BACKGROUNDWe identified an outbreak of AmpC–producingEscherichia coliinfections resistant to third-generation cephalosporins and carbapenems (CR) among 7 patients who had undergone endoscopic retrograde cholangiopancreatography at hospital A during November 2012–August 2013. Gene sequencing revealed a shared novel mutation in ablaCMYgene and a distinctivefumC/ fimHtyping profile.OBJECTIVETo determine the extent and epidemiologic characteristics of the outbreak, identify potential sources of transmission, design and implement infection control measures, and determine the association between the CRE. coliand AmpCE. colicirculating at hospital A.METHODSWe reviewed laboratory, medical, and endoscopy reports, and endoscope reprocessing procedures. We obtained cultures from endoscopes after reprocessing as well as environmental samples and conducted pulsed-field gel electrophoresis and gene sequencing on phenotypic AmpC isolates from patients and endoscopes. Cases were those infected with phenotypic AmpC isolates (both carbapenem-susceptible and CR) and identicalblaCMY-2,fumC, andfimHalleles or related pulsed-field gel electrophoresis patterns.RESULTSThirty-five of 49 AmpCE. colitested met the case definition, including all CR isolates. All cases had complicated biliary disease and had undergone at least 1 endoscopic retrograde cholangiopancreatography at hospital A. Mortality at 30 days was 16% for all patients and 56% for CR patients. Two of 8 reprocessed endoscopic retrograde cholangiopancreatography scopes harbored AmpC that matched case isolates by pulsed-field gel electrophoresis. Environmental cultures were negative. No breaches in infection control were identified. Endoscopic reprocessing exceeded manufacturer’s recommended cleaning guidelines.CONCLUSIONRecommended reprocessing guidelines are not sufficient.Infect Control Hosp Epidemiol2015;00(0): 1–9

SSPE cases in California occurred at a high rate among unvaccinated children, particularly those infected during infancy. Protection of unvaccinated infants requires avoidance of travel to endemic areas, or early vaccination prior to travel at age 6-11 months. Clinicians should be aware of SSPE in patients with compatible symptoms, even in older patients with no specific history of measles infection. SSPE demonstrates the high human cost of "natural" measles immunity.

This is the largest North American analysis of IGRA use and performance among children with TB disease. In children <5 years old, IGRA sensitivity is similar to TST, but sensitivity of both tests are reduced in children <2 years old. Indeterminate results are higher in children <1 year old and in central nervous system disease. In children ≥5 years old with laboratory-confirmed TB, IGRA has greater sensitivity than TST and should be considered the preferred immunodiagnostic test..

WHAT'S KNOWN ON THIS SUBJECT: Psychosocial stress in childhood has been associated with a greater risk of future overweight, although the associations have not always been consistent, the types of psychosocial stressors have often been somewhat extreme, and moderators of the association have rarely been examined. WHAT THIS STUDY ADDS:Experiencing many negative life events in childhood, particularly with chronicity or events that are family health related, increases risk of overweight by age 15 years. Maternal obesity and greater delay of gratification for food each intensify this risk.abstract OBJECTIVES: To test the association of life events in childhood with overweight risk in adolescence; to examine the effects of chronicity, timing, intensity, valence, and type of life events; and to test potential moderators.

These data, as well as data from previous California studies, suggest updated strategies for the management of severe pertussis. These include perform serial white blood cell counts, treat all presumptive cases with azithromycin, evaluate for pulmonary hypertension, intubate and administer oxygen for apneic episodes and administer inotropic/vasoactive agents for cardiogenic shock. Do not administer steroids or nitric oxide. Criteria for exchange blood transfusion therapy for leukocytosis with lymphocytosis are suggested.

Background Drowning is the second leading cause of unintentional injury death among U.S. children. Multiple studies describe decreased drowning risk among children possessing some swim skills. Current surveillance for this protective factor is self/proxy-reported swim skill rather than observed in-water performance; however, children’s self-report or parents’ proxy report of swim skill has not been validated. This is the first U.S. study to evaluate whether children or parents can validly report a child’s swim skill. It also explores which swim skill survey measure(s) correlate with children’s in-water swim performance. Methods For this cross-sectional convenience-based sample, pilot study, child/parent dyads (N=482) were recruited at three outdoor public pools in Washington state. Agreement between measures of self- and parental-reports of children’s swim skill was assessed via paired analyses, and validated by in-water swim-test results. Results Participants were representative of pool’s patrons (i.e., non-Hispanic White, highly educated, high income). There was agreement in child/parent dyads’ reports of the following child swim skill measures: “ever taken swim lessons”, perceived “good swim skills”, and “comfort in water over head”. Correlation analyses suggest that reported “good swim skills” was the best survey measure to assess a child’s swim skill – best if the parent was the informant (r=0.25–0.47). History of swim lessons was not significantly correlated with passing the swim test. Conclusion Reported “good swim skills” was most correlated with observed swim skill. Reporting “yes” to “ever taken swim lessons” did not correlate with swim skill. While non-generalizable, findings can help inform future studies.

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Responding to 1 measles case cost the pediatric clinic more than $5000, despite isolating the patient promptly after examination. Documentation of employee immunity, vaccination of eligible patients and strict infection control precautions might reduce ambulatory costs associated with measles containment.