Occupational risks during a monkeypox outbreak, Wisconsin, 2003.

We determined factors associated with occupational transmission in Wisconsin during the 2003 outbreak of prairie dog--associated monkeypox virus infections. Our investigation included active contact surveillance, exposure-related interviews, and a veterinary facility cohort study. We identified 19 confirmed, 5 probable, and 3 suspected cases. Rash, headache, sweats, and fever were reported by > 80% of patients. Occupationally transmitted infections occurred in 12 veterinary staff, 2 pet store employees, and 2 animal distributors. The following were associated with illness: working directly with animal care (p = 0.002), being involved in prairie dog examination, caring for an animal within 6 feet of an ill prairie dog (p = 0.03), feeding an ill prairie dog (p = 0.002), and using an antihistamine (p = 0.04). Having never handled an ill prairie dog (p = 0.004) was protective. Veterinary staff used personal protective equipment sporadically. Our findings underscore the importance of standard veterinary infection-control guidelines.

Impact of a child care educational intervention on parent knowledge about appropriate antibiotic use.

BACKGROUND: Parent education is an integral component to promoting judicious antibiotic use. Opportunities to educate parents directly are limited. Child care providers are in a position to relay information to parents. METHODS: A group-randomized trial assessed the impact of a child care center staff intervention on parental knowledge and attitudes regarding appropriate antibiotic use. A 9-point knowledge score and 3 attitude items were measured. RESULTS: Surveys were returned by 151 (51%) of 298 intervention center parents and 150 (42%) of 361 control center parents. Intervention center respondents were significantly more likely than control center respondents to be college graduates, non-Hispanic white, and insured. Among college graduates, the median knowledge score was 7.0 at intervention centers and 6.5 at control centers (P<0.01). No significant differences were found in knowledge scores among noncollege educated parents (P=0.11). After adjusting for clustering within child care centers, multivariate analysis demonstrated high knowledge score was associated with white race (P=0.02), being a college graduate (P=0.02), and being in the intervention group (P=0.06). CONCLUSION: An appropriate antibiotic use program for child care providers promotes better knowledge among parents of children aged <5 years, particularly among highly educated parents.

Spectrum of infection and risk factors for human monkeypox, United States, 2003.

For the 2003 monkeypox virus (MPXV) outbreak in the United States, interhuman transmission was not documented and all case-patients were near or handled MPXV-infected prairie dogs. We initiated a case-control study to evaluate risk factors for animal-to-human MPXV transmission. Participants completed a questionnaire requesting exposure, clinical, and demographic information. Serum samples were obtained for analysis of immunoglobulin G (IgG) and IgM to orthopoxvirus. When data were adjusted for smallpox vaccination, case-patients were more likely than controls to have had daily exposure to a sick animal (odds ratio [OR] 4.0, 95% confidence interval [CI] 1.2-13.4), cleaned cages and bedding of a sick animal (OR 5.3, 95% CI 1.4-20.7), or touched a sick animal (OR 4.0, 95% CI 1.2-13.4). These findings demonstrate that human MPXV infection is associated with handling of MPXV-infected animals and suggest that exposure to excretions and secretions of infected animals can result in infection.

Meningococcal disease incidence and mortality in Wisconsin, 1993-2002.

Neisseria meningitidis is a major cause of sepsis and meningitis in children and young adults in the United States. To examine recent epidemiologic features of meningococcal disease in Wisconsin, we evaluated Wisconsin case surveillance data collected during 1993-2002. Surveillance data for cases with onsets during this time were analyzed; statistical trends were assessed. Mortality was examined with regard to age, sex, serogroup, college student status, and young adult status by unadjusted and adjusted analyses. During 1993-2002, 462 cases of meningococcal disease were reported in Wisconsin; 55% of case patients were aged < 19 years. The annual incidence was 0.9 cases per 100,000 persons per year, and incidence was highest among children aged <2 years. Two seasonal peaks in cases were observed during January-April and September-October. The annual mortality rate during the 10-year interval was 0.09 deaths per 100,000 persons per year. Adjusted analysis indicated that serogroup C infection, young adult, and college student status (but not sex) were associated with mortality. Meningococcal disease remains uncommon and sporadic in Wisconsin. Incidence and mortality rates are highest among young children, but young adults who acquire the disease appear to be at an increased mortality risk.

FDG-PET imaging and the diagnosis of non-small cell lung cancer in a region of high histoplasmosis prevalence.

STUDY OBJECTIVE: Determine the sensitivity and specificity of [F-18]-fluorine-2-deoxy-D-glucose positron emission tomography (FDG-PET) in differentiating non-small cell lung cancer (NSCLC) from benign solitary pulmonary nodules (SPNs) in a region with a high endemic rate of histoplamosis. DESIGN: Prospective, clinical study. SETTING: University, tertiary referral hospital in the upper Mississippi River valley. PATIENTS: Ninety patients with SPNs. INTERVENTIONS: Independent interpretation of FDG-PET imaging, computed tomography and pathologic evaluation of the SPNs. MEASUREMENTS AND RESULTS: To detect malignant SPNs, FDG-PET imaging had a sensitivity of 93%, a specificity of 40%, a positive predictive value (PPV) of 88% and a negative predictive value (NPV) of 55%. CONCLUSIONS: In a region with a high prevalence of pulmonary fungal infection, FDG-PET is sensitive but has a low specificity and NPV for identifying NSCLC. In our study cohort, FDG-PET does not appear to reduce the need for SPN biopsies.

An evaluation of the quality and contents of asthma education on the World Wide Web.

STUDY OBJECTIVES: To measure the accessibility and quality of currently available asthma education World Wide Web sites using the following criteria: accessibility by readability, language, and download time; information quality based on inclusion of core educational concepts and compliance with Health On the Net (HON) principles; and utilization of innovative technology. DESIGN: Objective evaluation of 145 Web sites. MEASUREMENTS AND RESULTS: Four search engines or directories (Yahoo, HON, Alta Vista, and Healthfinder) were searched for "asthma, patient information." A maximum of 50 Web sites from each search engine or directory was evaluated. Only 90 of the 145 Web sites actually contained asthma educational material. The mean (+/- SD) time necessary to open each Web site on a 28.800-bits-per-second modem was 33.6 ( +/- 36.6) s. The mean number of graphics on the Web sites was 24.6 ( +/- 30.2) files per page. The educational material required a mean reading level beyond the 10th grade. Only nine Web sites contained multilingual asthma education material. The mean number of HON principles with which the Web sites conformed was 6.3 ( +/- 1.0) of 8 principles; 14 Web sites conformed to all the HON criteria. The average Web site contained 4.9 (+/- 2.5) of 8 core asthma educational concepts, and only 20 Web sites contained all 8 educational concepts. Very few Web sites utilized innovative educational technology. CONCLUSIONS: While patient asthma education Web sites are common, asthma educational material contains many accessibility barriers, is highly variable in quality and content, and takes little innovative use of technology. Patient educational material currently available on the World Wide Web fails to meet the information needs of patients.