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Peng P, Yang J, Wu Q, Wu M, Liu J, Zhang J. Fabrication of N-halamine polyurethane films with excellent antibacterial properties. E-POLYMERS 2021. [DOI: 10.1515/epoly-2021-0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
An N-halamine precursor, namely, 2-amino-5-(2-hydroxyethyl)-6-methylpyrimidin-4-one (AHM), was used as a chain extender in the preparation of a series of N-halamine polyurethane (PU) films, in order to also instill antibacterial properties. The mechanical properties, thermodynamic performance, and antimicrobial performance of the functionalized PU films were systematically studied. The results showed that the addition of AHM could improve the thermodynamic and mechanical properties of the developed PU films. Conducting tests in the presence of Escherichia coli and Staphylococcus aureus as the model microorganisms revealed that prior to chlorination the antibacterial properties of the chlorinated PU-AHM-Cl films improved significantly relative to the analogous films. The excellent antibacterial properties and the overall superior performance of the PU-AHM-Cl films allow their potential application in microbiological protection materials and related fields.
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Affiliation(s)
- Panpan Peng
- Anhui Province Key Laboratory of Environment-Friendly Polymer Materials, School of Chemistry and Chemical Engineering of Anhui Univerity , Hefei 230601 , People’s Republic of China
| | - Jianjun Yang
- Anhui Province Key Laboratory of Environment-Friendly Polymer Materials, School of Chemistry and Chemical Engineering of Anhui Univerity , Hefei 230601 , People’s Republic of China
| | - Qingyun Wu
- Anhui Province Key Laboratory of Environment-Friendly Polymer Materials, School of Chemistry and Chemical Engineering of Anhui Univerity , Hefei 230601 , People’s Republic of China
| | - Mingyuan Wu
- Anhui Province Key Laboratory of Environment-Friendly Polymer Materials, School of Chemistry and Chemical Engineering of Anhui Univerity , Hefei 230601 , People’s Republic of China
| | - Jiuyi Liu
- Anhui Province Key Laboratory of Environment-Friendly Polymer Materials, School of Chemistry and Chemical Engineering of Anhui Univerity , Hefei 230601 , People’s Republic of China
| | - Jianan Zhang
- Anhui Province Key Laboratory of Environment-Friendly Polymer Materials, School of Chemistry and Chemical Engineering of Anhui Univerity , Hefei 230601 , People’s Republic of China
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2
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Xu P, Zeng L, Xiong T, Choonara I, Qazi S, Zhang L. Safety of azithromycin in paediatrics: a systematic review protocol. BMJ Paediatr Open 2019; 3:e000469. [PMID: 31321320 PMCID: PMC6598555 DOI: 10.1136/bmjpo-2019-000469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Azithromycin is widely used in children not only in the treatment of individual children with infectious diseases, but also as mass drug administration (MDA) within a community to eradicate or control specific tropical diseases. MDA has also been reported to have a beneficial effect on child mortality and morbidity. However, concerns have been raised about the safety of azithromycin, especially in young children. The aim of this review is to systematically identify the safety of azithromycin in children of all ages. METHODS AND ANALYSIS MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, Embase, CINAHL, International Pharmaceutical Abstracts and adverse drug reaction (ADR) monitoring systems will be systematically searched for randomised controlled trials (RCTs), cohort studies, case-control studies, cross-sectional studies, case series and case reports evaluating the safety of azithromycin in children. The Cochrane risk of bias tool, Newcastle-Ottawa and quality assessment tools, and The Joanna Briggs Institute Critical Appraisal tools will be used for quality assessment. Meta-analyses will be conducted to the incidence of ADRs from RCTs if appropriate. Subgroup analyses will be performed in different age and azithromycin dosage groups. ETHICS AND DISSEMINATION Formal ethical approval is not required as no primary data are collected. This systematic review will be disseminated through a peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42018112629.
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Affiliation(s)
- Peipei Xu
- Departmentof Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-BasedPharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, China
| | - Linan Zeng
- Departmentof Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-BasedPharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, China
| | - Tao Xiong
- Neonataldepartment, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Imti Choonara
- AcademicDivision of Child Health, University of Nottingham, Derbyshire Children’sHospital, Derby, UK
| | - Shamim Qazi
- Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Swaziland
| | - Lingli Zhang
- Departmentof Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-BasedPharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, China
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3
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Abdellatif M, Ghozy S, Kamel MG, Elawady SS, Ghorab MME, Attia AW, Le Huyen TT, Duy DTV, Hirayama K, Huy NT. Association between exposure to macrolides and the development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Eur J Pediatr 2019; 178:301-314. [PMID: 30470884 DOI: 10.1007/s00431-018-3287-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 12/16/2022]
Abstract
Macrolides are bacteriostatic antibiotics with a broad spectrum of activity against Gram-positive bacteria. The aim of this study was to systematically review and meta-analyze the association between infantile hypertrophic pyloric stenosis (IHPS) and macrolides. Nine databases were searched systematically for studies with information on the association between macrolides and IHPS. We combined findings using random effects models. Our study revealed 18 articles investigating the association between macrolides and IHPS. There was a significant association between the development of IHPS and erythromycin (2.38, 1.06-5.39). The association was strong when erythromycin was used during the first 2 weeks of life (8.14, 4.29-15.45). During breastfeeding, use of macrolides showed no significant association with IHPS in infants (0.96, 0.61-1.53). IHPS was not associated with erythromycin (1.11, 0.9-1.36) or macrolides use during pregnancy (1.15, 0.98-1.36).Conclusions: There is an association between erythromycin use during infancy and developing IHPS in infants. However, no significant association was found between macrolides use during pregnancy or breastfeeding. Additional large studies are needed to further evaluate potential association with macrolide use. What is known? • Erythromycin intake in the first 2 weeks of life is associated with an increased risk of pyloric stenosis. What is New? • There is currently no evidence of significant association between macrolides use during pregnancy or breastfeeding and pyloric stenosis.
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Affiliation(s)
- Mohammed Abdellatif
- Neonatal Intensive Care Unit, Al-Adan hospital, Ministry of Health, Hadiya, Kuwait
- Online Research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan
| | - Sherief Ghozy
- Online Research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan
- Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, 41516, Egypt
| | - Mohamed Gomaa Kamel
- Online Research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan
- Faculty of Medicine, Minia University, Minia, 61519, Egypt
| | - Sameh Samir Elawady
- Online Research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan
- Faculty of Medicine, Tanta University, Tanta, 31527, Egypt
| | - Mohamed Mohy Eldeen Ghorab
- Online Research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan
- Faculty of Medicine, Alexandria University, Alexandria, 21111, Egypt
| | - Andrew Wassef Attia
- Online Research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan
- Ain Shams University Hospital, Cairo, 11633, Egypt
| | - Truong Thi Le Huyen
- Online Research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Diep Trong Vien Duy
- Online Research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
- Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
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4
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Feliz A, Holub JL, Azarakhsh N, Bachier-Rodriguez M, Savoie KB. Health disparities in infants with hypertrophic pyloric stenosis. Am J Surg 2017; 214:329-335. [DOI: 10.1016/j.amjsurg.2016.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/22/2016] [Accepted: 07/06/2016] [Indexed: 11/28/2022]
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5
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Godoy P, García-Cenoz M, Toledo D, Carmona G, Caylà JA, Alsedà M, Àlvarez J, Barrabeig I, Camps N, Plans P, Company M, Castilla J, Sala-Farré MR, Muñoz-Almagro C, Rius C, Domínguez À. Factors influencing the spread of pertussis in households: a prospective study, Catalonia and Navarre, Spain, 2012 to 2013. ACTA ACUST UNITED AC 2017; 21:30393. [PMID: 27918260 PMCID: PMC5144939 DOI: 10.2807/1560-7917.es.2016.21.45.30393] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 02/28/2016] [Indexed: 11/24/2022]
Abstract
We aimed to investigate transmission rates of pertussis in household contacts of cases and factors associated with transmission. A prospective epidemiological study was conducted in 2012 and 2013 to determine the incidence of pertussis among household contacts of reported cases in Catalonia and Navarre, Spain. An epidemiological survey was completed for each case and contact, who were followed for 28 days to determine the source of infection (primary case) and detect the occurrence of secondary cases. Odds ratios (ORs) were used to estimate the effectiveness of vaccination and chemoprophylaxis in preventing new cases, using the formula (1 − OR) × 100. For the 688 primary cases, a total of 2,852 contacts were recorded. The household transmission rate was 16.1% (459/2,852) and rose according to the age (> 18 years) and lack of immunisation of the primary cases, and also the age (0–18 years), family relationship (siblings and children), lack of vaccination and chemoprophylaxis of contacts. Pertussis vaccine effectiveness in preventing new cases was 65.0% (95% confidence interval (CI): 11.6 to 86.2) for full vaccination (≥ 4 doses) and 59.7% (95% CI: −6.8 to 84.8) for incomplete vaccination (< 4 doses). The effectiveness of chemoprophylaxis was 62.1% (95% CI: 40.3 to 75.9). To reduce household transmission, contacts should be investigated to detect further cases and to administer chemoprophylaxis. The current vaccination status of cases and contacts can reduce household transmission.
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Affiliation(s)
- Pere Godoy
- Agència de Salut Pública de Catalunya, Barcelona, Spain.,Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Institut de Recerca Biomèdica de Lleida, IRBLleida, Lleida, Spain
| | - Manuel García-Cenoz
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain.,Universidad Pública de Navarra (UPNA), Navarre, Spain
| | - Diana Toledo
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Universitat de Barcelona, Barcelona, Spain
| | | | - Joan A Caylà
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Miquel Alsedà
- Agència de Salut Pública de Catalunya, Barcelona, Spain.,Institut de Recerca Biomèdica de Lleida, IRBLleida, Lleida, Spain
| | - Josep Àlvarez
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | | | - Neus Camps
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Pere Plans
- Agència de Salut Pública de Catalunya, Barcelona, Spain.,Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - María Company
- Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Jesús Castilla
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain
| | | | - Carmen Muñoz-Almagro
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Hospital de Sant Joan de Dèu, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Rius
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Àngela Domínguez
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Universitat de Barcelona, Barcelona, Spain
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- Members of the group are listed at the end of the article
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Bryant KA, Humbaugh K, Brothers K, Wright J, Pascual FB, Moran J, Murphy TV. Measures to Control an Outbreak of Pertussis in a Neonatal Intermediate Care Nursery After Exposure to a Healthcare Worker. Infect Control Hosp Epidemiol 2016; 27:541-5. [PMID: 16755471 DOI: 10.1086/505666] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Accepted: 12/07/2005] [Indexed: 11/03/2022]
Abstract
Background.Hospitalized premature infants are particularly vulnerable to morbidity and mortality from pertussis. Effective prevention and investigative and control measures are not well described.Objective.To identify the source of nosocomial pertussis in a 2-month-old premature infant in a neonatal intermediate care nursery (ICN) and to critically review the investigation and outbreak control measures.Setting.An ICN and a neonatal intensive care unit.Methods.We queried healthcare workers (HCWs) and family members about cough illness and contacted potentially exposed patients to determine whether they had symptoms of pertussis. Culture and polymerase chain reaction (PCR) testing forBordetella pertussiswere performed by the hospital laboratory with specimens collected from symptomatic patients and HCWs. Levels of pertussis toxin immunoglobulin G antibodies were measured in HCWs with cough of at least 14 days' duration at a public health laboratory. Extensive control measures were instituted.Results.Four ICN HCWs met the clinical case definition for presence of pertussis. Serologic test results were positive for 3 of the HCWs. The primary case patient was a 36-year-old HCW with a cough illness of 3-weeks' duration that was accompanied by paroxysms, whoop, posttussive emesis, and pneumothorax. Among the 4 affected HCWs, the duration of cough illness prior to identification of the infant index patient ranged from 11 to 25 days. Outbreak control measures included isolation of the infant case patient, furlough and treatment of symptomatic HCWs, administration of chemoprophylaxis to contacts, and surveillance for additional cases. Seventy-two infant patients and 72 HCWs were exposed and were given antibiotic prophylaxis. One additional case of pertussis, confirmed by PCR and culture, occurred in a resident physician who declined prophylaxis; she had cared for the index patient but had no contact with symptomatic HCWs.Conclusion.HCWs or patients may serve as the source of pertussis in nosocomial outbreaks, which can result in substantial morbidity and outlay of resources for control measures. Our review suggested that a diagnosis of pertussis should be an early consideration for HCWs with cough illness. Targeted pertussis immunization of HCWs, employee health policies that provide for testing and furlough of HCWs with prolonged cough, and monitoring of HCWs for compliance with infection control measures could reduce the morbidity and costs associated with pertussis outbreaks. These measures will require evaluation of their effectiveness.
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Affiliation(s)
- Kristina A Bryant
- Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, KY 40202, USA.
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7
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Smith C, Egunsola O, Choonara I, Kotecha S, Jacqz-Aigrain E, Sammons H. Use and safety of azithromycin in neonates: a systematic review. BMJ Open 2015; 5:e008194. [PMID: 26656010 PMCID: PMC4679913 DOI: 10.1136/bmjopen-2015-008194] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To identify the use and adverse drug reactions associated with azithromycin in neonates. SETTING Databases MEDLINE (1948-August 2015), EMBASE (1980-August 2015) and Pubmed (August 2015) were searched for studies on azithromycin in neonates. PARTICIPANTS All studies involving neonates (<28 days old) who have received at least a single dose of azithromycin for which safety was evaluated. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was adverse event (AE) associated with use of azithromycin. Use of azithromycin in neonates was the secondary outcome. RESULTS A total of 11 articles involving 473 neonates were identified. 371 AEs were reported. Adverse events were mainly respiratory (358/1000 neonate), neurological (273/1000 neonates) and gastrointestinal (196/1000 neonates) in origin. Azithromycin significantly reduced the risk of bronchopulmonary dysplasia (BPD) in extremely premature neonates (RR=0.83, 95% CI 0.71 to 0.98, p=0.02). There was no significant difference in the incidence of elevated liver enzymes between the azithromycin and placebo group (p=0.76). There were four cases of infantile hypertrophic pyloric stenosis (IHPS). CONCLUSIONS Azithromycin significantly reduces the risk of BPD in preterm neonates. The relationship between azithromycin and IHPS requires further investigation.
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Affiliation(s)
- Coral Smith
- Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
| | - Oluwaseun Egunsola
- Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
| | - Imti Choonara
- Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
| | - Sailesh Kotecha
- Department of Child Health, Institute of Molecular & Experimental Medicine, Cardiff University School of Medicine, Wales Heart Research Institute, Heath Park, UK
| | - Evelyne Jacqz-Aigrain
- Univ Paris Diderot, Sorbonne Paris Cité, Department of Paediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, Paris, France
| | - Helen Sammons
- Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, UK
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8
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Roca A, Oluwalana C, Camara B, Bojang A, Burr S, Davis TME, Bailey R, Kampmann B, Mueller J, Bottomley C, D'Alessandro U. Prevention of bacterial infections in the newborn by pre-delivery administration of azithromycin: Study protocol of a randomized efficacy trial. BMC Pregnancy Childbirth 2015; 15:302. [PMID: 26585192 PMCID: PMC4653934 DOI: 10.1186/s12884-015-0737-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 11/10/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Neonatal deaths, estimated at approximately 4 million annually, now account for almost 40% of global mortality in children aged under-five. Bacterial sepsis is a leading cause of neonatal mortality. Assuming the mother is the main source for bacterial transmission to newborns, the primary objective of the trial is to determine the impact of one oral dose of azithromycin, given to women in labour, on the newborn's bacterial carriage in the nasopharynx. Secondary objectives include the impact of the intervention on bacterial colonization in the baby and the mother during the first month of life. METHODS/DESIGN This is a Phase III, double -blind, placebo controlled randomized clinical trial in which 830 women in labour were randomized to either a single dose of 2 g oral azithromycin or placebo (ratio 1:1). The trial included pregnant women in labour aged 18 to 45 years attending study health centres in the Western Gambia. A post-natal check of the mother and baby was conducted at the health centre by study clinicians before discharge and 8-10 days after delivery. Home follow up visits were conducted daily during the first week and then weekly until week 8 after delivery. Vaginal swabs and breast milk samples were collected from the mothers, and the pathogens Streptococcus pneumoniae, Group B Streptococcus (GBS) and Staphylococcus aureus were isolated from the study samples. For bacterial isolates, susceptibility pattern to azithromycin was determined using disk diffusion and E-test. Eye swabs were collected from newborns with eye discharge during the follow up period, and Chlamydial infection was assessed using molecular methods. DISCUSSION This is a proof-of-concept study to assess the impact of antibiotic preventive treatment of women during labour on bacterial infections in the newborn. If the trial confirms this hypothesis, the next step will be to assess the impact of this intervention on neonatal sepsis. The proposed intervention should be easily implementable in developing countries. TRIAL REGISTRATION ClinicalTrials.gov Identifier--NCT01800942--First received: February 26, 2013.
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Affiliation(s)
- Anna Roca
- Medical Research Council Unit, Fajara, The Gambia.
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | - Bully Camara
- Medical Research Council Unit, Fajara, The Gambia.
| | | | - Sarah Burr
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Timothy M E Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia.
| | - Robin Bailey
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | | | | | - Umberto D'Alessandro
- Medical Research Council Unit, Fajara, The Gambia.
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Vaccination policies among health professional schools: evidence of immunity and allowance of vaccination exemptions. Infect Control Hosp Epidemiol 2015; 36:186-91. [PMID: 25633001 DOI: 10.1017/ice.2014.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To characterize health professional schools by their vaccination policies for acceptable forms of evidence of immunity and exemptions permitted. METHODS Data were collected between September 2011 and April 2012 using an Internet-based survey e-mailed to selected types of accredited health professional programs. Schools were identified through accrediting associations for each type of health professional program. Analysis was limited to schools requiring ≥1 vaccine recommended by the Advisory Committee on Immunization Practices (ACIP): measles, mumps, rubella, hepatitis B, varicella, pertussis, and influenza. Weighted bivariate frequencies were generated using SAS 9.3. RESULTS Of 2,775 schools surveyed, 75% (n=2,077) responded; of responding schools, 93% (1947) required ≥1 ACIP-recommended vaccination. The proportion of schools accepting ≥1 non-ACIP-recommended form of evidence of immunity varied by vaccine: 42% for pertussis, 37% for influenza, 30% for rubella, 22% for hepatitis B, 18% for varicella, and 9% for measles and mumps. Among schools with ≥1 vaccination requirement, medical exemptions were permitted for ≥1 vaccine by 75% of schools; 54% permitted religious exemptions; 35% permitted personal belief exemptions; 58% permitted any nonmedical exemption. CONCLUSIONS Many schools accept non-ACIP-recommended forms of evidence of immunity which could lead some students to believe they are protected from vaccine preventable diseases when they may be susceptible. Additional efforts are needed to better educate school officials about current ACIP recommendations for acceptable forms of evidence of immunity so school policies can be revised as needed.
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Calderón TA, Coffin SE, Sammons JS. Preventing the Spread of Pertussis in Pediatric Healthcare Settings. J Pediatric Infect Dis Soc 2015; 4:252-9. [PMID: 26407429 DOI: 10.1093/jpids/piu056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/09/2014] [Indexed: 11/13/2022]
Abstract
The surge in pertussis incidence in recent years underscores a critical need for effective plans to prevent transmission in pediatric healthcare settings. Adolescents and adults are common sources of infection for unimmunized or incompletely immunized infants and children with waning immunity. Despite documented outbreaks being limited in size, pertussis poses a threat to pediatric healthcare facilities due to the risk for widespread transmission, potentially severe complications among vulnerable patient populations, and high outbreak control-related costs. Healthcare personnel, visitors, and parents have been identified as sources of outbreaks, underscoring the importance of coordinated efforts to prevent transmission in these settings. This comprehensive review demonstrates that the risk of pertussis transmission in pediatric healthcare settings warrants heightened focus on strategies to recognize disease earlier, improve diagnostic evaluation, and facilitate effective contact tracing and post-exposure prophylaxis measures. This review suggests that healthcare personnel can play a significant role in the prevention of healthcare-associated pertussis.
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Affiliation(s)
- Tirza A Calderón
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Susan E Coffin
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Pediatrics and Division of Infectious Diseases, Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Pennsylvania
| | - Julia S Sammons
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Pediatrics and Division of Infectious Diseases, Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Pennsylvania
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11
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Abstract
BACKGROUND AND OBJECTIVE Use of oral erythromycin in infants is associated with infantile hypertrophic pyloric stenosis (IHPS). The risk with azithromycin remains unknown. We evaluated the association between exposure to oral azithromycin and erythromycin and subsequent development of IHPS. METHODS A retrospective cohort study of children born between 2001 and 2012 was performed utilizing the military health system database. Infants prescribed either oral erythromycin or azithromycin as outpatients in the first 90 days of life were evaluated for development of IHPS. Specific diagnostic and procedural codes were used to identify cases of IHPS. RESULTS A total of 2466 of 1 074 236 children in the study period developed IHPS. Azithromycin exposure in the first 14 days of life demonstrated an increased risk of IHPS (adjusted odds ratio [aOR], 8.26; 95% confidence interval [CI], 2.62-26.0); exposure between 15 and 42 days had an aOR of 2.98 (95% CI, 1.24-7.20). An association between erythromycin and IHPS was also confirmed. Exposure to erythromycin in the first 14 days of life had an aOR of 13.3 (95% CI, 6.80-25.9), and 15 to 42 days of life, aOR 4.10 (95% CI, 1.69-9.91). There was no association with either macrolide between 43 and 90 days of life. CONCLUSIONS Ingestion of oral azithromycin and erythromycin places young infants at increased risk of developing IHPS. This association is strongest if the exposure occurred in the first 2 weeks of life, but persists although to a lesser degree in children between 2 and 6 weeks of age.
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Affiliation(s)
- Matthew D. Eberly
- Address correspondence to Matthew D. Eberly, MD, Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814. E-mail:
| | - Matilda B. Eide
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jennifer L. Thompson
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Cade M. Nylund
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Yasmin S, Sunenshine R, Bisgard KM, Wiedeman C, Carrigan A, Sylvester T, Garcia G, Rose K, Wright S, Miller S, Huerta RDL, Houser H, D'Souza A, Anderson S, Howard K, Komatsu K, Klein R. Healthcare-Associated Pertussis Outbreak in Arizona: Challenges and Economic Impact, 2011. J Pediatric Infect Dis Soc 2014; 3:81-4. [PMID: 26624909 DOI: 10.1093/jpids/pis136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 12/13/2012] [Indexed: 11/13/2022]
Abstract
An outbreak investigation identified 15 pertussis cases among 5 infants and 10 healthcare professionals at 1 hospital's neonatal intensive care unit (NICU). The cost of the outbreak to this hospital was $97 745. Heightened awareness of pertussis in NICUs is key to preventing healthcare-associated spread and minimizing outbreak-control-related costs. Bordetella pertussis is a highly communicable bacterial pathogen that causes a prolonged cough illness and is spread by respiratory droplet transmission. Infants aged ≤6 months are most susceptible to B pertussis infection and pertussis-associated complications, including pneumonia, encephalopathy, and death, and are commonly hospitalized for treatment [ 1]. Despite a universal pertussis vaccination program, 27 550 pertussis cases were reported in the United States during 2010 [ 2]. Pertussis outbreaks in healthcare settings can be challenging and costly to control [3]. On September 13, 2011 and September 15, 2011, 3 pertussis cases, including 2 confirmed by B pertussis isolation, among preterm infants discharged ≤30 days previously from a 71-bed NICU of a general hospital (NICU A) were reported by Hospital B, a large pediatric facility, to Maricopa County Department of Public Health. This report describes the outbreak, examines outbreak-associated costs and risk factors that might have contributed to healthcare-associated transmission, and provides guidance to prevent outbreaks in healthcare settings.
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Affiliation(s)
| | | | - Kristine M Bisgard
- Office of Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Karen Rose
- Maricopa County Department of Public Health
| | - Sun Wright
- Maricopa County Department of Public Health
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Maltezou HC, Ftika L, Theodoridou M. Nosocomial pertussis in neonatal units. J Hosp Infect 2013; 85:243-8. [PMID: 24156850 DOI: 10.1016/j.jhin.2013.09.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/19/2013] [Indexed: 11/25/2022]
Abstract
Pertussis remains a public health concern in many countries despite high vaccination coverage rates. Nosocomial outbreaks of pertussis continue to occur in neonatal units. Neonates and young infants admitted to neonatal intensive care units constitute a pool of susceptible high-risk patients given their prematurity, inadequate immune response and the fact that they are too young to have completed their primary vaccination series against pertussis. This article reviews nosocomial pertussis in neonates and infants, focusing on the role of healthcare workers (HCWs). Outbreaks in neonatal units are often traced to HCWs and are associated with serious morbidity or even a fatal outcome among susceptible young infants. A high index of suspicion is required for early recognition and isolation of patients admitted with suspected or proven pertussis, as well as for HCWs with a compatible clinical syndrome, regardless of vaccination status. Contact investigation is also essential in order to guide administration of post-exposure prophylaxis. Recommendations for a booster vaccination for HCWs are in place in several countries; however, the need of HCWs for lifelong immunity against pertussis cannot be fulfilled by the current vaccine.
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Affiliation(s)
- H C Maltezou
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece.
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Fanos V, Cuzzolin L, Atzei A, Testa M. Antibiotics and Antifungals in Neonatal Intensive Care Units: A Review. J Chemother 2013; 19:5-20. [PMID: 17309846 DOI: 10.1179/joc.2007.19.1.5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The incidence of infections is higher in the neonatal period than at any time of life. The basic treatment of infants with infection has not changed substantially over the last years. Antibiotics (with or without supportive care) are one of the most valuable resources in managing sick newborn babies. Early-onset (ascending or transplacental) or late-onset (hospital acquired) infections present different chronology, epidemiology, physiology and outcome. Some classes of antibiotics are frequently used in the neonatal period: penicillins, cephalosporins, aminoglycosides, glycopeptides, monobactams, carbapenems. Other classes of antibiotics (chloramphenicol, cotrimoxazole, macrolides, clindamycin, rifampicin and metronidazole) are rarely used. Due to emergence of resistant bacterial strains in Neonatal Intensive Care Units (NICU), other classes of antibiotics such as quinolones and linezolid will probably increase their therapeutic role in the future. Although new formulations have been developed for treatment of fungal infections in infants, amphotericin B remains first-line treatment for systemic Candida infection. Prophylactic antibiotic therapy is almost always undesirable. Challenges from pathogens and antibiotic resistance in the NICU may warrant modification of traditional antibiotic regimens. Knowledge of local flora and practical application of different antibiotic characteristics are key to an effective and safe utilization of antibiotics and antifungals in critical newborns admitted to the NICU, and especially in very low birth weight infants.
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Affiliation(s)
- V Fanos
- Neonatal Intensive Care Unit - University of Cagliari, Italy.
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Maltezou HC, Katerelos P, Poufta S, Pavli A, Maragos A, Theodoridou M. Attitudes toward mandatory occupational vaccinations and vaccination coverage against vaccine-preventable diseases of health care workers in primary health care centers. Am J Infect Control 2013; 41:66-70. [PMID: 22709989 DOI: 10.1016/j.ajic.2012.01.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 01/18/2012] [Accepted: 01/18/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to assess the attitudes regarding mandatory occupational vaccinations and the vaccination coverage against vaccine-preventable diseases among health care workers (HCWs) working in primary health care centers in Greece. METHODS A standardized questionnaire was distributed to HCWs working in all primary health care centers in Greece (n = 185). RESULTS A total of 2,055 of 5,639 HCWs (36.4% response rate) from 152 primary health care centers participated. The self-reported completed vaccination rates were 23.3% against measles, 23.3% against mumps, 29.8% against rubella, 3% against varicella, 5.8% against hepatitis A, 55.7% against hepatitis B, and 47.3% against tetanus-diphtheria; corresponding susceptibility rates were 17%, 25%, 18.6%, 16.7%, 87.5%, 35%, and 52.6%. Mandatory vaccinations were supported by 65.1% of 1,807 respondents, with wide differences by disease. Multiple logistic regression analysis revealed higher rates of acceptance of mandatory vaccination in physicians compared with other HCW categories. CONCLUSIONS Despite the fact that two-thirds of HCWs working in primary health care centers in Greece support mandatory vaccination for HCWs, completed vaccination rates against vaccine-preventable diseases are suboptimal.
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Maltezou HC, Wicker S, Borg M, Heininger U, Puro V, Theodoridou M, Poland GA. Vaccination policies for health-care workers in acute health-care facilities in Europe. Vaccine 2011; 29:9557-62. [DOI: 10.1016/j.vaccine.2011.09.076] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 08/19/2011] [Accepted: 09/19/2011] [Indexed: 11/17/2022]
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Greer AL, Fisman DN. Use of models to identify cost-effective interventions: pertussis vaccination for pediatric health care workers. Pediatrics 2011; 128:e591-9. [PMID: 21844056 DOI: 10.1542/peds.2010-0796] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Acellular pertussis vaccine is safe and effective in adults. An explicit recommendation for pertussis booster vaccination in pediatric health care workers is based on the importance of health care workers as a potential source of infection for patients. However, limited information is available on the economic attractiveness of this intervention. We sought to evaluate the health-economic attractiveness of a diphtheria-tetanus-acellular pertussis booster vaccination program for health care workers in a pediatric intensive care setting. METHODS We developed a Markov model to calculate the cost-effectiveness of vaccinating NICU health care workers in different proportions ranging from the current strategy of no pertussis booster vaccination program to a vaccination program that achieves between 25% and 95% vaccine coverage. RESULTS Implementation of a vaccination program that achieves 25% coverage was projected to be cost-saving compared with no vaccine program. At all coverage levels the intervention reduced costs, increased life expectancy, and was cost-effective. Projections were most sensitive to the risk of a pertussis introduction via an infected health care worker. Once the monthly risk of an introduction exceeded ∼0.3%, implementation of an immunization program with at least 25% coverage provided both greater health and greater economic benefits than having no vaccine program. CONCLUSIONS The implementation of a hospital-based and funded diphtheria-tetanus-acellular pertussis vaccine program administered through an occupational health program is cost-effective or cost-saving in the context of pediatric health care facilities in which many of the patients are at risk of serious morbidity and mortality should they acquire pertussis while hospitalized.
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Affiliation(s)
- Amy L Greer
- Public Health Agency of Canada, 180 Queen St W, 11th floor, Toronto, Ontario, Canada M5V 3L7.
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Greer AL, Fisman DN. Keeping vulnerable children safe from pertussis: preventing nosocomial pertussis transmission in the neonatal intensive care unit. Infect Control Hosp Epidemiol 2010; 30:1084-9. [PMID: 19785517 DOI: 10.1086/644755] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the impact of different acellular pertussis booster vaccination strategies on the probability of a nosocomial pertussis outbreak occurring and the distribution of outbreak sizes observed for each intervention strategy. SETTING Neonatal intensive care unit. METHODS We developed a stochastic, agent-based simulation model to examine the impact of booster vaccination strategies for pertussis on health care-related transmission. RESULTS Our results demonstrate that healthcare worker booster vaccination decreases the probability of secondary transmission from 49% (base case, no boosting) to 2% (if 95% of healthcare workers are boosted) and decreases final outbreak size. Boosting family caregivers did not have a clinically significant impact on nosocomial disease transmission. CONCLUSION The provision of booster vaccine to healthcare workers in the neonatal intensive care unit substantially reduces the risk of hospital-centered pertussis outbreaks in a manner that enhances the health of hospitalized children. A formal health economic analysis of this finding is currently under way. Policies to protect patient safety in pediatric facilities should include compliance with the United States Advisory Committee on Immunization Practices, which recommends provision of pertussis booster vaccination to healthcare workers.
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Affiliation(s)
- Amy L Greer
- Child Health Evaluative Sciences, Research Institute of the Hospital for Sick Children, Toronto, Ontario, Canada.
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Mirza A, Rathore MH. Immunization update II. Adv Pediatr 2009; 56:29-46. [PMID: 19968941 DOI: 10.1016/j.yapd.2009.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ayesha Mirza
- Department of Pediatrics, University of Florida, Pediatric Infectious Diseases & Immunology, 653-1 West 8th Street, LRC 3rd Floor, L-13 Jacksonville, FL 32209, USA
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Abstract
Pertussis, an acute respiratory infection caused by Bordetella pertussis, classically manifests as a protracted cough illness. The incidence of pertussis in the United States has been increasing in recent years. Immunity wanes after childhood vaccination, leaving adolescents and adults susceptible to infection. The transmission of pertussis in health care settings has important medical and economic consequences. Acellular pertussis booster vaccines are now available for use and have been recommended for all adolescents and adults. These vaccines are safe, immunogenic, and effective. Health care workers are a priority group for vaccination because of their increased risk of acquiring infection and the potential to transmit pertussis to high-risk patients. Health care worker vaccination programs are likely to be cost-effective, but further research is needed to determine the acceptability of pertussis vaccines among health care workers, the duration of immunity after booster doses, and the impact of vaccination on the management of pertussis exposures in health care settings.
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Posfay-Barbe KM, Zerr DM, Pittet D. Infection control in paediatrics. THE LANCET. INFECTIOUS DISEASES 2008; 8:19-31. [DOI: 10.1016/s1473-3099(07)70310-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chatterjee A, Plummer S, Heybrock B, Bardon T, Eischen K, Hall M, Lazoritz S. A modified "cover your cough" campaign prevents exposures of employees to pertussis at a children's hospital. Am J Infect Control 2007; 35:489-91. [PMID: 17765565 DOI: 10.1016/j.ajic.2007.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2005] [Revised: 02/12/2007] [Accepted: 02/14/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND In the 4th quarter of 2004, there was an increase in patients seeking medical care for pertussis symptoms at the Children's Hospital, Omaha, NE. The Hospital Epidemiology service noted a sharp rise in exposures of Children's Hospital employees to these patients, requiring employee testing, prophylactic antibiotic prescriptions, and relief from duty. METHODS Initial efforts at employee education failed to prevent the exposures. An exposure-control plan was then initiated by placing "Cover Your Cough" posters (in English and Spanish) describing appropriate cough etiquette at entrances to the emergency room, outpatient clinics, and hospital lobby. In addition, personal protective equipment (PPE) including child- and adult-sized masks, hand sanitizers, and tissues were provided at these stations for patients and their attendants. RESULTS Prior to the initiation of the above exposure control measures, there were 166 reports of employee exposure to patients and other employees with pertussis symptoms during a 4-week period. Of these, 140 were given prophylactic antibiotics, and 31 underwent diagnostic testing for pertussis and required paid time off from work. The cost of antibiotics and diagnostic testing was $17,407.00. After the introduction of the modified "Cover Your Cough" campaign, the number of employee exposures declined significantly to 37 in the next 4-week period. Notably, the number of patients tested for pertussis during the second 4-week period was 290 compared to 162 in the first 4-week period, indicating continuation of the epidemic. CONCLUSIONS Availability of PPE along with posters regarding cough etiquette at entry points of the hospital interrupted employee exposure to patients/personnel with pertussis symptoms significantly, when an employee educational initiative alone was unable to achieve this outcome.
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Affiliation(s)
- Archana Chatterjee
- Department of Pediatrics, Creighton University Medical Center, Children's Hospital, Omaha, Nebraska, USA.
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Abstract
AIM To explore the attitudes and knowledge of health-care workers (HCW) towards whooping cough and an adult whooping cough booster for HCW. METHODS HCW at Fairfield Health Service, who had clinical contact with infants or children, were sent a self-administered questionnaire. RESULTS Questionnaires were completed by 135 staff, giving a response rate of 74%. Thirty-five per cent were not known to be immunised against whooping cough. Fifty-nine per cent of doctors were known to be immunised, 33% of allied health staff and 28% of nurses. The rates of immunisation between the professional groups were significantly different (chi2 = 8.2 with 2 degrees of freedom; P = 0.017). Thirty-nine per cent of HCW did not know that primary immunisation did not provide lifelong protection. Twenty-seven per cent did not agree that HCW should be offered an adult whooping cough booster. Staff who felt at risk of contracting whooping cough were more likely to recommend that a booster should be offered (OR 2.71; 95% CI 1.22-6.04; P = 0.019). Doctors were less likely to recommend that a booster should be offered (OR 0.36; 95% CI 0.15-0.87; P = 0.028). CONCLUSIONS HCW have low rates of immunity to whooping cough and misconceptions about whooping cough infection and immunisation. Over a quarter of HCW did not agree that a booster should be offered. An ongoing education programme addressing the attitudes and misconceptions identified in this study is a crucial component of the campaign to increase the uptake of adult whooping cough booster immunisation by HCW.
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Affiliation(s)
- Elizabeth Peadon
- Community Paediatrics, Fairfield Health Service, Fairfield, New South Wales, Australia.
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Daskalaki I, Hennessey P, Hubler R, Long SS. Resource consumption in the infection control management of pertussis exposure among healthcare workers in pediatrics. Infect Control Hosp Epidemiol 2007; 28:412-7. [PMID: 17385146 DOI: 10.1086/513121] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 05/01/2006] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess consumption of resources in the infection control management of healthcare workers (HCWs) exposed to pertussis and to assess avoidability of exposure. SETTING Tertiary care children's medical center. METHODS Analysis of the extent of and reasons for HCW exposure to pertussis during contact with children with the disease, whether exposures were avoidable (because of the failure to recognize a case or to order or adhere to isolation precautions) or unavoidable (because the case was not recognizable or because another diagnosis was confirmed), and the cost of implementing exposure management. INTERVENTIONS Interventions consisted of an investigation of every HCW encounter with any patient who was confirmed later to have pertussis from the time of hospital admission of the patient, use of azithromycin as postexposure prophylaxis (PEP) for exposed HCWs, performance of 21-day surveillance for cough illness, testing of symptomatic exposed HCWs for Bordetella pertussis, and enhanced preexposure education of HCWs. RESULTS From September 2003 through April 2005, pertussis was confirmed in 28 patients (median age, 62 days); 24 patients were admitted. For 11 patients, pertussis was suspected, appropriate precautions were taken, and no HCW was exposed. Inadequate precautions for 17 patients led to 355 HCW exposures. The median number of HCWs exposed per exposing patient was 9 (range, 1-86 HCWs; first quartile mean, 2; fourth quartile mean, 61). Exposure was definitely avoidable for only 61 (17%) of 355 HCWs and was probably unavoidable for 294 HCWs (83%). The cost of 20-month infection control management of HCWs exposed to pertussis was $69,770. The entire cohort of HCWs involved in direct patient care at the facility could be immunized for approximately $60,000. CONCLUSIONS Exposure of HCWs to pertussis during contact with children who have the disease is largely unavoidable, and management of this exposure is resource intensive. Universal preexposure vaccination of HCWs is a better utilization of resources than is case-based postexposure management.
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Affiliation(s)
- Irini Daskalaki
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, PA, 19134, USA.
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Maheshwai N. Are young infants treated with erythromycin at risk for developing hypertrophic pyloric stenosis? Arch Dis Child 2007; 92:271-3. [PMID: 17337692 PMCID: PMC2083424 DOI: 10.1136/adc.2006.110007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Pascual FB, McCall CL, McMurtray A, Payton T, Smith F, Bisgard KM. Outbreak of pertussis among healthcare workers in a hospital surgical unit. Infect Control Hosp Epidemiol 2006; 27:546-52. [PMID: 16755472 DOI: 10.1086/506232] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Accepted: 11/10/2005] [Indexed: 11/03/2022]
Abstract
BACKGROUND In September 1999, a pertussis outbreak was detected among surgical staff of a 138-bed community hospital. Patients were exposed to Bordetella pertussis during the 3-month outbreak period. OBJECTIVE To describe the outbreak among surgical staff, to evaluate implemented control measures, and to determine whether nosocomial transmission occurred. METHODS Clinical pertussis was defined as acute cough illness with a duration of 14 days or more without another apparent cause; persons with positive culture, PCR, or serologic test results were defined as having laboratory-confirmed pertussis. Surgical healthcare workers (HCWs) were interviewed regarding pertussis symptoms, and specimens were obtained for laboratory analysis. Patients exposed to B. pertussis during an ill staff member's 3-week infectious period were interviewed by phone to determine the extent of nosocomial spread. PARTICIPANTS A total of 53 HCWs assigned to the surgical unit and 146 exposed patients. HCWs with pertussis were defined as case subjects; HCWs without pertussis were defined as non-case subjects. RESULTS Twelve (23%) of 53 HCWs had clinical pertussis; 6 cases were laboratory confirmed. The median cough duration in the 12 case subjects was 27 days (range, 20-120 days); 10 (83%) had paroxysms. Eleven (92%) of 12 case subjects and 28 (86%) of 41 non-case subjects received antibiotic treatment or prophylaxis. Seven case subjects (58%) reported they always wore a mask when near patients. Of 146 patients potentially exposed to pertussis from the 12 case subjects, 120 (82%) were interviewed; none reported a pertussis-like illness. CONCLUSIONS Surgical staff transmitted B. pertussis among themselves; self-reported data suggests that these HCWs did not transmit B. pertussis to their patients, likely because of mask use, cough etiquette, and limited face-to-face contact. Control measures might have helped limit the outbreak once pertussis was recognized.
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Affiliation(s)
- F Brian Pascual
- Bacterial Vaccine-Preventable Diseases Branch, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia, 30333, USA.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2005. [DOI: 10.1002/pds.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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