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Effective measures exist to prevent health care–associated hepatitis B virus (HBV) transmission, yet outbreaks continue to occur. In 2008, the Los Angeles County Department of Public Health identified an outbreak of HBV infections among psychiatric long-term care facility residents.
Residents underwent HBV serologic testing and were classified as acutely infected, chronically infected, susceptible, or immune. Persons residing in the facility during 2008 were enrolled in a retrospective cohort study to identify risk factors for acute HBV infection. We assessed infection control practices at the facility.
Nine of 81 residents (11%) enrolled in the cohort study had acute HBV infection. Five of 15 residents (33%) undergoing podiatric care on a single day subsequently developed acute infection (rate ratio, 4.33; 95% confidence interval, 1.18-15.92). Infection control observations of the consulting podiatrist revealed opportunities for cross-contamination of instruments with blood. Other potential health care and behavioral modes of transmission were identified as well. Residents were offered HBV vaccination, and infection control recommendations were implemented by the podiatrist and facility.
Of the multiple potential transmission modes identified, exposure to HBV during podiatry was likely the dominant mode in this outbreak. Long-term care facilities should ensure compliance with infection control standards among staff and consulting health care providers.
Using genome sequencing and household surveillance, National Institutes of Health (NIH) scientists and their colleagues from Columbia University Medical Center and St. George's University of London have pieced together how a newly emerging type of Staphylococcus aureus bacteria has adapted to transmit more easily among humans. Their new study underscores the need for vigilance in surveillance of S. aureus. A methicillin-resistant S. aureus (MRSA) strain known as livestock-associated (LA)-ST398 is a cause of severe infections in people in Europe who have close contact with swine, but the bacterium does not transmit well from person to person. More recently, a variant of LA-ST398 that presently is susceptible to methicillin has emerged as a significant cause of community-associated infections in several countries, including the United States, Canada and China. The new strain primarily infects the skin and soft tissue, but it can cause more severe disease. Based on samples from 332 households in northern Manhattan, New York, scientists have determined that this new strain, named ST398-NM, efficiently transmits from person to person - in contrast to the transmission characteristics of the livestock-associated strain. By analyzing and comparing the genomes of LA-ST398 and ST398-NM, the study, led by Anne-Catrin Uhlemann, M.D., Ph.D., at Columbia, charted several ways in which the bacterium has adapted to its hosts. For example, they learned that the human-adapted strain (ST398-NM) contains human-specific immune evasion genes, whereas the livestock-adapted strain does not. They also found that ST398-NM adheres well to human skin, thus increasing its ability to colonize and infect people. The study authors say it is possible that the ST398-NM strain emerging in northern Manhattan could acquire genes making it resistant to methicillin. Scientists at the NIH National Institute of Allergy and Infectious Diseases and their colleagues plan to continue global surveillance of ST398, paying close attention to its molecular adaptations. Their work promises to inform the development of new diagnostic and surveillance strategies against this emerging pathogen.