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1.  National trends in emergency department use of urinalysis, complete blood count, and blood culture for fever without a source among children ages 2–24 months in the PCV-7 era 
Pediatric emergency care  2013;29(5):560-567.
The epidemiology of serious bacterial infections (SBI) in children has changed since the introduction of the pneumococcal conjugate vaccine (PCV-7) in 2000. Whether Emergency Department (ED) physicians have changed diagnostic approaches to fever without source (FWS) in response is unknown. We examine trends in rates of complete blood counts (CBC), urinalyses (UA), and blood cultures among 2–24 month old children with FWS since the introduction of PCV-7.
The National Hospital Ambulatory Medical Care Survey-ED, 2001–2009 was used to identify visits to the ED by 2–24 month old children with FWS. Rates of CBC, UA, neither CBC nor UA, and blood culture were tracked across time. Trends were identified using Joinpoint regression, bivariate, and multivariate logistic regressions with year as the independent variable and ordering of each test as dependent variables.
In bivariate and multivariate analysis, CBC orders declined between 2004 and 2009 for visits by all children 2–24 months, children 2–11 months, and boys 2–24 months (adjusted OR (aOR): 0.88 per year, p<0.01; aOR: 0.88, p<0.05; and aOR: 0.83, p<0.01, respectively). Between 2004 and 2009 ordering neither CBC nor UA increased among all children 2–24 months (aOR: 1.10, p<0.05) and among boys (aOR=1.16, p<0.05). Orders for blood cultures declined across the time period in bivariate, but not multivariate analysis.
The rate of ordering a CBC for children in the 2–24 month age group presenting to the ED with FWS declined, a change coincident with the changing epidemiology of SBI since the PCV-7 vaccine was introduced.
PMCID: PMC3644309  PMID: 23603643
fever; pcv-7; emergency department; testing
2.  Antimicrobial Postexposure Prophylaxis for Anthrax: Adverse Events and Adherence 
Emerging Infectious Diseases  2002;8(10):1124-1132.
We collected data during postexposure antimicrobial prophylaxis campaigns and from a prophylaxis program evaluation 60 days after start of antimicrobial prophylaxis involving persons from six U.S. sites where Bacillus anthracis exposures occurred. Adverse events associated with antimicrobial prophylaxis to prevent anthrax were commonly reported, but hospitalizations and serious adverse events as defined by Food and Drug Administration criteria were rare. Overall adherence during 60 days of antimicrobial prophylaxis was poor (44%), ranging from 21% of persons exposed in the Morgan postal facility in New York City to 64% of persons exposed at the Brentwood postal facility in Washington, D.C. Adherence was highest among participants in an investigational new drug protocol to receive additional antibiotics with or without anthrax vaccine—a likely surrogate for anthrax risk perception. Adherence of <60 days was not consistently associated with adverse events.
PMCID: PMC2730317  PMID: 12396927
Anthrax; Bacillus anthracis; antimicrobial prophylaxis; adverse events; adherence
3.  The Public Health Response and Epidemiologic Investigation Related to the Opening of a Bacillus anthracis–Containing Envelope, Capitol Hill, Washington, D.C. 
Emerging Infectious Diseases  2002;8(10):1039-1043.
On October 15, 2001, a U.S. Senate staff member opened an envelope containing Bacillus anthracis spores. Chemoprophylaxis was promptly initiated and nasal swabs obtained for all persons in the immediate area. An epidemiologic investigation was conducted to define exposure areas and identify persons who should receive prolonged chemoprophylaxis, based on their exposure risk. Persons immediately exposed to B. anthracis spores were interviewed; records were reviewed to identify additional persons in this area. Persons with positive nasal swabs had repeat swabs and serial serologic evaluation to measure antibodies to B. anthracis protective antigen (anti-PA). A total of 625 persons were identified as requiring prolonged chemoprophylaxis; 28 had positive nasal swabs. Repeat nasal swabs were negative at 7 days; none had developed anti-PA antibodies by 42 days after exposure. Early nasal swab testing is a useful epidemiologic tool to assess risk of exposure to aerosolized B. anthracis. Early, wide chemoprophylaxis may have averted an outbreak of anthrax in this population.
PMCID: PMC2730304  PMID: 12396912
Bacillus anthracis; nasal swabs; epidemiology; bioterrorism; postexposure prophylaxis

Results 1-3 (3)