March/April · Volume 13, Issue 90

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Antimicrobial Resistance (AR)   Healthcare-Associated Infection (HAI)
Virginia Department of Health (VDH)   United States (U.S.)
Centers for Disease Control & Prevention (CDC)

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• Virginia Regional IPs
• NACCHO IPC Champions Series
• Tuberculosis Program Updates
• 2021-2022 Influenza Season
• Norovirus Updates
• COVID-19 Updates
• NHSN Updates
• Training & Education
  
  • Project Firstline 
  • Virginia Infection Prevention Training Center (VIPTC) 
  • VDH HAI/AR Program
  • NACCHO's Living Learning Network 
• Research
  • Future of HAI/AR Response in the Face of COVID-19
• Awareness Events

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News in Virginia

New Team Members. The VDH HAI/AR Program would like to welcome Carolyn Kiefer, RN, BSN, CIC as the Southwest and Northwest Regional Infection Prevention Coordinator. 

VDH Regional IPs. Did you know that VDH has eight regional infection preventionists (IPs) throughout the Commonwealth who are available to provide consultation and education on infection prevention and control (IPC)? These experienced IPs are an excellent resource to healthcare facilities across the continuum of care as well as to health department teams. For example, regional IPs work with healthcare facilities during proactive IPC assessments to help facilities identify IPC strengths and areas for improvement. Facilities can request a proactive IPC assessment on the VDH HAI/AR website. Future issues of the HAI High Sign will spotlight the work and impact of our regional IPs!

NACCHO IPC Champions Series: NACCHO recently published the latest installation of their IPC Champion series featuring the Fairfax County Health Department. Read the full member spotlight for more.

VDH Tuberculosis (TB) Program. The VDH TB Program has updated the High Burden TB Countries List and MDR TB High Burden Countries List 

2021-2022 Influenza Season. While sporadic cases continue in Virginia and across the country, influenza activity is declining. However, this season has seen more activity than last; CDC estimates that so far this season there have been at least 2.3 million flu illnesses, 22,000 hospitalizations, and 1,300 deaths from flu. Flu activity is still being observed in long-term care facilities (LTCFs).  According to the CDC, in the week of February 12th, (MMWR Week 6), 57 (0.4%) of 14,248 reporting LTCFs reported at least one influenza positive test among their residents. The majority of influenza viruses detected so far have been A(H3N2), which are genetically closely related to the vaccine virus. However, there are some antigenic differences that have developed as H3N2 viruses continue to evolve. The best way to prevent flu infection is to get vaccinated. According to the CDC, vaccination rates this year are lower than last year; it is not too late to get your vaccine!

Coinfections with COVID and flu were relatively rare last flu season because of reduced flu activity. Despite the fact that flu activity has declined globally since it reached its peak at the end of 2021, the importance of coinfection cannot be overemphasized. Vaccination with both COVID-19 and flu vaccine can help reduce the severity of illness caused by COVID-19, flu, or a coinfection of both viruses. Testing should be considered for both influenza and SARS-CoV-2 viruses in patients with influenza-like illness (ILI).

Increased Norovirus Activity in Virginia. Have you seen an increasing number of patients with nausea, vomiting, and diarrhea lasting approximately 1-2 days? 

• Noroviruses are highly contagious and are found in the feces and vomitus of infected people. These viruses can spread rapidly through congregate facilities (e.g., long-term care, daycare and school). Mitigation measures such as cleaning, disinfection, and hand washing for at least 20 seconds after using the bathroom, between seeing patients and before preparing or serving foods and medications prevents transmission via person-person or contaminated surfaces. Stay home from work or school if you are ill.
• Norovirus infections are usually diagnosed based on symptoms. However, the state public health laboratory will test stool specimens to identify the virus and confirm a suspected outbreak. Although individual cases of norovirus infection are not reportable to VDH, it is important to report suspected and confirmed outbreaks of norovirus to your local VDH health district.
• In the last norovirus season (August 1, 2020 - July 31, 2021), 48 norovirus or norovirus-like outbreaks were reported in Virginia, whereas 103  were reported  during the previous season (August 1, 2019 - July 31, 2020). Most of these outbreaks were spread through person-person transmission and occurred in long-term care facilities. So far this season, there have been 36 norovirus outbreaks reported in Virginia, and over half were in long-term care and restaurant settings.
• Norovirus Resources: Norovirus Infection Fact Sheet, Key Infection Control Recommendations for the Control of Norovirus Outbreaks in Healthcare Settings, Norovirus in Healthcare Facilities Fact Sheet 

COVID-19 Updates. 

• CDC COVID-19 Guidance: Below is a list of healthcare IPC and other related guidance documents that have been recently published or updated by CDC. For additional updates, CDC’s What’s New & Updated tool is a helpful way to stay up-to-date with new and updated content on CDC’s COVID-19 webpages. Users can filter by date, webpage type, audience, and topic.
  • Interim IPC Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes (2/2/22)
  • Interim IPC Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic (2/2/22)
  • Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 (1/21/22)
  • Strategies to Mitigate Healthcare Personnel Staffing Shortages (1/21/22)
  • Infection Prevention and Control Assessment Tool for Nursing Homes Preparing for COVID-19 (1/7/22)
• CDC Updated Clinical Considerations for COVID-19 Vaccination:  
  • For people who are moderately or severely immunocompromised: 
  • People who have completed a primary series of Pfizer-BioNTech or Moderna are recommended to receive an mRNA booster dose 3 months (previously 5 months) after completing the primary series
  • People who have received a single J&J vaccine should receive one additional dose of an mRNA (Pfizer-BioNTech or Moderna) vaccine and one booster dose (preferably mRNA) for a total of 3 vaccine doses
  • Clarification to confirm that those who have completed their primary series of 3 mRNA doses should then receive an mRNA booster dose (total of 4 doses)
  • Added considerations for an 8-week interval between the first and second doses of a primary mRNA vaccine schedule
• New Monoclonal Antibody: Bebtelovimab
• FDA granted emergency use authorization for bebtelovimab on February 11, 2022
• Shown in lab testing that it has activity against: Omicron variant and BA.2 subvariant
• Indicated for the treatment of patients with mild to moderate COVID-19 in adults and pediatric patients (12 years of age and older who weigh at least 40 kg): 
  • Who have a positive SARS-CoV-2 viral test and are at high-risk for progression to severe COVID-19, and who are not hospitalized
  • When alternative treatment options approved or authorized by FDA are not accessible or clinically appropriate
• Administered as a single intravenous infusion and given as soon as possible after diagnosis and within 7 days of symptom onset
• VDH Resources
  • Therapeutics
    • Updated VDH resource to outline steps to request immediate deployment of COVID-19 therapeutics for patients in congregate care settings (including long-term care facilities) in response to a COVID-19 outbreak
      • May include monoclonal antibody and/or oral antiviral treatment
  • Infection Prevention and Control
    • COVID-19 Long-Term Care Task Force page
      • Updated resources under Nursing Homes/Skilled Nursing Facilities and Guidance for all LTCFs (general infection prevention recommendations, outbreak response recommendations, PPE and cohorting guidance, and more)
    • Healthcare Professionals page
      • Resources on IPC best practices in emergency departments and an updated healthcare personnel risk assessment tool

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