Child Transmits MSSA to Doctor
A 4-month-old boy with fatal pneumonia transmitted Panton-Valentine leukocidin-producing Staphylococcus aureus to a physician who had attempted resuscitation.
This represents the first reported incident of Panton-Valentine leukocidin-producing S. aureus transmission during resuscitation, said Martin Chalumeau, M.D., of the Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris, and colleagues (Clin. Infect. Dis. 2005;41:e29–30).
The child had presented with 3 days of coughing and 1 day of fever, with normal chest radiography, but had developed progressive respiratory failure within 12 hours after hospital admission.
The resuscitation occurred in the general pediatric ward, when the child went into cardiac arrest while being examined by a physician. Necroscopy results revealed right lobar pneumonia, a necrotizing hemorrhage of the right lung and half of the left lung, and a tracheal aspirate culture that yielded methicillin-susceptible S. aureus (MSSA).
Five days after the incident, the physician who had performed the oral intubation developed furuncles on the fingers and face. MSSA was found in cultures from the physician's skin lesions, and in cultures collected from 5 of the 15 health care workers involved in the resuscitation.
The presence of Panton-Valentine leukocidin, a cytotoxin associated with tissue necrosis and leukocyte destruction, was confirmed in the child and the infected physician, but not in the other health care workers. None of the health care personnel involved in the resuscitation efforts was wearing a face mask or gloves.
Varicella Hospitalizations Down 88%
Hospitalizations for varicella have declined 88% since 1994–1995, with the biggest decrease seen among infants.
Because infants are not eligible to receive the vaccine, “the declines reflect the reduced force of varicella infection in the population (i.e., herd immunity), as do declining rates among adults” and adolescents, reported Dr. Fangjun Zhou, Ph.D., and associates (JAMA 2005;295:797–802).
Dr. Zhou of the Centers for Disease Control and Prevention examined varicella treatment codes from a national health plan database of about 4 million consumers, from 1994 to 2002 and found an overall decline in varicella hospitalization, from 2.3/100,000 to 0.3/100,000 (88%).
Hospitalization rates declined for every age group: 100% for infants, 91% for children aged 9 years and younger, 92% for children aged 10–19 years, and 78% for adults aged 20–49 years. Ambulatory visits also decreased significantly, declining 59% over the period. Again, the decrease was most apparent among infants (90%). The rate declined 63% for children aged 9 years and younger, 42% for those aged 10–19 years, and 60% for adults aged 20–49 years.
National spending on varicella hospitalizations and ambulatory visits declined from $85 million in 1994 and 1995 to $22 million in 2002, a 74% decrease.