News Scan for Oct 31, 2018

Saudi MERS cases
;
Congenital Zika
;
Flu rise in Asia, elsewhere
;
Enterovirus blood testing

MERS infects 2 more in Saudi Arabia

Saudi Arabia reported two more MERS-CoV cases, according to an update to its week 44 epidemiologic report today.

Neither of the patients had contact with camels, a factor known to raise the risk of contracting MERS-CoV (Middle East respiratory syndrome coronavirus). One patient is a 62-year-old man from the city of Omluj in Tabuk region in the northwest, and the other is a 53-year-old man from Riyadh in the central part of the country.

Both are hospitalized and thought to have primary exposure, meaning the virus probably wasn't transmitted from another patient.

Since the first human cases were detected in 2012, at least 2,266 MERS-CoV cases have been reported, at least 803 of them fatal. Most of the cases have been reported in Saudi Arabia.
Oct 31 Saudi MOH report

 

Maternal-fetal transmission found in 26% of Zika pregnancies

A new prospective cohort study conducted in French Guiana found that, in cases of maternal Zika virus infection, 26% of fetuses became congenitally infected. Of those, 21% suffered severe complications at birth, and 14% did not survive until birth. The study was published in the British Medical Journal (BMJ).

The study was conducted at the French Guiana Western Hospital Center during the 2016 Zika epidemic. The hospital admitted 1,690 pregnant women from Jan 1 through Jul 15, 2016, and tested all for Zika.

A total of 498 pregnant women tested positive for the virus, and 305 fetuses were included in the study. Seventy-six fetuses tested positive for Zika via testing of the umbilical cord, or placenta, amniotic fluid, cerebrospinal fluid, urine, or blood. Of the 76 fetuses, 34 were asymptomatic at birth, 15 had mild or moderate symptoms of congenital Zika syndrome (CZS), 16 had severe complications, and 11 suffered fetal loss.

The authors said only 13% (approximately one in eight) of all fetuses born to mothers positive for Zika virus presented with "severe adverse outcomes." This rate is similar to other congenital illnesses, including cytomegalovirus infection.

"The burden of CZS might be lower than initially described in South America and may not differ from other congenital infections," the authors concluded.
Oct 31 BMJ
study

 

Flu elevated in parts of South Asia, Southeast Asia, rising elsewhere

Flu in the Southern Hemisphere, which is nearing the end of its season, continued to decline, and though overall activity in the Northern Hemisphere is still at interseasonal levels, activity is starting to increase in Europe and North America, the World Health Organization (WHO) said this week, based on data from the first half of October.

In southern Asia, flu remain elevated, mainly due to the 2009 H1N1 virus, and in Nepal, detections of H3N2 and influenza B increased, the WHO said. Flu activity also rose in some Southeast Asian countries, such as Laos, where 2009 H1N1 is the dominant strain, and Myanmar, where health officials are mainly seeing H3N2 and influenza B.

Globally, of viruses that tested positive for flu in the first part of October, 84.2% were influenza A and 15.8% were influenza B. Of subtyped influenza A viruses, 80.1% were the 2009 H1N1 strain.
Oct 29 WHO global flu update

 

Study highlights role for blood tests for enterovirus in children

Testing blood for enteroviruses is helpful for diagnosing young children with fever without a source of sepsis-like syndrome, according to a study of French pediatric patients over two seasons, a research team reported yesterday in The Lancet Infectious Diseases.

Enteroviruses are a frequent cause of acute meningitis and increasingly implicated in sepsis-like disease and with fevers without a known source. Though testing cerebrospinal fluid (CSF) is the gold standard for diagnosis, researchers wanted to assess polymerase chain reaction (PCR) testing for the virus in blood.

The group's prospective observational study included newborns, infants, and children ages 2 through 16 from 35 French pediatric and emergency departments at 16 hospitals. The study enrolled 822 patients with fever without a source, sepsis-like syndrome, or suspected meningitis who underwent enterovirus testing in blood and in CSF from June through October of 2015 and 2016.

Overall, enterovirus was detected in 357 (43%) of children, which included 191 (54%) who had positive blood and CSF samples, 45 (13%) with a positive blood test but negative in CSF, and 40 (11%) with positive blood findings but no CSF available for testing. Only 81 children (23%) whose CSF was positive for enterovirus had negative findings in blood sample testing.

The researchers said the findings suggest that adding blood testing, or using it when CSF isn't available, significantly increases yield, detecting 24% of infections that wouldn't have been diagnosed otherwise. Testing positivity, however, varied by age, with blood-test-positives more frequent in children ages 2 and younger. In older children with suspected meningitis, enterovirus detection was more frequent in CSF than in blood.

In a commentary in the same issue, two experts from the department of pediatrics at the University of Colorado School of Medicine and Children's Hospital Colorado said blood isn't routinely tested and isn't included in many clinical guidelines for managing febrile children, but the study findings suggest that it can contribute to the diagnostic assessment of young children with unknown fever or sepsis-like syndrome, including when CSF isn't available for testing.

They said enterovirus testing is most cost-effective during seasonal circulation and that ideally, results should be available quickly, which can help clinician avoid unnecessary antibiotic prescribing. "The novel information contained in this article should be incorporated into future guidelines for febrile neonates and infants with fever without source, by including recommendations for blood PCR testing for enteroviruses," they wrote.
Oct 30 Lancet Infect Dis abstract
Oct 30 Lancet Infect Dis commentary

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