National capacity for surveillance, prevention, and control of West Nile virus and other arbovirus infections--United States, 2004 and 2012.

In the first 5 years after its introduction in the United States in 1999, West Nile virus (WNV) spread to the 48 contiguous states, resulting in 667 reported deaths. To establish detection and response capacity, WNV surveillance and prevention was supported through CDC Epidemiology and Laboratory Capacity (ELC) cooperative agreements with all 50 states and six large cities/counties. In 2005, the Council of State and Territorial Epidemiologists (CSTE) conducted an assessment of ELC recipients and determined that, since 1999, all had developed WNV surveillance and control programs, resulting in a national arboviral surveillance infrastructure. From 2004 to 2012, ELC funding for WNV surveillance decreased by 61%. In 2012, the United States had its most severe WNV season since 2003, prompting a follow-up assessment of the capacity of ELC-supported WNV programs. Since the first assessment, 22% of jurisdictions had stopped conducting active human surveillance, 13% had stopped mosquito surveillance, 70% had reduced mosquito trapping and testing, and 64% had eliminated avian mortality surveillance. Reduction in early detection capacity compromises local and national ability to rapidly detect changes in WNV and other arboviral activity and to initiate prevention measures. Each jurisdiction is encouraged to review its current surveillance systems in light of the local threat of WNV and emerging arboviruses (e.g., dengue and chikungunya) and ensure it is able to rapidly detect and respond to critical changes in arbovirus activity.

Notes from the field: outbreak of 2009 pandemic influenza A (H1N1) virus at a large public university in Delaware, April-May 2009.

BACKGROUND: In late April 2009, the first documented 2009 pandemic influenza A (pH1N1) virus infection outbreak in a university setting occurred in Delaware, with large numbers of students presenting with respiratory illness. At the time of this investigation, little was known about the severity of illness, effectiveness of the vaccine, or transmission factors of pH1N1 virus infection. We characterized illness, determined the impact of this outbreak, and examined factors associated with transmission. METHODS: Health clinic records were reviewed. An online survey was administered to all students, staff, and faculty to assess influenza-like illness (ILI), defined as documented or subjective fever with cough or sore throat. RESULTS: From 26 April-2 May 2009, the health clinic experienced a sharp increase in visits for respiratory illness, with 1080 such visits among a total of 1430 student visits, and then a return to baseline visit levels within 2 weeks. More than 500 courses of oseltamivir were distributed, and 24 cases of influenza A (pH1N1) virus infection were confirmed. Of 29,000 university students and faculty/staff, 7450 (30%) responded to the survey. ILI was reported by 604 (10%) of the students and 73 (5%) of the faculty/staff. Travel to Mexico (relative risk [RR], 2.9; 95% confidence interval [CI], 1.8-4.7) and participation in "Greek Week" activities (RR, 2.2; 95% CI, 1.8-2.8) were associated with ILI. Recipients of the 2008-2009 seasonal influenza vaccine had the same risk of ILI as nonrecipients (RR, 1.0). Four (3%) of the students with ILI were hospitalized; there were no deaths. CONCLUSIONS: pH1N1 spread rapidly through the University of Delaware community with a surge in illness over a 2-week period. Although initial cases appear to be associated with travel to Mexico, a rapid increase in cases was likely facilitated by increased student interactions during Greek Week. No protective effect from receiving seasonal influenza vaccine was identified. Although severe illness was rare, the outbreak caused a substantial burden and challenge to the university health care system. Preparedness efforts in universities and similar settings should include enhancing health care surge capacity.

Hypothyroxinemia in mechanically ventilated term infants is associated with increased use of rescue therapies.

OBJECTIVE: Although common in preterm infants, transient hypothyroxinemia (TH) has not been investigated extensively in ill term infants. The objectives of this study were to investigate serum thyroxine (T4) and thyroid-stimulating hormone (TSH) in sick term infants and to determine whether there is any association between measures of thyroid function and short-term outcome in term infants who receive mechanical ventilation. METHODS: The investigation consisted of both a prospective observational study and a retrospective cohort study. In the prospective study, T4 and TSH were measured after birth in a group of sick term infants (n = 38) and compared with a group of well term infants (n = 18). Infants in the sick group received mechanical ventilation or continuous positive airway pressure and/or had neonatal seizures. Illness severity was quantified using the Score for Neonatal Acute Physiology. The retrospective cohort study included term infants who required mechanical ventilation and were born over a 5-year period (n = 347). Routine T4 screening was collected on the fifth day of life. TH was diagnosed in infants with a T4 <10%, with a TSH <25 microIU/mL. Clinical outcomes in infants with TH were compared with infants without TH. RESULTS: In the prospective study, infants in the sick group had lower T4 on the fifth day of life as compared with infants in the well group (11.7 +/- 4.9 vs 18.9 +/- 5.4 microg/dL), and 34% of infants in the sick group had a T4 <10th percentile compared with 6% of infants in the well group. T4 on day of life 5 was inversely correlated with Score for Neonatal Acute Physiology (R = -0.52). In the retrospective study, 21% of mechanically ventilated infants developed TH and were given statistically more inhaled nitric oxide, high-frequency ventilation, vasopressors, and pharmacologic paralysis when compared with infants without TH. Moreover, infants with TH were statistically more likely to die or require transfer to an extracorporeal membrane oxygenation center compared with infants without TH. CONCLUSION: Our data show that, similar to preterm infants, ill term infants develop TH. Term infants with TH required more intensive rescue interventions, including inhaled nitric oxide and transfer to an extracorporeal membrane oxygenation center. However, whether T4 levels are a marker or a mediator of clinical outcome remains to be determined.

Admission thyroid evaluation in very-low-birth-weight infants: association with death and severe intraventricular hemorrhage.

OBJECTIVES: To determine if thyroxine (T(4)) and thyrotropin (TSH) levels, measured at the time of admission to the neonatal intensive care unit, are associated with the outcomes of death and/or severe intraventricular hemorrhage (IVH). STUDY DESIGN: Blood for total T(4) and TSH was obtained upon admission to the neonatal intensive care unit in infants with birthweights less than 1500 g. Infants were followed until hospital discharge. Statistical analysis included one-way analysis of variance, Pearson correlation, and logistic regression. Data are expressed as mean +/- standard deviation (SD). RESULTS: One hundred twenty-two infants were enrolled. The mean gestational age of the study population was 27 +/- 2.8 weeks. Both T(4) (R = 0.25, p < 0.01) and TSH (R = 0.39, p < 0.01) at the time of admission correlated with gestational age. Infants who died and/or had severe IVH (n = 31) had lower T(4) (5.0 +/- 2.1 vs. 8.4 +/- 4.1 microg/dL, p < 0.01) and lower TSH (5.5 +/- 6.0 vs. 18.1 +/- 18.1 microIU/mL, p = 0.03) at the time of admission compared to infants who survived without severe IVH. After controlling for gestational age, low T(4) remained associated with an increased odds of death and/or severe IVH (odds ratio for every 1 microg/dL decrease in T(4): 1.4, 95% confidence interval 1.1-1.7). CONCLUSIONS: Our data show that both low total T(4) and TSH, measured at the time of nursery admission, are associated with death and severe intraventricular hemorrhage. Our data suggest that it may be feasible to design a study of early T(4) supplementation to determine potential benefit in infants with the lowest T(4) values rather than treating based on associated factors such as gestational age.