NEWS SCAN: Tamiflu benefits, pertussis surge in UK, change in meningitis reporting, Uganda Ebola update, persistent hospital bug

Nov 30, 2012

Meta-analysis: Antivirals reduced severe outcomes in 2009 flu pandemic
A meta-analysis of 90 observational studies conducted during the 2009 flu pandemic showed that early neuraminidase-inhibitor (mainly oseltamivir [Tamiflu]) treatment of hospital patients reduced the risk of admission to a critical care unit or death, according to a report in the Journal of Infectious Diseases. The studies included 34,895 patients, 85% of whom had lab-confirmed 2009 H1N1 infections. The authors found that treatment at any time was linked with a nonsignificant reduction in mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.51-1.01). But they found significant reductions in mortality with early treatment (within 48 hours after illness onset) compared with later treatment (OR, 0.38; 95% CI, 0.27-0.53) and compared with no treatment (OR, 0.35; 95% CI, 0.18-0.71). For admission to a critical care unit, the researchers found that early treatment versus late treatment reduced the risk (OR, 0.41; 95% CI, 0.30-0.56). However, treatment at any time was linked with an increased risk versus no treatment (OR, 1.76; 95% CI, 1.22-2.54); the authors said this finding probably reflects the fact that sicker patients are more likely to receive antivirals and that untreated patients are likely to have had milder disease. In an accompanying commentary, Fred Y. Aoki, MD, and Frederick G. Hayden, MD, said the findings agree with those from earlier studies of oseltamivir treatment in hospitalized seasonal flu and H5N1 avian flu patients. Aoki and Hayden praised the "methodologic rigor" and large scope of the analysis.
Nov 29 J Infect Dis abstract
J Infect Dis commentary

Big pertussis surge continues in England, Wales
The number of pertussis cases in England and Wales through the end of October is nearly 10 times higher than in the last peak year, 2008, the UK Health Protection Agency (HPA) said today. The situation is similar to that in the United States, which is experiencing its worst pertussis year in decades, federal health officials have said. So far 7,727 lab-confirmed pertussis cases have been reported in England and Wales, which includes 13 infant deaths, three of which were reported in October. Dr. Gayatri Amirthalingam, an epidemiology consultant at the HPA, said in a statement that the most recent numbers show a continuing rise in pertussis cases, though surveillance is showing a decline in the number of infant infections. She added that it's too early to see an impact from a September Department of Health decision to offer the pertussis vaccine to pregnant women to protect their newborn babies.
Nov 30 HPA statement

CDC offers more details in fungal meningitis reporting
The US Centers for Disease Control and Prevention (CDC) yesterday announced a change in the way it reports fungal meningitis cases in the current outbreak associated with contaminated steroids from New England Compounding Center, a compounding pharmacy. The agency said it continues to receive reports of related paraspinal and spinal infections in patients with and without evidence of fungal meningitis. The CDC said it will now add case numbers for the other infection types alongside the meningitis and joint infection numbers it currently posts in its updates and will now update case counts on Mondays. The current total stands at 510 infections and 36 deaths, the same as the total for Nov 26. However, the CDC notes that 360 are meningitis cases, 128 are solely paraspinal or spinal infections, 14 are peripheral joint infections, and 8 involve stroke without lumbar puncture.
Nov 29 CDC fungal meningitis update
In other developments, Public Citizen, a nonprofit advocacy group based in Washington, DC, yesterday called on the US Food and Drug Administration (FDA) to reinspect compounding pharmacies that received warning letters from the FDA over the past decade. Public Citizen has criticized the FDA's response to the fungal meningitis outbreak, charging that the agency's warning letters suggest that it did have authority to regulate the firms. In recent congressional hearings the FDA said current laws and legal challenges have muddled the status of its power to enforce safety rules.
Nov 29 Public Citizen statement

Testing trims tally of Uganda Ebola cases
In the most recent update on Uganda's Ebola outbreak, the health ministry reported seven infections and four deaths, a decrease from the number of cases reported on Nov 23, the World Health Organization (WHO) said today. Some of the cases reported on Nov 23 were listed as probable, and testing has ruled out some of them, the WHO said. The earlier update said 10 cases (six confirmed and four probable) had been reported. Today's update also reflects one less death than the five reported in the earlier update. The WHO said field teams are continuing to investigate suspected cases reported by communities, but they are facing a major challenge because some communities believe witchcraft, not Ebola, is the cause of the deaths despite ongoing intensive awareness campaigns about the disease. Social mobilization teams are working with traditional healers and religious leaders to boost awareness of Ebola prevention and control, according to the WHO.
Nov 30 WHO update

Multidrug-resistant Acinetobacter persistent in hospital rooms
Current cleaning methods for hospital rooms contaminated with multidrug-resistant (MDR) Acinetobacter baumannii, a pathogen with increasing significance in hospital-acquired infections, may be inadequate, says a study released today in the American Journal of Infection Control. The researchers collected 487 cultures from 32 hospital intensive care rooms occupied by patients with a known history of MDR A baumannii before and after terminal cleaning following patient discharge. Fifteen rooms (46.9%) and 41 of 268 sites sampled (15.3%) were found to be contaminated with MDR A baumannii before terminal cleaning. Overall, a significant reduction was seen in the number of contaminated rooms (P=.01) postcleaning, but eight rooms (25%) and 12 of 219 sites (5.5%) still tested positive for the pathogen after terminal cleaning. Among sites found to remain contaminated were the floor (12.5%), call button (10%), door handle (9.4%), bedside table (7.4%), and supply cart (3.8%). The authors comment, "Persistent room contamination serves as a potential reservoir for transmission and colonization of future room occupants."
Nov 30 Association for Professionals in Infection Control and Epidemiology press release
Nov 30 AJIC article abstract

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