INFECTION PREVENTION NEWS & UPDATES

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1 CONTACT + DROPLET EBOLA INFECTION While the Ebola outbreak from the Democratic Republic of the Congo from earlier this year is over, a new outbreak of Ebola has been identified that has infected at least 102 people and caused 21 deaths. As this new outbreak is in a different part of the country, they two outbreaks are not believed to be related. It is likely this outbreak will be harder to contain because it is an area of the country where there is armed conflict. The Ebola virus causes an infection that includes hemorrhagic fever and has a high mortality rate. The virus is transmitted via contaminated blood and body fluids. Initial symptoms include: sudden onset fever, intense weakness, muscle pain, headache and sore throat. Following the initial symptoms, the person develops vomiting, diarrhea, rash, reduced kidney and liver function, and in some cases, bleeding. DEMOCRATIC REPUBLIC OF THE CONGO It can take up to 21 days for symptoms to start after exposure to contaminated blood or body fluids. People believing they may have become exposed to Ebola virus should seek medical attention immediately if they show the early symptoms listed above, especially if they have travelled to an area with the risk of exposure to the Ebola virus or have been in contact with someone suspected of having Ebola virus infection Diversey 1

2 MULTI-COUNTRY OUTBREAK CONTRACT + DROPLET + AEROSOL VENEZUELA, BRAZIL, EUROPE MEASLES VIRUS The ongoing measles outbreak in Venezuela is spilling over into neighboring Brazil with 1,237 cases reported in Brazil and 6 deaths. The cases in Brazil are believed to be caused by refugees fleeing Venezuela for neighboring countries bringing the virus with them, infecting people in the destination country. The high number of cases of measles in Brazil resulted in a travel advisory being issued by the CDC in late August, advising travelers to Brazil to ensure they are current on their measles vaccination. The WHO provided an update on the measles outbreak in Europe, which has now affected 41,000 children in the first half of 2018 with 21 deaths. This is roughly twice the highest yearly case total in the last decade. The countries reporting the highest case totals are Ukraine (23,000 cases) with France, Georgia, Greece, Italy, the Russian Federation, and Serbia all reporting more than 1,000 cases as well. Low immunization rates are the biggest driver of this outbreak and travelers to these countries are advised to ensure their vaccinations are current for measles. Measles is considered one of the most contagious infectious diseases and is a respiratory infection spread by coughing and sneezing with an incubation period of about 10 days (range of 7-18 days). People infected with measles can suffer from side effects including encephalitis, pneumonia, and the infection can be fatal, especially for children. Measles is the leading cause of vaccine preventable death with an estimated 134,200 deaths globally in Prior to widespread vaccination in 1980, there were ~2.6 million deaths globally each year. Outbreaks of measles are usually related to a lack of vaccination. It is important that all people receive both doses of the MMR vaccine to ensure a high degree of immunity and any recommended boosters. The best defense is for all staff to be immunized. Facilities should have immunization requirements to protect staff and customers Diversey 2

3 MULTI-COUNTRY OUTBREAK CONTACT + VECTOR WEST NILE VIRUS (WNV) Greece reports an outbreak of West Nile Virus (WNV) that has sickened 43 people, 35 of whom have developed neuro-invasive disease including encephalitis, meningitis, and/or acute flaccid paralysis. Italy has been experiencing an outbreak of WNV since the start of 2018 with 51 cases and 2 deaths. While WNV cases are common in Europe, this year finds several larger clusters in a number of countries, suggesting mosquito populations are more frequently carrying the virus. Israel is also reporting an outbreak of WNV this year with 68 cases, 14 patients in serious condition and 2 deaths. WNV occurs in Israel in low numbers. This year has seen a significant increase in the number of cases for GREECE, ITALY, ISRAEL West Nile Virus (WNV) is caused by a virus that is similar to Zika, Dengue, and La Crosse Encephalitis and is primarily spread by mosquitoes that feed on dead birds infected with the virus or infected mosquitoes biting birds or other animals. People are not believed to be at risk of becoming infected by handling live or dead birds carrying the virus. WNV is common in the United States and Europe, especially in rural areas during months with high mosquito populations. The disease is characterized by headache, fever, nausea, vomiting, drowsiness, dizziness and in severe cases, coma and seizures. There is currently no vaccine or specific treatment for the disease, but it often requires hospitalization, especially for severe cases. People exposed to contaminated blood and body fluids may also become infected by these routes, but this is relatively uncommon. WNV is spread primarily by mosquito bites, so mosquito suppression programs and taking precautions to prevent mosquito bites are key to preventing WNV infections, which includes wearing long clothing when outdoors, having screens on doors and windows in buildings that are not air conditioned, and the use of mosquito repellant when outdoors. There is currently no vaccination available to prevent WNV infections, so mosquito suppression is the primary method of preventing transmission and infection Diversey 3

4 TICK-BORNE ENCEPHALITIS The Czech Republic is experiencing an outbreak of tick-borne encephalitis with 38 cases so far this year which is roughly triple the number they usually experience. VECTOR There is a vaccination available to prevent tick-borne encephalitis, but most people do not get the vaccination, making them much more susceptible to the infection. Tick-borne encephalitis is caused by the tickborne encephalitis virus (TBEV), which is a member of the Flaviviridae family of viruses. CZECH REPUBLIC Preventing tick bites requires people to avoid bushes and tall grass and wearing clothing that covers the arms, legs, and feet, and checking the body for ticks after being outside Diversey 4

5 CONTACT HEPATITIS A The outbreak of Hepatitis A in the United States continues to grow and/ or affect other states. Kentucky continues to report approximately 50 new cases per week with 1,495 cases in total and 12 deaths. Tennessee reports 74 cases in the Nashville area in West Virginia is reporting 540 confirmed cases. Indiana reports 60 cases in 2018, which exceeds the total cases reported in Genetic testing is showing that the outbreaks is various states appear to be genetically linked. USA Hepatitis A is an infection that causes an inflammation of the liver. There are a number of viruses that can cause Hepatitis including Hepatitis A, Hepatitis B, and Hepatitis C, with vaccinations available for Hepatitis A and Hepatitis B. Hepatitis A is passed to other people through contact with infected feces, or if an infected person touches objects after using the toilet and not washing their hands, including contaminating food or drink from contact with contaminated hands, so handwashing and surface disinfection are important interventions to prevent the spread of the virus. It can also be spread by sexual contact. The virus can also be spread through contact with diapers or the stool of an infected child/person. It can take from days to develop symptoms once infected. Preventing Hepatitis A infections involves vaccination of high risk people, hand hygiene, environmental disinfection, and safe sexual practices. The virus causing this illness is hard to kill and AHP hydrogen peroxide disinfectants are the best option to kill it on environmental surfaces as low level disinfectants have minimal effect on Hepatitis A virus. In countries where disinfectants are often not used when cleaning, this is especially concerning because the virus can survive for periods of time in the environment in feces (most likely days to weeks) which allows for time for them to be transmitted from person to person. A highly effective vaccination is available and people may want to proactively vaccinate themselves to protect against this infection Diversey 5

6 CONTACT + DROPLET SINGAPORE HAND, FOOT, AND MOUTH DISEASE Singapore is experiencing an outbreak of Hand, Foot, and Mouth disease (HF&M) with 1,249 cases reported since 29 July, which is 50% higher than the rate of cases for last year with most of the cases occurring in day care centers and kindergartens. This outbreak is primarily caused by the Coxsachie type A virus. Hand, Foot, and Mouth (HF&M) disease is caused by several different enteroviruses, including Enterovirus 71 (EV-A71) and Coxsackievirus A16 and primarily infects children under 5 years old. HF&M causes painful sore/blisters in the mouth, on the palms of the hands, on the buttocks, and on the feet. In rare cases, severe side effects can be life threatening and cause death. The fluid from the blisters can be contagious and control measures should be used to prevent the spread of the virus. Outbreaks of HF&M are common globally, with cases being routinely reported in many countries. Summer months in Southeast Asia historically show the most activity. Preventing Hand, Foot, and Mouth disease involves hand hygiene, environmental disinfection, and respiratory hygiene practices. The virus causing this illness is hard to kill and AHP disinfectants are the best option to kill it as low level disinfectants have minimal effect on enteroviruses. Because the virus can be present in feces, changing the diaper of a baby with HF&M should be followed by thorough hand washing Diversey 6

7 CONTACT CYCLOSPORIASIS The outbreak of cyclospora in the US reported last month has continued to grow with 507 people across 15 states infected who ate salads at the same fast food restaurant chain. 24 people required hospitalization, but all are recovering and there are not expected to be any fatalities. The infections all appeared from May to August. The remaining salad was pulled from the fast food chain in July, so new cases are expected to stop shortly. Cyclosporiasis is an illness caused by the parasite Cyclospora cayetanesis which infects people through consuming contaminated food or water or swimming in contaminated water and causes watery diarrhea, loss of appetite, and fatigue that can go in cycles from a few days to more than a month. USA Cyclosporiasis is commonly associated with contaminated food. To prevent this infection, food should be cooked thoroughly. Raw fruit and vegetables should be washed thoroughly or avoided completely if they come from areas known to have certain foodborne illness risks such as Cyclosporiasis. Swimming in fresh water bodies that may be contaminated should be avoided Diversey 7

8 CONTACT + VECTOR BRAZIL YELLOW FEVER Brazil s Yellow Fever outbreak continues to grow. In the last 9 months there have been 2,043 confirmed cases with 676 deaths since the start of the outbreak in Dec This outbreak is the largest in decades. It is not unusual to have Yellow Fever in Brazil; but the recent case counts are more than 50% higher than prior to the outbreak. The virus that causes Yellow Fever is spread by Aedes mosquitoes, and as with Dengue and Zika, efforts to control Yellow Fever center on mosquito control. The symptoms of Yellow Fever are similar to other mosquitoborne diseases, including fever, chills, headache, back pain, body aches, nausea, and fatigue, but can include jaundice (yellowing of skin color), which is how the infection was named. While most people that get Yellow Fever show no symptoms, about 15% of those that show symptoms develop the more severe form of the disease, which includes the jaundice, high fever, bleeding, and eventually shock and organ failure. For those that develop the more severe symptoms, the mortality rate for Yellow Fever is 20-50%. If traveling to this country, you should discuss with your doctor whether you should have the Yellow Fever vaccination. Anyone planning to travel to areas of high risk for Yellow Fever will typically be advised to be vaccinated in advance Diversey 8

9 SEPTEMBER At Diversey, 2018we reduce the risk of infection to make your facility safer Across our customers facilities, our comprehensive cleaning, disinfection, and hand hygiene programs provide the solutions and expertise needed to reduce the risk of infection while increasing operational efficiency. Diversey provides resources to help our customers manage outbreaks including providing education and training for our customers regarding best practices for cleaning, disinfection, and hand hygiene in healthcare and public environments. INFLUENZA 3-5 MILLION people infected globally each year 250, ,000 deaths Our best in class solutions include the following: AHP Hydrogen Peroxide Disinfectants Realistic contact times that kill pathogens before surfaces dry Excellent staff safety profile - can be used without personal protective equipment Strong cleaning ability to reduce environmental bioburden Excellent sustainability profile to reduce environmental impact Available in a range of formats including prewetted disposable wipers IntelliCare Hand Hygiene Program Innovative dispenser including patented hybrid manual/touchless Full product range and formats from a single dispenser Electronic compliance monitoring program to increase efficiency Trusted brands, such as Lux, for a more home-like experience 21 million people infected in the US alone each year with deaths. NOROVIRUS PERTUSSIS WHOOPING COUGH 16 million people infected globally each year, 200,000 deaths. 20 million Our experts frequently consult with our customers on environmental hygiene practices for facilities in a wide range of industries including healthcare, hospitality, education, offices, and public buildings such as retail stores, shopping DENGUE malls, and airports. Not all outbreaks are environmentally 400 transmitted, but even for those with minimal environmental routes of transmission, we still help customers with other million aspects of prevention to create safer facilities. people infected globally each year, 12,500 deaths 2018 Diversey Diversey infected globally each year, 146,000 deaths MEASLES