James L. Hadler

The article by Doolan et al. in this issue of the Journal of Infectious Diseases [1] describes the immune responses to anthrax among persons exposed and possibly exposed when a letter containing spores that had been sent to Senator Daschle was opened in the Hart Senate Office Building (HSOB) in October 2001. The authors took advantage of this unfortunate but unique opportunity to conduct an observational study to determine whether high levels of inhalational exposure to anthrax spores resulted in clinical disease, as well as in humoral immune or cell‐mediated immune (CMI) responses.

In order to consider the ethical issues around vaccine distribution during an influenza pandemic, it is critical to have an understanding of the role of influenza vaccine in a pandemic, the rate at which vaccine is likely to be come available, who will likely produce and "own" the vaccine, how vaccine distribution and administration might be accomplished, and which are the groups that might be deemed highest priority to be vaccinated against influenza. The United States and Connecticut have been considering the more challenging of these issues and have learned from Canada, which previously discussed and made decisions on the challenges related to vaccine distribution. Although there is still some critical advance thinking that needs to be done, planning for the response to an influenza pandemic is now at an advanced stage. The keys to preparedness at this stage are to be aware of the vaccine distribution options, to know the benefits and limitations of each option, and to be flexible but nimble in dealing with a real pandemic.

Connecticut established telephone-based gram-positive rod (GPR) reporting primarily to detect inhalational anthrax cases more quickly. From March to December 2003, annualized incidence of blood isolates was 21.3/100,000 persons; reports included 293 Corynebacterium spp., 193 Bacillus spp., 73 Clostridium spp., 26 Lactobacillus spp., and 49 other genera. Around-the-clock GPR reporting has described GPR epidemiology and enhanced rapid communication with clinical laboratories.

The Connecticut Department of Public Health (CDPH) has continuously monitored daily nonelective hospital admissions through a syndromic surveillance reporting system (HASS) since September 2001. Admission diagnoses are categorized into 11 syndromes including one possible indicator of smallpox, fever with rash, and one possible indicator of influenza and pneumonia. The objectives are to describe findings from systematic investigation of individual admissions attributed to fever and rash and to determine the utility of monitoring pneumonia admissions as an indicator of severe influenza activity during the 2003-04 influenza season. The incidence of admissions for fever and rash illness was determined for a 12-month period, and results of clinical discharge diagnoses were tabulated. Excess admissions for pneumonia by week during the influenza seasons beginning 2001-03 were determined and compared. Trends in admissions from the 2003-04 season were compared with trends from laboratory and sentinel physician surveillance. A total of 57 admissions for fever and rash illness were reported from 32 acute-care hospitals and verified for an incidence of 1.7 per 100,000 population. Specific clinical diagnoses were made for 29. Many were compatible with the initial clinical presentation of smallpox. Excess admissions for pneumonia during the 2003-04 season occurred concurrently with sharp increases in positive laboratory reports and percentages of visits to physician's offices attributed to influenza-like illness. The 2003-04 influenza season had many more excess admissions than the 2001-02 and 2002-03 seasons. HASS is a useful surveillance tool for rapid detection of sentinel cases of smallpox. Monitoring excess pneumonia admissions during the influenza season appears to be an effective and specific method for determining levels of influenza activity and for quantification of influenza-related morbidity and impact on the hospital system.

West Nile virus (WNV) can cause large outbreaks of febrile illness and severe neurologic disease. This study estimates the seroprevalence of WNV infection and assesses risk perception and practices regarding potential exposures to mosquitoes of persons in an area with intense epizootics in 1999 and 2000. A serosurvey of persons aged ≥12 years was conducted in southwestern Connecticut during October 10‐15, 2000, using household‐based stratified cluster sampling. Participants completed a questionnaire regarding concern for and personal measures taken with respect to WNV and provided a blood sample for WNV testing. Seven hundred thirty persons from 645 households participated. No person tested positive for WNV (95% CI: 0‐0.5%). Overall, 44% of persons used mosquito repellent, 56% practiced ≥ two personal precautions to avoid mosquitoes, and 61% of households did ≥ two mosquito‐ source reduction activities. In multivariate analyses, using mosquito repellent was associated with age P <0.05). Females (OR = 2.0; CI = 1.2‐2.9) and persons very worried about WNV (OR = 3.8; CI = 2.2‐6.5) were more likely to practice ≥ two personal precautions. Taking ≥ two mosquito source reductions was associated with persons with English as the primary language (OR = 2.0; CI = 1.1‐3.5) and finding a dead bird on the property (OR = 1.8; CI = 1.1‐2.8). An intense epizootic can occur in an area without having a high risk for infection to humans. A better understanding of why certain people do not take personal protective measures, especially among those aged ≥50 years and those whose primary language is not English, might be needed if educational campaigns are to prevent future WNV outbreaks.

This study retrospectively analyzed the magnitude and epidemiology of community-onset Staphylococcus aureus (COSA) infections and methicillin-resista

In 1999, Connecticut was one of three states in which West Nile (WN) virus actively circulated prior to its recognition. In 2000, prospective surveillance was established, including monitoring bird deaths, testing dead crows, trapping and testing mosquitoes, testing horses and hospitalized humans with neurologic illness, and conducting a human seroprevalence survey. WN virus was first detected in a dead crow found on July 5 in Fairfield County. Ultimately, 1,095 dead crows, 14 mosquito pools, 7 horses, and one mildly symptomatic person were documented with WN virus infection. None of 86 hospitalized persons with neurologic illness (meningitis, encephalitis, Guillain-Barré-like syndrome) and no person in the seroprevalence survey were infected. Spraying in response to positive surveillance findings was minimal. An intense epizootic of WN virus can occur without having an outbreak of severe human disease in the absence of emergency adult mosquito management.