municipalities.

Bacteremic pneumococcal pneumonia (BPP) is an important disease that should be frequently re-evaluated due to changes in demographics and recommended treatment. We conducted a prospective study from 2000 to 2002 in adults aged 17 years and over who presented to any of 6 hospitals and 1 freestanding emergency room in Edmonton, Alberta, with signs and symptoms compatible with pneumonia, a chest radiograph interpreted as pneumonia by the attending physician, and a positive blood culture for Streptococcus pneumoniae. We identified 129 patients with BPP, for an overall incidence of 9.7/100,000 person years. The rate was markedly higher among pregnant women, homeless persons, and those in prison. Sixteen percent were managed as outpatients, 61.2% as ward patients, and 22.5% required admission to the intensive care unit (ICU). Tobacco smoking was predictive of BPP, and antibiotic therapy before presentation was protective. According to pneumonia severity index, 47.3% were in low-risk classes I-III, 31.0% were in class IV, and 21.7% were in class V. Twelve (9.3%) patients died. Four died within 24 hours of arrival at hospital, and 2 had end-stage lung disease that resulted in a decision to discontinue therapy. Of the S. pneumoniae isolates, 12.5% were not susceptible to penicillin. The overall rate of BPP appears to be decreasing, although the rate is markedly increased in certain populations, which now should be targeted for vaccination. We identified 3 subsets of patients with BPP according to the site of care (ambulatory, ward, and ICU), with different outcomes.

Taking care of the sick and scared: a local response in pandemic preparedness.

Virtually all health care operations, including public health, are undertaken only at a local or regional level. Large-scale infectious disease emergencies, such as SARS or pandemic influenza, will be recognized and managed at a local level. The creation of the Public Health Agency of Canada (PHAC) was an important step in strengthening public health capacity. However, we need adequate operational capacity in local public health departments to have a strong public health system. Local public health takes an integral role in the preparation for and management of infectious disease emergencies. Local public health departments and regional public health infrastructures must be positioned to both maintain core functions and to lead and support health sector response to emergencies. The local establishment of a flexible and sustainable emergency management system must address the need to: integrate health care and first responders; provide all-hazards tools for managing a crisis at the frontline; rank service priorities and provide surge resources; and provide accurate information on a timely basis. Only the leaders within the local or regional health care facilities and organizations can develop workable plans to deliver health care. PHAC must ensure and support the local public health infrastructure and local emergency preparedness. Without this support, there will be consequences for local response to major public health emergencies.