ABSTRACT Background Although hepatitis B virus (HBV) transmission in dental settings is rare, in 2009 a cluster of acute HBV infections was reported among attendees of a two-day portable dental ...clinic in West Virginia. Methods The authors conducted a retrospective investigation by using treatment records and volunteer logs, interviews of patients and volunteers with acute HBV infection as well as of other clinic volunteers, and molecular sequencing of the virus from those acutely infected. Results The clinic was held under the auspices of a charitable organization in a gymnasium staffed by 750 volunteers, including dental care providers who treated 1,137 adults. Five acute HBV infections—involving three patients and two volunteers—were identified by the local and state health departments. Of four viral isolates available for testing, all were genotype D. Three case patients underwent extractions; one received restorations and one a dental prophylaxis. None shared a treatment provider with any of the others. One case volunteer worked in maintenance; the other directed patients from triage to the treatment waiting area. Case patients reported no behavioral risk factors for HBV infection. The investigation revealed numerous infection control breaches. Conclusions Transmission of HBV to three patients and two volunteers is likely to have occurred at a portable dental clinic. Specific breaches in infection control could not be linked to these HBV transmissions. Practical Implications All dental settings should adhere to recommended infection control practices, including oversight; training in prevention of bloodborne pathogens transmission; receipt of HBV vaccination for staff who may come into contact with blood or body fluids; use of appropriate personal protective equipment, sterilization and disinfection procedures; and use of measures, such as high-volume suction, to minimize the spread of blood.
CASE DESCRIPTION A female alpaca, kept at pasture with 12 other female alpacas, 2 crias, and 5 goats, was evaluated because of clinical signs of aggression. CLINICAL FINDINGS The clinical signs of ...aggression progressed to include biting at other animals as well as disorientation. Three days later, the alpaca was euthanized because of suspicion of rabies virus infection. TREATMENT AND OUTCOME No physical injuries were found at necropsy. Brain tissue specimens were confirmed positive for rabies on the basis of direct fluorescent antibody test results. Molecular typing identified the rabies virus variant as one that is enzootic in raccoons. The farm was placed under quarantine, restricting movement of animals on and off the property for 6 months. To prevent further rabies cases, 14 alpacas (12 adults and 2 crias) were vaccinated by extralabel use of a large animal rabies vaccine. Of the 14 vaccinated alpacas, 8 had paired serum samples obtained immediately before and 21 days after vaccination; all 8 alpacas had adequate serum antirabies antibody production in response to rabies vaccination. As a result of an adequate serologic response, the quarantine was reduced to 3 months. In the year after the index rabies case, no other animals on the farm developed rabies. CLINICAL RELEVANCE Extralabel use of rabies vaccines in camelids was used in the face of a public health investigation. This report provides an example of handling of a rabies case for future public health investigations, which will undoubtedly need to develop ad-hoc rabies vaccination recommendations on the basis of the unique characteristics of the event.
Objectives
To determine the extent of a group A streptococcus (GAS) cluster (2 residents with invasive GAS (invasive case‐patients), 2 carriers) caused by a single strain (T antigen type 2 and M ...protein gene subtype 2.0 (T2, emm 2.0)), evaluate factors contributing to transmission, and provide recommendations for disease control.
Design
Cross‐sectional analysis and retrospective review.
Setting
Skilled nursing facility (SNF).
Participants
SNF residents and staff.
Measurements
The initial cluster was identified through laboratory notification and screening of SNF residents with wounds. Laboratory and SNF administrative records were subsequently reviewed to identify additional residents with GAS, oropharyngeal and wound (if present) swabs were collected from SNF staff and residents to examine GAS colonization, staff were surveyed to assess infection control practices and risk factors for GAS colonization, epidemiologic links between case‐patients and persons colonized with GAS were determined, and facility infection control practices were assessed.
Results
No additional invasive case‐patients were identified. Oropharyngeal swabs obtained from all 167 SNF residents were negative; one wound swab grew GAS that was the same as the outbreak strain (T2, emm 2.0). The outbreak strain was not identified in any of the 162 staff members. One of six staff members diagnosed with GAS pharyngitis worked while ill and had direct contact with invasive case‐patients within a few weeks before their onset of symptoms. Additional minor breaches in infection control were noted.
Conclusion
Sick healthcare workers may have introduced GAS into the SNF, with propagation by infection control lapses. “Presenteeism,” or working while ill, may introduce and transmit GAS to vulnerable in SNF populations. Identification of an invasive GAS case‐patient should trigger a prompt response by facilities to prevent further transmission and workplace culture, and policies should be in place to discourage presenteeism in healthcare settings.
HEPATITIS B: Authors’ response Radcliffe, Rachel, DVM, MPH; Bixler, Danae, MD, MPH
The Journal of the American Dental Association (1939),
March 2014, Letnik:
145, Številka:
3
Journal Article
To assess the knowledge, attitudes, and practices regarding rabies preexposure prophylaxis among veterinary facility owners in West Virginia and to compare facilities in counties where raccoon rabies ...virus variant (RRVV) is or is not enzootic.
Cross-sectional telephone survey.
124 owners of facilities licensed by the West Virginia Board of Veterinary Medicine.
In 2011, an owner of each licensed facility in West Virginia was contacted by telephone to complete a questionnaire regarding practice demographics, knowledge of rabies epidemiology, and preexposure prophylaxis policies. Data from facilities in counties where RRVV is enzootic were compared with data from facilities in counties where RRVV is not enzootic. Prevalence ratios and 95% confidence intervals were calculated to quantify the strength of associations.
Owners of 124 of the 162 (77%) veterinary facilities participated in the survey. West Virginia veterinarians were knowledgeable of rabies epidemiology in the state. Respondents agreed that veterinarians (122/124 98%) and technicians and assistants (111/124 90%) should receive preexposure prophylaxis. Fifty-six (45%) respondents required that veterinarians receive preexposure prophylaxis, whereas 19 (15%) respondents required that technicians and assistants receive preexposure prophylaxis. A preexposure prophylaxis policy was in effect at 20 of 64 (31%) facilities in counties where RRVV is enzootic and 6 of 60 (10%) facilities in counties where RRVV is not enzootic. Concerns related to cost of preexposure prophylaxis were reported.
Except for veterinarians, veterinary staff in West Virginia did not commonly receive preexposure prophylaxis or regular assessments of serum rabies virus neutralizing antibody titers. All veterinary practices are encouraged to consider revising or implementing a preexposure prophylaxis policy based on the Advisory Committee on Immunization Practices' recommendations.
Purpose of Review
This review aims to identify and characterize which neglected infections of poverty (NIPs) represent a public health risk in the United States (US) and describe the health ...disparities these NIPs represent within the US population. Another aim of this review is to describe public health surveillance for NIPs in the US, including potential gaps in surveillance, and suggest actions to mitigate the disparities represented by these infections.
Recent Findings
Data are insufficient to reliably estimate prevalence, burden of disease, and provide optimal diagnostics and treatment for various NIPs in the US. Some of these infections have a long history in the US; others emerged more recently and are expected to increase with climate change. Virtually all NIPs represent racial and economic disparities.
Summary
We provide an updated review of risk factors and suggest actions state, Tribal, local, and territorial public health jurisdictions can take now to respond to this uniquely American crisis.
US public health preparedness and response to highly pathogenic avian influenza A(H5N1) viruses are assessed in this survey study conducted by the CDC.
Background Recent outbreaks in ambulatory care settings have highlighted infection control breaches as risk factors for disease transmission. In May 2009, 3 patients were hospitalized with severe ...methicillin-susceptible Staphylococcus aureus (MSSA) infections after receiving epidural injections at a West Virginia outpatient pain clinic. Methods We conducted a retrospective cohort study evaluating clinic patients who received injections during a 3-week period. A case was defined as laboratory-confirmed infection or clinical evidence of infection ≤ 14 days after a patient received an injection. Infection control procedures were assessed. MSSA isolates from patient infections and clinic staff nasal swabs were genotyped by using pulsed-field gel electrophoresis. Results Eight (7%) of 110 cohort patients met the case definition; 6 (75%) cases were laboratory confirmed. Eight (12%) of 69 patients who received epidural injections were case patients compared with none of the other 41 patients ( P = .02). During procedures, staff use of face masks and preparation of patient skin were suboptimal; epidural injection syringes were reused to access shared medication vials. MSSA isolates from 2 patients and 1 staff member were indistinguishable by pulsed-field gel electrophoresis. Conclusion Infection control breaches likely facilitated MSSA transmission to patients receiving epidural injections. Adhering to correct infection control practices in ambulatory care settings is critical to prevent disease transmission.
We describe coronavirus disease (COVID-19) among US food manufacturing and agriculture workers and provide updated information on meat and poultry processing workers. Among 742 food and agriculture ...workplaces in 30 states, 8,978 workers had confirmed COVID-19; 55 workers died. Racial and ethnic minority workers could be disproportionately affected by COVID-19.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Background
During 2017, a multistate outbreak investigation occurred after the confirmation of Seoul virus (SEOV) infections in people and pet rats. A total of 147 humans and 897 rats were ...tested.
Methods
In addition to immunoglobulin (Ig)G and IgM serology and traditional reverse-transcription polymerase chain reaction (RT-PCR), novel quantitative RT-PCR primers/probe were developed, and whole genome sequencing was performed.
Results
Seventeen people had SEOV IgM, indicating recent infection; 7 reported symptoms and 3 were hospitalized. All patients recovered. Thirty-one facilities in 11 US states had SEOV infection, and among those with ≥10 rats tested, rat IgG prevalence ranged 2%–70% and SEOV RT-PCR positivity ranged 0%–70%. Human laboratory-confirmed cases were significantly associated with rat IgG positivity and RT-PCR positivity (P = .03 and P = .006, respectively). Genomic sequencing identified >99.5% homology between SEOV sequences in this outbreak, and these were >99% identical to SEOV associated with previous pet rat infections in England, the Netherlands, and France. Frequent trade of rats between home-based ratteries contributed to transmission of SEOV between facilities.
Conclusions
Pet rat owners, breeders, and the healthcare and public health community should be aware and take steps to prevent SEOV transmission in pet rats and to humans. Biosecurity measures and diagnostic testing can prevent further infections.
An investigation of Seoul virus infections in pet rats and people in the US found 31 infected facilities and 17 people with recent infections—all recovered with 3 hospitalized. Frequent trade of rats contributed to transmission of SEOV between facilities.
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