Past Updates from the Clinician Registry Listserv:
Update Sent December 19, 2005

NOTE: This document is provided for historical purposes only and may not provide our most accurate and up-to-date information. The most current Clinician's information can be found on the Clinician Home Page.

UPDATES TO INFORMATION AND GUIDANCE
The following updates were made to CDC information and guidance from December 12-19, 2005, or reflect current events. If you have any questions on these or other clinical issues, please write to us at coca@cdc.gov.

Today's topics Include:

• COCA Conference Call Audio Recording – Avian Influenza
• Seasonal Influenza
• Health Consultation – Murphy Oil Spill
• Smallpox Vaccine
• Lymphocytic Choriomeningitis Virus and Pregnancy

COCA Conference Call Audio Recording – Avian Influenza

In case you missed our last COCA call on avian influenza, you can listen to the audio recording of the call from the COCA website: http://www.bt.cdc.gov/coca/callsummary.asp

PowerPoint slides from the call are available from the following link: http://www.bt.cdc.gov/coca/confcall.asp

Seasonal Influenza

Update: Influenza Activity --- United States, October 2--December 3, 2005 – MMWR report
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5449a2.htm

Flu Activity
http://www.cdc.gov/flu/weekly/fluactivity.htm

Murphy Oil Spill

Health Consultation - updated
http://www.bt.cdc.gov/disasters/hurricanes/katrina/murphyoil/consultation_120905.asp

Smallpox Vaccine

Letter from Wyeth Extending the License of Dryvax® Vaccine– PDF File
http://www.bt.cdc.gov/agent/smallpox/vaccination/pdf/wyethletter30nov05.pdf

Lymphocytic Choriomeningitis Virus and Pregnancy

Facts and Prevention

The Centers for Disease Control and Prevention (CDC) is asking obstetricians, neonatologists, ophthalmologists, pediatricians, family practitioners, and infectious disease specialists to be aware of the possibility of lymphocytic choriomeningitis virus (LCMV) among pregnant patients and newborn infants.

On May 12, 2005, CDC investigated lymphocytic choriomeningitis virus (LCMV) illness in four solid organ transplant patients, three of whom died.  The source of the LCMV was traced to a hamster recently purchased by the organ donor of all four patients.  It was subsequently determined that LCMV-infected pet rodents might have been transported from a single distributor to pet stores in the northeastern and midwestern United States as early as February 2005 (1).  However, the risk of LCMV from rodent exposure is not limited only to this outbreak.  Medical personnel who work with pregnant women and infants need to be familiar with LCMV because of its apparent teratogenicity when a woman is infected during pregnancy.

LCMV can be carried by wild mice, as well as laboratory and pet rodents. Humans can become infected through: (1) direct contact with saliva, blood, urine, or feces of infected rodents; (2) inhalation of dust or droplets containing LCMV; (3) transplacental spread from an infected pregnant woman to her fetus; and (4) receipt of an organ transplant from an infected donor. In the general adult population, about 5% of people have serologic evidence of previous infection with LCMV (2,3). Most adults have mild, nonspecific symptoms (headache, fever, chills, and muscle aches) or are asymptomatic, but some develop meningitis. Patients with weakened immune systems can have severe, possibly fatal, illness.  Maternal infection with LCMV during pregnancy can result in spontaneous pregnancy loss or early neonatal death, as well as in defects similar to those of other congenital infections such as toxoplasmosis and cytomegalovirus (4–8).  Affected infants most often present with hydrocephalus, microcephaly or macrocephaly, and chorioretinitis.

Clinicians should counsel their patients about the risks of contracting LCMV from laboratory, pet, and wild rodents. Women who are pregnant or who are planning a pregnancy should avoid contact with rodents, their excreta, and nesting materials.  Wild mice in the home should be controlled and removed promptly by a professional pest control company or another member of the household.  While a woman is pregnant, pet rodents should be housed outside the home with a friend or other family member.  Alternatively, pet rodents can be housed in a separate part of the home where other household members or friends can care for the pet and clean its cage.  Counseling a woman already exposed to rodents during pregnancy can be challenging.  There is no reliable estimate of how frequently congenital LCMV infection occurs.  Contact your state health department and CDC in Atlanta, Georgia, for information about when testing is appropriate and where specimens can be sent.  Currently, there is no specific treatment for LCMV infection.  Ribavirin inhibits LCMV multiplication in laboratory experiments, but has not been tested in clinical trials. Theoretical questions about the teratogenicity of ribavirin have also been raised (9).

Further information about LCMV infection during pregnancy and its prevention, including management and prevention of rodent infestation in the home, is available at:

Special Pathogens Branch, Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/lcmv.htm and http://www.cdc.gov/ncbddd/bd/lcmv.htm, via e-mail (dvd1spath@cdc.gov) or by calling 404-639-1510.

Organization of Teratology Information Specialists (OTIS) at www.OTISpregnancy.org or by calling 1-866-626-6847.

References

1.  Centers for Disease Control and Prevention. Interim guidance for minimizing risk for human lymphocytic choriomeningitis virus infection associated with rodents. MMWR. July 29, 2005;54(Dispatch):1–3.

2.  Childs JE, Glass GE, Ksiazek TG, Rossi CA, Oro JG, Leduc JW. Human-rodent contact and infection with lymphocytic choriomeningitis and Seoul viruses in an inner-city population. Am J Trop Med Hyg. 1991;44(2):117–21.   

3.  Park JY, Peters CJ, Rollin PE, Ksiazek TG, Katholi CR, Waites KB, et al. Age distribution of lymphocytic choriomeningitis virus serum antibody in Birmingham, Alabama: evidence of a decreased risk of infection. Am J Trop Med Hyg. 1997;57(1):37¬¬¬¬–41.

4.  Barton LL, Mets MB. Congenital lymphocytic choriomeningitis virus infection: decade of rediscovery. Clin Infect Dis. 2001;33(3):370–4.

5.  Barton LL, Mets MB, Beauchamp CL. Lymphocytic choriomeningitis virus: emerging fetal teratogen. Am J Obstet Gynecol. 2002;187:1715–6.

6.  Wright R, Johnson D, Neumann M, Ksiazek TG, Rollin P, Keech, RV, et al. Congenital lymphocytic choriomeningitis virus syndrome: a disease that mimics congenital toxoplasmosis or cytomegalovirus infection. Pediatrics. 1997;100(1):E9.

7.  Ford-Jones EL, Ryan G . Implications for the fetus of maternal infections in pregnancy. In: Cohen J, Powderly WG, editors. Infectious diseases, 2nd ed. New York, NY: Mosby;2004. p. 709–23.

8.  Greenhow TL, Weintrub PS. Your diagnosis, please. neonate with hydrocephalus. Pediatr Infect Dis J. 2003;22(12):1099, 1111–2.

9.  Polifka JE, Friedman JM. Developmental toxicity of ribavirin/Ifα combination therapy: is the label more dangerous than the drugs? Birth Defects Res Part A Clin Mol Teratol. 2003;67:8–12.

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