News Scan for Sep 12, 2013

Dengue cases in Florida
;
Health departments and the recession
;
European foodborne disease
;
C diff, MRSA treatments

Dengue cases in Martin County, Florida, reach 18

Martin County, Florida, today confirmed 3 more dengue infections to bring the county's total to 18, The Global Dispatch reported, as a blood center suspended collections in Martin County and neighboring St. Lucie County.

The Florida Department of Health (FDH) said that all the cases were acquired in the Rio and Jensen Beach area of the county. Of the case-patients, 11 are Martin County residents, 2 are non-Floridians, 1 is a Palm Beach resident, and 4 are St. Lucie residents who visited Martin County.

In addition, officials said they plan to conduct a community survey to determine the extent of dengue fever in the area and to help stop disease spread, the Global Dispatch story said.

"Teams from the Florida Department of Health and Martin County Mosquito Control will begin visiting homes in the Rio and Jensen Beach area tomorrow," Karlette Peck, MPH, a health officer with the FDH in Martin County, said today. She said the 1-week effort will provide prevention information, survey residents about risk, and, with people's consent, draw blood for dengue testing.

Also, yesterday OneBlood, a Florida-based blood bank. announced that it has suspended blood collection operations in Martin and St. Lucie counties, the agency said in a press release.

"Safety of the blood supply is our number one priority," said Rita Reik, MD, OneBlood's chief medical officer. "We will resume blood collections in Martin and St. Lucie counties once it is determined the threat of dengue fever has been minimized."
Sep 12 Global Dispatch story
Sep 11 OneBlood
press release

 

Job losses, program cuts still burden local health departments

Nearly half of local health departments are experiencing reductions in or elimination of services, and more than a quarter had budget cuts last year, according to an economic survey covering 2012 data from the National Association of County & City Health Officials (NAACHO).

NACCHO found through its National Profile of Local Health Department Survey that the health departments have shown modest improvement since the recent recession but that work remains to rebuild to reach prior staffing and service levels, the group said in a press release yesterday.

Local health departments have lost 43,900 jobs since 2008 owing to layoffs and attrition, says the release. In 2012, losses and gains in jobs were about equal, with 4,000 jobs added and 4,300 lost, but "41% of departments nationwide experienced some type of reduction in workforce capacity," it said. Furthermore, 22% of departments had cuts in immunization services and 15% had cuts in emergency preparedness and maternal and child health services in 2012.

NACCHO's survey, carried out before the 2013 sequester cuts, contained questions regarding budget, staffing, and program cuts. Of the 2,532 surveys administered from January to March 2013, 2,000 were completed, for a response rate of 79%; results were weighted to adjust for nonresponses.
Sep 12 NACCHO press release
Summary of 2012 NAACHO economic survey findings
State-level findings of survey

 

Report: Foodborne Campylobacter, E coli up in Europe

A newly released epidemiologic report on surveillance focusing on six priority food- and waterborne diseases in the European Union/European Economic Area (EU/EEA) reports that campylobacteriosis and Shiga toxin/verotoxin–producing Escherichia coli (STEC/VTEC) increased in incidence and that salmonellosis, shigellosis, and yersiniosis declined over a 4-year study period.

The European Centre for Disease Prevention and Control (ECDC) annually produces an epidemiologic report, but the new one, "Surveillance of Food- and Waterborne Diseases in the EU/EEA," is the first dedicated to enhanced surveillance on the six priority diseases. The data analyzed were gathered through The European Surveillance System from 2006 through 2009.

Campylobacteriosis increased by 13% in 2009, with a notification rate of 47 cases per 100,000 population, says the report, and STEC/VTEC by 9%, with a rate of 0.77 cases per 100,000. About 90% of the former cases were acquired in the EU/EEA, as were 79% of the latter.

The incidence of salmonellosis declined by 33% over the study period, with a reporting rate of 24.3 cases per 100,000; shigellosis by 13% (from 2007 to 2009), with a rate of 1.63 cases per 100,000; and yersiniosis by 16% over the study period, with a rate 1.77 cases per 100,000.

About 86% of Salmonella infections were acquired domestically, as were 97% of Yersinia infections, whereas two thirds of Shigella infections were imported from outside the EU/EEA and related to travel, says the study. The risk of shigellosis was found to be highest in children under the age of 4 years.

Surveillance results for a large number of other diseases were also included in the report, among them Listeria and typhoid infections. Notable findings are that, while the mortality rate for most of the priority diseases was below 1%, the rate for listeriosis ranged from 17% to 20% from 2007 to 2009. Also, a sharp increase in the disease was seen among the elderly, particularly men over 85.
Sep 9 ECDC report (114 pages)

 

From ICAAC: Treatments for C diff, MRSA

In findings presented at the 53rd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) meeting in Denver this week, researchers reported that low-dose drug therapy for Clostridium difficile may be as effective as high-dose treatment, and a separate team spoke of promise for a new antibiotic against methicillin-resistant Staphylococcus aureus (MRSA).

In the first study, researchers from the Albert Einstein College of Medicine administered low doses of oral vancomycin (125 mg every 6 hours) to 197 patients and high doses (greater than 125 mg every 6 hours) to 103 patients for at least 72 hours. The patients had been hospitalized some time from 2006 to 2010 for diarrhea-associated C difficile illness.

The low- and high-dose cohorts showed the same rate of clinical improvement (85% and 86%, respectively) after 72 hours of drug therapy. The groups also compared favorably for rates of clinical improvement at end of therapy and time of hospital discharge (93% and 95%, respectively), in-hospital mortality (15% and 23%), re-treatment (4% and 6%), and 30-day readmission (34% and 24%).

Study author Philip Chung, PharmD, said in an Albert Einstein news release, "Antibiotic stewardship is an important focus in hospitals today. We are using our study findings to develop treatment guidelines that encourage low-dose treatment."
Sep 11 Albert Einstein press release

Elsewhere at ICAAC, an antibiotic approved 2 years ago showed promise for treating MRSA pneumonia in a small study, according to Henry Ford Hospital researchers presenting data yesterday.

The team found that patients treated with the antibiotic ceftaroline fosamil had a lower mortality rate after 28 days compared with patients treated with vancomycin, the most common drug therapy for MRSA pneumonia.

In the retrospective study, 33 of 38 hospitalized patients responded well to ceftaroline and were discharged after the infection resolved. Of the five patients who died (a 13% fatality rate), three deaths were attributed to other serious medical conditions. Twenty of the 38 patients were failing after treatment with vancomycin, cefepime, or both and were switched to ceftaroline. The investigators reported no complications in those 20 patients.

The mortality rate for patients treated with vancomycin has been reported to be as high as 32% after 28 days, according to a Henry Ford news release.
Sep 11 Henry Ford press release

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