News Scan for Apr 19, 2016

Public health funding
;
Saudi MERS cases
;
More chikungunya
;
New H7N9 cases
;
MRSA in athletes

TFAH says US public health spending still below pre-recession levels

A nonprofit group's annual report on US public health spending says overall funding is still stuck below where it was before the recession of 2008-09, although spending by states may be picking up a bit.

"Federal funding for public health has remained relatively level for years," says the report by the Trust for America's Health (TFAH), based in Washington, DC.

For example, funding for the Public Health Emergency Preparedness (PHEP) program, which supports state and local preparedness, is $651 million for fiscal year (FY) 2016, TFAH says, compared with $643 million in FY 2015. The program peaked at $940 million in FY 2002. The Hospital Preparedness Program is funded at $255 million this year, the same as last year.

Federal dollars for preventing disease and improving health in states in FY 2016 range from $15.99 per person in Indiana to $53.06 in Alaska, according to TFAH. That compares with a range of $15.14 to $50.09, bookended by the same states, cited in last year's TFAH report.

The FY 2016 budget for the Centers for Disease Control and Prevention is $6.34 billion, about $600 million less than in FY 2015 when adjusted for inflation, the report states.

As for state spending on public health, the median amount for FY 2014-15 was $33.50 per person, compared with $31.06 in FY 2013-14, according to TFAH. The amounts varied all the way from $4.10 in Nevada to $220.80 in West Virginia. The current level is about the same as the 2008 figure of $33.71, but when adjusted for inflation it represents an overall cut of $1.2 billion, the report contends.

Further, TFAH's analysis concluded that 16 states decreased their public health budgets from FY 2014 to 2015, and six states—Alabama, Indiana, Kansas, North Carolina, Ohio, and Oklahoma—cut their budgets 3 or more years in a row. A year ago TFAH reported that 22 states and Washington, DC, had cut their budgets in the preceding year.

TFAH offers a set of recommendations for increasing public health funding, with a priority of ensuring that "foundational public health capabilities and services" are provided nationwide.
Apr 19 TFAH report summary
Full TFAH report
Apr 16, 2015, CIDRAP News item on 2015 TFAH report

 

Saudi officials report 2 new MERS cases, 1 of them healthcare-related

Saudi Arabia's Ministry of Health (MOH) today reported two new MERS-CoV cases, one of which involved a healthcare worker.

The first MERS-CoV (Middle East respiratory syndrome coronavirus) case involved a 31-year-old foreign male healthcare worker in Riyadh. He is in stable condition, and his infection was healthcare-acquired, the MOH said. He had no contact with camels.

The second case involves a 24-year-old Saudi man from Hofuf who is asymptomatic. He is not a healthcare worker, and the probable source of his infection is contact with camels, the MOH said.

The country has now confirmed 1,376 cases since the outbreak began in 2012, including 587 deaths. Twelve patients are still being treated, the MOH said.
Apr 19 MOH update

 

PAHO reports 2,500 new chikungunya cases in Americas

The Pan American Health Organization (PAHO) late last week reported 2,508 new cases of chikungunya in the Americas, bringing the 2016 outbreak total to 43,624 confirmed and suspected cases.

The previous update, which included 2 weeks' worth of data, noted 4,587 new cases. The outbreak total since 2013 has now reached 1,923,170 cases.

According to the Apr 15 report, Colombia, the hardest-hit nation so far in 2016, reported the largest gain, with 1,628 new cases and 12,043 for the year. Honduras was next, with 579 newly reported cases and 7,181 for the year, followed by Venezuela, which logged 180 new infections, bringing its 2016 total to 2,080 cases. Many countries, however, have not reported new numbers for many weeks.

PAHO did report did not report any new chikungunya-related deaths for the year, leaving that number at two. The outbreak was first reported in December 2013 on St. Martin in the Caribbean with the first recorded cases of the disease in the Americas.
Apr 15 PAHO update

 

China and Hong Kong report pair of H7N9 cases

Health officials on China's mainland reported a case of H7N9 avian flu from Anhui province today, while Hong Kong reported an imported infection from Guangdong province, with live-poultry market exposure reported in both instances.

The health department in Anhui today said the virus sickened a 62-year-old man, according to a statement translated and posted by Avian Flu Diary, an infectious disease news blog.

An investigation revealed that the patient had visited a live poultry market before he got sick. The man is hospitalized in critical condition in the city of Ma'anshan. Anhui province, in eastern China, has reported six cases, four of them fatal, this year.

Also today, Hong Kong's Centre for Health Protection (CHP) reported its third imported case of the year, in an 80-year-old man who is hospitalized in stable condition.

The patient had traveled to Dongguan in Guangdong province during the first days of April, where he got sick a few days after buying a live chicken at a poultry market and slaughtering the bird. So far his two travel companions are asymptomatic, as are three of his close contacts, the CHP said, adding that further contact tracing efforts are under way.

Today's new cases, the region's fourth in recent days, raises the global H7N9 total to 780, according to a case list kept by FluTrackers, an infectious disease news message board.
Apr 19 Avian Flu Diary post
Apr 19 CHP statement
FluTrackers H7N9 case list

 

Athletes have high rate of MRSA colonization, risk of infection

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization in asymptomatic athletes, particularly college athletes, is comparable to that in people with chronic disease and higher than that in intensive care unit (ICU) patients, plus it is associated with a sevenfold risk for future infection, according to study findings published yesterday in Clinical Infectious Diseases.

Brown University researchers analyzed 15 studies of community-acquired MRSA in 1,485 asymptomatic athletes and athletic staff. Overall MRSA colonization prevalence was 5% (6% when only athletes were included), a rate that rose to 13% among collegiate athletes. Among the latter, prevalence was highest in wrestlers (22%), followed by football and basketball players (8% each), the authors said.

Once colonized, college athletes had a sevenfold increased risk of skin and soft tissue infections within 90 days. Decolonization treatment reduced subsequent infection risk by 33%, though treatment effectiveness was documented in only three studies, the authors said.

The USA300 strain, which has been associated with fatal MRSA infections, was the most common strain present, colonizing 22% of athletes. More than half of cases (62%) were resistant to clindamycin, while high rates of resistance were also observed for erythromycin (40%), trimethoprim/sulfamethoxazole (36%), tetracycline (31%), and rifampin (23%). Given potential resistance, the authors cautioned against using clindamycin and trimethoprim/sulfamethoxazole as empiric treatment.

Rates of MRSA colonization in college athletes were almost twice as high as those observed in ICU patients (7%) and higher than documented rates in people with HIV (6.9%) and people undergoing dialysis (6%).

Among the factors thought to increase the risk of MRSA in athletes are equipment sharing, close contact, and frequent skin trauma, notes the article. The authors conclude that "Infection control and decontamination protocols for this population need to be studied and implemented with urgency."
Apr 18 Clin Infect Dis study

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