November 4, 2005

Clostridium difficile-associated disease: Quebec (Historic)
Since 2002 an epidemic of Clostridium difficile-associated disease (CDAD) caused by a hypervirulent toxinotype III ribotype 027 strain has spread to many hospitals in Quebec. The strain has also been found in the United States, the United Kingdom and the Netherlands. A case-control study was undertaken to determine the effects of the epidemic on mortality and duration of hospital stay among patients admitted to a hospital in Quebec in 2003 and 2004. Patients with nosocomial CDAD and control subjects without CDAD were matched for sex, age, Charlson Comorbidity Index score and length of hospital stay up to the diagnosis of CDAD in the corresponding case. Thirty days after diagnosis 23.0% of the patients with CDAD had died, compared with 7.0% of the matched control subjects. Twelve months after diagnosis, mortality was 37.3% among patients with CDAD and 20.6% among the control subjects, for a cumulative attributable mortality of 16.7%. Each case of nosocomial CDAD led, on average, to 10.7 additional days in hospital.
Source: Canadian Medical Association Journal, Volume 173, No. 9, 25 October 2005

Avian Influenza: Canada
A national survey of wild migratory ducks has detected avian influenza. Preliminary results indicate that 28 of the positive reactions in Quebec and five in Manitoba were due to the H5 subtype. The detection of H5 avian influenza is not unusual: the virus is commonly seen in migratory bird populations around the world and various types and strains have been detected in North America over the last 30 years, with no impact on human health. The birds tested in this national survey were healthy, and there is no evidence of influenza-related illness among domestic or wild birds in the test areas.
Source: News Release, Public Health Agency of Canada, 31 October 2005

Invasive Pneumococcal Disease (IPD) Among Older Adults: United States
A conjugate vaccine targeting 7 pneumococcal serotypes was licensed for young children in 2000. In contrast to the 23-valent polysaccharide vaccine used in adults, the 7-valent conjugate vaccine affects pneumococcal carriage and transmission. Early after its introduction, incidence of IPD declined among older adults, a group at high risk for pneumococcal disease. Incidence of IPD among adults aged 50 years or older declined 28% from 40.8 cases/100,000 in 1998-1999 to 29.4 in 2002-2003. Among those aged 65 years or older, the 2002-2003 rate (41.7 cases/100,000) was lower than the Healthy People 2010 goal (42 cases/100,000). Among adults aged 50 years or older, incidence of disease caused by the 7 conjugate vaccine serotypes declined 55% from 22.4 to 10.2 cases/100 000. In contrast, disease caused by any of the 16 serotypes only in polysaccharide vaccine did not change, and disease caused by serotypes not in either vaccine increased somewhat, from 6.0 to 6.8 cases/100 000. The findings indicate that use of conjugate vaccine in children has substantially benefited older adults; however, persons with certain comorbid conditions may benefit less than healthier persons from the indirect effects of the new vaccine.
Source: Journal of the American Medical Association, Volume 294, No. 16, 26 October 2005

Measles Outbreak: Indiana
Over a four-week period in May-June 2005, a large measles outbreak occurred in Indiana. While measles transmission was eliminated from the United States in 2001 by high vaccination levels, globally measles causes 30 to 40 million cases and 530,000 deaths annually worldwide. The source of the Indiana outbreak was an unvaccinated teenager who had just returned from Romania where a large measles outbreak is currently occurring. Most of the 34 Indiana cases were children whose parents had declined to have them vaccinated. There were three hospitalizations, including one person who required mechanical ventilation in the intensive care unit. Strenuous containment efforts were required to prevent the outbreak from spreading further. The Advisory Committee on Immunization Practices has long-standing recommendations that children, foreign travelers, and health care workers should be vaccinated against measles. Had these recommendations been followed, the outbreak would not have occurred.
Source: Morbidity and Mortality Weekly Report, Volume 54, No. 42, 28 October 2005

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