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Keeping Our Kids Safe:
Recent Outbreaks in the News

LARA DANZIGER-ISAKOV, MD
ISHLT Infectious Diseases Council Chair

Lara.Danziger-Isakov@cchmc.org

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We've all worked so hard to make transplant successful in pediatrics; however, pitfalls crop up daily and many are unforeseen and unpredictable. While risks for infectious diseases may seem unpredictable, keeping our noses in the news can alert us to upcoming waves of risk that our patients may encounter. Over the past several months, new outbreaks have emerged that put our transplant patients at increased risk for infection after they return to their communities.

Influenza variant, H3N2v
Since July 2012, the Centers for Disease Control and Prevention have been reporting on an emerging influenza variant, H3N2v. This viral strain may spread more easily from pigs to humans than is usual for swine flu viruses. The infection has been reported in more than 300 cases in 2012, with the majority in Indiana and Ohio (http://www.cdc.gov/flu/swineflu/h3n2v-outbreak.htm). So far, investigations indicate that the major risk factor is prolonged exposure to pigs, predominantly in a fair setting. This led many local and state fairs to cancel their annual swine competitions in August and September. Person to person transmission has only been very limited. Higher risk patients include children younger than 5, people with certain chronic conditions heart disease, and those with weakened immune systems which clearly puts our patients at the top of the list! Keeping abreast of the situation and reminding our patients to use hand hygiene and avoid risky behaviors will be key to preventing potentially avoidable infection in our patients.

Pertussis is making a comeback!
While booster vaccination is advised for both adolescents and adults, pertussis continues to increase throughout the United States and abroad (http://www.cdc.gov/pertussis/outbreaks.html). In the United States, 48 states are reporting higher incidence rates that 2011, with 38 reporting at least a 2-fold increase in cases. For example, Washington State reports more than 4000 cases this year compared to just 427 cases in 2011—that's a 10-fold increase!! What can we do to protect our patients from pertussis?

  1. Check with your health officials to see if pertussis is circulating in your community or communities in which your patients live. Most local and state governmental health agencies provide this information on-line.
  2. Make certain your patients are vaccinated. For most vaccines, pre-transplant vaccination confers better immunity than vaccination after transplantation; however, there is limited data specifically on pertussis vaccine responses in pediatric transplant recipients. If your patients weren't vaccinated pre-transplant, vaccinate them after transplant.
  3. Provide a "ring of protection" around your patients by ensuring that their siblings, family members and caregivers - including YOU - are vaccinated as well.

West Nile Virus
Finally, West Nile virus re-emerged this summer infecting over 3000 individuals with 26 deaths to date (http://www.cdc.gov/ncidod/dvbid/westnile/index.htm). The highest concentration of cases have been reported in Texas, Mississippi, Michigan, South Dakota, Louisiana, Oklahoma, and California with almost 40% from Texas alone. West Nile Virus is spread through mosquitos, although some cases of donor-derived infection from transplantation have occurred. Many sites in the affected regions have employed nucleic acid amplification testing (NAT) of potential donors to decrease the likelihood of transmission. Encouraging the use of mosquito repellent and avoiding outdoor activities at dusk/dawn are just a couple of the measures suggested.

Remember, infections may surprise you, but if you keep track of emerging and re-emerging outbreaks, you can counsel your patients and their families to help avoid some potential risks.


Disclosure Statement: The author has no conflicts of interest to disclose.