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The findings in this report are subject to at least four imitations. First, measured incidence is subject to the limiations of the toxin-detection assays usually used for diagnosis of C. difficile. These assays can be insensitive (i.e., .55%-90% sensitivity) and nonspecific; in addition, 1%2% of persons tested with the most widely used toxin issays might test positive in the absence of infection. Because C. difficile is difficult and labor-intensive to isoate, culture usually is only used when a clinical need for verification of a positive toxin assay exists. Second, because ystematic patient interviews were not conducted, some patients might have had recent health-care exposures that were not recorded in available medical records, leading to potential misclassification of health-care-associated cases Is CA-CDAD. Third, underreporting might have occurred because laboratories were not required to report and no validation or assessment of completeness of reporting was conducted. Finally, because cultures were not routinely collected for isolation and molecular characterization of organisms, the extent to which recently described emergng strains are causing disease in Connecticut or are esponsible for illness in persons without established risk actors for CA-CDAD is unknown.
Future CA-CDAD surveillance measures in Connecticut vill focus on collecting detailed information on hospitalzed patients for whom more complete medical records are vailable. Continued population-based surveillance is necessary to monitor trends and describe the extent of CACDAD and possible risk factors. Although CA-CDAD surveillance systems are resource intensive, other states hould consider implementing these systems to assess trends n CA-CDAD and to help health-care providers become nore aware of this emerging problem.
1. Barbut F, Petit JC. Epidemiology of Clostridium difficile-associated infections. Clin Microbiol Infect 2001;7:405-10.
2. McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353: 2433-41.
3. Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multiinstitutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–9. 4. CDC. Severe Clostridium difficile-associated disease in populations previously at low risk-four states, 2005. MMWR 2005;54:1201-5. 5. McDonald LC, Coignard B, Dubberke E, Song X, Horan T, Kutty PK. Recommendations for surveillance of Clostridium difficileir associated disease. Infect Control Hosp Epidemiol 2007;28:140–5.
6. Rupnik M, Avensani V, Jane M, Eichel-Streiber C, Delmee M. A novel toxinotyping scheme and correlation of toxinotypes with serogroups of Clostridium difficile. J Clin Microbiol 1998;36:2240–7.
7. Dial S, Delaney JAC, Barkun AN, Suissa S. Use of gastric acidsuppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA 2005;294:2989-95.
8. Rodriguez-Palacios A, Staempfli H, Duffield T, et al. Clostridium difficile PCR ribotypes in calves, Canada. Emerg Infect Dis 2006;12:1730–6. 9. Rodriguez-Palacios A, Staempfli HR, Duffielf T, Weese JS. Clostridium difficile in retail ground meat, Canada. Emerg Infect Dis 2007;13: 485-7.
10. Warny M, Pepin J, Fang A, et al. Toxin-production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005;336:1079–84.
Updated Recommendation from the Advisory Committee on Immunization Practices (ACIP) for Use of 7-Valent Pneumococcal
Conjugate Vaccine (PCV7)
in Children Aged 24-59 Months
This notice updates the recommendation for use of 7-valent pneumococcal conjugate vaccine (PCV7) among children aged 24-59 months who are either unvaccinated or who have a lapse in PCV7 administration.* In February 2000, PCV7, marketed as Prevnar® and manufactured by Wyeth Vaccines (Collegeville, Pennsylvania), was approved by the Food and Drug Administration for use in infants and young children. At that time, the Advisory Committee on Immunization Practices (ACIP) recommended that children aged 24-59 months who have certain underlying medical conditions or are immunocompromised receive PCV7. In addition, ACIP recommended that PCV7 be considered for all other children aged 24–59 months, with priority given to those who are American Indian/Alaska Native or of African-American descent, and to children who attend group day care centers (1). The recommendation also provided schedules for administering PCV7 to children aged 24-59 months who were either unvaccinated or who had a lapse in PCV7 administration; these schedules included 1) 1 dose of PCV7 for healthy children, and 2) 2 doses of PCV7 ≥2 months apart for children with certain chronic diseases or immunosuppressive conditions (1).
* PCV7 is recommended for routine administration as a 4-dose series for infants at ages 2, 4, 6, and 12-15 months. Catch-up immunization is recommended for children aged ≤23 months, using fewer doses depending on age at the time of first vaccination.
ACIP's rationale for limiting the recommendation for
• For all healthy children aged 24-59 months who have
• For all children with underlying medical conditions
• For all children with underlying medical conditions
*The minimum interval between all doses of PCV7 for children aged 24–59
months is 8 weeks.
1. CDC. Preventing pneumococcal disease among infants and young
2. CDC. Pneumococcal conjugate vaccine shortage resolved. MMWR
3. CDC. Recommended immunization schedules for persons aged 0–18
Notice to Readers
National Child Abuse Prevention
April is National Child Abuse Prevention Month, a
During April, CDC and the federal Administration fo:
These publications and additional information regard
1. Leeb RT, Paulozzi L, Melanson C, Simon T, Arias I. Child maltreat-
Notice to Readers
National Public Health Week -
- Since 1995, the first full week of April has been desig-
In conjunction with the observance, CDC has developed resources and a list of actions that public health agencies can take to respond to potential health effects of climate change. Additional information regarding climate change and National Public Health Week is available at http://www. cdc.gov/nceh/climatechange and http://www.nphw.org.
Notice to Readers
New Public Health Emergency Law and Forensic Epidemiology Training Materials Released
CDC's Public Health Law Program has released version 3.0 of its Public Health Emergency Law and Forensic Epidemiology training materials on CD-ROM. These selfcontained training packages were developed for use by instructors in any jurisdiction in the United States to provide public health preparedness training to front-line practitioners.
Public Health Emergency Law is designed to help public health practitioners and emergency management professionals improve their understanding of the use of law as a public health tool. Forensic Epidemiology is designed to help public health and law enforcement agencies strengthen coordination of responses to pandemic influenza and similar threats. Materials include a new CDC-developed case study on pandemic influenza.
Information regarding ordering a free CD-ROM with the two sets of training materials is available at http://www2.cdc. gov/phlp/phel.asp. Additional information is available via e-mail at firstname.lastname@example.org.
FROM THE NATIONAL CENTER FOR HEALTH STATISTICS
Life Expectancy Ranking* at Birth,† by Sex - Selected Countries
Rankings are from the highest to lowest female life expectancy at birth.
* Life expectancy at birth represents the average number of years that a group of infants would live if the
$ Countries and territories were selected based on quality of data, high life expectancy, and a population
of at least 1 million population. Differences in life expectancy reflect differences in reporting methods,
¶ Most recent data available. Data for Ireland and Italy are for 2003.
In 2004, life expectancy at birth ranged from a low of 59.1 years for the Russian male population to a high of 85.6 years for the female population of Japan. In the United States, life expectancy for men (75.2 years) ranked 25th out of 37 countries and territories and 23rd for women (80.4 years). Japan and Hong Kong were the countries with the highest life expectancy, whereas the countries of Eastern Europe (e.g., Russian Federation, Romania, and Bulgaria) reported the lowest life expectancy.
SOURCES: Organisation for Economic Co-operation and Development. OECD health data 2007: statistics and indicators for 30 countries. Paris, France: Organisation for Economic Co-operation and Development; 2008. Available at http://www. oecd.org/health/healthdata.
CDC. Health, United States, 2007. With chartbook on trends in the health of Americans. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2007. Available at http://www.cdc.gov/nchs/ data/hus/hus07.pdf.
ABLE I. Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) eek ending March 29, 2008 (13th Week)*
antavirus pulmonary syndrome$
NY (1), OH (1), FL (1), CO (1), CA (10)
Incidence data for reporting years 2007 and 2008 are provisional, whereas data for 2003, 2004, 2005, and 2006 are finalized.
† Calculated by summing the incidence counts for the current week, the 2 weeks preceding the current week, and the 2 weeks following the current week, for a total of 5 preceding years. Additional information is available at http://www.cdc.gov/epo/dphsi/phs/files/5yearweeklyaverage.pdf.
§ Not notifiable in all states. Data from states where the condition is not notifiable are excluded from this table, except in 2007 and 2008 for the domestic arboviral diseases and influenza-associated pediatric mortality, and in 2003 for SARS-CoV. Reporting exceptions are available at http://www.cdc.gov/epo/dphs/phs/infdis.htm.
Includes both neuroinvasive and nonneuroinvasive. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, VectorBorne, and Enteric Diseases (ArboNET Surveillance). Data for West Nile virus are available in Table II.
The names of the reporting categories changed in 2008 as a result of revisions to the case definitions. Cases reported prior to 2008 were reported in the categories: Ehrlichiosis, human monocytic (analogous to E. chaffeensis); Ehrlichiosis, human granulocytic (analogous to Anaplasma phagocytophilum), and Ehrlichiosis, unspecified, or other agent (which included cases unable to be clearly placed in other categories, as well as possible cases of E. ewingii).
Data for H. influenzae (all ages, all serotypes) are available in Table II.
$$ Updated monthly from reports to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Implementation of HIV reporting influences the number of cases reported. Updates of pediatric HIV data have been temporarily suspended until upgrading of the national HIV/AIDS surveillance data management system is completed. Data for HIV/AIDS, when available, are displayed in Table IV, which appears quarterly.
Updated weekly from reports to the Influenza Division, National Center for Immunization and Respiratory Diseases. Fifty-nine cases occurring during the 2007-08 influenza season have been reported.
No measles cases were reported for the current week.
* Data for meningococcal disease (all serogroups) are available in Table II.
$$$ In 2008, Q fever acute and chronic reporting categories were recognized as a result of revisions to the Q fever case definition. Prior to that time, case counts were not differentiated with respect to acute and chronic Q fever cases.
The one rubella case reported for the current week was unknown.
Updated weekly from reports to the Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases.