NEWS SCAN: Babesiosis mapping, Salmonella update, cholera in Cuba, MRSA infections, smallpox vaccine indications

Jul 12, 2012

First year of surveillance shows babesiosis most common in Northeast, Midwest
Babesiosis, a tickborne disease ranging from asymptomatic to life threatening, was reported to the Centers for Disease Control and Prevention (CDC) in 1,124 individuals (847 confirmed and 277 probable cases) during 2011, the first year of surveillance. The areas where the disease is now reportable include 18 states and New York City, says the surveillance report available in this week's Mortality Morbidity Weekly Report (MMWR). Reported cases came from 15 of the 18 states, with 97% occurring in Connecticut, Massachusetts, Minnesota, New Jersey, New York (state and city), Rhode Island, and Wisconsin).Affected persons were 60 years or older in 57% of cases, and 82% of those for whom date of onset was available (879) were infected from June through August. Babesiosis parasites are usually tickborne but can be spread through blood transfusions or congenitally; the current report counts 10 cases as transfusion-associated and one as congenital. Most infected people did not recall having a tick bite. Babesiosis is treatable with antibiotics, so clinicians should maintain a high level of suspicion. The CDC recommends that people living in or traveling to the Northeast and upper Midwest this summer protect themselves against tick bites by applying repellents and wearing long pants and long-sleeve shirts outdoors.
Jul 13 MMWR report
Another MMWR article, this one on nationally notifiable arboviral (transmitted by mosquitoes and ticks) infections in 2011, says 871 cases were reported, with West Nile virus (WNV) accounting for 712. La Crosse virus was the most common among children, however, with 123 of the 130 cases (95%) occurring in people under 18. Other arbovirus infections included Powassan in 16 cases, St. Louis encephalities in 6, Eastern equine encephalitis in 4, and Jamestown Canyon in 3. The WNV cases were reported in 43 states and the District of Columbia and the La Crosse virus cases in 14 states. Of the 871 arbovirus infections reported, 624 (72%) were classified as neuroinvasive (meningitis, encephalitis, or acute flaccid paralysis), for a national incidence of 0.2 per 100,000 population.
Jul 13 MMWR report

CDC reports 21 more illnesses in hatchery-linked Salmonella outbreak
Twenty-one more people have been sickened in a Salmonella outbreak linked to chicks and ducklings from an Ohio mail-order hatchery, pushing the total to 144 cases from 26 states, the US Centers for Disease Control and Prevention (CDC) said today. The total includes one from one more state, Arizona. The other new infections were reported in Maine (1), Massachusetts (1), Michigan (1), North Carolina (2), Ohio (7), Pennsylvania (1), Tennessee (3), and Virginia (4). The latest illness onset was Jun 22. Of 90 patients with available information, 32 (36%) were hospitalized. One death was previously reported, but officials said it's not clear if the infection contributed to the patient's death. The CDC initially reported the outbreak on May 30. It involves three different Salmonella strains: Infantis, Newport, and Lille. The outbreak is one of four Salmonella events linked to mail-order chicks and ducklings since 2011. The most recent one, announced Jun 25, is a Salmonella Montevideo outbreak tied to a Missouri company's hatchery.
Jul 12 CDC outbreak update

Cholera cases in Cuba jump to 110
A Cuban government official said the cholera outbreak there has increased to 110 cases, but the official death toll remained at 3, according to a media report published today. Anna Maria Batista, an epidemiologist in Granma province, the center of the outbreak, put the case count on Jul 10 at 110, up from 85 a day earlier, according to an El Nuevo Herald story carried by some US newspapers. The government has confirmed only three cholera deaths, but dissidents have reported from 5 to 15 deaths, according to the story. Batista repeated her previous claims that the outbreak is under control but advised Granma residents to avoid unnecessary travel. Her reports on CNC Granma television every night since Jul 7 have been the only official comments on the outbreak since a brief government statement on Jul 3 confirmed the three deaths. Media reports have noted that many Cuban healthcare personnel work in Haiti, which has been battling a cholera epidemic since late 2010.

Improper use of single-dose vials cited in two MRSA clusters
Improper use of single-dose vials at outpatient clinics in Arizona and Delaware earlier this year led to invasive Staphylococcus aureus infections that sickened 10 patients. Authors from the US Centers for Disease Control and Prevention (CDC) and state health departments that investigated the clusters described the events today in MMWR. In both cases, staff members deviated from normal infection control practices because they had problems getting the right vial size. In the Arizona cluster, three patients got sick after they received injections from the same vial of diluted contrast solution at a pain management clinic. All were hospitalized 4 to 8 days after the procedure with severe methicillin-resistant Staphylococcus aureus (MRSA) infections. CDC tests found no contamination in unopened contrast-medium vials, but county health officials found that the vials had been improperly reused and that healthcare workers didn't wear masks when giving spinal injections. In the Delaware cluster, seven patients got sick after receiving joint injections at one orthopedic clinic in March. An investigation found clinic staff had used a single-dose vial of the anesthetic bupivacaine for multiple patients after a national drug shortage had disrupted supplies. All patients were hospitalized and required debridement of infected sites. Six clinical isolates were positive for the same MRSA type, which was also found in nasal swabs from a staff member responsible for preparing or administering the injections. The authors said the clusters serve as reminders of the serious consequences of multiple-patient use of single-dose vials.
Jul 13 MMWR report

Smallpox vaccine coverage extended to those with HIV, atopic dermatitis
The US government has expanded the population eligible to receive the attenuated smallpox vaccine Imvamune to individuals of all ages with HIV infection or atopic dermatitis (AD) in the event of a smallpox emergency, the vaccine's Danish manufacturer, Bavarian Nordic, announced yesterday. Conventional smallpox vaccine, which the United States stockpiles in amounts sufficient to cover the entire US population for use in a smallpox bioterrorist attack, may cause severe complications in immunosuppressed people or those with AD. So far the US government has ordered 20 million doses of Imvamune, enough to protect 10 million people. Bavarian Nordic is working on a freeze-dried version of Imvamune, which would extend the shelf life and aid shipment and storage.
Jul 11 Bavarian Nordic press release

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