"Invasive" MRSA cases
to be reported to VDH

By Julie Von Sternberg

To address increasing public concern over the drug-resistant staph infection called MRSA, Gov. Tim Kaine recently ordered all hospitals, clinics and schools to report the more virulent cases, called “invasive” infections, to the Virginia Department of Health (VDH).

Schools and hospitals previously kept records of such MRSA cases, but were not required to report them to the state. Deborah Carpenter, a nurse epidemiologist at the Central Shenandoah Health District, said the new emergency regulation will allow researchers to learn more details about how dangerous the bacterium could be for people of different ages and conditions as it continues to evolve in the coming years.

“We will be able to see if MRSA is becoming more and more resistant to even more antibiotics,” said Carpenter. “We can also learn if it is more common in the elderly or in the immune suppressed. The more data the better.”

MRSA, or methicillin-resistant Staphylococcus aureus, is a common antibiotic-resistant staph infection that has affected humans for thousands of years. While 20 to 30 percent of healthy individuals carry some form of staph on their skin or in their nose, only 1 to 2 percent carry MRSA.

Carpenter, who oversees five counties in the Shenandoah Valley, said that bacteria most likely became methicillin-resistant because of the overuse of antibiotics for less serious infections.

Dr. David Copeland at the Virginia Military Institute Hospital said he has seen 10 cases of MRSA this year. All cases were resolved with local treatments and alternative antibiotics.

Carpenter suspects that people are becoming more aware of MRSA because the number of cases is increasing.

“Before, MRSA was seen only in hospitals and health care facilities,” Carpenter said. “Now it is a part of communities.”

Teresa Luder, a practicing nurse at the W&L Health Center, said the public is also more aware of the problem because it is getting a lot of press.

In Virginia, MRSA attracted media attention when Ashton Bonds, 17, a senior at Staunton River High School in Moneta, died from the infection on Oct. 15. Bonds’ infection was invasive, meaning it migrated from places where it is typically found, such as the skin.

A recent study has shown that this type of MRSA infection is far more widespread than was generally assumed. The Centers for Disease Control and Prevention said it occurs in approximately 94,000 Americans each year and is associated with 19,000 deaths. That is higher than the HIV/ AIDS death rate.

The majority of cases, like those seen typically at W&L’s health center, are mild and can be treated easily if the infection is addressed promptly and appropriately.

One W&L student, who asked not to be named because of the stigma surrounding MRSA, realized something was wrong when a couple of small itchy bumps, similar to ingrown hairs, appeared in a line on his left leg. When the number increased he went to the W&L health center, where he was diagnosed with MRSA and given antibiotics. As a result, the symptoms disappeared in less than a week.

Often, a good cleaning of the wound and application of antibacterial ointment are all that are needed to eliminate the infection.

After Bonds’ death in Bedford County, the school ordered all 21 buildings in the school system to be cleaned. Some experts have questioned whether that was necessary. Health officials acknowledge that many cases are caused by interaction within a close group of individuals, on a sports team, for example.

Dr. Carl Armstrong, a state epidemiologist, says that while cleanliness is important, too much emphasis is being placed on the environment. Any cuts, blemishes on the skin such as pimples or boils are spots where the bacteria can enter. The most difficult quandary VDH faces is how to track infections.

“Are we in a position to follow up on every boil and every pimple and figure out where that person got it? No,” Armstrong told reporters at a press conference on Oct. 26. “It would be like trying to figure out where every child with a strep throat got their strep throat. We just don’t have the manpower to do that.”

Often a person can become infected weeks before symptoms become apparent. The location where the organism is acquired is not usually the place where the person notices the infection. According to Armstrong, schools have been erroneously designated as sources for MRSA when, in fact, the majority of infected children there were first exposed elsewhere.

Gov. Kaine’s recent emergency regulation will not prevent the spread of MRSA, but it will help track clusters and invasive cases. Kaine said that the main point of the regulation was to better enable VDH to respond to requests from the public for data.

While the VDH and CDC continue to do research, Armstrong said it will take the help of teachers, parents and coaches to reduce the number of cases.