Synopsis for February 25, 2005

The MMWR is embargoed until Thursday, 12 PM EDT.

1. Legionnaires Disease Associated with Potable Water in Hotel ― Ocean City, Maryland, October 2003-February 2004
2. Fatal Bacterial Infections Associated with Platelet Transfusions ― United States, 2004
3. Tularemia Transmitted by Insect Bites ― Wyoming, 2001-2003
4. Hypothermia-Related Deaths ― United States, 2003-2004
5. Progress Toward Elimination of Measles and Prevention of Congenital Rubella Infection ― European Region, 1990-2004

Legionnaires Disease Associated with
Potable Water in Hotel ― Ocean City, Maryland,
October 2003-February 2004

Outbreaks such as the one described in this article emphasize the need for improved state-based and national surveillance for travel-associated Legionnaires' disease cases.

The Worcester County Health Department, the Maryland Department of Health and Mental Hygiene (DHMH) and the Centers for Disease Control and Prevention investigated seven confirmed cases of Legionnaires' disease among persons who stayed at a hotel in Ocean City, Maryland over a four-month period. This report summarizes the joint local health department, DHMH and CDC investigation, which implicated the potable hot water system of the hotel as the likely source of infection. This outbreak investigation highlights the importance of enhanced, state-based surveillance for timely detection of travel-associated Legionnaires' disease clusters.

Fatal Bacterial Infections Associated with Platelet Transfusions ― United States, 2004

Although the blood supply is very safe, bacterial infection can be transmitted through transfusion, as currently used tests may not detect all contaminated units. For the past several years, bacterial sepsis from blood component contamination has become the greatest transfusion-transmitted infectious risk in the United States, particularly in platelet units.

This is because the risk of transfusion-transmitted viral diseases has declined with improved testing, while the risk from bacteria has remained. In 2004, the AABB adopted a new standard for member blood banks to implement measures to reduce this risk. However, clinicians should be aware, that, despite testing methods in place, fatal transfusion-associated bacterial sepsis can still occur. It is critical that clinicians consider the possibility of bacterial contamination when investigating febrile transfusion reactions. Hospital transfusion services, blood collection center personnel, and when, necessary, public health departments, should collaborate to manage suspected infections transmitted through blood transfusion.

Please see the following link for more information for clinicians on the AABB Standard: www.aabb.org/Pressroom/In_the_News/bactcontplat022305.htm

Tularemia Transmitted by Insect Bites ―
Wyoming, 2001-2003

Health care providers and the general public need to be familiar with signs and symptoms associated with tularemia; and also, be aware of the most common likely mode of contracting tularemia to prevent or reduce transmission.

In 2001-2003, Wyoming experienced an increase in reported human cases of tularemia. During this period, insect bites (particularly from biting flies such as deer flies) emerged as the most common likely mode of transmission according to the Wyoming Department of Health. This increase in human cases was geographically and temporally associated with a possible increase of tularemia in rabbits. Health care providers and the public should be knowledgeable about the local epidemiology of tularemia, particularly regarding the modes of transmission and resultant clinical types, in order to facilitate a timely diagnosis and take appropriate preventive measures.

Hypothermia-Related Deaths ― United States, 2003-2004

Recognizing risk factors and early signs and symptoms of hypothermia can help prevent associated deaths.

Hypothermia, the lowering of the body's core temperature to less than 95° F, causes nearly 700 deaths in the United States each year. Typically caused by prolonged exposure to cold temperature, hypothermia can be prevented by recognizing the risk factors and signs of this medical emergency. This report of hypothermia-related deaths found that proactive public health strategies can reduce hypothermia-related deaths. These strategies include identifying persons at greatest risk, ensuring resources are available to minimize exposure to cold, and ongoing communication with high-risk persons about how to protect themselves. The report also recommends educating public safety personnel and hospital staff to better recognize hypothermia signs and symptoms and to become familiar with initial treatments.

Progress Toward Elimination of Measles and
Prevention of Congenital Rubella Infection ― European Region, 1990-2004

Substantial progress has been made in EUR toward better control of measles and rubella, but further efforts are needed to achieve interruption of indigenous measles by 2010 and reduce CRS incidence to <1 per 100,000 live births.

European Region of the World Health Organization (EUR) aims to eliminate indigenous measles and reduce incidence of congenital rubella syndrome (CRS) to <1/100,000 live births by 2010. In 2004, all 52 countries in EUR had routine 2-dose measles vaccination program; 47 countries also used a rubella-containing vaccine. Routine coverage with the first dose of measles-containing vaccine among children aged 1 year has been ≥80% since early 1990s (>90% during1990-2003). During 1994-2004, approximately 27 million persons have been vaccinated against measles through supplemental vaccination implemented in nine countries. Measles incidence declined from 36.2 per 100,000 populations in 1990 to 3.2 in 2004, and some countries (e.g. Finland) succeeded in eliminating measles, mumps, and rubella. However, measles and rubella outbreaks continue to occur.

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