Using internet searches for influenza surveillance.

The Internet is an important source of health information. Thus, the frequency of Internet searches may provide information regarding infectious disease activity. As an example, we examined the relationship between searches for influenza and actual influenza occurrence.

Toxicity of extended courses of linezolid: results of an Infectious Diseases Society of America Emerging Infections Network survey.

Since linezolid was licensed, rare-but-serious adverse events caused by inhibition of mitochondrial protein synthesis have been identified. These events may be more common when the drug is used longer than 28 days, which is the treatment length currently approved by the US Food and Drug Administration. The purpose of this study was to determine how often longer courses of linezolid are prescribed and the nature and relative frequency of adverse events associated with longer courses.

Relationship of influenza vaccination declination statements and influenza vaccination rates for healthcare workers in 22 US hospitals.

The use of declination statements was associated with a mean increase of 11.6% in influenza vaccination rates among healthcare workers at 22 hospitals. In most hospitals, there were no negative consequences for healthcare workers who refused to sign the forms, and most policies were implemented along with other interventions designed to increase vaccination rates.

Staphylococcus aureus community-acquired pneumonia during the 2006 to 2007 influenza season.

Study Objective: Staphylococcus aureus is a cause of community-acquired pneumonia that can follow influenza infection. In response to a number of cases reported to public health authorities in early 2007, additional case reports were solicited nationwide to better define S. aureus community-acquired pneumonia during the 2006 to 2007 influenza season.

The duration of mumps virus shedding after the onset of symptoms.

To determine how long people shed virus after the onset of mumps, we used logistic regression modeling to analyze data from the 2006 outbreak of mumps in Iowa. Our model establishes that the probability of mumps virus shedding decreases rapidly after the onset of symptoms. However, we estimate that 8%-15% of patients will still be shedding the virus 5 days after the onset of symptoms and, thus, may still be contagious during this period.

Mycobacterial and other serious infections in patients receiving anti-tumor necrosis factor and other newly approved biologic therapies: case finding through the Emerging Infections Network.

We present the results of a nationwide survey of infectious disease consultants to identify mycobacterial and other serious infections in patients receiving anti-tumor necrosis factor compounds and other novel targeted therapies. Nontuberculous mycobacterial infections, histoplasmosis, and invasive Staphylococcus aureus infection were all reported more frequently than was tuberculosis disease in this context.

Clostridium difficile-associated diarrhea: an emerging threat to pregnant women.

Objective: To estimate if Clostridium difficile-associated disease (CDAD) is increasing in peripartum women.

Study Design: Peripartum CDAD was assessed through 1) passive surveillance collecting clinical and pathology data on severe cases and 2) survey among infectious disease consultants (ICDs) in the Emerging Infections Network.

Results: Ten severe cases were collected; most had associated antibiotic use.

Variability among pediatric infectious diseases specialists in the treatment and prevention of methicillin-resistant Staphylococcus aureus skin and soft tissue infections.

There are currently no clear consensus recommendations for the treatment and prevention of community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections in pediatric patients. We surveyed over 100 Pediatric Infectious Diseases consultants and found considerable variability in both the treatment of skin and soft tissue infections and the strategies used for the management of children with recurrent MRSA disease.

Use of a pandemic preparedness drill to increase rates of influenza vaccination among healthcare workers.

Objective: To determine the effect of a pandemic influenza preparedness drill on the rate of influenza vaccination among healthcare workers (HCWs).

Design: Before-after intervention trial.

Setting: The University of Iowa Hospitals and Clinics (UIHC), a large, academic medical center, during 2005.

Elements of influenza vaccination programs that predict higher vaccination rates: results of an emerging infections network survey.

Introduction: To address suboptimal influenza vaccination rates among health care workers, the Healthcare Infection Control Practices Advisory Committee and the Advisory Committee on Immunization Practices recently issued recommendations designed to increase the number of health care workers vaccinated against influenza. The purpose of the present study was to determine how widely these recommendations have been implemented and to identify important elements of successful influenza vaccine programs.

Methods: The Infectious Diseases Society of America Emerging Infections Network surveyed 991 infectious diseases consultants.

Effect of antiretroviral therapy and hepatitis c co-infection on changes in lipid levels in HIV-Infected patients 48 weeks after initiation of therapy.

Hepatitis C virus (HCV) commonly co-infects HIV-infected individuals. Antiretroviral therapy (ART) is associated with elevated serum lipid levels, and HCV infection is associated with low serum lipid levels. Fasting lipid levels were investigated in 1,434 ART-naïve HIV-infected people participating in the AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized Trials (ALLRT) protocol who prospectively initiated ART with 3 agents.

Clostridium difficile-associated disease in patients in a small rural hospital.

Objective: To determine the risk factors for Clostridium difficile-associated disease (CDAD) in a 25-bed rural hospital and to compare antimicrobial use ratios at the study hospital with those at a large academic medical center.

Design: Case-control study.

Setting: A 25-bed rural hospital in Iowa during the period from August 2002 through January 2005.

An outbreak of severe Clostridium difficile-associated disease possibly related to inappropriate antimicrobial therapy for community-acquired pneumonia.

We report a severe outbreak of Clostridium difficile infection. According to a chart review, half of the patients who received treatment for bacterial pneumonia before they developed C. difficile infection may not have had pneumonia.

Use of prediction markets to forecast infectious disease activity.

Prediction markets have accurately forecasted the outcomes of a wide range of future events, including sales of computer printers, elections, and the Federal Reserve's decisions about interest rates. We propose that prediction markets may be useful for tracking and forecasting emerging infectious diseases, such as severe acute respiratory syndrome and avian influenza, by aggregating expert opinion quickly, accurately, and inexpensively. Data from a pilot study in the state of Iowa suggest that these markets can accurately predict statewide seasonal influenza activity 2-4 weeks in advance by using clinical data volunteered from participating health care workers.

Incidence of invasive aspergillosis among allogeneic hematopoietic stem cell transplant patients receiving voriconazole prophylaxis.

We performed a retrospective observational study to examine the incidence of invasive aspergillosis (IA) among allogeneic hematopoietic stem cell transplant (HSCT) recipients, according to whether patients received at least 1 week of voriconazole prophylaxis. We report no cases of IA among 92 HSCT recipients who received voriconazole prophylaxis compared with a 10% (23/223) incidence among those receiving other systemic antifungals for prophylaxis (P < .0005).

Epidemiology of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in a rural state.

Background: Most data on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) isolates come from large tertiary care centers. Infection control personnel need to understand the epidemiology of MRSA and VRE across the continuum of care, including small rural hospitals, to develop effective control strategies.

Objective: To describe the epidemiology of MRSA and VRE in Iowa.

Risk factors for groin wound infection after femoral artery catheterization: a case-control study.

Objective: Groin wound infection (GWI) after femoral artery catheterization is unusual. However, several reports of GWI associated with the use of a Perclose device appear in the surgical literature.

Design: A case-control study.

Staphylococcus aureus Colonization and Nosocomial Infections: Implications for Prevention.

Colonization with Staphylococcus aureus is a risk factor for invasive S. aureus infections. Intranasal mupirocin has effectively eradicated S.

Association of hypocholesterolaemia with hepatitis C virus infection in HIV-infected people.

Objective: To study the impact of hepatitis C virus (HCV) status on serum cholesterol levels in HIV-infected patients.

Methods: We retrospectively analysed data from the 881 participants of the Veterans Ageing Cohort 3 Site Study. Four different models were constructed using total cholesterol, low-density lipid (LDL) cholesterol, high-density lipid (HDL) cholesterol and triglycerides as dependent variables.

Persistent GB virus C infection and survival in HIV-infected men.

Background: GB virus C (GBV-C), which is not known to be pathogenic in humans, replicates in lymphocytes, inhibits the replication of human immunodeficiency virus (HIV) in vitro, and has been associated with a decreased risk of death among HIV-positive persons in some, but not all, studies. Previous studies did not control for differences in the duration of HIV or GBV-C infection.

Methods: We evaluated 271 men who were participants in the Multicenter Acquired Immunodeficiency Syndrome Cohort Study for GBV-C viremia (by means of a reverse-transcriptase-polymerase-chain-reaction assay) or E2 antibody (by means of an enzyme-linked immunosorbent assay) 12 to 18 months after seroconversion to positivity for HIV (the early visit); a subgroup of 138 patients was also evaluated 5 to 6 years after HIV seroconversion (the late visit).

GB virus type C/hepatitis G virus: a non-pathogenic flavivirus associated with prolonged survival in HIV-infected individuals.

GB virus C (GBV-C) is a common virus that does not appear to cause disease. GBV-C persists in up to 50% of exposed individuals, and virus replication appears to be in lymphocytes including CD4+ T cells. GBV-C infection is common among HIV-positive people, and several studies have found that HIV-positive individuals co-infected with GBV-C survive for statistically significantly longer periods of time than people without GBV-C.

Inaccurate glycosylated hemoglobin A1C measurements in human immunodeficiency virus-positive patients with diabetes mellitus.

Persistent differences in blood glucose and serum glycosylated hemoglobin (HbA1C) measurements were observed in 4 human immunodeficiency virus-positive patients with diabetes mellitus, all of whom were taking drugs associated with hemolysis, which interferes with the reliability of HbA1C levels. Determination of fructosamine levels was a more accurate alternative for measuring average glycemic control in these patients.

Vaccines, biological warfare, and bioterrorism.

This article presents a brief history of the use of biological agents in warfare and bioterrorism. Bacillus anthracis, smallpox virus, and Yersinia pestis, historically have been and currently are considered the most likely candidates for potential use under these circumstances. This article discusses the clinical syndromes these agents cause and the role of vaccines in protection against them.