Last data update: May 20, 2024. (Total: 46824 publications since 2009)
Records 1-30 (of 38 Records) |
Query Trace: Benowitz I [original query] |
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Enhanced Contact Investigations for Nine Early Travel-Related Cases of SARS-CoV-2 in the United States (preprint)
Burke RM , Balter S , Barnes E , Barry V , Bartlett K , Beer KD , Benowitz I , Biggs HM , Bruce H , Bryant-Genevier J , Cates J , Chatham-Stephens K , Chea N , Chiou H , Christiansen D , Chu VT , Clark S , Cody SH , Cohen M , Conners EE , Dasari V , Dawson P , DeSalvo T , Donahue M , Dratch A , Duca L , Duchin J , Dyal JW , Feldstein LR , Fenstersheib M , Fischer M , Fisher R , Foo C , Freeman-Ponder B , Fry AM , Gant J , Gautom R , Ghinai I , Gounder P , Grigg CT , Gunzenhauser J , Hall AJ , Han GS , Haupt T , Holshue M , Hunter J , Ibrahim MB , Jacobs MW , Jarashow MC , Joshi K , Kamali T , Kawakami V , Kim M , Kirking HL , Kita-Yarbro A , Klos R , Kobayashi M , Kocharian A , Lang M , Layden J , Leidman E , Lindquist S , Lindstrom S , Link-Gelles R , Marlow M , Mattison CP , McClung N , McPherson TD , Mello L , Midgley CM , Novosad S , Patel MT , Pettrone K , Pillai SK , Pray IW , Reese HE , Rhodes H , Robinson S , Rolfes M , Routh J , Rubin R , Rudman SL , Russell D , Scott S , Shetty V , Smith-Jeffcoat SE , Soda EA , Spitters C , Stierman B , Sunenshine R , Terashita D , Traub E , Vahey GM , Verani JR , Wallace M , Westercamp M , Wortham J , Xie A , Yousaf A , Zahn M . medRxiv 2020 2020.04.27.20081901 Background Coronavirus disease 2019 (COVID-19), the respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. As part of initial response activities in the United States, enhanced contact investigations were conducted to enable early identification and isolation of additional cases and to learn more about risk factors for transmission.Methods Close contacts of nine early travel-related cases in the United States were identified. Close contacts meeting criteria for active monitoring were followed, and selected individuals were targeted for collection of additional exposure details and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction (RT-PCR) at the Centers for Disease Control and Prevention.Results There were 404 close contacts who underwent active monitoring in the response jurisdictions; 338 had at least basic exposure data, of whom 159 had ≥1 set of respiratory samples collected and tested. Across all known close contacts under monitoring, two additional cases were identified; both secondary cases were in spouses of travel-associated case patients. The secondary attack rate among household members, all of whom had ≥1 respiratory sample tested, was 13% (95% CI: 4 – 38%).Conclusions The enhanced contact tracing investigations undertaken around nine early travel-related cases of COVID-19 in the United States identified two cases of secondary transmission, both spouses. Rapid detection and isolation of the travel-associated case patients, enabled by public awareness of COVID-19 among travelers from China, may have mitigated transmission risk among close contacts of these cases.Competing Interest StatementThe authors have declared no competing interest.Funding StatementNo external funding was sought or received.Author DeclarationsAll relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.YesAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesData may be available upon reasonable request. |
Transmission of Mycobacterium tuberculosis to healthcare personnel resulting from contaminated bone graft material, United States, June 2021- August 2022
Li R , Deutsch-Feldman M , Adams T , Law M , Biak C , Pitcher E , Drees M , Hernandez-Romieu AC , Filardo TD , Cropper T , Martinez A , Wilson WW , Althomsons SP , Morris SB , Wortham JM , Benowitz I , Schwartz NG , White K , Haddad MB , Glowicz JB . Clin Infect Dis 2023 76 (10) 1847-1849 A nationwide tuberculosis outbreak linked to a viable bone allograft product contaminated with Mycobacterium tuberculosis was identified in June 2021. Our subsequent investigation identified 73 healthcare personnel with new latent tuberculosis infection following exposure to the contaminated product, product recipients, surgical instruments, or medical waste. |
Investigation of a prolonged and large outbreak of healthcare-associated mucormycosis cases in an acute care hospital-Arkansas, June 2019-May 2021
Jordan A , James AE , Gold JAW , Wu K , Glowicz J , Wolfe F , Vyas K , Litvintseva A , Gade L , Liverett H , Alverson M , Burgess M , Wilson A , Li R , Benowitz I , Gulley T , Patil N , Chakravorty R , Chu W , Kothari A , Jackson BR , Garner K , Toda M . Open Forum Infect Dis 2022 9 (10) ofac510 BACKGROUND: Outbreaks of healthcare-associated mucormycosis (HCM), a life-threatening fungal infection, have been attributed to multiple sources, including contaminated healthcare linens. In 2020, staff at Hospital A in Arkansas alerted public health officials of a potential HCM outbreak. METHODS: We collected data on patients at Hospital A who had invasive mucormycosis during January 2017-June 2021 and calculated annual incidence of HCM (defined as mucormycosis diagnosed within ≥7 days after hospital admission). We performed targeted environmental assessments, including linen sampling at the hospital, to identify potential sources of infection. RESULTS: During the outbreak period (June 2019-June 2021), 16 patients had HCM; clinical features were similar between HCM patients and non-HCM patients. Hospital-wide HCM incidence (per 100 000 patient-days) increased from 0 in 2018 to 3 in 2019 and 6 in 2020. For the 16 HCM patients, the most common underlying medical conditions were hematologic malignancy (56%) and recent traumatic injury (38%); 38% of HCM patients died in-hospital. Healthcare-associated mucormycosis cases were not epidemiologically linked by common procedures, products, units, or rooms. At Hospital A and its contracted offsite laundry provider, suboptimal handling of laundered linens and inadequate environmental controls to prevent mucormycete contamination were observed. We detected Rhizopus on 9 (9%) of 98 linens sampled at the hospital, including on linens that had just arrived from the laundry facility. CONCLUSIONS: We describe the largest, single-center, HCM outbreak reported to date. Our findings underscore the importance of hospital-based monitoring for HCM and increased attention to the safe handling of laundered linens. |
Evaluation of a Virtual Training to Enhance Public Health Capacity for COVID-19 Infection Prevention and Control in Nursing Homes.
Penna AR , Hunter JC , Sanchez GV , Mohelsky R , Barnes LEA , Benowitz I , Crist MB , Dozier TR , Elbadawi LI , Glowicz JB , Jones H , Keaton AA , Ogundimu A , Perkins KM , Perz JF , Powell KM , Cochran RL , Stone ND , White KA , Weil LM . J Public Health Manag Pract 2022 28 (6) 682-692 CONTEXT: Between April 2020 and May 2021, the Centers for Disease Control and Prevention (CDC) awarded more than $40 billion to health departments nationwide for COVID-19 prevention and response activities. One of the identified priorities for this investment was improving infection prevention and control (IPC) in nursing homes. PROGRAM: CDC developed a virtual course to train new and less experienced public health staff in core healthcare IPC principles and in the application of CDC COVID-19 healthcare IPC guidance for nursing homes. IMPLEMENTATION: From October 2020 to August 2021, the CDC led training sessions for 12 cohorts of public health staff using pretraining reading materials, case-based scenarios, didactic presentations, peer-learning opportunities, and subject matter expert-led discussions. Multiple electronic assessments were distributed to learners over time to measure changes in self-reported knowledge and confidence and to collect feedback on the course. Participating public health programs were also assessed to measure overall course impact. EVALUATION: Among 182 enrolled learners, 94% completed the training. Most learners were infection preventionists (42%) or epidemiologists (38%), had less than 1 year of experience in their health department role (75%), and had less than 1 year of subject matter experience (54%). After training, learners reported increased knowledge and confidence in applying the CDC COVID-19 healthcare IPC guidance for nursing homes (≥81%) with the greatest increase in performing COVID-19 IPC consultations and assessments (87%). The majority of participating programs agreed that the course provided an overall benefit (88%) and reduced training burden (72%). DISCUSSION: The CDC's virtual course was effective in increasing public health capacity for COVID-19 healthcare IPC in nursing homes and provides a possible model to increase IPC capacity for other infectious diseases and other healthcare settings. Future virtual healthcare IPC courses could be enhanced by tailoring materials to health department needs, reinforcing training through applied learning experiences, and supporting mechanisms to retain trained staff. |
Nationwide tuberculosis outbreak in the USA linked to a bone graft product: an outbreak report.
Schwartz NG , Hernandez-Romieu AC , Annambhotla P , Filardo TD , Althomsons SP , Free RJ , Li R , Wyatt Wilson W , Deutsch-Feldman M , Drees M , Hanlin E , White K , Lehman KA , Thacker TC , Brubaker SA , Clark B , Basavaraju SV , Benowitz I , Burton Glowicz J , Cowan LS , Starks AM , Bamrah Morris S , LoBue P , Stewart RJ , Wortham JM , Haddad MB . Lancet Infect Dis 2022 22 (11) 1617-1625 BACKGROUND: Mycobacterium tuberculosis transmission through solid organ transplantation has been well described, but transmission through transplanted tissues is rare. We investigated a tuberculosis outbreak in the USA linked to a bone graft product containing live cells derived from a single deceased donor. METHODS: In this outbreak report, we describe the management and severity of the outbreak and identify opportunities to improve tissue transplant safety in the USA. During early June, 2021, the US Centers for Disease Control and Prevention (CDC) worked with state and local health departments and health-care facilities to locate and sequester unused units from the recalled lot and notify, evaluate, and treat all identified product recipients. Investigators from CDC and the US Food and Drug Administration (FDA) reviewed donor screening and tissue processing. Unused product units from the recalled and other donor lots were tested for the presence of M tuberculosis using real-time PCR (rt PCR) assays and culture. M tuberculosis isolates from unused product and recipients were compared using phylogenetic analysis. FINDINGS: The tissue donor (a man aged 80 years) had unrecognised risk factors, symptoms, and signs consistent with tuberculosis. Bone was procured from the deceased donor and processed into 154 units of bone allograft product containing live cells, which were distributed to 37 hospitals and ambulatory surgical centres in 20 US states between March 1 and April 2, 2021. From March 3 to June 1, 2021, 136 (88%) units were implanted into 113 recipients aged 24-87 years in 18 states (some individuals received multiple units). The remaining 18 units (12%) were located and sequestered. 87 (77%) of 113 identified product recipients had microbiological or imaging evidence of tuberculosis disease. Eight product recipients died 8-99 days after product implantation (three deaths were attributed to tuberculosis after recognition of the outbreak). All 105 living recipients started treatment for tuberculosis disease at a median of 69 days (IQR 56-81) after product implantation. M tuberculosis was detected in all eight sequestered unused units tested from the recalled donor lot, but not in lots from other donors. M tuberculosis isolates from unused product and recipients were more than 99·99% genetically identical. INTERPRETATION: Donor-derived transmission of M tuberculosis via bone allograft resulted in substantial morbidity and mortality. All prospective tissue and organ donors should be routinely assessed for tuberculosis risk factors and clinical findings. When these are present, laboratory testing for M tuberculosis should be strongly considered. FUNDING: None. |
Keeping healthcare linens clean: Underrecognized hazards and critical control points to avoid contamination of laundered healthcare textiles
Glowicz J , Benowitz I , Arduino MJ , Li R , Wu K , Jordan A , Toda M , Garner K , Gold JAW . Am J Infect Control 2022 50 (10) 1178-1181 Outbreaks of healthcare-associated infections, particularly invasive mold infections, have been linked to environmental contamination of laundered healthcare textiles. Contamination may occur at the laundry or healthcare facility. This report highlights underrecognized hazards, control points, and actions that infection preventionists can take to help decrease the potential for patient exposure to contaminated healthcare textiles. Infection preventionists can use the checklists included in this report to assess laundry and healthcare facility management of laundered healthcare textiles. |
SARS-CoV-2 Outbreak Investigation in a Hospital Emergency Department - California, December 2020 - January 2021.
Li R , Beshearse E , Malden D , Truong H , Kraushaar V , Bonin BJ , Kim J , Kennedy I , McNary J , Han GS , Rudman SL , Perz JF , Perkins KM , Glowicz J , Epson E , Benowitz I , Villarino E . Infect Control Hosp Epidemiol 2022 1-21 We describe a large SARS-CoV-2 outbreak involving an acute care hospital emergency department during December 2020 and January 2021, in which 27 healthcare personnel worked while infectious, resulting in multiple opportunities for SARS-CoV-2 transmission to patients and other healthcare personnel. We provide recommendations for improving infection prevention and control. |
Remote Infection Control Assessments of US Nursing Homes During the COVID-19 Pandemic, April to June 2020.
Walters MS , Prestel C , Fike L , Shrivastwa N , Glowicz J , Benowitz I , Bulens S , Curren E , Dupont H , Marcenac P , Mahon G , Moorman A , Ogundimu A , Weil LM , Kuhar D , Cochran R , Schaefer M , Slifka KJ , Kallen A , Perz JF . J Am Med Dir Assoc 2022 23 (6) 909-916 e2 BACKGROUND: Nursing homes (NHs) provide care in a congregate setting for residents at high risk of severe outcomes from SARS-CoV-2 infection. In spring 2020, NHs were implementing new guidance to minimize SARS-CoV-2 spread among residents and staff. OBJECTIVE: To assess whether telephone and video-based infection control assessment and response (TeleICAR) strategies could efficiently assess NH preparedness and help resolve gaps. DESIGN: We incorporated Centers for Disease Control and Prevention COVID-19 guidance for NH into an assessment tool covering 6 domains: visitor restrictions; health care personnel COVID-19 training; resident education, monitoring, screening, and cohorting; personal protective equipment supply; core infection prevention and control (IPC); and communication to public health. We performed TeleICAR consultations on behalf of health departments. Adherence to each element was documented and recommendations provided to the facility. SETTING AND PARTICIPANTS: Health department-referred NHs that agreed to TeleICAR consultation. METHODS: We assessed overall numbers and proportions of NH that had not implemented each infection control element (gap) and proportion of NH that reported making ≥1 change in practice following the assessment. RESULTS: During April 13 to June 12, 2020, we completed TeleICAR consultations in 629 NHs across 19 states. Overall, 524 (83%) had ≥1 implementation gaps identified; the median number of gaps was 2 (interquartile range: 1-4). The domains with the greatest number of facilities with gaps were core IPC practices (428/625; 68%) and COVID-19 education, monitoring, screening, and cohorting of residents (291/620; 47%). CONCLUSIONS AND IMPLICATIONS: TeleICAR was an alternative to onsite infection control assessments that enabled public health to efficiently reach NHs across the United States early in the COVID-19 pandemic. Assessments identified widespread gaps in core IPC practices that put residents and staff at risk of infection. TeleICAR is an important strategy that leverages infection control expertise and can be useful in future efforts to improve NH IPC. |
Mycobacterium porcinum Skin and Soft Tissue Infections After Vaccinations - Indiana, Kentucky, and Ohio, September 2018-February 2019
Blau EF , Flinchum A , Gaub KL , Hartnett KP , Curran M , Allen VK , Napier A , Hesse EM , Hause AM , Cathey R , Feaster C , Mohr M , de Fijter S , Mitchell S , Moulton-Meissner HA , Benowitz I , Spicer KB , Thoroughman DA . MMWR Morb Mortal Wkly Rep 2021 70 (42) 1472-1477 During December 2018-February 2019, a multistate investigation identified 101 patients with vaccination-associated adverse events among an estimated 940 persons in Kentucky, Indiana, and Ohio who had received influenza; hepatitis A; pneumococcal; or tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines at the workplace during September 11-November 28, 2018. These vaccines had been administered by staff members of a third-party health care company contracted by 24 businesses. Company A provided multiple vaccine types during workplace vaccination events across 54 locations in these adjoining states. Injection-site wound isolates from patients yielded Mycobacterium porcinum, a nontuberculous mycobacteria (NTM) species in the Mycobacterium fortuitum group; subtyping using pulsed-field gel electrophoresis of all 28 available isolates identified two closely related clusters. Site visits to company A and interviews with staff members identified inadequate hand hygiene, improper vaccine storage and handling, lack of appropriate medical record documentation, and lack of reporting to the Vaccine Adverse Event Reporting System (VAERS). Vaccination-associated adverse events can be prevented by training health care workers responsible for handling or administering vaccines in safe vaccine handling, administration, and storage practices, timely reporting of any suspected vaccination-associated adverse events to VAERS, and notifying public health authorities of any adverse event clusters. |
Notes from the field: Tuberculosis outbreak linked to a contaminated bone graft product used in spinal surgery - Delaware, March-June 2021
Li R , Wilson WW , Schwartz NG , Hernandez-Romieu AC , Glowicz J , Hanlin E , Taylor M , Pelkey H , Briody CA , Gireesh L , Eskander M , Lingenfelter K , Althomsons SP , Stewart RJ , Free R , Annambhotla P , Basavaraju SV , Wortham JM , Morris SB , Benowitz I , Haddad MB , Hong R , Drees M . MMWR Morb Mortal Wkly Rep 2021 70 (36) 1261-1263 On May 25, 2021, a Delaware acute care hospital notified the Delaware Division of Public Health (DPH) of seven patients who developed tuberculosis after spinal surgery during March–April 2021. Hospital staff members identified a single common exposure: implantation of bone allograft material (product A) from a single product lot. DPH notified CDC, requested a field investigation, and issued a nationwide call for cases. In collaboration with the Food and Drug Administration, a CDC team was deployed to Delaware on June 2 to investigate the epidemiology of cases and opportunities for transmission and to provide prevention and treatment recommendations. On the same day, another state health department notified CDC about a person who developed tuberculosis after surgery involving the same product A lot, and the manufacturer issued a voluntary nationwide recall (1). |
Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States.
Burke RM , Balter S , Barnes E , Barry V , Bartlett K , Beer KD , Benowitz I , Biggs HM , Bruce H , Bryant-Genevier J , Cates J , Chatham-Stephens K , Chea N , Chiou H , Christiansen D , Chu VT , Clark S , Cody SH , Cohen M , Conners EE , Dasari V , Dawson P , DeSalvo T , Donahue M , Dratch A , Duca L , Duchin J , Dyal JW , Feldstein LR , Fenstersheib M , Fischer M , Fisher R , Foo C , Freeman-Ponder B , Fry AM , Gant J , Gautom R , Ghinai I , Gounder P , Grigg CT , Gunzenhauser J , Hall AJ , Han GS , Haupt T , Holshue M , Hunter J , Ibrahim MB , Jacobs MW , Jarashow MC , Joshi K , Kamali T , Kawakami V , Kim M , Kirking HL , Kita-Yarbro A , Klos R , Kobayashi M , Kocharian A , Lang M , Layden J , Leidman E , Lindquist S , Lindstrom S , Link-Gelles R , Marlow M , Mattison CP , McClung N , McPherson TD , Mello L , Midgley CM , Novosad S , Patel MT , Pettrone K , Pillai SK , Pray IW , Reese HE , Rhodes H , Robinson S , Rolfes M , Routh J , Rubin R , Rudman SL , Russell D , Scott S , Shetty V , Smith-Jeffcoat SE , Soda EA , Spitters C , Stierman B , Sunenshine R , Terashita D , Traub E , Vahey GM , Verani JR , Wallace M , Westercamp M , Wortham J , Xie A , Yousaf A , Zahn M . PLoS One 2020 15 (9) e0238342 Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19. |
Gastrointestinal flexible endoscopes: Infection control risks, lessons learned from outbreaks, and Centers for Disease Control and Prevention guidance
Benowitz I , Moulton-Meissner HA , Epstein L , Arduino MJ . Gastrointest Endosc Clin N Am 2020 30 (4) 723-733 Flexible endoscopes require cleaning, high-level disinfection, and sterilization between each patient use to reduce risk of transmitting pathogens. Public health investigations have identified concerns, including endoscope damage, mishandling, and reprocessing deficiencies, placing patients at risk for transmission of bacterial, viral, and other pathogens. Findings from outbreak investigations and other studies have led to innovations in endoscope design, use, and reprocessing, yet infection risks related to contaminated or damaged endoscopes remain. Strict adherence to infection control guidelines and manufacturer instructions for use, utilization of supplemental guidance, and training and oversight of reprocessing personnel, reduce risk of pathogen transmission by flexible endoscopes. |
Clinical and virologic characteristics of the first 12 patients with coronavirus disease 2019 (COVID-19) in the United States.
Kujawski SA , Wong KK , Collins JP , Epstein L , Killerby ME , Midgley CM , Abedi GR , Ahmed NS , Almendares O , Alvarez FN , Anderson KN , Balter S , Barry V , Bartlett K , Beer K , Ben-Aderet MA , Benowitz I , Biggs HM , Binder AM , Black SR , Bonin B , Bozio CH , Brown CM , Bruce H , Bryant-Genevier J , Budd A , Buell D , Bystritsky R , Cates J , Charles EM , Chatham-Stephens K , Chea N , Chiou H , Christiansen D , Chu V , Cody S , Cohen M , Conners EE , Curns AT , Dasari V , Dawson P , DeSalvo T , Diaz G , Donahue M , Donovan S , Duca LM , Erickson K , Esona MD , Evans S , Falk J , Feldstein LR , Fenstersheib M , Fischer M , Fisher R , Foo C , Fricchione MJ , Friedman O , Fry A , Galang RR , Garcia MM , Gerber SI , Gerrard G , Ghinai I , Gounder P , Grein J , Grigg C , Gunzenhauser JD , Gutkin GI , Haddix M , Hall AJ , Han GS , Harcourt J , Harriman K , Haupt T , Haynes AK , Holshue M , Hoover C , Hunter JC , Jacobs MW , Jarashow C , Joshi K , Kamali T , Kamili S , Kim L , Kim M , King J , Kirking HL , Kita-Yarbro A , Klos R , Kobayashi M , Kocharian A , Komatsu KK , Koppaka R , Layden JE , Li Y , Lindquist S , Lindstrom S , Link-Gelles R , Lively J , Livingston M , Lo K , Lo J , Lu X , Lynch B , Madoff L , Malapati L , Marks G , Marlow M , Mathisen GE , McClung N , McGovern O , McPherson TD , Mehta M , Meier A , Mello L , Moon SS , Morgan M , Moro RN , Murray J , Murthy R , Novosad S , Oliver SE , O’Shea J , Pacilli M , Paden CR , Pallansch MA , Patel M , Patel S , Pedraza I , Pillai SK , Pindyck T , Pray I , Queen K , Quick N , Reese H , Reporter R , Rha B , Rhodes H , Robinson S , Robinson P , Rolfes MA , Routh JA , Rubin R , Rudman SL , Sakthivel SK , Scott S , Shepherd C , Shetty V , Smith EA , Smith S , Stierman B , Stoecker W , Sunenshine R , Sy-Santos R , Tamin A , Tao Y , Terashita D , Thornburg NJ , Tong S , Traub E , Tural A , Uehara A , Uyeki TM , Vahey G , Verani JR , Villarino E , Wallace M , Wang L , Watson JT , Westercamp M , Whitaker B , Wilkerson S , Woodruff RC , Wortham JM , Wu T , Xie A , Yousaf A , Zahn M , Zhang J . Nat Med 2020 26 (6) 861-868 Data on the detailed clinical progression of COVID-19 in conjunction with epidemiological and virological characteristics are limited. In this case series, we describe the first 12 US patients confirmed to have COVID-19 from 20 January to 5 February 2020, including 4 patients described previously(1-3). Respiratory, stool, serum and urine specimens were submitted for SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) testing, viral culture and whole genome sequencing. Median age was 53 years (range: 21-68); 8 patients were male. Common symptoms at illness onset were cough (n = 8) and fever (n = 7). Patients had mild to moderately severe illness; seven were hospitalized and demonstrated clinical or laboratory signs of worsening during the second week of illness. No patients required mechanical ventilation and all recovered. All had SARS-CoV-2 RNA detected in respiratory specimens, typically for 2-3 weeks after illness onset. Lowest real-time PCR with reverse transcription cycle threshold values in the upper respiratory tract were often detected in the first week and SARS-CoV-2 was cultured from early respiratory specimens. These data provide insight into the natural history of SARS-CoV-2. Although infectiousness is unclear, highest viral RNA levels were identified in the first week of illness. Clinicians should anticipate that some patients may worsen in the second week of illness. |
Multiple Respiratory Syncytial Virus Introductions Into a Neonatal Intensive Care Unit.
Rose EB , Washington EJ , Wang L , Benowitz I , Thornburg NJ , Gerber SI , Peret TCT , Langley GE . J Pediatric Infect Dis Soc 2020 10 (2) 118-124 BACKGROUND: Outbreaks of respiratory syncytial virus (RSV) in neonatal intensive care units (NICUs) are of concern because of the risk of severe disease in young infants. We describe an outbreak of RSV in a NICU and use whole genome sequencing (WGS) to better understand the relatedness of viruses among patients.SummaryUsing whole genome sequencing, we found 2 introductions of respiratory syncytial virus (RSV) into a neonatal intensive care unit causing 7 infections. This outbreak highlights the risk of healthcare-associated infections during RSV season; early recognition is critical to limit transmission. METHODS: An investigation was conducted to identify patients and describe their clinical course. Infection control measures were implemented to prevent further spread. Respiratory specimens from outbreak-related patients and the community were tested using WGS. Phylogenetic trees were constructed to understand relatedness of the viruses. RESULTS: Seven patients developed respiratory symptoms within an 11-day span in December 2017 and were diagnosed with RSV; 6 patients (86%) were preterm and 1 had chronic lung disease. Three patients required additional respiratory support after symptom onset, and none died. Six of 7 patients were part of the same cluster based on > 99.99% nucleotide agreement with each other and 3 unique single-nucleotide polymorphisms were identified in viruses sequenced from those patients. The seventh patient was admitted from the community with respiratory symptoms and had a genetically distinct virus that was not related to the other 6. Implementation of enhanced infection control measures likely limited the spread. CONCLUSIONS: Using WGS, we found 2 distinct introductions of RSV into a NICU, highlighting the risk of healthcare-associated infections during RSV season. Early recognition and infection control measures likely limited spread, emphasizing the importance of considering RSV in the differential diagnosis of respiratory infections in healthcare settings. |
First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA.
Ghinai I , McPherson TD , Hunter JC , Kirking HL , Christiansen D , Joshi K , Rubin R , Morales-Estrada S , Black SR , Pacilli M , Fricchione MJ , Chugh RK , Walblay KA , Ahmed NS , Stoecker WC , Hasan NF , Burdsall DP , Reese HE , Wallace M , Wang C , Moeller D , Korpics J , Novosad SA , Benowitz I , Jacobs MW , Dasari VS , Patel MT , Kauerauf J , Charles EM , Ezike NO , Chu V , Midgley CM , Rolfes MA , Gerber SI , Lu X , Lindstrom S , Verani JR , Layden JE . Lancet 2020 395 (10230) 1137-1144 BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first detected in China in December, 2019. In January, 2020, state, local, and federal public health agencies investigated the first case of COVID-19 in Illinois, USA. METHODS: Patients with confirmed COVID-19 were defined as those with a positive SARS-CoV-2 test. Contacts were people with exposure to a patient with COVID-19 on or after the patient's symptom onset date. Contacts underwent active symptom monitoring for 14 days following their last exposure. Contacts who developed fever, cough, or shortness of breath became persons under investigation and were tested for SARS-CoV-2. A convenience sample of 32 asymptomatic health-care personnel contacts were also tested. FINDINGS: Patient 1-a woman in her 60s-returned from China in mid-January, 2020. One week later, she was hospitalised with pneumonia and tested positive for SARS-CoV-2. Her husband (Patient 2) did not travel but had frequent close contact with his wife. He was admitted 8 days later and tested positive for SARS-CoV-2. Overall, 372 contacts of both cases were identified; 347 underwent active symptom monitoring, including 152 community contacts and 195 health-care personnel. Of monitored contacts, 43 became persons under investigation, in addition to Patient 2. These 43 persons under investigation and all 32 asymptomatic health-care personnel tested negative for SARS-CoV-2. INTERPRETATION: Person-to-person transmission of SARS-CoV-2 occurred between two people with prolonged, unprotected exposure while Patient 1 was symptomatic. Despite active symptom monitoring and testing of symptomatic and some asymptomatic contacts, no further transmission was detected. FUNDING: None. |
The impact of exclusive use of very low nicotine cigarettes on compensatory smoking: An inpatient crossover clinical trial
Smith TT , Koopmeiners JS , White CM , Denlinger-Apte RL , Pacek LR , De Jesus VR , Wang L , Watson C , Blount BC , Hatsukami DK , Benowitz NL , Donny EC , Carpenter MJ . Cancer Epidemiol Biomarkers Prev 2020 29 (4) 880-886 BACKGROUND: The FDA is considering a mandated reduction in the nicotine content of cigarettes. Clinical trials have been limited by non-study cigarette use (noncompliance), which could mask compensation. The goal of this study was to assess whether compensation occurs when smokers provided with very low nicotine cigarettes cannot access normal nicotine cigarettes. METHODS: In a within-subjects, crossover design, current smokers (n = 16) were confined to a hotel for two 4-night hotel stays during which they were only able to access the research cigarettes provided. The hotel stays offered normal nicotine cigarettes or very low nicotine content (VLNC) cigarettes, in an unblinded design, available for "purchase" via a study bank. RESULTS: In the context of complete compliance with the study cigarettes (n = 16), there was not a significant increase during the VLNC condition for cigarettes smoked per day, expired carbon monoxide, or N-acetyl-S-(cyanoethyl)-l-cysteine (cyanoethyl-MA, metabolite of acrylonitrile). There was a significant nicotine x time interaction on urine N-acetyl-S-(3-hydroxypropyl)-l-cysteine (hydroxypropyl-MA, metabolite of acrolein), driven by an increase in the VLNC condition during the first 24 hours. By the end of the VLNC condition, there was no evidence of compensation across any measure of smoking or smoke exposure. CONCLUSIONS: Among current smokers who exclusively used VLNC cigarettes for 4 days, there was no significant compensatory smoking behavior. IMPACT: These data, combined with the larger body of work, suggest that a mandated reduction in nicotine content is unlikely to result in an increase in smoking behavior to obtain more nicotine. |
Mouth-level nicotine intake estimates from discarded filter butts to examine compensatory smoking in low nicotine cigarettes
Smith TT , Koopmeiners JS , Hatsukami DK , Tessier KM , Benowitz NL , Murphy SE , Strasser AA , Tidey JW , Blount BC , Valentin L , Bravo Cardenas R , Watson C , Pirkle JL , Donny EC . Cancer Epidemiol Biomarkers Prev 2020 29 (3) 643-649 BACKGROUND: A mandated reduction in the nicotine content of cigarettes could reduce smoking rate and prevalence. However, one concern is that smokers may compensate by increasing the intensity with which they smoke each cigarette to obtain more nicotine. This study assessed whether smokers engage in compensatory smoking by estimating the mouth-level nicotine intake of low nicotine cigarettes smoked during a clinical trial. METHODS: Smokers were randomly assigned to receive cigarettes with one of five nicotine contents for 6 weeks. An additional group received a cigarette with the lowest nicotine content, but an increased tar yield. The obtained mouth-level nicotine intake from discarded cigarette butts for a subset of participants (51-70/group) was estimated using solanesol as described previously. A compensation index was calculated for each group to estimate the proportion of nicotine per cigarette recovered through changes in smoking intensity. RESULTS: There was no significant increase in smoking intensity for any of the reduced nicotine cigarettes as measured by the compensation index (an estimated 0.4% of the nicotine lost was recovered in the lowest nicotine group; 95% confidence interval, -0.1 to 1.2). There was a significant decrease in smoking intensity for very low nicotine content cigarettes with increased tar yield. CONCLUSIONS: Reductions in nicotine content did not result in compensatory changes in how intensively participants smoked research cigarettes. IMPACT: Combined with data from clinical trials showing a reduction in cigarettes smoked per day, these data suggest that a reduction in nicotine content is unlikely to result in increased smoke exposure. |
Reprocessing, CDC, and IPs: Leveraging public health services and resources for sterilization and high-level disinfection of medical devices
Stuckey MJ , Benowitz I . Prev Strateg 2019 12 (3) 34-37 Sterilization and high-level disinfection (HLD) are highly technical processes informed by standards and guidelines. Improper reprocessing of medical devices puts patients at risk for healthcare-associated infections (HAIs), including those caused by bloodborne and bacterial pathogens. Commonly observed problems include failure to adhere to standards, guidelines, and manufacturer instructions for use; lack of understanding about how to monitor and interpret various quality indicators (e.g., sterilization parameters and controls); and complicated designs that make devices (e.g., some duodenoscopes) difficult to properly clean and disinfect. Adherence to best practices in the reprocessing of medical devices is a Standard Precaution and essential to facility HAI prevention and occupational health programs. |
Notes from the Field: Unexplained dermatologic, respiratory, and ophthalmic symptoms among health care personnel at a hospital - West Virginia, November 2017-January 2018
Lucas TJ , Holodniy M , de Perio MA , Perkins KM , Benowitz I , Jackson D , Kracalik I , Grant M , Oda G , Powell KM . MMWR Morb Mortal Wkly Rep 2019 68 (44) 1006-1007 During November 8–December 25, 2017, health care personnel at an 80-bed acute care facility in West Virginia reported dermatologic, respiratory, and ophthalmic symptoms to management or the occupational health clinic, prompting concern about a common exposure, possibly related to construction activities. Symptoms of affected staff members, who performed a range of clinical and nonclinical duties, often improved hours to days after leaving the hospital, suggesting potential exposure to an environmental irritant. Initially, hospital leadership encouraged symptomatic persons to seek evaluation at the occupational health clinic, although systematic evaluations were not implemented. No etiology was identified by environmental sampling for fibers, volatile organic compounds, or mold. In the absence of a clear etiology, hospital leadership stopped inpatient admissions, transferred inpatients from the two wards where most symptomatic staff members worked, and completed cleaning to include associated air-handling systems. Dermatology and allergy consultants evaluated symptomatic staff members, but because of varying clinical manifestations, results were inconclusive. On December 26, one of the closed wards reopened; during the ensuing week, six additional workers reported symptoms, and onsite CDC assistance was requested to identify an etiology. A CDC team arrived on January 8, 2018, and met with hospital and union leadership, reviewed occupational health records, observed occupational health encounters, performed unstructured individual interviews with both affected and unaffected health care personnel, assessed the physical environment, and reviewed environmental testing results. Despite these efforts, investigators were unable to identify an etiology, and the outbreak resolved without intervention. |
Biochemical verification of tobacco use and abstinence: 2019 update
Benowitz NL , Bernert JT , Foulds J , Hecht SS , Jacob P , Jarvis MJ , Joseph A , Oncken C , Piper ME . Nicotine Tob Res 2019 22 (7) 1086-1097 BACKGROUND: The changing prevalence and patterns of tobacco use, the advent of novel nicotine delivery devices, and the development of new biomarkers prompted an update of the 2002 Society for Research on Nicotine and Tobacco (SRNT) report on whether and how to apply biomarker verification for tobacco use and abstinence. METHODS: The SRNT Treatment Research Network convened a group of investigators with expertise in tobacco biomarkers to update the recommendations of the 2002 SNRT Biochemical Verification Report. RESULTS: Biochemical verification of tobacco use and abstinence increases scientific rigor and is recommended in clinical trials of smoking cessation, when feasible. Sources, appropriate biospecimens, cutpoints, time of detection windows and analytic methods for carbon monoxide, cotinine (including over the counter tests), total nicotine equivalents, minor tobacco alkaloids, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol are reviewed, as well as biochemical approaches to distinguishing cigarette smoking from use of electronic nicotine delivery devices (ENDS). CONCLUSIONS: Recommendations are provided for whether and how to use biochemical verification of tobacco use and abstinence. Guidelines are provided on which biomarkers to use, which biospecimens to use, optimal cutpoints, time windows to detection, and methodology for biochemical verifications. Use of combinations of biomarkers is recommended for assessment of ENDS use. IMPLICATIONS: Biochemical verification increases scientific rigor, but there are drawbacks that need to be assessed to determine whether the benefits of biochemical verification outweigh the costs, including the cost of the assays, the feasibility of sample collection, the ability to draw clear conclusions based on the duration of abstinence, and the variability of the assay within the study population. This paper provides updated recommendations from the 2002 SRNT report on whether and how to use biochemical markers in determining tobacco use and abstinence. |
Public health management of persons under investigation for Ebola virus disease in New York City, 2014-2016
Winters A , Iqbal M , Benowitz I , Baumgartner J , Vora NM , Evans L , Link N , Munjal I , Ostrowsky B , Ackelsberg J , Balter S , Dentinger C , Fine AD , Harper S , Landman K , Laraque F , Layton M , Slavinski S , Weiss D , Rakeman JL , Hughes S , Varma JK , Lee EH . Public Health Rep 2019 134 (5) 33354919870200 During 2014-2016, the largest outbreak of Ebola virus disease (EVD) in history occurred in West Africa. The New York City Department of Health and Mental Hygiene (DOHMH) worked with health care providers to prepare for persons under investigation (PUIs) for EVD in New York City. From July 1, 2014, through December 29, 2015, we classified as a PUI a person with EVD-compatible signs or symptoms and an epidemiologic risk factor within 21 days before illness onset. Of 112 persons who met PUI criteria, 74 (66%) sought medical care and 49 (44%) were hospitalized. The remaining 38 (34%) were isolated at home with daily contact by DOHMH staff members. Thirty-two (29%) PUIs received a diagnosis of malaria. Of 10 PUIs tested, 1 received a diagnosis of EVD. Home isolation minimized unnecessary hospitalization. This case study highlights the importance of developing competency among clinical and public health staff managing persons suspected to be infected with a high-consequence pathogen. |
Bacterial septic arthritis infections associated with intra-articular injection practices for osteoarthritis knee pain - New Jersey, 2017
Ross KM , Mehr JS , Carothers BL , Greeley RD , Benowitz I , Henry D , McHugh LA , DiFedele L , Adler E , Naqvi S , Taylor L , Lifshitz E , Tan C , Montana BE . Infect Control Hosp Epidemiol 2019 40 (9) 1-6 BACKGROUND: In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported. METHODS: An infection prevention assessment of the implicated facility's practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections. RESULTS: We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility. DISCUSSION: Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination. CONCLUSIONS: This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices. |
Hepatitis C Virus Potentially Transmitted by Opioid Drug Diversion from a Nurse - Washington, August 2017-March 2018.
Njuguna HN , Stinson D , Montgomery P , Turner N , D'Angeli M , Carr J , Podczervinski S , Wasserman C , Ramachandran S , Lucas T , Bixler D , Perkins K , Benowitz I , Moorman A . MMWR Morb Mortal Wkly Rep 2019 68 (16) 374-376 During January 22-March 23, 2018, a local health department in Washington was notified of two patients who received a diagnosis of acute hepatitis C virus (HCV) infection. Neither patient had behavioral risk factors associated with HCV acquisition; however, both had received injectable narcotic (opioid) drugs from the same nurse during separate visits to an emergency department (ED) at a local hospital on December 6 and December 16, 2017. Investigation revealed that the nurse had accessed the automated drug dispensing system at a higher frequency than had other staff members, admitted diverting* patients' injectable narcotic and antihistamine drugs for personal use, and tested positive for HCV antibodies (anti-HCV) on March 19, 2018, but did not have quantifiable HCV RNA. Specimens from both patients were sent to CDC for genetic testing, and HCV viral variants analysis found a significant level of genetically similar HCV variants in both patients, indicating a common source of infection. Further investigation was conducted to confirm the infection source, identify other potentially exposed patients, and treat any new patients who received an HCV diagnosis. Monitoring frequency of access to drug dispensing systems can help identify staff members with abnormal dispensing patterns, including diversion activities (1). U.S. health care facilities are required to prevent, identify, and report any loss, diversion, or theft of controlled substances (2). |
Notes from the Field: Respiratory syncytial virus infections in a neonatal intensive care unit - Louisiana, December 2017
Washington EJ , Rose EB , Langley GE , Hand JP , Benowitz I , Gerber SI , Salinas AL , Terry AL , Tonzel JL , Sokol TM , Smith AT , Richardson GJ . MMWR Morb Mortal Wkly Rep 2019 68 (1) 20-21 In December 2017, the Louisiana Department of Health was notified of seven cases of respiratory syncytial virus (RSV) infection in a five-unit (units A–E), 84-bed neonatal intensive care unit (NICU) that included 66 individual infant rooms. The first case occurred in an infant who had been discharged postpartum from the NICU 30 days earlier and was readmitted for respiratory distress (day 0), approximately 2 weeks after the peak in reported RSV cases in Louisiana (mid-November) (1). The other six infants had at least one respiratory symptom while in the NICU postpartum. Upon identification of the first case, the facility implemented contact precautions for symptomatic infants, and NICU staff members were asked to report any respiratory symptoms. Nasopharyngeal specimens were obtained from infants who had rhinorrhea, cough, or nasal congestion. Nasopharyngeal swabs were also obtained from asymptomatic infants in two of the three units where the seven identified patients resided. A case was defined as laboratory-confirmed RSV infection in an NICU patient during December 2017. After consultation with CDC, a team of Louisiana Department of Health epidemiologists visited the facility 3 days after notification to review medical charts, observe infection control procedures, interview NICU staff members, and determine measures to prevent further transmission. |
Collaborative method performance study of the measurement of nicotine, its metabolites, and total nicotine equivalents in human urine
Wang L , Bernert JT , Benowitz NL , Feng J , Jacob P , McGahee E , Caudill SP , Scherer G , Scherer M , Pluym N , Doig MV , Newland K , Murphy SE , Caron NJ , Sander LC , Shimizu M , Yamazaki H , Kim S , Langman LJ , Pritchett JS , Sniegoski LT , Li Y , Blount B , Pirkle JL . Cancer Epidemiol Biomarkers Prev 2018 27 (9) 1083-1090 BACKGROUND: Biomarkers of tobacco exposure have a central role in studies of tobacco use and nicotine intake. The most significant exposure markers are nicotine itself and its metabolites in urine. Therefore, it is important to evaluate the performance of laboratories conducting these biomarker measurements. METHODS: This report presents the results from a method performance study involving 11 laboratories from 6 countries which are currently active in this area. Each laboratory assayed blind replicates of 7 human urine pools at various concentrations on 3 separate days. The samples included 5 pools blended from smoker and nonsmoker urine sources, and 2 additional blank urine samples fortified with pure nicotine, cotinine and hydroxycotinine standards. All laboratories used their own methods, and all were based on some form of liquid chromatography / tandem mass spectrometry. RESULTS: Overall, good agreement was found among the laboratories in this study. Intralaboratory precision was good, and in the fortified pools the mean bias observed was < + 3.5% for nicotine, approximately 1.2% for hydroxycotinine, and less than 1% for cotinine (1 outlier excluded in each case). Both indirect and direct methods for analyzing the glucuronides gave comparable results. CONCLUSIONS: This evaluation indicates that the experienced laboratories participating in this study can produce reliable and comparable human urinary nicotine metabolic profiles in samples from people with significant recent exposure to nicotine. IMPACT: This work supports the reliability and agreement of an international group of established laboratories measuring nicotine and its metabolites in urine in support of nicotine exposure studies. |
Notes from the field: Nontuberculous mycobacteria infections in U.S. medical tourists associated with plastic surgery - Dominican Republic, 2017
Gaines J , Poy J , Musser KA , Benowitz I , Leung V , Carothers B , Kauerauf J , Mollon N , Duwell M , Henschel K , De Jesus A , Head SK , Lee K , Arboleda N , Esposito DH . MMWR Morb Mortal Wkly Rep 2018 67 (12) 369-370 Since 2013, CDC has received reports and investigated serious complications among medical tourists (i.e., persons whose primary purpose for international travel is medical care) upon their return to the United States (1). On May 1, 2017, the New York City Department of Health and Mental Hygiene informed CDC of three patients with nontuberculous mycobacteria (NTM) surgical site infections (SSI), all of whom had undergone cosmetic surgical procedures by a single surgeon at Centro Internacional de Cirugía Plástica Avanzada (CIPLA) in the Dominican Republic (2). | | To identify additional patients, calls for cases were issued via CDC’s Epidemic Information Exchange (Epi-X), state-based health alert systems, the Infectious Diseases Society of America’s Emerging Infections Network, and the American Society of Plastic Surgeons’ email distribution list. State and local health department staff members interviewed reported patients to collect information about medical care received abroad, symptoms, and treatment received after their original surgical procedures. A confirmed case of cosmetic surgery–associated NTM infection was defined as a diagnosed SSI and laboratory evidence confirming the presence of NTM in a U.S. resident who underwent a cosmetic surgery procedure in the Dominican Republic since January 1, 2017. |
Rapid identification of a cooling tower-associated Legionnaires' disease outbreak supported by polymerase chain reaction testing of environmental samples, New York City, 2014-2015
Benowitz I , Fitzhenry R , Boyd C , Levy M , Ying L , Passaretti T , Rakeman J , Saylors A , Shamoonian E , Smith T , Balter S . J Environ Health 2018 80 (8) 8-12 We investigated an outbreak of eight Legionnaires' disease cases among persons living in an urban residential community of 60,000 people. Possible environmental sources included two active cooling towers (air-conditioning units for large buildings) <1 km from patient residences, a market misting system, a community-wide water system used for heating and cooling, and potable water. To support a timely public health response, we used real-time polymerase chain reaction (PCR) to identify Legionella DNA in environmental samples within hours of specimen collection. We detected L. pneumophila serogroup 1 DNA only at a power plant cooling tower, supporting the decision to order remediation before culture results were available. An isolate from a power plant cooling tower sample was indistinguishable from a patient isolate by pulsed-field gel electrophoresis, suggesting the cooling tower was the outbreak source. PCR results were available <1 day after sample collection, and culture results were available as early as 5 days after plating. PCR is a valuable tool for identifying Legionella DNA in environmental samples in outbreak settings. |
Multistate outbreak of an emerging Burkholderia cepacia complex strain associated with contaminated oral liquid docusate sodium
Akinboyo IC , Sick-Samuels AC , Singeltary E , Fackler J , Ascenzi J , Carroll KC , Maldonado Y , Brooks RB , Benowitz I , Wilson LE , LiPuma JJ , Milstone AM . Infect Control Hosp Epidemiol 2018 39 (2) 237-239 We read with interest the article by Marquez et al1 in which the authors report an epidemiologic investigation into a Burkholderia cepacia complex outbreak among pediatric patients. This prompted a national recall of oral liquid docusatea in 2016.2 Here, we describe a similar outbreak in our pediatric intensive care unit (PICU) from May 19, 2017 to July 30, 2017, that prompted another national product recall.3,4 | | In May 2017, we were notified by our clinical microbiology laboratory of 3 patients in the PICU, all infants with multiple chronic medical conditions who had cultures (1 from blood and 2 from tracheal aspirates) positive for B. cepacia within the same week. A thorough review of the patients’ history, exposures and medications was conducted. Given the commonality of mechanical ventilation, we focused on possible respiratory sources of infection or exposure to previously recalled oral liquid docusate products.2 We did not identify common respiratory medications or equipment exposures among cases and all environmental cultures were negative for B. cepacia. |
Outbreak of septic arthritis associated with intra-articular injections at an outpatient practice - New Jersey, 2017
Ross K , Mehr J , Carothers B , Greeley R , Benowitz I , McHugh L , Henry D , DiFedele L , Adler E , Naqvi S , Lifshitz E , Tan C , Montana B . MMWR Morb Mortal Wkly Rep 2017 66 (29) 777-779 On March 6, 2017, the New Jersey Department of Health (NJDOH) was notified of three cases of septic arthritis in patients who had received intra-articular injections for osteoarthritic knee pain at a private outpatient practice. The practice voluntarily closed the next day. NJDOH, in conjunction with the local health department and the New Jersey Board of Medical Examiners, conducted an investigation and identified 41 cases of septic arthritis associated with intra-articular injections administered during 250 patient visits at the same practice, including 30 (73%) patients who required surgery. Bacterial cultures of synovial fluid or tissue from 15 (37%) patients were positive; all recovered organisms were oral flora. An infection prevention assessment of the practice identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, inappropriate use of pharmacy bulk packaged (PBP) products as multiple-dose containers and handling PBP products outside of required pharmacy conditions, and preparation of syringes up to 4 days in advance of their intended use. No additional septic arthritis cases were identified after infection prevention recommendations were implemented within the practice. |
Biomarkers of exposure to new and emerging tobacco delivery products
Schick SF , Blount BC , Jacob P 3rd , Saliba NA , Bernert JT , El Hellani A , Jatlow P , Pappas RS , Wang L , Foulds J , Ghosh A , Hecht SS , Gomez JC , Martin JR , Mesaros C , Srivastava S , St Helen G , Tarran R , Lorkiewicz PK , Blair IA , Kimmel HL , Doerschuk CM , Benowitz NL , Bhatnagar A . Am J Physiol Lung Cell Mol Physiol 2017 313 (3) ajplung.00343.2016 Accurate and reliable measurements of exposure to tobacco products are essential for identifying and confirming patterns of tobacco product use and for assessing their potential biological effects in both human populations and experimental systems. Due to the introduction of new tobacco-derived products and the development of novel ways to modify and use conventional tobacco products, precise and specific assessments of exposure to tobacco are now more important than ever. Biomarkers that were developed and validated to measure exposure to cigarettes are being evaluated to assess their utility for measuring exposure to these new products. Here, we review current methods for measuring exposure to new and emerging tobacco products, such as electronic cigarettes, little cigars, water pipe and cigarillos. Rigorously validated biomarkers specific to these new products are yet to be identified. Here, we discuss the strengths and limitations of current approaches, including whether or not they provide reliable exposure estimates. We provide specific guidance for choosing practical and economical biomarkers for different study designs and experimental conditions. Our goal is to help both new and experienced investigators measure exposure to tobacco products accurately, while avoiding common experimental errors. By identifying the capacity gaps in biomarker research on new and emerging tobacco products, we hope to provide researchers, policy makers and funding agencies with a clear action plan for conducting and promoting research on the patterns of use and health effects of these products. |
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