Biological Health Hazard – Healthcare-associated Infections (HAIs)
Carbapenem-resistant Enterobacteriaceae in Healthcare Settings
CRE, which stands for carbapenem-resistant Enterobacteriaceae, are a family of germs that are difficult to treat because they have high levels of resistance to antibiotics. Klebsiella species and Escherichia coli (E. coli) are examples of Enterobacteriaceae, a normal part of the human gut bacteria, that can become carbapenem-resistant. Types of CRE are sometimes known as KPC (Klebsiella pneumoniae carbapenemase) and NDM (New Delhi Metallo-beta-lactamase). KPC and NDM are enzymes that break down carbapenems and make them ineffective. Both of these enzymes, as well as the enzyme VIM (Verona Integron-Mediated Metallo-β-lactamase) have also been reported in Pseudomonas.
Healthy people usually do not get CRE infections – they usually happen to patients in hospitals, nursing homes, and other healthcare settings. Patients whose care requires devices like ventilators (breathing machines), urinary (bladder) catheters, or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are most at risk for CRE infections.
Some CRE bacteria have become resistant to most available antibiotics. Infections with these germs are very difficult to treat, and can be deadly—one report cites they can contribute to death in up to 50% of patients who become infected.
What are CRE?
CRE, which stands for Carbapenem-resistant Enterobacteriaceae, are an important emerging threat to public health.
Common Enterobacteriaceae include Klebsiella species and Escherichia coli (E. coli). These germs are found in normal human intestines (gut). Sometimes these bacteria can spread outside the gut and cause serious infections, such as urinary tract infections, bloodstream infections, wound infections, and pneumonia. Enterobacteriaceae can cause infections in people in both healthcare and community settings.
Carbapenems are a group of antibiotics that are usually reserved to treat serious infections, particularly when these infections are caused by germs that are highly resistant to antibiotics. Sometimes carbapenems are considered antibiotics of last resort for some infections. Some Enterobacteriaceae can no longer be treated with carbapenems because they have developed resistance to these antibiotics (i.e., CRE); resistance makes the antibiotics ineffective in killing the resistant germ. Resistance to carbapenems can be due to a few different mechanisms. One of the more common ways that Enterobacteriaceae become resistant to carbapenems is due to production of Klebsiella pneumoniae carbapenemase (KPC). KPC is an enzyme that is produced by some CRE that was first identified in the United States around 2001. KPC breaks down carbapenems making them ineffective. Other enzymes, in addition to KPC, can breakdown carbapenems and lead to the development of CRE, but they are uncommon in the United States.
How are CRE spread?
To get a CRE infection, a person must be exposed to CRE germs. CRE germs are usually spread person to person through contact with infected or colonized people, particularly contact with wounds or stool. CRE can cause infections when they enter the body, often through medical devices like ventilators, intravenous catheters, urinary catheters, or wounds caused by injury or surgery.
Who is most likely to get an infection with CRE?
Healthy people usually don’t get CRE infections. CRE primarily affect patients in acute and long-term healthcare settings, who are being treated for another condition. CRE are more likely to affect those patients who have compromised immune systems or have invasive devices like tubes going into their body. Use of certain types of antibiotics might also make it more likely for patients to get CRE.
Treatment for CRE
Many people with CRE will have the germ in or on their body without it producing an infection. These people are said to be colonized with CRE, and they do not need antibiotics for the CRE. If the CRE are causing an infection, the antibiotics that will work against it are limited but some options are often available. In addition, some infections might be able to be treated with other therapies, like draining the infection. Strains that have been resistant to all antibiotics are very rare but have been reported.
by Mark Koba
Cases of the contagious and deadly “superbug” known as CRE increased five-fold in community hospitals from 2008 to 2012 in the Southeastern U.S., according to a new study.
the actual number of patients discovered was low—305—the worry is that CRE infections are under-reported and threaten health care facilities nationwide, said one of the report’s authors…
“This is a wakeup call for hospitals on how to detect the disease,” said Dr. Joshua Thaden, one of the leading authors for the study published in the August issue of the medical journal, Infection Control and Hospital Epidemiology.
“And the reason this is very serious is because of the high mortality rate (50 percent) of CRE,” Thaden explained. “The fact that we’re seeing an increase is concerning.”
Adding to the concern is a report published last month that found another superbug, MRSA, at firehouses in Washington state.
Researchers at the University of Washington School of Public Health tested 33 firehouses for the presence of MRSA. The bug was found at 19 of those firehouses on ambulances, trucks and on kitchen surfaces.
Twelve crews reported having at least one member who had gotten an infection requiring medical care. No deaths have been reported.
MRSA stands for Methicillin-resistant Staphylococcus aureus, and is another drug-resistant bacteria. It causes a range of illnesses, from skin and wound infections to pneumonia and bloodstream infections that can cause sepsis and death.
Anyone can get MRSA through direct contact with an infected wound or by sharing personal items, such as towels or razors, that have touched infected skin.
There are more than 80,000 cases of MRSA detected each year in the U.S., with a reported 11,285 deaths.
CRE can be transferred from a patient to the hands of the care provider, like a doctor or nurse, and from their hands to another patient. An estimated 9,300 people in the U.S. are infected by CRE every year, resulting in around 600 deaths.
All in all, there are at least 2 million illnesses reported each year from the various superbugs, resulting in more than 23,000 deaths, according to the CDC.
Since most CRE cases—and even some MRSA infections—usually start in health care facilities, pressure has been mounting in hospitals to do a better job of tracking them…
Medical experts say that the overuse of antibiotics in humans and animals has led to the spread of superbugs.
That overuse is likely to continue in animals after a panel of the U.S. Second Court of Appeals ruled Thursday that the Food and Drug Administration does not have to consider banning the practice of feeding antibiotics to animals that are not sick.
The appeals court overturned two district court rulings in cases brought by the Natural Resources Defense Council and other groups. The suits sought to prompt the FDA to stop the routine use of certain antibiotics in healthy animals unless drug manufacturers proved the safety of such use.
Antibiotics are often used in livestock as a preventive measure. Eighty percent of all the antibiotics sold in the United States are used in livestock production.
There are calls for stronger antibiotics to deal with the superbug spread. However, that’s likely to just continue the vicious cycle of drug resistance, said Thaden, a Boston-based specialist in infectious disease.
“Developing new drugs is important, but the bacteria could end up resisting them as well,” he said.
Read Full Article at CNBC
Biological Hazard – Hantavirus Pulmonary Syndrome (HPS)
North-America - USA | State of Colorado, Western Slope Area
Bio-hazard Level: 4/4 Hazardous
Location: N 39° 57.750, W 105° 30.60
Biological Hazard in USA on Friday, 25 July, 2014 at 03:48 (03:48 AM) UTC.
Health officials say a western Colorado boy is being treated after contracting hantavirus. The Mesa County Health Department said Wednesday the boy, whose name and age have not been released, was taken to Denver over the weekend and is still being treated. Officials did not say where or how he contracted the virus, which is present in the saliva, urine, and feces of infected mice. People are infected by breathing in the virus during direct contact with rodents or by disturbing dust and feces from mice nests or surfaces contaminated with mice droppings or urine. Symptoms include muscle aches, fatigue, high fever, dizziness, headaches, chills, nausea, vomiting, diarrhea and abdominal pain, which can eventually lead to death.
Source: RSOE EDIS
Biological Health Hazard – Hemorrhagic Fever (Ebola virus)
Epidemic Hazard – Hemorrhagic Fever (Ebola virus) – Disease Outbreak
Africa - Nigeria | Somolu District, Lagos
Bio-hazard Level: 4/4 Hazardous
Location: N 6° 31.463, E 3° 22.752
Biological Hazard in Nigeria on Friday, 25 July, 2014 at 03:38 (03:38 AM) UTC.
The deadly Ebola hemorrhagic fever may have reached Nigeria, local health officials say. A Liberian man in his 40s is currently being tested for the virus in the capital city of Lagos, which is home to 21 million people. The most recent Ebola outbreak has already killed 632 people in Guinea, Liberia and Sierra Leone since February. This would be the first case in Nigeria, the most populous country in Africa. Abdulsalami Nasidi, project director of the Nigerian Centre for Disease Control, urged Nigerians to be proactive in stopping the disease, calling it a “time bomb,” according to a Thursday report in the Nigerian Tribune. Earlier this month, he told reporters that Nigeria was not prepared to fight the disease. The virus spreads through contact with blood or bodily fluids of infected people It’s been fatal for about 60 percent of infected patients during the recent outbreak. Sheik Umar Khan, one of the region’s top physicians who led the fight against Ebola, contracted the disease earlier this week. Nigeria ranked among the top five countries around the world in need of better health care systems by the Borgen Project, a nonprofit focused on poverty and hunger
Source: RSOE EDIS
Epidemic Hazard – Rabies
North-America- USA | State of North Carolina, Guilford County
Bio-hazard Level: 4/4 Hazardous
Location: N 36° 7.998, W 79° 50.421
Humans Infected: 4
Biological Hazard in USA on Friday, 25 July, 2014 at 03:34 (03:34 AM) UTC.
The sixth rabies case of the year in Guilford County required exposure vaccinations for a woman and three Guilford Courthouse National Military Park staff members. Monday, a woman carried a sick raccoon a quarter of mile to park rangers. Wednesday test results revealed the raccoon was rabid. Guilford County Environmental Health Director Scott Greene said though no one suffered a bite but all four have to get post-exposure vaccinations as a precaution. “Once you start to show symptoms of rabies, then it’s almost always fatal,” Greene said. Park staff and health professionals remind everyone not to touch any wild animal and to call animal control instead. Last year at this time, there were 10 rabies cases for the county.
Source: RSOE EDIS