Tag Archives: infection control

Increased cases of Mumps in McHenry County

The following in a memo released by the McHenry County Dept of public health on October 15th 2013.

This memo is to alert you of an increase in mumps cases in McHenry County. As of October of this year, there have been 4 cases reported. In 2009 there was 1 case of mumps reported and between 2010 –2012 there were no cases reported.
We are encouraging all healthcare providers to suspect mumps in any patient that presents with the following symptoms (despite their immunization status), test, and report:

  • Swollen and tender salivary glands under the ears on one or both sides (parotitis)
  • Fever
  • Headache
  • Tiredness
  • Muscle Aches Loss of appetite
    

Mumps Laboratory Testing & Specimen Collection

It is very important to obtain laboratory confirmation for cases and suspect cases of mumps. Due to cross reacting antibodies and other issues, sensitivity and specificity of commercially available IgM tests are problematic. The Centers for Disease Control and Prevention (CDC) and the IDPH do not recommend mumps IgM testing by commercial laboratories for confirmation or elimination of a diagnosis of mumps. A positive laboratory confirmation for mumps virus with reverse transcription polymerase chain reaction (RT-PCR) or culture in a patient with acute characteristics of the mumps illness are the only laboratory tests that will yield a “confirmed” mumps case by CDC and IDPH case definition. Therefore, the collection of clinical specimens for mumps virus isolation on all individuals with suspected mumps is extremely important and should be done.

A positive laboratory confirmation for mumps virus with reverse transcription polymerase chain reaction (RT-PCR) or culture in a patient with acute characteristics of the mumps illness are the only laboratory tests that will yield a “confirmed” mumps

A buccal swab is the best type of sample and is the preferred specimen for viral isolation. Collect a buccal swab up to 5 days after symptom onset, preferably within 3 day after onset. In unvaccinated persons, virus may be isolated from 7 days before until 9 days after parotid swelling. Maximal viral shedding, however, generally occurs just prior to and within the first 3 days of parotitis onset. In vaccinated persons, buccal swabs should be collected within 1 to 3 days of parotitis onset, otherwise viral detection in RT-PCR or culture may have low yield. Massage the parotid gland area (the space between the cheek and teeth just below the ear) for about 30 seconds prior to collection of the buccal secretions. The parotid duct (Stenson’s duct) drains in this space near the upper rear molars.

Reporting

According to the Illinois Adm. Code, Title 77, Section 690.100, any suspect case of mumps must be reported to the McHenry County Department of Health within 24 hours by calling 815–334–4500.

References

Centegra Antibiogram now available online

Centegra antibiogram is now available under Departments → Infection control → Antibiogram

Research Shows Probiotics Do Not Limit Antibiotic Associated Diarrhea or C. dif Diarrhea

Do probiotics prevent antibiotic associated diarrhea? A Welsh study published in The Lancet indicates that antibiotic-induced diarrhea is not prevented in the elderly by a daily dose of probiotics. Earlier research had shown potential, and prompted doctors to routinely prescribe antibiotics and probiotics together. The probiotic market had been estimated to reach $2.07 billion by 2015.

Approximately 10.8% of people in the probiotic group got antibiotic-associated diarrhea, compared to 10.4% of the control group. Researcher Stephen J. Allen concluded, “Our findings should discourage the use of microbial preparations for the prevention of AAD and C. difficile diarrhea.” He believes previous research showing promise was flawed because of microbial variation, small sample sizes, erroneous reporting, and poor trial designs.

References:

 

Victories in Infectious Diseases – Video of lecture

This lecture was presented at the July 2013 Centegra summer symposium. Continue reading

Measles case in Illinois – IDPH alert

The following is a memo from the Illinois Department of Public Health dated July 12th 2013. Images were added from CDC public domain for clarity.


The Illinois Department of Public Health, along with the Centers for Disease Control and Prevention and local health departments, have been investigating a confirmed and suspect case of measles in persons who traveled together to Poland and returned to Illinois in late June. The investigations are still ongoing, but it appears both cases are imported. Measles cases are rare in Illinois but do occur. Since 2009, only three other cases have been reported and all had onset in 2011.

Measles Disease

Measles is a highly contagious viral illness that is characterized by a rash, fever, cold symptoms, conjunctivitis, malaise, and Koplik’s spots (tiny white spots with bluish-white center inside the mouth).
Koplik spots - courtesy CDC
While measles is almost eradicated in the United States due to high vaccination coverage levels, it still kills nearly 200,000 people each year around the world. Currently the virus is endemic in many African, Asian, and European countries. Measles should be considered as a diagnosis in unvaccinated persons presenting with a febrile rash illness as described above and recent international travel or contact with travelers or other persons with rash illness.

Reporting of Suspicious Cases

Physicians and other providers should contact their local health department to report a suspected measles case as soon as possible but within 24 hours. In highly suspicious cases, health care providers should not wait for laboratory results before contacting their local health department.

Measles cases can develop complications, including encephalitis, pneumonia, ear infections (permanent loss of hearing can result) or diarrhea. These complications are more common among children under five years of age and adults over 20 years old. Measles infection can be fatal and can cause miscarriage, premature birth or a low-birth-weight baby in pregnant women.
Laboratories should also report to their local health department positive lab tests for measles within 24 hours. In turn, local health departments should report cases to the IDPH CD Section within the same time period.

Measles - photo courtesy CDC

Prompt recognition, reporting and investigation of measles cases are important since transmission can be limited with early case identification and vaccination of susceptible contacts. For cases that have recently traveled, obtaining travel details (e.g. flight dates, times and numbers) are important for identifying contacts among fellow travelers. Persons traveling abroad should inquire about vaccinations before traveling abroad to prevent measles illness.

Resources

The following resources on measles infections are available:

Risk of Guillain-Barré syndrome after seasonal influenza vaccination – Lancet study

The risk of Guillain-Barre is often viewed as an obstacle to influenza vaccination.

A recent study by Kwong et al published in the June 28th issue of the Lancet identified cases of Guillain-Barre that occurred with 6 weeks of vaccination and found that more cases occurred in the control group (not vaccinated) than in those who were vaccinated. Far greater number of Guillain-Barre cases were identified in the non-vaccinated group than in the ones vaccinated.

The conclusion reached was that the attributable risk for Guillain-Barre after seasonal inflluenza vaccination is lower than those after influenza disease itself. This study was funded by the Canadian Institute of Health Research.

Reference

Risk of Guillain-Barré syndrome after seasonal influenza vaccination and influenza health-care encounters: a self-controlled study; Dr Jeffrey C Kwong MD,Priya P Vasa MD,Michael A Campitelli MPH,Steven Hawken MSc,Kumanan Wilson MD,Laura C Rosella PhD,Prof Therese A Stukel PhD,Natasha S Crowcroft MD(Cantab),Prof Allison J McGeer MD,Lorne Zinman MD,Shelley L Deeks MD The Lancet Infectious Diseases – 28 June 2013 DOI: 10.1016/S1473–3099(13)70104-X]

A lecture on outbreaks in extended care facilities

This is the screen cast of a lecture titled “Outbreaks in extended care facilities (ECF)” given by Irfan Hafiz MD on April 19th 2013 at Centegra McHenry Hospital. It was co-sponsored by Centegra Health System and the McHenry County Dept. of Health.

Topics included in the lecture include:

  • Identifying current and emerging infectious disease common to long term care facilities (LTCF).
  • Describe preventive interventions for infectious disease in the context of LTCF.
  • Describe the unique challenges facing LTCF in the context of infectious diseases.

For upcoming lectures please look at the calendar and filter by “Education Events”.

 

Isolation guidelines

A page for Isolation guidelines is now available under Departments >> Infection Control >> Isolation guidelines.

MRSA control lecture – Audio and slides

MRSA – why do we do what we do?

The lecture

I recently presented a 30 minute lecture on MRSA control in the hospital setting at the fall symposium sponsored by Centegra Health System. The lecture describes the background of how MRSA is spread within medical facilities, the effects of its spread and measures that can be used to control it. The lecture also goes over some of the success stories of what an MRSA control program can expect to achieve. I also cover some of the historical background of how something as basic as hand washing became an actual event in medical history. I closed the lecture with some questions from the audience.

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Pertussis specimen collection

Collecting a pertussis specimen

We had a bit of confusion of pertussis collection this weekend, so I put together a brief overview on pertussis with focus on nasopharyngeal specimen collection for pertussis.
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