First Recurrence of Clostridium difficile-Associated Disease (CDAD): Quebec (2003-2004)
During an epidemic of CDAD caused by a strain that is a hyper-producer of toxins A and B, the frequency of a first recurrence after metronidazole treatment of the initial episode doubled in 2003-2004, compared with 1991-2002. To examine whether administration of metronidazole as treatment for a first recurrence of CDAD remained appropriate, data for patients with CDAD diagnosed in a hospital in Quebec, during 1991-2005, who experienced a first recurrence was reviewed. A total of 463 patients had a first recurrence of CDAD, of whom 154 (33.3%) experienced a second recurrence. Independent predictors of a second recurrence were age and duration of hospitalization after the first recurrence; this latter finding suggested that many such episodes were reinfections rather than relapses. Neither choice of treatment drug (metronidazole or vancomycin) nor use of the same drug for treatment of first recurrence, as had been used during the initial episode, was associated with increased risk of a second recurrence. However, 51 patients (11.0%) developed at least 1 complication during the first recurrence. Older age, a high leukocyte count, and renal failure at first recurrence were strongly associated with a complicated CDAD. Metronidazole is not inferior to vancomycin for treatment of patients with a first recurrence of CDAD, but the risk of complications with any treatment of CDAD may be higher than has previously been documented.
Source: Clinical Infectious Diseases, Volume 42, Number 6, 15 March 2006

Pertussis Vaccine: Quebec
The goal of pertussis control in Canada is to reduce the morbidity and mortality of pertussis across the entire lifespan. In 2003, the National Advisory Committee on Immunization (NACI) recommended administering a single dose of the adolescent/adult formulation of acellular pertussis vaccine to preadolescents and adolescents who have not received a dose of acellular vaccine. In 2004, the Quebec Department of Health and Social Services introduced the combined diphtheria-tetanus-acellular pertussis (dTap) vaccine to replace the diphtheria-tetanus vaccine ( d2T5) given as a booster to adolescents. The Canadian Immunization Guide recommends that d2T5 not be administered < 5 years after the last dose of the same vaccine, because the occurrence of adverse events is higher when repeated doses are given at close intervals. There was reason to anticipate the same phenomenon when dTap was administered < 5 years after a previous vaccinations with d2T5. When cases of pertussis occurred in Montreal high schools, it was decided that the benefit of protection against pertussis was greater than the risk of adverse events following the second vaccination. The dTap vaccine was offered to 1,367 high school students, whether they had previously received d2T5 or not. School nurses vaccinated 839 students, or 61% of the total. Follow-up to these vaccinations made it possible to compare the occurrence of vaccine adverse events in relation to the time that had elapsed since the last dose of d2T5 vaccine. These data on a total of 465 individuals suggest that previous vaccination with d2T5 does not increase the risk of local reaction at the injection site following vaccination with dTap. These results are consistent with recent results from the Yukon and Prince Edward Island. The reported adverse events and their severity are consistent with those described as common in the Protocole d'immunisation du Québec in cases where the vaccine is administered after an interval of > 5 years. In conlusion, the data in this study do not suggest any increase in vaccine adverse events when dTap is administered to an adolescent who has recently been vaccinated with d2T5.
Source: Canada Communicable Disease Report, Volume 32, Number 3, 3 February 2006

Pneumoccocal Vaccine: United Kingdom
The Department of Health has introduced pneumococcal vaccine to its childhood immunization schedule. The vaccine is being added to the schedule at 2, 4, and 13 months. There are around 5000 cases of invasive pneumococcal disease in England and Wales each year, around 530 of these in children < 2 years of age. Since the introduction of a similar programme in the United States, cases in young children caused by the strains in the vaccine have fallen by 94%, and cases in the over 65s have dropped by two thirds.
Source: Communicable Disease Weekly, Volume 16, Number 6, 9 February 2006

The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.