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Use of routine viral cultures at delivery to identify neonates exposed to herpes simplex virus
Volume June
17 Number
3
Reviews
1989
Overall, 38% of the respondents did not know the meaning of an AIDS antibody test. Only a few thought that the presence of antibody signified immunity; however, approximately one third of the general practitioners were not sure about this association. There was a great deal of misperception about whether physicians could decline treatment of patients with AIDS, whether they should obtain informed consent before testing for antibody, or whether they could perform invasive procedures safely on infected patients. This report will be extremely interesting for infection control practitioners involved in educating health professionals regarding AIDS. It is likely that the misperceptions and fears observed in British health care workers about AIDS are comparable with those of health care workers in the United States.
Inefficacy of pneumococcal high.rirk population
vaccine
163
mia (29%) and control subjects (24%). Furthermore, no differences were found in the serotypes of isolates recovered from nonvaccinated and vaccinated patients with bacteremia; 65% of the blood isolates from nonvaccinated patients with bacteremia were serotypes that were included in the vaccine compared with 69% of the isolates from vaccinated patients with bacteremia. The investigators concluded that pneumococcal vaccine was not protective in this high-risk veterans population. Infection control practitioners should be aware of the continuing controversy surrounding the efficacy of pneumococcal vaccine. The data presented in this paper supply further evidence that immunization may be ineffective in relatively old, compromised patients who are in high-risk groups for infection. Recommendations for widespread use of pneumococcal vaccine in high-risk patients may have to be reevaluated.
in a
Forrester HL, Jahnigen DW, LaForce FM. Am J Med 1987;83:425-30. Reprint requests: Dr. F. Marc LaForce, Veterans Administration Medical Center, 1055 Clermont St., Denver, CO 80220.
Use of routine viral cultures at delivery identify neonates exposed to herpes simplex virus
These investigators designed a case-control study to evaluate the efficacy of pneumococcal vaccine among patients hospitalized at the Denver Veterans Administration Medical Center. The case group was composed of 89 patients who were hospitalized with pneumococcal bacteremias; the control group consisted of patients who were matched to the cases by age, date of admission, and equally morbid conditions. The investigators reviewed medical records to determine the vaccination status of case patients and control subjects and the serotypes of pneumococcal isolates from the patients with bacteremia. They hypothesized that if vaccine were protective, vaccination rates should have been lower among the bacteremic cases, and the serotype distribution of blood isolates should have been different in patients with bacteremia who previously had received vaccine compared with those who had not. The investigators found no differences in vaccination rates between patients with bactere-
A group of California researchers obtained viral cultures from mothers, infants, or both, to identify subclinical carriers of herpes simplex virus at the time of 6904 deliveries. Specimens were collected without regard to the mothers’ histories of genital herpes. Herpes simplex virus type 2 (HSV-2) was recovered from 14 of the 6904 deliveries (0.2%); all 14 mothers were asymptomatic. Only 1 of the 14 women (7%) had a history of previous genital herpes, whereas 12 (86%) had serologic evidence of previous infection with HSV-2. None of the infants born to these 12 women contracted neonatal herpes. However, one of the two infants born to women with serologic evidence of a primary HSV infection at the time of delivery contracted neonatal herpes. These findings show that most infants at risk of infection with HSV at delivery will not be
to
Prober CG, Hensleigh PA, Boucher FD, et al. N Engl J Med 1988;318:887-91. Reprint requests: Dr. Charles G. Prober, Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA 94305.
American
t64
Reviews
INFECTION
identified if concern about asymptomatic viral shedding is limited to women with histories of previous genital herpes infection. Most neonatal exposure to an asymptomatic maternal HSV infection at delivery is neither predictable nor preventable. Screening all mothers with viral cultures to identify asymptomatic shedders of HSV would be prohibitively expensive. Therefore physicians caring for newborns need to consider neonatal herpes in their differential diagnosis when infants become ill during the first weeks of life, regardless of the presence or absence of identifiable maternal risk factors for HSV infection. FaffumoffffmwmmdMh8rpcutudue dovkor to provont P)vfru@towafs4w@eons
a !#apatfs
Reingold AL, Kane MA, Hightower AW. JAMA 1988;259:255880. Reprint requests: Dr. M. A. Kane, tiepatitk Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333.
A survey of 434 oral surgeons attending a national convention in 198 1 was conducted to examine risk factors for hepatitis B virus (HBV) infection. Overall, 112 (26%) of the participants demonstrated serologic evidence of past or current infection with HBV. Seropositivity was significantly associated with age, number of years in practice, and year of graduation from dental school. It was not associated with other variables such as the number of patients seen an-
Journai
01
CONTROL
nually or the number of patients seen who were at high risk of HBV infection. The strong correlation between years in practice and seropositivity was unaffected by reported use of gloves, face masks, or eye shields. The use of gloves and other protective devices did not appear to offer substantial protection against HBV exposure for oral surgeons. This is an interesting paper that makes us reconsider some of our widely held beliefs about the transmission and prevention of hepatitis B. The lack of association between infection of and exposures to high-risk patients points out the fact that many carriers of hepatitis B surface antigen are asymptomatic and do not fall into the well-known categories of high-risk patients. The lack of association between past infection and use of gloves may reflect the fact that gloves are ineffective in preventing the frequent puncture wounds that are sustained by oral surgeons or that other exposures, such as mucous membrane contact with aerosolized blood, also may be important routes of transmission. Despite the findings of this study the Centers for Disease Control still urges oral surgeons, dentists, and other personnel in the dental profession to use effective barrier precautions, including gloves, masks, protective eye wear, and rubber dams, to prevent exposure to patients’ blood. Nonetheless, infection control practitioners must be aware that gloving alone does not provide absolute protection from hepatitis B infection.
17 Number
3
Reviews
1989
Overall, 38% of the respondents did not know the meaning of an AIDS antibody test. Only a few thought that the presence of antibody signified immunity; however, approximately one third of the general practitioners were not sure about this association. There was a great deal of misperception about whether physicians could decline treatment of patients with AIDS, whether they should obtain informed consent before testing for antibody, or whether they could perform invasive procedures safely on infected patients. This report will be extremely interesting for infection control practitioners involved in educating health professionals regarding AIDS. It is likely that the misperceptions and fears observed in British health care workers about AIDS are comparable with those of health care workers in the United States.
Inefficacy of pneumococcal high.rirk population
vaccine
163
mia (29%) and control subjects (24%). Furthermore, no differences were found in the serotypes of isolates recovered from nonvaccinated and vaccinated patients with bacteremia; 65% of the blood isolates from nonvaccinated patients with bacteremia were serotypes that were included in the vaccine compared with 69% of the isolates from vaccinated patients with bacteremia. The investigators concluded that pneumococcal vaccine was not protective in this high-risk veterans population. Infection control practitioners should be aware of the continuing controversy surrounding the efficacy of pneumococcal vaccine. The data presented in this paper supply further evidence that immunization may be ineffective in relatively old, compromised patients who are in high-risk groups for infection. Recommendations for widespread use of pneumococcal vaccine in high-risk patients may have to be reevaluated.
in a
Forrester HL, Jahnigen DW, LaForce FM. Am J Med 1987;83:425-30. Reprint requests: Dr. F. Marc LaForce, Veterans Administration Medical Center, 1055 Clermont St., Denver, CO 80220.
Use of routine viral cultures at delivery identify neonates exposed to herpes simplex virus
These investigators designed a case-control study to evaluate the efficacy of pneumococcal vaccine among patients hospitalized at the Denver Veterans Administration Medical Center. The case group was composed of 89 patients who were hospitalized with pneumococcal bacteremias; the control group consisted of patients who were matched to the cases by age, date of admission, and equally morbid conditions. The investigators reviewed medical records to determine the vaccination status of case patients and control subjects and the serotypes of pneumococcal isolates from the patients with bacteremia. They hypothesized that if vaccine were protective, vaccination rates should have been lower among the bacteremic cases, and the serotype distribution of blood isolates should have been different in patients with bacteremia who previously had received vaccine compared with those who had not. The investigators found no differences in vaccination rates between patients with bactere-
A group of California researchers obtained viral cultures from mothers, infants, or both, to identify subclinical carriers of herpes simplex virus at the time of 6904 deliveries. Specimens were collected without regard to the mothers’ histories of genital herpes. Herpes simplex virus type 2 (HSV-2) was recovered from 14 of the 6904 deliveries (0.2%); all 14 mothers were asymptomatic. Only 1 of the 14 women (7%) had a history of previous genital herpes, whereas 12 (86%) had serologic evidence of previous infection with HSV-2. None of the infants born to these 12 women contracted neonatal herpes. However, one of the two infants born to women with serologic evidence of a primary HSV infection at the time of delivery contracted neonatal herpes. These findings show that most infants at risk of infection with HSV at delivery will not be
to
Prober CG, Hensleigh PA, Boucher FD, et al. N Engl J Med 1988;318:887-91. Reprint requests: Dr. Charles G. Prober, Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA 94305.
American
t64
Reviews
INFECTION
identified if concern about asymptomatic viral shedding is limited to women with histories of previous genital herpes infection. Most neonatal exposure to an asymptomatic maternal HSV infection at delivery is neither predictable nor preventable. Screening all mothers with viral cultures to identify asymptomatic shedders of HSV would be prohibitively expensive. Therefore physicians caring for newborns need to consider neonatal herpes in their differential diagnosis when infants become ill during the first weeks of life, regardless of the presence or absence of identifiable maternal risk factors for HSV infection. FaffumoffffmwmmdMh8rpcutudue dovkor to provont P)vfru@towafs4w@eons
a !#apatfs
Reingold AL, Kane MA, Hightower AW. JAMA 1988;259:255880. Reprint requests: Dr. M. A. Kane, tiepatitk Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333.
A survey of 434 oral surgeons attending a national convention in 198 1 was conducted to examine risk factors for hepatitis B virus (HBV) infection. Overall, 112 (26%) of the participants demonstrated serologic evidence of past or current infection with HBV. Seropositivity was significantly associated with age, number of years in practice, and year of graduation from dental school. It was not associated with other variables such as the number of patients seen an-
Journai
01
CONTROL
nually or the number of patients seen who were at high risk of HBV infection. The strong correlation between years in practice and seropositivity was unaffected by reported use of gloves, face masks, or eye shields. The use of gloves and other protective devices did not appear to offer substantial protection against HBV exposure for oral surgeons. This is an interesting paper that makes us reconsider some of our widely held beliefs about the transmission and prevention of hepatitis B. The lack of association between infection of and exposures to high-risk patients points out the fact that many carriers of hepatitis B surface antigen are asymptomatic and do not fall into the well-known categories of high-risk patients. The lack of association between past infection and use of gloves may reflect the fact that gloves are ineffective in preventing the frequent puncture wounds that are sustained by oral surgeons or that other exposures, such as mucous membrane contact with aerosolized blood, also may be important routes of transmission. Despite the findings of this study the Centers for Disease Control still urges oral surgeons, dentists, and other personnel in the dental profession to use effective barrier precautions, including gloves, masks, protective eye wear, and rubber dams, to prevent exposure to patients’ blood. Nonetheless, infection control practitioners must be aware that gloving alone does not provide absolute protection from hepatitis B infection.