Synopsis for December 5, 2003

The MMWR is embargoed until NOON ET, Thursdays.

1. Using Partner Counseling and Referral Services to Identify Persons with Previously Undiagnosed HIV – North Carolina, 2001
2. Clostridium perfringens Endophthalmitis After Cornea Transplantation – Florida, 2003
3. Update: Creutzfeldt-Jakob Disease Associated with Cadaveric Dura Mater Grafts – Japan, 1979-2003
4. Invasive Streptococcus pyogenes Disease after Allograft Implantation – Colorado, 2003
5. Outbreak in a Homeless Population – Portland, Maine, 2002-2003

Synopsis for December 5, 2003

Using Partner Counseling and Referral Services to Identify Persons with Previously Undiagnosed HIV – North Carolina, 2001

According to a study released today by the CDC, voluntary Partner Counseling and Referral Services (PCRS) are effective tools in the campaign to help more Americans learn their HIV status.

The data from North Carolina show that PCRS, which seeks to locate sex and needle sharing partners of those who test HIV-positive and notify them of their risk, can identify large numbers of previously undetected HIV cases. Twenty percent of the partners tested in this study were diagnosed with HIV, while less than 1 percent of HIV tests performed at North Carolina clinics in 2001 were positive. PCRS also allows tested partners to receive counseling and prevention services, and if HIV-positive, referral to treatment earlier in the course of infection. Study authors note that PCRS has long been an important part of CDC’s national HIV prevention strategy. As a condition of funding, CDC requires that all states implement procedures for confidential and voluntary PCRS and CDC continually works with states to improve and evaluate PCRS.

Clostridium perfringens Endophthalmitis After Cornea Transplantation – Florida, 2003

No summary available.

Update: Creutzfeldt-Jakob Disease Associated with Cadaveric Dura Mater Grafts – Japan, 1979-2003

CJD needs to be considered in persons developing rapidly progressive dementia, particularly if there is a history of dural graft implantation or other neurosurgical procedure.

Creutzfeldt-Jakob disease (CJD) is a rapidly progressive, fatal dementing illness that may rarely be transmitted through direct inoculation of the central nervous system (CNS) with infected material. Cases worldwide have occurred from receipt of improperly treated dura mater harvested from CJD patients and used in neurosurgical procedures; the majority of these cases have occurred in Japan. Changes in dural graft screening and treatment procedures in 1987 have decreased this risk. However, due to the long incubation period of CJD, Japan continues to identify cases who received dural grafts processed before 1987. The latency period may exceed 22 years, and more cases are likely to be identified. In the United States, health professionals should report patients with a rapidly progressive dementia and history of dural graft implantation to local and state health departments.

Invasive Streptococcus pyogenes Disease after Allograft Implantation – Colorado, 2003

Cadaveric allografts may cause infections in patients, but these infections are rare. CDC is working with the tissue industry and other partners to continue to improve the safety of tissue allografts.

Donated tissues can improve the lives of many people. Cadaveric tissue donations, called allografts, serve diverse needs, from skin grafts for severe burns to ligament reconstruction for injured knees. However, reports of infections due to allograft tissues reveal the need for improved tissue industry standards. The MMWR article describes a healthy adolescent who developed a severe infection with the bacteria Streptococcus pyogenes after knee surgery using contaminated allograft tissue. During the investigation, tests revealed the donor had died of an undiagnosed infection with the same bacteria. Methods for donor screening and tissue preparation did not prevent distribution of this contaminated allograft. The CDC, along with the Food and Drug Administration (FDA) and other partners, are working to improve the safety of tissue allografts.

Outbreak in a Homeless Population – Portland, Maine, 2002-2003

This report summarizes the preliminary results of the ongoing investigation into an outbreak of active pulmonary tuberculosis (TB) disease in seven homeless men in Portland, Maine reported to the Maine Bureau of Health during June 2002-July 2003.

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