[Pilot project of a pediatric antibiotic stewardship initiative at the Hauner children's hospital]. / Pilotprojekt einer pädiatrischen Antibiotic-Stewardship-Initiative am Dr. von Haunerschen Kinderspital - neue Wege der pädiatrischen Infektiologie.

The steady increase in antimicrobial resistance is of growing concern in healthcare. Antibiotic Stewardship [ABS] Strategies are important tools to control antibiotic use and -prevent antimicrobial resistance. An increasing number of institutions are developing ABS initiatives also in pediatrics. However, few data are available assessing the implementation and efficiency of these pediatric ABS programs.At the Dr. von Hauner Children's Hospital, Ludwig-Maximilian University, a tertiary care pediatric reference center, a pediatric ABS Team has been implemented. Key structural elements were the same as for adult patients, but antimicrobials agents selected for monitoring and appropriate clinical endpoints are different in pediatrics.Key features were: 1. prospective-audit with feedback and formulary restriction and 2. pre-authorization (also referred to as prior approval). The ABS team consisted of one pediatric infectious disease specialist, one clinical fellow in pediatric infectious diseases, and one clinical pharmacist with training in infectious diseases.With the implementation of a pediatric ABS strategy we could significantly influence antimicrobial consumption in our hospital. Cost-savings are estimated to be above 330 000 € per year, and concomitantly the use of broad-spectrum antibiotics and antifungal compounds was significantly reduced.Antibiotic Stewardship [ABS] Strategies may be an effective tool to control antibiotic use in the setting of a large tertiary pediatric teaching hospital. A national guideline for ABS initiatives may help to further improve rational use of antibiotics in the hospital setting.

Transmission of Oropouche virus from man to hamster by the midge Culicoides paraensis.

Oropouche virus (arbovirus family Bunyaviridae, Simbu serological group) was experimentally transmitted from man to hamster by the bite of the midge Culicoides paraensis. Infection rates and transmission rates were determined after the midge had engorged on patients with viremia. The threshold titer necessary to enable infection or transmission by the midges was approximately 5.3 log10 of the median lethal dose of the virus in suckling mice per milliliter of blood. Transmission was achieved 6 to 12 days after C. paraensis had taken the infective blood meal. This represents conclusive evidence of transmission of an arbovirus of public health importance to man by a member of the Ceratopogonidae family.

Insecticide barrier spraying for the control of sand fly vectors of cutaneous leishmaniasis in rural Guatemala.

An initial evaluation of insecticide barrier spraying directed against sand fly vectors of cutaneous leishmaniasis was done in a nonclimax forested area with heavy undergrowth in Peten, Guatemala. A 100 m-wide swath of vegetation was sprayed once with a 1:3 mixture of cyfluthrin insecticide and a palm oil carrier using back-pack sprayers to simulate a central cantonment area in one site while another site remained as an untreated control. Prior to spraying and throughout 87 days post-treatment, sand fly populations were monitored at both sites with light traps set at ground and canopy levels at 50-m intervals radiating out from the centers of the cantonments, 150-m in the four cardinal directions. A total of 2,876 female sand flies were captured, representing 16 species. Three species, Brumptomyia galindoi, Lutzomyia panamensis, and Lu, ovallesi, comprised 70% of the total collection. The single insecticide barrier significantly reduced sand flies from reaching the cantonment area for more than 80 days, while sand fly populations outside the treated cantonment and in the untreated (control) cantonment remained high (52 sand flies in the treated cantonment versus 235 sand flies in the untreated cantonment).

Replication of Rift Valley fever virus in the sand fly Lutzomyia longipalpis.

Rift Valley fever virus was shown to replicate in Lutzomyia longipalpis after intrathoracic inoculation. Viral titers peaked at approximately 4 days postinoculation [mean titer = 10(4.0) plaque forming units (PFU)] and remained relatively constant through day 7. A minimum of 6 of 326 sand flies transmitted virus by bite to susceptible hamsters after 5-9 days of extrinsic incubation. Viral titers of sand flies exposed per os declined steadily through day 9. None of 378 flies that had ingested approximately 10(4.0) PFU of virus transmitted virus when refed on susceptible hamsters.

Mechanical transmission of Rift Valley fever virus by hematophagous Diptera.

Experimental studies were conducted to determine if hematophagous Diptera were capable of mechanical transmission of Rift Valley fever (RVF) virus to laboratory animals. All species tested (Glossina morsitans, Aedes aegypti, Aedes taeniorhynchus, Culex pipiens, Stomoxys calcitrans, Lutzomyia longipalpis, and Culicoides variipennis) mechanically transmitted the virus to hamsters. Mechanical transmission rates for G. morsitans ranged from 0-100%, with the probability of mechanical transmission positively correlated with initial viremia titer and negatively correlated with the time after virus exposure. Mechanical transmission of RVF virus to lambs was demonstrated with both G. morsitans and Cx. pipiens. These findings demonstrated that mechanical transmission of RVF virus by hematophagous flies may contribute to the natural transmission and dissemination of this virus.

An outbreak of Mayaro virus disease in Belterra, Brazil. III. Entomological and ecological studies.

Results in entomological and vertebrate host investigations made during dual outbreaks of Mayaro (MAY) and yellow fever (YF) viruses in Belterra, Pará, Brazil in 1978 are reported. Over 9,000 insects representing 26 species were assayed in 396 pools for the presence of arboviruses. Pools of Haemagogus janthinomys Dyar yielded the only isolates of either MAY or YF virus. The minimum field infection rate for nine isolates of MAY virus from Hg. janthinomys was 1:82, and for two isolates of YF virus was 1:368. Analysis of collection data showed Hg. janthinomys to be attracted to man as a blood source and present in all habitats sampled, although most abundant in the forest canopy. Twelve hundred bird sera and 584 mammal sera were tested by hemagglutination-inhibition (HI) tests for antibody to MAY virus. Highest MAY antibody prevalence rates were found among marmosets (Calithrix argentata, 32 positive of 119 tested, 27%). Mayaro virus was also isolated from the blood of a sylvan marmoset captured at the peak of the MAY virus outbreak. Experimental infection of marmosets with MAY virus confirmed that a substantial viremia follows infection with this virus. Marmosets were also found with HI antibody to YF virus (5/119, 4%). The results presented indicate that Hg. janthinomys was the principal vector of both MAY and YF viruses and that marmosets were the main amplifying hosts for MAY virus, and perhaps for YF virus as well.

Oropouche virus. IV. Laboratory transmission by Culicoides paraensis.

Biological transmission of Oropouche (ORO) virus by Culicoides paraensis (Goeldi) has been successfully demonstrated in the laboratory. Adult Culicoides, collected in an area where ORO virus was absent, were infected by feeding on viremic hamsters and then periodically exposed to susceptible hamsters at specific intervals post-infectious blood meal. These C. paraensis were capable of biological transmission of the virus 4-9 days post-feeding on viremic hamsters circulating 6.7-9.9 log10SMLD50/ml virus. Infection rates of 54% and 80% were found for C. paraensis assayed 7 days post-feeding. Virus transmission rates for these experiments were 83% and 25%, respectively. No evidence of mechanical transmission of ORO virus by C. paraensis was observed when interrupted feeding of Culicoides on viremic hamsters was followed by feeding on susceptible hamsters.

Oropouche virus. III. Entomological observations from three epidemics in Pará, Brazil, 1975.

Urban epidemics of Oropouche (ORO) fever in three municipalities in Pará, Brazil were studied in 1975. Culicoides paraensis (Goeldi) were collected during each of the epidemics and there was a positive correlation, by study areas within the city of Santarém, between human seropositivity to ORO virus and population densities of C. paraensis and Culex quinquefasciatus Say. The best numerical correlation was with populations of C. paraensis. The relative absence of other species in the areas of high disease attack rates was further evidence C. paraensis were the probable vectors of ORO virus. These biting midges were found to bite readily inside of houses, with an indoor/outdoor ratio of 29%, and were most active around 1700-1800 hours. Other biological observations on C. paraensis are presented.

Laboratory evaluation of a new repellent camouflage face paint.

A combined formulation of the U.S. Army's camouflage face paints and the new extended duration topical insect/arthropod repellent was tested on human volunteers to determine repellency and duration of protection (2-12 h) against Aedes aegypti and Anopheles stephensi. Under laboratory conditions (27 degrees C and 80% RH), the face paint/repellent formulation provided > or = 95% repellency or better for up to 6 h for Ae. aegypti and 8 h for An. stephensi. An analysis of variance showed no significant differences in the repellent efficacy of the 4 camouflage colors: white, green, loam, and sand.

Host-seeking behavior and seasonal abundance of Culicoides paraensis (Diptera: Ceratopogonidae) in Brazil.

The ecology of Culicoides paraensis was studied with human bait collections at an agricultural research station near Belém and within 2 neighborhoods of Belém, Brazil, from 1977 to 1978. From collections conducted along transects that were centered on a house, we found most dense populations of host-seeking midges within and near the house. Host-seeking activity was least in areas fully exposed to sunlight compared to the levels of activity indoors and in shaded areas outside. Numbers of flies biting under shade trees and within the house increased during intervals of rain; concomitantly the levels of activity decreased in open areas. Seasonal population densities correlated with the pattern of rainfall, with a 2-month lag due to the long maturation time of immature C. paraensis. The effects of temperature and humidity on host-seeking activity are discussed.