march 019 infection revention€¦ · the philippines estimates that 63% of those infected were not...

INFECTION PREVENTIONNEWS & UPDATES

MARCH 2019

www.diversey.com© 2019 Diversey 1

The outbreak of Lassa virus infection in Nigeria is accelerating. The outbreak is now present in more states and many hospitals have run out of specialized bed spaces to treat the 80+ people infected. Public Health leaders are calling for shutting down schools and certain open spaces in the areas with the highest number of people infected until the outbreak is under control.

The Lassa virus is transmitted primarily via rats which are believed to be the primary host for the virus. Infected rats secrete the virus in urine and feces, so cleaning areas where rats are prevalent can spread the virus as can food preparation with dead rats and eating infected rats.

WHAT YOUSHOULD KNOW

Lassa Fever is a viral hemorrhagic fever with a high mortality rate and outbreaks of Lassa Fever in Africa are not unusual, but are always of a concern because of the ease with which the virus can be carried to other countries by infected people.

FAST FACTS

LocationNIGERIA

SeverityLOCAL OUTBREAK

TransmissionCONTACT + DROPLET + VECTOR

LASSA VIRUS/LASSA FEVER

http://www.diversey.com


MARCH 2019


FAST FACTS

LocationUSA, PANAMA

SeverityMULTI-COUNTRY OUTBREAK

TransmissionCONTACT + DROPLET

Marin County in California (near San Francisco) is reporting an outbreak of Pertussis with 241 confirmed cases. Low vaccination rates are seen as a major cause of the outbreak. Panama is reporting an outbreak with 81 confirmed cases and 9 fatalities – all children under 2 years of age.

Pertussis (Whooping Cough) is caused by the bacteria Bordetella pertussis, which attaches itself to the lining of the lungs producing inflammation and coughing fits that include a characteristic “whooping” sound. The bacteria can be transmitted from person to person by respiratory secretions from coughing and sneezing which can be inhaled or indirectly contacted.

WHAT YOUSHOULD KNOW

Outbreaks of Pertussis are usually related to a lack of vaccination. It is important that all people receive immunization to ensure a high degree of immunity. The best defense is for all staff to be immunized. Facilities should have immunization requirements to protect staff and customers. The bacteria can be transmitted via environmental surfaces and hands, so good hand hygiene and proper surface cleaning and disinfection are also important parts of preventing the spread of Pertussis.

WHOOPING COUGH/PERTUSSIS



MARCH 2019


ACUTE FLACCID MYELITIS - NON-POLIO ENTEROVIRUSNew cases of Acute Flaccid Myelitis (AFM) continue to be reported in a number of states in the US with the CDC reporting 527 confirmed cases of AFM from Aug 2014 to Oct 2018. Recently published studies by the University of Arizona are focusing increasing interest in Enterovirus EV=D68 as the main pathogen likely to cause AFK.

The disease typically starts with a fever and often with a respiratory infection and results in Acute Flaccid Myelitis 3-10 days later, which is a polio-like symptom that causes paralysis of the limbs over a period of time. Children between 2 -8 are at highest risk. AFM occurs as a result of certain infections, including non-polio enteroviruses. While not polio, infections that result in Acute Flaccid Myelitis (AFM) are often called “polio-like” because the enteroviruses causing the infection are similar to polio and have the potential to cause AFM as a result of the infection. Enteroviruses often cause minor respiratory diseases including Hand, Foot, and Mouth disease. However severe complications are possible including meningitis, encephalitis and acute flaccid paralysis.

WHAT YOU SHOULD KNOW

Preventing enterovirus infections hand hygiene, environmental disinfection, and respiratory hygiene practices. The virus causing this illness is hard to kill and AHP disinfectants are the best option to kill it as low level disinfectants have minimal effect on enteroviruses. Because the virus can be present in feces, changing the diaper of a baby with an enterovirus infection should be followed by thorough hand washing.

FAST FACTS

LocationUSA


TransmissionDROPLET



MARCH 2019


10 million+ cases of measles globally with only the most serious being reported. Measles cases are notoriously underreported making it difficult to know for certain how many infections occur globally each year, but the WHO has worked to improve the reporting process over the last several decades. The WHO further reports that since the introduction of the vaccine in the 1960s, the global number of cases of measles each year had been declining until 2017 when case totals started to increase. Vaccine hesitancy and misinformation on vaccine safety have been identified as the main drivers of the increase in infections.

Measles is considered one of the most contagious infectious diseases and is a respiratory infection spread by coughing and sneezing with an incubation period of about 10 days (range of 7-18 days). People infected with measles can suffer from side effects including encephalitis, pneumonia, and the infection can be fatal, especially for children with a mortality rate of 0.1-0.2%. Measles is the leading cause of vaccine preventable death with an estimated 134,200 deaths globally in 2015. Prior to widespread vaccination in 1980, there were ~2.6 million deaths globally each year.

WHAT YOUSHOULD KNOW

Outbreaks of measles are usually related to a lack of vaccination. It is important that all people receive both doses of the MMR vaccine to ensure a high degree of immunity and any recommended boosters. The best defense is for all staff to be immunized. Facilities should have immunization requirements to protect staff and customers.

FAST FACTS

LocationUSA, PHILIPPINES

SeverityMULTI-COUNTRY OUTBREAK

TransmissionCONTACT + DROPLET + AEROSOL

The measles outbreaks in the United States continue to spread with 101 confirmed cases from 10 states involved in 5 separate outbreaks in the first five weeks of 2019. The vaccination rate for measles in the United States has fallen from 0.9% unvaccinated to 1.3% unvaccinated between 2011 and 2015 and this decrease is being blamed for most of the outbreak with some of the affected counties showing vaccination rates of only 80%.

An ongoing measles outbreak in the Philippines has infected 12,736 with 203 deaths so far in 2019. The median age of those infected is 2 years old and 57% of those infected are under 5 years old. The government of the Philippines estimates that 63% of those infected were not properly vaccinated.

The World Health Organization recently provided an update on measles cases globally, reporting that there were 229,000 cases of measles in 2018 with 136,000 deaths. Since measles does not have a high mortality rate (typically 1-2 deaths per 1,000 infected), this suggests that there were

MEASLES VIRUS



MARCH 2019


FAST FACTS

LocationCENTRAL AFRICA REPUBLIC


TransmissionCONTACT + DROPLET + VECTOR

An outbreak of Monkeypox in Central Afriica Republic (CAR) has infected 25 with 2 deaths with the cases spread across 3 health districts suggesting the outbreak in more than a localized event. Outbreaks of Monkeypox in CAR are not new as they have experienced at least one every year since 2013, suggesting a zoonotic reservoir (animal population carrying the virus) that infects people on an infrequent basis.

Monkeypox is caused by the monkeypox virus which is part of the orthopoxvirus genus of viruses, which is the family of viruses that includes smallpox. The virus is usually found only in Africa, but there have been occasional instances of infections outside Africa caused by infected animals traveling from Africa. The natural reservoir is unknown but believed to involve African rodents. There are two forms of the disease – Central African Monkeypox, which is the severe form of the disease, and West African Monkeypox, which is a mild form of the disease.

WHAT YOUSHOULD KNOW

Preventing monkeypox virus infection involves avoiding contact with sick or dead animals that may be infected, performing hand hygiene, bathing, and laundering of clothing that may have come in contact with an infected person, avoiding contact with bedding that may be contaminated with the blood or body fluids of an infected person or animal, and using appropriate personal protective equipment when caring for an infected person.

MONKEYPOX



MARCH 2019


The second outbreak of Ebola virus in the Democratic Republic of the Congo (DRC) continues to increase with 829 cases and 521 deaths with a further 201 cases under investigation. More than 79,000 people have been vaccinated using the vaccine Merck is developing as the DRC government works with the WHO to contain the outbreak. Current vaccination efforts are reaching ~800 people per day which is believed to be a significant factor in controlling the number of people infected, especially those in healthcare treating the people infected with Ebola.

The Ebola virus causes an infection that includes hemorrhagic fever and has a high mortality rate. The virus is transmitted via contaminated blood and body fluids. Initial symptoms include: sudden onset fever, intense weakness, muscle pain, headache and sore throat. Following the initial symptoms, the person develops vomiting, diarrhea, rash, reduced kidney and liver function, and in some cases, bleeding.

WHAT YOUSHOULD KNOW

It can take up to 21 days for symptoms to start after exposure to contaminated blood or body fluids. People believing they may have become exposed to Ebola virus should seek medical attention immediately if they show the early symptoms listed above, especially if they have travelled to an area with the risk of exposure to the Ebola virus or have been in contact with someone suspected of having Ebola virus infection.

FAST FACTS

LocationDEMOCRATIC REPUBLIC OF THE CONGO


TransmissionCONTACT + DROPLET

EBOLA INFECTION



MARCH 2019


FAST FACTS

LocationSWITZERLAND


TransmissionVECTOR

Switzerland continues to experience a high level of people infected with tick-borne encephalitis. Only 2 cantons are not considered high risk as this is a country-wide issue. 380 people were infected with tick-borne encephalitis in 2018 versus an average of 100 cases per year in recent years.

There is a vaccination available to prevent tick-borne encephalitis, but most people do not get the vaccination, making them much more susceptible to the infection. Tick-borne encephalitis is caused by the tick-borne encephalitis virus (TBEV), which is a member of the Flaviviridae family of viruses.

WHAT YOUSHOULD KNOW

Preventing tick bites requires people to avoid bushes and tall grass and wearing clothing that covers the arms, legs, and feet, and checking the body for ticks after being outside.

TICK-BORNE ENCEPHALITIS



MARCH 2019


FAST FACTS

LocationEUROPE

SeverityREGIONAL OUTBREAK

TransmissionCONTACT + VECTOR

The European CDC (E-CDC) recently provided final data for 2018 on the outbreak of West Nile virus in Europe. The total number of people infected was 2,083 (with 188 deaths) which was ten times higher than the 2017 total of 200 cases. Affected countries included Italy (576 cases), Greece (311), Romania (277), Hungary (215), Croatia (53), France (27), Austria (20), and Bulgaria (15).

West Nile Virus (WNV) is caused by a virus that is similar to Zika, Dengue, and La Crosse Encephalitis and is primarily spread by mosquitoes that feed on dead birds infected with the virus or infected mosquitoes biting birds or other animals. People are not believed to be at risk of becoming infected by handling live or dead birds carrying the virus. WNV is common in the United States and Europe, especially in rural areas during months with high mosquito populations. The disease is characterized by headache, fever, nausea, vomiting, drowsiness, dizziness and in severe cases, coma and seizures. There is currently no vaccine or specific treatment for the disease, but it often requires hospitalization, especially for severe cases. People exposed to contaminated blood and body fluids may also become infected by these routes, but this is relatively uncommon.

WHAT YOUSHOULD KNOW

WNV is spread primarily by mosquito bites, so mosquito suppression programs and taking precautions to prevent mosquito bites are key to preventing WNV infections, which includes wearing long clothing when outdoors, having screens on doors and windows in buildings that are not air conditioned, and the use of mosquito repellant when outdoors. There is currently no vaccination available to prevent WNV infections, so mosquito suppression is the primary method of preventing transmission and infection.

WEST NILE VIRUS (WNV)



MARCH 2019


FAST FACTS

LocationBRAZIL


TransmissionCONTACT + VECTOR

Brazil is currently experiencing an outbreak of Yellow Fever, which is common between December and May. From Dec 2018 to Jan 2019 there have been 361 confirmed cases with 8 deaths. While it is too early in the outbreak to know how large the outbreak will be, it is important to note that it appears to be ongoing and is showing no signs of stopping at this point.

The virus that causes Yellow Fever is spread by Aedes mosquitoes, and as with Dengue and Zika, efforts to control Yellow Fever center on mosquito control. The symptoms of Yellow Fever are similar to other mosquito-borne diseases, including fever, chills, headache, back pain, body aches, nausea, and fatigue, but can include jaundice (yellowing of skin color), which is how the infection was named. While most people that get Yellow Fever show no symptoms, about 15% of those that show symptoms develop the more severe form of the disease, which includes the jaundice, high fever, bleeding, and eventually shock and organ failure. For those that develop the more severe symptoms, the mortality rate for Yellow Fever is 20-50%.

WHAT YOUSHOULD KNOW

If traveling to this country, you should discuss with your doctor whether you should have the Yellow Fever vaccination. Anyone planning to travel to areas of high risk for Yellow Fever will typically be advised to be vaccinated in advance.

YELLOW FEVER



MARCH 2019


FAST FACTS

LocationUSA


TransmissionAIRBORNE

Levels of the fungal infection Coccidiodomycosis in California showed an increased in 2018 to 8,100 cases, which is 42% above the 2016 levels and shows a sustained increase in cases over multiple years. Of the 10,000 cases in the US each year, most occur in California.

Valley Fever, or Coccidiodomycosis, is a fungal infection caused by the fungus Coccidioides that naturally occurs in soil. People breathing in the spores can become infected, but the infection does not appear to be passed from person to person and most people exposed to the spores do not develop symptoms of infection. While typically a mild infection that resolves after weeks to months, some people require anti-fungal antibiotics and the severe form of the infection can cause blindness or even death.

WHAT YOUSHOULD KNOW

While the infection is not generally passed from person to person, reducing exposure to fungal spores in dust/dirt can help reduce the risk of infection. People with active Coccidiodomycosis infection may transmit the infection to other people through contact with an infected wound. Certain people are at higher risk of Coccidiodomycosis infection if exposed to the fungal spores and the CDC website lists the high risk groups.

COCCIDIODOMYCOSIS (VALLEY FEVER)



MARCH 2019


Hepatitis B, and Hepatitis C, with vaccinations available for Hepatitis A and Hepatitis B. Hepatitis A is passed to other people through contact with infected feces, or if an infected person touches objects after using the toilet and not washing their hands, including contaminating food or drink from contact with contaminated hands, so handwashing and surface disinfection are important interventions to prevent the spread of the virus. It can also be spread by sexual contact. The virus can also be spread through contact with diapers or the stool of an infected child/person. It can take from 15-50 days to develop symptoms once infected.

WHAT YOUSHOULD KNOW

Preventing Hepatitis A infections involves vaccination of high risk people, hand hygiene, environmental disinfection, and safe sexual practices. The virus causing this illness is hard to kill and AHP hydrogen peroxide disinfectants are the best option to kill it on environmental surfaces as low level disinfectants have minimal effect on Hepatitis A virus. In countries where disinfectants are often not used when cleaning, this is especially concerning because the virus can survive for periods of time in the environment in feces (most likely days to weeks) which allows for time for them to be transmitted from person to person. A highly effective vaccination is available and people may want to proactively vaccinate themselves to protect against this infection.

FAST FACTS

LocationUSA


TransmissionCONTACT

Kentucky reported end of 2018 case totals indicating that 4,091 people have been infected with 1,982 hospitalizations and 40 deaths since Nov 2017 when the outbreak started. The outbreak is showing no signs of slowing with more than 100 new cases per week for the last 12 weeks. Kentucky reports that their case totals for Hepatitis A now stand at 3,719 cases with 1,825 hospitalizations and 22 deaths with the number of new infections increasing suggesting the worst of this outbreak is yet to come. These case totals are well above the 10 year average for Hepatitis A infections for Kentucky.

West Virginia reports their current case counts as 2,276 cases with 1,141 hospitalizations and 12 deaths. The case totals for West Virginia are declining, suggesting that their outbreak may be over soon.

Hepatitis A is an infection that causes an inflammation of the liver. There are a number of viruses that can cause Hepatitis including Hepatitis A,

HEPATITIS A



MARCH 2019


FAST FACTS

LocationMEXICO


TransmissionVECTOR

In February, an outbreak of American Trypanosomiasis (Chagas Disease) has been reporter in Yucatan in Mexico infecting 24 people. In 2017 there were only 62 cases for the entire year, so this cluster of cases represents a significant increase.

American Trypanosomiasis (AT) (also known as Chagas Disease) is common in places where tratomine insects (also called kissing bugs or chiggers) carry the Trypanosoma cruzi parasite. Contaminated blood can also pass the infection, so contact with blood from an infected person can pass the parasite to another person, but this is much less common.

WHAT YOUSHOULD KNOW

Control of the insects that carry the parasite are the key to preventing AT infections. Spraying for insects, keeping houses closed (screens on doors and windows) and eliminating breeding grounds for insects are the keys to prevention. Blood donations in areas with high rates of AT should be screened to ensure there is no risk of subsequent infection.

AMERICAN TRYPANOSOMIASIS/CHAGAS DISEASE



MARCH 2019


3-5

MILLIO

N

INFLUENZA

people infected globally each year

250,000 – 500,000 deaths

NOR

OVIRUS21 million people infected in the US alone each year with

600-800 deaths.

PERTUSSIS16 million people infected globally each year, 200,000 deaths.

WHOOPING COUGH

MEA

SLES

infected globally each year, 146,000 deaths

20million

DENGUE

people infected globally each year, 12,500 deaths

400million

Across our customers facilities, our comprehensive cleaning, disinfection, and hand hygiene programs provide the solutions and expertise needed to reduce the risk of infection while increasing operational efficiency.

Diversey provides resources to help our customers manage outbreaks including providing education and training for our customers regarding best practices for cleaning, disinfection, and hand hygiene in healthcare and public environments.

AHP® Hydrogen Peroxide Disinfectants• Realistic contact times that kill

pathogens before surfaces dry• Excellent staff safety profile - can

be used without personal protective equipment

• Strong cleaning ability to reduce environmental bioburden

• Excellent sustainability profile to reduce environmental impact

• Available in a range of formats including prewetted disposable wipers

IntelliCare Hand Hygiene Program• Innovative dispenser including

patented hybrid manual/touchless• Full product range and formats from

a single dispenser• Electronic compliance monitoring

program to increase efficiency• Trusted brands, such as Lux, for a

more home-like experience

At Diversey, we reduce the risk of infection to make your facility safer

Our best in class solutions include the following:

Our experts frequently consult with our customers on environmental hygiene practices for facilities in a wide range of industries including healthcare, hospitality, education, offices, and public buildings such as retail stores, shopping malls, and airports. Not all outbreaks are environmentally transmitted, but even for those with minimal environmental routes of transmission, we still help customers with other aspects of prevention to create safer facilities.

www.diversey.com© 2019 Diversey


march 019 infection revention€¦ · the philippines estimates that 63% of those infected were not...

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