News Scan for Feb 19, 2018

MERS in Saudi Arabia
;
H5N8 in endangered penguins
;
Ebola PPE contamination, errors
;
Chikungunya in infants

New Saudi MERS case linked to camels

The Saudi Arabian Ministry of Health (MOH) confirmed one new case of MERS-CoV on Feb 17. The MOH has issued only sporadic updates this month, and this is the second update in 3 weeks.

A 74-year-old Saudi woman from Rafha was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus). She is in stable condition. The probable source of her infection is indirect contact with camels, a likely risk factor for the virus.

The new case brings Saudi Arabia's MERS totals since 2012 to 1,796, including 731 deaths. Five people are still being treated for their infections, the MOH said.
Feb 17 MOH report

 

H5N8 detected in South African penguins, on more Iraqi poultry farms

South Africa's agriculture ministry today reported highly pathogenic H5N8 avian flu outbreaks involving Western Cape province sea birds, including African penguins that will be treated for their illnesses because of their endangered status.

In a statement, officials said seven birds from six sites on the province's coastline have tested positive for the virus. One of the birds has survived, and the treatment protocol involves nutrition, hydration, vitamins, and anti-inflammatory drugs or antibiotics, as needed.

South Africa reported its first H5N8 outbreak in poultry in June 2017 and has noted a few detections in wild birds, though no outbreaks have been reported in poultry since October.

In H5N8 developments elsewhere, Iraq yesterday reported two more outbreaks on poultry farms, one that began on Feb 11 in Diyala province and another that began on Feb 12 in Baghdad province, according to a notification from the World Organization for Animal Health (OIE). Over the two locations, the virus killed 52,750 of 95,200 susceptible poultry, and authorities destroyed the survivors as part of outbreak response.
Feb 19 South Africa agriculture ministry statement
Feb 18 OIE report on H5N8 in Iraq

 

Studies note viral transfer, doffing errors in Ebola PPE practice

In two new studies in Clinical Infectious Diseases, researchers from Georgia assess doffing (taking off) of personal protective equipment (PPE) for Ebola disease, noting viral transfer to inner gloves and errors that could lead to contamination.

The first study involved 10 healthcare workers (HCWs) experienced in Ebola care donning and doffing PPE following biocontainment unit protocols that incorporate trained observer guidance and alcohol-based hand rub (ABHR). The researchers applied two types of harmless bacteriophages to four PPE sites to approximate typical body fluid Ebola viral load. After the HCWs performed a patient care task, they removed their PPE and the investigators sampled inner glove, faces, hands, and scrubs for virus, and they also tested environmental sites using a visible fluorescent marker.

The researchers found no presence of the enveloped phage (one with an outer coating) except for low levels on the scrubs of one HCW. The nonenveloped phage, however, was detected on 2 HCWs' scrubs, 1 HCW's hands, and 7 HCWs' inner gloves. Neither phage was detected on environmental samples.

The authors concluded, "Nonenveloped virus was infrequent on hands and scrubs but common on inner gloves, suggesting that inner gloves, but not necessarily ABHR, protect against hand contamination. Optimizing doffing protocols to protect against all types of viruses may require reinforcing careful handling of scrubs and good glove/hand hygiene with effective agents."

In the second study, the investigators used video to identify errors among 11 HCWs who participated in simulations under the same conditions as the first study, including contamination with the same two bacteriophages. They identified 51 doffing errors, with hand hygiene mistakes and missteps in removing the powered air-purifying respirator topping the list.|
Jan 17 Clin Infect Dis abstract on virus transfer
Jan 17 Clin Infect Dis abstract on doffing errors

 

Analysis finds WHO diagnostic criteria for chikungunya not apt for infants

A study of 22 infants infected with chikungunya in Curacao has determined that none of them met the World Health Organization (WHO) clinical guidelines for probable infection, suggesting that the recommendations need to change for infants.

The study, detailed in The Pediatric Infectious Disease Journal, involved infants from 1 week to 6 months of age who tested positive for chikungunya virus during a 2014-15 epidemic. All had fever for a mean of 3 days, 17 were irritable, 14 had maculopapular rash, 12 had feeding difficulties, and 8 had compromised circulation.

The researchers applied the WHO criteria to identify probable chikungunya infection, but none of the infants fulfilled them. Some of the criteria not seen in the study infants include arthralgia or arthritis, limb edema, and synovitis.

The investigators concluded, "When fast laboratory tests are not available, clinical recognition of ChikV [chikungunya virus] during an epidemic is important. The WHO criteria for probable ChikV infection may be inappropriate for this specific group of patients. We suggest that the criteria are reconsidered and modified."
March Pediatr Infect Dis J study

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