Outbreak Summary

Home , Ebola, Monkeypox, Monkeypox virus

JANUARY 2019 INFECTION PREVENTION NEWS & UPDATES

FAST FACTS ADENOVIRUS Similar to the adenovirus outbreak in New Jersey reported last month,

Severity Maryland is also experiencing an adenovirus outbreak that has infected 22 LOCAL OUTBREAK college students with one death at the University of Maryland. A number of additional students are believed to have been affected, but have already recovered as testing was not started until recently. Many of those infected display symptoms of a respiratory infection which can be confused Transmission CONTACT + DROPLET as influenza or a cold, likely contributing to the delay in identifying the outbreak.

Adenovirus causes an upper respiratory tract infection, but can be fatal in some people, especially children.

Location USA WHAT YOU SHOULD KNOW

Preventing Adenovirus infections involves hand hygiene, environmental disinfection, and respiratory hygiene practices. Where infants are involved or if the infected person has diarrhea, hand hygiene after diapering or after using the toilet are also important. The virus causing this illness is hard to kill and AHP hydrogen peroxide disinfectants are the best option to kill it as low level disinfectants have minimal effect on non-enveloped viruses such as Adenovirus.

FAST FACTS EBOLA INFECTION The second outbreak of Ebola virus in the Democratic Republic of the

Severity Congo (DRC) has increased to 542 cases and 319 deaths, demonstrating LOCAL OUTBREAK that the outbreak has not been stopped despite significant efforts on the part of the WHO and the government of the DRC and the vaccination of more than 42,000 people.

Transmission CONTACT + DROPLET The Ebola virus causes an infection that includes hemorrhagic fever and has a high mortality rate. The virus is transmitted via contaminated blood and body fluids. Initial symptoms include: sudden onset fever, intense weakness, muscle pain, headache and sore throat. Following the initial symptoms, the person develops vomiting, diarrhea, rash, reduced kidney and liver function, and in some cases, bleeding.

Location DEMOCRATIC REPUBLIC OF THE CONGO

WHAT YOU SHOULD KNOW

It can take up to 21 days for symptoms to start after exposure to contaminated blood or body fluids. People believing they may have become exposed to Ebola virus should seek medical attention immediately if they show the early symptoms listed above, especially if they have travelled to an area with the risk of exposure to the Ebola virus or have been in contact with someone suspected of having Ebola virus infection.

FAST FACTS HEPATITIS A Additional states in the US are also reporting an increase in Hepatitis A

Severity cases as the outbreak in the US continues. Indiana reports 697 cases LOCAL OUTBREAK versus a typical year of 20 cases per year. Arkansas has reported 200+ cases versus the 3-5 cases they typically see in a year. Kentucky provided updates on their case counts through the end of the year with 3,265 cases since Aug 2017 with 21 deaths. The case totals are increasing with 100+ Transmission CONTACT cases per week being reported.

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 Location USA 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 MALARIA South Africa typically sees sustained transmission of malaria from

Severity mosquitoes. Through the end of Oct they report 16,000+ cases of malaria LOCAL OUTBREAK with 110 deaths. This is more than average over the last 10 years, but less than in 2017, which saw the highest case totals in a decade.

Malaria is caused by the Plasmodium parasite that infects Anopheles Transmission VECTOR mosquitoes, which in turn infects people. There are more than 100 species of Plasmodium parasite that can infect animals and people. There are an estimated 214 million cases of malaria each year in people resulting in 438,000 deaths, mostly children in Africa.

Location SOUTH AFRICA WHAT YOU SHOULD KNOW

As Malaria is transmitted via mosquitos, control of mosquitoes is an important part of combatting Malaria infections, including use of mosquito repellants and eliminating breeding grounds for mosquitoes. If traveling to an area with high levels of Malaria, recommended precautions include the use of Malaria pills, insect repellant, long-sleeved clothing, bed nets, and the use of door and window screens or air conditioning (to reduce the potential for mosquitoes to enter buildings).

FAST FACTS ACUTE FLACCID MYELITIS - NON-POLIO ENTEROVIRUS Severity New cases of Acute Flaccid Myelitis (AFM) continue to be reported in MULTI-COUNTRY OUTBREAK a number of states in the US with Michigan being the latest to report a spike in cases. The UK recently reported 28 cases of AFM in England with Enterovirus EV-D68 being identified in about half the cases, which is

Transmission believed to be capable of causing AFM. CONTACT + DROPLET The disease typically starts with a fever and often with a respiratory infection and results in Acute Flaccid Myelitis 3-10 days later, which is a polio-like symptom that causes paralysis of the limbs over a period of time. Children between 2 -8 are at highest risk. AFM occurs as a result of certain infections, including non-polio enteroviruses. While not polio, infections that result in Acute Flaccid Myelitis (AFM) are often called

Location “polio-like” because the enteroviruses causing the infection are similar USA, UK to polio and have the potential to cause AFM as a result of the infection. Enteroviruses often cause minor respiratory diseases including Hand, Foot, and Mouth disease. However severe complications are possible including meningitis, encephalitis and acute flaccid paralysis.

WHAT YOU SHOULD KNOW

Preventing enterovirus infections hand hygiene, environmental disinfection, and respiratory hygiene practices. The virus causing this illness is hard to kill and AHP disinfectants are the best option to kill it as low level disinfectants have minimal effect on enteroviruses. Because the virus can be present in feces, changing the diaper of a baby with an enterovirus infection should be followed by thorough hand washing.

FAST FACTS TICK-BORNE ENCEPHALITIS The Czech Republic is experiencing an outbreak of tick-borne encephalitis

Severity with 690 cases so far this year which is slightly higher than in 2017 LOCAL OUTBREAK but the highest level since 2006. The Czech authorities are seeking to increase vaccination broadly across the country to help slow the growth of the infection.

Transmission VECTOR There is a vaccination available to prevent tick-borne encephalitis, but most people do not get the vaccination, making them much more susceptible to the infection. Tick-borne encephalitis is caused by the tick- borne encephalitis virus (TBEV), which is a member of the Flaviviridae family of viruses.

Location CZECH REPUBLIC WHAT YOU SHOULD KNOW

Preventing tick bites requires people to avoid bushes and tall grass and wearing clothing that covers the arms, legs, and feet, and checking the body for ticks after being outside.

FAST FACTS MONKEYPOX The Monkeypox outbreak in Nigeria from late 2017 was believed to have

Severity stopped, but there continue to be small clusters of cases reported on a LOCAL OUTBREAK regular basis, making public health authorities think the outbreak is now increasing. 15 new cases were reported in December with 114 cases in 2018 in total. The outbreak which started in 2017 has seen 311 people infected in total and genetic epidemiology has shown that person to person Transmission CONTACT + DROPLET + VECTOR transmission is occurring.

Monkeypox is caused by the monkeypox virus which is part of the orthopoxvirus genus of viruses, which is the family of viruses that includes smallpox. The virus is usually found only in Africa, but there have been occasional instances of infections outside Africa caused by infected animals traveling from Africa. The natural reservoir is unknown but believed to involve African rodents. There are two forms of the disease – Location NIGERIA Central African Monkeypox, which is the severe form of the disease, and West African Monkeypox, which is a mild form of the disease.

WHAT YOU SHOULD KNOW

Preventing monkeypox virus infection involves avoiding contact with sick or dead animals that may be infected, performing hand hygiene, bathing, and laundering of clothing that may have come in contact with an infected person, avoiding contact with bedding that may be contaminated with the blood or body fluids of an infected person or animal, and using appropriate personal protective equipment when caring for an infected person.

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