Decontaminating N95 respirators during the COVID-19 pandemic: simple and practical approaches to increase decontamination capacity, speed, safety and ease of use.

BACKGROUND: The COVID-19 pandemic has caused a severe shortage of personal protective equipment (PPE), especially N95 respirators. Efficient, effective and economically feasible methods for large-scale PPE decontamination are urgently needed. AIMS: (1) to develop protocols for effectively decontaminating PPE using vaporized hydrogen peroxide (VHP); (2) to develop novel approaches that decrease set-up and take-down time while also increasing decontamination capacity; (3) to test decontamination efficiency for N95 respirators heavily contaminated by make-up or moisturizers. METHODS: We converted a decommissioned Biosafety Level 3 laboratory into a facility that could be used to decontaminate N95 respirators. N95 respirators were hung on metal racks, stacked in piles, placed in paper bags or covered with make-up or moisturizer. A VHP® VICTORY™ unit from STERIS was used to inject VHP into the facility. Biological and chemical indicators were used to validate the decontamination process. FINDINGS: N95 respirators individually hung on metal racks were successfully decontaminated using VHP. N95 respirators were also successfully decontaminated when placed in closed paper bags or if stacked in piles of up to six. Stacking reduced the time needed to arrange N95 respirators for decontamination by approximately two-thirds while almost tripling facility capacity. Make-up and moisturizer creams did not interfere with the decontamination process. CONCLUSIONS: Respirator stacking can reduce the hands-on time and increase decontamination capacity. When personalization is needed, respirators can be decontaminated in labelled paper bags. Make up or moisturizers do not appear to interfere with VHP decontamination.

Surveillance for outbreaks of gastroenteritis in elderly long-term care facilities in France, November 2010 to May 2012.

This article describes outbreaks of gastroenteritis in elderly long-term care facilities (LTCF) in France from November 2010 to May 2012 reported through the surveillance system for gastroenteritis outbreaks in LTCF. A total of 1,072 outbreaks were reported, causing 26,551 episodes of illness and 60 deaths. The median attack rate (AR) among residents was 32%. Norovirus and person-to-person transmission were the most frequently reported aetiology and mode of transmission. Control measures were implemented in 1,054 (98%) outbreaks and for 928 outbreaks, the timing of such measures could be inferred. Of these, 799 (86%) had put control measures into effect within three days of the occurrence of the first case. Outbreaks of gastroenteritis in LTCF cause substantial morbidity and mortality among elderly people in France. LTCF are encouraged to develop infection prevention and control plans and to notify any gastroenteritis outbreak to health authorities to ensure rapid control.

Unusual increase in reported cases of paratyphoid A fever among travellers returning from Cambodia, January to September 2013.

From January to September 2013, a marked increase in notifications of Salmonella Paratyphi A infections among travellers returning from Cambodia occurred in France. An investigation revealed 35 cases without a common source: 21 in France, five in Germany, three in the Netherlands, one in Norway, one in the United Kingdom, four in New-Zealand. Data suggest an ongoing event that should trigger further investigation. Travellers to Cambodia should observe preventive measures including good personal hygiene and food handling practices.

Epidemiological and microbiological investigation of a large outbreak of monophasic Salmonella Typhimurium 4,5,12:i:- in schools associated with imported beef in Poitiers, France, October 2010.

An outbreak due to the emerging monophasic Salmonella Typhimurium 4,5,12:i:- occurred in four schools in Poitiers in October 2010. Food trace-back investigation led to the identification of beef burgers as the cause of the outbreak and their subsequent withdrawal. The Institute for Public Health Surveillance conducted a retrospective epidemiological investigation to assess the extent of the outbreak and describe cases. Self-administered questionnaires were completed by students and personnel attending each of the four schools affected. Clinical cases were defined as anyone having eaten at the school when the beef burgers were served and reporting diarrhoea or fever with at least one digestive symptom (nausea, vomiting or abdominal pain), within five days after the incriminated school meal or with unknown date of onset within a 15-day period after the incriminated school meal. Of 1,559 persons exposed, 554 clinical cases were identified corresponding to an overall attack rate of 35.5%. Of 554 clinical cases, a total of 286 (53%) sought medical care and 31 (6%) were hospitalised for more than 24 hours. This multi-school outbreak is one of the biggest food-borne outbreaks of monophasic Salmonella Typhimurium 4,5,12:i:- described in France. Prompt notification of cases and rapid identification and withdrawal of the incriminated batch of beef burgers was crucial to limit the extension of this outbreak.

First evidence of a food poisoning outbreak due to staphylococcal enterotoxin type E, France, 2009.

At the end of 2009, six food poisoning outbreaks caused by staphylococci were reported in France. Soft cheese made from unpasteurized milk was found to be the common source of the outbreaks. Staphylococcal enterotoxin type E was identified and quantified in the cheese using both official and confirmatory methods of the European Union Reference Laboratory (EU-RL). To our knowledge, this is the first report of food poisoning outbreaks caused by staphylococcal enterotoxin type E in France.

Outbreak of Salmonella enterica serotype Muenster infections associated with goat's cheese, France, March 2008.

Salmonella enterica serotype Muenster (hereafter referred to as S. Muenster) is rare in France and in Europe. In France, a nationwide outbreak of gastrointestinal illness due to S. Muenster occurred during March and April 2008. Twenty-five laboratory-confirmed cases of S. Muenster were documented by telephone using a trawling questionnaire. Four patients were admitted to hospital and no death was recorded. Among the 21 interviewed cases, 16 reported consumption of goat's cheese in the days prior to symptoms. The investigation incriminated goat's cheese from producer X as being the most likely source of the outbreak. S. Muenster was isolated from both cases and the incriminated goat's cheese. The pulsed-field gel electrophoresis profiles of the food isolates of producer X and the isolates from cases were indistinguishable. Following the withdrawal of the contaminated batch of cheese, the number of cases decreased to its usual level. To our knowledge, this is the first published outbreak of S. Muenster associated with food consumption in Europe.

Import of norovirus infections in the Netherlands and Ireland following pilgrimages to Lourdes, 2008--preliminary report.

Between mid-September and 19 October 2008, nine clusters of norovirus infection involving around 90 primary cases and over a hundred secondary cases were identified in patients from the Netherlands, Ireland, Italy and France, linked to pilgrimage to Lourdes, France.

Outbreak of Salmonella enterica serotype Manhattan infection associated with meat products, France, 2005.

Between August 2005 and March 2006 in France, 69 cases of Salmonella enterica serotype Manhattan (Salmonella Manhattan) were reported, 51 (74%) of them from southeastern France. At the time of the alert (November 2005), 13 cases and 33 controls were interviewed. Cases were more likely than controls to have eaten pork sausages (OR=5.9, confidence interval CI [1.3; 26.9]) and beef (OR=9.3, CI [1.3; 68.6]). At the same time, 19 strains of Salmonella Manhattan isolated from meat products in southeastern France, reported to the French food safety agency (Afssa, Agence francaise de securite sanitaire des aliments) in September and November 2005, had an indistinguishable PFGE profile to the 7 human isolates of Salmonella Manhattan from the outbreak in southeastern France. Trace-back investigations revealed that pork samples came from one wholesaler whose pork products had tested positive for S. Manhattan during routine food testing in August 2005. This wholesaler supplied retail outlets in southeastern France. Additionally, a slaughterhouse supplying the wholesaler was inspected and widespread contamination with Salmonella spp. and S. Manhattan was found. Cooperation between the national agencies in charge of human health (Institut de veille sanitaire, InVS) and food safety (Afssa) allowed us to determine the most probable source of contamination and to take appropriate control measures.

Outbreak of Salmonella enterica serotype Manhattan infection associated with meat products, France, 2005.

Between August 2005 and March 2006 in France, 69 cases of Salmonella enterica serotype Manhattan (Salmonella Manhattan) were reported, 51 (74%) of them from southeastern France. At the time of the alert (November 2005), 13 cases and 33 controls were interviewed. Cases were more likely than controls to have eaten pork sausages (OR=5.9, confidence interval CI [1.3; 26.9]) and beef (OR=9.3, CI [1.3; 68.6]). At the same time, 19 strains of Salmonella Manhattan isolated from meat products in southeastern France, reported to the French food safety agency (Afssa, Agence française de sécurité sanitaire des aliments) in September and November 2005, had an indistinguishable PFGE profile to the 7 human isolates of Salmonella Manhattan from the outbreak in southeastern France. Trace-back investigations revealed that pork samples came from one wholesaler whose pork products had tested positive for S. Manhattan during routine food testing in August 2005. This wholesaler supplied retail outlets in southeastern France. Additionally, a slaughterhouse supplying the wholesaler was inspected and widespread contamination with Salmonella spp. and S. Manhattan was found. Cooperation between the national agencies in charge of human health (Institut de veille sanitaire, InVS) and food safety (Afssa) allowed us to determine the most probable source of contamination and to take appropriate control measures.

Efficacy of orally delivered cochleates containing amphotericin B in a murine model of aspergillosis.

Cochleates containing amphotericin B (CAMB) were administered orally at doses ranging from 0 to 40 mg/kg of body weight/day for 14 days in a murine model of systemic aspergillosis. The administration of oral doses of CAMB (20 and 40 mg/kg/day) resulted in a survival rate of 70% and a reduction in colony counts of more than 2 logs in lungs, livers, and kidneys. Orally administered CAMB shows promise for the treatment of aspergillosis.

Heterocyclization of functionalized vinylic derivatives of imidazo.

Heterocyclization of functionalized vinylic derivatives of imidazo[1,2-a]pyridines was explored experimentally and theoretically using semiempirical AM1 and ab initio methods. A range of functionalized vinylic derivatives (azido, amino, and carbodiimide groups) were prepared for conversion into pyrroloazaindoles 19-22, imidazo[1,x]-, (x = 5, 6, 7, 8), [2,6]-, and [2,7]naphthyridines 28-30, 35-38 by thermal reaction. In the case of vinylic groups in the 5 position, peri annulation also was observed. The experimental and theoretical data are compared and discussed.

New restriction fragment length polymorphism (RFLP) markers for Aspergillus fumigatus.

In this study, we isolated and tested restriction fragment length polymorphism (RFLP) markers for Aspergillus fumigatus based on PCR products amplified by the random amplified polymorphic DNA (RAPD) primer R108. Four DNA fragments, Afd, Af5, Af4, and Af4A, were amplified. Fragments Afd and Af5 were 85% and 88% identical at the DNA level to part of the Afut1 retrotransposon from A. fumigatus. Fragment Af4A is a duplication of fragment Af4 and both showed similarity at the amino acid level with endonucleases from other fungal retrotransposons. We used both RAPD with primer R108 and RFLP assays with Afut1, Afd, and Af4A, to determine the genetic relatedness of clinical isolates of A. fumigatus isolated sequentially from four patients colonized with A. fumigatus. The combination of these different methods suggested that the isolates infecting the four patients were not identical.

Phase change in amylose-water mixtures as seen by Fourier transform infrared.

The phase content of amylose-water mixtures (0.7/0.3 w/w) has been analyzed by transmission Fourier transform infrared (FTIR) spectroscopy in the 1175-950 cm(-1) region. Spectra are obtained under three different conditions: (a) as a function of temperature (T) from 25 to 97 degrees C; (b) at room temperature (RT), after slow cycles of T; and (c) at RT after quenching. T(max), the maximum temperature in the cycle, ranges from 50 to 120 degrees C. The quality of the seven-band spectra allows for an unambiguous determination of each band area. Unexpectedly, slow cooling after different T(max) brings about wide changes in the spectra while quenching does not. Two jumps in the absorbance are found: one at 70 degrees C and the other above 105 degrees C. Previous work on slow calorimetry of amylose-water mixtures suggests that these temperatures correspond to the beginning and the end of the same physical phenomena that takes place slowly between these two temperatures-namely the dissolution of the strained network phase. The spectra have two distinct regions, the low wavenumber region (1078-950 cm(-1)) and the high wavenumber region (1175-1078 cm(-1)). A distinct gain in the integrated absorbance of the 1175-1078 cm(-1) region at the expanse of that of the 1078-950 cm(-1) region when T(max) increases is interpreted as a change from strained to unstrained environments. A nonequilibrium state between the chains is a strained environment. In light of the (13)C NMR evaluation of the change of molecular order with T, the observed changes of the ir spectra could correspond to a transformation of a network of double helices into freer chains, possibly single helices. The present in-depth analysis of equilibrium or near equilibrium states by FTIR can serve to understand, through in situ spectra, molecular mechanisms during the gelation/crystallization of amylose and other gel-forming polymers.

Efficacy of oral cochleate-amphotericin B in a mouse model of systemic candidiasis.

Amphotericin B (AMB) remains the principal therapeutic choice for deep mycoses. However, its application is limited by toxicity and a route of administration requiring slow intravenous injection. An oral formulation of this drug is desirable to treat acute infections and provide prophylactic therapy for high-risk patients. Cochleates are a novel lipid-based delivery system that have the potential for oral administration of hydrophobic drugs. They are stable phospholipid-cation crystalline structures consisting of a spiral lipid bilayer sheet with no internal aqueous space. Cochleates containing AMB (CAMB) inhibit the growth of Candida albicans, and the in vivo therapeutic efficacy of CAMB administered orally was evaluated in a mouse model of systemic candidiasis. The results indicate that 100% of the mice treated at all CAMB doses, including a low dosage of 0.5 mg/kg of body weight/day, survived the experimental period (16 days). In contrast, 100% mortality was observed with untreated mice by day 12. The fungal tissue burden in kidneys and lungs was assessed in parallel, and a dose-dependent reduction in C. albicans from the kidneys was observed, with a maximum 3.5-log reduction in total cell counts at 2.5 mg/kg/day. However, complete clearance of the organism from the lungs, resulting in more than a 4-log reduction, was observed at the same dose. These results were comparable to a deoxycholate AMB formulation administered intraperitoneally at 2 mg/kg/day (P < 0.05). Overall, these data demonstrate that cochleates are an effective oral delivery system for AMB in a model of systemic candidiasis.

Permethrin-impregnated bed nets for the prevention of malaria in schoolchildren on the Thai-Burmese border.

A double-blind controlled trial was undertaken from August 1990 to February 1991 among Karen children on the Thai-Burmese border to evaluate the effects on malaria incidence and prevalence of permethrin-treated bed nets. Three hundred and fifty schoolchildren, aged 4 to 15 years, were allocated at random to receive either a permethrin-impregnated net or a non-treated net. The incidence of malaria infections, confirmed by a blood film, was assessed during 6 months. Three surveys were conducted, on admission and 3 and 6 months later, to measure the prevalence of infections and spleen rates. Compliance was assessed by monthly home visiting. The use of permethrin-treated bed nets reduced the number of parasitaemic Plasmodium falciparum infections by 38% and the number of symptomatic episodes by 42%. The number of P. vivax malaria attacks was similar in each group. The prevalence of positive blood films in the 2 groups did not change significantly during the study. A reduction in spleen rate by 50% in both groups at the end of the study period could not be related to the overall use of nets. Compliance was high and no side-effect was reported. The long-term effects on morbidity and mortality need to be assessed after distribution of permethrin treated bed nets at the village level.

Malaria on the Thai-Burmese border: treatment of 5192 patients with mefloquine-sulfadoxine-pyrimethamine.

Multidrug-resistant falciparum malaria is a major health problem along the Thai-Burmese border. From July 1985 until December 1986 a total of 5192 patients with falciparum malaria (1734 males, 3458 females) from this area were given supervised treatment with the combination mefloquine-sulfadoxine-pyrimethamine (MSP). The radical cure rate, assessed 21 days after drug administration, was 98.4% for the first 1975 patients, and 98.8% when assessed at 28 days for the remaining 3217 patients. In 3.8% of cases, parasites were still detected in peripheral blood smears on day 7 after treatment but this had fallen to 0.27% by day 9. Adverse reactions among the first 1975 patients were: vertigo (7.5% of patients), vomiting (5.8%), epigastric pain (0.6%), and transient confusional state (one case). MSP is an effective and well-tolerated drug for the treatment of drug-resistant falciparum malaria; however, delayed parasite clearance may give a false impression of RII resistance.