Phoenix-area hospitals fight highly toxic 'supergerm'
by Ginger Rough - May. 29, 2010 12:00 AM
The Arizona Republic
Maricopa County health officials have confirmed that a relatively new, extremely toxic strain of bacteria has been found in hospitals and other health-care facilities in the Valley.
The germ, known as Clostridium difficile, has long plagued the medical profession and is blamed for an increasing amount of illness in patients.
But this is the first time the new strain, known in medical circles as "NAP1," is believed to have been linked to patient illness and deaths in Arizona, health officials said. It carries at least 20 times as much toxin as the original strain.
According to the county, at least 10 patients have fallen severely ill from this new type of C. diff since early March. Two of those who were infected have died, though the germ has not been named conclusively as the cause of death. All the patients were elderly and suffered from health problems.
"Assuming this continues to evolve, it is going to be a real pain for our health-care communities," said Dr. Bob England, director of the Maricopa County Department of Public Health.
Like other "supergerms," all strains of C. diff are resistant to powerful antibiotics, and the infection is difficult and expensive to treat. The germ causes pronounced diarrhea and, in severe cases, can lead to inflammation of the colon, which can be fatal.
Healthy and younger people usually don't get C. diff. Most cases occur in health-care facilities, and those represent only a small fraction of the tens of millions of admissions to U.S. hospitals and nursing homes every year. But the number of cases has risen sharply over the past decade, to nearly 500,000 in 2007, according to the latest data from the U.S. Centers for Disease Control and Prevention.
The Arizona Republic first learned of an ongoing C. diff outbreak last month after filing a state Public Records Law request to obtain a health alert issued by the Arizona Department of Health Services.
The alert contained no information about how the outbreak started, which hospitals were involved or how many patients were affected. County officials maintained that they were not obligated to provide that information.
This week, officials with the county Public Health Department and Banner Health, a non-profit group, met with a reporter and an editor from The Republic. Banner revealed that Banner Baywood Medical Center in Mesa had identified the strain after seeing some patients become very ill.
The hospital alerted the county to the problem in early March.
"If there's a cluster, an outbreak, we want to report that," said Dr. John Hensing, executive vice president and chief medical officer at Banner Health, a Phoenix-based non-profit health-care group.
Banner officials say they believe that most, if not all, patients came to Banner Baywood with an active C. diff infection, rather than contracting it at the facility. Some arrived from long-term-care facilities and nursing homes or went to the emergency room after falling sick at home.
The patients were elderly, suffered from other health problems and had been on extensive antibiotics. Prolonged antibiotic use can heighten a patient's susceptibility to C. diff because the drugs can kill off the body's "good" bacteria, allowing it to flourish.
Arizona, like many other states, does not track incidences of C. diff.
But a Republic analysis of hospital-discharge records shows that from Jan. 1, 2008, to Dec. 31, 2009, patients at Arizona hospitals were identified as having a C. diff infections more than 15,400 times.
The bug is becoming a major problem for hospitals because it spreads easily. Traditional cleansers and hand sanitizers fail to neutralize its spores, which are often spread through fecal-oral contact. The best ways to deter C. diff is with bleach and aggressive hand-washing.
Banner said officials at Baywood took immediate steps to control the outbreak, including isolating patients who exhibited symptoms of illness.
They also sanitized surfaces and equipment throughout the hospital with bleach and instituted new hand-washing protocols for all patients, including those too sick to get out of bed.
Nurses now bring them bottles of water so they can scrub their hands with soap without getting up, officials said.
They believe they have the outbreak under control.
This is not the first time Banner Baywood has dealt with a spike in germ-related infections.
In April 2008, hospital officials noticed a spike among post-surgical patients. Nineteen cases involved a supergerm known as methicillin-resistant Staphylococcus aureus, or MRSA. Seven infections were tied to the E. coli bacterium, and about a dozen others were caused by various other bacteria, according to the hospital. The facility implemented a series of aggressive procedures over several months to eliminate the problem.
County public-health officials say it's likely that this strain will continue to crop up in community and health-care facilities.
Officials from the U.S. Centers for Disease Control and Prevention agree. The CDC said Tuesday that the NAP1 C. diff strain has been spreading rapidly since it was first identified in health-care settings in six states from 2000 to 2003.
It has now been officially identified in 39 states, although it's likely throughout the country, CDC officials said.
"Do I think it just got here? No. But this is the first time it was reported to public health," said Dr. Rebecca Sunenshine, medical epidemiologist for the county's Public Health Department. "So, I would start operating under the assumption that every strain we see is this new strain."
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Breakthrough in fight against fatal Ebola as new drug saves 100% of monkeys tested
By Daily Mail Reporter
A gene silencing approach can save monkeys from high doses of the most lethal strain of Ebola virus in what researchers call the most viable route yet to treating the deadly and frightening infection.
They used small interfering RNAs or siRNAs, a new technology being developed by a number of companies, to hold the virus at bay for a week until the immune system could take over. Tests in four rhesus monkeys showed that seven daily injections cured 100 per cent of them.
U.S. government researchers and a small Canadian biotech company, Tekmira Pharmaceuticals, worked together to develop the new approach, described in the Lancet medical journal on Thursday.
Deadly: A government hospital in Uganda quarantined to handle an outbreak in Ebola cases
'The delivery system is the real key,' said Thomas Geisbert of Boston University School of Medicine, who did some of the work while at the U.S. Army Medical Research Institute of Infectious Diseases in Fort Detrick, Maryland.
Ebola viruses are a family of viruses that can often cause very serious hemorrhagic fevers. They have caused dozens of frightening and deadly outbreaks across Africa and threaten endangered gorilla populations as well as people.
There is no treatment and no vaccine against Ebola, which passes via close personal contact.
The siRNAs are stretches of genetic material that can block the action of a specific gene. This particular one attaches to three different areas on the Ebola virus, preventing it from replicating.
Geisbert's team worked with a strain called Zaire that comes from the Democratic Republic of Congo and kills up to 90 per cent of those infected.
'We have just had very difficult times developing treatments - antivirals or just any kind of a strategy,' Geisbert said. 'It's been a very tough nut to crack.'
The team has announced a number of near-successes, most recently a vaccine that provided partial protection in monkeys in 2006.
Geisbert then teamed-up with Ian MacLachlan at Tekmira.
Serious infection: The Ebola virus viewed under a microscope
Tests in guinea pigs suggested the siRNAs delivered in lipid particles would work. But to get Ebola to sicken rodents requires changing it substantially from the strain that attacks people and monkeys, Geisbert said.
The treatment holds the virus in check while the immune system gears up to fight it, Geisbert said. 'There is a critical threshold for virus load and if you go over that, you die,' he said. 'This drug is knocking down enough of the virus so it tips the balance.'
Now the company and researchers are seeking U.S. federal funding to continue their work, Geisbert said. For new drugs to treat lethal infections, the Food and Drug Administration requires proof that the treatment does not hurt people and is effective in at least two animal species.
Tekmira has deals with a number of pharmaceutical companies, including Bristol-Myers Squibb and Pfizer.
Last week a team at the National Institutes of Health reported it had developed a vaccine that protects monkeys against several strains of Ebola.
http://www.dailymail.co.uk/health/article-1282559/Ebola-virus-Scientists-discover-breakthrough.html
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