Download Literature Review of Laboratory Acquired Infections in Canada and

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Literature Review of Laboratory
Acquired Infections in Canada and the
United-States between 2000 and 2009
Genevieve Lacroix
Office of Laboratory Security
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Overview
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Definitions
Under-reporting
Previous Reports
Current Reports (2000-2009)
Noteworthy Cases
Conclusion
HPTA
Reporting: A Useful Biosafety Tool
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Definition
• LAIs are defined as all infections
acquired through laboratory or
laboratory-related activities regardless
of whether they are symptomatic or
asymptomatic in nature.
• Laboratory-associated infections
• Autopsy-related infections
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LAI Reports
• LAIs continue to occur:
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Historically >5000 cases with >200
deaths
• Rate of LAIs appears to be declining
since 1990:
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–
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Improved containment facilities,
equipment?
Improved biosafety practices?
Lack of reporting?
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Under-reporting
• No official legal requirements
–
except for the UK
• Fear of reprisal or stigma associated
with report of LAI
• Lack of public system for report
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No national database
Space restrictions in scientific or medical
journals
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Under-reporting
No. of LAIs from 1979 through 2004 (USA)
Category of Symptomatic
agents
LAIs
Asymptomatic
LAIs
Total
LAIs
Publications
Bacteria
598
60
658
125
Rickettsiae
187
214
401
13
Viruses
608
430
1 038
97
49
4
53
30
Fungi
6
0
6
5
Total
1 448
708
2 156
270
Parasites
Adapted from Harding and Byers.
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Under-reporting
No. of LAIs from 1979 through 2004 (USA)
Category of agents
Total LAIs
Deaths
Bacteria
658
7
Rickettsiae
401
0
1 038
10
53
0
Fungi
6
0
Total
2 156
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Viruses
Parasites
Adapted from Harding and Byers.
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Previous reports –
Shifts and Trends
The most commonly reported LAIs, 1975-91 (USA)
Harrington and
Shannon, 1976
Pike, 1978
Miller, 1987
Grist and Emslie,
1981-91
Brucellosis
Brucellosis
Brucellosis
Shigellosis
Tubercullosis
Q Fever
Tuberculosis
Tuberculosis
Q Fever
Hepatitis
Psittacosis
Hepatitis
Hepatitis
Typhoid
Leptospirosis
Salmonellosis
Tularaemia
Tularaemia
Dermatomycoses
Typhus
Tuberculosis
Newcastle disease
Thyphoid
Dermatomycoses
Salmonellosis
Psittacosis
Fungal infections
Venezuelan equine
encephalitis
Shigellosis
Psittacosis
Coccidiomycosis
Adapted from, Collins and Kennedy.
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Type of Facilities
1930-19751
1979-20042
58.8%
50%
Clinical / Diagnostic
17%
45%
Teaching
2.7%
0,1%
Biological Production
3.4%
-
Other / Unspecified
21%
4%
Type of Facility
Research
1Pike,
1976 (in Collins and Kennedy & Harding and Byers)
2Harding and Byers
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Sources of LAIs
Accidents:
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Spills & splashes (27%)
Needles & syringes (25%)
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Sharps & broken glass (16%)
Bites & scratches (13.5%)
Aspiration through pipette
(13%)
Unspecified (5.5%)
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Pike, 1976 (in Collins and Kennedy & Harding and Byers)
18%
82%
Unknown
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Route of Exposure
Most common routes of exposure:
• Ingestion
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–
–
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Eating / drinking in lab
Mouth pipetting
Transfer of agent to mouth through contaminated
objects
Transfer of agent to mouth through contaminated
fingers
• Inoculation
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–
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Needlesticks
Cuts
Animal bites and scratches
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Route of Exposure - 2
• Inhalation
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–
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Aerosols
Droplets
Airborne infectious particles
• Contamination of the skin and
mucous membranes
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–
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Splashes: mouth, eyes, nose
Applying, removing contact lenses
Transfer from contaminated surfaces
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Literature Review of
Reported LAIs
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In Canada and USA
Between 2000-2009
Sources
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Pubmed
Morbidity & Mortality Weekly Report (MMWR),
CDC
Pro-Med
Biosafety Websites (PHAC, Belgium)
Newspaper
Others
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Reported LAIs
Canada
USA
Total
Exposures
26
55
81
Confirmed
3
31
34
0
3
3
Cases
Deaths
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Category of Agents
Agents
Bacteria
Rickettsiae
Viruses
Number of LAIs
Fungi
0%
22
0
Viruses
32%
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Parasites
1
Fungi
0
Total
Parasites
3%
34
Rickettsiae
0%
Bacteria
65%
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Most Commonly Reported
Infectious Agents
Number
of LAIs
Vaccinia
9
Neisseria meningitidis
7
Brucella
5
E. coli O157:H7
3
Francisella tularensis
3
West Nile virus
2
Salmonella enteritidis
2
Bacillus anthracis
1
Burkholderia mallei
1
Plasmodium vivax
1
Burkholderia
Bacillus
mallei
Plasmodium
3%
anthracis
vivax
3%
3%
Salmonella
enteritidis
Vaccinia
6%
25%
West Nile virus
6%
Neisseria
meningitidis
21%
Francisella
tularensis
9%
Brucella
15%
E. coli O157:H7
9%
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Type of Facilities
Type of
Number of
Facility
LAIs
Research
15
Clinical /
15
Biological
Production
6%
Other /
Unspecified
6%
Teaching
0%
Diagnostic
Teaching
0
Biological
2
Production
Other /
Unspecified
2
Clinical /
Diagnostic
44%
Research
44%
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Routes of Exposure /
Sources
Route of
Number
Exposure
of LAIs
Inhalation
0
Ingestion
0
Inoculation
Contamination
10
3
Inhalation
0%
Inoculation
29%
Contamination of
the skin and
muccuous
membranes
9%
of the skin
and mucous
Ingestion
0%
membranes
Unknown
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Unknown
62%
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Noteworthy Cases –
Neisseria meningitidis
• 7 cases (3 of them fatal)
• Fatal cases occurred in Clinical /
Diagnostic labs
• No use of BSC, open bench work
• Direct manipulation of patient fluids
• Manipulation of cultured material
• App. 50% mortality rate in LAIs
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Noteworthy Cases –
Francisella tularensis
• Boston University 2004
• 3 cases, none fatal
• Material was believed to be Live
Vaccine Strain (LVS) of F. tularensis
• The LVS stock was contaminated with
F. tularensis wild type virulent Type A
• Inconsistent laboratory practices
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Noteworthy Cases –
Salmonella serotype enteritidis
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2 confirmed cases and 21 suspected cases
No secondary cases in family members
Poultry vaccine facility
Spill of 1 to 1,5 L of fermented culture
Spill was cleaned using 5% bleach and the
worker wore PPE
Facility did not have a written spill procedure
and spill kit
Person-to-person transmission may have
occurred
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Conclusion
• Clear under-reporting of LAIs
• No HIV LAIs found?
• Addition of primary containment
devices?
• Need for more training on safe
laboratory techniques and use of
equipment
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Human Pathogens and
Toxins Act
• Bill C-11, Section 13
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« …licence holder has reason to believe
that an incident involving a human
pathogen or toxin that is in their
possession has, or may have, caused
disease in an individual, the licence
holder shall, without delay, inform the
Minister…”
• Enforced once regulations will be in
place
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Reporting: A Useful
Biosafety Tool
• Improve biosafety training
• Support guidelines and policies
• Publicly available database
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References - Resources
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Laboratory-acquired Infections: History,
Incidence, Causes and Preventions, 4th
edition. Eds. C. H. Collins and D. A. Kennedy.
Butterworth Heinemann, Oxford 1999.
Biological Safety: Principles and Practices, 4th
edition. Eds D. O. Fleming and D. L. Hunt.
Washington, 2006.
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Chapter 4: Epidemiology of LaboratoryAssociated Infections, by Harding and Byers.
Complete list of articles available upon
request.
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Thank You!
Genevieve Lacroix
Office of Laboratory Security
Public Health Agency of Canada
[email protected]
http://www.phac-aspc.gc.ca/olsbsl/index-eng.php