Eczematous skin disease and recall of past diagnoses: implications for smallpox vaccination

Article Abstract:

Background: Persons with atopic dermatitis or eczema, regardless of disease severity or activity, may develop eczema vaccinatum if they or their close contacts receive the smallpox vaccine. According to current recommendations, a preexposure vaccination program should identify these persons and exclude them from participating. Objective: To determine the prevalence of diagnosed atopic dermatitis and eczema in a defined population and assess the sensitivity of screening questions to identify patients who have received these diagnoses. Design: Population-based prevalence survey and telephone interview. Setting: 14 ZIP code regions in Wisconsin. Patients: Persons given a diagnosis of atopic dermatitis or eczema in 2000 and 2001 were identified from a population-based cohort. Persons with a history of atopic dermatitis diagnosed since 1979 were eligible for the telephone survey. Measurements: Prevalence of diagnosed atopic dermatitis or eczema; proportions of respondents able to recall a past diagnosis of atopic dermatitis, eczema, or recurrent rash. Results: The prevalence of atopic dermatitis or eczema diagnosis in 2000 or 2001 was 0.8%. At least 2.4% of the cohort would be ineligible for smallpox vaccination because of active skin disease in themselves or household members. Among 94 adult respondents with atopic dermatitis, 55 (59%) correctly self-reported skin disease. Seventy-nine (60%) of 133 household contacts of adults with atopic dermatitis correctly reported the presence of skin disease in a household member. Parental recall of skin disease in children with atopic dermatitis was 70% (123 of 177). Conclusions: Identifying dermatologic contraindications to smallpox vaccination by relying only on a self-reported history of rash illnesses is likely to miss a substantial proportion of individuals who should not receive smallpox vaccines in a preexposure vaccination campaign.

Complications and side effects, Atopic dermatitis, Recollection (Psychology), Eczema, Recall (Memory), Smallpox vaccine, Smallpox vaccines, Author Abstract

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Enterococci resistant to multiple antimicrobial agents, including vancomycin

Article Abstract:

Hospitalized patients, particularly those who are seriously ill or receiving organ transplants, may become infected with vancomycin-resistant intestinal bacteria despite efforts to curb the spread of these infections. Researchers randomly tested the urine of 30% of 59,196 hospitalized patients in a university medical center for vancomycin-resistant bacterial infection. They found these infections in 16.9% of the patients tested. The highest infection rates were in the organ transplant and surgical intensive care units. Despite reducing the amount of vancomycin prescribed and isolating patients with these infections, there was an 18.7% incidence of vancomycin-resistant infections one year later. Eight percent of the patients with vancomycin-resistant infection died. No cases of vancomycin-resistant bacterial infections were found in any of the healthy volunteers tested.

Research, Risk factors, Physiological aspects, Diseases, Drug resistance in microorganisms, Vancomycin, Microbial drug resistance, Hospital patients, Gastrointestinal diseases, Nosocomial infections, Cross infection

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Relapsing invasive group B streptococcal infection in adults

Article Abstract:

A common cause of repeated group B streptococcal infections in adults may be a return of the same strain of the organism. Researchers surveyed a metropolitan area over a two-year period and identified 395 surviving adult patients and 241 surviving infant patients with group B streptococcal infection. Fifty-three adult patients with a non-recurring group B streptococcal infection served as controls. Group B streptococcal infections recurred in 22 of the adult patients but only one infant patient. Thirteen of these 22 adult patients had recurring infections with the same strain of the organism as their first infection. The time between the first and second infection was nearly three times shorter in the adult patients re-infected with the same streptococcal strain. The medical conditions associated with the recurring infections tended to be more severe.

Case studies, Streptococcus agalactiae

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