Top Infectious Disease News of the Week—June 16, 2019

#5: A Decade After the 2009 H1N1 Pandemic: Where Are We Now?

It’s been 10 years since the beginning of the worldwide (H1N1)pdm09 influenza virus pandemic, and while preparedness to detect and respond to influenza pandemics has improved in the decade since, it remains 1 of the greatest public health challenges of our time.

According to estimates from the US Centers for Disease Control and Prevention (CDC), the United States saw 60.8 million cases, 274,304 hospitalizations, and 12,469 deaths due to H1N1 virus between April 12, 2009 to April 10, 2010. Worldwide, the virus caused an estimated 151,700-575,400 deaths. In an interview with Contagion^®, William Schaffner, MD, past president of the National Foundation for Infectious Diseases pointed out just how hard it is to predict the severity of flu from season to season.

“As we say in the trade, if you’ve seen 1 flu season, you’ve seen 1 flu season,” joked Schaffner about the mutable virus. “Almost at any time could we have a major new influenza pandemic with a new virus such as 2009.”

Read about pandemic preparedness.

#4: Investigators Use Experimental Flu Drug to Cure Tick-Borne Virus in Mice

Bourbon virus, a recently discovered tick-borne virus, is rare but can be deadly. The virus has only been confirmed on 3 occasions, with 2 cases resulting in death, due to a lack of specific treatments for the virus. However, a team of investigators from Washington University School of Medicine in St. Louis has successfully cured mice infected with the virus by treating the animals with an experimental antiviral flu drug.

For the research, published in the journal PLOS Pathogens, the investigators evaluated the drug favipiravir, which is approved in Japan for the treatment of influenza. This drug was selected because influenza virus is a distant cousin of Bourbon virus and favipiravir inhibits a key protein that the tick-borne virus requires for multiplication.

The research team, led by Jacco Boon, PhD, an assistant professor of medicine, were limited to conducting the study in an animal model due to the rarity of the infection in humans.

Read about curing Bourbon virus in mice.

#3: PrEP-Related Bone Density Loss Most Concerning Among Young MSM, Study Says

The effects of HIV pre-exposure prophylaxis (PrEP) on bone mineral density (BMD) have been a topic of ongoing study. A new study involving young men who have sex with men that aimed to determine whether a loss of BMD reverses after discontinuation of the treatment revealed some improvement with some lingering concerns, particularly among the youngest participants.

The study, published in the journal Clinical Infectious Diseases, examined data from 2 open-label studies of tenofovir disoproxil fumarate with emtricitabine (TDF/FTC) given once orally for 48 weeks. Study participants included men ages 15-22 years and the investigators measured BMD and bone mineral content (BMC) at baseline, 24 and 48 weeks by dual-energy X-ray absorptiometry, at lumbar spine, total hip and whole body.

The study found partial or full BMD recovery 48 weeks after discontinuation of PrEP, with lumbar spine and whole-body BMD Z scores remained below baseline for those ages 15-19 years.

Read about bone density loss in young MSM.

#2: Tackling Dirty Sinks

For decades we’ve been taught that hand hygiene is the most critical aspect of infection control. Although that may be true, what about the sinks and faucets? These oft overlooked areas can easily pose infection control risks. How clean can your hands really be if the sink and faucet are heavily contaminated and dirty? The topic of slime and biofilm is increasingly being brought up as we focus more on vulnerabilities in health care and the role of environmental contamination.

Earlier this year, there were studies that identified sink proximity to toilets as a risk factor for contamination. Bugs like Klebsiella pneumoniae carbapenemase-producing organisms tend to be prolific in moist environments and are often pervasive in intensive care unit sinks and drains. Researchers found that sinks near toilets were 4-times more likely to host the organisms than those further from toilets.

More and more, infection prevention is having to look at hospital faucets and sinks for their role in hosting microbial growth. This was also a topic of interest at last week’s annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC 2019). Investigators with the University of Michigan Health System discussed how they worked to identify vulnerabilities and potential sink designs that might contribute to bioburden and biofilm in hospital faucets. Assessing 8 different designs across 4 intensive care units, the research team ultimately found that those sinks with a more shallow depth tended to allow higher rates of contamination (ie, splash of dirty water) onto equipment, surfaces, and patient care areas. In some instances, the splash of contaminated water could be found up to 4 feet from the sink.

Read about tackling dirty sinks.

#1: Dr. Drew Urges Clinicians to Speak Up on West Coast Infectious Disease Crisis

Drew Pinsky, MD, is calling on his peers in medicine to help sound the alarm about the abysmal conditions on the Pacific Coast driving the explosion of infectious diseases that have some cities, particularly Los Angeles, teetering on the brink of a humanitarian crisis.

“Speak up and talk about what you’re seeing in the emergency rooms and in the clinics. We are the early detection systems. We know what’s going on before anybody. We see the trends, we know what they are, we see it coming,” Pinsky, an internist and globally recognized addiction medicine specialist, told Contagion®in an exclusive interview.

The problem stems from the homeless population, Pinsky said, and the “gigantic unsanitary accumulations” that go hand-in-hand with thousands of people living on the streets.

“It is an absolute complete breakdown where the people living on the streets are defecating and urinating and every excrement, every byproduct of what they’re eating and food and everything else is just piling in the streets,” he explained.

The number of people experiencing homelessness in Los Angeles County rose 12% this year, and increased 16% within the city itself, according to newly released statistics from the Los Angeles Homeless Services Authority.

The uptick in the rate of people without permanent housing, coupled with a dip in the vaccination rate and a rise in medical exemptions to vaccines, has created a trifecta of opportunity for infectious disease that has health experts worried about a potential pandemic. Factor in the crumbling sanitation infrastructure and there are all the makings of a serious public health emergency.

Among large homeless populations “there is…an increased risk for communicable or infectious diseases, such as hepatitis A, associated with a lack of proper sanitation (especially the lack of hand-washing, bathing, and clothes-washing facilities) as well as for those associated with rodent infestations and the insect vectors they can carry,” a spokesperson with the Los Angeles County Department of Public Health told Contagion®.

Read more of Contagion®’s interview with Dr. Drew Pinsky.