Reminder: CRE/C.diff HAI Control COCA Call Tomorrow

 

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Although I mentioned it last week, I wanted to remind my readers of tomorrow's  COCA (Clinician Outreach and Communication Activity) call that focuses on controlling two of the biggest HAI (hospital acquired infection) risks facing healthcare today; CRE and C. difficile..

 

Although primarily of interest to clinicians, the CDC holds frequent COCA  calls which are designed to ensure that practitioners have up-to-date information for their practices.

 

Tomorrow’s COCA call is  a follow up to this month’s Vital Signs report (A Coordinated Approach To Curb The Spread Of Antibiotic Resistance), which featured mathematical modeling that projected increases in drug-resistant infections and Clostridium difficile (C. difficile) without `immediate, nationwide improvements in infection control and antibiotic prescribing’.

 

The details of the event come from the CDC’s COCA website:

 

CRE and C. difficile : Is Your Healthcare Facility Implementing the Necessary Approach to Stop the Spread?

= No Continuing Education

Date:Thursday, August 20, 2015

Time:2:00 - 3:00 pm (Eastern Time)

Join by Phone:

• 888-469-1370 (U.S. Callers)
• 517-308-9046 (International Callers)

Passcode:3791890

Join by Webinar:

https://www.mymeetings.com/nc/join.php?i=PW5080898&p=3791890&t=c

Moderator:

Arjun Srinivasan, MD
Associate Director for Healthcare-Associated Infection Prevention Programs
Division of Healthcare Quality Promotion
Centers for Disease Control and Prevention

Presenter(s):

Robert A. Weinstein, MD
Professor of Medicine
Chairman, Division of Infectious Diseases, Stroger Hospital of Cook County
Chief Operating Officer, Ruth M. Rothstein CORE Center
Co-Director, Rush Translational Sciences Consortium

Sara Cosgrove, M.D., M.S., FSHEA, FIDSA
Associate Hospital Epidemiologist
Director, Antimicrobial Stewardship Program
Associate Professor of Medicine
Johns Hopkins University School of Medicine

Overview:

We're at a tipping point: an increasing number of germs no longer respond to the drugs designed to kill them. Inappropriate prescribing of antibiotics and lack of infection control actions can contribute to drug resistant infections such as carbapenem-resistant Enterobacteriaceae (CRE) and put patients at risk for deadly diarrhea (caused by Clostridium difficile). Even if one facility is following recommended infection controls, germs can be spread inside of and between healthcare facilities when patients are transferred from one healthcare facility to another without appropriate actions to stop spread. During this call, clinicians will hear from some of the nation’s top clinical experts on preventing antibiotic resistant infections and improving antibiotic stewardship. Join the discussion to learn about best practices that can be implemented today to protect patients from these potentially deadly infections.

 

For a few earlier blogs on CRE and/or C. difficile, you may wish to revisit:

 

WHO: Survey & Analysis On Global Response To Antimicrobial Resistance

MMWR Vital Signs: Carbapenem-Resistant Enterobacteriaceae (CRE)

CDC: Improving Antibiotic Prescribing Practices In Hospitals

Unnecessary Antibiotic Use & C. Difficile Infections

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Saudi MOH: 3 More MERS Cases In Riyadh

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Although a considerable reduction over the numbers we’ve seen over the past couple of days, the Saudi MOH nonetheless reports three new MERS cases from Riyadh this morning, along with three deaths, plus 2 recoveries from Najran.

Since the 3rd of August, Saudi Arabia has reported 61 MERS cases, with 58 of those from Riyadh.

 

While details have been scant, the majority of recent cases appear to be nosocomial in nature, with many cases only having a history of being admitted to medical facilities where MERS patients were being treated (see WHO MERS Update – Saudi Arabia – August 18th).  

 

A pattern not unlike what South Korean was dealing with two months ago.

Of note, of the three new cases announced today, 2 are reported in critical condition and 1 has already expired.  Of yesterday’s 10 cases, 4 were already in critical condition and 1 had expired, and the day before, 4 out of 9 were listed in critical condition.

 

Without onset dates, it is difficult to determine just how `current’  these recently announced cases really are, but based on previous WHO GAR updates, cases are sometimes announced as much as a week after they have tested positive. A couple of recent examples:

• The 63 year-old male reported infected on August 11th by the MOH reportedly tested positive on August 5th (cite WHO). 
• The 57 year old male reported infected on August 10th by the MOH tested positive for MERS-CoV on August 2nd.

There appears to be no pattern regarding reporting delays, as some cases are reported almost immediately.  The bottom line here is that  - despite the billing  from the MOH -  the daily totals being reported by the Saudis don’t necessarily represent the level of MERS activity over the previous 24 hours.

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mBio: The Reemergence Of H1N1 in 1977 and The GOF Debate

 

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Although few remember it today, an extraordinary thing happened during the influenza season of 1977. For the first time in the relatively short history of  tracking flu, two subtypes of influenza A  were found co-circulating  the globe.

To understand how unexpected this was, all you need do is look at the graphic at the top of this post. 

 

From 1918 through 1976 we’d seen three influenza A pandemics (1918, 1957, 1968) and each time the pandemic virus completely supplanted the previously circulating influenza A virus.  The descendents of the 1918 H1N1 virus reigned supreme (and alone) until it was unseated by H2N2 in 1957.  H2N2 held court until H3N2 pushed it aside eleven years later.

There were certainly influenza B viruses in the mix, but the norm appeared to be only one influenza A subtype each flu season.

In 1977, however, a second influenza A virus abruptly appeared, or rather - re-appeared – and began circulating along side H3N2.  A throwback to the 1950s, the 1977 H1N1 `Russian flu’  was generally mild in adults, but hit children and adolescents born before 1957 the hardest. 

 

This unusual turn of events happened one year after our 1976 H1N1 swine flu scare, when as a young paramedic, I got my first taste of pandemic planning (see my account in Deja Flu, All Over Again).  What we dodged in 1976 turned into a frantic flu season for children, hospitals and EMS the following year.

Since 1977  we’ve seen two influenza A subtypes co-circulate every year.  Even when the 2009 H1N1 pandemic virus completely supplanted the old (1977) H1N1 virus, H3N2 continued to circulate. 

 

For years scientists have tried to explain how a virus – gone from the wild for 20 years – could just suddenly reappear.  Particularly one that was practically identical to a strain last seen more than a quarter of a century before.  The most popular theory has been that of an accidental release from a Russian or Chinese research facility, but solid evidence has been lacking..

 

Yesterday, in the journal mBio, two researchers from UPMC Center for Health Security published a paper that looks at the available evidence, and discusses several plausible scenarios. They also discuss its possible relevance (or lack thereof)  to the GOF (Gain of Function) debates of today (see mBio: The Risks & Benefits Of `GOF’ Experimentation On Pathogens With Pandemic Potential).

 

It’s a fascinating report, so follow the link below to read:

 

 

The Reemergent 1977 H1N1 Strain and the Gain-of-Function Debate

Michelle Rozo, Gigi Kwik Gronvall

 

ABSTRACT

The 1977-1978 influenza epidemic was probably not a natural event, as the genetic sequence of the virus was nearly identical to the sequences of decades-old strains. While there are several hypotheses that could explain its origin, the possibility that the 1977 epidemic resulted from a laboratory accident has recently gained popularity in discussions about the biosafety risks of gain-of-function (GOF) influenza virus research, as an argument for why this research should not be performed. There is now a moratorium in the United States on funding GOF research while the benefits and risks, including the potential for accident, are analyzed. Given the importance of this historical epidemic to ongoing policy debates, we revisit the evidence that the 1977 epidemic was not natural and examine three potential origins: a laboratory accident, a live-vaccine trial escape, or deliberate release as a biological weapon. Based on available evidence, the 1977 strain was indeed too closely matched to decades-old strains to likely be a natural occurrence. While the origin of the outbreak cannot be conclusively determined without additional evidence, there are very plausible alternatives to the laboratory accident hypothesis, diminishing the relevance of the 1977 experience to the modern GOF debate.

(Continue . . )

 

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Le Cordon Bleu Malaysia

	Bonjour France at Isetan KLCC 2015 7th May 2015 Together with Business France and Isetan KLCC, Le Cordon Bleu Malaysia brings you Master Chefs cooking demonstrations and Le Cordon Bleu Alumni Pop Up Café for you to (re)discover a Taste of France and to "Feed Your Curiosity" » Discover More
	Madagascan vanilla cream, blackberry jelly and sugar match stick International recipe On a hot summer’s day, nothing beats a fresh and light dessert with fruit. Vanilla cream, blackberry jelly, fresh fruits and a crispy element, this summer recipe, which is not only easy but can also be made in advance, will provide the perfect finale to your dinner! » Try this recipe

Article is courtesy by Le Cordon Bleu Malaysia Newsletter. 

For more information, please contact your nearest JM Office today!

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RESEP SEBLAK BASAH ENAK PEDAS KHAS BANDUNG

Resep Seblak Bandung - Menyajikan makanan untuk camilan sederhana bercita rasa pedas, kita dapat memilih kreasi resep seblak basah enak khas Bandung yang satu ini. Sajian yang enak dan pedas seuhah (istilah sunda) merupakan kuliner spesial dari Bandung yang termasuk dalam aneka jajanan populer bagi masyarakat Sunda Jawa Barat.

Seblak basah merupakan varian selain kerupuk seblak kering. Walaupun saat ini di warung-warung penjual seblak, telah ditemukan banyak kreasi pada variasi bahan dan bumbu seblak, cara membuat seblak basah original dari bahan kerupuk tetap menjadi santapan favorit karena enak dan berasa kenyal-kenyal lembut di mulut.

Bagi orang Bandung mungkin tak asing dengan gambar seblak di bawah ini. Sedangkan bagi yang berminat ingin mencoba dan mencicipinya, silahkan simak resep membuat seblak basah dari kerupuk yang saat ini sudah dikenal luas.

Jenis kerupuk yang biasa digunakan adalah kerupuk yang dikenal dengan sumber sari atau kerupuk aci (kanji/ tapioka). Macam-macam kerupuk ini sering dipakai buat pelengkap hidangan bubur ayam, lotek, nasi goreng dan aneka jajanan lainnya bisa berwarna merah, orange, kuning, putih, belang dan sebagainya.

Kerupuk untuk seblak adalah yang masih mentah atau belum digoreng kemudian dimasak beserta bumbu seblak atau direbus dahulu secara terpisah atau juga bisa direndam air panas saja untuk seblak kerupuk yang tidak ingin terlalu lembek.

Resep Seblak Telur
Bumbu seblak aslinya terdiri dari bawang, cabai dan kencur sebagai ciri khasnya, selain itu tentu kita dapat mengkreasikannya tergantung selera bahkan dengan level spesial super pedas bila mau.

Di samping variasi bumbu dalam resep seblak basah, kita juga dapat mencampurkan bahan dasar kerupuk dengan kombinasi atau perpaduan bahan lainnya seperti pemakaian telur dalam cara membuat seblak enak di bawah ini atau sering disebut dengan seblak telor. Persiapan bahan dan bumbunya adalah sebagai berikut :

• 125 gram kerupuk aci belang atau sesuai selera
• 1 buah telur dikocok lepas
• 200 ml air mendidih
• 100 ml air untuk tumisan bumbu
• 1/2 sdt garam
• 1/2 sdt kaldu bubuk atau penyedap rasa
• minyak secukupnya untuk menumis bumbu

Haluskan :

• 1 siung bawang putih
• 3 butir bawang merah
• 1 cm kencur
• 8 buah cabe rawit merah
• 8 buah cabe keriting merah

Cara Membuat Seblak Telur

1. Rendam kerupuk dengan air yang sudah dididihkan kurang lebih selama 15 menit, angkat dan tiriskan (buang airnya).
2. Panaskan minyak, tumis bumbu halus hingga harum lalu tuang air, garam dan kaldu bubuk. Aduk-aduk rata kemudian masukkan kocokan telur dan aduk-aduk lagi supaya merata hingga berbulir.
3. Masukkan kerupuk yang sudah direndam tadi, aduk rata hingga kuah mengering dan matang lalu angkat dan siap untuk disajikan.

Resep Kerupuk Seblak Basah

Resep dan cara membuat seblak basah kerupuk campur telur yang pertama di atas adalah update terbaru, sedangkan artikel yang lama masih tetap bisa kita lihat dalam proses pembuatan kerupuk seblak basah enak dan sederhana berikut ini.

Bahan dan Bumbu :

• 2 ons kerupuk aci sumber sari
• air secukupnya
• minyak untuk menumis

Haluskan :

• 2 butir bawang merah
• 2 siung bawang putih
• ½ ruas jari kencur
• 6 buah cabe rawit merah (cabai setan/ cengek domba)
• garam dan penyedap secukupnya

Cara Membuat Seblak Basah Kerupuk

1. Didihkan air, masukkan kerupuk, rebus hingga lembek atau rendam air panas saja lalu angkat dan tiriskan.
2. Panaskan minyak, tumis bumbu halus hingga harum. Beri sedikit air, tambahkan garam dan penyedap secukupnya, aduk rata.
3. Masukkan kerupuk yang telah direbus lalu aduk lagi hingga rata. Masak hingga matang, angkat dan sajikan.

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APHIS: Preparatory Steps For Stockpiling & Using An HPAI H5 Vaccine

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Although no decision has been made regarding the use of  HPAI H5 vaccines on American poultry flocks, the USDA has been working throughout the summer to help pave the way for their use if needed. In June APHIS announced that Additional Criteria Must Be Met Before HPAI Poultry Vaccines Can Be Approved, and while many in the beleaguered poultry industry are lobbying heavily for them, their use is not without some serious downsides.

 

We looked recently at some of those potential pitfalls in MPR: Poultry AI Vaccines Are Not A `Cure-all’  and  PLoS Bio: Imperfect Poultry Vaccines, Unintended Results, so I’ll not rehash those points today.  .

 

Whether they are ever sanctioned for use, it only makes sense to take those steps necessary to make their rapid rollout possible if they are ultimately required. And so today APHIS has announced two steps they are taking in that regard:

 

1. The issuance of a request for proposals for vaccine doses to equip the National Veterinary Stockpile
2. Notification that APHIS will publish an environmental assessment evaluating the potential environmental impacts of using vaccine in the event of an HPAI outbreak

 

Even assuming a fast track, there are numerous logistical and regulatory hurdles ahead before any AI vaccine could be deployed in this country. So America’s poultry industry will be relying on strict biosecurity - and the quarantining and culling of infected flocks - for the foreseeable future.

 

APHIS to Issue Environmental Assessment and Request for Proposals for Highly Pathogenic Avian Influenza Vaccine

Published: Aug 18, 2015

Print

August 18, 2015—The U.S. Department of Agriculture’s Animal and Plant Health Inspection Service (APHIS) has been preparing for the potential recurrence in the fall of the highly pathogenic avian influenza (HPAI) virus that affected more than 48 million birds at over 200 poultry facilities earlier this year. As part of these preparations, APHIS and its state and industry partners are examining the potential use of vaccine to help prevent illness in birds and interrupt the spread of the disease.  APHIS is today announcing two actions related to vaccine use: the issuance of a request for proposals for vaccine doses to equip the National Veterinary Stockpile, and notification that APHIS will publish an environmental assessment evaluating the potential environmental impacts of using vaccine in the event of an HPAI outbreak.

While APHIS has not approved the use of vaccine to respond to HPAI to date, the Agency is preparing to ensure that vaccine is available should the decision be made to use it. APHIS is seeking to create a stockpile of vaccine for the Eurasian H5 (EA H5) virus strain that circulated in domestic poultry earlier this year.   APHIS issued a request for proposals yesterday for vaccine manufacturers with the interest and capability to supply a variety of EA H5 vaccines in sufficient numbers to establish the emergency stockpile.

Vaccines will be carefully evaluated on a number of factors including their efficacy against EA H5 viruses, and products must meet all of APHIS’ safety, potency, and purity standards.  All eligible products to be considered must be either conditionally or fully licensed or permitted at the time of submission.  Vaccine manufacturers will be evaluated on their ability to produce such vaccines in a timely manner in adequate numbers to meet the needs of the response.

The RFP is available here: https://www.fbo.gov/index?s=opportunity&mode=form&id=56f3e86d4538b147c5803c4e335ad9f6&tab=core&_cview=1

In the coming weeks, APHIS will also publish an environmental assessment that examines the impacts of using HPAI vaccine in the field during an outbreak response.  This assessment will look at two alternatives: approving vaccine use targeting EA H5 viruses or taking no action.  Once published, the EA will have a 30-day public comment period.

It is important to note that these actions do not obligate APHIS to purchase vaccines from any companies that respond to the request for proposals and do not imply the Agency has made a decision to use vaccination. A decision to use vaccination would require careful consideration of the efficacy of the vaccine, any impacts of using HPAI vaccine in the field, and the potential trade impacts, and would be made jointly by APHIS and State animal health authorities. Today’s actions are being taken to ensure the Agency and its partners are well-positioned to respond to a future outbreak.

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The Atlantic Begins To Stir: TD #4 Forms

 

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While the remainder of the  2015 Atlantic Tropical season is forecast to run below average (see NOAA: Revised 2015 Atlantic Hurricane Season Outlook), that in no way precludes us from seeing one or more hurricanes in the weeks to come. 

 

Instead of seeing 6 or even 10 hurricanes, we are simply more likely to see 3 or 4.

 

But even with the dampening effects of El Niño, any one of those could still become a major (CAT 3) storm.  The Atlantic’s waters are very warm, have been undisturbed by earlier tropical systems, and can provide plenty of fuel for these tropical heat engines.

 

A short while ago the National Hurricane Center in Miami, which has been following a mid-Atlantic tropical wave for a couple of days, upgraded it to become the 4th tropical depression of the year.  Conditions are favorable for it to become a tropical storm in the hours  ahead, and it is forecast to reach hurricane strength as it approaches the Leeward Islands in a few days.

 

From the NHC 11am Discussion:

The overall atmospheric and oceanic environments surrounding the cyclone appear conducive for slow but steady  strengthening throughout the forecast period. The only inhibiting factor will be occasional brief intrusions of dry mid-level air associated with the Saharan Air Layer that lies just to the north of the depression.

 
However, given the very low vertical wind shear of less than 5 kt, the convective structure is expected to steadily increase in organization, allowing the dry air intrusions to be mixed out. The official intensity forecast closely follows the intensity consensus model IVCN through 72 hours, and then leans closer to a blend of the Decay-SHIPS and LGEM models at 96 and 120 hours.

FORECAST POSITIONS AND MAX WINDS

INIT  18/1500Z 10.6N  36.5W   30 KT  35 MPH
12H  19/0000Z 11.0N  37.9W   35 KT  40 MPH
24H  19/1200Z 11.3N  39.5W   40 KT  45 MPH
36H  20/0000Z 11.6N  40.9W   50 KT  60 MPH
48H  20/1200Z 12.1N  41.9W   60 KT  70 MPH
72H  21/1200Z 13.2N  44.2W   70 KT  80 MPH
96H  22/1200Z 13.7N  47.8W   80 KT  90 MPH
120H  23/1200Z 14.0N  52.4W   85 KT 100 MPH

 

While it is far too soon to speculate what effects – if any – this system will have on the continental United States, it is never too soon to prepare for hurricane season.  So, if you haven’t already downloaded the updated Tropical Cyclone Preparedness Guide, now would be an excellent time to do so.

When it comes to getting the latest information on hurricanes, your first stop should always be the National Hurricane Center in Miami, Florida. These are the real experts, and the only ones you should rely on to track and forecast the storm.

And if you are on Twitter, you should also follow @FEMA, @CraigatFEMA, @NHC_Atlantic, @NHC_Pacific and @ReadyGov.

We are also now just two weeks away from the start of  National Preparedness Month, so now is an opportune time to become better prepared as an individual, family, business owner, or community to deal with all types of disasters   I would invite you to visit the following preparedness sites.

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

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