News Scan for Nov 06, 2017

News brief

Supplement details group B Streptococcus, resistance risks

Group B Streptococcus (GBS) bacteria cause at least 147,000 stillbirths and infant deaths worldwide each year, but providing effective treatment brings up antibiotic resistance and stewardship issues, according to a supplement to Clinical Infectious Diseases published today.

Led by the London School of Hygiene & Tropical Medicine (LSHTM) and involving more than 100 researchers from around the world, the series of 11 research papers estimates that about 18% of women globally harbor GBS. The researchers also conservatively estimate that, out of 410,000 GBS cases every year, at least 147,000 stillbirths and infant deaths occur around the globe annually. Africa had the highest burden, with 54% of estimated cases and 65% of stillbirths and infant deaths, despite housing only 13% of the world's population.

According to the new research, funded by the Bill & Melinda Gates Foundation, the top five countries by numbers of pregnant women colonized with GBS were India (2,466,500), China (1,934,900), Nigeria (1,060,000), the United States (942,800), and Indonesia (799,100).

GBS prevention focuses on prescribing antibiotics to women in labor, aiming to reduce disease in infants, given that no vaccine is available, according to an LSHTM news release. At least 60 countries have a policy for antibiotic use in pregnancy to prevent newborn GBS disease, but implementation of policies varies.

Joy Lawn, MB BS, PhD, an LSHTM professor, said in the release, "Antibiotics currently prevent an estimated 29,000 cases of early-onset group B Streptococcal disease per year, almost all in high-income settings. However, this approach may be difficult in low-income settings where many births take place at home, and laboratory capacity for screening for GBS is limited. In addition, giving antibiotics to 21.7 million women may contribute to antimicrobial resistance—a major global health crisis."
Nov 6 Clin Infect Dis supplement
Nov 6 LSHTM news release

 

CDC announces end to papaya-linked Salmonella outbreak investigations

The Centers for Disease Control and Prevention (CDC) late last week announced the end of official investigations into a Salmonella outbreak linked to Maradol papayas imported from Mexico. The CDC said the outbreaks appear to be over.

A total of 251 people were sickened in 25 states, in four separate outbreaks, each linked to a different papaya grower in Mexico. Two people died, and 79 were hospitalized. Since the CDC's last updates on Sep 13, officials have confirmed 16 new cases.

The largest outbreak occurred with fruit grown on the Carica de Campeche farm in Tenabo, Campeche. In that outbreak, the first to be identified by the CDC, 220 people in 23 states were infected, including 1 death in New York City, and 68 hospitalizations. Patients reported illness onset dates from May 17 to Oct 4. Of 145 people interviewed by the CDC during this outbreak, 79 (54%) reported eating papayas.

The outbreaks led to recalls from Grande Produce and Bravo Produce, among other distributors of Mexican papayas.
Nov 3 CDC
update on largest outbreak
Nov 3 CDC update on Urbana outbreak
Nov 3 CDC
update on Infantis outbreak
Nov 3 CDC
update on Anatum outbreak

 

New study to investigate genetic susceptibility to Ebola

The US National Institute of Allergy and Infectious Diseases (NIAID) launched a new prospective study to examine the role genes may play in Ebola virus. The study is based in Liberia, and will enroll 8,000 children and adults, including people who got sick and survived during the 2013-2016 outbreak, people wo had close contact with a patient but didn't get sick, and people with no known Ebola exposure.

In addition, researchers will use blood samples from 500 patients who died from Ebola virus. The blood samples of enrollees will be analyzed by teams of researchers in the United States and Liberia, who will use special equipment to read each patient's DNA in an effort to determine if certain genes are more likely to confer Ebola virus disease or certain symptoms.

"Why some infections are asymptomatic while others are fatal, or why some people rapidly clear the infection while others remain in treatment for weeks or have lingering traces of virus months or years after infection, remains unclear," the NIAID said in a press release. "Investigators predict that by studying people's DNA, they might uncover genetic differences that influence these outcomes."
Nov 3 NIAID
press release  

 

Minnesota officials report deadly 17-case outbreak of MDR-TB

Ramsey County, Minnesota, home to St. Paul, is combatting the nation's largest outbreak of multidrug-resistant tuberculosis (MDR-TB), which has grown to 17 cases and 6 deaths, the Minneapolis Star Tribune reported today.

The outbreak has primarily affected elderly residents of the county's Hmong community, with 10 cases linked to a senior care center, where the first case was detected last year. Four other Ramsey County Hmong residents also contracted MDR-TB.

Of the 6 deaths, 3 were a direct result of the disease, health officials said. State officials are monitoring more than 350 people who may have been exposed. Testing on 125 people has revealed 58 latent TB cases, which means people who have no symptoms but can pass the disease to others. The report did not say whether those cases involved resistant strains. People with latent TB are being urged to take second-tier antibiotics—the same as MDR-TB patients—but the treatment can last up to 2 years and cost $134,000. (First-line treatment lasts at least 6 months and costs $17,000, the story said.)

"In the case of these individuals, if there wasn't evidence that they had been exposed to multi-drug resistant tuberculosis, then they would have just been recommended to get the normal course of treatment," said Kris Ehresmann, RN, MPH, infectious disease director at the Minnesota Health Department. "But the [second-tier] treatment is arduous and has many side effects."

The outbreak represents another costly challenge for Minnesota health officials, who had to deal with a 79-case measles outbreak earlier this year. The state has tapped almost $225,000 in emerging fund to combat the MDR-TB outbreak.

Minnesota has the second-largest US Hmong population, after California.
Nov 6 Star Tribune story

Vector-borne Disease Scan for Nov 06, 2017

News brief

Florida announces sexually transmitted Zika case

The Florida Department of Health (Florida Health) on Nov 3 said a sexually transmitted Zika infection has been confirmed in Miami-Dade County, affecting a person whose partner had recently traveled to several countries, including Cuba, where active transmission is occurring.

In a press release, officials said there is no evidence of ongoing active Zika transmission anywhere in Florida. The patient had no history of travel, and the patient and partner both tested positive for Zika virus.

In response, Florida Health notified mosquito control authorities, who conducted mosquito reduction steps. Officials said the case is a reminder that Zika can transmit sexually and that it is important to take precautions if an individual or his or her partner traveled to an area where the virus is circulating.

The announcement marks Florida's second locally acquired Zika case of the year. In the middle of October, Florida Health said a case had been confirmed in Manatee County, which wasn't one of the areas that reported cases last year. The investigation found a couple had recently traveled to Cuba, with one experiencing Zika symptoms shortly after returning home. Evidence suggested that the infected patient was bitten by a mosquito in or around the home, which passed the virus to the other partner.
Nov 3 Florida Health press release
Oct 12 CIDRAP News scan "
Florida announces its first local Zika case of the year"

 

As Nigeria yellow fever outbreak grows, more vaccine drives planned

In the wake of a yellow fever case confirmed in September in a girl from Nigeria's Kwara state, enhanced surveillance for acute jaundice syndrome has turned up 166 cases, 10 of them fatal, from six states, and tests on half of the cases have resulted in three confirmed cases, the World Health Organization Regional Office for Africa (WHO AFRO) said in its weekly update on outbreaks and other emergencies.

Among the three confirmed cases, based on plaque reduction neutralization testing (PRNT) at the Pasteur Institute in Dakar, two were fatal. Patients are from Kogi and Kwara state. Results from nine other people are still pending.

In the middle of October, Nigeria launched a yellow fever vaccination campaign targeting 874,000 people in Kwara and Kogi states. According to today's update, the campaign achieved 98% coverage. More vaccination campaigns in the affected areas are planned for December.

The WHO said investigators have found suboptimal routine yellow fever vaccine coverage in a number of states. Though the response to the outbreak has been rapid, a full risk assessment for yellow fever transmission is still needed as officials step up surveillance for acute jaundice syndrome and scale up immunization activities.
Nov 6 WHO AFRO weekly bulletin on outbreaks and other emergencies

 

Burkina Faso battles dengue surge involving multiple subtypes

A dengue fever outbreak in Burkina Faso that began in early August has so far resulted in 6,699 illnesses, 13 of them fatal, the WHO said today in a statement.

The case total quickly passed earlier seasonal outbreaks, and, unlike an outbreak in 2016, several serotypes have been detected. Illnesses have been reported in 12 of the country's 13 health regions, though 64% are in the central region, especially in the city of Ouagadougou, the country's capital.

Of cases reported through Oct 27, virus characterization of 72 samples revealed that 58 were dengue virus type 2, 12 were type 3, and 2 were type 1.

The WHO said the outbreak is occurring against the backdrop of an improved but still limited dengue surveillance system in Burkina Faso and that the weekly number of reported cases is probably an underestimate. It warned that the country's outbreak could involve more severe cases this year, because last year's outbreak involved dengue type 2 only. Repeat illnesses with a different strain are known to carry a higher risk of severe infection. The timing of the outbreak, which is following the rainy season, poses a continued threat of ample mosquito breeding areas, especially in cities.

Burkina Faso has activated its national epidemic management committee, strengthened surveillance, provided free medical care for severely ill people who are treated in hospitals, intensified vector control, and distributed 1,500 long-lasting insecticidal nets to hospitals.
Nov 6 WHO statement

 

Latest PAHO updates show small increases in chikungunya cases

In the past 5 weeks the Pan American Health Organization (PAHO) has reported just 580 new chikungunya infections, bringing the yearly total to 183,530 confirmed, suspected, and imported cases.

Because of the low numbers, CIDRAP News has not reported on the outbreak since PAHO's Sep 29 update, when the agency noted 223 new cases. The week before that (Sep 22), PAHO reported 37,254 new cases, almost all of them in Brazil.

During the most recent weeks, Peru reported the highest increase, with 127 new cases and 1,668 total for the year, according PAHO's Nov 3 update. Colombia was next, with 89 new cases, for a total of 995 so far in 2017. Several other nations reported small increases, including the United States, which has now confirmed 80 imported cases.

A host of nations, however, including Brazil, which has reported more than 90% of this year's total, have not reported on their chikungunya situation for weeks.

Since the outbreak began in 2013 on the Caribbean island of St. Martin, the Americas region has reported 2,569,661 cases.
Nov 3 PAHO update

This week's top reads

Our underwriters