News Scan for Jun 27, 2019

News brief

CDC says number of summertime Crypto outbreaks rises each year

The number of Cryptosporidium outbreaks, which occur most commonly in the summer, has risen about 13% each year from 2009 to 2017, according to a new report from the US Centers for Disease Control and Prevention (CDC) published today in Morbidity and Mortality Weekly Report (MMWR).

Researchers looked at 444 outbreaks reported from 2009 through 2017, which sickened 7,465 people, hospitalized 287, and led to 1 death.

The parasite, spread though the feces of infected humans or animals, is the leading cause of outbreaks in the United States linked to pools and other recreational water. Cryptosporidium parasites have an outer shell that allow them to survive for days in chlorinated water, and they can easily cause outbreaks, because they are excreted in high numbers that exceed the infectious dose for humans.

Diarrhea, the most common symptom, can last up to 3 weeks. Illnesses disproportionately affect children ages 1 to 4. An outbreak at a treated water location can spread to other water venues and childcare settings, leading to hundreds or thousands of cases

The researchers found 35% of outbreaks were linked to treated swimming water, 15% were linked to contact with cattle, especially nursing calves, 13% were connected to illnesses in childcare settings, and 3% were from drinking raw (unpasteurized) milk or apple cider.

Michele Hlavsa, RN, MPH, chief of the CDC's Healthy Swimming Program, said in a CDC press release, "Young children can get seriously sick and easily spread Crypto. They don’t know how to use the toilet and wash their hands, or are just learning how. But we as parents can take steps to help keep our kids healthy in the water, around animals, and in childcare."

The CDC notes that the increase in outbreaks might reflect increased use of multipathogen testing panels that include Cryptosporidium. With the summer season starting, the CDC recommends that people take steps to protect themselves and others from the parasite, such as avoiding swimming while sick with diarrhea, keeping kids sick with diarrhea out of daycare, and washing hands with soap and water after having contact with animals or their environments.
Jun 28 MMWR report
Jun 27 CDC
press release

 

Latest Saudi MERS patient had recent camel contact

Though MERS-CoV cases in Saudi Arabia have tapered off since early in the year, the country's Ministry of Health (MOH) continues to report a steady stream, including a new one today in Riyadh.

A 38-year-old man in Riyadh has contracted MERS-CoV (Middle East respiratory syndrome coronavirus), the MOH said, after recent camel contact. Officials list his case as "primary," meaning the disease did not likely transmit from another person.

So far this year Saudi Arabia has had 154 MER cases. Since 2012 when the virus was first reported, the World Health Organization has confirmed at least 2,442 cases, the vast majority in Saudi Arabia. At least 842 patients have died from their infections.
Jun 27 Saudi MOH update

 

New draft Lyme disease guidelines issued, open for comment

The Infectious Diseases Society of America, American Academy of Neurology, and American Academy of Rheumatology today issued new draft guidelines for the prevention, diagnosis, and treatment of Lyme disease and opened a comment period on the document.

Among the recommendations in the new guidelines, which were last updated in 2006, is that prophylactic antibiotics should be administered to adults and children within 72 hours after removal of a high-risk tick bite. High-risk bites are those that come from an identified Ixodes tick that was engorged and attached for more than 36 hours and occur in a highly endemic area. The recommended antibiotic is a single dose of oral doxycycline.

For patients with erythema migrans—a skin lesion at the site of the tick bite often shaped like a bullseye that indicates early localized Lyme disease—the guidelines recommend clinical diagnosis over antibody testing, and treatment with a 10-day course of doxycycline or a 14-day course of amoxicillin, cefuroxime axetil, or phenoxymethylpenicillin.

The guidelines also recommend serum antibody testing for patients who have manifestations of Lyme neuroborreliosis and routine testing for those who've had plausible exposure to Ixodes ticks infected with Borrelia burgdorferi and present with meningitis, painful radiculoneuritis, mononeuropathy multiplex, and acute cranial neuropathies. Routine testing is not recommended for patients with other neurologic conditions or psychiatric illnesses who have no history of a tick bite or other manifestations of Lyme disease, or for children presenting with symptoms of developmental, behavioral, or psychiatric disorders.

For patients who have persistent or recurring non-specific symptoms such as fatigue, pain, or cognitive impairment following Lyme treatment, the guidelines advise against additional antibiotics. The authors also call for more studies on patients who've been diagnosed as having chronic Lyme disease—a term that currently lacks an accepted definition but refers to patients with infections lasting more than 6 months.

A public comment period on the draft guidelines is open for 45 days, with a submission deadline of Aug 10.
Jun 27 draft Lyme disease guidelines

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