News

Morbidity and Mortality Weekly Report MMWR of March 25,2011 reported on 2

children at a Denver Area Hospital that developed Bacillus cereus infections.A

subsequent investigation found that 40/60 non-sterile alcohol prep pads were

contaminated with the organism.These pads were not clearly labeled as non

sterile on the individual packages.  I was not aware that alcohol individual prep pads would not even be available in non-sterile form. We checked our office and found that though

we had ordered sterile pads–we had been switched to non-sterile –through a

medical supply house. These pads were clearly labeled as non-sterile.

1.Please check all your alcohol prep products and make sure they are sterile

2.One would question as to why non-sterile alcohol preps would ever be available

in health care facilities.  Dr

Smith

1.Swine influenza has now spread to 5 states.The largest number in a single state has been 28 in a school in Queens-New York City.No one in the USA has died-only 1 patient has been hospitalized.

2.World Health Organization(WHO) has raised the pandemic level to Phase 4.This signifies human to human transmission and ability to sustain community wide outbreaks.

3.Cases have now been reported in many part of the world including Spain,Scotland,Canada(6),New Zealand and Israel.

4.Disease seems more severe in Mexico where 152 have died. Complete information on these deaths is not available at this time.

5.The European Union Health Commissioner has suggested that travelers from Europe avoid non-essential travel to Mexico and parts of the United States.

6.Many governments are instituting screening on travelers who are returning from endemic areas.

SHADES OF 1976-THE SWINE FLU RETURNS.-Beginning in March of 2009-cases of Influenza -like illness (ILI) began appearing in Mexico.To date approximately 1600 cases have been reported. Whether all of these represent the new new Swine Flu strain is unclear at this point.Of the Mexican cases-18 have been laboratory confirmed as Swine Influenza A/HINI.12 /18 are identical to strains isolated in California.Appoximately 20 cases have been reported in the United States–at least 8 have been positively confirmed as Swine A/HINI.Cases so far reported are from California (San Diego and Imperial counties) and Texas (Guadalupe county) and New York City.It is not clear at this time if the symptoms are substantially different from usual seasonal Influenza.

The following recommendations are made at this time:

      1.Clinicians should consider swine influenza infection in patients with febrile respiratory illnesses who have traveled to Mexico or to the areas in the United States where the disease has been reported

      2.Symptoms seen in these individuals  may include:Fever greater than 100.0 degrees F.,sore throat,cough,stuffy nose,chills,headache and body aches, and fatigue.

     3.Individuals traveling to epidemic areas should be advised of the risk and consider this in their travel plans.

     4.Fortunately the Swine Influenza strain is full susceptible to Tamiflu and Relenza.

     5.The relative severity and extent of communicability and spread throughout the world is unclear at this moment.

     6.The United States Government has declared a Public Health Emergency

     7.Partial Protection is provided by current influenza vaccines.

     8.If clinicians encounter suspect cases in Mississippi with the above listed symptoms(app travel exposure and app. symptoms) please obtain a nasopharyngeal swab–place in viral transport media and refrigerate and call Mississippi Dept of Health 601-576-7725 during normal working hours or 601-576-7400 after hours for specific instructions regarding transport of the specimen to the State Labororatory.

For additional information go to.

www.cdc.gov/swineflu/

www.cdc.gov/travel

 www.who.int

Mississippi Dept of Health Web-Site–No cases yet in Mississippi

www.newyorktimes.com

For additional questions or advice to specific travelers regarding specific destinations. Please contact us at

www.centerofinfectiousdisease.com

David L. Smith M.D. 4/27/2009 11:30 A.M.

The Mississippi State Department of Health has identified 20 cases of Influenza as of 2/16/2009.No cases have been confirmed  in Hinds,Rankin and Madison counties though we have identified approximately 10 at our facility though rapid antigen testing(not included in the 20 total).Thus the true number is probably in the 200-500 category statewide.The most reliable indicators of influenza activity are 1. Increased school absenteeism 2. Increased Numbers of Respiratory Deaths.

Important facts about influenza this year and every year.

1.The diagnosis of influenza is a clinical one strongly suggested by a. The time of year and activity known to be in the state and your communityb.Symptoms suggestive a a severe respiratory illness-usually with high fevers and myalgia.It is much different than the common cold.

2.Influenza testing is poor.a. The rapid test is only about 60% sensitive. It will miss 4 out of 10 cases of influenza.b.Viral cultures are not easily available and the results are delayed past any clinical usefulness.

3.Influenza vaccines are the first line of defense and are moderately effective.They are recommended for children and adolescents as well as the usual age groups. We are probably moving towards universal influenza immunization-especially as we are seeing rapid development of resistance to first line prophylactic/treatment agents.

4.A nasal vaccine is now available for those who prefer this method to shots.Contact the Center.

4..77% of the influenza strains isolated this year are of the new resistant H1N1 variety.

These strains are resistant to Tamiflu

Treatment Recommendations for the Influenza Season 2009

1.First line treatment is Relenza–the inhaled Glaxo product.

2.If for some reason Relenza cannot be used or is not available use the combination of  Tamiflu and Rimantadine or Amantadine

Useful Web Sites for further information.

www.2a.cdc.gov

www.msdh.state.ms

A  new outbreak of food contaminated by Salmonella was first recognized in November 2008. This discovery was made possible by the diligent work of CDC, CDC Pulse Net, FDA and the Epidemiology sections of the states of Minnesota and Connecticut.This discovery was notable for the occurrence of a new Salmonella typhimurium strain.It was soon determined by these agencies that the contaminated vehicle was a type of bulk peanut butter “King Nut”.The epidemic strain was recovered from unopened containers of this product.This product was traced back to the” Peanut Corporation of America”It was later determined that 2 well known brands of peanut butter crackers-Keebler and Austin were also contaminated.The products  produced by this plant included:peanut butter,whole peanuts, and peanut butter paste and other peanut products.At this time there is no evidence that common grocery store peanut butters i.e. major national brands are involved in this outbreak. The problem with this outbreak is that the company was a major supplier to many food producers. This has resulted in a broad product recall involving more than 2000 different products.This includes both human and animal food products.For a listing of the products recalled you can go to www.fda.gov.The recall on products produced by this company has now been extended to products produced since 2007.

To date there have been approximately 600 cases nationwide in 44 states with 116 hospitalizations and 8 deaths in which the illness may have played a role.There have been 7 cases in Mississippi though there probably is at least 10 times that number.

Advice to the public:

1.Major brand peanut butters purchased in grocery stores may be safely consumed

2.Go to fda web site and determine if  you have any of the recalled products in your home.If you do destroy them in a manner in which there is no possiblity that they can be consumed by others.

3. People who have become ill while eating peanut containing products especially those on the recall list should consult their health care provider.

4.There is no evidence that this Salmonella strain is more deadly thatn other Salmonella strains.

Web Sites for further information for health care professionals or the public:

1.www.fda.gov

2.www.msdh.state.ms

3.www.cdc.gov

DAVID L. SMITH M.D.

Six things I want to tell you about this new epidemic:

1. This germ affects the healthy and the unhealthy—in or out of the hospital
2. If this germ gets onto your body you are 5-10 times more likely to develop disease i.e. boils or worse than the “old” Staph.
3. Many of the older and popular antibiotics are not effective against the “new” Staph.
4. To get “rid” of these bacteria requires not only proper antibiotic treatment perhaps with drainage but disinfection of our nose and skin where the bacteria may live and later cause disease with a break in our skin.
5. If one member of a household gets the bug—all the members need to be checked. Some may be carrying it—and it needs to be disinfected before it causes problems.
6. If you are going to have elective surgery or a possible C section—it is important to be sure you are not carrying this germ—as a surgical incision provides a way for the germ to enter our body and cause disease.

Staph, boils, risings, spider bites: All of these names refer to the most common serious contagious bacterial infection that humans encounter.

In the community, we are primarily exposed to the bacteria through contact with individuals who have been a patient work or reside in such facilities as hospitals, nursing homes, day care facilities or dialysis units. Schools and athletic teams have also experienced “Staph” outbreaks.

The common method of acquiring this organism is by direct physical contact with another person who is shedding the bacteria. The person who has the “staph” could have an obvious lesion such as a boil or impetigo. Many times the “staph” is not obvious but is being carried without signs or symptoms in the “staph carrier”. Such individuals can then transmit the “staph” to another person usually be direct physical contact. The second person now carries the “staph” and may then be a carrier or develop active disease soon after the staph has been transmitted. If the patient initially becomes a carrier—there is about a 30% chance he/she will develop active disease over a 6 month period. Commonly the bacteria initially set up “housekeeping” in the front part of the inside of our nose or under our fingernails.

In the community, the bacteria are patient and waits for some type of skin breakdown (as intact skin is a powerful protective shield) such as a cut, scrape or burn. This enables the “staph” to move from the surface and thus to get beneath our skin. Typically the disease produced is a boil.

In the hospital, Staph aureus is the number 1 organism. It is most commonly seen in surgical wound infections but may display a wide range of presentations. More patients die each year from staphylococcal infections than from AIDS.  Strong infection control programs with an emphasis towards hand washing before and after each patient contact –attempt to lower the burden of “staph” illness in the hospital.

Once “staph” infection affects one family/household member—all other individuals in close contact with that infected individual are at risk of acquiring the organism by close personal contact. The acquisition by other family members commonly may even precede the first or “index” case in a family. Infection control practices are not commonly practiced in the home—thus the spread of the germ is much easier than in the hospital.

New and more toxic strains of staphylococci began to circulate in our country around the 2000.They have rapidly taken over the universe of “staph”and pushed the older strains out of the community and hospital. Such strains now represent approximately 80% of all “staph” in the hospital and community. These new strains are uniformly resistant to many of the older anti-staphylococcal antibiotics. The boil lesions produced by them often have a black center and can be confused with a brown recluse spider bite.

In the community—individuals must suspect these new “staph”strains in all boils but particularly those with a dark center. Proper antibiotics with or without drainage must be given to treat the active disease. Individuals who have these boils/impetigo and their close personal/household./family contacts need to have hand and nose cultures. If either are positive—-specific disinfection-not oral antibiotics needs to be used and patients need to be re-cultured after treatment to make sure that the disinfection has worked. Special  ointment anti-infectives and soaps are used to accomplish this disinfection. All culture positive individuals need to be followed for at least 1 year to see that the “staph” does not relapse or return. Once “staph” gets into a family unit the members can “ping-pong” the disease back and forth for prolonged periods of time.

Certain medical conditions such as diabetes, obesity or tobacco addiction predispose to “staph” infections.

I strongly advise individuals in whom either elective surgery or possible C-section are contemplated—to make sure that they have nose cultures done before undergoing the procedure. It appears that patients are bringing these strains into the hospital and then they spread to the surgical wound. The above predisposing conditions greatly enhance your risk of such infections. If you have any of the following please notify your doctor so that additional measures may be taken:

1. Contact with hospital, nursing home or other medical facility or with individuals who have had contact with the above areas.
2. Recent history of boils in yourself or in family members.

Hopefully, I have convinced you of the 6 points I set out to make at the start of this article.

The MRSA Clinic of Mississippi is a Division of the Center of Infectious Disease Excellence at River Oaks Hospital. It is a resource for individuals and for organizations. It is specifically committed to the prevention, diagnosis d eradication of staphylococcal infections. The MRSA Clinic’s medical supervision is provided by David L. Smith M.D. Dr. Smith has guided and directed more than 300 clinical studies and is the senior practicing infectious disease individual in the state of Mississippi. Dr. Smith is a Clinical Professor of Medicine at the University of Mississippi School of Medicine. Connie Brinson is the Administrator and Nurse Clinician in the Clinic.

The clinic is located:

1040 River Oaks Drive (immediately to the South of Marty’s Pharmacy)
Suite 303
Flowood Ms. 39232
Telephone 601-936-0706
Fax-601-936-6150
e-mail: mrsaclinicofmississippi@comcast.net