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NEJM — Collection Updates for Infectious Diseases

BOOK REVIEW:
Laboratory medicine has no more urgent role than in the diagnosis and management of infections in immunocompromised patients. For this vulnerable population, clinical algorithms are logically rooted in the need...
ORIGINAL ARTICLE: Evaluation of Universal Antenatal Screening for Group B Streptococcus
Melissa K. Van Dyke, Ph.D., Christina R. Phares, Ph.D., Ruth Lynfield, M.D., Ann R. Thomas, M.D., Kathryn E. Arnold, M.D., Allen S. Craig, M.D., Janet Mohle-Boetani, M.D., Ken Gershman, M.D., William Schaffner, M.D., Susan Petit, M.P.H., Shelley M. Zansky, Ph.D., Craig A. Morin, M.P.H., Nancy L. Spina, M.P.H., Kathryn Wymore, M.P.H., Lee H. Harrison, M.D., Kathleen A. Shutt, M.S., Joseph Bareta, M.P.H., Sandra N. Bulens, M.P.H., Elizabeth R. Zell, M.Stat., Anne Schuchat, M.D., and Stephanie J. Schrag, D.Phil.Background: Group B streptococcal disease is one of the most common infections in the first week after birth. In 2002, national guidelines recommended universal late antenatal screening of pregnant women...
IMAGES IN CLINICAL MEDICINE: Biliary Stones
Ping-Hsien Chen, M.D. and Chiao-Hsiung Chuang, M.D.A 63-year-old woman presented with a 2-day history of fever, abdominal pain, and vomiting. There was no history of previous episodes. Physical examination revealed fever and moderate abdominal tenderness in...

Centers for Disease Control and Prevention

CDC Recommends Shingles Vaccine
People age 60 and older should be vaccinated against shingles, or herpes zoster, a condition often marked by debilitating chronic pain...
New CDC Study Finds Arthritis Can be a Barrier for Adults Seeking to Manage Diabetes through Physical Activity
More than half of adults with diagnosed diabetes also have arthritis, a painful condition that can be a barrier to physical activity—an important health strategy for managing diabetes...
Falls a Leading Cause of Injury-Related Emergency Department Visits for Infants Each Year, CDC Study Shows
Half of the estimated 328,500 infants 12 months of age or younger who were treated for injuries in hospital emergency departments each year from 2001 to 2004 were injured as a result of a fall, according to a study by the Centers for Disease Control and Prevention.

BMC Infectious Diseases - Latest Articles

Use of a T cell interferon gamma release assay in the investigation for suspected active tuberculosis in a low prevalence area
Niclas WinqvistPer BjorkmanAnn NorenHakan Miorner Fri, 03 Jul 2009 00:00:00 -0000
Background: In settings with low background prevalence of tuberculosis (TB) infection, interferon-gamma release assays (IGRA) could be useful for diagnosing active TB. This study aims to evaluate the performance of QuantiFERON(R)-TB Gold (QFT-G) in the investigation for suspected active TB, with particular attention to patients originating in high-incidence countries. Furthermore, factors associated with QFT-G results in patients with active TB were assessed. Methods: From patients investigated for clinically suspected active TB, blood was obtained for QFT-G testing, in addition to routine investigations. Positive (PPV) and negative (NPV) predictive values for QFT-G were calculated, comparing patients with confirmed TB and those with other final diagnoses. QFT-G results in TB patients originating from countries with intermediate or high TB incidence were compared with QFT-G results from a control group of recently arrived asymptomatic immigrants from high-incidence countries. Factors associated with QFT-G outcome in patients with confirmed TB were assessed. Results: Among 141 patients, 41/70 (58.6%) with confirmed TB had a positive QFT-G test, compared to 16/71 (22.6%) patients with other final diagnoses, resulting in overall PPV of 71.9% and NPV of 67.6%. For patients with pulmonary disease, PPV and NPV were 61.1% and 67.7%, respectively, and 90.5% and 66.7% for subjects with extrapulmonary manifestations. Comparing patients from high-incidence countries with controls yielded a PPV for active TB of 76.7%, and a NPV of 82.7%. Patients with confirmed TB and positive QFT-G results were characterized by a lower median peripheral white blood cell count (5.9E9/L vs. 8.8E9/L; P<0.001) and a higher median body mass index (22.7 vs. 20.7; P=0.043) as compared to QFT-G-negative TB patients. Conclusions: The overall PPV and NPV of QFT-G for identifying active TB were unsatisfactory, especially for pulmonary disease. Thus, the usefulness of QFT-G for this purpose is questionable. However, a high PPV was observed for extrapulmonary TB and QFT-G might be considered in the diagnostic process in this situation. The PPV and NPV for identifying active TB among persons originating from regions with high-and intermediate TB incidence was similar to that observed in subjects originating in the low-incidence region.
Role of pathogenic oral flora in postoperative pneumonia following brain surgery
Kinga BagyiAngela HaczkuIldiko MartonJudit SzaboAttila GasparMelinda AndrasiImre VargaJudit TothAlmos Klekner Mon, 29 Jun 2009 00:00:00 -0000
Background: Post-operative pulmonary infection often appears to result from aspiration of pathogens colonizing the oral cavity. It was hypothesized that impaired periodontal status and pathogenic oral bacteria significantly contribute to development of aspiration pneumonia following neurosurgical operations. Further, the prophylactic effects of a single dose preoperative cefazolin on the oral bacteria were investigated. Methods: A matched cohort of 18 patients without postoperative lung complications was compared to 5 patients who developed pneumonia within 48 hours after brain surgery. Patients waiting for elective operation of a single brain tumor underwent dental examination and saliva collection before surgery. Bacteria from saliva cultures were isolated and periodontal disease was scored according to type and severity. Patients received 15 mg/kg cefazolin intravenously at the beginning of surgery. Serum, saliva and bronchial secretion were collected promptly after the operation. The minimal inhibitory concentrations of cefazolin regarding the isolated bacteria were determined. The actual antibiotic concentrations in serum, saliva and bronchial secretion were measured by capillary electrophoresis upon completion of surgery. Bacteria were isolated again from the sputum of postoperative pneumonia patients. Results: The number and severity of coexisting periodontal diseases were significantly greater in patients with postoperative pneumonia in comparison to the control group (p=0.031 and p=0.002, respectively). The relative risk of developing postoperative pneumonia in high periodontal score patients was 3.5 greater than in patients who had low periodontal score (p<0.0001). Cefazolin concentration in saliva and bronchial secretion remained below detectable levels in every patient. Conclusions: Presence of multiple periodontal diseases and pathogenic bacteria in the saliva are important predisposing factors of postoperative aspiration pneumonia in patients after brain surgery. The low penetration rate of cefazolin into the saliva indicates that its prophylactic administration may not be sufficient to prevent postoperative aspiration pneumonia. Our study suggests that dental examination may be warranted in order to identify patients at high risk of developing postoperative respiratory infections.
Truncation in the tcdC region of the Clostridium difficile PathLoc of clinical isolates does not predict increased biological activity of Toxin B or Toxin A.
Ruth MurrayDave BoydMichael MulveyPaul LevettMichelle Alfa Sun, 28 Jun 2009 00:00:00 -0000
Background: The increased severity of disease associated with the NAP1 strain of Clostridium difficile has been attributed to mutations to the tcdC gene which codes for a negative regulator of toxin production. To assess the role of hyper-production of Toxins A and B in clinical isolates of Clostridium difficile, two NAP1-related and five NAP1 non-related strains were compared. Methods: Sequencing was performed on tcdC, tcdR, and tcdE to determine if there were differences that might account for hyper-production of Toxin A and Toxin B in NAP1-related strains. Biological activity of Toxin B was evaluated using the HFF cell CPE assay and Toxin A biological activity was assessed using the Caco-2 Trans-membrane resistance assay. Results: Our results confirm that Toxin A and Toxin B production in NAP1-related strains and ATCC 43255 occurs earlier in the exponential growth phase compared to most NAP1-nonrelated clinical isolates. Despite the hyper-production observed in ATCC 43255 it had no mutations in tcdC, tcdR or tcdE. Analysis of the other clinical isolates indicated that the kinetics and ultimate final concentration of Toxin A and B did not correlate with the presence or lack of alterations in tcdC, tcdR or tcdE. Conclusions: Our data do not support a direct role for alterations in the tcdC gene as a predictor of hyperproduction of Toxin A and B in NAP1-related strains.
Outbreaks of Streptococcus pneumoniae carriage in day care cohorts in Finland - implications for elimination of transmission
Fabian HotiPanu ErastoTuija LeinoKari Auranen Sat, 27 Jun 2009 00:00:00 -0000
Background: Day care centre (DCC) attendees play a central role in maintaining the circulation of Streptococcus pneumoniae (pneumococcus) in the population. Exposure within families and within DCCs are the main risk factors for colonisation with pneumococcal serotypes in DCC attendees. Methods: Transmission of serotype specific carriage was analysed with a continuous time event history model, based on longitudinal data from day care attendees and their family members. Rates of acquisition, conditional on exposure, were estimated in a Bayesian framework utilising latent processes of carriage. To ensure a correct level of exposure, non-participating day care attendees and their family members were included in the analysis. Posterior predictive simulations were used to quantify transmission patterns within day care cohorts, to estimate the basic reproduction number for pneumococcal carriage in a population of day care cohorts, and to assess the critical vaccine efficacy against carriage to eliminate pneumococcal transmission. Results: The model, validated by posterior predictive sampling, was successful in capturing the strong temporal clustering of pneumococcal serotypes in the day care cohorts. In average 2.7 new outbreaks of pneumococcal carriage initiate in a day care cohort each month. While 39% of outbreaks were of size one, the mean outbreak size was 7.6 individuals and the mean length of an outbreak was 2.8 months. The role of families in creating and maintaining transmission was minimal, as only 10% of acquisitions in day care attendees were from family members. Considering a population of day care cohorts, a child-to-child basic reproduction number was estimated as 1.4 and the critical vaccine efficacy against acquisition of carriage as 0.3. Conclusions: Pneumococcal transmission occurs in serotype specific outbreaks of carriage, driven by within-day-care transmission and between-serotype competition. An amplifying effect of the day care cohorts enhances the spread of pneumococcal serotypes within the population. The effect of vaccination, in addition to reducing susceptibility to pneumococcal carriage in the vaccinated, induces a herd effect, thus creating a counter-effect to the amplifying effect of the cohort. Consequently, the critical vaccine efficacy against carriage, required for elimination of transmission, is relatively low. Use of pneumococcal conjugate vaccines is expected to induce a notable herd protection against pneumococcal disease.
Tularemia induces different biochemical responses in BALB/c mice and common voles
Hana BandouchovaJana SedlackovaMiroslav PohankaLadislav NovotnyMartin HubalekFrantisek TremlFrantisek VitulaJiri Pikula Fri, 26 Jun 2009 00:00:00 -0000
Background: Both BALB/c mice and common voles (Microtus arvalis) are considered highly susceptible to tularemia. However, the common vole is reported to harbour Francisella tularensis in European habitats as well as to survive longer with chronic shedding of the bacterium. The purpose of the present study was to compare the response of these two rodents to a wild Francisella tularensis subsp. holarctica strain infection. Methods: Rodents were evaluated for differences in the total antioxidant capacity derived from lowmolecular-weight antioxidants, biochemistry including lipid metabolism, tissue bacterial burdens and histopathology following experimental intraperitoneal infection with 160 colony forming units (CFU) pro toto. Results: Bacterial burdens in common voles started to develop later post-exposure and amounted to lower levels than in BALB/c mice. Elevation of liver function enzymes was more pronounced in mice than common voles and there were marked differences in lipid metabolism in the course of tularemia in these two species. Hypertriglyceridemia and hypercholesterolemia developed in mice, while physiologically higher levels of triglycerides and cholesterol showed a decreasing tendency in common voles. On the other hand, the total plasma antioxidant capacity gradually dropped to 81.5% in mice on day 5 post-infection, while it increased to 130% on day 6 post-infection in common voles. Significant correlations between tissue bacterial burdens and several biochemical parameters were found. Conclusions: As differences in lipid metabolism and the total antioxidant capacity of highly susceptiblerodent species were demonstrated, the role of triglycerides, cholesterol and antioxidants intularemic sepsis should be further investigated.
Allergic sensitisation in tuberculosis patients at the time of diagnosis and following chemotherapy
Linda EllertsenDag StorlaLien DiepKarl BrokstadHarald WikerGeir Hetland Fri, 26 Jun 2009 00:00:00 -0000
Background: It is still a matter of debate whether there is an association between infection with Mycobacterium tuberculosis (M. tuberculosis) and allergy. Previously, we have shown higher levels of specific IgE to different inhalant allergens and total IgE in tuberculosis (TB) patients compared to controls. The objectives of this study were to evaluate a possible change in allergic sensitisation after successful TB treatment and to confirm the finding of our previous study of enhanced allergic sensitisation in TB patients compared to controls in a more controlled setting. Additionally, we wanted to determine the cytokine profile in the same groups and finally to evaluate the association between Bacillus Calmette-Guerin vaccination (BCG) scar and allergic sensitisation among the controls. Methods: Sera were analysed for specific IgE to inhalant allergens (Phadiatop) and total IgE by the use of ImmunoCAP 1000 (Pharmacia Diagnostics). Thirteen different cytokines were also analysed in the sera by multiplex bead immunoassay (Luminex 100, Luminex Corporation), and clinical symptoms of allergy and BCG scar were reported in a questionnaire. Results: A reduction in levels of specific and total IgE were observed after successful TB treatment. TB patients also had higher levels of specific and total IgE compared to healthy controls. Both interleukin (IL)-6 and interferon (IFN)gamma were higher in tuberculosis patients compared to healthy controls. The levels of IL-6 were reduced after successful tuberculosis treatment. The presence of a BCG scar was associated with a reduced risk of developing allergic sensitisation. Conclusions: We observed a reduced level of allergic sensitisation after successful TB treatment. TB patients seem to be more allergically sensitised than healthy controls confirming our previous finding. Furthermore, we observed an inverse association between allergic sensitisation and visible BCG scar, which adds additional support to the hygiene hypothesis.

 

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CDC: West Nile Virus - Describes the entomology, and gives details of the NYC area outbreak, as well as providing background information on surveillance, control, and prevention.
Meta Description: [ The West Nile Virus Home Page of the U.S. Centers for Disease Control and Prevention (CDC), an agency of the U.S. government. ]

National Pesticide Information Center: West Nile Virus - Features disease information, links, statistics, and maps.

Alabama: West Nile Virus - Information about the disease in the state.

404 Alberta Health and Wellness: West Nile Virus - Features prevention tips and disease information.

American Academy of Pediatrics: West Nile Virus Information - History and prevention of the disease.

amp; Human Services - West Nile Virus in Montana - Features fact sheet and information on the disease in the state.

Annals of Internal Medicine: West Nile Virus: A Primer for the Clinician - Provides doctors with information on the diagnosis, reporting, and management of patients with suspected West Nile virus infection.

Arbovirus Information Web Site - Arbovirus Information for Massachusetts, includes hotline, daily mosquito and bird update, news releases, and fact sheets.
Meta Description: [ West Nile Virus Information Web Site Homepage ]

Are Crows the New Plague Carriers? - Discussed the connection between the West Nile virus and large-scale deaths of crows. Concludes that horses and migratory birds are the main vectors for spread of the disease.

Arizona: West Nile Virus Surveillance and Prevention - Includes facts about the disease and the prevention program in the state.

Association for Professionals in Infection Control and Epidemiology: West Nile Virus - History of the disease, articles, and links.
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BBC News: Killer virus 'may have reached UK' - News article on the disease.
Meta Description: [ The West Nile virus, which has killed more than 188 people in the US so far this year, may be present in UK birds, say scientists. ]

California West Nile Virus Surveillance Information Center - Information on the disease and prevention of the disease in the state.
Meta Description: [ The website for West Nile Virus education, statistics, and dead bird reporting for California. ]

CBC News - West Nile Virus - Discussion of the spread of the disease in Canada. Includes information on patients, blood screening, tests, and prevention, as well as provincial statistics and media clips.
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CDC - West Nile Virus in Mexico: Evidence of Widespread Circulation since July 2002 - Article on the disease's spread in Mexico.

Chicago Department of Public Health: West Nile Virus - Features press releases, fact sheet, mosquito control information, and treatment areas.

Colorado West Nile Virus Information - From the Colorado Department of Public Health and Environment. Press releases and information about the disease in the state.
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Cornell West Nile Virus Bibliography of Scientific Literature - Bibliography, including links, of scientific articles related to the West Nile Virus.

District of Columbia Department of Health: West Nile Virus - Features disease information, mosquito control measures, brochures, and information for clinicians.

eMedicinehealth - West Nile Virus - Dr. David Donson offers a report on the symptoms of West Nile virus infection such as flulike fever, encephalitis, and meningitis. Includes information on emergency care and mosquito bite prevention tips.
Meta Description: [ West Nile virus is transmitted to humans by a mosquito bite. The virus can cause encephalitis (inflammation of the brain) or meningitis (inflammation of the lining of the brain and ... ]

European Commission Public Health: West Nile Virus - Features disease information, outbreaks, press releases, publications, projects, and documents.
Meta Description: [ European Commission - Public Health, West Nile virus (WNV) has been recognised since 1937 when it was first isolated in Uganda. ]

Florida Department of Agriculture and Consumer Services West Nile Virus Information - Press releases, FAQs, emergency management plan, resources for virus information, and contacts.
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Florida State Arboviral Encephalitis and West Nile Virus Information - Information for physicians, maps of locations, press releases, and how to report incidences of the diseases.
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Food and Drug Administration: West Nile Virus - Features information about the possibility of the virus being in blood products, plus other fact sheets and links.
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Georgia Department of Public Health - Vector-borne Diseases - Information on West Nile virus and other mosquito borne diseases in the state.

Hawaii: West Nile Virus Information Center - Includes disease information, brochures, FAQ, and notice to clinicians.

Idaho West Nile Virus - Idaho Department of Health and Welfare, Communicable Disease Prevention. General information and prevention measures.
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Illinois Department of Public Health: West Nile Virus - Information about the disease in the state, including news releases, surveillance information, and public education.

Indiana State Department of Health: West Nile Virus - Features news releases, links, maps, and references. In English and Spanish.

Inside Illinois: UI lab confirms first cases of West Nile in canines, squirrels - News report of the confirmation of fatal cases of the diease in squirrels, a wolf, and a dog.

Iowa West Nile Virus Surveillance and Dead Bird Submission - Includes map and newsletter for health care providers.
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Kansas Epidemiologic Services: West Nile Virus - Includes fact sheets, news releases, and links.
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Kentucky Department for Public Health: West Nile Virus - Information about the disease and mosquito control information.

Kids and the West Nile Virus - Risk and symptoms of the disease in children.
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Kidshealth: West Nile Virus - Factsheets with cause, symptoms, and prevention.
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le Virus - Features press releases, surveillance, hotline, and educational materials.

Louisiana OPH - Infectious Disease Epidemiology Program: West Nile Virus and Other Arboviruses - Surveillance for West Nile Virus was initiated in Louisiana in 2000, sentinels include 16 hospital emergency rooms, chicken flocks, mosquitoes, horses, and birds.

404 Maine West Nile Virus Home - West Nile Virus information page for the state of Maine.
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MayoClinic.com - West Nile Virus - Features signs and symptoms, diagnosis, treatment, and prevention.
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MedlinePlus Medical Encyclopedia: West Nile Virus - Includes cause, risk factors, prognosis, diagnosis, complications, tests, and prevention.

MEDLINEplus: West Nile Virus - Features news stories and links.
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Minnesota Department of Health : West Nile Virus and Other Mosquito-Transmitted Diseases - Features maps, fact sheets, links, and information about the disease in the state.

Mississippi State Department Of Health: West Nile Virus - Information, news releases and forms.
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National Audubon Society: West Nile Virus - Information on the disease and its effects on humans and birds.

National Biological Information Infrastructure : West Nile Virus - Provides data, information, and maps related to outbreaks of the West Nile virus and mosquito-borne encephalitis in the United States.
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National Safety Council Fact Sheet : West Nile Virus - Includes information about the disease and the mosquitoes that carry it.
Meta Description: [ The West Nile Virus is primarily a disease of birds. It is commonly found in Africa, West Asia, and the Middle East, but has also caused outbreaks in Europe. In humans, it can cause encephalitis, an infection of the brain. West Nile Virus is similar to the virus that causes St. Louis enceph... ]

Nebraska HHS System: West Nile Virus Surveillance Program - Includes fact sheets, surveillance information and forms, and links.

404 Nevada: West Nile Virus - General information on the disease and brochures.
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New Hampshire: West Nile Virus - General overview-history of West Nile virus, prevention, treatment, reporting processes and forms, and test results.
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New Jersey Department of Health and Senior Services, West Nile Virus - Features articles, news stories, and fact sheet.
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404 New Mexico Department of Health: West Nile Virus - Includes updates on the virus in the state and brochures on the disease.

New Scientist: Traces of West Nile virus found in UK birds - First reported confirmation of antibodies to the disease in UK birds.
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New York City Department of Health - West Nile Virus - Information, fact sheets, reporting forms and local news related to the West Nile Virus in the New York City area.

New York Hospital Queens - Provides information about the investigational treatment protocol for West Nile Virus employing alpha interferon.
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New York State Department of Health: West Nile Virus - Features information on the disease in the state, journalist's guide to the West Nile Virus, and fact sheet for healthcare providers.
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North Carolina: West Nile Virus - Information and reports on the disease in the state.

North Dakota Arbovirus Encephalitis Surveillance Program - West Nile surveillance information for the state.

Ohio West Nile Virus - Information about the diease in the state.

On Watch for West Nile Virus in Oklahoma - Feature fact sheets, surveillance reports, and dead bird reporting information.
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Ontario Ministry of Health and Long-Term Care: West Nile Virus - Includes publications and surveillance activities.

Oregon Public Health Services : West Nile Virus - Includes fact sheets and reporting information on the disease in the state.
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Pennsylvania: West Nile Virus - News releases and information about the disease in the state.

Postgraduate Medicine: West Nile Virus Infection - Medical and scientific article on the virus and disease.

Research on West Nile Virus - National Institute of Allergy and Infectious Diseases fact sheet.

Rhode Island: West Nile Virus - Links and information about the disease and mosquito control in the state.

South Carolina: West Nile Virus - Information and resources on the disease in the state.

South Dakota Department of Health: West Nile Virus - Information about the disease in the state, links, and fact sheets.
Meta Description: [ This site explains what West Nile Virus is, how it is transmitted, and how it can be prevented. It provides surveillance information about human West Nile Virus cases in South Dakota along with bird, horse, and mosquito pool detection. It includes links to other useful sites. ]

State and Local Government Sites - West Nile Virus - Links to official sites, including how to report dead birds.
Meta Description: [ The West Nile Virus Home Page of the U.S. Centers for Disease Control and Prevention (CDC), an agency of the U.S. government. ]

404 Tennessee: West Nile Virus - Features fact sheets, disease and vector information, and surveillance information.

Texas Department of Health Zoonosis Control Division - West Nile Virus - Information about the disease in humans, horses, and birds in Texas. Includes maps, statistics, news releases, and fact sheets about the disease.
Meta Description: [ First page for West Nile Virus in Texas ]

404 TheHorse.com: West Nile Virus - Information and articles about the disease and its effects on horses and humans.
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US Department of Agriculture: West Nile Virus - Information on the current status of this disease and its prevention and control in horses, poultry, and other livestock.

USA Today: 21 West Nile deaths reported in Illinois in worst outbreak in the country - News article about the human cases of the disease in the Chicago area, plus links to other stories concerning the disease.
Meta Description: [ Bob Meisenheimer liked to sit in his back yard with friends on sultry summer nights, wearing a T-shirt and trying to solve the world's problems. The one that killed him West Nile virus has authorities scrambling for answers. ]

Utah: West Nile Virus - Includes fact sheets, press releases, and information about the disease in the state.
Meta Description: [ Utah Department of Health West Nile Virus Information ]

404 Vermont Department of Health: West Nile Virus Information - Includes fact sheet, news releases, and state surveillance and response plan.

404 Virginia Department of Health: West Nile Virus - Includes reporting information, prevention tips, and surveillance information in the state.

Vitritis and Chorioretinitis in a Patient With West Nile Virus Infection - Abstract of Archives of Ophthalmology article about a patient presenting with floaters and other eye problems.
Meta Description: [ Archives of Ophthalmology is a monthly professional medical journal published by the American Medical Association. Archives of Ophthalmology publishes peer-reviewed, original articles on such topics as epidemiology and biostatistics, mechanisms of ophthalmic disease, ophthalmic molecular genetics... ]

Washington State Department of Health: West Nile Virus - Includes press releases, FAQ, and brochures.
Meta Description: [ The Washington State Department of Health's West Nile Virus website is a great resource of information on West Nile virus intended for the general public, health care providers, veterinarians, local health departments, and mosquito control districts. ]

washingtonpost.com: West Nile Virus - Archive of news stories about the disease in birds, horses, and people, with emphasis on the Washington, DC metropolitan area.

West Nile Fever.com - Fact sheet, tips for prevention, symptoms and care, West Nile Hotlines and spray schedules.
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West Nile Fever: A Medical Detective Story - The story behind the discovery and identification of West Nile Virus during its initial 1999 outbreak in NYC.

404 West Nile Virus - Background information for journalists covering the topic.
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West Nile Virus - Fact sheets and advisories from the US Geological Survey as well as link to additional information.

West Nile Virus - Policies, research, fact sheets, and other West Nile Virus information from the Department Of Defense Deployment Health Clinical Center.
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West Nile Virus - Reports on West Nile Virus, press releases, educational resources, and test specimen collection contact information.
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West Nile Virus - Vads Corner - Features links to information about the disease, with the focus on news links.

West Nile Virus and Bird Surveillance Program in Kansas - Offers information on the status of West Nile Virus in Kansas, gives information on how to report a dead bird, and provides links to additional sites for information on west nile virus in North America.
Meta Description: [ West Nile Virus Surveillance program in Kansas, reporting on the status of mosquito trapping, reports of dead birds and blood sampling from around the state ]

West Nile Virus Information - West Nile Virus information and resources from the Maryland Department of Health and Mental Hygiene.
Meta Description: [ What is West Nile encephalitis? West Nile Virus: Questions and Answers from the Centers for Disease Control and Prevention ]

500 West Nile Virus Information Page - From Virginia Tech University. Links and articles.

West Nile Virus Maps - nationalatlas.gov - Maps showing west nile virus distribution from 2002 - 2004.
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West Nile Virus Moves Into Wisconsin - Information from the Medical College of Wisconsin, stressing that no human cases have been found in the state, and recommending mosquito protection.
Meta Description: [ West Nile Virus has been introduced to Wisconsin, and apparently it’s here to stay. ]

West Nile Virus Response Manual - A free stat manual for the identification, management and treatment of the West Nile Virus.

West Nile Virus Surveillance Information - Bureau of Infectious Diseases - PPHB - Health Canada - Information about the disease and the efforts in Canada to detect it.
Meta Description: [ The Public Health Agency of Canada’s Centre for Infectious Disease Prevention and Control (CIDPC) and National Microbiology Laboratory produce weekly or biweekly West Nile Virus MONITOR reports, summarizing West Nile virus surveillance activities in Canada. ]

West Virginia: West Nile Virus - Brochures and information about the disease in the state.

Wisconsin: West Nile Virus - Includes news releases, state statistics, surveillance, and brochures.

Wyoming West Nile Virus Information - Includes news releases, surveillance information in the state, forms, and fact sheet.