Respiratory virus sampling in India turns up human H9N2 avian flu
Researchers studying the incidence of respiratory syncytial virus (RSV) deaths in India's Maharashtra state earlier this year identified an H9N2 avian flu infection in a 17-month-old boy, according to a study published today in Emerging Infectious Diseases.
As part of a surveillance study in 93 villages, the team collected 2,085 nasopharyngeal swabs from children with severe or fatal pneumonia to test them for flu, RSV, and other respiratory pathogens. Low-pathogenic H9N2 viruses have a wide host range, and an earlier study in India suggested that 5% to 6% of people with direct exposure to poultry had H9N2 antibodies. However, confirmed human H9N2 infections have been reported only in Hong Kong, China, Bangladesh, and Pakistan.
A swab received by India's National Institute for Virology lab on Feb 12 tested positive by polymerase chain reaction for H9N2. The boy's symptoms, which included fever, cough, and shortness of breath, began on Jan 31, and a sample was obtained 2 days after he got sick. An investigation revealed he had gotten all of his routine childhood vaccinations. He had traveled with his family to a local religious gathering 1 week before his symptoms began. His father also became ill after the event, but migrant work kept him from getting tested. No direct exposure to poultry was found. The boy recovered uneventfully.
Whole genome sequencing of the H9N2 virus showed a mixed lineage of G1 and H732. Tests suggested that the virus was susceptible to adamantanes and neuraminidase inhibitors. Bayesian analysis suggested multiple introductions of H9N2 avian flu into Indian poultry.
Nov 6 Emerg Infect Dis report
Study highlights long-term effects of postop infections
A study that examined the long-term effects of postsurgical infections found that an infection in the first 30 days following surgery increased the risk of another infection within the following year and increased the risk of death. Researchers published their findings today in JAMA Surgery.
For the study, the team looked at data on people who had major surgery at Veteran's Health Administration facilities from January 2008 through December 2015. Of 659,486 patients, most were male, and the average age was 59.7 years. Overall, 3.6% had an infection in the 30 days after surgery. The most common infections were surgical site, urinary tract, pneumonia, and bloodstream. Findings revealed that 6.6% had a long-term infection, with urinary tract, skin and other soft tissue, bloodstream, and pneumonia most common. Of those with early post-surgical infections, 3.8% died during the 1-year follow-up period.
The investigators calculated that patients who had 30-day postoperative infections had a 3.2-fold higher risk of 1-year infection and a 1.9-fold higher risk of death compared with those who didn't have infections within the 30-day postoperative period. The authors concluded that cost-benefit calculations for surgical infection prevention programs should include the costs of long-term infection and death and that prevention steps targeting the 30-day postsurgical window may improve long-term patient outcomes.
In a related commentary, two experts from the University of Louisville wrote that much of the earlier literature focuses on 30-day morbidity and mortality. They note that the new report sheds light on prolonged consequences, with findings validated across a range of surgical specialties and infection types, independent of patient comorbidity. They hope, however, that future studies tease out other factors, such as inpatient status and postoperative infection type and mortality.
Nov 6 JAMA Surge abstract
Nov 6 JAMA Surg commentary
Philippines confirms 4th polio case
An outbreak of polio is growing in the Philippines, after the department of health confirmed the virus in another child, Xinhua reported today. This is the country's fourth case of the paralyzing illness.
The child is from Mindanao in the southern Philippines, but the exact location has not been confirmed by government officials, the story said. The department of health said a round of polio vaccination will begin this month in the area around Mindanao.
Until Sep 19, the Philippines had been polio-free for 19 years. The previous cases have been in children under the age of 5 and classified as poliovirus type 2.
Following the first case detection, the government launched a nationwide polio vaccine campaign, and health officials said that, as of Oct 31 more than 95% of children 0 to 59 months old have been vaccinated against the virus.
Nov 6 Xinhua news story