By Jordan Rau
The bacterial outbreak at a Los Angeles hospital highlights shortcomings in the federal government’s efforts to avert the most lethal hospital infections, which are becoming increasingly impervious to treatment.
Government efforts are hobbled, infection control experts say, by gaps in monitoring the prevalence of these germs both within hospitals and beyond. The continued overuse of antibiotics — due to over-prescription by doctors, patients’ insistence and the widespread use in animals and crops — has helped these bacteria evolve into more dangerous forms and flourish.
In the outbreak at UCLA’s Ronald Reagan Medical Center, two patients have died and more than 100 may have been exposed to CRE, an antibiotic-resistant bacteria commonly found in the digestive tract. When this germ reaches the bloodstream, fatality rates are 40 percent. The government estimates about 9,000 infections, leading to 600 deaths, are caused each year by CRE, which stands for carbapenem-resistant Enterobacteriaceae.
UCLA Health says the infections probably were passed around by inadequately sterilized scopes used to peer inside a body.
Previous CRE outbreaks have occurred elsewhere in the country, including hospitals in Illinois and Seattle.
The immediate public health response has focused on the safety of the scopes and tracking down people who may have been exposed.
The U.S. Food and Drug Administration Thursday issued a warning about the devices. But the California outbreak comes amid the government’s broader struggle to spot and battle the swelling ranks of bacteria that are resistant to most, if not all, antibiotics. Continue reading
A fourth case of measles was identified in Clallam County. The fourth case is a 14-year old male who is a sibling of the second case. The 14-year old male was quarantined during his infectious period so he had no public contact.
Dr. Jeanette Stehr-Green, Clallam County Health Officer, again under scored the importance of adherence to quarantine among exposed persons, daily reports to Public Health nurses regarding symptoms, and no contacts with unvaccinated individuals as critical to stopping the spread of measles.
A person with measles is contagious from approximately four days before the onset of rash to four days after the rash appears and should not be in contact with any susceptible persons during this time.
Clallam County Health and Human Service, Public Health Section will continue with no cost clinics on February 23, 24, 26, and 27.
Clinics will be held at 111 3rd St, Port Angeles.
Feb. 23 Feb. 24 Feb. 26 Feb. 27
8:30 a.m. – 4:00 p.m. 8:30 a.m. – 12:00 noon 8:30 a.m. – 4:00 p.m. 8:30 a.m. – 4:00 p.m.
People are encouraged to call 360-417-2274 to make appointments. Walk-ins will be served but there may be a wait.
HHS continues to evaluate when and where to have clinics outside of the Port Angeles area. All parents are encouraged to check the vaccination status of children. Two vaccinations for children are needed for protection.
By Eyob Mazengia, PhD, RS, Food Protection Program
Public Health – Seattle & King County
When I started as a food inspector, I was assigned to the International District. And I liked it. It was almost like walking into a new culture, a new era.
What fascinated me was that as a public health worker, I had permission to walk into people’s personal spaces. I liked the smells, the sounds of their languages, their wall hangings and the way things looked.
It was a privilege, really, to be allowed into their personal spaces. Going on food inspections in the I.D., it was like walking into 3-4 different countries every day, without traveling outside the neighborhood.
Over the years, I established good relationships with the restaurant establishments. They were no longer just restaurant operators—they were mothers, fathers, grown kids. They’re not just businesses—there’s a family behind every door, people who had often gone through difficult times to be here.
And as I got to know them, I could recognize the sacrifices they made to give their children better opportunities in the U.S., and what they left behind. Even those born and raised here, you could recognize the sacrifices they were making. Continue reading
From January 1 to February 13, 2015, 141 people from 17 states and Washington DC were reported to have measles, according to the US Centers for Disease Control and Prevention
State tallies: [AZ (7), CA (98), CO (1), DC (1), DE (1), IL (11), MI (1), MN (1), NE (2), NJ (1), NY (2), NV (4), OR (1), PA (1), SD (2) TX (1), UT (2), WA (4)]†. Most of these cases [113 cases (80%)] are part of a large, ongoing multi-state outbreak linked to an amusement park in California.
The potential outbreak in the Puget Sound region is more than a health concern. The spread of measles or other preventable diseases could result in a ripple effect that could directly impact the local economy. If schools close to protect children from getting sick and parents then have to stay home, that could rack up a lot of missed days at work. Costs to the public health system and hospitals can also easily spiral out of control.
From the Idaho Department of Health and Welfare
February 6 – An outbreak of mumps that began in September 2014 among students at the Moscow campus of the University of Idaho continues to spread outside the Moscow area.
Idaho has 21 reported confirmed and probable cases, including six in the Boise area, as of Friday, Feb. 6. Two cases in Washington also are associated with this outbreak.
The measles, mumps and rubella (MMR) vaccine is the best way to prevent mumps and measles. Public health officials urge students and people who come in close contact with them to check their vaccination records to make certain they are current for MMR vaccine.
Examples of close contact include face-to-face contact or living in the same home. Mumps also spreads easily from sharing saliva through kissing, shared eating utensils or water bottles.
University of Idaho students and those in close contact with them who have not previously had mumps or who have no record of any doses of MMR vaccine should receive two doses at least 28 days apart.
Those who received only one dose should receive a second dose. Student health services, primary care providers, local public health offices, and local pharmacies may offer the vaccine.
The MMR vaccine will also protect against measles, which is increasing in the western U.S. because of a large outbreak linked to an amusement park in California. Continue reading
By Christine Vestal
The U.S. Centers for Disease Control and Prevention issued a health advisory this month about an ongoing measles outbreak, with more than 102 cases in 14 states so far. The highly contagious disease can cause severe health complications, including pneumonia, encephalitis, and death.
By 2000, measles had been nearly wiped out in the U.S., with fewer than 60 cases per year – most connected with foreign travel. Public health officials declared victory, the result of effective state-based immunization campaigns requiring kids to be vaccinated before they enter public schools.
Since then, however, the number of cases has risen along with the number of parents who have received religious or philosophical exceptions to state rules. In 2014, there were at least 23 outbreaks and more than 600 cases.
The federal government’s goal is to immunize at least 90 percent of all children before they enter school to keep measles and other childhood diseases at bay. Although the national average immunization rate (91.1 percent) exceeds that number, several states fall below it.
“To have pockets where community immunity is below 90 percent is worrisome as they will be the ones most vulnerable to a case of measles exploding into an outbreak,” said Litjen (L.J) Tan, chief strategy officer of the Immunization Action Coalition, which advocates for higher levels of immunization.
State immunization rates vary widely, with generally lower rates of inoculation occurring in states that make it relatively easy to get an exception. Lawmakers in California, Oregon, and Washington state are trying to tighten their laws to allow fewer nonmedical exemptions.
Laws allowing religious exemptions have been around longer than those allowing philosophical or “personal belief” exemptions, said Joy Wilson, of the National Conference of State Legislatures.
In many but not all states, philosophical exemptions are easier to get than religious exemptions, which typically require parents to cite and explain the religious doctrine in question. Overall, states with philosophical exemptions have 2.5 times the rate of opt-outs than states with only religious exemptions.
The British newspaper Guardian has a very good interactive feature the demonstrates how herd immunity created by measles vaccination protects vulnerable people, such as infants who can’t be vaccinated, from infection.
Unfortunately, they use Washington state’s Okanagan, Thurston and Island counties as examples of what happens when the virus enters a community with a low vaccination rate.
To view The Guardian’s interactive go here:
With measles in the national spotlight, Meaghan Munn and Libby Page in our Communicable Disease Epidemiology and Immunizations unit created interactive maps showing the immunization levels at local schools to help King County residents know the extent of vaccination in their own communities.
Measles was considered eliminated in the United States in 2000, but the large number of cases nationally has shown that the virus can find a toehold when people without full protection are exposed. High vaccination rates are crucial to prevent a resurgence of this serious disease.
“It’s possible that we could have a measles outbreak locally, particularly in areas with pockets of people who have not been fully vaccinated,” said Dr. Jeff Duchin, Interim Local Health Officer. “We want to do whatever we can to prevent that from happening. This tool allows parents and guardians to see how well their community would be protected if there was a case of measles at their neighborhood school.”
Searchable maps show immunization rates
King County residents can search maps at www.kingcounty.gov/school-immunizations to see the number of students at private and public schools who have completed all the required immunizations or shown proof of their immunity.
The maps show the most recent immunization data for kindergartners, sixth graders, and K-12 reported by each school to the Washington State Department of Health (DOH). One map specifically shows immunization levels for the measles, mumps and rubella (MMR) vaccine. Continue reading
From Public Health – Seattle & King County
A Clallam County resident with measles visited several public areas in Clallam and King Counties while contagious between Monday, January 26, 2015 and Friday, January 30, 2015.
Anyone who was in one of the following locations during the indicated times may have been exposed to measles: Continue reading
By Jenny Gold
State lawmakers in California introduced legislation Wednesday that would require children to be fully vaccinated before going to school, a response to a measles outbreak that started in Southern California and has reached 107 cases in 14 states.
California is one of 19 states that allows parents to enroll their children in school unvaccinated through a “personal belief exemption” to public health laws. The outbreak of measles that began in December in Anaheim’s Disneyland amusement park has spread more quickly in communities where many parents claim the exemption.
State Sens. Dr. Richard Pan and Ben Allen have proposed eliminating the personal belief exemption altogether in California.
“Every year that goes by we are adding to the number of unvaccinated people and so that’s putting everyone at greater risk,” said Pan, who is also a pediatrician. “We shouldn’t have to wait until someone sickens and dies to act.”
The exemption isn’t new — it’s been around since the 1960s. But the number of parents taking the exemption went way up in the past decade. In some schools in California, more than half of children have an exemption.
If their law passes, all of those children would be required to get fully vaccinated in order to go to school. Pan says the most parents in the state would support that. Continue reading
From Public Health – Seattle & King County
Local public health officials have confirmed a measles infection in an adult international traveler who wasin King County during the contagious period.
The traveler, who was unimmunized, was most likely exposed in the individual’s home country.
This measles case is not linked to the large, ongoing national outbreak linked to an amusement park in California. Nationally, there have been over 100 cases of measles since the beginning of the year.
This case brings the statewide total to four in 2015, including two cases in King County. There were 13 cases in King County in 2014, and four in 2013, with no cases in 2012 or 2011.
Locations of potential exposure to measles
Before receiving the measles diagnosis, the traveler was in the following public locations. Anyone who was at the following locations during the times listed was possibly exposed to measles:
January 25, 2015
8:00 a.m. – 10:00 a.m. Sheraton Hotel (common areas), 1400 6th Ave, Seattle
9:00 a.m. – 1:00 p.m. Sea-Tac Airport, Main Terminal and Concourse D
If you were at the following locations at the times listed above and are not immune to measles, the most likely time you would become sick is between February 1 and February 15.
What to do if you were in a location of potential measles exposure Continue reading
The Seattle Times reported this morning that there had been an outbreak of multidrug-resistant “superbug” infections spread by contaminated endoscopes between 2012 and 2014 in which at least 32 patients at Virginia Mason Medical Center were infected .
Neither the hospital nor health officials notified patients or the public, the Seattle Times reported.
In response to the paper’s report, Public Health – Seattle & King County has posted the following Q & A on its Public Health Insider blog:
Q & A about Public Health’s investigation of an endoscope associated outbreak
Voluntary reporting by Virginia Mason Medical Center led to identification of an outbreak of multidrug resistant bacterial infections in 2013. After months of investigative work, Public Health—working with Virginia Mason Medical Center, Washington State Department of Health and the Centers for Disease Control Prevention (CDC)—linked the outbreak to a procedure called endoscopic retrograde cholangiopancreatography (ERCP). Since discovering the risk from this procedure, our Communicable Disease Epidemiology staff has taken a leadership role in drawing national attention to this issue in the medical community. Dr. Jeff Duchin, Interim Health Officer and Chief of Communicable Disease Epidemiology answered questions about this outbreak.
What is an ERCP used for?
The ERCP procedure uses a scope, or tube, that goes through a patient’s mouth and throat to reach their upper small bowel and bile duct system. ERCP is used in persons with serious medical problems including cancers and other diseases that cause obstruction or narrowing of the bile ducts.
What kind of bacteria caused the infections?
Infections were caused by two closely-related types of bacteria that are resistant to many antibiotics. In some cases, the bacteria were also resistant to powerful antibiotics called carbapenems. These bacteria are referred to as CRE (carbapenem resistant Enterobacteriaceae).
Was the outbreak caused by a CRE “superbug?”
No. The type of CRE that has caused outbreaks in other healthcare facilities has been referred to as a “CRE superbug.” It usually produces an enzyme that inactivates carbapenem antibiotics. The outbreak we investigated was not caused by this type of CRE, which did not have a carbapenemase enzyme.
What is the role of Public Health in this investigation? Continue reading