News Scan for Mar 25, 2016

More Elizabethkingia
Norovirus in kids
2 Saudi MERS cases

Wisconsin Elizabethkingia cases rise to 59

The number of bloodstream infections caused by Elizabethkingia anophelis in Wisconsin rose by 5 this week, to 59, bringing the number of US cases to 60.

In a Mar 23 update, the Wisconsin Department of Health Services (WDHS) reported 52 confirmed, 4 possible, and 3 "under investigation" cases. Last week's Elizabethkingia total in the state was 54 cases.

Regarding possible cases, the WDHS said, "These are cases that tested positive for Elizabethkingia, but will never be confirmed as the same strain of Elizabethkingia anophelis because the outbreak specimens are no longer available to test."

The WDHS said in its update, "At this time, the source of these infections is unknown and the Department is working diligently to contain this outbreak." It said it is working with the US Centers for Disease Control and Prevention to visit sites and collect environmental samples from homes and healthcare facilities.

Last week Michigan reported a fatal case with a strain matching the Wisconsin outbreak strain.

E anophelis, which can be present in the soil and other environmental sources, is multidrug-resistant, but the Wisconsin strain is susceptible to fluoroquinolones, rifampin, trimethoprim/sufamethoxazole, and minocycline. The organism typically affects people who are immunocompromised or have other health conditions.
Mar 23 WDHS update
Mar 17 CIDRAP News scan on Michigan case


Study: Most kids in poverty contract norovirus by age 2

Norovirus places a considerable disease burden on young children living in poverty worldwide, as evidenced by a longitudinal study published yesterday in Clinical Infectious Diseases showing that nearly 90% of a cohort from eight countries experienced at least one norovirus infection in the first 2 years of life.

A total of 1,457 healthy children in eight countries with high rates of diarrheal disease and malnutrition—Bangladesh, Brazil, Pakistan, Peru, South Africa, Tanzania, Nepal, and India—were enrolled within 17 days of birth and followed until 24 months of age. The study period ran from November 2009 through February 2012.

Stools were collected monthly during the first year of life as well as at 15, 18, 21, and 24 months. Children's homes were visited twice a week to monitor for diarrhea or other symptoms (eg, fever, vomiting).

Testing for norovirus and analysis for coinfection and disease severity were done on all diarrheal stool samples collected. In addition, routine stool samples from a subset of 199 randomly selected infants were also tested and analyzed longitudinally.

Among the 199-subject subset of children, 89% had at least one norovirus infection during the first 24 months of life; 22.7% of all diarrheal stools tested positive for norovirus. The incidence of genogroup II (GII) infection was higher than that of genogroup I and peaked between 6 and 11 months of age across all sites.

Undernutrition was identified as a risk factor for symptomatic norovirus infection. Children with GII infection had a 27% reduction in the hazard of subsequent infection (hazard ratio, 0.727; P = 0.010), indicating some degree of acquired immunity for this type.

The authors estimate, with some caveats, that "an effective vaccine could avert approximately 99 million episodes of diarrhea [annually] among children aged 6-24 months."
Mar 24 Clin Infect Dis study


Saudi Arabia reports 2 new MERS cases, 1 fatal

Saudi Arabia today reported two more MERS-CoV cases, one of which is in Buraydah, bringing the number of cases in that north-central city since Mar 3 to 30.

The MERS-CoV (Middle East respiratory syndrome coronavirus) case in Buraydah involves a 57-year-old foreign man who is hospitalized in stable condition, according to the Saudi Ministry of Health (MOH). His infection, however, does not appear to be linked to a hospital, because it is listed as "primary." Most cases in Buraydah have been healthcare related.

The other MERS patient is a 76-year-old Saudi woman in Riyadh who died from her infection. Her exposure to the virus is under investigation, the MOH said. Neither of the newly reported patients were healthcare workers.

The agency also reported the death of a 55-year-old male expatriate in Ha'il. He had preexisting disease and was not a health worker. In addition, the MOH noted that two men, a 68-year-old in Shaqra and a 41-year-old in Al Zulfi, have recovered from the disease.

Today's update brings the MERS total in Saudi Arabia since 2012 to 1,357 cases, including 579 deaths.
Mar 25 MOH update

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