Measles in Ontario, more endoscope-related infections, a study of postnatal Zika infections, research and development on a river blindness vaccine, and using CRISPR to tackle Zika are the articles that make up this week’s Top 5.
“This outbreak is an excellent example of why it is important that everybody ensures that their immunization status is up to date,” senior author Shelley L. Deeks, MD, interim chief of Communicable Disease, Emergency Preparedness and Response for Public Health Ontario, told Contagion®. “We live in a global and interconnected world. We are continually exposed to other people in our everyday lives. For a disease such as measles, that is extremely contagious and transmitted through the air, an individual can be exposed to an infected person and be at risk of disease with limited interaction.”
Dr. Deeks notes that measles can be transmitted through limited contact with a contagious individual, a noninfected individual can catch it by sitting beside someone on a plane who is infected, or walking into a room an hour after an infected individual has left; it’s also easily spread to others through coughing and sneezing.
More on the needs for immunizations in Ontario is available here.
Although this exposure is different than the infamous outbreak of carbapenem-resistant Enterobacteriaceae (CRE) at University of California, Los Angeles (UCLA) Medical Center, it highlights the consistent disinfection issues associated with endoscopic equipment and procedures. The UCLA outbreak involved duodenoscopes and design flaws that made disinfection extremely challenging. This recent exposure involving the base in Qatar is centered around poor disinfecting practices between procedures. The endoscopes were not cleaned according to US Food and Drug Administration (FDA) guidelines and further review found that the medical technicians responsible for disinfection used “an alternate method that included manual cleaning and inspection, rather than the recommended automated process. Specifically, it was noted that during equipment reprocessing, the flushing and brushing of the scope lumens were not completed as recommended by the manufacturer.”
This is particularly concerning on several levels—first, given all the attention that was placed on duodenoscope reprocessing, healthcare facilities have ramped up disinfection monitoring methods for all flexible endoscopes to ensure compliance and avoid adverse events. Was this increased scrutiny not present at the Al Udeid clinic?
Read more about the never-ending story of endoscope-related infections here.
This new study can have a positive impact on families living in rural Guatemala, a place that is fraught with poverty, in that it can provide access to an early Zika diagnosis. The researchers are looking for answers regarding whether the virus is capable of interfering “with the normal development of young children.” According to Antonio Bolaños, MD, medical director at the FUNSALUD clinic where the study will occur, “any Zika effect on neurodevelopment [of impoverished children in the country] will add burden to their futures.”
The researchers aim to enroll around 1200 infants and children (all under 5 years) in the study. In addition, they plan to include a cohort consisting of 300 children who were infected with Zika and/or Dengue virus postnatally. These children were also included in the University of Colorado’s surveillance study. They will also enroll a cohort of around 500 newborn babies who have not been infected with Zika virus, as well as these babies’ mothers and siblings. The cohort consisting of siblings will comprise about 400 children who are under 5 years of age.
Continue reading about this study on postnatal Zika infection here.
Transmitted by the parasitic worm Onchocerca volvulus through bites from blackflies, river blindness is the world’s second leading infectious cause of blindness. The disease is endemic to 31 countries in sub-Saharan Africa and has also been transmitted in Yemen as well as in parts of Latin America. The blackfly that carries the parasite breeds in the fast-flowing waters of rivers and streams, and once a female adult worm enters a human body, it produces larval worms that travel to the skin and eyes. According to the Centers for Disease Control and Prevention (CDC), an adult O. volvulus worm can live inside a human for up to 15 years, and female worms can produce thousands of larvae each day. While some infected individuals do not experience symptoms, those who do may develop itchy skin rashes, nodules under the skin, vision changes, and eventually blindness.
River blindness is typically treated with the anti-parasite medication ivermectin, and the World Health Organization (WHO) notes that in the absence of a vaccine to prevent these infections, the disease has been largely mitigated or eliminated through insecticide spraying and other methods. From 1974 to 2002, the Onchocerciasis Control Programme in West Africa used insect spraying and ivermectin distribution to relieve 40 million cases of river blindness, prevent blindness in 600,000 individuals, and protect 18 million children from being born into the threat of the disease.
More on the research and development of a vaccine for river blindness is available here.
CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) is a relatively new biotechnology that allows the user to target specific genetic codes within DNA and edit them, working like a pair of DNA scissors with a copy & paste button. CRISPR is easier and cheaper than previous gene editing technologies and has been highly regarded as a breakthrough tool for correcting genetic conditions and even infectious diseases through gene drive. Whether it be the latest announcement that CRISPR reversed Huntington’s Disease in mice or that it could provide rapid diagnostic improvements, the technology is being considered a breakthrough for many diseases and conditions, including vector-borne diseases.
By harnessing the power of gene drive, CRISPR could ensure that edited genes are passed down through all generations. Harnessing the power of gene drive means that instead of 50% of offspring getting a gene passed down (the natural process), and researchers can ensure that all offspring inherit the altered gene. In short, harnessing the gene drive gives us the capability to make sure that a specific gene is passed down through all generations of an organism.
Continue reading on how CRISPR could tackle Zika here.