It’s Spring. Time to Think about Lyme Disease

Ticks Ixodes pacificus (shown here in CDC image) and Ixodes scapularis are known vectors of Borrelia burgdorferi (Lyme disease)

National data confirm that diagnoses of Lyme disease begin to rise each year during the month of April, then rapidly reach their peak in June and July. Just in time for “Lyme season,” readers can learn more about the disease in “Lyme Disease: Diagnosis, Treatment, and Prevention” in this month’s AJN.

Lyme disease was first recognized in 1975 in Lyme, Connecticut. From 492 confirmed cases in 1982 (the first year in which Lyme was a reportable disease) to more than 35,000 confirmed and probable cases in 2016, the causative organism, Borrelia burgdorferi, has continued to expand its geographic reach. The CE article notes that these numbers may be undercounts and cites analysis of laboratory and medical claims data from 2008 suggesting that the true number of annual diagnoses may actually be between 240,000 to 444,000.  […]

2018-04-04T09:11:38-04:00April 4th, 2018|climate change, infectious diseases, Nursing, Public health|0 Comments
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The 1918 Influenza Epidemic’s Long Reach in Time

“It would be impossible to relate all the sad and terrible scenes . . . all night long . . . witnessing death scenes, seeing weeping relatives and trying to take care of emergencies . . . “

A mother’s death remembered.

Litter carriers at Red Cross Emergency Ambulance Station in Washington, D.C., during influenza pandemic of 1918.

When my grandfather was six years old, his mother went to sleep one night and never woke up. She was one of the nearly 700,000 Americans who died during the 1918–1919 influenza pandemic, which killed an estimated 50 million people worldwide. The rest of her young family—my grandfather and his twin brother, their seven-year-old sister, and my great-grandfather—survived. The shock of losing his mother so suddenly was still evident when my grandfather talked about her 70 years later. She was 29 years old and healthy, and then she was gone.

High mortality, even among healthy young adults.

My family was not alone as it mourned. The CDC estimates that one-third of the world’s population was infected by what’s become known as the “Spanish flu.” (The origin of this name is unclear: some sources suggest it’s due to a misunderstanding about […]

2018-03-07T09:08:45-05:00March 7th, 2018|infectious diseases, Nursing, Public health|1 Comment
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Late in a High Anxiety Season, Some Flu and Vaccine Basics

After what has seemed like constant media scrutiny for months, influenza hasn’t been in the news as often in recent days. Still, CDC data indicate that flu activity remains “widespread” across the country, so it’s still too early to eliminate flu from your list of “differential diagnoses,” at work or at home.

Maybe it’s the general state of our national psyche, but this year the “flu” seems to have caused more than its usual share of anxiety. This is not a pandemic; there are no brand-new strains of flu in circulation to which no one is immune. But the H3N2 strain that has been predominant this year does tend to lead to a harsher-than-usual season. (The 2014-2015 season was also severe, but the public heard relatively little about it because media were focused on the Ebola outbreak.)

Influenza surveillance basics.

How do we know how bad a flu season really is? Since the 1997–1998 flu season, lab data and clinical reporting have facilitated real-time flu surveillance in the U.S. Public health laboratories in every state, in collaboration with National Respiratory and Enteric Virus Surveillance System laboratories, track the types (A or B) and subtypes (H3N2, H1N1, etc.) of flu in circulation.

To complement these data, the U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet) tracks the percentage of […]

2018-02-28T12:20:28-05:00February 28th, 2018|infectious diseases, Nursing, Public health|0 Comments
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A Closer Look at Preventing C. Diff Transmission

Clostridium difficile/ CDC

It’s estimated that Clostridium difficile (C. diff) causes about 450,000 infections and 15,000 deaths each year. Recently, on Facebook, AJN’s question of the week asked about isolation precautions for patients with C. diff. Most readers could not provide the correct answer to the multiple choice question.

In this month’s issue, “Six Things You Can Do Today to Prevent Hospital-Onset C. difficile Tomorrow” offers a quick update of the best ways to prevent C. diff infection and transmission in hospitalized patients.

Author and infection prevention nurse Nancy O’Connor explores the finer points of key basics, including the importance of maintaining a high index of suspicion for cases, performing excellent hand hygiene, and cleaning all surfaces in a case patient’s room with a bleach solution. (And did you know that if the patient remains in the same room posttreatment, after symptoms have resolved, the room should be terminally cleaned to avoid reinfection?)

Isolation precautions and C. diff.

So, what about isolation precautions, which need to be started as soon as C. diff is suspected? Most respondents to our Facebook question thought that standard precautions were sufficient until a C. diff diagnosis was confirmed. But if this “rule-out” patient with diarrhea is positive, does s/he begin to shed C. diff only after the infection […]

2017-09-22T11:21:11-04:00September 22nd, 2017|infectious diseases, Nursing|0 Comments
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Tuberculosis: Nurses Play Critical Role in Prevention, Diagnosis, Treatment

Mantoux skin test/CDC PHIL

In the U.S., the chances are that tuberculosis isn’t on your mind a lot. Most of us focus on TB only when we have a patient on airborne precautions—or when we’ve been exposed to TB at work.

Globally, TB was one of the top 10 causes of death in 2015. In the U.S., after a spike in cases early in the HIV epidemic, the incidence of TB has fallen to about three cases per 100,000 people. In TB-endemic countries, incidence rates run into hundreds per 100,000. But with TB elimination defined as a rate of less than one case per million people, we are far from eradicating this disease in the U.S. In fact, the number of TB cases in the U.S. rose slightly from 2014 to 2015.

Also, of course, nurses often work with people who are at high risk of acquiring TB—transplant recipients, others who are immunocompromised, people with HIV or certain cancers, those who are refugees or homeless—increasing our own risk for the disease as well. Therefore, the low overall U.S. incidence rate doesn’t reflect the experience (or risk) of most nurses. (And if you are “PPD positive,” click here for some reminders about what that should mean to you as a nurse: “Nurses and Latent TB Infection.”) […]

2017-08-18T08:58:20-04:00August 18th, 2017|infectious diseases, Nursing, Public health|2 Comments
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