A comparison of hospital policies for measles, mumps, and rubella infection control in Los Angeles County, 1989 and 1992.

BACKGROUND: A survey was conducted in 1992 in Los Angeles County, California, to assess changes since an earlier survey in 1989 in the numbers of acute care hospitals that had established policies on measles, mumps, and rubella infection control and the extent to which these policies were implemented. METHODS: A questionnaire inquiring about measles, mumps, and rubella infection control was sent to ICPs of 133 acute care hospitals in Los Angeles County. The results were compared with those of a similar survey conducted in 1989. The increase in the number of hospitals with such policies between 1989 and 1992 was analyzed. RESULTS: In 1989, 29 (28%), 9 (9%), and 65 (64%) of the 102 respondent hospitals had measles, mumps, and rubella infection control policies, respectively. Larger proportions of the 95 respondent hospitals in 1992 had measles (56, 59%), mumps (15, 16%), and rubella (69, 73%) infection control policies. CONCLUSIONS: The number of hospitals with infection control policies for measles, mumps, and rubella increased from 1989 to 1992. Efficiency and scope of such policies varied, however, and could be improved by making the policies mandatory, requiring written documentation of employee immunity, and extending policies to cover all employees. The most dramatic increase was in the number of hospitals with infection control policies for measles; this increase may have been caused by the 1987 to 1989 measles epidemic in Los Angeles County, by increased awareness of the Immunization Practices Advisory Committee recommendations, or by increased sensitivity to the issue of infection control triggered by the 1989 survey.

Listeria monocytogenes infection and serotype distribution among HIV-infected persons in Los Angeles County, 1985-1992.

Persons infected with human immunodeficiency virus (HIV) are at greater risk of infection with Listeria monocytogenes (LM) than the general population. We quantify the risk of listeriosis in persons with acquired immune deficiency syndrome (AIDS) and HIV infection in Los Angeles County (LAC) and report the LM serotype distribution among HIV-infected patients with listeriosis. Active surveillance for listeriosis was performed in LAC during most of the period from 1985 through 1992. Thirty-four (10%) of 351 nonperinatal cases of listeriosis reported in LAC from 1985 through 1992 were in HIV-infected persons, 25 of whom met the 1987 AIDS case definition. The incidence of listeriosis was 95.8 and 8.8 cases per 100,000 person-years among persons with AIDS and all HIV-infected persons, respectively, but only 1.0 case per 100,000 person-years in the total population. Excluding cases from a 1985 listeriosis epidemic associated with consumption of contaminated Mexican-style cheese, 11 (65%) of 17 HIV-infected persons with available isolates were infected with LM serotype 1/2b, whereas only 64 (31%) of 208 other persons with listeriosis and available isolates were infected with LM serotype 1/2b (odds ratio = 4.1; 95% confidence interval = 1.3-14.1). LM serogroup 1/2b may have been more common among HIV-infected persons in LAC than among other persons with listeriosis because of differences in diet or sexual practices, or to chance alone. Persons with HIV-infection, especially those with AIDS, should be educated in avoiding foods at high risk of listerial contamination, such as soft cheeses, foods sold from delicatessen counters, and undercooked chicken.

Measles reporting completeness during a community-wide epidemic in inner-city Los Angeles.

A study was undertaken to determine the extent of measles underreporting among preschool-age children. In two community surveys conducted in inner-city Los Angeles during 1990 and 1991, respondents were asked whether preschool-age children in their households had ever been ill with measles. Information about measles episodes was obtained and medical records were reviewed, when available. A probable measles case was defined as having 3 or more days of rash with fever of 38.3 degrees centigrade or greater, and either cough, coryza, or conjunctivitis. To determine the proportion of cases reported, probable measles cases identified were matched with measles cases reported to the Los Angeles County Department of Health Services. Of the 947 children ages 6 weeks through 59 months included in the surveys, 35 children had experienced an illness episode which met the probable measles case definition. Ten (29 percent) of the 35 probable measles cases were reported to the health department. Hospitals reported 9 (69 percent) of 13 probable measles cases evaluated while private physicians' offices reported 0 (0 percent) of 12 evaluated (Fisher's exact test, P < 0.001), although 5 children were seen by private physicians before rash onset. Reporting was more complete for cases occurring during 1990 and 1991 (33 percent) than from 1987 through 1989 (18 percent). The hospitalization rate for preschool-age children with probable measles cases in the catchment area was estimated to be 8 percent (95 percent confidence interval = 0 to 18 percent). Although measles is a serious communicable disease which is almost completely preventable, cases of it among preschool-age children in this high incidence area were substantially underreported,especially by private physicians. Due to reporting bias, reported measles cases were representative of more severe cases than all the cases that occurred.

An increase in Haemophilus influenzae type B vaccination among preschool-aged children in inner-city Los Angeles, 1990 through 1992.

Haemophilus influenzae type b (Hib) vaccination coverage and disease incidence were measured among preschool-aged children residing in inner-city Los Angeles. Among children 1.5 to 14 months of age, vaccination coverage of at least one dose increased from 0% in 1990 to 82% (95% confidence interval [CI] = 73%, 91%) in 1992. Among children 15 to 59 months old, vaccination coverage of at least one Hib dose administered at or after age 15 months increased from 35% (95% CI = 29%, 41%) in 1990 to 63% (95% CI = 56%, 70%) in 1992. Although Hib vaccination has reduced disease incidence in this population, greater use of vaccine can result in further reductions.

Listeriosis: a previously unreported medical complication in women with multiple gestations.

OBJECTIVE: Our purpose was to determine whether women pregnant with multiple gestations are at greater risk for perinatal listeriosis than are women pregnant with singletons. STUDY DESIGN: Active surveillance for perinatal listeriosis was carried out in Los Angeles County, California, medical records were reviewed, and rates of listeriosis were calculated from live birth and fetal death data. RESULTS: From January 1985 through December 1992, 12 (4.0%) of 301 perinatal listeriosis cases occurred in pregnant women with multiple gestations, almost four times the overall multiple gestation rate in Los Angeles County. Rates of listeriosis in pregnant women per 100,000 live births and fetal deaths were 19.8 for singleton and 74.9 for multiple gestations (risk ratio 3.8, 95% confidence interval 2.1 to 6.8). Compared with singleton pregnancies, greater risk of listeriosis was observed in pregnancies with triplet gestations (risk ratio 38.4, 95% confidence interval 9.6 to 153.3) than in those with twin gestations (risk ratio 3.2, 95% confidence interval 1.7 to 6.0). Increased risk of listeriosis during multiple-gestation pregnancies was most notable among women > or = 35 years (risk ratio 13.6, 95% confidence interval 5.2 to 35.5) and Hispanic women (risk ratio 5.3, 95% confidence interval 2.8 to 10.0). CONCLUSIONS: To reduce the risk of listeriosis, obstetricians should incorporate dietary recommendations into routine prenatal nutritional counseling for all pregnant women and should especially counsel women pregnant with multiple gestations of their greater risk.

A survey of hospital postpartum and postabortion rubella vaccination policies in Los Angeles County, 1992.

OBJECTIVE: To determine the proportion of Los Angeles County (LAC) hospitals offering obstetrical services that have postpartum and postabortion rubella vaccination policies. DESIGN: A survey was sent to the infection control practitioners (ICPs) of all operational acute care hospitals (N = 133) in LAC in 1992. A remainder and second survey was mailed to ICPs who did not respond to the first mailing. RESULTS: Of 75 hospitals with obstetrical departments, 56 (75%) responded. Thirty-four (61%) of the 56 respondent hospitals had post-partum rubella vaccination policies. Of the 34 hospitals with policies, 30 (88%) accepted only a written record of rubella seropositivity as proof of immunity, 30 (88%) screened women with unknown immunity status before hospital discharge, and 32 (94%) vaccinated susceptible women before hospital discharge. Of the 32 hospitals that performed induced abortions, only two (6%) provided screening and vaccination services for these women. CONCLUSION: Only 61% of hospitals in LAC offering obstetrical services had postpartum rubella vaccination policies while only minimal screening and vaccination occurred in association with abortion services. Widespread implementation of postabortion screening and vaccination, and more stringent compliance with Advisory Committee on Immunization Practices recommendations for postpartum screening and vaccination in hospitals offering obstetrical services would reduce the number of rubella-susceptible women who have been missed by other prevention strategies.

A cluster of coagulase-negative staphylococcal bacteremias associated with peripheral vascular catheter colonization in a neonatal intensive care unit.

BACKGROUND: A cluster of six neonatal cases of coagulase-negative staphylococcal bacteremias occurred in a Los Angeles County neonatal intensive care unit in March 1989. METHODS: A retrospective cohort study assessed the impact of host-and delivery-related variables, length of hospitalization, duration of antibiotic treatment, performance or duration of invasive procedures, and staffing variables on risk of coagulase-negative staphylococcal bacteremia. RESULTS: Unstratified analyses yielded eight risk factors with risk ratios greater than 2. After stratification by gestational age (less than 29 weeks) and low birth weight (less than 1500 gm), frequency of blood transfusions, duration of respiratory therapy, heparin lock and central vascular line placement, and hyperalimentation remained associated with elevated risk. Two species were identified, arguing against a common source of infection. Of four cohort months with more than 15 very low birth weight infants in the neonatal intensive care unit, an elevation of coagulase-negative staphylococcus-positive blood cultures and diagnosed bacteremias occurred in only two. CONCLUSIONS: This cluster of coagulase-negative staphylococcal bacteremia was probably caused by frequent manipulation of catheters in neonates who were at heightened risk because of low birth weight and prematurity.

Resurgence of congenital rubella syndrome in the 1990s. Report on missed opportunities and failed prevention policies among women of childbearing age.

OBJECTIVE: To assess previous missed opportunities for rubella screening and vaccination of women delivering infants with congenital rubella syndrome and to discuss prevention strategies. DESIGN: Descriptive analysis of data collected through interviews and review of medical records. POPULATION STUDIED: Twenty-one women who delivered infants with congenital rubella syndrome in four Southern California counties from January 1, 1990, through January 8, 1991. RESULTS: Twelve (57%) of the women had a total of 22 known missed opportunities for rubella screening or vaccination. Of the 22 missed opportunities, three (14%) were missed screenings at the time of marriage, two (9%) were missed screenings during previous pregnancies, five (23%) were missed screenings during induced abortions, and 12 (55%) were missed opportunities for vaccination postpartum or after induced abortions. Nine (43%) of the women had no known missed opportunities for rubella screening or vaccination. Of 12 women educated in California, only four (33%) were subject to the 1982 California school rubella immunization requirement. CONCLUSIONS: Congenital rubella syndrome could have been prevented in more than half of the infants born to these women if missed opportunities for rubella testing and/or vaccination had not occurred. Because premarital rubella testing and school immunization requirements do not ensure that all women of childbearing age are immune to rubella, physicians and hospitals should establish procedures for postpartum rubella vaccination of susceptible women. Family planning and abortion clinics should implement routine rubella testing and follow-up vaccination of susceptible women.

Measles vaccination coverage among Latino children aged 12 to 59 months in Los Angeles County: a household survey.

A high rate of measles transmission has occurred in Los Angeles County since 1987. To determine measles vaccination coverage among Latino preschoolers, the group at highest risk of measles during this period, a cluster survey was conducted among Latino households with children aged 12 to 59 months. Of 279 children enrolled, 240 (86%, 95% confidence interval = 81% to 91%) reportedly had received the measles vaccine. Measles vaccination coverage among Latino preschoolers in Los Angeles County is insufficient to halt measles transmission within this subpopulation.