News Scan for Feb 01, 2018

News brief

More yellow fever cases, deaths reported in Brazil

A new report from Brazil's Ministry of Health showed a steady rise in the number of yellow fever cases confirmed and suspected since an update posted last week. There are now 213 confirmed cases, 83 more than last week, and 1,080 suspected cases, an increase of 479 since the previous report.

There have been a total of 81 deaths so far between Jul 1, 2017 and Jan 30, 2018, the Ministry of Health said. Between July of 2016 and January of 2017, Brazil reported a total of 468 confirmed yellow fever cases, including 147 deaths.

Yellow fever cases tend to spike during the rainy, spring months in Brazil. There is still no evidence that urban Aedes aegypti mosquito populations are transmitting the virus. Instead, the Ministry of Health said all human cases remain caused by sylvatic spillover. The information was translated and posted on ProMED Mail, the online reporting system of the International Society for Infectious Diseases.

As reported last week, a vaccination campaign is set to launch this month in some of Brazil's most populous states, using both standard and fractional doses of the yellow fever vaccine. Both vaccines offer 99% protection against the virus within 1 month of administration.
Jan 30 ProMED Mail post
Jan 24 CIDRAP News story "Yellow fever case counts jump in Brazil"

Lone star ticks off the hook for transmitting Lyme disease

A review of 30 years' worth of literature shows that the lone star tick is not capable of spreading the bacteria that causes Lyme disease to humans. The review was published yesterday in the Journal of Medical Entomology.

Led byEllen Stromdahl, BCE, an entomologist at the US Army Public Health Center, the review of 60 published scientific journal articles failed to produce evidence that the tick (Amblyomma americanum) can spread Borrelia burgdorferi, the bacterium that causes Lyme disease. In fact, there is evidence that the tick's saliva destroys Borrelia burgdorferi.

"Lone star tick saliva is a very effective barrier against B. burgdorferi—it literally explodes them," said Graham Hickling, PhD, a tick researcher from the University of Tennessee who contributed to the review in an interview with Entomology Today. "Lone star ticks are constantly being exposed to B. burgdorferi as they feed on infected animals, but the bacteria species has never been cultured from a Lone Star tick in a lab. However, it has been cultured from rodents and blacklegged ticks in the Southeast."

The authors said that early literature detecting B. burgdorferi in lone star ticks used methods that were not Borrelia species-specific, and any spirochetes that were detected were likely other species.
Jan 31 J Med Entomol study
Jan 31 Entomology Today story

First Seoul virus outbreak in United States and Canada described

2017 brought the first Seoul virus outbreak to the United States and Canada, and emphasized the need for proper rodent handling, according to a report today in Morbidity and Mortality Weekly Report (MMWR).

In December of 2016, a Wisconsin resident was hospitalized with fever and leukopenia, among other symptoms. The person owned an in-home rat breeding facility. Because of his or her contact with rats, the patient was tested for hantaviruses, including Seoul virus. The Centers for Disease Control and Prevention (CDC) confirmed the presence of Seoul virus in January of 2017, and an investigation was launched to identify additional human and rat infections.

By March of 2017, 31 US ratteries with human and/or rat Seoul virus infections were discovered in 11 states, including 6 that exchanged rats with Canadian ratteries. A total of 17 people were infected with Seoul virus, with 8 becoming ill and 3 hospitalized. All cases recovered fully.

Seoul virus is a hantavirus in the Bunyaviridae family, found most commonly in the Norway rat.

"Pet rat owners should be aware of the potential for Seoul virus infection," the authors of the report write. "To keep themselves and their pets healthy, all persons with rodent contact should avoid bites or scratches and practice good hand hygiene, especially children and persons with compromised immune systems."
Feb 2 MMWR report

CDC posts travel notices for malaria in Brazil, yellow fever in Nigeria

The CDC posted two new travel notices, one a level 2 alert warning of a malaria outbreak in Brazil's Bahia state and the other a level 1 alert that relates to yellow fever activity in Nigeria.

In Brazil, the mosquitoes that spread malaria are present in Bahia state in the eastern part of the country, but the disease isn't usually found there. The CDC said the outbreak in the town of Wenceslau Guimaraes probably began with an infected person who traveled from Para state, in northern Brazil, where the disease is known to spread. The CDC's level 2 precaution urges travelers to practice enhanced precautions, specifically for travelers to the affected town to take antimalarial medication.

Meanwhile, the notice for Nigeria relates to an outbreak that has been under way since September 2017, with lab-confirmed cases reported in at least seven states. Vaccination campaigns are ongoing in the country. The CDC's level 1 watch urges travelers to practice usual precautions, and the CDC recommends anyone 9 months or older who will travel to any part of Nigeria to be vaccinated against yellow fever.
Jan 31 CDC travel notice on malaria in Brazil
Jan 30 CDC travel notice on yellow fever in Nigeria

Stewardship / Resistance Scan for Feb 01, 2018

News brief

Investigative report finds widespread colistin use in Indian poultry

A new story by the UK-based Bureau of Investigative Journalism alleges the last-resort antibiotic colistin is being widely used on Indian poultry farms, despite worldwide concerns that using the drug in food-producing animals could render it ineffective.

According to the story, India is importing at least 150 tons of colistin each year, and at least five animal pharmaceutical companies in India are openly advertising products containing colistin as growth promoters.

Colistin resistance emerged as a global concern in 2015, when scientists discovered the colistin resistance gene MCR-1 in Escherichia coli bacteria isolated from pigs, pork products, and humans in China. Since then the gene, which is located on mobile pieces of DNA called plasmids and can be transferred within and between different bacterial species, has spread around the globe in animals and humans. Public health officials fear that when already multidrug-resistant bacteria acquire MCR-1, untreatable infections could result.

"Colistin is the last line of defense," Timothy Walsh, PhD, an antibiotic resistance expert at Cardiff University who was a member of the team that discovered MCR-1, told the Bureau of Investigative Journalism. "It is the only drug we have left to treat critically ill patients with a carbapenem-resistant infection. Giving to chickens as feed is crazy."

The emergence of MCR-1 has been linked to widespread use of colistin on Chinese farms, and in 2016 China announced that it would no longer allow use of the drug in food-producing animals. While many countries have banned use of colistin as a growth promoter, it is still used for disease prevention. In November 2017, the World Health Organization recommended restrictions on the use of medically important antibiotics like colistin in food-producing animals, including a ban on their use for growth promotion.
Jan 30 Bureau of Investigative Journalism story

FAO official calls Southeast Asia a 'hot spot' for AMR

Widespread misuse of antibiotics in food production in Southeast Asia could magnify the threat of antimicrobial resistance (AMR) in the region, an official with the Food and Agriculture Organization (FAO) told Reuters yesterday.

FAO Chief Veterinary Officer Juan Lubroth told the news service that intense food and agriculture production, combined with high population growth, in Southeast Asia's megacities could create increased risks for drug-resistant bacterial infections in humans.

"Here in Southeast Asia…we would consider it a hotspot because of the population growth, urbanization dynamics, the production of food," Lubroth said.

The comments were made on the sidelines of a meeting in Bangkok of the Interagency Coordination Group on Antimicrobial Resistance, a body formed to guide countries in the creation of national AMR action plans and ensure sustained global action against the AMR threat.

Lubroth said the FAO advocates educating farmers about the dangers of using medically important antibiotics to promote growth in food animals, and wants stronger enforcement of rules governing food production.
Jan 31 Reuters story

Contaminated ice machines could spread microbes, researchers say

Ice machines in healthcare facilities are often contaminated with gram-negative bacilli and Candida species and are a potential source of dispersal for these organisms, researchers reported yesterday in Infection Control and Hospital Epidemiology.

In a two-part study conducted at 5 hospitals and 2 nursing homes in northeast Ohio, researchers took swab samples from 64 ice machines. In visual assessments prior to culture collection, many of these machines had stagnant water in the drain pan, had drain pans with visible grime and a layer of slime, and showed visible water dispersal onto surrounding countertops or the floor.

Gram-negative bacilli and/or Candida spp were recovered from 100% of drain pans, 52% of ice chutes, and 72% of drain-pan grilles. Of the 91 colonies of bacilli further analyzed, 55 (60.4%) were Enterobacteriaceae, and 7 isolates were resistant to carbapenems, including single isolates of Klebsiella pneumoniae, Acinetobacter baumannii, and Enterobacter cloacae.

In the second part of the study, the researchers investigated potential mechanisms of microbial dispersal by observing how the machines were used and conducting simulations in five of the machines using a fluorescent lotion to trace the path of microbes. This revealed that ice frequently fell through the drain pan grille and melted in the drain pan, resulting in stagnant, contaminated water; when more ice cubes fell through the grille into the contaminated water, the splattering dispersed microbes to the hands of users, cups, and the drain pan grille. They also found that contamination of the ice chute could result in contamination of ice cubes exiting the chute.

"Effective strategies to prevent the dispersal of microorganisms contaminating ice machines need to be developed," the authors conclude. "Regularly scheduled cleaning of ice machines has been recommended and may be beneficial in reducing the burden of microbes such that dispersal is reduced."
Jan 31 Infect Control Hosp Epidemiol abstract