MMWR – Morbidity and Mortality Weekly Report

1. Respiratory Syncytial Virus Activity — United States, July 2011–January 2013

CDC
Division of News & Electronic Media
404-639-3286

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory infection in infants and young children worldwide. In the United States, RSV predominantly circulates in the fall, winter and spring. A network of U.S. laboratories report RSV specimen results to the National Respiratory and Enteric Virus Surveillance System, which summarizes geographic and temporal RSV trends. The 2011–12 RSV season began nationally in mid-November and ended in early-April. Circulation peaked in late January. During the 2012–13 RSV season, onset occurred in all but one of the 10 HHS regions by December 15, 2012. RSV circulation in both seasons varied among the regions and Florida. RSV seasonality guides diagnostic testing and timing of RSV immunoprophylaxis for children at high risk for severe respiratory infection. RSV seasonal patterns in 2011-12 remained consistent with previous years and demonstrated the usual differences in RSV circulation among HHS regions.

2. Secondary and Tertiary Transmission of Vaccinia Virus After Sexual Contact with a Smallpox Vaccinee — San Diego, California, 2012

Rachael Joseph, VMD, MPH, DACVPM
LCDR, US Public Health Service
Epidemic Intelligence Service, CDC 
County of San Diego, Health & Human Services Agency
619-515-6579  Rachael.Joseph@sdcounty.ca.gov

Unintended transmission of vaccinia virus can occur through contact with civilian and military personnel vaccinated under the U.S. Department of Defense smallpox vaccination program. In this report, sexual contact with a recent smallpox vaccinee led to secondary and tertiary transmission of vaccinia virus in two patients. Vaccinia lesions in the genital and perianal areas resulted in patient illness. The location and number of vaccinia lesions also raised concerns about preventing autoinoculation and local inoculation by clothing and other fomites. VIGIV was administered to both patients to prevent worsening, and further spread, of lesions. This report highlights the potential for transmission of vaccinia virus beyond direct sexual contacts of smallpox vaccinees, and the importance of vaccinee compliance with covering the inoculation site. Vaccinia virus can be transmitted to secondary and tertiary sexual contacts of recent smallpox vaccinees who fail to keep the inoculation site covered. VIGIV might be indicated in patients with vaccinia lesions in genital areas to prevent worsening and further spread of lesions.

3. Impact of an Innovative Approach to Prevent Mother-to-Child Transmission of HIV — Malawi, June 2011–September 2012

CDC
Division of News & Electronic Media
404-639-3286

In Malawi, the number of pregnant and breastfeeding women with HIV who started life-saving antiretroviral treatment (ART) increased by over 700 percent after the start of an innovative new policy called “Option B+” in July of 2011.  Option B+ offers life-long ART to all pregnant or breastfeeding women infected with HIV regardless of the stage of their HIV infection. Lifelong ART not only reduces mother-to-child HIV transmission rates from 40 percent without intervention to less than 5 percent, it also maintains a mother’s health and protects future pregnancies.   Other existing prevention of mother-to-child transmission approaches (Option A and Option B) base the decision to start lifelong ART on the stage of a woman’s HIV infection. Women not yet eligible for lifelong ART are offered other antiretroviral medications during pregnancy and breastfeeding to prevent HIV transmission to their infants. Determining eligibility for ART requires laboratory tests which can be difficult to access in settings with limited equipment and other resources.  In Malawi, under Option B+, the number of pregnant and breastfeeding women started on ART has increased and the 12-month retention rate has remained similar to the rate of adults continuing to receive ART at 12 months prior to Option B+ implementation. Other countries have adopted this innovative approach as a means to accelerate progress towards reaching the goal of an AIDS free generation.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES