News Scan for Nov 01, 2016

WHO details MERS cases
Weather factors and flu
Contaminated robot surgery tools

WHO details 7 recent Saudi MERS cases

The World Health Organization (WHO) today detailed seven cases of MERS-CoV reported by the Saudi Arabian Ministry of Health (MOH) between Sep 16 and Oct 10. Three of the cases are linked to direct or indirect contact with camels, including drinking raw camel milk. The sources of exposure are being investigated in the remaining four cases.

The four cases with unknown exposure were all in men. A 28-year-old male expatriate in Hail, and a 43-year-old male expatriate in Riyadh, both with no known risk facts for MERS-CoV (Middle East respiratory syndrome coronavirus) remain hospitalized in stable condition. They were diagnosed on Oct 8 and Sep 22, respectively, and have no co-morbidities. A 52-year-old Saudi man from Wadi ad-Dawasir is in critical condition after being hospitalized on Sep 19. He had co-morbidities. Finally a 70-year-old Saudi from Hail died on Sep 27 after being admitted to the hospital on Sep 13.

 A 51-year-old Saudi woman from Al Kharj was diagnosed as having MERS on Sep 29. She had contact with camels in the 2 weeks prior to symptom onset and remains in critical condition in an intensive care unit. Both a 78-year-old Saudi woman from Sakakah and 50 year-old man from Shaqra remain in stable condition with MERS. Both had a history of drinking raw camel milk.

The update does not include a group of three recently reported healthcare-related cases in Arar, among other cases.
Nov 1 WHO update


Study links humidity and temperature to flu outbreaks

Absolute humidity and temperature are the two environmental factors linked to flu outbreaks, shedding new light on what might help drive disease activity in tropical locations, which had previously been harder to pinpoint. A team based at Scripps Institution of Oceanography published its findings yesterday in Proceedings of the National Academy of Sciences (PNAS).

Flu activity in temperate countries is known to relate to changes in temperature and absolute humidity, but the picture has been less clear for tropical regions that experience less climate fluctuation.

The researchers used an empirical dynamic modeling approach designed to predict flu outbreaks based on absolute humidity, temperature, relative humidity, and precipitation. They incorporated World Health Organization (WHO) data on lab-lab confirmed flu from Jan 1, 1996, to Mar 26, 2014, and National Oceanic and Atmospheric Administration weekly temperature and absolute humidity data for each country.

The researchers found that absolute humidity drives flu activity across different latitudes, with the temperature determining whether the association is positive or negative, with the balance shifting at around 70° to 75°F.

At all latitudes, temperature and absolute humidity were more potent drivers of flu activity than were relative humidity and precipitation. The authors wrote that the findings offer a unified explanation for how environmental factors affact global flu outbreaks.

The findings help set the stage for lab studies to test the threshold, with results that could someday support public health measures such as placing humidifiers in schools and hospitals in cold, dry temperate winters or using dehumidifiers or air conditioners in public buildings in the tropics when the temperature is above 75°F.
Oct 31 PNAS report

In its latest global flu update yesterday, meanwhile, the WHO said disease activity in the Southern Hemisphere continues to decline, including in Australia, where flu activity—dominated by H3N2—peaked in September.

Northern Hemisphere countries are still at interseasonal levels, and globally only a few countries are reporting upticks. Examples include Cuba, French Guiana, Costa Rica, Laos, and Thailand.

Testing at WHO-affiliated labs in the first half of October showed that 85.3% of flu detections were influenza A, and, of subtyped influenza A samples, 93.4% were H3N2.
Oct 31 WHO global flu update


Study: Fully cleansing robot surgical instruments almost impossible

Completely removing all contamination from robotic surgical instruments is nearly impossible, even after multiple cleanings, according to Japanese researchers who reported their findings yesterday in Infection Control and Hospital Epidemiology.

The team collected instruments immediately after surgery or in-house cleaning and measured residual protein levels after three repeated cleanings. For comparison, they also used the same methods to gauge residual protein on ordinary surgical tools. In-house cleaning methods included manual ultrasonication based on manufacturers' directions. The researchers examined 132 robotic and ordinary instruments over a 21-month period at facilities in Japan.

Robotic tools had more protein residue and lower cleaning efficacy compared with the ordinary tools, with 97.6% cleaning effectiveness for the robotic tools and 99.1% for the ordinary tools. Investigators said the complex structure of the robotic tools makes them more difficult to clean and that the findings point to a need to establish new cleaning methods based on repeated residual protein measurements, rather than just one.

Yuhei Saito, RN, PHN, MS, lead author of the study and assistant professor at the University of Tokyo Hospital, said in a press release from the Society for Healthcare Epidemiology of America (SHEA), the publisher of the journal, said the robotic instruments are wonderful tools that allow surgeons to operate with care, but complete decontamination has been a challenge. "By implementing new cleaning procedures using repeated measurements of the level of contamination on an instrument more than once, we could potentially save many patients from future infections."
Oct 31 Infect Control Hosp Epidemiol abstract
Oct 31 SHEA press release

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