Need for #Aeromedical #Evacuation High-Level #Containment #Transport #Guidelines (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 5—May 2019 / Research Letter

Need for Aeromedical Evacuation High-Level Containment Transport Guidelines

Shawn G. Gibbs, Jocelyn J. Herstein  , Aurora B. Le, Elizabeth L. Beam, Theodore J. Cieslak, James V. Lawler, Joshua L. Santarpia, Terry L. Stentz, Kelli R. Kopocis-Herstein, Chandran Achutan, Gary W. Carter, and John J. Lowe

Author affiliations: Indiana University School of Public Health, Bloomington, Indiana, USA (S.G. Gibbs, A.B. Le); University of Nebraska Medical Center College of Public Health, Omaha, Nebraska, USA (J.J. Herstein, T.J. Cieslak, C. Achutan, J.J. Lowe); University of Nebraska Medical Center College of Nursing, Omaha (E.L. Beam); University of Nebraska Medical Center College of Medicine, Omaha (J.V. Lawler, J.L. Santarpia); National Strategic Research Institute, Omaha (J.V. Lawler, J.L. Santarpia, G.W. Carter); University of Nebraska–Lincoln Charles W. Durham School of Architectural Engineering and Construction, Lincoln, Nebraska, USA (T.L. Stentz, K.R. Kopocis-Herstein)

 

Abstract

Circumstances exist that call for the aeromedical evacuation high-level containment transport (AE-HLCT) of patients with highly hazardous communicable diseases. A small number of organizations maintain AE-HLCT capabilities, and little is publicly available regarding the practices. The time is ripe for the development of standards and consensus guidelines involving AE-HLCT.

Keywords: Biological Hazards; Biocontainment; Infectious Diseases; Emerging Diseases.

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#REDCap for #Biocontainment #Worker Symptom #Monitoring (Health Secur., asbtract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Health Secur. 2019 Feb 6. doi: 10.1089/hs.2018.0086. [Epub ahead of print]

REDCap for Biocontainment Worker Symptom Monitoring.

O’Keefe AL1, Buss BF2,3, Koirala S4,5, Gleason MX6, Mudgapalli A7, Schwedhelm S8.

Author information: 1 Anne L. O’Keefe, MD, is Senior Epidemiologist, Douglas County Health Department, Omaha, Nebraska. 2 Bryan F. Buss, DVM, is a Career Epidemiology Field Officer, the Nebraska Department of Health and Human Services, Lincoln, Nebraska. 3 Bryan F. Buss, DVM, the Center for Preparedness and Response, Division of State and Local Readiness, Centers for Disease Control and Prevention (CDC), Lincoln, NE. 4 Samir Koirala, MBBS, is a CDC Temporary Epidemiology Field Assignee, the Nebraska Department of Health and Human Services, Lincoln, Nebraska. 5 Samir Koirala, MBBS, the Center for Preparedness and Response, Division of State and Local Readiness, Centers for Disease Control and Prevention (CDC), Lincoln, NE. 6 Michael X. Gleason, PhD, is a Programmer/Analyst, the Research IT Office, University of Nebraska Medical Center, Omaha. 7 Ashok Mudgapalli, PhD, is Director, the Research IT Office, University of Nebraska Medical Center, Omaha. 8 Shelly Schwedhelm, MSN, is Executive Director, Emergency Management & Biopreparedness, Nebraska Medicine, Omaha.

 

Abstract

The Ebola epidemic of 2014 demonstrated that outbreaks of high-consequence infectious diseases, even in remote parts of the world, can affect communities anywhere in the developed world and that every healthcare facility must be prepared to identify, isolate, and provide care for infected patients. The Nebraska Biocontainment Unit (NBU), located at Nebraska Medicine in Omaha, Nebraska, cared for 3 American citizens exposed in West Africa and confirmed with Ebola virus disease (EVD). Symptom monitoring of healthcare workers caring for these patients was implemented, which included twice daily contact to document the absence or presence of signs of fever or illness. This article describes the symptom monitoring experience of the NBU and local and state public health agencies. Based on lessons learned from that experience, we sought a more efficient solution to meet the needs of both the healthcare facility and public health authorities. REDCap, an open-source application used commonly by academic health centers, was used to develop an inexpensive symptom monitoring application that could reduce the burden of managing these activities, thus freeing up valuable time. Our pilot activities demonstrated that this novel use of REDCap holds promise for minimizing costs and resource demands associated with symptom monitoring while offering a more user-friendly experience for people being monitored and the officials managing the response.

KEYWORDS: Biocontainment; Epidemic management/response; Hospital preparedness; Infectious diseases

PMID: 30724610 DOI: 10.1089/hs.2018.0086

Keywords: Infectious Diseases; Emerging Diseases; Biocontainment; HCWs.

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Evaluating Promising #Investigational #Medical #Countermeasures: #Recommendations in the Absence of #Guidelines (Health Secur., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Health Secur. 2019 Feb 6. doi: 10.1089/hs.2018.0092. [Epub ahead of print]

Evaluating Promising Investigational Medical Countermeasures: Recommendations in the Absence of Guidelines.

Bhadelia N1, Sauer L2, Cieslak TJ3, Davey RT4, McLellan S5, Uyeki TM6, Kortepeter MG7; National Ebola Training and Education Center’s Special Pathogens Research Network (SPRN)’s Medical Countermeasures Working Group.

Collaborators (12): Akers M, Dierberg K, Eiras D, Evans J, Figueroa E, Kraft C, Kratochvil C, Martins K, Measer G, Mehta A, Hu-Primmer J, Risi G.

Author information: 1 Nahid Bhadelia, MD, MA, is Medical Director, Special Pathogens Unit, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA. 2 Lauren Sauer, MS, is Assistant Professor, Director of Research, Johns Hopkins Biocontainment Unit, Department of Emergency Medicine, Johns Hopkins Medicine, Baltimore, MD. 3 Theodore J. Cieslak, MD, MPH, is Associate Professor, Department of Epidemiology, University of Nebraska College of Public Health, Omaha, NE. 4 Richard T. Davey, MD, is Deputy Clinical Director, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD. 5 Susan McLellan, MD, MPH, is Medical Director, Biocontainment Treatment Unit, Division of Infectious Diseases, University of Texas Medical Branch at Galveston, TX. 6 Timothy M. Uyeki, MD, MPH, MPP, is Chief Medical Officer, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. 7 Mark G. Kortepeter, MD, MPH, is Professor, Department of Epidemiology, University of Nebraska College of Public Health, Omaha, NE.

 

Abstract

Emerging and re-emerging infectious diseases pose growing global public health threats. However, research on and development of medical countermeasures (MCMs) for such pathogens is limited by the sporadic and unpredictable nature of outbreaks, lack of financial incentive for pharmaceutical companies to develop interventions for many of the diseases, lack of clinical research capacity in areas where these diseases are endemic, and the ethical dilemmas related to conducting scientific research in humanitarian emergencies. Hence, clinicians providing care for patients with emerging diseases are often faced with making clinical decisions about the safety and effectiveness of experimental MCMs, based on limited or no human safety, preclinical, or even earlier product research or historical data, for compassionate use. Such decisions can have immense impact on current and subsequent patients, the public health response, and success of future clinical trials. We highlight these dilemmas and underscore the need to proactively set up procedures that allow early and ethical deployment of MCMs as part of clinical trials. When clinical trials remain difficult to deploy, we present several suggestions of how compassionate use of off-label and unlicensed MCMs can be made more informed and ethical. We highlight several collaborations seeking to address these gaps in data and procedures to inform future clinical and public health decision making.

KEYWORDS: Drug development; Ebola; Emerging infectious diseases; Ethics; Medical countermeasures; Outbreaks

PMID: 30724616 DOI: 10.1089/hs.2018.0092

Keywords: Infectious Diseases; Emerging Diseases; Antivirals; Vaccines.

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#Kynurenine is a #CSF #biomarker for #bacterial and #viral #CNS #infections (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Kynurenine is a cerebrospinal fluid biomarker for bacterial and viral CNS infections

Kurt-Wolfram Sühs, Natalia Novoselova, Maike Kuhn, Lena Seegers, Volkhard Kaever, Kirsten Müller-Vahl, Corinna Trebst, Thomas Skripuletz, Martin Stangel, Frank Pessler

The Journal of Infectious Diseases, jiz048, https://doi.org/10.1093/infdis/jiz048

Published:  05 February 2019

 

Abstract

Background

The tryptophan-kynurenine-NAD+ pathway is closely associated with regulation of immune cells toward less inflammatory phenotypes and may exert neuroprotective effects. Investigating its regulation in CNS infections would improve our understanding of pathophysiology and end-organ damage, and, furthermore, open doors to its evaluation as a source of diagnostic and/or prognostic biomarkers.

Methods

We measured concentrations of kynurenine (Kyn) and tryptophan (Trp) in 220 cerebrospinal fluid samples from patients with bacterial and viral (herpes simplex, varicella zoster, enteroviruses) meningitis/encephalitis, neuroborreliosis, autoimmune neuroinflammation (anti-NMDA-R encephalitis, multiple sclerosis), and noninflamed controls (Bell’s palsy, normal pressure hydrocephalus, Tourette syndrome).

Results

Kyn concentrations correlated strongly with CSF markers of neuroinflammation (leukocyte count, lactate, and blood-CSF-barrier dysfunction) and were highly increased in bacterial and viral CNS infections, but were low or undetectable in anti-NMDA-R encephalitis, multiple sclerosis, and controls. Trp was decreased mostly in viral CNS infections and neuroborreliosis. Multiple logistic regression analysis revealed combinations of Kyn, Trp and Kyn/Trp ratio with leukocyte count or lactate as accurate classifiers for the clinically important differentiation between neuroborreliosis, viral CNS infections, and autoimmune neuroinflammation.

Conclusions

The Trp-Kyn-NAD+ pathway is activated in CNS infections and provides highly accurate CSF biomarkers, particularly when combined with standard CSF indices of neuroinflammation.

Biomarkers, Borrelia, central nervous system, diagnosis, infection, kynurenine, metabolites, tryptophan

Issue Section: Major Article

This content is only available as a PDF.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Infectious diseases; Encephalitis; Meningitis.

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High #ambient #temperature dampens adaptive immune #responses to #influenza A virus #infection (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

High ambient temperature dampens adaptive immune responses to influenza A virus infection

Miyu Moriyama and Takeshi Ichinohe

PNAS published ahead of print February 4, 2019 / DOI: https://doi.org/10.1073/pnas.1815029116

Edited by Ruslan Medzhitov, Yale University School of Medicine, New Haven, CT, and approved December 26, 2018 (received for review August 31, 2018)

 

Significance

Although half of the world’s population could face severe food crisis as a result of global warming by the end of this century, the effects of environmental temperature and host nutritional status in host defense to viral infection in vivo are less clear. Here, we demonstrated that exposure of mice to the high ambient temperature of 36 °C reduced their food intake and impaired adaptive immune responses to influenza virus infection. In addition, we found that administration of glucose or dietary short-chain fatty acids restored influenza virus-specific adaptive immune responses in high heat-exposed mice. Our results imply possible public health problems and concerns that outside temperature and host nutritional status may be critical determinants of viral pathogenesis or vaccine efficacy.

 

Abstract

Although climate change may expand the geographical distribution of several vector-borne diseases, the effects of environmental temperature in host defense to viral infection in vivo are unknown. Here, we demonstrate that exposure of mice to the high ambient temperature of 36 °C impaired adaptive immune responses against infection with viral pathogens, influenza, Zika, and severe fever with thrombocytopenia syndrome phlebovirus. Following influenza virus infection, the high heat-exposed mice failed to stimulate inflammasome-dependent cytokine secretion and respiratory dendritic cell migration to lymph nodes. Although commensal microbiota composition remained intact, the high heat-exposed mice decreased their food intake and increased autophagy in lung tissue. Induction of autophagy in room temperature-exposed mice severely impaired virus-specific CD8 T cells and antibody responses following respiratory influenza virus infection. In addition, we found that administration of glucose or dietary short-chain fatty acids restored influenza virus-specific adaptive immune responses in high heat-exposed mice. These findings uncover an unexpected mechanism by which ambient temperature and nutritional status control virus-specific adaptive immune responses.

global warming – vector-borne diseases – immunity to viral infection – autophagy – inflammasomes

 

Footnotes

1 To whom correspondence should be addressed. Email: ichinohe@ims.u-tokyo.ac.jp.

Author contributions: M.M. and T.I. designed research; M.M. and T.I. performed research; M.M. and T.I. analyzed data; and T.I. wrote the paper.

The authors declare no conflict of interest.

This article is a PNAS Direct Submission.

This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10.1073/pnas.1815029116/-/DCSupplemental.

Published under the PNAS license.

Keywords: Influenza A; Climate Change; Global Warming.

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Recent #advances in understanding the #epidemiology of #healthcare-associated #infections (F1000Res., abstract)

[Source: F1000 Research, full page: (LINK). Abstract, edited.]

Recent advances in understanding the epidemiology of healthcare-associated infections [version 1; referees: 2 approved]

Pranavi Sreeramoju

Author details: University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA

 

Abstract

Since the 2014 publication of updates to the Society for Healthcare Epidemiology of America (SHEA) compendium of strategies to reduce healthcare-associated infections, there have been several advances in understanding the epidemiology of these diseases. This review article captures many of the key advances but does not include all of them.

Keywords: healthcare-associated infections, infection prevention, updates in literature

Corresponding author: Pranavi Sreeramoju

Competing interests: No competing interests were disclosed.Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright:  © 2019 Sreeramoju P. This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Sreeramoju P. Recent advances in understanding the epidemiology of healthcare-associated infections [version 1; referees: 2 approved]. F1000Research 2019, 8(F1000 Faculty Rev):106 (https://doi.org/10.12688/f1000research.15891.1)

First published: 25 Jan 2019, 8(F1000 Faculty Rev):106 (https://doi.org/10.12688/f1000research.15891.1)

Latest published: 25 Jan 2019, 8(F1000 Faculty Rev):106 (https://doi.org/10.12688/f1000research.15891.1)

Keywords: Nosocomial Outbreaks; Infectious diseases.

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#Limiting factors for wearing personal protective equipment (#PPE) in a #healthcare #environment evaluated in a randomised study (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Limiting factors for wearing personal protective equipment (PPE) in a health care environment evaluated in a randomised study

Martina Loibner, Sandra Hagauer, Gerold Schwantzer, Andrea Berghold, Kurt Zatloukal

Published: January 22, 2019 / DOI: https://doi.org/10.1371/journal.pone.0210775

 

Abstract

Pandemics and re-emerging diseases put pressure on the health care system to prepare for patient care and sample logistics requiring enhanced personnel protective equipment (PPE) for health care workers. We generated quantifiable data on ergonomics of PPE applicable in a health care setting by defining error rates and physically limiting factors due to PPE-induced restrictions. Nineteen study volunteers tested randomly allocated head- or full body-ventilated PPE suits equipped with powered-air-purifying-respirators and performed four different tasks (two laboratory tutorials, a timed test of selective attention and a test investigating reaction time, mobility, speed and physical exercise) during 6 working hours at 22°C on one day and 4 working hours at 28°C on another day. Error rates and physical parameters (fluid loss, body temperature, heart rate) were determined and ergonomic-related parameters were assessed hourly using assessment sheets. Depending on the PPE system the most restrictive factors, which however had no negative impact on performance (speed and error rate), were: reduced dexterity due to multiple glove layers, impaired visibility by flexible face shields and back pain related to the respirator of the fully ventilated suit. Heat stress and liquid loss were perceived as restrictive at a working temperature of 28°C but not 22°C.

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Citation: Loibner M, Hagauer S, Schwantzer G, Berghold A, Zatloukal K (2019) Limiting factors for wearing personal protective equipment (PPE) in a health care environment evaluated in a randomised study. PLoS ONE 14(1): e0210775. https://doi.org/10.1371/journal.pone.0210775

Editor: Regan Marsh, Brigham and Women’s Hospital, Harvard Medical School, UNITED STATES

Received: January 12, 2017; Accepted: December 29, 2018; Published: January 22, 2019

Copyright: © 2019 Loibner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: We would like to acknowledge the Christian Doppler Research Fund (Austrian Federal Ministry of Science, Research and Economy, the National Foundation for Research, Technology and Development) and ERINHA (European Research Infrastructure on Highly Pathogenic Agents, FP7-INFRA-2010-2-2.8) for financial support of our research project to KZ. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Pandemic Preparedness; Infectious Diseases; PPE; Healthcare workers.

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