Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
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Query Trace: Kerins J[original query] |
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Investigation of an mpox outbreak affecting many vaccinated persons in Chicago, IL-March 2023-June 2023
Faherty EAG , Holly T , Ogale YP , Spencer H , Becht AM , Crisler G , Wasz M , Stonehouse P , Barbian HJ , Zelinski C , Kittner A , Foulkes D , Anderson KW , Evans T , Nicolae L , Staton A , Hardnett C , Townsend MB , Carson WC , Panayampalli SS , Hutson CL , Gigante CM , Quilter LAS , Gorman S , Borah B , Black SR , Pacilli M , Kern D , Kerins J , McCollum AM , Rao AK , Tabidze I . Clin Infect Dis 2024 BACKGROUND: After months of few mpox cases, an increased number of cases were reported in Chicago during May 2023; predominantly among fully vaccinated patients. We investigated the outbreak scope, differences between vaccinated and unvaccinated patients, and hypotheses for monkeypox virus (MPXV) infection after vaccination. METHODS: We interviewed patients and reviewed medical records to assess demographic, behavioral, and clinical characteristics, mpox vaccine status, and vaccine administration routes. We evaluated serum antibody levels after infection and compared patient viral genomes with MPXV sequences in available databases. We discussed potential vaccine compromise with partners who manufactured, handled, and administered vaccine associated with breakthrough infections. RESULTS: During March 18-June 27, 2023, we identified 49 mpox cases; 57% of these mpox patients were fully vaccinated (FV). FV patients received both JYNNEOS doses subcutaneously (57%), intradermally (7%), or via heterologous administration (36%). FV patients had more median sex partners (3, IQR=1-4) versus not fully vaccinated (NFV) patients (1, IQR=1-2). Thirty-six of 37 sequenced specimens belonged to lineage B.1.20 of clade IIb MPXV, which did not demonstrate any amino acid changes relative to B.1, the predominant lineage from May 2022. Vaccinated patients demonstrated expected humoral antibody responses; none were hospitalized. No vaccine storage excursions were identified. Approximately 63% of people at risk for mpox in Chicago were FV during this period. CONCLUSIONS: Our investigation indicated cases were likely due to frequent behaviors associated with mpox transmission, even with relatively high vaccine effectiveness and vaccine coverage. Cases after vaccination might occur in similar populations. |
Notes from the field: Emergence of an mpox cluster primarily affecting persons previously vaccinated against mpox - Chicago, Illinois, March 18-June 12, 2023
Faherty EAG , Holly T , Ogale YP , Crisler G , Becht A , Kern D , Nicolae L , Spencer H , Wasz M , Kerins JL , Kittner A , Staton A , Hardnett C , Hutson C , Gigante CM , Quilter L , Kracalik I , Black S , McCollum AM , Rao AK , Tabidze I . MMWR Morb Mortal Wkly Rep 2023 72 (25) 696-698 During April 17–May 5, 2023, 13 monkeypox (mpox) cases were reported to the Chicago Department of Public Health (CDPH) after 2 months during which only a single case had been reported. The cluster was remarkable because it comprised more than 10 cases at a time when sporadic cases or small clusters (i.e., involving fewer than three cases) were being reported in the United States, and >69% of the persons in this cluster had received 2 doses of JYNNEOS or 1 dose of ACAM2000 vaccine.* Some cases among persons who received doses of JYNNEOS vaccine are expected to occur based on vaccine effectiveness data (1,2); however, the observed proportion of cases among persons who had received 2 doses of JYNNEOS or 1 dose of ACAM2000 in this cluster was unusual. This increase in cases before large summer events scheduled nationwide and in Chicago raised concerns about possible future case increases. | | On May 9, 2023, CDPH issued a health alert,† urging clinicians to remain vigilant for mpox cases and encouraging vaccination for persons at risk for mpox.§ CDPH and CDC launched an investigation to 1) determine the cluster’s scope and etiology by evaluating patients’ commonalities, JYNNEOS¶ vaccine cold-chain management, whole genome sequencing of clinical samples, and serologic immune response after infections, and to 2) identify important risk factors for mpox exposure to guide prevention efforts. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.** |
Mpox among public festival attendees, Chicago, Illinois, USA, July-August 2022
Faherty EAG , Teran RA , Black SR , Chundi V , Smith S , Bernhardt B , Weber E , Brassil B , Ruestow P , Kerins JL . Emerg Infect Dis 2023 29 (5) 1059-1061 We investigated an mpox outbreak after a 2022 LGBTQ event in Chicago, Illinois, USA. Among case-patients, 38% had received 1 dose of mpox vaccine, none 2 doses; most reported sexual activity during the probable exposure period. Among other preventive measures, persons at risk should complete mpox vaccination 14 days before an event. |
COVID-19 Outbreaks Linked to Workplaces, 23 US Jurisdictions, August-October 2021.
Luckhaupt SE , Horter L , Groenewold MR , dePerio MA , Robbins CL , Sweeney MH , Thomas I , Valencia D , Ingram A , Heinzerling A , Nguyen A , Townsend EB , Weber RC , Reichbind D , Dishman H , Kerins JL , Lendacki FR , Austin C , Dixon L , Spillman B , Simonson S , Tonzel J , Krueger A , Duwell M , Bachaus B , Rust B , Barrett C , Morrison B , OwersBonner KA , Karlsson ND , Angelon-Gaetz K , McClure ES , Kline KE , Dangar D , Reed C , Karpowicz J , Anderson SM , Cantor S , Chaudhary I , Ellis EM , Taylor ML , Sedon A , Kocharian A , Morris C , Samson ME , Mangla AT . Public Health Rep 2022 138 (2) 333549221138294 OBJECTIVES: Early in the COVID-19 pandemic, several outbreaks were linked with facilities employing essential workers, such as long-term care facilities and meat and poultry processing facilities. However, timely national data on which workplace settings were experiencing COVID-19 outbreaks were unavailable through routine surveillance systems. We estimated the number of US workplace outbreaks of COVID-19 and identified the types of workplace settings in which they occurred during August-October 2021. METHODS: The Centers for Disease Control and Prevention collected data from health departments on workplace COVID-19 outbreaks from August through October 2021: the number of workplace outbreaks, by workplace setting, and the total number of cases among workers linked to these outbreaks. Health departments also reported the number of workplaces they assisted for outbreak response, COVID-19 testing, vaccine distribution, or consultation on mitigation strategies. RESULTS: Twenty-three health departments reported a total of 12 660 workplace COVID-19 outbreaks. Among the 12 470 workplace types that were documented, 35.9% (n = 4474) of outbreaks occurred in health care settings, 33.4% (n = 4170) in educational settings, and 30.7% (n = 3826) in other work settings, including non-food manufacturing, correctional facilities, social services, retail trade, and food and beverage stores. Eleven health departments that reported 3859 workplace outbreaks provided information about workplace assistance: 3090 (80.1%) instances of assistance involved consultation on COVID-19 mitigation strategies, 1912 (49.5%) involved outbreak response, 436 (11.3%) involved COVID-19 testing, and 185 (4.8%) involved COVID-19 vaccine distribution. CONCLUSIONS: These findings underscore the continued impact of COVID-19 among workers, the potential for work-related transmission, and the need to apply layered prevention strategies recommended by public health officials. |
Monkeypox case investigation - Cook County Jail, Chicago, Illinois, July-August 2022
Hagan LM , Beeson A , Hughes S , Hassan R , Tietje L , Meehan AA , Spencer H , Turner J , Richardson M , Howard J , Schultz A , Ali S , Butler MM , Arce Garza D , Morgan CN , Kling C , Baird N , Townsend MB , Carson WC , Lowe D , Wynn NT , Black SR , Kerins JL , Rafinski J , Defuniak A , Auguston P , Mosites E , Ghinai I , Zawitz C . MMWR Morb Mortal Wkly Rep 2022 71 (40) 1271-1277 Knowledge about monkeypox transmission risk in congregate settings is limited. In July 2022, the Chicago Department of Public Health (CDPH) confirmed a case of monkeypox in a person detained in Cook County Jail (CCJ) in Chicago, Illinois. This case was the first identified in a correctional setting in the United States and reported to CDC during the 2022 multinational monkeypox outbreak. CDPH collaborated with CCJ, the Illinois Department of Public Health (IDPH), and CDC to evaluate transmission risk within the facility. Fifty-seven residents were classified as having intermediate-risk exposures to the patient with monkeypox during the 7-day interval between the patient's symptom onset and his isolation. (Intermediate-risk exposure was defined as potentially being within 6 ft of the patient with monkeypox for a total of ≥3 hours cumulatively, without wearing a surgical mask or respirator, or potentially having contact between their own intact skin or clothing and the skin lesions or body fluids from the patient or with materials that were in contact with the patient's skin lesions or body fluids.) No secondary cases were identified among a subset of 62% of these potentially exposed residents who received symptom monitoring, serologic testing, or both. Thirteen residents accepted postexposure prophylaxis (PEP), with higher acceptance among those who were offered counseling individually or in small groups than among those who were offered PEP together in a large group. Monkeypox virus (MPXV) DNA, but no viable virus, was detected on one surface in a dormitory where the patient had been housed with other residents before he was isolated. Although monkeypox transmission might be limited in similar congregate settings in the absence of higher-risk exposures, congregate facilities should maintain recommended infection control practices in response to monkeypox cases, including placing the person with monkeypox in medical isolation and promptly and thoroughly cleaning and disinfecting spaces where the person has spent time. In addition, officials should provide information to residents and staff members about monkeypox symptoms and transmission modes, facilitate confidential monkeypox risk and symptom disclosure and prompt medical evaluation for symptoms that are reported, and provide PEP counseling in a private setting. |
Epidemiologic and clinical characteristics of Monkeypox cases - United States, May 17-July 22, 2022
Philpott D , Hughes CM , Alroy KA , Kerins JL , Pavlick J , Asbel L , Crawley A , Newman AP , Spencer H , Feldpausch A , Cogswell K , Davis KR , Chen J , Henderson T , Murphy K , Barnes M , Hopkins B , Fill MA , Mangla AT , Perella D , Barnes A , Hughes S , Griffith J , Berns AL , Milroy L , Blake H , Sievers MM , Marzan-Rodriguez M , Tori M , Black SR , Kopping E , Ruberto I , Maxted A , Sharma A , Tarter K , Jones SA , White B , Chatelain R , Russo M , Gillani S , Bornstein E , White SL , Johnson SA , Ortega E , Saathoff-Huber L , Syed A , Wills A , Anderson BJ , Oster AM , Christie A , McQuiston J , McCollum AM , Rao AK , Negrón ME . MMWR Morb Mortal Wkly Rep 2022 71 (32) 1018-1022 Monkeypox, a zoonotic infection caused by an orthopoxvirus, is endemic in parts of Africa. On August 4, 2022, the U.S. Department of Health and Human Services declared the U.S. monkeypox outbreak, which began on May 17, to be a public health emergency (1,2). After detection of the first U.S. monkeypox case), CDC and health departments implemented enhanced monkeypox case detection and reporting. Among 2,891 cases reported in the United States through July 22 by 43 states, Puerto Rico, and the District of Columbia (DC), CDC received case report forms for 1,195 (41%) cases by July 27. Among these, 99% of cases were among men; among men with available information, 94% reported male-to-male sexual or close intimate contact during the 3 weeks before symptom onset. Among the 88% of cases with available data, 41% were among non-Hispanic White (White) persons, 28% among Hispanic or Latino (Hispanic) persons, and 26% among non-Hispanic Black or African American (Black) persons. Forty-two percent of persons with monkeypox with available data did not report the typical prodrome as their first symptom, and 46% reported one or more genital lesions during their illness; 41% had HIV infection. Data suggest that widespread community transmission of monkeypox has disproportionately affected gay, bisexual, and other men who have sex with men and racial and ethnic minority groups. Compared with historical reports of monkeypox in areas with endemic disease, currently reported outbreak-associated cases are less likely to have a prodrome and more likely to have genital involvement. CDC and other federal, state, and local agencies have implemented response efforts to expand testing, treatment, and vaccination. Public health efforts should prioritize gay, bisexual, and other men who have sex with men, who are currently disproportionately affected, for prevention and testing, while addressing equity, minimizing stigma, and maintaining vigilance for transmission in other populations. Clinicians should test patients with rash consistent with monkeypox,(†) regardless of whether the rash is disseminated or was preceded by prodrome. Likewise, although most cases to date have occurred among gay, bisexual, and other men who have sex with men, any patient with rash consistent with monkeypox should be considered for testing. CDC is continually evaluating new evidence and tailoring response strategies as information on changing case demographics, clinical characteristics, transmission, and vaccine effectiveness become available.(§). |
Multistate Outbreak of Infection with SARS-CoV-2 Omicron Variant after Event in Chicago, Illinois, USA, 2021.
Spencer H , Teran RA , Barbian HJ , Love S , Berg R , Black SR , Ghinai I , Kerins JL . Emerg Infect Dis 2022 28 (6) 1281-1283 Bars and restaurants are high-risk settings for SARS-CoV-2 transmission. A multistate outbreak after a bar gathering in Chicago, Illinois, USA, highlights Omicron variant transmissibility, the value of local genomic surveillance and interstate coordination, vaccination value, and the potential for rapid transmission of a novel variant across multiple states after 1 event. |
Rabies in a dog imported from Azerbaijan - Pennsylvania, 2021
Whitehill F , Bonaparte S , Hartloge C , Greenberg L , Satheshkumar PS , Orciari L , Niezgoda M , Yager PA , Pieracci EG , McCullough J , Evenson A , Brown CM , Schnitzler H , Lipton B , Signs K , Stobierski MG , Austin C , Slager S , Ernst M , Kerins J , Simeone A , Singh A , Hale S , Stanek D , Shehee P , Slavinski S , McDermott D , Zinna PA , Campagna R , Wallace RM . MMWR Morb Mortal Wkly Rep 2022 71 (20) 686-689 On June 16, 2021, rabies virus infection was confirmed in a dog included in a shipment of rescue animals imported into the United States from Azerbaijan. A multistate investigation was conducted to prevent secondary rabies cases, avoid reintroduction of a dog-maintained rabies virus variant (DMRVV), identify persons who might have been exposed and would be recommended to receive rabies postexposure prophylaxis, and investigate the cause of importation control failures. Results of a prospective serologic monitoring (PSM) protocol suggested that seven of 32 (22%) animals from the same shipment as the dog with confirmed rabies virus infection and who had available titer results after rabies vaccine booster had not been adequately vaccinated against rabies before importation. A requirement for rabies vaccination certificates alone will not adequately identify improper vaccination practices or fraudulent paperwork and are insufficient as a stand-alone rabies importation prevention measure. Serologic titers before importation would mitigate the risk for importing DMRVV. |
Investigation of SARS-CoV-2 Transmission Associated With a Large Indoor Convention - New York City, November-December 2021.
Sami S , Horter L , Valencia D , Thomas I , Pomeroy M , Walker B , Smith-Jeffcoat SE , Tate JE , Kirking HL , Kyaw NTT , Burns R , Blaney K , Dorabawila V , Hoen R , Zirnhelt Z , Schardin C , Uehara A , Retchless AC , Brown VR , Gebru Y , Powell C , Bart SM , Vostok J , Lund H , Kaess J , Gumke M , Propper R , Thomas D , Ojo M , Green A , Wieck M , Wilson E , Hollingshead RJ , Nunez SV , Saady DM , Porse CC , Gardner K , Drociuk D , Scott J , Perez T , Collins J , Shaffner J , Pray I , Rust LT , Brady S , Kerins JL , Teran RA , Hughes V , Sepcic V , Low EW , Kemble SK , Berkley A , Cleavinger K , Safi H , Webb LM , Hutton S , Dewart C , Dickerson K , Hawkins E , Zafar J , Krueger A , Bushman D , Ethridge B , Hansen K , Tant J , Reed C , Boutwell C , Hanson J , Gillespie M , Donahue M , Lane P , Serrano R , Hernandez L , Dethloff MA , Lynfield R , Como-Sabetti K , Lutterloh E , Ackelsberg J , Ricaldi JN . MMWR Morb Mortal Wkly Rep 2022 71 (7) 243-248 During November 19-21, 2021, an indoor convention (event) in New York City (NYC), was attended by approximately 53,000 persons from 52 U.S. jurisdictions and 30 foreign countries. In-person registration for the event began on November 18, 2021. The venue was equipped with high efficiency particulate air (HEPA) filtration, and attendees were required to wear a mask indoors and have documented receipt of at least 1 dose of a COVID-19 vaccine.* On December 2, 2021, the Minnesota Department of Health reported the first case of community-acquired COVID-19 in the United States caused by the SARS-CoV-2 B.1.1.529 (Omicron) variant in a person who had attended the event (1). CDC collaborated with state and local health departments to assess event-associated COVID-19 cases and potential exposures among U.S.-based attendees using data from COVID-19 surveillance systems and an anonymous online attendee survey. Among 34,541 attendees with available contact information, surveillance data identified test results for 4,560, including 119 (2.6%) persons from 16 jurisdictions with positive SARS-CoV-2 test results. Most (4,041 [95.2%]), survey respondents reported always wearing a mask while indoors at the event. Compared with test-negative respondents, test-positive respondents were more likely to report attending bars, karaoke, or nightclubs, and eating or drinking indoors near others for at least 15 minutes. Among 4,560 attendees who received testing, evidence of widespread transmission during the event was not identified. Genomic sequencing of 20 specimens identified the SARS-CoV-2 B.1.617.2 (Delta) variant (AY.25 and AY.103 sublineages) in 15 (75%) cases, and the Omicron variant (BA.1 sublineage) in five (25%) cases. These findings reinforce the importance of implementing multiple, simultaneous prevention measures, such as ensuring up-to-date vaccination, mask use, physical distancing, and improved ventilation in limiting SARS-CoV-2 transmission, during large, indoor events.(†). |
Multiple Variants of SARS-CoV-2 in a University Outbreak After Spring Break - Chicago, Illinois, March-May 2021.
Doyle K , Teran RA , Reefhuis J , Kerins JL , Qiu X , Green SJ , Choi H , Madni SA , Kamal N , Landon E , Albert RC , Pacilli M , Furtado LE , Hayden MK , Kunstman KJ , Bethel C , Megger L , Fricchione MJ , Ghinai I . MMWR Morb Mortal Wkly Rep 2021 70 (35) 1195-1200 To prevent transmission of SARS-CoV-2, the virus that causes COVID-19, colleges and universities have implemented multiple strategies including testing, isolation, quarantine, contact tracing, masking, and vaccination. In April 2021, the Chicago Department of Public Health (CDPH) was notified of a large cluster of students with COVID-19 at an urban university after spring break. A total of 158 cases of COVID-19 were diagnosed among undergraduate students during March 15-May 3, 2021; the majority (114; 72.2%) lived in on-campus dormitories. CDPH evaluated the role of travel and social connections, as well as the potential impact of SARS-CoV-2 variants, on transmission. Among 140 infected students who were interviewed, 89 (63.6%) reported recent travel outside Chicago during spring break, and 57 (40.7%) reported indoor social exposures. At the time of the outbreak, undergraduate-aged persons were largely ineligible for vaccination in Chicago; only three of the students with COVID-19 (1.9%) were fully vaccinated. Whole genome sequencing (WGS) of 104 specimens revealed multiple distinct SARS-CoV-2 lineages, suggesting several nearly simultaneous introductions. Most specimens (66; 63.5%) were B.1.1.222, a lineage not widely detected in Chicago before or after this outbreak. These results demonstrate the potential for COVID-19 outbreaks on university campuses after widespread student travel during breaks, at the beginning of new school terms, and when students participate in indoor social gatherings. To prevent SARS-CoV-2 transmission, colleges and universities should encourage COVID-19 vaccination; discourage unvaccinated students from travel, including during university breaks; implement serial COVID-19 screening among unvaccinated persons after university breaks; encourage masking; and implement universal serial testing for students based on community transmission levels. |
COVID-19 Outbreak Among Attendees of an Exercise Facility - Chicago, Illinois, August-September 2020.
Lendacki FR , Teran RA , Gretsch S , Fricchione MJ , Kerins JL . MMWR Morb Mortal Wkly Rep 2021 70 (9) 321-325 On September 8, 2020, the Chicago Department of Public Health (CDPH) was notified of a potential outbreak of coronavirus disease 2019 (COVID-19) at an exercise facility. COVID-19 cases were identified among 55 (68%) of 81 attendees of in-person classes held during August 24–September 1, 2020, including 49 (60%) cases confirmed by real-time reverse transcription–polymerase chain reaction (RT-PCR) testing and six (7%) probable cases among attendees who had compatible symptoms but negative or no RT-PCR test results. Overall, 43 (78%) attendees with COVID-19 participated in multiple classes while potentially infectious.* Twenty-two (40%) attendees with COVID-19 attended on or after the day of symptom onset. Among 58 exercise class attendees who provided information on in-class behaviors, 44 (76%) reported infrequent mask use, including 32 of 38 (84%) attendees with COVID-19 and 12 of 20 (60%) without COVID-19. The increased respiratory exertion that occurs in the enclosed spaces of indoor exercise facilities facilitates transmission of SARS-CoV-2, the virus that causes COVID-19, in these settings (1,2). To reduce SARS-CoV-2 transmission in exercise facilities, employees and patrons should wear a mask, even during high-intensity activities when ≥6 ft apart. In addition, facilities should provide engineering and administrative controls including 1) improving ventilation; 2) enforcing consistent and correct mask use and physical distancing (maintaining ≥6 ft of distance between all persons and limiting physical contact, class size, and crowded spaces); 3) reminding infected employees and patrons to stay home and away from others for ≥10 days after symptom onset or, if asymptomatic, after a positive test result, as well as to observe quarantine guidance after close contact with a person with COVID-19 and while awaiting test results; and 4) increasing opportunities for hand hygiene. Conducting exercise activities entirely outdoors or virtually could further reduce SARS-CoV-2 transmission risk. |
Risk Factors for Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Homeless Shelters in Chicago, Illinois-March-May, 2020.
Ghinai I , Davis ES , Mayer S , Toews KA , Huggett TD , Snow-Hill N , Perez O , Hayden MK , Tehrani S , Landi AJ , Crane S , Bell E , Hermes JM , Desai K , Godbee M , Jhaveri N , Borah B , Cable T , Sami S , Nozicka L , Chang YS , Jagadish A , Chee M , Thigpen B , Llerena C , Tran M , Surabhi DM , Smith ED , Remus RG , Staszcuk R , Figueroa E , Leo P , Detmer WM , Lyon E , Carreon S , Hoferka S , Ritger KA , Jasmin W , Nagireddy P , Seo JY , Fricchione MJ , Kerins JL , Black SR , Butler LM , Howard K , McCauley M , Fraley T , Arwady MA , Gretsch S , Cunningham M , Pacilli M , Ruestow PS , Mosites E , Avery E , Longcoy J , Lynch EB , Layden JE . Open Forum Infect Dis 2020 7 (11) ofaa477 BACKGROUND: People experiencing homelessness are at increased risk of coronavirus disease 2019 (COVID-19), but little is known about specific risk factors for infection within homeless shelters. METHODS: We performed widespread severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction testing and collected risk factor information at all homeless shelters in Chicago with at least 1 reported case of COVID-19 (n = 21). Multivariable, mixed-effects log-binomial models were built to estimate adjusted prevalence ratios (aPRs) for SARS-CoV-2 infection for both individual- and facility-level risk factors. RESULTS: During March 1 to May 1, 2020, 1717 shelter residents and staff were tested for SARS-CoV-2; 472 (27%) persons tested positive. Prevalence of infection was higher for residents (431 of 1435, 30%) than for staff (41 of 282, 15%) (prevalence ratio = 2.52; 95% confidence interval [CI], 1.78-3.58). The majority of residents with SARS-CoV-2 infection (293 of 406 with available information about symptoms, 72%) reported no symptoms at the time of specimen collection or within the following 2 weeks. Among residents, sharing a room with a large number of people was associated with increased likelihood of infection (aPR for sharing with >20 people compared with single rooms = 1.76; 95% CI, 1.11-2.80), and current smoking was associated with reduced likelihood of infection (aPR = 0.71; 95% CI, 0.60-0.85). At the facility level, a higher proportion of residents leaving and returning each day was associated with increased prevalence (aPR = 1.08; 95% CI, 1.01-1.16), whereas an increase in the number of private bathrooms was associated with reduced prevalence (aPR for 1 additional private bathroom per 100 people = 0.92; 95% CI, 0.87-0.98). CONCLUSIONS: We identified a high prevalence of SARS-CoV-2 infections in homeless shelters. Reducing the number of residents sharing dormitories might reduce the likelihood of SARS-CoV-2 infection. When community transmission is high, limiting movement of persons experiencing homelessness into and out of shelters might also be beneficial. |
Seoul virus infection and spread in US home-based ratteries-rat and human testing results from a multistate outbreak investigation.
Knust B , Brown S , de St Maurice A , Whitmer S , Koske SE , Ervin E , Patel K , Graziano J , Morales-Betoulle ME , House J , Cannon D , Kerins J , Holzbauer S , Austin C , Gibbons-Burgener S , Colton L , Dunn J , Zufan S , Choi MJ , Davis WR , Chiang CF , Manning CR , Roesch L , Shoemaker T , Purpura L , McQuiston J , Peterson D , Radcliffe R , Garvey A , Christel E , Morgan L , Scheftel J , Kazmierczak J , Klena JD , Nichol ST , Rollin PE . J Infect Dis 2020 222 (8) 1311-1319 BACKGROUND: During 2017, a multi-state outbreak investigation occurred following 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 IgG and IgM serology and traditional 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; seven reported symptoms and three 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 lab-confirmed cases were significantly associated with rat IgG positivity and RT-PCR positivity (p=0.03 and p=0.006, 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. |
Community Transmission of SARS-CoV-2 at Two Family Gatherings - Chicago, Illinois, February-March 2020.
Ghinai I , Woods S , Ritger KA , McPherson TD , Black SR , Sparrow L , Fricchione MJ , Kerins JL , Pacilli M , Ruestow PS , Arwady MA , Beavers SF , Payne DC , Kirking HL , Layden JE . MMWR Morb Mortal Wkly Rep 2020 69 (15) 446-450 SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), has spread rapidly around the world since it was first recognized in late 2019. Most early reports of person-to-person SARS-CoV-2 transmission have been among household contacts, where the secondary attack rate has been estimated to exceed 10% (1), in health care facilities (2), and in congregate settings (3). However, widespread community transmission, as is currently being observed in the United States, requires more expansive transmission events between nonhousehold contacts. In February and March 2020, the Chicago Department of Public Health (CDPH) investigated a large, multifamily cluster of COVID-19. Patients with confirmed COVID-19 and their close contacts were interviewed to better understand nonhousehold, community transmission of SARS-CoV-2. This report describes the cluster of 16 cases of confirmed or probable COVID-19, including three deaths, likely resulting from transmission of SARS-CoV-2 at two family gatherings (a funeral and a birthday party). These data support current CDC social distancing recommendations intended to reduce SARS-CoV-2 transmission. U.S residents should follow stay-at-home orders when required by state or local authorities. |
Regional emergence of Candida auris in Chicago and lessons learned from intensive follow-up at one ventilator-capable skilled nursing facility
Pacilli M , Kerins JL , Clegg WJ , Walblay KA , Adil H , Kemble SK , Xydis S , McPherson TD , Lin MY , Hayden MK , Froilan MC , Soda E , Tang AS , Valley A , Forsberg K , Gable P , Moulton-Meissner H , Sexton DJ , Jacobs Slifka KM , Vallabhaneni S , Walters MS , Black SR . Clin Infect Dis 2020 71 (11) e718-e725 BACKGROUND: Since the identification of the first two Candida auris cases in Chicago, Illinois, in 2016, ongoing spread has been documented in the Chicago area. We describe C. auris emergence in high-acuity long-term healthcare facilities and present a case-study of public health response to C. auris and carbapenemase-producing organisms (CPOs) at one ventilator-capable skilled nursing facility (vSNF A). METHODS: We performed point prevalence surveys (PPSs) to identify patients colonized with C. auris, infection control (IC) assessments, and provided ongoing support for IC improvements in Illinois acute and long-term care facilities during August 2016-December 2018. During 2018, we initiated a focused effort at vSNF A, and conducted seven C. auris PPSs; during four PPSs, we also performed CPO screening and environmental sampling. RESULTS: During August 2016-December 2018 in Illinois, 490 individuals were found to be colonized or infected with C. auris. PPSs identified highest prevalence of C. auris colonization in vSNF settings (prevalence 23-71%). IC assessments in multiple vSNFs identified common challenges in core IC practices. Repeat PPSs at vSNF A in 2018 identified increasing C. auris prevalence from 43% to 71%. Most residents screened during multiple PPSs remained persistently colonized with C. auris. Among 191 environmental samples collected, 39% were positive for C. auris, including samples from bedrails, windowsills, and shared patient-care items. CONCLUSIONS: High burden in vSNFs along with persistent colonization of residents and environmental contamination point to the need for prioritizing IC interventions to control spread of C. auris and CPOs. |
A guide to investigating suspected outbreaks of mucormycosis in healthcare
Hartnett KP , Jackson BR , Perkins KM , Glowicz J , Kerins JL , Black SR , Lockhart SR , Christensen BE , Beer KD . J Fungi (Basel) 2019 5 (3) This report serves as a guide for investigating mucormycosis infections in healthcare. We describe lessons learned from previous outbreaks and offer methods and tools that can aid in these investigations. We also offer suggestions for conducting environmental assessments, implementing infection control measures, and initiating surveillance to ensure that interventions were effective. While not all investigations of mucormycosis infections will identify a single source, all can potentially lead to improvements in infection control. |
Notes from the Field: Large cluster of Verona integron-encoded metallo-beta-lactamase-producing carbapenem-resistant Pseudomonas aeruginosa isolates colonizing residents at a skilled nursing facility - Chicago, Illinois, November 2016-March 2018
Clegg WJ , Pacilli M , Kemble SK , Kerins JL , Hassaballa A , Kallen AJ , Walters MS , Halpin AL , Stanton RA , Boyd S , Gable P , Daniels J , Lin MY , Hayden MK , Lolans K , Burdsall DP , Lavin MA , Black SR . MMWR Morb Mortal Wkly Rep 2018 67 (40) 1130-1131 On November 1, 2016, a point prevalence survey conducted at a Chicago skilled nursing facility with ventilated residents (vSNF A) to understand the prevalence of carbapenemase-producing organisms in health care facilities in the Chicago region identified 20 patients with Verona integron-encoded metallo-beta-lactamase–producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA) colonization. To determine the extent of VIM-CRPA colonization at vSNF A and provide infection control recommendations, the Chicago Department of Public Health conducted an investigation. | | The first VIM-CRPA outbreak reported in the United States occurred in a Chicago acute care hospital in 2003 (1). Other outbreaks have been described; however, none was associated with a single skilled nursing facility (2–5). Carbapenemase-producing CRPA are uncommon in the United States; a surveillance pilot for CRPA at five U.S. sites identified only two carbapenemase-producing CRPA among 129 isolates tested (CDC, unpublished data, 2017). |
Multiple introductions and subsequent transmission of multidrug-resistant Candida auris in the USA: a molecular epidemiological survey.
Chow NA , Gade L , Tsay SV , Forsberg K , Greenko JA , Southwick KL , Barrett PM , Kerins JL , Lockhart SR , Chiller TM , Litvintseva AP . Lancet Infect Dis 2018 18 (12) 1377-1384 BACKGROUND: Transmission of multidrug-resistant Candida auris infection has been reported in the USA. To better understand its emergence and transmission dynamics and to guide clinical and public health responses, we did a molecular epidemiological investigation of C auris cases in the USA. METHODS: In this molecular epidemiological survey, we used whole-genome sequencing to assess the genetic similarity between isolates collected from patients in ten US states (California, Connecticut, Florida, Illinois, Indiana, Maryland, Massachusetts, New Jersey, New York, and Oklahoma) and those identified in several other countries (Colombia, India, Japan, Pakistan, South Africa, South Korea, and Venezuela). We worked with state health departments, who provided us with isolates for sequencing. These isolates of C auris were collected during the normal course of clinical care (clinical cases) or as part of contact investigations or point prevalence surveys (screening cases). We integrated data from standardised case report forms and contact investigations, including travel history and epidemiological links (ie, patients that had shared a room or ward with a patient with C auris). Genetic diversity of C auris within a patient, a facility, and a state were evaluated by pairwise differences in single-nucleotide polymorphisms (SNPs). FINDINGS: From May 11, 2013, to Aug 31, 2017, isolates that corresponded to 133 cases (73 clinical cases and 60 screening cases) were collected. Of 73 clinical cases, 66 (90%) cases involved isolates related to south Asian isolates, five (7%) cases were related to South American isolates, one (1%) case to African isolates, and one (1%) case to east Asian isolates. Most (60 [82%]) clinical cases were identified in New York and New Jersey; these isolates, although related to south Asian isolates, were genetically distinct. Genomic data corroborated five (7%) clinical cases in which patients probably acquired C auris through health-care exposures abroad. Among clinical and screening cases, the genetic diversity of C auris isolates within a person was similar to that within a facility during an outbreak (median SNP difference three SNPs, range 0-12). INTERPRETATION: Isolates of C auris in the USA were genetically related to those from four global regions, suggesting that C auris was introduced into the USA several times. The five travel-related cases are examples of how introductions can occur. Genetic diversity among isolates from the same patients, health-care facilities, and states indicates that there is local and ongoing transmission. FUNDING: US Centers for Disease Control and Prevention. |
Notes from the Field: Outbreak of severe illness linked to the vitamin K antagonist brodifacoum and use of synthetic cannabinoids - Illinois, March-April 2018
Moritz E , Austin C , Wahl M , DesLauriers C , Navon L , Walblay K , Hendrickson M , Phillips A , Kerins J , Pennington AF , Lavery AM , El Zahran T , Kauerauf J , Yip L , Thomas J , Layden J . MMWR Morb Mortal Wkly Rep 2018 67 (21) 607-608 Synthetic cannabinoids, also known as K2 and spice, are heterogeneous psychoactive compounds identified as substances of abuse (1,2). On March 22, 2018, the Illinois Department of Public Health was notified by the Illinois Poison Center of four patients seen in emergency departments (EDs) during the preceding 2 weeks with unexplained bleeding and high international normalized ratios (INRs; range from 5 to >20 [normal <1.1]), indicating a clotting disorder, and reported synthetic cannabinoid use during the previous 3 days. None reported taking prescription anticoagulants or exposure to anticoagulant rodenticides. An investigation by the Illinois Department of Public Health, the Illinois Poison Center, CDC, local health departments, and law enforcement agencies was initiated to identify additional cases, ascertain epidemiologic links among patients, and implement control measures. |
Outbreak of Seoul virus among rats and rat owners - United States and Canada, 2017
Kerins JL , Koske SE , Kazmierczak J , Austin C , Gowdy K , Dibernardo A . MMWR Morb Mortal Wkly Rep 2018 67 (4) 131-134 In December 2016, the Wisconsin Department of Health Services (WDHS) notified CDC of a patient hospitalized with fever, leukopenia, elevated transaminases, and proteinuria. The patient owned and operated an in-home rattery, or rat-breeding facility, with approximately 100 Norway rats, primarily bred as pets. A family member developed similar symptoms 4 weeks later, but was not hospitalized. Because both patients were known to have rodent contact, they were tested for hantavirus infections. In January 2017, CDC confirmed recent, acute Seoul virus infection in both patients. An investigation was conducted to identify additional human and rat infections and prevent further transmission. Ultimately, the investigation identified 31 facilities in 11 states with human and/or rat Seoul virus infections; six facilities also reported exchanging rats with Canadian ratteries. Testing of serum samples from 183 persons in the United States and Canada identified 24 (13.1%) with Seoul virus antibodies; three (12.5%) were hospitalized and no deaths occurred. This investigation, including cases described in a previously published report from Tennessee (1), identified the first known transmission of Seoul virus from pet rats to humans in the United States and Canada. Pet rat owners should practice safe rodent handling to prevent Seoul virus infection (2). |
Notes from the field: Ongoing transmission of Candida auris in health care facilities - United States, June 2016-May 2017
Tsay S , Welsh RM , Adams EH , Chow NA , Gade L , Berkow EL , Poirot E , Lutterloh E , Quinn M , Chaturvedi S , Kerins J , Black SR , Kemble SK , Barrett PM , Barton K , Shannon DJ , Bradley K , Lockhart SR , Litvintseva AP , Moulton-Meissner H , Shugart A , Kallen A , Vallabhaneni S , Chiller TM , Jackson BR . MMWR Morb Mortal Wkly Rep 2017 66 (19) 514-515 In June 2016, CDC released a clinical alert about the emerging, and often multidrug-resistant, fungus Candida auris and later reported the first seven U.S. cases of infection through August 2016 (1). Six of these cases occurred before the clinical alert and were retrospectively identified. As of May 12, 2017, a total of 77 U.S. clinical cases of C. auris had been reported to CDC from seven states: New York (53 cases), New Jersey (16), Illinois (four), Indiana (one), Maryland (one), Massachusetts (one), and Oklahoma (one) (Figure). All of these cases were identified through cultures taken as part of routine patient care (clinical cases). Screening of close contacts of these patients, primarily of patients on the same ward in health care facilities, identified an additional 45 patients with C. auris isolated from one or more body sites (screening cases), resulting in a total of 122 patients from whom C. auris has been isolated. |
Investigation of the first seven reported cases of Candida auris, a globally emerging invasive, multidrug-resistant fungus - United States, May 2013-August 2016
Vallabhaneni S , Kallen A , Tsay S , Chow N , Welsh R , Kerins J , Kemble SK , Pacilli M , Black SR , Landon E , Ridgway J , Palmore TN , Zelzany A , Adams EH , Quinn M , Chaturvedi S , Greenko J , Fernandez R , Southwick K , Furuya EY , Calfee DP , Hamula C , Patel G , Barrett P , Lafaro P , Berkow EL , Moulton-Meissner H , Noble-Wang J , Fagan RP , Jackson BR , Lockhart SR , Litvintseva AP , Chiller TM . MMWR Morb Mortal Wkly Rep 2016 65 (44) 1234-1237 Candida auris, an emerging fungus that can cause invasive infections, is associated with high mortality and is often resistant to multiple antifungal drugs. C. auris was first described in 2009 after being isolated from external ear canal discharge of a patient in Japan. Since then, reports of C. auris infections, including bloodstream infections, have been published from several countries, including Colombia, India, Israel, Kenya, Kuwait, Pakistan, South Africa, South Korea, Venezuela, and the United Kingdom. To determine whether C. auris is present in the United States and to prepare for the possibility of transmission, CDC issued a clinical alert in June 2016 informing clinicians, laboratorians, infection control practitioners, and public health authorities about C. auris and requesting that C. auris cases be reported to state and local health departments and CDC. This report describes the first seven U.S. cases of C. auris infection reported to CDC as of August 31, 2016. Data from these cases suggest that transmission of C. auris might have occurred in U.S. health care facilities and demonstrate the need for attention to infection control measures to control the spread of this pathogen. |
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