Outbreak of measles in an unvaccinated population, British Columbia, 2014.

BACKGROUND: Although Canada eliminated endemic measles in 1998, outbreaks are expected to occur periodically through import-related transmission in geographically clustered unvaccinated communities. In the spring of 2014, in association with an outbreak in the Netherlands, a large measles outbreak occurred in British Columbia in a community unvaccinated for religious reasons. METHODS: Case finding with assistance of the local community, its school and religious leaders and local health care providers was conducted to identify confirmed, probable and suspect cases. Measles control guidelines were implemented with limited uptake of measles-containing vaccine (MCV) but higher adherence with infection control measures and travel restrictions. RESULTS: A total of 433 cases (325 confirmed and 108 probable) were identified. Rash onset ranged from February 22 to June 9, with 98% during March and April. Fifty-seven percent of cases were students of one school. The median age of cases was 11 years and 68% of cases were aged five to 19 years. Ninety-nine percent of cases were unvaccinated. One case had encephalitis and recovered. Only five cases occurred outside of the affected community. Genotyping results were consistent with importation from the Netherlands outbreak. CONCLUSION: This outbreak in a community with low-vaccination rates affected largely the pediatric-age population, compatible with acquisition of measles immunity by adult members due to prior wild-type measles infection. Although vaccine hesitancy persisted in this population, containment of the outbreak was facilitated by a high degree of community cooperation with infection control measures and restriction of movement.

Using the glucagon test to predict hypoglycemia in anorexia nervosa.

BACKGROUND: Hypoglycemia is an important but uncommon complication of anorexia nervosa (AN) that usually occurs when refeeding begins. The response to an iv bolus of glucagon has been used to investigate hypoglycemia, but not in AN. There are no published standards in AN to screen for hypoglycemia, to treat hypoglycemia, or for the response of the fasting blood sugar to an intravenous bolus of glucagon. METHOD: We report the change in blood glucose that resulted from bolus iv injection of glucagon in a case series of 9 patients with AN who were suspected of having experienced hypoglycemia. Our standard protocol for the glucagon test in AN is measurement of blood sugar at baseline, 10 minutes, and 20 minutes following a 1.0 mg iv bolus of glucagon in the fasting state. We take as normal any blood glucose measurement of 7.0 mmol/l or greater. RESULTS: Five of nine patients had abnormal tests. The body mass index (BMI) was not different in those who had normal compared to those who had abnormal tests. CONCLUSION: The glucagon test may be of use to predict the likelihood of developing hypoglycemia in AN. However, a larger study is required to define the normal response to the glucagon test in AN.

Hypomagnesemia during refeeding in anorexia nervosa.

BACKGROUND: Magnesium deficiency can cause weakness, constipation, seizures and arrhythmias. We frequently observe hypomagnesemia during refeeding in AN. OBJECTIVE: To determine the incidence and time of onset of hypomagnesemia during refeeding in anorexia nervosa (AN). DESIGN: Observational cohort study. SETTING: University teaching hospital in Vancouver, Canada. PATIENTS: Patients with AN (DSM-IV criteria) admitted for refeeding. INTERVENTION: All patients were admitted for supervised refeeding by meal support, in conjunction with our standard medical and psychological treatment. MEASUREMENTS: Serum magnesium was measured daily for 5 days and then 3 times a week. RESULTS: Fifty patients were admitted for an average of 24 days. Sixty percent (30/50) had low serum magnesium during their admission. Hypomagnesemia was present on admission in 16% but as late as the third week of refeeding in others. CONCLUSION: Serum magnesium should be measured on admission and rechecked weekly for the first 3 weeks of refeeding as a minimum.