Synopsis for April 12, 2007

The MMWR is embargoed until Thursday, 12 PM EST.

1. Severe Methicillin-Resistant Staphylococcus Aureus Community-Acquired Pneumonia Associated with Influenza – Louisiana and Georgia, 2006-2007
2. Nail-Gun Injuries Treated in Emergency Departments – United States, 2001-2005
3. Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections – United States, 2006
4. Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food – 10 States, United States, 2006
5. Progress toward Poliomyelitis Eradication – Pakistan and Afghanistan, January 2006-February 2007

Severe Methicillin-Resistant Staphylococcus Aureus Community-Acquired Pneumonia Associated with Influenza – Louisiana and Georgia, 2006-2007

Although rare, physicians should be aware that MRSA is a potentially fatal cause of community-acquired pneumonia, especially during the influenza season. Methicillin-resistant Staphylococcus aureus (MRSA) is a rare but potentially fatal cause of community-acquired pneumonia (CAP), especially during the influenza season. We identified ten cases of severe MRSA CAP in previously healthy children and adults in Louisiana and Georgia, including four pediatric deaths. Past history of MRSA skin infections may be a risk factor for MRSA CAP. Four of the six Louisiana cases had a history of MRSA skin infection, or had close contact in the months before developing MRSA pneumonia with someone who had an MRSA skin infection. Physicians should suspect MRSA pneumonia in patients with a history of MRSA skin infection or if influenza presents with severe respiratory symptoms. Updated treatment guidelines by the Infectious Diseases Society of America and the American Thoracic Society now recommend empiric treatment with vancomycin or linezolid when MRSA community-acquired pneumonia is suspected.

Nail-Gun Injuries Treated in Emergency Departments – United States, 2001-2005

Consumers and workers should be aware that nail gun injuries are common and can be severe. Current users and new tool purchasers should make sure that their nail gun has the safer sequential-trip trigger mechanism. Since 1991, consumer nail-gun injuries treated in US emergency departments (ED) have increased more than 200 percent, as these tools have become increasingly accessible to consumers. While training in safe work practices is important, consumers, employers, and workers who use nail-guns on the job should be aware that engineering interventions are available that can reduce the risk of such injuries, principally a safety feature called a sequential-trip trigger.

Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections – United States, 2006

• CDC Changes Recommendations for Gonorrhea Treatment Due to Drug Resistance
  Press Release April 12, 2007

Preliminary 2006 data show that fluoroquinolone-resistant gonorrhea is now widespread among both heterosexuals and men who have sex with me (MSM) in the United States, prompting CDC to report that it no longer recommends that this class of antibiotics be used to treat gonorrhea in the United States. Data from CDC’s Gonococcal Isolate Surveillance project (GISP) in 26 U.S. cities found that among heterosexual men, 6.7 percent of gonorrhea cases were fluoroquinolone resistant in the first half of 2006, up from 0.6 percent in 2001 and above the recognized threshold (5 percent) for changing treatment recommendations. Among MSM, for whom this threshold was crossed in earlier years, 38 percent of gonorrhea cases were fluoroquinolone resistant in the first half of 2006. CDC recommended in 2004 that fluoroquinolones not be used any longer as first line treatment for gonorrhea among MSM. Overall, the new data indicate that resistance is now occurring across the United States (at 25 of 26 GISP sites). With the loss of fluoroquinolones, recommended gonorrhea treatments are limited to a single class of antibiotics, cephalosporins. The report emphasizes the need for increased monitoring for emerging cephalosporin resistance, and accelerated research into new treatments, to continue the nation’s progress in controlling this common sexually transmitted disease.

Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food – 10 States, United States, 2006

• New Report Highlights Growing Foodborne Illness Challenges E. coli O157, Salmonella and Vibrio among Notable Concerns
  Press Release April 12, 2007

Although important declines have occurred in the incidence of some foodborne infections, most declines occurred prior to 2006. Infections caused by Shiga-toxin producing Escherichia coli (STEC) O157 and Salmonella have not declined, and Vibrio infections have increased, indicating that additional efforts are needed to reduce the burden of foodborne illness. Foodborne illnesses are a substantial health burden in the United States. The Foodborne Diseases Active Surveillance Network (FoodNet) collects data from 10 U.S. states regarding diseases caused by enteric pathogens transmitted commonly through food. FoodNet quantifies and monitors the incidence of these infections by conducting active, population-based surveillance for laboratory-confirmed illnesses. This report describes preliminary surveillance data for 2006 and compares them with baseline data from the period 1996–1998. Incidence of infections caused by Campylobacter, Listeria, Shigella, and Yersinia has declined since the baseline period. Incidence of infections caused by Shiga toxin-producing Escherichia coli O157 (STEC O157) and Salmonella, however, did not decrease significantly, and Vibrio infections have increased, indicating that further measures are needed to prevent foodborne illness and achieve national health objectives.

Progress toward Poliomyelitis Eradication – Pakistan and Afghanistan, January 2006-February 2007

The governments of Pakistan and Afghanistan are making special efforts to improve the polio eradication activities in the high polio transmission border area with compromised security. Successfully interrupting wild poliovirus in both these countries will depend upon continued support from the international partners, plus sustained commitment and coordination of both countries. From January 2006 to February 2007, reported poliovirus cases increased in Pakistan and Afghanistan. However, the genetic diversity of the virus has decreased, indicating restriction in the transmission of poliovirus. The governments of both countries have high level commitment and have coordinated cross-border polio activities, including two joint large-scale vaccination campaigns. Mobile populations have been targeted specifically for immunization, and vaccination posts have been increased along the border between the two countries. Successfully interrupting wild poliovirus transmission in both countries will require accessing and vaccinating children along the large, remote and increasingly security-compromised border between these two countries.

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