JAMA -- Abstract: Nosocomial Transmission of Human Granulocytic Anaplasmosis in China, November 19, 2008, Zhang et al. 300 (19): 2263

[Giuseppe]

JAMA -- Abstract: Nosocomial Transmission of Human Granulocytic Anaplasmosis in China, November 19, 2008, Zhang et al. 300 (19): 2263

Nosocomial Transmission of Human Granulocytic Anaplasmosis in China

Lijuan Zhang, MD, PhD; Yan Liu, MD; Daxin Ni, MD; Qun Li, MD; Yanlin Yu, MD; Xue-jie Yu, MD, PhD; Kanglin Wan, MD, PhD; Dexin Li, MD; Guodong Liang, MD; Xiugao Jiang, MD; Huaiqi Jing, MD; Jing Run, MD; Mingchun Luan, MD; Xiuping Fu, MD; Jingshan Zhang; Weizhong Yang, MD; Yu Wang, MD, PhD; J. Stephen Dumler, MD; Zijian Feng, MD; Jun Ren, MD; Jianguo Xu, MD, PhD

JAMA. 2008;300(19):2263-2270.

Context
Human granulocytic anaplasmosis (HGA) is an emerging tick-borne disease in China. A cluster of cases among health care workers and family members following exposure to a patient with fulminant disease consistent with HGA prompted investigation.

Objective
To investigate the origin and transmission of apparent nosocomial cases of febrile illness in the Anhui Province.

Design, Setting, and Patients
After exposure to an index patient whose fatal illness was characterized by fever and hemorrhage at a primary care hospital and regional tertiary care hospital's isolation ward, secondary cases with febrile illness who were suspected of being exposed were tested for antibodies against Anaplasma phagocytophilum and by polymerase chain reaction (PCR) and DNA sequencing for A phagocytophilum DNA. Potential sources of exposure were investigated.

Main Outcome Measure
Cases with serological or PCR evidence of HGA were compared with uninfected contacts to define the attack rate, relative risk of illness, and potential risks for exposure during the provision of care to the index patient.

Results
In a regional hospital of Anhui Province, China, between November 9 and 17, 2006, a cluster of 9 febrile patients with leukopenia, thrombocytopenia, and elevated serum aminotransferase levels were diagnosed with HGA by PCR for A phagocytophilum DNA in peripheral blood and by seroconversion to A phagocytophilum. No patients had tick bites. All 9 patients had contact with the index patient within 12 hours of her death from suspected fatal HGA while she experienced extensive hemorrhage and underwent endotracheal intubation. The attack rate was 32.1% vs 0% (P = .04) among contacts exposed at 50 cm or closer, 45% vs 0% (P = .001) among those exposed for more than 2 hours, 75% vs 0% (P < .001) among those reporting contact with blood secretions, and 87.5% vs 0% (P = .004) among those reporting contact with respiratory secretions from the index patient.

Conclusion
We report the identification of HGA in China and likely nosocomial transmission of HGA from direct contact with blood or respiratory secretions.

Author Affiliations: National Institute of Communicable Disease Control and Prevention, China CDC, Beijing (Drs L. Zhang, Wan, Jiang, Jing, Luan, Fu, and Xu and Mr J. Zhang); Anhui Center for Disease Control and Prevention, Hefei, Anhui Province, China (Drs Liu, Q. Li, and Ren); Chinese Center for Diseases Prevention and Control, Beijing (Drs Ni, Yang, Wang, and Feng); Yijishan Hospital, Wuhu, Anhui Province, China (Drs Yu and Run); Department of Pathology, University of Texas Medical Branch, Galveston (Dr X. Yu); National Institute for Viral Diseases Prevention and Control, Beijing, China CDC (Drs D. Li and Liang); State Key Laboratory for Infectious Diseases Prevention and Control, Beijing, China (Drs Wan, D. Li, Liang, Jing, and Xu); and Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Dumler).
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<cite cite="http://jama.ama-assn.org/cgi/content/abstract/300/19/2263?etoc">JAMA -- Abstract: Nosocomial Transmission of Human Granulocytic Anaplasmosis in China, November 19, 2008, Zhang et al. 300 (19): 2263</cite>

 

[sharon sanders]

Re: JAMA -- Abstract: Nosocomial Transmission of Human Granulocytic Anaplasmosis in China, November 19, 2008, Zhang et al. 300 (19): 2263

Study Documents What May Be First Cases Of Certain Tick-borne Disease In China

ScienceDaily (Nov. 29, 2008) ? It appears that for the first time human granulocytic anaplasmosis (HGA), an emerging tick-borne infectious disease found in the U.S. and Europe, has been identified in China and apparently was transmitted from person to person, according to a study in the November 19 issue of JAMA.

HGA was recognized in the United States in 1990 and in Europe in 1997, with the annual number of infections reported in the U.S. steadily increasing. Data suggests that infection rates in endemic areas are as high as 15 percent to 36 percent, implying that the diagnosis is often missed or that infection is mild or asymptomatic, according to background information in the article. "Because epidemiological, clinical, and microbiological information about HGA is limited, the disease is likely underrecognized and underreported worldwide," the authors write. Lijuan Zhang, M.D., Ph.D., of the National Institute of Communicable Disease Control and Prevention, China CDC, Beijing, and colleagues conducted a study to determine the origin and transmission of the apparent first cases of HGA acquired in China, as well as the first finding of human-to-human transmission. A cluster of cases among health care workers and family members following exposure to a patient with disease symptoms consistent with HGA prompted the investigation. Subsequent questioning of the patient's family revealed that she was bitten by a tick 12 days before onset of fever.


After exposure to the index patient (initial person with symptoms), whose fatal illness was characterized by fever and hemorrhage at a primary care hospital and regional tertiary care hospital's isolation ward, secondary cases (health care workers and family members) with fever who were suspected of being exposed were tested for antibodies against the bacteria Anaplasma phagocytophilum. Potential sources of exposure were investigated.


In a regional hospital of Anhui Province, China, between November 9 and 17, 2006, a cluster of nine patients with fever and other symptoms were diagnosed with HGA. No patients had tick bites. All nine patients had contact with the index patient within 12 hours of her death from suspected fatal HGA while she experienced extensive hemorrhage and underwent endotracheal intubation (the placement of a flexible plastic tube into the trachea for the purpose of ventilating the lungs). The patients indicated they were unlikely to have used gloves or wash after contact with the index patient.
Among the 28 individuals who reported close contact (20 inches or less) with the index patient during the final 12 hours of her life, nine were infected. The index patient was exposed to 20 contacts for more than 2 hours, and nine were infected. All nine infected patients reported contact with blood and seven had contact with respiratory secretions. Those persons with skin exposure to blood or respiratory secretions, or those with pre-existing skin lesions or injuries followed by exposure to blood were significantly more likely to be infected.


"The most remarkable aspect of these cases was that transmission was very unlikely to be tick-borne, but was closely associated with blood or respiratory secretion exposure from an index patient who died of a [sudden and severe] illness with hemorrhage," the authors write.



http://www.sciencedaily.com/releases/2008/11/081118161239.htm