NEWS SCAN: H5N1 case in Egypt, bird outbreak in India, debate in Indonesia

first_imgJan 19, 2010Egypt reports human H5N1 case, more bird infectionsEgypt has identified its 91st human case of H5N1 avian influenza, according to a Jan 13 report by Strengthening Avian Influenza Detection and Response (SAIDR), an Egypt-based project funded by the US Agency for International Development. The Egyptian health ministry said the case involves a 20-year-old woman from Beni Suef governorate who fell ill Jan 6, was hospitalized, and was reported to be in stable condition on Jan 13. Her family said she had had contact with sick and dead poultry. Meanwhile, Egypt’s Ministry of Agriculture and Land Reclamation today reported 17 detections of H5N1 cases in household birds in eight governorates, according to a separate SAIDR report. Officials said the number of findings was a result of the strengthening of passive surveillance in veterinary clinics.H5N1 hits India’s West Bengal stateAnimal health officials in India confirmed an H5N1 avian influenza outbreak in backyard birds in three villages in the country’s West Bengal state, according to a Jan 15 report from the World Organization for Animal Health (OIE). The outbreak, India’s first since October 2009, killed 1,000 of about 80,000 susceptible birds in the three Murshidabad district villages. The remaining birds and those in a 3-kilometer radius around the area were culled to prevent the spread of the virus. The government will compensate owners for the poultry. Veterinary authorities are conducting intensive surveillance in areas within 10 kilometers of the outbreak site. They have also closed poultry markets in the area and have prohibited the sale and transport of birds. Investigators haven’t yet determined the source of the virus. West Bengal is in eastern India near its border with Bangladesh.Jan 15 OIE reportIndonesia’s H5N1 status debated as outbreak reportedHealth and agriculture officials in Indonesia say fewer H5N1 outbreaks in poultry may have decreased the number of infections in humans, but other experts say the risk has not changed and that the country’s poultry surveillance system is weak, the United Nations Integrated Regional Information Networks (IRIN) reported yesterday. Indonesian Health Minister Endang Rahayu Sedyaningsih said there have been no human illnesses since November 2009, and Agus Wiyono, the agriculture ministry’s director of animal health, said no major poultry outbreaks have occurred in 3 years. But Dr Chairil Nidom, a microbiologist at Airlangga University in Surabaya, Indonesia, said some poultry outbreaks have probably gone unreported and that the surveillance system is weak. A World Health Organization (WHO) spokesman told IRIN that the group’s assessment of Indonesia’s risk has not changed. The country leads the world in human H5N1 infections and deaths. The mixed assessments of Indonesia’s risk came as veterinary officials in East Java reported that the virus recently struck chickens in a village, which led to the culling of 270 birds, Indonesia’s Antara news agency reported today. Rapid-test results on 100 birds were positive, an official from Pamekasan regency’s veterinary health office told the news service.Jan 18 IRIN storyJan 19 Antara storylast_img read more

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E coli outbreak strain found in hazelnut sample

first_img Mar 8 Capital Press story Shaun George, a representative of George Packing Co., based in Newberg, Ore., told the Capital Press the company declined to share the grower names with the FDA, because the information is proprietary and the hazelnuts had not been definitively linked to the E coli illnesses. Mar 7 CIDRAP News story “Suspected pathogens spark peanut butter, hazelnut recalls” George said he believed the FDA would investigate practices at the farms, where nuts are harvested off the ground. On Mar 4, DeFranco and Sons, based in Los Angeles, recalled its bulk and consumer-pack in-shell hazelnut products after illness investigations in Michigan, Minnesota, and Wisconsin linked them to seven E coli O157:H7 infections. The company said it received the in-shell nuts from suppliers and growers and distributed them nationwide and to Canada. In other developments, a hazelnut packer that distributed some of the products is refusing share the names of farm sources with US Food and Drug Administration (FDA) investigators, the Capital Press, a grower industry Web site, reported yesterday. In the Mar 4 FDA recall notice, George Packing was listed as one of the brands distributed by DeFranco and Sons. Other nuts are harvested off the ground as well, but in 2007, the US Department of Agriculture said California almonds had to comply with new pasteurization regulations established in response to Salmonella outbreaks linked to almonds. The rule was developed by the Almond Board of California, an industry group. California is the world’s largest almond producer. Joshua Rounds, MPH, an epidemiologist with the Minnesota Department of Health (MDH), said the in-shell hazelnuts were collected for testing by the Minnesota Department of Agriculture. The findings are the first product test to suggest that the hazelnuts were contaminated. Earlier epidemiologic investigations in Michigan, Minnesota, and Wisconsin had already found that the seven patients sickened in the outbreak had consumed in-shell hazelnuts.center_img Mar 9, 2011 (CIDRAP News) – Lab tests have shown that Escherichia coli O157:H7 coli found in hazelnuts from the home of one of three Minnesotans sickened in a three-state E coli outbreak matches the outbreak strain, Minnesota officials said today. So far, the hazelnuts from one of Minnesota’s three patients appear to be the only ones available for testing. Spokeswomen from the Michigan and Wisconsin health departments told CIDRAP News that none of their patients had nuts left for testing. They also said no new illnesses in the two states have been associated with the outbreak. See also: The United States is the world’s third largest hazelnut producer, behind Turkey and Italy. About 99% of the nation’s hazelnut crop is grown in Oregon’s Willamette Valley, according to an Iowa State University industry profile. In 2008 US growers sold 22,400 tons of in-shell hazelnuts. Iowa State University background information on the hazelnut industry Apr 6, 2007, FoodNaviagator-usa.com storylast_img read more

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US debuts life sciences dual-use research policy

first_imgMar 29, 2012 (CIDRAP News) – Federal health officials today unveiled a new policy for overseeing life sciences dual-use research, such as two recent H5N1 transmission studies that have sparked bioterror concerns as well as cries of censorship.The launch of the new policy, first reported by ScienceInsider, comes while a US biosecurity advisory group is meeting to discuss the latest version of two H5N1 transmission papers, one by a group from Erasmus University in the Netherlands and one by a team from the University of Wisconsin, Madison.The move also follows a demand from a US congressman that President Obama’s science office explain why the National Science Advisory Board for Biosecurity (NSABB) didn’t consider the dual-use implications until after the studies were completed and what safeguards are in place to protect Americans against biological attacks. The congressman, Rep Jim Sensenbrenner, R-Wisc., asked John Holdren, who leads the White House Office of Science and Technology Policy, to report back by Mar 31.The NSABB is meeting today and tomorrow to weigh further data presented by the two research groups on their studies.The 4-page policy, which came from the National Institutes of Health (NIH) Office of Biotechnology Activities, requires federal agencies to routinely review potential risks of federally funded studies that involve 15 “high consequence” pathogens and toxins, including H5N1 avian flu, Bacillus anthracis, and Ebola virus.According to the NIH’s Web site, “The fundamental aim of this oversight is to preserve the benefits of life sciences research while minimizing the risk of misuse of the knowledge, information, products, or technologies provided by such research.”The policy expands reviews that the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), the government’s two largest biomedical agencies, already conduct on staff-run studies and extends oversight to federally funded studies at universities and other facilities. The new requirements also apply to other federal agencies that conduct unclassified life sciences research, such as the Department of Defense.It applies to research studies that are on the horizon and ones that have already been funded. Reviews that find dual-use potential require the funding agencies and scientists to develop a risk mitigation plan.According to the new policy, if the risks can’t be mitigated with several suggested measures, federal agencies are required to determine whether to request voluntary redaction of the resulting research publications or communications, to classify the research, or to withhold or terminate funding for the study.Actions to restrict publication may have implications for export control laws and regulations, the new policy states. Earlier this month, the Dutch government said it was considering using export controls to prevent full publication by the Erasmus group.Within 60 days federal agencies are required to report to the White House the number of proposed or ongoing studies related to the 15 high-consequence agents, and in 90 days to report how many have dual-use potential.The NIH has already completed its own dual-use biosecurity assessment and found fewer than 10 studies that warrant further risk management, the Washington Post reported today.See also:Mar 29 ScienceInsider storyUS government dual-use oversight policyNIH Web site on dual useMar 12 CIDRAP News story “Dutch export rules could block publication of Fouchier H5N1 study”Mar 5 CIDRAP News story “Details of H5N1 study sparks queries from congressman, experts”last_img read more

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BioShield report shows growth in biodefense stockpile

first_img BARDA has contracted for a total of 20 million doses of Imvamune, at a cost of $505 million. The government previously bought enough doses of the conventional vaccine to immunize the entire population. BARDA previously bought a total of 28.75 million doses of the anthrax vaccine BioThrax from Emergent BioSolutions, at a cost of $691 million. Project BioShield, established in 2004 and strengthened in 2006, provides authority and funds to support the development of countermeasures against chemical, biological, radiological, and nuclear threat agents. By the end of 2011, BARDA had acquired 57,102 doses of the monoclonal antibody Raxibacumab, used as an antitoxin to treat anthrax (Bacillus anthracis infection), from Human Genome Sciences. That includes 20,000 doses delivered under a fulfilled 2005 contract and 37,102 of 45,000 doses ordered under a 2009 contract option. For comparison, the total supply of Raxibacumab at the end of 2010 was 36,102 doses, according to earlier reports. “Project BioShield Annual Report to Congress” for 2011 Jul 28, 2011, CIDRAP News story covering renewal of preparedness law and 2010 annual report For botulism, BARDA has acquired 107,560 doses of Botulinum Antitoxin Therapeutic, made by Cangene, out of the 200,000 doses originally ordered. The supply at the end of 2010 was about 97,000 doses. BARDA’s medical countermeasures page The BioShield program is administered by the Department of Health and Human Services’ Biomedical Advanced Research and Development Authority (BARDA). The new report is for calendar year 2011. For smallpox, by the end of 2011 BARDA had acquired 5.9 million doses of the Imvamune vaccine, made by Bavarian Nordic, up from 2.02 million doses a year earlier. The product is an attenuated vaccine intended for immunocompromised persons, who are at risk for complications from the conventional vaccinia virus vaccine.center_img The agency also has ordered 1.7 million treatment courses of the experimental smallpox drug ST-246, made by SIGA Technologies, under a $433 million contract. None of that amount had been delivered by the end of last year, the report says. It says the contract “works toward the USG [US government] goal of developing two smallpox antivirals.” The report states, among other things, that the government has decided it doesn’t need the full 200,000 doses of an antitoxin for Clostridium botulinum (the botulism agent) that were ordered in 2006, instead settling for about 107,000 doses. The original contract for the product, which is derived from horse serum, was for $415 million. The report says $61 million was added to the contract to “maintain the horse herd, stockpile plasma, and continue stability testing of plasma and product in the SNS. This contract modification will ensure preparedness out to 2026.” “Reevaluation of the requirement led to a decrease in the number of doses necessary in the SNS [Strategic National Stockpile],” the report says. “Thus HHS/BARDA has met the requirement.” Sep 17, 2012 (CIDRAP News) – The recently released annual report for the federal Project BioShield program gives a snapshot of the US arsenal for blunting bioterrorist attacks, showing growth in the supplies of certain countermeasures for anthrax, botulism, and smallpox. In addition, in 2011 BARDA completed the acquisition of 10,000 doses of Anthrax Immune Globulin (AIG) from Cangene, also used to treat anthrax. The supply at the end of 2010 was listed as 7,327 doses. Total spending on Raxibacumab and AIG comes to $478 million, the report shows. See also: Oct 6, 2011, CIDRAP News story on BARDA’s 5-year planlast_img read more

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NEWS SCAN: H5N1 reports from Nepal, possible H7N3 in Mexico, flu and RSV seasonality, NDM bacteria cluster

first_imgFeb 15, 2013Nepal reports five recent H5N1 outbreaksLivestock officials in Nepal today reported five H5N1 avian influenza outbreaks, four of which were noted earlier this week in media coverage, according to a report today to the World Organization for Animal Health (OIE). Nepal has recently experienced a spate of outbreaks in the Kathmandu valley, plus one in Mechi zone, located in the eastern part of the country near the border with India. Today’s OIE report included another outbreak in the Kathmandu valley, a commercial broiler flock located in Setidevi village. All of the outbreaks occurred at commercial farms except for the one in Mechi zone, which struck the affected village’s backyard poultry. The five outbreaks killed 3,651 of 16,560 susceptible birds, and the remaining poultry were destroyed to curb the spread of the virus.Feb 15 OIE reportLarge Mexican poultry producer battling possible H7N3 avian fluMexico’s largest poultry producer and processor yesterday announced a possible outbreak of H7N3 avian flu on five of its breeder farms in the state of Guanajuato. Work is ongoing to verify the outbreak and to implement sanitary measures if needed. The company, Industrias Bachoco, is one of the largest poultry producers in the world and has almost 100 breeder farms in Mexico that produce hatching eggs for producing chickens. A press release from the company says that it is reinforcing its biosecurity measures at all facilities, particularly its breeder farms, and “analyzing steps to mitigate possible negative effects.” H7N3 avian flu was detected in the neighboring state of Jalisco in 2012 on farms owned by other poultry producers and led to the culling of millions of poultry. The virus again struck poultry farms last month in Aguascalientes state, directly north of Jalisco, as well as separate farms in Jalisco, leading to the culling of almost 700,000 birds.Feb 14 Bachoco press releaseFlu and RSV show temporal seasonality, even in much of the tropicsMany tropical regions worldwide, commonly thought to experience influenza and respiratory syncytial virus (RSV) year-round, actually have seasonal variations in the diseases similar to those in temperate climes, according to what is likely the first quantitative study of the subject on a global scale. The meta-analysis, which evaluated information gathered through the literature and electronic surveillance Web sites from 137 locations on five continents, was published yesterday in PLoS One. One third of the study’s data came from tropical areas. The authors found the expected peaks during winter months for both flu and RSV in temperate areas, with some showing peaks in both winter and summer for flu and Northern Europe showing biennial cycles for RSV. Overall, 80% and 50% of tropical areas showed distinct seasons lasting 6 months or less for RSV and flu, respectively. Tropical areas of Southeast Asia fairly commonly showed semiannual peaks in activity for both viruses. Weak latitudinal gradients were apparent in the timing of epidemics of both flu and RSV, with peak activity later in the year with increasing latitude (P < 0.03). No location studied had constant respiratory activity throughout the year when individual years were considered.Feb 14 PLoS One studyDenver cluster was biggest US outbreak of NDM-producing bacteriaEight patients in a Denver hospital last year harbored Klebsiella pneumoniae carrying New Delhi metallo-beta-lactamase (NDM), an enzyme that confers resistance to many antimicrobials, marking the biggest such outbreak in the United States so far, according to the Centers for Disease Control and Prevention (CDC). The outbreak was first spotted with the detection of carbapenem-resistant K pneumoniae (CRKP) in respiratory samples from two patients in July and August, says an article in today's Morbidity and Mortality Weekly Report (MMWR). Review of records and surveillance cultures identified six more cases. The patients had been hospitalized for a median of 18 days before CRKP was identified. Three of them were treated for CRKP infections, and five were found to be asymptomatically colonized. All of them survived. Tests revealed that the initial isolates were resistant to all antimicrobials except tigecycline. An epidemiologic investigation suggested that multiple transmission events had occurred and that "undetected, asymptomatically colonized patients were involved in some transmission routes." How the pathogen got into the hospital was unclear. Before this outbreak, only 16 isolates of NDM-producing carbapenem-resistant Enterobacteriaceae (CRE) had been found in the United States, 14 of them in patients who had received medical care in South Asia. In a Health Alert Network advisory e-mailed to reporters today, the CDC said that, of the 37 unusual forms of CRE reported in the United States, 15 have been reported since July 2012. The agency called for healthcare providers to act aggressively to prevent the emergence and spread of these organisms.Feb 15 MMWR articleRelated Aug 15, 2012, CIDRAP News itemlast_img read more

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Study hints flu shot effects may last more than one season

first_imgA new study found that influenza vaccine yielded moderate overall protection during the 2012-13 flu season, an unsurprising result. But it also offered a couple of surprises, including that patients who missed the current vaccine but had received the previous year’s version still seemed to have some protection against the virus.The study, published this week in the Journal of Infectious Diseases, also suggested that the flu vaccine was not significantly protective against influenza A/H3N2 in children ages 9 through 17, a finding that puzzled the authors.The investigators also found that the trivalent (three-strain) vaccine for 2012-13 provided moderate protection against both lineages of influenza B, not just the Yamagata lineage included in the vaccine—unlike some previous studies.”Cross-lineage protection and residual effects from prior vaccination were observed and warrant further investigation,” the report observes tersely.Test-negative design usedThe study was conducted by the Centers for Disease Control and Prevention’s (CDC’s) US Influenza Vaccine Effectiveness (VE) Network, which includes five centers around the country, in Marshfield, Wis.; Ann Arbor and Detroit; Temple-Belton, Tex.; Seattle; and Pittsburgh.The authors used a test-negative case-control study design, wherein patients with an acute respiratory illness during flu season are tested for flu and their vaccination status is determined. Those who test positive are classified as cases and those who test negative as controls.The team enrolled 6,766 patients in the study, of whom 6,452 were included in the analysis. Of those, 36% tested positive for flu. Among cases in which the flu type could be determined, 1,292 were H3N2, 52 were 2009 H1N1, 582 were influenza B/Yamagata (the vaccine strain), and 303 were B/Victoria.Current-season flu vaccination was documented in 45% (2,877) of the patients. Of these, 83% received inactivated flu vaccine (IIV), 8% received the live attenuated (nasal spray) vaccine (LAIV), less than 1% received other vaccine types, and 8% had an unknown vaccine type. Current and prior-year vaccination were highly correlated.Overall effectiveness 49%With those numbers, the authors calculated the overall VE, adjusted for various confounders, at 49% (95% confidence interval [CI], 43%-55%). By virus subtype, VE was 39% against H3N2 (95% CI, 29%-47%), 66% against B/Yamagata (95% CI, 58%-73%), and 51% against B/Victoria (95% CI, 36%-63%). VE against H1N1 was not assessed because there were too few cases to give meaningful results.In an age-group analysis, the researchers found that the vaccine provided significant protection against any flu strain in all groups except those 65 and older. For H3N2, VE was low not only in the elderly (11%; 95% CI, –41%-43%) but also in children ages 9 through 17 (24%; 95% CI, –12%-49%).In other findings, the effectiveness of IIV and LAIV did not differ significantly in children aged 2 through 17 years, the report says. For H3N2, IIV had 36% effectiveness (95% CI, 15%-51%), compared with 46% for LAIV (95% CI, 13%-66%). For B/Yamagata, the numbers were 68% (54%-77%) for IIV and 53% (20%-73%) for LAIV.Effect of prior-year vaccinationTo assess the effects of previous-year vaccination, the researchers defined four vaccine-exposure groups: those vaccinated in both the current and prior seasons, vaccinated in the current season only, vaccinated in the prior season only, and not vaccinated in either season. They limited the analysis to patients at least 9 years old. Also, they note that the H3N2 and B components of the vaccine were changed for the 2012-13 season.The investigators found that, when compared with those who received neither year’s vaccine, the first three groups all had similar protection against H3N2. The adjusted VE numbers were 35% (CI, 21%-47%) for those vaccinated both years, 37% (CI, 19%-51%) for current-season-only vaccinees, and 33% (12%-49%) for prior-season-only vaccinees. The results varied somewhat by age-group.In the same analysis for type B, the researchers found that VE was higher than for H3N2 and similar for all combinations of current and prior-season vaccination and all age-groups. For example, VE against B/Yamagata was 62% for both-season vaccination, 69% for current-season only, and 50% for prior season only.”Overall, we found minimal differences in effectiveness against A/H3N2 and B for each of the three current and prior season vaccination exposure groups, suggesting some residual effect of prior vaccination on current season VE,” the authors wrote.More than expected residual protection”The point is that there’s more residual protection than we thought,” said coauthor Arnold Monto, MD, a professor of epidemiology and public health at the University of Michigan, in an interview. But he cautioned, “I think the whole issue of prior-year vaccination is one we don’t fully understand.”Monto said his group has been analyzing some of its findings from comparative clinical trials of IIV and LAIV from 2004 to 2008 and has found that with IIV, the waning of antibodies after vaccination was less than previously thought. “Therefore the concept that it’s very important to get vaccinated late in the vaccination season,” to shorten the time between vaccination and potential flu exposure, “may have been relatively overstated.”The current findings contrast with those of a study published last year by Monto and colleagues in Clinical Infectious Diseases. They recruited 328 households and monitored them during the 2010-11 flu season. The results showed that flu risk was almost the same in vaccinated and unvaccinated participants. But when the researchers looked separately at participants who had been vaccinated in the 2010-11 season but not in the previous season, they found a VE of 62%, whereas those who were vaccinated in both years had no significant protection.Monto said his group’s household studies generally suggest that those who were vaccinated in the current season but not the previous season had more protection than those who were vaccinated in both seasons. “But the differences are not that great,” as the confidence intervals for the estimates tend to be wide and overlapping, he added.In the new paper, the authors observe, “The immunologic effects of repeated vaccination are not well understood, and additional studies are needed to understand the impact of past infections, past vaccinations, and antigenic variability on risk of illness.”In other comments, the authors said the low VE against H3N2 in 9- to 17-year-old children was unexpected, since vaccine performance in that age-group was similar to that in other groups in the previous season. Further work, they said, is needed to identify factors that might contribute to lower protection in older children.Monto suggested that the finding of low VE for H3N2 in older kids may not mean much. “If you cut things too much in terms of the age-groups, you’ll find results that can’t be replicated in other years,” he said in the interview. “There’s some degree of random variation, because we’ve always found that age-group pretty responsive” to the vaccine.As for the finding of significant protection against both type B lineages, the authors wrote that cross-lineage protection was also found in Canada in 2012-13 and in the United States in 2011-12, but Canadian data for 2011-12 showed little or no cross-lineage protection.The authors said their current finding of cross-lineage effectiveness, along with the similar previous evidence, suggests that quadrivalent (four-strain) flu vaccines “may provide little or no additional protection compared to trivalent vaccines,” which target just one type B lineage.They added that further research is needed to assess whether quadrivalent vaccines yield greater benefits in children, who have had fewer natural influenza B infections than older groups have.McLean HQ, Thompson MG,. Sundaram ME, et al. Influenza vaccine effectiveness in the United States during 2012-13: variable protection by age and virus type. J infect Dis 2014 (Early online publication Nov 18) [Full text]See also: Mar 1, 2013, CIDRAP News story on earlier Michigan study examining effect of prior-year vaccinationlast_img read more

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As Korean MERS cases grow, experts analyze patterns

first_imgSouth Korea announced 5 more MERS-CoV cases today, raising the number of cases to 30 and leading experts to question if the rapidly evolving hospital cluster is following a pattern seen in Saudi Arabia or if other factors are helping fuel the outbreak.South Korea is on a list of 16 countries—including the United States—that have reported travel-linked cases. Its outbreak began on May 20 with the detection of MERS-CoV  (Middle East respiratory syndrome coronavirus) in a man who had returned from the Middle East.A flurry of hospital-linked illnesses linked to the man, though, has quickly vaulted the country into the third-most-affected country, behind Saudi Arabia and the United Arab Emirates.Five new cases, four tied to index caseIn a statement today translated and posted by the infectious disease news blog Avian Flu Diary, South Korea’s health ministry said the five new MERS cases include four patients who are direct contacts of the index patient and one who was exposed by a secondary case.That raises the number of tertiary cases (involving three generations of transmission) in the cluster to three.The translation suggests that the likely tertiary case-patient had been exposed to a 40-year-old man who got sick after being on the same hospital ward as the index patient.WHO warns of further casesThe World Health Organization (WHO) said in a statement today that it is in close contact with South Korea and that the quality of reporting has allowed a nearly real-time insight into outbreak dynamics. It added that aggressive contact tracing and testing may help explain the cluster’s rapid expansion.Though human-to-human transmission has been documented, there is no evidence that it is sustained, the WHO said in discussing the first 25 outbreak patients.Patients sickened in the outbreak so far had a range of exposures. Some were in the same room as the index patient and others were on the same ward. Preliminary data suggest exposure times may have been as short as 5 minutes to a few hours, the WHO said.It warned that because a number of clinics and hospitals cared for the index patient, more cases are expected.Experts discuss outbreak profileMaria Van Kerkhove, PhD, an epidemiologist with the Pasteur Institute Center for Global Health in Paris, said the pattern unfolding in South Korea is concerning but has been seen in earlier nosocomial outbreaks. She noted that when the index case-patient returned to South Korea he visited four healthcare facilities before his MERS-CoV infection was detected.She said the situation facilitated allowing the virus to spread to family members, hospital roommates, patients on the same ward, and health providers before the man’s illness was detected and before adequate prevention and control measures were in place.She said tertiary transmission has been seen before in a few other clusters, such as in some in Saudi Arabia (in Al Hasa, Jeddah, and Riyadh). She said that, although there are signs of tertiary transmission in South Korea, all of the reported cases have epidemiologic links to the index case or a secondary case and pointed out, as did the WHO, that there is no sign of community or sustained human-to-human transmission.Though South Korea’s outbreak is the largest outside of the Middle East, the epidemiologic pattern isn’t unexpected, unfortunately, Van Kerkhove said. “We know that strict adherence to infection prevention and control can stop transmission in healthcare settings.”Marion Koopmans, DVM, PhD, a virologist at Erasmus Medical Center and the National Institute for Public Health and Environment in the Netherlands, said the outbreak is remarkable and serves as a clear reminder of what viruses can do.So far, she said, it’s difficult to tell if the events in South Korea amount to more than what has been seen in Saudi Arabian hospital clusters. She added that it will be useful to compare the situation to what happens in China, where an imported case-patient from South Korea is hospitalized in Guangdong province.”Of course, it is important to keep monitoring the properties of the viruses as well, just to be sure nothing has changed there,” she said.Infectious disease experts quoted in a Canadian Press story today suggested that the South Korean outbreak stands out for officials’ and the media’s prompt reporting of developments, unlike the murky and often delayed picture of what’s happening with Saudi Arabia hospital clusters.In a report today from ScienceInsider, Peter Ben Embarek, PhD, who leads the WHO’s MERS response, said the simplest explanation is a “superspreading event,” signifying a lapse in hospital infection control measures. He noted also that more information is needed about what happened at the hospital.Other factors could include the spread of a slightly different strain of the virus and potential elevated susceptibility of people in South Korea to the virus, according to the story.Officials still mum on revealing hospitalsSouth Korean health officials are facing increasing pressure to name the hospitals and patients affected by the MERS-CoV outbreak, though clues are emerging that one of the facilities is probably located in the Gyeongii province city of Pyeongtaek, a town of about 427,000 located roughly 40 miles south of Seoul.The country’s health ministry said today at a briefing that it will disclose the names to medical officials who need to know, but will avoid sharing them with the public to avoid misunderstanding and anxiety, the Korea Herald reported today.A local civic group based in Pyeongtaek, where one patient was known to be diagnosed as having the disease, is calling for the information to be made public.Fears prompt school closuresThough Korean officials haven’t named the affected hospitals, the location of one triggered temporary school closures. In Pyeongtaek, more than 40 private kindergartens and elementary schools closed for the week after authorities signaled that 22 schools near a hospital where a woman died from the disease may be at risk, Yonhap News Service reported today.The woman’s illness wasn’t detected until after she died, and the hospital that treated her is the same one that treated the country’s first case-patient, Yonhap said. Earlier reports said the hospital had been shuttered because of a surge of nosocomial infections—involving patients on the same ward, health workers, and visitors—linked to the first case.Elsewhere, four schools in North Chuncheong province cancelled classes for the rest of the week after a teacher at one of them was identified as a close contact of a MERS-CoV patient, according to the Yonhap report.Negative test results in Hong KongAnd a 32-year-old Hong Kong doctor who got sick with respiratory symptoms after returning from a medical exchange activity at a Seoul hospital was admitted to the hospital but has tested negative for MERS-CoV, according to statements today from Hong Kong’s Centre for Health Protection (CHP).Three other people who were tested for MERS-CoV also had negative test results, the CHP said. They include a 26-year-old woman who came down with respiratory symptoms after traveling to Seoul, where she visited a health facility during her stay; a 40-year-old woman who got sick after returning from Dubai and Bahrain; and a 68-year-old man who had a cough and a runny nose after traveling to Dubai.At a media briefing in Hong Kong today, Ko Wing-man, MBBS, Hong Kong’s secretary for food and health, said he was worried about South Korea’s MERS situation, especially because some tertiary infections are suspected and because he said South Korean officials haven’t been very transparent.”Up to this moment, we still cannot obtain information about the healthcare institutions involved,” he said, according to a briefing transcript.He added that Hong Kong has added extra prevention measures, based on an emergency meeting yesterday. Travelers arriving in Hong Kong with fever and respiratory symptoms will have to sign a health assessment form that says those who withhold information will be subject to prosecution.Ko also said Hong Kong officials have advised health workers to suspend medical exchange activities with South Korea.See also:Jun 2 Avian Flu Diary postJun 2 WHO statementFluTrackers South Korea MERS-CoV case listJun 2 Canadian Press storyJun 2 ScienceInsider  reportJun 2 Korea Herald articleJun 2 Yonhap News story on school closuresJun 2 CHP statement on negative MERS-CoV testsJun 2 CHP Ko Wing-man statementlast_img read more

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Saudis note 2 new MERS cases; WHO details 7 others

first_imgSaudi Arabia’s Ministry of Health (MOH) confirmed 2 new MERS-CoV cases today in Buraydah, which has now had 23 cases in less than 2 weeks, while the World Health Organization (WHO) provided details on 7 previously reported Saudi cases, 4 in Buraydah.One new case proved fatalOne of the new MERS-CoV (Middle East respiratory syndrome coronavirus) cases in Buraydah reported today by the MOH was fatal. It also does not appear to be linked to a large hospital outbreak in the city.Dead is an 84-year-old Saudi man. His case is listed as “primary,” meaning he likely did not acquire his infection from another patient.The other case involves a 54-year-old foreign man who is hospitalized in critical condition. He contracted the disease in a healthcare setting, so he is probably part of a large hospital outbreak in the city. Yesterday the MOH said that 18 of 23 MERS cases reported in the city at that time were associated with one hospital, which it did not name.Neither man is a healthcare worker. Of the 23 cases in Buraydah reported by the MOH since Mar 3, 11 have been fatal.The agency also noted that three men have recovered from their MERS-CoV infections. Two of them, aged 36 and 81, are from Buraydah, and the other, 49 years old, is in Jeddah. The oldest man had preexisting disease, while the others, both healthcare workers, did not.Saudi Arabia has now confirmed 39 MERS cases so far this month after reporting 24 in all of February. Only 9 of the 39 cases have involved women. Since the outbreak began in the country in 2012, the MOH has confirmed 1,346 cases, including 572 deaths. Nineteen patients are still undergoing treatment.WHO details 7 cases, 5 severeThe WHO, meanwhile, today detailed four cases in Buraydah and one each in Taif, Jubail, and Jeddah. All tested positive for MERS-CoV on Mar 8 or 9.Two of the cases involved recent contact with camels, a known risk factor. Two of the patients are hospitalized in stable condition, three are in critical condition, and two died.The four patients in Buraydah are all linked to the outbreak hospital, the WHO said, and one is a healthcare professional there. Investigation into how all four might have been exposed to the virus is ongoing.The healthcare worker, a 26-year-old man, is in stable condition after testing positive for MERS-CoV. He had preexisting disease.The other Buraydah patients are a 22-year-old woman with comorbidities who is in severe condition, a 29-year-old man with preexisting disease who died on Mar 9, and a 50-year-old man with comorbidities who is in critical condition on a mechanical ventilator.The three cases outside of Buraydah involve a 75-year-old man in Taif who is in critical condition, a 62-year-old man in Jubail city in critical condition, and a 64-year-old man in Jeddah who died on Mar 8. The former two had frequent camel contact and drank their raw milk, while an investigation into a possible MERS-CoV source for the third man is ongoing.The WHO said that, since September 2012, it has been informed of 1,684 lab-confirmed MERS cases worldwide, including at least 600 deaths.See also:Mar 16 MOH updateMar 16 WHO news releaselast_img read more

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CDC notes Shigella strains with reduced susceptibility

first_imgThe Centers for Disease Control and Prevention (CDC) is warning clinicians and public health officials of emerging strains of Shigella bacteria with reduced susceptibility to ciprofloxacin, one of the main antibiotics used to treat shigellosis.In a health advisory issued yesterday, the CDC said it has identified an increase in Shigella isolates in the United States with minimum inhibitory concentration (MIC) values of 0.12 to 1.0 microgram per milliliter (mcg/mL) for ciprofloxacin, a fluoroquinolone antibiotic, and that preliminary data suggest that all Shigella isolates with ciprofloxacin MICs in this range harbor at least one quinolone resistance gene. Shigella isolates without a quinolone resistance gene typically have a ciprofloxacin MIC of 0.015 (mcg/mL) or less, the CDC says.MIC values are used to determine the resistance of an organism to an antimicrobial agent. Antibiotics with lower MIC scores are considered more effective, because the lower MIC value means less of the drug is required to inhibit growth of the organism. Clinicians in turn use MIC values as a guide for choosing which antibiotic to use to treat an infection. But the advisory notes that under the current interpretive criteria of the Clinical and Laboratory Standards Institute (CLSI), Shigella isolates with a ciprofloxacin MIC of 1.0 (mcg/mL) or less are considered susceptible to ciprofloxacin.While the agency does not yet know whether using fluoroquinolones to treat a Shigella infection with a ciprofloxacin MIC of 0.12 to 1.0 mcg/mL is associated with worse outcomes or increases the risk of transmission, it’s recommending that clinicians consider other antibiotics out of concern that fluoroquinolone treatment may be less effective and may increase the risk of secondary cases.”Clinicians treating patients with multidrug-resistant shigellosis for whom antibiotic treatment is indicated should avoid prescribing fluoroquinolones if the ciprofloxacin MIC is 0.12 mcg/mL or higher even if the laboratory report identifies the isolate as susceptible, and should work closely with their clinical microbiology laboratory and infectious disease specialists to determine appropriate antimicrobial therapy,” the CDC advised.Growing resistanceShigella bacteria, mainly S sonnei and S flexneri, cause about 500,000 cases of diarrhea in the United States each year and are highly contagious. Exposure to even the smallest amount of contaminated fecal matter can cause illness. Shigella infection most commonly occurs from eating food contaminated by people who have shigellosis, but it is also associated with travel to disease-endemic areas, crowding, poverty, and attendance at daycare centers.While diarrhea caused by Shigella usually resolves without the need for antibiotics, antibiotic treatment can shorten the duration of symptoms in more severe cases. Yet antibiotic resistance in Shigella is a growing problem, with resistance to traditional first-line antibiotics like ampicillin and trimethoprim-sulfamethoxazole now common and resistance to azithromycin and ciprofloxacin—the two drugs most commonly used to treat shigellosis—on the rise.The CDC, which declared antibiotic-resistant Shigella an urgent threat in the United States in 2013, estimates that 27,000 US Shigella infections annually are resistant to one or both of these antibiotics.In its health advisory, the CDC said rising resistance to fluoroquinolones in Shigella isolates could be related to the emergence of plasmid-mediated quinolone resistance (PMQR) genes in Shigella species in the United States. PMQR genes are a concern because of their ability to spread fluoroquinolone resistance to Shigella bacteria that have never been exposed to the drugs; they can also spread resistance to other types of bacteria. While high prevalence of PMQR genes in Shigella bacteria has been reported in countries such as China and India, prevalence in US Shigella is currently unknown, the CDC said.Guidance for clinicians, health officialsThe agency recommends that clinicians order stool culture for patients suspected of having a Shigella infection, and order antimicrobial susceptibility testing for isolates. In patients for whom antibiotic treatment is indicated, clinicians are advised to use the susceptibility testing results to guide antibiotic choice, with special attention given to MIC values for fluoroquinolone antibiotics.   Because shigellosis is a nationally notifiable condition, all cases have to be reported to local health department. The CDC says clinicians should include the identification of isolates with a MIC value of 0.12 mcg/mL or higher in their reports. In addition, public health officials are urged to submit those isolates to the state public health laboratory for whole-genome sequencing, which can identify quinolone resistance genes.The CDC says it will continue to monitor trends in antimicrobial susceptibility of Shigella isolates. The agency added that it is working with clinical and public health partners to determine if ciprofloxacin is associated with worse outcomes in patients infected with Shigella strains carrying quinolone resistance genes.See also:Apr 18 CDC health advisorylast_img read more

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ASP Scan (Weekly) for Oct 06, 2017

first_imgOur weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scansAntimicrobial use in Danish animals drops for 3rd straight yearTotal antimicrobial consumption in Danish food and companion animals has fallen for the third consecutive year, according to the annual DANMAP report that is based on 2016 data. It’s from researchers at Statens Serum Institut and from the National Veterinary Institute and the National Food Institute, both departments at the Technical University of Denmark (DTU).In 2016, total antimicrobial consumption in kilograms was down about 5% in Danish animals, compared with a drop of 4% in 2015 and 2% in 2014. And overall antimicrobial use has declined 10% since 2013, which is the equivalent of 12 tons of drugs, according to a DTU National Food Institute news release yesterday.The 2016 reduction was substantially driven by a 4% reduction in antimicrobial use in swine production compared with 2015, as pig production in Denmark constitutes about 85% of the country’s meat production and about 75% of veterinary-prescribed drugs.After 2 years of much higher than normal drug use in poultry because of serious outbreaks in poultry, antimicrobial use in that industry dropped 36% from 2015 levels. And use in aquaculture was at its lowest in a decade in 2016, the report noted.Antimicrobial use in pets increased slightly from 2015 to 2016 but has generally decreased in the past 5 years, especially regarding the consumption of third- and fourth-generation cephalosporins.”A reduction in the use of antimicrobials is necessary if we are to tackle the problem of antimicrobial resistant bacteria,” division head Flemming Bager with the National Food Institute said in the release. “The Danish Veterinary and Food Administration has in recent years implemented several initiatives to limit consumption, and it is positive to see that the downward trend in consumption continues.”Oct 5 DTU National Food Institute news releaseOct 5 DANMAP report Scientists develop rapid susceptibility test for urinary tract infectionsOriginally published by CIDRAP News Oct 4California researchers have developed a rapid test to detect antibiotic susceptibility in urinary tract infections (UTIs) in less than 30 minutes, which could allow patients to be diagnosed and prescribed effective antibiotics during just one healthcare visit, according to a study today in Science Translational Medicine.The team of scientists used an ultrafast single-molecule DNA amplification and quantification method called digital real-time loop-mediated isothermal amplification (dLAMP), which directly counts bacterial genomes in urine samples instead of relying on lab cultures, which can take days. The researchers diluted and incubated the samples for 15 minutes before dLAMP testing, which takes about 7 minutes. The dLAMP analysis calculated the ratios of DNA concentration between untreated samples and those treated with antibiotics to determine susceptibility and resistance levels among UTI pathogens.The researchers validated the test using 51 clinical samples that had already been confirmed as either susceptible or resistant to ciprofloxacin or nitrofurantoin.UTIs, which almost always are treated with antibiotics, account for about 8 million primary care visits a year, and antibiotic resistant infections are a growing threat, the authors note.They conclude, “Here, we solved three problems to determine phenotypic antibiotic susceptibility in clinical samples within 30 min. First, we used digital quantification of a DNA marker to reduce the antibiotic exposure time to 15 min. Second, we showed that dAST [digital antimicrobial susceptibility testing] is robust to the presence of commensal bacteria and clinical urine matrices. Third, we developed and optimized a rapid, high-resolution measurement method for quantifying NA [nucleic acid] targets that shortens the measurement step to less than 10 min.”Oct 4 Sci Transl Med abstract Acute kidney injury tied to combo antibiotics in hospitalized kidsOriginally published by CIDRAP News Oct 3Researchers from Philadelphia and Cincinnati yesterday reported a potential tripling of the risk of acute kidney injury in children administered intravenous (IV) vancomycin combined with piperacillin/tazobactam, according to their study in JAMA Pediatrics.The retrospective cohort study included 1,915 children hospitalized for 3 or more days and prescribed IV vancomycin plus one other antipseudomonal beta-lactam combination therapy at six large US children’s hospitals from Jan 1, 2007, through Dec 31, 2012. Patients with underlying kidney disease or abnormal serum creatinine levels on hospital days 0 to 2 were excluded from the analysis.Of the 1,915 patients, 157 (8.2%) had antibiotic-associated acute kidney injury. After adjusting for various potential confounders, the investigators determined that the adjusted odds ratio for sustaining such injuries after receiving IV vancomycin plus piperacillin/tazobactam was 3.4 compared with IV vancomycin plus other beta-lactam combo therapies.The authors conclude, “Pediatricians must be cognizant of the potential added risk of this combination therapy when making empirical antibiotic choices.”Oct 2 JAMA Pediatr studylast_img read more

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