Hot Topics in IPC: Influenza, COVID-19, and Mechanical Ventilation and Drug-Resistant Pathogens

Influenza and COVID-19 Activity

This is the winter where we expect a tripledemic—COVID-19, influenza, and respiratory syncytial virus, but are we there yet? It’s still early in the respiratory virus season (usually, it starts to hit in later November), but some of the indicators are pointing to hopefully a moderate—and not severe—respiratory syndrome. In terms of COVID-19, the CDC is reporting some key metrics we can take into consideration.

First, the US has an 8.7% test positivity, a slight downward trend from October 15 to 21, 2023, which is the latest reported. Regarding emergency department visits diagnosed with COVID-19, the rate is sitting at 1.3%, down 4.6% from the previous week. What is concerning, though, is that 2.7% of all deaths in the US are due to COVID-19 (during the October 15 to 21 week), which is an increase of 12.5%. In terms of wastewater reporting, the number of sites reporting has dropped, which is concerning, and there’s been an increase in virus levels, all of which should be worrisome—data is critical!

This week in influenza, we’re seeing a relative hold at 1.7% of clinical lab results being positive for influenza (most being influenza A H1N1). There have been over 44k specimens tested during week 42 (again, the week ending October 21st). What is often a canary in the coal mine is outpatient respiratory illness rates; this is up and sitting at 2.5%, and something to watch. If we consider what our colleagues in Australia experienced during their influenza season, it will likely be moderate and hopefully end earlier.

All in all, this is an important time to ensure staff are vaccinated, masking and visitor restriction protocols are in place, and you have solid data metrics to determine actions. Regarding vaccinations, we’re still seeing challenges for many individuals getting the newest booster and with pandemic fatigue. It’s still important for folks to get vaccinated. While it’s likely we won’t see a COVID-19 winter similar to what we’ve already experienced, over time, this drop in immunity due to lackluster vaccination rates could cause larger issues. It’s also helpful to ensure staff have disinfecting wipes out and are reminded that this is for them to. Use them to wipe down the workstations, high-touch surfaces, etc.

Mechanical Ventilation and Drug-Resistant Pathogens

There’s an insightful article that has been recently published in the Journal of the American Medical Association that discussed the results of a point prevalence study of those patients receiving mechanical ventilation and test positivity for Candida auris, Acinetobacter baumannii (A baumannii), as well as carbapenem-resistant A baumannii (CRAB). In their findings, the researchers noted that “among the 482 patients who had samples collected, 30.7% (148/482) grew A baumannii; 88 of the 148 (59.5%) of these A baumannii were CRAB. In acute care hospitals, 8.2% (23/282) of patients sampled had A baumannii compared with 62.5% (125/200) in long-term care facilities (RR, 7.66 [95% CI, 5.11-11.50], P < .001). For CRAB, 6.4% (18/282) of patients sampled in acute care hospitals were colonized compared with 35.0% (70/200) of patients in long-term care facilities (RR, 5.48 [95% CI, 3.38-8.91], P < .001).

I discussed the findings with one of the researchers, Anthony Harris, MD, MPH, which you can read here in Infection Control Today’s sister brand, ContagionLive– ultimately, we need to start doing more surveillance on vented patients and consider stronger infection prevention and control interventions.

Another tidbit of Knowledge You Might Find Interesting

Chronic Wasting Disease (CWD) Reported in Michigan Deer – That’s right, a 4-year-old doe was diagnosed with CWD, which has been found in several Michigan counties.