Infection Prevention News & Updates

APRIL 2018 INFECTION PREVENTION NEWS & UPDATES

FAST FACTS HEPATITIS A Hepatitis A outbreaks continue to occur as the global prevalence appears

Severity to be rapidly increasing. Victoria Australia is seeing its outbreak grow with MULTI-COUNTRY OUTBREAK 58 confirmed cases, 7 probably cases, 16 cases under early investigation, and one death. Being homeless or an IV drug user is associated with a higher probability of becoming infected. The initial laboratory analysis suggests the strain is similar to a strain circulating in Europe, suggesting Transmission CONTACT there is a travel associated case linking the outbreaks.

The outbreak in Kentucky in the US is continuing to grow with 150 cases, 124 of which are in the greater Louisville area. As with other outbreaks, the homeless and IV drug users are at a higher risk of getting disease. The Utah outbreak has 217 confirmed cases. Genetic sequencing of the virus has shown that the Arizona and California outbreaks reported previously are tied to these outbreaks as well. Location AUSTRALIA, USA Hepatitis A is an infection that causes an inflammation of the liver. There are a number of viruses that can cause Hepatitis including Hepatitis A, Hepatitis B, and Hepatitis C, with vaccinations available for Hepatitis A and Hepatitis B. Hepatitis A is passed to other people through contact with infected feces, or if an infected person touches objects after using the toilet and not washing their hands, including contaminating food or drink from contact with contaminated hands, so handwashing and surface disinfection are important interventions to prevent the spread of the virus. It can also be spread by sexual contact. The virus can also be spread through contact with diapers or the stool of an infected child/person. It can take from 15-50 days to develop symptoms once infected.

WHAT YOU SHOULD KNOW

Preventing Hepatitis A infections involves vaccination of high risk people, hand hygiene, environmental disinfection, and safe sexual practices. The virus causing this illness is hard to kill and AHP hydrogen peroxide disinfectants are the best option to kill it on environmental surfaces as low level disinfectants have minimal effect on Hepatitis A virus. In countries where disinfectants are often not used when cleaning, this is especially concerning because the virus can survive for periods of time in the environment in feces (most likely days to weeks) which allows for time for them to be transmitted from person to person. A highly effective vaccination is available and people may want to proactively vaccinate themselves to protect against this infection. FAST FACTS MEASLES VIRUS As with many countries in Europe, France is reporting an increase in

Severity cases of measles. France reports 1,077 cases since Nov 17 primarily as MULTI-COUNTRY OUTBREAK a result of inadequate vaccination. Where infants are recommended to have 2 doses of the vaccination and a country should strive to maintain a vaccination rate of >95% for infants, in France the current rate is 79%.

Transmission CONTACT + DROPLET + AEROSOL The European outbreak of measles is also affecting neighboring Ukraine with 8,434 reported cases in 2018 with 2,956 being adults and 5,478 being children. As measles is a disease that primarily affects unvaccinated children, this follows global trends.

Measles is considered one of the most contagious infectious diseases and is a respiratory infection spread by coughing and sneezing with an incubation period of about 10 days (range of 7-18 days). People infected Location UKRAINE, FRANCE with measles can suffer from side effects including encephalitis, pneumonia, and the infection can be fatal, especially for children. Measles is the leading cause of vaccine preventable death with an estimated 134,200 deaths globally in 2015. Prior to widespread vaccination in 1980, there were ~2.6 million deaths globally each year.

WHAT YOU SHOULD KNOW

Outbreaks of measles are usually related to a lack of vaccination. It is important that all people receive both doses of the MMR vaccine to ensure a high degree of immunity and any recommended boosters. The best defense is for all staff to be immunized. Facilities should have immunization requirements to protect staff and customers. FAST FACTS YELLOW FEVER Brazil’s Yellow Fever outbreak continues to grow. In the last 9 months

Severity there have been 1,098 confirmed cases with 340 deaths. It is not unusual LOCAL OUTBREAK to have Yellow Fever in Brazil; but the recent case counts are more than 50% higher than 2017.

The virus that causes Yellow Fever is spread by Aedes mosquitoes, and as Transmission CONTACT + VECTOR (MOSQUITO) with Dengue and Zika, efforts to control Yellow Fever center on mosquito control. The symptoms of Yellow Fever are similar to other mosquito- borne diseases, including fever, chills, headache, back pain, body aches, nausea, and fatigue, but can include jaundice (yellowing of skin color), which is how the infection was named. While most people that get Yellow Fever show no symptoms, about 15% of those that show symptoms develop the more severe form of the disease, which includes the jaundice, high fever, bleeding, and eventually shock and organ failure. For those that Location BRAZIL develop the more severe symptoms, the mortality rate for Yellow Fever is 20-50%.

WHAT YOU SHOULD KNOW

If traveling to the Nigeria, you should discuss with your doctor whether you should have the Yellow Fever vaccination. Anyone planning to travel to areas of high risk for Yellow Fever will typically be advised to be vaccinated in advance. FAST FACTS NOROVIRUS An outbreak of norovirus at the Olympics in South Korea infected 283

Severity people. The investigation into the outbreak is now over and it was LOCAL OUTBREAK determined that the water talks in the portable toilets was the source of the virus. These portable toilets have a water tank for hand washing and brushing teeth and unfortunately the water used to fill the tanks was contaminated with norovirus. This highlights the risk in using portable Transmission CONTACT + DROPLET toileting and water supplies if the source of the water used in the water tanks has not been guaranteed to be drinking quality.

Norovirus is caused by a small non-enveloped virus that is hard to kill by traditional disinfectants and hand hygiene products. It is generally spread through a fecal-oral route, indicating that hand hygiene and surface hygiene play key roles in the spread of the virus, but it can also be transmitted via food, which appears to be the case here. Close contact Location SOUTH KOREA with infected persons increases the risk of transmission.

WHAT YOU SHOULD KNOW

As norovirus may not be killed by certain alcohol-based hand sanitizers or low-level disinfectants, it is important to ensure the alcohol-based hand rub and the surface disinfectant are capable of killing norovirus and that proper procedures are in place to control an outbreak once it occurs. If the source is food related, surfaces that contacted the contaminated food should be disinfected and rinsed and sanitized before reuse. FAST FACTS MUMPS VIRUS A mumps outbreak in the United States at James Madison University

Severity in Virginia has sickened 5 staff and 14 students. It is not clear what the LOCAL OUTBREAK source of the outbreak is, but an investigation is ongoing.

Mumps is an infection of the salivary glands that causes significant swelling of the glands in the neck and while side effects are rare, can Transmission CONTACT + DROPLET cause side effects such as hearing loss and meningitis. The virus causing mumps is spread via coughing, sneezing, or contact with saliva.

WHAT YOU SHOULD KNOW

Outbreaks of mumps are usually related to a lack of vaccination. It is Location USA important that all people receive both doses of the MMR vaccine and any required boosters to maintain immunity. The best protection for a facility is to ensure all staff are properly immunized. The virus can be spread by sharing common items, such as cups, dishes, and tableware and via droplets from respiratory secretions so hand hygiene and surface cleaning and disinfection are also important interventions to prevent transmission, especially for non-immunized people. FAST FACTS LEPTOSPIROSIS The island of Reunion, which is part of France but is located in the Indian

Severity ocean is experiencing a higher rate of leptospirosis infection than in recent LOCAL OUTBREAK years with 42 cases since Jan 1. Heavy rains in the region are believed to be the cause.

Leptospirosis is a zoonotic bacterial disease, meaning it occurs in animals Transmission CONTACT + DROPLET and can be transmitted to people. The Leptospira bacteria can cause inflections that include kidney damage, meningitis, liver failure, respiratory distress, and even death. The bacteria is spread through the urine of infected animals. When infected animals urinate in a fresh water body, such as a river or stream, the bacteria is transmitted into the water. If a person drinks the contaminated water without purifying it, they can become infected. Direct contact with the infected urine also can transmit the infection, but this is relatively rare. Location RÉUNION

WHAT YOU SHOULD KNOW

In the aftermath of natural disasters, people without access to safe drinking water may resort to drinking from streams, rivers, and lakes or swimming/bathing in them. If these water bodies are contaminated with Leptospira or other bacteria, infection can result. Access to safe drinking water for drinking, cooking, and bathing is essential to prevent this infection. FAST FACTS CHOLERA Yemen’s outbreak of cholera in 2017 continues to add cases but at a very

Severity slow rate. In total there have been 1,080,422 cases and 2,266 deaths since LOCAL OUTBREAK the start of the epidemic in 2017. Children under 5 years old are 28.8% of all cases. This outbreak represents one of the worst public health disasters in recent times and will undoubtedly be the source of significant investigation to see what steps could have been implemented to slow the Transmission CONTACT + VECTOR outbreak.

Cholera is an infection caused by a bacterium, Vibrio cholera. Cholera outbreaks usually occur due to contaminated water supplies especially where sewage contaminates the water supply. Cholera infections are an indication of the fragility of the water supply and waste treatment systems.

Location YEMEN WHAT YOU SHOULD KNOW

Cholera infections can be prevented by vaccination, access to clean water and proper sanitation for wastes. In countries without access to clean drinking water and proper sewage treatment, risks of a Cholera outbreak are usually significantly increased. FAST FACTS LASSA VIRUS/LASSA FEVER The new outbreak of Lassa Fever in Nigeria reported last month has

Severity continued to grow in size. There are now 1,613 suspected cases and 134 LOCAL OUTBREAK deaths. Most of the suspect cases are proving to be negative, but 394 are confirmed positive, including all the deaths.

The Lassa virus is transmitted primarily via rats which are believed to be Transmission CONTACT + DROPLET + VECTOR the primary host for the virus. Infected rats secrete the virus in urine and feces, so cleaning areas where rats are prevalent can spread the virus as can food preparation with dead rats and eating infected rats.

WHAT YOU SHOULD KNOW

Location NIGERIA Lassa Fever is a viral hemorrhagic fever with a high mortality rate and outbreaks of Lassa Fever in Africa are not unusual but are always of a concern because of the ease with which the virus can be carried to other countries by infected people. At Diversey, we reduce the risk of infection to make your facility safer

Across our customers facilities, our comprehensive cleaning, disinfection, and hand hygiene programs provide the solutions and expertise needed to reduce the risk of infection while increasing operational efficiency. INFLUENZA MILLION Diversey provides resources to help our customers manage outbreaks including providing education and training for our customers regarding best practices for cleaning, disinfection, pe3-5ople infected and hand hygiene in healthcare and public environments. globally each year 250,000 – 500,000 deaths

Our best in class solutions include the following:

AHP® Hydrogen Peroxide Disinfectants • Realistic contact times that kill VIRUS O pathogens before surfaces dry R 21 million • Excellent staff safety profile - can O people infected be used without personal protective N in the US alone equipment each year with 600-800 deaths. • Strong cleaning ability to reduce environmental bioburden • Excellent sustainability profile to reduce environmental impact • Available in a range of formats including prewetted disposable WHOOPING wipers PERTUSSIS COUGH 16 million people infected globally IntelliCare Hand Hygiene Program each year, 200,000 deaths. • Innovative dispenser including patented hybrid manual/touchless • Full product range and formats from a single dispenser 20 each i

min llion f • Electronic compliance monitoring ected globa l y program to increase efficiency ea r ,

1 • Trusted brands, such as Lux, for a 4 6 l , y 000

more home-like experience d ea t h s Our experts frequently consult with our customers on environmental hygiene practices for facilities in a wide range MEASL E of industries including healthcare, hospitality, education, offices, and public buildings such as retail stores, shopping DENGUE malls, and airports. Not all outbreaks are environmentally transmitted, but even for those with minimal environmental routes of transmission, we still help customers with other 400 aspects of prevention to create safer facilities.