News Scan for May 07, 2015

Listeria ice cream findings
H5N6 genetic analysis
Broad benefits of measles vaccine
Polio progress and problems
Drug abuse and hepatitis C

Listeria findings noted in Blue Bell, Jeni's plants

Blue Bell Creameries, which has been linked to 10 listeriosis cases in four states in an outbreak that spans several years, had evidence of Listeria in its Oklahoma plant as early as March 2013, a Food and Drug Administration (FDA) report today said, according to an Associated Press (AP) story.

In spite of the findings, the company continued to ship ice cream from that plant after what the FDA labeled inadequate cleaning. The FDA released its findings from Blue Bell plant inspections in Oklahoma, Texas, and Alabama after the AP submitted a Freedom of Information request.

The FDA noted 16 positive tests for Listeria on equipment and in ice cream from March 2013 through January 2015 at the Oklahoma plant, the AP said. Violations included dirty equipment, inadequate food storage, and employees not properly washing hands. The FDA also noted some violations at the Texas and Alabama plants.
May 7 AP story on Blue Bell findings
May 7 FDA update
May 7 CDC update

In related news, the Listeria monocytogenes contamination recently discovered in samples of Jeni's Splendid Ice Creams has been traced to the spout of a pint-filling machine in its Columbus, Ohio, production facility, according to a separate AP story today and a company press release yesterday.

No clues have been found as to how the bacteria got into the machine, but the company is reworking the production kitchen "into a facility that provides the best defenses against any contamination," to the tune of at least $200,000, said company CEO John Lowe in the release. "We will spend whatever it takes."

Part of the new company system will be a test-and-hold program in which all finished product is tested before shipping, noted the press release.

The company planned to destroy about 265 tons of its ice cream, worth $2.5 million, the AP reported.

Jeni's recalled all its retail products, including ice creams, frozen yogurts, sorbets, and ice cream sandwiches Apr 23 after Listeria was found in a sample collected by the Nebraska Department of Agriculture; no illnesses have been reported. The company has also closed ice cream shops in six states, even though the machine implicated in the contamination is not used in filling buckets for the shops, said the release.

No connection between contamination at the two companies is apparent, according to the Centers for Disease Control and Prevention (CDC).
May 7 AP story on Jeni's findings
May 6 Jeni's press release


Study: H5N6 viruses in poultry likely stem from H5N1, H6N6 viruses

In a letter in Emerging Infectious Diseases yesterday detailing a genetic analysis, Chinese scientists noted that H5N6 avian flu viruses that caused bird outbreaks in Laos and China last year are reassortants of wild duck H5N1 and swine H6N6 viruses, both of which have pandemic potential.

The team analyzed H5N6 viruses from two March 2014 outbreaks: one in Laos and one in Guangdong province in southern China. Whole genes of the two viruses shared 98.2% to 99.7% identity with each other, indicating they are from the same genotype.

In addition, the researchers determined via multiple-sequence analysis that the hemagglutinin (HA) component of the Guangdong virus—the H5—was 97.5% similar to the HA of an H5N1 virus from a wild duck in Shandong province farther to the north. In addition, its neuraminidase (NA) gene—the N6 portion—was 96.6% to 98.3% similar to the NA gene of an H6N6 virus isolated from a Guangdong pig.

The internal genes of the Guangdong H5N6 virus were 97.6% to 98.5% similar to an H5N1 virus isolated from a wild duck in Fujian province in 2011. Fujian lies just to the north of Guangdong province.

The authors concluded that their evidence shows that the H5N6 viruses "are reassortants of wild duck H5N1 and H6N6 viruses, both of which have pathogenic and potential pandemic capacity in southern China." Reassortment might have stemmed from co-infection of H5N1 and H6N6 in the same host, they wrote.

H5N6 avian flu is known to have infected three people in 2014 and 2015, all in China and two of whom died.
May 6 Emerg Infect Dis letter


Measles vaccination may lead to protection against other diseases as well

Because infection with the measles virus may suppress the immune system for up to 3 years, opening the way to other opportunistic infections, the protection afforded by vaccination might extend to more than just measles, according to an analysis of years of US, UK, and Danish data by US and Dutch researchers published today in Science.

The investigators—from Princeton and Emory universities, the US National Institutes of Health, and Erasmus University in the Netherlands—applied mathematical formulas to population-level data going back as far as the 1940s to assess the relationship between measles, measles vaccination, and other infectious diseases.

They looked at deaths among children aged 1 to 9 years in Europe and 1 to 14 in the United States in both pre- and post-vaccination eras. They then applied a basic association test to compare measles incidence and deaths from other diseases, which showed a statistically significant but rather weak connection between the two.

The team then evaluated the data using different assumptions about how long the immune-suppression effects of measles may last. This analysis showed a very strong correlation between measles incidence and deaths from other diseases that was consistent across age-groups in all countries and also between pre- and post-vaccine eras.

"This paper suggests that immune suppression lasts much longer than previously suspected," said C. Jessica Metcalf, PhD, of Princeton in a university news release. "In other words, if you get measles, 3 years down the road, you could die from something that you would not die from had you not been infected with measles."

"Our findings suggest that measles vaccines have benefits that extend beyond just protecting against measles itself," said lead author Michael Mina, PhD, an Emory University medical student.

The authors called for cohort studies to verify the effect.
May 7 Science abstract
May 7 Princeton University news release


WHO panel sees progress on polio but says emergency continues

Pakistan, the world's leading polio hot spot, has made progress against the disease in the past year, but polio transmission still constitutes a public health emergency of international concern (PHEIC), the World Health Organization's (WHO's) polio emergency committee said this week.

The committee, which met by teleconference on Apr 24, said that since the emergency declaration nearly a year ago, countries have made "strong progress" in response to WHO recommendations, according to a May 5 WHO statement.

"No cases of wild poliovirus have been reported in Africa for eight months; in 2015, Pakistan and Afghanistan have reported less than half the number of cases that were reported during the same period in 2014; there has been no exportation from Pakistan since October 2014; and the number of persistently missed and inaccessible children is declining in Pakistan," the statement said.

"The number of inaccessible children has declined from an estimated 300,000 to 50,000 in Federally Administered Tribal Areas [of Pakistan]," it added. Also, since November Pakistan has vaccinated an average of 370,000 departing international travelers per month at health facilities and points of exit.

On the other hand, the panel noted that three polio exportations from Afghanistan to Pakistan occurred late in 2014, signaling continued international spread. In addition, 21 of 22 global polio cases so far this year were in Pakistan, and factors that promote the spread of polio out of Pakistan have not changed sufficiently since the committee last met in February.

In Afghanistan, reported cases have declined, and cross-border transit vaccination activities have been strengthened, particularly in the Southeast Region, the panel said. But areas with chronically missed or inaccessible populations remain.

Also, the committee said the expansion of conflict zones in the Middle East and Central Africa has worsened the risk of international spread of polio. The group recommended the extension of the WHO's temporary recommendations on polio for another 3 months.
May 5 WHO statement


CDC notes hepatitis C spike in central Appalachian injection drug abusers

Amid a national rise in hepatitis C infections, the largest increase is in four central Appalachian states among young rural adults who inject opioid drugs, a team from the CDC and their state health partners reported today.

The group examined surveillance data for four states—Kentucky, Tennessee, Virginia, and West Virginia—for people age 30 or younger from 2006 through 2012, comparing the data with drug treatment admission for the same period. They published their findings today in the latest issue of Morbidity and Mortality Weekly Report (MMWR).

Their investigation found a 364% increase in acute hepatitis C infections in young adults during that span, most of it in non-Hispanic whites from both urban and rural areas, with the rate more than double in nonurban areas. The team noted that other states have seen similar increases. The four states also reported that treatment for opioid addiction rose 21.1% during the period, with a significant increase (12.6%) in people who used injection drugs.

Increases in hepatitis C infections in central Appalachia seems to highly correlate with the region's prescription opioid drug abuse epidemic, the team concluded. They added that the pattern has a potential to thwart national efforts to curb the disease and raises concerns about possible increases in HIV infections.

Indiana recently reported an HIV outbreak linked to opioid injection drug use, and a majority of patients are co-infected with hepatitis C. In late April the CDC issued a health alert about the outbreak, urging clinicians in other parts of the country to be vigilant for other similar clusters.

In a separate report in today's MMWR, researchers described a project at six Philadelphia health centers that provided services for people disproportionately affected by hepatitis C in ambulatory care settings. The model enables medical assistants to guide patients through testing procedures, includes tests to detect active infection, and enables patients to receive referrals at the same visit.
May 8 MMWR report on hepatitis C in injection drug users
May 8 MMWR report on hepatitis C identification and care
Apr 24 CIDRAP News story "Indiana HIV outbreak grows, prompts national alert"


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