News Scan for Oct 11, 2018

Polio-like illness in 5 states
;
MERS in Saudi Arabia
;
Carbapenem-resistant Pseudomonas

More AFM cases in Illinois, Washington, Texas, New Jersey, New York

The health departments of Illinois and Washington state have reported nine and five cases of acute flaccid myelitis, respectively, and local media in Texas, New Jersey, and New York are also highlighting cases of the polio-like illness.

"The Illinois Department of Public Health (IDPH) has received recent reports from health care providers of nine sporadic, clinically diagnosed cases of acute flaccid myelitis (AFM)," the IDPH said yesterday in a statement. The agency said it issued an alert to healthcare providers last month about reporting the condition. Since the Centers for Disease Control and Prevention (CDC) first described the syndrome in 2014, the CDC has confirmed four previous AFM cases in Illinois.

The Washington State Department of Health (WSDH), meanwhile, and four local public health agencies are investigating reports of five children hospitalized for a sudden onset of paralysis of one or more limbs, the WSDH said yesterday in a news release. It is working with CDC neurologists to confirm AFM. All children are under 6 years old.

In related news, local media are reporting three cases in northern Texas and one each in New Jersey and New York. The New York case, in Buffalo, is suspected. Earlier this week officials in Minnesota and Pennsylvania reported AFM cases.

The CDC said on Oct 8 that it has confirmed 38 AFM cases in 16 states through September. In 2014 and 2016 the condition spiked, affecting 120 and 149 children, respectively. Many cases in the past have been linked to enteroviruses.
Oct 10 IDPH statement
Oct 10 WSDH news release
Oct 10 CBS DFW story
Oct 10 NBC 10 news story
Oct 10 WIVB4 story
Oct 10 CIDRAP News scan on previous cases
Oct 8 CIDRAP News story "States and CDC probe reports of rare poliolike symptoms in kids"

 

MERS sickens 1 more in Saudi Arabia

Saudi Arabia's health ministry today reported one new MERS-CoV case, involving a 41-year-old woman who from Taif region in the country's southwest who had contact with camels.

In a report for epidemiologic week 41, the ministry said the woman from the city of Almoai has been hospitalized for her MERS-CoV (Middle East respiratory syndrome coronavirus) infection.

Also, the World Health Organization Eastern Mediterranean Regional Office (WHO EMRO) posted a summary of 14 MERS-CoV cases reported in September, which includes 13 from Saudi Arabia and 1 imported illness detected in South Korea. Of Saudi Arabia's cases, 5 are classified as secondary, 2 were in household contacts, and 3 were healthcare-related. Of Saudi Arabia's 13 cases, 6 were fatal.

The WHO said recent cases don't show any changes in epidemiologic patterns. Bases on cases reported to the WHO through September, the global total is 2,260 cases from 27 countries, mostly from Saudi Arabia. So far at least 803 illnesses have been fatal.
Oct 11 MOH update
Oct 10 WHO EMRO summary for September

 

Investigation finds cluster of carbapenem-resistant Pseudomonas carriers

An investigation by the Chicago Department of Health has identified a large cluster of residents colonized with Verona integron-encoded beta-lactamase-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA) at several healthcare facilities in the city. The findings appear today in the CDC's Morbidity and Mortality Weekly Report (MMWR).

The outbreak centers around a single skilled nursing facility with ventilated residents (called "vSNF A" by the authors), where a November 2016 point prevalence survey identified 20 residents with VIM-CRPA colonization. VIM-CRPA are rare in the United States; a surveillance study conducted by the CDC at five US sites found only 2 carbapenemase-producing CRPA among 129 isolates.

To determine whether transmission was ongoing at that facility, the investigators conducted 10 additional point prevalence surveys from November 2016 to March 2018. Screening of 903 swabs from 209 residents identified an additional 18 residents colonized with VIM-CRPA, with one other resident identified by screening upon admission to an acute care hospital. Point prevalence surveys conducted at six other vSNFs and six long-term acute care facilities in Chicago identified 12 more VIM-CRPA–positive patients (at five vSNFs and one long-term acute care hospital).

Whole-genome sequencing of 26 isolates from five different facilities revealed that 25 belonged to multilocus sequence type (ST) 233, and clusters of highly related isolates indicated transmission at the index facility (vSNF A). The authors of the study say it's the largest healthcare-associated cluster of VIM-CRPA colonizing residents reported in the United States.

"Although centered in one vSNF, this investigation highlights the interconnectedness of health care facilities through patient sharing and how prolonged, undetected transmission can result in spread through a region," the authors write.
Oct 12 CDC MMWR Notes from the field

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