Meta-analysis documents rise in drug-resistant bacteria at the Hajj

A review and meta-analysis of studies on bacterial transmission and antibiotic resistance during the annual pilgrimage to Mecca has found rising rates of resistance among certain gram-positive and gram-negative bacteria, researchers report in Travel Medicine and Infectious Disease.

The review of drug-resistant bacteria at the Hajj included 31 studies involving pilgrims, food workers, and local patients at hospitals in Mecca, Mina, and Medina. The studies were conducted during the Hajj seasons from 2000 to 2015 and most of them provided antibiotic susceptibility results, with 11 identifying antibiotic-resistance genes. While many of the pilgrims came from different continents and countries, most were from Saudi Arabia and France; the majority of patients with infections were from Saudi Arabia.

While resistance rates varied between studies, the review indicates rising rates of antibiotic-resistant bacteria in the Hajj area. Methicillin-resistant Staphylococcus aureus (MRSA) isolated from food handlers rose from 0 in a 2001-02 study to 20% in a 2014 study, while MRSA isolated from pilgrims rose from 1% in 2000 to 63.2% in 2015. Studies of patients with bacterial infections reported rising rates of third-generation cephalosporin-resistant Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii from 2005 to 2015, ranging from 18.8% to 94%.

Carbapenem-resistant bacteria were detected in fewer than 10% of E coli isolates but up to 100% of K pneumoniae and A baumannii isolates. An increase in colistin-resistant bacteria, including MCR-1–producing E coli and K pneumoniae, was also noted. Rates of vancomycin-resistant gram-positive bacteria remained low.

The rising rates of antibiotic resistant bacteria are a concern because the mass gathering, which involves more than 2 million participants from over 184 countries each year, can facilitate the acquisition and spread of bacterial pathogens. "Hajj pilgrims therefore have the potential to disseminate or acquire [antibiotic resistant] bacteria during their stay in Saudi Arabia and to spread these bacteria when returning to their home country," the authors write.
Jun 24 Travel Med Infect Dis abstract

Another MERS case confirmed in Riyadh

The Saudi Arabian Ministry of Health (MOH) said there was another case of MERS-CoV in Riyadh, the site of three concurrent hospital-based outbreaks, late last week.

A 70-year-old Saudi man is in critical condition after being diagnosed as having Middle East respiratory syndrome coronavirus (MERS-CoV). The man's source of infection is under investigation, but he was not a healthcare worker.

The MOH also said a previously reported case, a 47-year-old expatriate man in Riyadh, has died from MERS.

The new cases bring Saudi Arabia's MERS-CoV total since 2012 total 1,667, including 680 deaths. Thirteen people are still being treated for their infections, the MOH said in its latest update today.
Jun 23 MOH report
Jun 27 MOH report

New Mexico reports 2 more cases of human plague

The New Mexico Department of Health (NMDOH) announced two more human cases of plague yesterday, bringing the state's total this year to three.  All three cases have been reported in Santa Fe County.

The new cases were confirmed in two women, ages 52 and 62. The women, like the first patient identified on Jun 7, are hospitalized. So far, there have been no deaths.

Plague is a serious and sometimes fatal bacterial infection transmitted to humans via flea bites or contact with infected animals.

"Pets that are allowed to roam and hunt can bring infected fleas from dead rodents back into the home, putting you and your children at risk," said Paul Ettestad, DVM, public health veterinarian for the NMDOH in a press release. "Keeping your pets at home or on a leash and using an appropriate flea control product is important to protect you and your family.”

Last year there were four human plague cases in New Mexico with no fatalities. In 2015 there were also four cases, including one death.
Jun 26 NMDOH press release


Cat bite suspected as source of Minnesota woman's tularemia infection

The Minnesota Department of Health (MDH) recently notified health providers about a human tularemia case in Dakota County, located in the southern Twin Cities metro area. It occurred in a 60-year-old woman who got sick after she was bitten by a stray cat.

The woman suffered the bite on May 10 and became ill May 13 with headache, muscle aches, worsening wound infection, lymphadenopathy, and fever, according to a Jun 21 HAN notice. She was hospitalized twice for a total of 6 days. Clinicians isolated Francisella tularensis from her bite wound.

Tularemia in Minnesota is rare in animals and humans, the MDH said, adding that in 2016, however, cases were detected in 3 people, 12 cats, and 2 rabbits, an increase over previous years.
Jun 21 MDH HAN notice


Latest HPV vaccine follow-up finds further prevalence drop, herd immunity

In the latest study to gauge the impact of the human papillomavirus (HPV) vaccine since it was first routinely recommended for girls in 2006, researchers found that 8 years following introduction, the vaccine decreased prevalence of the four strains covered by the vaccine by 71% in 14- to 19-year-olds and that its effectiveness is high at 83%.

Researchers from the US Centers for Disease Control and Prevention (CDC) based their findings on HPV prevalence based on self-collected cervicovaginal swabs collected as part of the National Health and Nutrition Examination Survey (NHNES). The samples have been collected since 2003, which allowed the group to compare HPV prevalence before and after the vaccine was introduced. Earlier studies have already confirmed benefits of the vaccine, and the latest study, published yesterday in the Journal of Infectious Diseases, looked at NHNES data through 2014 and explored other issues, such as possible herd protection and cross-protection against other strains.

For the 20- to 24-year-old age-group, the team saw a 61% decline from prevaccine levels, but they didn't see a significant decline for women ages 25 to 29 or 30 to 34. They said the larger increases in the current study for the two younger age-groups reflect increasing vaccine coverage.

For the first time in the US population, researchers saw a significant decline (34%) in the vaccine HPV types in unvaccinated women, which suggests herd protection, another consequence of rising vaccine coverage.

The 83% vaccine effectiveness observed, though high, was still less than the greater-than-96% level seen in clinical trials, which the researchers said could reflect the fact that the study probably included some females who were infected before vaccination and some who did not receive the whole vaccine series.

The study didn't find strong evidence of cross-protection or any worrisome increases in HPV types that aren't included in the four-strain vaccine.
Jun 26 J Infect Dis abstract


Belgium reports two more H5N8 outbreaks

In the latest avian flu outbreak developments, Belgium reported two more highly pathogenic H5N8 events, according to a report today from the World Organization for Animal Health (OIE).

The country has reported several outbreaks since early June. The newest ones involve nonpoultry species including wild birds at two locations in Hainaut province in the west.

Outbreaks began on Jun 20 and Jun 22, killing 57 of 86 susceptible birds. The surviving ones were slated for culling. Authorities said the source of the virus was the introduction of new live animals.
Jun 27 OIE report on H5N8 in Belgium

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