A major and possibly fatal infection with Clostridium tetani, which causes tetanus, has been identified among at least 20 residents of the long-term care facility where dozens of cases of a mysterious neurological illness have been found.
The cases occurred among people who were given an antitoxin to the bacteria, and the vaccine to tetanus, decades earlier and, as a result, were less likely to have any severe reaction to the illness than someone who has not received those earlier doses.
Health officials do not know how the Clostridium tetani bacterium was introduced into the room where the cases occurred, but it is believed that staffers or others entered the room.
"This is extremely rare," Dr. Daniel Jernigan, CDC's director for noninfectious diseases, told reporters today at a teleconference.
"We're not really sure what's causing it," he said. "It's probably not something that was done on purpose."
He and other CDC officials said the long-term care facility had taken measures to improve sanitation and ventilation and to test its air, water and surfaces.
At least 25 people in the facility have been diagnosed with Guillain-Barre syndrome, a rare neurological disorder that causes muscle weakness, headaches, fatigue and, in some patients, paralysis. The cases have affected residents as young as 3 months old and as old as 95.
In response, the facility has cleaned carpets, floors and walls, repaired cracked ceilings, replaced water supplies, and instituted better ventilation. But Jernigan said the facility may want to consider "re-purposing" the building to another use because of its history of high-level infection.
CDC officials did not say how many people may have been exposed, but it's believed at least 20 have been infected.
A resident at the facility is believed to have been the source of at least one of the cases. That individual is in isolation at a hospital in Philadelphia, and at least 18 other residents and nine healthcare workers are in isolation in the area, Jernigan said.
Officials are also testing four dogs that may have been exposed and they plan to test pets of family members of infected residents to look for antibodies, Jernigan said.
He said there have been 12 deaths, but the agency does not expect this outbreak to last as long as the ones in 1976 that began at a Philadelphia health facility and occurred over several years.
"At this point we still believe we can see an end to this outbreak," Jernigan said. "We have many ways to stop this and that's what we're all working on."
In 1976, CDC officials traced the outbreak to L-forms -- a kind of bacterial life that does not have the cell wall that protects bacteria. Staffers at the facility introduced the forms into the facility after working in an area with a high level of soil contamination, they said.
The form was found in the air, in tap water and in the skin of workers and residents.
CDC said it's conducting similar testing to look for the L-forms, though none have been detected. But officials say the facility needs to use more effective cleaning methods such as steam cleaning and to institute better ventilation.
The new outbreak began in November at the facility in Pennsylvania, which has a population of about 200.
It was found to be caused by infection with a bacteria called C. botulinum. The bacteria are known to cause botulism, a neurotoxin that results in symptoms including paralysis of respiratory muscles.
Health officials believe the cases began to be noticed around October because a resident who had already been diagnosed with the illness died, officials said.
They also said one resident was infected in late September but didn't show symptoms until November.
Officials suspect that germs in a room for ventilator-bound patients may have spread to other patients through an exhaust duct, as well as to family members through an air-cleaning system.
There were outbreaks of severe respiratory illness in the 1950s at the facility, according to officials.
In 2012, the facility received a $1 million grant from the U.S. Department of Health and Human Services, and officials "immediately" instituted changes, CDC officials said. The grant was made under a program to help older adult and disabled people with expenses and provide quality home care.
Jernigan said all of the exposed individuals have been in a vegetative state or require a ventilator, and that "they're extremely sick."
He also said all of the people who were infected are residents of the facility. Only one family member of an infected resident has shown symptoms, Jernigan said.
The facility, which has not been identified, is operated by United Healthcare-owned Extendicare. Jernigan said the facility is in an "older building."
He said the room in which the cases occurred had at least six patients who were paralyzed, though officials don't know the degree of paralysis because they can't communicate with those patients.
"The patients have a large amount of infections, a lot of sepsis and pneumonia, but they're in fact in a room that has ventilation," Jernigan said.
"They're not on respirators, and we believe it's very likely the ventilation system has provided the exposure," he said.
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"Every effort to stop the spread is being done," Jernigan said. He also warned that facilities are required by law to post clear signage in rooms where patients have died or are known to have diseases that put them at risk of spreading illness to staff and others.
The agency said that more than 40 of those diagnosed are being treated in six hospitals across the region and that a team of 50 infectious disease specialists is on the scene.
Officials also advised those who are taking any of the drugs used to treat tetanus, including antibiotics, to consult their physicians to make sure that taking those medicines won't cause another problem.
Doctors and nurses are in touch with dozens of families to provide the latest update, which officials plan to do again Tuesday.
The CDC advises older adults and people with weakened immune systems or chronic lung or heart disease to get a booster shot against tetanus as a preventative measure.
If they develop symptoms of the illness, they should seek immediate medical attention.
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