Meningococcus in the Laboratory
Source: MMWR Morb Mortal Wkly Rep. 2002;51:141-144.
Acquisition of meningococcus is an occupational hazard for laboratory workers, especially microbiogists who are directly manipulating laboratory isolates. Fortunately, this risk remains low as long as laboratory workers follow accepted infection control practices. Following the receipt of 2 reports of 2 microbiologists in Michigan and Alabama who died in 2001 from laboratory-acquired invasive meningococcal disease, the CDC distributed an electronic request for additional cases. A laboratory-acquired case was defined as confirmed or probable meningococcus in a laboratory worker with exposure within the previous 2 weeks and infection with a serotype matching the source isolate.
Fourteen additional cases were reported, 6 of which occurred in the United States between 1996 and 2001. All 6 US laboratory workers were infected with isolates obtained from blood or CSF specimens. Of the 16 total cases, 8 (50%) were fatal—about twice the case fatality rate of community acquired invasive meningococcal disease. More than half (56%) of the cases were due to serotype B, and the remainder were due to serotype C, a similar case fatality rate for each.
All 16 people worked in the microbiology lab—and all but one had failed to use a biosafety cabinet when handling isolates. Most were responsible for directly handling isolates, such as plating, subculturing, and serotyping. This kind of direct manipulation of isolates on an open bench is believed to be one of the highest risk activities, much riskier than handling the original patient specimens.
These data also suggest that handling isolates from cases of invasive disease may be even riskier. Organisms found in respiratory specimens are believed to be less virulent. The use of a biosafety cabinet is essential to reducing the risk of transmission of Neisseria meningitis in the lab. Vaccination with the new quadrivalent meningococcal polysaccharide vaccine may help to reduce the risk of invasive disease. However, vaccination does not eliminate the risk of colonization in the event of exposure. Laboratory workers exposed to meningococcus should receive appropriate prophylaxis regardless of vaccination status.
The Power of Prayer
Source: Leibovici L. BMJ. 2001;323: 1450-1451.
The power of prayer—even the act of praying for persons unknown, called remote intercessory prayer—has been reported to be beneficial in critically ill patients. Leibovici cleverly tried a slightly different approach. In July 2000, Leibovici collected the names of 3393 adults with bacteremia admitted to a single university hospital between 1990 and 1996. Subjects were randomly assigned, using a computer-generated program, to an intervention prayer group or no prayer. A short prayer was then said for each of the individuals in the intervention group, who were identified by first name only, and for the group as a whole.
Overall, there was no apparent difference in mortality between the intervention group and the no-prayer group (28.1% vs 30.2%; P = .40). However, the duration of hospitalization and the days of fever were significantly shorter in those assigned to the prayer group (P = .01 and P = .04, respectively), despite the fact that the intervention was done 4 to 10 years later! Even retrospectively applied, prayer was associated with a better outcome in patients with bacteremia, and Leibovici argues that prayer is a cost-effective intervention (how much does a prayer cost?).
How could this be? Leibovici argues that our concepts of linear time may not apply to the healing effects of prayer. Thus, prayer may not need to occur contemporaneously with the illness to be of benefit.
Leibovici also slyly noted that none of the patients in this study were lost to follow-up—despite the fact that some were dead.
Is Communion Too Communal?
Source: Sacramento Bee, January 19, 2002:E1. (www.sacbee.com/content/lifestyle)
While prayer may have a beneficial effect on those with serious illness, this article addressed long-standing but poorly substantiated concerns that communion may present a public health hazard to participants. Recently, a Texas woman died of meningococcemia after drinking from a common communion cup at Catholic mass, sparking renewed debate. Given the large numbers of people who share a common drinking cup while taking communion, it would not be surprising if there was a low-level risk of transmission of common respiratory illnesses, such as the common cold, herpes simplex, mononucleosis, and strep throat. However, various studies have examined this question and found no significant risk of contagion, and no significant outbreaks of illness have been linked to communion. Unfortunately, the wine used for communion seldom has a sufficient alcohol content to function as a disinfectant, although there may still be some theoretical benefit to using real wine. Common sense suggests that people with active herpes, the flu, or other infectious respiratory illness refrain from taking common communion.
Dr. Kemper, Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center, is Associate Editor of Infectious Disease Alert.
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