Flu Scan for Apr 23, 2015

News brief

Avian flu outbreaks confirmed in Niger, Taiwan, South Africa

Avian flu has struck domestic birds in Niger, Taiwan, and South Africa, according to separate reports posted yesterday by the World Organization for Animal Health (OIE).

Veterinary officials in Niger reported a highly pathogenic H5N1 avian flu outbreak at a poultry farm in Maradi, the country's third-largest city, in south-central Niger. It is the country's first H5N1 outbreak since 2006.

The outbreak began Apr 2 at a farm housing laying hens and breeding stock. The virus killed 2,290 of 2,440 susceptible birds, with the rest slated for culling. Results were confirmed on Apr 21 at the OIE reference lab in Padua, Italy. So far the source of the outbreak isn't known.

Two of Niger's neighboring countries—Nigeria and Burkina Faso— have recently reported H5N1 outbreaks.
Apr 22 OIE report on Niger outbreak

Elsewhere, Taiwan yesterday reported seven low-pathogenic H5N2 outbreaks, affecting four different counties and Tainan City, according to a second OIE report. The affected counties are Pingtung, Chiayi, Yunlin, and Changhua.

Though Taiwan has reported several highly pathogenic H5N2 outbreaks over the past few months in the same area, tests on Apr 1 at Taiwan's national laboratory confirmed the virus as low pathogenic, causing less than 75% mortality in the chickens tested. These seven outbreaks began in January and February.

All of the locations are commercial chicken farms. Of a total of 244,400 susceptible birds, the virus killed 75,319, with the remaining ones stamped out to curb the spread of the virus.
Apr 22 OIE report on Taiwan outbreaks

And South African veterinary authorities yesterday reported a low-pathogenic H5N2 outbreak at a commercial ostrich farm in Western Cape province, an area that has reported several such outbreaks over the past few years.

The virus sickened 2,212 of 6,204 susceptible birds. Response steps include quarantine, curbing bird movements, and screening.
Apr 22 OIE report on South Africa outbreak

Study: Cloth face masks raise infection risk in high-risk conditions

The use of cloth face masks by healthcare workers is not only not adequately protective in high-risk situations but may be harmful, setting users up for an increased risk of infection, according to a cluster-randomized, controlled clinical study published yesterday in BMJ Open.

The authors, from Australia and Vietnam, say their results are the first of their kind and that use of cloth masks should be discouraged globally.

The researchers randomly assigned 1,607 full-time healthcare workers in high-risk wards of 14 hospitals in Hanoi, Vietnam, to (1) use cloth (cotton) masks on every shift over a 4-week period, (2) use medical/surgical (disposable) masks on every shift, or (3) follow their customary practices, which may or may not include mask use.

On filtration testing of the masks, the penetration by particles was found to be almost 97% for the cloth and 44% for the medical masks.

The rate of all infections was highest in the cloth-mask group, with the rates for influenza-like infection (ILI) significantly higher in the cloth-mask group than the medical-mask group (relative risk [RR], 13.25; 95% confidence interval [CI], 1.74-100.97) and the control group (RR, 3.49; 95% CI, 1.00-12.7).

Cloth masks have been replaced by medical masks in many settings but are still commonly used in more than half the world because of the expense and supply/access problems associated with medical masks in many areas of the world, say the authors. They say the physical properties, moisture retention, reuse, and varying cleaning frequency and effectiveness of cloth masks may account for the increased risks they incur.

"Effective controls of outbreaks and pandemics at the origin impacts us directly, so it is important for global disease control that the use of cloth masks be discouraged in high-risk situations," said lead author Raina MacIntyre, PhD, in a press release from the University of New South Wales (UNSW).
Apr 22 BMJ Open study
Apr 22 UNSW press release

Study identifies gene tied to severe 2009 H1N1, H7N9 infection

Researchers have pinpointed a human gene that is associated with severe disease in 2009 H1N1 (pH1N1) flu and also with contracting H7N9 influenza.

An international team led by University of Hong Kong scientists evaluated genetic risk in 409 pH1N1 patients, 162 of whom had severe cases. They determined that the GG genotype of rs2070788, a higher-expression variant of TMPRSS2, doubled the risk of severe disease.

They also studied 102 H7N9 patients and 106 healthy controls and found that rs2070788 and rs383510 were significantly associated with susceptibility to H7N9 influenza.

The authors summarize: "We demonstrate that genetic variants with higher TMPRSS2 expression confer higher risk to severe A(H1N1)pdm09 influenza. The same variants also increase the susceptibility to human A(H7N9) influenza."
Apr 22 J Infect Dis abstract

News Scan for Apr 23, 2015

News brief

Study finds MERS-CoV common in live and dead Saudi camels

Researchers have found that 29% of live camels in Saudi Arabia harbor MERS-CoV in their noses, and 62% of dead ones harbor the virus in their lungs, according to a study in Emerging Infectious Diseases yesterday.

The team, from King Faisal University, Al-Ahsa, Saudi Arabia, and the US Centers for Disease Control and Prevention (CDC), obtained samples from April 2013 through May 2014. Investigators studied nasal swab samples from 96 camels in Al-Ahsa province. Twenty-eight (29.2%) were positive for MERS-CoV (Middle East respiratory syndrome coronavirus) RNA by reverse transcription polymerase chain reaction (RT-PCR).

Two of the MERS-CoV–positive animals were calves that had purulent nasal discharge, the only sign of illness among the camels.

The researchers also obtained lung tissue samples from 91 camels that had been slaughtered, 56 of which (61.5%) tested positive by RT-PCR. Positive samples were more common in animals less than 4 years old before they died compared with older animals.

The detection of positive samples in both groups varied by month, with peak detections during November 2013 and January 2014 and ebbs during March and May 2014. The researchers noted, "Detection of MERS-CoV RNA by RT-PCR does not necessarily indicate active virus replication."

They added, "Although we did not collect matching premortem nasal swab samples from slaughtered animals to determine how many were also positive for MERS-CoV in the upper respiratory tract, our findings raise the possibility that testing upper respiratory tract samples alone may underestimate the true number of actively infected animals."
Apr 22 Emerg Infect Dis study

Travel to tropics often tied to drug-resistant Enterobacteriaceae

Half of travelers to tropical regions return with multidrug-resistant Enterobacteriaceae (MRE) among their souvenirs, with the rate much higher among visitors to Asia, a French study yesterday in Clinical Infectious Diseases noted.

Investigators analyzed data on 824 people who traveled to the tropics from February 2012 through April 2013. Of the 574 who provided a stool sample, 292 (50.9%) acquired an average of 1.8 MREs, and 3 travelers acquired carbapenemase-producing Enterobacteriaceae.

Acquisition rates varied by region visited. The low was in Latin America, at 31.1%, followed by 47.7% in sub-Saharan Africa and 72.4% in Asia. MRE acquisition was associated with the type of travel, diarrhea, and exposure to beta-lactam antibiotic during travel.

MRE carriage did not last long: 3 months after returning, only 4.7% of all the travelers carried MRE. Carriage lasted longer in travelers returning from Asia and in travelers with more abundance of MRE upon their return.
Apr 22 Clin Infect Dis abstract

Officials issue measles alerts for Germany, Florida

The CDC yesterday issued a travel health notice warning about a surge of measles cases in Germany, especially around Berlin, and Florida health officials have also issued measles warnings, following the detection of four cases, three of them in the state's Indian River County.

The CDC's travel notice said that, as of Mar 30, Berlin's health department has reported more than 950 measles infections, most of them in Berlin and in surrounding Brandenburg state. It added that measles cases have also been detected in Sachsen, which is close to Berlin in eastern Germany, and in Baden-Wurttemberg, located in the southern part of the country.

The CDC urges travelers to Germany and other international destinations to ensure that they are vaccinated against measles.

Meanwhile, the Florida Department of Health (Florida Health) has reported four measles cases in the past week, one in St. Lucie County and three in neighboring Indian River County, located in the state's Treasure Coast region.

In an Apr 16 statement, Florida Health announced a measles infection in an unvaccinated 6-year-old child from St. Lucie County and said officials were working with the school district to limit possible exposure. Two days later it announced measles infections in two unvaccinated adults in Indian River County, one of whom who had acquired the infection overseas. The second case-patient is a household contact.

The fourth case, announced Apr 21, involves an unvaccinated adolescent from Indian River County who has recovered.
Apr 22 CDC travel alert
Apr 21 Florida Health press release
Apr 18 Florida Health press release
Apr 16 Florida Health press release

In other measles developments, Italian researchers yesterday reported in Clinical Infectious Diseases that about half of the cases in a large measles outbreak in 2014 linked to cruise ship exposure were nosocomial infections.

The outbreak in Sardinia was sparked by a cruise ship passenger, with the index patient admitted to a local hospital in February. By July, 136 outbreak cases were reported, including 80 from a secondary outbreak in Italy, of which 44 were linked to nosocomial transmission.

The index patient passed the virus to six people, four of them in the hospital setting: an adult visitor in the emergency department and three healthcare workers.
Apr 22 Emerg Infect Dis report

Increasing antibacterial shortages of concern for patient care

Antibiotics, including those used for life-threatening infections, are often in short supply in the United States, with the trend rising and putting patients at risk, say findings of a comprehensive evaluation published yesterday in Clinical Infectious Diseases, the journal of the Infectious Diseases Society of America (IDSA).

The cross-sectional study, which used the national University of Utah Drug Information Service database, evaluated drug shortage data from January 2001 to December 2013, focusing on antibacterial drugs. During that time, shortages of 1,751 pharmaceutical products were reported, 148 involving antibacterial agents. A shortage was defined as a supply issue affecting how the pharmacy prepared or dispenses a drug product or influences patient care when prescribers must use an alternative agent.

The average number of drugs on shortage per month overall was 14.2 (95% confidence interval [CI], 12.8-15.5). That number increased over time, with an average of 9.7 per month before July 2007 and 17.9 after that time (P < 0.001). Thirty-two drugs (22%) had multiple shortages over the study period.

Median duration among all the resolved shortages was 232 days, with the median for injectable drugs at 250 days and for noninjectable drugs at 129 days (P = 0.06). Drugs without an available alternative had a median shortage duration of 149.5 days, compared with 262 days for drugs with alternatives (P = 0.10). Sixty-eight of the shortages (47%) involved drugs used for high-risk pathogens, including methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa.

The authors cite the recession as a likely reason for the changing supply trend before and after 2007. Business-related reasons—manufacturing delays or other problems—were most commonly cited as the reason for shortages.

Among the main concerns raised through their findings, say the authors, are shortages in "gold standard" therapies and agents for highly drug-resistant pathogens. "It is imperative to develop a comprehensive strategy to mitigate the implications of shortages on clinical practice and patient outcomes, including improved communication, alternative algorithms, and antimicrobial stewardship policies," they stated.
Apr 22 Clin Infect Dis study abstract
Apr 23 IDSA press release