Infection Prevention eBug Bytes February 2016

1. Infection PreventioneBug BytesFebruary 2016

2. Zika is possibly the scariest virus since HIV • Other viruses are known to harm neonates. For example genital herpes can be fatal to a newborn, but this can be overcome by choosing a C-section over a natural birth. Rubella (German measles) also causes birth defects, but there has been a highly effective vaccine available since 1969. But, neither is spread by mosquitos, which is why this scare is quite different, and why Zika is still a big unknown. It is primarily being spread by the Aedes aegypti mosquito, which clearly prefers warm areas, but they are not the only carrier. It was just revealed that Zika was detected in amniotic fluid of two Brazilian women who gave birth to babies with microcephaly. This suggests that the virus can cross the placenta. And a few days earlier, the first evidence was produced of Zika in the brains of babies whose mothers were (probably) infected with the virus during their first trimesters. The first cases were seen on Bonaire this week. Puerto Rico is now using only imported blood for transfusions, and a travel alert has been issued for Aruba. There have been 82 cases reported in the U.S., all from travelers. The virus has been detected in semen, urine, and saliva. There is very little that we know about this virus. It is not unreasonable that Zika could infect more common mosquito species, such as Culex, which could then put much of the country at potential risk. Although there are successful vaccines for other flavivirus infections (yellow fever), it will take years at a minimum to develop a Zika vaccine. Source: http://acsh.org/news

3. Bed bugs developing resistance to common insecticides • Researchers from Virginia Tech and New Mexico State University say the overuse of commercial chemicals has made many of the pests resistant to the compounds. Now researchers say bedbugs are becoming resistant to the most common insecticides used to kill them. Specifically, the researchers looked at a group of commonly used pesticides called neonicotinoids, which are often used together with pyrethroids to treat bedbugs. • To determine the bed bugs' resistance levels, the researchers took samples of the creatures from several locations. Some had been exposed to neonicotinoids and some had been isolated in a lab with no exposure to pesticides. In yet another group, the bugs had been exposed to the poison, but not since 2008. The bugs from the non-exposed group died when exposed to a small amount of insecticide, while those exposed in 2008 showed "moderate resistance. The groups which had been exposed to pesticide had much higher levels of resistance. When exposed to neonicotinoids, bed bugs produce "detoxifying enzymes" to fight the effects of the chemicals. Those bugs with a history of exposure appeared to have more of the enzymes than their susceptible counterparts. • This, researchers say, could mean having to look for other ways to stem the spread of the blood-sucking insects. "Unfortunately, the insecticides we were hoping would help solve some of our bed bug problems are no longer as effective as they used to be, so we need to re-evaluate some of our strategies for fighting them," said Anderson. • Source: http://www.voanews.com/content/mht-bed-bugs-developing-resistance-to-common-insecticides/3166627.html

4. 10 Essential Facts About MERS • 1. The current MERS outbreak is centered in South Korea, with only one case each confirmed in China, the Philippines, and Thailand this year. Most cases since the discovery of the virus have been in one country — Saudi Arabia. MERS infections were first reported in 2012 in that country. Only two U.S. cases of MERS have been reported — in 2014 — and both were in health workers from Saudi Arabia who traveled to the United States (to Indiana and Florida). • 2. About 37 percent of patients who were diagnosed with MERS have died. While MERS is rare, it can be deadly. As of June 19, a total of 1,338 cases and 475 deaths from MERS. • 3. MERS-CoV belongs to a group of related pathogens known as coronaviruses. • 4. MERS-CoV infections of camels have been reported and may put a person at risk too, according to the CDC. Camels not only carry MERS but can also be a source of infection for people • 5. A person with a chronic condition is more susceptible to a severe case of MERS. • 6. Coughing is one way the disease may be passed on to close contacts. Symptoms may appear anywhere from 2 to 14 days after you’re exposed to MERS-CoV. • 7. There is no MERS vaccine and no MERS-specific drug treatment. • 8. If you are believed to have MERS and come to the United States, the CDC may detain you. • 9. You can protect yourself from MERS by washing your hands frequently (and avoiding camels). • 10. The U.S. general public is at very low risk for MERS

5. Why it took years for the FDA to warn about infections tied to medical scopes • An outbreak at a Pennsylvania hospital in late 2012 should have been an early warning that a reusable medical scope was spreading deadly infections and nearly impossible to disinfect. But staff at the federal FDA lost the report, one of multiple missteps that allowed doctors and hospitals to continue using the scope for three more years even as dozens of patients were sickened. The missing paperwork, revealed in a recent Senate inquiry, underscores the serious shortcomings in the antiquated national database used to monitor the safety of medical devices.. Regulators did not warn hospitals about its risks until after the Los Angeles Times reported an outbreak at UCLA that killed three patients. Not only is the FDA's existing database of device injuries and deaths difficult to use, but it relies on hospitals and manufacturers to report problems they are often reluctant to disclose because of the possibility of litigation. In their Jan. 13 report, Senate investigators found that not one of 16 or more hospitals with outbreaks linked to scopes properly filed the federal report required when a medical device kills or injures a patient. By the time the FDA began looking Olympus and another scope manufacturer had sent five reports of outbreaks to the agency. But when the FDA staff searched the database, they found just one of those reports. It took another 17 months for the agency to warn hospitals the scope was almost impossible to clean. By then, at least 195 patients in 16 hospitals across the country had been sickened. The FDA now makes a disclaimer when it uses information from its database to evaluate the safety of a device. • Source: HPN Feb 2015

6. C section Study: CHG/alcohol vs Iodine/alcohol • An estimated 1.3 million women in the US delivered their babies by C-section in 2013, with surgical-site infections complicating 5 to 12 percent of those deliveries. The average cost of treating those cesarean-related infections in the hospital is $3,500 and may be much higher for severe infections. • The research shows patients in the chlorhexidine-alcohol group developed significantly fewer infections than patients in the iodine-alcohol group. Those who received the chlorhexidine-alcohol combination had a 4 percent infection rate, which is nearly half that of the patients who received the iodine-alcohol combination—7.3 percent. The clinical trial included 1,147 patients who underwent cesarean sections at Barnes-Jewish Hospital from 2011 to 2015. Of 572 patients randomly assigned to receive the chlorhexidine-alcohol combination, 23 developed an infection at the site of the surgery within 30 days of the procedure. Of 575 patients who randomly received the iodine-alcohol combination, 42 developed a surgical-site infection. The investigators pointed out that all other standard procedures for reducing the risk of infection after surgery, including giving preventive antibiotics beforehand, were the same in both groups. The superiority of the chlorhexidine-alcohol combination was consistent whether the C-section was scheduled or unscheduled, whether or not the patient was obese, whether staples or sutures were used to close the wound, and whether the patient had chronic medical conditions, including diabetes. Source: NEJM Feb 4 2016

7. Island of Hawaii declares state of emergency over dengue fever • The mayor of Hawaii's Big Island declared a state of emergency on Monday to deal with a growing outbreak of dengue fever, spread by infected mosquitoes, with 250 cases confirmed over the past four months. As a result of Hawaii County Mayor Billy Kenoi's order people on the Big Island will be allowed to resume disposing of old tires in landfills, since tires which are left lying around are a known breeding spot for mosquitoes. There have been 250 confirmed cases of dengue fever on the island since Oct. 29, making it the largest outbreak in the state since the 1940s, according to the mayor's declaration and Hawaii health officials. Dengue fever causes flu-like symptoms and can develop into the deadly dengue hemorrhagic fever. Hawaii Governor David Ige said in a statement he supported the efforts on the Big Island but would not issue a statewide emergency declaration unless the outbreak spread to other islands or expanded to include other diseases, such as the Zika virus. Last month, a baby born with brain damage at a hospital in Oahu, Hawaii, was apparently the first case of the mosquito-borne Zika virus in a birth on U.S. soil. Dengue is not endemic to Hawaii but has occasionally spread after being imported by infected travelers. The outbreak on the Big Island is the first cluster of locally-acquired dengue fever since a 2011 outbreak on Oahu, the Hawaii Department of Health said.

8. Booster vaccine aimed at protecting teens against whooping cough may wear off • A latest study has suggested that a booster vaccine aimed to protect teens from whooping cough could wear off eventually. Eesearchers analyzed 1,200 cases of whooping cough in 280,000 California teens between January 2006 and March 2015. Despite the presence of soaring vaccination rates against the disease in teens, two major outbreaks occurred in this group in California, in the years 2010 and 2014. The researchers discovered that within the first year after a teen got vaccinated withTdap there was a moderate effectiveness. It prevented 69% of whooping cough cases in teens who got exposed. But, that effectiveness fell to below 9% by four years after vaccination. In the 1990s the US shifted from whole-cell pertussis (DTwP) vaccine to the acellular pertussis (DTaP) vaccine. The move was taken because of the concerns regarding the side effects. Presently, five doses of DTaP vaccine is given during childhood, at the ages 2 months, 4 months, 6 months, 12 to 18 months, and 4 to 6 years. Despite soaring vaccination rates, the US and other developed countries have seen a rise in whopping cough cases since the shift to DTaP. Just over 1,200 children and teens were diagnosed with whooping cough between 2006 and 2015. Most fell ill during two statewide epidemics, in 2010 and 2014, the research found. • Source: http://perfscience.com/content/2143214-booster-vaccine-aimed-protecting-teens-against-whooping-cough-may-wear-over-time

9. Ursinus College, PA – Norovirus Outbreak • Test results confirmed that Norovirus swept across the Collegeville campus, sickening at least 214 students, plus faculty and staff, since last Tuesday. • "This is the agent we have suspected since this outbreak began," said Montgomery County Commissioner Valerie Arkoosh, a physician and interim medical director of the county health department. • But how it emerged and spread on Ursinus campus is unclear. And officials "will probably never know" the original source, said Montgomery County spokesman Frank Custer. Campus dining facilities were temporarily closed last week for cleaning after a health inspection found 17 violations, though not necessarily related to the illness. As of Sunday night, school officials said, 214 students had reported symptoms of vomiting, diarrhea, and abdominal pain. Ten of those became sick during the weekend, and some called in from home to report their symptoms, which typically subside after 12 to 24 hours.Source: http://www.philly.com/philly/education/20160216__Ursinus_plague__on_wane__classes_resume.html#8C6mhOIdVJZgqCIO.99

10. CDC: Superbugs threaten hospital patients www.cdc.gov • The national data in this Vital Signs report, along with data from CDC's latest annual progress report on HAI prevention, show that acute care hospitals have achieved: • A 50 percent decrease in central line-associated bloodstream infections (CLABSIs) between 2008 and 2014. • 1 in 6 remaining CLABSIs are caused by urgent or serious antibiotic-resistant bacteria. • A 17 percent decrease in surgical site infections (SSIs) between 2008 and 2014 related to 10 procedures tracked in previous HAI progress reports. • 1 in 7 remaining SSIs are caused by urgent or serious antibiotic-resistant bacteria. • No change in the overall catheter-associated urinary tract infections (CAUTIs) between 2009 and 2014. During this time, however, there was progress in non-ICU settings, progress in all settings between 2013 and 2014, and most notably, even more progress in all settings towards the end of 2014. •1 in 10 CAUTIs are caused by urgent or serious antibiotic-resistant bacteria. The six antibiotic-resistant threats are: • Carbapenem-resistant Enterobacteriaceae (CRE) • Methicillin-resistant Staphylococcus aureus (MRSA) • ESBL-producing Enterobacteriaceae (extended-spectrum β- lactamases) • Vancomycin-resistant Enterococcus (VRE) • Multidrug-resistant Pseudomonas aeruginosa • Multidrug-resistant Acinetobacter

11. CDC: The Vital Signs • The Vital Signs report examines the role of Clostridium difficile (C. difficile), the most common type of bacteria responsible for infections in hospitals. C. difficile caused almost half a million infections in the United States in 2011 alone. CDC's annual progress report shows that progress has been made in decreasing hospital-onset C. difficile infections by 8 percent between 2011 and 2014. • Along with the updated annual progress report, CDC released the Antibiotic Resistance Patient Safety Atlas, a new web app with interactive data on HAIs caused by antibiotic resistant bacteria. The tool provides national, regional, and state map views of superbug/drug combinations showing percent resistance over time. The Atlas uses data reported to CDC's National Healthcare Safety Network from 2011 to 2014 from more than 4,000 healthcare facilities. • CDC is calling on doctors, nurses, healthcare facility administrators, and state and local health departments to continue to do their part to prevent HAIs. The report recommends doctors and nurses combine three critical efforts to accomplish this: Prevent the spread of bacteria between patients; Prevent infections related to surgery and/or placement of a catheter; and • Congress has recognized the urgent need to combat antibiotic resistance. • www.cdc.gov