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Changes in antibiotic-prescribing practices and carriage of penicillin-resistant Streptococcus pneumoniae: A controlled intervention trial in rural Alaska.

From 1998 to 2000, 13 rural Alaskan villages (population, 3326) were surveyed annually by nasopharyngeal cultures for Streptococcus pneumoniae carriage. Data regarding antibiotic use for the entire population was abstracted from clinic records. In 1999, education of medical providers and the community about appropriate antibiotic use began in 4 villages; this program was expanded to include all villages in 2000. Antibiotic courses per person decreased by 31% in the initial intervention villages and by 35% in the remaining villages after education (P<.01 for each). Samples were obtained for culture from a mean of 31% of the population each year; 31% carried pneumococcus. No sustained decrease in carriage of penicillin-nonsusceptible strains was observed. When linear regression was used, serotype accounted for 81% of the variance in pneumococcal minimum inhibitory concentrations after the intervention, compared with 7% for antibiotic use. This suggests that reducing the carriage of serotypes associated with antibiotic resistance by use of pneumococcal conjugate vaccines may have a greater short-term impact than does decreasing antibiotic use.

Alaska↗

Detection of immunoglobulin M antibody to hepatitis A virus in Alaska residents without other evidence of hepatitis.

During a 38-month period, 13 of 41 persons with test results positive for IgM antibody to hepatitis A virus did not meet the case definition for hepatitis A or have a clear indication for testing, which suggests that test results were falsely positive. No single testing platform or kit was used. Health care providers should restrict serologic testing for hepatitis A to patients with clinical or epidemiologic indications.

Adult↗

Growth and hematological changes in the Eskimo children of Wainwright, Alaska: 1968 to 1977.

The growth and hematological status of all 152 Eskimo children of Wainwright, AK observed in 1977 are reported and compared with the respective status of the children living there in 1968. Fifty-two children (34%) in the 1977 study were also in the 1968 study. Comparison of height data observed in 1977 with those observed in 1968 reveals that male children less than 11 yr of age and female children ages 3 to 9 yr showed a significant improvement in stature (p less than 0.05). At the same time, an improvement in nutrition was observed among the children in 1977 as evidenced by the marked decrease in anemia for children under 6 yr (p less than 0.001). These changes in growth and hematological status have occurred during a time in which health services were improved, a supplemental nutrition program was instituted, and subsistence food gathering remained high. These changes underscore the contribution of environmental factors rather than of genetic variability to the growth potential of these children.

Adolescent↗