Minnesota Department of Health (MDH) Bug Bytes
August 19, 2002
Vol. 3: No. 10
Topics in this Issue:
1. West Nile Virus Update
2. New Group B Streptococcus Prevention Guidelines
3. Minnesota Uncovers National Outbreak
4. Knee Surgery Update
5. First Quarter 2002 Invasive Bacterial Disease Report
1.West Nile Virus Update
Since the last Bug Bytes issue, we have been swept into the frontier of West Nile Virus's (WNV) westward migration. We have been inundated with more than 4000 reports of dead birds. To date, WNV has been confirmed in 134 birds (primarily crows) from 32 counties representing every region of Minnesota, including the Twin Cities and their suburbs. We have stopped testing birds from counties that have had multiple positive birds; however, we still have many more birds in the testing pipeline. In addition, WNV has thus far been confirmed in 93 horses in 33 counties. The areas of greatest WNV activity in horses have been: 1) Carver, Wright, and northwestern Hennepin Counties; and 2) western Minnesota from Iowa to Canada, with numerous reports from Clay and Murray Counties. Our website (at http://www.health.state.mn.us/divs/
idepc/diseases/westnile/) contains information on WNV including updated maps displaying county location of positive birds and horses.
No human cases of WNV have yet been reported. However, because
of intense epizootic among birds and horses, we would like
to enhance our surveillance for human cases. Therefore, we
are encouraging all physicians who see potential cases of
WNV disease to submit CSF and/or serum samples for testing
(see below for criteria).
Even after being infected by a mosquito, the chances of becoming severely ill is <1%. Clinical cases can be seen in any age group, but most will be in the elderly. Illness is characterized by sudden high fevers and various neurological manifestations (headache, stiff neck, myalgia, nausea/vomiting, cranial nerve abnormalities, lethargy, seizures, coma). WNV has also been known to cause severe muscle weakness and flaccid paralysis similar to Guillain-Barre syndrome. MDH is asking physicians who see compatible cases (i.e. those patients whose clinical presentation warrants at minimum a lumbar puncture and/or hospitalization) to submit CSF and serum samples to us for WNV and other arboviral testing. More specifically:
1. Any adult or pediatric patient with presumptive viral encephalitis/meningo-encephalitis or any non-infant aseptic meningitis (CSF specimens with mild to moderate elevations in WBC but non-diagnostic for bacterial, fungal, herpesviruses, or enterovirus).
2. Any adult or pediatric patient with presumed Guillain-Barre syndrome or acute flaccid paralysis.
Free arboviral testing is available if the above criteria are met. Please call us at 651-201-5414 or 1-877-676-5414 to report your suspect cases and to arrange arboviral testing.
Serum - collection of acute (<10 days after onset) and
convalescent (2-4 weeks after onset) sera is recommended (1-2
ml each). These samples can be submitted separately to our
lab. ELISA for IgG and IgM will be performed, as well as indirect
fluorescent antibody assays (IFA) for the LaCrosse, California,
Eastern Equine, Western Equine, and St. Louis encephalitites.
Cerebral spinal fluid - at least 2-3 ml are required. Antibody detection, PCR (TaqMan), and viral culture are all available.
On a related note, we have recorded our first 2 cases of LaCrosse encephalitis of the year. One was from Hennepin County, and the other in Dodge County. Both cases were in young children, presented to their respective hospitals in late July, and were diagnosed serologically. They both required hospital stays (one in the ICU), but are now recovering well. We see an average of 6 cases of LaCrosse encephalitis per year in Minnesota, from the Twin Cities down through the southeastern Minnesota. Cases almost exclusively occur in children <16 years of age.
2. New Group B Streptococcus Prevention
The much anticipated 2002 revised Perinatal Group B Streptococcal (GBS) Disease Prevention guidelines have just been released (at http://www.cdc.gov/mmwr/
/preview/mmwrhtml/rr5111a1.htm). Several projects conducted here in Minnesota have helped shape these revised guidelines. One recently completed study demonstrated that the screening approach was >50% more effective than the risk-based approach at preventing perinatal GBS disease. Thank you to all those helped us - you have helped shape national public health policy!
These recommendations replace the 1996 guidelines. Key changes include the recommendation for universal prenatal screening for all pregnant women at 35-37 weeks gestation as well as updated prophylaxis regimens for women with penicillin allergy.
3. Minnesota Uncovers National
As stated in the previous article, we are always crediting you, our Emerging Infections Program active surveillance partners, for helping us address national infectious disease issues. Another very real recent example was reported in the August 9 MMWR (at http://www.cdc.gov/mmwr/
preview/mmwrhtml/mm5131a2.htm). Through your timely reporting of cases and submission of isolates, on July 16 we identified 2 cases of Salmonella serotype Javiana infections among persons who had attended the 2002 U.S. Transplant Games held at a theme park in Orlando, Florida, during June 25-9. Isolates from both patients were indistinguishable by pulsed field gel electrophoresis (PFGE). The U.S. Transplant Games is a 4-day athletic competition among recipients of solid organ and bone marrow transplants. Approximately 6,000 persons from the U.S. and five other countries, including 1,500 transplant-recipient athletes, participated in the games.
We reported our findings to CDC. Their subsequent investigation identified 141 ill persons, including 3 who were hospitalized, in 32 states who attended the games. Ill persons were significantly more likely to report eating foods containing diced Roma tomatoes than were well persons. Preliminary microbiologic evaluation indicates fecal coliform contamination of the diced tomatoes.
To identify other potential cases of S. Javiana, the PFGE pattern for the outbreak strain was posted on PulseNet, the National Molecular Subtyping Network for foodborne disease surveillance. A total of 18 additional S. Javiana infections with an indistinguishable PFGE pattern were identified in eight other states. Of 16 patients who were interviewed, one was a games participant, and 12 others had visited the same theme park during the last week of June but did not attend the games.
Thanks to you for helping us identify this national outbreak with potential serious complications among transplant recipients!
4. Knee Surgery Update
Our investigation last Fall of three unexpected deaths following knee surgery revealed that one of the deaths was due to Clostridium sordellii from a contaminated tissue allograft that had been harvested from a cadaver. Our report initiated additional reports from all over the U.S. The CDC has received approximately 55 such reports and is investigating them. As a result of this investigation and followup visits to the facility (Cryolife, Inc.) that provided the allograft to our initial case-patient, the U.S. Food and Drug Administration has ordered Cryolife, Inc. to recall distributed human tissue processed from October 3, 2001 to the present. It must also withhold from the market or destroy tissue processed after that date. The full FDA announcement of their action is at http://www.fda.gov/bbs/topics/NEWS/2002/
5. First Quarter 2002 Invasive Bacterial
First quarter summary statistics for invasive bacterial disease including Neisseria meningitidis, Haemophilus influenzae, group A Streptococcal disease, group B Streptococcal disease, and Streptococcus pneumoniae are available at www.health.state.mn.us/divs/idepc/
Bug Bytes is a combined effort of the Infectious Disease Epidemiology, Prevention and Control Division and the Public Health Laboratory Division of MDH. We provide Bug Bytes as a way to say THANK YOU to the infection control professionals, laboratorians, local public health professionals, and health care providers who assist us.
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