News Scan for Mar 13, 2017

MERS hospital outbreak
;
Yellow fever in Rio
;
Pneumococcal vaccine in kids
;
New chikungunya cases
;
MDRO screening, isolation

Seven Saudi MERS cases reported, 6 tied to suspected hospital outbreak

Over the past few days Saudi Arabia reported seven new MERS-CoV infections, including six that appear to be linked to a hospital outbreak in Wadi ad-Dawasir in the south central part of the country.

Last week Saudi Arabia's Ministry of Health (MOH) announced three MERS-CoV (Middle East respiratory syndrome coronavirus) cases in Wadi ad-Dawasir, one of whom had healthcare exposure and the other two for whom exposure was still under review.

Of the six new patients who appear to be part of the hospital outbreak, 3 were exposed in a healthcare setting, 2 are listed as household contacts, and 1 is a healthcare worker who is asymptomatic, according to statements released by the Saudi Arabia's ministry of health on Mar 10, 11, and 12. The three people who were exposed while patients are two women ages 39 and 56, both in stable condition, and a 72-year-old man whose condition is listed as critical. The two household contacts are both women, ages 52 and 32, and are both listed in stable condition. The healthcare worker is a 39-year-old male expatriate.

The new reports suggest that as many as nine MERS-CoV cases may be involved in the Wadi ad-Dawasir hospital outbreak. Earlier this year Saudi Arabia reported a small hospital outbreak in Buraydah that sickened six people. The virus is known to spread easily in hospital settings, where it has been implicated in several outbreaks, some of them large.

The MOH on Mar 11 also reported an infection in a 79-year-old Saudi man from Al Qunfudhah in the southwest who had direct contact with camels and is hospitalized in stable condition.

So far Saudi Arabia has reported 1,578 MERS-CoV cases, 653 of them fatal, since the virus was first detected in humans in 2012. Sixteen people are still being treated for their infections.
Mar 10 Saudi MOH report
Mar 11 Saudi MOH report
Mar 12 Saudi MOH report

 

Rio de Janeiro to vaccinate against yellow fever

The Rio de Janeiro state of Brazil plans to vaccinate its population against yellow fever in light of the country's current outbreak, according to a Mar 11 report from the Associated Press (AP).

Though there have been no reports of yellow fever in Rio de Janeiro state this year, there have already been more than 300 confirmed cases of yellow fever in Brazil (and more than 1,500 suspected) in 2017, most in the Minas Gerais state. Last week, the World Health Organization said anyone visiting the state of Espirito Santo should get vaccinated against the mosquito-borne illness. Experts warn that the current outbreak is moving towards Brazil's Atlantic coast, home to the country's most populated cities.

The Associated Press said Rio de Janeiro state expects to reach a 90% vaccination rate by the end of 2017. Brazil will need approximately 12 million doses of yellow fever vaccine to complete this campaign.
Mar 11 Associated Press story
Mar 9 CIDRAP News story "Yellow fever in Brazil raises worries of a new Zika-like threat"

 

Pneumococcal vaccine tied to 95% reduction in bacteremia in children

A new study in the journal Pediatrics shows that vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) was associated with a 95.3% reduction of Streptococcus pneumoniae in children ages 3 to 36 months.

The study was based on a retrospective review of hospital and outpatient clinic records from before and after the vaccine was used. A total of 57,733 blood cultures were collected in the California population of children 3 to 36 months old, and researchers compared bacteremia rates from September 1, 1998 to August 31, 2014. From 2000 to 2010, Kaiser Permanente used the 7-valent pneumococcal conjugate vaccine, which was replaced by PVC13 in June of 2010. After its introduction in 2010, PCV13 has decreased pneumonia bacteremia incidence from 74.5 to 10 to 3.5 per 100 000 children per year.

"As shown by time series analysis, the dramatic decline in S pneumoniae bacteremia rates was clearly related to the impact of immunization," the authors write. As PCV13 has made bacteremia from S pneumoniae a rare event, the authors say clinicians must focus on other pathogens that can cause severe illness in young children.

"In the post-PCV13 period, bacteremia was increasingly caused by E coli (39%), Salmonella spp (21%), and S aureus (17%). This changing distribution of pathogens has also been observed in the United Kingdom and Israel," the authors write.
Mar 10 Pediatrics study

 

PAHO reports 600 new chikungunya cases

The Pan American Health Organization (PAHO) in the past 2 weeks added 606 confirmed, suspected, and imported chikungunya cases to its total, bringing the case count for 2017 so far to 5,153.

Paraguay accounted for most of the new cases, noting 421 new cases and 423 for the year, according to a Mar 10 PAHO update. Colombia reported 74 new cases to bring its 2017 total to 279, while Peru notched 49 new cases and 239 for the year. The vast majority of countries in the Americas, however, have not posted for weeks, including any reports in 2017.

The outbreak began in late 2013 on the Caribbean island of St. Martin and has now sickened at least 2,392,146 people.
Mar 10 PAHO update

 

Study supports targeted contact precautions for MDR organism carriage

A new study in the American Journal of Infection Control suggests that isolation-targeted screening is non-inferior to universal screening and isolation for detecting carriage of multidrug-resistant organisms (MDROs).

In the single-center observational study, investigators at a French university-affiliated hospital compared two consecutive 6-month periods at the hospital's 20-bed medical and surgical intensive care unit (ICU). During the first period (June 2012-November 2012), rectal swabs were obtained for all ICU patients on admission, and additional contact precautions (including hand hygiene upon entering and leaving patient rooms and wearing gloves and gowns) were implemented for all patients pending culture results. The screening was focused on extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) and carbapenem-resistant Enterobacteriaceae (CRE).

During the second period (February 2013-August 2013), all consecutively admitted patients were screened on admission with rectal swabs, but additional contact precautions were implemented only for patients who had at least one risk factor for MDRO carriage. The primary outcome was the rate of MDRO acquisition during ICU stay.

Overall, 327 and 297 admissions were analyzed during the two periods, with 33 patients (10%) in the first period and 30 patients (10%) in the second period having a positive MDRO screening on admission. A second screening conducted with 147 patients from the first period and 127 patients from the second period found that the rate of acquired MDRO was similar in both groups (10% and 11.8%, respectively). A prior hospitalization of more than 5 days was the only factor associated with MDRO carriage on ICU admission.

"Further searches on risk factors for MDRO carriage are needed to improve targeted screening and/or isolation on ICU admission," the authors conclude.
Mar 10 Am J Infect Control study

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