Exposure to antibiotics, hand contamination, and physical independence were among the factors associated with environmental contamination with vancomycin-resistant Enterococci (VRE) in nursing homes, researchers reported last week in The Lancet Health Longevity.

The study, conducted by researchers with the University of Michigan Medical School, aimed to identify characteristics associated with contamination of the environment by nursing home residents colonized with VRE. While most nursing homes try to disrupt the transmission of VRE and other resistant pathogens through environmental cleaning and promotion of hand hygiene among staff, the researchers wanted to see if they could disrupt the process of transmission earlier by identifying characteristics that might make patients more likely to shed and spread VRE.

The researchers enrolled 245 participants from six US nursing homes, collecting patient data and analyzing surveillance cultures obtained from participants (hands, groin, perirectal region, and oropharynx) and their rooms (including surfaces such as doorknobs, wheelchairs, and toilet seats) over multiple visits.

At baseline, VRE colonization was present in 49 participants, and environmental contamination was present for 36 of those participants. VRE prevalence across all hand samples was significantly higher when VRE was found on both participant and environmental sites (hands contaminated in 50 of 99 samples) than when VRE was only present on body sites (7 of 55 hand samples).

Antibiotic stewardship, hand hygiene could cut spread

Multivariable analysis identified antibiotic exposure (adjusted odds ratio [aOR], 2.75; 95% confidence interval [CI], 1.22 to 6.16) and male sex (aOR, 2.75; 95% CI, 1.24 to 6.08) as being associated with increased risk of environmental contamination by VRE-colonized patients and physical dependence as being associated with a reduced risk of environmental contamination (aOR, 0.91; 95% CI, 0.83 to 0.99).

"Our results support a model of VRE transmission in nursing homes whereby colonised residents with sufficient physical independence can contaminate their environment via their hands, which is likely to increase the chance of a resident with an antibiotic-disrupted microbiota acquiring VRE colonisation, either directly from the contaminated environment or via a health-care worker intermediate," the study authors wrote.

They say the findings highlight antibiotic stewardship and hand hygiene as possible interventions for reducing VRE contamination and transmission.

In its latest update, the Centers for Disease Control and Prevention (CDC) said today that flu activity and hospitalizations continue to rise, especially in the South. Covering the week ending November 4, the report said outpatient visits for respiratory illnesses are now at the national baseline of 2.9%.

The south central and southeastern regions, where flu activity often rises ahead of the rest of the country, are above their regional baselines, while activity in the western region has risen to its baseline. Outpatient visits are rising for all age-groups but are highest in children ages 4 and younger. Test positivity is highest in the southern regions, with levels in other regions stable but trending upward, the CDC said.

The CDC said four jurisdictions are reporting high flu activity, another marker of outpatient visits for flulike illness. Puerto Rico is one of the hot spots. Last week, the territory's health department declared an influenza epidemic, its first since 2016, according to a statement translated and posted by Avian Flu Diary, an infectious disease news blog. According to CDC data, the three others are Alaska, New Mexico, and Florida.

Of respiratory samples that tested positive at public health laboratories during the reporting week, about 77% were influenza A, and of subtyped samples, about 90% were the 2009 H1N1 strain.

Hospitalization surveillance shows a slight rise compared to the week before, with levels highest in seniors, followed by children younger than 4.

So far, one pediatric flu death has been reported in the current flu season.

The nation's COVID indicators—the main ones and the early markers— declined or held steady for the week ending November 4, the Centers for Disease Control and Prevention (CDC) said today in its latest update.

In its severity indicators, hospitalizations declined 8% compared to the previous week, and of the very few counties reporting high levels, most were in the Midwest and Northwest. Deaths, which had been slightly rising over the past weeks, remained level, making up 2.5% of deaths, which appear to be higher in Kentucky than in other parts of the country.

Of the early markers, emergency department (ED) visits declined 5.3%, and New Mexico is the only state at the moderate level. Test positivity remained level and is at 9% nationally but is a bit higher in the Midwest and West.

In its variant proportion updates, the CDC said the HV.1 Omicron subvariant, which descends from EG.5.1, continues to rise, and 29% is the most common variant. Another that showed rises over the past 2 weeks was HK.3, another EG.5.1 descendant. The level of BA.2 viruses, which likely include the highly mutated BA.2.86, showed a very small rise, currently making up an estimated 1% of samples.

In Nebraska, the Douglas County Health Department (DCHD) recently announced that tests have confirmed an active tuberculosis (TB) case at a drop-in daycare in Omaha and that it is investigating more than 500 possible exposures.

In a press release, the DCHD said the exposures occurred from late spring through late October. Officials are investigating the patient's activities while he or she was contagious, helping the patient isolate, and observing treatment completion until tests are negative. The DCHD is also notifying parents of children and anyone else who had close contact with the patient, which is focused on extended time spent in the same room with the patient.

Children's Nebraska hosted a clinic over the weekend to test children ages 4 and younger who were exposed to the patient over the last 10 weeks. The DCHD also said it is holding clinics at the daycare facility, Westview YWCA, to test anyone exposed between late May until August 21.

Officials said it regularly manages TB cases, having confirmed 15 cases in 2022 and 15 cases so far this year. The DCHD said the US Centers for Disease Control and Prevention (CDC) have reported more than 8,000 cases this year. Symptoms can include a cough that lasts several weeks, chest pain, and coughing up blood or sputum, along with weight loss, decreased appetite, fever, and chills.

Idaho Fish and Game has confirmed the first chronic wasting disease (CWD) case this hunting season in a new area of the state.

The affected mule deer was found just south of New Meadows in Game Management Unit 32A. Before this case, CWD had been detected only in Unit 14, north of Riggins, in fall 2021.

"This is an unfortunate situation, but it's why we test throughout the state for this disease," Fish and Game Director Jim Fredericks said in a news release. "If it's on the landscape, we want to know where, and we rely on hunters to provide samples so we can test for it and continue to manage to limit the spread of this disease."

Migration patterns to determine management

To determine the extent of CWD in Unit 32A, Fish and Game asks deer and elk hunters in Units 32A, 22, 23, 24, and 32 to have the heads or lymph nodes of their harvested animals tested for the disease. It also asks motorists to report any road-killed or sick-looking deer or elk in the Highway 95 corridor from Riggins to Weiser.

The CWD detection in Unit 32A will likely be managed differently than the 2021 detection in Unit 14 because of migration patterns, the news release said.  

If it's on the landscape, we want to know where, and we rely on hunters to provide samples so we can test for it and continue to manage to limit the spread of this disease.

"In the Slate Creek area north of Riggins, most animals remain nearby year-round, but migration patterns and winter ranges of deer where this particular animal was harvested are more complex," Fredericks said. "Most animals have already moved out of the northern part of unit 32A and will not return until spring."

CWD is a fatal prion disease that causes neurodegeneration, similar to "mad cow disease," in cervids, or members of the deer family. The disease hasn't been shown to infect people, but health officials urge people to avoid eating infected animals and to use precautions, such as wearing rubber gloves and minimizing contact with brain and spinal tissues, when processing deer.