The zoster vaccine markedly reduced morbidity from herpes zoster and postherpetic neuralgia among older adults.

Highlights SARS-CoV-2 infection can spread rapidly among residents and staff of a nursing home facility Implementing effective infection control practices can be challenging especially when facing shortage of PPE Creating a geographic “COVID” unit, implementing universal screening tests of residents and staff, and strictly enforcing infection control measures had all been important to contain a COVID-19 outbreak in a Veterans nursing home.

Background Respiratory syncytial virus (RSV) is increasingly becoming an important cause of respiratory infections in adults, especially those living in long-term care facilities (LTCFs). Seasonal outbreaks peaking from October to April are common. We report an outbreak of RSV involving 2 LTCFs with total capacity of 80 beds in 2019. Methods Retrospective chart review of cases identified with positive RSV infection via DNA polymerase chain reaction (PCR) from January 24 to February 24, 2019, at 2 LTCF units, in close proximity to each other, at Northport Affairs Medical Center. Results Twenty veterans (18 men and 2 women) tested positive for RSV by rapid PCR. The median age was 73 (47–89) years, 85% are Caucasian, and 5 patients had temperature of greater than 100°F (100°F–102.4°F). All had rhinorrhea and 65% had cough. Medical history shows 45% with dementia, 30% with stroke, and 35% with diabetes; 2 patients on hemodialysis; and 2 patients with chronic obstructive pulmonary disease (COPD). Four patients required hospitalization, and 2 of them required admission to intensive care unit. Length of stay ranged from 1 to 9 days. One patient with COPD required mechanical ventilation. One patient with computed tomography finding of airway impaction had antibiotics stopped by infectious diseases consult, yet he developed Clostridium difficile diarrhea. No deaths were observed, and all patients recovered. Aggressive infection control measures were implemented. Conclusions Respiratory syncytial virus is highly infectious and can easily cause an outbreak in an LTCF. Polymerase chain reaction testing was contributory to identify cases rapidly. Rapid PCR results and intensified infection control measures were instrumental to halt the outbreak.

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Background Transcatheter edge-to-edge mitral valve repair using the MitraClip device is increasingly used for high surgical risk patients with severe mitral regurgitation (MR). Previous guidelines for infective endocarditis prophylaxis prior to dental procedures focused on high-risk patients, but without explicit recommendation for MitraClip recipients. We believe this could be the first reported case to identify Streptococcus oralis as the causative organism. Case presentation An 87-year-old male with severe MR treated with two MitraClip devices three months prior to index admission, presented with worsening malaise and intermittent chills on a background of multiple comorbid conditions. The patient had dental work a month prior to presentation, including a root canal procedure, without antibiotic prophylaxis. Vitals were significant for fever and hypotension. On physical examination, there was a holosystolic murmur at the apex radiating to the axilla, bilateral pitting edema in the lower extremities, and elevated jugular venous pulsation. A transthoracic echocardiogram showed severe MR with a possible echodensity on the mitral valve, prompting a transesophageal echocardiogram, which demonstrated a pedunculated, mobile mass on the posterior leaflet of the mitral valve. Five blood cultures grew gram positive cocci in pairs and chains, later identified as Streptococcus oralis, with minimum inhibitory concentration to penicillin 0.06 mg/L. Initial empiric antibiotics were switched to ceftriaxone 2 gr daily and subsequent blood cultures remained negative. However, the patient developed pulmonary edema and worsening hemodynamic instability requiring vasopressors. As surgical risk for re-operation was considered prohibitive, the decision was made to continue medical management and comfort-directed care. The patient died a week later. Conclusions Despite low incidence, infective endocarditis should be included in the differential among MitraClip recipients. The explicit inclusion of this growing patient population in the group requiring prophylaxis prior to dental procedures in the 2020 ACC/AHA valvular heart disease guidelines is an important step forward.