Saudi Arabian health ministry notes 30 new MERS cases

After several months of silence, the Saudi Arabian Ministry of Health (MOH) recently uploaded information on 30 new MERS-CoV case detections on its website, including a cluster of 11 household cases from Najran detected in late May and early June.

The 11 Najran MERS-CoV (Middle East respiratory syndrome coronavirus) cases were all in men. The most recent case involves a 41-year-old Saudi man in Dammam who was hospitalized for MERS on Aug 3. He is listed in stable condition, and the MOH said he had direct contact with camels.

Nine cases were recorded in July, 8 in June, and 13 in May. All case-patients are listed in stable condition except 3, and the MOH notes two deceased patients, including a 68-year-old man from Arar city who acquired MERS in a hospital setting. The other death occurred in a 57-year-old man from Jeddah who had camel contact.

At this time, the MOH is not providing the cumulative number of MERS cases since the virus was first detected in Saudi Arabia in 2012.
MOH Epidemic Events webpage

 

Northern Europe sees spike in echovirus infections

A new report from the European Centre for Disease Prevention and Control (ECDC) said that Scandinavia-area nations and the United Kingdom reported a surge of cases of echovirus 30 (E30) in 2018.

Based on surveillance data, 259 E30 cases from Denmark (38), Latvia (1), the Netherlands (85), Norway (37), Sweden (21) and the United Kingdom (England and Scotland; 77) have been reported since January. Twenty-two percent of cases have occurred in infants ages 0 to 3 months, and 38% in 26- to 45-year-olds.

According to the ECDC, Denmark reported that 61% of its E30 detections were from cerebrospinal fluid specimens, which can signal a severe infection. In total, 149 out of 167 patients (89%) were reported with central nervous system symptoms from the Netherlands, Norway, and the United Kingdom.

E30 is a non-polio enterovirus that causes aseptic meningitis outbreaks worldwide, usually in 5-to 6-year intervals, the ECDC said. E30 is usually transmitted in an oral-to-oral or oral-to-fecal route, but no transmission route has been clearly identified in these current outbreaks.
Aug 3 ECDC report

 

Possible variant flu cases reported in California with possible pig link

The Public Health Department (PHD) of San Luis Obispo County in California is investigating several potentially variant flu cases to determine if they have any connection to a case of influenza in a pig at the California Mid-State Fair.

Details are sparse, but the PHD said several people who had extended contact with pigs at the fair now have "tested positive for an influenza virus that may be different from viruses that commonly circulate among people during flu season."

"At this time, the Public Health Department does not have any laboratory confirmation that the cases are linked to pigs.  In each of the laboratory-confirmed local cases of influenza being investigated, patients have recovered on their own within several days," the department said on its website.

Variant influenza cases often occur after swine contact at county fairs, but these are the first cases reported in California this year. According to the US Centers for Disease Control and Prevention (CDC), there have been 435 variant flu cases in the United States since 2005. Most cases resulted in mild illness.
Aug 3 San Luis Obispo PHD notice

Jul 6 CDC report

 

Malaysia, Vietnam report high-path H5 avian flu outbreaks in poultry

Malaysia has reported a highly pathogenic H5N1 avian flu outbreak at a layer farm, its first in more than a year, and Vietnam reported three more H5N6 outbreaks, according to the latest notifications from the World Organization for Animal Health (OIE).

In Malaysia, the outbreak location is a commercial layer farm in the state of Sabah, in the country's eastern region on the island of Borneo. The farm reported high numbers of chicken deaths to state veterinary officials on Jul 27, and investigation and sampling took place on the same day. The virus killed 3,000 of 28,000 susceptible birds, and the survivors were culled as part of the response to the outbreak.

The report said the outbreak was the first to hit Sabah state. Malaysia's last H5N1 outbreak occurred in March 2017, which struck backyard poultry in Kelantan state on the northeast side of the peninsular part of the country.

Meanwhile, Vietnam reported three more H5N6 outbreaks in two northern provinces, all involving village poultry. One was in Nghe An province and the others were in Hai Phong. The outbreaks began from Jul 28 to Jul 30, killing 1,590 of 12,620 birds. Officials culled the remaining birds, and other responses steps included vaccination and enhanced surveillance and disinfection.

The country reported its last H5N6 outbreak in March of this year.
Aug 6 OIE report on H5N1 in Malaysia
Aug 3 OIE report on H5N6 in Vietnam

Stewardship / Resistance Scan for Aug 06, 2018

News brief

Study shows benefits of phased approach for implementing stewardship

Researchers with a large community hospital system report that a phased approach for implementation of antibiotic stewardship programs was associated with significant clinical and financial benefits.

The study, published in the American Journal of Infection Control, describes the efforts of the Hospital Corporation of America (HCA) to implement a stewardship initiative in its network of 178 community hospitals in 20 states. The HCA Antimicrobial Management Program (AMP) was implemented in four phases—preparatory work, foundational work, clinical care optimization, and stewardship refinement—with individual facilities needing to meet goals before moving to the next phase. Surveys were distributed to the hospitals in 2010 (pre-implementation), 2015 (mid-implementation), and 2017 (post-implementation) to assess progress.  

The results or the surveys showed that stewardship activities improved in most areas of the HCA AMP initiative in 2015, with substantial improvement by 2017. Among the highlights were the increase in established stewardship programs at individual hospitals, from 82% in 2010 to 88% in 2015 and 96% in 2017. In addition, programs with physician champions increased from 73% in 2010 to 94% in 2017, prospective audit and feedback programs increased from 58% in 2010 to 83% in 2017, and tracking of antibiotic use metrics rose from 54% in 2010 to 100% in 2017. Total antibiotic cost per adjusted patient day fell by 40% from the 2010 baseline.

The authors conclude that these improvements have helped build momentum for the larger goals of better patient outcomes, reduced morbidity and mortality, prevention or slowing of the emergence of antimicrobial resistance, and reduced healthcare expenditures.
Aug 3 Am J Infect Control study

 

Researchers find inappropriate antimicrobial use in remote Amazon region

A new study in PLoS One suggests that inappropriate antibiotic use is occurring in even the remotest places.

A team of Brazilian and Spanish researchers conducted the population-based cross-sectional study among riverside dwellers in the Amazon Basin. The riverside dwellers live in isolated communities with a poor health infrastructure and limited access to urban areas. The study looked specifically at the population of the Coari municipality, located in Amazonas state in the central Amazon region, with the researchers interviewing and collecting information on antimicrobial use among 492 riverside dwellers.

The investigators found that 346 of those surveyed (70.3%) had taken at least one medication in the previous month, and 74 (21.4% of those taking a medication, 15.0% of the entire study population) used an antimicrobial. In addition, 49 of the patients taking an antimicrobial (66.2%) obtained it without a prescription, and 32.5% of the antimicrobials consumed were for a non-infectious or non-bacterial disease. Respondents reported that antimicrobials such as amoxicillin, ampicillin, and tetracycline were consumed for symptoms such as "gut inflammation," "pain," and "flu."

The researchers say the findings highlight the need for specific public health policies in the region regarding the appropriate use of antimicrobials.
Aug 3 PLoS One study

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