Infection Prevention eBug Bytes August 2015

1. Infection PreventioneBug BytesAugust2015 Bubonic plague

2. Plague kills Second Person in Colorado: Fleas to blame for disease • Plague, which killed roughly a third of the population of Europe at the end of the Middle Ages, causes fever, chills, and swollen and painful lymph nodes as it spreads throughout the body. While normally treated by antibiotics, the disease can become deadly if untreated. The victim may have contracted the disease, which is caused by the bacterium, Yersinia pestis, from fleas on a dead rodent or other animal, according to the health officials.   • Plague is predominately reported in Africa, Asia and South America, but occasionally occurs in the southwestern United States. Roughly 1,006 plague cases occurred in the United States between 1900 and 2012, mainly in its bubonic form, according to the Center of Disease Control (CDC). • At least 64 cases of human plague have been reported in Colorado since the state began recording the data, and nine have died from the disease, including the death in Pueblo. The plague death in Pueblo is the first incident in Pueblo County in 11 years, according to local media. • The second victim may have contracted the disease, caused by the bacterium, Yersinia pestis, after being bitten by fleas on a dead rodent or other animal, according to health officials. • Source: http://www.ibtimes.com/plague-kills-colorado-fleas-blame-diseases-second-victim-year-2040643

3. VA can’t rule out ‘superbug’ infections tied to dirty scopes • Nearly 100 patients treated with specialized medical scopes at 39 VA centers between 2010 and 2015 tested positive for multidrug-resistant infections, and officials said they couldn’t rule out the possibility that the devices may have been a factor in some cases. The investigation results, released in response to a public-records request by The Seattle Times, are the VA’s first acknowledgment that infections tied to hard-to-clean duodenoscopes — similar to those detected at Seattle’s Virginia Mason Medical Center — may have occurred within the veterans’ medical system. Previously, VA officials in Washington, D.C., said they didn’t know whether any infections from carbapenem-resistant Enterobacteriaceae, or CRE, tied to the scopes had occurred at federal centers. The VA launched the investigation after reports of scope-associated infections in Seattle and Los Angeles. The new analysis of nearly 56,000 procedures in more than 40,000 veterans between January 2010 and February 2015 detected nearly 5,000 CRE isolates in 2,300 patients. • During that time, 97 patients who were treated with the specialized medical scopes at 39 VA centers were infected with at least one CRE isolate, the report found. Twenty patients had the infections before the procedures. • Source: http://www.seattletimes.com/

4. FDA issues warning to scope makers over spread of deadly superbugs The Food and Drug Administration sent warning letters last week to three medical device manufacturers whose endoscopes have been blamed for spreading deadly bacteria. The devices, made by Olympus, Pentax, and Fujifilm, are used in hundreds of thousands of procedures each year. The FDA says the companies failed to report problems with the scopes as required by law and in some cases failed to ensure that the devices could be adequately cleaned. Olympus and Pentax were specifically cited for failing to relay to FDA reports that their devices ''may have caused or contributed to a death or serious injury'' within 30 days of learning about the event. Pentax and Fujifilm were cited for failing to make sure their instructions for cleaning the scopes were valid. The FDA has already offered hospitals advice on ways to improve cleaning the scopes, which have been linked to at least 13 deaths and dozens of infections at US hospitals. An expert panel convened by the agency in May determined that duodenoscopes, the devices linked to outbreaks at UCLA Medical Center and Virginia Mason Medical Center, aren't reliably safe. But the agency has declined to take them off the market, citing the needs of patients for sometimes lifesaving procedures. Olympus learned that 16 patients contracted the bacterial infection Pseudomonas aeruginosa after endoscopies in May 2012. Companies are supposed to report such events to the FDA within 30 days. Olympus didn't file a report until 2015, the agency says. Pentax didn't report cases of the deadly superbug known as carbapenem-resistant enterobacteriaceae, or CRE - the FDA learned of the infections from a company that imports Pentax devices instead, according to the warning letter. The FDA asked the companies to respond with plans to correct the violations within 15 business days. Boston Globe - FDA Warns Endoscope Manufacturers

5. Africa’s Ebola epidemic isn’t over yet • Recent news from West Africa that the number of new Ebola cases continues to fall and that an Ebola vaccine appears to provide protection against infection is heartening. But focusing only on these positive developments overlooks the huge challenges that remain. • The West African epidemic, which has caused at least 11,298 deaths since it was first reported in Guinea in March 2014, is incredibly stubborn and has proved hard to control. With a grave shortage of health professionals in the region, the international community needs to remain committed to rebuilding health-care systems in the wake of Ebola's destruction. Even the remarkable improvement in Liberia, which went from hundreds of new infections a week in September 2014 to being declared Ebola-free in May, was short-lived — further outbreaks have occurred. Right now, there are no known cases in Liberia, but there is widespread apprehension about whether more will occur. It will be years before these West African countries are able to train nurses, develop and implement a sustainable medical education model, and supply an adequate number of homegrown health-care workers. Without sustained assistance from the international community, the nations of West Africa face a losing war of attrition with the epidemic. Ebola has virtually shut down clinics and public health infrastructure in many areas. Without a doubt, more people have died from the epidemic's crippling effect on these hobbled health systems than from the virus itself. Visits for routine health services dropped precipitously. In Guinea alone, health facilities treated an estimated 74,000 fewer malaria cases (compared with previous years) during this outbreak. • Source: The Record - Ebola is Not Over Yet

6. Vomiting device offers direct evidence that vomit aerosolizes norovirus-like particles • Using a vomiting device of their creation, researchers at North Carolina State University and Wake Forest University are reporting the first direct evidence that vomiting can aerosolize virus particles similar to human norovirus. • The researchers contaminated fake vomit with a virus called the MS2 bacteriophage -- a commonly-used proxy for norovirus that does not harm humans -- and used the vomiting device to determine whether the virus was bioaerosolized during a simulated vomiting event. The researchers also wanted to know, if the virus was aerosolized, how much of the virus was becoming airborne. • "In terms of overall percentage, not a lot of the virus is aerosolized," says Francis de los Reyes III, a professor of civil, construction and environmental engineering at NC State who is corresponding author of the paper. "But in absolute terms, it is a lot compared to the amount of virus needed to cause infection." • "At most, only 0.02 percent of the total virus in the vomit was aerosolized," Jaykus says. "But that can still amount to thousands of virus particles -- more than enough to infect other people.“ Future directions for the work include assessing how long virus particles can remain airborne, and how far they may be able to travel in the air. • Source: Grace Tung-Thompson, Dominic A. Libera, Kenneth L. Koch, Francis L. de los Reyes, Lee-Ann Jaykus. Aerosolization of a Human Norovirus Surrogate, Bacteriophage MS2, during Simulated Vomiting. PLOS ONE, 2015; 10 (8): e0134277 DOI: 10.1371/journal.pone.0134277

7. Multiple strains of C. difficile cause severe patient outcomes • No single genetic strain of the widespread Clostridium difficile (C. difficile) bacteria appears to be any more harmful than other strains. The findings contradict previous research suggesting that the emergence of the most severe C. difficile infections (CDI) could be linked with a particular strain known as Ribotype 027 (R027). This multicenter observational cohort study used data from more than 700 patients at seven hospitals in the Houston, TX area to assess disease severity at presentation and the clinical outcomes of patients with varying C. difficile strains. Researchers conducted epidemiologic strain typing of C. difficile to identify both the prevalence of different strains, as well as the impact of distinct strains on disease severity and patient outcomes. • Although C. difficile R027 was the most prevalent strain associated with severe onset of the disease, it was found to not be any more likely to cause severe outcomes than other C. difficile strains. However, researchers noted that continued use of non-C. difficile antibiotics was a strong predictor of severe CDI outcomes in all strains. The continued use of other antibiotics has previously been associated with prolonged diarrhea and CDI treatment failure. • Source: .Samuel L. Aitken, M. Jahangir Alam, Mohammed Khaleduzzuman, Seth T. Walk, William L. Musick, Vy P. Pham, Jennifer L. Christensen, Robert L. Atmar, Yang Xie, Kevin W. Garey. In the Endemic Setting, Clostridium difficile Ribotype 027 Is Virulent But Not Hypervirulent. Infection Control & Hospital Epidemiology, 2015; 1 DOI: 10.1017/ice.2015.187

8. Don’t let the bedbugs bite • The number of bedbug infestations across the United States has risen over the past several years, and that's bad news for travelers. Fortunately, there are precautionary measures that everyone can take to avoid bringing unwanted guests into their home. The recent resurgence of bedbugs can be traced back to the ban on strong insecticides like DDT, which had virtually eliminated the pests. After these chemicals were outlawed because of their harmful effects on humans and the environment, bedbugs began to reappear, and their comeback was aided by several other factors. In addition, air travel has become more widespread and less expensive, creating more opportunities for bedbugs to travel with passengers. Because they're so small -- about the size of an apple seed -- bedbugs and their eggs can be hard to spot. Visible signs of a bedbug infestation may include specks of blood, small dark spots of bedbug excrement and the bugs' discarded outer shells, or exoskeletons. A sweet, musty odor in the room also may indicate a heavy infestation. Upon observing signs of bedbugs in a hotel room, travelers should immediately return to the front desk to request another room, bringing their belongings with them. In addition to checking their hotel rooms for bedbugs, travelers should store their luggage as high and as far away from the bed as possible, placing suitcases on the dresser or luggage rack rather than on the floor or the bed. He also recommends hanging up clothes in the closet, rather than storing them in drawers where bedbugs may lurk. Bedbug bites can be treated with a topical corticosteroid, which can help alleviate the itching. Bedbugs are not known to carry any diseases so further treatment is typically not necessary. • Source: American Academy of Dermatology. "Don’t let the bedbugs bite." ScienceDaily. ScienceDaily, 20 August 2015

9. What you need to know about the brain-eating amoeba • Naegleriafowleri, the so-called brain eating amoeba, has been blamed for three deaths so far this year in the United States. Now, health officials in Louisiana are keeping a close eye on two water systems that have tested positive for the parasite. The amoeba is found in warm fresh water, such as lakes and rivers, but can also live in sediment. Health officials say you can't get infected drinking contaminated water, but caution that you can get sick if the water goes up your nose and the amoeba reaches the brain. Infections from the amoeba are rare but almost always fatal. Symptoms start off similar to many other, more common illnesses, such as bacterial meningitis, and include fever, headache, stiff neck, and vomiting. Experts urge people to seek medical attention immediately if they're experiencing these symptoms, particularly if they have been in warm fresh water recently. Only 35 cases were documented between 2005 and 2014. In recent years, a new drug helped two people survive the devastating infection. • For communities in Louisiana where the amoeba was detected in the water, the CDC recommends the following precautions: • -DO NOT allow water to go up your nose or sniff water into your nose when bathing, showering, washing your face, or swimming in small hard plastic/blow-up pools. -DO NOT jump into or put your head under bathing water (bathtubs, small hard plastic/blow-up pools); walk or lower yourself in. • -DO NOT allow children to play unsupervised with hoses or sprinklers, as they may accidentally squirt water up their nose. Avoid slip-n-slides or other activities where it is difficult to prevent water going up the nose. -DO run bath and shower taps and hoses for five minutes before use to flush out the pipes. This is most important the first time you use the tap after the water utility raises the disinfectant level. • -DO keep small hard plastic/blow-up pools clean by emptying, scrubbing and allowing them to dry after each use. -DO use only boiled and cooled, distilled or sterile water for making sinus rinse solutions for neti pots or performing ritual ablutions. Source:www.cbs.news

10. New surge of MERS infections hits Saudi Arabia • Saudi Arabia is facing a new surge in cases of Middle East respiratory syndrome, a viral disease that has infected more than 1,100 people and killed more than 480 in the kingdom since it appeared in 2012. The Saudi authorities shuttered the emergency ward of one of the kingdom's largest hospitals this week after the appearance of 46 new cases there of MERS, the Saudi news media reported, citing a Health Ministry official. • Fifteen of those infected were medical workers, and 20 other patients showing symptoms were being tested. • The spike in cases was the largest since the peak of the virus's spread last summer and has raised fears that the virus could threaten the more than two million visitors expected next month for the annual hajj pilgrimage. • MERS, a virus that can cause breathing problems, fever, pneumonia and kidney failure, is believed to have passed to humans from camels. • While it emerged in Saudi Arabia and most of its victims have been there, travelers have taken it to other countries. • Some international medical professionals criticized Saudi Arabia as being slow to put in place measures to stop the virus's spread, exacerbating the outbreak. At the virus's peak, infections were jumping from bed to bed in crowded hospitals, and medical workers were falling sick because of lax sanitary standards. Source: On Thursday, the Saudi Health Ministry reported two new deaths, bringing the total death toll in the kingdom to 485 out of 1,128 diagnosed cases since 2012. Source: New York Times

11. Personal Clothing May Spread Respiratory Infections Within NICU • Respiratory syncytial virus (RSV), which is the leading cause of childhood respiratory hospitalizations among premature babies, can be detected from the clothes worn by caregivers and visitors who are visiting infants in the neonatal intensive care unit (NICU). The study was conducted in the NICU of the Royal Hospital for Women in Sydney, Australia during peak community circulation of RSV. Once every week for two months, collected specimens from the hands, nose, and the clothes of the doctors, nurses and visitors in the NICU. A nasal swab specimen was also collected from the infants admitted. The swab specimens were tested for RSV using molecular technology. Though it could not be determined whether the virus was infectious or not, the study shows that RSV can be detected from the NICU even in the absence of an outbreak. • A total of 4 percent of the swabs collected from the personal clothing of caregivers/visitors in the NICU had detectable RSV. In addition, RSV was detected from 9 percent of the high-touch areas in the NICU including computers on the nurse's table, chairs adjacent to the admitted infants and their bed rails. RSV was not detectable in the hands of the doctors, nurses or the visitors. There was alcohol-based handrub available at point of care and hand hygiene practices were prevalent within the NICU. As hands are the main mode of transmission for respiratory viruses, having optimal hand hygiene practices may mitigate the risk of respiratory infection within the NICU. Suboptimal hand hygiene practices may lead to transmission of the virus from the dresses to the infants. It is therefore crucial to maintain hand hygiene before and after touching the infants in the NICU. Source: American Society for Microbiology