Patients Face More Lethal Infections from CRE
Some germs are beating even our strongest antibiotics. Rapid action by clinicians and healthcare leaders is needed to stop the rise of lethal CRE infections.
A 2013 Vital Signs report shows that antibiotics are being overpowered by lethal germs called carbapenem-resistant Enterobacteriaceae (CRE).These germs cause lethal infections in patients receiving inpatient medical care, such as in hospitals, long-term acute care facilities, and nursing homes.
In their usual forms, germs from the Enterobacteriaceae family (e.g. E. coli) are a normal part of the human digestive system. However, some of these germs have developed defenses to fight off all or almost all antibiotics we have today. When these germs get into the blood, bladder or other areas where germs don't belong, patients suffer from infections that are difficult, and sometimes impossible, to treat.
Untreatable and hard-to-treat infections from CRE germs are on the rise among patients in medical facilities.
While CDC has warned about CRE for more than a decade, new information shows that these germs are now becoming more common. One type of CRE has been detected in medical facilities in 42 states. Even more concerning, this report documents a seven-fold increase in the spread of the most common type of CRE during the past 10 years.
Why are CRE so alarming?
Even though these infections are not common, their rise is alarming because they kill up to half of people who get severe infections from them. In addition to causing lethal infections among patients, CRE are especially good at giving their antibiotic-fighting abilities to other kinds of germs. This means that in the near future, more bacteria will become immune to treatment, and more patients' lives could be at risk from routine bladder or wound infections. Without serious efforts to stop CRE in medical facilities, and without rapid improvement in the way doctors everywhere prescribe antibiotics, CRE will likely become a problem in the community, among otherwise healthy people not receiving medical care.
How can CRE be stopped?
There have been major successes in stopping CRE in medical facilities in the United States, and nationally in other countries. Stopping CRE will take a rapid, coordinated, and aggressive "Detect and Protect" action that includes intense infection prevention work and antibiotic prescribing changes. CDC released a CRE prevention toolkit reiterating practical CRE prevention and control steps. Leadership and medical staff in hospitals, long-term acute care hospitals, nursing homes, health departments, and even outpatient practices must work together to implement these recommendations to protect patients from CRE.
Outbreaks highlight the importance of CDC and state health departments working collaboratively to identify and stop spread of antibiotic resistant pathogens. In the FY 16 budget, CDC has requested funding to support State Antibiotic Resistance Prevention Programs[370 KB] in all 50 states and 10 large cities and a regional lab network[275 KB] to help identify and to respond faster to outbreaks. This funding would provide critical national infrastructure to prevent the growing threat of CRE and other drug-resistant pathogens.
Texas Department of State Health Services
Sept. 29, 2014
Influenza Vaccine Available Across Texas as Flu Season Begins
Flu vaccine has been arriving in doctor’s offices, clinics and pharmacies across Texas, and the Texas Department of State Health Services encourages everyone 6 months old and older to get vaccinated now. Oct. 1 is Texas Influenza Awareness Day and the traditional start to the flu season.
While DSHS encourages vaccination for everyone at least 6 months old, it is especially important for certain high-risk groups. People 65 and older, pregnant women, young children and those with chronic health conditions are at higher risk for serious complications and even death if they get the flu and should minimize that risk by getting vaccinated. Twenty Texas children died as a result of the flu during the 2013-2014 flu season.
People need to be vaccinated each year because researchers determine which flu viruses are most likely to spread in that year and formulate the vaccine to protect against them. Getting vaccinated now will provide protection throughout the flu season.
“There are more options than ever to help protect you against the flu,” said DSHS Commissioner Dr. David Lakey. “Whether you choose a standard shot that protects against three or four strains of the flu, the intradermal shot with a smaller needle, the nasal spray version, or a high-dose vaccine that can boost immunity for people 65 and older, the most important thing is that everyone 6 months old and older get vaccinated.”
All flu vaccines this season are made to protect against the strains A/California/7/2009 (H1N1), A/Texas/50/2012 (H3N2) and B/Massachusetts/2/2012. For the second year, some vaccines also include protection against a fourth strain, B/Brisbane/60/2008. About half of the 150 million or more doses produced this season are expected to be four-strain varieties.
In addition to getting vaccinated, people should help stop the spread of the flu and other illnesses by covering all coughs and sneezes, washing their hands frequently, disinfecting commonly touched surfaces and staying home when sick.
People can contact their health care provider, local health department or dial 2-1-1 to find out where to get a flu shot. Flu information and tips for protecting against the flu are at texasflu.org.
Texas Department of State
Sept. 5, 2014
Opening of Hunting Season Prompts Precautions Around Animals
This week’s start to hunting season in Texas has prompted the Texas Department of State Health Services to remind hunters to protect themselves from diseases that can spread from animals to humans.
Two animals in Edwards County were recently confirmed with anthrax, a disease caused by naturally occurring bacteria present in the soil worldwide. Animals usually get the disease by swallowing anthrax spores while grazing, and people can get anthrax by handling infected animals, whether alive or dead, or eating their meat. Illnesses such as tularemia, brucellosis and rabies can also be transmitted to people through direct contact with live animals or while dressing game that has been killed. West Nile virus, Lyme disease, plague and other diseases transmitted by insects and ticks also are a concern.
“Using insect repellent and wearing long sleeves and pants can help protect against mosquito- and tick-borne illnesses,” said Dr. Tom Sidwa, manager of DSHS’s Zoonosis Control Branch. “Some common sense measures like wearing gloves while dressing game and washing your hands afterward can minimize the risk of other infections.”
DSHS recommends the following precautions to limit the risk of contracting diseases that can be transmitted by wildlife:Do not harvest animals that appear ill or are acting abnormally.
Sept. 1 marked the opening of dove season in most areas of the state, the first of the 2014-2015 hunting seasons. Seasons for other animals will begin over the next few months.
Cyclospora Illnesses in Texas Prompt Investigation
A recent surge in reports of illnesses due to the parasite Cyclospora has prompted the Texas Department of State Health Services to begin an investigation into the infections in hopes of determining a common source. DSHS has received reports of 77 Cyclosporiasis cases from around Texas this year, including 69 in the last month. The department is collaborating with local health departments to gather information and identify the cause.
Last year, Texas had 351 cases, more than any other state. In most previous years, the number of cases reported was in the single or low double digits.
Cyclosporiasis is an intestinal illness caused by consuming food or water contaminated with the Cyclospora parasite. The major symptom is watery diarrhea lasting a few days to a few months. Additional symptoms may include loss of appetite, fatigue, weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting and a low fever. Symptoms may come and go multiple times over a period of weeks.
People who think they may have a Cyclospora infection should contact their health care provider. DSHS encourages health care providers to test patients for Cyclospora if they have diarrheal illness lasting more than a few days or diarrhea accompanied by a severe loss of appetite or fatigue. Cases should be reported promptly.
DSHS recommends thoroughly washing fresh produce, but that may not entirely eliminate the risk because Cyclospora can be difficult to wash off. Cooking will kill the parasite.
Although no common exposure source has been identified yet, past outbreaks in the United States have been associated with imported fresh produce, including pre-packaged salad mix, raspberries, basil, snow peas and mesclun greens. A 2013 outbreak in Texas was linked, at least in part, to fresh cilantro from Puebla, Mexico.
Two recent cases of hantavirus pulmonary syndrome were confirmed in residents of the Texas Panhandle and South Plains, bringing the year’s total to three.
Texas had one case in 2013. No cases were reported from 2009 to 2012.
The disease is severe and sometimes fatal, prompting the Texas Department of State Health Services to remind people to protect themselves from the virus that causes HPS. A case confirmed earlier this year was a resident of the Panhandle.
Hantavirus is carried by certain species of rats and mice that shed the virus in their urine, droppings and saliva. The virus can be transmitted to people when nesting materials or dust contaminated by infected rat or mouse urine, droppings and saliva are stirred up, allowing the virus to be breathed in by humans. The illness is rare, but HPS cases are frequently associated with spring cleaning.
DSHS recommends general safety precautions that apply to Hantavirus as well as other infectious diseases:
Early symptoms of hantavirus infection include fatigue, fever and muscle aches. These symptoms may be accompanied by headaches, dizziness, chills, nausea, vomiting, diarrhea and abdominal pain. Later symptoms include coughing and shortness of breath. If hantavirus is suspected, people should contact their health care provider immediately and inform the practitioner of exposure to rodents, their waste, or their nesting material.
A total of 41 HPS cases have been confirmed in Texas since 1993, the first year it was reported. 14 of those cases resulted in death.
The Texas Department of State Health Services has confirmed the state’s first human case of chikungunya, a viral disease that can cause fever and severe joint pain and is spread to people by mosquitoes.
The patient recently returned to Texas from a trip to the Caribbean where chikungunya has been causing human disease since late 2013. To date, no local spread of the virus has been reported in the continental United States, though imported cases make local spread possible because the mosquitoes that can transmit the virus are found in Texas. The Texas case is a Williamson County resident.
Chikungunya is not transmitted from direct person to person contact, but a person with the disease can be the source of the virus for mosquitoes that can then transmit the virus to others through a bite. To prevent the spread of the disease, people with chikungunya illness should be especially careful to avoid exposure to mosquitoes during the first week of illness.
Infections are rarely fatal but can cause severe joint pain, high fever, head and muscle aches, joint swelling and rash. Symptoms usually begin three to seven days after being bitten by a mosquito. There is no vaccine or treatment for the virus. Most people feel better within a week, though some people may develop longer-term joint pain.
DSHS encourages people to protect themselves from mosquito bites at home and while traveling. The Aedes mosquitoes that transmit chikungunya are active and bite during the day. Precautions include:
According to the Centers for Disease Control and Prevention, with recent outbreaks in the Caribbean and the Pacific, the number of chikungunya cases among travelers visiting or returning to the United States from affected areas will likely increase. Cases have occurred in Africa, Southern Europe, Southeast Asia, and islands in the Indian and Pacific Oceans
Because the symptoms are similar, DSHS encourages physicians to consider both chikungunya and dengue infection in patients with acute onset of fever and joint pain and who have recently visited areas where at least one of the viruses is present.
The Texas Department of State Health Services today confirmed the state’s first case of West Nile illness of the season. DSHS is urging people to take precautions to reduce the risk of contracting West Nile virus, a mosquito-borne illness.
“The best way to protect yourself is by using insect repellent every time you go outside,” said Tom Sidwa, State Public Health Veterinarian and manager of the Zoonosis Control Branch. “West Nile virus can make people very sick, with symptoms that can last for weeks or months.”
West Nile fever was confirmed in a patient from Travis County. Additional details about the patient are not being released to protect the patient’s identity.
The West Nile season typically runs from June through October. Last year, there were 183 human cases of West Nile illness in Texas, including 14 deaths. The 2012 season was an unprecedented year for West Nile with record numbers of cases and deaths reported in the state. The intensity of West Nile activity in Texas fluctuates from year to year and is difficult to predict. It depends on a variety of factors including the weather, the numbers of birds and mosquitoes that maintain and spread the virus and human behavior. The season can last up until the first hard freeze of the year.
To reduce exposure to West Nile virus:
Symptoms of the milder form of illness, West Nile fever, can include headache, fever, muscle and joint aches, nausea and fatigue. People with West Nile fever typically recover on their own, although symptoms may last for several weeks. Symptoms of the more serious form of illness, West Nile neuroinvasive disease, can include those of West Nile fever plus neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness and paralysis. Up to 80 percent of people infected with the virus will have no symptoms.
There are no medications to treat or vaccines to prevent West Nile virus infection. People over 50 years old and those with other health issues are at a higher risk of becoming seriously ill or dying when they become infected with the virus. If people have symptoms and suspect West Nile virus infection, they should contact their healthcare provider.
For current case counts, visit: www.dshs.state.tx.us/news/updates.shtm. For disease background and more information, go to: www.dshs.state.tx.us/idcu/disease/arboviral/westNile/.
Health Alert - September 3, 2013
As of August 27, 2013 Texas has reported 1,935 pertussis cases to the CDC. If cases continue to be diagnosed and reported at the current rate, Texas will report the highest number of pertussis cases it has had in over 50 years. Biweekly updates on pertussis in Texas are available at http://www.dshs.state.tx.us/idcu/disease/pertussis/. Early recognition of cases, effective treatment and prophylaxis and appropriate vaccination are vital to limiting the spread of pertussis. Pertussis can cause serious and potentially life-threatening complications in infants and young children who are not fully vaccinated. More than half of infants younger than 12 months of age who get pertussis require hospitalization.
Pertussis is characterized by a long cough illness, which may be preceded by a cold-like illness. The cough will often occur in paroxysms and may be followed by vomitting or a "whoop" sound. Vaccinated children, adolescents and adults may not present with the classic "whoop" sound. Coughing fits may continue for several weeks or even months. Infants with pertussis may not have coughing fits; instead they may have gag, gasp, vomit or experience apnea or cyanosis.
What you should know about Pertussis before school starts!
School will start on Monday August 26th and there is a growing threat that your child may get Pertussis, unless certain precautions are met. In some cases, even with vaccination some persons will still contract Pertussis. If this does happen Milam county Public Health Department has outlined a few helpful tips to help with understanding it a little better.
Symptoms of Pertussis: The disease usually starts with cold-like symptoms and maybe a mild cough or fever. After 1 to 2 weeks, severe coughing can begin. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks. In infants, the cough can be minimal or not even there. Infants may have a symptom known as "apnea." Apnea is a pause in the child’s breathing pattern. Pertussis is most dangerous for babies. More than half of infants younger than 1 year of age who get the disease must be hospitalized.
Pertussis can cause violent and rapid coughing, over and over, until the air is gone from the lungs and you are forced to inhale with a loud "whooping" sound. This extreme coughing can cause you to throw up and be very tired. The "whoop" is often not there and the infection is generally milder (less severe) in teens and adults, especially those who have been vaccinated.
How is pertussis spread? Pertussis bacteria are spread through droplets produced during coughing or sneezing. These droplets don’t travel very far through the air and usually only infect persons nearby.
How long should someone with pertussis stay home from childcare, school, or work? Persons with pertussis should stay home from child care, school, work, and other activities until they have finished 5 days of antibiotics, unless they have already been coughing for 3 or more weeks.
Prevention: The best way to prevent pertussis (whooping cough) among infants, children, teens, and adults is to get vaccinated. Also, keep infants and other people at high risk for pertussis complications away from infected people.
State Health Department Issues Pertussis Advisory
Citing six deaths and more than 1,000 cases of pertussis, or whooping cough, in Texas so far this year, the Texas Department of State Health Services is issuing a health advisory urging immunization against the potentially lethal illness. The six deaths so far this year are the most for a single year since 2005. There were 961 total Texas cases of pertussis last year, down from a peak of 3,358 in 2009.
Five of the deaths were among infants under two months old, the age at which the first pertussis vaccination is recommended. This underscores how important it is for parents and others around newborns to make sure they have received the recommended doses of vaccine. The sixth death was of an unvaccinated older child with underlying medical conditions.
Pertussis is a very contagious bacterial illness usually spread by coughing or sneezing. It often starts with cold-like symptoms and a mild cough. After a week or two, severe coughing can begin. The symptoms are usually milder in teens and adults but can be life threatening for young children because of the risk of apnea, a pause in breathing.
To protect babies, the U.S. Centers for Disease Control and Prevention and DSHS recommend pregnant women get a pertussis vaccine any time after 20 weeks gestation. Others who will be around infants should also get a shot: fathers, older siblings, other caregivers and health care professionals like doctors and nurses who care for babies.
Doctors who suspect pertussis should report the case to their local health department as soon as possible to help stop the disease from spreading. Patients who have pertussis should not go back to work or school until they’ve had five days of antibiotic treatment.The complete health advisory, including recommendations for vaccination for all ages, is available at http://www.dshs.state.tx.us/news/releases/PertussisAdvisory-090612.pdf.