News Scan for Feb 28, 2018

Salmonella in sprouts
1918 pandemic harbinger wave
Flu vaccine and heart failure

Salmonella investigation linked to sandwich shop sprouts closes

The Centers for Disease Control and Prevention (CDC) today ended its investigation into a multistate outbreak of Salmonella Montevideo linked to raw sprouts.

Ten women in three states were sickened with the Salmonella strain, but there were no hospitalizations or deaths. The CDC first announced the outbreak on Jan 19, and symptom onset ranged from Dec 20, 2017, to Jan 28. Whole-genome sequencing showed that isolates from ill people were closely related, and people in the outbreak shared a common source of infection.

Epidemiological investigations showed that 80% of the cases reported eating raw sprouts on sandwiches from various Jimmy John's restaurants in the week before their illnesses. One person reported eating raw sprouts purchased from a grocery store in Minnesota. No single contamination source was identified, the CDC said.

"Raw and lightly cooked sprouts are a known source of foodborne illness. CDC recommends that consumers, restaurants, and other retailers always follow food safety practices to avoid illness from eating sprouts," the CDC said.
Feb 28 CDC update


New review finds more evidence for 'herald' 1918 pandemic flu wave

A new review of clinical, epidemiologic, and virologic information from the months leading up to the 1918 influenza pandemic found stronger evidence of a mild "herald" wave in the spring and summer, a concept once seen as controversial, that preceded the devastating autumn outbreak. A research team from the National Institute of Health's Fogarty International Center, along with colleagues from Denmark, Tulane University, and New York City's health department, reported their findings yesterday in Annals of Epidemiology.

The group found more evidence of the herald wave from historical accounts and other information from the Americas, Europe, Asia, and Pacific regions. For example, the found information that supports pandemic activity in New York City as early as February 1918, as well as in Kentucky, Arizona, Missouri, and military training camps in March and April of that year. Overall, their review supports widespread occurrence of herald waves in the Northern Hemisphere, with less frequency in the Southern Hemisphere.

One of the 1918 pandemic's well-known hallmarks was that young adults ages 20 to 40 were at highest risk of death. They found the same signature mortality pattern in the milder wave that occurred in the spring and summer. A similar pattern was seen during the 2009 H1N1 pandemic.

The pandemic H1N1 virus was found in autopsy specimens from US soldiers who died of flulike illness between May and August of 1918. Researchers says more analysis of the virus is needed to identify any genetic changes that might explain the sharp increase in the fatality rate that occurred in the fall. They also noted that people who were sick during the earlier waves seemed to be protected during the second wave, further hinting that the viruses in the two waves were closely related.

Patterns seen in past pandemics, especially that more severe second and subsequent waves seem to be the rule rather than the exception, can help public health officials plan for future events, the team concluded. They also noted that a sustained response is critical and that multiple waves can build in more time to deploy vaccines and antivirals.
Feb 27 Ann Epidemiol study


Flu vaccine may be tied to lower death risk in heart failure patients

In the first study of its kind, researchers found that seasonal flu vaccination in patients with heart failure is associated with a 50% drop in the risk of death during flu season and a 20% drop in the risk of death during the rest of the year. Hidekatsu Fukuta, MD, a cardiologist from Japan and the study's lead author, reported the meta-analysis findings today at the annual meeting of the American College of Cardiology in Washington, DC.

The team looked at six studies conducted in the United States, Europe, and Asia, which included data from more than 78,000 heart-failure patients, the American College of Cardiology (ACC) said in a press release. Five were observational studies and one was a retrospective analysis of clinical trial results. They didn't find any randomized clinical trials that were specifically designed to evaluate flu vaccination patients with heart failure.

Along with their main findings about the drop in the risk of death, they found that vaccination was associate with a 22% reduction in the risk of being hospitalized for cardiovascular problems.

When they examined the proportion of heart failure patients who were vaccinated against flu, coverage ranged from 26% to 86%, reflecting wide variability that they said may be the results of limited guidance. They said the Heart Failure Society of America recommends annual flu vaccination for all heart failure patients who don't have known contraindications, but the ACC/American Heart Association and European Society of Cardiology guidelines don't make specific recommendations. The CDC recommends annual flu vaccination for everyone age 6 months and older.

Fukuta said in the press release, "Given the high mortality rate and the relatively low influenza vaccination rates in heart failure patients worldwide, our study supports a wider use of influenza vaccination in heart failure patients."
Feb 28 ACC press release

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