Top Infectious Disease News of the Week—February 24, 2019

#5: Controlling Measles in the US Not as Easy as Tweaking Vaccine Exemption Laws

With 6 ongoing outbreaks, individual cases reported across 10 states, and the US Food and Drug Administration (FDA) commissioner contemplating federal intervention, measles remains at the forefront of the collective consciousness.

Although it was considered eliminated in the United States in 2000, the current outbreaks are largely linked to international travelers bringing back the disease, which then spreads through pockets of unvaccinated people or communities, according to the US Centers for Disease Control and Prevention.

The issue in the United States comes down to vaccination coverage, and the exemption rules that vary from state to state. Currently, 17 states allow philosophical exemptions from vaccination due to personal, moral, or other beliefs, according to data from the National Conference of State Legislatures, and 48 states allow exemptions on a religious basis.

Read about vaccine exemption laws in the US.

#4: Workplace Infection Risks Evolving, Employers Struggle to Keep Up

Although health care-acquired infections (HAIs) remain a pressing issue for health care organizations, new research from the US Centers for Disease Control and Prevention (CDC) highlights the fact that it’s not only admitted patients who are at risk of contracting infections; it’s also the employees.

Moreover, it’s not just workers in the health care industry who face the risk of workplace infection; the risk is widespread across industries, and sometimes in surprising places.

The new CDC report was published this month in Emerging Infectious Diseases. It examines existing literature about infectious diseases in the workplace, finding 66 investigations of workplace infection cases between the years 2006 and 2015. In addition to health care, the industries most at risk for workplace infections include laboratories, especially work involving animals, and public service work.

Read about workplace infection risks.

#3: Rates of Lung Disease May Be Influenced by Mycobacterial Colonization in Municipal Water

Nontuberculosis mycobacteria are opportunistic human pathogens and several species, including members of the Mycobacterium avium complex (MAC), can trigger difficult-to-treat and life-threatening pulmonary infections. Therefore, determining sources of MAC infections are a critical part of disease prevention and control.

In a new study published in the US Centers for Disease Control and Prevention (CDC)’s Emerging Infectious Diseases journal, investigators assessed MAC colonization of household plumbing in suburban Philadelphia, an area identified as 1 of 7 counties in the United States with a high risk for MAC lung disease.

“Proof of an environmental source of M avium has broad implications regarding prevention of recurrent infection in existing patients as well as prevention of new disease in susceptible persons,” the investigators wrote in the research letter.

Read more about mycobacterial contamination in water systems.

#2: Can HAI Reporting Limit Infection Prevention Presence?

Health care-associated infections (HAIs) are a considerable problem in the United States. The US Centers for Disease Control and Prevention (CDC) estimate that on any given day, 1 in every 31 patients has a HAI. Each year, 2 million Americans will suffer from a HAI and nearly 90,000 will die. Not only are these infections costly in terms of morbidity and mortality, HAIs also represent a direct cost to hospitals that ranges between $28 billion to $45 billion per year.

In the face of this problem, many states have implemented mandatory HAI reporting laws.

Unfortunately, these laws can negatively impact the individuals conducting the surveillance and reporting: the infection prevention and control programs.

For many of us in infection prevention, the mandated reporting for Medicare reimbursement through the Center for Medicare and Medicaid Services is time consuming and can account for 5 hours of our work day. Now, adding in the required state reporting increases the work load.

Read about the limitations associated with HAI reporting laws.

#1: Investigators Develop Tool to Measure Intact HIV Proviruses

A new tool may accurately assess the HIV reservoir in patients and could help target treatment of the disease, according to a research letter published in the journal Nature.

"If you want to seriously try to eradicate it, you have to know what you're dealing with," Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Disease (NIAID), told Contagion^®.

The assay can accurately distinguish between intact and defective proviruses that lie latent within infected cells and will enable physicians to determine the extent to which their interventions are effective.

"It's a technical advance to allow us to accurately assess the size and the extent of the reservoir," Dr. Fauci said in the interview, calling the reservoir "one of the real stumbling blocks in curing HIV infection."

Funded by the NIAID, which is part of the National Institutes of Health, the research examined 431 HIV-1 genome sequences taken from 28 patients with HIV-1 undergoing suppressive antiretroviral therapy. The team, led by Robert F. Siliciano, MD, at Johns Hopkins University School of Medicine, mapped deletions and lethal mutations and then developed genetic probes to distinguish flawed proviruses from intact proviruses. Using a nanotechnology method, the team counted how many proviruses were intact.

Among the 28 patients studied, 24 had suppression of viruses in the blood for longer than 6 months when studied and 5 showed viruses in the blood at the time of the study. Defects in the proviruses varied depending on when the antiretroviral therapy was started and the amount of virus detectable in the blood.

"Our results show that the small subset of proviruses with the potential to cause viral rebound show different dynamics than the vast excess of defective proviruses captured in standard PCR assays, emphasizing the importance of direct measurement of intact proviruses," the investigators wrote in their research letter. "The availability of a scalable assay for intact proviruses should accelerate cure research."

Read about measuring intact HIV proviruses.