Molecular Epidemiologic and Geo-Spatial Characterization of Staphylococcus aureus Cultured from Skin and Soft Tissue Infections from United States-Born and Immigrant Patients Living in New York City

(1) Background: With increasing international travel and mass population displacement due to war, famine, climate change, and immigration, pathogens, such as Staphylococcus aureus (S. aureus), can also spread across borders. Methicillin-resistant S. aureus (MRSA) most commonly causes skin and soft tissue infections (SSTIs), as well as more invasive infections. One clonal strain, S. aureus USA300, originating in the United States, has spread worldwide. We hypothesized that S. aureus USA300 would still be the leading clonal strain among US-born compared to non-US-born residents, even though risk factors for SSTIs may be similar in these two populations (2) Methods: In this study, 421 participants presenting with SSTIs were enrolled from six community health centers (CHCs) in New York City. The prevalence, risk factors, and molecular characteristics for MRSA and specifically clonal strain USA300 were examined in relation to the patients' self-identified country of birth. (3) Results: Patients born in the US were more likely to have S. aureus SSTIs identified as MRSA USA300. While being male and sharing hygiene products with others were also significant risks for MRSA SSTI, we found exposure to animals, such as owning a pet or working at an animal facility, was specifically associated with risk for SSTIs caused by MRSA USA300. Latin American USA300 variant (LV USA300) was most common in participants born in Latin America. Spatial analysis showed that MRSA USA300 SSTI cases were more clustered together compared to other clonal types either from MRSA or methicillin-sensitive S. aureus (MSSA) SSTI cases. (4) Conclusions: Immigrants with S. aureus infections have unique risk factors and S. aureus molecular characteristics that may differ from US-born patients. Hence, it is important to identify birthplace in MRSA surveillance and monitoring. Spatial analysis may also capture additional information for surveillance that other methods do not.

Zika among international travellers presenting to GeoSentinel sites, 2012-2019: implications for clinical practice

INTRODUCTION

International travellers contribute to the rapid spread of Zika virus (ZIKV) and its sentinel identification globally. We describe ZIKV infections among international travellers seen at GeoSentinel sites with a focus on ZIKV acquired in the Americas and the Caribbean, describe countries of exposure and traveller characteristics, and assess ZIKV diagnostic testing by site.

METHODS

Records with an international travel-related diagnosis of confirmed or probable ZIKV from January 2012 through December 2019 reported to GeoSentinel with a recorded illness onset date were included to show reported cases over time. Records from March 2016 through December 2019 with an exposure region of the Americas or the Caribbean were included in the descriptive analysis. A survey was conducted to assess the availability, accessibility and utilization of ZIKV diagnostic tests at GeoSentinel sites.

RESULTS

GeoSentinel sites reported 525 ZIKV cases from 2012 through 2019. Between 2012 and 2014, eight cases were reported, and all were acquired in Asia or Oceania. After 2014, most cases were acquired in the Americas or the Caribbean, a large decline in ZIKV cases occurred in 2018-19.Between March 2016 and December 2019, 423 patients acquired ZIKV in the Americas or the Caribbean, peak reporting to these regions occurred in 2016 [330 cases (78%)]. The median age was 36 years (range: 3-92); 63% were female. The most frequent region of exposure was the Caribbean (60%). Thirteen travellers were pregnant during or after travel; one had a sexually acquired ZIKV infection. There was one case of fetal anomaly and two travellers with Guillain-Barré syndrome. GeoSentinel sites reported various challenges to diagnose ZIKV effectively.

CONCLUSION

ZIKV should remain a consideration for travellers returning from areas with risk of ZIKV transmission. Travellers should discuss their travel plans with their healthcare providers to ensure ZIKV prevention measures are taken.

Risk of hepatitis E infection to travelers

Hepatitis E virus (HEV), previously referred to as enterically transmitted non-A, non-B hepatitis, is a major cause of epidemic hepatitis and acute, sporadic hepatitis in endemic areas of the world. The existence of HEV was suspected based upon epidemiological grounds for many years. However, it was only in the early 1990s that confirmation occurred when two prototype strains of HEV from Burma and Mexico were sequenced.1-3 Outbreaks of HEV infection as well as sporadic transmission commonly occur in Asia, Africa, Central and South America, the Middle East, and the Republics of the former USSR. Southeast Asia seems to be a particularly high HEV endemic region. HEV is transmitted via the fecal-oral route, and contaminated drinking water is a common source of infection.4 Many of the large outbreaks have occurred after heavy rains and flooding.4 During interepidemic periods sporadic infections occur frequently. This suggests a constant environmental reservoir, allowing for transmission between epidemics. The existence of a zoonotic reservoir for the virus is likely. HEV has been detected in a number of species, including swine, rats, and chicken.

Simultaneous amoebic liver abscess and hepatitis A infection

Hepatitis A virus (HAV) infection and amoebic liver abscess have an identical mode of transmission (fecal-oral route) and similar epidemiology. Either of these diseases might be considered in patients presenting with clinical signs and symptoms of liver disease in areas of the world where hepatitis and Entamoeba histolytica are endemic. The following two cases describe patients with simultaneous infection of HAV and amoebic liver abscess. This report emphasizes the role of dual infection in patients from endemic areas. It also challenges the assumption that jaundice in patients with amoebic liver abscess is due to amoebic hepatitis, rather than co-infection with viral hepatitis.