Outbreak of scarlet fever caused by an erythromycin-resistant Streptococcus pyogenes emm22 genotype strain in a day-care center.

We report an outbreak of scarlet fever and pharyngeal colonization with Streptococcus pyogenes in a day-care center in Mexico City. The outbreak strain was resistant to erythromycin but susceptible to clindamycin. T-type 11,12 serotype was found in eight isolates, from two patients and six carriers, which had the emm22 gene. The recognition of streptococci resistant to macrolides causing outbreaks has implications for infection control and for improving antibiotic prescribing patterns in the day-care setting.

[Bacteremia and pseudobacteremia caused by coagulase-negative Staphylococcus in children]. / Bacteriemia y pseudobacteriemia causada por Staphylococcus coagulasa negativa en niños.

OBJECTIVE: To compare patients with Coagulase Negative Staphylococcus bacteremia (CoNS-B) and pseudobacteremia (CoNS-PB) in a pediatric hospital. METHODS: Descriptive and comparative study between children diagnosed with CoNS-B and CoNS-PB. RESULTS: A total of 159 children with CoNS positive blood cultures were evaluated. 66 children were classified as CoNS-B (41.5%) and 93 as CoNS-PE3 (58.5%). On the average CoNS was isolated on day 21 among children with bacteremia (B) and on day 2 in those with PB (p < 0.01). Excluding newborns, patients with B and PB had on average 2.6 and 1.1 positive cultures respectively. Most children with bacteremia were at the intensive care unit (67.2%), while patients with PB were mostly detected at the emergency room. Using logistic regression analysis, we found four factors independently associated with CoNS bacteremia: total parenteral nutrition (OR 5.4; 95% CI 2.2-12.9), low birth weight (OR 2.6; 95% CI 1.1-5.9), catheters placed by cut-down technique (OR 1.9; 95% CI 1.1-3.8), and inmuno-compromised patients (OR 2.7; 95% CI 1.1-6.7). Resistance to oxacilin was reported in 71.7% of the CoNS isolated. The overall mortality associated to CoNS-B was 6%. Among children with CoNS-PB, 10% received antibiotics, half of them vancomycin. CONCLUSIONS: These results show that CoNS-B occurs mainly as a nosocomial episode. CoNS-PB more likely resulted from specimen contamination at collection, being responsible for almost 60% of all positive blood cultures. The false-positive results caused unnecessary administration of antibiotics in a significant proportion of CoNS-PB events and have a potential impact upon the emergence of resistant pathogens.

[Incidence of Helicobacter pylori infection in a cohort of infants in the State of Morelos]. / Incidencia de infección por Helicobacter pylori en una cohorte de lactantes en el estado de Morelos.

OBJECTIVE: To study the incidence of Helicobacter pylori infection in infants from the State of Morelos, Mexico. MATERIAL AND METHODS: A cohort of 110 healthy infants was studied between 1997 and 1999. Serum samples were collected from mothers and their infants at 2, 6, 18, and 24 months of life. All serum samples were tested for antibodies against Helicobacter pylori with the ELISA test. A questionnaire was used to collect socio-economic and clinical data. Associations among selected variables and Helicobacter pylori infection were determined using Fisher's exact test. RESULTS: Two thirds of mothers and six (5.5%) infants tested positive. Two of the six positive infants were born to positive mothers; both of them became negative before age two. The other four infants remained positive. Although not statistically significant, a vaginal birth and more than five people living in the household are possible risk factors for infant H. pylori infection. CONCLUSIONS: Despite the previously reported high prevalence of infection by H. pylori in Mexican children, in this population we found a low incidence of infection in infants up to two years of age. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

[Incidence of nosocomial bacteremia and pneumonia in pediatric unit]. / Incidencia de bacteriemia y neumonía nosocomial en una unidad de pediatría.

OBJECTIVE: To determine the incidence of catheter-related bacteremia and ventilator-associated pneumonia in children admitted to a secondary care hospital. MATERIAL AND METHODS: A prospective active surveillance system was conducted from January 1999 to June 2000, at the Hospital General of Instituto Mexicano del Seguro Social in Durango, Mexico. Daily visits to the pediatric ward were conducted to detect episodes of bacteremia and pneumonia, according to the Official Mexican Norm. Hospitalized patients under mechanical ventilation and/or with a central venous catheter, were followed from the first day of exposure, until a nosocomial infection was detected, or until the invasive device was removed. Blood and tracheal aspirate cultures were obtained from all exposed patients. Incidence rates with 95% confidence intervals were calculated for ventilator-associated pneumonia and bacteremia/sepsis per 1000 exposure days. Also, the monthly infection rate is presented for days of exposure, using statistical control graphs. RESULTS: A total of 47 episodes of bacteremia/sepsis and 44 of ventilator associated pneumonia were recorded. The incidence rate of pneumonia and bacteremia/sepsis was 28 and 26 cases respectively, per 1000 days of exposure to and invasive device. The gram-positive rods (61.11%) were more common than the gram negative rods (38.88%). CONCLUSIONS: The most striking finding of this study was the higher incidence of these two nosocomial infections in children, as compared to that reported elsewhere. These findings call for preventive strategies and guidelines for handling intravenous catheters and mechanical ventilation in Mexico.

[FARMAC: a program designed for monitoring the prescription of antimicrobials in hospitals]. / FARMAC: programa diseñado para vigilar la prescripción de antimicrobianos en hospitales.

INTRODUCTION: The use of computer programs for monitoring the prescription of antimicrobial agents in hospitals is of paramount importance in the incorporation of electronic databases developed and analyzed by several hospital committees, including the following: infection control; pharmacy; morbidity and mortality; and quality assurance committees, as well as other key areas or departments such as pathology, pharmacy, microbiology, radiology, or hospital administration. OBJECTIVE: To describe the development and use of an "information system" employed for monitoring the prescription of antimicrobial agents in hospitalized patients. MATERIAL AND METHODS: A printed format was developed in order for physicians to ask for authorization for the use of restricted antimicrobial agents (i.e. third-generation cephalosporins and other newly introduced beta lactams, fluoroquinolones, antifungals, antivirals, etc). A computer program, "FARMAC", was designed using the Dbase IV program. FARMAC contemplates the presentation on a screen of a main menu allowing for the use of several options: admissions; antibiotic changes; consultations; discharges; hospital transfers; reports, and distribution. The reports are generated from the menu and appear on the screen or are printed in representative tables and figures. Generally speaking, the system processes information on the use of antimicrobial agents, files information, allows for consultation, of the information and generates reports quickly and efficiently. RESULTS: The presentations were defined on screen, taking into account the space needed in order to avoid an inadequate distribution of the messages, therefore obtaining an optimal image. A database was created defining the necessary fields for storing information with reference to patients and usage patterns of restricted antimicrobial agents. DISCUSSION: The development of an information and surveillance system on the prescription of antibiotics allows for consulting updated information, making the data analysis easier for decision making. Its use will allow for surveying tendencies and usage patterns of controlled and non-controlled antimicrobial agents.

[Prevalence of nosocomial infections in children: survey of 21 hospitals in Mexico]. / Prevalencia de infecciones nosocomiales en niños: encuesta de 21 hospitales en México.

OBJECTIVE: The purpose of this study was to determine the prevalence of nosocomial infections, associated risk factors, microbiology, use of antibiotics, and associated mortality among hospitalized children. MATERIAL AND METHODS: A 1-day prevalence survey was conducted among 1,183 children hospitalized in a nationwide network of 21 public hospitals caring for children. To attain consistency between hospitals, CDC nosocomial infection definitions were used. Adjusted relative odds of bacteremia were estimated using logistic regression analysis. RESULTS: The prevalence of nosocomial acquired infection was 9.8% (CI 95%, 8.1-11.6). The more prevalent infections were pneumonia (25%), sepsis/bacteremia (19%), and urinary tract infection (5%). The main microorganism isolated in blood cultures drown from patients with nosocomial infection was K. pneumoniae (31%). The prevalence of antibiotics use was 49% with substantial variation between hospitals (range 3-83%). Using logistic regression analysis, four factors were independently associated with the risk of nosocomial infection: central venous catheters (OR 3.3; CI 95% 1.0-5.9), total parenteral nutrition (OR 2.1; CI 95% 1.0-4.5) mechanical ventilation (OR 2.3; CI 95% 1.2-4.1), and low birth weight (OR 2.6; CI 95% 1.0-6.8). The overall mortality was 4.8%; however, patients with nosocomial infection had two times greater risk to die as compared to non-infected children (OR 2.6; CI 95% 1.3-5.1). CONCLUSIONS: This rapid assessment survey using a standard methodology allows to document the prevalence of nosocomial infections in children. The results were used to develop targeted programs on central catheters and mechanical ventilation aimed to reduce bacteremia/sepsis and pneumonia, two nosocomial infections characterized by high prevalence and mortality.

Improved serological response to human diploid cell rabies vaccine when given simultaneously with antirabies hyperimmune globulin.

BACKGROUND: The prevention of rabies in Mexico continues to be an important goal for the health sector. Although the prevalence of this disease continues to fall, between 1990 and 1995 a total of 238 cases were registered (an average of 40 cases annually), with a mean annual incidence of 0.04 cases per 100,000 inhabitants and a mortality of almost 100%, so that it is important to rely on highly effective vaccines with few side effects. The objective of this work was to evaluate seroconversion and tolerance to the human diploid cell antirabies vaccine administered to individuals with a history of exposure to rabies, to compare these results with those reported in the literature for the Fuenzalida vaccine, a rabies vaccine produced in the brain tissue of suckling mice, and to find the role antirabies hyperimmune gamma globulin plays in the concentration of post-vaccination antibody concentrations. METHODS: An analytical transverse study was carried out in 40 children and adults with a history of rabies exposure who were given a complete, five-dose intramuscular schedule of the human diploid cell rabies vaccine. Subjects were followed daily, and local and systemic signs and symptoms were recorded. Two blood samples (at baseline and at the end of the vaccination schedule) were taken and antibody titers against rabies glycoprotein, using the ELISA technique, were measured. RESULTS: Adverse side effects produced by the human diploid cell antirabies vaccine, such as frequency of pain, erythema, itching, and regional adenopathy were fewer than those reported in the literature for the Fuenzalida vaccine (p < 0.05), and of induration and local pain (p < 0.05) in relation to the latter vaccine. All patients seroconverted, producing geometric mean antibody titers of 6.22 IU/mL, an arithmetic mean titer of 9.66 IU/mL with a SD of 9.1 IU/mL. The level of tolerance to the diploid cell vaccine was good and its adverse effects were minimal and fewer than those reported for the Fuenzalida rabies vaccine. Patients receiving the diploid cell vaccine plus antirabies hyperimmune gamma globulin developed higher antibody titers (measured by ELISA test) at the end of the vaccination schedule than those only receiving the vaccine. CONCLUSIONS: These results are important in order to achieve an adequate and opportune level of protection provided by prophylactic vaccines to patients with exposure to rabies.

[Surveillance and the costs related to the prescription of antimicrobials in a pediatric hospital]. / Vigilancia y costos relacionados con la prescripción de antimicrobianos en un hospital pediátrico.

INTRODUCTION: Important considerations in the selection of an antimicrobial agent include the indications for its prescription, its efficacy, toxicity and cost. However, is has been observed that up to 50% of these prescriptions are inappropriate. OBJECTIVE: To evaluate the utilization patterns and costs of restricted antimicrobial agents requiring authorization of the infectious diseases service for their prescription, in a tertiary care pediatric hospital through the use of a computer software antimicrobial use surveillance program designed by the investigators. MATERIAL AND METHODS: A one-year longitudinal descriptive and prolective survey was conducted in all patients requiring antimicrobial therapy during their hospitalization. Information on the prescription and costs of antimicrobial agents was recorded from both the medical chart and pharmacy registers. RESULTS: A total of 748 patients were prescribed at least one restricted antimicrobial agent, corresponding to 9.6% of the total number of patients hospitalized and 63.4% of the antibiotic expenditures during the study. CONCLUSIONS: Hospital surveillance of antimicrobial prescription is useful for detecting antimicrobial prescription patterns and costs. These types of studies are inexpensive and of easy access when a computerized register is available in the pharmacy.

Intravenous lipid emulsions are the major determinant of coagulase-negative staphylococcal bacteremia in very low birth weight newborns.

BACKGROUND: Intravenous lipid emulsions and the i.v. catheters through which they were administered were the major risk factors for nosocomial coagulase-negative staphylococcal (CONS) bacteremia among newborns in our neonatal intensive care units a decade ago. However, medical practice is changing, and these and other interventions may have different effects in the current setting. OBJECTIVES: We determined the independent risk factors for CONS bacteremia in current very low birth weight newborns after adjusting for severity of underlying illness. METHODS: We surveyed 590 consecutively admitted newborns with birth weights < 1500 g hospitalized in 2 neonatal intensive care units and conducted a case-control study in a sample of 74 cases of CONS bacteremia and 74 pairs of matched controls. Adjusted relative odds of bacteremia were estimated for a number of attributes and therapeutic interventions in 2 time intervals before CONS bacteremia: any time before bacteremia and the week before bacteremia. RESULTS: Using conditional logistic regression to adjust for indicators of severity of illness, two procedures were independently associated with subsequent risk of CONS bacteremia at any time during hospitalization: i.v. lipids, odds ratio (OR) = 9.4 [95% confidence interval (CI) 1.2 to 74.2]; and any surgical or percutaneously placed central venous catheter, OR = 2.0 (95% CI 1.1 to 3.9). Considering only the week immediately preceding bacteremia, the independent risk factors were: mechanical ventilation, OR = 3.2 (95% CI 1.3 to 7.6); and short peripheral venous catheters, OR = 2.6 (95% CI 1.0 to 6.5). CONCLUSIONS: During the last decade exposure to i.v. lipids any time during hospitalization has become an even more important risk factor for CONS bacteremia (OR = 9.4). Of these bacteremias 85% are now attributable to lipid therapy. In contrast the relative importance of intravenous catheters as independent risk factors has declined. Mechanical ventilation in the week before bacteremia has emerged as a risk factor for bacteremia.

Mortality associated with systemic candidiasis in children.

The purpose of this study was to determine factors associated with an increased risk of mortality due to systemic Candida infections in children hospitalized at our tertiary care facility. A total of 71 cases of Candida bloodstream infections were identified over a 2-year period. The attack rate was 47 cases of candidemia per 10,000 discharges and the case fatality rate was 46.5%. Sixty-one cases occurred in infants under 2 years; 27 were newborns (38%). Using logistic regression analysis, we evaluated the independent effects of potential risk factors for death due to candidemia. Three factors were associated with the subsequent risk for death due to systemic candida infection: malnutrition (OR = 4.3; 95% CI 1.2-14.8), prior surgery (OR = 3.8; 95% CI 1.2-13.2), and the number of days between the first positive candida blood culture and the onset of antifungal treatment (OR = 1.12; 95% CI 1.06-1.25). Newborns showed an almost three times greater risk of death due to candidemia as compared to other age groups, but this association was only marginally significant (OR = 2.8; 95% CI 0.9-9.3). There was no difference in the rate of candidemia between the 2 years of the study; however, the observed mortality declined significantly from 65% in year one to 20% in year two (p = 0.02). The major finding of this study was to observe that for every day treatment was delayed the risk of death increased significantly. Thus, this study provides support for empirical antifungal therapy early in the course of suspected systemic candidiasis in order to improve survival among children.

[The health worker and counseling about HIV and AIDS]. / El trabajador de salud y la consejería sobre el VIH y SIDA.

By December 1993, more than 17,000 AIDS cases had been reported in Mexico and some estimates indicate approximately 100,000 individuals currently infected with HIV. From the patient's perspective, being HIV positive or having AIDS, places an enormous burden on psychosocial coping mechanisms. Thus, psychosocial support is required for all of these patients. This paper summarizes our educational intervention on counseling techniques and provides information of our demonstration project on the effectiveness of the educational intervention among 89 Mexican health care workers. Overall, these professionals showed improvement in their knowledge and goals of providing counseling. One of the more striking was the discovery of homophobic attitudes among them, particularly those with no previous experience in the care of HIV infected people. This exploratory study allowed us to identify research and educational needs of health care workers. The overwhelming number of estimated cases of HIV infections and the current trends of the epidemic reveal the necessity for training in medical counseling that over 73,000 physicians in Mexico will face in the immediate future.

[The impact of Haemophilus influenzae infections on Mexican children]. / Impacto de las infecciones por Haemophilus influenzae en niños mexicanos.

A review of Haemophilus influenzae (Hi) infections in Mexico over the past 32 years was conducted. The proportion of Hi isolates in relation to positive cultures for distinct diseases was distributed as follows for meningitis (9-69%) and for pneumonia with empyema (6-28%). There was no difference in the proportion of Hi isolation between under developed countries and the United States. In other diseases such as septic arthritis, epiglottitis, acute otitis media, acute maxillary sinusitis and in the nasopharyngeal carrier state, the information was too limited. The incidence of Hib invasive disease has been almost eliminated in some areas of the world related to the use of Hib conjugated vaccine. It is imperative for the practitioner to be aware of the advantages of Hib vaccine in infancy.

[Candida endocarditis in the first year of life]. / Endocarditis por Candida en el primer año de vida.

Candida is an increasing problem as a causal agent of nosocomial infection in neonates and infants. We report 15 cases of infective endocarditis caused by Candida spp treated at the Hospital Infantil de Mexico between 1980 and 1991. The diagnosis of endocarditis was established by the identification of Candida in at least two blood cultures and echocardiographic assessment. From 110 cases of systemic candidiasis during the eleven years period of study, fifteen patients presented endocarditis (13.6%), all had a central venous catheter. Three had antecedent of congenital heart disease. Candida isolation was obtained an average of 28 days after admission. The major clinical findings were: fever in 13 patients, respiratory distress and cardiac murmurs observed in nine respectively. Thrombocytopenia was present in eight children. The echocardiographic evaluation showed vegetations located in the superior vena cava in six, right atrium in five, tricuspid valve in two, inferior vena cava and right ventricle in one respectively. Three cases were subjected to surgical treatment. Nine patients died for a case fatality rate of 60%. The echocardiographic evaluation practiced in all patients with suspicion of systemic candidiasis is critical for the prognosis. The identification of endocardiac involvement coupled with the opportune administration of antifungal therapy and surgical treatment may improved the survival.

[Protection of health personnel against hepatitis B by DNA recombinant vaccine]. / Protección contra hepatitis B en trabajadores de salud con vacuna de DNA recombinante.

Hepatitis B (HVB) is a worldwide spread health problem. It has been assessed that there are more than 300 millions of carriers. HVB has a special concern for health care workers (HCW's) due to the high risk among them of getting the infection in clinic-setting areas. According to some estimation, the risk for hepatitis B among HCW's is 2 to 10 times higher than the risk for general population. The risk is related to the degree of direct contact with blood and body fluids, as well as, with the frequency of traumatic exposure in the work place. The control of this infection is based on the observance of universal precautions and the vaccination, since there is not treatment against this disease. The results of an efficacy-evaluation of DNA recombinant vaccine against hepatitis B are reported; 174 HCW's were studied; three dosages of vaccine were administered (0.1st and 6th month) by I.M. via. In addition, three serum samples were collected at 0, 1st and 9th month after vaccine administration. We did not find carriers of surface antigen of hepatitis B. With regards to seroconverted individuals we observed the following results: there were a satisfactory response to the vaccine in 163 individuals (93.7%); however, 8 (4.6%) persons did not reach titles of protective antibodies and 3 (1.7%) did not show seroconversion at all. Therefore, 11 persons (6.3% of the total) did not result immunized. The secondary reactions to the vaccines were low in frequency and mainly of local presentation. Among the study population we did not find chronic carries of hepatitis B.(ABSTRACT TRUNCATED AT 250 WORDS)

[Overview of HIV infections in pediatric population]. / Panorama de la infección por el virus de la inmunodeficiencia humana en población pediátrica.

A general overview of HIV infection/AIDS in the pediatric population, in Mexico, is provided. The principal categories of transmission in our country are: 45.5% perinatal, 44.0% following transfusion for hemophilia or for other reasons, and less frequently sexual transmission. In the United States and Europe, similar patterns are seen with perinatal transmission being the most important route, at higher percentages than ours. The number of cases of HIV infection in children continues to grow worldwide, primarily reflecting the problem in the adult population.

[Immunizations in hospitalized and outpatient children: the reduction of lost vaccination opportunities]. / Inmunizaciones en niños hospitalizados y de consulta externa: reducción de las oportunidades perdidas de vacunación.

Among the strategies directed towards the control of preventable illnesses through vaccination, are the "National Days for Vaccination" and the intensive campaigns for country-wide vaccination, which have been taking place in our country during the last few years. An important aspect that must be taken into account is the immunization of children or patients who are hospitalized or those are under medical supervision due to changing chronic pathologies which have is some way interfered with the normal course of the application of the basic scheme of immunizations. The causes which have lead to incomplete vaccination schemes or to unstarted ones have been analyzed in different studies. In many cases, it has been observed that the information available to parents as well as to health workers in inexact. Hospitalization per se does not constitute a contraindication for vaccination, except in certain circumstances where there is some relation to the type of vaccine, as for example that of live attenuated virus or the existence of an underlying disease, like neoplasms and congenital or acquired immunodeficiency, which should be individually studied to evaluate the application of the vaccine depending on each individual case.

PIP: Mexico's control strategy for immunopreventable diseases calls for universal vaccination of children. In addition to the National Vaccination Days begun in the 1980s, vaccines are bought to homes and schools by health promoters, physicians, and nurses. Recently attention has been directed to the need to vaccinate children in hospitals and clinics in order to achieve better vaccination coverage. Hospitalization in itself does not constitute a contraindication to vaccination, and for some children illness is the only reason for visiting a health service and the only opportunity for vaccination. According to the Public Health Service, a minor illness such as an upper respiratory infection with fever does not contraindicate vaccination. The Federico Gomez Children's Hospital in Mexico City has initiated a program to vaccinate children in both its inpatient and outpatient services. A program to inform health personnel of the need to vaccinate, talks for parents of patients, an evaluation of the immunization status of each patient presenting for outpatient consultation or hospitalizations, and a greater availability of vaccines were the main program measures. Vaccination was authorized on discharge of each patient, including patients with infections who had been afebrile for 24 hours. A survey of vaccination coverage was conducted from September 19 to October 9, 1991 in the pediatric inpatient and outpatient services. The vaccination card, other written record, or a verbal report of vaccination was requested for each child. The completeness of vaccination was assessed for each child in accordance with age. Another survey was conducted to assess the incidence of contraindications to vaccination for hospitalized children. The average number of doses of vaccines administered per month increased from 150 before the program began to 600 after it was underway. 5832 of the 1027 pediatric patients seen in the inpatient and outpatient services were judged completely vaccinated for their age levels. 18% of the children observed had not received any vaccinations. Only 44.8% of the children had vaccination cards. 10.6% of hospitalized patients had a contraindication to vaccination. Among these 57 patients, 27 were immunosuppressed, 14 had convulsions, 12 had cancer, and 4 had lymphoenia.

[Neonatal meningitis: observations on its etiology, mortality and sequelae]. / Meningitis neonatal: observaciones sobre etiología, mortalidad y secuelas.

A retrospective study was carried out on all cases diagnosed with neonatal meningitis at the Hospital Infantil de México Federico Gómez. A rate of 9.6 cases per 1,000 discharged patients was found as well as 6.7% association with sepsis. In 50 of the cases analyzed, an etiologic agent was identified in 23 children; the main bacteria identified were Escherichia coli (24%), Klebsiella pneumoniae (14%), Enterobacter (4%), Proteus mirabilis and Pseudomonas sp (2%), respectively. The mortality rate was 60% and sequelae were seen in 13 of the surviving 20 patients. The unfavorable prognosis of neonates with meningitis forces us to establish an early diagnosis, make every effort to identify the causing agent and try new medications as well as co-adjuvant treatments.

[Epidemiologic overview of measles in Mexico: current situation and perspectives]. / Panorama epidemiológico del sarampión en México: situación actual y perspectivas.

It has been recognized that due to immunization campaigns and specific treatment of medical complications, has resulted in a reduced measles mortality in México as in others countries. However, during the last few years the number of measles cases in México has shown an increasing trend over previous years due to two larges epidemics, in 1985 and 1989. As a vaccine preventable disease, the number of measles cases has shown an important decline in mortality as compared with mortality in the general population. From the total deaths in children under five years the measles deaths have been reduced from a level of 2.8% in 1969 to a level of 1.6% in 1985. The more recent mortality data available shows that 597 deaths caused by measles were registered in 1986, for a mortality rate of 0.75 per 100,000 inhabitants. At higher rate was observed in the age groups less than 1 year with a mortality rate of 5.9 per 100,000 inhabitants compared with 4.2 in the group from 1 to 4 years. The morbidity epidemiologic surveillance system among governmental health services reported a total of 20,076 cases in 1989, with an incidence rate of 23.8 cases per 100,000 inhabitants and a estimated mortality rate of 6.6%. This recent emergence of the measles activity in México is part of a pandemic that is affecting several countries around the world. The impact of these cases on an increased demand of medical care as well as its clinical complications, outcome and mortality, makes measles a high priority problem in México.

[Nosocomial measles: a proposal for its control in hospitals]. / Sarampión nosocomial: propuestas para su control en hospitales.

The transmission of measles in medical settings has become increasingly recognized. Due to the lack of information on nosocomial measles in Mexico we performed a 14 year retrospective study at the Hospital Infantil de México Federico Gómez. The objectives of our study were: a) to determine the frequency of the disease in our hospital; b) to determine the association between nutritional status and risk of acquiring nosocomial measles and c) to establish the relationship between nutritional status and complications in morbidity and mortality due to nosocomial measles. Eighty nine children with nosocomial measles were identified. We observed that patients with severe malnutrition had a greater risk of acquiring nosocomial measles developing complication and dying. The most frequent complication was pneumonia.