Top Infectious Disease News of the Week—July 28, 2019

#5: One Year of Ebola in DRC: What Makes the North Kivu Province Outbreak Distinct?

Krutika Kuppalli, MD, is no stranger to Ebola. Kuppalli, the incoming vice chair of the Infectious Diseases Society of America’s Global Health Committee, served as medical director of the Ebola Treatment Unit of the Port Loko Government Hospital in Sierra Leone from 2014 to 2015.

As the Ebola outbreak in the Democratic Republic of the Congo (DRC) has been ongoing for 1 year, Contagion® spoke to Kuppalli, also an affiliated assistant clinical professor in the Division of Infectious Diseases and Geographic Medicine at Stanford University School of Medicine, about the outbreak and what makes is distinct from the West African Ebola outbreak.

Read the full Q&A with Kuppalli.

#4: Empathetic Health Care Providers Drive Successful HIV Treatment

Want to make a difference when it comes to encouraging patients with HIV to start and stay in treatment? Show compassion and a lack of judgment, a new studyfinds.

A team of investigators at the François-Xavier Bagnoud Center at Rutgers School of Nursing in Newark, New Jersey, conducted a systematic review of 41 studies encompassing 1597 adults with HIV that were published in the US between 1997 and 2017. They discovered that a “confirming relationship” is paramount, with respondents wanting respect, compassion, and to be seen as a whole person. Patients who were treated paternalistically, or who experienced bumpy transitions, such as being released from prison without adequate coordination of health care services, were less likely to seek treatment and more likely to discontinue once started.

Often, a patient’s success or failure when it came to HIV treatment was influenced by a provider’s conversational style. One common complaint: “Patients felt like they were being grilled about their medications,” Andrea Norberg, DNP, MS, RN, executive director of the Francois-Xavier Bagnoud Center and lead author of the study, told Contagion®.

Read about the role of empathetic health care providers.

#3: European Syphilis Cases Up 70% Since 2010

After dipping slightly a decade ago, the number of reported syphilis cases in Europe reached the highest case count yet in 2017, according to a new reportfrom the European Centre for Disease Prevention and Control (ECDC).

Recent studies have noted increases in the incidence of certain sexually transmitted infections (STIs), such as chlamydia, gonorrhea, and syphilis. The trend is particularly concerning among men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) to prevent HIV infection and who engage in risky sexual behavior such has having sex without condoms. The troubling report released by the ECDC on syphilis and congenital syphilis in Europe reviews epidemiological trends from 2007 to 2018 and notes that syphilis notifications in Europe have increased by 70% since 2010.

Following a period of decline in reported syphilis cases in Europe from 2007 to 2010, which saw as few as 19,000 cases documented in a year, the new report notes that notification rates in European Union (EU) and European Economic Area (EEA) countries reached an all-time high in 2017 with more than 33,000 reported syphilis cases. “Since 2010, syphilis notification rates in the EU/EEA have been on the increase, but in recent years this trend seems to accelerate, predominantly among men having sex with men (MSM),” notes that report. “Similar trends have been observed in high-income countries outside the EU/EEA.”

Read about the rise in European syphilis cases.

#2: Breaking Down Resistant Rumors and C diff Disinfectants

Clostridioides difficile (C diff) is one of the infections that stops people in their tracks, from infection preventionists to providers and nurses alike. Roughly half a million Americans will contract this bacterial infection every year, and 20% will relapse after treatment. Moreover, 1 in 11 people with health care-associated C diff who are over 65 years of age will die within 1 month of their diagnosis. Studies have shown that the cost of managing and treating C diff infections are quite significant at around $18,000.

On top of these startling statistics, C diff also poses a challenge because the bacterium is particularly environmentally hardy. When it’s in its spore form, it’s quite resistant to disinfectants and ultimately requires bleach-based products (Clorox has become the strongest tool in our arsenal to combatting C diff). Moreover, even alcohol-based hand sanitizers aren’t enough to get rid of the bug, which requires health care workers and patients to use soap and water as a way to get the spores off through friction.

One recent study in the United Kingdom, though, sought to test the hardiness of C diff on hospital gowns and stainless steel, while also assessing the efficacy of disinfectants. Investigators first wanted to evaluate the role of gowns as fomites in C diff transmission, as there has been suspicion that they could play an active role. Studying this first relationship, the research team found that when they applied spores in sterilized water at various concentrations to the surgical gown, the number of recovered spores did not increase over time, which means that any transmission would occur within the first 10 seconds of contact. Since the gowns are capable of trapping these spores though, it is a critical reminder to only use them once and discard immediately after use.

Read about C diff disinfectants.

#1: Basil From Mexico Likely Source of Cyclospora Outbreak

As of July 24, 2019, 132 individuals have been diagnosed with Cyclospora infection as part of a multistate outbreak linked to consumption of fresh basil.

According to the US Centers for Disease Control and Prevention (CDC), all of the cases in this outbreak have been traced back to exposures in restaurants in Florida, Minnesota, New York, and Ohio, but confirmed cases have been documented in 11 states.

Early epidemiological evidence suggests that the outbreak source is fresh basil from Siga Logistics de RL de CV of Morelos, Mexico.

The onset of illness ranges from June 14 to July 9, 2019, with ill individuals ranging from 19 to 98 years with a median age of 54 years. No deaths have been reported at this time, but 4 hospitalizations have occurred.

The US Food and Drug Administration (FDA) reports that the agency has requested a voluntary recall of the basil and is working alongside Siga Logistics de RL de CV to coordinate the recall. The agency has also ramped up screening of basil imported into the United States.

At this time, the FDA advises importers, distributors, restaurants, and food service providers to refrain from selling, serving, or distributing basil imported from Siga Logistics de RL de CV. If information about the source of fresh basil from Mexico is unavailable, the product should not be sold or served.

Read about the Cyclospora outbreak linked to basil.