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Regional Emergence of Candida auris in Chicago and Lessons Learned from Intensive Follow-Up at One Ventilator-Capable Skilled Nursing Facility

Pacilli, Massimo; Kerins, Janna L; Clegg, Whitney J; Walblay, Kelly A; Adil, Hira; Kemble, Sarah K; Xydis, Shannon; McPherson, Tristan D; Lin, Michael Y; Hayden, Mary K; Froilan, Mary Carl; Soda, Elizabeth; Tang, Angela S; Valley, Ann; Forsberg, Kaitlin; Gable, Paige; Moulton-Meissner, Heather; Sexton, D Joseph; Jacobs Slifka, Kara M; Vallabhaneni, Snigdha; Walters, Maroya Spalding; Black, Stephanie R
BACKGROUND:Since the identification of the first two Candida auris cases in Chicago, Illinois, in 2016, ongoing spread has been documented in the Chicago area. We describe C. auris emergence in high-acuity long-term healthcare facilities and present a case-study of public health response to C. auris and carbapenemase-producing organisms (CPOs) at one ventilator-capable skilled nursing facility (vSNF A). METHODS:We performed point prevalence surveys (PPSs) to identify patients colonized with C. auris, infection control (IC) assessments, and provided ongoing support for IC improvements in Illinois acute and long-term care facilities during August 2016-December 2018. During 2018, we initiated a focused effort at vSNF A, and conducted seven C. auris PPSs; during four PPSs, we also performed CPO screening and environmental sampling. RESULTS:During August 2016-December 2018 in Illinois, 490 individuals were found to be colonized or infected with C. auris. PPSs identified highest prevalence of C. auris colonization in vSNF settings (prevalence 23-71%). IC assessments in multiple vSNFs identified common challenges in core IC practices. Repeat PPSs at vSNF A in 2018 identified increasing C. auris prevalence from 43% to 71%. Most residents screened during multiple PPSs remained persistently colonized with C. auris. Among 191 environmental samples collected, 39% were positive for C. auris, including samples from bedrails, windowsills, and shared patient-care items. CONCLUSIONS:High burden in vSNFs along with persistent colonization of residents and environmental contamination point to the need for prioritizing IC interventions to control spread of C. auris and CPOs.
PMID: 32291441
ISSN: 1537-6591
CID: 4453172

Lack of Serologic Evidence of Infection Among Health Care Personnel and Other Contacts of First 2 Confirmed Patients With COVID-19 in Illinois, 2020

McPherson, Tristan D; Ghinai, Isaac; Binder, Alison M; Freeman, Brandi D; Hoskin Snelling, Chantel; Hunter, Jennifer C; Anderson, Kristin M; Davenport, Polly; Rudd, Deborah L; Zafer, Mujeeb; Christiansen, Demian; Joshi, Kiran; Rubin, Rachel; Black, Stephanie R; Fricchione, Marielle J; Pacilli, Massimo; Walblay, Kelly A; Korpics, Jacqueline; Moeller, Darcie; Quartey-Kumapley, Pearl; Wang, Chen; Charles, E Matt; Kauerauf, Judy; Patel, Megan T; Disari, Vishal S; Fischer, Marc; Jacobs, Max W; Lester, Sandra N; Midgley, Claire M; Rasheed, Mohammed Ata Ur; Reese, Heather E; Verani, Jennifer R; Wallace, Megan; Watson, John T; Thornburg, Natalie J; Layden, Jennifer E; Kirking, Hannah L
OBJECTIVES/OBJECTIVE:Widespread global transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (COVID-19), continues. Many questions remain about asymptomatic or atypical infections and transmission dynamics. We used comprehensive contact tracing of the first 2 confirmed patients in Illinois with COVID-19 and serologic SARS-CoV-2 antibody testing to determine whether contacts had evidence of undetected COVID-19. METHODS:Contacts were eligible for serologic follow-up if previously tested for COVID-19 during an initial investigation or had greater-risk exposures. Contacts completed a standardized questionnaire during the initial investigation. We classified exposure risk as high, medium, or low based on interactions with 2 index patients and use of personal protective equipment (PPE). Serologic testing used a SARS-CoV-2 spike enzyme-linked immunosorbent assay on serum specimens collected from participants approximately 6 weeks after initial exposure to either index patient. The 2 index patients provided serum specimens throughout their illness. We collected data on demographic, exposure, and epidemiologic characteristics. RESULTS:Of 347 contacts, 110 were eligible for serologic follow-up; 59 (17% of all contacts) enrolled. Of these, 53 (90%) were health care personnel and 6 (10%) were community contacts. Seventeen (29%) reported high-risk exposures, 15 (25%) medium-risk, and 27 (46%) low-risk. No participant had evidence of SARS-CoV-2 antibodies. The 2 index patients had antibodies detected at dilutions >1:6400 within 4 weeks after symptom onset. CONCLUSIONS:In serologic follow-up of the first 2 known patients in Illinois with COVID-19, we found no secondary transmission among tested contacts. Lack of seroconversion among these contacts adds to our understanding of conditions (ie, use of PPE) under which SARS-CoV-2 infections might not result in transmission and demonstrates that SARS-CoV-2 antibody testing is a useful tool to verify epidemiologic findings.
PMID: 33108976
ISSN: 1468-2877
CID: 4645752

Community Transmission of SARS-CoV-2 at Two Family Gatherings - Chicago, Illinois, February-March 2020

Ghinai, Isaac; Woods, Susan; Ritger, Kathleen A; McPherson, Tristan D; Black, Stephanie R; Sparrow, Laura; Fricchione, Marielle J; Kerins, Janna L; Pacilli, Massimo; Ruestow, Peter S; Arwady, M Allison; Beavers, Suzanne F; Payne, Daniel C; Kirking, Hannah L; Layden, Jennifer E
SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), has spread rapidly around the world since it was first recognized in late 2019. Most early reports of person-to-person SARS-CoV-2 transmission have been among household contacts, where the secondary attack rate has been estimated to exceed 10% (1), in health care facilities (2), and in congregate settings (3). However, widespread community transmission, as is currently being observed in the United States, requires more expansive transmission events between nonhousehold contacts. In February and March 2020, the Chicago Department of Public Health (CDPH) investigated a large, multifamily cluster of COVID-19. Patients with confirmed COVID-19 and their close contacts were interviewed to better understand nonhousehold, community transmission of SARS-CoV-2. This report describes the cluster of 16 cases of confirmed or probable COVID-19, including three deaths, likely resulting from transmission of SARS-CoV-2 at two family gatherings (a funeral and a birthday party). These data support current CDC social distancing recommendations intended to reduce SARS-CoV-2 transmission. U.S residents should follow stay-at-home orders when required by state or local authorities.
PMID: 32298246
ISSN: 1545-861x
CID: 4453182

Active Monitoring of Persons Exposed to Patients with Confirmed COVID-19 - United States, January-February 2020

Burke, Rachel M; Midgley, Claire M; Dratch, Alissa; Fenstersheib, Marty; Haupt, Thomas; Holshue, Michelle; Ghinai, Isaac; Jarashow, M Claire; Lo, Jennifer; McPherson, Tristan D; Rudman, Sara; Scott, Sarah; Hall, Aron J; Fry, Alicia M; Rolfes, Melissa A
In December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, began in Wuhan, China (1). The disease spread widely in China, and, as of February 26, 2020, COVID-19 cases had been identified in 36 other countries and territories, including the United States. Person-to-person transmission has been widely documented, and a limited number of countries have reported sustained person-to-person spread.* On January 20, state and local health departments in the United States, in collaboration with teams deployed from CDC, began identifying and monitoring all persons considered to have had close contact† with patients with confirmed COVID-19 (2). The aims of these efforts were to ensure rapid evaluation and care of patients, limit further transmission, and better understand risk factors for transmission.
PMID: 32134909
ISSN: 1545-861x
CID: 4453152

Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States

Burke, Rachel M; Balter, Sharon; Barnes, Emily; Barry, Vaughn; Bartlett, Karri; Beer, Karlyn D; Benowitz, Isaac; Biggs, Holly M; Bruce, Hollianne; Bryant-Genevier, Jonathan; Cates, Jordan; Chatham-Stephens, Kevin; Chea, Nora; Chiou, Howard; Christiansen, Demian; Chu, Victoria T; Clark, Shauna; Cody, Sara H; Cohen, Max; Conners, Erin E; Dasari, Vishal; Dawson, Patrick; DeSalvo, Traci; Donahue, Matthew; Dratch, Alissa; Duca, Lindsey; Duchin, Jeffrey; Dyal, Jonathan W; Feldstein, Leora R; Fenstersheib, Marty; Fischer, Marc; Fisher, Rebecca; Foo, Chelsea; Freeman-Ponder, Brandi; Fry, Alicia M; Gant, Jessica; Gautom, Romesh; Ghinai, Isaac; Gounder, Prabhu; Grigg, Cheri T; Gunzenhauser, Jeffrey; Hall, Aron J; Han, George S; Haupt, Thomas; Holshue, Michelle; Hunter, Jennifer; Ibrahim, Mireille B; Jacobs, Max W; Jarashow, M Claire; Joshi, Kiran; Kamali, Talar; Kawakami, Vance; Kim, Moon; Kirking, Hannah L; Kita-Yarbro, Amanda; Klos, Rachel; Kobayashi, Miwako; Kocharian, Anna; Lang, Misty; Layden, Jennifer; Leidman, Eva; Lindquist, Scott; Lindstrom, Stephen; Link-Gelles, Ruth; Marlow, Mariel; Mattison, Claire P; McClung, Nancy; McPherson, Tristan D; Mello, Lynn; Midgley, Claire M; Novosad, Shannon; Patel, Megan T; Pettrone, Kristen; Pillai, Satish K; Pray, Ian W; Reese, Heather E; Rhodes, Heather; Robinson, Susan; Rolfes, Melissa; Routh, Janell; Rubin, Rachel; Rudman, Sarah L; Russell, Denny; Scott, Sarah; Shetty, Varun; Smith-Jeffcoat, Sarah E; Soda, Elizabeth A; Spitters, Christopher; Stierman, Bryan; Sunenshine, Rebecca; Terashita, Dawn; Traub, Elizabeth; Vahey, Grace M; Verani, Jennifer R; Wallace, Megan; Westercamp, Matthew; Wortham, Jonathan; Xie, Amy; Yousaf, Anna; Zahn, Matthew
Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19.
PMID: 32877446
ISSN: 1932-6203
CID: 4583672

Health Literacy and Demographic Disparities in HIV Care Continuum Outcomes

Rebeiro, Peter F; McPherson, Tristan D; Goggins, Kathryn M; Turner, Megan; Bebawy, Sally S; Rogers, William B; Brinkley-Rubinstein, Lauren; Person, Anna K; Sterling, Timothy R; Kripalani, Sunil; Pettit, April C
Studies evaluating the association between human immunodeficiency virus (HIV) infection continuum of care outcomes [antiretroviral (ART) adherence, retention in care, viral suppression] and health literacy have yielded conflicting results. Moreover, studies from the southern United States, a region of the country disproportionately affected by the HIV epidemic and low health literacy, are lacking. We conducted an observational cohort study among 575 people living with HIV (PLWH) at the Vanderbilt Comprehensive Care Clinic (Nashville, Tennessee). Health literacy was measured using the brief health literacy screen, a short tool which can be administered verbally by trained clinical personnel. Low health literacy was associated with a lack of viral suppression, but not with poor ART adherence or poor retention. Age and racial disparities in continuum of care outcomes persisted after accounting for health literacy, suggesting that factors in addition to health literacy must be addressed in order to improve outcomes for PLWH.
PMCID:6051900
PMID: 29560569
ISSN: 1573-3254
CID: 4453132

Cabotegravir in the treatment and prevention of Human Immunodeficiency Virus-1

McPherson, Tristan D; Sobieszczyk, Magdalena E; Markowitz, Martin
INTRODUCTION/BACKGROUND:Human Immunodeficiency Virus (HIV) is a chronic infection that depletes the immune system of essential components causing those infected to be at risk for multiple life-threatening infections. Worldwide, millions live with this infection, the vast majority attributable to HIV-1. Transmission persists with hundreds of thousands of new infections reported yearly. Implementation of combination antiretroviral therapy (cART) has been effective in improving outcomes and decreasing transmission. Newer co-formulated agents have provided simpler medication regimens, fewer side effects, and, in some cases, a higher barrier to the emergence of medication resistance. Areas covered: Here, we review trials of cabotegravir (CAB) as treatment of HIV-1 infection and its potential use as pre-exposure prophylaxis (PrEP) in high risk individuals, including issues around oral lead in and potential resistance emergence. Expert opinion: CAB is efficacious when used in combination therapy orally or given intramuscularly every 4 to 8 weeks. Its availability in a long-acting injectable formulation (CAB-LA) makes it a valuable, novel drug to treat HIV-1 infection when combined with long-acting injectable rilpivirine (RPV-LA). Moreover, pre-clinical and early Phase 2a studies support its testing as monotherapy as PrEP. Studies are underway comparing the efficacy of every 8 week CAB-LA to tenofovir disoproxil fumarate/emtricitabine (TDF/FTC).
PMID: 29633869
ISSN: 1744-7658
CID: 4453142