reappear (3). Any red, raised, pruritic skin lesions (especially on the upper back) that are not obviously due to other causes are suspect and should be scraped. Scraping will often yield Demodex folliculorum mites, which may produce lesions without extensive pruritis, in addition to S. scabiei. Treatment of residents, especially those with atypical, crusted rashes, should be aggressive (e.g., lindane lotion for 1 day, followed by 10% crotamiton lotion for 5 days, followed by a second lindane treatment). Treatment should include the entire body from the neck down, with special attention to the underside of well-trimmed fingernails. Mass prophylaxis will not totally eliminate scabies, and the decision to use it should be based on the prevalence of scabies infestation in the facility. Follow-up examinations are recommended to assess overall control. Patients who cannot be successfully treated should receive monthly maintenance treatments for an extended period (e.g., applications of 10% crotamiton lotion for 2 days each month). Use of protective clothing and gloves by the nursing staff and isolation of patients would not serve any useful purpose since treatment failures usually reflect inadequate application of the scabicide to all appropriate body surfaces and not reinfestation from other patients or staff. Treatment failures occasionally result from resistance of mites to scabicides; failure for elderly, institutionalized persons may reflect concurrent cellmediated immunodeficiency (3). Nursing personnel frequently acquire scabies, especially on the upper arms and abdomen, but rarely on the hands and wrists (4,5). Recovering mites in scrapings from these persons is difficult because they usually carry a small number of adult mites. Occasionally, personnel experience psychogenic scabies or acarophobia, especially after recent treatment. Standard treatment will usually eliminate the problem and should be given to the staff's family members. Health-care workers with persistent complaints are best managed by emotional support and repeated skin scrapings to demonstrate the absence of mites (6). References 1. Orkin M. Resurgence of scabies. JAMA 1971;217:593-7. 2. Orkin M, Maiback HI. Current concepts in parasitology: this scabies pandemic. N Engl J Med 1978;298:496-8. 3. Juranek DD, Currier RW, Millikan LE. Scabies control in institutions. In: Orkin M, Maiback HI, eds. Cutaneous infestations and insect bites. New York: Dekker, 1985:139-56. 4. Lerche NW, Currier RW, Juranek DD, Baer W, Dubay NJ. Atypical crusted "Norwegian" scabies: report of nosocomial transmission in a community hospital and an approach to control. Cutis 1983;31:637-42,668,684. 5. Cooper CL, Jackson MM. Outbreak of scabies in a small community hospital. Am J Infect Control 1986;14:173-9. 6. Currier RW. Scabies and pediculosis: hospitalized mites and lice. Asepsis - The Infection Control Forum 1984;6:13-21. The Morbidity and Mortality Weekly Report is prepared by the Centers for Disease Control, Atlanta, Georgia, and available on a paid subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, (202) 783-3238. The data in this report are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday. The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other public health problems of current interest to health officials. Such reports and any other matters pertaining to editorial or other textual considerations should be addressed to: Editor, Morbidity and Mortality Weekly Report, Centers for Disease Control, Atlanta, Georgia 30333. MMWR MORBIDITY AND MORTALITY WEEKLY REPORT 195 Short Course in Field Epidemiology Recommendations of the Immunization 203 Practices Advisory Committee (ACIP) 14262 Human Immunodeficiency Virus Supplementary ACIP Statement The Immunization Practices Advisory Committee (ACIP) recently reviewed data both on the risks and benefits of immunizing children infected with human immunodeficiency virus (HIV) (1) and on severe and fatal measles in HIV-infected children in the United States (2). Since this review, the committee has revised its previous recommendations for measles vaccination and for mumps and rubella vaccination. Previously published ACIP statements on immunizing HIV-infected children have recommended vaccinating children with asymptomatic HIV infection, but not those with symptomatic HIV infection (3). After considering reports of severe measles in symptomatic HIV-infected children, and in the absence of reports of serious or unusual adverse effects of measles, mumps, and rubella (MMR) vaccination in limited studies of symptomatic patients (4,5), the committee feels that administration of MMR vaccine should be considered for all HIV-infected children, regardless of symptoms. This approach is consistent with the World Health Organization's recommendation for measles vaccination (6). receive MMR and do not need revaccination (7). If the decision to vaccinate is made, symptomatic HIV-infected children should receive MMR vaccine at 15 months, the age currently recommended for vaccination of children without HIV infection and for those with asymptomatic HIV infection. When there is an increased risk of exposure to measles, such as during an outbreak, these children should receive vaccine at younger ages. At such times, infants 6 to 11 months of age should receive monovalent measles vaccine and should be revaccinated with MMR at 12 months of age or older. Children 12-14 months of age should protein) administered at regular intervals is being studied to determine whether it will The use of high-dose intravenous immune globulin (IGIV) (approximately 5 gm% prevent a variety of infections in HIV-infected children. It should be recognized that UNIVERSITY OF MICHIGAN APRANGABICE UNIV. of MICH. APR 29 1 LIBRARIES U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES/PUBLIC HEA Documents Center DEPOSITED BY UNITED STATES OF AN The Morbidity and Mortality Weekly Report is prepared by the Centers for Disease Control, Atlanta, Georgia, and available on a paid subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, (202) 783-3238. The data in this report are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday. The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other public health problems of current interest to health officials. Such reports and any other matters pertaining to editorial or other textual considerations should be addressed to: Editor, Morbidity and Mortality Weekly Report, Centers for Disease Control, Atlanta, Georgia 30333. Immunization of Children Infected With Human Immunodeficiency Virus - Supplementary ACIP Statement The Immunization Practices Advisory Committee (ACIP) recently reviewed data both on the risks and benefits of immunizing children infected with human immunodeficiency virus (HIV) (1) and on severe and fatal measles in HIV-infected children in the United States (2). Since this review, the committee has revised its previous recommendations for measles vaccination and for mumps and rubella vaccination. Previously published ACIP statements on immunizing HIV-infected children have recommended vaccinating children with asymptomatic HIV infection, but not those with symptomatic HIV infection (3). After considering reports of severe measles in symptomatic HIV-infected children, and in the absence of reports of serious or unusual adverse effects of measles, mumps, and rubella (MMR) vaccination in limited studies of symptomatic patients (4,5), the committee feels that administration of MMR vaccine should be considered for all HIV-infected children, regardless of symptoms. This approach is consistent with the World Health Organization's recommendation for measles vaccination (6). If the decision to vaccinate is made, symptomatic HIV-infected children should receive MMR vaccine at 15 months, the age currently recommended for vaccination of children without HIV infection and for those with asymptomatic HIV infection. When there is an increased risk of exposure to measles, such as during an outbreak, these children should receive vaccine at younger ages. At such times, infants 6 to 11 months of age should receive monovalent measles vaccine and should be revaccinated with MMR at 12 months of age or older. Children 12-14 months of age should receive MMR and do not need revaccination (7). The use of high-dose intravenous immune globulin (IGIV) (approximately 5 gm% protein) administered at regular intervals is being studied to determine whether it will prevent a variety of infections in HIV-infected children. It should be recognized that UNIV. of MICH. ABR 2.9.19 UNIVERSITY OF MICHIGAN APR 29.198810 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES/PUBLIC HEALTH SERVICE Documents Center DEPOSITED BY UNITED STATES OF AMERICA |