JPIDS releases consensus statement on research definitions for drug-resistant TB in children

The Journal of the Pediatric Infectious Diseases Society (JPIDS) today released its June issue, which includes a consensus statement of the global Sentinel Project on Pediatric Drug-Resistant Tuberculosis. It establishes standardized definitions, measurements, and other key attributes that will effect research. This is the first step as the group of international stakeholders collaborate to raise visibility and share evidence and resources that can improve children's access to prompt and effective treatment.

Consensus Statement on Research Definitions for Drug-Resistant Tuberculosis in Children

"Colonization Pressure"(CP) is one predictor of healthcare associated Methicillin-resistant Staphylococcus aureus (MRSA) infections. It is a gauge of the proportion of patients on a given unit colonized during a defined period. As new strains of MRSA emerge outside the healthcare environment, Rodriguez, et al, hypothesized that CP would also be a good measurement tool for households, where S aureus infections cluster, and that cases with a higher baseline household colonization pressure (HHCP) would be at greater risk for persistent S aureus colonization and recurrent S aureus skin and soft tissue infection (SSTI). They conducted an individual vs. household decolonization intervention study for pediatric patients with community-onset SSTI and colonization. Patients colonized or infected with either MRSA or Methicillin-susceptible Staphylococcus aureus (MSSA) were eligible, and the team shared decolonization strategies with the households.

The team evaluated 92 cases and 296 of their household contacts quarterly for a year. They found that high MRSA HHCP is associated with persistent MRSA colonization in children. Surprisingly, although cases with household contacts that experienced an SSTI in the past year had a higher baseline S aureus HHCP than those without that history, the team did not find a relationship between baseline S aureus HHCP and subsequent SSTI. The team posits that because they were educating about and encouraging decolonization efforts simultaneously, the success of that program may have masked their ability to find a connection.

HHCP may be a useful tool to predict future MRSA colonization, and identify families at higher MRSA risk, which may benefit from targeted eradication interventions.

Measurement and Impact of Staphylococcus aureus Colonization Pressure in Households

Collier et al, underscore the importance of vaccination in an article describing a 2011 measles outbreak in Indiana. The onset occurred when one unvaccinated person spent a year in Indonesia, contracted the disease, and became ill on the airplane returning to the US. Indiana State Department of Health officials spent 960 personnel hours and more than $30,000 (not including direct patient care expenses or resources spent by local health departments) to contain the contagion, the second largest US outbreak of 2011.

After outreach to the community (workplace and social settings), airline passengers, and healthcare facilities where the source had sought treatment, officials determined 868 people were exposed. Of those, 38 suspected measles cases were identified and 14 confirmed. Thirteen of these cases occurred among unvaccinated members of one extended family, one a 32-week pregnant woman who was hospitalized. The remaining victim was a 23-month old child who was exposed at a party.

Although measles endemic to the US was declared eliminated in 2000, it is important to note that the disease has re-emerged in Europe and remains in other parts of the globe, including widespread attacks in Africa. The authors stress the need for vaccination before traveling. They recommend that healthcare facilities require proof of measles immunity as a condition of employment, and that physicians inquire about recent travel and immunization when evaluating patients with measles-like symptoms.

Provided by Pediatric Infectious Diseases Society