NEWS SCAN: More Salmonella cases, flu symptoms in pregnancy, C difficile hygiene, rotavirus vaccine coverage, H5N1 in Indonesia

May 6, 2010

CDC reports 20 more cases in pepper-linked Salmonella outbreak
Twenty more cases have been reported in a 9-month-old Salmonella Montevideo outbreak linked to Italian-style meats seasoned with pepper, pushing the count to 272, the Centers for Disease Control and Prevention (CDC) said in a final report on its outbreak investigation this week. The previous update, on Apr 1, listed 252 cases. Illnesses have been reported in 44 states and Washington, DC. The first cases in the outbreak go back to July 2009, and the latest reported case began Apr 14, the agency said. Fifty-two of 203 patients with available information were hospitalized, but no deaths have been reported, the CDC said in its May 4 update. The outbreak was traced to salami and other meat products that were seasoned with red and black pepper and sold by Daniele International Inc., a Rhode Island company. The illnesses led to recalls by Daniele and by two spice distributors that sold pepper to Daniele. The CDC said the number of cases peaked in November and that reported infections with the outbreak strain of Salmonella Montevideo (a common strain) have dropped to the expected baseline of about 3 to 4 per month. Some of the recalled products have long shelf lives and could cause further illnesses if consumed, the agency said. It also noted that, because the outbreak strain is a common one, some of the cases included in its count are not actually part of the outbreak.
May 4 CDC update on Salmonella outbreak

Nausea, tachycardia may signal flu in pregnant women
In pregnant women, recognizing nausea and tachycardia as common symptoms of seasonal flu could help doctors more quickly diagnose and treat the condition in this high-risk group, researchers from the University of Texas (UT) Southwestern Medical Center reported in Obstetrics & Gynecology. Their findings come from a review of 107 pregnant women who were diagnosed as having influenza during part of the 2003-04 flu season, a year when influenza A/H3N2 was the dominant strain that didn't match the vaccine. Flu was most commonly diagnosed during the third trimester. Though cough, myalgias, and rhinorrhea were common symptoms, 60% of the women had nausea or vomiting, and 21% had a maximum heart rate greater than 130 beats per minute. The researchers found no difference in complications in mothers or their babies among those with and without flu. Lead author Dr Vanessa Rogers said in a press release, "I think our findings should encourage people to be vigilant and to take symptoms seriously," adding that women in the study group may have had good outcomes because they were diagnosed and treated early.
May 6 UT Southwestern press release
May Obstet Gynecol abstract

Soap and water beats alcohol rubs for removing C difficile
Soap-and-water washing is a significantly more effective way to remove spores of Clostridium difficile, an important cause of diarrheal illness in hospitals, from the hands than is use of alcohol-based hand rubs (ABHRs), according to a study reported in the June issue of Infection Control and Hospital Epidemiology. Researchers from Loyola University and two other institutions used washing with plain water as the standard for comparing the effects of soap-and-water washing and three different ABHRs. Soap and water was significantly better than plain water or any of the ABHRs; only one of the three hand rubs worked significantly better than plain water. The researches also found that after use of ABHRs, residual spores were readily transferred to another person by a handshake. In an accompanying commentary, Katherine Ellingson, PhD, and Clifford McDonald, MD, write that while ABHRs don't work well against C difficile, their use has led to tremendous gains in hand hygiene overall. Accordingly, they endorse recommendations to wash hands when C difficile is suspected in outbreak or endemic settings, while continuing to encourage ABHR use as the preferred hand hygiene method in all other circumstances.
Infect Control Hosp Epidemiol study abstract
Accompanying commentary

Rotavirus vaccine coverage lags behind other infant immunizations
A review of rotavirus vaccine coverage in US infants conducted by the CDC at its sentinel sites revealed today that though coverage has increased to 72% since the vaccine was introduced, the number of 5-month-old infants who have received at least one dose of the vaccine is 13% lower than that of two other commonly given childhood vaccines, acellular pertussis and 7-valent pneumococcal conjugate. The findings appeared today in Morbidity and Mortality Weekly Report (MMWR). The CDC's vaccine advisory group recommended routine rotavirus vaccination of all infants with three doses of a pentavalent vaccine and in 2008 updated its advice to include use of a new two-dose monovalent version of the vaccine. The CDC said the lower coverage rate for the rotavirus vaccine could be related to the maximum age limit for receiving it, but also suggested other barriers exist—physicians' financial concerns and vaccine safety concerns among parents and physicians. The CDC added that the last two rotavirus seasons were shorter than in prevaccine years, but said more efforts are needed to educate parents and providers.
May 7 MMWR report

WHO confirms two recent Indonesian H5N1 cases
The World Health Organization (WHO) today confirmed two recently reported H5N1 avian influenza cases from Indonesia, one of them fatal, based on reports it received from the country's health ministry. The first case was in a 45-year-old woman from East Java province who got sick on Feb 22, within 4 days of disposing of dead chickens. She recovered and is in good condition, the WHO said in its statement today. The second case was in a 4-year-old girl from Riau province who became ill on Apr 19, was hospitalized on Apr 22, but died on Apr 28. The WHO said an investigation into the source of her infection is ongoing. The two cases raise Indonesia's H5N1 total to 165 cases, of which 136 were fatal. The newly confirmed cases push the world's total for the disease to 498 cases, including 294 deaths.
May 6 WHO statement

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