News Scan for Oct 17, 2018

Salmonella and raw chicken
;
Oseltamivir use in pregnancy
;
Bioterrorism readiness

Almost 100 sick with multidrug-resistant Salmonella tied to raw chicken

The Centers for Disease Control and Prevention (CDC) today announced a new outbreak of multidrug-resistant Salmonella Infantis infections tied to raw chicken products.

So far, 92 people in 29 states have been infected with the bacterium. Twenty-one patients have been hospitalized, and there have been no deaths. No single supplier of chicken has been identified in the outbreak, but raw chicken pet food, raw chicken products, and live chickens have all tested positive for the outbreak strain.

Pennsylvania has the most cases, with 11, followed by New York state, which has reported 10 cases. Symptom onset began between Jan 19 and Sep 9 of this year.

Of 54 people interviewed, 48 (89%) reported preparing or eating chicken products that were purchased raw, including ground chicken, chicken pieces, and whole chickens. At least one person reported handling pet food made with raw chicken.

Whole-genome sequencing of isolates collected from 43 patients and 68 food or environmental samples show resistance to several antibiotics, including ampicillin, ceftriaxone, chloramphenicol, ciprofloxacin, fosfomycin, gentamicin, hygromycin, kanamycin, nalidixic acid, streptomycin, sulfamethoxazole, tetracycline, and trimethoprim-sulfamethoxazole.
Oct 17 CDC notice

 

Study: No evidence of negative birth outcomes after oseltamivir exposure

A study yesterday in BMC Infectious Diseases shows no association between negative birth outcomes after prenatal exposure to oseltamivir (Tamiflu), an antiviral used to shorten the duration of flu symptoms.

The study was based on birth outcomes from recorded pregnancies in Denmark from 2002 to 2013. Researchers used data from population registries to examine any associations between oseltamivir use in pregnancy (first trimester, second/third trimester, none) and congenital malformations, fetal death, preterm birth, fetal growth, and low 5-minute Apgar score.

Of the 946,176 pregnancies included in the study, 449 involved first-trimester exposure and 1,449 involved second or third-trimester exposure to oseltamivir; 92% of pregnancies were exposed during the 2009-10 pandemic flu season.

The odds ratios from propensity-score matched regression analysis were 0.94 (95% confidence interval [CI], 0.49 to 1.83) for any malformation and 1.75 (95% CI, 0.51 to 5.98) for congenital heart defects, the authors found. The results also showed adjusted incidence rate ratios associated with oseltamivir exposure were 0.99 (95% CI ,0.66 to 1.48) for miscarriage and 0.64 (95% CI, 0.41 to 1.00) for induced abortion. 

The authors concluded there was no risk associated with oseltamivir treatment in addition to the risks inherent with influenza infection.
Oct 16 BMC Infect Dis study

 

Experts underscore need for improved bioterrorism preparedness

As part of a series on bioterrorism, US and Israeli experts point out in a review article in The Lancet Infectious Diseases yesterday that preparedness for intentional outbreaks has the added value of strengthening preparedness for natural epidemics, and vice versa.

The scientists outline the current threat of bioterrorism, biological agents most likely to be used by terrorists, how the pathogens might be disseminated, and details on disease caused by such agents. The also discuss protecting healthcare workers during outbreaks, the role of vaccines, risk communication, and international preparedness, among other topics.

Among the group's key takeaways:

  • Preparedness for intentional outbreaks will strengthen the response to naturally occurring epidemics—and vice versa
  • High-level leadership must be maintained with responsibility and authority
  • Healthcare providers should maintain awareness of biological agents with bioterrorism potential and consider the presence of unknown pathogens
  • Personal protective equipment needs to be improved to become more user friendly
  • Improved surge capacity is required, particularly in peripheral areas
  • Lab should be increased for faster, more reliable diagnostic tests
  • New and improved vaccines and treatment regimens should be developed
  • International cooperation needs to include multinational exercises

Oct 16 Lancet Infect Dis abstract

 

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