News Scan for Feb 26, 2016

Saudi MERS cases
;
Local dengue in Uruguay
;
MCR-1 in Tunisia
;
Antibiotics, HUS, and E coli
;
Polio in Laos

Saudi Arabia reports two more MERS cases

Saudi Arabia's Ministry of Health (MOH) today confirmed two new MERS-CoV infections in Saudi men, marking 11 new cases in as many days.

One new MERS-CoV (Middle East respiratory syndrome coronavirus) infection involves a 72-year-old man in the central town of Ruwaidah Alard, not far from Riyadh. He is hospitalized in critical condition. The MOH said that he is not a healthcare worker and had no recent contact with camels. His infection is listed as primary, meaning he did not contract the disease from another person.

The second case-patient is a 68-year-old man from Riyadh who is in stable condition. He is not a healthcare worker and had no exposure to camels. The MOH said that his infection is also primary.

Saudi Arabia's cumulative total of MERS cases has reached 1,304, including 742 recoveries, 554 deaths, and 8 patients still under treatment, the MOH said.
Feb 26 MOH update

 

Uruguay reports first locally acquired dengue case

The World Health Organization (WHO) yesterday announced that Uruguay reported its first locally acquired case of dengue on Feb 13.

The case involves a 31-year-old woman from Montevideo with symptom onset on Feb 5 and no recent travel outside of Uruguay. She was hospitalized for 2 days and is now in good health, the WHO said. Her samples tested positive for dengue by reverse transcription polymerase chain reaction (RT-PCR) and have been sent to a regional reference laboratory for additional confirmation.

If confirmed, the woman's infection would be Uruguay's first locally acquired case of dengue. Health officials are investigating the source of the infection and the potential for other cases in the community.

The WHO said that several factors may be contributing to the identification of dengue in Uruguay, including possible proliferation of Aedes aegypti mosquitoes, the country's proximity to Brazil and Argentina, where dengue is widespread, and current Uruguay River flooding leading to ideal mosquito breeding sites.
Feb 25 WHO report

 

Tunisian team identifies MCR-1 gene in poultry imported from France

A microbiological investigation of samples from Tunisian chicken farms revealed more evidence that the food animal trade is contributing to the spread of the MCR-1 antibiotic-resistance gene, according to researchers from Tunisia and France writing yesterday in Eurosurveillance.

Chinese researchers first described the MCR-1 gene, which disables resistance to the last-line antibiotic colistin, in November. Since then, scientists in several countries have found the gene after poring through their sample collections, which have sometimes revealed the concerning finding that it can appear alongside other resistance genes.

In the new study, investigators looked at 52 fecal samples collected from healthy birds in July 2015 at three Tunisian farms to assess levels of extended-spectrum beta lactamase (EBSL)–producing Escherichia coli in the poultry. Testing turned up 37 E coli isolates from 29 of the birds. During their testing, the Chinese MCR-1 study was published, and the Tunisian group further investigated the colistin-resistant isolates they had identified.

Researchers found a high prevalence of MCR-1 and CTX-M-1-producing E coli at the Tunisian farms, all of which had chicken or chicks imported from France. They also found that the plasmid that carried the genes was one found earlier in French livestock and a Portuguese food sample.

"It is now crucial to determine the prevalence of the mcr-1 gene in poultry and poultry meat as well as in other livestock (live animals or meat) in Tunisia and other African countries in order to estimate the risk to human health," the authors wrote, adding that urgent attention is needed on the global market of veterinary drugs for food animals.
Feb 25 Eurosurveill report

 

Analysis links antibiotics to HUS in patients with STEC infections

A literature review to help sort out if antibiotic treatment for people infected with Shiga toxin–producing E coli (STEC) is associated with the development of hemolytic uremic syndrome (HUS), a potentially fatal kidney complication, found that the five highest quality studies they looked at point to a significant association. The Canadian-led team published its findings in Clinical Infectious Diseases (CID).

The group based its review on 17 studies published up to Apr 29, 2015, that included a total of 1,896 patients. When they pooled the data from all of the studies, they found that antibiotics weren't linked to an increased risk of developing HUS.

When they focused on the five most rigorous studies, however—ones that excluded a high risk of bias and had an acceptable HUS case definition—they found a significant association. The odds ratio was 2.24 (95% confidence interval, 1.45 to 3.45). They said the finding supports recommendations against prescribing antibiotics for patients with STEC infections.

In an editorial in the same CID issue, two experts from the US Centers for Disease Control and Prevention said that, because of a shortage of good data, the researchers had an impossible task of trying to assess any type of antibiotic treatment for diarrhea from all types of STEC and the relationship to HUS.

They said the key finding based on the five best studies was that treatment of E coli O157 diarrhea with certain antibiotics is associated with an increased risk of developing HUS, especially since 95% of all STEC-linked HUS is associated with that serogroup. The two concluded that the findings support avoiding the most-studied antibiotics for people with E coli O157 infections and that it seems wise to extend the recommendation to other virulent STEC.

"The lack of evidence of a protective effect of these antibiotics against development of HUS in multiple sub-analyses further adds to the strength of this recommendation," they wrote.
Feb 24 Clin Infect Dis report
Feb 24 Clin Infect Dis editorial

 

Laos reports 3 more vaccine-derived polio cases in ongoing outbreak

The WHO said yesterday that Laos has reported three more cases of type 1 circulating vaccine-derived poliovirus (cVDPV1) in Vientiane province between Feb 6 and Feb 16.

The first case occurred in a 15-month-old girl in Phonhoung district who developed paralysis on Jan 8. The second case-patient is a 44-year-old woman in Feuang district who developed paralysis on Jan 11. Both patients tested positive for cVDPV1, although the cases are not linked epidemiologically.

The third case of cVDPV1 involved an 18-year-old man from Meun district who developed paralysis on Jan 3. His tests are pending, but his infection is classified as cVDPV1 because of a positive sample collected from a contact.

The WHO said that all three cVDPV1 isolates are genetically linked yet are different from the current outbreak strain circulating in Laos, meaning that multiple strains of cVDPV1 may now be present in the country.

Laos has confirmed 10 cVDPV1 cases and positive samples from 23 healthy case-contacts since the outbreak began in fall 2015.
Feb 25 WHO update
Feb 12 CIDRAP News scan on Laos outbreak

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