- Email: [email protected]
The roles of vaccination and amantadine prophylaxis in controlling an outbreak of influenza A (H3N2) in a nursing home
Volume 17 Number 1 February 1989
avoid donors at high risk for acquired immunodeficiency syndrome (AIDS). The authors contend that directed donations are no safer than volunteer donations and that they introduce several legal, ethical, and administrative problems for blood collection centers. Present methods for screening donated blood are extremely reliable in eliminating units that might be contaminated with either HIV or hepatitis viruses. The likelihood that recipient-selected donors might test positive is similar to that of anonymous, volunteer donors. In addition, in contrast to volunteer donors, the anonymity of directed donors cannot be guaranteed. Thus it would be difficult, if not impossible, to hide the identify of a deferred directed donor whose test for HIV infection showed positive results. The authors of this commentary present convincing arguments that problems associated with directed blood donations far outweigh their medical value. At the same time they suggest that we must continue to develop and encourage medically sound approaches to safer transfusion therapy. These approaches include the more conservative use of blood and blood products, increased use of autologous blood, and research into new blood substitutes. This paper provides an excellent reference for infection control practitioners who must counsel surgical patients about the possible risk of transfusion-associated AIDS.
Reviews
47
test the efficacy of condoms in preventing HIV transmission. Twenty condoms containing 6.6% nonoxynol 9, 0.9 ml, and ten condoms without nonoxynol 9 were studied. Each condom was mounted on a hollow dildo and placed in a glass cylinder. The HIV inoculum and HIVfree medium were placed on opposite sides of the condom. Intercourse was simulated by pumping the dildo up and down in the cylinder before and after deliberate rupture of the condom. Samples for HIV culture were taken from outside and inside the condom before and after rupture. No condom without nonoxynol 9 leaked HIV before rupture, but after rupture HIV could be detected in the outside medium in seven of ten condoms tests; HIV could not be detected in outside medium after rupture of any of the nonoxynol 9-containing condoms. Despite their results the investigators concluded that condoms, even in combination with nonoxynol 9, probably will not provide absolute protection against HIV transmission. They recommended that persons with HIV infection should abstain from vaginal or anorectal intercourse and that persons at risk for HIV infection should engage in mutually monogamous relationships with a known HIV-negative partner. However, for those who find it impossible to live a life of sexual abstinence or monogamy, the authors recommended the proper use of condoms in combination with generous amounts of nonoxynol 9 or any other latex-compatible, watersoluble agent proved to kill HIV.
Condoms as physical and c h e m i c a l bawlers against h u m a n i m m u n o d e f l c l e n c y virus Rietmeijer CAM, Krabs JW, Feorino PM, Judson FN. JAMA
1988;259:1851-3. Reprint requests: Denver Disease Control Service, 605 Bannock St., Denver, CO 80204-4507.
This report may appear to be somewhat far afield for infection control practitioners whose main job is to prevent the transmission of nosocomial infections. It is relevant, however, to those of us who are asked to educate patients and the public about the transmission of human immunodeficiency virus (HIV) infection and ways in which its spread may be prevented. The authors developed an in vitro model to
T h e roles of v a c c i n a t i o n and a m a n t a d i n e prophylaxis in controlling an o u t b r e a k of Influenza A ( H 3 N 2 ) in a nursing h o m e Arden NH, Patriarca PA, Fasano MB, et al. Arch Intern Med 1988;148:865-8. Reprint requests: Ms. Nancy Arden, Influenza Branch, 7-112, Centers for Disease Control, Atlanta, GA 30333.
This report describes an outbreak of influenza A/Philippine/2/82 (H3 N2) that occurred in a partially vaccinated nursing home population in January 1985. During the first 6 days of the outbreak, influenza-like illness developed in 14 (25%) of 55 residents. The risk of illness was
American Journal of
48
Reviews
most strongly associated with undetectable levels of antibody against the epidemic strain, with unvaccinated patients having more severe illnesses and a higher rate of hospitalization than vaccinated patients (5 / 8 vs 0 / 6). To control the epidemic, amantadine hydrochloride (100 mg/day) was given to all residents in w h o m clinical symptoms had not yet developed. Only 2 (5%) of the remaining 41 residents became ill, even though 11 (27%) had no detectable antibody. Relatively few clinically significant side effects were associated with the use of amantadine. Although the n u m b e r of patients involved in this outbreak are few, the findings are impressive. The outbreak illustrates the rapidity with which influenza virus can be transmitted in a nursing home and the need for aggressive measures for prevention and control. It appears that influenza vaccination was beneficial in reducing both the incidence and severity of infection even though it failed to prevent occurrence of the outbreak. This report also demonstrates t h e value of early prophylaxis with relatively lowdose (100 mg/day) amantadine hydrochloride to prevent the spread of infection.
N o m ~ s i a a tmmmdsskm of Cone R, Mohan K, Thouless M, Corey L. Pediatr Infect Dis J 1988;7:103-9. Repdnt requests: Richard Cone, MD, c/o Virology Laboratory, Children's Hospital and Medical Center, P.O. Box C5371, Seattle, WA 98105.
This report is a prospective study that describes the incidence and epidemiology of noso-
INFECTION CONTROL
comial rotavirus infection on an infant ward. The sera of children admitted to the ward during a 5-month period were sampled for evidence of rotavirus infection at admission and at 4-day intervals during subsequent hospitalization. Rotavirus was detected in 51 / 315 infants, 24 at admission and 27 after 72 hours of hospitalization. The prevalence of rotavirus increased with increasing lengths of hospitalization. Of the 27 nosocomially acquired infections the diagnosis was suspected in only 22%. Only 11 of the 27 instances of nosocomial infection were epidemiologically associated with antigen-positive roommates; in four of these instances, different viral subgroups were present in the two roommates. This report suggests that nosocomlal acquisition of rotavirus infection is a relatively comm o n event. It does not appear, however, that patient-to-patient transmission is very important in the epidemiology of nosocomial infection. Instead, visitors, hospital personnel, and environmental sources must be involved in spreading infection within institutions. Infection control personnel working in pediatric units should be familiar with the epidemiology of this disease. Rotavirus infections have the potential for epidemic spread within the hospital. Everyone having contact with hospitalized children should pay close attention to proper infection control practices.
avoid donors at high risk for acquired immunodeficiency syndrome (AIDS). The authors contend that directed donations are no safer than volunteer donations and that they introduce several legal, ethical, and administrative problems for blood collection centers. Present methods for screening donated blood are extremely reliable in eliminating units that might be contaminated with either HIV or hepatitis viruses. The likelihood that recipient-selected donors might test positive is similar to that of anonymous, volunteer donors. In addition, in contrast to volunteer donors, the anonymity of directed donors cannot be guaranteed. Thus it would be difficult, if not impossible, to hide the identify of a deferred directed donor whose test for HIV infection showed positive results. The authors of this commentary present convincing arguments that problems associated with directed blood donations far outweigh their medical value. At the same time they suggest that we must continue to develop and encourage medically sound approaches to safer transfusion therapy. These approaches include the more conservative use of blood and blood products, increased use of autologous blood, and research into new blood substitutes. This paper provides an excellent reference for infection control practitioners who must counsel surgical patients about the possible risk of transfusion-associated AIDS.
Reviews
47
test the efficacy of condoms in preventing HIV transmission. Twenty condoms containing 6.6% nonoxynol 9, 0.9 ml, and ten condoms without nonoxynol 9 were studied. Each condom was mounted on a hollow dildo and placed in a glass cylinder. The HIV inoculum and HIVfree medium were placed on opposite sides of the condom. Intercourse was simulated by pumping the dildo up and down in the cylinder before and after deliberate rupture of the condom. Samples for HIV culture were taken from outside and inside the condom before and after rupture. No condom without nonoxynol 9 leaked HIV before rupture, but after rupture HIV could be detected in the outside medium in seven of ten condoms tests; HIV could not be detected in outside medium after rupture of any of the nonoxynol 9-containing condoms. Despite their results the investigators concluded that condoms, even in combination with nonoxynol 9, probably will not provide absolute protection against HIV transmission. They recommended that persons with HIV infection should abstain from vaginal or anorectal intercourse and that persons at risk for HIV infection should engage in mutually monogamous relationships with a known HIV-negative partner. However, for those who find it impossible to live a life of sexual abstinence or monogamy, the authors recommended the proper use of condoms in combination with generous amounts of nonoxynol 9 or any other latex-compatible, watersoluble agent proved to kill HIV.
Condoms as physical and c h e m i c a l bawlers against h u m a n i m m u n o d e f l c l e n c y virus Rietmeijer CAM, Krabs JW, Feorino PM, Judson FN. JAMA
1988;259:1851-3. Reprint requests: Denver Disease Control Service, 605 Bannock St., Denver, CO 80204-4507.
This report may appear to be somewhat far afield for infection control practitioners whose main job is to prevent the transmission of nosocomial infections. It is relevant, however, to those of us who are asked to educate patients and the public about the transmission of human immunodeficiency virus (HIV) infection and ways in which its spread may be prevented. The authors developed an in vitro model to
T h e roles of v a c c i n a t i o n and a m a n t a d i n e prophylaxis in controlling an o u t b r e a k of Influenza A ( H 3 N 2 ) in a nursing h o m e Arden NH, Patriarca PA, Fasano MB, et al. Arch Intern Med 1988;148:865-8. Reprint requests: Ms. Nancy Arden, Influenza Branch, 7-112, Centers for Disease Control, Atlanta, GA 30333.
This report describes an outbreak of influenza A/Philippine/2/82 (H3 N2) that occurred in a partially vaccinated nursing home population in January 1985. During the first 6 days of the outbreak, influenza-like illness developed in 14 (25%) of 55 residents. The risk of illness was
American Journal of
48
Reviews
most strongly associated with undetectable levels of antibody against the epidemic strain, with unvaccinated patients having more severe illnesses and a higher rate of hospitalization than vaccinated patients (5 / 8 vs 0 / 6). To control the epidemic, amantadine hydrochloride (100 mg/day) was given to all residents in w h o m clinical symptoms had not yet developed. Only 2 (5%) of the remaining 41 residents became ill, even though 11 (27%) had no detectable antibody. Relatively few clinically significant side effects were associated with the use of amantadine. Although the n u m b e r of patients involved in this outbreak are few, the findings are impressive. The outbreak illustrates the rapidity with which influenza virus can be transmitted in a nursing home and the need for aggressive measures for prevention and control. It appears that influenza vaccination was beneficial in reducing both the incidence and severity of infection even though it failed to prevent occurrence of the outbreak. This report also demonstrates t h e value of early prophylaxis with relatively lowdose (100 mg/day) amantadine hydrochloride to prevent the spread of infection.
N o m ~ s i a a tmmmdsskm of Cone R, Mohan K, Thouless M, Corey L. Pediatr Infect Dis J 1988;7:103-9. Repdnt requests: Richard Cone, MD, c/o Virology Laboratory, Children's Hospital and Medical Center, P.O. Box C5371, Seattle, WA 98105.
This report is a prospective study that describes the incidence and epidemiology of noso-
INFECTION CONTROL
comial rotavirus infection on an infant ward. The sera of children admitted to the ward during a 5-month period were sampled for evidence of rotavirus infection at admission and at 4-day intervals during subsequent hospitalization. Rotavirus was detected in 51 / 315 infants, 24 at admission and 27 after 72 hours of hospitalization. The prevalence of rotavirus increased with increasing lengths of hospitalization. Of the 27 nosocomially acquired infections the diagnosis was suspected in only 22%. Only 11 of the 27 instances of nosocomial infection were epidemiologically associated with antigen-positive roommates; in four of these instances, different viral subgroups were present in the two roommates. This report suggests that nosocomlal acquisition of rotavirus infection is a relatively comm o n event. It does not appear, however, that patient-to-patient transmission is very important in the epidemiology of nosocomial infection. Instead, visitors, hospital personnel, and environmental sources must be involved in spreading infection within institutions. Infection control personnel working in pediatric units should be familiar with the epidemiology of this disease. Rotavirus infections have the potential for epidemic spread within the hospital. Everyone having contact with hospitalized children should pay close attention to proper infection control practices.