Below are the PICNet news archives from May-September 2014. Because the PICNet website was migrated to a new platform in September 2014, some of the links below may now be out of date.

August 11: Ebola precautions in place in BC; Ebola page on IPAC-Canada website

B.C.’s deputy provincial health officer, Dr. Bonnie Henry, asserted that if anyone entering B.C. is suspected of having Ebola, precautions will immediately be implemented. You can read the full Vancouver Sun article here.

IPAC-Canada has created a new web page with lots of information and links about the ebola virus. The page is available to the general public.

August 1: Ebola updates

You can find the most up-to-date information on Ebola, including travel advisories, at the following websites:

July 30: First Chikungunya case acquired in the United States

Photo: mosquito.

From US Centers for Disease Control and Prevention:

Seven months after the mosquito-borne virus chikungunya was recognized in the Western Hemisphere, the first locally acquired case of the disease has surfaced in the continental United States. The case was reported in Florida in a male who had not recently traveled outside the United States. The Centers for Disease Control and Prevention is working closely with the Florida Department of Health to investigate how the patient contracted the virus; CDC will also monitor for additional locally acquired U.S. cases in the coming weeks and months.

You can read the full press release on the CDC website, where there is also an information page on chikungunya.

July 28: Ebola virus outbreak in Western Africa

New cases continue to be reported for the Ebola virus disease (EVD) outbreak currently occurring in Western Africa. As of July 23rd, 2014, 1,201 cases and 672 deaths were reported to the World Health Organization by the Ministries of Health in Guinea, Liberia, and Sierra Leone and additional cases are expected. More information on the outbreaks can be found on the World Health Organization’s Global Alert and Response website: http://www.who.int/csr/don/archive/disease/ebola/en/. In addition cases have been reported in Aid workers from the US who had been providing care to Ebola cases in the affected areas. 

In Canada, the provinces, territories and the Public Health Agency of Canada continue to monitor the situation and the National Microbiology Laboratory currently has a team in Sierra Leone providing assistance. We have not been notified of any cases among Canadians related to this outbreak, although we are aware that Canadians are participating in the response in affected countries.  The risk to most travellers is considered low; however, healthcare workers in Canada should be vigilant for persons with symptoms compatible with EVD and who have returned from these countries within 21 days (the incubation period for EVD) of symptom onset. Healthcare workers who have been involved in response to the Ebola outbreak in West Africa should self monitor for 21 days following their last contact and contact public health immediately if they develop any symptoms of concern.

Health care professionals are advised to be on the lookout for illnesses compatible with EVD in recent travellers, including health care workers, to affected areas and should consider isolation pending diagnostic testing and results; however, other illnesses prevalent in this region should also be considered, (e.g. Malaria, Typhoid, etc). Strict infection control practices should be implemented for any suspected or probable case of EVD.  All probable cases of EVD MUST BE IMMEDIATELY REPORTED to your local public health unit/Medical Health Officer by phone.  Contact the BCCDC Medical Microbiologist on-call at 604 661 7033 to complete a risk assessment and plan for submission of samples.

Ebola virus disease is a severe disease that causes haemorrhagic fever in humans and animals. Diseases that cause haemorrhagic fevers, such as Ebola, are often fatal as they affect the body’s vascular system (how blood moves through the body). This can lead to significant internal bleeding and organ failure.

The Ebola virus can spread through:

  • contact with infected animals
  • contact with blood, body fluids or tissues of infected persons
  • contact with medical equipment (such as needles) that are contaminated with infected body fluids

Outbreaks of Ebola are largely in Central and West Africa. There have not been any cases of Ebola in Canada.

As long as precautions are taken, there is low risk of contracting Ebola in a country where the disease is present. the incubation period for EVD is 2-21 days. People become contagious once they begin to show symptoms; they are not contagious during the incubation period.

Information on Ebola virus disease, including symptoms, prevention, and treatment is available at: http://www.phac-aspc.gc.ca/id-mi/vhf-fvh/ebola-eng.php.

July 25: Clean Shots survey

Did you participate in the Clean Shots photo contest? If so, we’d love to hear your thoughts on it, including whether you’d like a similar contest next year. Please complete a short survey at http://fluidsurveys.com/s/cleanshots/. Thanks!

And you can still view all the great photos at picnet.ca/cleanshots.

HH_angels

Trophy Ceremony

The trophy for the greatest number of entries (with VCH beating PHSA by just one photo!) was accepted last week by Vancouver Coastal Health CEO Mary Ackenhusen.

Trophy
Vancouver Coastal Health CEO Mary Ackenhusen with BC Patient Safety and Quality Council Chair Doug Cochrane

Organizers
Some of the organizing committee decided to get into the selfie act!

July 17: New MRSA Resources on BCCDC Website

BCCDC, in collaboration with the Do Bugs Need Drugs? program and the Provincial Infection Control Network (PICNET), has created some new web pages and resources on Methicillin-Resistant Staphylococcus Aureus (MRSA), especially with respect to its role in community-associated skin and soft tissue infections.

CA-MRSA is an ongoing problem in Canada, including British Columbia. Prevention and hygiene is the key and thus the website has information for the public including posters, video and interactive plays which can help translate key messages to your clients who are at risk of CA-MRSA or have an active infection.

Specifically for healthcare professionals, the website has information on treatment of CA-MRSA, including updated BC Guidelines, current susceptibility patterns, the IDSA guidelines, and a webinar by Infectious Disease Specialist, Dr. Natasha Press.

The website link is: www.bccdc.ca/prevention/AntibioticResistance/MRSA/default.htm or alternatively you can access it through www.bccdc.ca under the Prevention tab, Antibiotic Resistance, and then MRSA.

Video

July 16: Virox Technologies Inc. Announces the Syed A Sattar African Scholarship

Virox Technologies Inc., in partnership with ICAN (Infection Control Africa Network), has established a scholarship fund in honour of Dr. Syed A. Sattar.

In recognition of Dr. Sattar’s highly notable scientific career spanning nearly five decades, Virox announced the creation of the scholarship on May 25th at the IPAC 2014 National Conference.

Dr. Syed A. Sattar’s research into the influence of environmental factors on the fate of human pathogens has evolved into hundreds of published papers, several books and book chapters, and scores of addresses to scientific meetings on four continents. He was singularly instrumental in the creation and evolution of the Teleclass Education Lecture Series that now reaches into tens of thousands of hospitals in almost every country on the globe. He is a preeminent authority and trusted advisor to many governments and standard-setting agencies, and his work forms the basis of national and international standards. In the course of Sattar’s remarkable career, he has received numerous fellowships, awards, and honours.

The Syed A. Sattar African Scholarship award will enable a deserving recipient from an African country to attend the annual conference of the Infection Control Africa Network.

You can read more about Dr. Sattar’s Scholarship Fund here.

July 11: Report recommends ban of triclosan and triclocarban 

A new report from the Canadian Environmental Law Association recommends that Canada should ban the use of triclosan and triclocarbon in antibacterial consumer products.

Triclosan is present in many consumer “antibacterial” soaps, as well as other products. 

PICNet’s position is that antibacterial agents are unnecessary in soaps. The purpose of soap is to remove dirt and germs from the surface our hands when washing; the germs are then rinsed down the drain. Adding an antibacterial agent creates no additional benefit and may actually cause harm. These chemicals build up in the environment and have been shown to mimic human hormones.

Triclosan is not present in alcohol-based hand rubs (ABHR); the alcohol kills germs on contact and leaves no chemical residue. You can reassure your staff that they can still safely use ABHR.

 

June 27: Scientific discovery has potential to combat antibiotic resistance

CBC published this interesting article on the discovery of a fungal compound that makes certain “superbugs” susceptible to conventional antibiotic defence. Findings of the study have been published in this month’s edition of Nature journal.

June 27: Scientific discovery has potential to combat antibiotic resistance

CBC published this interesting article on the discovery of a fungal compound that makes certain “superbugs” susceptible to conventional antibiotic defence. Findings of the study have been published in this month’s edition of Nature journal.

June 18: Emerging Respiratory Virus Update

from BCCDC:

Since the last full bulletin on 30 April 2014, cases of MERS-CoV continue to be identified but reports have declined substantially since the surge in activity that began mid-March and peaked late-April 2014.

A WHO mission has since concluded that the dramatic surge in MERS-CoV cases in the Arabian Peninsula during the spring 2014 can be largely explained by breaches in WHO-recommended infection prevention and control measures in health care settings.  A seasonal increase in virus circulation within the animal reservoir (i.e. camels) and spill over into the human population contributed to primary cases within the community but nosocomial outbreaks amplified secondary spread and case counts where rigorous infection control precautions were not applied. There remains no evidence for mutations in the virus to promote more effective human-to-human transmission and no evidence of sustained human-to-human transmission in the community.

Yesterday (16 June 2014), the WHO convened its 6th meeting of the IHR Emergency Committee concerning MERS-CoV and again concluded that the conditions for a Public Health Emergency of International Concern (PHEIC) have not yet been met. However, the Committee did emphasise that the situation remains of concern. Their concerns centred on the anticipated increase in travel to Saudi Arabia for religious pilgrimage and breaches in infection prevention and control in health care settings.

This year, the Hajj – the annual pilgrimage to Mecca, Saudi Arabia – will take place approximately during 2-7 October 2014. However, Umrah is a similar pilgrimage that can be undertaken any time of the year and this year it is expected that the largest number of Umrah pilgrims will be during the upcoming Ramadan period occurring approximately between 28 June and 28 July 2014.

Travel-associated cases linked to upcoming religious pilgrimage to Saudi Arabia may therefore be anticipated. In advance of that possibility, we provide you with an update on recent MERS-CoV activity. For completeness, we also provide a brief update on recent H7N9 activity in China.

1. MERS-CoV UPDATE [Total: 830 cases; Deaths: 307+], Middle East

a. Countries reporting cases

As of 16 June 2014, the WHO has been informed of 701 lab-confirmed cases of MERS-CoV but this total does not include an additional 113 cases retrospectively identified and reported by the Saudi Arabia Ministry of Health on 3 June 2014 accrued across the period 2012-2014 and for which further epidemiologic details are still pending. 

To date since June 2012, 21 countries have reported more than 800 cases of MERS-CoV overall (see attached MERS-CoV map). This tally may increase to 22 countries if a recently reported case this week in Bangladesh is also confirmed by the WHO. As interesting historical context and comparison recall that in 2003, 26 countries in total reported more than 8000 confirmed cases of SARS-CoV (two-thirds from mainland China) over just a 5 month period before spread of that emerging coronavirus was ultimately extinguished in July 2003.

Saudi Arabia still accounts for more than 80% of MERS-CoV cases but 9 countries in total within the Arabian Peninsula have reported cases (Saudi Arabia, Qatar, Jordan, United Arab Emirates (UAE), Oman, Kuwait, Lebanon, Yemen, Iran). Other countries have reported travel-associated cases including 6 countries of Europe (UK, Germany, France, Italy, Greece and the Netherlands), 3 countries of North Africa (Egypt, Tunisia, Algeria), 2 countries of south-east Asia (Malaysia, Philippines) and 1 country of North America (United States). Three countries outside the Arabian Peninsula that have received travel-associated cases have also experienced limited onward indigenous transmission (UK, France, Tunisia).

Countries reporting travel-associated cases linked to exposure in health care settings within the Arabian Peninsula include Greece, the Philippines and the United States. To date, 4 countries have reported travel-associated cases linked to religious pilgrimage to Saudi Arabia (the Netherlands, Jordan, Malaysia and Algeria). The majority of recent pilgrimage-related cases have either visited a health care facility or come in contact with camels or raw camel products.  The WHO has issued specific travel advice for pilgrims, available here: http://www.who.int/ith/updates/20140603/en/.

For PHAC travel health notice related to MERS-CoV more generally, see: http://www.phac-aspc.gc.ca/tmp-pmv/notices-avis/notices-avis-eng.php?id=108

b. Case characteristics

As with previous updates, MERS-CoV cases continue to be predominantly older, adult men; overall, the median age of cases is 47 years (range:

c. Camel Connection

Dromedary (one-humped) camels are now recognized as the primary animal reservoir for human MERS-CoV infections. Evidence to support the role of camels in the MERS-CoV transmission cycle comes from numerous serological studies that have identified anti-MERS-CoV antibodies in camels across a wide geographic area in the Middle East and parts of Africa, including serum samples dating back as early as 1992, as well as phylogenetic analyses that have identified antigenically equivalent MERS-CoV partial and whole genome sequences in camels, including those in close contact with human cases. Six countries in the Middle East, including Saudi Arabia, Qatar, UAE, Oman, Egypt and, most recently, Kuwait, have now identified MERS-CoV nucleic acid in camels. Preliminary evidence from Qatar suggests that people working in close contact with camels (e.g. farmers, abattoir workers, veterinarians) may be at higher risk of MERS-CoV infection.

The exact route of direct or indirect transmission from camels to humans (or vice versa) remains unknown. In their interim recommendations, the WHO advises that individuals should practice good hand hygiene following contact with camels and avoid consumption of raw (unpasteurized) camel products (e.g. milk, urine) or undercooked meat. For individuals at high risk of infection, the WHO recommends avoiding contact with camels or camel products altogether.

For a summary of MERS-CoV transmission from animals to humans, and interim recommendations for at-risk groups see: http://www.who.int/csr/disease/coronavirus_infections/MERS_CoV_RA_20140613.pdf?ua=1.

d. Additional MERS-CoV links

 For the latest WHO summary and literature update (11 June 2014), see: http://www.who.int/csr/disease/coronavirus_infections/archive_updates/en/.

For ongoing WHO MERS-CoV updates, see: www.who.int/csr/disease/coronavirus_infections/en/index.html.

For the media statement of the IHR Emergency Committee concerning MERS-CoV see: http://www.who.int/mediacentre/news/statements/2014/ihr-emergency-committee-merscov/en/

2. H7N9 UPDATE [Total: 450 cases; 157 deaths], China

Since our last bulletin, 18 new human cases of avian influenza A(H7N9) and 11 deaths have been reported. However, the number of reported cases has decreased substantially since the second-wave peak in January 2014, when on average 40 cases per week were reported. The geographic distribution of cases has not changed since our previous bulletin.

To stay current with ongoing developments, please consult the WHO avian influenza A(H7N9) page:

www.who.int/influenza/human_animal_interface/influenza_h7n9/en/index.html.

3. ACTION AND ADVICE

In the event of severe acute respiratory illness (SARI) in a patient with links to affected areas in the two weeks prior to symptom onset (i.e. residence, travel history or contact with someone with such history), clinicians should notify their local health authority/Medical Health Officer.

Health care workers should implement respiratory precautions immediately, and cases should be managed in respiratory isolation with contact and droplet precautions. Airborne precautions are warranted in the event of aerosol-generating procedures or conditions. Given a spectrum of illness inclusive of milder or atypical presentations, clinicians are encouraged to use their judgement and/or consult infection control for guidance around enhanced measures where the index of suspicion (e.g. based on contact, comorbidity or clustering history) and exposure risk may be higher. Facilities should be mindful of the protection of other patients and visitors, in addition to healthcare workers, to minimize nosocomial transmission and risk.

For diagnostic testing for suspected MERS-CoV, please discuss with your local health authority/Medical Health Officer and consult a virologist or microbiologist at the BC Public Health Microbiology & Reference Laboratory (PHMRL) to arrange advance notification and direct shipping. Lower respiratory specimens (e.g. sputum, endotracheal aspirate, or bronchoalveolar lavage) are recommended, where possible and clinically indicated. Follow strict infection prevention and control guidelines when collecting respiratory specimens.

To review prior bulletins issued by the BCCDC Influenza & Emerging Respiratory Pathogens team, see: http://www.bccdc.ca/dis-cond/DiseaseStatsReports/EmergingRespiratoryVirusUpdates.htm

May 21: News Release: Hospital workers take clean “selfies” to prevent spread of illness and win a national prize
.

PHSA_Logo BC_Govt

NEWS RELEASE

For immediate release
May 21, 2014

Provincial Infection Control Network
Provincial Health Services Authority
Ministry of Health

Hospital workers take clean “selfies” to prevent spread of illness and win a national prize

Vancouver – A contest challenging healthcare workers around the province to submit creative photos to promote hand cleaning has captured a national prize.

Hand cleaning is the single most effective way to prevent the spread of infection, and is strongly promoted in the province’s hospitals and other healthcare facilities to protect patients. Effective hand cleaning is so important that the Provincial Infection Control Network (PICNet), a provincial program of PHSA, issues regular reports on hand hygiene.

PICNet’s “Clean Shots” contest ran during April and May in BC, and resulted in a sizeable collection of sometimes serious, sometimes zany photos from health authority staff.

The contest was the brainchild of a committee made up of members from PICNet, the BC Patient and Safety Quality Council and the six BC health authorities.

A national organization, the Canadian Patient Safety Institute (CPSI) named the Clean Shots campaign as the 2014 winner for the best hand hygiene initiative from across the country.

Photos of the finalists are available here: https://www.flickr.com/photos/cleanshots/sets/72157644676994875/

Quotes
Terry Lake, Health Minister
“People who work in healthcare demonstrate their commitment to infection control every day, in so many ways. Capturing a national award by this innovative contest shows yet another way that BC healthcare workers are on track in their efforts to protect patients while caring for them in BC hospitals and other health facilities.”

Bruce Gamage, President of Infection Prevention and Control Canada and PICNet Network Manager “With hand cleaning, it’s important that all levels of staff in all areas are reminded of how important it is, and how often it needs to be done – this is a great way to have the staff remind and encourage each other.”

The Provincial Health Services Authority plans, manages, and evaluates selected specialty and province-wide healthcare services across BC, working with the five geographic health authorities to deliver province-wide solutions that improve the health of British Columbians. For more information, visit www.phsa.ca.

For more information or to arrange an interview:

Media Contact:
Ben Hadaway
Provincial Health Services Authority
Ben.Hadaway@phsa.ca
604-675-7416
Media pager: 604-871-5699

Lesley Pritchard
Provincial Health Services Authority
Lesley.pritchard@phsa.ca
604.675.7472
Media Pager: 604.871.5699

May 13: Second travel-associated case of MERS-CoV in North America announced by the United States

from BCCDC:

The U.S. Centers for Disease Control and Prevention (CDC) today announcd a second imported case of MERS-CoV in a traveler returning to the United States from Saudi Arabia. The patient is a health care worker who resides in Saudi Arabia.

This is the second imported case of MERS-CoV reported in the United States. The first case, also a health care worker residing in Saudi Arabia, was reported in our previous bulletin to you ten days ago on May 2. The two cases are not epidemiologically linked.

On May 1, the current case traveled from Jeddah, Saudi Arabia to Orlando, Florida via London, UK, Boston and Atlanta. The patient developed symptoms on May 1, feeling unwell during the flight from Jeddah to London, and with symptoms that included fever, chills and a slight cough during subsequent flights.  On May 9, the patient presented to an emergency department of a hospital in Florida and was admitted the same day.  The patient is currently doing well. Investigation of close contacts, including airline passengers, is ongoing.

Globally, as of May 12, 2014, the WHO has been informed of more than 500 laboratory-confirmed cases of MERS-CoV, including at least 145 deaths; of these, more than 80% of cases and deaths have been reported from Saudi Arabia. The public health risk to individuals in the community remains low at this time. However, as communicated previously, further importation of MERS-CoV cases to countries outside of the Arabian Peninsula is anticipated given ongoing activity in the region. Nosocomial transmission following a breakdown in WHO-recommended infection prevention and control practices is reminiscent of the SARS-CoV experience in 2003 and is thought to be driving the current surge in activity in health care settings, in combination with possible seasonal amplification in an animal reservoir, believed to be camels. We reinforce that clinicians stay alert for possible importation and obtain a travel history from patients presenting with severe acute respiratory illness (SARI).

Action and Advice

In the event of SARI in a patient with links to affected areas (e.g. residence, travel history or contact with someone with such history), clinicians should discuss with their local Medical Health Officer and consult a virologist or microbiologist at the BC Public Health Microbiology & Reference Laboratory (PHMRL) to arrange for advance notification and direct specimen shipping. Healthcare workers should immediately implement infection control precautions to prevent further spread to other healthcare workers, their patients and visitors.

For the US CDC Press Release related to this second case, see: http://www.cdc.gov/media/releases/2014/p0512-US-MERS.html

For the latest WHO MERS-CoV Summary and Literature Update (May 9, 2014), see: http://www.who.int/csr/disease/coronavirus_infections/archive_updates/en/

For current information on MERS-CoV from the Public Health Agency of Canada (PHAC), see: http://www.phac-aspc.gc.ca/eri-ire/coronavirus/index-eng.php  including:

  1. Summary risk assessment at:  http://www.phac-aspc.gc.ca/eri-ire/coronavirus/risk_assessment-evaluation_risque-eng.php
  2. Travel health notice at: http://www.phac-aspc.gc.ca/tmp-pmv/notices-avis/notices-avis-eng.php?id=108 
  3. Infection Prevention and Control Guidance for Acute Care Settings: http://www.phac-aspc.gc.ca/eri-ire/coronavirus/guidance-directives/nCoV-ig-dp-eng.php

For previous of our BCCDC Emerging Respiratory Pathogens Bulletins, see:

http://www.bccdc.ca/dis-cond/DiseaseStatsReports/EmergingRespiratoryVirusUpdates.htm.

May 5: First travel-associated case of MERS-CoV in North America announced by the United States

from BCCDC:

Reinforcing the message to you in our earlier bulletin this week regarding the dramatic surge in MERS-CoV cases in the Arabian Peninsula and possible importation elsewhere, the U.S. Centers for Disease Control and Prevention (CDC) has today announced an imported case of MERS-CoV in a traveler returning to the United States from Saudi Arabia.

This patient traveled on April 24 from Riyadh, Saudi Arabia to Chicago, Illinois via London, England by plane and then to Indiana from Chicago by bus. The patient developed respiratory symptoms on April 27 and was admitted to hospital on April 28; the patient is currently in isolation and in stable condition. Contact tracing investigations are ongoing.

Since our last bulletin to you on April 30, 2014, 19 new cases of MERS-CoV have been reported, including 17 from Saudi Arabia and one from Jordan, as well as this latest reported case from the United States (ex. Saudi Arabia). Since the beginning of the outbreak in April 2012, a total of 472 cases and at least 126 deaths have thus now been reported globally. Previous travel-associated cases of MERS-CoV have been reported from countries in Europe, North Africa and Southeast Asia, with some limited, indigenous transmission to close contacts.

As communicated to you in the last bulletin, the majority of recent MERS-CoV cases are secondary cases, most of whom acquired their infection in health care settings. The current MERS-CoV epidemiologic pattern is thus reminiscent of the SARS-CoV experience in 2003, driven by nosocomial transmission in healthcare settings but without sustained community-level spread.  The public health risk to individuals in the community remains low at this time.

However, further importation of cases to countries outside the Arabian Peninsula is anticipated and given SARS-like nosocomial amplification of MERS-CoV within that region, clinicians are again reminded to stay alert for possible importation and to obtain a travel history from patients presenting with severe acute respiratory illness (SARI). In the event of SARI in a patient with links to affected areas (e.g. residence, travel history or contact with someone with such history) clinicians should discuss with their local Medical Health Officer and consult a virologist or microbiologist at the BC Public Health Microbiology & Reference Laboratory (PHMRL) to arrange for advance notification and direct specimen shipping. Healthcare workers should immediately implement infection control precautions to prevent further spread to other healthcare workers, their patients and visitors.

For the full version of the US CDC Press Release, see: http://www.cdc.gov/media/releases/2014/p0502-US-MERS.html.