Stewardship / Resistance Scan for Nov 28, 2016

News brief

CDC: 21 ill from multidrug-resistant Salmonella outbreak tied to dairy calves

At least 21 people in eight states have been sickened by multidrug-resistant Salmonella linked to contact with dairy bull calves in an outbreak dating back to January, the Centers for Disease Control and Prevention (CDC) said today.

Among 19 patients with available information, illness-onset dates range from Jan 11 to Oct 24, and ages vary from less than 1 year to 72, with a median age of 21; 62% of case-patients are female. Eight (42%) of the 19 have been hospitalized, but no deaths have been reported.

Wisconsin has reported 12 of the infections, Minnesota and South Dakota 2 each, and California, Iowa, Idaho, Missouri, and Oklahoma 1 apiece.

"Epidemiologic, traceback, and laboratory findings have linked this outbreak to contact with dairy bull calves purchased from livestock markets in Wisconsin," the CDC said. "Dairy bull calves are young, male cattle that may be raised for meat." All isolates tested were multidrug-resistant Salmonella Heidelberg.

The CDC, which said the outbreak investigation is ongoing, advised people to wash hands thoroughly after touching livestock or their environs, use dedicated clothes, and employ other preventive measures to avoid Salmonella infection.
Nov 28 CDC outbreak notice

Survey highlights resistant Enterobacteriaceae in European hospitals

A multinational survey of European hospitals is providing the first laboratory-substantiated data on the incidence of carbapenemase-producing Enterobacteriaceae(CPE) across the continent, according to a news release from the European Centre for Disease Prevention and Control (ECDC).

For the European Survey on CPE (EuSCAPE), national laboratories in 36 countries collected the first 10 carbapenem non-susceptible Klebsiella pneumoniae and Escherichia coli clinical isolates from 455 sentinel hospitals, along with 10 susceptible same-species comparator isolates and pertinent patient and hospital information, between November 2013 and April 2014. Analysis of the isolates showed that 850 of 2,301 K pneumoniae samples (37%) and 77 of 402 E coli samples (19%) tested positive for carbapenemase production.

The most frequently detected carbapenemases in K pneumoniae were KPC enzymes, followed by OXA-48-like, NDM, and VIM. In E coli, the most frequently detected carbepenemases were OXA-48-like enzymes, followed by NDM and KPC.

Overall, the results showed that on average in Europe, 1.3 patients per 10,000 hospital admissions had a carbapenemase-producing K pneumoniae or E coli infection, with the highest incidence found in southern and southeastern Europe. In Italy, for example, the rate was 6 patients per 10,000 hospital admissions. In addition, high proportions of K pneumoniae resistant to the last-line antibiotics colistin, fosfomycin, and tigecycline were found in Italy, Romania, Turkey, and Spain. The authors note that this finding could reflect greater use and selection pressure in these countries.

The ECDC says the results "highlight the need to develop a system for public health surveillance of CPE across healthcare systems in Europe" as a tool to inform risk assessment and infection control programs.

The survey results were published earlier in the Lancet Infectious Diseases.
Nov 25 ECDC news release
Nov 17 Lancet Infect Dis study

News Scan for Nov 28, 2016

News brief

WHO: MERS cases down 58% from last year; Saudi Arabia has 3 new cases

In a MERS-CoV situation report today, the World Health Organization (WHO) said there are 58% fewer cases reported in September and October of this year compared with the same period last year.

The respiratory illness still primarily occurs in those aged 50 to 59. "However, the females in the age group of 20–29 and 30–39 are acquiring MERS infection in higher numbers when compared to males in the same age group," the WHO reports. That increase may be because more women are healthcare workers and exposed to MERS-CoV (Middle East respiratory syndrome coronavirus) through patients, the agency said.
Nov 28 WHO report

In other news, the Saudi Arabian Ministry of Health (MOH) reported a new case of MERS yesterday, diagnosed in a 56-year-old Saudi man from Hafar Al Batin. The man is in stable condition and the source of his infection is listed as primary, meaning he did not contract the disease from another person.

Today the MOH reported two addition cases. A 47-year-old woman in Riyadh is in stable condition. She is a secondary household contact of a primary patient. And a 35-year-old Saudi man from Taif is also in stable condition. The MOH said the man had direct contact with a camel.

The new cases raise Saudi Arabia's MERS-CoV total to 1,488, of which 618 have been fatal. Eight people are still being treated for their infections.
Nov 27 MOH report
Nov 28 MOH report

266 suspected cases of Rift Valley fever in Niger

The WHO said late last week there are 17 confirmed and 266 suspected cases of Rift Valley fever (RVF) in Niger, resulting in 32 deaths. The outbreak began on Aug 30 and is affecting the nomadic stockbreeder population that moves within that country.

"The stockbreeder population is highly mobile and moves along stock routes to find pasture for their herds in the Sahel region that incorporates a number of neighboring countries," the WHO statement warned. Though RVF is not easily transmitted from person to person, the WHO said surrounding nations, including Mali, Burkina Faso, Nigeria, Chad, Benin, Togo and Cameroon, should be aware of the public health risk the outbreak poses.

RVF is an acute viral disease often transmitted among livestock. It can cause vision loss and death in humans in rare, severe cases. Like Ebola, it is one of the viral hemorrhagic fevers. It can often mask itself as malaria in milder forms.
Nov 24 WHO statement

CDC notes variant H1N2 flu case in Iowa

Iowa officials confirmed a case of variant H1N2 (H1N2v) influenza in a person who had recent swine contact, bringing to four the number of such cases this year, the Centers for Disease Control and Prevention (CDC) said today in its weekly FluView update.

The CDC did not say when the person contracted the disease or give any demographic information, but it noted that the person was not hospitalized and has fully recovered. The agency reported the first H1N2v cases on May 13, in Minnesota, as well as another Minnesota case and one in Wisconsin on Jul 1. Two of those three earlier cases required hospitalization.

Since 2005, state officials have reported nine H1N2v cases, six of them in Minnesota. That compares with 372 H3N2v cases and 20 H1N1v cases in the same period, according to CDC data. In 2012, more than 300 people tested positive for H1N1v, H1N2v, or H3N2v strains—primarily the latter—in cases that were mostly linked to county and state fairs in the Midwest.

Eighteen H3N2v cases have been reported in Michigan and Ohio this year.
Nov 28 CDC FluView update
Jul 1 CIDRAP News scan "Wisconsin, Minnesota report variant H1N2 flu cases"
CDC variant influenza case totals
Aug 26 CIDRAP News scan "Seven more fairgoers ill with variant H3N2"

Study: No link between maternal flu infection, vaccine and child autism

A study today in JAMA Pediatrics shows no link between maternal influenza infection or vaccination and childhood autism diagnosis.

In the cohort study of 196,929 children, where 3,103 had autism spectrum disorders, maternal flu infection during pregnancy was not associated with increased autism risk. Maternal flu vaccination during the first trimester did suggest an increased risk of autism, but the association was deemed statistically insignificant after adjusting for multiple comparisons.

The researchers based their conclusions on 10 years of data collected through the Kaiser Permanente California hospital system from 2000 to 2010. Only mothers with confirmed influenza were included in the study. Infection in any trimester of pregnancy was not associated with an increased risk of autism.

Influenza vaccination rates increased from 6% of mothers in 2000 to 58% in 2010, and vaccination was associated with increased maternal age, education, and socioeconomic status. The slight increase in autism diagnoses in children whose mothers received the flu vaccine during the first trimester of pregnancy was likely due to chance, the authors said.

"While we do not advocate changes in vaccine policy or practice, we believe that additional studies are warranted to further evaluate any potential associations between first-trimester maternal influenza vaccination and autism," the authors concluded.
Nov 28 JAMA Pediatr study