News Scan for May 12, 2017

Brazil ends Zika emergency
;
Drug-resistance in Belgium
;
GAO weighs avian flu control
;
Emergency readiness challenges

Brazil declares end to Zika emergency

Yesterday Brazil's Ministry of Health lifted the state of emergency caused by the Zika virus, due to the country's dwindling case counts of the mosquito-borne disease.

Brazil was the country hardest hit by the 2016 Zika epidemic, and continues to report the most cases of congenital birth defects, including microcephaly, associated with prenatal exposure to the virus. But this year has seen a dramatic reduction in case counts: From Jan 1 to Apr 15, the country reported 7,911 Zika cases. During the same time period in 2016, Brazil tallied 170,535 cases. That is a 95.5% reduction in cases.

According to The Rio Times, there has also been a significant slowdown in the reporting of microcephaly cases in 2017. Only 230 cases have been confirmed this year. Since November of 2015, the country has seen 2,653 cases of microcephaly.
May 11 Rio Times story

In other Zika news, researchers from the University of Wisconsin-Madison have demonstrated highly efficient mother-to-fetus transmission in four pregnant rhesus macaques who were injected with Asian-lineage Zika virus. They reported their findings yesterday in bioRxiv, a prepublication Web portal for scientific studies.

Three of the four monkeys had prolonged viremia, and all pregnancies had signs of first trimester fetal tissue damage. The authors say this work can help identify infection patterns in pregnant women infected with Zika.
May 11 bioRxiv study


Rise of carbapenemase-producing enterobacteriaceae reported in Belgium

Belgian researchers are reporting a rise in carbapenemase-producing enterobacteriaceae (CPE), including a colistin-resistant MCR-1 producer, in hospitals and the community in Belgium.

In a surveillance and outbreak report published yesterday in Eurosurveillance, the researchers report on a survey of non-duplicated enterobacteriaceae isolates from clinical specimens collected at 24 hospital-based and 10 private laboratories from September to November 2015. All isolates were tested locally for susceptibility to the carbapenem antibiotics meropenem and ertapenem, and those showing decreased susceptibility were tested for carbapenemase production.

In total, 4,705 and 1,991 enterobacteriaceae isolates were tested by the hospital-based and private labs, respectively. The results showed the minimal estimated proportion of CPE was 0.55% (26 of 4,705) among clinical isolates from hospitalized patients, which represents a doubling of the proportion (0.25%) found in a similar survey conducted in Belgian hospitals in 2012. The minimal estimated proportion of CPE among isolates from ambulatory patients was 0.60% (12 of 1,991). This is the first documentation of CPE in an ambulatory setting in Belgium, the authors note.

Of the 38 CPE isolates detected, 86% (26 of 38) were Klebsiella pneumoniae, and 74% (28 of 38) were found to carry the OXA-48 carbapenemase gene. Other organisms included Escherichia coli, Klebsiella oxytoca, Citrobacter freundii, and Citrobacter koseri. Other carbapenemase genes detected included NDM-1, KPC-2, KPC-3, and NDM-5. Of the 7 CPE isolates that were resistant to the last-resort antibiotic colistin, one was found to carry the plasmid-mediated MCR-1 gene

"Although the proportion of CPE remained globally low, the steady progression and spread of CPE in Belgian hospitals and the emergence of colistin-resistant (including plasmid-mediated mcr-1 harbouring) strains among CPE raises major concerns," the authors write.
May 11 Eurosurveill report

 

GAO finds progress on avian flu control, sees need to evaluate actions

Responding to questions on avian influenza from US Congress members in the wake of recent poultry outbreaks in the United States, the Government Accountability Office (GAO) yesterday issued its findings, saying that the US Department of Agriculture (USDA) has taken several steps based on lessons learned but doesn't have a plan to evaluate their effectiveness.

In a 59-page report, the GAO identified 15 lessons learned and 308 related corrective actions. It based its findings on interviews with federal officials and stakeholders from the poultry industry, as well as a review of the global avian flu situation and the economic impact of the disease.

Investigators found that the USDA has completed about 70% of the corrective actions. For example, one of the lessons was a lack of workers skilled at poultry depopulation, which led to delays in completing that key response step.

The GAO's main recommendation was to develop a plan to evaluate the actions, which it said would help gauge effectiveness and guide future policy. It also outlined some challenges the industry faces, such as the voluntary nature of biosecurity measures among poultry producers and that much of the current influenza vaccine technology is based on chicken eggs, which would be at risk during avian flu outbreaks. The USDA agreed with the GAO's recommendations.
May 11 GAO report

 

Isolation unit network in wake of Ebola faces support, readiness challenges

A 2016 survey of high-level isolation units (HLIUs) in the United States that were used during the Ebola outbreak uncovered challenges hospitals face in sustaining them, especially in the face of uncertain funding, researchers reported this week in Emerging Infectious Diseases.

Survey questions went to 56 designated HLIUs, which included 10 that had been selected as US Department of Health and Human Services (HHS) regional treatment centers for Ebola and other pathogens. Thirty-six hospitals (64%) responded, and 33 completed the full survey. Of that number, 3 said they had phased out their HLIU capability.

Nineteen hospitals said they used the special units, when not needed for infectious diseases, for other patients, while 14 said they used them exclusively for infectious diseases or for training. The adapted units had challenges, including unavailability for training and the need for relocating multiple patients when used for infectious disease purposes.

Since 2015, 25 facilities had received some federal support, but 8 hadn't received any. The 14 units with HHS regional designation had spent $9.1 million more than they had been reimbursed by the federal government, resulting in struggles to maintain operations and readiness.

The researchers said that, without Ebola or another disease threat on the horizon, support for special treatment units is shaky. With additional support uncertain, the facilities must craft ways to sustain the units if they are to maintain their readiness, the team added.
May 10 Emerg Infect Dis report

 

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