News Scan for Aug 14, 2017

MERS case
;
Multidrug-resistant BSIs in India
;
Polio emergency continues
;
Ricin vaccine funding
;
Chikungunya in the Americas

New MERS case reported in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) reported a new case of MERS-CoV over the weekend.

The 89-year-old Saudi man from Baljurashi in the southwestern part of the country is in stable condition after being diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus). The source of his infection is listed as "primary," meaning it's unlikely he contracted the disease from another person.

The latest case raises Saudi Arabia's total number of MERS-CoV illnesses since the virus was detected for the first time in humans in 2012 to 1,695, with 689 deaths. Eleven people are still being treated for their infections.
Aug 12 MOH report

 

Study finds high mortality for colistin- and carbapenem-resistant BSIs

An in-hospital mortality rate of nearly 70% was observed in Indian patients with dual colistin- and carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CCRKP BSI), researchers report in a new study in the American Journal of Infection Control.

In a small trial conducted at a single tertiary care hospital in India from January 2011 through December 2015, the researchers found that out of 75 patients identified as having CCRKP BSI, 52 (69.3%) died in hospital. Among the patients who died, 27 died within 48 hours of developing bacteremia.

In univariate analysis, risk factors significantly associated with increased mortality included intensive care unit stay at the time of BSI (66% of patients who survived vs 88% of patients who died), length of stay prior to BSI onset (10.1 vs 19.3 days), Pitt bacteremia score of 4 or greater (21.7% vs 84.6%), and pneumonia as the source of BSI (4.3% vs 26.9%). In multivariate analysis, only Pitt bacteremia score of 4 or greater was significantly associated with increased mortality (odds ratio 19.8). Carbapenem-based combination therapy was administered to 55 patients (17 of 23 patients who survived, 38 of 52 patients who died), but no survival benefit was observed.

The authors note that the findings are consistent with those of a previous study from Greece that reported a 75% in-hospital mortality among patient with CCRKP BSI. The emergence of CCRKP strains in India is believed to be the result of increasing use of polymixin-based therapies to treat carbapenem-resistant K pneumoniae infections.

"In conclusion, CCRKP BSIs are associated with high mortality," the authors write. "There is an urgent need for new antibiotics to treat these infections."
Aug 11 Am J Infect Control abstract

 

WHO extends polio global emergency

The World Health Organization (WHO) emergency committee on polio met for the 14th time on Aug 3 by teleconference and unanimously agreed that recent developments warrant keeping in place a public health emergency of international concern (PHEIC) for spread of the virus.

A PHEIC, as defined by the International Health Regulations, has been in place for polio since May 2014. The WHO's emergency committee on the disease typically meets every 3 months, or sooner as needed. The group's last meeting was on Apr 24.

Regarding the spread of wild poliovirus type 1 (WPV1), the group said it was encouraged by steady progress in all three countries still affected-—Pakistan, Afghanistan, and Nigeria. Globally, the number of new cases continues to decline, and no international spread has been detected in the past 3 months. The group commended both Pakistan's and Afghanistan's improvements with vaccination but raised concerns about the widespread nature of positive environmental samples in Pakistan and pockets of missed children in vaccination campaigns in southern Afghanistan.

The group noted that no new WPV1 cases have been detected in Nigeria in about a year, but it said about 250,000 children in Borno state are partially or totally inaccessible to vaccine campaigns. They worried about all the countries experiencing conflict in the Lake Chad basin region, posing a threat of international spread from Nigeria.

New outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2) in the Democratic Republic of Congo (DRC) and Syria are very concerning, because they highlight underimmunization due to conflict or remote geographic conditions. The committee urged any country receiving Syrian refugees, especially from Deir ez-Zor and Raqqa, the two governorates that have reported cVDPV cases, to ensure polio vaccination with inactivated polio vaccine.

Given the latest recommendations, the experts recommended keeping temporary recommendations in place for another 3 months.
Aug 3 WHO statement

In other polio developments, the WHO today said Somalia has gone 3 years without a polio case, which was celebrated at an event in Mogadishu. Somalia saw the end of endemic polio transmission in 2002 but has detected imported cases twice since then. Mahmoud Fikri, MD, director of the WHO's Eastern Mediterranean Regional Office (EMRO) said in a statement that the absence of polio cases in Somalia is a testament to leadership in the country and to the support and collaboration of many partners. However, he added that gaps still need to be addressed, including political insecurity and inaccessibility to some of the children targeted for vaccination.
Aug 14 WHO EMRO statement

 

Ricin vaccine gets additional funding  

Soligenex, the company developing a heat-stable ricin vaccine, received an additional $2.5 million in funding from the National Institute of Allergy and Infectious Diseases (NIAID), for work on RiVax, their ricin vaccine.

The funding will advance the development of Soligenix's thermostabilization technology, ThermoVax, which is used in combination with the company’s ricin toxin vaccine, RiVax.

"The exercise of this option demonstrates the positive and productive collaboration between NIAID and the Soligenix team," said Christopher J. Schaber, PhD, president and chief executive officer of Soligenix.

Ricin is a plant-derived toxin that's highly lethal in doses as small as a grain of salt. The toxin could be used in as a weapon of bioterrorism, and currently there are no known treatments for exposure.
Aug 14 Soligenix press release

 

Countries in the Americas see small rise in chikungunya cases

Nations and territories in the World Health Organization's Americas region reported 153 more suspected, confirmed, and imported chikungunya cases, the Pan American Health Organization (PAHO) said in its latest weekly update.

The region has now reported 141,419 cases for the year. The number of deaths from the disease remained at 51.

The weekly total of 153 was down steeply from the previous week's 607 new cases. Many locations didn't report, including Brazil, the country hit hardest by the disease this year. Most of the new cases were reported from Costa Rica, Guatemala, Nicaragua, and Bolivia. Also, Guadeloupe and Martinique—located in the Americas' Latin Caribbean subregion—reported a few more cases.

Since the outbreak began in the Americas in 2013, the region has now reported 2,528,130 chikungunya infections.
Aug 11 PAHO statement

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