Sharon Worcester

World Health Regulations

The World Health Organization should be notified about all major health events of international concern, international health officials concluded at the 58th World Health Assembly.

The conclusion was prompted mainly by the SARS and avian influenza outbreaks. Reportable disease outbreaks under the newly adopted international health regulations include those involving flu or suspected bioterrorism. The new regulations, which should become effective in 2007, also require that the WHO assist member nations in responding to disease outbreaks and provide a basis for improved international cooperation in responding to such outbreaks.

The regulations, which were first adopted in 1969 and revised in 1973 and 1981, were revised again in May by the World Health Assembly, which includes health ministers and senior health officials from 192 countries.

Long-Term WNV Outcomes

Initial disability was high in 22 West Nile virus patients who had acute central nervous system infection, and mortality was confined to the most severely affected patients—usually those with respiratory failure—an 18-month follow-up has shown.

Seven patients (32%) died. The mean time to death was 77 days after hospital admission. Respiratory failure was strongly associated with mortality (odds ratio 24.0), reported Lara E. Jeha, M.D., and associates at the Cleveland Clinic Foundation.

All patients were independent in activities of daily living prior to their illness, as measured by a Barthel index score of 100 on a 0–100 scale. At hospital or rehabilitation discharge, nearly half of the 15 surviving patients had Barthel index scores below 50. The low scores persisted at 18 months in only 13% of the patients (Infect. Dis. Clin. Pract. 2005;13:101–3).

Ongoing neuropsychiatric symptoms were common among the survivors. About 48% reported ongoing fatigue, memory problems, or difficulty concentrating. These complaints were most common in those who had encephalitis. Sensorimotor deficits, also reported by about 48% of patients, were most common in those who had weakness at presentation.

Asthma and Pneumococcal Disease

Asthma is an independent risk factor for invasive pneumococcal disease, a nested case-control study suggests. Patients with asthma had a 2.4-fold higher risk, compared with controls.

Asthma was present in about 18% of 635 individuals with invasive pneumococcal disease, compared with 8% of 6,350 controls in the study, Thomas R. Talbot, M.D., of Vanderbilt University in Nashville and his colleagues reported.

Risk was greatest for those with high-risk asthma, defined as having had an emergency department visit, hospital admission, use of rescue therapy, use of long-term oral corticosteroids, or receipt of three or more prescriptions for ?-agonists in the previous year. They had an annual incidence of 4.2 episodes of invasive pneumococcal disease per 10,000 persons, compared with 2.3 episodes per 10,000 persons with low-risk asthma (those diagnosed with or treated for asthma, but not qualifying as high risk), and 1.2 episodes per 10,000 controls (N. Engl. J. Med. 2005;352:2082–90).

The findings suggest asthma should be included in the list of conditions that increase risk of invasive pneumococcal disease, and pneumococcal vaccination for asthma patients should be studied.

Gonorrhea Screening

Clinicians should perform routine screening of all sexually active women at increased risk for gonorrhea, because of the high risk for pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain associated with asymptomatic gonorrhea infection, according to the U.S. Preventive Services Task Force.

Those at risk include sexually active women under age 25, those with previous gonorrhea or other sexually transmitted infections, those with new or multiple sex partners, those who don't consistently use condoms, sex workers, and drug users. Pregnant women with these risk factors should be screened at the first prenatal visit, and those with ongoing or new risk factors should also be screened during the third trimester because gonorrhea increases the risk of preterm rupture of membranes, chorioamnionitis, and preterm labor (Ann. Fam. Med. 2005;3:263–7).

The task force recommended against routine screening in women and men at low risk for gonorrhea, and found insufficient evidence for or against routine screening in men at high risk.

World Health Regulations

The World Health Organization should be notified about all major health events of international concern, international health officials concluded at the 58th World Health Assembly.

The conclusion was prompted mainly by the SARS and avian influenza outbreaks. Reportable disease outbreaks under the newly adopted international health regulations include those involving flu or suspected bioterrorism. The new regulations, which should become effective in 2007, also require that the WHO assist member nations in responding to disease outbreaks and provide a basis for improved international cooperation in responding to such outbreaks.

The regulations, which were first adopted in 1969 and revised in 1973 and 1981, were revised again in May by the World Health Assembly, which includes health ministers and senior health officials from 192 countries.

Long-Term WNV Outcomes

Initial disability was high in 22 West Nile virus patients who had acute central nervous system infection, and mortality was confined to the most severely affected patients—usually those with respiratory failure—an 18-month follow-up has shown.

Seven patients (32%) died. The mean time to death was 77 days after hospital admission. Respiratory failure was strongly associated with mortality (odds ratio 24.0), reported Lara E. Jeha, M.D., and associates at the Cleveland Clinic Foundation.

All patients were independent in activities of daily living prior to their illness, as measured by a Barthel index score of 100 on a 0–100 scale. At hospital or rehabilitation discharge, nearly half of the 15 surviving patients had Barthel index scores below 50. The low scores persisted at 18 months in only 13% of the patients (Infect. Dis. Clin. Pract. 2005;13:101–3).

Ongoing neuropsychiatric symptoms were common among the survivors. About 48% reported ongoing fatigue, memory problems, or difficulty concentrating. These complaints were most common in those who had encephalitis. Sensorimotor deficits, also reported by about 48% of patients, were most common in those who had weakness at presentation.

Asthma and Pneumococcal Disease

Asthma is an independent risk factor for invasive pneumococcal disease, a nested case-control study suggests. Patients with asthma had a 2.4-fold higher risk, compared with controls.

Asthma was present in about 18% of 635 individuals with invasive pneumococcal disease, compared with 8% of 6,350 controls in the study, Thomas R. Talbot, M.D., of Vanderbilt University in Nashville and his colleagues reported.

Risk was greatest for those with high-risk asthma, defined as having had an emergency department visit, hospital admission, use of rescue therapy, use of long-term oral corticosteroids, or receipt of three or more prescriptions for ?-agonists in the previous year. They had an annual incidence of 4.2 episodes of invasive pneumococcal disease per 10,000 persons, compared with 2.3 episodes per 10,000 persons with low-risk asthma (those diagnosed with or treated for asthma, but not qualifying as high risk), and 1.2 episodes per 10,000 controls (N. Engl. J. Med. 2005;352:2082–90).

The findings suggest asthma should be included in the list of conditions that increase risk of invasive pneumococcal disease, and pneumococcal vaccination for asthma patients should be studied.

Gonorrhea Screening

Clinicians should perform routine screening of all sexually active women at increased risk for gonorrhea, because of the high risk for pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain associated with asymptomatic gonorrhea infection, according to the U.S. Preventive Services Task Force.

Those at risk include sexually active women under age 25, those with previous gonorrhea or other sexually transmitted infections, those with new or multiple sex partners, those who don't consistently use condoms, sex workers, and drug users. Pregnant women with these risk factors should be screened at the first prenatal visit, and those with ongoing or new risk factors should also be screened during the third trimester because gonorrhea increases the risk of preterm rupture of membranes, chorioamnionitis, and preterm labor (Ann. Fam. Med. 2005;3:263–7).

The task force recommended against routine screening in women and men at low risk for gonorrhea, and found insufficient evidence for or against routine screening in men at high risk.

World Health Regulations

The World Health Organization should be notified about all major health events of international concern, international health officials concluded at the 58th World Health Assembly.

The conclusion was prompted mainly by the SARS and avian influenza outbreaks. Reportable disease outbreaks under the newly adopted international health regulations include those involving flu or suspected bioterrorism. The new regulations, which should become effective in 2007, also require that the WHO assist member nations in responding to disease outbreaks and provide a basis for improved international cooperation in responding to such outbreaks.

The regulations, which were first adopted in 1969 and revised in 1973 and 1981, were revised again in May by the World Health Assembly, which includes health ministers and senior health officials from 192 countries.

Long-Term WNV Outcomes

Initial disability was high in 22 West Nile virus patients who had acute central nervous system infection, and mortality was confined to the most severely affected patients—usually those with respiratory failure—an 18-month follow-up has shown.

Seven patients (32%) died. The mean time to death was 77 days after hospital admission. Respiratory failure was strongly associated with mortality (odds ratio 24.0), reported Lara E. Jeha, M.D., and associates at the Cleveland Clinic Foundation.

All patients were independent in activities of daily living prior to their illness, as measured by a Barthel index score of 100 on a 0–100 scale. At hospital or rehabilitation discharge, nearly half of the 15 surviving patients had Barthel index scores below 50. The low scores persisted at 18 months in only 13% of the patients (Infect. Dis. Clin. Pract. 2005;13:101–3).

Ongoing neuropsychiatric symptoms were common among the survivors. About 48% reported ongoing fatigue, memory problems, or difficulty concentrating. These complaints were most common in those who had encephalitis. Sensorimotor deficits, also reported by about 48% of patients, were most common in those who had weakness at presentation.

Asthma and Pneumococcal Disease

Asthma is an independent risk factor for invasive pneumococcal disease, a nested case-control study suggests. Patients with asthma had a 2.4-fold higher risk, compared with controls.

Asthma was present in about 18% of 635 individuals with invasive pneumococcal disease, compared with 8% of 6,350 controls in the study, Thomas R. Talbot, M.D., of Vanderbilt University in Nashville and his colleagues reported.

Risk was greatest for those with high-risk asthma, defined as having had an emergency department visit, hospital admission, use of rescue therapy, use of long-term oral corticosteroids, or receipt of three or more prescriptions for ?-agonists in the previous year. They had an annual incidence of 4.2 episodes of invasive pneumococcal disease per 10,000 persons, compared with 2.3 episodes per 10,000 persons with low-risk asthma (those diagnosed with or treated for asthma, but not qualifying as high risk), and 1.2 episodes per 10,000 controls (N. Engl. J. Med. 2005;352:2082–90).

The findings suggest asthma should be included in the list of conditions that increase risk of invasive pneumococcal disease, and pneumococcal vaccination for asthma patients should be studied.

Gonorrhea Screening

Clinicians should perform routine screening of all sexually active women at increased risk for gonorrhea, because of the high risk for pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain associated with asymptomatic gonorrhea infection, according to the U.S. Preventive Services Task Force.

Those at risk include sexually active women under age 25, those with previous gonorrhea or other sexually transmitted infections, those with new or multiple sex partners, those who don't consistently use condoms, sex workers, and drug users. Pregnant women with these risk factors should be screened at the first prenatal visit, and those with ongoing or new risk factors should also be screened during the third trimester because gonorrhea increases the risk of preterm rupture of membranes, chorioamnionitis, and preterm labor (Ann. Fam. Med. 2005;3:263–7).

The task force recommended against routine screening in women and men at low risk for gonorrhea, and found insufficient evidence for or against routine screening in men at high risk.

ORLANDO, FLA. — Moderate-intensity exercise coupled with caloric restriction was better than exercise alone for inducing favorable changes in waist circumference in women in a recent study.

This combination approach was particularly beneficial for reducing waist circumference, which is important, because central adiposity is widely considered to be the central aspect of metabolic syndrome, Theodore J. Angelopoulos, Ph.D., said at an international conference on women, heart disease, and stroke.

Of 98 women with an average age of 43 years who were randomly assigned to either an exercise-only group or an exercise and caloric restriction group, all experienced improvements in the various components of metabolic syndrome. In addition to waist circumference, these included glucose, HDL-cholesterol and triglyceride levels, and diastolic and systolic blood pressure, said Dr. Angelopoulos of Rippe Lifestyle Institute in Celebration, Fla., at a news conference at the meeting.

The change in waist circumference was statistically significant in both groups, with a reduction from 92 cm to 87 cm in the exercise-only group and from 90 cm to 82 cm in the diet and exercise group. This was the only component in which the difference in the exercise and caloric restriction group was significantly greater than the difference in the exercise-only group. However, the improvements in glucose levels and systolic blood pressure were significant in both groups, and the improvement in diastolic blood pressure was significant in the exercise-only group.

Women in both groups followed a typical exercise regimen recommended by the American College of Sports Medicine, and those in the exercise-plus-caloric restriction group also reduced caloric intake by 500 kcal/day.

ORLANDO, FLA. — Moderate-intensity exercise coupled with caloric restriction was better than exercise alone for inducing favorable changes in waist circumference in women in a recent study.

This combination approach was particularly beneficial for reducing waist circumference, which is important, because central adiposity is widely considered to be the central aspect of metabolic syndrome, Theodore J. Angelopoulos, Ph.D., said at an international conference on women, heart disease, and stroke.

Of 98 women with an average age of 43 years who were randomly assigned to either an exercise-only group or an exercise and caloric restriction group, all experienced improvements in the various components of metabolic syndrome. In addition to waist circumference, these included glucose, HDL-cholesterol and triglyceride levels, and diastolic and systolic blood pressure, said Dr. Angelopoulos of Rippe Lifestyle Institute in Celebration, Fla., at a news conference at the meeting.

The change in waist circumference was statistically significant in both groups, with a reduction from 92 cm to 87 cm in the exercise-only group and from 90 cm to 82 cm in the diet and exercise group. This was the only component in which the difference in the exercise and caloric restriction group was significantly greater than the difference in the exercise-only group. However, the improvements in glucose levels and systolic blood pressure were significant in both groups, and the improvement in diastolic blood pressure was significant in the exercise-only group.

Women in both groups followed a typical exercise regimen recommended by the American College of Sports Medicine, and those in the exercise-plus-caloric restriction group also reduced caloric intake by 500 kcal/day.

ORLANDO, FLA. — Moderate-intensity exercise coupled with caloric restriction was better than exercise alone for inducing favorable changes in waist circumference in women in a recent study.

This combination approach was particularly beneficial for reducing waist circumference, which is important, because central adiposity is widely considered to be the central aspect of metabolic syndrome, Theodore J. Angelopoulos, Ph.D., said at an international conference on women, heart disease, and stroke.

Of 98 women with an average age of 43 years who were randomly assigned to either an exercise-only group or an exercise and caloric restriction group, all experienced improvements in the various components of metabolic syndrome. In addition to waist circumference, these included glucose, HDL-cholesterol and triglyceride levels, and diastolic and systolic blood pressure, said Dr. Angelopoulos of Rippe Lifestyle Institute in Celebration, Fla., at a news conference at the meeting.

The change in waist circumference was statistically significant in both groups, with a reduction from 92 cm to 87 cm in the exercise-only group and from 90 cm to 82 cm in the diet and exercise group. This was the only component in which the difference in the exercise and caloric restriction group was significantly greater than the difference in the exercise-only group. However, the improvements in glucose levels and systolic blood pressure were significant in both groups, and the improvement in diastolic blood pressure was significant in the exercise-only group.

Women in both groups followed a typical exercise regimen recommended by the American College of Sports Medicine, and those in the exercise-plus-caloric restriction group also reduced caloric intake by 500 kcal/day.

HIV Testing

Adding nucleic acid amplification testing to standard HIV antibody testing improves detection of acute HIV infection, according to Christopher D. Pilcher, M.D., of the University of North Carolina at Chapel Hill and his colleagues.

In a 12-month multicenter observational study, all serum samples that yielded a negative standard HIV antibody test were retested using a nucleic acid amplification pooling algorithm in an effort to identify those with acute HIV infection who were viremic but antibody negative. Pools that yielded a positive result were broken down for further testing.

Of 109,250 people tested, 606 had HIV-positive results. Of these, 23 were antibody negative and were identified as HIV-positive only with the nucleic acid amplification testing; the latter increased the HIV case identification rate by 4% over standard testing alone (N. Engl. J. Med. 2005;352:1873–83).

For a total added testing cost of $3.63 per specimen (a 3% budget increase in North Carolina, where the study was conducted), nucleic acid amplification testing led to the use of emergency HIV prevention in 21 patients whose HIV would not have been detected using standard testing methods. As a result, 48 sex partners and one fetus were protected against high-risk exposure to HIV, the investigators said.

This form of testing should be included as a standard tool for HIV prevention and surveillance, they concluded.

Xenotransplantation Standards

Recent progress in studies of animal-to-human organ transplantation is raising concerns about whether adequate controls of the practice are in place, and the World Health Organization has urged its member states to allow xenotransplantation only with appropriate oversight by national health authorities.

Several countries have rigorous guidelines and oversight procedures for xenotransplantation, but in other countries, there is a lack of quality and safety controls, according to the WHO.

The main concern is the potential for transmission of diseases and infections that originate in animals but can spread to transplant recipients and then to the larger population.

To assist member states in their efforts to implement stronger protection measures and to stop illegal performance of xenotransplantation—as well as to “harness the real potential of this promising field”—the WHO has revised an action plan by updating relevant guidelines and recommendations.

The updates describe methods for collecting and disseminating information on xenotransplantation practices, raising awareness among health authorities, and promoting high ethical standards and well-regulated practices.

The guidance and its effective regulation can be obtained from the WHO at

www.who.int/transplantation/xeno

Rapid MRSA Test

A novel, real-time polymerase chain reaction assay reliably identifies methicillin-resistant Staphylococcus aureus in nasal specimens in less than an hour, Ann Huletsky, Ph.D., of Université Laval, Sainte-Foy, Canada, and her colleagues reported.

In a study evaluating their assay, 331 nasal specimens from 162 patients at risk for colonization were tested using both the PCR assay and the standard mannitol agar culture method.

The assay detected MRSA in all 76 culture-positive samples, as well as in 9 additional culture-negative samples (5 of which proved culture positive on repeat testing), for a specificity of 98.4%, a positive predictive value of 95.3%, and a sensitivity and negative predictive value of 100% (Clin. Infect. Dis. 2005;40:976–81).

Compared with the standard surveillance culture method for detecting MRSA, which requires at least 48 hours to obtain results, the new assay could facilitate MRSA surveillance programs by enabling earlier implementation of contact precautions, thereby limiting the spread of the organism, the investigators said.

Anthrax Vaccine Contract

The U.S. Department of Health and Human Services has awarded a $123 million contract for the manufacture and delivery of 5 million doses of licensed anthrax vaccine.

The contract, awarded to BioPort Corp. (Lansing, Mich.), is the third granted under Project BioShield, a program signed into law by President Bush last year in an effort to accelerate development and acquisition of medical countermeasures for biological, chemical, radiological, and nuclear threats.

The anthrax vaccine supply will be placed in the nation's Strategic National Stockpile, along with an existing stockpile of antibiotics, for use in the event of a bioterror attack involving anthrax.

HIV Testing

Adding nucleic acid amplification testing to standard HIV antibody testing improves detection of acute HIV infection, according to Christopher D. Pilcher, M.D., of the University of North Carolina at Chapel Hill and his colleagues.

In a 12-month multicenter observational study, all serum samples that yielded a negative standard HIV antibody test were retested using a nucleic acid amplification pooling algorithm in an effort to identify those with acute HIV infection who were viremic but antibody negative. Pools that yielded a positive result were broken down for further testing.

Of 109,250 people tested, 606 had HIV-positive results. Of these, 23 were antibody negative and were identified as HIV-positive only with the nucleic acid amplification testing; the latter increased the HIV case identification rate by 4% over standard testing alone (N. Engl. J. Med. 2005;352:1873–83).

For a total added testing cost of $3.63 per specimen (a 3% budget increase in North Carolina, where the study was conducted), nucleic acid amplification testing led to the use of emergency HIV prevention in 21 patients whose HIV would not have been detected using standard testing methods. As a result, 48 sex partners and one fetus were protected against high-risk exposure to HIV, the investigators said.

This form of testing should be included as a standard tool for HIV prevention and surveillance, they concluded.

Xenotransplantation Standards

Recent progress in studies of animal-to-human organ transplantation is raising concerns about whether adequate controls of the practice are in place, and the World Health Organization has urged its member states to allow xenotransplantation only with appropriate oversight by national health authorities.

Several countries have rigorous guidelines and oversight procedures for xenotransplantation, but in other countries, there is a lack of quality and safety controls, according to the WHO.

The main concern is the potential for transmission of diseases and infections that originate in animals but can spread to transplant recipients and then to the larger population.

To assist member states in their efforts to implement stronger protection measures and to stop illegal performance of xenotransplantation—as well as to “harness the real potential of this promising field”—the WHO has revised an action plan by updating relevant guidelines and recommendations.

The updates describe methods for collecting and disseminating information on xenotransplantation practices, raising awareness among health authorities, and promoting high ethical standards and well-regulated practices.

The guidance and its effective regulation can be obtained from the WHO at

www.who.int/transplantation/xeno

Rapid MRSA Test

A novel, real-time polymerase chain reaction assay reliably identifies methicillin-resistant Staphylococcus aureus in nasal specimens in less than an hour, Ann Huletsky, Ph.D., of Université Laval, Sainte-Foy, Canada, and her colleagues reported.

In a study evaluating their assay, 331 nasal specimens from 162 patients at risk for colonization were tested using both the PCR assay and the standard mannitol agar culture method.

The assay detected MRSA in all 76 culture-positive samples, as well as in 9 additional culture-negative samples (5 of which proved culture positive on repeat testing), for a specificity of 98.4%, a positive predictive value of 95.3%, and a sensitivity and negative predictive value of 100% (Clin. Infect. Dis. 2005;40:976–81).

Compared with the standard surveillance culture method for detecting MRSA, which requires at least 48 hours to obtain results, the new assay could facilitate MRSA surveillance programs by enabling earlier implementation of contact precautions, thereby limiting the spread of the organism, the investigators said.

Anthrax Vaccine Contract

The U.S. Department of Health and Human Services has awarded a $123 million contract for the manufacture and delivery of 5 million doses of licensed anthrax vaccine.

The contract, awarded to BioPort Corp. (Lansing, Mich.), is the third granted under Project BioShield, a program signed into law by President Bush last year in an effort to accelerate development and acquisition of medical countermeasures for biological, chemical, radiological, and nuclear threats.

The anthrax vaccine supply will be placed in the nation's Strategic National Stockpile, along with an existing stockpile of antibiotics, for use in the event of a bioterror attack involving anthrax.

HIV Testing

Adding nucleic acid amplification testing to standard HIV antibody testing improves detection of acute HIV infection, according to Christopher D. Pilcher, M.D., of the University of North Carolina at Chapel Hill and his colleagues.

In a 12-month multicenter observational study, all serum samples that yielded a negative standard HIV antibody test were retested using a nucleic acid amplification pooling algorithm in an effort to identify those with acute HIV infection who were viremic but antibody negative. Pools that yielded a positive result were broken down for further testing.

Of 109,250 people tested, 606 had HIV-positive results. Of these, 23 were antibody negative and were identified as HIV-positive only with the nucleic acid amplification testing; the latter increased the HIV case identification rate by 4% over standard testing alone (N. Engl. J. Med. 2005;352:1873–83).

For a total added testing cost of $3.63 per specimen (a 3% budget increase in North Carolina, where the study was conducted), nucleic acid amplification testing led to the use of emergency HIV prevention in 21 patients whose HIV would not have been detected using standard testing methods. As a result, 48 sex partners and one fetus were protected against high-risk exposure to HIV, the investigators said.

This form of testing should be included as a standard tool for HIV prevention and surveillance, they concluded.

Xenotransplantation Standards

Recent progress in studies of animal-to-human organ transplantation is raising concerns about whether adequate controls of the practice are in place, and the World Health Organization has urged its member states to allow xenotransplantation only with appropriate oversight by national health authorities.

Several countries have rigorous guidelines and oversight procedures for xenotransplantation, but in other countries, there is a lack of quality and safety controls, according to the WHO.

The main concern is the potential for transmission of diseases and infections that originate in animals but can spread to transplant recipients and then to the larger population.

To assist member states in their efforts to implement stronger protection measures and to stop illegal performance of xenotransplantation—as well as to “harness the real potential of this promising field”—the WHO has revised an action plan by updating relevant guidelines and recommendations.

The updates describe methods for collecting and disseminating information on xenotransplantation practices, raising awareness among health authorities, and promoting high ethical standards and well-regulated practices.

The guidance and its effective regulation can be obtained from the WHO at

www.who.int/transplantation/xeno

Rapid MRSA Test

A novel, real-time polymerase chain reaction assay reliably identifies methicillin-resistant Staphylococcus aureus in nasal specimens in less than an hour, Ann Huletsky, Ph.D., of Université Laval, Sainte-Foy, Canada, and her colleagues reported.

In a study evaluating their assay, 331 nasal specimens from 162 patients at risk for colonization were tested using both the PCR assay and the standard mannitol agar culture method.

The assay detected MRSA in all 76 culture-positive samples, as well as in 9 additional culture-negative samples (5 of which proved culture positive on repeat testing), for a specificity of 98.4%, a positive predictive value of 95.3%, and a sensitivity and negative predictive value of 100% (Clin. Infect. Dis. 2005;40:976–81).

Compared with the standard surveillance culture method for detecting MRSA, which requires at least 48 hours to obtain results, the new assay could facilitate MRSA surveillance programs by enabling earlier implementation of contact precautions, thereby limiting the spread of the organism, the investigators said.

Anthrax Vaccine Contract

The U.S. Department of Health and Human Services has awarded a $123 million contract for the manufacture and delivery of 5 million doses of licensed anthrax vaccine.

The contract, awarded to BioPort Corp. (Lansing, Mich.), is the third granted under Project BioShield, a program signed into law by President Bush last year in an effort to accelerate development and acquisition of medical countermeasures for biological, chemical, radiological, and nuclear threats.

The anthrax vaccine supply will be placed in the nation's Strategic National Stockpile, along with an existing stockpile of antibiotics, for use in the event of a bioterror attack involving anthrax.

ORLANDO, FLA. — Men with heart failure and/or bundle branch block are preferentially treated more aggressively with implantable devices than are women with similar health status, a review of nearly 11,000 cases suggests.

The 10,931 patients, of whom 4,138 (38%) were women, were listed in an administrative database and represented consecutive admissions to any of numerous hospitals owned by Hospital Corporation of America. All had a diagnosis of heart failure, bundle branch block, or both, and underwent a primary procedure of pacemaker, cardiac resynchronization therapy pacemaker (CRT-P), implantable cardioverter defibrillator (ICD), or cardiac resynchronization therapy defibrillator (CRT-D) implantation, Robert Fishel, M.D., said at an international conference on women, heart disease, and stroke.

Women received 52% of the pacemakers, 33% of the CRT-Ps, 22% of the ICDs, and 21% of the CRT-Ds implanted, said Dr. Fishel of the J.F.K. Medical Center, Atlantis, Fla. Logistic regression analysis showed that men were significantly less likely than women to receive a pacemaker (odds ratio 0.35) and more likely to receive an ICD (OR 1.34) or CRT-D (OR 1.48). There was no significant difference in device utilization of CRP-Ps between sexes.

After controlling for device, diagnoses, age, and comorbidities, there were no significant differences between men and women in measured clinical outcomes, including mortality, postoperative stroke, postoperative infection, or ICD or pacemaker mechanical malfunction. However, further research is needed to determine if these differences in device use have any long-term effects on outcomes in women, he said.

ORLANDO, FLA. — Men with heart failure and/or bundle branch block are preferentially treated more aggressively with implantable devices than are women with similar health status, a review of nearly 11,000 cases suggests.

The 10,931 patients, of whom 4,138 (38%) were women, were listed in an administrative database and represented consecutive admissions to any of numerous hospitals owned by Hospital Corporation of America. All had a diagnosis of heart failure, bundle branch block, or both, and underwent a primary procedure of pacemaker, cardiac resynchronization therapy pacemaker (CRT-P), implantable cardioverter defibrillator (ICD), or cardiac resynchronization therapy defibrillator (CRT-D) implantation, Robert Fishel, M.D., said at an international conference on women, heart disease, and stroke.

Women received 52% of the pacemakers, 33% of the CRT-Ps, 22% of the ICDs, and 21% of the CRT-Ds implanted, said Dr. Fishel of the J.F.K. Medical Center, Atlantis, Fla. Logistic regression analysis showed that men were significantly less likely than women to receive a pacemaker (odds ratio 0.35) and more likely to receive an ICD (OR 1.34) or CRT-D (OR 1.48). There was no significant difference in device utilization of CRP-Ps between sexes.

After controlling for device, diagnoses, age, and comorbidities, there were no significant differences between men and women in measured clinical outcomes, including mortality, postoperative stroke, postoperative infection, or ICD or pacemaker mechanical malfunction. However, further research is needed to determine if these differences in device use have any long-term effects on outcomes in women, he said.

ORLANDO, FLA. — Men with heart failure and/or bundle branch block are preferentially treated more aggressively with implantable devices than are women with similar health status, a review of nearly 11,000 cases suggests.

The 10,931 patients, of whom 4,138 (38%) were women, were listed in an administrative database and represented consecutive admissions to any of numerous hospitals owned by Hospital Corporation of America. All had a diagnosis of heart failure, bundle branch block, or both, and underwent a primary procedure of pacemaker, cardiac resynchronization therapy pacemaker (CRT-P), implantable cardioverter defibrillator (ICD), or cardiac resynchronization therapy defibrillator (CRT-D) implantation, Robert Fishel, M.D., said at an international conference on women, heart disease, and stroke.

Women received 52% of the pacemakers, 33% of the CRT-Ps, 22% of the ICDs, and 21% of the CRT-Ds implanted, said Dr. Fishel of the J.F.K. Medical Center, Atlantis, Fla. Logistic regression analysis showed that men were significantly less likely than women to receive a pacemaker (odds ratio 0.35) and more likely to receive an ICD (OR 1.34) or CRT-D (OR 1.48). There was no significant difference in device utilization of CRP-Ps between sexes.

After controlling for device, diagnoses, age, and comorbidities, there were no significant differences between men and women in measured clinical outcomes, including mortality, postoperative stroke, postoperative infection, or ICD or pacemaker mechanical malfunction. However, further research is needed to determine if these differences in device use have any long-term effects on outcomes in women, he said.

ORLANDO, FLA. — Women presenting with myocardial infarction continue to receive less intensive treatment and have higher mortality than men with similar presentations, but the gender gap in medical interventions prescribed at hospital discharge may be narrowing, according to studies presented at an international conference on women, heart disease, and stroke.

One retrospective study included nearly 26,700 Swedish patients who were treated for ST-elevation MI (STEMI) at cardiac intensive care units during 1997–2001. Reperfusion therapy was administered to 71% of the 17,243 men in the study, compared with 62% of the 9,455 women in the study, Sofia Sederholm Lavesson, M.D., reported.

Men, compared with women, had lower in-hospital mortality (9% vs. 16%), 30-day mortality (11% vs. 18%), and 1-year mortality (16% vs. 25%), said Dr. Lavesson of Linköping (Sweden) University.

After adjusting for numerous confounding factors, women remained significantly less likely than men to receive reperfusion therapy (odds ratio 0.83) and to survive while in the hospital (OR 1.23), she said, noting that the differences between men and women cannot be fully explained by differences in age and comorbidities. “[Greater] age is the main explanation for the higher mortality in women, but less intensive treatment also appears to contribute.”

A similar conclusion was reached in a study of more than 55,000 patients who were admitted to any of 153 different hospitals with a primary diagnosis of Q-wave acute MI during January 2000 to June 2004.

Mortality was 13% in the 19,034 women in the study, compared with 7% in the 35,969 men. After adjusting for 24 variables, including age, various comorbidities, and type of hospital providing the treatment (heart surgery hospital, cath lab hospital, and hospital with no heart surgery or cath lab), men were shown to be less likely than women to die (OR 0.71). Additionally, men were more likely than women to be transferred for further treatment (OR 1.24), receive thrombolytics (OR 1.16), receive percutaneous coronary intervention (OR 1.12), and/or receive coronary artery bypass grafting (OR 1.64), Allan L. Anderson, M.D., of the Medical City Dallas Hospital, reported.

“Women with Q-wave acute MI continue to have significantly worse mortality rates and receive less revascularization than men,” he concluded, noting that additional research is needed to determine how women with MI can obtain clinical parity with men.

But such parity is being achieved when it comes to the prescribing of medical interventions at hospital discharge in patients who present with heart attack or chest pain, a third study suggests.

That ongoing study showed such men and women are being prescribed appropriate drug interventions at the about the same frequency. The subanalysis of a National Institutes of Health-funded study of 177 men and 35 women with acute coronary syndrome showed that women were prescribed aspirin, β-blockers, and statins as frequently as men, however, it also showed that 10% of women with acute coronary syndrome didn't receive aspirin or β-blockers and that more than 30% didn't receive statins, Shu-Fen Wung, Ph.D., and Heather Hiscox of the University of Arizona, Tucson, reported in a poster.

Also, women in this study lived significantly longer than men following their hospitalization (179 days vs. 156 days), with both age and gender showing a significant association with 6-month survival, the investigators noted.

The findings suggest that more people are following the guidelines of the American Heart Association and American College of Cardiology, and that progress is being made in the treatment of both men and women, Dr. Wung said in a statement.

ORLANDO, FLA. — Women presenting with myocardial infarction continue to receive less intensive treatment and have higher mortality than men with similar presentations, but the gender gap in medical interventions prescribed at hospital discharge may be narrowing, according to studies presented at an international conference on women, heart disease, and stroke.

One retrospective study included nearly 26,700 Swedish patients who were treated for ST-elevation MI (STEMI) at cardiac intensive care units during 1997–2001. Reperfusion therapy was administered to 71% of the 17,243 men in the study, compared with 62% of the 9,455 women in the study, Sofia Sederholm Lavesson, M.D., reported.

Men, compared with women, had lower in-hospital mortality (9% vs. 16%), 30-day mortality (11% vs. 18%), and 1-year mortality (16% vs. 25%), said Dr. Lavesson of Linköping (Sweden) University.

After adjusting for numerous confounding factors, women remained significantly less likely than men to receive reperfusion therapy (odds ratio 0.83) and to survive while in the hospital (OR 1.23), she said, noting that the differences between men and women cannot be fully explained by differences in age and comorbidities. “[Greater] age is the main explanation for the higher mortality in women, but less intensive treatment also appears to contribute.”

A similar conclusion was reached in a study of more than 55,000 patients who were admitted to any of 153 different hospitals with a primary diagnosis of Q-wave acute MI during January 2000 to June 2004.

Mortality was 13% in the 19,034 women in the study, compared with 7% in the 35,969 men. After adjusting for 24 variables, including age, various comorbidities, and type of hospital providing the treatment (heart surgery hospital, cath lab hospital, and hospital with no heart surgery or cath lab), men were shown to be less likely than women to die (OR 0.71). Additionally, men were more likely than women to be transferred for further treatment (OR 1.24), receive thrombolytics (OR 1.16), receive percutaneous coronary intervention (OR 1.12), and/or receive coronary artery bypass grafting (OR 1.64), Allan L. Anderson, M.D., of the Medical City Dallas Hospital, reported.

“Women with Q-wave acute MI continue to have significantly worse mortality rates and receive less revascularization than men,” he concluded, noting that additional research is needed to determine how women with MI can obtain clinical parity with men.

But such parity is being achieved when it comes to the prescribing of medical interventions at hospital discharge in patients who present with heart attack or chest pain, a third study suggests.

That ongoing study showed such men and women are being prescribed appropriate drug interventions at the about the same frequency. The subanalysis of a National Institutes of Health-funded study of 177 men and 35 women with acute coronary syndrome showed that women were prescribed aspirin, β-blockers, and statins as frequently as men, however, it also showed that 10% of women with acute coronary syndrome didn't receive aspirin or β-blockers and that more than 30% didn't receive statins, Shu-Fen Wung, Ph.D., and Heather Hiscox of the University of Arizona, Tucson, reported in a poster.

Also, women in this study lived significantly longer than men following their hospitalization (179 days vs. 156 days), with both age and gender showing a significant association with 6-month survival, the investigators noted.

The findings suggest that more people are following the guidelines of the American Heart Association and American College of Cardiology, and that progress is being made in the treatment of both men and women, Dr. Wung said in a statement.

ORLANDO, FLA. — Women presenting with myocardial infarction continue to receive less intensive treatment and have higher mortality than men with similar presentations, but the gender gap in medical interventions prescribed at hospital discharge may be narrowing, according to studies presented at an international conference on women, heart disease, and stroke.

One retrospective study included nearly 26,700 Swedish patients who were treated for ST-elevation MI (STEMI) at cardiac intensive care units during 1997–2001. Reperfusion therapy was administered to 71% of the 17,243 men in the study, compared with 62% of the 9,455 women in the study, Sofia Sederholm Lavesson, M.D., reported.

Men, compared with women, had lower in-hospital mortality (9% vs. 16%), 30-day mortality (11% vs. 18%), and 1-year mortality (16% vs. 25%), said Dr. Lavesson of Linköping (Sweden) University.

After adjusting for numerous confounding factors, women remained significantly less likely than men to receive reperfusion therapy (odds ratio 0.83) and to survive while in the hospital (OR 1.23), she said, noting that the differences between men and women cannot be fully explained by differences in age and comorbidities. “[Greater] age is the main explanation for the higher mortality in women, but less intensive treatment also appears to contribute.”

A similar conclusion was reached in a study of more than 55,000 patients who were admitted to any of 153 different hospitals with a primary diagnosis of Q-wave acute MI during January 2000 to June 2004.

Mortality was 13% in the 19,034 women in the study, compared with 7% in the 35,969 men. After adjusting for 24 variables, including age, various comorbidities, and type of hospital providing the treatment (heart surgery hospital, cath lab hospital, and hospital with no heart surgery or cath lab), men were shown to be less likely than women to die (OR 0.71). Additionally, men were more likely than women to be transferred for further treatment (OR 1.24), receive thrombolytics (OR 1.16), receive percutaneous coronary intervention (OR 1.12), and/or receive coronary artery bypass grafting (OR 1.64), Allan L. Anderson, M.D., of the Medical City Dallas Hospital, reported.

“Women with Q-wave acute MI continue to have significantly worse mortality rates and receive less revascularization than men,” he concluded, noting that additional research is needed to determine how women with MI can obtain clinical parity with men.

But such parity is being achieved when it comes to the prescribing of medical interventions at hospital discharge in patients who present with heart attack or chest pain, a third study suggests.

That ongoing study showed such men and women are being prescribed appropriate drug interventions at the about the same frequency. The subanalysis of a National Institutes of Health-funded study of 177 men and 35 women with acute coronary syndrome showed that women were prescribed aspirin, β-blockers, and statins as frequently as men, however, it also showed that 10% of women with acute coronary syndrome didn't receive aspirin or β-blockers and that more than 30% didn't receive statins, Shu-Fen Wung, Ph.D., and Heather Hiscox of the University of Arizona, Tucson, reported in a poster.

Also, women in this study lived significantly longer than men following their hospitalization (179 days vs. 156 days), with both age and gender showing a significant association with 6-month survival, the investigators noted.

The findings suggest that more people are following the guidelines of the American Heart Association and American College of Cardiology, and that progress is being made in the treatment of both men and women, Dr. Wung said in a statement.

Hydrocortisone for Pneumonia

Hydrocortisone infusion in patients with severe community-acquired pneumonia leads to earlier resolution and prevents development of sepsis-related complications, a prospective multicenter study suggests.

A total of 46 patients with severe community-acquired pneumonia were enrolled and randomized to receive protocol-guided antibiotic treatment plus 7 days of hydrocortisone infusion or placebo. Hydrocortisone was given as an intravenous 200-mg loading bolus followed by infusion of 240 mg in 500 cc of 0.9% saline at a rate of 10 mg/hour, Marco Confalonieri, M.D., of Trieste, Italy, and his colleagues reported.

At study day eight, 20 of 23 patients in the treatment group, compared with 9 of 23 controls, had improved ratios of arterial oxygen pressure to fraction of inspired oxygen. Significantly greater reductions in multiple organ dysfunction syndrome scores and chest radiograph scores were observed in the treatment group. C-reactive protein (CRP) levels, which were higher in the treatment group at study entry, fell by more than 50% in 21 of 23 patients, compared with 5 of 23 controls (Am. J. Respir. Crit. Care Med. 2005;171:242–8).

Patients with persistent CRP elevations had a higher incidence of delayed septic shock than those with reduced CRP levels (nine vs. zero patients). Also reduced in the treatment group were duration of mechanical ventilation (median 4 vs. 10 days), hospital stay (median 13 vs. 21 days), and 60-day mortality (0% vs. 38%).

Poliomyelitis Eradication

Efforts to eradicate poliomyelitis suffered a setback in 2004, according to the Centers for Disease Control and Prevention.

The most progress was made in Egypt and in three Asian countries where the disease is endemic: during peak transmission season, the number of cases was the lowest ever reported in those countries. However, a resurgence of poliomyelitis in 2 African countries spread to a total of 14 countries that had not reported polio for more than 1 year (MMWR 2005;54:408–12).

Eradication efforts should focus on high-quality vaccination campaigns and on monitoring surveillance quality to ensure rapid detection of circulating virus or importation and a timely response, according to the CDC, which stresses that the greatest threat to eradication is continued failure to vaccinate all high-risk children.

RSV Common in Adults

Respiratory syncytial virus is at least as common as influenza A in elderly and high-risk adults and is an important disease in this population, a large prospective study suggests.

The study included 608 healthy adults aged 65 or older, 540 adults over age 20 with chronic heart or lung disease, and 1,388 patients hospitalized with acute pulmonary conditions, who were evaluated for respiratory illnesses over four consecutive winters. RSV infection was identified in 102 patients from the prospective cohorts and 142 of the hospitalized patients; influenza A was diagnosed in 44 and 154 of those two groups, respectively, Ann R. Falsey, M.D., of Rochester (N.Y.) General Hospital and her colleagues reported.

RSV and influenza were symptomatic in a similarly high percentage of cases (89% and 91%), and both resulted in considerable health care use. Forty-two percent of elderly patients with influenza A and 17% with RSV sought medical attention, and 60% of the high-risk adults with influenza A and 29% with RSV sought medical attention (N. Engl. J. Med. 2005;352:1749–59).

The findings confirm the importance of influenza A in adults, but also document the importance of RSV in these populations, and underscore the need for development of an effective vaccine against RSV.

Aspiration Pneumonia Rx

Intravenous clindamycin therapy was as effective as but lower in cost than three other recommended antibiotic regimens for the treatment of mild to moderate aspiration pneumonia in elderly patients in a prospective, randomized study.

In 100 patients treated twice daily with either 1.5 g or 3 g of IV ampicillin/sulbactam, 0.5 g of IV panipenem/betamiprom, or 600 mg of IV clindamycin, cure rates were similar (76%–88%), as were duration of IV treatment (8–10 days) and number of adverse events (3–4), reported Maiko Kadowaki, M.D., and colleagues at the University of Fukui (Japan) (Chest 2005;127:1276–82).

Based on treatment duration, clindamycin therapy cost about $127, compared with $208 for the lower dose of ampicillin/sulbactam, $444 for the higher dose of ampicillin/sulbactam, and $258 for panipenem/betamiprom. Clindamycin was also associated with a lower rate of posttreatment methicillin resistant Staphylococcus aureus: zero cases vs. five cases in each of the ampicillin/sulbactam groups and eight cases in the panipenem/betamiprom group.

Hydrocortisone for Pneumonia

Hydrocortisone infusion in patients with severe community-acquired pneumonia leads to earlier resolution and prevents development of sepsis-related complications, a prospective multicenter study suggests.

A total of 46 patients with severe community-acquired pneumonia were enrolled and randomized to receive protocol-guided antibiotic treatment plus 7 days of hydrocortisone infusion or placebo. Hydrocortisone was given as an intravenous 200-mg loading bolus followed by infusion of 240 mg in 500 cc of 0.9% saline at a rate of 10 mg/hour, Marco Confalonieri, M.D., of Trieste, Italy, and his colleagues reported.

At study day eight, 20 of 23 patients in the treatment group, compared with 9 of 23 controls, had improved ratios of arterial oxygen pressure to fraction of inspired oxygen. Significantly greater reductions in multiple organ dysfunction syndrome scores and chest radiograph scores were observed in the treatment group. C-reactive protein (CRP) levels, which were higher in the treatment group at study entry, fell by more than 50% in 21 of 23 patients, compared with 5 of 23 controls (Am. J. Respir. Crit. Care Med. 2005;171:242–8).

Patients with persistent CRP elevations had a higher incidence of delayed septic shock than those with reduced CRP levels (nine vs. zero patients). Also reduced in the treatment group were duration of mechanical ventilation (median 4 vs. 10 days), hospital stay (median 13 vs. 21 days), and 60-day mortality (0% vs. 38%).

Poliomyelitis Eradication

Efforts to eradicate poliomyelitis suffered a setback in 2004, according to the Centers for Disease Control and Prevention.

The most progress was made in Egypt and in three Asian countries where the disease is endemic: during peak transmission season, the number of cases was the lowest ever reported in those countries. However, a resurgence of poliomyelitis in 2 African countries spread to a total of 14 countries that had not reported polio for more than 1 year (MMWR 2005;54:408–12).

Eradication efforts should focus on high-quality vaccination campaigns and on monitoring surveillance quality to ensure rapid detection of circulating virus or importation and a timely response, according to the CDC, which stresses that the greatest threat to eradication is continued failure to vaccinate all high-risk children.

RSV Common in Adults

Respiratory syncytial virus is at least as common as influenza A in elderly and high-risk adults and is an important disease in this population, a large prospective study suggests.

The study included 608 healthy adults aged 65 or older, 540 adults over age 20 with chronic heart or lung disease, and 1,388 patients hospitalized with acute pulmonary conditions, who were evaluated for respiratory illnesses over four consecutive winters. RSV infection was identified in 102 patients from the prospective cohorts and 142 of the hospitalized patients; influenza A was diagnosed in 44 and 154 of those two groups, respectively, Ann R. Falsey, M.D., of Rochester (N.Y.) General Hospital and her colleagues reported.

RSV and influenza were symptomatic in a similarly high percentage of cases (89% and 91%), and both resulted in considerable health care use. Forty-two percent of elderly patients with influenza A and 17% with RSV sought medical attention, and 60% of the high-risk adults with influenza A and 29% with RSV sought medical attention (N. Engl. J. Med. 2005;352:1749–59).

The findings confirm the importance of influenza A in adults, but also document the importance of RSV in these populations, and underscore the need for development of an effective vaccine against RSV.

Aspiration Pneumonia Rx

Intravenous clindamycin therapy was as effective as but lower in cost than three other recommended antibiotic regimens for the treatment of mild to moderate aspiration pneumonia in elderly patients in a prospective, randomized study.

In 100 patients treated twice daily with either 1.5 g or 3 g of IV ampicillin/sulbactam, 0.5 g of IV panipenem/betamiprom, or 600 mg of IV clindamycin, cure rates were similar (76%–88%), as were duration of IV treatment (8–10 days) and number of adverse events (3–4), reported Maiko Kadowaki, M.D., and colleagues at the University of Fukui (Japan) (Chest 2005;127:1276–82).

Based on treatment duration, clindamycin therapy cost about $127, compared with $208 for the lower dose of ampicillin/sulbactam, $444 for the higher dose of ampicillin/sulbactam, and $258 for panipenem/betamiprom. Clindamycin was also associated with a lower rate of posttreatment methicillin resistant Staphylococcus aureus: zero cases vs. five cases in each of the ampicillin/sulbactam groups and eight cases in the panipenem/betamiprom group.

Hydrocortisone for Pneumonia

Hydrocortisone infusion in patients with severe community-acquired pneumonia leads to earlier resolution and prevents development of sepsis-related complications, a prospective multicenter study suggests.

A total of 46 patients with severe community-acquired pneumonia were enrolled and randomized to receive protocol-guided antibiotic treatment plus 7 days of hydrocortisone infusion or placebo. Hydrocortisone was given as an intravenous 200-mg loading bolus followed by infusion of 240 mg in 500 cc of 0.9% saline at a rate of 10 mg/hour, Marco Confalonieri, M.D., of Trieste, Italy, and his colleagues reported.

At study day eight, 20 of 23 patients in the treatment group, compared with 9 of 23 controls, had improved ratios of arterial oxygen pressure to fraction of inspired oxygen. Significantly greater reductions in multiple organ dysfunction syndrome scores and chest radiograph scores were observed in the treatment group. C-reactive protein (CRP) levels, which were higher in the treatment group at study entry, fell by more than 50% in 21 of 23 patients, compared with 5 of 23 controls (Am. J. Respir. Crit. Care Med. 2005;171:242–8).

Patients with persistent CRP elevations had a higher incidence of delayed septic shock than those with reduced CRP levels (nine vs. zero patients). Also reduced in the treatment group were duration of mechanical ventilation (median 4 vs. 10 days), hospital stay (median 13 vs. 21 days), and 60-day mortality (0% vs. 38%).

Poliomyelitis Eradication

Efforts to eradicate poliomyelitis suffered a setback in 2004, according to the Centers for Disease Control and Prevention.

The most progress was made in Egypt and in three Asian countries where the disease is endemic: during peak transmission season, the number of cases was the lowest ever reported in those countries. However, a resurgence of poliomyelitis in 2 African countries spread to a total of 14 countries that had not reported polio for more than 1 year (MMWR 2005;54:408–12).

Eradication efforts should focus on high-quality vaccination campaigns and on monitoring surveillance quality to ensure rapid detection of circulating virus or importation and a timely response, according to the CDC, which stresses that the greatest threat to eradication is continued failure to vaccinate all high-risk children.

RSV Common in Adults

Respiratory syncytial virus is at least as common as influenza A in elderly and high-risk adults and is an important disease in this population, a large prospective study suggests.

The study included 608 healthy adults aged 65 or older, 540 adults over age 20 with chronic heart or lung disease, and 1,388 patients hospitalized with acute pulmonary conditions, who were evaluated for respiratory illnesses over four consecutive winters. RSV infection was identified in 102 patients from the prospective cohorts and 142 of the hospitalized patients; influenza A was diagnosed in 44 and 154 of those two groups, respectively, Ann R. Falsey, M.D., of Rochester (N.Y.) General Hospital and her colleagues reported.

RSV and influenza were symptomatic in a similarly high percentage of cases (89% and 91%), and both resulted in considerable health care use. Forty-two percent of elderly patients with influenza A and 17% with RSV sought medical attention, and 60% of the high-risk adults with influenza A and 29% with RSV sought medical attention (N. Engl. J. Med. 2005;352:1749–59).

The findings confirm the importance of influenza A in adults, but also document the importance of RSV in these populations, and underscore the need for development of an effective vaccine against RSV.

Aspiration Pneumonia Rx

Intravenous clindamycin therapy was as effective as but lower in cost than three other recommended antibiotic regimens for the treatment of mild to moderate aspiration pneumonia in elderly patients in a prospective, randomized study.

In 100 patients treated twice daily with either 1.5 g or 3 g of IV ampicillin/sulbactam, 0.5 g of IV panipenem/betamiprom, or 600 mg of IV clindamycin, cure rates were similar (76%–88%), as were duration of IV treatment (8–10 days) and number of adverse events (3–4), reported Maiko Kadowaki, M.D., and colleagues at the University of Fukui (Japan) (Chest 2005;127:1276–82).

Based on treatment duration, clindamycin therapy cost about $127, compared with $208 for the lower dose of ampicillin/sulbactam, $444 for the higher dose of ampicillin/sulbactam, and $258 for panipenem/betamiprom. Clindamycin was also associated with a lower rate of posttreatment methicillin resistant Staphylococcus aureus: zero cases vs. five cases in each of the ampicillin/sulbactam groups and eight cases in the panipenem/betamiprom group.

Hormonal contraception and two common genital tract conditions appear to be among the risk factors for genital tract shedding of herpes simplex virus type 2 in women.

In a 12-month study of 330 women who were evaluated every 4 months, independent predictors of genital tract shedding of HSV-2 were HSV-2 seroconversion during the previous 4 months (adjusted odds ratio [OR] 3.0), bacterial vaginosis (adjusted OR 2.3), heavy colonization with group B streptococcus (adjusted OR 2.2), and the use of hormonal contraceptives (adjusted OR 1.8), according to Thomas L. Cherpes, M.D., and his colleagues at the University of Pittsburgh (Clin. Infect. Dis. 2005;40:1422ndash;8).

Because hormonal contraception is widespread, and bacterial vaginosis and vaginal group B streptococcus colonization are two of the most common genital conditions in women of reproductive age, the associations between these variables and increased genital tract shedding of HSV-2 is of concern.

Hormonal contraception and two common genital tract conditions appear to be among the risk factors for genital tract shedding of herpes simplex virus type 2 in women.

In a 12-month study of 330 women who were evaluated every 4 months, independent predictors of genital tract shedding of HSV-2 were HSV-2 seroconversion during the previous 4 months (adjusted odds ratio [OR] 3.0), bacterial vaginosis (adjusted OR 2.3), heavy colonization with group B streptococcus (adjusted OR 2.2), and the use of hormonal contraceptives (adjusted OR 1.8), according to Thomas L. Cherpes, M.D., and his colleagues at the University of Pittsburgh (Clin. Infect. Dis. 2005;40:1422ndash;8).

Because hormonal contraception is widespread, and bacterial vaginosis and vaginal group B streptococcus colonization are two of the most common genital conditions in women of reproductive age, the associations between these variables and increased genital tract shedding of HSV-2 is of concern.

Hormonal contraception and two common genital tract conditions appear to be among the risk factors for genital tract shedding of herpes simplex virus type 2 in women.

In a 12-month study of 330 women who were evaluated every 4 months, independent predictors of genital tract shedding of HSV-2 were HSV-2 seroconversion during the previous 4 months (adjusted odds ratio [OR] 3.0), bacterial vaginosis (adjusted OR 2.3), heavy colonization with group B streptococcus (adjusted OR 2.2), and the use of hormonal contraceptives (adjusted OR 1.8), according to Thomas L. Cherpes, M.D., and his colleagues at the University of Pittsburgh (Clin. Infect. Dis. 2005;40:1422ndash;8).

Because hormonal contraception is widespread, and bacterial vaginosis and vaginal group B streptococcus colonization are two of the most common genital conditions in women of reproductive age, the associations between these variables and increased genital tract shedding of HSV-2 is of concern.

ORLANDO, FLA. — Metabolic syndrome may be a greater risk factor for stroke and vascular events in women than in men, Bernadette Boden-Albala, Ph.D., reported at an international conference on women, heart disease, and stroke.

In the longitudinal Northern Manhattan Study (NOMAS) of 3,297 adult community residents who were stroke-free at study entry and followed for a mean of 5 years, nearly 46% of the 2,077 women and 35% of the men met the criteria for metabolic syndrome at study entry, said Dr. Boden-Albala of the Neurological Institute, New York.

After adjustment for age, race and ethnicity, education, and risk factors, the effect of metabolic syndrome on vascular events was significantly greater in women (hazard ratio [HR] 1.8) than in men (1.4). The HRs for stroke risk associated with metabolic syndrome were 2.0 for women and 1.1 for men. Metabolic syndrome accounted for 27% of vascular events and 30% of stroke events in women.

Metabolic syndrome was more prevalent in Hispanic (48%) than in white (36%) or black (34%) women. After adjustment for age, women with metabolic syndrome were significantly more likely to be Hispanic, socially isolated, Medicaid users, and physically inactive.

ORLANDO, FLA. — Metabolic syndrome may be a greater risk factor for stroke and vascular events in women than in men, Bernadette Boden-Albala, Ph.D., reported at an international conference on women, heart disease, and stroke.

In the longitudinal Northern Manhattan Study (NOMAS) of 3,297 adult community residents who were stroke-free at study entry and followed for a mean of 5 years, nearly 46% of the 2,077 women and 35% of the men met the criteria for metabolic syndrome at study entry, said Dr. Boden-Albala of the Neurological Institute, New York.

After adjustment for age, race and ethnicity, education, and risk factors, the effect of metabolic syndrome on vascular events was significantly greater in women (hazard ratio [HR] 1.8) than in men (1.4). The HRs for stroke risk associated with metabolic syndrome were 2.0 for women and 1.1 for men. Metabolic syndrome accounted for 27% of vascular events and 30% of stroke events in women.

Metabolic syndrome was more prevalent in Hispanic (48%) than in white (36%) or black (34%) women. After adjustment for age, women with metabolic syndrome were significantly more likely to be Hispanic, socially isolated, Medicaid users, and physically inactive.

ORLANDO, FLA. — Metabolic syndrome may be a greater risk factor for stroke and vascular events in women than in men, Bernadette Boden-Albala, Ph.D., reported at an international conference on women, heart disease, and stroke.

In the longitudinal Northern Manhattan Study (NOMAS) of 3,297 adult community residents who were stroke-free at study entry and followed for a mean of 5 years, nearly 46% of the 2,077 women and 35% of the men met the criteria for metabolic syndrome at study entry, said Dr. Boden-Albala of the Neurological Institute, New York.

After adjustment for age, race and ethnicity, education, and risk factors, the effect of metabolic syndrome on vascular events was significantly greater in women (hazard ratio [HR] 1.8) than in men (1.4). The HRs for stroke risk associated with metabolic syndrome were 2.0 for women and 1.1 for men. Metabolic syndrome accounted for 27% of vascular events and 30% of stroke events in women.

Metabolic syndrome was more prevalent in Hispanic (48%) than in white (36%) or black (34%) women. After adjustment for age, women with metabolic syndrome were significantly more likely to be Hispanic, socially isolated, Medicaid users, and physically inactive.