News Scan for Apr 20, 2015

Two more MERS cases
H5N1 in Egypt
Chikungunya uptick
New approach to sepsis
Fake-drug alert

Saudi Arabia announces two more MERS cases

Saudi Arabia today reported two more MERS-Cov cases in different cities, after a weekend with no new cases.

The Saudi Ministry of Health (MOH) said the latest infections involve two men in stable condition: a 61-year-old Saudi in Hofuf and a 49-year-old foreigner in Riyadh. Neither is a healthcare worker and neither had contact with other MERS-CoV (Middle East respiratory syndrome coronavirus) patients in the community or in medical settings. No information on animal exposure was given.

Yesterday the MOH announced the death of a 93-year-old Mecca man whose MERS case was previously reported.

The latest reports raise the MOH's MERS count to 981 cases, with 428 deaths, 548 recoveries, and 5 patients still getting treatment. The country has reported 8 cases so far in April, compared with 75 cases in February and 53 in March.
Apr 20 MOH statement
Apr 19
MOH statement
MERS statistics home page


H5N1 sickens 6 more in Egypt

Six more human H5N1 avian influenza infections have been reported in Egypt, according to individual reports to the United Nations Food and Agriculture Organization (FAO) compiled and posted by Avian Flu Diary, an infectious disease and emergency preparedness news blog.

The FAO notifications don't contain any details other than location and dates observed and reported. Cases are from four different governorates: Beheira (3), Damietta (1), Qena (1), and Kafr el-Sheikh (1). Two of the Beheira cases are from the same city, with observation dates that are 3 days apart. The observation dates for the cases range from Mar 29 through Apr 6, and all of the cases were reported on Apr 18.

The new cases appear to push Egypt's H5N1 total so far this year to 143 cases, according to a case list maintained by FluTrackers, an infectious disease news message board.

Egypt is experiencing an unprecedented surge of H5N1 cases that started in November, which pushed Egypt to the top of the list for the country with the most cases. The World Health Organization (WHO) has said initial lab tests don't show any changes in the virus that would make it more transmissible from birds to humans. It said that the increase may be fueled by a combination of factors, including increased H5N1 circulation in poultry, an increasing number of households with small farms and backyard flocks, lower risk awareness, and weather conditions that favor virus survival.
Apr 20 Avian Flu Diary post
FluTrackers H5N1 case list for Egypt


PAHO reports small increase in chikungunya cases

The number of chikungunya cases reported in the Americas grew by just 722 cases last week, putting the total at 1,372,126 cases, according to an Apr 17 update from the Pan American Health Organization (PAHO).

The increase is dramatically lower than increases that have ranged from 13,000 to 30,000 in recent weeks. Many countries, though, have not reported to PAHO on their chikungunya situation in several weeks.

The total reported last week reflects 1,338,240 suspected, 30,266 confirmed and 3,620 imported cases. The vast majority of imported cases are from the United States.

Brazil reported the largest increase, with 438 new cases, followed by Paraguay, with 267. Those countries now have 5,791 and 782 total cases, respectively.
Apr 17 PAHO update


Commission says new approach needed for sepsis

An international team of experts today warned that clinical and public recognition of sepsis must improve if the deaths are to be prevented from this common, life-threatening condition, according to a commission report published in The Lancet Infectious Diseases.

Sepsis—sometimes mislabeled "blood poisoning"—is a common condition whereby an infection triggers an extreme immune response, resulting in widespread inflammation, blood clotting, and swelling. Although no specific cure exists, sepsis can often be treated effectively with intensive medical care, including antibiotics and intravenous fluid, if it's identified early enough.

In addition to the high fatality rate from sepsis, survivors are at an increased risk of long-term chronic illness and mental or physical impairment, according to a Lancet press release. In low- to middle-income nations, most sepsis cases occur outside hospitals, presenting unique challenges.

"The number of people dying from sepsis every year—perhaps as many as 6 million worldwide—is shocking, yet research into new treatments for the condition seems to have stalled," said lead author Jonathan Cohen, MSc MB, in the release. "Researchers, clinicians, and policymakers need to radically rethink the way we are researching and diagnosing this devastating condition."

The commission spells out a roadmap for future research. Recommendations include prioritizing the study of biomarkers, which would allow quicker diagnosis; better education of medical staff; heightened public awareness; rethinking clinical trial design; developing targeted treatments; and ensuring that universities and drug companies do not abandon research and development.
Apr 20 Lancet Infect Dis abstract
Apr 19 Lancet
press release
Apr 20 related commentaries by Ron Daniels and Raffaella Bosurgi


Researchers warn of global threat from fake and substandard drugs

Quality tests on drugs to treat some of the world's top infectious disease threats, such as HIV/AIDS, malaria, and tuberculosis, show that as many as 41% fail to meet quality standards, outlining an urgent problem, according to a group of 17 journal articles on the topic published early online today in the American Journal of Tropical Medicine and Hygiene.

One of the reports details fake and substandard malaria drugs in Africa that led to an estimated 122,350 deaths in children in 2013.

The special supplement covers different aspects of the topic, including poor-quality antibiotics, new methods for detecting poor-quality or fake drugs, solutions to the problems, and policy interventions, including the need for an international framework and stricter national laws that bar drug counterfeiting. The publication was supported by the Fogarty International Center, part of the National Institutes of Health (NIH); the Bill and Melinda Gates Foundation; and the New Venture Fund.

Jim Herrington, PhD, MPH, who coedited the supplement, said in an NIH press release, "The pandemic of falsified and substandard medicines is pervasive and underestimated, particularly in low- and middle-income countries where drug regulatory systems are weak or nonexistent, as shown by field studies in the supplement."
Apr 20 Am J Trop Med Hyg reports
Apr 20 NIH press release

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