Increase in Clostridium difficile–related Mortality Rates, United States, 1999–2004

Reported mortality rates from Clostridium difficile disease in the United States increased from 5.7 per million population in 1999 to 23.7 per million in 2004. Increased rates may be due to emergence of a highly virulent strain of C. difficile. Rates were higher for whites than for other racial/ethnic groups

Leptospirosis in “Eco-Challenge” Athletes, Malaysian Borneo, 2000

Adventure travel is becoming more popular, increasing the likelihood of contact with unusual pathogens. We investigated an outbreak of leptospirosis in “Eco-Challenge” multisport race athletes to determine illness etiology and implement public health measures. Of 304 athletes, we contacted 189 (62%) from the United States and 26 other countries. Eighty (42%) athletes met our case definition. Twenty-nine (36%) case-patients were hospitalized; none died. Logistic regression showed swimming in the Segama River (relative risk [RR]=2.0; 95% confidence interval [CI]=1.3 to 3.1) to be an independent risk factor. Twenty-six (68%) of 38 case-patients tested positive for leptospiral antibodies. Taking doxycycline before or during the race was protective (RR=0.4, 95% CI=0.2 to 1.2) for the 20 athletes who reported using it. Increased adventure travel may lead to more frequent exposure to leptospires, and preexposure chemoprophylaxis for leptospirosis (200 mg oral doxycycline/week) may decrease illness risk. Efforts are needed to inform adventure travel participants of unique infections such as leptospirosis

MRSA outbreak was controlled with daily hexachlorophene showers and hygiene education.

MRSA outbreak was controlled with daily hexachlorophene showers and hygiene education

Alcaligenes xylosoxidans Bloodstream Infections in Outpatient Oncology Office

Gaps in infection control led to biofilm production in central venous catheters and resultant bloodstream infection

Generalisability of vaccine effectiveness estimates: an analysis of cases included in a postlicensure evaluation of 13-valent pneumococcal conjugate vaccine in the USA

External validity, or generalisability, is the measure of how well results from a study pertain to individuals in the target population. We assessed generalisability, with respect to socioeconomic status, of estimates from a matched case–control study of 13-valent pneumococcal conjugate vaccine effectiveness for the prevention of invasive pneumococcal disease in children in the USA

Semen Donors as the Source of Sexually Transmitted Diseases in Artificially Inseminated Women: The Saga Unfolds

Some things in life are not as straightforward as they used to be. With the latest medical technology, sexual intercourse is no longer a prerequisite for a woman to acquire a sexually transmitted disease. Artificial insemination must now be included as a possible source of these infections. In 1986 in the United States, an estimated 60 000 inseminations by donor semen were performed in women who conceived and were delivered of a child1 through this technique. Additionally, an unknown number of inseminations were performed in women who either did not conceive or did not carry their pregnancy to completion. No national data are available to estimate precisely the number of inseminations performed each year, the number of semen donors used, the number of practitioners using the procedure, or the risk of sexually transmitted diseases in the recipients

Screening to Reduce Transmission of Sexually Transmitted Diseases in Semen Used for Artificial Insemination

The practice of artificial insemination by donor semen is increasing in the United States. Many sexually transmitted organisms are found in semen, but screening procedures for the detection of these agents in donor semen have not been standardized. Sexually transmitted organisms have been transmitted during artificial insemination by donor, and such transmission can cause local, disseminated, or fatal disease in the recipient woman and may harm the fetus or newborn. Therefore, screening of both the donor and the donated semen is necessary to avoid infectious complications. Because semen samples cannot be evaluated completely on the day of donation, the use of fresh semen for artificial insemination should be discouraged. Until accurate, rapid diagnostic tests are available, only frozen semen that has been appropriately screened should be used