BCCDC Influenza Update: Sporadic Flu Detections in BCAug182017

Sporadic influenza activity has been detected in BC and elsewhere in Canada this summer, with some provinces reporting summer outbreaks in long-term care facilities. Influenza A(H3N2) had been the predominant subtype during this period.

In the southern hemisphere where they are in the midst of their winter seasonal epidemic, influenza activity has increased or peaked in most countries in recent weeks. In Australia and New Zealand, influenza activity predominately due to A(H3N2) is increasing with lesser co-circulation of B(Yamagata) viruses. In some Southeast Asian countries, high levels of influenza activity continue to be reported, including in Myanmar where A(H1N1)pdm09 is predominating and in Southern China and Hong Kong where a severe summer influenza epidemic due to A(H3N2) is underway.

As in previous years, the US CDC has reported sporadic human cases of novel influenza A viruses associated with exposure to swine at agriculture fairs, including human cases of A(H1N2)v (the first reported in 2017) and A(H3N2)v, this summer.

Sporadic detections of Middle East Respiratory Syndrome coronavirus (MERS-CoV) associated with a hospital cluster in Saudi Arabia and avian influenza A(H7N9) in China were also reported during this period.

BC Influenza Surveillance Bulletins are available from the BCCDC website.

Please remember to notify BCCDC of any ILI outbreak occurring in your region by sending an e-mail to ilioutbreak@bccdc.ca. A copy of the current outbreak report form can be downloaded here.

Feel free to contact the BCCDC Influenza & Emerging Respiratory Pathogens Team with any questions or concerns.


Canadian scientists find new way to attack antibiotic-resistant lung infectionsAug072017

Excerpted from CBC.ca

Enzymes used to break down the walls built by microbes

Canadian scientists have discovered a possible way to break through the defences of some antibiotic-resistant respiratory infections. It’s hoped that the findings could someday benefit people with cystic fibrosis and other chronic lung diseases who are at greater risk of infections.

The research looked at biofilms, which are one of the main causes of hospital-acquired infections. Microbes form biofilms on surfaces like the insides of our lungs, heart valves and artificial hips. In fact, implanted medical devices could account for up to 70 per cent of hospital-related infections, according to previous research.

For doctors and scientists, biofilms have been a tough nut to crack. That’s because some bacteria and fungi secrete a matrix of sugar molecules to form the biofilm armour — a physical and chemical barrier to keep antibiotics and our immune cells out so they don’t have a chance to kill the pathogens.

Think of how humans shifted from life as hunter gatherers to building up walls around their town to protect themselves from invaders, said Sheppard, a clinician-scientist at the Research Institute at McGill University Health Centre in Montreal. Some bacteria and fungi build a biofilm matrix, a type of city wall to defend their communities. 

Sheppard and Howell were the lead authors of a study published in the journal of the Proceedings of the National Academy of Sciences in June. They focused on two microbes that are responsible for lung infections: Aspergillus fungi and Pseudomonas aeruginosa bacteria.

In test tube experiments, the researchers discovered that the microbes use enzyme “saws” to cut and then build the walls of their biofilm homes out of uniform pieces, like two-by-four pieces of lumber.

They were able to turn the microbe’s defence against itself, using its machinery to engineer the enzymes and control where the cuts were made. Instead of small, uniform wooden boards, the biofilms were cut into the equivalent of 10-foot-long pieces. The microbes weren’t able to use those unwieldy pieces to repair the gaping holes scientists inflicted on the biofilm walls.

“We made the uncontrolled versions, which cut willy-nilly and destroy the biofilm,” Sheppard said. “Lo and behold the enzymes worked in an animal model,” Sheppard said. Specifically, it was a lung infection model of Aspergillus fungus in mice.

It took 10 years of basic laboratory research to prove it was the enzymes at work. They also discovered that both the fungi and bacteria used the same tool, which was active across the two species.

Howell, a senior scientist at SickKids and a professor of molecular biology at the University of Toronto, said when they realized they understood the mechanics well enough to apply the approach more broadly, “it was like one of those light bulb moments” in science.

The discovery could be applied therapeutically, said Howell, in the form of biofilm-busting enzyme therapy for people with cystic fibrosis and other chronic lung diseases. In the case of CF lungs, Howell said the underlining genetic defect prevents cilia, or small hairs on the surface of the airway, from doing their job of beating together to move mucus up and out of the lung.

The airways in people with CF also provide an ideal environment for some bacterial infections to take hold.

Whether the engineered enzymes work the same in humans as in mice, without toxic effects, remains to be seen. Sheppard estimates the first studies in people are at least five years away.

Read the full article, and watch the video, on CBC.ca


Stethoscope hygiene failures can lead to patient infectionsJul212017

Excerpted from: Outbreak News Today

You can lead a doctor to disinfection, but how do you get them to clean…or wipe ….or swab a stethoscope?

That’s the question raised by a new quality improvement project published in the July issue of the American Journal of Infection Control, the official journal of the Association for Professionals in Infection Control and Epidemiology (APIC).

It is the latest report to find that healthcare providers rarely perform stethoscope hygiene between patient encounters, despite its importance for infection prevention. Infection control guidelines from the Centers for Disease Control and Prevention state that re-usable medical equipment, such as stethoscopes, must undergo disinfection between patients.

“Stethoscopes are used repeatedly throughout the day and become contaminated after each patient exposure, so they must be treated as potential vectors of transmission,” said Linda Greene, RN, MPS, CIC, FAPIC, 2017 president of APIC. “Failing to disinfect stethoscopes could constitute a serious patient safety issue similar to ignoring hand hygiene.”

The report describes a quality improvement pilot project in which the authors observed stethoscope hygiene (alcohol swabs, alcohol gel, or disinfectant wipes) at the start of a four-week rotation for medical students, resident physicians, and attending physicians at a tertiary care academic teaching hospital. The baseline observation of stethoscope hygiene among staff found zero occurrences. The project also looked at hand hygiene, which can include alcohol gel or soap and water.

Read the full media article on Outbreak News Today

Read the journal paper Can education influence stethoscope hygiene? in the American Journal of Infection Control


Multidrug-resistant Candida auris: PHAC interim guidanceJul112017

The Public Health Agency of Canada (PHAC) has recently been informed of a case of multidrug-resistant Candida auris. Whole genome sequence analysis performed by the National Microbiology Laboratory (NML) was consistent with C. auris. Further analyses to compare the isolate with global strains are pending. A case report will be published in the Canada Communicable Disease Report (CCDR).

Candida auris is an emerging fungal infection that can cause invasive healthcare-associated infections, including bloodstream infections, wound infections, and otitis media. It was first reported in Japan in 2009 as an infectious agent in a patient’s ear. Information available to date indicates that cases of C. auris have occurred in at least nine other countries including Korea, India, Pakistan, Kuwait, South Africa, Venezuela, Colombia, the United Kingdom and the United States.

This emerging AMR pathogen may have potential implications for healthcare facilities and for pubic health laboratories. C. auris can be transmitted in healthcare settings with reports of severe illness in hospitalized patients.  Of concern is that C. auris can persist on surfaces in healthcare environment sand may spread between patients, unlike most other Candida species. The precise mode of transmission is unknown. Adherence to infection prevention and control practices and environmental cleaning may help prevent transmission in healthcare settings. Some C. auris strains have shown resistance to all 3 major classes of antifungal medicines (i.e., are MDR).

You can read the interim guidance in this document from PHAC (Download PDF).

You can read about the first reported case in this CCDR article.