The role of femA regulating gene on methicillin-resistant Staphylococcus aureus clinical isolates

Objective

The authors investigated the role of femA regulating gene on methicillin-resistant Staphylococcus aureus (MRSA).

Methods

High-level MRSA, low-level MRSA, and methicillin-susceptible Staphylococcus aureus (MSSA) were determined by agar diffusion methods. β-lactamase was then detected by nitrocefin and the presence of mecA was determined by PCR. Only β-lactamase-negative but mecA-positive isolates were included in further studies. The femA gene and its 250 bp upstream sequence were amplified by PCR. Expression levels of femA were determined by real-time fluorescent quantitative PCR. The 250 bp upstream sequence of femA was labeled by BrightStar Psoralen-Biotin and was detected by electrophoretic mobility shift assay (EMSA).

Results

The expression levels of femA in the three different groups (MSSA, low-level MRSA, and high-level MRSA) ranged from 3.53 × 10–3% to 29.91%, 5.54 × 10–3% to 3.1 × 102%, and 13.88% to 5.50 × 104%, respectively. EMSA could detect the signal shift in 55 high-level MRSA isolates but not in four low-level MRSA and four MSSA strains.

Conclusion

The expression levels of femA in high-level MRSA (non-β-lactamase-producing) were higher than in low-level MRSA and MSSA. The femA regulating gene probably lies in the 250 bp upstream sequence in MRSA. High-level expression of femA seems to be essential for high-level MRSA.     

Panton-Valentine leukocidin producing Staphylococcus aureus nasal carriage,in North-Lebanon

Objectives

We investigated the prevalence and the risk factors of nasal carriage of Staphylococcus aureus carrying Panton-Valentine leukocidin genes [Sa PVL(+)] in pupils.

Study population and methods

Two hundred and fifty-seven pupils were screened by nasal swabbing. The detection of 16S rRNA, mecA and luk-PV genes was performed by PCR and the risk factors were assessed with the statistical analysis of a questionnaire.

Results

Thirty-one percent of pupils were colonized, with 16.4% of isolates carrying the luk-PV gene and 8.8% the mecA gene. Children aged 7 years or more and living in a boarding school were the factors promoting nasal carriage 60% of children who presented with an abscess in the previous year were carriers of luk-PV gene Sa.

Conclusion

The study revealed a high prevalence of luk-PV gene among methicillin-susceptible strains and a statistically significant correlation between the presence of this gene and presenting with an abscess.     

Staphylococcus aureus carrying Panton-Valentine leukocidin genes nasal colonization and skin infection: screening in case of outbreak in a school environment

Objectives

An outbreak of Staphylococcus aureus (SA) carrying the gene coding for Panton-Valentine leukocidin (PVL) skin infections in a primary school was investigated and monitored in the Val-d’Oise region (Greater Paris) in 2006.

Patients and methods

Skin infections reported after the beginning of the school year in primary-school teachers, students and their relatives were diagnosed and treated at the local hospital and screening for nasal colonization was implemented. A patient presenting with folliculitis, an abscess or furuncle with a positive-skin test or nasal swab for SA-PV was considered to be a case of infection. Colonization was defined as identification of SA-PVL in a nasal swab in the absence of skin lesions. In addition to recommended control measures, treatment by topical intranasal mupirocin was prescribed to all colonized patients and relatives of infected patients.

Results

Over five months, 22 cases of PVL-positive SA skin infections, including a case of simple folliculitis, were confirmed in 15 primary-school students (attack rate = 18.5%) and seven relatives. The occurrence of nasal colonization in relatives not attending the same school ranged from 0 to 30% according to the number of cases of skin infection in the family (p < 0,01). Two-thirds of patients treated with mupirocin were decolonized.

Conclusion

Transmission of this SA strain in school and family environments confirms the epidemic potential of PVL-positive isolates; however, screening for nasal colonization should be restricted to cases of skin infection and people in their immediate environment.     

Genotypic screening of atypical Staphylococcus aureus strains isolated from clinical samples for presence of selected adhesin genes

Objective

The aim of this study was to screen Staphylococcus aureus negative for production of coagulase or clumping factor and for presence of selected adhesin genes.

Methods

Sixty coagulase-negative and 20 clumping factor-negative S. aureus strains were studied. Detection of methicillin resistance was performed using the agar screen technique with 6 mg/L of oxacillin and was confirmed by amplification mec A gene. The presence of bone binding protein (bbp), collagen binding protein (cna), fibronectin A binding protein (fnbA), fibronectin B binding protein (fnbB) and clumping factor A (clfA) genes was detected by multiplex PCR.

Results

Almost all (98%) of the strains were positive for clfA gene. There were fnbA and fnbB in 85%, cna in 54% and bbp in 5% of strains found. No correlation between presence of the particular genes and clinical samples was observed. The prevalence of fnbA, fnbB and cna was statistically higher in coagulase-negative than in clumping factor-negative strains (89, 89, 66 and 70, 70, 15%, respectively). Similarly, all of these genes were more often observed in MRSA than in MSSA atypical strains. The cna was detected only in coagulase-negative MRSA.     

Methicillin-resistant Staphylococcus aureus among a network of French private-sector community-based-medical laboratories

Objective

The aim of this study was to estimate the frequency of methicillin-resistant Staphylococcus aureus (MRSA) strains in the French community and the proportion of Panton-Valentine (PVL)-MRSA.

Design

A cross-sectional study was made during a 3-month period in 2003 through a network of private-sector, community-based medical laboratories selected throughout France: the Labville network. Each MRSA isolate was included and characterized by French National Reference Center for Staphylococci. The total number of S. aureus isolates was also collected.

Results

Among the 283 patients infected or colonized by MRSA, 166 (59%) were considered as healthcare-associated, 14 (5%) as nursing-associated and 39 (14%) as community-acquired. The proportion of methicillin resistance among S. aureus was 14%. Taking into account the sampling design, the incidence of MRSA cases in French outpatients was estimated to be 0.50 [CI95%: 0.41–0.60] per 10,000 inhabitants. The molecular analysis confirmed that 80.6% belong to the Lyon clone, the most prevalent hospital MRSA clone spreading in France and 10.6% to a closely related clone. An emerging MRSA clone containing the tst1 gene was detected in six patients and the PVL-positive ST80 clone only in one, 22-year-old, patient.

Conclusion

Most of MRSA cases diagnosed in the community in France, in 2003, were elderly with specific risk factors and harbored hospital strains. The prevalence of PVL-MRSA remained low.     

Prevalencia de anticuerpos frente al virus de la hepatitis A en trabajadores del ámbito sanitario y variables asociadas

Objective

Vaccination against hepatitis A is recommended in risk groups, including healthcare workers. The objective of this study was to determine the prevalence of antibodies to HAV (IgG) among workers in the healthcare setting in order to establish criteria for vaccination.

Methods

A cross-sectional, analytic, observational study of 4,864 employees was undertaken in four healthcare companies in Catalonia (Spain). The variables gathered included personal data, professional category, location of employment, and serology.

Results

The overall prevalence of antibodies to HAV was 52.7%. The prevalence significantly increased with greater age. The mean age of seropositive workers was 41.5 years compared with 34.3 in workers with negative serology. The highest prevalence of antibodies was found in cleaning employees (74.2%) and catering staff (75.3%).

Discussion

Given the high prevalence of seronegative adults susceptible to infection and the characteristics of their professional activities, vaccination of all staff working in health institutions should be considered.     

Primary eye care skills scores for health workers in routine and enhanced supervision settings

Introduction

Primary health care in Tanzania is provided at two types of health units, the dispensary and the health centre. Theoretically, primary health workers (with knowledge of primary eye care [PEC]) are ideally placed to identify people in need of eye care services. In Tanzania, they are expected to be able to identify, treat, or correctly refer a number of eye conditions including cataract, trauma, presbyopia, and the ‘red eye’. They are also expected to be able to measure visual acuity correctly and to educate the community about prevention.

Objectives

The objective was to determine the effect of enhanced supervision of health workers on PEC knowledge and skills in Kilimanjaro Region, Tanzania.

Study design

This was a quasi-experimental, cluster randomized intervention study of an enhanced supervisory method compared to a routine supervisory method; 36 dispensaries were randomly allocated into the two groups.

Participants

Health workers based at government dispensaries in Mwanga District.

Data collection

Participants were interviewed pre and post intervention and the information was recorded using a standardized pretested questionnaire.

Results

Mean scores of knowledge in healthcare workers was higher in the intervention group (score = 6.43, 80.4% improvement) compared to the non-intervention group (score = 4.71, 58.9% improvement). The ability to describe and demonstrate vision testing was better (score = 1.8) in the enhanced supervision group compared to the routine supervision group (score = 0.88, P = 0.03). There was a high level of attrition (24%) within one year from the time of baseline survey, especially amongst clinical officers (44%).

Conclusion

During the pilot study, enhanced supervision improved PEC knowledge and skills of health workers compared to health workers with routine supervision.

Recommendations

Training in PEC needs revision to become more practicum-based. There is need to revise supervision guidelines (to be skills-based) and the supervision skills of district eye coordinators (DECs) need to be enhanced. There is a huge need to improve governance (accountability and rule of law) of health staff.     

Knowledge and Perceptions About Community-acquired Staphylococcal Infections Among Health Care Workers in Hawai‘i

Since the early 1990s, national rates of methicillin-resistant Staphylococcus aureus (MRSA) infections have increased dramatically.^1,2 Initially identified in health care settings, community-acquired MRSA is now a major public health concern. With Hawai‘i''s expanding S. aureus and MRSA epidemic closely approximating the national trend in inpatient and outpatient settings,^7,8 a high level of knowledge and awareness among health care workers is essential to successfully control this evolving epidemic. Health care and related workers were surveyed to assess their knowledge and perceptions about staphylococcal and MRSA infections. Knowledge was estimated by demonstrated ability to correctly identify risk factors including diabetes and obesity, as well as to demonstrate awareness of a growing staphylococcal and MRSA epidemic.^9,10 Perceptions were estimated by level of concern of antibiotic resistance as well as of the severity of the staphylococcal and MRSA epidemic. Variations in knowledge and perception concerning basic principles associated with S. aureus infections as well as characteristics of the evolving S. aureus and MRSA epidemic were observed among various occupations (advance clinical practitioners, nurses, public health professionals, athletic trainers, and non-medical workers) as well as work locations (hospital, community, and non-clinical community). Overall, health care and related workers in community settings demonstrated disparities in knowledge regarding S. aureus and MRSA infections. They were also more likely to misperceive this growing threat. These findings provide support for focused educational interventions targeting community health care and related workers to improve awareness of staphylococcal infections in order to successfully address and combat this evolving epidemic.     

Validez y concordancia de la historia clínica electrónica de atención primaria (AP-Madrid) en la vigilancia epidemiológica de la diabetes mellitus. Estudio PREDIMERC

Objective

To assess the validity and concordance of diabetes data in the electronic health records of primary care (Madrid-PC) by comparing with those from the PREDIMERC study.

Methods

The sensitivity, specificity, positive predictive value, negative predictive value and kappa index of diabetes cases recorded in the health records of Madrid-PC were calculated by using data from PREDIMERC as the gold standard. The prevalence of diabetes was also determined according to each data source.

Results

The sensitivity of diabetes recorded in Madrid-PC was 74%, the specificity was 98.8%, the positive predictive value was 87.9%, the negative predictive value was 97.3%, and the kappa index was 0.78. The prevalence of diabetes recorded in Madrid-PC was 6.7% versus 8.1% by PREDIMERC, where known diabetes was 6.3%.

Conclusions

The electronic health records of primary care are a valid source for epidemiological surveillance of diabetes in Madrid.     

Progressive changes in pneumococcal carriage in children attending daycare in Portugal after 6 years of gradual conjugate vaccine introduction show falls in most residual vaccine serotypes but no net replacement or trends in diversity

Objectives

To track ongoing trends in pneumococcal (Sp) serotype carriage under the selection pressure of moderate pneumococcal conjugate vaccine (PCV) use, children in a community in Portugal were studied in the same months in 3 consecutive years.

Methods

Nasopharyngeal specimens were collected (children aged 3 months to <7 years) in 8 urban daycare centers in February 2008 (n = 561) and 2009 (n = 585). Sp isolates were serotyped.

Results

While demographics were similar in 2008–2009 and a previously reported sample in 2007, PCV coverage (at least one dose) in the children studied rose from 76.5% to 84% although national coverage was lower than this. Sp carriage fell from 61% to 51% with a concomitant fall in PCV7 serotype carriage from 12.1% to 4.3%. Remaining PCV7 serotypes declined to near (23F) or totally (6B, 14) undetectable levels except 19F which persisted unchanged in around 4% of children. Although carriage of 3 and 6C rose, there was no net increase in non-PCV7 serotypes and no progressive trend in serotype diversity.

Conclusions

Ecological changes induced by PCVs where uptake is moderate appear to be different from high usage settings. We report falling Sp carriage due to PCV7 serotype disappearance with persistence of 19F and no ongoing net replacement after several years of PCV7 use and slowly rising uptake.     

El cuidado familiar prestado por mujeres inmigrantes y su repercusión en la calidad del cuidado y en la salud

Objective

To understand the effects of care within the family provided by live-in female immigrants on elderly dependents and their families and the carers themselves in Seville (Spain).

Methods

We designed a qualitative study using in-depth interviews of key informants, immigrant care workers, elderly dependents and their families, and discussion groups composed of health professionals. The study was carried out in Seville between 2006 and 2008. The observation unit consisted of the families of elderly dependents with a live-in female immigrant care worker. The analysis units were health, care, dependence, gender, ethnicity and social class. Category analysis was carried out using QSR-NUD*ISTVivo1.3. After saturation, we triangulated among disciplines, researchers, sources and techniques to validate the results.

Results

The most important factors for carers’ health were the migration process and care tasks. Interpersonal relationships constituted the principal factor affecting the health of all involved.

Conclusions

The care tasks provided by immigrant women, together with the migration process, have an important impact on their health. Good and egalitarian interpersonal relationships are a protective factor for health.     

Predictive value of the eosinophil counts in the biological diagnosis of lymphatic filariasis in French Polynesia

Settings

Lymphatic filariasis is common in many tropical and subtropical areas and is a major public health issue in south Pacific islands. In endemic areas, most infected individuals are asymptomatic but may harbor microfilariae or filarial antigens in their peripheral blood. Microscopy remains the reference diagnostic tool for the identification of microfilariae but is weakly sensitive. The diagnosis of Wuchereria bancrofti infection was dramatically altered by the development of filarial antigen tests, which are easy to perform but expensive for routine use. Lymphatic filariasis is responsible for acquired eosinophilia and blood eosinophil count is commonly used as a screening tool in endemic areas.

Method

We retrospectively analyzed all the results of eosinophil counts, antigen and microfilariae detection performed in our laboratory over a 24-month period. We calculated the prevalence of antigenemia for various eosinophilic cut offs.

Results

The prevalence of antigenemia was estimated at 25.78% with eosinophilia defined as a count eosinophilic PMN above 500 per mm³.

Discussion

Our prevention strategy against lymphatic filariasis is based on annual mass drug administration, vector control, and systematic treatment of antigenemic and microfilaremic patients. Antigenemic and microfilaremic detection cannot be routinely performed because of their cost. Current treatments used for lymphatic filariasis are safe and cheaper than antigenic detection. A possible additional strategy to decrease the prevalence of antigenemia would be the systematic treatment of patients with hypereosinophilia.     

Emergence of the European ST80 clone of community-associated methicillin-resistant Staphylococcus aureus as a cause of healthcare-associated infections in Eastern Algeria

Aims

The authors had for aim to assess whether an in-hospital spread of the European community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) clone was on-going in Annaba, Eastern Algeria.

Material and methods

We carried out a molecular epidemiological study of S. aureus strains causing infections in 4 hospitals located in Annaba, between February and October 2010.

Results

Our study revealed a very low healthcare-associated MRSA (HCA-MRSA) infection incidence rate of 0.34 per 1000 patient-days. However, the rates of HCA-MRSA strains (85/119) and CA-MRSA (7/29) among S. aureus strains are much higher than those found in France. The European CA-MRSA clone (clonal complex 80, Staphylococcal Cassette Chromosome mec IVc, spa type t044, lukS/F-PV-positive) accounted for 14.1% of all healthcare-associated (HCA) MRSA infections.

Conclusion

This study confirmed the emerging role of CA-MRSA as HCA pathogens in North-African Africa.     

Glycopeptide intermediate Staphylococcus aureus and prevalence of the luk-PV gene in clinical isolates,in Northern Lebanon

Objectives

The aim of our study was to confirm the identification of 113 meticillin-resistant Staphylococcus aureus (MRSA) strains by pyrosequencing, to determine the susceptibility of these clinical isolates to various classes of antibiotics, to determine the minimum inhibitory concentration (MIC) to glycopeptides, and to detect mecA and luk-PV genes.

Methodology

The Staphylococcus species was identified by pyrosequencing of the variable region (V3) of the 16SrRNA. The susceptibility of these 113 strains of MRSA to antibiotics was determined by the disk diffusion method on Mueller-Hinton agar. The MIC of glycopeptides was determined by using the dilution method on solid media. mecA gene and luk-PV gene were detected by PCR.

Results

The disk diffusion method proved full susceptibility to vancomycin, teicoplanin, and linezolid; whereas MIC (dilution method) indicated that 5/113 strains were resistant to teicoplanin, giving a probability of having heterogeneous glycopeptide intermediate S. aureus (hGISA) strains. The mecA gene was detected in all MRSA strains ruling out the probability of having new variants of this gene in the tested strains. The luk-PV gene was detected in 28 out of 113 MRSA strains (24.8%).

Conclusion

The originality of this study was the detection of hGISA strains knowing that they were susceptible to glycopeptides according to the diffusion method. Thus it is necessary to check the level of susceptibility of MRSA clinical isolates to glycopeptides for immunodeficient patients, by determining the MIC.     

Correlates of 2009 H1N1 influenza vaccination among day care-aged children, Miami-Dade County

Background

The aim of this study was to assess factors influencing 2009 H1N1 influenza vaccination among a demographically diverse group of day care-aged children. Day care children were chosen because they were an initial target group for vaccination and are at higher risk of influenza infection than children cared for at home.

Methods

A cross-sectional study was conducted from March to May 2010 among parents of day care aged children in 13 day care facilities in Miami-Dade County. Data was collected by an anonymous self-administered two-page 20 question survey which consisted of demographic variables and information regarding 2009 H1N1 influenza vaccine knowledge, attitude and acceptance. Data was analyzed using SAS to conduct both bivariate and multivariate analyses.

Results

There were 773 participants in the study. The response rate ranged from 42% to 72.2% among day care centers. A total of 172 parents (22.3%) and 225 (29.1%) children had received the 2009 H1N1 influenza vaccine. Non-Hispanic White and Black parents were more likely to vaccinate their children than Hispanic and Haitian parents. Primary reasons for non-vaccination included vaccine safety (36.7%) and side effects (27.1%). Among parents who spoke with a health care professional, 274 (61.4%) stated the health care professional recommended the vaccine.

Conclusion

Misperceptions about influenza vaccination among parents created a barrier to 2009 H1N1 influenza vaccination. Parents who got the vaccine, who believed the vaccine was safe and whose children had a chronic condition were more likely to immunize their children. Clear, reliable and consistent vaccine information to the public and health care providers and initiatives targeting minority groups may increase vaccination coverage among this population.     

Perspectives on Parkinson Disease Care in Dutch Nursing Homes

Introduction

Parkinson's disease (PD) is a complex and disabling disorder. Ultimately, 20% to 40% of patients are admitted to a nursing home, and neurologists often lose track of these patients. Care and treatment of these institutionalized patients have not been addressed comprehensively, but anecdotal reports suggest it is suboptimal. We conducted a qualitative study to analyze the quality of PD care in Dutch nursing homes from the perspective of residents, caregivers, and health care workers.

Methods

Experiences and (unmet) needs of 15 nursing home residents with PD and parkinsonism (90% Hoehn and Yahr stage 4 and 5) and 15 informal caregivers were assessed using semistructured interviews. Furthermore, 5 focus group discussions were organized with 13 nurses and 22 other health care professionals to explore the experiences and barriers of PD care.

Results

Three core unmet needs were identified: (1) unsatisfactory empathy and emotional support, according to residents and informal caregivers; (2) insufficient staff knowledge on PD-related issues, such as motor fluctuations, leading to poorly timed administration of levodopa; (3) suboptimal organization of care with limited access to neurologists and specialized PD nurses.

Conclusions

PD care in Dutch nursing homes is suboptimal according to residents, informal caregivers, and health care workers. Three core areas for improvement were identified, including greater attention for psychosocial problems, improved PD-specific knowledge among nursing home staff, and better collaboration with hospital staff trained in movement disorders.     

Nasopharyngeal carriage of Streptococcus pneumoniae in Taiwan before and after the introduction of a conjugate vaccine

Background

The heptavalent pneumococcal conjugate vaccine was introduced in Taiwan in October 2005. To evaluate the effect of the vaccination, we conducted an active, prospective, large-scale, long-term, and multicenter study to assess the prevalence of nasopharyngeal Streptococcus pneumoniae carriage in Taiwanese children.

Methods

This study was performed at three tertiary teaching hospitals in northern, central, and southern Taiwan. Questionnaires provided demographic, family/household, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and serotypes. In addition, influenza virus and Staphylococcus aureus were recovered from nasopharyngeal and nasal swabs, respectively.

Results

Between July 2005 and July 2008, 857 pneumococcal strains were recovered from a total of 6057 children aged >2 months to 5 years (carriage rate, 14.1%). Carriage rates differed geographically and varied with subject age. In a multivariate analysis, having at least one sibling, attendance at day-care centers, a history of otitis media, and history of upper respiratory tract infection in the previous 2 weeks were each associated with a higher risk of pneumococcal colonization of the nasopharynx. Staphylococcus aureus nasal colonization was inversely associated with nasopharyngeal carriage of pneumococcus (p = 0.000; odds ratio [OR]: 0.48; 95% CI: 0.39-0.58). Daycare attendance was the only risk factor for carriage of penicillin non-susceptible S. pneumoniae (OR: 2.37; 95% CI: 1.22-4.88). Although vaccination rates rose from 2005 to 2008, no concomitant decrease in S. pneumoniae carriage occurred. The rate of penicillin resistance among S. pneumoniae isolates was 92.8% (using the meningitis criteria). The prevalence of cefotaxime resistance (21.6%) was higher than that of penicillin (6.9%; non-meningitis criteria). Slightly more than half (57.4%) of the isolates belonged to strains covered by the heptavalent pneumococcal conjugate vaccine when both vaccine and vaccine-related serotypes were included.

Conclusions

Although vaccination rates rose from 2005 to 2008, no concomitant decrease occurred in S. pneumoniae carriage. Interaction between S. aureus and S. pneumoniae may influence vaccination efficacy. These findings provide baseline data to further compare pneumococcal carriage rates and antibiotic resistance patterns in Taiwanese children as vaccination rates continue to increase.     

Pneumococcal carriage in children and adults two years after introduction of the thirteen valent pneumococcal conjugate vaccine in England

Background/Aims

In April 2010 the 7-valent pneumococcal conjugate vaccine (PCV7) was replaced by the 13-valent PCV. We investigated pneumococcal carriage in children eligible for PCV7 or PCV13 and their household contacts.

Methods

Eligible families in Hertfordshire and Gloucester were identified and a nasopharyngeal swab obtained from consenting household members between July 2012 and March 2013. Samples were cultured for Streptococcus pneumoniae and serotyped by standard methods. For each serotype the ratio of its prevalence in invasive pneumococcal disease (IPD) to its carriage prevalence (case:carrier ratio, CCR) was calculated. Results were compared with previous carriage studies in 2001/2002 and 2008/2009, before and after PCV7 introduction.

Results

217 households were included. Among <5-year olds 47.7% (95% confidence interval 41.8–53.5) were carrying a pneumococcus compared with 51.0% (95% CI: 44.0–58.0) in 2008/2009 and 48.4% (95% CI: 44.1–52.7) in 2001/2002. The odds of carrying a PCV7 serotype was significantly reduced in 2008/2009 (0.07, 95% CI: 0.03–0.16) and 2012/2013 (0.01 95% CI: 0.00–0.07) relative to 2001/2002, while the odds of carrying any of the extra six PCV13 serotypes increased after PCV7 introduction (1.38, 95%CI: 0.73–2.59) but declined significantly after PCV13 introduction (0.05, 95%CI: 0.01–0.37). The CCRs for the frequently carried serotypes were relatively low, with the highest CCR observed for serotypes 7F, 19A, 3, 8, and 33F. Across the three carriage studies, CCR estimates were stable for nearly all serotypes.

Conclusion

Carriage of additional PCV13 serotypes has rapidly reduced post-PCV13 introduction in both vaccinated and unvaccinated individuals with a continued decline in transmission of PCV7 serotypes. Carriage rates in children remain unchanged, but the low CCRs of replacing serotypes would be expected to further reduce overall IPD across all age groups.     

Meningococcal carriage prevalence in university students, 1824 years of age in Santiago,Chile

Introduction

Neisseria meningitidis invasive disease is a major public health problem. Pharyngeal carriage is considered a prerequisite for invasive infection. Prevalence reaches 10% in general population and up to 30% in the 20–24 years age group. The aim of this study was to asses pharyngeal carriage prevalence in healthy subjects aged 18–24 years, and as secondary endpoints evaluate known risk factors, to identify serogroups and sequence in the isolated strains.

Methods

Cross-sectional study in 500 healthy subjects; students from Universidad de Chile aged 18–24 years, Santiago, Chile, October 2012. Each subject underwent a risk factor survey prior to throat culture sampling. Samples were processed in one central Microbiology Laboratory of Hospital Luis Calvo Mackenna and serogrouping and sequencing was performed at Instituto de Salud Pública de Chile.

Results

We obtained throat samples from 500 healthy subjects, 20 (4%) positive for N. meningitidis. Of positive strains 20% were serogroup B, 15% W and the rest non groupable. The median age was 20 years, 50% were men. Of the risk factors evaluated, 24% were current smokers, 16% shared a room, 72% had kissed someone during the last month, 64% had gone to pub and 76% had consumed alcohol in the same period of time.

Discussion

Literatures meningococcal carriage prevalence reaches up to 30% in people aged 18–24 years. Prevalence in our study was 4%. Different interpretations could be given; one could be the absence of overcrowding in our students because of the lack of dorms in our scholar system and also the characteristics of our enrolled group.

Conclusions

Our results suggest the necessity to extend the study to other age groups and to other cities, to better understand the Chilean reality, as well as others regions of America, considering that these results cannot be extrapolated to another countries.     

What lies behind the low rates of vaccinations among nurses who treat infants?

Background

In most countries rates of immunizations of health care workers with recommended vaccines are not satisfactory.

Objectives

To identify reasons behind the low rates of compliance of Israeli nurses in Mother and Child Healthcare Centers (MCHC) with an official request for pertussis vaccination.

Methods

Three focus groups were conducted. Qualitative analysis identified themes that could explain the nurses’ non-compliance.

Results

Trust in health authorities was low, mainly following the A/H1N1 purported influenza pandemic. In addition, nurses did not see the importance of being role models for the public and demanded the autonomy to decide whether to receive vaccinations. The nurses differentiated between their role as nurses and their personal life, expressed fear of new vaccines and exhibited low levels of risk perception. Misconceptions regarding vaccinations were expressed by the nurses.

Conclusions

Antivaccinationist ideas were expressed by MCHC nurses and these attitudes may have led to non-compliance with vaccination guidelines.