News Scan for Jul 03, 2013

News brief

CDC reports 47 more Salmonella cases linked to baby poultry

Another 47 people in 23 states have been infected with Salmonella Typhimurium since Jun 6 in an outbreak linked to chicks, ducklings, and other live baby poultry, the Centers for Disease Control and Prevention (CDC) announced yesterday.

The outbreak now includes a total of 271 people, mostly children, in 37 states. It is unrelated to another current outbreak of baby poultry–related Salmonella involving four serotypes: Infantis, Lille, Newport, and Mbandanka.

Illness-onset dates in the outbreak range from Mar 4 to Jun 10, the CDC reported. The median age of patients is 6 years, and 62% of them are 10 years or younger. Among 162 people with available information, 43 (27%) have been hospitalized, but no one has died.

Investigators have linked the outbreak to contact with chicks, ducklings, and other live baby poultry bought from multiple feed stores and sourced from multiple mail-order hatcheries, according to the CDC. Investigations into the source of the live poultry involved in the outbreak are continuing.

The CDC advises thorough hand washing after touching live poultry or anything in their environment.
Jul 2 CDC update

Fermented tofu blamed for two botulism cases in New York

Two recent Chinese immigrants in New York City last year fell seriously ill with botulism from a highly unusual source: fermented tofu, according to the CDC.

The two, a 39-year-old man and a 36-year-old woman who didn't know each other, bought tofu from the same Chinese grocery in Queens and used similar recipes to ferment it, the CDC said in in the Jul 5 issue of Morbidity and Mortality Weekly Report.

The man was hospitalized on Mar 3, 2012, with a history of vomiting, dysphagia, diplopia, dysarthria, dyspnea, and difficulty walking. After eventual treatment with botulinum antitoxin, he was discharged to a rehab facility on Mar 26, and a stool specimen tested positive for botulinum toxin type B on Mar 27.

The woman was admitted to the same hospital on Mar 28, 2012, with similar signs and symptoms; botulism was immediately suspected. After antitoxin treatment, she was discharged on Apr 18. Because botulinum toxin was not detected, her case was classified as probable.

The clinical investigation was challenging because both patients had atypical clinical presentations and because tofu was not immediately recognized as a potential source of Clostridium botulinum, the report says. Fermented tofu has been associated with botulism only once before in the United States, though in China it is one of the leading causes of the illness.

Investigators found botulinum toxin in leftover fermented tofu from the same batch consumed by the male patient, but not in tofu from the female patient or in fresh tofu from the Chinese grocery. The report says the toxin can be distributed unevenly in food.

"Public health professionals should be aware of the association between fermented tofu and botulism, and that botulism can present atypically," the report advises.
Jul 5 MMWR article

Case reports reveal new tick-borne disease

A newly recognized spirochete, Borrelia miyamotoi, should be considered if a tick-exposed patient does not respond quickly to treatment or has negative results on confirmatory testing for human granulocytic anaplasmosis (HGA), according to a report of two such patients published yesterday in the Annals of Internal Medicine.

The case-patients were a 61-year-old man from Massachusetts and an 87-year-old man from New Jersey. Deer ticks are common in both areas, and Lyme disease, babesiosis, and HGA are not uncommon. Both men were hospitalized with undifferentiated acute febrile illness, elevated aminotransferase levels, leukopenia, and thrombocytopenia, suggestive of HGA.

After doxycycline therapy was instituted, neither responded within 24 hours, nor was molecular evidence of Anaplasma phagocytophilum, the causative agent of HGA, found.

Upon further investigation, B miyamotoi was identified in each patient by polymerase chain reaction testing of acute whole blood samples. Both recovered with continued doxycycline treatment.

The authors state that clinicians should be aware of B miyamotoi infection and include it in the differential diagnosis of presumed HGA infection.
Jul 2 Ann Intern Med abstract

Flu Scan for Jul 03, 2013

News brief

Cambodian man survived H5N1 coinfection

Cambodian health officials have identified another H5N1 avian influenza case, in a 58-year-old man who tested positive for flu in January but whose samples revealed co-infection with H5N1 in routine retrospective tests.

The man's infection was announced yesterday in a joint statement from Cambodia and the World Health Organization (WHO). It included news of the recent death of a 6-year-old girl from H5N1 and another retrospective H5N1 case, that of a 5-year-old girl, that was confirmed in early May.

The man is from Phnom Penh and was first tested for flu on Jan 9. He had been hospitalized in Khmer-Soviet Friendship Hospital and has since recovered. The statement didn't say what other strain the man had along with H5N1.

The man's illness was counted as Cambodia's 12th H5N1 case so far this year, and his infection and the 6-year-old girl's death raise the country's cumulative total to 34 cases, of which 28 were fatal. The two new Cambodian cases raise the global H5N1 count to 632 cases and 376 deaths, according to the WHO.
Jul 2 WHO/Cambodia joint statement
Jul 2 CIDRAP News story "Cambodian girl dies from H5N1 infection"

Study: Other factors may explain GI illness in kids after flu shots

The association that has been observed in some studies between inactivated trivalent influenza vaccination (TIV) and subsequent gastrointestinal (GI) illness in young children may actually be due to factors related to the medical visit itself rather than to the vaccination, according to a case-control study published online yesterday in Vaccine.

The authors used electronic health record (EHR) data from six managed-care organizations to find children aged 24 to 59 months who received medical care for a GI illness during the 2002 through 2006 flu seasons. Each of the 2,062 children identified was matched with four controls (total 8,248).

The researchers then looked to see whether in the 14 days before the GI visit the children had had a medical encounter for something other than GI problems or TIV. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using conditional logistic regression.

Increased odds of GI illness within the 14 days after a medical encounter were observed in children both without and with chronic conditions (OR, 1.9; 95% CI, 1.7-2.2; and OR, 3.9; CI, 2.5-6.2, respectively).

These findings, say the authors, may indicate that previously identified associations between TIV and GI illness may actually be due to such factors as exposure to GI pathogens at medical visits; a reaction to treatment for an unrelated condition, such as antibiotics; or overlapping seasonal patterns for TIV and GI illnesses.

The authors also comment that their findings demonstrate the importance of considering confounding factors in interpreting results of vaccine safety studies that use EHR data.
Jul 2 Vaccine abstract