News Scan for Jun 14, 2016

Third US MCR-1 finding
Yellow fever in Angola
Lassa over in Benin

CDC reports another detection of MCR-1 resistance gene in pig sample

Federal officials have detected the MCR-1 resistance gene in another Escherichia coli isolate taken from a pig, bringing to three the number of US detections in 3 weeks, after the gene was found in late May in samples from a person and a separate pig.

MCR-1 confers resistance to colistin, an antibiotic of last resort for drug-resistant infections. The gene was first detected in China in November 2015, and since then at least 20 countries have reported it, the Centers for Disease Control and Prevention (CDC) said yesterday in a Health Alert Network (HAN) advisory. The CDC issued the HAN notice to remind healthcare facilities about how to prevent resistant bacteria and to give guidance on detecting and reporting bacteria with the MCR-1 gene.

Most reports thus far have involved E coli, but MCR-1 has also been detected in Salmonella, Shigella sonnei, and Klebsiella pneumoniae.

As with the previously reported pig detection, the new US finding involves E coli isolated from a swine intestine. But unlike the previous sample, which was resistant to several antibiotics in addition to colistin, the newly reported sample was susceptible to other drugs.

The gene can transfer to other, more resistant organisms for which colistin is used as a last line of defense, like carbapenem-resistant Enterobacteriaceae, the CDC said. Such a possibility makes MCR-1 particularly worrisome.

"CDC is increasing its surveillance of human samples from U.S. healthcare settings," the agency said in the advisory. "CDC's National Antimicrobial Resistance Monitoring System, in collaboration with the Food and Drug Administration (FDA) and the U.S. Department of Agriculture (USDA), will continue to look for mcr-1 mediated colistin resistance in enteric bacteria from humans, retail meat, and food animals."
Jun 13 CDC HAN advisory


Angola's yellow fever outbreak slowing but still of critical concern

Cases of yellow fever in a large outbreak in Angola that has taxed global supplies of vaccine and caused grave concern about spread to neighboring countries are "slowly decreasing, though new clusters of cases are being reported in new districts," according to a World Health Organization (WHO) statement today.

Among the 3,137 suspected cases from all 18 of the country's provinces, 847 in 16 provinces have been confirmed and 345 have been fatal. The Luanda and Huambo provinces have seen the largest concentrations of cases (1,778 and 508, respectively), followed by Benguela (291), Huila (135), Cuanza Sul (99), and Uige (54).

Imported cases have been reported from the Democratic Republic of the Congo (DRC), Kenya, and China. Cases in the heavily affected Luanda province have been of most concern, because the province shares borders with the highly populous DRC, and large numbers of people and goods regularly cross the border, the WHO said.

Yellow fever is vaccine preventable, and as of Jun 10 nearly half the population of Angola has been vaccinated (well over 10 million people), the WHO noted. To achieve even this level of vaccination, the country has, as of May 27, had to request additional vaccine four times, according to a new WHO timeline, and the 6-million-dose global stockpile of vaccine for emergency response, normally enough for a year, has had to be replenished twice already this year.

"The evolution of the epidemiological situation in Angola is concerning and needs to be closely monitored," states the WHO. There is an urgent need to continue strengthening the quality of the response in Angola and to enhance preparedness in neighbouring countries and in countries that have diaspora communities in Angola," the organization adds.

The WHO published a timeline of the Angola outbreak online yesterday as well as a video explaining how the global vaccine stockpile works and a document titled "Yellow Fever Strategic Response Framework June-August 2016," which is intended to guide the international response.
Jun 14 WHO update
WHO timeline of Angola outbreak
WHO video on yellow fever vaccine stockpile
WHO Strategic Response announcement and document


WHO: Benin's 2nd Lassa fever outbreak resolved

An outbreak of Lassa fever in Benin that began early this year, the second in that country, was declared ended by the country's ministry of health on May 23, the WHO said yesterday. The previous outbreak occurred in 2014.

This year's outbreak, which began Jan 25, comprised 54 suspected cases, of which 16 were laboratory confirmed. Cases were fatal in 28 patients. Cases occurred across eight regions of the country, with the most (31 cases, 16 deaths) in the northeast department of Borgou.

Five of the cases, three of them confirmed and all in Borgou, occurred in healthcare workers, two of whom died.

A total of 739 contacts were identified and monitored. Just one contact was confirmed as having Lassa. No cases have been reported since Apr 10.

Lassa fever is endemic in neighboring Nigeria as well as in other countries of West Africa. The WHO, which deployed a team to Benin to support the response, encourages investigation of the factors contributing to the outbreak and its high mortality rate as well as strengthened surveillance.
Jun 13 WHO update
Apr 1, 2015, CIDRAP News item on 2014 outbreak

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