Pamela S. Diaz

Outbreak of Adenovirus Genome Type 7d2 Infection in a Pediatric Chronic-Care Facility and Tertiary-Care Hospital

An outbreak of adenovirus infection that involved residents of a pediatric chronic-care facility, staff of a tertiary-care hospital, and a nosocomial hospital case was studied. In the pediatric facility, 31 (33%) of 93 residents had adenovirus infection, and 8 died. Risk factors for illness were an age of < 7 years (P = .004), presence of a tracheostomy (P = .015), and residence on a particular floor (P < .001). In the tertiary-care hospital, 36 health care workers had adenovirus infection; 26 (72%) had failed to follow strict contact and droplet precautions, and 30 (83%) continued to care for patients while they had symptoms. A 5-month-old patient with underlying lung disease acquired severe adenovirus infection in this hospital. All isolates were adenovirus type 7 (Ad7). DNA restriction analysis revealed the band patterns of all isolates to be identical and characteristic of the genome type d2. Thus, Ad7d2 caused significant morbidity and mortality in persons in the pediatric chronic-care facility and tertiary-care hospital. This is the first published description of Ad7d2 strains in the United States.

Pharmacokinetics of acyclovir suspension in infants and children.

Eighteen children from 3 weeks to 6.9 years of age were given an oral acyclovir suspension for herpes simplex or varicella-zoster virus infections. Thirteen patients who were 6 months to 6.9 years old received 600 mg/m2 per dose, and three infants and two children less than 2 years old were given 300 mg/m2 per dose. The drug was given four times a day, except to one infant who was treated with three doses a day. Among the 13 children who received the 600-mg/m2 dose, the maximum concentration in plasma (Cmax) was 0.99 +/- 0.38 microgram/ml (mean +/- standard deviation), the time to maximum concentration (Tmax) was 3.0 +/- 0.86 h, the area under the curve (AUC) was 5.56 +/- 2.17 micrograms.h/ml, and the elimination half-life (t1/2) was 2.59 +/- 0.78 h. The three infants less than 2 months of age who received the 300-mg/m2 dose had a Cmax of 1.88 +/- 1.11 micrograms/ml, a Tmax of 4.10 +/- 0.48 h, an AUC of 6.54 +/- 4.32 micrograms.h/ml, and a t1/2 of 3.26 +/- 0.33 h. The acyclovir suspension was well tolerated by young children. No adverse effects requiring discontinuation of the drug occurred.

A Prolonged Outbreak of Shigella sonnei Infections in Traditionally Observant Jewish Communities in North America Caused by a Molecularly Distinct Bacterial Subtype

During 1994-1996, Shigella sonnei outbreaks occurred in 8 North American traditionally observant Jewish communities. These communities remain relatively separate from neighboring populations while maintaining close contact by travel with coreligionists in other cities. Epidemiologic investigations suggested community-to-community transmission via travel. Outbreak-related and control isolates of S. sonnei from each city were subtyped by pulsed-field gel electrophoresis (PFGE) to confirm an epidemiologic linkage between outbreaks. Forty-three (94%) of 46 outbreak-related isolates had closely related PFGE patterns, constituting a single subtype; 33 (94%) of 35 control isolates demonstrated unrelated PFGE patterns. Several patterns differing by < or = 3 bands were identified within the outbreak subtype; one of these accounted for 65% of outbreak isolates. Hence, a single subtype of S. sonnei caused an international outbreak involving 8 traditionally observant Jewish communities, but not neighboring populations, over a 2-year period, suggesting sustained propagation of the epidemic strain between communities.

Molecular Epidemiology of Neisseria meningitidis Isolates from an Outbreak of Meningococcal Disease among Men Who Have Sex with Men, Chicago, Illinois, 2003

ABSTRACT We characterized five Neisseria meningitidis serogroup C isolates from a Chicago outbreak of meningococcal disease that occurred in 2003 among a community of men who have sex with men. Isolates from this outbreak were identical to each other but distinct from the clone that caused a similar outbreak in Canada in 2001.

Intensive Investigation of Bacterial Foodborne Disease Outbreaks: Proposed Guidelines and Tools for the Collection of Dose-Response Data by Local Health Departments

Local health departments that investigate foodborne disease outbreaks do not have adequate guidelines for collecting data that could be used to estimate dose-response relationships, a key component of hazard characterization in quantitative microbial risk assessment. To meet this need, criteria and a questionnaire template for the collection of appropriate dose-response data in the context of outbreaks were developed and applied in the investigation of a point-source outbreak linked to Salmonella serotype Enteritidis in a salmon entrée in February 2000. In this outbreak, the attack rate and risk of hospitalization increased with the amount of salmon entrée consumed, and detailed data were obtained on illness severity measures and host susceptibility factors. Local health departments might consider broadening investigations to include the collection of additional data when investigating outbreaks that have met a specific set of conditions. These data could provide information needed by federal regulatory agencies and other organizations for quantitative microbial risk assessment. Intensive investigations of outbreaks could prevent future illnesses by providing information needed to develop approaches to minimizing risk.

Outbreak of Food-borne Illness Associated with Plant Material Containing Raphides

Background. Many botanicals, particularly ornamental houseplants, contain crystals of calcium oxalate called raphides. Raphides have known toxic effects when chewed, including painful edema, vesicle formation, and dysphagia. We report a food-borne illness outbreak associated with ingestion of raphides. Methods. On February 24, 2003, the Chicago Department of Public Health was notified of multiple cases of oral burning and facial edema associated with lunch in an office cafeteria on February 21. The investigation included a case-control study, interviews with kitchen staff, an environmental inspection, and laboratory analysis of leftover foods. Results. Ten cases were identified, including one admitted to the Intensive Care Unit for potential airway obstruction secondary to severe edema, and another seen by Emergency Department staff for oral edema and pain. Ten of 10 case-patients reported oral stinging and burning, and 8 of 10 reported dysphagia. Four of 10 case-patients continued to have symptoms 2 weeks later. Food from the cafeterias international buffet was consumed by 10 of 10 case-patients and by 1 of 22 control subjects (odds ratio = undefined); each of the 10 case-patients reported consumption of a Chinese vegetable entrée from the international buffet and had no other foods in common. Plant material from the Chinese vegetable entrée contained raphides. Conclusion. This outbreak was associated with consumption of raphides resembling those from common botanicals. Clinicians and public health practitioners should be aware of raphide-containing plants as a potential cause of food-borne illness.

Measles Surveillance in 5 Major US Cities: Chicago, Houston, Los Angeles, Miami, and New York

Endemic measles, if it occurs in the United States, will likely be found in cities, because large populations are required to sustain transmission and importations of measles virus are most frequent in cities. We investigated measles surveillance systems in 5 cities (Chicago, Houston, Los Angeles, Miami, New York City) during 1995-1999. The passive reporting of a measles case activated the systems to look for more cases and to intervene to prevent more cases. During 1995-1999, 1363 suspected measles cases were investigated. Only 58 of these were confirmed as measles (0.24 cases/100000 people), and the majority (57%) of confirmed cases were imported or linked to an importation. Most (83%) suspected cases that met the case definition had a complete case investigation, including a laboratory test for measles. We conclude that surveillance in these 5 cities shows no evidence of endemic measles transmission.

The Safety and Efficacy of High-Dose (HD) Acyclovir (ACV) in Neonatal Herpes Simplex Virus (HSV) Infections

The Safety and Efficacy of High-Dose (HD) Acyclovir (ACV) in Neonatal Herpes Simplex Virus (HSV) Infections

Emergence of Pork Carnitas as a Cause of Foodborne Disease Outbreaks in Chicago

Carnitas are fried chunks of pork frequently served in Mexican-origin households, food service establishments, and social gatherings. During 1995-2002, carnitas emerged as the most frequently implicated vehicle of transmission in foodborne disease outbreaks in Chicago. Five (6%) of 90 foodborne disease outbreaks investigated and reported in Chicago during this period were linked to carnitas, and they accounted for 108 illnesses and 11 hospitalizations. The etiologic agent in four outbreaks was Salmonella, and these outbreaks accounted for 29% of the 14 Salmonella-associated foodborne disease outbreaks in Chicago during this period. Unsafe food handling practices that occurred after cooking were identified as contributing to multiple carnitas-associated outbreaks. Local health departments that serve significant Mexican-origin populations should be aware of carnitas as a potential source of foodborne disease, particularly salmonellosis.

The Analysis of Immunity to Specific Proteins of Herpes Simplex and Varicella Zoster Virus and Its Clinical Applications

Herpes viral glycoproteins are considered likely to be important targets of virus-specific immunity because they are expressed on the membranes of infected cells and because monoclonal antibodies to the surface glycoproteins of human herpes viruses often have neutralizing activity (Corey and Spear, 1986; Friedrichs and Grose, 1984; Keller et al. 1984; Rasmussen et al. 1985). Recent studies in viral immunology also demonstrate a host response to the nonglycosylated, internal or nucleoproteins of several viruses (Townsend et al. 1984; Yewdell et al. 1986). The investigation of immunity to proteins of both herpes simplex virus (HSV) and varicella-zoster virus (VZV) has progressed over the past few years in parallel with the expansion of knowledge about the molecular virology of these herpes viruses. These advances have allowed the mapping of gene sequences for many of the major viral proteins and their expression in plasmids and by transfection of mammalian cells (Davison and Scott, 1986; Pachl et al. 1987). Similarities between HSV and VZV have been defined at the molecular level with the identification of homologies between several gene sequences and, in the case of the HSV gB and VZV gp II, the demonstration of antigenic crossreactivity.