Indwelling urinary catheters are common in health care settings and can lead to catheter-associated urinary tract infection (CAUTI). Long-term catheterization causes polymicrobial colonization of the catheter and urine, for which the clinical significance is poorly understood. Through prospective assessment of catheter urine colonization, we identified Enterococcus faecalis and Proteus mirabilis as the most prevalent and persistent co-colonizers. Clinical isolates of both species successfully co-colonized in a murine model of CAUTI, and they were observed to co-localize on catheter biofilms during infection. We further demonstrate that P. mirabilis preferentially adheres to E. faecalis during biofilm formation, and that contact-dependent interactions between E. faecalis and P. mirabilis facilitate establishment of a robust biofilm architecture that enhances antimicrobial resistance for both species. E. faecalis may therefore act as a pioneer species on urinary catheters, establishing an ideal surface for persistent colonization by more traditional pathogens such as P. mirabilis.

States in the United States and jurisdictions in other countries should consider adding parental counseling by health care provider as a requirement for obtaining exemptions to vaccination requirements.

A large measles outbreak in Washington State has prompted officials to declare a state of emergency. As of March 4, 2019, the Washington State Health Department reported 71 confirmed cases, 1 with the majority of cases among individuals who were not vaccinated or who had an unverified vaccination status. The outbreak is centered in a geographic cluster of persistently high vaccine exemption rates among young children. 2 This cluster has persisted despite the overall reduction in vaccine exemptions in the state of Washington, subsequent to the introduction of legally mandated health care practitioner counseling of parents seeking vaccine exemptions. 2 During the past 5 years, a series of similar measles outbreaks have occurred across the United States. In 2014, a large outbreak of 383 cases, occurring primarily among unvaccinated Amish communities in Ohio, was associated with a large measles outbreak in the Philippines. In 2014-2015, a large measles outbreak first reported at Disneyland in California resulted in 147 cases of measles. 3 In 2017, a 75-case outbreak was reported in Minnesota in a Somali-American community with poor vaccination coverage. This community was the focus of some antivaccination advocates.

Standardized case definitions are needed in decision-making regarding respiratory syncytial virus(RSV) control strategies, including vaccine evaluation. A syndromic case definition comprising of "wheeze or apnea or cyanosis" could be useful for community-based surveillance of moderate RSV infection among young infants particularly in resource-limited settings. However, this definition showed modest specificity (29.2-49.6%) indicating that community-based surveillance may need augmentation with other data.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.