MMWR News Synopsis for April 30, 2015
Outbreak of Human Pneumonic Plague with Dog-to-Human and Possible Human-to-Human Transmission — Colorado, June–July 2014
This outbreak highlights 1) the need to consider plague in the differential diagnosis of sick domestic animals from plague endemic areas, including dogs, 2) the limitations of automated diagnostic systems for identifying rare bacteria such as Yersinia pestis, and 3) the potential for milder forms of illness in patients taking antimicrobial agents. Hospital laboratories in plague-endemic areas should be aware of the limitations of current diagnostic methodologies in diagnosing rare diseases such as plague. In July 2014, the Colorado Department of Public Health and Environment Laboratory identified Yersinia pestis in a blood sample collected from a middle-aged man hospitalized with pneumonia. An investigation led by Tri-County Health Department revealed that the man’s dog had been ill and was euthanized. The dog later tested positive for Y. pestis. Three additional persons with contact with the dog and/or patient were ill and tested positive for Y. pestis. One of the cases may have resulted through person-to-person transmission from the index patient, potentially the first such event in North America since 1924. Human illness due to plague remains an ongoing risk in endemic areas. Early recognition of plague, especially the pneumonic form, is critical to clinical management and a timely public health response.
Laboratory-Acquired Vaccinia Virus Infection in a Recently Immunized Person — Massachusetts, 2013
Vaccination and laboratory-safety measures are the most important preventative measures to protect against transmission of vaccinia virus in the laboratory setting. Furthermore, it is critical that the local and/or state health departments are in communication when there is a laboratory associated infection so that patients receive appropriate treatment rapidly and control measure to reduce infection transmission are implemented. This is the first report of a laboratory-acquired vaccinia virus infection in a recently vaccinated laboratory worker. Through collaboration between the local and federal health agencies, the laboratory, and the university, the patient was rapidly assessed and received appropriate treatment. The health agencies also identified areas in the laboratory requiring improvements in occupational safety. Finally, though this is a rare report of an appropriately vaccinated laboratory worker exhibiting symptoms of infection after inadvertent inoculation, the preventative recommendations for laboratory personnel who handle cultures or animals infected with wildtype vaccinia virus are smallpox vaccination and appropriate training in laboratory-safety protocols.
Using Electronic Clinical Quality Measure Reporting for Public Health Surveillance
Using reports automatically generated from electronic health records (EHRs) for population health surveillance can save money and reduce health care providers’ workloads. Alignment of such electronic clinical-quality measures across federal and private sector programs enables clinicians to collect data once and report to a variety of programs. A collaboration across Federal programs used data from the Medicare Electronic Health Record (EHR) Incentive Program to track progress towards the Million Hearts® goal to reduce 1 million heart attacks and strokes by 2017. In 2013, approximately 63,000 health care providers reported clinical data on more than 17 million patients with hypertension. Average performance on the measure is between 60-63 percent. More than one-third of these providers are at or above the Million Hearts clinical target of 70 percent.