February 2014

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 20, No. 2, (February 2014)

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1. Fungal Endophthalmitis Associated with Compounded Products , Christina A. Mikosz et al.

Fungal endophthalmitis is a rare but serious infection of the eye. In March 2012, several cases of fungal endophthalmitis occurring after invasive ocular procedures were reported nationwide. In total, 47 cases were identified in nine states. Two products were implicated, both produced by Franck’s Compounding Lab in Ocala, Florida. Compounding is the combination, mixing, or altering of drug ingredients to create a different medication tailored to a specific need. Compounded drugs are primarily regulated at the state level, and only fall under the purview of the Food and Drug Administration in specific scenarios. These two concurrent outbreaks of fungal endophthalmitis represent neither the first outbreaks associated with contaminated compounded products nor the first investigation of Franck’s for improper compounding practices. Maintaining the safety of compounded drugs in the United States demands a thorough review and improvement of compounding pharmacy regulatory practices.

Contact:
CDC Press Office
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2. Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults, Maho Imanishi, et al.

Anthrax: Special Considerations for Pregnant and Postpartum Women, Dana Meaney-Delman, et al.

Biodefense experts currently place B. anthracis, the bacteria that causes anthrax, at or near the top of the list for potential threat agents – it is available, easy to disseminate, and systemic anthrax infections carry a high death rate. Since the 2001 anthrax attack, anthrax has been a high priority threat and a major focus of national emergency preparedness planning.  In 2011 and 2012, anthrax experts met to review and update guidelines for preventing anthrax in nonpregnant adults exposed to anthrax (postexposure prophylaxis) and for treating nonpregnant adults with anthrax . Topics discussed included use of antibiotics and antitoxins, clinical management, and future research needs such as development of tests to enable earlier diagnosis and treatment, and animal studies to evaluate currently recommended treatments. Another meeting held in 2012 focused on anthrax in pregnant, postpartum, and lactating women. These women require special consideration with regard to the prevention and treatment of infectious disease. Thus, a comprehensive plan for anthrax readiness must provide specific recommendations for inpatient and outpatient care of these women. When research leads to prevention and treatment that can reduce deaths from anthrax, then anthrax will become a less effective, and thus less desirable, bioterrorism weapon.

Contact for Drs. William Bower and Dana Meaney-Delman via: 
CDC Press Office
404-639-3286
media@cdc.gov

3. Lymphocytic Choriomeningitis Virus among Humans and Mice in a Multifacility Rodent- breeding Operation, USA, 2012, Barbara Knust et al.

Trace-Forward Investigation of Mice in Response to Lymphocytic Choriomeningitis Virus Outbreak, L. Edison et al.

Infection with lymphocytic choriomeningitis virus (LCMV) can range from mild fever to severe nervous system disease and/or severe birth defects. The virus is carried and spread by rodents, mainly the common house mouse. In April 2012, when LCMV infection was diagnosed in two workers at a rodent-breeding facility, an outbreak investigation of three such facilities found that 32 percent of employees and 21 percent of mice tested had been exposed to the virus; nine employees became ill, four of whom developed meningitis. It is presumed that wild mice transmitted the virus to the facility mice and that the outbreak spread between facilities when mice were transported for use as breeding stock. A follow-up investigation found that infected mice had been distributed from one of these breeding facilities to more than 500 locations in 21 states. All mice at the 3 breeding facilities and their distribution sites were euthanized, after which no more infections were detected in humans. Future outbreaks can be prevented by applying strict infection-control practices and by teaching employees how to prevent and recognize LCMV infection.

Contact Dr. Barbara Knust via:
CDC Press Office
404-639-3286
media@cdc.gov

For Trace-Forward Investigation of Mice in Response to Lymphocytic Choriomeningitis Virus Outbreak, contact:
Laura Edison
Georgia Department of Public Health, Acute Disease Epidemiology Section, Atlanta, GA
kgq2@cdc.gov

4. Novel Paramyxovirus Associated with Severe Acute Febrile Disease, South Sudan and Uganda, 2012, César G. Albariño et al.

In 2012, a female wildlife biologist became severely ill after returning to the United States from a 6-week field expedition to South Sudan and Uganda. As part of her work there, she had handled many types of bats and rodents while wearing different levels of personal protective equipment. The cause of her illness was identified as a new paramyxovirus, named Sosuga virus. The woman eventually recovered. Exactly how and where she contracted the virus remains unknown. However, because genetic make-up of the virus is similar to that of other paramyxoviruses carried by fruit bats, the suspected source of her infection is bats. Bats in Africa are currently being examined to determine whether they carry this new virus and thus whether they pose a risk for other people.

Contact Dr. Ute Ströher via:
CDC Press Office
404-639-3286
media@cdc.gov

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES