Joann Schulte

Maternal Health and Child Survival: Opportunities to Protect Both Women and Children from the Adverse Consequences of Reproductive Tract Infections

Although AIDS, human papilloma virus infection, and other newly identified sexually transmitted diseases (STDs) are attracting much attention, we must remain vigilant to the serious sequelae of conventional STDs, especially in areas where traditional “venereal diseases” have not been controlled. The problems currently associated with syphilis and gonorrhea during pregnancy in various parts of the world are strikingly reminiscent of those faced by the Western world in the early 1900s. Particularly compelling is the need to control fetal wastage, prematurity, and complications in neonates caused by reproductive tract infections (RTIs), especially in Third World countries.

Evaluation of transmission of Mycobacterium tuberculosis in a pediatric setting

OBJECTIVE To determine the extent of transmission of Mycobacterium tuberculosis to pediatric patients exposed to a pediatrician with smear- and culture-positive pulmonary tuberculosis (TB). METHODS Clinic billing and hospital admission records were used to identify patients seen during the pediatricians infectious period. Patients were notified of the potential exposure and were offered screening. RESULTS A total of 1416 pediatric patients were identified as exposed. Of the 606 who completed screening, 12 (2%) had a skin test result > or = 10 mm, 2 (0.3 had a result 5 to 9 mm, and 592 (98%) had a negative test result (0 to 4 mm). No active TB cases were identified. Of the 14 children with a skin test result > or = 5 mm, 7 were U.S.-born and had no other risk for a positive skin test. The remaining seven had either been exposed to another person with infections TB or were from countries with a high prevalence of TB. CONCLUSION We found evidence of limited transmission of Mycobacterium tuberculosis in the outpatient pediatric setting. Despite extensive resources dedication, only 43% of exposed children completed screening. In similar situations decision should balance the responsibility to protect children exposed to Mycobacterium tuberculosis with other public health priorities and available resources.

HSV-1 and HSV-2 seroprevalence in the united states among asymptomatic women unaware of any herpes simplex virus infection (Herpevac Trial for Women).

Objectives Recent evidence suggests that the epidemiology of herpes simplex viruses (HSVs) is changing because fewer HSV-1 infections are acquired in childhood and increased sexual transmission of HSV-1 is reported. The objective of the study was to assess the seroprevalence of type-specific antibodies to HSV-1 and HSV-2 in the United States. Methods We used the Western blot antibody screening data from a large phase III vaccine efficacy trial (Herpevac Trial for Women) to assess the seroprevalence of type-specific antibodies to HSV-1 and HSV-2 in the United States. Results The antibody status of 29,022 women (>31,000 women interviewed and then had their blood drawn for the HSV testing [29,022 women]) between the ages of 18 and 30 years in the United States revealed that increasing age was associated with increasing seroprevalence to HSV. Overall, in asymptomatic women unaware of any HSV infection, HSV-1/-2 status was positive/negative in 45%, negative/positive in 5%, positive/positive in 7%, negative/negative in 38%, and indeterminate in 5%. HSV-1 infections were more common in Hispanic and non-Hispanic black women and in the US northeast and in individuals living in urban areas. HSV-2 was more common in non-Hispanic black women, the US south, and in urban areas. Conclusions Seronegative status for both HSV-1 and HSV-2 was the second most common finding after positive antibody to HSV-1 but negative antibody to HSV-2. Despite recent changes in genital herpes epidemiology, most women acquired HSV-1 but not HSV-2 infections before 18 years of age. Among participants screened for study participation and who were unaware of any HSV infection, progressively higher prevalence of the HSV-1 or HSV-2 antibody was observed in older subjects. Many women who test positive for HSV-1 and/or HSV-2 are unaware of their status.

Florida Epidemic Intelligence Service Program: The First Five Years, 2001–2006

The Florida Epidemic Intelligence Service Program was created in 2001 to increase epidemiologic capacity within the state. Patterned after applied epidemiology training programs such as the Centers for Disease Control and Prevention Epidemic Intelligence Service and the California Epidemiologic Investigation Service, the two-year postgraduate program is designed to train public leaders of the future. The long-term goal is to increase the capacity of the Florida Department of Health to respond to new challenges in disease control and prevention. Placement is with experienced epidemiologists in county health departments/consortia. Fellows participate in didactic and experiential components, and complete core activities for learning as evidence of competency. As evidenced by graduate employment, the program is successfully meeting its goal. As of 2006, three classes (n=18) have graduated. Among graduates, 83% are employed as epidemiologists, 67% in Florida. Training in local health departments and an emphasis on graduate retention may assist states in strengthening their epidemiologic capacity.

Tuberculosis skin testing among HIV-infected pregnant women in Miami, 1995 to 1996

OBJECTIVE: Approximately 6000 women deliver annually at Jackson Memorial Hospital in Miami, where 2.4% of women has human immunodeficiency virus (HIV) and 60% is foreign-born. We conducted a retrospective review of prenatal records among HIV-infected women to evaluate tuberculin skin testing (TST).STUDY DESIGN: We determined how many women had TSTs placed and read, and the TST results.RESULTS: We identified 207 HIV-infected women, 87% of such women delivering in 1995 to 1996. Most did not know their HIV status before seeking prenatal care (109, 54%) and most (176, 85%) had TSTs done. Of the women, 45 had positive TSTs, 96 had negative TSTs, and 35 were anergic. Most results were not recorded using millimeters of induration. Two women (1%) had active tuberculosis (TB) disease.CONCLUSION: Overall, 21% of all HIV-infected women had positive TSTs and 1% had active TB disease. Focused TB skin testing should be part of routine prenatal care in clinics serving populations at high-risk for TB, such as those with HIV infection and the foreign-born.

Maternal and Congenital Brucellosis in Texas: Changing Travel Patterns and Laboratory Implications

Brucellosis is an uncommon disease in the US, but Texas reports approximately a third of cases. We review the investigation of a pair of mother-infant cases that were unique in the demographics, the nature of travel exposure and the resulting brucellosis exposure in a hospital’s delivery suite and laboratory. These cases illustrate the changing nature of travel and the need to obtain a relevant travel history and adequate laboratory procedures. Clinicians and laboratory workers in Texas need to understand that brucellosis remains an endemic disease, but that its epidemiology is changing.

Tuberculosis Cases Reported Among Migrant Farm Workers in the United States, 1993-97

Migrant farm workers (MFWs) are considered a high-risk group for tuberculosis. MFW tuberculosis cases reported to the Centers for Disease Control and Prevention represented 1 percent of all reported tuberculosis cases from 1993 to 1997. Most of these cases (70 percent) were reported from Florida, Texas, and California. MFW tuberculosis cases were more likely to be male, foreign-born, or Hispanic and to have a history of alcohol abuse and homelessness than were non-MFWs. Most (79 percent) foreign-born MFWs were from Mexico. HIV status was poorly reported, with results available for only 28 percent of MFW and 33 percent of non-MFW cases. Of the MFWs tested, 28 percent were HIV infected, whereas 34 percent of non-MFWs were HIV infected. Twenty percent of MFWs move or are lost to follow-up before completing therapy; these cases pose a management challenge for the nations tuberculosis control efforts.

Starting Statins — Polling Results

In April, we invited you to share your opinions about the use of statins in persons considered to be at risk according to the new American Heart Association and American College of Cardiology guidelines. We now present the polling results.

How we didn't clean up until we washed our hands: shigellosis in an elementary and middle school in North Texas.

Background Shigella outbreaks often continue for months and are linked frequently to poor hygiene and hand washing. Such outbreaks are found often in day care facilities, but rarely are reported in schools. We present the investigation of an outbreak in autumn 2007 at a building that housed an elementary school and a middle school in separate wings in a small Texas city north of Dallas-Fort Worth. Methods We canvassed local hospitals, school attendance records, and physician offices for cases. Ill individuals were interviewed using a standard questionnaire for symptoms, disease onset, and the presence of the illness in an ill person’s household. Results A music teacher was the index case for this outbreak of gastrointestinal illness caused by S. sonnei. Ten percent of the students in the school building were ill, and 15 households had secondary cases. Installing liquid soap in dispensers in student restrooms was the initial control measure, followed by sustained instruction in hand washing, scheduled hand washing times, and monitored cleaning and disinfection procedures for surfaces and inanimate objects. Enhanced surveillance detected no new cases in the school district. Conclusions Appropriate soap supplies and repeated instruction in hand washing and its monitoring were needed to control the outbreak.

Management of Type 2 Diabetes — Polling Results

In October, we invited you to share your opinions about the effective management of type 2 diabetes. We now present the polling results.