Methicillin-resistant Staphylococcus aureus (MRSA) has not been studied in child care centers. The prevalence of MRSA colonization was determined at two centers with an index patient. Two (3%) of 61 children at center X had MRSA; strains from both children and the index illness were pulsed-field gel electrophoresis type B. Nine (24%) of 40 children at center Y had MRSA; strains from 5 children and the index illness were type B, and strains from 4 children were type A. Ten of 11 colonized children were in classes with 2- and 3-year-old children. Colonization with MRSA was not associated with health care contact by subjects or by members of their households. MRSA in child day care centers indicates accelerated spread of MRSA in the community.
We studied the epidemiology of invasive disease caused by Streptococcus pneumoniae in 1995 among 1.9 million residents of Dallas County, Texas. The sociodemographic characteristics and chronic medical conditions of 432 patients were identified through active, population-based surveillance and review of medical records. The incidence of disease was 22 cases per 100,000 person-years and was highest for children < 2 years of age (136 cases per 100,000 person-years) and for adults > or = 65 years of age (80 cases per 100,000 person-years). Twenty percent of isolates were nonsusceptible to penicillin; the highest rates of resistance were among the youngest and oldest age groups (28% and 22% of isolates, respectively). An increased incidence of disease was associated with low income (42 cases per 100,000 person-years) and black race (39 cases per 100,000 person-years). The frequency of most chronic medical conditions increased with age; smoking, heavy alcohol use, and infection due to human immunodeficiency virus were most common between 30 and 64 years of age. Of otherwise healthy patients 30-64 years of age, 47% were current smokers, an association requiring further investigation. Characterizing groups at risk for invasive pneumococcal disease could aid in the development of prevention programs and increase the benefits from wide use of effective vaccines.
The ability of different Haemophilus influenzae type b conjugate vaccines to induce immunologic memory was compared in 381 infants who were vaccinated with one of three conjugate vaccines beginning at 2 months of age. All infants were vaccinated with unconjugated type b capsular polysaccharide, polyribosylribitol phosphate (PRP), at 12 months. In each group, high antibody responses were detected by 6-9 days after vaccination. One month after receiving PRP, infants primed with PRP conjugated to the outer membrane protein of Neisseria meningitidis or PRP oligomers conjugated to the cross-reactive mutant diphtheria protein, CRM197, had twofold higher total anti-PRP antibody concentrations than did infants primed with PRP conjugated to tetanus toxoid (P < .005). After the conjugate and the PRP boost, notable differences were present among vaccine groups with respect to the magnitude of the IgG anti-PRP antibody concentrations and light chain variable region usage as determined by idiotypic analysis. Thus, each of the conjugate vaccines primed infants for the ability to evoke memory antibody responses to PRP, but qualitative and quantitative differences in priming induced by different vaccines may affect their ability to confer protection against disease.
Access to a complete immunization record, be it the provider's, the parent's or ideally both, decreases substantially a child's risk of unnecessary immunization.
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