Minnesota Department of Health (MDH) Bug Bytes

October 1, 2001
Vol. 2: No. 18

Topics in this Issue:

1. Pneumococcal Conjugate Vaccine Failure
2. Catch the Latest on Appropriate Antibiotic Use
3. Neisseria - Is it meningitidis or gonorrhoeae?
4. Bioterrorism Resources and Hold that Prescription, Please

1. Pneumococcal Conjugate Vaccine Failure
In October 2000, the Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommended the use of PCV7 (7-valent, pneumococcal polysaccharide-protein conjugate vaccine, Prevnar) among all children aged 2 - 23 months and for children aged 24 - 59 months who are at increased risk for pneumococcal disease (http://www.cdc.gov/mmwr/
Attention: Non-MDH link). Since PCV7 was licensed for use, CDC has received several reports of invasive pneumococcal disease among infants and children who had received at least one dose of PCV7. Cases following vaccination are to be expected, since vaccine efficacy was 97% for invasive disease with pneumococcal serotypes included in the vaccine and 89% for all serotypes.

CDC is interested in hearing about such cases of invasive pneumococcal disease in children under 5 years of age who have received at least one dose of PCV7. Please call us at 651-201-5414 and we will collect additional information such as host conditions that may have contributed to vaccine failure, and vaccine lot numbers that may be associated with decreased protection.

Thanks to all your help, MDH performs active surveillance for invasive cases of pneumococcal disease in the 7-county Twin Cities area and cases of meningitis statewide as part of our Emerging Infections Program. We will include all cases statewide in 2002. Active surveillance includes isolate collection with serotyping performed at MDH.

2. Catch the Latest on Appropriate Antibiotic Use
The Minnesota Antibiotic Resistance Collaborative (MARC), Wisconsin Antibiotic Resistance Network (WARN) and the U.S. Centers for Disease Control and Prevention (CDC) invite you to a satellite conference on Thursday, November 15, 2001, from noon to 1 p.m. on "Adult Respiratory Illness and Antibiotics: Management Strategies to Promote Appropriate Use." Ralph Gonzales, MD, MSPH, from the University of California at San Francisco is the keynote speaker. Dr. Gonzales is a nationally renowned expert on appropriate antibiotic use and chaired the national panel responsible for "Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in Adults" published in March 20, 2001 Annals of Internal Medicine.

This free program been approved for AMA/PRA Category 1 CME credit, AAFP Prescribed credit, and nursing contact hours. It will be broadcast live from the Marshfield Clinic and can be viewed at many sites throughout Minnesota.

As cold and flu season approaches, this is a good opportunity to review the latest treatment recommendations for adult respiratory illness and learn about effective patient communication strategies to promote appropriate antibiotic use. The program will also offer a question and answer session with the speaker.

To register at a site location near you, check this website: www.wismed.org Attention: Non-MDH link. If you do not have web site access or have questions, call the Minnesota Department of Health at 651-201-5414 or toll free at 1-877-676-5414.

MARC (Attention: Non-MDH link) is a broad-based collaborative whose mission is to decrease antibacterial resistance in Minnesota. MARC member organizations include: MDH, BlueCross BlueShield BluePlus of Minnesota, HealthPartners, Medica, Minnesota Medical Association, Minnesota Pharmacy Association, PreferredOne, StratisHealth, and UCare of Minnesota.

3. Neisseria - Is it meningitidis or gonorrhoeae?
Last week received a timely call from an ICP (thank you!) regarding a college student hospitalized with suspect meningococcal disease. The student initially had upper respiratory infection symptoms, then developed swollen joints and a rash around her joints. A blood culture showed the presence of gram negative diplococci; CSF from spinal tap was normal. Our initial concern was that this was a meningococcal infection and we needed to initiate chemoprophylaxis for close dormitory contacts. However, the infectious disease consultant found that the patient had had sexual contact with a male two weeks prior. The consultant suspected that the patient has disseminated gonococcal infection (DGI)(Neisseria gonorrhoeae). DGI occurs in 0.5%-3% of all infected patients. Septic arthritis, polyarthritis, and dermatitis are the predominant manifestations. Half the patients with DGI have positive blood cultures. Further laboratory tests (growth requirements on selective media) confirmed that the infection was N. meningitidis and not N. gonorrhoeae and we initiated chemoprophylaxis of close contacts.

4. Bioterrorism Resources and Hold that Prescription, Please
We have been getting lots of requests for information on bioterrorism. We have put together a packet of articles on anthrax, botulism, smallpox, plague, and tularemia and would be happy to send you one (all of the articles are also available on-line at www.jama.com Attention: Non-MDH link or www.cdc.gov Attention: Non-MDH link). We also have produced a colorful poster designed to alert clinicians to the possibility of bioterrorism. We turned the medical training adage of "when you hear hoofbeats to think horses not zebras" around, so that clinicians consider zebras (illness due to a bioterrorism release). The poster is perfect for hanging in your emergency room, urgent care clinic, doctor's lounge, or home den (that level of awareness warms our hearts). Please call us at 651-201-5414 for copies; it is also available on our new MDH website bioterrorism page at http://www.health.state.mn.us/

On a related note, many schemes have popped up in the last few weeks preying on people's fears. One involves physicians writing a prescription for Ciprofloxacin as an "anthrax safety pack". Ciprofloxacin is one antibiotic recommended for treatment and postexposure prophylaxis for inhalational anthrax that would result from an aerosolization of anthrax spores in a bioterrorism attack. Pharmacies across the U.S. are running out of Ciprofloxacin. This is a bad idea for several reasons. First, although the threat of bioterrorism may be high, we cannot predict where or who would be affected. Second, our job is to investigate such incidents to accurately identify those at risk so we can target treatment and postexposure prophylaxis. Third, we have been planning for such threats. Resources include state and federal pharmaceutical stockpiles including massive caches of antibiotics that would be available within 12-24 hours. Fourth, the overuse of such antibiotics leads to antibiotic resistance (see the second article above and sign up for the conference!). Fifth, a patient's mental health is also important. Such schemes perpetuate undue fears. We know that Bug Bytes readers are leaders and will help us get the correct message out to patients.



Bug Bytes is a combined effort of the Infectious Disease Epidemiology, Prevention and Control Division and the Public Health Laboratory Division of MDH. We provide Bug Bytes as a way to say THANK YOU to the infection control professionals, laboratorians, local public health professionals, and health care providers who assist us.

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Updated Friday, November 19, 2010 at 02:16PM