Hot Topics in IPC: Updates on EzriCare Artificial Tears, the Bird Flu, and COVID-19

Saskia v. Popescu, PhD, MPH, MA, CIC

Artificial Tears and Pseudomonas

A Health Alert Network (HAN) was released on February 1st from the Centers for Disease Control and Prevention (CDC) regarding an outbreak of extensively drug-resistant Pseudomonas aeruginosa that was related to artificial tears. The outbreak has resulted in cases across 12 states, and the CDC has reported that most patients reported the use of artificial tears. This particular outbreak involves an extensively drug-resistant strain of Verona Integron-mediated Metallo-β-lactamase (VIM) and Guiana-Extended Spectrum-β-Lactamase (GES)-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-GES-CRPA) and isolates from EzriCare Artificial Tears have pointed to a likely culprit. As a result, the CDC issued a recommendation for immediate discontinuation of EzriCare Artificial Tears (pending a full investigation) and for those individuals using the product to monitor for signs of infection. Affecting those individuals across inpatient and outpatient settings, the HAN alert noted that “as of January 31, 2023, CDC in partnership with state and local health departments identified 55 case-patients in 12 states (CA, CO, CT, FL, NJ, NM, NY, NV, TX, UT, WA, WI) with VIM-GES-CRPA, a rare strain of extensively drug-resistant P aeruginosa. Thirty-five patients are linked to 4 healthcare facility clusters. The dates of specimen collection were from May 2022 to January 2023. Isolates have been identified from clinical cultures of sputum or bronchial wash (13), cornea (11), urine (7), other nonsterile sources (4), blood (2), and from rectal swabs (25) collected for surveillance; some patients had specimens collected from more than one anatomic site.”

Let’s Talk About Bird Flu

We all know infectious diseases don’t take a break and despite our best wishes for some “quiet time” (I know – the “q-word” is something we like to avoid saying infection prevention and control), the truth is that the world of microbes is only getting busier. Or are we becoming more aware? In either case, we’re seeing increasing concern and conversations over H5N1, which is avian influenza. Seventy outbreaks in poultry have been noted in January, not to mention 90 events in other birds, which all resulted in the culling or death of 3 million birds. Why is this concerning? We’ve been lucky that H5N1 is not great at spreading between people. For the most part, it’s been quite self-limiting in humans, which means we don’t see the sustained human-to-human transmission. Influenza viruses are known for their habitual mutation, which has long worried scientists. How much would this virus need to really change to cause wider illness and disease in humans? How big of a shift or drift? Growing cases in mink farms, poultry, and more countries reporting significant outbreaks have only fueled this worry. This week though, health authorities in Peru reported the virus in sea lions and dolphins. As Lisa Schnirring, news editor for the Center for Infectious Disease Research and Policy at the University of Minnesota, noted, “In a follow-up, SENASA said at least 585 sea lions and 55,000 wild birds have been found dead in seven of the country's coastal nature preserves, likely due to avian flu. Also, media reports citing Peru's health ministry said tests on a zoo lion in central Peru identified H5N1 as the cause of death. The reports add to a growing number of detections in mammals, including recent reports from the United Kingdom and H5N1 in farmed minks in Spain. The United States has so far reported 110 detections in mammal species. The H5N1 clade circulating in birds, poultry, and an increasing number of mammals has a mutation that makes the virus more recognizable by mammalian airway cells.

COVID-19: Some Good News!

I’d be remiss without noting something about COVID-19, but let’s make it good news! Since China halted its Zero-COVID approach to the pandemic, there’s been a significant surge, but, no new variants have emerged during this time.