News Scan for Jan 26, 2017

News brief

H7N9 sickens 2 more in China

With H7N9 cases in China in January already outpacing December's sudden and steep rise, China reported at least two more cases today, according to the latest official reports.

Hong Kong's Center for Health Protection (CHP) today acknowledged two cases reported from Hubei province yesterday, a 65 year-old man and a 78 year-old woman from two different cities, both in critical condition.

Also, the CHP reported a new case from Shandong province, involving a 59 year-old man. The second new case-patient is a 67 year-old man from Hunan province who is in critical condition after having contact with poultry, according to a report today from China's state news agency Xinhua, which cited Hunan province's health department.
Jan 26 CHP statement
Jan 26 Xinhua story

 

H9N2 infects Chinese baby

China recently reported an H9N2 avian influenza infection, involving a 7-month-old girl from Guangdong province who had a mild illness, the World Health Organization (WHO) said in its latest monthly report on flu transmitted between animals and humans. The report covers cases reported between Dec 20 and Jan 16.

The baby's symptoms began on Dec 11, and she wasn't hospitalized and has since recovered. Investigators found she had been exposed to a live poultry market before she got sick.

The case is China's first since last summer when it reported two H9N2 cases to the WHO. Unlike H7N9, many the of the H9N2 cases have been in children. H9N2 is endemic in Chinese poultry.
Jan 16 WHO flu at the human-animal interface report

 

Texas reports local Zika infection in a pregnant woman

Health officials in Texas yesterday announced that a pregnant woman who had been in Brownsville when other local cases were detected has tested positive for Zika virus.

The Texas Department of State Health Services (TDSHS) said the woman from Bexar County had visited Brownsville in November around the time six residents contracted the virus from local mosquitoes. She had not traveled outside of Texas, wasn't sick, and her infection was detected during routine prenatal care.

The woman could have been exposed to the virus by a mosquito bite or through sexual contact with an infected partner, the TDSHS said.
Jan 25 TDSHS statement

 

Saudi Arabia reports new MERS case

The Saudi Arabian Ministry of Health (MOH) reported one new case of MERS-CoV today in the city of Turbah.

The 59-year-old Saudi man is in critical condition after presenting with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus). The man had direct contact with camels, a known risk factor for the disease.

The new case raises Saudi Arabia's MERS-CoV total to 1,546 infections, including 641 deaths. Nine people are still in treatment or monitoring.

Today the World Health Organization (WHO) released details on nine cases of MERS-CoV reported by Saudi Arabia between Jan 2 and 7. The report details a small healthcare-related outbreak of five cases, including two deaths, in the city of Buraydah. Two hospitals were involved.

There was one patient with exposure to camels, a 70-year-old Saudi man from Medina who reported drinking camel milk.

Since September 2012, 1,888 laboratory-confirmed cases of infection with MERS-CoV, including at least 670 related deaths, have been reported to WHO.
Jan 26 MOH report
Jan 27 WHO
report

 

CDC details multistate 2016 E coli outbreak involving dessert pizza dough

Thirteen cases of Escherichia coli poisoning have been linked to contaminated dessert pizza dough, according to a new report published in this week’s Morbidity and Mortality Weekly Report (MMWR). The cases were reported early last winter.

The cases appeared in Iowa, Illinois, Kansas, Minnesota, North Carolina, Nebraska, New Jersey, South Dakota, and Wisconsin. All states reported one case each, except Minnesota which reported five cases. The median age of patients was 17 years (range, 7 to 71 years) and 53% were female. Eight patients were hospitalized, but no deaths were reported.

The Centers for Disease Control and Prevention (CDC) interviewed 12 patients and all reported eating a dessert pizza from "restaurant A," identified by the media last year as Pizza Ranch. Dry dough mix samples from restaurant A showed contaminated flour as the possible source of pathogen introduction.

"Flour is usually not thought to be a food safety risk, but flour-based mixes are ubiquitous in restaurants and are often used for dusting of surfaces for transfer of pizzas," the authors write. "This outbreak serves as a reminder that consumers, industry, and government should consider that flour, a raw agricultural product, might be contaminated with pathogens and, when consumed raw or undercooked, might pose a risk to human health."
Jan 26 MMWR study

Stewardship / Resistance Scan for Jan 26, 2017

News brief

VHA says its stewardship efforts have cut antibiotic use 12%

More than 90% of Veterans Health Administration (VHA) hospitals have developed written antimicrobial stewardship policies, and the agency's Antimicrobial Stewardship Initiative has cut antibiotic use 12% overall so far, VHA officials noted yesterday in an analysis in Infection Control and Hospital Epidemiology.

The analysis of the 140-plus VHA medical facilities in the United States found that 92% had written stewardship policies by 2015. The investigators also noted that, while the proportional distribution of antibiotics did not change, inpatient antibiotic use decreased significantly (P < .0001) after the VHA stewardship initiative activities were implemented. They reported a 12% decrease in antibiotic use overall.

The analysis also noted significantly declining use overall of antimicrobials prescribed for resistant gram-negative organisms, including carbapenems, and declining hospital readmission and mortality rates. They also reported decreased rates of Clostridium difficile infection.

The VHA's stewardship efforts include continuing education, disease-specific guidelines, and development of example policies.
Jan 25 Infect Control Hosp Epidemiol study

 

European experts call for innovation on antimicrobial use in food animals

European health and food safety experts say in a new report that while efforts to reduce the use of antimicrobials in food-producing animals have had an impact, innovative solutions are needed to further protect animal and public health.

In a joint report issued this week, experts from the European Medicines Agency (EMA) and the European Food Safety Authority (EFSA) reviewed the measures that have already been taken by European Union (EU) nations and concluded that the wide range of control strategies implemented have produced favorable results, especially in northern European countries. These strategies use a multifaceted approach, take into account the local livestock production system, and have certain elements in common, such as national targets for reducing antimicrobial use.

But the authors note that while it's reasonable to assume that these efforts have had an impact on antimicrobial resistance in food-producing animals and food, assessing that impact has been difficult.

Beyond continuing efforts to encourage responsible antimicrobial use in food-producing animals, the authors conclude that more antimicrobial reduction strategies are necessary, including improved disease prevention measures to stop the spread of microorganisms within and between farms. In addition, they argue that antimicrobial alternatives, such as vaccines, probiotics, and bacteriophages, should be considered. And they suggest that alternative farming systems that require fewer antimicrobials without sacrificing animal health should be explored.

"It is clear that strategies that are already available can be implemented immediately and will have a positive impact on levels of antimicrobial resistance," EFSA Executive Director Bernhard Url, DVM, says in a press release. "At the same time, there is a need for innovative solutions—we need to find alternative ways to prevent and treat bacterial infections in animals."
Jan 24 EMA and EFSA joint scientific opinion
Jan 24 EMA and EFSA press release

 

Study shows high MDR Staph capitis levels in French NICUs

The multidrug-resistant Staphylococcus capitis clone, NRCS-A, that has been isolated from neonatal intensive care units (NICUs) in 17 countries is plaguing some NICUs in France, according to a research letter in Emerging Infectious Diseases today.

The French team conducted a lab-based retrospective epidemiologic probe of 47 of the country's 57 NICUs to estimate NRCS-A prevalence. The researchers found that only 4 NICUs were completely free of the bacterium. Of the 43 affected NICUs, NRCS-A strains accounted for up to 46% of cases of positive blood cultures from newborns, with a median of 13%.

The authors conclude that these data and other global data "unquestionably demonstrate the unusual worldwide endemicity of the multidrug-resistant NRCS-A clone in NICUs. In addition, the epidemiologic data from France highlight the propensity of NRCS-A to invade and settle in most NICUs on a national scale.

"Once endemic in a NICU, NRCS-A strains expose infected neonates to a risk of therapeutic failure because treatment of neonatal sepsis involving methicillin-resistant coagulase-negative staphylococci is usually based on vancomycin and aminoglycosides, to which NRCS-A isolates are not susceptible."
Jan 26 Emerg Infect Dis research letter

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