BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus and methicillin-sensitive S. aureus infections are common to south-western Alaska and have been associated with traditional steambaths. More than a decade ago, recommendations were made to affected communities that included preventive skin care, cleaning methods for steambath surfaces, and the use of protective barriers while in steambaths to reduce the risk of S. aureus infection. OBJECTIVE: A review of community medical data suggested that the number of skin infection clinical encounters has increased steadily over the last 3 years and we designed a public health investigation to seek root causes. STUDY DESIGN: Using a mixed methods approach with in-person surveys, a convenience sample (n=492) from 3 rural communities assessed the range of knowledge, attitudes and practices concerning skin infections, skin infection education messaging, prevention activities and home self-care of skin infections. RESULTS: We described barriers to implementing previous recommendations and evaluated the acceptability of potential interventions. Prior public health messages appear to have been effective in reaching community members and appear to have been understood and accepted. We found no major misconceptions regarding what a boil was or how someone got one. Overall, respondents seemed concerned about boils as a health problem and reported that they were motivated to prevent boils. We identified current practices used to avoid skin infections, such as the disinfection of steambaths. We also identified barriers to engaging in protective behaviours, such as lack of access to laundry facilities. CONCLUSIONS: These findings can be used to help guide public health strategic planning and identify appropriate evidence-based interventions tailored to the specific needs of the region.

BACKGROUND: In 2012, the Alaska Section of Epidemiology investigated personnel potentially exposed to a Brucella suis isolate as it transited through three laboratories. METHODS: We summarize the first implementation of the United States Centers for Disease Control and Prevention 2013 revised recommendations for monitoring such exposures: (1) risk classification; (2) antimicrobial postexposure prophylaxis; (3) serologic monitoring; and (4) symptom surveillance. RESULTS: Over 30 people were assessed for exposure and subsequently monitored for development of illness. No cases of laboratory-associated brucellosis occurred. Changes were made to gaps in laboratory biosafety practices that had been identified in the investigation. CONCLUSION: Achieving full compliance for the precise schedule of serologic monitoring was challenging and resource intensive for the laboratory performing testing. More refined exposure assessments could inform decision making for follow-up to maximize likelihood of detecting persons at risk while not overtaxing resources.

Rocky Mountain spotted fever, a tick-borne disease caused by Rickettsia rickettsii, is difficult to diagnose and rapidly fatal if not treated. We describe a decedent who was co-infected with group A beta-hemolytic streptococcus and R. rickettsii. Fatal cases of Rocky Mountain spotted fever may be underreported because they present as difficult to diagnose co-infections.

BACKGROUND: Hepatitis B antibody persistence was assessed in individuals who had previously received a vaccine booster. METHODS: We measured hepatitis B surface antigen antibody (anti-HBs) levels 7-9 years post-hepatitis B booster in individuals with primary vaccination at birth. RESULTS: While 95 (91.3%) of 104 participants had detectable anti-HBs (minimum 0.1 mIU/mL, maximum 1029 mIU/mL), only 43 (41%) had protective levels ≥10mIU/mL. Pre- and four week post-booster anti-HBs levels were significant predictors of hepatitis B immunity at follow-up (P <0.001). CONCLUSIONS: Almost all participants had detectable anti-HBs 7-9 years after hepatitis B vaccine booster, but less than half had levels ≥10mIU/mL.

BACKGROUND: Hepatitis A is mostly a self-limiting disease but causes substantial economic burden. Consequently, United States Advisory Committee for Immunization Practices recommends inactivated hepatitis A vaccination for all children beginning at age 1 year and for high risk adults. The hepatitis A vaccine is highly effective but the duration of protection is unknown. METHODS: We examined the proportion of children with protective hepatitis A antibody levels (anti-HAV ≥20mIU/mL) as well as the geometric mean concentration (GMC) of anti-HAV in a cross sectional convenience sample of individuals aged 12-24 years, who had been vaccinated with a two-dose schedule in childhood, with the initial dose at least 5 years ago. We compared a subset of data from persons vaccinated with two-doses (720 EL.U.) at age 3-6 years with a demographically similar prospective cohort that received a three-dose (360 EL.U.) schedule and have been followed for 17 years. RESULTS: No significant differences were observed when comparing GMC between the two cohorts at 10 (P=0.467), 12 (P=0.496), and 14 (P=0.175) years post-immunization. For the three-dose cohort, protective antibody levels remain for 17 years and have stabilized leveled-off over the past 7 years. CONCLUSION: The two- and three-dose schedules provide similar protection >14 years after vaccination, indicating a booster dose is not needed at this time. Plateauing anti-HAV GMC levels suggest protective antibody levels may persist long-term.

CDC recommends hepatitis A vaccination for all children at age 1 year and high risk adults. The vaccine is highly effective; however, protection duration is unknown. We report hepatitis A antibody concentrations 17 years after childhood immunization, demonstrating protective antibody levels remain and have stabilized over the past 7 years.