Saudi Arabia reports new MERS case

Saudi Arabia's Ministry of Health (MOH) today announced one new MERS-CoV illness, involving a 93-year-old man from Hofuf, a town in the eastern part of the country that has reported family and hospital outbreaks over the past few months. His illness is the first to be reported in the town since Jun 25.

The man is listed in stable condition. The ministry said he didn't have contact with suspected or confirmed MERS-CoV (Middle East respiratory syndrome coronavirus) cases in the community or in hospitals.

The latest case lifts Saudi Arabia's total from the disease to 1,048 cases, of which 460 were fatal. So far 580 people have recovered from their illnesses, and 8 are still considered active cases.
Jul 16 Saudi MOH update

WHO notes progress, problems in global childhood immunizations

The World Health Organization (WHO) offered good and bad news on childhood vaccine coverage today, saying the number of countries that reach at least 90% of children with key vaccinations has doubled since 2000, but 65 countries need to make big changes to meet internationally agreed goals.

In 2014, the WHO said, 129 countries immunized at least 90% of their children with the required three doses of diphtheria-tetanus-pertussis vaccines (DTP3), 6 more countries than the year before.

In 2012, all 194 WHO members endorsed the Global Vaccine Action Plan (GVAP), including a target of 90% DTP3 vaccination coverage in all countries by this year, the WHO said. That goal has not yet been met, as global DTP3 coverage stands at 86%, the agency said. On the other hand, the number of children who have not received even one DTP dose is 12 million, down from 21 million in 2000.

In April the WHO warned that progress toward five of the six GVAP targets, including the DTP3 coverage target, was "worryingly off-track," with only one target, for the introduction of under-utilized vaccines, showing sufficient progress.

"The new data highlight the fact that 65 countries will require game changing strategies in order to meet the GVAP goal," the WHO said. Among them are 6 countries with less than 50% DTP3 coverage: Central African Republic, Chad, Equatorial Guinea, Somalia, South Sudan, and Syria.

In other observations, the agency said:

• The proportion of children who received three doses of hepatitis B vaccine reached 82% in 2014, up from 30% in 2000, but more needs to be done to ensure that infants get their first dose within the first 24 hours of life.
• Haemophilus influenzae type b (Hib) vaccine, one of the newest recommended vaccines, has been introduced in all countries except China and Thailand, but coverage remains low, at 56%.
• Only 19% of children have received a rotavirus vaccine, which has not yet been introduced in some countries with the heaviest burden of diarrheal disease.

Jul 16 WHO statement
WHO immunization coverage data
Related Apr 22 CIDRAP News item

H5N1 strikes more poultry in Nigeria, Ghana

Agriculture officials in Nigeria today reported three new highly pathogenic H5N1 avian flu outbreaks, and two outbreaks were confirmed in Ghana, according to separate reports to the World Organization for Animal Health (OIE).

In Nigeria, the virus was detected on two commercial farms, affecting 76- and 33-week-old layers, and in backyard poultry in Lagos state. All three of the outbreaks began on Jul 14.

Of 4,150 susceptible birds at the three sites, the virus killed 353, and the rest were slated for slaughter to control the spread of the virus.

After a several-year hiatus, Nigeria has been battling the resurgence of H5N1 in poultry since January.
Jul 16 OIE report on Nigerian outbreaks

In Ghana, which has also seen a recent H5N1 resurgence after a long lapse, veterinary officials announced two more outbreaks, both in Greater Accra region in the southern part of the country, according to a Jul 14 OIE report.

One outbreak occurred in backyard cockerels, and the other in laying hens and broilers at a commercial farm. The backyard outbreak began on Jul 3, and the farm event started on Jul 8.

Of 2,020 susceptible birds, 183 deaths were reported, with the remaining ones to be culled.
Jul 14 OIE report on Ghana outbreaks

Medicare seeks antibiotic stewardship programs in care facilities

As part of the US government's efforts to guard the effectiveness of antimicrobials, Medicare is proposing to require participating long-term care facilities (LTCFs) to implement antibiotic stewardship programs.

The plan is part of a lengthy proposed revision of the requirements for LTCFs that participate in the Medicare and Medicaid programs, released in a Federal Register notice from the Center for Medicare and Medicaid Services (CMS) today.

"We propose that each facility's infection prevention and control program (IPCP) include an antibiotic stewardship program, which includes antibiotic use protocols and antibiotic monitoring," the notice states. "Antibiotic resistance has emerged as a national healthcare concern, and even the appropriate use of antibiotics can contribute to antibiotic resistance. Nursing homes are the next frontier where new antibiotic resistant organisms may emerge and flourish."

The proposal on antibiotic stewardship is one of a host of changes described in the 403-page notice. The agency is inviting the public to comment on the proposals within 60 days.

The proposal drew praise from the Infectious Diseases Society of America (IDSA). In an e-mailed press release, the group said it has been advocating for the step for a long time.

"Stewardship programs have been shown to reduce the percentage of antibiotic‐resistant organisms in a facility, reduce the occurrence of Clostridium difficile infections, improve patient outcomes, decrease toxicity, and reduce pharmacy costs," the IDSA said.

The IDSA was on a long list of medical organizations that signed an October 2014 letter urging CMS to require hospitals and LTCFs to adopt antibiotic stewardship programs. The letter said that step was recommended by the President's Council of Advisors on Science and Technology.
Jul 16 CMS Federal Register notice
Oct 31, 2014, letter to CMS

WHO: Neglected zoonotic diseases can be controlled with existing tools

A new report from the WHO asserts that neglected zoonotic diseases, such as rabies and cysticercosis, can be controlled with existing tools, if the world can muster the commitment to tackle them.

The report, titled From Advocacy to Action, is the product of the fourth international meeting on neglected zoonotic diseases, held last November in Geneva. The first in the series of meetings was held in 2005.

In a statement, the WHO said the 48-page report acknowledges the momentum generated over the past decade and emphasizes the need to focus efforts on the neglected zoonoses included in the WHO Roadmap on neglected tropical diseases (NTDs).

In addition to rabies and cystercicosis, the neglected zoonoses include such ailments as human African trypanosomiasis, echinococcosis, foodborne trematode infections, and leishmaniasis, the report notes.

"The international community must rise up and take responsibility in pushing ahead for the control and elimination of these neglected zoonotic diseases," Bernadette Abela-Ridder, DVM, PhD, WHO team leader for NTDs, said in the WHO statement. "These infections affect mainly poor segments of populations that interact closely with animals, and our role should be to implement proven measures now that can contribute to the health and improved livelihood of affected families."

The WHO said nearly two thirds of all human pathogens originate as zoonoses, making it important to take a "one health" approach that involves cooperation between the veterinary and medical sectors in battling zoonotic diseases.
Jul 16 WHO statement
Full text of report

UK study identifies odd new Streptococcus variant

UK researchers have discovered a new Streptococcus variant that has contributed to a rise in UK cases in the past 17 years but is very sensitive to existing antibiotics, according to a report this week in mBio.

The team observed that a strain called emm 89 was outpacing other Streptococcus strains from 1998 to 2009 in the country, so they tested 9 to 11 samples from patients each year from 2004 to 2013, with roughly equal numbers of noninvasive and invasive strains. Genetic sequencing revealed a new subtype of emm 89 whose emergence paralleled the surge in cases.

The new variant has evolved two important differences from other emm 89 subtypes: it produces more toxin and has lost its outer capsule.

"The fact that it had lost its capsule was a complete surprise, because it was believed that the capsule was essential for group A streptococcus to cause invasive disease," said lead author Claire Turner, PhD, of Imperial College London, in an Imperial College news release.

The researchers are still uncertain about why the new variant without capsule has produced higher levels of disease. "We know that without capsule, they stick better to surfaces, so that may help them to transmit more easily. Another possibility is that they can more easily get inside human cells, which makes them harder to treat," said Turner.

"Luckily, the new variant remains exquisitely sensitive to penicillin and related antibiotics."
Jul 14 mBio study
Jul 14 Imperial College London press release