Infection PreventioneBug Bytes

November 2014

Outbreak of Henipavirus Infection, Philippines, 2014

• On April 2, 2014, the Philippine National Epidemiology Center received a report of human deaths in 2 villages, Tinalon and Midtungok with Henipavirus. The case definition was met by 17 persons. Clinical signs developed for the index case-patient on March 10 and for the last case-patient on April 21. The case-fatality rate among those with acute encephalitis syndrome was 82%; no patient with influenza like illness or meningitis died. Of acute encephalitis syndrome survivors, 1 experienced residual severe cognitive impairment, motor weakness, and ataxia, and the other experienced persistent ophthalmoplegia. Median incubation period for case-patients with known exposure was 8 days.

• Henipaviruses belong to a genus of recently emerging viruses within the family Paramyxoviridae and include 2 zoonotic members: Hendra virus (HeV) and Nipah virus (NiV). Epidemiologic data suggest that the most common route of virus transmission to humans was direct exposure to infected horses, contact with contaminated body fluids during slaughtering of sick horses, and/or consumption of undercooked meat from infected horses.

• . http://wwwnc.cdc.gov/eid/article/21/2/14-1433_article

Ebola treatment studies to begin by December 2014

• Doctors Without Borders will begin clinical trials of three experimental Ebola therapies in West Africa in December, the aid group announced Wednesday. The studies, to be conducted at the group's treatment centers in Guinea and Liberia, will test therapies already used in some Ebola patients in the USA and Europe: the antiviral drugs brincidofovir and favipiravir, as well as blood donations from Ebola survivors. Brincidofovir, made by Chimerix of North Carolina, was given to cameraman Ashoka Mukpo, Liberian national Thomas Eric Duncan and physician Craig Spencer. Mukpo and Spencer survived. Duncan received the drug just a couple days before he died. Favipiravir, an anti-flu drug made by Japan's Fujifilm Holding Corp., was given to a French nurse who worked with Doctors Without Borders. And blood donations from Ebola survivors, which contain antibodies against the virus, have been used since the first Ebola outbreak in 1976. More recently, American Ebola patient Kent Brantly, a physician, received a blood donation from a teenage survivor before he left Liberia for treatment at Atlanta's Emory University Hospital. He later donated blood to several other Ebola patients: Mukpo, physician Richard Sacra and nurses Nina Pham and Amber Vinson. Missionary Nancy Writebol, also treated at Emory, donated blood to Vinson and Spencer. Brantly and Writebol also both received the experimental drug ZMapp. Supplies of that drug, which takes months to manufacture, are now exhausted.

Hospital Workers Wash Hands Less Frequently Toward End of Shift

Hand-washing in hospitals has been demonstrated to reduce infections and save money. In a 2000 study of Swiss hospitals, researchers found that a 1 percentage point increase in handwashing compliance reduced the number of infections by 3.9 per 1,000 patients. Another study, in 2009, estimated that the cost per patient with a healthcare-acquired infection is $20,549. Using these data, Dai and her colleagues extrapolated their findings to all 5,723 registered hospitals in the United States and estimated that there would be an additional 600,000 infections per year at a cost of approximately $12.5 billion annually. Researchers led by Hengchen Dai, a PhD candidate at the University of Pennsylvania, looked at three years of handwashing data from 4,157 caregivers in 35 U.S. hospitals. They found that "handwashing compliance rates" dropped by an average of 8.7 percentage points from the beginning to the end of a typical 12-hour shift. The decline in compliance was magnified by increased work intensity. Sixty-five percent of the caregivers in the sample were nurses. The remainder were patient care technicians (12 percent), therapists (7 percent), physicians (4 percent) and a handful of other types of employees. Reference: Dai H, et al. The Impact of Time at Work and Time Off From Work on Rule Compliance: The Case of Hand Hygiene in Health Care. Published online Nov. 3, 2014, Journal of Applied Psychology.

Update: Ebola Virus Disease Epidemic — West Africa, November 2014

• According to the latest World Health Organization update on November 14, 2014 (3), a total of 14,383 Ebola cases have been reported as of November 11 from three West African countries (Guinea, Liberia, and Sierra Leone) where transmission is widespread and intense. The highest reported case counts were from Liberia (6,878 cases) and Sierra Leone (5,586), followed by Guinea (1,919). Peaks in the number of new cases occurred in Liberia (509 cases), Sierra Leone (540 cases), and Guinea (292 cases) at epidemiologic weeks 38 (September 14–20), 44 (October 26–November 1), and 41 (October 5–11). A total of 5,438 deaths have been reported. Investigation of localized transmission in two locations in Mali (Kourémalé and Bamako) is currently underway (4). Transmission was interrupted successfully in Nigeria (October 19) and prevented in Senegal (October 17) (3). The 2,705 new Ebola cases reported during October 19–November 8 were more widely distributed geographically among districts in Guinea and Liberia compared with the 2,809 new cases reported during September 28–October 18 (5). During both periods, counts of Ebola cases reported were highest in the area around Monrovia, Liberia; the Western and northwest districts of Sierra Leone, particularly Bombali and Port Loko; and the prefectures of Kérouané, Macenta, and Nzérékoré, Guinea. As of November 8, the highest cumulative incidence rates (>100 cases per 100,000 population) were reported by two prefectures in Guinea (Guéckédou and Macenta), four counties in Liberia (Bomi, Lofa, and particularly Margibi and Montserrado), and five districts in Sierra Leone (Bombali, Kailahun, Kenema, Port Loko, and Western Area). Evidence of decreasing incidence in Lofa and Montserrado, Liberia, is described elsewhere. www.cdc.gov

New insights in survival strategies of bacteria

• Bacteria are particularly ingenious when it comes to survival strategies. They often create a biofilm to protect themselves from a hostile environment, for example during treatment with antibiotics. A biofilm is a bacterial community that is surrounded by a protective slime capsule consisting of sugar chains and “curli”. Scientists have for the first time created a detailed three-dimensional image of the pores through which the curli building blocks cross the bacterial cell wall, a crucial step in the formation of the protective slime capsule.

• Bacteria protect themselves against external stress factors by organizing as a biofilm. This allows pathogenic bacteria to defend themselves against treatment with antibiotics, or allows them to hide from the immune system. Bacteria also create biofilms in industrial installations, which can hamper the processes in the installation and result in blockages. Biofilms are bacterial communities that surround themselves with a protective slime capsule consisting of sugar chains and protein fibers or "curli." In order to produce this protective slime capsule, bacteria use a modified transport system to deliver curli building blocks safely to the outside of the bacteria, so that the curli fibers can be produced there.

• Source: Parveen G, et al: Structural and mechanistic insights into the bacterial amyloid secretion channel CsgG. Nature, 2014;

Fatal Gastrointestinal Mucormycosis in an Infant Following Ingestion of Contaminated Dietary Supplement – Connecticut, 2014

• The CDC, FDA, and Connecticut Departments of Public Health and Consumer Protection are investigating a fatal case of gastrointestinal (GI) mucormycosis caused by Rhizopus oryzae in a premature infant. The infant received ABC Dophilus® Powder, a dietary supplement product containing viable microbial ingredients purchased from Solgar, Inc., Leonia, New Jersey.

• The product claimed to have “probiotic” properties and is marketed for infants and children. Subsequent testing of the same lot of unopened Solgar ABC Dophilus® Powder revealed contamination with Rhizopus oryzae. Mucormycosis is a rare infection caused by mold in the order Mucorales, including Rhizopus spp. GI mucormycosis is a very rare manifestation of this disease and occurs when mucormycosis involves the GI tract causing signs and symptoms such as: Abdominal pain, Abdominal distension, Nausea, Vomiting

• These symptoms are thought to occur primarily when a susceptible person ingests the fungus, and they usually occur in immunocompromised individuals. http://www.cdc.gov/fungal/rhizopus-investigation.html

Pertussis Epidemic — California, 2014• On June 13, 2014, the California Department of Public Health (CDPH) declared that a

pertussis epidemic was occurring in the state when reported incidence was more than five times greater than baseline levels. The incidence of pertussis in the United States is cyclical, with peaks every 3–5 years, as the number of susceptible persons in the population increases. The last pertussis epidemic in California occurred in 2010, when approximately 9,000 cases were reported, including 808 hospitalizations and 10 infant deaths, for a statewide incidence of 24.6 cases per 100,000 population (1). During January 1–November 26, 2014, a total of 9,935 cases of pertussis with onset in 2014 were reported to CDPH, for a statewide incidence of 26.0 cases per 100,000. CDPH is working closely with local health departments to prioritize public health activities, with the primary goal of preventing severe cases of pertussis, which typically occurs in infants. All prenatal care providers are being encouraged to provide tetanus, diphtheria, and acellular pertussis vaccine (Tdap) to pregnant women during each pregnancy, ideally at 27–36 weeks' gestation, as is recommended by the Advisory Committee on Immunization Practices (ACIP) (4), or refer patients to an alternative provider, such as a pharmacy or local public health department, to receive Tdap.

• Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6348a2.htm?s_cid=mm6348a2_e