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Biological Health Hazard – Elizabethkingia anophelis (fatal): Wisconsin (Update 2016-06-11)

2016/06/11

ELIZABETHKINGIA ANOPHELIS – USA (17): (WISCONSIN) FATAL, COMMUNITY ACQUIRED
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Published Date: 2016-06-11 12:29:55
Subject: PRO/EDR> Elizabethkingia anophelis – USA (17): (WI) fatal, community acq
Archive Number: 20160611.4277339
Date: Wednesday, 8 June 2016
Source: Wisconsin Department of Health Services [edited]

Wisconsin 2016 _Elizabethkingia anophelis_ outbreak
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The Wisconsin Department of Health Services (DHS), Division of Public Health (DPH) is currently investigating an outbreak of bacterial infections caused by _Elizabethkingia anophelis_. The majority of patients acquiring these infections are over 65 years old, and all patients have a history of at least one underlying serious illness.

The department quickly identified effective antimicrobial treatment for _E. anophelis_, and has alerted health care providers, infection preventionists, and laboratories statewide. Since the initial guidance was sent on 15 Jan 2016, there has been a rapid identification of cases and healthcare providers have been able to treat and improve outcomes for patients. DHS continues to provide updates of outbreak-related information that includes laboratory testing, infection control, and treatment guidance.

At this time, the source of these infections is still unknown, and the department continues to work diligently to control this outbreak.

Disease detectives from the department and the Centers for Disease Control and Prevention [CDC] are conducting a comprehensive investigation which includes:
– interviewing patients with _E. anophelis_ infection and/or their families to gather information about activities and exposures related to healthcare products, food, water, restaurants, and other community settings;
– obtaining environmental and product samples from facilities that have treated patients with _E. anophelis_ infections. To date, these samples have tested negative and there is no indication the bacterium was spread by a single healthcare facility;
– conducting a review of medical records;
– obtaining nose and throat swabs from individuals receiving care on the same units in health care facilities as a patient with a confirmed _E. anophelis_ to determine if they are carrying the bacteria. To date, all of these specimens tested negative, which suggests the bacterium is not spreading from person to person in healthcare settings;
– obtaining nose and throat swabs from household contacts of patients with confirmed cases to identify if there may have been exposure in their household environment;
– performing a “social network” analysis to examine any commonalities shared between patients including healthcare facilities or shared locations or activities in the community.

Wisconsin 2016 _E. anophelis_ outbreak:
Case counts between 1 Nov 2015 and 8 Jun 2016
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Confirmed = 63
Under investigation = 0
Possible cases = 4
Total cases reported to Wisconsin DPH = 67

Affected counties include Columbia, Dane, Dodge, Fond du Lac, Jefferson, Milwaukee, Ozaukee, Racine, Sheboygan, Washington, Waukesha, and Winnebago.

There have been 18 deaths among individuals with confirmed _E. anophelis_ infections and an additional one death among possible cases for a total of 19 deaths. It has not been determined if these deaths were caused by the infection or other serious pre-existing health problems. Counties where these deaths occurred are: Columbia, Dodge, Fond du lac, Milwaukee, Ozaukee, Racine, Sheboygan, Washington, and Waukesha.

This investigation is ongoing. Case counts may change as additional illnesses are identified and more cases are laboratory confirmed.

The possible cases are cases that tested positive for elizabethkingia, but will never be confirmed as the same strain of _E. anophelis_ because the outbreak specimens are no longer available to test.

communicated by:
ProMED-mail
<promed@promedmail.org>

[Three new cases involving the outbreak strain of _E. anophelis_ have been reported over the past 4 weeks in Wisconsin. It is not known whether these are new cases or just cases finally coming to light from sometime in the past few months. No new Wisconsin counties appear to have been involved; all 12 affected counties are in the south east corner of the state. No new cases have been reported from the outbreak strain of _E. anophelis_ from the adjacent states of Illinois and Michigan, which have reported one fatal case each.

It remains curious that surprisingly little more information is known:
– the county locations of the newly suspected cases are not reported;
– no information has come out regarding the time line of cases as to date of onset of illness and location;
– no additional information has been released regarding the recently reported, but older, outbreak of a genetically different strain of _E. anophelis_ in Illinois.

The state of Wisconsin can be located on the HealthMap/ProMED-mail interactive map at http://healthmap.org/promed/p/250. A county map can be seen at http://geology.com/county-map/wisconsin-county-map.gif. – Mod.LL]

See Also

Elizabethkingia anophelis – USA (16): (WI) fatal, community acquired 20160505.4203699
Elizabethkingia anophelis – USA (15): (WI) possible neonatal case 20160429.4190297
Elizabethkingia anophelis – USA (14): (WI) fatal, community acquired 20160427.4187853
Elizabethkingia anophelis – USA (13): (WI,IL) fatal, community acq 20160422.4176668
Elizabethkingia anophelis – USA (12): (WI,IL) fatal, community acq 20160421.4174417
Elizabethkingia anophelis – USA (11): (WI) fatal, community acq 20160415.4162001
Elizabethkingia anophelis – USA (10): (WI, IL) fatal, community acquired 20160413.4158063
Elizabethkingia anophelis – USA (09): (WI) fatal, community acquired 20160408.4146997
Elizabethkingia anophelis – USA (08): (WI) fatal, community acquired 20160331.4129125
Elizabethkingia anophelis – USA (07): (WI,MI) fatal, community acq 20160324.4116626
Elizabethkingia anophelis – USA (06): (WI,MI) fatal, community acq 20160322.4110826
Elizabethkingia anophelis – USA (05): (WI,MI) fatal, community acquired 20160318.4104623
Elizabethkingia anophelis – USA (04): (WI) fatal, community acquired 20160317.4099438
Elizabethkingia anophelis – USA (03): (WI) fatal, community acquired 20160311.4083895
Elizabethkingia anophelis – USA (02): (WI) fatal, community acq., comment, RFI 20160309.4080818
Elizabethkingia anophelis – USA: (WI) fatalities, community acquired, RFI 20160303.4067424
………………………………………….sb/ll/sh

Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases


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