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Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010 

SUMMARY

The 2010 influenza recommendations include new and updated information.  Highlights of the 2010 recommendations include:

1. a recommendation that annual vaccination be administered to all persons aged≥6 months for the 2010-11 influenza season
2. a recommendation that children aged 6 months-8years whose vaccination status is unknown or who have never received seasonal influenza vaccine before (or who received seasonal vaccine for the first time in 2009-10 but received only 1 dose in their first year of vaccination) as well as children who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine regardless of previous influenza vaccine history should receive 2 doses of a 2010-11 seasonal influenza vaccine (minimum interval: 4 weeks) during the 2010-11 season
3. a recommendation that vaccines containing the 2010-11 trivalent vaccine virus strains A/California/7/2009 (H1N1)-like (the same strain as was used for 2009 H1N1monovalent vaccines), A/Perth/16/2009 (H3N2)-like and B/Brisbane/60/2008-like antigens be used
4. information about Fluzone High-Dose, a newly approved vaccine for persons aged ≥65 years
5. information about other standard-dose newly approved influenza vaccines and previously approved vaccines with expanded age indications.

Vaccination efforts should begin as soon as the 2010-11 seasonal influenza vaccine is available and continue through the influenza season.  These recommendations also include a summary of safety data for U.S.-licensed influenza vaccines.  These recommendations and other information are available at CDC’s influenza website (http://www.cdc/gov/flu) ; any updates or supplements that might be required during the 2010-11 influenza season also will be available at this website.  Recommendations for influenza diagnosis and antiviral use will be published before the start of the 2010-11 influenza season.

To obtain a copy of this entire publication visit: www.cdc.gov/mmwr

Reference:  MMWR, Prevention and Control of Influenza with Vaccines, Recommendation of the Advisory Committee on Immunization Practices (ACIP, 2010

What is Eastern equine encephalitis (EEE)?

EEE is a rare disease that is caused by a virus spread by infected mosquitoes.  EEE virus (EEEV) is one of a group of mosquito-transmitted viruses that can cause inflammation of the brain (encephalitis).  Tn the United States, approximately 5-10 EEE cases are reported annually.

How do people get infected with EENV?

EEEV is transmitted through the bite of an infected mosquito.  Disease transmission does not occur directly from person to person.

Where and when have most cases of EEE occurred?

Most cases of EEE have been reported from Atlantic and Gulf Coast states.  Cases have also been reported from the Great Lakes region.  EEE cases occur primarily from late spring through early fall, but is subtropical endemic areas (e.g., the Gulf States), rare cases can occur in winter.

Who is at risk for infection with EEEV?

Anyone in an area where the virus is circulating can get infected with EEEV.  The risk is highest for people who live in or visit woodland habitats, and people who work outside or participate in outdoor recreational activities, because of greater exposure to potentially infected mosquitoes.

How soon do people get sick after getting bitten by an infected mosquito?

It takes 4-to 10 days after the bite of an infected mosquito to develop symptoms of EEE.

What are the symptoms of EEV disease?

Severe cases of EEV infection (EEE, involvin encephalitis, an inflammation of the brain) begin with the sudden onset of headache, high fever, chills, and vomiting.  The illness may then progress into disorientation, seiures, and coma.  Approximately a third of patients who develop EEE die, and many of those who survive have mild to severe brain damage.

How is EEE diagnosed?

Diagnosis is based on tests of blood or spinal fluid.  These tests typically look for antibodies that the body makes against the viral infection.

What is the treatment for EEE?

There is no specific treatment for EEE.  Antibiotics are not effective against viruses, and no effective anti-viral drugs have been discovered.  Severe illnesses are treated by supportive therapy which may include hospitalization, respiratory support, IV fluids, and prevention of other infections.

How can people reduce the chance of getting infected with EEEV?

Prevent mosquito bites.  There is no vaccine or preventive drug.

• Use insect repellent containing DEET, picaridin, IR3535 or oil of lemon eucalyptus on exposed skin and/or clothing.  The repellent/insecticide permethrin can be used on clothing to protect through several washes.  Always follow the directions on the package.
• Wear long sleeves and pants when weather permits.
• Have secure, intact screens on windows and doors to keep mosquitoes out.
• Eliminate mosquito breeding sites by emptying standing water from flower pots, buckets, barrels, and other containers.  Drill holes in tire swings so water drains out.  Keep children’s wading pools empty and on their sides when they aren’t being used.

Waht should I do if I think a family member might have EEE?

Consult your healthcare provider for proper diagnosis.

Reference: www.cdc.gov/EasternEquineEncephalitis/gen/qa.html

Eastern equine emcephalitis virus (EEEV) is transmitted to humans by the bite of an infected mosquito.  Eastern equine encephalitis (EEE) is a rare illness in humans, and only a few cases are reported in the United States each year.  Most cases occur in the Atlantic and Gulf Coast states. Most persons infeced with EEEV have no apparent illness.  Severe cases of EEE (incolving encephalitis, an inflammation of the brain) begin with a sudden onset of headache, high fever, chills, and vomiting.  The illness may then progress into disorientation, seizures, or coma.  EEE is one of the most severe mosquito-transmitted diseases in the United States with approximately 33% mortality and significant brain damage in most survivors.  There is no specific treatment for EEE; care is based on symptoms.  You can reduce your risk of being infected with EEEV by using insect repellent, wearing protective clothing, and staying indoors while mosquitoes are most active.  If you think you or a family member may have EEE, it is important to consult you healthcare provider for proper diagnosis.

Increased Potential for Dengue Infection in Travelers Returning from International and Selected Domestic Areas

Summary: Dengue virus transmission has been increasing to epidemic levels in many parts of the tropics and subtropics.  Travelers to these areas are at risk of acquiring dengue virus and developing dengue fever (DF) or the severe form of the disease, dengue hemorrhagic fever (DHF).  The Centers for Disease Control and Prevention (CDC) strongly advises that health care providers in the United States should: 1) consider DF an

Dengue transmission has been increasing to epidemic levels in many parts of the tropics and subtropics where it had previously been absent or mild.  Dengue affected areas are widely distributed throughout Africa, Asia, Pacific, the Americas and the Caribbean.  This calendar year, more than 50 countries have reported evidence of dengue transmission; including 17 countries in Asia, 17 in the Americas, 10 in Africa, seven in the Caribbean, and one in the Pacific.  With an extensive dengue outbreak occurring in Puerto Rico and evidence of continued transmission in Key West, Florida, travel to certain domestic locations may also pose a risk for the traveler.  The mosquitoes known to transmit dengue virus, Aedes aegypti and Aedes albopictus, are present throughout much of the southeastern United States and infected returning travelers may pose a risk for initiating local transmission.

SYMPTOMS

Dengue virus infections can manifest as a subclinical infection or DF, and may develop into potentially fatal DHF. DF is a self limiting febrile illness that is characterized by high fever plus two or more of the following: headache, retro-orbital pain, join pain, muscle or bone pain, rash, mild hemorrhagic manifestations (e.g., bleeding of nose or gums, petechiae, or easy bruising), and leukopenia.  Because the incubation period for dengue infection ranges from 3 to 14 days, the patient may not present with illness until after returning from travel. 

Clinical management of DF consists of symptomatic treatment (avoid aspirin, NSAIDS and corticosteroids, as they can promote hemorrhage) and monitoring for the development of severe disease at or around the time of defervescence.  A small proportion of patients develop DHF, which is caracterized by presence of resolving fever or a recent history of fever, lasting 2-7 days, any hemorrhagic manifestation, thrombocytopenia (platelet count≤100,000/mm³), and increased vascular permeability, evidenced by hemoconcentration, hyposlbuminemia or hypoproteinemia, ascites, or pleural effusion. DHF can result in circulatory instability or shock.  Adequate management requires timely recognition and hospitalization, close monitoring of hemodynamic status, and judicious administration of intravascular fluids.  There is no antiviral drug or vaccine against the dengue virus.

Updated guidelines for the management of dengue can be found at http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

July 23, 2010-As of July 18, 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18366 deaths.

WHO is actively monitoring the progress of the pandemic through frequent consultation with the WHO Regional Offices and member states and through monitoring of multiple sources of information.

Globally pandemic influenza activity remains low.  The most active areas of influenza transmission remained in the tropical zones; primarily in West Africa, Central America, the Caribbean, and South and Southeast Asia, although activity is localized to relatively small areas in each region.  In the temperate zone of the southern hemisphere, Australia and New Zealand have showed signs of increased respiratory disease in recent weeks.

Media Contact:

Kathryn Cook, Vestagen Technical textiles, kcook@rlfcommunications.com (336)420-2767

[ORLANDO, Fla] July 12, 2010 - Vestagen Technical Textiles today announced the completion of the first clinical trial involving its Vestex™ nanotechnology-based products.  The clinical trial was conducted by the Department of Epidemiology and Infection Control at Virginia Commonwealth University (VCU).

Medical research has consistently documented that garments and fabrics used in the healthcare environment including scrubs, uniforms, lab coats, privacy curtains and gowns are contaminated with high levels of dangerous microbes such as MRSA which may pose a threat to health care workers, their patients and the community.

The 16-week, blinded cross-over clinical trial compared levels of bacterial contamination, known as Colony Forming Unit (CFU) counts, on Vestex treated scrubs versus standard scrubs.  More than 300 cultures were performed on 32 health care workers in a medical respiratory intensive care unit.

The landmark study was led by Gonzalo Bearman, MD, MPH, associates professor of medicine, epidemiology and community medicine at VCU.  “The results for this study are encouraging,” Said Bearman, “as the Vestex scrubs had significantly fewer MRSA colonies.”

“We are very pleased with the outcome of The Virginia Commonwealth University research of our technology,” said Ben Favret, president and CEO of Vestagen.  “This data further supports the evidence-based research documenting the clinical, operational and financial benefits of Vestex.”

The performance of Vestex is the result of impregnated nano-sized particles that change the surface area of the fabric, increasing surface tension.  The proprietary technology creates a barrier to contaminants and fluids such asw blood.  The repellency of the barrier protection sheds bulk contaminants allowing the imbedded antimicrobial properties of Vestex to control microorganisms on the fabric.

“We hope that this technology, when coupled with hand hygiene and other infection control measures, will aid in the prvention of hospital acquired infections and protect healthcare workers,” said Bearman

Vestex products, including scrubs, lab coats, protective isolation gowns and long-sleeved T-shirts, are currently available for sale.  Individual orders can be placed online at www.vestexproducts.com. For information on placing an instituational order please contact Lorrie Anderson, director of marketing, at 407-781-2570.

About Vestagen Technical Textiles LLC

Vestagen Technical Textiles is an Orlando-based marketer and manufacturer of advanced performance textiles.  Vestagen is led by a skilled management team with nearly a century of combined experience in the health care textile and apparel industries.  Backed by V-Ten Capital Partners.   Vestagen is committed to creating innovative textile solutions.  For more information, visit www.vestagen.com and ww.vestexprotects.com

March 23, 2010 (Atlanta, Georgia) — Hospital-onset healthcare-facility-associated Clostridium difficile infections (CDI) have increased in incidence and have surpassed methicillin-resistant Staphylococcus aureus (MRSA) infections, according to a new study of a large cohort of patients from community hospitals.

Becky A. Miller, MD, an infectious disease fellow from Duke University in Durham, North Carolina, presented the findings during an oral session here at the Fifth Decennial International Conference on Healthcare-Associated Infections 2010.

“This is the first time this has been described using patient-level data (i.e., with the number of cases as the numerator and the number of patient days as the denominator),” Dr. Miller told Medscape Infectious Diseases.

“We think this trend, particularly in community hospitals, would not have been captured without our large network of 39 hospitals where we perform infection control and surveillance,” she said. “We were also unaware that cases of nosocomial C difficile infection had increased and surpassed MRSA.”

The researchers performed a prospective cohort study in 28 community hospitals participating in the Duke Infection Control Outreach Network between January 2008 and December 2009.

The cohort consisted of 3,007,457 patient-days. Numerically, nosocomial CDI was the most common healthcare-associated infection (847 cases), followed closely by nosocomial bloodstream infection (838 cases).

Nosocomial infections due to MRSA and intensive care unit device-related infections were approximately equal, at 680 and 681 cases, respectively.

Patients with nosocomial CDI (n = 840) and nosocomial MRSA (n = 655) were equally likely to be male, and to have diabetes or end-stage renal disease requiring hemodialysis. However, patients who developed nosocomial CDI were, on average, older than patients who developed nosocomial MRSA infection (65 vs 59 years; P < .0001). In addition, time to infection was, on average, 8 days for CDI and 7 days for MRSA infection (P < .0001), and overall mortality was higher among patients with MRSA infection than CDI (P < .0001).

The rate of nosocomial CDI was 0.28 cases per 1000 patient-days, whereas the rate of nosocomial MRSA infection was 0.23 cases per 1000 patient-days. Thus, nosocomial CDI occurred 25% more frequently than nosocomial MRSA infection.

Since 2007, rates of healthcare-associated MRSA infection have steadily decreased, whereas rates of CDI have increased, Dr. Miller said during her presentation.

According to Dr. Miller, C difficile spores are shed in stool, and these spores can persist in the hospital environment for months. “These infections are not being prevented by methods that are clearly working to prevent nosocomial infections due to MRSA,” she said. She added that “we think that this study represents the tip of the iceberg, as we did not include nosocomial C difficile cases diagnosed after patients leave the hospital.”

In another presentation on C difficile, researchers described a targeted strategy to eliminate C difficile using ultragermicidal bleach wipes. Robert Orenstein, DO, from the Mayo Clinic in Rochester, Minnesota, reported the findings here in a poster session.

“The beauty of this project was that implementation was relatively simple — it required putting together a committed team and emphasizing our goal of improving patient outcomes,” Dr. Orenstein told Medscape Infectious Diseases.

The researchers targeted 2 units with a focused intervention of daily cleaning of all patient rooms with Clorox brand ultragermicidal bleach wipes containing 6.15% sodium hypochlorite, and cleaning after the patient had been discharged.

Cleaning was assessed by environmental services supervisors, and Clean-Trace technology was used. Patients and environmental services employees who cleaned the rooms responded to a survey regarding satisfaction and tolerance of the cleaning procedure.

Before the intervention was initiated, the incidence of CDI was 18.4 per 10,000 patient-days; after the intervention was initiated, the incidence was 3.76 per 10,000 patient-days, “far exceeding” their goal of a reduction in incidence of 30%, Dr. Orenstein said.

According to the authors, patients tolerated the cleaning well, and although environmental services “employees initially had concerns regarding odor and irritation, these were resolved.” The cost of the intervention was estimated at $18,671 per year.

“I am struck by the fact that our highest-risk unit has gone 6 months without a hospital-acquired case attributable to their unit, despite the fact that the overall incidence (i.e., cases admitted with this infection) continues to rise,” Dr. Orenstein said. “This suggests what we did really had a great impact,” he added. “This is especially gratifying knowing the impact that C difficile disease can have on our patients lives.”

“C difficile has been in the news for the last decade,” said Carlene A. Muto, MD, medical director for infection control at the University of Pittsburgh School of Medicine in Pennsylvania. “What has taken focus this year is that the environment matters,” she said.

According to Dr. Muto, an analysis by their group presented in the late-breaking session described the undetected reservoir in patients who asymptomatically carry C difficile (~6% of the patients tested).

“Many studies have described noncompliance with cleaning patient rooms and how a focused effort can change this behavior,” Dr. Muto told Medscape Infectious Disease. “Our group implemented a bleach/detergent cleaning program years ago, but since June 2009, we have used this product on every surface, every time, not just in the rooms of patients known to be positive.”

She noted that “patients not known to be colonized/infected one day may be so the next. We did see a decrease in C difficile healthcare-associated infections using this approach.”

Neither study was commercially funded. Dr. Miller, Dr. Orenstein, and Dr. Muto have disclosed no relevant financial relationships.

Fifth Decennial International Conference on Healthcare-Associated Infections (ICHAI) 2010: Abstract 386, presented March 20, 2010; Abstract 142, presented March 19, 2010.

LAKEWOOD RANCH, FLORIDA - A consultant says Lakewood Ranch Medical Center is the first hospital in the world to have some of its staff try a new medical garment that combats infections with a germ-killing ingredient woven into it.

Orlando-based Vestagen Technical Textiles has manufactured scrub tops, pants, lab coats, isolation gowns, sheets for patient’s beds, cubicle curtains and T-shirts under the Vestex brand name that not only have an antimicrobial woven in to repel microbes, but a nano-particle barrier that can repel body fluids, said Linda Spaulding, an international infection control consultant.

Spaulding, a registered nurse who lives in Lakewood Ranch, has done consulting for Lakewood Ranch Medical Center and is on the advisory board for Vestagen Technical Textiles, which enabled her to get the products to Lakewood Ranch Medical Center recently for a test, she said.

“I think this could revolutionize the way health care works,” Spaulding said.

How it works is perhaps a little hard to understand for non-scientists, but the company Web site, www.vestagen.com, explains the clothing lines uses a “nanoparticle hydrophobic barrier” to repel fluids of all kinds. The antimicrobial agent imbedded in the fabric is what can be a barrier against infections, Spaulding said.

“If drool or blood splashes on it, it won’t adhere,” Spaulding said.

Wilma Schmidt, a registered nurse at Lakewood Ranch Medical Center, plans to wear Vestex clothing while working during an upcoming trip to Haiti.

Vestagen has offered to provide free scrubs to Schmidt and seven others from her church group who are going to Haiti soon, Schmidt said.

“It’s going to make working in those conditions more bearable since we won’t be soaking wet with sweat all day long,” Schmidt said.

Spaulding laughed when it was suggested the outfits could be used for staying clean while eating spaghetti at a restaurant, but she said the company could consider that, and perhaps a line of children’s clothing.

The company’s Web site quotes statistics compiled by the Centers for Disease Control and Prevention that state that infections kill nearly 100,000 yearly and add roughly $30 billion to the nation’s health care tab.

The outfits seem to cost only a few dollars more than non-antimicrobial garments.

Traditional scrub pants, for example, run about $19 while the new material pants cost $24, Spaulding said.

Other garments are also $4 to $6 more, Spaulding said.

The whole hospital has not converted over to the new scrubs, but the surgery manager of the hospital is wearing the new gear as well as the emergency room staff, Spaulding said.

“I’ve had pregnant women say they want these scrubs,” Spaulding said. “I currently have a lab coat made of the new textile that I wear every day. It’s hard to go back once you realize you are protected.”

Read the full article now at the Bradenton Herald website

By Anthony Colarossi, Orlando Sentinel
2:51 AM EST, January 21, 2010

Like any good entrepreneur, Ben Favret saw vast potential in a solid idea - a breakthrough garment designed for the industry he knows so very well: health
care.

He researched the technology, pitched the concept to industry contacts and raised the capital required to get his Orlando startup, Vestagen Technical Textiles, going.

Then, all he had to do was market Vestex - a brand of medical garments made to repel blood and other bodily fluids while killing off any infectious microorganisms
left behind.

Favret was busy doing just that when last week’s earthquake shook and tore apart much of Haiti’s urban center. Vestex products are cut and sewn in Haiti.

Fortunately - perhaps shockingly - for the company, the manufacturing operations it uses there were not seriously damaged in the quake. Nonetheless, Favret and his team asked themselves what many Central Floridians are asking in the wake of an epic tragedy: How can we help? “We thought our technology could be a part of helping the workers that are part of the relief effort,” said Favret, Vestagen’s president and CEO.

Favret’s team has approached the American Red Cross to see if the company could partner with the organization in Haiti relief efforts. The pitch is a donation of Vestex garments such as scrubs and lab coats.

As doctors, nurses and medical technicians pour into Haiti, they’re finding unsanitary conditions in makeshift hospitals erected alongside the rubble. And as body counts mount and Haiti’s infrastructure remains crippled, the spread of infectious disease will become a greater concern in the coming days and weeks. Favret and his company’s leaders figured these conditions would provide for an ideal, real-world application of their products, which are specially designed to prevent the spread of infections and disease in hospital settings.

“Our technology fits the conditions of these [volunteer aid] workers very well,” Favret said. “In this situation, it is important and it does help. If people are uncomfortable, they don’t work as well.” Materials used in the garments repel blood and other bodily fluids with a barrier Favret compared to a high-tech raincoat. The “nanotechnology” used in the garments prevents liquids and dirt from collecting on the surface.

“The overwhelming majority [of fluids] would hit and just run off, like water off a duck’s back,” he said.

A demonstration of the specially treated garments at Vestagen’s offices near downtown on Wednesday showed how fluids simply bead up on the exterior of the garments and then roll off.
Any remaining bacteria die off, thanks to a “rapidly active” anti-microbial agent that prevents such microorganisms from adapting in the environment. “It kills bacteria on contact,” Favret said. Typical scrubs are made of polyester-cotton blends on which many microorganisms can thrive.

The outfits medical workers wear, those used by their patients, hospital curtains and fabrics on furniture in hospitals are all surfaces where infectious organisms can grow, leading to hospitalacquired infections such as MRSA. “Our products can be applied to any of those,” said Favret, a 22-year veteran of the health-care industry with sales and marketing management and product launch and startup business leadership experience. He founded Vestagen just last year.

In addition, the Vestex garment products are designed to wick away sweat and help control body temperatures, another helpful factor for medical personnel working in Haiti’s balmy weather.

“Here’s an area where people are going to be very hot,” Favret said. “This will help people stay clean and dry.”

Geoff Kaufmann, American Red Cross CEO for the North Central Region, learned about the products and the company’s offer to donate garments through Vestagen’s Chief Commercial Officer Brian Crawford. Kaufmann then forwarded the idea to Red Cross officials in Washington, D.C. “I would think that any and all kinds of donations for medical workers [in Haiti] would be welcome,” Kaufmann said Wednesday. “I thought it was a great gesture. I know it has gone up the chain. It’s waiting for confirmation.”

Some stock of the Vestex garments is already available for shipping from a warehouse in Jacksonville, Crawford said. The issue would be figuring out how to get those garments into the
country. Later on, garments finished in Haiti could be used for the relief effort, too. The cutting and sewing operations located about 10 to 15 miles outside Port-au-Prince could be back online within a couple of weeks, the Vestagen officials said Favret said he has great confidence in the product, its performance and its viability in medical settings around the country. By donating the garments, Favret said his company will help protect the medical workers in Haiti and their patients and help put some of the Haitian labor force back to work finishing
the products.

And if doctors and nurses who wear the garments in Haiti report how well they work - and share that information with hospital administrators back home - Favret said that won’t be such a bad thing for Vestagen, a new company with products that promise to stay “clean, cool and dry.”

Anthony Colarossi can be reached at acolarossi@orlandosentinel.com or 352-742-5934.

Reading The Story Here on the Orlando Sentinel website