Fighting Malaria, Saving Lives!

On June 26, 2023, the CDC issued a Health Alert Network (HAN) health advisory to share information and notify clinicians, public health authorities and the public about Plasmodium vivax malaria cases acquired in Florida and Texas. Although no evidence suggests that cases in the two states are related, active surveillance for additional cases is ongoing.

Malaria is the number one killer of all the parasitic disease known to man. In 2020, an estimated 200+ million cases occurred worldwide and over 600,000 deaths were recorded (WHO,2005). More than 80% of deaths worldwide occur in sub-Saharan Africa. Most cases in the U.S are due to travelers and immigrants returning from countries where malaria is endemic (sub-Saharan African and South Asia).

Four species of Plasmodium causes malaria in humans. One of the species, Plasmodium falciparum, is the most pathogenic of all. Transmission to humans is by the blood-sucking bite of a female Anopheles mosquito. The parasite multiplies in the red blood cell of humans. Incubation period is between 9-30 days. Symptoms include fever, flu-like symptoms, headache and muscle aches. Malaria control and prevention includes the elimination of mosquito breeding sites like stagnant water and bushes, use of PPE against mosquitoes (ex. screen and pyrethrin treated nets) and use of anti-malaria medications.

Below are recommended resources on malaria:

General information on malaria by the CDC

https://www.cdc.gov/parasites/malaria/index.html

WHO information on Malaria

https://www.who.int/news-room/fact-sheets/detail/malaria

Malaria and Travelers for U.S. Residents

https://www.cdc.gov/malaria/travelers/index.html

Genetically modified mosquitoes cut the insect number by 96 percent

https://www.newscientist.com/article/2344811-genetically-modified-mosquitoes-cut-the-insects-number-by-96-per-cent/

Cheaper Malaria Vaccine recommended by WHO.

https://www.newscientist.com/article/2395634-cheaper-malaria-vaccine-recommended-by-the-who/

Recommended vaccine Malaria Vaccine for children at risk

https://www.who.int/news/item/06-10-2021-who-recommends-groundbreaking-malaria-vaccine-for-children-at-risk

WHO Malaria Toolkit App

https://www.who.int/teams/global-malaria-programme/malaria-toolkit-app

Other Recommendations:

Review of malaria diagnosis and treatment in the United States

First US malaria cases diagnosed in decades in Florida and Texas

Why Mosquitoes are good at smelling you.

The battle against Malaria (A New York Times editorial)

The Rise of Congenital Syphilis

Congenital syphilis is a disease that occurs when a pregnant person with syphilis passes it onto their baby during pregnancy (Centers for Disease Control and Prevention, 2023). Syphilis can be transmitted to a baby in utero through placental blood flow or through direct contact with lesions during childbirth. Currently, Penicillin is the only treatment from perinatal syphilis because it can cross the placenta to treat the infection in the fetus. When a syphilis infection is identified in the early stages, treatment with Penicillin is 98% effective in preventing mortality and morbidities commonly associated with congenital infection. Cases of congenital syphilis have been on the rise and have increased seven-fold in live births in the United States from 2012 to 2020. In 2021, 2000 cases were reported, the highest number of reported cases since 1994. Increases in cases have highlighted issues including gaps in prevention, timely diagnosis, treatment, and management of perinatal syphilis. The increases in congenital syphilis other STI’s has led to the U.S. Department of Health and Human Services launching the Sexually Transmitted Infections National Strategic Plan in January 2021 (Fang et al., 2022). This plan aims to create, enhance, and expand STI prevention among individuals. Through this plan the United States can be a place where STI’s are prevented, and every person has access high-quality prevention, screenings, care, and treatment free of stigma and discrimination (U.S. Department of Health and Human Services).

For More Information on Congenital Syphilis See the Resources Below: 

  • Centers for Disease Control and Prevention. (2023, April 11). STD facts – Congenital Syphilis. Centers for Disease Control and Prevention. https://www.cdc.gov/std/syphilis/stdfact-congenital-syphilis.htm
  • STI National Strategic Plan 2021-2025 (STI plan) Toolkit. U.S. Department of Health and Human Services. (2021, January 12). https://www.hhs.gov/programs/topic-sites/sexually-transmitted-infections/plan-overview/toolkit/index.html#:~:text=This%20first%2Dever%20STI%20National,free%20from%20stigma%20and%20discrimination.

 Cited Sources

Centers for Disease Control and Prevention. (2023, April 11). STD facts – Congenital Syphilis. Centers for Disease Control and Prevention. https://www.cdc.gov/std/syphilis/stdfact-congenital-syphilis.htm

Fang, J., Partridge, E., Bautista, G. M., & Sankaran, D. (2022, December 27). Congenital syphilis epidemiology, prevention, and management in the United States: A 2022 update. U.S. National Library of Medicine . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9879571/

Antimicrobial Resistance and Multi-Drug Resistant Organism in Hospitals and Long-Term Care Facilities

Antimicrobial resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow. Resistant infections can be difficult, and sometimes impossible to treat. Multidrug-resistant organisms are bacteria’s that have become resistant to certain antibiotics, and these antibiotics can no longer be used to control or kill the bacteria. Antibiotics are important medicines. They help fight infections that are caused by bacteria. Bacteria that resist treatment with more than one antibiotic are called multidrug-resistant organisms (MDROs for short), (ct.gov,2023).

Examples of (MDROs), includes methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and certain gram-negative bacilli (GNB) which have important infection control implications that either have not been addressed or received only limited consideration (CDC,2015).

Below are recommended resources for hospitals and long-term care facilities on MDROs:

ANTIMICROBIAL RESISTANCE
The Changing Landscape of Antimicrobial Resistance Following the COVID-19 Pandemic
MULTI DRUG-RESISTANT ORGANISMS (MDROs)
General Recommendations for Routine Prevention and Control of MDROs in Healthcare Settings
Preventing the Spread of Novel or Targeted Multidrug-resistant Organisms (MDROs)
Infection Prevention of MDROs in Long-Term Care Settings

Extensively drug-resistant Pseudomonas aeruginosa causing infection outbreak.

Infections from a rare extensively drug-resistant strain of Pseudomonas aeruginosa have been identified in 12 states (CA, CO, CT, FL, NJ, NY, NV, TX, UT, WA, WI). Most of the infections were from patients who reported using artificial tears. Patients reported more than 10 brands of artificial tears, but most patients reported using Ezricare Artificial Tears, an over-the-counter product. Patients who were infected have experienced permanent vision loss resulting from a cornea infection, hospitalization, and one death has been reported due to a systematic infection (CDC, 2023). The University of California at San Diego’s Center for Innovative Phage Applications and Therapeutics have identified a bacteriophage with activity against the outbreak strain. A minimum inhibitory concentration for aztreonam-avibactam has been identified, however, clinical breakpoints have not been established for antimicrobial combination.

Resources

  • For recommendations from the CDC for Healthcare Providers, Clinical Laboratories, and the Public, visit the link here.
  • Clinicians interested in phage as a potential treatment option should contact IPATH at ipath@health.ucsd.edu.
  • Susceptibility testing for this combination to inform clinical decision making is available through
  • CDC – refer to CDC Test Directory.

Cited Resources

Centers for Disease Control and Prevention. (2023, February 1). Health Alert Network (HAN) – 00485. Centers for Disease Control and Prevention. Retrieved April 5, 2023, from https://emergency.cdc.gov/han/2023/han00485.asp

Candida auris: A multi-drug resistant pathogen

Candida auris is an emerging pathogen that results in nosocomial infections and is considered a serious global health problem. It was first observed as a novel  Candida species in 2009 and has been isolated in 35 countries.

C. auris may cause invasive infections associated with high mortality. It is considered a multi-drug resistant species, having variable resistance patterns to many typical antifungal agents used to treat other Candida infections.

The CDC is concerned about C. auris for three main reasons:

  1. It is often multidrug-resistant, meaning that it is resistant to multiple antifungal drugs commonly used to treat Candida infections. Some strains are resistant to all three available classes of antifungals.
  2. It is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology. Misidentification may lead to inappropriate management.
  3. It has caused outbreaks in healthcare settings. For this reason, it is important to quickly identify C. auris in a hospitalized patient so that healthcare facilities can take special precautions to stop its spread.

Candida Auris: What is it? Can we stop it? | ARC IPC

Resources for Candida auris:

General Information:
Infection Prevention:
For Healthcare Providers:
Webinars

What You Should Know About the 2022 Monkeypox Outbreak

From early May 2022 to June 13, 2022 (the date of this podcast recording), over 1,300 confirmed cases of monkeypox have been reported across 31 countries that normally don’t see any cases of monkeypox. Occasionally, outbreaks have occurred outside Africa. But, in most instances, these cases were associated with international travel or contact with individuals or animals from endemic regions. Currently, the CDC and World Health Organization are tracking multiple reported cases and monitoring several person in counties without endemic monkeypox and with no known travel links to an endemic area. 

In today’s podcast, we welcome back Dr. Rachael Lee, Associate Professor in the UAB Division of Infectious Diseases and UAB Health Epidemiologist to talk to us about monkeypox – what it is and if we should be worried?

Thank you to our co-sponsor for this podcast, the Alabama Public Health Training Network at the Alabama Department of Public Health a community-based training partner of the Region IV Public Health Training Center.

Further Reading:

For Healthcare Providers:

News Articles:

Hepatitis Outbreak in Children

Figure 1: “States and Jurisdictions Reporting at Least One Person Under Investigation (38)* as of June 1, 2022.” CDC

The State of Alabama has had a lot of firsts; the first open-heart surgery in the Western Hemisphere was performed in Montgomery in 1902, in 1968 the first 911 call was placed from Haleyville, AL, and unfortunately in 2021 amid the ongoing COVID-19 pandemic Alabama identified their first case of a new Hepatitis outbreak among children under the age of 10. Children in Alabama began to fall ill with symptoms of Hepatitis, an inflammation of the liver that can cause jaundice, fever, fatigue, nausea, vomiting, joint pain, and more symptoms. Despite the mysterious onset and widespread unconnected cases under investigation doctors and other researchers are still trying to pin down the direct cause. The onset of symptoms has not been shown to be related to COVID-19 or its vaccinations, as once thought could be the case. Now, research points to the outbreak possibly being related to a new adenovirus strain. As of June 1, 2022, the outbreak and cause are still under investigation, with 246 cases under investigation of children under the age of ten showing symptoms of hepatitis with an unknown cause across 38 different states with 6 deaths since October 2021. Unfortunately, as is frequently the case with outbreaks, cases have been seen beyond the borders of Alabama or the United States where it started, with cases of hepatitis with an unknown cause among children being reported across the globe with roughly 650 cases spread across 33 different countries. Doctors and researchers are working to determine the cause of the outbreak in order to curb the case count, but until then check out our podcast and the resources below to help you stay informed on the latest happenings in Infection Prevention and Control.

Listen to a podcast from Dr. Wes Stubblefield, District Medical Officer for the Northern and Northeastern Public Health Districts at the Alabama Department of Public Health on this recent outbreak of pediatric hepatitis.

Further Reading:

For Parents:

News Articles: