News Scan for Nov 20, 2015

News brief

Researchers find new E coli gene in China resistant to last-line antibiotics

Researchers have identified an Escherichia coli strain in pigs, pork, and humans in China that is resistant to colistin—a critical last-line antibiotic—and the gene that causes the resistance is readily transferred to other bacteria, posing an epidemic threat, according to a new study in The Lancet Infectious Diseases.

Chinese researchers, along with Timothy Walsh, DSc, of Cardiff University in Wales, while conducting routine surveillance of food animals in China, discovered that a certain E coli strain, SHP45, was resistant to colistin, of the polymyxin class of antibiotics. They pinpointed a gene called MCR-1 as causing the plasmid-mediated polymyxin resistance. Plasmids are tiny sections of DNA that can transfer resistance between organisms.

The investigators found the presence of MCR-1 in E coli isolates collected from 78 of 523 isolates from raw pork (15%) and from 166 of 804 pigs (21%) sampled from 2011 through 2014, as well as in 16 of 1,322 samples (1.2%) from inpatients who had E coli infections.

They also found that the plasmid bearing MCR-1 was readily passed between E coli strains, including those with epidemic potential, like ST131.The plasmid also transferred to Klebsiella pneumoniae and Pseudomonas aeruginosa bacteria. The team also noted that the plasmid was stable, another factor that could enhance spread.

The authors concluded, "Although no additional information is available, the possibility that mcr-1-positive E coli have spread outside China and into other countries in southeastern Asia is deeply concerning." They also note, "Acquisition of mcr-1 by carbapenemase-producing Enterobacteriaceae strains has the potential to make them truly pan-drug resistant and the resulting infections untreatable."

In a related commentary, University of Queensland experts David L. Paterson, MD, PhD, and Patrick Harris, BSc, said, "The implications of this finding are enormous."

They add, "There have been previous calls for curtailing the use of polymyxins in agriculture. We must all reiterate these appeals and take them to the highest levels of government or face increasing numbers of patients for whom we will need to say, 'Sorry, there is nothing I can do to cure your infection.' "
Nov 18 Lancet Infect Dis study
Nov 18 Lancet Infect Dis commentary


Three new states involved as Chipotle-linked E coli cases rise to 45

An outbreak of E coli O26 illnesses tied to Chipotle restaurants has grown by 4 states and 7 cases, to 6 states and 45 cases, as California, Minnesota, New York, and Ohio join Oregon and Washington on the outbreak map, the Centers for Disease Control and Prevention (CDC) said today in an update.

"The epidemiologic evidence available at this time suggests that a common meal item or ingredient served at Chipotle Mexican Grill restaurants in several states is a likely source of this outbreak," the CDC said. "The investigation is still ongoing to determine what specific food is linked to illness."

Washington has confirmed 26 cases, followed by Oregon, 13; California and Minnesota, 2; and New York and Ohio with 1 apiece. Two of the new cases were in Washington, with the rest in the states first reporting cases (see CDC map)

Illness-onset dates range from Oct 19 to Nov 8, and patients range in age from 2 years to 94, with a median age of 22. Investigators have interviewed all the patients, and 43 of them (96%) said they had eaten at Chipotle before becoming ill.

Sixteen patients (36%) reported being hospitalized, which is up from 13 in the previous CDC update 3 days ago. No reports of hemolytic uremic syndrome—a severe, sometimes fatal kidney complication—have been confirmed, and no patients have died.

"Investigators are using whole genome sequencing, an advanced laboratory technique, to get more information about the DNA fingerprint of the STEC O26 bacteria causing illness," the CDC said. "To date, 10 STEC O26 isolates from ill people in Washington (9) and Minnesota (1) were found to be highly related genetically to one another."

The agency said Chipotle officials are cooperating with the investigation.
Nov 20 CDC update


Intelligence sources warn of ISIS chemical weapon development

The terror group ISIS, or Islamic State, is aggressively pursuing the development of chemical weapons, though so far it doesn't appear to have the capacity to develop a sophisticated tool such as nerve gas, the Associated Press (AP) reported yesterday, citing anonymous Iraqi and US intelligence sources.

So far the only hint that the group has used chemical weapons is initial evidence of traces of mustard gas on ISIS mortars that hit Kurdish targets in Iraq earlier this year. But intelligence officials say the group has set up a branch to pursue chemical weapons and has recruited foreign and regional scientists to assist with the efforts, according to the AP story.

Iraqi officials fear the group has a safe haven to test and develop weapons in parts of Iraq and Syria it has overrun, and in response has equipped some Iraqi troops with gas masks and acquired protective suits from Russia.

Former US military intelligence official Richard Zahner told the AP that al Qaida unsuccessfully tried to develop such weapons for two decades, but he warned that ISIS appears to be more innovative and have more resources than their predecessors. "Even a few competent scientists and engineers, given the right motivation and a few material resources, can produce hazardous industrial and weapons-specific chemicals in limited quantities," he said.
Nov 19 AP story

In other insurgent-related development, the International Federation of Red Cross and Red Crescent Societies recently raised concern about a growing measles epidemic in parts of Cameroon that are in Boko Haram control, according to a Nov 17 ReliefWeb report.

Of 858 cases recorded in the country, 587 have occurred in Mokolo district, in the northern area where the terror group is active. The area is close to borders with Chad and Nigeria, raising the risk of epidemic spread.
Nov 17 ReliefWeb report


WHO experts warn of meningitis C threat to Africa

An expert group from the World Health Organization (WHO) that recently met to discuss the rising levels of Neisseria meningitidis serogroup C infections in Africa's meningitis belt warned that the risks of more epidemics in the region is high for 2016.

The worries about the new subgroup, which led to an outbreak in Nigeria and Niger this year that sickened 11,000 people and led to 800 deaths, comes just after a major report documented dramatic progress of vaccination against serogroup A infections. The expert group met to discuss the serogroup C threat in October, and their findings were published today in the WHO Weekly Epidemiologic Record.

International health officials are trying to obtain 5 million doses of C-containing vaccines, but they estimate there are only 4 million doses in the global stockpile. Earlier this year production constraints involving C-containing vaccines hampered control of epidemics in the two countries.

Factors that led to the group's risk warnings include rapid subregional expansion, the emergence of a unique serogroup C clone, and lack of population immunity, given that the last serogroup C epidemics in the region occurred in the late 1970s and that few campaigns involved vaccines that included serogroup C.
Nov 20 WHO Wkly Epidemiol Rec report

Flu Scan for Nov 20, 2015

News brief

US flu activity shows slight increase

US flu activity rose slightly last week, with two regions of the country—the south central and central Midwest—at or above their regional baseline that measures clinic visits for flulike illness, the US Centers for Disease Control and Prevention (CDC) said today in its weekly update.

The south central region includes Texas and surrounding states, and the central Midwestern region includes Iowa, Missouri, Kansas, and Nebraska. One state—South Carolina—reported moderate flu activity, another measure of clinic visits. The only area that reported widespread flu last week was Guam, with Puerto Rico reporting regional flu and four states reporting local flu spread: Hawaii, Iowa, New Hampshire, and Oregon.

Overall, the national marker for flu clinic visits rose slightly, from 1.4% to 1.6%, which is still below the US baseline of 2.1%. The percentage of respiratory tests that were positive for flu increased last week, from 1.2% to 1.6%. The CDC said the H3N2 virus is still the predominant strain.

The first pediatric flu death of the season was reported and involved an unsubtyped influenza A virus.
Nov 20 CDC FluView report


H5N1 hits Nigerian poultry farm

Nigeria's agriculture ministry yesterday reported another H5N1 avian flu outbreak, this time striking a commercial layer farm in Rivers state, located in the southern part of the country.

In a report to the World Organization for Animal Health (OIE), officials said the outbreak started on Nov 13 and was resolved 4 days later. Of 2,100 susceptible birds, the virus killed 310, and the remaining stocks were culled to control the spread of the disease.

The ministry said the source of the outbreak wasn't known but added that the farm had poor biosecurity measures in place.

Nigeria is among a handful of African countries that have reported a reemergence of H5N1 in poultry after a several-year hiatus. Nigeria has been especially hard hit, and reporting 101 outbreaks so far this year.
Nov 19 OIE report

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