10/25/2024

Public Health Infection Control Weekly Update for 10.25.24

Infection Control and Public Health Weekly Meeting Summary
10.25.2024

Pertussis Cases at University of Cincinnati

• Ongoing outbreak of pertussis at UC (symptom based and PCR diagnosis) requiring isolation congregate living exposures in dorms. Masks required for outside activities.  Antibiotic prophylaxis with azithromycin x 5 days.   Letters sent to potentially exposed classmates.
• Letter sent to all students. Looking at vaccination rates in dorms
• Respiratory / droplet isolation 5 days of antibiotic (otherwise 21 days of symptoms) from the first day of paroxysms.
• Pertussis is Class B Reportable in Ohio (report by the end of the next business day after the existence of a case, a suspected case, or a positive laboratory result is known.)
• Most cases occur in children under five years, although the number of cases in adolescents and adults is increasing, probably due to waning of vaccine immunity.
• Pertussis is thought to account for up to 7% of cough illnesses per year in adults.
• The incubation period is usually 7 to 10 days, with a range of 4 to 21 days.

This OAC guidance is reflected in the IDCM entry for pertussis, as well: https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/section3/section-3-pertussis

Update - Critical National Shortage of IV Fluids

• Baxter was able to get much of their IV fluid stock out of the North Carolina plant prior to the arrival of Hurricane Helene but it is not anticipated that the plant will be back to full operation for another two months. 
• In collaboration with HHS and the FDA, Baxter activated seven plants worldwide, resulting in ability to increase allocation from 40% to 60%.  
• FDA authorization permits the temporary importation from five Baxter facilities located in Canada, China, Ireland and the U.K., covering 19 IV solution and dialysis production codes. 
• S. has invoked the Defense Production Act, a wartime power that will prioritize resources to Baxter to clean and rebuild its facility.

Peritoneal Dialysis

• Two primary suppliers (Baxter and Fresenius) will not be able manufacture enough peritoneal dialysis fluids to support
• No new starts on peritoneal dialysis. 
• Hospitalized patients on peritoneal dialysis asked to bring home supply of PD fluids
• May need to transition to hemodialysis short term

Irrigation Fluids Shortage

• Unlike IV fluids, the utilization rate of irrigation fluids has not significantly decreased. 
• Mostly lactated ringers

Marburg Update

• Department of Homeland Security routing passengers from Rwanda to three designated ports of entry for public health screenings - Chicago O’Hare (ORD), New York (JFK), and Washington-Dulles (IAD).
• CDC text messages to travelers include the following: “Watch for these Marburg disease symptoms until 21 days AFTER you left Rwanda: fever, chills, headache, muscle aches, rash, chest pain, sore throat, nausea, vomiting, diarrhea, or unexplained bleeding or bruising (late stage).”

Hamilton County Overdose Deaths First Half of 2024

• 129 overdose deaths (Q1/Q2 2024)
• Fentanyl was detected in 64% and Xylazine detected in 43% of presumptive overdoses –
• 71% of cases had three or more substances in their system at time of death (12% had a single substance detected)

FDA Approves First Home COVID-19/Flu Combo Test

The FDA has granted marketing authorization for the Healgen Rapid Check COVID-19/Flu A&B Antigen Test.  The test detects SARS-CoV-2, influenza A, and influenza B proteins and provides results in approximately 15 minutes.  Authorized for home use without a prescription and suitable for individuals aged 14 and older (self-testing) or 2 and older (adult-administered).

A study involving symptomatic individuals showed the following accuracy rates:

• SARS-CoV-2: 99% negative and 92% positive sample identification
• Influenza A and B: 99.9% negative sample identification
• Influenza A: 92.5% positive sample identification
• Influenza B: 90.5% positive sample identification

Increasing THC Content of Marijuana

• Cannabinoid receptors in the brain named anandamides, a Sanskrit word for “supreme joy.” 
• These receptors are found all over the brain and are still called endocannabinoid receptors. 
• Prior to the 1990s it was less than 2%. In the 1990s it grew to 4%, and between 1995 and 2015 there has been a 212% increase in THC content in the marijuana flower. In 2017 the most popular strains found in dispensaries had a range of THC content from 17–28%. 
• Marijuana plants that produce higher levels of THC produce less CBD. 
• Concentrated THC products such as vaping oil and edibles that have THC concentration upwards of 95%.   

Public Health Tuberculosis Summit

Wednesday, Nov 20; Zoom only, 5:00 - 6:15 pm

Zoom info to follow.

DPIC Infectious disease hotline: 877-774-4636