NIH will share more info about outbreaks, high-profile diseases


In this photo taken Aug. 21, 2012, Dr. Tara Palmore, deputy hospital epidemiologist at the National Institutes of Health Clinical Center, left, and Dr. Julie Segre, a geneticist with the National Human Genome Research Institute, pose at the NIH Clinical Center in Bethesda, Md. Last year a deadly superbug spread through the nation's leading research hospital, killing six patients before it could be stopped. (Patrick Semansky/AP)
November 21, 2012

After absorbing criticism for failing to immediately disclose a deadly superbug outbreak, officials at the National Institutes of Health have agreed to notify state and county officials of any potentially high-profile diseases or outbreaks, even those that do not pose an obvious public risk, county officials said this week.

The new agreement between NIH, Maryland and Montgomery County is scheduled to be finalized after the Thanksgiving holiday, an NIH spokeswoman said. The pact is designed to prevent the controversy spawned after an antibiotic-resistant strain of the bacterium Klebsiella pneumoniae spread throughout the 234-bed research facility in Bethesda.

The germ arrived at the hospital in June 2011 with a New York woman who needed a lung transplant. It infected more patients by August 2011, eventually infecting a total of 18, 12 of whom died. Seven of the deaths were directly attributed to the superbug.

In December, as the situation worsened, NIH contacted Maryland’s state epidemiologist, seeking advice. But neither NIH nor the state shared any information with the county about the outbreak, which became public in August 2012, when NIH researchers published a scientific paper about it. At the time, Montgomery County Council President Roger Berliner (D-Potomac-Bethesda) complained that the county hadn’t been notified.

Carol Jordan, the county health department’s director of communicable diseases and epidemiology, said recent discussions about the new agreement have clarified all the parties’ public health responsibilities, including informing the public.

Under the pact, NIH will notify the county of rare or potentially high-profile diseases or outbreaks that might alarm the public, even if there is no public health risk, Jordan said.

“Nobody wanted a repeat of what happened during the Klebsiella outbreak over there,” she said.

Jordan said the outbreak “was probably not a risk to the public,” but added, “When a paper is published about it, it will certainly raise questions from the public. . . . And that kind of thing, the county needs to know about.”

NIH officials have said they did not alert the public earlier for several reasons. Experts at NIH and elsewhere said healthy people outside the hospital were at minimal risk. The infection was not among the infectious diseases required to be reported to the federal Centers for Disease Control and Prevention. And as a federal facility not licensed by Maryland, NIH is not required to report health-care-acquired infections or certain other diseases to the state.

When the outbreak erupted, the clinical center’s infection control staff scrambled, walling off infected patients, tearing out plumbing and swabbing equipment, walls, railings and patients to track and contain the bacterium. Despite these extreme efforts, the outbreak still ticked along for more than a year as the hardy superbug lingered on hard surfaces — and inside patients, among the sickest of the sick.

Residents who live and work near the sprawling NIH campus, as well as some employees exposed to the affected wards, grumbled that they had been put at risk because they hadn’t been told about the infection.

There have been no new cases of patients with the original Klebsiella strain at NIH since the death in September of a young man from Minnesota. One adult patient who arrived in mid-
summer from another health-care facility was found to have a different Klebsiella strain, NIH clinical center spokeswoman Maggie McGuire said. That patient is in a single room at the end of a unit. NIH is using human monitors to ensure that all staff and visitors are scrubbing their hands and following other precautions. The center is also continuing to test all inpatients monthly for Klebsiella and patients on high-risk units every two weeks.

Meanwhile, Berliner now says he understands the Klebsiella infection posed no threat to the broader public. He and Montgomery County Executive Isiah Leggett (D) toured the medical facility with NIH Director Francis Collins and Clinical Center Director John Gallin on Nov. 9.

“This was a learning experience that we hadn’t had previously,” Berliner said. “They are very open and willing to share with us at any point in time,” even in situations that pose only a “borderline” risk to public health.

Still, he added, it’s important to have a plan in place for communicating to the county and state about potentially worrisome situations at the hospital.

Under the agreement, when there is a potential infection cluster at the clinical center, NIH will consult with the Maryland Department of Health and Mental Hygiene and voluntarily report to the state those cases the state considers public health risks, NIH spokeswoman McGuire said. Instead of relying on the state to inform the county, NIH will now notify the county health department directly, she said.

In addition, NIH will notify the county when patients in the hospital have communicable diseases that pose a threat to county residents.

For example, if an Ohio resident arrived at NIH and was found to have measles, NIH would tell the county because measles is a highly contagious illness. NIH employees who live in the community and others could be at risk, and the county would need to launch a disease investigation.

“Not only has the person exposed everybody else at the hospital, including the staff, we would need to find out where else did that person go, like did they go to lunch at Denny’s,” said Cindy Edwards, administrator for Montgomery County’s disease control program.

Other federal facilities, such as Walter Reed National Military Medical Center, report diseases affecting county residents to the county.

Brian Vastag contributed to this report.

Lena H. Sun is a national reporter for The Washington Post, focusing on health.
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