Lack of Serologic Evidence of Infection Among Health Care Personnel and Other Contacts of First 2 Confirmed Patients With COVID-19 in Illinois, 2020.

OBJECTIVES: Widespread global transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (COVID-19), continues. Many questions remain about asymptomatic or atypical infections and transmission dynamics. We used comprehensive contact tracing of the first 2 confirmed patients in Illinois with COVID-19 and serologic SARS-CoV-2 antibody testing to determine whether contacts had evidence of undetected COVID-19. METHODS: Contacts were eligible for serologic follow-up if previously tested for COVID-19 during an initial investigation or had greater-risk exposures. Contacts completed a standardized questionnaire during the initial investigation. We classified exposure risk as high, medium, or low based on interactions with 2 index patients and use of personal protective equipment (PPE). Serologic testing used a SARS-CoV-2 spike enzyme-linked immunosorbent assay on serum specimens collected from participants approximately 6 weeks after initial exposure to either index patient. The 2 index patients provided serum specimens throughout their illness. We collected data on demographic, exposure, and epidemiologic characteristics. RESULTS: Of 347 contacts, 110 were eligible for serologic follow-up; 59 (17% of all contacts) enrolled. Of these, 53 (90%) were health care personnel and 6 (10%) were community contacts. Seventeen (29%) reported high-risk exposures, 15 (25%) medium-risk, and 27 (46%) low-risk. No participant had evidence of SARS-CoV-2 antibodies. The 2 index patients had antibodies detected at dilutions >1:6400 within 4 weeks after symptom onset. CONCLUSIONS: In serologic follow-up of the first 2 known patients in Illinois with COVID-19, we found no secondary transmission among tested contacts. Lack of seroconversion among these contacts adds to our understanding of conditions (ie, use of PPE) under which SARS-CoV-2 infections might not result in transmission and demonstrates that SARS-CoV-2 antibody testing is a useful tool to verify epidemiologic findings.

Inappropriate Administration of Rabies Postexposure Prophylaxis, Cook County, Illinois, USA.

Administration of rabies postexposure prophylaxis (PEP) is expensive and time-consuming. In suburban Cook County, Illinois, USA, administration of 55.5% of PEP treatments did not follow Advisory Committee on Immunization Practices guidelines. Health department consultation lowered the odds of inappropriate PEP administration by 87%. Providers should consult their health department before prescribing PEP.

Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States.

Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19.

First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first detected in China in December, 2019. In January, 2020, state, local, and federal public health agencies investigated the first case of COVID-19 in Illinois, USA. METHODS: Patients with confirmed COVID-19 were defined as those with a positive SARS-CoV-2 test. Contacts were people with exposure to a patient with COVID-19 on or after the patient's symptom onset date. Contacts underwent active symptom monitoring for 14 days following their last exposure. Contacts who developed fever, cough, or shortness of breath became persons under investigation and were tested for SARS-CoV-2. A convenience sample of 32 asymptomatic health-care personnel contacts were also tested. FINDINGS: Patient 1-a woman in her 60s-returned from China in mid-January, 2020. One week later, she was hospitalised with pneumonia and tested positive for SARS-CoV-2. Her husband (Patient 2) did not travel but had frequent close contact with his wife. He was admitted 8 days later and tested positive for SARS-CoV-2. Overall, 372 contacts of both cases were identified; 347 underwent active symptom monitoring, including 152 community contacts and 195 health-care personnel. Of monitored contacts, 43 became persons under investigation, in addition to Patient 2. These 43 persons under investigation and all 32 asymptomatic health-care personnel tested negative for SARS-CoV-2. INTERPRETATION: Person-to-person transmission of SARS-CoV-2 occurred between two people with prolonged, unprotected exposure while Patient 1 was symptomatic. Despite active symptom monitoring and testing of symptomatic and some asymptomatic contacts, no further transmission was detected. FUNDING: None.

Using an Emergency Department Syndromic Surveillance System to Evaluate Reporting of Potential Rabies Exposures, Illinois, 2013-2015.

OBJECTIVES: Mandatory reporting of potential rabies exposures and initiation of postexposure prophylaxis (PEP) allow local health authorities to monitor PEP administration for errors. Our objectives were to use an emergency department (ED) syndromic surveillance system to (1) estimate reporting compliance for exposure to rabies in suburban Cook County, Illinois, and (2) initiate interventions to improve reporting and reassess compliance. METHODS: We queried ED records from 45 acute care hospitals in Cook County and surrounding areas from January 1, 2013, through June 30, 2015, for chief complaints or discharge diagnoses pertaining to rabies, PEP, or contact with a wild mammal (eg, bat, raccoon, skunk, fox, or coyote). We matched patients with ≥1 ED visit for potential rabies exposure to people with potential rabies exposure reported to the Cook County Department of Public Health. We considered nonmatches to have unreported exposures. We then initiated active surveillance in July 2015, disseminated education on reporting requirements in August and September 2015, and reassessed reporting completeness from July 2015 through February 2016. RESULTS: Of 248 patients with rabies-related ED visits from January 2013 through June 2015, 63 (25.4%) were reported. After interventions were implemented to increase reporting compliance, 53 of 98 (54.1%) patients with rabies-related ED visits from July 2015 through February 2016 were reported. Patients with ED visits for potential rabies exposure were twice as likely to be reported postintervention than preintervention (risk ratio = 2.1; 95% CI, 1.6-2.8). The volume of potential rabies exposure cases reported to the health department from July 2015 through February 2016 increased by 252% versus the previous year. CONCLUSIONS: Potential rabies exposures and PEP initiation are underreported in suburban Cook County. ED syndromic surveillance records can be used to estimate reporting compliance and conduct active surveillance.

Outbreak of Pantoea agglomerans Bloodstream Infections at an Oncology Clinic-Illinois, 2012-2013.

OBJECTIVE To determine the source of a healthcare-associated outbreak of Pantoea agglomerans bloodstream infections. DESIGN Epidemiologic investigation of the outbreak. SETTING Oncology clinic (clinic A). METHODS Cases were defined as Pantoea isolation from blood or catheter tip cultures of clinic A patients during July 2012-May 2013. Clinic A medical charts and laboratory records were reviewed; infection prevention practices and the facility's water system were evaluated. Environmental samples were collected for culture. Clinical and environmental P. agglomerans isolates were compared using pulsed-field gel electrophoresis. RESULTS Twelve cases were identified; median (range) age was 65 (41-78) years. All patients had malignant tumors and had received infusions at clinic A. Deficiencies in parenteral medication preparation and handling were identified (eg, placing infusates near sinks with potential for splash-back contamination). Facility inspection revealed substantial dead-end water piping and inadequate chlorine residual in tap water from multiple sinks, including the pharmacy clean room sink. P. agglomerans was isolated from composite surface swabs of 7 sinks and an ice machine; the pharmacy clean room sink isolate was indistinguishable by pulsed-field gel electrophoresis from 7 of 9 available patient isolates. CONCLUSIONS Exposure of locally prepared infusates to a contaminated pharmacy sink caused the outbreak. Improvements in parenteral medication preparation, including moving chemotherapy preparation offsite, along with terminal sink cleaning and water system remediation ended the outbreak. Greater awareness of recommended medication preparation and handling practices as well as further efforts to better define the contribution of contaminated sinks and plumbing deficiencies to healthcare-associated infections are needed. Infect Control Hosp Epidemiol 2017;38:314-319.

Measles Outbreak in a Child Care Center, Cook County, Illinois, 2015.

BACKGROUND: During January-February 2015, Cook County Department of Public Health led an investigation of a measles outbreak predominantly affecting infants at a child care center who were too young for routine immunization with measles-mumps-rubella (MMR) vaccine. METHODS: Measles cases and contacts were investigated by Illinois public health officials. Cases were isolated for 4 days after rash onset. Exposed healthcare workers and child care center staff were required to provide documentation of receipt of 2 doses of MMR vaccine or laboratory evidence of immunity to return to work. Susceptible contacts were actively monitored for 21 days after exposure and provided postexposure prophylaxis (PEP) if certain criteria were met. RESULTS: Fifteen confirmed measles cases were identified; 12 (80%) occurred in infants who were attendees of a child care center. Clinical misdiagnosis of 1 case allowed for continued transmission within the center. Twelve (86%) of 14 exposed infants at the child care center were diagnosed with measles; no other attendees or staff were infected. Five cases visited outpatient pediatric clinics during their infectious period, exposing 33 infants. Six exposed child care center staff and 3 healthcare workers did not have documentation of immunity available and were excluded from work until this was obtained. No healthcare-associated transmission was identified. Ninety-one contacts were actively monitored and 20 received PEP. CONCLUSIONS: This outbreak underscores the vulnerability of infants to measles, the need for early consideration of measles in susceptible patients presenting with a febrile rash illness, and the importance of immunity among individuals working closely with infants.

Impact of port of entry referrals on initiation of follow-up evaluations for immigrants with suspected tuberculosis: Illinois.

US-bound immigrants with suspected non-infectious TB are encouraged to be medically re-evaluated after arrival in the United States. We evaluated the Centers for Disease Control and Prevention's immigrant referral process, designed to facilitate timely post-arrival evaluations. Over 1,200 immigrants with suspected TB arriving during October 1, 2008-September 30, 2010 were identified. In 2011, differences in days to evaluation initiation were assessed by referral type using survival analysis and Cox proportional hazard models. Among those receiving any referral, median time to post-arrival evaluation was significantly lower compared with immigrants receiving no referral (16 vs. 69 days, respectively; p < 0.0001). After adjusting for the covariates, immigrants receiving any referral initiated follow-up at 4 times the rate (adjusted hazard ratio = 4.0; p < 0.0001) of those receiving no referral. Implementing a referral system at US ports of entry will improve timeliness and increase the proportion of immigrants initiating domestic evaluation.

Acute hepatitis B outbreaks related to fingerstick blood glucose monitoring in two assisted living facilities.

OBJECTIVES: To establish the etiology for outbreaks of hepatitis B virus (HBV) infections at two assisted living facilities (ALFs) and devise appropriate control measures. DESIGN: Multisite outbreak investigations, retrospective cohort. SETTING: Two ALFs in Illinois. PARTICIPANTS: Facility A residents (n=120) and Facility B residents (n=105) and nursing staff (n=6). MEASUREMENTS: For Facility A, a retrospective cohort study to identify risk factors for HBV infection through serological testing of all residents and a medical record extraction. For Facility A and B, investigation of fingerstick blood glucose monitoring techniques. For Facility B, serological HBV testing of nurses and residents receiving fingerstick blood glucose monitoring. RESULTS: At Facility A, five confirmed acute, two probable acute, and one probable chronic HBV infections were identified in the 109 residents tested. All of the eight identified residents with HBV infection had diabetes mellitus. HBV deoxyribonucleic acid (DNA) sequences from the chronic and acute cases were identical. Transmission of HBV was associated with fingerstick blood glucose monitoring (relative risk (RR)=28.5, 95% confidence interval (CI)=1.6-498; P<.001) and insulin injections (RR=7.4, 95% CI=1.3-40.8; P=.03). At Facility B, seven of 21 residents (33.3%) receiving fingerstick blood glucose monitoring had evidence of recent HBV infection. CONCLUSION: Nurses probably transmitted HBV infection from resident to resident during fingerstick blood glucose monitoring in two separate ALFs, causing outbreaks. Awareness of the high risk for HBV transmission during procedures for the care of diabetes mellitus was limited. Following established infection control measures is critical to prevent spread of this highly contagious virus.

Demographic characteristics and survival with AIDS: health disparities in Chicago, 1993-2001.

OBJECTIVES: We examined correlations between survival and race/ethnicity, age, and gender among persons who died from AIDS-related causes. METHODS: We estimated survival among 11 022 persons at 12, 36, and 60 months after diagnosis with AIDS in 1993 through 2001 and reported through 2003 to the Chicago Department of Public Health. We estimated hazard ratios (HRs) by demographic and risk characteristics. RESULTS: All demographic groups had higher 5-year survival rates after the introduction of highly active retroviral therapy (1996-2001) than before (1993-1995). The HR for non-Hispanic Blacks to Whites was 1.18 in 1993 to 1995 and 1.51 (P < .01) in 1996 to 2001. The HR for persons 50 years or older to those younger than 30 years was 1.63 in 1993-1995 and 2.28 (P < .01) in 1996-2001. The female-to-male HR was 0.90 in 1993-1995 and 1.20 (P < .02) in 1996-2001. CONCLUSIONS: The risk of death was higher for non-Hispanic Blacks and Hispanics than for non-Hispanic Whites. Interventions are needed to increase early access to care for disadvantaged groups.

Diagnostic evaluation of newly arrived asymptomatic refugees with eosinophilia.

BACKGROUND: Refugees may arrive for resettlement with asymptomatic parasitic infections, and eosinophilia may be the only clue to the presence of infection. Our aim was to determine the prevalence of eosinophilia and develop a standardized approach to the evaluation of asymptomatic refugees with eosinophilia. METHODS: We reviewed the medical records of refugees seen from October 1998 through May 2002 at Boston Medical Center. Data examined included age, country of origin, absolute eosinophil count, results of stool ova and parasite testing, and results of serological testing for Strongyloides stercoralis, Schistosoma species, and filaria. RESULTS: Eosinophilia--defined as an absolute eosinophil count of >or=450 cells/microL--was present in 266 (12%) of 2224 refugees. Patients with eosinophilia ranged in age from 2 months to 81 years and had arrived from Africa, Eastern Europe, Southeast Asia, South America, the Caribbean, and the Middle East. Absolute eosinophil counts ranged from 450 to 3224 cells/microL. Pathogens were identified in stool samples of 76 (29%) of 265 patients. Serological testing for S. stercoralis, Schistosoma species, and/or filaria was done for 120 (45%) of 266 patients. Results of serological testing were positive for S. stercoralis in 45 (39%) of 115 patients, for Schistosoma species in 15 (22%) of 67 patients, and for filaria in 18 (51%) of 35 patients. Serological evidence of parasitic infection was seen at all levels of eosinophilia and in patients with and without pathogens identified in their stool samples. CONCLUSIONS: Systematic evaluation for parasites in asymptomatic, newly arrived refugees with eosinophilia should include stool ova and parasite examination, serological examination for S. stercoralis for all patients, and serological examination for Schistosoma species and filaria in patients from regions where these organisms are endemic.

Intrapulmonary percussive ventilation vs incentive spirometry for children with neuromuscular disease.

BACKGROUND: Pulmonary infections can be life threatening for children with neuromuscular diseases who have impaired ability to clear secretions. Intrapulmonary percussive ventilation (IPV) is a pneumatic device that delivers air and aerosol to the lungs at frequencies of 200 to 300 cycles per minute at peak pressures from 20 to 40 cm H(2)O. Anecdotal reports and pilot studies show its safety and effectiveness in mobilizing secretions in patients with cystic fibrosis. OBJECTIVE: To test the hypothesis that IPV used in a pulmonary program for adolescents with neuromuscular disease would reduce the number of days of antibiotic use for pulmonary infection. METHODS: A randomized, controlled study was conducted to compare efficacy of IPV with incentive spirometry (IS) in reducing number of days of antibiotic use in adolescents with neuromuscular disease. The secondary endpoints were the number of respiratory infections, hospitalizations, and school days missed. RESULTS: A total of 18 patients were enrolled (9 IPV, 9 IS). Antibiotic use was significantly higher with IS (24/1000 patient-days) compared with IPV (0/1000 patient-days), (incidence rate ratio, 43; 95% confidence interval, 6-333). The IS group spent more days hospitalized (4.4/1000 patient-days vs 0/1000 patient-days) than the IPV group (incidence rate ratio, 8.5; 95% confidence interval, 1.1-67). The IPV group had 0 episodes of pneumonia or bacterial bronchitis compared with 3 events in the IS group, although this did not meet statistical significance. CONCLUSION: Intrapulmonary percussive ventilation as part of a preventive pulmonary regimen reduced days of antibiotic use and hospitalization for respiratory illness in adolescents with neuromuscular disease.

Comparison of varicella history with presence of varicella antibody in refugees.

OBJECTIVE: To compare history of varicella with presence of varicella antibody in refugees and to determine the number of unnecessary doses of varicella vaccine administered to refugee children > or =7 years of age. METHODS: Cross-sectional study of refugees > or =7 years of age evaluated between July 2000 and October 2002 by the Refugee Health Assessment Program at Boston Medical Center. We recorded age, sex, region of origin, varicella history, and results of serologic testing for presence of varicella antibodies. RESULTS: Eighty-eight percent of individuals with a positive history of clinical varicella had varicella antibody; 65% of those with negative history had varicella antibody. The positive predictive value of a history of clinical varicella was 88%. The negative predictive value of a negative history was 39%. CONCLUSION: History of varicella was not a reliable predictor of presence or absence of varicella antibody in refugees. Strategies to protect individuals with negative histories of clinical varicella include immediate immunization or serotesting followed by immunization of susceptible individuals. Relying on positive histories of clinical varicella may leave some individuals susceptible to varicella and impede efforts to eliminate varicella in the US.

Assessing missed opportunities for HIV testing in medical settings.

BACKGROUND: Many HIV-infected persons learn about their diagnosis years after initial infection. The extent to which missed opportunities for HIV testing occur in medical evaluations prior to one's HIV diagnosis is not known. DESIGN: We performed a 10-year retrospective chart review of patients seen at an HIV intake clinic between January 1994 and June 2001 who 1). tested positive for HIV during the 12 months prior to their presentation at the intake clinic and 2). had at least one encounter recorded in the medical record prior to their HIV-positive status. Data collection included demographics, clinical presentation, and whether HIV testing was recommended to the patient or addressed in any way in the clinical note. Prespecified triggers for physicians to recommend HIV testing, such as specific patient characteristics, symptoms, and physical findings, were recorded for each visit. Multivariable logistic regression was used to identify factors associated with missed opportunities for discussion of HIV testing. Generalized estimating equations were used to account for multiple visits per subject. RESULTS: Among the 221 patients meeting eligibility criteria, all had triggers for HIV testing found in an encounter note. Triggers were found in 50% (1702/3424) of these 221 patients' medical visits. The median number of visits per patient prior to HIV diagnosis to this single institution was 5; 40% of these visits were to either the emergency department or urgent care clinic. HIV was addressed in 27% of visits in which triggers were identified. The multivariable regression model indicated that patients were more likely to have testing addressed in urgent care clinic (39%), sexually transmitted disease clinic (78%), primary care clinics (32%), and during hospitalization (47%), compared to the emergency department (11%), obstetrics/gynecology (9%), and other specialty clinics (10%) (P <.0001). More recent clinical visits (1997-2001) were more likely to have HIV addressed than earlier visits (P <.0001). Women were offered testing less often than men (P =.07). CONCLUSIONS: Missed opportunities for addressing HIV testing remain unacceptably high when patients seek medical care in the period before their HIV diagnosis. Despite improvement in recent years, variation by site of care remained important. In particular, the emergency department merits consideration for increased resource commitment to facilitate HIV testing. In order to detect HIV infection prior to advanced immunosuppression, clinicians must become more aware of clinical triggers that suggest a patient's increased risk for this infection and lower the threshold at which HIV testing is recommended.

Health-related quality of life of patients with HIV disease: impact of hepatitis C coinfection.

Health-related quality of life (HRQOL) is diminished in patients infected with both hepatitis C virus (HCV) and human immunodeficiency virus (HIV), but the effect of HIV/HCV coinfection on HRQOL is unknown. We compared the HRQOL of urban HIV/HCV coinfected patients with that of patients infected with either HCV or HIV alone. We then compared the 3 groups with a US population sample, adjusting for demographic characteristics. HRQOL for the group of HIV/HCV coinfected patients was statistically similar to that of HRQOL in patients with either HCV or HIV alone, but the 3 groups had a significantly decreased HRQOL than did the adjusted US population. Using multivariate techniques, we determined that age, unemployment, injection drug use, and depression were associated with impaired HRQOL. These findings underscore the importance of a multidisciplinary approach to the treatment of these patient populations.

Self-assessment of tuberculosis infection risk by urban adolescents.

OBJECTIVE: To examine self-reported risks for tuberculosis (TB) infection relative to recalled receipt of TB risk assessments and skin testing in a cohort of urban adolescents. DESIGN, SETTING, AND PARTICIPANTS: Survey of ninth graders and their parents from 3 inner-city public high schools. Students and parents were asked about TB infection risk factors, frequency of routine health maintenance visits, TB risk assessments, and TB skin testing. Students were surveyed in schools and asked to take home surveys for their parents to complete. RESULTS: Of 578 students (95.4% response rate), 436 (75.4%) claimed at least 1 TB infection risk factor. Although 468 (81.0%) of the students reported having a regular checkup within the past year, only 128 (22.1%) recalled being asked TB risk assessment questions and only 231 (40.0%) recalled undergoing skin testing during the previous year. Parent response rates were low (n = 207; 34.2% response rate), and parents of students attending bilingual classes were overrepresented among responders. There were no significant relationships between self-indicating a risk for TB infection and self-recollection of having undergone TB screening, having had a tuberculin skin test placed, or having had a regular checkup, with the exception that students who responded that they lived with a tuberculin skin test-positive person were 38% less likely to recall having had a tuberculin skin test themselves (n = 21; 95% confidence interval, 24%-50%). The level of agreement between student and parent responses in the 207 survey pairs available for analysis ranged from poor to good (kappa = 0.07-0.61) on individual questions. CONCLUSIONS: These observations suggest that most at-risk adolescents in this city are not being adequately screened for TB infection. Programs to improve health care provider acceptance of targeted testing principles or to reengage in school-based screening of students with certain risk factors seem necessary.

Cost-effectiveness of serotesting compared with universal immunization for varicella in refugee children from six geographic regions.

BACKGROUND: It is unknown whether it is more cost-effective to test for varicella antibody or to immunize without testing in immigrant populations. The reliability of history of varicella disease is also unclear. METHODS: The prevalences of varicella antibody in immigrant children from six regions of the world were used in a cost-effectiveness model to calculate the antibody prevalence above which it is more cost-effective to test rather than to immunize. History of varicella disease was obtained from chart review. We calculated the positive and negative predictive values of varicella history by age group and region. RESULTS: The prevalence of varicella antibody above which it is more cost-effective to test than to immunize was 34% for children less than 13 years old and 17% for those aged 13 years and older. Overall, the positive predictive value of varicella history was 93-100% and the negative predictive value of varicella history was 28-66% among the six geographic regions. CONCLUSION: Immunization without serotesting was cost-effective in children <5 years of age. Testing prior to immunization was cost-effective in children 5 years of age and older. History of varicella was a good predictor of the presence of antibody to varicella, whereas a negative history was a poor predictor of the absence of antibody to varicella.

Screening for sexually transmitted infections in substance abuse treatment programs.

OBJECTIVES: We evaluated the prevalence of the sexually transmitted infections (STIs) chlamydia and gonorrhea in clients at a methadone maintenance program and a residential detoxification program. METHODS: We collected urine specimens for chlamydia and gonorrhea ligase chain reaction testing and assessed sexual, substance abuse and STI histories. RESULTS: Of 700 subject assessments, 490 occurred among detoxification clients and 210 in methadone maintenance. Chlamydia trachomatis was detected in 5/700 (0.9, 95% CI=0.1-1.8%) and Neisseria gonorrhoeae in none. All chlamydia infected subjects were recruited from the detoxification program. Subjects reported high risk sexual behavior: 17% reported commercial sex exchange, and 22% reported inconsistent condom use with multiple sexual partners during the prior 2 months. CONCLUSION: Based on prevalence in Boston, MA, universal screening for STI in substance abuse treatments programs is not warranted. However, routine screening for younger substance abusers and in communities with high prevalence should be considered.

Seroprevalence of measles, rubella, and varicella in refugees.

Immigrant children who enter the United States without immunization records may be required to receive vaccines for diseases to which they are already immune or for which they have previously received immunization. We tested 669 newly arrived refugees (age range, 0-20 years) for antibody to measles, rubella, and varicella, to determine the seroprevalence of antibodies to these diseases in this group of immigrants. Five hundred forty-nine (82%) of 669 patients had antibody to measles, 545 (82%) of 668 had antibody to rubella, and 430 (64%) of 668 had antibody to varicella. Antibody to all 3 diseases increased with increasing age. No clinically significant differences in presence of antibody were noted by region of origin.