Staphylocococcus aureus (MRSA)
Since the emergence of
methicillin-resistant Staphylococcus aureus (MRSA), vancomycin has been the
first-line and only uniformly effective antimicrobial agent for treatment of serious
infections with MRSA. Of great concern was whether or not S.aureus could acquire
glycopeptide resistance and become non-responsive to vancomycin, resulting in
staphylococcal infections with similar morbidity and mortality to that which characterized
these types of infections in the pre-antibiotic era.
Since 1997, three patients infected with S.
aureus with intermediate resistance to the glycopeptide vancomycin (GISA/VISA, MIC = 8
µg/ml) have been reported in the United States. As such, there has been concern that the
frequency of vancomycin resistant/intermediate S. aureus will increase rapidly over
the next several years and become a major public health problem. Some reports suggest
these pathogens may already be causing therapeutic difficulties, but they are not being
detected with current laboratory methods. Laboratory evidence suggests that the same
mechanism of resistance which caused these strains of S. aureus to develop
vancomycin MICs of 8 µg/ml is present in methicillin- or oxacillin-resistant isolates
with vancomycin MICs of 4 µg/ml. Therefore, these S. aureus strains with reduced
susceptibility to vancomycin (MIC> 4 µg/ml) should be considered a potential
public health problem. Through information provided by collaboration with a proprietary
surveillance system of 150 U.S. hospitals, it is estimated that 0.6% of MRSA isolates
exhibit reduced susceptibility to vancomycin (MIC = 4 µg/ml), and each hospital reports
approximately 200-700 of these MRSA isolates/year. Therefore, each hospital has on average
103 MRSA isolates with a vancomycin MIC = 4 µg/ml.
"... there has
been concern that the frequency of vancomycin resistant /intermediate S. aureus will
increase rapidly over the next several years and become a major public health
In order to learn about the
epidemiology of these S. aureus strains with reduced susceptibility to vancomycin,
the Hospital Infections Program, Centers for Disease Control and Prevention (CDC) has
developed a nationwide case-control study that is currently undergoing IRB review. This
study will attempt to define risk factors for acquisition of these strains, determine the
risk of transmission, and assess the adequacy of the CDC recommendations in preventing
transmission of S. aureus with reduced susceptibility to vancomycin from
patient-to-patient or patient-to-healthcare worker.
The CDC would like to collaborate
with state and local health departments to enroll patients in the case-control study.
States would not be required to use any resources for this project. The CDC would request
cooperation with infection control staff affiliated with the infected patient to collect
information on these patients. The state health departments would be kept informed of any patient enrollment
into the study, and state health departments would be asked to refer any inquiries
regarding these S. aureus strains. Reports from other surveillance efforts will
also be welcomed.
For additional information concerning
this nationwide epidemiologic study, you may contact the CDC Hospital Infections Program
at (404) 639-4951 or email (firstname.lastname@example.org).
Adapted from Department of Health & Human
Services, Public Health Service letter to CSTE members.
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Its In The
The recall. From August 1998 to February 5, 1999,
approximately 70 cases of listeriosis caused by a rare strain of Listeria monocytogenes
have been reported in the United States. A total of 16 deaths have been reported; 11
adults have died and 5 pregnant women have had miscarriages. (No cases or deaths have been
reported to date in Utah residents.) Epidemiologic and laboratory investigations have
identified hot dogs and possibly deli meats that were produced by one manufacturer as the
likely means of transmission. On December 22, 1998, the manufacturer, Bil Mar Foods,
voluntarily recalled specific lots of the hot dogs and deli meats that might be
contaminated. Recalled products have the establishment numbers EST P261 or EST 6911 on the
outer edge of the package. The affected products include hot dogs and deli meats with the
brand names Ball Park, Bil Mar, Bryan Bunsize, Bryan 3-lb Club Pack, Grillmaster, Hygrade,
Mr. Turkey, Sara Lee Deli Meat, and Sara Lee Home Roast brands. Packages for the above
brand names that carry other establishment numbers are not affected by the recall.
Other Sara Lee products that are not meat also are not affected. Consumers who have the
affected products should not eat them, but should discard them or return them to the store
where they were purchased.
Who could get listeriosis?
Every year in the United States, roughly 1,100 persons become seriously ill with
listeriosis. Of these, approximately 250 will die. Those most likely to become seriously
ill or die include pregnant women, newborns, adults with weakened immune systems, and the
elderly. Healthy adults and children may become infected with the bacteria, but they
rarely become seriously ill as a result of it.
How do you get listeriosis?
Listeriosis is believed to be caused primarily by eating food that is contaminated with L.
monocytogenes. Food can become contaminated with L. monocytogenes in a
variety of ways because these bacteria are commonly found in soil and water. Vegetables
may become contaminated from the soil or from manure used as a fertilizer. Animals can
carry these bacteria without appearing ill and may contaminate foods of animal origin such
as meats and dairy products. L. monocytogenes has been found in raw foods, such
as meat and vegetables, and in processed foods that were contaminated after processing,
such as soft cheeses and cold cuts. Unpasteurized (raw) milk or foods made from
unpasteurized milk may also contain these bacteria.
How do you know if you have listeriosis?
The symptoms of listeriosis frequently include fever and muscle aches. People with
listeriosis may develop nausea and diarrhea, and if the infection spreads to their nervous
system, they may have a headache, a stiff neck, confusion, loss of balance, or
convulsions. Pregnant women may have a mild illness; however, infection with L.
monocytogenes during pregnancy may lead to premature delivery, an infection in the
newborn, or stillbirth.
The symptoms of listeriosis can be similar to those
of other diseases. To definitively confirm the diagnosis, a health care provider will need
to obtain either a blood or cerebrospinal fluid sample and have it tested for the presence
of L. monocytogenes.
Can listeriosis be treated?
Antibiotics can be used to treat listeriosis, but for these to be most effective, they
need to be given as soon as possible. When infection occurs during pregnancy, antibiotics
given promptly to the pregnant woman can often prevent infection of the fetus or newborn.
Serious infections in newborns, children or adults may result in death, however, even with
prompt treatment with antibiotics. Death is more likely in the elderly and in persons with
other serious medical problems.
How can listeriosis be prevented?
The main steps to prevent listeriosis are the same as those you need to take to prevent
any foodborne illness:
- Cook thoroughly raw food from animal
sources, such as beef, pork, or poultry.
- Wash raw vegetables thoroughly before eating.
- Keep uncooked meats separate from other foods that will
not be cooked thoroughly before they
- Avoid unpasteurized (raw) milk or foods made from
- Wash hands, knives, and cutting boards after handling
If you are pregnant or if you have a weakened immune
system, you may want to consider taking the following precautions:
- Avoid soft cheeses
such as feta, Brie, Camembert, blue-veined, and Mexican-style cheese. (Hard
cheeses, processed cheeses, cream cheese, cottage cheese, or yogurt need not be
- Cook until steaming
hot any left-over foods or ready-to-eat foods, such as hot dogs, before eating.
While the risk of listeriosis associated with foods
from deli counters is believed to be low, pregnant women and those with weakened immune
systems may want to avoid these foods or thoroughly reheat cold cuts before eating them.
To learn more: We have a fact sheet on listeriosis
at the Utah Department of Healths web site
(http://www.health.state.ut.us/els/epidemiology/epifacts/listerio.html). The CDC also has
a fact sheet (http//www.cdc.gov/ncidod/diseases/foodborn/lister.htm). The latest
information on the recall is also available from the CDC
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- Still A Problem
Head lice can be a frustrating
problem. Here is some information we hope can be of help.
First, the good news! Head lice do
not transmit disease. While a person with lice might develop a secondary bacterial
infection from itching their scalp, the lice themselves do not transmit disease.
Facts about lice. Head lice live
only on the human scalp. They need a blood meal every four to six hours, and die in
24 hours if not able to feed. Adult females lay eggs which are attached to hair shafts
close to the scalp. The eggs hatch in seven to 12 days. In the course of a 30-day
lifetime, each female louse produces approximately 110 to 140 eggs.
A few other facts. 1) Head lice are
not rare. Every year in the United States, six to 12 million persons get them. 2) People
do not get lice because they are not clean, and being obsessively clean will not prevent
lice. Most of the time, people get head lice when they have direct, head-to-head contact
with someone else who has head lice. 3) While lice can scurry, they do not fly or hop from
one head to another. 4) Most people infested with head lice have very few (one or two)
lice in their hair.
How do you know if someone has head lice?
Many people have no symptoms. The best way to check for lice is to use a fine-toothed comb
to separate the hair and a strong light for viewing. Lice will hide from light, so spend
at least three to five minutes looking for them. Adult females are about as big as a
sesame seed, and reddish brown to black in color. Eggs and nits (empty eggs) are attached
to hair shafts and are often found behind the ears and at the nape of the neck.
What to do (and not to do) about
head lice. 1) Dont panic! Head
lice are unpleasant but not a disease threat, and they can be treated. 2) Purchase a
shampoo or cream rinse designed to kill head lice. Follow the enclosed directions exactly.
3) After the treatment, use a fine-toothed comb to remove lice eggs. This may be
difficult, but it is crucial because eggs left behind may hatch and begin a new
infestation. 4) Repeat the whole treatment in seven to 12 days. 5) While lice do not live
long away from the scalp,
it is wise to clean the infested persons clothes, bedding, etc. Put washable
clothing and bedding through 20 minutes of a high heat dryer cycle first, and then into
the washing machine. Dry clean things that cannot be washed, or seal them in a plastic bag
for two weeks. 6) Thoroughly vacuum all fabric surfaces that may have had contact with the
persons head ( i.e., furniture, car upholstery).
For more help. Contact your local
health department or the Bureau of Epidemiology (801-538-6191) for additional advice.
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Due to some recent developments in
the manufacture and distribution of immune globulin for intramuscular injection (IMIG), it
appears that over the next 6-12 months, enough IMIG will be produced to adequately meet
national requirements. In addition, CDC will no longer screen large orders. The following
is a list of manufacturers and the distributors that IMIG can be purchased from:
1. Bayer Corporation
FFF Enterprises. . . . . . . . . . . . . . . . . . . . . . . . . . .1-800-843-7477
Coalition . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-456-7283
Medical . . . . . . . . . . . . . . . . . . . . . . . . . . .1-800-221-7180
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-800-344-6087
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-997-8846
2. Massachusetts Public
FFF Enterprises . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Bio Port Corporation
(formally the Michigan
Biologics Products Institute)
Distributors (ASD) . . . . . . . . . . . . . . . . . . . . . . . .
Systems, Inc . . . . . . . . . . . . . . . . . . . . . . . . .1-800-304-3064
Although there is no limit on the size of IMIG
orders, health departments and other institutions are requested to spread orders to
replenish stock over a period of 6-12 months. For questions concerning the management of
hepatitis A outbreaks and exposure situations, please contact the Bureau of Epidemiology
to table of contents
Department of Health, Bureau of Epidemiology
Monthly Morbidity Summary - February 1999 - Provisional Data
The Epidemiology Newsletter is published
monthly by the Utah Department of Health, Division of Epidemiology
and Laboratory Services, Bureau of Epidemiology, to disseminate
epidemiologic information to the health care professional and
the general public.
Send comments to: The Bureau of Epidemiology, Box 142104, Salt
Lake City, UT 84114-2104, or call (801) 538-6191
Approval 8000008:Appropriation 3705
Rod Betit, Executive Director,Utah Department of Health
Charles Brokopp, Dr.P.H., Division of Epidemiology and Laboratory
Craig R Nichols, MPA, Editor, State Epidemiologist, Director Bureau
Cristie Chesler, BA, Managing Editor
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