Current epidemiology and trends in invasive Haemophilus influenzae disease--United States, 1989-2008.

Background: With the introduction of Haemophilus influenzae serotype b (Hib) conjugate vaccines, there has been a dramatic reduction of Hib disease in young children and the epidemiological trends of invasive H. influenzae have shifted.

Methods: Data were collected from active surveillance for invasive H.

Description of antiviral treatment among adults hospitalized with influenza before and during the 2009 pandemic: United States, 2005-2009.

Background: The 2009 influenza pandemic led to guidelines emphasizing antiviral treatment for all persons hospitalized with influenza, including pregnant women. We compared antiviral use among adults hospitalized with influenza before and during the pandemic.

Methods: The Emerging Infections Program conducts active population-based surveillance for persons hospitalized with community-acquired, laboratory-confirmed influenza in 10 states.

A review of multidrug-resistant Enterobacteriaceae.

Enterobacteriaceae that are resistant to multiple drugs are a public health concern and present a challenge to health care providers in terms of prevention and control. This article describes the changing resistance mechanisms that allow bacteria to circumvent antibiotics and how multidrug-resistant bacterial infections can spread within hospitals, among health care facilities, and across national borders. It also discusses the challenges associated with identifying and treating these infections and what health care providers need to do to prevent their transmission.

Outbreak of tuberculosis among Guatemalan immigrants in rural Minnesota, 2008.

Objectives: We described the outbreak investigation and control measures after the Minnesota Department of Health identified a cluster of tuberculosis (TB) cases among Guatemalan immigrants within three rural Minnesota counties in August 2008.

Methods: TB cases were diagnosed by tuberculin skin test followed by chest radiography and sputum testing for Mycobacterium tuberculosis (M. tuberculosis).

Staphylococcal toxic shock syndrome 2000-2006: epidemiology, clinical features, and molecular characteristics.

Introduction: Circulating strains of Staphylococcus aureus (SA) have changed in the last 30 years including the emergence of community-associated methicillin-resistant SA (MRSA). A report suggested staphylococcal toxic shock syndrome (TSS) was increasing over 2000-2003. The last population-based assessment of TSS was 1986.

Identifying host genetic risk factors in the context of public health surveillance for invasive pneumococcal disease.

Host genetic factors that modify risk of pneumococcal disease may help target future public health interventions to individuals at highest risk of disease. We linked data from population-based surveillance for invasive pneumococcal disease (IPD) with state-based newborn dried bloodspot repositories to identify biological samples from individuals who developed invasive pneumococcal disease. Genomic DNA was extracted from 366 case and 732 anonymous control samples.

Pandemic (H1N1) 2009-associated deaths detected by unexplained death and medical examiner surveillance.

During the pandemic (H1N1) 2009 outbreak, Minnesota, New Mexico, and Oregon used several surveillance methods to detect associated deaths. Surveillance using unexplained death and medical examiner data allowed for detection of 34 (18%) pandemic (H1N1) 2009-associated deaths that were not detected by hospital-based surveillance.

Hepatitis A infection in recent international adoptees and their contacts in Minnesota, 2007-2009.

Objective: The goal of this study was to describe hepatitis A-infected adoptees and the risk of transmission to their contacts.

Methods: This was a retrospective review of adoptee-associated cases of hepatitis A and hepatitis A-infected adoptees identified in Minnesota from 2007 through 2009.

Results: From 2007 through 2009 in Minnesota, 10 cases of hepatitis A, including 1 fulminant case, were associated with international adoptees.

Vaccine-derived poliomyelitis 12 years after infection in Minnesota.

A 44-year-old woman with long-standing common variable immunodeficiency who was receiving intravenous immune globulin suddenly had paralysis of all four limbs and the respiratory muscles, resulting in death. Type 2 vaccine-derived poliovirus was isolated from stool. The viral capsid protein VP1 region had diverged from the vaccine strain at 12.

The burden of invasive early-onset neonatal sepsis in the United States, 2005-2008.

Background: Sepsis in the first 3 days of life is a leading cause of morbidity and mortality among infants. Group B Streptococcus (GBS), historically the primary cause of early-onset sepsis (EOS), has declined through widespread use of intrapartum chemoprophylaxis. We estimated the national burden of invasive EOS cases and deaths in the era of GBS prevention.

Children with asthma hospitalized with seasonal or pandemic influenza, 2003-2009.

Objective: To describe the characteristics and clinical courses of asthmatic children hospitalized with seasonal or 2009 pandemic H1N1 influenza and compare complications by influenza type.

Methods: During the 2003-2009 influenza seasons and the 2009 pandemic, we conducted surveillance of 5.3 million children aged 17 years or younger for hospitalization with laboratory-confirmed influenza and identified those with asthma (defined as those aged 2-17 years with a history of asthma in their medical record or a discharge code for acute asthma exacerbation or status asthmaticus).

Risk factors for household transmission of community-associated methicillin-resistant Staphylococcus aureus.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a community pathogen. Community-associated (CA) MRSA infections have occurred among multiple members of a household. We describe the incidence of and risk factors for MRSA colonization among household contacts of children with CA-MRSA infections.

Bacterial meningitis in the United States, 1998-2007.

Background: The rate of bacterial meningitis declined by 55% in the United States in the early 1990s, when the Haemophilus influenzae type b (Hib) conjugate vaccine for infants was introduced. More recent prevention measures such as the pneumococcal conjugate vaccine and universal screening of pregnant women for group B streptococcus (GBS) have further changed the epidemiology of bacterial meningitis.

Methods: We analyzed data on cases of bacterial meningitis reported among residents in eight surveillance areas of the Emerging Infections Programs Network, consisting of approximately 17.

Seasonal and 2009 pandemic influenza A (H1N1) virus infection during pregnancy: a population-based study of hospitalized cases.

We sought to describe characteristics of hospitalized reproductive-aged (15-44 years) women with seasonal (2005/2006 through 2008/2009) and 2009 pandemic influenza A (H1N1) virus infection. We used population-based data from the Emerging Infections Program in 10 US states, and compared characteristics of pregnant (n = 150) and nonpregnant (n = 489) seasonal, and pregnant (n = 489) and nonpregnant (n = 1088) pandemic influenza cases using χ(2) and Fisher's exact tests. Pregnant women represented 23.

Effective state-based surveillance for multidrug-resistant organisms related to health care-associated infections.

In September 2008, the Council of State and Territorial Epidemiologists and the Centers for Disease Control and Prevention sponsored a meeting of public health and infection-control professionals to address the implementation of surveillance for multidrug-resistant organisms (MDROs)-particularly those related to health care-associated infections. The group discussed the role of health departments and defined goals for future surveillance activities. Participants identified the following main points: (1) surveillance should guide prevention and infection-control activities, (2) an MDRO surveillance system should be adaptable and not organism specific, (3) new systems should utilize and link existing systems, and (4) automated electronic laboratory reporting will be an important component of surveillance but will take time to develop.

Epidemiology of 2009 pandemic influenza A (H1N1) deaths in the United States, April-July 2009.

During the spring of 2009, pandemic influenza A (H1N1) virus (pH1N1) was recognized and rapidly spread worldwide. To describe the geographic distribution and patient characteristics of pH1N1-associated deaths in the United States, the Centers for Disease Control and Prevention requested information from health departments on all laboratory-confirmed pH1N1 deaths reported from 17 April through 23 July 2009. Data were collected using medical charts, medical examiner reports, and death certificates.

Cost of screening intensive care unit patients for methicillin-resistant Staphylococcus aureus in hospitals.

Background: The objective of this study is to determine the costs per hospital admission of screening intensive care unit patients for methicillin-resistant Staphylococcus aureus (MRSA) and isolating those who are colonized.

Methods: Data on the costs of the intervention come from the Minneapolis Veterans Affairs Medical Center, a 279-bed teaching hospital and outpatient facility. A microcosting approach is used to determine the intervention costs for 3 different laboratory testing protocols.

Socioeconomic and racial/ethnic disparities in the incidence of bacteremic pneumonia among US adults.

Objectives: We examined associations between the socioeconomic characteristics of census tracts and racial/ethnic disparities in the incidence of bacteremic community-acquired pneumonia among US adults.

Methods: We analyzed data on 4870 adults aged 18 years or older with community-acquired bacteremic pneumonia identified through active, population-based surveillance in 9 states and geocoded to census tract of residence. We used data from the 2000 US Census to calculate incidence by age, race/ethnicity, and census tract characteristics and Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs).

Health care-associated invasive MRSA infections, 2005-2008.

Context: Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of public health importance; MRSA prevention programs that may affect MRSA transmission and infection are increasingly common in health care settings. Whether there have been changes in MRSA infection incidence as these programs become established is unknown; however, recent data have shown that rates of MRSA bloodstream infections (BSIs) in intensive care units are decreasing.

Objective: To describe changes in rates of invasive health care-associated MRSA infections from 2005 through 2008 among residents of 9 US metropolitan areas.

Guidelines to implement medical examiner/coroner-based surveillance for fatal infectious diseases and bioterrorism ("Med-X").

Medical examiners and coroners investigate deaths that are sudden, unexplained, and violent. Oftentimes these deaths are a consequence of infections, many of which have public health consequences. Additionally, because deaths from bioterrorism are homicides, they fall under the jurisdiction of medical examiners and coroners.

Adult hospitalizations for laboratory-positive influenza during the 2005-2006 through 2007-2008 seasons in the United States.

Background: Rates of influenza-associated hospitalizations in the United States have been estimated using modeling techniques with data from pneumonia and influenza hospitalization discharge diagnoses, but they have not been directly estimated from laboratory-positive cases.

Methods: We calculated overall, age-specific, and site-specific rates of laboratory-positive, influenza-associated hospitalization among adults and compared demographic and clinical characteristics and outcomes of hospitalized cases by season with use of data collected by the Emerging Infections Program Network during the 2005-2006 through 2007-2008 influenza seasons.

Results: Overall rates of adult influenza-associated hospitalization per 100,000 persons were 9.

Prevention of invasive pneumococcal disease among HIV-infected adults in the era of childhood pneumococcal immunization.

Objective: Human immunodeficiency virus (HIV) infection and AIDS increase the risk of invasive pneumococcal disease (IPD). We evaluated IPD among HIV-infected adults over a 10-year period in the US to identify opportunities for prevention of IPD among HIV-infected adults.

Design: IPD and HIV surveillance in seven population-based and laboratory-based Active Bacterial Core surveillance areas.

Virulence genes and genotypic associations in nasal carriage, community-associated methicillin-susceptible and methicillin-resistant USA400 Staphylococcus aureus isolates.

It is not well understood why strains of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), a major cause of skin and soft tissue infections, became successful so quickly, overtaking the place of methicillin-sensitive S. aureus (MSSA) in many communities. To evaluate the genetic basis of differences in their virulence traits, 293 S.