SASKIA V. POPESCU, PHD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in biodefense from George Mason University where her research focused on the role of infection prevention in facilitating global health security efforts. She is certified in infection control and has worked in both pediatric and adult acute care facilities.

Saskia v. Popescu, PhD, MPH, MA, CIC

Environmental service worker in full prevention gear

As we head to the end of 2022, which I’m convinced has been the longest of years, there are so many topics and issues we’ve faced and some to which we may not have given enough attention. To bring this year to a close and look at all we’ve managed to do to prevent the spread of infectious diseases, here’s a breakdown of the top infection prevention and control (IPC) stories of 2022.

Respiratory syncytial virus (RSV) is a respiratory virus we tend to see in children. It is a mostly seasonal bug that can be devastating to a child’s body. With public health interventions such as masking, distancing, hand hygiene, and staying home in place because of COVID-19, we’ve seen a significant drop in cases since 2020. In fact, I think many forgot about RSV. Unfortunately, the United States is now seeing a surge of RSV infections and hospitalizations, which is deeply worrisome. Starting in September, we saw a rapid rise in cases that’s beginning to strain health care facilities.

 Many reasons are being cited: the immune debt we would often see addressed through childhood socialization and exposure related to school and social interactions, a lack of respiratory precautions in place, etc. With this significant surge, many are calling for a renewed interest in RSV vaccines, which have been long discussed but have not come to fruition. The surge in RSV cases across the United States is a recent reminder that we’ve been shielded from the more seasonal respiratory infections since the pandemic began. But we must continue to be vigilant; COVID-19 isn’t the only infectious disease we face.

Omicron, Bivalent Boosters, and Paxlovid, Oh My!

It’s hard not to include COVID-19 in an annual review of IPC stories, but it’s also challenging to know where to start. A year in the COVID-19 pandemic feels like 5 years on Earth. Because of the Omicron variant, the year started with the most significant wave of COVID-19 infections we’ve faced. Per the Centers for Disease Control and Prevention (CDC), we saw a peak on January 19, 2022, with 5.58 million cases of COVID-19 that week in the United States.

 Omicron spread far, wide, and efficiently. Its capabilities also changed, and we saw this new variant spreading with ease. COVID-19 reinfections increasingly posed a challenge; gone was the robust immune protection we had from previous variant infections, and we encountered immune-evasive variants. Omicron revealed that immunity acquired from previous infections was a lot less effective at protecting us against the new variant. Although Omicron didn’t yield the same level of hospitalizations and deaths, its rapid spread and shorter period of immune protection against reinfection challenged us in many ways. Now we have 2 subvariants of Omicron, BA.4 and BA.5, which may be challenging for response because of the concern that previous infection may yet again offer less protection. There’s good news, however. “Recent research shows that previous infection with an older variant (such as Alpha, Beta, or Delta) offers some protection against reinfection with BA.4 or BA.5 and that a prior Omicron infection is substantially more effective. That was the conclusion of a study that evaluated all of Qatar’s COVID-19 cases since the wave of BA.4 and BA.5 infections began” as noted in an article in Nature.

In 2022, we also had new interventions and tools in our arsenal against this pandemic: bivalent boosters and Paxlovid. The bivalent boosters were rolled out in September of this year to intervene against Omicron subvariants BA.4 and BA.5. Uptake has been slow, in some ways mirroring the level of interest and attention that individuals give COVID-19 in the third year of the pandemic. Ultimately, this underscores the need for faster development and response to variants as they are identified, so we can intervene during surges instead of well after them. Paxlovid has been a newer tool for us against COVID-19, changing the game by preventing the need for hospitalization. The antiviral therapy is widely prescribed to help reduce symptoms and risk for severe disease, which has been great. It did, however, alert us to rebound, which is when symptoms flare up a few days after recovery. At first, this rebound was experienced by those taking the antiviral. But now we’ve found individuals can experience rebound without having taken the medication, which is an interesting aspect to acute infection but a bigger issue for infection prevention.

 Those who experience rebound can still spread the virus, and they need to isolate. This poses a risk to those around the person, but it also muddies the waters; will they think it’s the same infection and not isolate as a result? Is there less incentive to report rebound if you know it’ll lead to isolation? In either case, rebound has underscored a new aspect of acute SARS-CoV-2 infections that require our attention.

One last important piece to add about COVID-19 in 2022 is related to the CDC guidance. In late December 2021, the CDC recommended shortened isolation and quarantine periods. The shift in August of this year to continue relaxing public interventions and lessen the necessity for contact tracing encourages spread of the disease in high-risk areas like health care and congregating settings.

 The national relaxation of masking requirements for public transportation, such as on trains, also had a huge impact, signaling for many that the pandemic was over. CDC guidance has been a challenging aspect of COVID-19 infection prevention. On one hand, we understand the impact such restrictions have on the public. But on the other hand, the shifting nature of these restrictions and questionable decisions have affected trust in the federal agency. The recommendation for shortened isolation periods of 5 days has had a large impact, whereas many studies underscore that individuals can still be infectious after 5 days.

 Developing guidance during a pandemic was never going to be easy (and many cite progress, not perfection), but we need to work harder to achieve a middle ground and better science communication.

Many reasons are being cited: the immune debt we would often see addressed through childhood socialization and exposure related to school and social interactions, a lack of respiratory precautions in place, etc. With this significant surge, many are calling for a renewed interest in RSV vaccines, which have been long discussed but have not come to fruition. The surge in RSV cases across the United States is a recent reminder that we’ve been shielded from the more seasonal respiratory infections since the pandemic began. But we must continue to be vigilant; COVID-19 isn’t the only infectious disease we face.

we also had new interventions and tools in our arsenal against this [COVID-19] pandemic: bivalent boosters and Paxlovid."

           --Saskia v. Popescu, PhD, MPH, MA, CIC

Yes—we had a monkeypox outbreak on an international scale that was declared a public health emergency of international concern. Monkeypox, an orthopoxvirus and cousin of smallpox, is not one we typically see in the United States. In fact, most of the cases in this global event were in countries that historically had not reported the virus. Not only is this a unique event and a reminder that a disease anywhere is a threat everywhere, but this outbreak brought to light social stigma and a mishandled response we haven’t seen since HIV/AIDS. Early in the monkeypox outbreak, there were epidemiological findings that cases were initially being spread in social networks among men who have sex with men (MSM). Each outbreak yields its own findings early on, and we find trends that can help us target interventions. But sadly, US response struggled with this.

 Much time had to be spent explaining that monkeypox is not spread solely in MSM, that it is not considered a sexually transmitted infection, and that stigma only hurts response.

From delays in testing access to vaccine distribution, the United States was woefully inadequate in its response. I mention this because it underscores the increasing and continued threat of emerging infectious diseases but also shows that managing a new global outbreak during a pandemic comes with an increased burden, requiring continued vigilance and awareness for how we operate and communicate risk.

Other Important IPC Stories You May Have Missed

. Wastewater samples in New York City and other counties in New York state pointed to several cases. In those areas, vaccination rates were around 60%, which is low. We know that vaccine-preventable diseases have been on the rise with vaccine hesitancy, but polio always seemed like one we had a handle on. Although this clustered concern doesn’t pose a risk to the public, it does reiterate the importance of childhood vaccines and improving uptake in areas with low vaccination rates and that such diseases are only as controlled as we allow them to be.

. Uganda saw a new outbreak of Ebola caused by the Sudan strain (not the strain we saw in the 2014/2016 outbreak).⁹ As of October 26, 2022, there were 115 confirmed cases, 21 probable cases, and 1844 contacts under active follow-up. Although this strain of Ebola virus is not as fatal as the Zaire strain, there have 32 confirmed deaths. Now is a good time to initiate travel-related emergency department and urgent care warnings and have educational talks with providers about the ongoing outbreak.

. Not what you thought I’d mention in a talk about top IPC stories, right? I share this for a few reasons. The effort to improve biosecurity is an important global topic, and even though we don’t often deal with geopolitics in IPC, they still trickle into our realm. Earlier this year, Russia accused the United States and Ukraine of violating the Biological Weapons Convention (an international treaty) as it invaded Ukraine. In an effort to distract with disinformation, it triggered a review within the United Nations despite few countries backing Russia’s claim (and even then, it was mostly a consultation process, not support for the allegations). Why is this important? Russia’s claims made use of disinformation surrounding biolabs and portrayed US military biological activities as nefarious rather than supportive of global biosecurity and health initiatives. This poses a concern for larger work in science, efforts to keep the world free of bioweapons through biodefense, and partnership on a global scale that could affect research and innovation.

I’ll admit my own bias—I’m an infection preventionist and hospital epidemiologist who has focused a lot of my research and work on the roadblocks we face to building and supporting biopreparedness programs within health care. We’re often forgotten when it comes to discussing health care worker burnout and what frontline responders did during the COVID-19 pandemic. Facing the third year of the pandemic, we’ve seen increases in health care–associated infections (HAIs) and antimicrobial resistance and a deep need for sustained response to infectious diseases, and that means infection prevention. We’ve battled monkeypox, extreme burnout, and changing CDC guidance, and carried the burden of ensuring ongoing COVID-19 safety while reducing the risk for HAIs. The world is learning more about IPC efforts and the role we’ve played in this pandemic, but such change doesn’t happen overnight. While we wait for a more recognized role within health care and public health, I want to end on this note: Infection preventionists are critical resources for responding to infectious disease threats, be they HAIs or novel pathogens, and ultimately form the intersection of public health and health care.

Thompson D. Cases of child RSV are swamping hospitals. What are the symptoms, treatments? 

. October 25, 2022. Accessed October 28, 2022. 

https://www.usnews.com/news/health-news/articles/2022-10-25/cases-of-child-rsv-are-swamping-hospitals-what-are-the-symptoms-treatments

Trends in number of COVID-19 cases and deaths in the US reported to CDC, by state/territory. Centers for Disease Control and Prevention. Accessed October 28, 2022. https://covid.cdc.gov/covid-data-tracker/#trends_weeklycases_select_00

Prillaman M. Prior Omicron infection protects against BA.4 and BA.5 variants. 

. July 25, 2022. Accessed October 28, 2022. 

https://www.nature.com/articles/d41586-022-01950-2

Sheikh K. Covid-19 symptoms can rebound even if you don’t take Paxlovid. 

. October 27, 2022. Accessed October 28, 2022. 

https://www.nytimes.com/2022/10/27/well/live/covid-symptoms-rebound-paxlovid.html

Massetti GM, Jackson BR, Brooks JT, et al. Summary of guidance for minimizing the impact of COVID-19 on individual persons, communities, and health care systems - United States, August 2022. 

. 2022;71(33):1057-1064. doi:10.15585/mmwr.mm7133e1

Marquez C, Kerkhoff AD, Schrom J, et al. COVID-19 symptoms and duration of rapid antigen test positivity at a community testing and surveillance site during pre-Delta, Delta, and Omicron BA.1 periods. 

2022;5(10):e2235844. doi:10.1001/jamanetworkopen.2022.35844

Wu KJ. What should worry most Americans about our monkeypox response. 

. August 4, 2022. Accessed October 28, 2022. 

https://www.theatlantic.com/health/archive/2022/08/monkeypox-public-health-emergency-response/671060/

Mputubwele N, Osmundson J. A viral colonial legacy: HIV, monkeypox emerged due to ongoing colonial viral neglect. Contagion Live. September 25, 2022. Accessed October 28, 2022. 

https://www.contagionlive.com/view/a-viral-colonial-legacy-hiv-monkeypox-emerged-due-to-ongoing-colonial-viral-neglect

Ebola disease caused by Sudan virus - Uganda. World Health Organization. October 28, 2022. Accessed October 28, 2022. 

https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON421

Articles

A summary of the top stories of 2022, and what to look for in the new year. 

Recounting the Top IPC Stories of 2022

The holidays are fast approaching and for much of the United States, that means gatherings. Friends, family, coworkers, etc. Tis the time for breakroom potlucks, right? Well, let’s keep in mind a few things….

First, we’re facing a dire situation across the country in terms of pediatric hospitalizations, deaths, and 

respiratory syncytial virus infection (RSV)

And, of course, influenza, and COVID-19. Many hospitals have had to initiate emergency efforts, such as diversion and resource to crisis capacity. Bed and staffing shortages are rampant, and some individuals are having to postpone elective surgeries. Now more than ever, using visitor restrictions and respiratory precautions will be critical.

 cases are continuing to rise. Across the country, there’s a 7% increase in the last two weeks. Test positivity is also up, now at 8.6%, which is a 4% change in the last 14 days. Several states are seeing significant upticks in cases. In terms of 

, Arizona is up 110%, Nebraska 60%, California 56%, Oregon 34%, Washington is now up 279%, and Alaska is up 63%. Very few states are seeing a drop in cases, and Maine is the winner of the biggest drop in cases over the last two weeks with a 45% decrease in cases. Right now in the United States, there are 111.4 million people fully vaccinated. If we look at 

. population, 34% are boosted, and only 68% are fully vaccinated.

Looking back around this time last year, keeping in mind we saw the novel variant–Omicron–come into the picture, it was right around early December when cases started to rise. Not surprising if you consider the Thanksgiving gatherings and travel, but will we see the same trend this year? Hopefully not and definitely hoping to avoid another new highly transmissible variant. What is worrisome though, is the perfect storm brewing that could lead to a significant surge. First, it’s important to remember that viruses mutate where they can spread…so we want to avoid transmission in general. No brainer, right?

The piece so many experts are so concerned about is this perfect storm–the waning interest in boosters and vaccines, but also the waning immunity that is creeping up on us. Those low hospitalization and death rates are are a result of effective vaccines and, thankfully, a variant that appears to cause less significant disease. The other component is a total relaxation of pretty much all public health interventions. Gone are the days of mask mandates, focused eating outside, and quality ventilation, and employer-mandated quarantine or isolation. Did I mention access to quality tests? Yes, antigen tests from your local stores are a wonderfully accessible tool, but too often we see people testing negative in the first few days of illness and not retesting, despite knowing everything from low viral levels to poor sample collection could be an issue…not to mention that antigen tests aren’t that precise. All these things are worrisome and require us to try and infuse some COVID-19 infection prevention efforts into this holiday season.

Need some reading on non-COVID-19 topics this week? Check out these articles on infectious disease. A 

 discusses global mortality associated with 33 bacterial pathogens (hint, 

 is a major one). There’s also this one on 

 following cataract surgery in South Korea.

Now is the time to enjoy the holidays, but it is not time to forget to protect against RSV, COVID-19, and influenza. 

Hot Topics: 2022 Holiday Season Begins: RSV Running Rampant, COVID-19 Spiking

Saskia v. Popescu, PhD, MPH, MA, CIC, discusses this weeks Hot Topics in Infection Prevention.

? Not particularly surprising…this is our third winter with COVID-19, so perhaps we’ll know what to do…better, this time?

Health Care Associated-Infections (HAIs)– Up in 2021

This isn’t surprising either, and for many individuals, this was expected based off personal experience, but it was nice to see the official 

data shared by the Centers for Disease Control and Prevention (CDC

). Between the first year of the COVID-19 pandemic (2020) and last year (2021), the CDC reports through an annual highly that there was a 7% increase in central line-associated bloodstream infections (CLABSIs), a 5% increase in catheter-associated urinary tract infections (CAUTIs); both types of infections were notably in intensive care units (ICUs), but also a 12% increase in VAE with the biggest jump of 16% in non-ICUs.

Thankfully, there was not a significant change to surgical site infections (SSIs), but those were only in the 10 procedures tracked. The CDC did note an 11% increase in abdominal hysterectomy SSIs. Interesting, there was a 14% increase in hospital onset MRSA bacteremia and a 3% decrease in hospital onset 

.What’s interesting is that if we look at the 

 (comparing 2019 to 2020), there was a 24% increase in CLABSIs, no significant change in CAUTIs, but a 35% increase in ventilator-associated events (VAEs).

What is even more interesting was the 15% increase in hospital onset methicillin-resistant 

 (MRSA) bacteremia and the 11% decrease in hospital onset 

. I mention this because it points to improvement in how we are managing HAIs in the face of the pandemic. The capacity to address a serious rise in HAIs in the second year of a pandemic, while rolling out vaccinations and managing novel variants, is a feat that has gotten little recognition. One piece, though, I find interesting is the from an 11% decrease in 

 cases to 3% in this most recent report. It begs the question if we’ve overcorrected so much with discussions around cleaning and disinfection related to COVID-19 in the first year of the pandemic, that it’s rippled into our general behaviors and practices.

presenting COVID-19 incidence among staff and students across schools in relation to universal masking. Keeping it short and sweet: When masking requirements were lifted, there was an associated increase in cases. According to the authors, “Before the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts. During the 15 weeks after the statewide masking policy was rescinded, the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff (95% confidence interval, 32.6 to 57.1), which corresponded to an estimated 11,901 cases and to 29.4% of the cases in all districts during that time.”

The Ebola outbreak in Uganda has officially 

 (eastern Uganda) and outside of the central region it had been mostly impacting, bringing the total cases to 135 confirmed and 53 deaths. 

Arizona has just reported a case of locally-acquired Dengue

, which is worrisome for the state in which the virus does not traditionally exist. Mosquito trap surveillance confirmed the presence of the virus through a positive sample as well.

Saskia v. Popescu, PhD, MPH, MA, CIC, covers updates on health care associated-infections, masking at schools, and Ebola in Uganda and Dengue in Arizona. Read on for all the details. 


Hot Topics in IPC: Health Care Associated-Infections, COVID-19, Ebola, Dengue 

Saskia v. Popescu presents Hot Topics in Infection Prevention

. But the future of COVID-19 heavily discussed, and, of course, infectious diseases don’t take a break.

Good news: globally, COVID-19 cases and deaths are dropping in most of the world. Bad news: except in Southeast Asia and the Western Pacific, which are reporting increasing cases. Last week, the world saw 2.1 million new cases, which is 

 than the week before. Unfortunately, those countries with the most new cases include Japan, South Korea, the United States, Germany, and China. China is still pursuing the “zero-COVID[-19]” strategy, which has many individuals frustrated with continued shutdowns and surges. In the United States, COVID-19 cases are up 7% in the last 2 weeks, with a daily average just over 40,000 cases. Test positivity is 8.8%, and there are roughly 316 daily deaths. Some states in the US are still showing a consider up-tick in cases: the 4 Corners (Arizona, New Mexico, Colorado, and Utah) are all showing at least a 30% increase in cases, with other states slowly climbing up, such as South Carolina, Oregon, Nevada (up 96%!), and Louisiana. Not all states are climbing, though; Oklahoma is down in cases by 25%, similar to Michigan and New Hampshire.

 was released on how Paxlovid may help cut the risk of long COVID-19 and a great article on how 

annual COVID-19 shots may make our lives easier

. If you’re interested in global health news and articles on vaccine equity, 

 on vaccine hoarding and the impact globally.

It seems a while since we’ve had to respond to what felt like a true respiratory virus season while tackling the COVID-19 pandemic. Unfortunately, we’re seeing that now. Some states are reporting influenza test positivity rates upwards of 20%, and significant regions in the United States are seeing H1N1 activity rise. The Centers for Disease Control and Prevention’s 

 went out last week as well, giving health care providers strategies for treating, testing, and combating respiratory viruses on the move.

Good News Against Urinary Tract Infections (UTIs)

Two clinical trials for an investigational antibiotic for UTIs were halted earlier than expected due to meeting their goals head of schedule. The British pharmaceutical company, GSK, “

 the decision to stop enrollment for the EAGLE-2 and EAGLE-3 trials, which were evaluating the novel oral antibiotic gepotidacin for treatment of uncomplicated UTIs in adult and adolescent women, was based on a pre-specified interim analysis of efficacy and safety data by the Independent Data Monitoring Committee. The interim analysis found that gepotidacin met the combined primary efficacy endpoint in both trials, which included more than 3,000 patients in 12 countries.”

The outbreak of Ebola in Uganda has now hit 136 confirmed cases and 53 deaths, with projections as high as 1,200 by April. Most cases have been in the capital city of Kampala and World Health Organization's Director-General Tedros Ghebreyesus 

 about the focused efforts and ensuring support for contact tracing, infection prevention, and community engagement. During this time, 

 gone up as 19 countries report a rise in cases. In general cases are down significantly from the peak in August, but the WHO has reported a 2.5% increase in cases for the last week, most heavily in the Americas and European regions.

Infection prevention and control personnel don't elect to ever stop. Dr. Popescu tells us what's in the news this week of the mid-term elections.

Hot Topics in IPC:  Mid-term Election Week

The author, Saskia v. Popescu, PhD, MPH, MA, CIC.

What’s scary to an infection preventionist? In truly, I always jokingly say that my personal risk tolerance is pretty nutty from years of working infectious diseases and that I tend to hit the panic button around 

 more than other things that would worry folks. As we celebrated Halloween this week, I’d be curious if your version of “scary” in the work of infection prevention and control (IPC) has changed over the years? What about since COVID-19? 

 is likely on the list for most of us, though. (

Unfortunately, Uganda has reported 2 more Ebola Sudan cases and 9 more deaths, which now means this outbreak has reached 130 cases and 43 deaths. “At a World Health Organization (WHO) 

Director-General Tedros Adhanom Ghebreyesus

, PhD, said Mubende is still the most affected district, but cases have recently risen in two neighboring districts. He said that, so far, 17 cases have been confirmed in Kampala, the country's capital and largest city. He also added that the WHO yesterday released an additional $5.7 million from its emergency contingency fund to further support the response.” Efforts are ongoing to perform contact tracing and control the spread of the outbreak. Given these numbers, it would be helpful to share with emergency department and urgent care personnel about travel-related exposures and to ask those important questions. Remember, in 2014 we didn’t think Ebola wouldn’t happen in the United States…until it did.

COVID-19: Are We Starting to See an Increase in Cases?

From October 29th until early November, we’ve 

 in cases of COVID-19 within the United States. Ever so small, but a 2% increase in cases in the last two weeks. This is also mirrored in hospitalizations.If we look at what’s happening across the country, some places are seeing a more substantial increase in cases. Missouri has a 67% increase in cases in the last two weeks, while New Mexico has a 53% spike, Arizona has 101%, and Nevada has a 92% increase in cases as well. It’s early still, but those numbers are already starting to worry many. With respiratory syncytial virus (RSV) numbers causing a spike in pediatric cases and hospitalizations, and flu on the rise, it’s not surprising that these numbers are something we should keep an eye on in healthcare readiness and infection prevention. Pandemic fatigue is real, but we all know how severe the winters can be, so now is the time to check on personal protection equipment (PPE) levels, make sure those isolation signs are available, and folks are aware of what surges in influenza and RSV are like after several years of (mostly) COVID-19.

A few tidbits that you may find interesting…

 may want to worry – chronic wasting disease (CWD) has been confirmed in two elk within the state. Officials from The Wyoming Game and Fish Department are now working to collect samples and warning people not to eat meat from infected animals.

What was the hospitalization rate for monkeypox patients? A new study assessed 7,553 reported cases and the 555 hospitalizations that occurred as a result of monkeypox infection. This 

 found a hospitalization rate of 14.1% in monkeypox patients, and this current outbreak ultimately experienced lower case-fatality rates as well.

What is scary in infection prevention and control? Dr. Popescu tells us what's in the news this week of Halloween.

Infection Prevention Hot Topics: Week of Halloween

The author, Saskia v. Popescu, PhD, MPH, MA, CIC, discusses hot topics in Infection prevention.

 was released regarding frontline workers that sheds some light on symptoms, viral load, and the impact of vaccines. Pulling from the HEROES-RECOVER network, which is a large prospective cohort of frontline workers (health care personnel, first responders, and other essential services such as educational, food processing, transportation, etc, across 6 states), the research team evaluated the association between the second and third doses of mRNA COVID vaccines. Since December 14, 2020, 1119 participants were evaluated, and stratification included SARS-CoV-2 strain and vaccination status.

What did they find? During this long study period, most individuals were infected with Omicron (62%), and per the investigators, “Participants vaccinated with the second vaccine dose 14 to 149 days before Delta infection were significantly less likely to be symptomatic compared with unvaccinated participants (21/27 [77.8%] vs 74/77 [96.1%]; odds ratio (OR), 0.13 [95% CI, 0-0.6]) and, when symptomatic, those vaccinated with the third dose 7 to 149 days before infection were significantly less likely to report fever or chills (5/13 [38.5%] vs 62/73 [84.9%]; OR, 0.07 [95% CI, 0.0-0.3]) and reported significantly fewer days of symptoms (10.2 vs 16.4; difference, −6.1 [95% CI, −11.8 to −0.4] days).”

This means that asymptomatic cases were more closely linked to Omicron infections. Of those with symptoms, the longest duration was for those with Delta—16.4 days. Workers with a second vaccine dose prior to a Delta infection were much less likely than those unvaccinated to have symptoms. For those individuals with 3 doses and ended up experiencing symptoms, they were less likely to experience a fever or chills and, ultimately, had symptoms for fewer days. Last little tidbit, with Omicron-infected workers, that third dose made a much more significant difference in ensuring mild symptoms, and ultimately, they found that those symptomatic participants had much higher viral loads than those asymptomatic cases. The lowest viral loads? Workers who were given their second dose and had either Delta or Omicron infections when compared to their unvaccinated counterparts.

Total cases are now at 80 with 44 deaths. Uganda’s Health Ministry has initiated a 3-week lockdown for 2 districts most heavily impacted, and there has been a new isolation facility established in Madudu with support from partners like Doctors Without Borders. Stay vigilant, folks: Relevant travel and symptoms will be key as this is the Sudan strain, and there are no vaccines or treatments approved for it.

In not particularly surprising, but nonetheless important news, the Centers for Disease Control and Prevention has 

 a few unique cases of monkeypox disease and transmission in the latest 

). Two studies were reviewed: One discussed 5 cases of ocular monkeypox that involved vision impact and worry for long-term vision issues. Four out of the 5 cases involved hospitalization. Ultimately, the authors emphasized that in the event of ocular monkeypox, hand hygiene becomes key—just another reason to wash your hands! The second case study from the 

 emphasized occupational exposures through the lens of a nurse who was infection via a needlestick injury. The emergency department nurse had the exposure when capping the needle used to swap the rash of a monkeypox patient. Despite being given the first dose of the Jynneos vaccine within 15 hours of the event, she developed a lesion at the site of the needlestick puncture 10 days later. This serves as a painful, but important reminder of not only needlestick injuries, but how unique needle-swabbing practices may be a source for risk in those unusual outbreaks or situations.

Saskia v. Popescu, PhD, MPH, MA, CIC, covers updates on COVID-19 in frontline workers, an Ebola outbreak in Uganda, and ocular and needlestick monkeypox.