News Scan for Sep 11, 2017

News brief

CDC reports 39 sick in Campylobacter outbreak linked to puppies

The US Centers for Disease Control and Prevention (CDC) said 39 cases of Campylobacter infections have been identified in people who had recently come into contact with puppies at Petland pet stores.

Seven states (Florida, Kansas, Missouri, Ohio, Pennsylvania, Tennessee, and Wisconsin) reported illnesses. Twenty-seven people who fell ill reported recently buying a puppy from Petland, visiting a Petland store, or visiting a home with a new puppy purchased from Petland. Twelve people who became ill were Petland employees.

Illnesses began on Sep 15, 2016, through Aug 12, 2017, with the most recent illness reported on Sep 1. Patients range in age from under 1 to 64 years. Nine people were hospitalized, but no deaths have been reported.

According to the CDC, Campylobacter can be spread through contact with dog feces, and whole-genome sequencing identified Campylobacter closely related to the outbreak strain in puppies sold through Petland in Florida.
Sep 11 CDC announcement

Another outbreak strain, another papaya brand recalled due to Salmonella

The CDC)today noted a new Salmonella outbreak tied to Mexico papayas, and the Food and Drug Administration (FDA) announced yesterday that Bravo Produce Inc., of San Ysidro, Mexico, recalled its Maradol papayas after fruit tested positive for Salmonella.

The new outbreak of illnesses has been caused by a new strain, Salmonella Anatum, which was found on the skins of Bravo Produce Inc.'s Maradol papayas. Fourteen people in three states—Arizona, California, and Colorado—have fallen ill with Salmonella from this strain. According to the CDC, illnesses started on dates ranging from Dec 20, 2016, to Apr 8, 2017. Five ill people have been hospitalized, and one person in California has died.

There are now four separate and ongoing papaya-Salmonella outbreaks in the United States. In a separate update today, the CDC said the case count from the other three outbreaks has remained the same, at 201, including 1 death.

"Bravo Produce Inc will be taking precautionary measures to ensure the safety of its imported products by taking samples from each cargo to a private laboratory authorized by that agency for the determination of Salmonella," the FDA said in a statement. "The company is also cooperating with FDA in its investigation and will provide all possible assistance."

The FDA first announced papaya-linked Salmonella outbreaks on Jul 21, involving Maradol papayas grown at the Carica de Campeche farm in Tenabo, Mexico. Bravo Produce Inc. joins Carica de Campeche, Caraveo Produce, and El Zapotanito, as growers who have voluntarily removed their papayas from the US market.
Sep 11 CDC update on Salmonella Anatum
Sep 11 CDC update on other outbreaks
Sep 10 FDA announcement

New case of MERS confirmed in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) reported a new case of MERS-CoV in Az Zulfi on Sep 8, and a death in a previously announced patient on Sep 10.

A 61-year-old Saudi woman from Az Zulfi was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) after presenting with symptoms of the virus. She is in stable condition. The woman's source of infection is listed as "primary," meaning it's unlikely she contracted the virus from another person.

On Saturday the MOH said a 21-year-old Saudi man from Dumah Al Jandal had passed away after contracting MERS-CoV.

Saudi Arabia's MERS-CoV case count since 2012 has now reached 1,721, including 694 deaths. Seven patients are still being treated, according to the MOH.
Sep 8 MOH report
Sep 10 MOH report

Researchers note multiple reassortments in H5N6 avian flu viruses in Japan

Japanese investigators report that five distinct reassortants of H5N6 highly pathogenic avian influenza virus (HPAIV) affected Japanese poultry and wild birds last winter.

In a study in Virology, the researchers analyzed 89 H5N6 viruses belonging to clade 2.3.4.4 obtained from birds. In testing neuraminidase genes, they found three distinct PA genes and two NS genes that originated from distinct H5N6 viruses from China.

The authors conclude, "Japanese H5N6 HPAIVs were generated from an ancestral H5N6 virus, presumably an H5N6 HPAIV that circulated in China, through several reassortment events with other H5N6 HPAIVs or 3 different lineages of AIVs (or both)." They add that their findings highlight the importance of active surveillance.
Sep 9 Virology study

Stewardship / Resistance Scan for Sep 11, 2017

News brief

More children with asthma getting unnecessary antibiotics, study finds

New research presented today at the annual meeting of the European Respiratory Society (ERS) indicates that children with asthma are more likely to be prescribed antibiotics than those without a diagnosis of asthma, even though antibiotics are not recommended for asthma treatment.

The study, presented by Esme Baan, MD, of Erasmus University in the Netherlands, compared antibiotic prescription data for 1.5 million children from the United Kingdom, including 150,000 with asthma, and 375,000 from the Netherlands, including approximately 30,000 with asthma. The patients, ages 5 to 18 years, were identified from population-based primary care databases in both countries.

Baan and her co-authors found that 197 antibiotic prescriptions were dispensed per 1,000 children with asthma per year in the Netherlands, compared with 126 prescriptions per 1,000 children without asthma. The United Kingdom saw 374 antibiotic prescriptions per 1,000 children with asthma annually, compared with 250 prescriptions per 1,000 children without asthma. In both countries, amoxicillin was the most commonly prescribed antibiotic.

Baan said in a news release that their analysis found most of the antibiotic prescriptions in the asthmatic children were linked to asthma exacerbations or bronchitis—conditions often caused by a virus.

"It can be difficult for a GP [general practitioner] to differentiate between a deterioration in asthma symptoms and a bacterial respiratory infection," Baan said. "We think this might be leading to more antibiotic prescriptions in children with asthma."

The Netherlands and the United Kingdom both follow the same international guidelines on asthma treatment, which state that antibiotics should not be given for deterioration in asthma symptoms. Baan says she suspects the situation may be similar in other countries.
Sep 11 ERS International Congress 2017 news release
Sep 11 MedPage Today story

Environmental hygiene cited as key to combating resistant bacteria in ICU

Clinicians in Spain were able to combat a simultaneous intensive care unit (ICU) outbreak of OXA-48–producing Enterobacteriaceae (OXA-48-PE) and multidrug-resistant Acinetobacter baumannii (MRAB) by focusing on environmental hygiene and other measures, according to a new study in the American Journal of Infection Control.

The authors describe on outbreak from July to October 2015 that involved 13 patients colonized or infected by OXA-48-PE and 18 by MRAB in an ICU. Interventions included patient isolation, daily hygiene with 4% chlorhexidine soap, and contact precautions. An in-depth cleaning of the ICU was performed with a chlorine solution, followed by decontamination with vaporized hydrogen peroxide (VHP). Researchers obtained environmental samples before and after the decontamination.

The cumulative incidence of OXA-48-PE and MRAB was 3.48% and 4.81%, respectively, before interventions. In the period after the intervention, the rates were 0.8% and 0%, respectively. Before the VHP biodecontamination, 4.5% of environmental samples were positive for OXA-48-PE and none for MRAB. After biodecontamination, 1.4% of samples were positive for OXA-48-PE and none for MRAB.

The authors conclude, "This study emphasizes the importance of environmental hygiene in the control of outbreaks caused by microorganisms of high environmental impact. The rapid effect after the VHP treatment suggests an influence of this measure in eradication."
Sep 8 Am J Infect Control study