News Scan for May 06, 2019

News brief

Saudi Arabia records new MERS case in Riyadh

The Saudi Arabian Ministry of Health (MOH) recently recorded a new case of MERS-CoV in Riyadh in an epidemiologic week 18 update.

A 59-year-old man from Riyadh was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus). The man's case is listed as "primary," meaning he likely did not contract the disease from someone else. It is unknown if he had recent contact with camels.

The case raises Saudi Arabia's MERS-CoV total for the year to 136 infections, including 61 linked to a large outbreak in Wadi ad-Dawasir.
May 4 MOH update

 

CDC records 5 new AFM cases—2 from 2018

The Centers for Disease Control and Prevention (CDC) today recorded 3 new cases of acute flaccid myelitis (AFM) in 2019 and 2 new cases for 2018, bringing last year's total to 230 and this year's to 7.

California, Maryland, Nebraska, North Carolina, Texas, Utah, and West Virginia have all reported one case this year. The 7 cases confirmed in 2019 are from 34 reports of patients under investigation, the CDC said.

AFM is a mysterious disease with no known cause or cure. It affects the spinal cord, leaving patients—almost always children—with partial or total limb paralysis or muscle weakness. AFM appears to be cyclical, with cases spiking in the United States every other year. Some past cases have been linked to enterovirus infections.

"It is currently difficult to interpret trends of the AFM data. Collecting information about patients under investigation (PUIs) for AFM is relatively new," the CDC said. The CDC began tracking AFM in 2014. Last year marked the highest number of US cases on record.
May 6 CDC update

 

As US flu season ebbs, CDC reports 5 new deaths in kids, 101 total

Although influenza-like activity (ILI) in the United States continues to decline, the CDC late last week reported 5 new flu-associated deaths in children, bringing the total for the year to 101, the CDC said in its weekly FluView update.

The 5 deaths in kids occurred in February through April, and 3 were attributed to the H3N2 virus and 2 to an influenza A virus for which subtyping was not performed. The 101 pediatric deaths during the 2018-19 season compares with 95 in 2015-16, 110 in 2016-17, and 186 in 2017-18.

ILI accounted for 1.8% of outpatient clinic visits for the week ending on Apr 27, down from 2.1% the week before and below the national baseline of 2.2%. No state reported high ILI activity, only Puerto Rico, which is the same as the previous week. Flu was widespread in three states, down from five the week before.

The flu-associated hospitalization rate was 64.7 per 100,000 population, up slightly from 64.2 the week before. The rate was 216.6 hospitalizations per 100,000 people, up from 214.1 the week before. Two thirds of 100 influenza A viruses that were subtyped in US public health labs were H3N2 and one-third H1N1, the CDC said. Over the season, however, H1N1 was outpaced by H3N2 strains, 58% to 42%.
May 3 CDC FluView report

 

Pakistan polio vaccination killed; country makes Facebook request

In the fifth attack of its kind over the past month, a 35-year-old polio worker in Pakistan was killed as he drove home on his motorbike, according to Dawn, a media outlet in Pakistan.

According to the report, the attack occurred in Bajaur tribal district, and the man was a union council polio officer affiliated with the World  Health Organization.

In a related development, Pakistan has asked Facebook to block anti-polio vaccination content from platforms operating within the country, saying the harmful content is jeopardizing the polio eradication push and putting polio vaccinators' lives at risk, The News International, an English-language newspaper based in Pakistan, reported today.

According to earlier reports, the country temporarily paused vaccination efforts following the earlier attacks, which officials said were preceded by rumors and a viral video on Facebook of a man claiming that children were getting sick after polio vaccination.
May 6 Dawn story
May 6 News International story
Apr 30 CIDRAP News scan "Attacks prompt pause in Pakistan polio vaccination"

 

Data on first flu exposure hint at tougher H1N1 seasons

An analysis of US flu season surveillance and birth cohort data found that risk of flu from influenza A changed following the 2009 H1N1 pandemic and that, as the population ages, disease levels may be greater in H1N1-dominant seasons than ones when H3N2 predominates. A team led by CDC experts published its findings late last week in the Journal of Infectious Diseases.

It's thought that an individual's very first exposure to flu affects the immune response to future flu exposures, and several researcher efforts are under way to better understand the process—called imprinting—to help build more effective flu vaccines and guide flu prevention activities.

The team looked at seven 5-year birth cohorts of people born from 1918 to 1989, with the start year for each cohort marked by a new influenza A subtype or significant antigenic change in the circulating flu strain. Then they compared the findings with data from three US flu surveillance systems that track clinical disease.

They found that before the 2009 pandemic, there were more flu hospitalizations during H3N2-predominant seasons for all birth cohorts, but especially for those whose first flu exposure involved H1N1 viruses. After the pandemic, however, cohorts born after 1957 had more severe illness during H1N1 seasons. And the findings were consistent across all three surveillance systems.

The authors suggest that over the years as there are fewer people alive who fare better in H1N1 seasons and people who fare worse during H1N1 seasons age and become more vulnerable to flu complications, seasons led by H1N1 viruses may be linked to more severe illness than H3N2-predominant seasons. "As influenza viruses continue to evolve, it will be necessary to revisit these analyses to determine if the morbidity and mortality patterns described here continue," they wrote.
May 3 J Infect Dis abstract

Stewardship / Resistance Scan for May 06, 2019

News brief

Nursing home stewardship intervention shows mixed results

Implementation of an antimicrobial stewardship program intervention at 27 nursing homes in North Carolina was associated with reductions in urine culture and culture-positive rates, according to a study today in Infection Control and Hospital Epidemiology. But high proportions of antimicrobial resistance were still observed among common urinary pathogens.

The intervention, which was implemented in June 2015, was designed to optimize antibiotic use and improve knowledge and understanding of urinary tract infections (UTIs) among staff, resident, and families, with training sessions on causes of antimicrobial resistance, urine culture reports, asymptomatic bacteriuria, and UTI management. To investigate the impact of the program, researchers collected and analyzed urine culture results before and after implementation, comparing culture rates, culture positive rates, and antimicrobial resistance patterns in urinary pathogens.

Of the 6,718 urine cultures studied, 68% were positive, 18% were negative, and 14% were recorded as polymicrobial. Both the urine and urine positive culture rates per 1,000 resident-days showed a decrease from baseline through the active antimicrobial stewardship intervention period, with low "P" values for both the urine culture rate (P = .014) and the positive culture rate (P ≤ .001). Most of the identified potentially uropathogenic isolates were Escherichia coli (38%), Proteus spp (13%), and Klebsiella pneumoniae (12%).

While resistance varied, a significant decrease was observed during the intervention period in nitrofurantoin resistance among E coli (P ≤ .001) and ciprofloxacin resistance among Proteus spp (P ≤ .001). But carbapenem resistance increased for Proteus spp (P ≤ .001). Multidrug resistance also increased for Proteus spp compared to the baseline. In addition, the high baseline resistance of E coli to the commonly prescribed antimicrobials ciprofloxacin and trimethoprim-sulfamethoxazole did not change during the intervention.

The authors note that while some downward reductions in resistance were observed, they were too small and scattered to conclude that the intervention significantly changed resistance patterns.
May 6 Infect Control Hosp Epidemiol abstract

 

NY senator urges CDC to declare Candida auris a public emergency

US Senator Chuck Schumer yesterday urged the Centers for Disease Control and Prevention (CDC) to declare a public emergency over Candida auris.

Schumer, D-NY, said in a press release that declaring a public emergency over the multidrug-resistant fungal infection would help New York, the state with the most cases, gain access to millions of dollars in public health crisis response funding. Schumer said the money would be available if the agency qualified "superbugs" as eligible for official emergency response funding, as it has done with Zika and Ebola. 

"While the CDC is doing a fine job honing in on the threat this superbug presents to New York and the country, with the wave of a pen, they can help beat back the wave of this fungus' spread across New York in an even tougher way," Schumer said. "And that is what they should do: deliver a new raid of resources to stop this superbug from spreading even more across New York, Long Island and Upstate."

Of the 643 confirmed and probable C auris cases in the United States, 323 are in New York. C auris can spread easily in hospitals and cause serious invasive infections in patients who have compromised immune systems. The CDC has estimated that 30% to 60% of patients with infections have died.

Schumer said the money could be used to boost state and local testing capacity, invest in more rapid detection technology, fund surveillance efforts, and develop a public awareness campaign.
May 5 Senator Schumer press release

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