News Scan for Feb 10, 2020

New DRC Ebola case
;
MERS in Saudi Arabia
;
E-nudge to cut C diff testing
;
Dengue activity spikes
;
Multiple avian flu outbreaks

Only 1 new Ebola case recorded in past 4 days

According to the World Health Organization's (WHO's) online Ebola dashboard, only one new case of Ebola has been recorded in the Democratic Republic of the Congo (DRC) since Feb 6, raising the outbreak total to 3,431 confirmed cases. The WHO also noted 123 probable cases, and 441 suspected cases still under investigation.

Since the outbreak in North Kivu and Ituri provinces began in August 2018, 2,249 people have died from Ebola.

Over the weekend the DRC's Ebola technical committee (CMRE) said the single case reported was from Beni, the current hot spot for the virus.

The CMRE also updated vaccine totals, with 11,313 people having received the Johnson & Johnson vaccine to date, and 290,516 having received Merck's rVSV-ZEBOV.
WHO Ebola dashboard
Feb 8 CMRE report

 

Three more Saudi MERS cases reported

Saudi Arabia's Ministry of Health (MOH) has reported three more MERS-CoV cases over the weekend and through today, bringing the February total to four.

The two cases reported today include a 53-year-old man in Dammam whose exposure to MERS-CoV (Middle East respiratory syndrome coronavirus) is listed as primary, but whose contact with camels is unknown. The other is a 47-year-old man from Mecca classified as a primary case with unknown camel contact. A case reported on Feb 8 involved a 55-year-old man in Al Jouf with primary exposure and unknown camel contact. None of the men are healthcare workers.

Saudi Arabia reported 15 cases in January, including a probable healthcare-related cluster of 6 cases in Abha.

The WHO said in its latest monthly update that, since 2012, it has received reports of 2,499 MERS-CoV cases, at least 861 of them fatal. Most of these cases were from Saudi Arabia.
Feb 10 MOH report
Feb 8 MOH report

 

Electronic medical record intervention linked to fewer C diff test orders

An electronic medical record (EMR) "nudge" implemented at four hospitals in an academic medical network was associated with a reduction in inappropriate and total hospital-onset Clostridioides difficile infection (HO-CDI) orders, researchers from Emory University School of Medicine reported today in Infection Control and Hospital Epidemiology.

The retrospective study analyzed a 2-year period before and 2 years after the four hospitals implemented a popup notification in the EMR that was triggered when providers entered a C difficile test order for patients who had received a laxative or stool softener within the previous 24 hours—an order defined as inappropriate. No other system interventions to reduce HO-CDI testing were implemented during the study period. The primary outcome was the change in the rates of total and inappropriate HO-CDI orders per 1,000 patient days between the pre- and post-intervention periods.

Of the 17,694 HO-CDI test orders assessed in the study, 7% were inappropriate, and the intervention was associated with a decrease in the proportion of inappropriate orders (8% in the pre-intervention period vs. 6% in the post-intervention period). In addition, monthly HO-CDI orders decreased by 21% post-intervention (rate ratio [RR], 0.79; 95% confidence interval [CI], 0.73 to 0.86), and there was a modest continuing decline in order rate (trend change after RR, 0.99; 95% CI, 0.98 to 1.0).

In the interrupted time series analysis, the intervention was not significantly associated with an immediate decrease in the inappropriate HO-CDI order rate (level change RR, 0.80; 95% CI, 0.61 to 1.05). However, after the intervention, the order rate significantly decreased with time (trend change after intervention RR, 0.95; 95% CI, 0.93 to 0.97).

"Implementing an EMR nudge is a relatively simple method that can help healthcare systems improve diagnostic efficiency and limit the number of C. difficile tests ordered," the authors write. "However, depending on individual hospital practices, this intervention alone may not be sufficient to reduce HO-CDI rates."
Feb 10 Infect Control Hosp Epidem abstract

 

PAHO reports record-setting dengue activity in 2019

The WHO's Pan American Health Organization (PAHO) published an epidemiologic update on dengue in the Americas, noting that 2019 showed the highest dengue activity on record.

In total in 2019, PAHO tracked 3,139,335 cases of dengue (321.58 cases per 100,000 population), including 1,538 deaths.

"The number of cases reported in 2019 through EW 52 (3,139,335) is the largest recorded in the history of dengue in the Americas, exceeding the number of cases reported in the 2015-2016 epidemic period by 30%," PAHO said. "In 2019, the proportion of severe dengue (0.9%) has exceeded that observed in the previous four years; however, it is below that observed between 2010-2014 (ranging 1.35% to 3.05%)."

So far in 2020, 155,343 dengue cases have been reported, including 28 deaths. Bolivia, Honduras, Mexico, and Paraguay are all showing higher case counts than this time last year, PAHO said.

A total of 34 countries in the Americas reported dengue in 2019, with Belize, Costa Rica, El Salvador, Mexico, and Nicaragua reporting three times more cases than the previous year. Nicaragua, Beliza, and Honduras had the highest rates of case incidence.
Feb 7 PAHO report

 

Four countries report avian flu outbreaks

Three Asian countries (China, Vietnam, and Taiwan), as well as Scotland, have reported avian flu outbreaks in recent days, according to the World Organization for Animal Health  (OIE), Reuters, and the BBC.

China's agriculture ministry said a highly pathogenic H5N6 strain of avian flu had been found in a poultry farm in southwestern Sichuan province, Reuters reported. The ministry said 1,840 birds had died in the farm of 2,497, and the remainder had been culled to curb the spread of the virus.

Vietnam also reported three H5N6 outbreaks in villages, which sickened 1,280 birds and resulted in the slaughtering of 14,525 more. The villages are near each other, in the northeastern corner of the country. H5N5 was detected in Taipei City, Taiwan, in a poultry slaughterhouse. Fifteen birds died, the OIE said.

Finally, poultry farmers in Scotland are on high alert after highly pathogenic avian flu was detected in a free-range laying flock, the BBC reported. Officials suspected the flock contracted the virus from wild birds, but said Scottish eggs are safe to consume.
Feb 9 Reuters story
Feb 9 Vietnam OIE report
Feb 10 Taipei OIE report
Feb 10 BBC story

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