October 2018

Emerging Infectious Diseases Journal^®

Highlights: Emerging Infectious Diseases, Vol. 24, No. 10, October 2018

EID requests that, when possible, you link directly to the actual journal article in your stories. Once the embargo lifts, this month’s articles will be found in the Ahead of Print section of the EID website at https://wwwnc.cdc.gov/eid/ahead-of-print.

1.      Candida auris in Healthcare Facilities, New York, USA, 2013- 2017, Eleanor Adams et al.

Candida auris is an emerging yeast that causes healthcare-associated infections. These infections can be hard to diagnose (because doing so requires specialized laboratory techniques and the species are sometimes misidentified) and hard to treat (because the organism is often resistant to antifungal medications). Those difficulties were apparent in an investigation of C. auris infections in healthcare facilities in New York, when researchers found that some infections had been initially misdiagnosed and most organisms were resistant to the commonly used antifungal fluconazole. In addition, they found frequent colonization (harboring the organism without symptoms of illness) of people who had been in contact with infected patients, they isolated the organism from environmental surfaces in healthcare facilities, and they found lapses in infection control procedures at the facilities. The New York State Department of Health responded by conducting intensive case investigations and providing infection control assessments and assistance for healthcare facilities. They also conducted educational webinars for state clinicians and created a web page for healthcare personnel and the public. Those intensive infection prevention and control efforts continue, with the goals of slowing the spread, preventing outbreaks, and blunting the effects of C. auris infections in New York and the rest of the United States.

Contact: Gary Holmes, New York State Department of Health, email: gary.holmes@health.ny.gov or phone: (518) 474-7354

2.    Mapping Histoplasma capsulatum Exposure, United States, Amelia W. Maiga et al.

Histoplasmosis is an infection caused by breathing in spores of a fungus called Histoplasma. The fungus lives in the environment, particularly in soil that contains large amounts of bird or bat droppings. In the United States, Histoplasma mainly lives in the central and eastern states, especially near the Ohio and Mississippi River valleys. Although most people who breathe in the spores don’t get sick, those who do may experience fever, cough, and fatigue; people with weakened immune systems can get severely ill. The fungus also causes lung nodules, which can be mistaken for cancer. For the early recognition, diagnosis, and treatment of histoplasmosis, accurate maps of where it is likely to occur are helpful so that healthcare providers in these areas can be alert for it. However, the last such maps were created 50 years ago, and since then, the factors that predispose an area to the fungus (environment, climate, and land use) have changed drastically. To update knowledge of where histoplasmosis is likely to occur, researchers developed a model, using environmental factors preferred by H. capsulatum, to produce a large-scale map that would determine patients’ risk on the basis of their geographic history. This process is called suitability mapping (determining a geographic region’s suitability for the organism). Suitability mapping indicated that the preferred soil environment for H. capsulatum has migrated into the upper Missouri River basin. This model could be applied to other infectious agents strongly associated with geographic-specific vectors and used to inform healthcare providers and improve public health assessments and interventions.

Contact: Stephen Deppen, Department of Thoracic Surgery and Division of Epidemiology, Vanderbilt University Medical Center, email: steve.deppen@vanderbilt.edu or phone: 615-343-6284

3.      Invasive Pneumococcal Disease in Refugee Children, Germany, Stephanie Perniciaro et al.

Invasive pneumococcal disease (IPD) is a major cause of childhood death, especially in resource-poor environments. Germany has taken in more than 1 million refugees since 2015, more than one third of whom were children. Of the 10 most frequent countries of origin for refugees arriving in Germany in 2017 (Syria, Iraq, Afghanistan, Turkey, Iran, Nigeria, Eritrea, Russia, Somalia, and Albania), only 6 have a national vaccination program that includes pneumococcal conjugate vaccines (the vaccines that protect against IPD). However, because of the crisis conditions facing refugees, many of these children were not properly vaccinated against IPD in their countries of origin or in Germany, and outbreaks of other vaccine-preventable diseases have occurred in refugee housing facilities in Germany. Researchers compared isolates from 21 refugee children with IPD and isolates from 405 Germany-born children with IPD over a 3-year period. They found that refugee children in Germany were at greater risk of contracting vaccine-type IPD and multiple-antibiotic-resistant IPD. Pneumococcal conjugate vaccination of newly arrived refugees presents an opportunity to cost-effectively, safely, and humanely protect a vulnerable population from vaccine-preventable diseases, so the researchers propose that a pneumococcal conjugate vaccine program for refugee children might be worth considering in Germany.

Contact: Stephanie Perniciaro, German National Reference Center for Streptococci, Department of Medical Microbiology, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen Germany, email: sperniciaro@ukaachen.de

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