News Scan for Jan 02, 2019

Saudi MERS case
;
More acute flaccid myelitis
;
H9N2 infection in China
;
MRSA pneumonia screening
;
Gastroenteritis in elderly

MERS infects 1 more in Saudi Arabia

Saudi Arabia's health ministry yesterday reported a new MERS-CoV case, its first of 2019, according to an epidemiological week 1 notification.

The patient is a 54-year-old man from the city of Riyadh who is hospitalized for his MERS-CoV (Middle East respiratory syndrome coronavirus) illness. An investigation has so far found that he had no contact with camels or another MERS patient.

Based on a recent overview from the World Health Organization (WHO), the new case would raise the global total since 2012 to 2,281 cases, at least 806 of them fatal.
Jan 1 MOH report

 

CDC confirms 4 more acute flaccid myelitis cases, 186 total

In an update this week, the Centers for Disease Control and Prevention (CDC) confirmed 4 new cases of acute flaccid myelitis (AFM)—the polio-like illness affecting a record number of people, mostly young children, in the United States this year—bringing the total for 2018 to 186 confirmed cases.

Thirty-nine states have recorded cases, a number that has not changed since the CDC's previous update on Dec 24. Texas has reported the most cases, 25, followed by Colorado (16), and Ohio (12). Three states—Minnesota, New Jersey, and Washington—have recorded 10 cases.

Since the CDC began logging AFM cases in 2014, they have peaked every other year in the fall. 2014 saw 120 cases, followed by 22 in 2015, 149 in 2016, and 35 in 2017.

More than 90% of patients report mild respiratory symptoms consistent with a viral infection before AFM symptom onset, which typically involves limb weakness and paralysis. "AFM is a complex condition, and it is difficult to determine why only some people go from having a mild respiratory illness or fever to developing AFM," the CDC said. The agency has yet to determine a cause for the 2018 cases. Some cases in previous years were linked to enterovirus infections.
Dec 31 CDC update

 

China reports H9N2 avian flu case in Guangdong province

Chinese health officials have confirmed an H9N2 avian flu infection in a 32-year-old woman from the city of Shenzhen in Guangdong province, according to a Macao government statement today translated and posted by Avian Flu Diary, an infectious disease news blog.

The woman's symptoms began on Dec 19, and she was hospitalized on Dec 25. According to the report, her illness is mild. The report didn't include any details about potential exposure sources.

The H9N2 case is China's sixth of 2018. The World Health Organization (WHO) in a December update on zoonotic flu, noted China's fourth and fifth cases of 2018, both affecting children younger than 5.

One was from Guangdong province, with an illness onset of Oct 16, and the other was from Guangxi province, with symptoms that began on Oct 10. The child from Guangdong province had been exposed to live poultry, a known risk factor for contracting the virus.
Jan 2 Avian Flu Diary post
Dec 13, 2018, WHO monthly zoonotic flu
update

 

Review supports MRSA nasal screening in pneumonia patients

A systematic review of 19 studies has found that methicillin-resistant Staphylococcus aureus (MRSA) nasal screening for patients with pneumonia has a high negative predictive value and could be a valuable tool for antibiotic stewardship programs (ASPs). The findings appear today in the Annals of Pharmacotherapy.

The 19 observational and retrospective studies, published from 1990 through 2018, included 21,790 patients, mostly in intensive care units. The review found that the negative predictive value for MRSA nasal screening ranged from 76% to 99.4% across all types of pneumonia, with most studies suggesting that few patients who are screened for MRSA soon after hospital admission and have a negative result will actually develop MRSA pneumonia.

Further evaluation found that using nasal MRSA screening for anti-MRSA antibiotic de-escalation could reduce the use of vancomycin in pneumonia patients and provide additional cost benefits. The reviewers determined that a cutoff of 7 days between nasal swab and culture or infection onset seems most appropriate for using the test to de-escalate anti-MRSA antibiotics.

"Consideration for the inclusion of the utility of MRSA nasal screening in MRSA pneumonia should be made for future pneumonia and ASP guidelines," the authors conclude. "Additional studies are warranted to fully evaluate specific pneumonia classifications, culture types, culture timing, and clinical outcomes associated with the use of this test in patients with pneumonia."
Jan 2 Ann Pharmacother study

 

Study notes gastroenteritis affects older patients less—but more severely

A comprehensive study published today in Clinical Infectious Diseases involving data from the United States, Canada, and Australia on Campylobacter, Salmonella, and acute gastroenteritis cases has determined that, although older adults are more likely to have severe illness and be hospitalized, the proportion of people reporting symptoms declines with age.

Researchers from the three nations analyzed data from their respective national databases (including information for more than 100 million people) and case-control studies across a number of years. They included in their analysis data on 3,702 Campylobacter cases (1,311 in the United States, 1,846 in Canada, and 545 in Australia), 2,736 Salmonella cases (1,288, 1,337, and 111, respectively); and 6,876 cases of acute gastroenteritis (5,536, 548, and 792).

They compared data by age-group (younger than 5 years, 5 to 24, 25 to 64, and 65 years and older) and tallied the percentage reporting bloody diarrhea, fever, vomiting, and abdominal pain, as well as the percentage hospitalized, the duration of hospitalization, and the duration of illness.

Across the three countries, the percentage reporting each symptom was similar by age-group for the three illnesses. However, the researchers reported that symptoms decreased in general with increasingly older age-groups, except for bloody diarrhea with acute gastroenteritis, which was more prevalent in older adults.

Hospitalization rates, however, increased with age, from 7% among the youngest group to 48% among those aged 85 years and older for Campylobacter and a range of 17% to 49% for Salmonella. For acute gastroenteritis the range was 1% to 17%.

In a commentary on the study in the same journal, three infectious disease experts from the University of Kentucky note that the findings underscore the need to transition away from culture-based diagnostics to more rapid, organism-specific testing. They write, "With the cost of hospitalization and public health concerns, as well as patient outcomes, which potentially worsen as the illness persists, the onus on medicine is to get to the definitive diagnosis rapidly."
Jan 2 Clin Infect Dis study
Jan 2 Clin Infect Dis
commentary

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