Invasive Nontuberculous Mycobacterial Infections among Cardiothoracic Surgical Patients Exposed to Heater-Cooler Devices1.

Invasive nontuberculous mycobacteria (NTM) infections may result from a previously unrecognized source of transmission, heater-cooler devices (HCDs) used during cardiac surgery. In July 2015, the Pennsylvania Department of Health notified the Centers for Disease Control and Prevention (CDC) about a cluster of NTM infections among cardiothoracic surgical patients at 1 hospital. We conducted a case-control study to identify exposures causing infection, examining 11 case-patients and 48 control-patients. Eight (73%) case-patients had a clinical specimen identified as Mycobacterium avium complex (MAC). HCD exposure was associated with increased odds of invasive NTM infection; laboratory testing identified patient isolates and HCD samples as closely related strains of M. chimaera, a MAC species. This investigation confirmed a large US outbreak of invasive MAC infections in a previously unaffected patient population and suggested transmission occurred by aerosolization from HCDs. Recommendations have been issued for enhanced surveillance to identify potential infections associated with HCDs and measures to mitigate transmission risk.

Public health response to commercial airline travel of a person with Ebola virus infection - United States, 2014.

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.

Birth-related, psychosocial, and emotional correlates of positive maternal-infant bonding in a cohort of first-time mothers.

OBJECTIVE: to describe the development of a shortened 10-item version of the Postpartum Bonding Questionnaire (S-PBQ) and examine the relationship between birth-related, psychosocial, and emotional factors and maternal-infant bonding. DESIGN: cross-sectional interview study. SETTING: women having their first baby in Pennsylvania, USA. PARTICIPANTS: we interviewed 3005 women in their third trimester and at one month post partum who were enroled in the First Baby Study. MEASUREMENTS AND FINDINGS: for the S-PBQ, we completed factor analysis and examined instrument properties. We examined the relationship between birth-related, psychosocial, and emotional factors and maternal-infant bonding using adjusted linear regression models. The S-PBQ demonstrated acceptable internal reliability (Cronbach׳s α=0.67). Analysis revealed a socio-economic bias such that women who were older, more educated, not living in poverty, and married reported lower bonding scores. Maternal-infant bonding was significantly negatively correlated with maternal stress, maternal pain, and post partum depression, and positively correlated with partner support with the infant, and social support. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: For researchers who wish to measure maternal-infant bonding but are in need of a relatively short scale, the 10 item S-PBQ may be a useful alternative to the original version. However, it is important that researchers measuring maternal-infant bonding also investigate socio-economic bias in their studies and adjust for this effect as needed. Our results also indicate that clinicians should be aware of life stressors that may impact the maternal-infant relationship, in order that intervention may be provided to improved health outcomes for mothers, infants, and families.