Longitudinal #Outbreak of #MDR #Tuberculosis in a #Hospital Setting, #Serbia (Emerg Infect Dis., abstract)

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

Volume 25, Number 3—March 2019 / Dispatch

Longitudinal Outbreak of Multidrug-Resistant Tuberculosis in a Hospital Setting, Serbia

Irena Arandjelović1  , Matthias Merker1, Elvira Richter, Thomas A. Kohl, Branislava Savić, Ivan Soldatović, Thierry Wirth, Dragana Vuković1, and Stefan Niemann1

Author affiliations: University of Belgrade, Belgrade, Serbia (I. Arandjelović, B. Savić, I. Soldatović, D. Vuković); Leibniz-Zentrum für Medizin und Biowissenschaften, Borstel, Germany (M. Merker, T.A. Kohl, S. Niemann); Laboratory Limbach, Heidelberg, Germany (E. Richter); Paris Sciences & Lettres University, Paris, France (T. Wirth); Sorbonne Universités, Paris (T. Wirth); German Center for Infection Research, Borstel, Germany (S. Niemann)



A retrospective population-based molecular epidemiologic study of multidrug-resistant Mycobacterium tuberculosis complex strains in Serbia (2008–2014) revealed an outbreak of TUR genotype strains in a psychiatric hospital starting around 1990. Drug unavailability, poor infection control, and schizophrenia likely fueled acquisition of additional resistance and bacterial fitness–related mutations over 2 decades.

Keywords: Antibiotics; Drugs Resistance; Mycobacterium tuberculosis; Nosocomial outbreaks; Serbia.



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



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.


#SARI Associated with Human #Metapneumovirus in Nursing Home, #NM, #USA (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 2—February 2019 / Research Letter

Severe Respiratory Illness Associated with Human Metapneumovirus in Nursing Home, New Mexico, USA

Sandra A. Peña1, Sarah Shrum Davis, Xiaoyan Lu, Senthil Kumar K. Sakthivel, Teresa C.T. Peret, Erica Billig Rose, Chad Smelser, Eileen Schneider  , Nimalie D. Stone, and John Watson

Author affiliations: New Mexico Department of Health, Santa Fe, New Mexico, USA (S.A. Peña, S. Shrum Davis, C. Smelser); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (X. Lu, S.K.K. Sakthivel, T.C.T. Peret, E. Billig Rose, E. Schneider, N.D. Stone, J. Watson)



Human metapneumovirus is an emerging pathogen that causes upper and lower respiratory illness. Nursing home outbreaks of infection with this virus can cause severe illness and lead to poor patient outcomes. We report an outbreak investigation in a nursing home during 2018 and infection control guidelines to assist in disease control.

Keywords: Metapneumovirus; SARI; USA; New Mexico; Nosocomial outbreaks.


#Scope and extent of #healthcare-associated #MERS #coronavirus #transmission during two contemporaneous #outbreaks in #Riyadh, #Saudi Arabia, 2017 (Infect Control Hosp Epidemiol., abstract)

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

Infect Control Hosp Epidemiol. 2019 Jan;40(1):79-88. doi: 10.1017/ice.2018.290.

Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017.

Alanazi KH1, Killerby ME2, Biggs HM2, Abedi GR2, Jokhdar H1, Alsharef AA1, Mohammed M1, Abdalla O1, Almari A1, Bereagesh S1, Tawfik S1, Alresheedi H1, Alhakeem RF1, Hakawi A1, Alfalah H3, Amer H3, Thornburg NJ2, Tamin A2, Trivedi S4, Tong S2, Lu X2, Queen K2, Li Y2, Sakthivel SK5, Tao Y2, Zhang J2, Paden CR2, Al-Abdely HM1, Assiri AM1, Gerber SI2, Watson JT2.

Author information: 1 Ministry of Health,Riyadh,Saudi Arabia. 2 Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States. 3 King Saud Medical City,Riyadh,Saudi Arabia. 4 IHRC,contractor to National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States. 5 Batelle, contractor to National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA,USA.




To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.


Outbreak investigation.


Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.


Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.


In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.


We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.

PMID: 30595141 DOI: 10.1017/ice.2018.290

Keywords: MERS-CoV; Nosocomial Outbreaks; Saudi Arabia.


#Clinical Practice #Guidelines by the #IDSA: 2018 #Update on Diagnosis, Treatment, #Chemoprophylaxis, and Institutional #Outbreak Management of Seasonal #Influenza (Clin Infect Dis., abstract)

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

Clin Infect Dis. 2018 Dec 19. doi: 10.1093/cid/ciy866. [Epub ahead of print]

Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza.

Uyeki TM1, Bernstein HH2, Bradley JS3,4, Englund JA5, File TM Jr6, Fry AM1, Gravenstein S7, Hayden FG8, Harper SA9, Hirshon JM10, Ison MG11, Johnston BL12, Knight SL13, McGeer A14, Riley LE15, Wolfe CR16, Alexander PE17,18, Pavia AT19.

Author information: 1 Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. 2 Division of General Pediatrics, Cohen Children’s Medical Center, New Hyde Park, New York. 3 Division of Infectious Diseases, Rady Children’s Hospital. 4 University of California, San Diego. 5 Department of Pediatrics, University of Washington, Seattle Children’s Hospital. 6 Division of Infectious Diseases Summa Health, Northeast Ohio Medical University, Rootstown. 7 Providence Veterans Affairs Medical Center and Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island. 8 Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville. 9 Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia. 10 Department of Emergency Medicine, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore. 11 Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 12 Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, Canada. 13 Library and Knowledge Services, National Jewish Health, Denver, Colorado. 14 Division of Infection Prevention and Control, Sinai Health System, University of Toronto, Ontario, Canada. 15 Department of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston. 16 Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina. 17 McMaster University, Hamilton, Ontario, Canada. 18 Infectious Diseases Society of America, Arlington, Virginia. 19 Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City.



These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic. This document addresses new information regarding diagnostic testing, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal influenza. It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza. The guidelines consider the care of children and adults, including special populations such as pregnant and postpartum women and immunocompromised patients.

PMID: 30566567 DOI: 10.1093/cid/ciy866

Keywords: Seasonal Influenza; Antivirals; Nosocomial Outbreaks.


Individual and #network characteristic associated with #hospital-acquired #MERS #coronavirus (J Infect Public Health, abstract)

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

J Infect Public Health. 2018 Dec 18. pii: S1876-0341(18)30318-6. doi: 10.1016/j.jiph.2018.12.002. [Epub ahead of print]

Individual and network characteristic associated with hospital-acquired Middle East Respiratory Syndrome coronavirus.

Adegboye O1, Saffary T2, Adegboye M3, Elfaki F4.

Author information: 1 Australian Institute of Tropical Health & Medicine, James Cook University, Townsville, QLD 4811, Australia. Electronic address: oyelola.adegboye@jcu.edu.au. 2 Independent Researcher, MD 20876, USA. 3 American University of Nigeria, 640001 Yola, Nigeria. 4 Department of Mathematics, Statistics and Physics, Qatar University, 2713 Doha, Qatar.




During outbreaks of infectious diseases, transmission of the pathogen can form networks of infected individuals connected either directly or indirectly.


Network centrality metrics were used to characterize hospital-acquired Middle East Respiratory Syndrome Coronavirus (HA-MERS) outbreaks in the Kingdom of Saudi Arabia between 2012 and 2016. Covariate-adjusted multivariable logistic regression models were applied to assess the effect of individual level risk factors and network level metrics associated with increase in length of hospital stay and risk of deaths from MERS.


About 27% of MERS cases were hospital acquired during the study period. The median age of healthcare workers and hospitalized patients were 35 years and 63 years, respectively, Although HA-MERS were more connected, we found no significant difference in degree centrality metrics between HA-MERS and non-HA-MERS cases. Pre-existing medical conditions (adjusted Odds ratio (aOR)=2.43, 95% confidence interval: (CI) [1.11-5.33]) and hospitalized patients (aOR=29.99, 95% CI [1.80-48.65]) were the strongest risk predictors of death from MERS. The risk of death associated with 1-day increased length of stay was significantly higher for patients with comorbidities.


Our investigation also revealed that patients with an HA-MERS infection experienced a significantly longer hospital stay and were more likely to die from the disease. Healthcare worker should be reminded of their potential role as hubs for pathogens because of their proximity to and regular interaction with infected patients. On the other hand, this study has shown that while healthcare workers acted as epidemic attenuators, hospitalized patients played the role of an epidemic amplifier.

Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

KEYWORDS: Healthcare workers; Hospital-acquired infections; MERS; Network analysis

PMID: 30578142 DOI: 10.1016/j.jiph.2018.12.002

Keywords: MERS-CoV; Nosocomial Outbreaks.


‘When I die, let me be the last.’ #Community #HCWs #perspectives on past #Ebola and #Marburg #outbreaks in #Uganda (Glob Public Health, abstract)

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

Glob Public Health. 2018 Dec 20:1-11. doi: 10.1080/17441692.2018.1552306. [Epub ahead of print]

‘When I die, let me be the last.’ Community health worker perspectives on past Ebola and Marburg outbreaks in Uganda.

Englert EG1,2, Kiwanuka R3, Neubauer LC1.

Author information: 1 a Feinberg School of Medicine, Northwestern University , Chicago , IL , USA. 2 b Kellogg Institute for International Studies, University of Notre Dame , Notre Dame , IN , USA. 3 c Palliative Care Association of Uganda , Kampala , Uganda.



Uganda suffered four Ebola and five Marburg virus outbreaks from 2000 to 2012 with significant health worker mortality. This paper describes findings from 41 interviews with health workers from three outbreaks. Interviewees frequently encountered stigma from their communities, sometimes accompanied by mistrust and violence. These difficulties were defined as ‘challenges of society.’ Health workers also suffered emotional trauma, depressive symptoms, and fear classified as ‘challenges of psyche.’ As the incidence of such outbreaks will likely increase due to ecological and economic trends, health workers require greater access to personal protective equipment (PPE) and knowledge of viral containment. Such improvements would create an optimal psychosocial climate for managing infectious patients ultimately decreasing the severity of future outbreaks.

KEYWORDS: Ebola virus; Marburg virus; Uganda; health worker; psychosocial

PMID: 30570442 DOI: 10.1080/17441692.2018.1552306

Keywords: Ebola; Marburg; Uganda; Nosocomial Outbreaks; HCWs; Society.