NEWS SCAN: CDC emergency guide, terms for resistant bacteria, E coli gene clues, HVAC sampling for bioterror agents

Jul 28, 2011

CDC issues new edition of public health emergency guide
An updated version of the Center for Disease Control and Prevention's (CDC's) Public Health Emergency Response Guide for State, Local, and Tribal Public Health Directors was issued yesterday. The all-hazards reference tool, first published in early 2009, provides information on activating a jurisdiction's public health system and integrating it into the existing emergency response structure, focusing on the first 24 hours after an incident. The assessments needed and the actions to initiate are divided into the immediate (0-2 hours), intermediate (2-6 hours), and extended (6-24 hours) response phases. Also included is discussion of ongoing functions and tasks after the initial 24 hours as well as guidance on responses to specific incidents such as floods, earthquakes, and acts of terrorism. The manual is available in Spanish as well as English and has templates for users to record such individualized data as contacts, assignments, and assessment of preparedness levels. As stated by CDC, "The guide is not a substitute for emergency preparedness activities and is not intended to replace existing emergency operations plans, procedures, or guidelines within a jurisdiction's health department."
CDC page with links to online versions, templates, and hard copy ordering information
Direct link to pdf version

ECDC, CDC offer standard terminology for multidrug-resistant bacteria
With the aim of improving surveillance for antimicrobial-resistant bacteria, a committee of experts from European Centre for Disease Prevention and Control (ECDC) and the CDC has released a set of standardized definitions and terms for bacteria that are resistant to multiple drugs, the ECDC announced yesterday. The terms describe resistance profiles in several pathogens that commonly cause infections in hospitals and are prone to multidrug resistance: Staphylococcus aureus, Enterococcus species, Enterobacteriaceae (other than Salmonella and Shigella), Pseudomonas aeruginosa, and Acinetobacter species. The ECDC said harmonized definitions are needed so that epidemiologic and surveillance data can be reliably collected and compared across healthcare settings and countries. The definitions were published online yesterday by Clinical Microbiology and Infection. The article notes that many different definitions are currently used in the medical literature for "multidrug-resistant," "extensively drug-resistant," and "pandrug-resistant."
Jul 27 ECDC statement
Clin Micro Infect article

Gene study sheds more light on German E coli outbreak strain
Third-generation, real-time DNA sequencing of the complete genome of the German Escherichia coli O104:H4 outbreak strain by a group led by University of Maryland researchers found that it is closely related to other enteroaggregative strains of the same subtype but contains a prophage encoding Shiga toxin 2 and distinct virulence and antibiotic resistance factors. They published their analysis yesterday in the New England Journal of Medicine. Their investigation involved new single-molecule real-time testing technology from their collaborators at Pacific Biosciences, based in Menlo Park, Calif. The researchers made genomewide comparisons of the outbreak strain with seven other diarrhea-associated E coli O104:H4 strains from Africa, four enteroaggregative E coli strains from other serotypes, and 40 previously sequenced E coli isolates. Findings suggest the strain emerged through horizontal genetic exchange, which can occur due to the plasticity of bacterial genomes. David Rasko, PhD, first author of the study, said in a University of Maryland press release that the outbreak strain isn't a true hybrid because it only contains a small amount of DNA sequence from enterohemorrhagic E coli. He said scientists have not seen the unique combinations in the past, but with new technological tools may be identifying them more in the future. Rasko praised international researchers who have been studying the outbreak strain and sharing their findings. "This was an international collaboration pulled together in a matter of days. I expect we will see more collaborations like this to deal with new emerging pathogens in the future," he said in the statement.
Jul 27 University of Maryland press release
Jul 27 N Engl J Med abstract

Study: HVAC air sampling a valuable tool for bioterror response
A pilot project carried out in New York City in 2006-07 has demonstrated that a "native air sampling" (NAS) strategy could be implemented with effective public-private collaboration as a valuable and relatively inexpensive step in responding to release of an aerosolized bioweapon, according to a report in Biosecurity and Bioterrorism. Theoretically, samples from the NAS filters from the heating, ventilation, and air conditioning (HVAC) systems in commercial properties could help quantify the threat to the public after initial detection of an agent through dedicated air sampling (DAS). DAS, the first-line tool for detecting the release of weaponized agents, is accomplished through such initiatives as the federal BioWatch program. The authors say NAS could help determine the size and direction of a pathogen plume and would be far more efficient than environmental surface sampling and testing. The method, they write, "represents an untapped, scientifically sound, efficient, widely distributed, and comparably inexpensive resource for postevent environmental sampling." Through the pilot project, the researchers were able to determine nominal building requirements for NAS locations (eg, 24/7/365 operation and emergency access), develop procedures to identify and evaluate candidate NAS buildings, design data collection and other tools to expedite building selection and evaluation, and write sample playbooks for emergency responders.
Jul 27 Biosec Bioterror article

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