News Scan for Sep 18, 2013

H7N9 surveillance
;
Test for viral, bacterial infections
;
Plague cases, deaths
;
Malaria prevention in pregnancy
;
MRSA pneumonia

FAO launches 2 H7N9 surveillance efforts in Southeast Asia

The United Nations Food and Agriculture Organization (FAO) today announced two emergency regional projects aimed at detecting and containing H7N9 avian flu in Southeast Asia, the agency said in a press release.

The two projects will help countries to enhance surveillance, detection, control, and response to the virus, the FAO said. The ventures were announced at a 3-day workshop and will be coordinated with experts at the World Organization for Animal Health (OIE), World Health Organization (WHO), and US Agency for International Development (USAID).

In announcing the launch of the projects, Hiroyuki Konuma, FAO regional representative for Asia and the Pacific, said that H7N9 in China "is still present and there is still a great deal not yet understood about this H7N9 virus. Other influenza viruses that circulate in poultry often decrease dramatically during the summer months, only to reappear later in the year during cold season. Also, many low pathogenic influenza viruses in poultry have transformed into highly pathogenic viruses."

Konuma urged veterinary experts at the workshop to "discuss how to adjust surveillance and response mechanisms and to prepare for a possible resurgence of H7N9," and asked participants to explore how various sectors can work together.

 

New test may help distinguish viral from bacterial infections

A blood test developed by US scientists that uses the cell response from an infected person showed more than 90% accuracy in distinguishing viral from bacterial infections in people with respiratory disease, according to a study today in Science Translational Medicine.

The test, which detects specific genetic "signatures" that the host's immune system expresses as a response to infection, demonstrates potential for diagnosing the source of illnesses that have long been tough to pinpoint, the authors said.

The test uses a reverse-transcription polymerase chain reaction (RT-PCR) TaqMan low-density array (TLDA) platform.

"In instances such as pandemic flu or the coronavirus that has erupted in the Middle East, it's extremely important to diagnose a viral illness far more accurately and speedier than can be done using traditional diagnostics," said coauthor Geoffrey S. Ginsburg, MD, PhD, of Duke University School of Medicine in a Duke news release. "Current tests require knowledge of the pathogen to confirm infection, because they are strain-specific. But our test could be used right away when a new, unknown pathogen emerges."

The researchers used the RT-PCR TLDA test on 102 people arriving at an emergency department with fever, 28 of whom had a viral infection, 39 a bacterial infection, and 35 healthy controls. The team was able to accurately classify more than 90% of the patients as having viral infection or not. It had an 89% true-positive and a 94% true-negative rate.

"This work opens new approaches to diagnosis of infectious diseases," said Geoffrey S.F. Ling, MD, PhD, deputy director of the Defense Sciences Office for the Defense Advanced Research Projects Agency (DARPA), in the Duke press release. It could also help reduce antibiotic overprescribing by ruling out a bacterial infection early, the release said.

The researchers said larger studies are planned, and they are working on reducing the 12 hours it takes to obtain test results. The study was supported in part by DARPA, the National Institutes of Allergy and Infectious Diseases, and the Department of Veterans Affairs.
Sep 18 Science Transl Med abstract
Sep 18 Duke University
press release

 

Plague sickened 21,000, killed 1,600 in past 10 years

From 2000 through 2009, plague has sickened 21,725 people, killing 1,612 of them (7.4%), according to a review in the American Journal of Tropical Medicine and Hygiene.

The Democratic Republic of the Congo (DRC) reported the most cases, 10,581, to surpass Madagascar, which led the world in the previous decade. From 2000 through 2009, Madagascar reported 7,182 cases, and Zambia was third at 1,309. The DRC and Madagascar accounted for 17,763, or 82% of all cases. All told, more than 97% of the cases were in Africa.

The United States, with 57 cases, ranked 11th of the 12 nations cited, but it was one of only four countries that logged plague cases in each of the 10 years of the review. The others were the DRC, Madagascar, and Peru, which had the eighth most cases, at 185.

The review used WHO data and said that 16 countries reported plague cases during the review period.

Of the 57 US cases, 7 were fatal, according to the review. Two of the deaths involved scientists. One was a wildlife biologist who performed a necropsy on a mountain lion in Arizona in 2007. The other was a Chicago geneticist with diabetes and subclinical hemochromatosis who handled an attenuated strain of Yersinia pestis in 2009.

The rise in DRC cases has been attributed to civil wars and declining health services and possibly to increased contacts of people with rodents and fleas, the review said. The DRC saw two large outbreaks of pneumonic plague in 2005 and 2006.
Sep 16 Am J Trop Med Hyg review

 

Malaria prevention in pregnant Africans progressing but short of goals

While nearly 40% of pregnant women in malaria-endemic countries of sub-Saharan Africa used insecticide-treated sleeping nets during pregnancy in 2010, only slightly more than 20% received intermittent preventive treatment. These numbers represent improvements, but they fall far short of international targets, say the authors of a meta-analysis published online today in The Lancet Infectious Diseases.

The authors estimated use of treated nets and coverage with at least two doses sulfadoxine-pyrimethamine among pregnant women by using data from nationally representative household surveys from 2009 to 2011.

Treated nets were used by an estimated 10.5 million mothers in 26.9 million births (38.8%; 95% confidence interval [CI], 34.6 to 43.0) across 37 African countries in 2010. Among 24 countries with previous estimates available, net use increased from 17.9% (95% CI, 15.1 to 20.7) in 2007 to 41.6% (95% CI, 37.2 to 46.0) in 2010.

Among 21.4 million malaria-exposed births across 27 countries in 2010, 4.6 million (21.5%; 95% CI, 19.3 to 23.7) of the mothers received intermittent preventive treatment. In the 22 countries with previous estimates available, such treatment increased from 13.1% (95% CI, 11.9 to 14.3) in 2007 to 21.2% (95% CI, 18.9 to 23.5) in 2010.

High disbursements of funds for malaria control were associated with both use of nets and receipt of preventive treatment, say the authors. The latter showed more inequity overall than use of nets, with women who were richer, more educated, and living in urban areas more likely to have received treatment.

Targets of 80% for use of treated nets and receipt of intermittent preventive treatment by 2010 were set by the Roll Back Malaria (RBM) Partnership. RBM was launched in 1998 by the WHO, the UN Children's Fund, the UN Development Program, and the World Bank in an effort to provide a coordinated global response to malaria.
Sep 18 Lancet Infect Dis abstract
Sep 18 Lancet Infect Dis commentary on the study

 

MRSA pneumonia associated with severe disease

Pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) has a relatively low incidence in Canadian hospitals but is associated with significant disease and death, according to a study in PLoS One yesterday.

In what they say is a first in Canada, researchers analyzed data on 161 patients with MRSA pneumonia in 11 Canadian hospitals in 2011. They said that 90 (56%) were hospital-acquired, 26 (16%) healthcare-associated, 45 (28%) community-associated, and 23 (14%) ventilator-associated.

They calculated 30-day all-cause mortality to be 28.0%, and found through multivariable analysis that multiorgan failure, disease severity at presentation, and infection with a pathogen that has reduced susceptibility to vancomycin were associated with death.
Sep 17 PLoS One study

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