News Scan for Sep 09, 2019

More US measles
;
Yellow fever in Nigeria
;
Treating complex abdominal infection

CDC reports 7 new measles cases, 1,241 total

The US Centers for Disease Control and Prevention (CDC) said today it has received reports of 7 more measles cases last week, lifting the number of confirmed cases this year to 1,241 from 31 states. However, it noted that only 2 of the patients were recently sick and that the other 5 are past cases.

The weekly total last week was down from 19 cases reported the previous week. There are only three active outbreaks, down from four the previous week. The active outbreaks are located in New York's Rockland and Wyoming counties and in El Paso, Texas. All are linked to travelers who brought measles back from other countries that are experiencing large outbreaks, such as Israel, the Ukraine, and the Philippines.

This year's US cases are the most in the country since 1992, and more than 75% are linked to outbreaks in New York. Of the illnesses reported this year, 130 people were hospitalized and 65 experiences complications such as pneumonia and encephalitis.

To mark the start of the new school year, the US Food and Drug Administration in a Sep 6 statement reiterated the importance of vaccine such as the measles, mumps, and rubella (MMR) vaccine.

Peter Marks, MD, PhD, who directs the FDA's Center for Biologics Evaluation and Research, said in the statement that it's deeply concerning to see vaccine-preventable diseases such as measles or mumps reemerging in the United States. He urged parents with questions about vaccine to discuss them with their child's health provider. "The FDA always strives to use the best available scientific evidence to promote and protect the well-being of individuals and the public health, and the evidence fully supports the safety and effectiveness of this vaccine," he added.
Sep 9 CDC update
Sep 6 FDA statement

In international measles developments, an outbreak in New Zealand since the first of the year has grown to 1,131 cases, according to an update today from the country's health ministry. Of the total, 944 are in the Auckland region. On Aug 30 the health ministry took steps to establish an incident management team to coordinate the response to the Auckland outbreak.
Sep 9 New Zealand health ministry measles update

 

Yellow fever outbreak prompts vaccination campaign in 3 Nigerian states

Nigeria's government and its global health partners announced the launch of a yellow fever vaccination campaign to help control a growing outbreak in the country's Ebonyi state, located in the southeastern region, according to a Sep 7 press release from the World Health Organization (WHO) regional office for Africa (WHO AFRO).

Since May, more than 55 suspected cases have been reported across eight local government areas (LGAs) in Ebonyi state. Most have been reported in recent weeks from Izzi LGA. Samples from nine patients were positive for yellow fever, and further tests are pending. Twenty of the patients with suspected yellow fever have died, resulting in a case-fatality rate of 40%, the WHO said.

The 10-day vaccination campaign started on Sep 7, targeting 1.6 million people in Ebonyi and two bordering states, Benue and Cross River. Nigeria's partners include the WHO and Gavi, the Vaccine Alliance.

Nigeria has also formed a rapid response team to investigate the cases, take efforts to control virus circulation, and sensitize health workers and community members.

Meanwhile, Nigeria has reported a cluster of yellow fever cases in Bauchi state in the north central part of the country, and on Sep 6 it activated an emergency operations center to coordinate outbreak response, according to a statement from the Nigeria Centre for Disease Control (NCDC). So far, there are four cases, three of them in residents of Alkaleri LGA and one involving a tourist who visited Kano state and the Yankari Game Reserve in Bauchi state. The tourist's father also had similar symptoms, but died before a sample could be collected.

An epidemiology team from Borno state reported deaths of college students who visited the game resort in August. Of 95 who visited the location, 8 developed symptoms and 6 died. Testing is under way on samples from the patients.
Sep 7 WHO AFRO press release
Sep 6 NCDC statement

 

Analysis: Beta-lactams effective alternative for intra-abdominal infections

A systematic review and meta-analysis of treatment for complicated intra-abdominal infections (cIAIs) found no difference in clinical outcomes between carbapenem antibiotics and non-carbapenem beta-lactams, Chinese researchers reported today in Open Forum Infectious Diseases.

In a search of literature published up to November 2018, the researchers identified 22 randomized controlled trials, involving 7,720 patients, comparing the safety and effectiveness of carbapenems versus alternative beta-lactam treatments for cIAIs. While both carbapenems and alternative beta-lactams alone or in combination are recommended for cIAIs by the Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America, the researchers say the rise of carbapenem-resistant infections reflects illustrates the need for better treatment options.

"Due to the current lack of new antibiotic agents without overlapping mechanisms of resistance, judicious use of these broad-spectrum agents for treatment of resistant gram-negative infections is critical to preserve their future utility," they write.

The meta-analysis found no differences in clinical treatment success (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.71 to 1.05), microbiological treatment success (OR, 0.88; 95% CI, 0.71 to 1.09), adverse events (OR, 0.98; 95% CI, 0.87 to 1.09), or mortality (OR, 0.96; 95% CI, 0.68 to 1.35). Subgroup analyses found that patients treated with imipenem were more likely to experience clinical or microbiological failure than those treated with alternative beta-lactams monotherapy or in combination.

"In conclusion, the current meta-analysis revealed that beta-lactams monotherapy or in combination can be an effective and safe treatment option for cIAI, similar to carbapenem," the researchers write.
Sep 9 Open Forum Infect Dis abstract

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