Laura S. Callinan

Fatal Rocky Mountain Spotted Fever in the United States, 1999–2007

Death from Rocky Mountain spotted fever (RMSF) is preventable with prompt, appropriate treatment. Data from two independent sources were analyzed to estimate the burden of fatal RMSF and identify risk factors for fatal RMSF in the United States during 1999-2007. Despite increased reporting of RMSF cases to the Centers for Disease Control and Prevention, no significant changes in the estimated number of annual fatal RMSF cases were found. American Indians were at higher risk of fatal RMSF relative to whites (relative risk [RR] = 3.9), and children less than 10 years of age (RR=5.1) [corrected] and adults ≥ 70 years of age (RR = 3.0) were also at increased risk relative to other ages. Persons with cases of RMSF with an immunosuppressive condition were at increased risk of death (RR = 4.4). Delaying treatment of RMSF was also associated with increased deaths. These results may indicate a gap between recommendations and practice.

Kawasaki syndrome and factors associated with coronary artery abnormalities in California.

Background: Kawasaki syndrome (KS) occurs in children <18 years of age and is the leading cause of acquired heart disease among children in the United States. Understanding the epidemiology of KS and factors associated with coronary artery abnormalities (CAA) may lead to timely diagnosis and treatment of KS and could limit CAA. Methods: Epidemiologic characteristics, including risk factors for the development of CAA, among KS and incomplete KS patients <18 years of age with onset during 2000–2009 reported by the California Department of Public Health to the Centers for Disease Control and Prevention’s national KS surveillance system were analyzed. Results: A total of 2056 KS and incomplete KS patients <18 years of age were reported during 2000–2009. The median age of patients was 2 years; 60% of patients were male. Of 1818 patients with race information reported, 56% were white and 28% were Asian/Pacific Islander. Ninety-eight percent of patients received intravenous immunoglobulin. Of 1843 patients with information on cardiac complications, 89 (5%) had coronary artery aneurysms and 341 (19%) had CAA. Characteristics associated with the occurrence of CAA in KS patients were male sex, Asian/Pacific Islander race, age <1 year or 9–17 years, and not receiving intravenous immunoglobulin treatment before the fifth day of illness. Conclusions: This study suggests that intravenous immunoglobulin treatment before the fifth day of illness may reduce CAA among KS patients. Timely diagnosis and treatment of KS continue to be important in reducing the occurrence of cardiac complications.

Increasing trend in the rate of infectious disease hospitalisations among Alaska Native people

Objectives To examine the epidemiology of infectious disease (ID) hospitalisations among Alaska Native (AN) people. Methods Hospitalisations with a first-listed ID diagnosis for American Indians and ANs residing in Alaska during 2001–2009 were selected from the Indian Health Service direct and contract health service inpatient data. ID hospitalisations to describe the general US population were selected from the Nationwide Inpatient Sample. Annual and average annual (2007–2009) hospitalization rates were calculated. Results During 2007–2009, IDs accounted for 20% of hospitalisations among AN people. The 2007–2009 average annual age-adjusted ID hospitalisation rate (2126/100,000 persons) was higher than that for the general US population (1679/100,000; 95% CI 1639–1720). The ID hospitalisation rate for AN people increased from 2001 to 2009 (17%, p<0.001). Although the rate during 2001–2009 declined for AN infants (<1 year of age; p=0.03), they had the highest 2007–2009 average annual rate (15106/100,000), which was 3 times the rate for general US infants (5215/100,000; 95% CI 4783–5647). The annual rates for the age groups 1–4, 5–19, 40–49, 50–59 and 70–79 years increased (p<0.05). The highest 2007–2009 age-adjusted average annual ID hospitalisation rates were in the Yukon-Kuskokwim (YK) (3492/100,000) and Kotzebue (3433/100,000) regions; infant rates were 30422/100,000 and 26698/100,000 in these regions, respectively. During 2007–2009, lower respiratory tract infections accounted for 39% of all ID hospitalisations and approximately 50% of ID hospitalisations in YK, Kotzebue and Norton Sound, and 74% of infant ID hospitalisations. Conclusions The ID hospitalisation rate increased for AN people overall. The rate for AN people remained higher than that for the general US population, particularly in infants and in the YK and Kotzebue regions. Prevention measures to reduce ID morbidity among AN people should be increased in high-risk regions and for diseases with high hospitalisation rates.

Risk factors for diarrhea-associated infant mortality in the United States, 2005-2007.

Background: Diarrhea-associated deaths among US children increased from the mid-1980s through 2006, particularly among infants. Understanding risk factors for diarrhea-associated death could improve prevention strategies. Methods: Records of singleton infants with diarrhea listed anywhere on the death certificate were selected from the US Linked Birth/Infant Death data for the period, 2005 to 2007; characteristics of these infants were compared with those of infants who survived their first year. Results: During 2005 to 2007, 1087 diarrhea-associated infant deaths were reported; 86% occurred among low birth weight (LBW, <2500 g) infants. Compared with normal birth weight (NBW, ≥2500 g) infants, LBW infants had a greater mortality rate (risk ratio: 91.9, 95% confidence interval: 77.4–109.0) and younger median age at death (7 versus 15 weeks, P < 0.0001). The most common codiagnoses for diarrhea-associated death among LBW and NBW infants were sepsis (26%) and volume depletion (20%), respectively. Among LBW infants, 97% of diarrhea-associated deaths occurred in inpatient settings, whereas 27% of NBW infant deaths occurred in outpatient settings and 5.3% in the decedent’s home. Male sex, black race, unmarried status and low 5-minute Apgar score (<7) increased mortality odds among LBW infants whereas, among NBW infants, low 5-minute Apgar score, black race, young maternal age (<25 years) and high birth order (third or more) increased mortality odds. Conclusions: Efforts to reduce diarrhea-associated morality should focus on understanding and improving management of diarrhea in vulnerable LBW infants. For prevention of diarrhea-associated deaths in NBW infants, educating mothers who fit the high-risk profile regarding home hydration therapy and timely access to medical treatment is important.

Kawasaki disease hospitalization rate among children younger than 5 years in California, 2003-2010.

In California, the 2010 annual Kawasaki disease hospitalization rate for children <5 years of age was higher than the rate in 2003. An increasing trend during 2003–2010 appears to be driven by an increase from 2003 to 2006, whereas the Kawasaki disease hospitalization rate remained stable through 2010.

Community Survey after Rabies Outbreaks, Flagstaff, Arizona, USA

Educational outreach should inform the public about dangers of translocation of wild animals and general aspects of rabies.

Evaluation of clinical characteristics of Kawasaki syndrome and risk factors for coronary artery abnormalities among children in Denmark

To examine clinical characteristics, treatment and outcome of Kawasaki syndrome patients in Denmark.

Influenza hospitalizations among american indian/alaska native people and in the United States general population.

American Indian/Alaska Native (AI/AN) people appear to be at increased risk for hospitalization from influenza illness compared with the general US population. Our results should inform policymakers on seasonal epidemic and pandemic influenza preparedness and response.

Reply: To PMID 22565293.

6. Newburger JW, Takahashi M, Gerber MA, et al.; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics. 2004;114:1708–1733.