NEWS SCAN: H5 at NYC bird market, cough duration and antibiotics, cholera in Cuba, UK norovirus, coccidioidomycosis in the military

Jan 15, 2013

H5 virus detected in duck at NYC live bird market
Testing is under way to charachterize an H5 virus found in a Muscovy duck during suveillance at a Brooklyn, N.Y., live bird market, according to a clarification from a US Department of Agriculture (USDA) official who responded to queries from the infectious disease message board FluTrackers and shared the information to ProMED Mail and other outlets. The questions arose after an earlier report from a poultry trade publication surfaced on FluTrackers and ProMED Mail. It erroneously said the virus was a low-pathogenic H5N1 strain. However, Randall Levings, DVM, PhD, a scientific advisor with the Emergency Management and Diagnostics division of the USDA's Animal and Plant Health Inspection Service (APHIS) wrote that the duck tested negative for the neuraminidase N1 gene of the avian influenza virus, that viral isolation is pending, and that the N-type hasn't yet been determined. Amino acid sequencing suggests the virus is compatible with North American low-pathogenic avian influenza. Levings said the market underwent an immediate sell-down, closure, and cleaning, which was completed on Jan 11, and that authorities are tracing and testing source flocks.
FluTrackers thread
Jan 15 ProMED Mail post

Study: Mistaken ideas about cough duration may prompt antibiotic overuse
On the basis of an opinion survey and a literature review, researchers say acute cough illnesses (ACIs) generally last considerably longer than patients expect and that this may contribute to the overuse of antibiotics. A University of Georgia team led by Mark Ebell, MD, MS, conducted a population-based telephone survey of 493 adults in Georgia and a systematic review of observational studies and the untreated control groups of randomized controlled trials to assess the duration of ACI, according to their report in Annals of Family Medicine. The review included 19 studies. The literature analysis revealed that the mean duration of ACI was 17.8 days, whereas the survey showed that respondents expected a cough to last a mean of 7.2 to 9.3 days, depending on the illness. In a university press release, Ebell said clinical trials have shown that antibiotics yield little benefit in ACIs because most of them are caused by viruses. He said CDC data show that over half of patients who see a doctor for ACIs receive antibiotics, but the percentage should be much lower. In the study, independent predictors of the belief that antibiotics are always helpful for ACIs included nonwhite race, some college education or less, and previous antibiotics for an ACI. To modify patients' expectations, Ebell recommended educating them about the natural course of illnesses.
Jan/Feb Ann Family Med abstract
Jan 14 University of Georgia press release

Cuban health ministry reports cholera outbreak
Cuba's health ministry said in a statement today that public health workers are battling a cholera outbreak in the capital city Havana that was detected on Jan 6 and has so far sickened at least 51 people, Reuters reported today. The statement said the outbreak started in the Cerro municipality and spread to other parts of the metro. Health officials speaking off the record told Reuters that there are hundreds of suspected cases and that the first cases were linked to a baseball game in Cerro where they suspect contaminated pork sandwiches or soda were served.  So far no tourists have been reported to be infected. The public response has included making departing transporation passengers sterilize their shoes before leaving town and inspecting and sometimes closing eateries. Three Havana hospitals have been set up to handle cholera cases. A health ministry official told Reuters that more chlorine has been added to the water supply, though there is no sign that it is contaminated. Rumors have spread about dozens of fatalities, but so far there has only been one, officials said. A cholera outbreak struck the eastern part of Cuba last summer, which was the country’s first in more in more than a century. More reports of infections, including in Havana, started cropping up again in early December after flooding in parts of the country in the wake of Hurricane Sandy.
Jan 15 Reuters story
Related Dec 27, 2012, CIDRAP News item

UK norovirus cases start to ebb
Norovirus in Britain reached 4,407 cases through the first week of this year, with 175 new cases confirmed, the UK Health Protection Agency (HPA) said today. The total cases so far this season are up 56% from this time last year, when the country had 2,828 cases. The weekly number, however, is down from 257 during the previous week. "This shows the unpredictability of the norovirus season where the number of confirmed cases rises and falls. However, there will still be new cases arising before the season ends," the HPA said in its weekly update. Hospital outbreaks, however, rose to 39 in the most current 2 weeks, compared with 33 during the previous fortnight. All told the country has had 728 such outbreaks this season. Officials are urging people who have gastrointestinal symptoms common in norovirus infections to phone their physicians rather than visit a healthcare center and risk spreading the disease.
Jan 15 HPA update

Coccidioidomycosis in US military members holds steady
More than 400 active military members in the southwestern United States have contracted coccidioidomycosis in the past 13 years, with those of Asian or Pacific Island descent having markedly higher rates, according to a report in the current Medical Surveillance Monthly Report (MSMR). Researchers analyzed data from 1999 through 2011. They said the 483 cases of the disease, which is caused by inhalation of Coccidioides species of fungi, amounted to a rate of 2.69 cases per 100,000 person-years. The rate has held relatively steady, according to the report. About 12 % of all diagnoses were extrapulmonary, involving such areas as the skin, skeleton, or central nervous system. Asians and Pacific Islanders had an infection rate more than five times higher than white service members, and a rate of extrapulmonary cases more than 10 times higher. Also, those older than 40 and male also had higher rates than younger and female members. The report discusses possible prevention steps, including personal protective equipment during high-risk exercises.
December MSMR report

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