#Clostridiodes difficile in #COVID19 Patients, #Detroit, #Michigan, #USA, March–April 2020 (Emerg Infect Dis., summary)

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

Volume 26, Number 9—September 2020 | Letter

Clostridiodes difficile in COVID-19 Patients, Detroit, Michigan, USA, March–April 2020

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To the Editor: Sandhu et al. (1) reported 9 patients who were co-infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Clostridioides difficile. C. difficile infection (CDI) can be a co-occurrence or result of antimicrobial drug overuse and is potentially a complication of coronavirus disease (COVID-19). We report a 52-year-old man with hypertension who had fever, respiratory symptoms, abdominal pain, and diarrhea for 3 days. At admission to Saint Michael’s Medical Center (Newark, New Jersey, USA), he had a temperature of 101.8°F but was otherwise hemodynamically stable. He had an elevated absolute lymphocyte count (700 cells/μL), indicating lymphopenia. He tested positive for SARS-CoV-2 RNA by reverse transcription PCR and had elevated inflammatory markers on blood profile. He tested positive for C. difficile toxin and antigen at admission. He did not use antimicrobial drugs or proton pump inhibitors and had no known contacts with persons with diarrhea. He was mechanically ventilated and received oral vancomycin, intravenous metronidazole, and vasopressors. He died of respiratory failure and septic shock. In comparison to the patients described by Sandhu et al., the patient we report was younger and did not have a history of antimicrobial use.

(…)

Keywords: SARS-CoV-2; COVID-19; Bacterial infection; USA; Michigan.

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Initial and Repeated Point #Prevalence #Surveys to Inform #SARS-CoV-2 #Infection #Prevention in 26 Skilled #Nursing #Facilities — #Detroit, #Michigan, March–May 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly  Report, full page: (LINK). Abstract, edited.]

Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities — Detroit, Michigan, March–May 2020

Early Release / July 1, 2020 / 69

Guillermo V. Sanchez, MSHS, MPH1; Caitlin Biedron, MD1; Lauren R. Fink, MPH2; Kelly M. Hatfield, MSPH1; Jordan Micah F. Polistico, MD3,4; Monica P. Meyer, MS, MPH3,4; Rebecca S. Noe, MN, MPH1; Casey E. Copen, PhD1; Amanda K. Lyons, MS1; Gonzalo Gonzalez, DNP2; Keith Kiama2; Mark Lebednick2; Bonnie K. Czander2; Amen Agbonze2; Aimee R. Surma, MS2; Avnish Sandhu, DO3,4; Valerie H. Mika, MS4; Tyler Prentiss, MA5; John Zervos, JD5; Donia A. Dalal2; Amber M. Vasquez, MD1; Sujan C. Reddy, MD1; John Jernigan, MD1; Paul E. Kilgore, MD4; Marcus J. Zervos, MD4,5; Teena Chopra, MD3,4; Carla P. Bezold, ScD2; Najibah K. Rehman, MD2

Corresponding author: Guillermo V. Sanchez, xkv4@cdc.gov.

1 CDC COVID-19 Response Team; 2 Detroit Health Department, Detroit, Michigan; 3 Detroit Medical Center, Detroit, Michigan; 4 Wayne State University, Detroit, Michigan; 5 Henry Ford Health System, Detroit, Michigan.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. John Zervos and Tyler Prentiss report grants from the United Way of Southeastern Michigan, Vattikuti Foundation, and Abbott Laboratories during the conduct of the study. Marcus J. Zervos reports grants from Pfizer, Merck, and Serono, outside the submitted work. No other potential conflicts of interest were disclosed.

Suggested citation for this article: Sanchez GV, Biedron C, Fink LR, et al. Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities — Detroit, Michigan, March–May 2020. MMWR Morb Mortal Wkly Rep. ePub: 1 July 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6927e1

 

Summary

  • What is already known about this topic?
    • Symptom-based screening in skilled nursing facilities (SNFs) is inadequate to detect SARS-CoV-2 transmission. Repeated point prevalence surveys can identify asymptomatic cases during outbreaks.
  • What is added by this report?
    • Repeated point prevalence surveys at 26 Detroit SNFs identified an attack rate of 44%; within 21 days of diagnosis, 37% of infected patients were hospitalized and 24% died. Among 12 facilities participating in a second survey and receiving on-site infection prevention and control (IPC) support, the percentage of newly identified cases decreased from 35% to 18%.
  • What are the implications for public health practice?
    • Repeated point prevalence surveys in SNFs can identify asymptomatic COVID-19 cases, inform cohorting and IPC practices, and guide prioritization of health department resources.

 

Abstract

Skilled nursing facilities (SNFs) are focal points of the coronavirus disease 2019 (COVID-19) pandemic, and asymptomatic infections with SARS-CoV-2, the virus that causes COVID-19, among SNF residents and health care personnel have been described (1–3). Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) have been used to identify asymptomatic infections and have reduced SARS-CoV-2 transmission during SNF outbreaks (1,3). During March 2020, the Detroit Health Department and area hospitals detected a sharp increase in COVID-19 diagnoses, hospitalizations, and associated deaths among SNF residents. The Detroit Health Department collaborated with local government, academic, and health care system partners and a CDC field team to rapidly expand SARS-CoV-2 testing and implement infection prevention and control (IPC) activities in all Detroit-area SNFs. During March 7–May 8, among 2,773 residents of 26 Detroit SNFs, 1,207 laboratory-confirmed cases of COVID-19 were identified during three periods: before (March 7–April 7) and after two point prevalence surveys (April 8–25 and April 30–May 8): the overall attack rate was 44%. Within 21 days of receiving their first positive test results, 446 (37%) of 1,207 COVID-19 patients were hospitalized, and 287 (24%) died. Among facilities participating in both surveys (n = 12), the percentage of positive test results declined from 35% to 18%. Repeated point prevalence surveys in SNFs identified asymptomatic COVID-19 cases, informed cohorting and IPC practices aimed at reducing transmission, and guided prioritization of health department resources for facilities experiencing high levels of SARS-CoV-2 transmission. With the increased availability of SARS-CoV-2 testing, repeated point prevalence surveys and enhanced and expanded IPC support should be standard tools for interrupting and preventing COVID-19 outbreaks in SNFs.

(…)

Keywords: SARS-CoV-2; COVID-19; Diagnostic tests; Institutional outbreaks; USA; Michigan.

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#Clostridiodes difficile in #COVID19 Patients, #Detroit, #Michigan, #USA, March–April 2020 (Emerg Infect Dis., abstract)

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

Volume 26, Number 9—September 2020 | Research Letter

Clostridiodes difficile in COVID-19 Patients, Detroit, Michigan, USA, March–April 2020

Avnish Sandhu, Glenn Tillotson, Jordan Polistico, Hossein Salimnia, Mara Cranis, Judy Moshos, Lori Cullen, Lavina Jabbo, Lawrence Diebel, and Teena Chopra

Author affiliations: Detroit Medical Center, Detroit, Michigan, USA (A. Sandhu, J. Polistico, H. Salimnia, M. Cranis, J. Moshos, L. Cullen, L. Jabbo, T. Chopra); Wayne State University School of Medicine, Detroit (A. Sandhu, J. Polistico, H. Salimnia, L. Diebel, T. Chopra); GST Micro LLC, Henrico, Virginia, USA (G. Tillotson)

 

Abstract

We describe 9 patients at a medical center in Detroit, Michigan, USA, with severe acute respiratory syndrome coronavirus 2 and Clostridiodes difficile. Both infections can manifest as digestive symptoms and merit screening when assessing patients with diarrhea during the coronavirus disease pandemic. These co-infections also highlight the continued importance of antimicrobial stewardship.

Keywords: SARS-CoV-2; COVID-19; USA; Michigan; Clostridiodes difficile.

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#Decline in #Child #Vaccination #Coverage During the #COVID19 Pandemic — #Michigan Care Improvement Registry, May 2016–May 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Decline in Child Vaccination Coverage During the COVID-19 Pandemic — Michigan Care Improvement Registry, May 2016–May 2020

Early Release / May 18, 2020 / 69

Cristi A. Bramer, MPH1; Lynsey M. Kimmins, MPH1; Robert Swanson, MPH1; Jeremy Kuo, MPH1; Patricia Vranesich1,2; Lisa A. Jacques-Carroll, MSW2; Angela K. Shen, ScD2,3

Corresponding author: Angela K. Shen, shenak@email.chop.edu, 301-467-7770.

1 Division of Immunization, Michigan Department of Health and Human Services; 2 Immunization Action Coalition, Saint Paul, Minnesota; 3 Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Bramer CA, Kimmins LM, Swanson R, et al. Decline in Child Vaccination Coverage During the COVID-19 Pandemic — Michigan Care Improvement Registry, May 2016–May 2020. MMWR Morb Mortal Wkly Rep. ePub: 18 May 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6920e1

 

Abstract

On March 13, 2020, the United States declared a national state of emergency to control the pandemic spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1). Public health response measures to mitigate the pandemic have centered on social distancing and quarantine policies, including shelter-in-place and stay-at-home orders. Michigan implemented a stay-at-home order on March 23, 2020, to facilitate social distancing (2). Such strategies might result in decreased accessibility to routine immunization services, leaving children at risk for vaccine-preventable diseases and their complications (3). To evaluate whether vaccination coverage has changed during the pandemic, data from the Michigan Care Improvement Registry (the state’s immunization information system) (MCIR) were analyzed. Changes in vaccine doses administered to children and the effects of those changes on up-to-date status were examined for vaccinations recommended at milestone ages corresponding to the end of an Advisory Committee on Immunization Practices (ACIP) recommendation period for one or more vaccines (4).

Keywords: SARS-CoV-2; COVID-19; USA; Pediatrics; Vaccines.

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Comparison of #WGS of #Legionella pneumophila in #Tap #Water and in #Clinical Strains, #Flint, #Michigan, #USA, 2016 (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 11—November 2019 / Research

Comparison of Whole-Genome Sequences of Legionella pneumophila in Tap Water and in Clinical Strains, Flint, Michigan, USA, 2016

Emily Garner, Connor L. Brown, David Otto Schwake, William J. Rhoads, Gustavo Arango-Argoty, Liqing Zhang, Guillaume Jospin, David A. Coil, Jonathan A. Eisen, Marc A. Edwards, and Amy Pruden

Author affiliations: West Virginia University, Morgantown, West Virginia, USA (E. Garner); Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA (E. Garner, C.L. Brown, W.J. Rhoads, G. Arango-Argoty, L. Zhang, M.A. Edwards, A. Pruden); Methodist University, Fayetteville, North Carolina, USA (D.O. Schwake); University of California at Davis, Davis, California, USA (G. Jospin, D.A. Coil, J.A. Eisen)

 

Abstract

During the water crisis in Flint, Michigan, USA (2014–2015), 2 outbreaks of Legionnaires’ disease occurred in Genesee County, Michigan. We compared whole-genome sequences of 10 clinical Legionella pneumophila isolates submitted to a laboratory in Genesee County during the second outbreak with 103 water isolates collected the following year. We documented a genetically diverse range of L. pneumophila strains across clinical and water isolates. Isolates belonging to 1 clade (3 clinical isolates, 3 water isolates from a Flint hospital, 1 water isolate from a Flint residence, and the reference Paris strain) had a high degree of similarity (2–1,062 single-nucleotide polymorphisms), all L. pneumophila sequence type 1, serogroup 1. Serogroup 6 isolates belonging to sequence type 2518 were widespread in Flint hospital water samples but bore no resemblance to available clinical isolates. L. pneumophila strains in Flint tap water after the outbreaks were diverse and similar to some disease-causing strains.

Keywords: Legionellosis; USA; Michigan.

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#Text-Based #Illness #Monitoring for #Detection of Novel Influenza A Virus Infections During an #Influenza A #H3N2v Virus #Outbreak in #Michigan, 2016: #Surveillance and Survey (JMIR Public Health Surveill., abstract)

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

JMIR Public Health Surveill. 2019 Apr 26;5(2):e10842. doi: 10.2196/10842.

Text-Based Illness Monitoring for Detection of Novel Influenza A Virus Infections During an Influenza A (H3N2)v Virus Outbreak in Michigan, 2016: Surveillance and Survey.

Stewart RJ1,2, Rossow J3,4, Eckel S5, Bidol S5, Ballew G6, Signs K5, Conover JT7, Burns E1, Bresee JS1, Fry AM1, Olsen SJ1, Biggerstaff M1.

Author information: 1 Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States. 2 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States. 3 Epidemiology Elective Program, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, United States. 4 College of Veterinary Medicine, University of Georgia, Athens, GA, United States. 5 Michigan Department of Health and Human Services, Lansing, MI, United States. 6 Compliant Campaign, Scottsdale, AZ, United States. 7 Michigan State University Extension, East Lansing, MI, United States.

 

Abstract

BACKGROUND:

Rapid reporting of human infections with novel influenza A viruses accelerates detection of viruses with pandemic potential and implementation of an effective public health response. After detection of human infections with influenza A (H3N2) variant (H3N2v) viruses associated with agricultural fairs during August 2016, the Michigan Department of Health and Human Services worked with the US Centers for Disease Control and Prevention (CDC) to identify infections with variant influenza viruses using a text-based illness monitoring system.

OBJECTIVE:

To enhance detection of influenza infections using text-based monitoring and evaluate the feasibility and acceptability of the system for use in future outbreaks of novel influenza viruses.

METHODS:

During an outbreak of H3N2v virus infections among agricultural fair attendees, we deployed a text-illness monitoring (TIM) system to conduct active illness surveillance among households of youth who exhibited swine at fairs. We selected all fairs with suspected H3N2v virus infections. For fairs without suspected infections, we selected only those fairs that met predefined criteria. Eligible respondents were identified and recruited through email outreach and/or on-site meetings at fairs. During the fairs and for 10 days after selected fairs, enrolled households received daily, automated text-messages inquiring about illness; reports of illness were investigated by local health departments. To understand the feasibility and acceptability of the system, we monitored enrollment and trends in participation and distributed a Web-based survey to households of exhibitors from five fairs.

RESULTS:

Among an estimated 500 households with a member who exhibited swine at one of nine selected fairs, representatives of 87 (17.4%) households were enrolled, representing 392 household members. Among fairs that were ongoing when the TIM system was deployed, the number of respondents peaked at 54 on the third day of the fair and then steadily declined throughout the rest of the monitoring period; 19 out of 87 household representatives (22%) responded through the end of the 10-day monitoring period. We detected 2 H3N2v virus infections using the TIM system, which represents 17% (2/12) of all H3N2v virus infections detected during this outbreak in Michigan. Of the 70 survey respondents, 16 (23%) had participated in the TIM system. A total of 73% (11/15) participated because it was recommended by fair coordinators and 80% (12/15) said they would participate again.

CONCLUSIONS:

Using a text-message system, we monitored for illness among a large number of individuals and households and detected H3N2v virus infections through active surveillance. Text-based illness monitoring systems are useful for detecting novel influenza virus infections when active monitoring is necessary. Participant retention and testing of persons reporting illness are critical elements for system improvement.

©Rebekah J Stewart, John Rossow, Seth Eckel, Sally Bidol, Grant Ballew, Kimberly Signs, Julie Thelen Conover, Erin Burns, Joseph S Bresee, Alicia M Fry, Sonja J Olsen, Matthew Biggerstaff. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 26.04.2019.

KEYWORDS: agricultural; fairs; influenza; novel; surveillance; texting

PMID: 31025948 DOI: 10.2196/10842

Keywords: Swine Influenza; H3N2v; Michigan; USA; Society.

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#Influenza A(#H3N2) Virus in #Swine at #Agricultural #Fairs and #Transmission to #Humans, #Michigan and #Ohio, USA, 2016 (@CDC_EIDjournal, abstract)

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

Volume 23, Number 9—September 2017 / Dispatch

Influenza A(H3N2) Virus in Swine at Agricultural Fairs and Transmission to Humans, Michigan and Ohio, USA, 2016

Andrew S. Bowman, Rasna R. Walia, Jacqueline M. Nolting, Amy L. Vincent, Mary Lea Killian, Michele M. Zentkovich, Joshua N. Lorbach, Sarah E. Lauterbach, Tavis K. Anderson, C. Todd Davis, Natosha Zanders, Joyce Jones, Yunho Jang, Brian Lynch, Marisela R. Rodriguez, Lenee Blanton, Stephen E. Lindstrom, David E. Wentworth, John Schiltz, James J. Averill, and Tony Forshey

Author affiliations: The Ohio State University, Columbus, Ohio, USA (A.S. Bowman, J.M. Nolting, M.M. Zentkovich, J.N. Lorbach, S.E. Lauterbach); US Department of Agriculture, Ames, Iowa, USA (R.R. Walia, A.L. Vincent, M.L. Killian, T.K. Anderson, J. Schiltz); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.T. Davis, N. Zanders, J. Jones, Y. Jang, B. Lynch, M.R. Rodriguez, L. Blanton, S.E. Lindstrom, D.E. Wentworth); Michigan Department of Agriculture and Rural Development, Lansing, Michigan, USA (J.J. Averill); Ohio Department of Agriculture, Reynoldsburg, Ohio (T. Forshey)

 

Abstract

In 2016, a total of 18 human infections with influenza A(H3N2) virus occurred after exposure to influenza-infected swine at 7 agricultural fairs. Sixteen of these cases were the result of infection by a reassorted virus with increasing prevalence among US swine containing a hemagglutinin gene from 2010–11 human seasonal H3N2 strains.

Keywords: USA; Michigan; Ohio; Human; Pigs; Swine Influenza; H3N2v; Reassortant Strain.

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#Porcine Hemagglutinating #Encephalomyelitis Virus and #Respiratory #Disease in Exhibition Swine, #Michigan, #USA, 2015 (@CDC_EIDjournal, abstract)

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

Volume 23, Number 7—July 2017 / Dispatch

Porcine Hemagglutinating Encephalomyelitis Virus and Respiratory Disease in Exhibition Swine, Michigan, USA, 2015

Joshua N. Lorbach1, Leyi Wang1, Jacqueline M. Nolting, Madonna G. Benjamin, Mary Lea Killian, Yan Zhang, and Andrew S. Bowman

Author affiliations: The Ohio State University, Columbus, Ohio, USA (J.N. Lorbach, J.M. Nolting, A.S. Bowman); Ohio Department of Agriculture, Reynoldsburg, Ohio, USA (L. Wang, Y. Zhang); Michigan State University, East Lansing, Michigan, USA (M. Benjamin); National Veterinary Services Laboratories, Ames, Iowa, USA (M.L. Killian)

 

Abstract

Acute outbreaks of respiratory disease in swine at agricultural fairs in Michigan, USA, in 2015 raised concern for potential human exposure to influenza A virus. Testing ruled out influenza A virus and identified porcine hemagglutinating encephalomyelitis virus as the cause of influenza-like illness in the affected swine.

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Suggested citation for this article: Lorbach JN, Wang L, Nolting JM, Benjamin MG, Killian ML, Zhang Y, et al. Porcine hemagglutinating encephalomyelitis virus and respiratory disease in exhibition swine, Michigan, USA, 2015. Emerg Infect Dis. 2017 Jul [date cited]. https://doi.org/10.3201/eid2307.170019

DOI: 10.3201/eid2307.170019

1These authors contributed equally to this article.

Keywords: USA; Michigan; Pigs; Porcine hemagglutinating encephalomyelitis.

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#Michigan, Suspect #deer confirmed #positive for chronic wasting disease [#CWD] (DNR, December 11 2015, edited)

[Source: Michigan Department of Natural Resources, full page: (LINK).]

Suspect deer confirmed positive for chronic wasting disease [      ]

Contact: Chad Stewart, 517-641-4903, ext. 263  / Agency: Natural Resources / Dec. 11, 2015

Deer was harvested in Dewitt Township; Eaton County hunters urged to voluntarily check deer and stop baiting and feeding of deer

As of Thursday, the Michigan Department of Natural Resources reports a total of 3,695 deer in Michigan this year have been tested for chronic wasting disease (CWD). Four deer have been confirmed positive for the disease, with the fourth positive just recently found.

During the firearm deer season, a hunter from Dewitt Township (Clinton County) in the Core CWD Area brought a 1 1/2-year-old buck into the DNR’s Rose Lake deer check station. The U.S. Department of Agriculture’s National Veterinary Services Laboratory in Ames, Iowa, confirmed the deer as CWD positive.

Because the deer was harvested within 10 miles of the Eaton County border, the DNR strongly encourages all hunters within Eaton County to voluntarily stop baiting and feeding, continue hunting and, most importantly, bring harvested deer into a DNR check station.

“Deer hunters in DMU 333 have been a great help by bringing in their deer to be tested. We couldn’t be more thankful or impressed with their dedication to the resource,” said Chad Stewart, DNR deer specialist. “We continue to need their help and are also asking Eaton County hunters to join our efforts. In addition, we have begun conversations with DeWitt Township, and they, too, are becoming great partners in this fight against CWD.”

There will be no mandatory regulation changes from now through the end of the deer season, as the DNR conducts CWD surveillance and decides what additional steps might be needed for the 2016 season.

CWD is a fatal neurological disease that affects white-tailed deer, mule deer, elk and moose. It is caused by the transmission of infectious, self-multiplying proteins (prions) contained in saliva and other body fluids of infected animals. Susceptible animals can acquire CWD by direct exposure to these fluids, or from environments contaminated with these fluids or the carcass of a diseased animal.

Some chronically CWD-infected animals will display abnormal behaviors, progressive weight loss and physical debilitation; however, deer can be infected without showing internal or external symptoms for many years. There is no cure; once a deer is infected with CWD, it will die.

To date, there is no evidence that chronic wasting disease presents any risk to non-cervids, including humans, either through contact with an infected animal or from handling venison. However, as a precaution, the U.S. Centers for Disease Control and the World Health Organization recommend that infected animals not be consumed as food by either humans or domestic animals.

The DNR provides weekly CWD updates at mi.gov/cwd. Announcements of additional CWD-positive deer also will be posted online.

The Michigan Department of Natural Resources is committed to the conservation, protection, management, use and enjoyment of the state’s natural and cultural resources for current and future generations. For more information, go to www.michigan.gov/dnr.

Keywords: USA; Updates; Michigan; Deer; Chronic Wasting Disease; Prions.

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