Report describes rare US vancomycin-resistant Staph case

News brief

A letter published today in Emerging Infectious Diseases describes a case of vancomycin-resistant Staphylococcus aureus (VRSA) identified in North Carolina in 2021. It's just the 16th confirmed case of VRSA identified in the United States since 2002.

The case-patient was a 55-year-old man with a history of diabetes, hypertension, arthritis, pulmonary disease, peripheral vascular disease, methicillin-resistant S aureus (MRSA), and vancomycin-resistant enterococci (VRE). In the 60 days prior to VRSA identification, he had been in a skilled nursing facility (SNF), an acute-care hospital (ACH), and a wound-care clinic (WCC) and had received care for a non-healing foot wound and five antibiotics, including vancomycin. The VRSA isolate was cultured from the foot wound.

Site visits by investigators from the Centers for Disease Control and Prevention, the North Carolina Department of Health and Human Services, and the Caldwell County Health Department revealed several infection-prevention and -control gaps at the SNF, including inappropriate use or absence of personal protective equipment, low adherence to hand hygiene, poor wound-care technique, inability to outline cleaning and disinfection protocols, crowded/cramped spaces, and no dedicated infection preventionist.

But screening of specimens from 115 patient contacts (83 ACH and WCC staff, 12 SNF staff, 16 SNF residents, and 4 household members) did not identify any VRSA transmission.

Concerns about emergence of more transmissible strains

The investigators say the VRSA isolate belonged to the CC45 lineage, which circulates in both healthcare facilities and the community, and that the patient's history of MRSA and VRE infections supports the theory that his VRSA infection resulted from conjugal transfer of the vancomycin-resistance gene vanA from VRE to MRSA.

"In conclusion, emergence of this unique VRSA strain highlights the potential for emergence of other novel transmissible strains," they wrote. "Although the lack of transmission is reassuring, continued vigilance and investigation for all confirmed cases is paramount given the potential for vancomycin resistance to emerge in different S. aureus lineages, thereby resulting in novel strains that are more fit and thus more transmissible."

Europe says flu, RSV on the rise and affecting health systems

News brief

Stephanie Soucheray, MA

Today, the European Centre for Disease Control and Prevention (ECDC) today posted an epidemiologic alert about a sharp rise in flu and respiratory syncytial virus (RSV) activity in most European countries.

The report said the uptake is starting to have an impact on health systems.

“The EU/EEA 10% primary care test positivity threshold signaling the start of the influenza season has been reached, with influenza A(H1N1)pdm09, A(H3N2) and B viruses co-circulating,” the ECDC said, noting that although all three seasonal flu viruses are circulating, it’s too early to identify a dominant strain.

In Australia, the flu season was being co-dominated by A(H1N1)pdm09 (47.9%) and A(H3N2) (47.7%) viruses, with very little circulation of B/Victoria-lineage viruses (4.4%).

COVID activity is stable

COVID-19 activity remains relatively stable, the ECDC noted, after increased activity this past summer. The report urged citizens and healthcare workers not yet vaccinated against COVID-19 or seasonal influenza to do so as soon as possible before next week’s holidays.

The end-of-year festive season is traditionally associated with activities such as social gatherings, shopping and travelling, which pose additional risks for intensified respiratory virus transmission.

“The end-of-year festive season is traditionally associated with activities such as social gatherings, shopping and travelling, which pose additional risks for intensified respiratory virus transmission,” the ECDC said.

First CWD case identified on Menominee Indian reservation in Wisconsin

News brief

Mary Van Beusekom, MS

White-tailed buck in Wisconsin — tuchodi / Flickr cc

Yesterday, the Menominee Indian Tribe of Wisconsin reported the first confirmed case of chronic wasting disease (CWD) on its reservation.

The affected buck was harvested by a hunter on November 19 in the southeast corner of the reservation, which is located in northeastern Wisconsin.

"As a reminder to tribal hunters, current tribal hunting regulations ban the baiting of deer on the reservation, which will remain in effect," Gena Kakkak, chair of the Menominee Tribal Legislature, said in a Facebook post. "Further, the tribe continues to encourage hunters to get their deer tested after harvest."

Infected animals appear healthy early in disease

CWD, a neurodegenerative disease caused by misfolded infectious proteins called prions, affects cervids such as deer, moose, caribou, and elk. Prions are extremely resilient and can persist in the environment for years. CWD can spread from animal to animal and through environmental contamination.

Further, the tribe continues to encourage hunters to get their deer tested after harvest.

Gena Kakkak

While no human CWD cases have been reported, the Centers for Disease Control and Prevention and the World Health Organization advise against eating meat from sick cervids and urge taking precautions when handling carcasses.

Common signs of advanced disease include weight loss, drooping head and ears, uncoordinated movement, excessive salivation, and loss of fear of humans. "Infected deer typically appear healthy for many months after contracting the disease, so OHS [Wisconsin Department of Health Services] encourages testing for the disease regardless of the physical condition of the harvested deer, especially in areas prevalent with CWD," Kakkak said.