Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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To assess the value of rotavirus vaccination in India, we determined the potential impact and cost-effectiveness of a national rotavirus vaccination program. ⋯ A national rotavirus vaccination program in India would prevent substantial rotavirus morbidity and mortality and would be highly cost-effective at a range of vaccine prices. Public health officials can use this locally derived data to evaluate how this highly cost-effective intervention might fit into India's long-term health care goals.
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Ventilator-associate pneumonia (VAP) is the most common nosocomial infection in patients in intensive care units (ICU). Because of its association with unwanted clinical outcomes, preventive measures have been studied intensively in the past 25 years. Unfortunately, a large amount of clinical trials yielded disappointingly few clear-cut answers. ⋯ Only topical antimicrobial prophylaxis (either alone in the oropharynx or in combination with intestinal decontamination) has been demonstrated to improve patient outcome resulting from prevention of VAP. However, this was demonstrated in not-so-average circumstances-in ICUs with extremely low levels of antibiotic resistance. Despite the obvious challenges with using antibiotics as preventive measures, careful evaluation of these strategies in settings with higher drug-resistance levels is now justified, and future studies should be designed to demonstrate outcome benefits rather than reductions in VAP rates.
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A model survey for assessing 2009 pandemic influenza A (H1N1) virus disease burden in the workplace.
Emergence of 2009 pandemic influenza A (H1N1) (pH1N1) virus in 2009 raised concern about the potential impact of widespread or severe disease on the nation's workforce. The Centers for Disease Control and Prevention recommended that employers develop flexible pandemic response plans. We used the Behavioral Risk Factor Surveillance System's influenza module as a model for a brief workplace survey to ascertain the influenza-like illness (ILI) burden on epidemiology staff in Centers for Disease Control and Prevention Emergency Operations Center. ⋯ The 10 respondent ILI cases missed 24 total work days, although none sought medical care. Eleven (14%) of 77 household contacts also had ILI, but no ILI case was hospitalized. This survey enabled us to rapidly obtain information about our workforce ILI burden and evaluate the potential need for additional resources because of employee absence.
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A strong evidence base provides the foundation for planning and response strategies. Investments in pandemic preparedness included support for research that aided early detection, response, and control of the 2009 influenza A (H1N1) (pH1N1) pandemic. Scientific investigations conducted during the pandemic guided understanding of the virus, disease severity, and epidemiologic risk factors. ⋯ Communication of this evolving evidence base was important to sustaining credibility of public health. Areas where substantial controversy emerged, such as the optimal approach to respiratory protection of healthcare workers, often suffered from gaps in the evidence base. Many aspects of the 2009-2010 pandemic influenza experience provide ongoing opportunities for additional study, which will strengthen plans for future pandemic response as well as control of seasonal influenza.