Ebola virus disease in health care workers--Sierra Leone, 2014

Health care workers (HCWs) are at increased risk for infection in outbreaks of Ebola virus disease (Ebola). To characterize Ebola in HCWs in Sierra Leone and guide prevention efforts, surveillance data from the national Viral Hemorrhagic Fever database were analyzed. In addition, site visits and interviews with HCWs and health facility administrators were conducted. As of October 31, 2014, a total of 199 (5.2%) of the total of 3,854 laboratory-confirmed Ebola cases reported from Sierra Leone were in HCWs, representing a much higher estimated cumulative incidence of confirmed Ebola in HCWs than in non-HCWs, based on national data on the number of HCW. The peak number of confirmed Ebola cases in HCWs was reported in August (65 cases), and the highest number and percentage of confirmed Ebola cases in HCWs was in Kenema District (65 cases, 12.9% of cases in Kenema), mostly from Kenema General Hospital. Confirmed Ebola cases in HCWs continued to be reported through October and were from 12 of 14 districts in Sierra Leone. A broad range of challenges were reported in implementing infection prevention and control measures. In response, the Ministry of Health and Sanitation and partners are developing standard operating procedures for multiple aspects of infection prevention, including patient isolation and safe burials; recruiting and training staff in infection prevention and control; procuring needed commodities and equipment, including personal protective equipment and vehicles for safe transport of Ebola patients and corpses; renovating and constructing Ebola care facilities designed to reduce risk for nosocomial transmission; monitoring and evaluating infection prevention and control practices; and investigating new cases of Ebola in HCWs as sentinel public health events to identify and address ongoing prevention failures.

Emergence of a new pathogenic Ehrlichia species, Wisconsin and Minnesota, 2009

BACKGROUND

Ehrlichiosis is a clinically important, emerging zoonosis. Only Ehrlichia chaffeensis and E. ewingii have been thought to cause ehrlichiosis in humans in the United States. Patients with suspected ehrlichiosis routinely undergo testing to ensure proper diagnosis and to ascertain the cause.

METHODS

We used molecular methods, culturing, and serologic testing to diagnose and ascertain the cause of cases of ehrlichiosis.

RESULTS

On testing, four cases of ehrlichiosis in Minnesota or Wisconsin were found not to be from E. chaffeensis or E. ewingii and instead to be caused by a newly discovered ehrlichia species. All patients had fever, malaise, headache, and lymphopenia; three had thrombocytopenia; and two had elevated liver-enzyme levels. All recovered after receiving doxycycline treatment. At least 17 of 697 Ixodes scapularis ticks collected in Minnesota or Wisconsin were positive for the same ehrlichia species on polymerase-chain-reaction testing. Genetic analyses revealed that this new ehrlichia species is closely related to E. muris.

CONCLUSIONS

We report a new ehrlichia species in Minnesota and Wisconsin and provide supportive clinical, epidemiologic, culture, DNA-sequence, and vector data. Physicians need to be aware of this newly discovered close relative of E. muris to ensure appropriate testing, treatment, and regional surveillance. (Funded by the National Institutes of Health and the Centers for Disease Control and Prevention.).

Shoulder response characteristics and injury due to lateral glenohumeral joint impacts

The objective of this study was to determine response characteristics and injury of the shoulder due to lateral impacts. The need for this data was heightened in the 1990s with increasing interest in harmonization of side impact standards, and questions regarding the measurement capabilities of dummies used in evaluating side impacts. A pneumatic impacting ram was employed in carrying out twentytwo lateral impacts to eleven unembalmed human cadavers at the level of the glenohumeral joint. Velocity of the ram at the time of impact was varied throughout the impacts from 3.5 to 7.0 m/sec, in an attempt to determine injury threshold. The cadavers were instrumented with tri-axial accelerometer blocks at ten locations in the shoulder region. Bony structures instrumented included the sternum, the first thoracic vertebra (T1), clavicles and scapulae. Output from the accelerometers was utilized to calculate impact forces and to exa mine the movement of the instrumented structures. Photographic target pins were inserted into the accelerometer blocks, thus permitting image analysis of the shoulder girdle displacement. Autopsies, radiographs, and magnetic resonance images (MRIs) were performed to document trauma that occurred as a result of the impact to the shoulder. Clavicles from the cadavers were subjected to bone density scans and threepoint bending tests. Results from these evaluations were used to assess and compare properties of bones of the upper extremities. Observations from autopsy, MRI, and radiography have shown looseness of the sternoclavicular joint and fracture of the distal clavicle to be the most common injuries. Significant findings include normalized shoulder forcedeflection curves and probability of injury distribution.