EIP newsletter Spring 2014 PDF

Epigram
Spring 2014
The Newsletter of the Georgia Emerging Infections Program (GA EIP)
Summer: the foodborne disease season
Summer rapidly approaches, and the peak season for foodborne disease is upon us.
Thank you to all the labs who have done an incredible job of getting Salmonella isolates to the Georgia Public Health Lab (GPHL) directly or via the GA EIP. In 2013,
99% of Salmonella from the 20 county Atlanta Metropolitan Statistical Area (MSA) were
serotyped! See the table below for our most common serotypes. Please continue submitting your Salmonella isolates. While far fewer, please submit Vibrio and Listeria isolates as well and report them in SendSS. These organisms require a rapid response
from public health for patient interview, as well as laboratory testing.
The GA EIP is currently conducting a nonO157 Shiga Toxin producing Escherichia coli
(STEC) case control study looking at risk factors for infection. It is crucial that GPHL
receive any positive STECs your lab may identify. Cases can only be enrolled in this
study if there is confirmation at GPHL. All isolates are then sent to CDC for further molecular characterization.
Finally, please keep in mind that FoodNet is interested in foodborne organisms from
any body site. A list of foodborne organisms under surveillance is on the back of this
newsletter.
For your summer reading pleasure, CDC recently published a MMWR entitled
“Incidence and Trends of Infection with Pathogens Transmitted Commonly Through
Food — Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2006–2013”
which can be found at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6315a3.htm?
s_cid=mm6315a3_w
For further information about FoodNet or foodborne diseases, please visit
www.cdc.gov/foodnet or the GA EIP website at http://dph.georgia.gov/EIP.
Atlanta Metropolitan Statistical Area Salmonella 2013 (N=655)
Top 10
Serotype
Count
Percent
1
ENTERITIDIS
120
18.3
2
TYPHIMURIUM / SUBSP I, 4, 5, 12 . I . (MONOPHASIC)
94
14.3
3
NEWPORT
73
11.1
4
JAVIANA
72
11.0
5
SUBSP I 13,23.B.- / MISSISSIPPI
45
6.9
6
BRAENDERUP
23
3.5
7
UNKNOWN
21
3.2
8
INFANTIS
20
3.1
9
SAINT PAUL
17
2.6
10
MUENCHEN
17
2.6
In the news-MERS
Three individuals with Middle East Respiratory Syndrome (MERS) infection have been
reported in the United States. For more information, please go to:
http://www.cdc.gov/coronavirus/mers/US.html
In this issue:
FoodNet ………….…….. Pg.1
Outbreak Corner………...Pg.1
Candidemia Declining..…Pg.2
EIP Spotlight..……..…….Pg.2
Enhanced Pertussis …....Pg.3
HAI Prevalence……….....Pg.3
EIP Staff List…………….Pg.3
EIP on the Web………….Pg.3
Outbreak Corner:
Whole Genome Sequencing
(WGS) used for Listeria outbreak investigation
From August 1, 2013 to November 27, 2013 eight persons
in California and Maryland
were reported infected with a
Listeria outbreak strain identified by PulseNet, using pulsedfield electrophoresis (PFGE).
Five of the illnesses were pregnancy related: four cases from
two mother-newborn pairs and
a fifth in only the newborn. The
three other cases were in
adults. Seven of the eight cases were hospitalized and one
died. Five of the ill adults reported consuming a semi-soft
Hispanic-style cheese produced by one manufacturer.
Whole genome sequencing
(WGS), available as part of
the Listeria WGS project, found
that Listeria strains isolated
from the cheese products were
highly related to Listeria strains
from patients. Compared to
PFGE, WGS provides more
specific genetic information
that allows investigators to
quickly distinguish between
foods sources and patients that
are likely to be part of an outbreak and those that are not.
http://www.cdc.gov/listeria/
outbreaks/cheese-02-14/
Please note that the GA EIP
collects Listeria isolates from
all body sites.
Candidemia-Declining rates, evolving resistance
GA EIP is in its sixth year of Candida bloodstream infection surveillance. An eligible
case is a resident of the eight counties in the metropolitan Atlanta area (Clayton,
Cobb, Dekalb, Douglas, Fulton, Gwinnett, Newton, and Rockdale) known as Health
District 3 (HD3) with an incident episode of Candidemia (30 or more days since any
prior positive blood culture).
From March 2008 through February 2014, HD3 facilities have reported 2648 incident
cases of Candidemia. A total of 2722 incident isolates have been collected from the
2648 cases; 2035 isolates were submitted to the GA EIP. Submitted isolates are
then forwarded to CDC for species confirmation and antifungal susceptibility testing.
Over the six years of surveillance, HD3 has experienced an overall decline in case
rates from 14.1 to 9.2 per 100,000 population. Declines have been particularly notable in the elderly (from 64.5 to 33.6 per 100,000) and in infants (from 41.7 to 16.9 per
100,000). Rates have declined in blacks and whites and males and females. Species
distribution has remained relatively unchanged over the five years (Figure 1).
Speciation of Georgia isolates at CDC has demonstrated 95% concordance with clinical lab speciation. Georgia antifungal susceptibility test results have shown a slight
reduction in fluconazole-resistant isolates (from 8.0% to 7.1%). However, HD3 has
also experienced a modest increase in echinocandin-resistant isolates (from 1.2% to
2.9%), most of which have been C. glabrata, which is generally nonsusceptible to
fluconazole. This dual drug resistance poses a treatment challenge and underscores
the importance of both continued surveillance and isolate submission for testing.
Thank you to all HD3 laboratory and IP personnel for submitting Candidemia isolates,
laboratory line listings, and epidemiologic information to make this project possible.
For more information, please visit http://www.cdc.gov/hai/eip/candida.html . If you
have any questions, please ask your GA EIP surveillance officer or the GA EIP Candidemia surveillance coordinator, Betsy Stein, at (404) 321-6111 ext 4087 (email
[email protected]).
EIP Staff Updates
EIP welcomes:
 Dr. Evan Anderson, Influenza CoInvestigator
 Dr. Sujan Reddy, EIP Fellow
EIP wishes a fond farewell to:
 Leigh Ann Clark, EIP SO for 7 1/2
years
 Dr. Matt Crist, EIP Medical Epidemiologist to the SC DHEC
 Dr. Andre Melendez, EIP Fellow
 Dr. Sarah Kabbani, EIP Fellow
EIP Spotlight
Dekalb Medical
Center
As one of the largest contributing
facilities in the GA EIP catchment
area, DeKalb Medical Center is an
integral part of GA EIP activities.
DeKalb’s microbiology lab, staffed
by 11 people and led by Adrianna
Karettis, performs testing for all
three of its associated facilities,
including DeKalb Medical Hillandale Hospital and DeKalb Medical
Downtown Decatur long term
acute care facility.
In 2013 the microbiology laboratory submitted isolates for 97% of
Candidemia cases, 91% of C. difficile specimens, and is one of six
GA Health District 3 (HD3) contributors of sterile site MRSA isolates. In 2012-13 Dekalb was the
only hospital laboratory in the area to participate in a C. difficile/
viral coinfection project, submitting stool samples for study at
CDC.
The Infection Prevention department, led by Marti Shaver, plays
an active and vital role in GA EIP
activities, including case ascertainment at DeKalb MC, participation in CDC’s 2011 HAI Prevalence Survey, as well as the Appropriateness of Antimicrobial Use
(AAU) assessment done in 2013.
Ms. Karettis and Ms. Shaver collaborated with the GA EIP in 2011
to ensure a smooth MuGSI project startup (CRE surveillance),
and while Ms. Shaver runs the
instrument reports for us (thank
you!), both have worked on MuGSI troubleshooting and data quality when needed. Thanks also to
Yvonne Price, Data Support Specialist for DeKalb Quality Institute,
for providing reports for EIP projects.
We look forward to many more
years of productive work with
DeKalb MC!
TO RECEIVE THIS NEWSLETTER
BY EMAIL OR TO CHANGE
YOUR ADDRESS,
EMAIL: [email protected]
New at the EIP: Enhanced Pertussis Surveillance
(EPS)
EIP Staff
Monica M. Farley, MD
Since the introduction of the Bordetella pertussis vaccines in the 1940s, the number of Bordetella pertussis (pertussis) infections in the United States has decreased drastically. However, pertussis cases began increasing in the 1990s and
peaked in 2012, with over 48,000 cases nationwide. Pertussis cases should be
routinely reported to the Centers for Disease Control and Prevention (CDC)
through the Nationally Notifiable Disease Surveillance System (NNDSS). Despite
national reporting requirements, this system often contains incomplete and missing data. In order to improve the quality of data and learn more about pertussis
cases, CDC developed Enhanced Pertussis Surveillance (EPS) to collect additional information and ensure completeness of reported data. The primary objectives
of EPS are to determine the incidence and epidemiology of pertussis, characterize
the molecular epidemiology, and monitor the impact of pertussis vaccines. EPS
also collects information on other Bordetella species.
The GA EIP joined EPS in January 2014. Georgia is the seventh site to be included in this surveillance system. GA EIP is conducting surveillance for clinical infection with pertussis and other Bordetella species in residents of Atlanta’s 8county Health District 3 (HD3). In Georgia, district health departments routinely
interview pertussis case-patients reported through the State Electronic Notifiable
Disease surveillance system (SendSS). Through EPS, district epidemiologists in
HD3 will begin collecting additional information on pertussis cases, including clinical data, complications, treatment information, laboratory data, vaccine history,
epidemiologic data, and maternal Tdap information where applicable. The GA
EIP will assist the Georgia Department of Public Health (GDPH) in completing the
EPS data with information and follow-up from medical providers. The GA EIP will
also complete an EPS standardized case report form through medical chart review for all hospitalized Bordetella cases that reside in GA HD3. GDPH continues
to encourage laboratories to send appropriate specimens and isolates to GPHL
for testing and submission to CDC for further characterization. These specimens
and isolates are essential in order to better understand the changing molecular
epidemiology of this emerging infection as well as monitor the impact of pertussis
vaccines.
For more information on EPS or to report Pertussis cases, specimens or isolates
please contact your GA EIP surveillance officer or the GA EIP ABCs coordinator
Stepy Thomas at (404) 321-6111 ext 6059.
Melissa Tobin-D'Angelo, MD, MPH
Susan M. Ray, MD
Cherie Drenzek, DVM, MS
David S. Stephens, MD
Jesse Jacob, MD
Evan Anderson, MD
Sarah Satola, PhD
Sujan Reddy, MD
Wendy Baughman, MSPH
Suzanne Segler, MPH
Stepy Thomas, MSPH
Kyle P. Openo, MPH
Amy (Holst) Tunali, MPH
Betsy Stein, RN, BSN
Lewis Perry, RN, BSN/HCM,MPH
Olivia Almendarez, MSPH
Sasha Harb, MPH
Jessica Reno, MPH
Andrew Revis, MPH
Ashley Moore, MS,MPH
Nadine Oosmanally, MSPH
Lauren Lorentzson, MPH
Becky Meyer, MPH
Zirka Thompson, MPH
Chris Bower, MPH
Calista Schenck, MPH (cand.)
Emma Paras. MPH
Jacqui Hurd, MPH
Isabel Pereira de Almeida, MPH
Randy Von Dolson, MPH (cand.)
Lillian Morgan, BS
Nicole Romero, BS
Healthcare-Associated Infection Prevalence Survey
And Appropriate Antimicrobial Use
EIP on the Web
In 2011, the Georgia Emerging Infections Program conducted a survey of 22
acute care hospitals within the 20 county MSA to determine the prevalence of
healthcare-associated infections (HAIs) and describe the rationale for and use of
antimicrobials. This prevalence survey was conducted along with 9 other EIP
sites across the country to estimate a national HAI prevalence rate. Of 11,282
patients in 183 hospitals across all EIP sites, 452 (4%) had one or more health
care-associated infections. The most common types of infections were pneumonia (21.8%), surgical-site infections (21.8%), and gastrointestinal infections
(17.1%). The most commonly reported pathogen was Clostridium difficile, causing
12.1% of health care-associated infections. The authors estimate that there were
648,000 patients with 721,800 health care-associated infections in U.S. acute care
hospitals in 2011. http://www.nejm.org/doi/full/10.1056/NEJMoa1306801
In 2013 the GAEIP conducted an assessment of the appropriateness of antimicrobial use (AAU) among a sample of patients from selected hospitals who participated in the 2011 survey. AAU was evaluated for four major events observed in the
2011 survey: community-onset lower respiratory infections, urinary tract infections, piperacillin/tazobactam use, and vancomycin, daptomycin or linezolid use.
To enable facilities to create antimicrobial use tools for improvement initiatives,
methodologies utilizing pharmacy data and admission diagnoses from a larger
number of patients and hospitals are under development.
GA EIP Page
http://dph.georgia.gov/EIP
Georgia Department of
Public Health
http://dph.georgia.gov
SENDSS disease reporting
https://sendss.state.ga.us/
ABCs Web Page
www.cdc.gov/abcs
FoodNet Web Page
www.cdc.gov/foodnet
CDC Influenza Web Page
www.cdc.gov/flu
Healthcare-associated Infections
(HAI) Projects Web Page
www.cdc.gov/hai/eip
CDC EIP Page
www.cdc.gov/ncezid/dpei/eip
Atlanta VAMC Office
Research 151, Building 13
1670 Clairmont Road
Decatur, GA 30033
Ph 404.321.6111 x6478
Fax 404.728.5011
Grady Office
69 Jesse Hill Jr. Drive
2nd Floor
Atlanta, GA 30303
Ph 404.616.0403
Fax 404.616.0408
GA Department of
Public Health
Acute Disease Epidemiology
14th Floor, Suite 102
Atlanta, GA 30303
Ph 404.657.6440
Fax 404.657.9700
The Georgia Emerging Infections Program is a collaboration between:
Be on the look out!!
The GA EIP conducts active surveillance for all the organisms listed below.
Please continue to set the isolates / specimens aside for the EIP
ABCs
FOODNET
ALL BODY SITES — MSA
Campylobacter
Cryptosporidium*
Cyclospora*
E. coli O157/STEC
Listeria
Salmonella
Shigella
Vibrio
Yersinia
STERILE BODY SITES — MSA
Group A Streptococcus
Group B Streptococcus
Haemophilus influenzae
Legionella-SPECIMENS NOT COLLECTED
Methicillin Resistant Staphylococcus aureus*
Neisseria meningitidis
Streptococcus pneumoniae
*CRYPTO & CYCLO SPECIMENS NOT COLLECTED
*MRSA COLLECTED AT SELECT HOSPITALS ONLY
STERILE SITES INCLUDE BLOOD, BONE , CSF, JOINT, MUSCLE, PERICARDIAL FLUID, PERITONEAL FLUID, PLACENTA/AMNIOTIC FLUID,
PLEURAL FLUID, AND INTERNAL BODY SITES;
GAS from any site with NF or STSS
RAPID TEST+/PCR+ HOSPITALIZED CASE
HD3
NP swab in viral media can be sent via
EIP to GPHL for RT-PCR testing
MuGSI
URINE AND STERILE SITES—HD3
Carbapenem-nonsusceptible:
Enterobacteriaceae
Acinetobacter baumannii
ISOLATES COLLECTED AT HD3 HOSPITALS
CDI
Candida
STOOL & ILEOSTOMY—HD3
Clostridium difficile
BLOOD ONLY—HD3
Candida all species
SPECIMENS COLLECTED AT SELECT HOSPITALS
ISOLATES COLLECTED AT HD3 HOSPITALS
HD3 REFERS TO THE 8 COUNTY
METRO ATLANTA AREA
• CLAYTON • COBB • DEKALB •
DOUGLAS • FULTON• GWINNETT •
NEWTON • ROCKDALE•
MSA REFERS TO THE 20 COUNTY METRO ATLANTA AREA
• BARROW • BARTOW • CARROLL • CHEROKEE • CLAYTON •
COBB • COWETA• DEKALB • DOUGLAS • FAYETTE • FORSYTH •
FULTON • GWINNETT • HENRY • NEWTON • PAULDING •
PICKINS • ROCKDALE • SPALDING • WALTON•

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