According to the 2008 recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, influenza vaccine should be administered on an annual basis to all children aged 6 months through 18 years. School-age children are more likely than any other age group to be infected with influenza, and young children are at high risk for hospitalization resulting from influenza-related complications. Given children's pivotal role in transmission of influenza to their schoolmates, household contacts, and members of their communities, it has been suggested that routinely vaccinating children against the disease might reduce the burden of disease in the US population as a whole. School-located vaccination clinics could go a long way toward improving the rates of pediatric influenza immunization and enhancing the pandemic preparedness of communities. School nurses are urged to consider ways in which they can help advocate for, plan, and/or implement school-located influenza vaccination clinics.
Seasonal influenza is a major cause of morbidity and mortality in the United States. It also has major social and economic consequences in the form of high rates of absenteeism from school and work as well as significant treatment and hospitalization costs. In fact, annual influenza epidemics and the resulting deaths and lost days of productivity are estimated to cost US$10.4 billion in direct medical expenses and US$16.4 billion in lost potential earnings. Given the enormous burden of seasonal influenza and the important role that school-age children play in the cycle of disease, school nurses need to be knowledgeable about all aspects of this condition, including its clinical course and how it is transmitted; the range of options for preventing and treating the disease; and steps that can be taken to improve the rates of immunization against influenza. School nurses also can help by making sure that they themselves are vaccinated in a timely manner.
Cutibacterium (formerly Propionibacterium) acnes (C. acnes) is a commensal bacteria commonly found on the human skin and in the mouth. While the virulence of C. acnes is low in humans, it does produce a biofilm and has been identified as an etiologic agent in a growing number of implant-associated infections. C. acnes infections can prove diagnostically challenging as laboratory cultures can often take greater than 5 days to yield positive results, which are then often disregarded as contaminant. Patients with recurrent bacteremia in the setting of implantable devices warrant further studies to evaluate for an associated valvular or lead endocarditis. The patient in this report demonstrates how cardiac device-related endocarditis secondary to C. acnes can be overlooked due to the indolent nature of this pathogen. This patient presented with an implanted cardiac pacemaker device, as well as retained leads from a prior pacemaker. Transesophageal echocardiography was required to confirm the diagnosis in the setting of multiple positive blood cultures and negative transthoracic echocardiograms over a period of 4 years. The purpose of this report is to highlight the difficulties encountered in diagnosing C. acnes endocarditis in a patient with a cardiac implantable electronic device and persistently positive blood cultures.
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