MMWR

Morbidity and Mortality Weekly Report

Malaria in Refugees from Tanzania – King County, Washington, 2007

PRESS CONTACT: Division of Media Relations
(404) 639-3286

It is important that health care providers who care for recently arrived refugee populations from malaria-endemic areas remain vigilant regarding the possibility of malaria, even among persons previously treated for malaria prior to resettlement. This report describes three cases of Plasmodium falciparum malaria and two cases of P. ovale malaria in Burundian refugees from Tanzania that occurred during June 27–October 15, 2007 in King County, Washington. Since 2005, CDC has recommended presumptive falciparum malaria treatment with artemisinin-based combination therapy (ACT; e.g., artemether-lumefantrine) for refugees from sub-Saharan Africa before their departure for the United States. In Tanzania, predeparture administration of presumptive ACT for refugees started in July 2007. Even with documented predeparture ACT, two of the P. falciparum cases in this report were diagnosed with malaria soon after arrival. This underscores the importance of provider awareness of malaria in this patient population, even when there is a prior history of treatment.

Survey of Laboratory Syphilis Testing Algorithms Using Treponemal Screening Tests – Four Sites, New York City, 2005-2006

PRESS CONTACT: National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
(404) 639-8895

The Centers for Disease Control and Prevention (CDC) studied four New York City labs that were using a new syphilis screening test and found that about 3 percent of those screened with a new testing sequence received results that were not seen with earlier screening methods. In the United States, syphilis screening traditionally consists of first administering a non-treponemal test. If that specimen is reactive, a confirmatory treponemal test is then administered. If both are reactive, the results indicate a past or present infection. However, some labs are now reversing the order of the tests and administering a treponemal test first, followed, if reactive, by a non-treponemal test. Using the new approach, some persons are testing reactive to a treponemal test, but non-reactive to a non-treponemal test. Since these results were not seen with the traditional testing approach, there are no formal recommendations about how such results should be interpreted or how patients should be managed. Health care professionals who receive such results should determine if the person has been treated for syphilis in the past. If they have not, a second treponemal test should be done. If that test is reactive, most should be treated for late latent syphilis.

Clarification of Infection-Control Requirements for Dialysis Facilities and Guidance on Parenteral Medication Vials

PRESS CONTACT: Division of Media Relations
(404) 639-3286

In dialysis and other healthcare settings, injected medications that are labeled for single-use should be used one time for one patient only. To avoid contamination and potential spread of infection in dialysis settings, medications and solutions must be handled using proper infection control precautions as described in CDC guidelines and now mandated through the new CMS Conditions for Coverage. This includes injection preparation using only new sterile needles/syringes in a clean area separate from patient treatment areas and contaminated items. Beginning in October 2008, outpatient dialysis facilities will be required by the Centers for Medicare and Medicaid Services (CMS) to follow CDC infection control guidelines that pertain to hemodialysis settings. These guidelines include recommendations for correct handling and use of injected medications. To prevent transmission of both bacteria and bloodborne viruses in hemodialysis settings, all injectable medications labeled as “single-use” should be used for one patient and be entered one time only. Medications packaged as multidose should be assigned to a single patient whenever possible. All parenteral medications should be prepared using sterile injection equipment in a clean area that is removed from the patient treatment area and separate from potentially contaminated items and surfaces.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES