NEWS SCAN: UK H1N1 deaths, mandatory flu vaccination, MRSA in pets, resistant Acinetobacter

Nov 1, 2011

UK data show almost fourfold increase in H1N1 deaths in 2nd pandemic wave
Deaths in the United Kingdom attributed to pandemic 2009 H1N1 flu were almost four times as high during the second wave as during the first, according to data from Department of Health researchers published today. They investigated deaths reported through the country's mandatory reporting system and found a rate of 5.4 per million during the second wave in the fall of 2009, compared with a rate of 1.6 per million in the first wave in the preceding summer (P < 0.001). They found per-million mortality rates during both waves particularly high in those with chronic neurologic disease (450), chronic heart disease (100), immune suppression (94), and chronic respiratory disease (39), compared with a rate of 2.4 in those with no risk factors. The difference between the two waves, they suggest, may have been based largely on people's behavior, such as actions reflecting a decreased perception of risk. They conclude that the data emphasize "the importance of maintaining preventative and treatment-seeking behaviours in the population beyond the period of initial high profile that the pandemic phenomenon attracts."
Nov 1 Epidemiol Infect abstract

More than half of US hospitals require flu vaccination for employees
More than half of US hospitals require employees to receive influenza immunization, according to a survey conducted by investigators with the Centers for Disease Control and Prevention. The authors defined an institutional reqirment as a policy requiring staff to receive or decline flu vaccination, with or without consequences for refusing. They found that, of 808 responding hospitals (81% response rate), 440 (56%) reported an institutional requirement for vaccination. In addition, 44% (194) had consequences for refusal, with 69% of those hospitals offering nonmedical exemptions. Required mask wearing was the most common consequence of vaccine refusal (74% of 194 requirements), and 29 of 194 hospitals (14%) terminated unvaccinated healthcare personnel (HCP). The researchers found four variables associated with mandatory vaccination: location in a state requiring HCP to receive or decline flu vaccine, caring for vulnerable patients, use of nine or more vaccine strategies recommended by the Advisory Committee on Immunization Practices, and for-profit status.
Dec 1 Clin Infect Dis abstract

Study shows MRSA may transmit to pets
Minnesota researchers examined 29 pets in 28 households that had a pediatric case of methicillin-resistant Staphylococcus aureus (MRSA) and found the disease in 2 pets but found no evidence of ongoing transmission, according to a letter yesterday in Clinical Infectious Diseases. The team identified the households from MRSA reports collected from 12 sentinel state hospitals, and trained professionals collected swab samples from pets at an initial visit and 6 months and 1 year later. Initial visits occurred from 44 to 107 days after onset of MRSA in the child. A community-associated USA300 genotype was isolated from a dog at the second visit but not at the first or third visit. The same strain was isolated from a cat at the first visit but not on subsequent visits. Both animals were asymptomatic. The authors conclude, "This limited study provides evidence for interspecies transmission of MRSA in household settings. It is unclear whether the pets were colonized when the child became infected or whether the pet was exposed to MRSA from the child or a contaminated environment." They called for using infection-control practices such as proper hand hygiene to limit interspecies transmission.
Oct 31 Clin Infect Dis extract

Positive environment samples common in ICU rooms of Acinetobacter patients
A study of multi-drug resistant Acinetobacter baumannii (MDR-AB) in intensive care unit (ICU) rooms of patients colonized or infected with the pathogen found that environmental samples were positive in 48% of patients. A baumannii is an emerging cause of healthcare-associated infection outbreaks, and the gram-negative bacteria are known to survive in the environment for prolonged periods. Investigators from the University of Maryland School of Medicine took samples from 10 surfaces of 50 ICU rooms of patients with recent or remote history of MDR-AB colonization or infection between Oct 8, 2008, and Jan 28, 2009. Of the rooms, 24 had one or more positive environmental sample. They found that the surfaces most likely to yield a positive sample were among those routinely touched by healthcare workers: supply carts, floors, infusion pumps, ventilator touch pads, and bed rails. Patients with recent history of MDR-AB were no more likely to have contamination in their environment than those with a more remote history. The authors noted the study drawbacks included a small sample size and the inability to determine transmission patterns. However, they said enhanced cleaning and monitoring of high-risk areas may be needed.
November Am J Infect Control abstract
Nov 1 APIC press release