Top Infectious Disease News of the Week—August 19, 2018

#5: A “Substantial Proportion” of Hospital MRSA Infections Occur Post-Discharge, Study Concludes: Public Health Watch

Methicillin-resistant Staphylococcus aureus (MRSA) is an old enemy.

However, the findings of a study published on August 11 in Clinical Infectious Diseases (CID) suggests infectious disease and public health specialists may need to think about the troubling gram-positive bacteria in a new way. That’s because the team of researchers working with the US Department of Veterans Affairs (VA) and the Veterans Health Administration have found that a “substantial proportion” of hospital-associated MRSA infections actually occur following patient discharge.

“The first step is recognizing that assessments of whether infection control practices have been successful should not be confined to what happens to patients between admission and discharge,” Richard E. Nelson, PhD, research health scientist, IDEAS Center, George E. Wahlen Department of Veterans Affairs Medical Center, and research associate professor, division of epidemiology, University of Utah School of Medicine told Contagion^®. “Symptoms from infections that were picked up during a hospital stay may not manifest until days or even weeks later. For this reason, contact precautions, improved hand hygiene efforts, and other infection control strategies designed to prevent transmission in the inpatient setting should have an impact on post-discharge infections as well.”

Read more about hospital MRSA infections.

#4: Brown Dog Tick Causes RMSF Epidemic in Mexico, Could Spread Stateside

A recent molecular study has confirmed the causative agent involved in a large epidemic of Rocky Mountain spotted fever (RMSF) in humans and dogs in Mexicali, in Baja California, Mexico. Because Mexicali is a town adjacent to the border with the United States, investigators now express concern that the epidemic may be spreading stateside.

Dr. Luis Tinoco-Gracia, from the Universidad Autónoma de Baja California, Mexicali, Mexico, and colleagues from the University of California, Davis, USA, published the report in the September 2018 issue of Emerging Infectious Diseases, the monthly peer-reviewed public health journal of the US Centers for Disease Control and Prevention (CDC).

Read more about the RMSF epidemic.

#3: An Update to Antiretroviral Therapies for Pediatric Patients Living with HIV

The burden of pediatric HIV infection in the United States has decreased in the recent years. The number of patients 19 years and younger at their HIV diagnosis declined from 4250 in 2011 to 3813 in 2016. And among children who received the diagnosis when they were younger than 13 years, the number of perinatal infections fell to below 100 in the United States in 2016.¹ This drop may be attributed to efforts focused on the prevention of HIV transmission from mother to child. Examples of such efforts include universal prenatal HIV screening, combination antiretroviral therapies (ARTs) to maximally suppress the maternal viral load, elective cesarean delivery, provision of neonatal antiretroviral (ARV) prophylaxis, and neonatal replacement feeding.

In the current era of ART, treatment options are more potent but have fewer toxicities and better adverse effect profiles. Lower pill burdens and dosing frequencies and more combination drug formulations, including single-tablet regimen (STR) options, provide multiple options to complement patients’ preferences and lifestyles. Specifically, for pediatric patients who have difficulty swallowing pills, the availability of chewable formulations, such as chewable raltegravir (Isentress), provides patients a better chance of improved adherence to achieve viral suppression and preservation of immune function.

Read more about ART for pediatric patients with HIV.

#2: Smallpox—A Nightmare We Cannot Shake

There are some things in public health that seem to leave a mark forever. The Black Death, smallpox contaminated blankets used as a weapon, Amerithrax, the Tuskegee syphilis study, etc. Public health is filled with wonderful and horrifying moments alike and the truth is that we do not get many moments to truly celebrate on a global level. Outbreaks may end, but the act of completely eradicating a disease? That’s something we’ve been striving toward for centuries, and with smallpox, we hit the goal in 1980. The eradication is considered one of the greatest public health accomplishments in history. A monumental global effort, it is something we remember as a proud moment in public health. Given the success of eradication, it begs the question: Why does the nightmare of smallpox still linger?

In July 2018, the antiviral TPOXX was approved as the first ever treatment for smallpox. It may seem odd that treatments for an eradicated disease are still being developed, but the truth is that there is still a chance smallpox could resurface. That may seem a bit “doomsday-ish” but here are a few reasons why we should take the threat of smallpox seriously.

Read more about smallpox.

#1: Cyclospora Outbreak Connected to McDonald’s Salads Continues to Grow

Health officials across the United States are investigating an increase in Cyclospora cases reported in a multistate outbreak which has been linked back to salads sold at McDonald’s locations throughout the country.

The most recent case counts reveal that there have been 476 confirmed cases of cyclosporiasis related to this outbreak spanning 15 states; the majority of cases, or 246, have been reported in Illinois.

As of August 16, 2018, the US Centers for Disease Control and Prevention (CDC) reported that all illnesses associated with the Cyclospora outbreak started on or after May 20, with the median illness onset date of June 29. The cases have been confirmed in individuals between the ages of 14 and 91; the median age of those infected is 53. Additionally, the CDC reports that 66% of those affected in the outbreak are female. There have been 21 hospitalizations, but no deaths have been reported at this time. Illnesses that began after July 5, 2018, may not be reported or confirmed yet.

Read more about the Cyclospora outbreak.