News Scan for Oct 13, 2017

Vaccine attack in Syria
;
El Nino and Zika
;
Detecting congenital Zika
;
MDR pneumonia

WHO condemns attack on Syrian vaccine supply 

The World Health Organization (WHO) today said it has received word of an attack at medical facilities in Syria that destroyed the only vaccines cold room in a district where several polio cases have been reported over the past several months.

At the time of the attack, more than 100,000 doses of measles vaccine, 35,000 doses of polio vaccine, equipment, and supplies of vaccines for other childhood diseases were stored in the facilities. In a statement, the WHO said if confirmed, the attack would set back efforts to protect children in Deir ez-Zur from preventable diseases, including polio. Polio vaccination has been stepped up in the area, where the disease has affected 48 children this year.

Elizabeth Hoff, WHO's representative in Syria, said, "We unequivocally condemn these actions. Vaccines are not a legitimate target of war."
Oct 13 WHO statement

In related develoments, three more vaccine-derived polio cases have been identified in Syria, according to the Global Polio Eradication Initiative's (GPEI's) weekly update. One of the patients has symptoms, while the other two confirmed cases occurred in healthy children.

The patient who is symptomatic had no history of polio vaccination. He was 19 months old when symptoms began. All three new cases were detected in Mayadeen district, Deir ez-Zur governorate, where most of Syria's vaccine-derived cases have occurred this year. The onsets of paralysis ranged from Mar 3 to Aug 19.

Oral monovalent polio vaccine is being used to combat this outbreak. The second immunization round for Raqqa began on Oct 7 and targets children younger than 5 years.
Oct 13 GPEI report

 

Study: Climate change, natural disasters contributed to Zika epidemic

A study yesterday in the journal GeoHealth argues that natural disasters caused by climate change lead to an increase in infectious disease outbreaks, including Zika, West Nile, and dengue.

The research was conducted by scientists at the University of Colorado Anschutz Medical Campus who looked at the spike in Zika cases following a magnitude 7.7 earthquake that struck Manabi, Ecuador, in April 2016. The following months saw a 12-fold increase in Zika cases in the quake zone.

According to the study, in July of 2016 UNICEF reported that the number of Zika cases in Ecuador spiked from 92 cases before the earthquake to 1,106 cases just 3 months after the event. The vast majority of these new cases (80%) occurred in Manabi.

In addition, the earthquake was accompanied by changes in El Nino, a weather pattern that brought heavy rainfall to the area. Extra rainfall, warm temperatures, and more people storing water in plastic containers near their homes after the earthquake had damaged municipal water systems all contributed to more mosquitoes and more Zika transmission, the authors said.

"Following the earthquake, the incidence of ZIKV in Manabi surged as social conditions brokedown in the aftermath of the earthquake. We hypothesize that the trigger of a natural disaster during anomalous climate conditions and underlying social vulnerabilities were force multipliers contributing to the spread of ZIKV in this region of Ecuador," the authors concluded.
Oct 12 GeoHealth study
Oct 12 CU Anschutz
press release

 

Data show brain calcifications not a good diagnostic criterion for Zika

The presence or absence of cerebral calcifications should not be considered a major diagnostic criterion for Zika infection in infants. That's the conclusion made by researchers who studied brain computed tomography (CT) scans of 37 infants with confirmed or probable Zika virus and compared those scans with images taken 1 year later.

The study, published in BMJ, showed that brain calcifications reduced in size, disappeared, and diminished in density over the year, despite other presentations of Zika virus. In the 37 Brazilian children studied, 34 experienced shrinking calcifications, 2 showed no change, and 1 had calcifications that were no longer visible.

"Our finding—that brain calcifications in this population of children with confirmed or probable congenital Zika syndrome diminished over time—suggests that the presence of cerebral calcifications should no longer be considered a major criterion for late diagnosis of congenital Zika syndrome," concluded the authors. "Our findings could, in part, explain the difficulty in diagnosing congenital Zika syndrome in children without microcephaly at initial presentation."

The diminished calcifications did not correlate with clinical improvement.
Oct 13 BMJ abstract

 

Study identifies MDR risk factors in hemodialysis pneumonia

A multi-hospital study in South Korea has identified risk factors for infection with multidrug-resistant (MDR) pathogens in patients with hemodialysis-associated pneumonia (HDAP), researchers reported yesterday in BMC Infectious Diseases.

The retrospective observational study identified 105 patients with HDAP at three South Korean hospitals. The responsible pathogen was identified in 53 (50.4%) of these patients, and MDR pathogens were identified in 24 (22.8%). The most frequent MDR pathogen was methicillin-resistant Staphylococcus aureus (MRSA), found in 10 patients (9.5%), followed by Pseudomonas aeruginosa (7 patients, 6.6%) and Acinetobacter baumannii (6 patients, 5.7%).

Multivariate logistic regression analysis found that the occurrence of MDR pathogens in HDAP patients was associated with recent hospitalization (adjusted odds ratio [aOR]: 3.0) and a pneumonia severity index (PSI) score of more than 147 (aOR: 1.0). Based on these findings, the investigators created a prediction tool to identify HDAP patients with MDR pathogens. The tool showed that as the number of risk factors increased, the prevalence of infection with an MDR pathogen also increased (0 risk factors, 7.6%; 1 risk factor, 28.2%; 2 risk factors, 64.2%).

The findings are noteworthy because pneumonia is a common and leading cause of death in hemodialysis patients, and early proper management of HDAP patients—such as treatment with anti-MRSA or anti-pseudomonal agents—could reduce mortality.

The authors conclude, "Although large-scale prospective studies are needed to confirm our results, our findings would be helpful for physicians' decisions to select HDAP patients harboring MDR pathogens."
Oct 12 BMC Infect Dis study

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