News Scan for Oct 11, 2016

Africa malaria deaths
Arkansas mumps outbreak
ASPs in peds hospital
Cholera in Haiti
H5N1 cases in Egypt

Malaria mapping finds 57% drop in deaths in sub-Saharan Africa

Malaria deaths in Africa have dropped by more than half in the past 15 years, but some countries still struggle with high malaria mortality rates, according to a study yesterday in the New England Journal of Medicine.

UK and US researchers combined data from the Malaria Atlas Project and the Global Burden of Disease Study to estimate malaria mortality across sub-Saharan Africa geographically from 1990 through 2015. They used a spatiotemporal modeling framework of data with known latitude and longitude to estimate malaria death rates by very localized regions.

Their calculations showed that from 2000 to 2015, overall malaria deaths across the entire region declined from an estimated 57%, from 12.5 per 10,000 population per year in 2000 to 5.4 per 10,000 per year in 2015. This means that sub-Saharan Africa had a 37% annual net drop in the number of malaria deaths, from 1,007,000 in 2000 to 631,000 in 2015.

The share of malaria deaths among children 5 years and younger ranged from more than 80%—at a rate of death of more than 25 per 10,000—to less than 40% at rates below 1 per 10,000. The authors noted that Nigeria, Angola, and Cameroon and parts of the Central African Republic, Congo, Guinea, and Equatorial Guinea all have high fatality rates (10 per 10,000 and higher) and less than 50% coverage of insecticide-treated bed nets and antimalarial drugs.
Oct 10 N Engl J Med study


Hundreds affected by mumps outbreak in northwest Arkansas

Hundreds of confirmed or suspected cases of mumps in about 30 schools in northwest Arkansas are under investigation, according to a release yesterday from the Arkansas Department of Health (ADH).

Cases being investigated so far number 476 and involve the Huntsville, Rogers, and Springdale districts, as well as a number of workplaces.

Students in affected schools who have an exemption for the measles, mumps, and rubella (MMR) vaccine are being required to stay home from school for 26 days after exposure or until no new cases have occurred in the school for 26 days. If students' exemptions are nonmedical and they do receive the MMR vaccination regimen, they may return to school before that time, the ADH noted.

Mumps is a viral illness spread via respiratory droplets or saliva. It causes swollen, painful salivary glands as well as such symptoms as fever, headache, and fatigue. Male patients may experience testicular swelling. The disease is typically mild in children but can be serious in adults.

MMR vaccination, which is 88% effective, according to the ADH, is usually given to infants at 12 to 15 months of age and again at age 4 to 6 years. Previously unvaccinated adults receive two doses 28 days apart. Those born before 1957 are considered to be immune to the disease.
Oct 10 ADH statement


ASP at a children's hospital is tied to declines in antimicrobial use

Parenteral antimicrobial use at a Tennessee children's hospital decreased at a rate of 11.1% a year after implementation of an antibiotic stewardship program (ASP), according to a new study published in the Journal of the Pediatric Infectious Disease Society.

In an evaluation of the ASP implemented at Monroe Carell Jr. Children's Hospital at Vanderbilt in 2012, researchers examined 643 interventions that were made by the ASP team from January 2013 to June 2014. The team included a pharmacist with infectious disease (ID) training and an attending pediatric ID physician, and the primary strategy was a prospective audit with feedback (PAWF)—a method that allows the ASP team to interact directly with prescribers to tailor antibiotic therapy.

The 11.1% decline in parenteral antimicrobial use at the hospital after the ASP implementation, which included parenteral antimicrobials in all classes, was nearly twice the median decline observed at 45 other children's hospitals in the Pediatric Health Information System (PHIS) database over the same period. Monthly median expenditures for all parenteral antimicrobials decreased by more than $42,000.

These findings were not unexpected or surprising. But the researchers say that, in addition to further establishing the value of ASPs, the results help distill some of the factors associated with compliance with PAWF recommendations.

Analysis of the interventions showed that in 495 of the 643 interventions (77%), prescribers adhered to the nonbinding recommendations of the ASP team, with a notable difference in adherence observed among different provider types. In particular, recommendations made to a team pharmacist were most likely to succeed, followed by recommendations made to a resident. Nurse practitioners were least likely to adhere to ASP recommendations.

Understanding these compliance factors, the authors say, can help stewardship programs maximize efficacy.
Oct 7 J Pediatr Infect Dis Soc abstract

Hurricane Matthew causes cholera to surge in Haiti as UN asks for funds

The United Nations (UN) and its public health arm, the World Health Organization (WHO), are preparing for a surge of cholera cases in Haiti after Hurricane Matthew wreaked havoc on the nation in the last several days.

On Tuesday the WHO said it was sending 1 million cholera vaccine doses to Haiti, Reuters reported today. The UN, meanwhile, announced it was asking for $120 million in aid for 2.1 million Haitians who have been affected by the hurricane, according to The Guardian. The money will be used for rebuilding efforts.

The WHO said the hurricane will affect many Haitians' access to clean water. So far, 150 new cases of cholera were already reported in Grand'Anse department, and another 50 in South department.

Since 2010, a cholera outbreak has killed approximately 10,000 people and sickened more than 800,000 in Haiti. Earlier this summer, the UN took partial responsibility for the outbreak, which was tied to the improper dumping of human waste into the Arbonite River by UN peacekeepers, who were in Haiti following the 2010 earthquake.
Oct 11 Reuter's story
Oct 11 Guardian story


WHO: Most recent H5N1 cases in Egypt, both in 3-year-olds, were fatal

The WHO yesterday, in its latest update on influenza at the human-animal interface, provided more details on two fatal Egyptian cases of H5N1 avian flu that its Eastern Mediterranean office first mentioned 2 days ago.

Neither case is recent, but they have not previously been reported by Egypt's health officials.

The first patient was a 3-year-old boy from Faiyum governorate, just southwest of Cairo. He first had symptoms May 7 and was hospitalized and treated with antivirals but died on May 20. He was exposed to healthy-appearing poultry before he contracted the disease.

The second patient was a 3-year-old girl from Giza governorate, which wraps around Faiyum to its north, extending both east and southwest of it. The girl first became ill on Jul 24 and was also hospitalized. After receiving antiviral drugs for pneumonia, she died on Jul 31. She was exposed to market poultry that had died.

No further cases were detected after monitoring of close contacts, the WHO said. On Oct 9 the WHO Regional Office for the Eastern Mediterranean reported the cases without providing any details. The country has now reported 10 H5N1 cases after having a huge surge in late 2014 through early 2015.
Oct 10 WHO report (dated Oct 3)
Oct 10 CIDRAP News story noting the cases

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