NEWS SCAN: E coli outbreak, food safety report, TB treatment guide, chickenpox vaccine, H5N1 update

May 10, 2010

Arizona-grown lettuce may be source of E coli outbreak
Romaine lettuce grown in the Yuma, Ariz., area may be the source of an Escherichia coli O145 outbreak that has sickened people in Michigan, Ohio, and New York, the Associated Press (AP) reported. The outbreak prompted Freshway Foods of Sydney, Ohio, last week to recall romaine lettuce sold in 23 states. Devon Beer, a company vice president, told the AP that Freshway worked with the US Food and Drug Administration to trace the contaminated lettuce to a Yuma grower but did not identify the grower. Federal officials said last week that the outbreak included 19 confirmed cases and 10 probable cases; the AP story said three of the patients had life-threatening illnesses. The Centers for Disease Control and Prevention said it had no new case numbers today. The AP story said that several students at four middle and high schools in two New York towns, Wappingers Falls and nearby Hopewell Junction, also might have been affected by the outbreak. As reported previously, patients have included students at the University of Michigan in Ann Arbor, Ohio State University in Columbus, and Daemen College in Amherst, N.Y.

Report recommends adopting European food-safety reforms
Efforts to improve food safety could be strengthened if the United States adopted the data-based reforms practiced by several European countries, the Produce Safety Project of Georgetown University said Monday. Its report, "Building the Science Foundation of a Modern Food Safety System," examines practices in Denmark, the Netherlands, and the United Kingdom, including consolidation of authority in one agency, integrated data collection, and annual reports written in consumer-friendly language. To improve US efforts, the report recommends adopting national surveillance plans, coordinating grant-giving for research, and improving traceability.

WHO updates TB treatment guidelines
In the fourth edition of its tuberculosis (TB) guidelines, the World Health Organization (WHO) recently revised its guidance for treating patients who have TB. It is the first update of the guidelines since 2003. Among several changes in the 160-page guide is a recommendation to increase the length of rifampicin treatment from 2 to 6 months. The change is designed to reduce the number of relapses and failures, which the WHO authors say could reduce patient suffering while conserving medical resources. The new edition confirms the WHO's earlier recommendation to test drug susceptibility in all previously treated TB patients to avoid retreatment with first-line drugs. Finding and treating multidrug-resistant TB (MDR-TB) in previously treated patients should help improve the poor outcomes in these patients, the WHO said. The new guidelines address drug susceptibility testing within the context of laboratory advances and each country's progress in adding lab capacity. Testing should guide treatment in countries that have access to rapid molecular-based tests, and empiric treatment with an MDR regimen is recommended when conventional testing is used and there is a high likelihood of MDR-TB. The latest edition also details the need to prevent MDR-TB in newly diagnosed TB patients who already have isoniazid-resistant TB, a group shown to be at greater risk for acquiring drug resistance.
WHO summary of new TB treatment guide

Two-dose combination vaccine prevents chickenpox
A combination vaccine on a two-dose schedule is more efficacious at preventing chickenpox, according to a paper presented Sunday at the annual meeting of the European Society for Pediatric Infectious Diseases and reported by the Web site Doctor's Guide. The study, conducted at the Czech Republic's University of Defense, compared two vaccine formulations in a randomized, controlled, blinded study. Children aged 12 to 22 months were given either two doses of measles-mumps-rubella (MMR) vaccine followed by a single dose of varicella vaccine, or two doses of a measles-mumps-rubella-varicella (MMRV) vaccine. A control group was given only two doses of MMR. Both the varicella and the MMRV vaccines were made by GlaxoSmithKline, which funded the study. At the end of 35 months, 37 of the 2,279 children (1.6%) in the MMRV group had developed varicella, compared with 243 of the 2,263 children (10.7%) in the MMR-plus-varicella group (and 201 of the 743 children [27.1%] in the control group). Vaccine efficacy was 94.9% in the MMRV group and 65.4% in the MMR-plus-varicella group.
May 9 Doctor's Guide report

Egypt updates H5N1 findings, Israel reports H5N1 in zoo emus
In an update on H5N1 avian influenza outbreak and surveillance activities in Egypt since early March, the Egypt-based Strengthening Avian Influenza Detection and Response (SAIDR) Web site recently added 113 new reports. The reports span 19 governorates, with Menofia, Kafr el Sheikh, and 6th of October listing the highest totals. Twenty-four reports detail H5N1 findings on farms, most of which reflect premarket testing. The remaining reports detail H5N1 findings in households, with testing prompted by outbreaks or surveillance activities. Investigation into some of the outbreaks revealed that the source of infection was young ducks that were purchased from peddlers or live bird markets. The H5N1 virus is thought to be endemic in Egypt, and the country has reported several human cases this year. In other developments, Israeli animal health officials reported on May 6 that H5N1 was detected in two emus in a minizoo at Ein Gedi kibbutz near the Dead Sea in southern Israel, according to a report filed with the World Organization for Animal Health (OIE). The first emu died on May 1, 2 days after showing signs of weakness; its mother showed the same signs and died a few days later. The zoo's remaining 113 birds were culled to control the outbreak. An investigation into the source of the infections was inclusive. Zoo officials said no new birds had been introduced to the zoo for the past several months and that no commercial poultry farms were located within 10 kilometers of the zoo.
Oct 6 OIE report

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