Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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The largest reported mumps outbreak at a US college in 19 years occurred in 2006 at a Kansas university with a 2-dose measles-mumps-rubella (MMR) vaccination policy. We assessed vaccine performance and mumps risk factors, including the possibility of waning vaccine protection. ⋯ High 2-dose MMR coverage protected many students from developing mumps but was not sufficient to prevent the mumps outbreak. Vaccine-induced protection may wane. Similar US settings where large numbers of young adults from wild-type naive cohorts live closely together may be at particular risk for mumps outbreaks.
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Comparative Study
Use of throat swab or saliva specimens for detection of respiratory viruses in children.
Nasopharyngeal (NP) specimens are commonly used for the detection of respiratory viruses, but throat and saliva specimens are easier to obtain. The objective of this study was to compare the viral yield of direct fluorescent antigen detection of NP specimens and nucleic acid amplification tests (NAT) of direct fluorescent antigen-negative NP specimens with the viral yield of NAT of throat swab and saliva specimens. ⋯ Throat swab and saliva specimens are inferior to NP specimens for the detection of respiratory viruses but might be acceptable for screening in a setting where it is impractical to obtain an NP specimen.
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Multicenter Study Comparative Study
Do hospitalists or physicians with greater inpatient HIV experience improve HIV care in the era of highly active antiretroviral therapy? Results from a multicenter trial of academic hospitalists.
Little is known about the effect of provider type and experience on outcomes, resource use, and processes of care of hospitalized patients with human immunodeficiency virus (HIV) infection. Hospitalists are caring for this population with increasing frequency. ⋯ Provider type and attending physician experience with HIV-infected inpatients had minimal effect on the quality of care of HIV-infected inpatients. Approaches other than provider experience, such as the use of multidisciplinary inpatient teams, may be better targets for future studies of the outcomes, processes of care, and resource use of HIV-infected inpatients.
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Bacteremia due to Pseudomonas aeruginosa is associated with grave clinical outcomes. Recent studies have emphasized the importance of appropriate empirical therapy, but controversy arises when piperacillin-tazobactam is used against isolates with reduced susceptibility. ⋯ In P. aeruginosa bacteremia due to isolates with reduced piperacillin-tazobactam susceptibility, empirical piperacillin-tazobactam therapy was associated with increased mortality. Additional studies are warranted to examine the appropriateness of the current Clinical Laboratory Standards Institute resistance breakpoint of piperacillin-tazobactam.
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Italy had intermediate-level endemicity for hepatitis B virus (HBV) infection in the 1970s and 1980s. In 1991, vaccination of infants and adolescents became mandatory. We report the impact of universal vaccination 14 years after its beginning. ⋯ Universal vaccination has contributed to a decreasing AHB incidence in Italy, especially by reducing the risk of infection among persons aged 15-24 years. Most infections occur in persons aged > or =25 years in association with injection drug use, unsafe sexual activity, percutaneous treatment, and iatrogenic exposure. Improvement of vaccine coverage in high-risk groups and adherence to infection control measures during surgery and percutaneous treatment are needed. The high risk still associated with blood transfusion needs to be further investigated, with consideration of occult HBV infection in blood donors. The potential spread of HBV infection from the immigrant population deserves adequate health policy prevention programs.