News Scan for Dec 19, 2017

More monkeypox
;
Contaminated rattlesnake pills
;
Resistant gonorrhea
;
H5N1 in Cambodia
;
Madagascar plague

Nigeria monkeypox outbreak grows to 61 confirmed cases

According to an updated situation report from the Nigeria Centre for Disease Control (NCDC), there are now 61 monkeypox cases in that country, 5 more than last month. This is Africa's largest-ever monkeypox outbreak.

The 61 lab-confirmed cases have occurred in 10 states, with 172 suspected cases reported from 23 states since the outbreak began earlier this fall. So far, one death has been attributed to monkeypox, with most patients recovering within 3 weeks of symptom onset.

The NCDC said there has been a decline in the number of suspected cases over the last 5 weeks.

There is no cure for monkeypox, which is related both to smallpox. The disease is transmitted when humans come into contact with infected animals, most often through hunting or animal bites and scratches. Less often, the disease is transmitted from person to person via direct contact with saliva or blood.

According to the NCDC, only 7% of the current cases in Nigeria have been linked to human-to-human transmission, including one healthcare worker.
Dec 9 NCDC update

 

CDC: Rattlesnake pills contained Salmonella

The US Centers for Disease Control and Prevention (CDC) said today a case of Salmonella illness has been linked to contaminated rattlesnake pills.

The case was reported to the Kansas Department of Health and Environment. A patient bought the pills in Mexico and was later found to have contracted a Salmonella Oranienburg infection. That Salmonella strain matched a strain found in rattlesnake pills from Mexico collected in an earlier, unrelated investigation.

Rattlesnake pills contain dehydrated rattlesnake meat ground into a powder. They’re often touted as an alternative cure for cancer and HIV.

"Reptiles and their meat can carry Salmonella and make people sick. Past outbreak investigations have identified rattlesnake pills as a source of human Salmonella infections," the CDC said in a news release. The agency said anyone considering taking rattlesnake pills should talk to their healthcare provider.
Dec 19 CDC notice

 

Study shows direct sexual transmission of drug-resistant gonorrhea

Australian researchers have found that transmission of antibiotic-resistant strains between sexual partners is a key driver of resistance rates in gonorrhea among men who have sex with men (MSM), according to a new study in Sexually Transmitted Infections.

Increasing resistance to the last remaining treatment for Neisseria gonorrhea has become a major global health problem, and transmission of drug-resistant gonorrhea strains has repeatedly been linked to MSM. But direct evidence of such transmission is limited. To investigate the role of direct transmission in MSM, investigators with the University of Melbourne used whole-genome sequencing (WGS) to compare isolates and their resistance to antibiotics at a genome level.

The study included 458 male couples who were tested for gonorrhea at the Melbourne Sexual Health Centre on the same day from September 2005 to September 2014. WGS was conducted on all isolates (94) from 34 couples (68 men) where both men had N gonorrhea cultured from at least one site. All but two isolates (98%) were resistant to penicillin, six (7%) showed decreased susceptibility to ceftriaxone, 41 (45%) were resistant to ciprofloxacin, and 7 (8%) were tetracycline resistant.

WGS showed that the resistance-determining genes and mutations were identical in isolates from each partner in 33 out of 34 couples (97%). In addition, resistance determinants in isolates from 23 of 23 men (100%) with multisite infections were identical within an individual. Other molecular typing methods also indicated that the partner and within-host isolates were indistinguishable.

"To our knowledge, our study is the first to provide detailed genomic evidence for direct transmission of the genetic determinants for N. gonorrhoeae resistance between men across multiple antibiotic classes at a person-to-person level," the authors write, adding that the improved understanding of transmission dynamics will inform treatment and prevention guidelines. They note that the findings may not extend to gonorrhea in heterosexuals.
Dec 15 Sex Transm Infect study

 

H5N1 avian flu strikes Cambodian duck farm

Cambodia yesterday reported another highly pathogenic H5N1 avian flu outbreak, marking the second detection of the virus in just over a week, according to a report from the World Organization for Animal Health (OIE).

The outbreak began on Dec 8 at a duck farm in Kampong Thom province in the central part of the country, killing 4,000 of 5,000 susceptible ducks. The remaining birds were culled to control the spread of the virus.

Cambodia's earlier outbreak, reported on Dec 9, involved an outbreak at a chicken farm in neighboring Kampong Cham province. The event marked the country's first H5N1 detection since January.
Dec 18 OIE report

 

Madagascar plague cases continue to slow

Though an unusual spike in plague infections in Madagascar was deemed to be contained a few weeks ago, the country continues to report a declining number of cases, with 33 more reported for the week ending Dec 10, the World Health Organization's (WHO's) Regional Office for Africa said in its latest weekly health emergencies update. Four of the illnesses were fatal.

The disease is endemic in Madagascar, which typically sees a seasonal rise from September to April. However, the country this fall experienced a steep rise in pneumonic cases, especially in urban areas.

Since August, officials have reported 2,575 confirmed, probable, or suspected cases, including 221 deaths. Of the total, 1,985 cases have been classified as the more serious pneumonic form.

Over the most recent reporting week, Analamanga region has been most affected, and active surveillance and health worker training are under way in the area's private and public health facilities.
Dec 15 WHO AFRO weekly health emergencies bulletin

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