RESUMEN
BACKGROUND: The Diamond Princess cruise ship was the site of a large outbreak of coronavirus disease 2019 (COVID-19). Of 437 Americans and their travel companions on the ship, 114 (26%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We interviewed 229 American passengers and crew after disembarkation following a ship-based quarantine to identify risk factors for infection and characterize transmission onboard the ship. RESULTS: The attack rate for passengers in single-person cabins or without infected cabinmates was 18% (58/329), compared with 63% (27/43) for those sharing a cabin with an asymptomatic infected cabinmate, and 81% (25/31) for those with a symptomatic infected cabinmate. Whole genome sequences from specimens from passengers who shared cabins clustered together. Of 66 SARS-CoV-2-positive American travelers with complete symptom information, 14 (21%) were asymptomatic while on the ship. Among SARS-CoV-2-positive Americans, 10 (9%) required intensive care, of whom 7 were ≥70 years. CONCLUSIONS: Our findings highlight the high risk of SARS-CoV-2 transmission on cruise ships. High rates of SARS-CoV-2 positivity in cabinmates of individuals with asymptomatic infections suggest that triage by symptom status in shared quarters is insufficient to halt transmission. A high rate of intensive care unit admission among older individuals complicates the prospect of future cruise travel during the pandemic, given typical cruise passenger demographics. The magnitude and severe outcomes of this outbreak were major factors contributing to the Centers for Disease Control and Prevention's decision to halt cruise ship travel in US waters in March 2020.
Asunto(s)
COVID-19 , Navíos , Diamante , Brotes de Enfermedades , Humanos , Cuarentena , SARS-CoV-2 , Viaje , Estados Unidos/epidemiologíaRESUMEN
To determine prevalence of, seroprevalence of, and potential exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among a cohort of evacuees returning to the United States from Wuhan, China, in January 2020, we conducted a cross-sectional study of quarantined evacuees from 1 repatriation flight. Overall, 193 of 195 evacuees completed exposure surveys and submitted upper respiratory or serum specimens or both at arrival in the United States. Nearly all evacuees had taken preventive measures to limit potential exposure while in Wuhan, and none had detectable SARS-CoV-2 in upper respiratory tract specimens, suggesting the absence of asymptomatic respiratory shedding among this group at the time of testing. Evidence of antibodies to SARS-CoV-2 was detected in 1 evacuee, who reported experiencing no symptoms or high-risk exposures in the previous 2 months. These findings demonstrated that this group of evacuees posed a low risk of introducing SARS-CoV-2 to the United States.
Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Cuarentena/estadística & datos numéricos , Adolescente , Adulto , Anciano , COVID-19 , Prueba de COVID-19 , Niño , Preescolar , Infecciones por Coronavirus/diagnóstico , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pandemias , Prevalencia , SARS-CoV-2 , Estudios Seroepidemiológicos , Viaje , Estados Unidos/epidemiología , Adulto JovenRESUMEN
An estimated 30 million passengers are transported on 272 cruise ships worldwide each year* (1). Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness (2). SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) was first identified in Wuhan, China, in December 2019 and has since spread worldwide to at least 187 countries and territories. Widespread COVID-19 transmission on cruise ships has been reported as well (3). Passengers on certain cruise ship voyages might be aged ≥65 years, which places them at greater risk for severe consequences of SARS-CoV-2 infection (4). During February-March 2020, COVID-19 outbreaks associated with three cruise ship voyages have caused more than 800 laboratory-confirmed cases among passengers and crew, including 10 deaths. Transmission occurred across multiple voyages of several ships. This report describes public health responses to COVID-19 outbreaks on these ships. COVID-19 on cruise ships poses a risk for rapid spread of disease, causing outbreaks in a vulnerable population, and aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.
Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Brotes de Enfermedades/prevención & control , Salud Global/estadística & datos numéricos , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Práctica de Salud Pública , Navíos , Enfermedad Relacionada con los Viajes , Adulto , Anciano , Betacoronavirus/aislamiento & purificación , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Factores de Riesgo , SARS-CoV-2 , Estados Unidos/epidemiologíaRESUMEN
To achieve compliance with the revised World Health Organization International Health Regulations (IHR 2005), countries must be able to rapidly prevent, detect, and respond to public health threats. Most nations, however, remain unprepared to manage and control complex health emergencies, whether due to natural disasters, emerging infectious disease outbreaks, or the inadvertent or intentional release of highly pathogenic organisms. The US Centers for Disease Control and Prevention (CDC) works with countries and partners to build and strengthen global health security preparedness so they can quickly respond to public health crises. This report highlights selected CDC global health protection platform accomplishments that help mitigate global health threats and build core, cross-cutting capacity to identify and contain disease outbreaks at their source. CDC contributions support country efforts to achieve IHR 2005 compliance, contribute to the international framework for countering infectious disease crises, and enhance health security for Americans and populations around the world.
Asunto(s)
Centers for Disease Control and Prevention, U.S. , Salud Global , Vigilancia en Salud Pública , Salud Pública , Creación de Capacidad , Control de Enfermedades Transmisibles , Enfermedades Transmisibles/epidemiología , Brotes de Enfermedades , Urgencias Médicas , Epidemiología/educación , Humanos , Cooperación Internacional , Salud Pública/educación , Salud Pública/métodos , Administración en Salud Pública , Estados Unidos , Recursos Humanos , Organización Mundial de la SaludRESUMEN
Using data from travelers to 4 countries in the Middle East, we estimated 3,250 (95% CI 1,300-6,600) severe cases of Middle East respiratory syndrome occurred in this region during September 2012-January 2016. This number is 2.3-fold higher than the number of laboratory-confirmed cases recorded in these countries.
Asunto(s)
Infecciones por Coronavirus/epidemiología , Coronavirus del Síndrome Respiratorio de Oriente Medio , Humanos , Incidencia , Medio Oriente/epidemiología , ViajeRESUMEN
In 2012, an outbreak of infection with Middle East respiratory syndrome coronavirus (MERS-CoV), was detected in the Arabian Peninsula. Modeling can produce estimates of the expected annual number of symptomatic cases of MERS-CoV infection exported and the likelihood of exportation from source countries in the Middle East to countries outside the region.
Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Brotes de Enfermedades/prevención & control , Coronavirus del Síndrome Respiratorio de Oriente Medio/fisiología , Modelos Estadísticos , Viaje/estadística & datos numéricos , Animales , Camelus/virología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Reservorios de Enfermedades/virología , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Medio Oriente/epidemiología , Coronavirus del Síndrome Respiratorio de Oriente Medio/patogenicidad , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: The WHO declared the 2014 west African Ebola epidemic a public health emergency of international concern in view of its potential for further international spread. Decision makers worldwide are in need of empirical data to inform and implement emergency response measures. Our aim was to assess the potential for Ebola virus to spread across international borders via commercial air travel and assess the relative efficiency of exit versus entry screening of travellers at commercial airports. METHODS: We analysed International Air Transport Association data for worldwide flight schedules between Sept 1, 2014, and Dec 31, 2014, and historic traveller flight itinerary data from 2013 to describe expected global population movements via commercial air travel out of Guinea, Liberia, and Sierra Leone. Coupled with Ebola virus surveillance data, we modelled the expected number of internationally exported Ebola virus infections, the potential effect of air travel restrictions, and the efficiency of airport-based traveller screening at international ports of entry and exit. We deemed individuals initiating travel from any domestic or international airport within these three countries to have possible exposure to Ebola virus. We deemed all other travellers to have no significant risk of exposure to Ebola virus. FINDINGS: Based on epidemic conditions and international flight restrictions to and from Guinea, Liberia, and Sierra Leone as of Sept 1, 2014 (reductions in passenger seats by 51% for Liberia, 66% for Guinea, and 85% for Sierra Leone), our model projects 2.8 travellers infected with Ebola virus departing the above three countries via commercial flights, on average, every month. 91,547 (64%) of all air travellers departing Guinea, Liberia, and Sierra Leone had expected destinations in low-income and lower-middle-income countries. Screening international travellers departing three airports would enable health assessments of all travellers at highest risk of exposure to Ebola virus infection. INTERPRETATION: Decision makers must carefully balance the potential harms from travel restrictions imposed on countries that have Ebola virus activity against any potential reductions in risk from Ebola virus importations. Exit screening of travellers at airports in Guinea, Liberia, and Sierra Leone would be the most efficient frontier at which to assess the health status of travellers at risk of Ebola virus exposure, however, this intervention might require international support to implement effectively. FUNDING: Canadian Institutes of Health Research.
Asunto(s)
Viaje en Avión/estadística & datos numéricos , Brotes de Enfermedades , Ebolavirus/patogenicidad , Fiebre Hemorrágica Ebola/epidemiología , Tamizaje Masivo/normas , Modelos Estadísticos , Guinea/epidemiología , Fiebre Hemorrágica Ebola/transmisión , Humanos , Liberia/epidemiología , Salud Pública , Factores de Riesgo , Sierra Leona/epidemiologíaRESUMEN
Zika virus is a mosquito-borne flavivirus primarily transmitted by Aedes aegypti mosquitoes (1,2). Infection with Zika virus is asymptomatic in an estimated 80% of cases (2,3), and when Zika virus does cause illness, symptoms are generally mild and self-limited. Recent evidence suggests a possible association between maternal Zika virus infection and adverse fetal outcomes, such as congenital microcephaly (4,5), as well as a possible association with Guillain-Barré syndrome. Currently, no vaccine or medication exists to prevent or treat Zika virus infection. Persons residing in or traveling to areas of active Zika virus transmission should take steps to prevent Zika virus infection through prevention of mosquito bites (http://www.cdc.gov/zika/prevention/).
Asunto(s)
Guías como Asunto , Enfermedades Virales de Transmisión Sexual/prevención & control , Infección por el Virus Zika/prevención & control , Centers for Disease Control and Prevention, U.S. , Condones/estadística & datos numéricos , Femenino , Humanos , Masculino , Embarazo , Características de la Residencia/estadística & datos numéricos , Abstinencia Sexual , Viaje/estadística & datos numéricos , Estados Unidos , Infección por el Virus Zika/transmisiónRESUMEN
Zika virus is a flavivirus transmitted primarily by Aedes species mosquitoes. Increasing evidence links Zika virus infection during pregnancy to adverse pregnancy and birth outcomes, including pregnancy loss, intrauterine growth restriction, eye defects, congenital brain abnormalities, and other fetal abnormalities. The virus has also been determined to be sexually transmitted. Because of the potential risks associated with Zika virus infection during pregnancy, CDC has recommended that health care providers discuss prevention of unintended pregnancy with women and couples who reside in areas of active Zika virus transmission and do not want to become pregnant. However, limitations in access to contraception in some of these areas might affect the ability to prevent an unintended pregnancy. As of March 16, 2016, the highest number of Zika virus disease cases in the United States and U.S. territories were reported from Puerto Rico. The number of cases will likely rise with increasing mosquito activity in affected areas, resulting in increased risk for transmission to pregnant women. High rates of unintended and adolescent pregnancies in Puerto Rico suggest that, in the context of this outbreak, access to contraception might need to be improved. CDC estimates that 138,000 women of reproductive age (aged 15-44 years) in Puerto Rico do not desire pregnancy and are not using one of the most effective or moderately effective contraceptive methods, and therefore might experience an unintended pregnancy. CDC and other federal and local partners are seeking to expand access to contraception for these persons. Such efforts have the potential to increase contraceptive access and use, reduce unintended pregnancies, and lead to fewer adverse pregnancy and birth outcomes associated with Zika virus infection during pregnancy. The assessment of challenges and resources related to contraceptive access in Puerto Rico might be a useful model for other areas with active transmission of Zika virus.
Asunto(s)
Anticoncepción/estadística & datos numéricos , Brotes de Enfermedades/prevención & control , Accesibilidad a los Servicios de Salud/organización & administración , Evaluación de Necesidades , Infección por el Virus Zika/prevención & control , Adolescente , Adulto , Femenino , Humanos , Embarazo , Puerto Rico/epidemiología , Adulto Joven , Infección por el Virus Zika/epidemiologíaRESUMEN
The U.S. Department of Health and Human Services (HHS), CDC, other U.S. government agencies, the World Health Organization (WHO), and international partners are taking multiple steps to respond to the current Ebola virus disease (Ebola) outbreak in West Africa to reduce its toll there and to reduce the chances of international spread. At the same time, CDC and HHS are working to ensure that persons who have a risk factor for exposure to Ebola and who develop symptoms while in the United States are rapidly identified and isolated, and safely receive treatment. HHS and CDC have actively worked with state and local public health authorities and other partners to accelerate health care preparedness to care for persons under investigation (PUI) for Ebola or with confirmed Ebola. This report describes some of these efforts and their impact.
Asunto(s)
Brotes de Enfermedades/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Exposición a Riesgos Ambientales/prevención & control , Monitoreo del Ambiente/métodos , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/terapia , Equipo Hospitalario de Respuesta Rápida/organización & administración , África Occidental/epidemiología , Instituciones de Atención Ambulatoria/organización & administración , Centers for Disease Control and Prevention, U.S./organización & administración , Diagnóstico Precoz , Exposición a Riesgos Ambientales/análisis , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/transmisión , Humanos , Factores de Riesgo , Viaje/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
Before the current Ebola epidemic in West Africa, there were few documented cases of symptomatic Ebola patients traveling by commercial airline, and no evidence of transmission to passengers or crew members during airline travel. In July 2014 two persons with confirmed Ebola virus infection who were infected early in the Nigeria outbreak traveled by commercial airline while symptomatic, involving a total of four flights (two international flights and two Nigeria domestic flights). It is not clear what symptoms either of these two passengers experienced during flight; however, one collapsed in the airport shortly after landing, and the other was documented to have fever, vomiting, and diarrhea on the day the flight arrived. Neither infected passenger transmitted Ebola to other passengers or crew on these flights. In October 2014, another airline passenger, a U.S. health care worker who had traveled domestically on two commercial flights, was confirmed to have Ebola virus infection. Given that the time of onset of symptoms was uncertain, an Ebola airline contact investigation in the United States was conducted. In total, follow-up was conducted for 268 contacts in nine states, including all 247 passengers from both flights, 12 flight crew members, eight cleaning crew members, and one federal airport worker (81 of these contacts were documented in a report published previously). All contacts were accounted for by state and local jurisdictions and followed until completion of their 21-day incubation periods. No secondary cases of Ebola were identified in this investigation, confirming that transmission of Ebola during commercial air travel did not occur.
Asunto(s)
Aeronaves , Brotes de Enfermedades/prevención & control , Fiebre Hemorrágica Ebola/prevención & control , Práctica de Salud Pública , Viaje , Trazado de Contacto , Personal de Salud , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Nigeria/epidemiología , Enfermedades Profesionales , Estados Unidos/epidemiologíaRESUMEN
Inhalation anthrax occurred in a man who vacationed in 4 US states where anthrax is enzootic. Despite an extensive multi-agency investigation, the specific source was not detected, and no additional related human or animal cases were found. Although rare, inhalation anthrax can occur naturally in the United States.
Asunto(s)
Carbunco/microbiología , Bacillus anthracis/genética , Exposición por Inhalación , Infecciones del Sistema Respiratorio/microbiología , Esporas Bacterianas/patogenicidad , Animales , Carbunco/diagnóstico , Bacillus anthracis/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Tipificación de Secuencias Multilocus , Infecciones del Sistema Respiratorio/diagnóstico , Viaje , Estados UnidosRESUMEN
The Centers for Disease Control and Prevention convened panels of anthrax experts to review and update guidelines for anthrax postexposure prophylaxis and treatment. The panels included civilian and military anthrax experts and clinicians with experience treating anthrax patients. Specialties represented included internal medicine, pediatrics, obstetrics, infectious disease, emergency medicine, critical care, pulmonology, hematology, and nephrology. Panelists discussed recent patients with systemic anthrax; reviews of published, unpublished, and proprietary data regarding antimicrobial drugs and anthrax antitoxins; and critical care measures of potential benefit to patients with anthrax. This article updates antimicrobial postexposure prophylaxis and antimicrobial and antitoxin treatment options and describes potentially beneficial critical care measures for persons with anthrax, including clinical procedures for infected nonpregnant adults. Changes from previous guidelines include an expanded discussion of critical care and clinical procedures and additional antimicrobial choices, including preferred antimicrobial drug treatment for possible anthrax meningitis.
Asunto(s)
Vacunas contra el Carbunco/administración & dosificación , Carbunco/prevención & control , Antibacterianos/uso terapéutico , Bacillus anthracis/patogenicidad , Adulto , Carbunco/tratamiento farmacológico , Carbunco/inmunología , Carbunco/microbiología , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Antitoxinas/uso terapéutico , Bacillus anthracis/efectos de los fármacos , Bacillus anthracis/inmunología , Bioterrorismo , Centers for Disease Control and Prevention, U.S. , Competencia Clínica , Cuidados Críticos , Manejo de la Enfermedad , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Guías de Práctica Clínica como Asunto , Estados UnidosRESUMEN
Bacillus anthracis was identified in a 61-year-old man hospitalized in Minnesota, USA. Cooperation between the hospital and the state health agency enhanced prompt identification of the pathogen. Treatment comprising antimicrobial drugs, anthrax immune globulin, and pleural drainage led to full recovery; however, the role of passive immunization in anthrax treatment requires further evaluation.
Asunto(s)
Carbunco/microbiología , Anticuerpos Antibacterianos/sangre , Anticuerpos Antivirales/sangre , Antígenos Bacterianos/sangre , Bacillus anthracis/aislamiento & purificación , Toxinas Bacterianas/sangre , Infecciones del Sistema Respiratorio/microbiología , Carbunco/diagnóstico , Carbunco/inmunología , Carbunco/terapia , Antibacterianos/uso terapéutico , Bacillus anthracis/patogenicidad , Drenaje Postural , Esquema de Medicación , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/inmunología , Infecciones del Sistema Respiratorio/terapia , Resultado del TratamientoRESUMEN
CDC is investigating reports of potential occupational exposure to human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and Mycobacterium tuberculosis among workers performing preparation and dissection procedures on human nontransplant anatomical materials at a nontransplant anatomical donation center in Arizona. CDC is working with Arizona public health officials to inform persons exposed to these potentially infected materials. Nontransplant anatomical centers around the United States process thousands of donated cadavers annually. These materials (which might be fresh, frozen, or chemically preserved) are used by universities and surgical instrument and pharmaceutical companies for medical education and research. The American Association of Tissue Banks has developed accreditation policies for nontransplant anatomical donation organizations. It also has written standards that specify exclusion criteria for donor material, as well as use of proper environmental controls and safe work practices to prevent transmission of infectious agents during receipt and handling of nontransplant anatomical materials. At the center under investigation, which is now closed, these standards might not have been consistently implemented.
Asunto(s)
Enfermedades Transmisibles/epidemiología , Enfermedades Profesionales/epidemiología , Exposición Profesional/efectos adversos , Bancos de Tejidos , Arizona/epidemiología , Centers for Disease Control and Prevention, U.S. , Infecciones por VIH/epidemiología , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Humanos , Medición de Riesgo , Tuberculosis/epidemiología , Estados UnidosRESUMEN
In response to the largest recognized Ebola virus disease epidemic now occurring in West Africa, the governments of affected countries, CDC, the World Health Organization (WHO), and other international organizations have collaborated to implement strategies to control spread of the virus. One strategy recommended by WHO calls for countries with Ebola transmission to screen all persons exiting the country for "unexplained febrile illness consistent with potential Ebola infection." Exit screening at points of departure is intended to reduce the likelihood of international spread of the virus. To initiate this strategy, CDC, WHO, and other global partners were invited by the ministries of health of Guinea, Liberia, and Sierra Leone to assist them in developing and implementing exit screening procedures. Since the program began in August 2014, an estimated 80,000 travelers, of whom approximately 12,000 were en route to the United States, have departed by air from the three countries with Ebola transmission. Procedures were implemented to deny boarding to ill travelers and persons who reported a high risk for exposure to Ebola; no international air traveler from these countries has been reported as symptomatic with Ebola during travel since these procedures were implemented.
Asunto(s)
Aeropuertos , Epidemias/prevención & control , Fiebre Hemorrágica Ebola/prevención & control , Tamizaje Masivo/estadística & datos numéricos , Viaje , África Occidental/epidemiología , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Medición de Riesgo , Estados Unidos/epidemiologíaRESUMEN
Since mid-March 2014, the frequency with which cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported has increased, with the majority of recent cases reported from Saudi Arabia and United Arab Emirates (UAE). In addition, the frequency with which travel-associated MERS cases have been reported and the number of countries that have reported them to the World Health Organization (WHO) have also increased. The first case of MERS in the United States, identified in a traveler recently returned from Saudi Arabia, was reported to CDC by the Indiana State Department of Health on May 1, 2014, and confirmed by CDC on May 2. A second imported case of MERS in the United States, identified in a traveler from Saudi Arabia having no connection with the first case, was reported to CDC by the Florida Department of Health on May 11, 2014. The purpose of this report is to alert clinicians, health officials, and others to increase awareness of the need to consider MERS-CoV infection in persons who have recently traveled from countries in or near the Arabian Peninsula. This report summarizes recent epidemiologic information, provides preliminary descriptions of the cases reported from Indiana and Florida, and updates CDC guidance about patient evaluation, home care and isolation, specimen collection, and travel as of May 13, 2014.
Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Coronavirus/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Infecciones por Coronavirus/prevención & control , Femenino , Guías como Asunto , Humanos , Lactante , Control de Infecciones , Masculino , Persona de Mediana Edad , Medio Oriente , Aislamiento de Pacientes , Guías de Práctica Clínica como Asunto , Administración en Salud Pública , Viaje , Estados Unidos/epidemiología , Adulto JovenRESUMEN
The US Public Health Emergency Medical Countermeasures Enterprise convened subject matter experts at the 2010 HHS Burkholderia Workshop to develop consensus recommendations for postexposure prophylaxis against and treatment for Burkholderia pseudomallei and B. mallei infections, which cause melioidosis and glanders, respectively. Drugs recommended by consensus of the participants are ceftazidime or meropenem for initial intensive therapy, and trimethoprim/sulfamethoxazole or amoxicillin/clavulanic acid for eradication therapy. For postexposure prophylaxis, recommended drugs are trimethoprim/sulfamethoxazole or co-amoxiclav. To improve the timely diagnosis of melioidosis and glanders, further development and wide distribution of rapid diagnostic assays were also recommended. Standardized animal models and B. pseudomallei strains are needed for further development of therapeutic options. Training for laboratory technicians and physicians would facilitate better diagnosis and treatment options.
Asunto(s)
Antibacterianos/administración & dosificación , Burkholderia mallei/patogenicidad , Burkholderia pseudomallei/patogenicidad , Muermo/prevención & control , Melioidosis/prevención & control , Profilaxis Posexposición/métodos , Combinación Amoxicilina-Clavulanato de Potasio/administración & dosificación , Animales , Ceftazidima/administración & dosificación , Modelos Animales de Enfermedad , Susceptibilidad a Enfermedades , Muermo/diagnóstico , Muermo/tratamiento farmacológico , Humanos , Melioidosis/diagnóstico , Melioidosis/tratamiento farmacológico , Meropenem , Factores de Riesgo , Tienamicinas/administración & dosificación , Combinación Trimetoprim y Sulfametoxazol/administración & dosificaciónRESUMEN
This report describes the first case of naturally acquired inhalation anthrax in the United States since 1976. The patient's clinical course included adjunctive treatment with human anthrax immunoglobulin. Clinical correlation of serologic assays for the lethal factor component of lethal toxin and anti-protective antigen immunoglobulin G are also presented.
Asunto(s)
Vacunas contra el Carbunco/administración & dosificación , Carbunco/diagnóstico , Carbunco/terapia , Antígenos Bacterianos/inmunología , Inmunoglobulina G/inmunología , Adulto , Vacunas contra el Carbunco/inmunología , Bacillus anthracis/aislamiento & purificación , Análisis Químico de la Sangre , Exposición a Riesgos Ambientales/efectos adversos , Ensayo de Inmunoadsorción Enzimática , Exotoxinas/sangre , Estudios de Seguimiento , Humanos , Inmunoglobulina G/metabolismo , Inhalación , Masculino , Medición de Riesgo , Índice de Severidad de la Enfermedad , Viaje , Estados UnidosRESUMEN
In the event of an influenza pandemic, patients with severe acute respiratory failure (ARF) due to influenza will require positive-pressure ventilation (PPV) in order to survive. In countries with widely available critical care services, PPV is delivered almost exclusively through use of full-feature mechanical ventilators in intensive care units (ICUs) or specialized hospital wards. But the supply of these ventilators is limited even during the normal course of hospital functioning. Purchasing and maintaining additional full-feature mechanical ventilators to be held in reserve and used only during mass casualty events is too expensive to allow the stockpiling of such equipment. Consequently, planning and preparedness efforts to respond to a severe influenza pandemic have stimulated consideration of limited-feature, less-expensive ventilation devices to augment traditional PPV capacity. This article offers guidance to authorities charged with preparing for mass casualty PPV in deciding which PPV equipment would be adequate for ventilating patients for days, weeks, or even months during a medical catastrophe.