None.

Data on influenza epidemiology in HIV-infected persons are limited, particularly for sub-Saharan Africa, where HIV infection is widespread. We tested respiratory and blood samples from patients with acute lower respiratory tract infections hospitalized in South Africa during 2009–2011 for viral and pneumococcal infections. Influenza was identified in 9% (1,056/11,925) of patients enrolled; among influenza case-patients, 358 (44%) of the 819 who were tested were infected with HIV. Influenza-associated acute lower respiratory tract infection incidence was 4–8 times greater for HIV-infected (186–228/100,000) than for HIV-uninfected persons (26–54/100,000). Furthermore, multivariable analysis showed HIV-infected patients were more likely to have pneumococcal co-infection; to be infected with influenza type B compared with type A; to be hospitalized for 2–7 days or >7 days; and to die from their illness. These findings indicate that HIV-infected persons are at greater risk for severe illnesses related to influenza and thus should be prioritized for influenza vaccination.

The measurement of pneumococcal carriage in the nasopharyngeal reservoir is subject to potential confounders that include low-density and multiple-strain colonization. To compare different methodologies, we picked a random sampling of 100 nasopharyngeal specimens recovered from infants less than 2 years of age who were previously assessed for pneumococcal carriage and serotypes by a conventional method that used direct plating from the transport/storage medium (50 specimens were culture negative and 50 specimens were culture positive for pneumococci). We used a broth enrichment approach and a conventional PCR approach (with and without broth enrichment) to determine pneumococcal carriage and serotypes, and the results were compared to the initial conventional culture-based results. Additionally, we used a lytA-targeted real-time PCR for pneumococcal detection. Broth enrichment for both the culture-based and the PCR-based methods enhanced the isolation of pneumococci and detection of serotype diversity, with the most effective serotype deduction method being one that used broth enrichment prior to sequential multiplex PCR. Similarly, we also found that broth enrichment followed by the lytA-specific real-time PCR was the most sensitive for the detection of apparent pneumococcal carriage. The broth enrichment, conventional multiplex PCR, and real-time PCR approaches used in this study were effective in detecting pneumococcal carriage in the 50 specimens that were negative by conventional direct plating from transport medium (range of numbers of positive specimens, 8/50 to 22/50 [16 to 44%]), and the three different serotyping approaches that used broth enrichment increased the number of serotype identifications from the 100 specimens (12 to 29 additional serotype identifications to be positive). A PCR-based approach that employed a broth enrichment step appeared to best enhance the detection of mixed serotypes and low-density pneumococcal carriage.The principal habitat of the opportunistic pathogen Streptococcus pneumoniae is the nasopharynx, where it normally resides commensally. Current multivalent vaccines against pneumococci target subsets of the 91 known capsular serotypes known to be expressed by this organism (12). Although the biology of pneumococcal carriage is not well understood, it appears that pneumococcal disease occurs as a sequela of nasopharyngeal (NP) carriage (7, 15). Accurate assessment of the serotype distribution associated with pneumococcal colonization, together with knowledge of the serotype distribution associated with pneumococcal disease, could be of great value in the evaluation and formulation of pneumococcal vaccines.Detection of the NP carriage of pneumococci and serotyping have traditionally relied on conventional culture methods of direct plating of NP specimens from transport or storage media. For example, a recent major study used classical culture isolation and Quellung reaction-based serotyping to reveal significant effects of vaccination on the carriage of vaccine serotype str...

Spanish-speaking patients whose families have a language barrier seem to have a significantly increased risk for serious medical events during pediatric hospitalization compared with patients whose families do not have a language barrier.

Influenza is a major cause of respiratory illness in Africa, especially in children. Further strengthening influenza surveillance, along with conducting special studies on influenza burden, cost of illness, and role of other respiratory pathogens will help detect novel influenza viruses and inform and develop targeted influenza prevention policy decisions in the region.

Background Rotavirus vaccine use in national immunisation programmes has led to declines in hospital admissions for rotavirus gastroenteritis among children; however, the global impact of rotavirus vaccine introduction has not been described using primary data. We describe the impact of rotavirus vaccine introduction on admissions for acute rotavirus gastroenteritis in primarily low-income and middle-income countries, using 9 years of data from the WHOcoordinated Global Rotavirus Surveillance Network (GRSN).

EXECUTIVE SUMMARYMonitoring multidrug-resistant organisms (MDROs) and the infections they cause in a healthcare setting is important to detect newly emerging antimicrobial resistance profiles, to identify vulnerable patient populations, and to assess the need for and effectiveness of interventions; however, it is unclear which metrics are the best, because most of the metrics are not standardized. This document describes useful and prac tical metrics and surveillance considerations for measuring MDROs and the infections they cause in the practice of in fection prevention and control in healthcare settings. These metrics are designed to aid healthcare workers in docu menting trends over time within their facility and should not be used for interfacility comparison.The following MDROs are addressed: (1) methicillin-re sistant Staphylococcus aureus; (2) vancomycin-resistant En terococcus species; (3) multidrug-resistant gram-negative ba cilli; and (4) vancomycin-resistant S. aureus. We convened a working group of experts that reviewed current practices, the peer-reviewed literature, and existing guidelines on surveil lance strategies and key metrics.We propose that healthcare facilities use the following 4 routine metrics to monitor MDROs and the infections they cause: (1) an MORO-specific line list for tracking patients who have acquired an MDRO; (2) an antibiogram for mon itoring susceptibility patterns of isolates recovered from pa tients; (3) the incidence of hospital-onset MDRO bacteremia, which is an objective, laboratory-based metric that is highly associated with invasive disease and does not require chart review to estimate infection burden; and ( 4) clinical culture results, to measure incidence of infection or colonization, to quantify the number of people whose MORO acquisition is healthcare associated. In addition, healthcare facilities may want to calculate both the overall prevalence of carriage and the prevalence of carriage at admission, the latter of which can be useful in detecting importation of methicillin-resistant S. aureus into healthcare facilities, to estimate the exposure burden. Active surveillance testing can augment and increase the accuracy of some metrics. Healthcare facilities not per forming active surveillance testing might wish to consider point-prevalence screening, to help assess how much the number of positive clinical culture results underestimates the hidden reservoir of MDROs. It is important to understand the limitations of all proxy metrics. Because of the paucity of published research findings focused on this area of study, most recommendations were based on opinion and were heavily influenced by the perceived usefulness and simplicity of the metric for assessing MDROs in the hospital setting and for determining the impact of interventions.

Further understanding of RSV seasonality in developing countries and various climate regions will be important to better understand the epidemiology of RSV and for timing the use of future RSV vaccines and immunoprophylaxis in low- and middle-income countries.