Hot topics in epidemiology

Hot Topics in Epidemiology
Excerpts from Colorado Department of Public Health and
1. UPDATE - Influenza Surveillance
o Mesa County
o Colorado
o National
2. Reports of Pediatric Influenza-related Neurologic Illness
3. NEJM - Emergence of Ciprofloxacin-Resistant Neisseria meningitides in

North America


Mesa County

The CDPHE counts only hospitalized cases of influenza. Currently, Mesa County has 10
hospitalized influenza cases (9 - type A and 1 - type B). Surveillance of local labs shows
a decrease in testing for Influenza-Like Illness (ILI) over the past few weeks. The graph
below shows the current season as well as last year’s season.
For the week ending March 14, influenza activity continued to be “widespread” and at
approximately the same level as the previous few weeks. Hospitalizations appear to have
peaked during the week ending 2/28. Sentinel laboratory positivity plateaued (without
any distinct peak) between the weeks ending 2/14 and 3/7. ILI rates in the Denver metro
area plateaued between the weeks ending 2/14 and 2/28.
For more information during the 2008-09 influenza season, please visit CDPHE’s
Influenza Su
For the week ending March 7, influenza activity in the United States remained high, but
at approximately the same level as in the previous week. Thirty-five states (including
CO) reported widespread influenza activity.
To view the full national weekly influenza surveillance report, go to:
2. Reports of Pediatric Influenza-related Neurologic Illness

Pediatric Infectious Disease physicians at the Children's Hospital in Aurora, Colorado,
have consulted on two recent patients presenting with fever and significant neurological
symptoms. Both of these patients tested positive upon admission for Influenza type B.
The first patient was a 6-year-old female who presented to the emergency department
with a history of URI symptoms, sudden deterioration in mental status and fever. A MRI
revealed marked abnormality in deep white matter, thalamus, posterior brainstem and
cerebellar white matter consistent with acute necrotizing encephalitis, or acute
disseminated encephalomyelitis.
The second patient, aged 6 months, presented with fevers, URI symptoms, seizure
activity and focal neurologic signs. Her MRI scan showed marked abnormality scattered
throughout the white matter and thalami consistent with an infectious etiology such as
multifocal encephalitis or acute disseminated encephalomyelitis.
3. NEJM - Emergence of Ciprofloxacin-Resistant Neisseria meningitides in North
We report on three cases of meningococcal disease caused by ciprofloxacin-resistant
Neisseria meningitidis, one in North Dakota and two in Minnesota. The cases were
caused by the same serogroup B strain. To assess local carriage of resistant N.
meningitidis, we conducted a pharyngeal-carriage survey and isolated the resistant strain
from one asymptomatic carrier. Sequencing of the gene encoding subunit A of DNA
gyrase (gyrA) revealed a mutation associated with fluoroquinolone resistance and
suggests that the resistance was acquired by means of horizontal gene transfer with the
commensal N. lactamica. In susceptibility testing of invasive N. meningitidis isolates
from the Active Bacterial Core surveillance system between January 2007 and January
2008, an additional ciprofloxacin-resistant isolate was found, in this case from California.
Ciprofloxacin-resistant N. meningitides has emerged in North America.
N Engl J Med 2009;360:886-92 (February 26, 2009)
Please contact the Mesa County Health Department 24/7 Communicable Disease
Reporting line with any questions at 254-4120.


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