News Scan for Jun 05, 2013

Severe H7N9 cases
Salmonella from baby poultry
MDR-TB cases
US school TB outbreak

Chinese researchers note that severe H7N9 can progress rapidly

H7N9 avian flu infections can progress rapidly from the onset of symptoms to severe illness and death, according to a letter yesterday in the Annals of Internal Medicine from Chinese researchers on 22 deaths from the disease.

The researchers based their calculations on patients who died from lab-confirmed infections as of Apr 30. Median age of the patients was 68 years, and 16 were men. The median number of days from the first symptoms was 2 days for the first medical encounter, 5 days for hospitalization, 9.5 days for lab confirmation, and 13 days for death.

Of 14 patients with available information, 330 close contacts were monitored, and health workers found no additional H7N9 infections. Researchers calculated that the case-fatality rate (CFR) was 19%—higher than for seasonal flu and the 2009 H1N1 virus, but lower than H5N1 avian flu. However, they predicted that the CFR will probably decrease as experts learn more about the disease and because illnesses identified early in the outbreak probably represent the severe end of the spectrum.

The group urged early antiviral treatment.
Jun 4 Ann Intern Med letter

Salmonella outbreak linked to poultry chicks grows to 98 cases

An outbreak involving four strains of Salmonella linked to live baby poultry has grown to 98 illnesses in 21 states, which is up by 37 cases and 3 states since May 10, the US Centers for Disease Control and Protection (CDC) said in an update yesterday.

Of the 98 people infected with Salmonella Infantis, Lille, Newport, or Mbandaka, 16 (27%) have required hospitalization and 43 (44%) were children 10 years old or younger. Illness-onset dates range from Mar 8 to May 15.

The outbreak has been traced to contact with chicks, ducklings, and other live baby poultry from Mt Healthy Hatchery in Ohio. States with the most cases were Ohio, 17, and Virginia, 13.
Jun 4 CDC update

One-fifth of MDR-TB cases domestically acquired, study finds

Data from eight US states revealed 168 recent cases of multidrug-resistant tuberculosis (MDR-TB), of which 22% were contracted in the United States, 22% involved imported TB, and 41% involved reactivation of the disease, according to a cross-sectional study today in Lancet Infectious Diseases.

Researchers analyzed information on reported cases in California (from Jan 1, 2007, to Dec 31, 2009), Texas (from Jan 1, 2007, to Mar 31, 2009), and Colorado, Maryland, Massachusetts, New York, Tennessee, and Washington (from Jan 1, 2007, to Dec 31, 2008).

Of 92 MDR-TB patients who were interviewed, 20 (22%) developed MDR-TB domestically, 20 (22%) had imported active TB, and 38 (41%) had reactivation of TB, of whom 14 (15%) had a previous TB episode outside the United States. Five patients (5%) had documented treatment of a previous episode in the country and were thus deemed to have relapsed.

MDR-TB "needs to be diagnosed rapidly to reduce potential infectious periods, and clinicians should consider latent tuberculosis infection treatment—tailored to the results of drug susceptibility testing of the putative source case—for exposed individuals," the authors conclude.
Jun 5 Lancet Infect Dis abstract

Eight of 58 infected kids at South Carolina school have TB disease

South Carolina health officials said 58 children at a school in Greenwood, S.C., have been infected with the bacteria that cause TB, and 8 of them have the disease, according to an Associated Press (AP) story today.

The children are among 463 school employees, students, and volunteers who were tested. At a news conference, Catherine Templeton, director of the state Department of Health and Environmental Control (DHEC), said 58 children at Ninety Six Primary School had positive skin tests for TB, indicating latent TB infection.

X-rays showed that eight of those children have active TB, but they are not contagious, Templeton said. She reported that the index case in the outbreak is in a school employee who has not cooperated with the investigators but is now isolated at home. Templeton said only those who have been inside the school recently and close contacts of the index case-patient should be concerned about possible infection.

Last week parents of children at the school voiced concern that they hadn't been notified about the outbreak sooner, and Templeton then revealed that several DHEC employees had been fired for responding too slowly to the outbreak, the story said.
Jun 5 AP story
Jun 3 DHEC press release

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