News Scan for Oct 17, 2017

Southern Hemisphere flu decline
;
Influenza in VA hospitals
;
H5N6 avian flu in China
;
H5N8 in South Africa
;
Hospital-acquired pneumonia

Flu starts to decline in Australia, elsewhere

Influenza is finally on the decline in Australia, according to yesterday's global flu update from the World Health Organization (WHO). Influenza A, H3N2, remained the dominant circulating strain, followed by influenza B.

Several parts of South Asia joined Australia and New Zealand in reporting declining flu levels, including India, where H1N1—the other circulating "A" strain—has been most frequently detected. Flu activity remained high, however, in Cambodia. In East Asia, flu activity remains low.

Both South America and Southern Africa reported downward trends in flu activity. Caribbean and Central American countries reported low activity in general, but respiratory syncytial virus (RSV) activity remained high in several countries. In temperate parts of the Northern Hemisphere, flu activity is still at low levels.

According to data collected in laboratories across the globe between Sep 18 and Oct 1, 73.4% of positive flu samples were typed as influenza A and 26.6% as influenza B. Of the subtyped influenza A viruses, 15.1% were H1N1 and 84.9% H3N2.
Oct 16 WHO update

 

Flu trends in VA system correspond to national trends

A new study that analyzed flu trends in the Veterans Affairs (VA) hospital systems from 2011 to 2016 and compared those data to the Centers for Disease Control and Prevention's (CDC's) FluView data found high levels of correlation between rates of hospitalization and positive tests. The study was published yesterday in Influenza and Other Respiratory Viruses.

For 13,690 influenza-coded VA hospitalizations, the median patient age was 67 years, 12,914 (94%) were male, and the median stay was 4 days, with 2,148 (16%) involving intensive care and 406 deaths (3%). These number track national trends presented in CDC's FluView.

The authors said their data can help both VA and CDC decision-makers who must estimate the annual burden of influenza.

"These data are important to understand influenza epidemiology, local impacts, and effects on an entire healthcare system. It is also valuable for developing prevention strategies, containment measures, and for resource allocation and supply distribution," the authors concluded.
Oct 16 Influenza Other Respir Viruses study

 

China reports H5N6 outbreak at commercial poultry farm

China's agriculture ministry today announced a highly pathogenic H5N6 avian flu outbreak, which struck a commercial broiler farm in the city of Hexian in Anhui province in the eastern region, Reuters reported, citing a ministry statement.

The virus infected 28,650 chickens, killing 15,066 of them. Local authorities culled 30,196 as part of the outbreak response. The ministry said the outbreak is under control, according to the report. China's last H5N6 outbreak, reported in August, struck a quail farm in Guizhou province in the southwestern part of the country.

H5N6 has been linked to poultry outbreaks in China and a handful of other Asian nations. The virus is notable because it can also infect humans. So far 17 infections have been reported, all of them in China.
Oct 17 Reuters story

In other H5N6 developments, Chinese researchers who analyzed genetic sequences of H5N6 viruses from the nation found increasing diversity. They published their findings in an Oct 13 letter to the Journal of Infection.

Reassortant H5N6 viruses fell into two cocirculating lineages, one of which was seen in Sichuan province and a more predominant one found in human isolates from Guangdong and other provinces, suggesting distinct geographic distribution patterns. The investigators said genetic diversity has increased with geographic distribution since June 2012, peaking in March 2014.

They noted that almost half of the human H5N6 cases have occurred in Guangdong province, which hints at a threat of persistence and dissemination in southern China. They noted the vulnerability of Guangdong province to novel avian flu reassortment; it has many miles of coastline, wetlands, and lakes and is in the middle of a migratory flyway. Also, the province has many poultry farms, free-range ducks in numerous backyard farms, and live-poultry markets.
Oct 13 J Infect abstract

 

H5N8 hits more farms, wild birds in South Africa

South Africa today reported 13 more highly pathogenic H5N8 avian flu outbreaks, 6 in poultry and 7 in other captive birds and wild birds, according to separate reports from the World Organization for Animal Health (OIE).

The poultry farm outbreaks began from Aug 28 to Oct 10, two of which struck commercial ostrich facilities. Five of the events hit farms in Western Cape province in the southwest, and one farm is in Free State province in the central part of the country. Of 788,713 susceptible poultry, the virus killed 20,687, and authorities destroyed the surviving birds.

Agriculture officials also confirmed seven more outbreaks in other captive birds and in wild birds. The detections occurred from Sep 13 to Oct 10, one in Eastern Cape province and six in hard-hit Western Cape province. Some involved hobby farms, and others involved wild birds including a crow, a falcon, and laughing doves found dead. Taken together, 40 bird deaths were reported.
Oct 17 OIE report on H5N8 in South African poultry
Oct 17 OIE report on H5N8 other South African birds

 

Studies find hospital pneumonia tied to higher costs, mortality

Two studies published yesterday in the American Journal of Infection Control yesterday found varying levels of non-ventilator hospital-acquired pneumonia (NV-HAP) in US hospitals and noted that it is associated with increased costs, length of hospital stay, and mortality.

In the first study, Dian Baker, PhD, RN, and Barbara Quinn, MS, RN, of Sacramento, Calif., conducted a chart review of NV-HAP cases in 21 US hospitals in 2014. They identified 1,300 patients, and estimated that the NV-HAP rate varied from 0.12 to 2.28 cases per 1,000 patient-days.

Almost three fourths of cases (70.8%) were acquired outside of intensive care units (ICUs), and 18.8% required transfer into the ICU. The authors found that NV-HAP occurred in every hospital unit, including in younger, previously healthy patients. They conclude, "This indicates that although some patients are clearly at higher risk, all patients carry some NV-HAP risk. Therapeutic interventions aimed at NV-HAP prevention are frequently not provided for patients in acute care hospitals."

In the second study, Baker and Quinn were joined by Karen Giuliano, PhD, RN, of Northeastern University in Boston. The researchers analyzed 2012 US National Inpatient Sample data to compare an NV-HAP group to four other cohorts: pneumonia on admission, general hospital admissions, matched on mortality and disease severity, and ventilator-associated pneumonia (VAP). The main outcome was NV-HAP incidence, but they also assessed hospital length of stay, total hospital charges, and mortality.

They found that the overall incidence of NV-HAP was 1.6%, or 3.63 cases per 1,000 patient-days. NV-HAP was associated with increased total hospital charges, a longer hospital length of stay, and higher mortality compared with all groups except VAP patients.
Oct 16 Am J Infect Control multicenter study
Oct 16 Am J Infect Control
national dataset study

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