News Scan for Aug 23, 2013

Global HCW hand hygiene
West Nile cases rise
H9N2 mutations
Cyclospora total grows
FDA warns about third-party lab

WHO push for HCW hand hygiene called simple, effective

The World Health Organization's (WHO's) strategy for better hand hygiene in healthcare workers (HCWs) is easily implemented and can make a major impact on patient safety worldwide, says a study published today in Lancet Infectious Diseases.

It is well known that transmission of healthcare-related infections occurs mainly via the hands of HCWs. The WHO's strategy is simple and inexpensive and includes such practices as ensuring that alcohol-based hand rub is available at the point of patient care, training HCWs on the most important times during patient care for hand hygiene, and posting visual reminders of hand hygiene in the workplace.

The "quasi-experimental" study to test compliance with and the effectiveness of the strategy involved 55 departments at 43 hospitals in Costa Rica, Italy, Mali, Pakistan, and Saudi Arabia over a 2-year period from December 2006 through December. 2008.

Overall compliance increased from 51% before the intervention (95% confidence interval [CI], 45.1 to 56.9) to 67% afterward (CI, 61.8 to 72.2), and all sites reported sustained or further-improved compliance 2 years following the study period. Greater effects of the intervention occurred in low- to moderate-income than in high-income countries. In addition, HCWs' knowledge of microbial transmission and hand-hygiene principles, as determined by their questionnaire scores, improved at all sites.

The strategy has been implemented in nearly 16,000 healthcare settings in 169 countries. "The current study validates its use as a universal gold standard of patient care," states a WHO press release on the study.
Aug 23 Lancet Infect Dis abstract
Aug 23 WHO press release


CDC: 296 West Nile virus cases in 43 states so far

The count of West Nile virus (WNV) infections jumped to 296 in 43 states in the week that ended Aug 20, up from 174 a week earlier, and four more deaths raised the death toll to 11, the Centers for Disease Control and Prevention (CDC) reported today. But the numbers remain far below last year's pace.

Of the 296 cases, 145 (49%) involved neuroinvasive disease, the more deadly form, the CDC said. Forty-three states and the nation's capital have reported cases so far, compared with 42 a week ago.

States reporting the most cases are California, 59; South Dakota, 52; Colorado, 36; Minnesota, 24, and North Dakota, 23. The number of presumed viremic blood donors reached 56, 16 more than a week earlier.

At this time last year the CDC was reporting 1,118 WNV cases, including 41 deaths and 629 neuroinvasive illnesses. Last year Texas had about a third of the nation's annual total of 5,674 WNV cases, but so far this year the CDC count shows just 13 cases there.
Meanwhile, the European Union had 42 WNV cases and neighboring countries had 176 cases for the season as of yesterday, the European Centre for Disease Prevention and Control (ECDC) reported today. In the past week, 12 cases have been reported in the EU and 57 in neighboring countries.
Aug 23 CDC update
Aug 23 ECDC update


H9N2 viruses in Bangladesh show mammalian mutations

H9N2 avian influenza viruses found in poultry in Bangladesh have mutations suggesting they may be adapting to mammals, according to a report published this week in Emerging Infectious Diseases.

H9N2 viruses circulate widely in Asian poultry and spill over rarely into humans, typically causing mild illness. Because of concern that H9N2 could evolve into a human pandemic strain, the US government in 2004 contracted with a pharmaceutical company to make an H9N2 vaccine.

In the study, researchers from Bangladesh and the United States tested for flu viruses in poultry in Bangladesh live markets from 2008 to 2011. They found that H9N2 viruses were present year-round, whereas highly pathogenic H5N1 viruses circulated mainly in the winter.

Phylogenetic analysis revealed that the H9N2 viruses were reassortants that contained genetic material from H7N3 viruses but no material from H5N1 viruses, the report says.

"Molecular analysis showed that multiple mammalian-specific mutations have become fixed in the subtype H9N2 viruses, including changes in the hemagglutinin, matrix, and polymerase proteins," the article states. "Our results indicate that these viruses could mutate to be transmissible from birds to mammals, including humans."
Aug 20 Emerg Infect Dis report
Aug 14, 2008, CIDRAP News story on pandemic potential of H9N2
CIDRAP overview of human disease caused by avian flu viruses


Cyclospora infection total grows to 629

Eight more Cyclospora infections have been reported to the US Centers for Disease Control and Prevention (CDC), pushing its total so far to 609, according to an update today. The Texas Department of State Health Services (TDSHS) is reporting 20 more cases that aren't yet reflected in the CDC's tally, which would raise the multistate outbreak total to 629.

The number of affected states held steady at 22, and among patients with available information, 40 (9%) have been hospitalized. No deaths have been reported. The latest illness onset was Jul 31, but most cases were reported in mid June through mid July, according to the CDC.

So far it's not clear if all of the cases are part of the same outbreak. Cyclospora cases in Iowa and Nebraska have been linked to a bag lettuce mix from Mexico that was served at Olive Garden and Red Lobster restaurants, which are part of the same chain.
Aug 23 CDC update
Aug 23 TDSHS update


FDA airs concerns about Colorado independent lab

In the latest development in an ongoing probe of problems unveiled by a 2012 fungal meningitis outbreak, the US Food and Drug Administration (FDA) has warned compounding pharmacies about the risk of inaccurate test results from a third-party lab that many of them use to verify the sterility and potency of their products.

The FDA in an Aug 21 statement urged compounding pharmacies not to use Front Range Laboratories for sterility and other types of quality testing for now. The warning follows a recent inspection of the Loveland, Colo., facility, where investigators observed problems with testing methods that the FDA said could lead to inaccurate test results.

About 100 pharmacies in 32 states use Front Range for their testing. The FDA said it is working with the lab to notify its customers and to determine if certain drugs should be recalled because of safety concerns.

A fungal illness outbreak linked to methylprednisolone acetate injections from a Massachusetts compounding pharmacy, with 749 illnesses and 63 deaths, sparked the federal investigation, which is looking into how the industry is regulated. Inspections and an enhanced focus on the company's products have turned up problems at other compounders as well.

In June the FDA said tests on unopened vials from Main Street Family Pharmacy in Newbern, Tenn., found bacteria and mold species that were linked to suspected skin and soft-tissue infections. Earlier this month the agency said bloodstream infections were reported at two Texas hospitals in patients who had received intravenous infusions that included a mineral supplement from a Texas compounder.
Aug 21 FDA statement
Aug 12 CIDRAP News Scan "Texas compounding pharmacy's mineral supplement sickens 15"


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