CDC confirms 4 new H1N2v flu cases in 3 states

For the second week in a row the Centers for Disease Control and Prevention (CDC) has confirmed four cases of variant H1N2 (H1N2v) flu, this time in California, Michigan, and Ohio.

In its weekly FluView report today, the CDC said 2 of the new H1N2v cases are in California and 1 each in Michigan and Ohio. Last week the agency confirmed 2 cases in California and 2 in Michigan. The only other variant flu case reported so far this year was caused by the much more common H3N2v strain, in a patient in Indiana.

Of the four new cases, three involved exposure to swine at agriculture fairs in the week before illness onset, while the other person attended a fair but had no contact with swine, the CDC said. Three patients were children and one an adult younger than 25. None required hospitalization.

"Early identification and investigation of human infections with novel influenza A viruses are critical so that the risk of infection can be more fully understood and appropriate public health measures can be taken," the CDC said.
Aug 17 CDC FluView report


Study finds no tie between pH1N1 vaccine, narcolepsy except in Sweden

A study involving data from nine countries has found that, other than elevated narcolepsy levels after 2009-10 pandemic flu vaccination campaigns in Sweden, there was no association between narcolepsy and AS03- or MF59-adjuvanted 2009 H1N1 (pH1N1) flu vaccines in children or adults.

Reporting yesterday in the journal Vaccine, a large international group of scientists said they used electronic health databases to conduct a dynamic retrospective cohort study to assess narcolepsy incidence before and during pH1N1 virus circulation—and after pH1N1 vaccination campaigns—in Canada, Denmark, Spain, Sweden, Taiwan, the Netherlands, and the United Kingdom. In addition, they used a case-control study design to evaluate the risk of narcolepsy following AS03- and MF59-adjuvanted pH1N1 vaccines in Argentina, Canada, Spain, Switzerland, Taiwan, and the Netherlands.

In 2010, narcolepsy was associated with vaccination with Pandemrix, an AS03-adjuvanted monovalent pH1N1 vaccine. Adjuvants boost the body's immune response to a virus.

The researchers found no change in narcolepsy rates in any period in single-study sites except in Sweden and Taiwan. In Taiwan, narcolepsy incidence increased after wild-type pH1N1 virus circulation, and in Sweden it increased after the start of pH1N1 vaccination.
Aug 16 Vaccine abstract


Russia reports H5N2 avian flu on farm; other strains in Denmark, Bulgaria

In highly pathogenic avian flu developments, Russia reported an H5N2 outbreak in commercial poultry and two European countries—Denmark and Bulgaria—reported new detections of different subtypes: H5N6 in a wild bird and H5N8 in backyard poultry.

Russia's H5N2 outbreak is the second involving the subtype this year in poultry in Kostrom oblast, in the west of the country. The latest event began Aug 9 at a location housing 498,485 birds, with the virus killing 506, according to a notification yesterday from the World Organization for Animal Health (OIE). So far 1,223 birds have been destroyed as part of the outbreak response.

The report said an analysis of the virus's H and N gene fragments suggest that it belongs to the Asian lineage of the highly pathogenic avian influenza clade that spread in Russia, Europe, the Middle East, and African countries from 2016 through 2018.

Elsewhere, Denmark said tests on a mute swan found dead on a beach near the city of Korsar on Aug 9 were positive H5N6. The country had reported its last detection of the virus in April. And Bulgaria reported an H5N8 outbreak in backyard poultry that began Jul 6 in a town in Dobric, killing 10 of 62 birds. Its most recent outbreak involving the subtype was in June at a commercial farm in Dobric, which is in the northeastern part of the country.
Aug 16 OIE report on H5N2 in Russia
Aug 17 OIE report on H5N6 in Denmark
Aug 17 OIE report on H5N8 in Bulgaria

News Scan for Aug 17, 2018

News brief

Cyclospora outbreak tied to McDonald's salads sickens 40 more

The US Centers for Disease Control and Prevention (CDC) yesterday reported 40 more cases in a Cyclospora outbreak linked to McDonald's salads, pushing the illness total to 476.

Among the sick patients, the latest illness onset is Jul 20. The CDC notes that it can take 6 weeks between illness onset and when illnesses are reported in people infected with Cyclospora cayetanensis, the parasite that causes the disease.

One more patient was hospitalized, putting that number at 21. No deaths have been reported. The number of affected states remained at 15.

In late July, the US Food and Drug Administration (FDA) identified Cyclospora in a romaine lettuce and carrot salad mix distributed to McDonald's by a Fresh Express processor in Streamwood, Ill.  So far there's no evidence that the Cyclospora outbreak related to McDonald's salads is related to an earlier Cyclospora event connected to Del Monte fresh vegetable trays.

The FDA said yesterday that the investigation is ongoing and it is reviewing distribution and supplier information for romaine lettuce and carrots.
Aug 16 CDC update
Aug 16 FDA update


Polio cases reported in Afghanistan, Papua New Guinea, Nigeria

Afghanistan has a new case of wild poliovirus type 1 (WPV1) infection, while Papua New Guinea and Nigeria are reporting vaccine-derived polio cases, according to today's weekly update from the Global Polio Eradication Initiative (GPEI).

The WPV1 case in Afghanistan is in Kandahar province and involves onset of paralysis on Jul 17, the GPEI said. It pushes the number of WPV1 cases in the country to 11 this year. Officials also reported a WPV1-positive environmental sample in the same province.

In Papua New Guinea, a new case of circulating vaccine-derived poliovirus type 1 (cVDPV1) has been reported in Eastern Highland province, with onset of paralysis on Jul 8. The case is the same one reported earlier this week by the World Health Organization's Western Pacific regional office. The country has now recorded 4 such cases in 2018, with the others in Morobe (2 cases) and Enga (1) provinces. Officials are planning three more vaccination campaigns through October.

The case in Nigeria involves circulating vaccine-derived poliovirus type 2 (cVDPV2) in Katsina state. The patient first had paralysis symptoms on Jul 15. Nigerian officials also confirmed cVDPV2 in stool samples from a contact of a previously reported person in Yobe state who had acute flaccid paralysis indicative of polio.

"The country continues to be affected by two separate cVDPV2 outbreaks, the first centered in Jigawa state, and the second in Sokoto state," the GPEI said in its report. Nigeria has reported four cVDPV2 cases so far this year.
Aug 17 GPEI update

ASP Scan (Weekly) for Aug 17, 2018

News brief

VA study finds MRSA colonization significantly increases infection risk

Originally published by CIDRAP News Aug 16

A longitudinal study of inpatients at Department of Veterans Affairs (VA) acute care hospitals has found that methicillin-resistant Staphylococcus aureus (MRSA) colonization significantly increases the risk of MRSA infection, with a substantial number of infections occurring after discharge from the hospital, VA researchers report in Clinical Infectious Diseases.

The retrospective study looked at a cohort of 985,626 inpatient admissions to VA acute care hospitals from 2008 through 2015, focusing only on patients who had surveillance testing for colonization status performed on admission. A patient whose admission MRSA screen and all subsequent screens were negative was categorized as not colonized. A patient who had a positive MRSA screen was classified as an importer, and a patient who had a negative MRSA screen on admission, but a subsequent positive screen, was defined as an acquirer.

For each of the three groups, the researchers calculated the proportion of MRSA infections that occurred prior to discharge and at 30, 90, 180, and 365 days after discharge, then determined the relationship between MRSA colonization status and infection.

Overall, 903,190 patients (91.6%) were found not to be colonized with MRSA during their hospitalization, 72,388 (7.3%) were importers, and 10,048 (1.0%) were acquirers. The MRSA infection rate across the predischarge and 180-day postdischarge time period was 5.5% in importers and 7.0% in acquirers, rising to 11.4% in importers and 11.7% in acquirers who were admitted directly to the intensive care unit. In the multivariable regression analysis, the predischarge hazard ratio for MRSA infection was 29.6 for importers and 28.8 for acquirers compared to those not colonized. When measured at 180 days postdischarge, 63.9% of all pre- and postdischarge infections among importers occurred during the postdischarge period. For acquirers, this value was 61.2%.

"In conclusion, acquisition of MRSA during hospitalization markedly increases the risk to a patient of subsequent infection that may not become manifest until after discharge," the authors wrote. "These factors should be taken into account when optimizing infection control strategies for MRSA."
Aug 11 Clin Infect Dis study


Study indicates high prevalence of mupirocin-resistant S aureus in Africa

Originally published by CIDRAP News Aug 16

A systematic review and meta-analysis yesterday in Antimicrobial Resistance & Infection Control suggests there is a high rate mupirocin-resistant S aureus in Africa.

Mupirocin nasal ointment, alone or in combination with chlorhexidine, is considered the main decolonization strategy for S aureus carriage, which is an important risk factor for subsequent infection among patients with surgical site infections and atopic dermatitis. The emergence of mupirocin-resistant (mupR) S aureus threatens this decolonization strategy. While mupR S aureus has been reported in several countries, there is no data summarizing screening, prevalence, characterization, and geographic spread in Africa.

Using five electronic databases, researchers from South Africa and Nigeria identified 43 eligible studies. Only 12 of 54 African countries (22%) reported data on screening for mupR S aureus. The pooled prevalence of mupR S aureus in Africa, based on 11 human studies conducted in South Africa, Ghana, Libya, Egypt, and Nigeria, was 14%. The proportion of S aureus isolates with the mupA gene, which confers high-level mupirocin resistance (HmupR), ranged between 0.5 and 8%. Isolates that expressed HmupR and low-level resistance (LmupR) ranged between 0.5 and 38% and 4 and 47%, respectively. The frequency of mupR-MRSA isolates ranged between 5 and 50%.

The authors of the study say the findings show the paucity of data on the continent and support the need for mupR S aureus surveillance data to provide information on it epidemiology and clinical significance. In addition, they note the need for data on administration and use of mupirocin in the community and hospital setting in Africa.  
Aug 15 Antimicrob Resist Infect Control study


MCR-3 detected in study of English pigs

Originally published by CIDRAP News Aug 15

A study of pigs has detected the presence of the MCR-3 colistin-resistance gene in England for the first time, United Kingdom researchers reported yesterday in the Journal of Antimicrobial Chemotherapy. But the study also found that stopping the use of colistin can mitigate long-term on-farm persistence.

To gain a better understanding of the molecular epidemiology of MCR-positive Enterobacteriaceae, circulating plasmids, and their on-farm persistence, researchers from the UK's Animal and Plant Health Agency used whole-genome sequencing to analyze MCR-1-positive Enterobacteriaceae isolates from pig samples on a single pig farm. They collected fecal samples from three cohorts of pigs: one that was initially treated with colistin following diarrhea, a younger cohort that was untreated but overlapped with the first cohort over a period of 5 months, and a third cohort on the same farm 20 months after the initial diagnostic submission.

The results showed that Escherichia coli harboring MCR-1 and multiple resistance genes were detected in the colistin-treated cohort of pigs as well as the untreated cohort. The researchers theorize that the presence of MCR-1 in the untreated pigs may have been because these pigs had moved into accommodations previously occupied by the treated pigs and had been exposed to environmental contamination with MCR-1 E coli. Additionally, the researchers found MCR-3 in seven of the E coli isolates from the treated cohort, with some isolates also harboring multiple copies of MCR-1 on different plasmids.

Neither MCR-1 nor MCR-3 were detected when the farm was re-sampled after 20 months.

"In conclusion, this study indicated that although mcr E. coli had become widespread on a farm in England, measures taken to mitigate on-farm risk were successful," the authors wrote. 
Aug 14 J Antimicrob Chemother study


Study shows emergence of E coli ST131 clade in Europe

Originally published by CIDRAP News Aug 15

In another study yesterday in the Journal of Antimicrobial Chemotherapy, a team of European researchers report the emergence of an extended-spectrum beta-lactamase (ESBL)-producing E coli ST131 clade in European hospital patients.

In the study, 688 ESBL E coli isolates were obtained from rectal swabs of patients in hospitals in Berlin, Geneva, Madrid, and Utrecht. The researchers were looking to assess the prevalence, geographical distribution, and microbiological characteristics of E coli ST13—a multidrug-resistant pandemic clone causing urinary tract and bloodstream infections—and its dominant sublineage, C/H30.

The analysis found that the ST131 detection rate among ESBL E coli carriers was 20.5% (141/688), with 16% (46/295) prevalence in Madrid, 18% (31/172) prevalence in Utrecht, 23% (31/135) in Berlin, and 38% (33/86) in Geneva. Subclone typing further revealed that C/H30 subset compromised the majority of the ST131 isolates (70.2%, 99/141). But there was significant difference in subclone prevalence, with C1/H30R1 isolates more prevalent in Geneva (49%, 16/33) and C2/H30Rx more prevalent in Madrid (67%, 31/46). While the C2/H30Rx isolates were significantly associated with the CTX-M-15 enzyme, the C1/H30R1 isolates were more associated with the CTX-M-27 enzyme.

Isolates belonging to this new ST131-C1-M27 clade have previously been detected among Japanese, French, and German isolates, but the detection of isolates from this clade in all four hospitals suggest it is circulating throughout Europe. The authors of the study say the findings demonstrate a changing epidemiology of ESBLs in Europe caused by ST131 subclones.
Aug 14 J Antimicrob Chemother abstract


Promising phase 2 trial for complicated UTI treatment

Originally published by CIDRAP News Aug 14

A phase 2 clinical trial for Entasis Therapeutics' β-lactamase inhibitor, ETX2514, in combination with sulbactam (ETX2514SUL), suggested safe and efficacious treatment of complicated urinary tract infections (cUTI) including acute pyelonephritis (kidney infection) in adults, the company said in a press release today.

The results will prepare Entasis for a Phase 3 trail in the early part of next year, which will focus on carbapenem-resistant Acinetobacter baumannii infections.

"Infections caused by Gram-negative bacteria are a major healthcare challenge today, as resistance to older antibiotics is growing," said Manos Perros, chief executive officer of Entasis in the press release. "The results of this Phase 2 trial support progression of ETX2514SUL into Phase 3, an important next step in developing our pipeline of pathogen-targeted products against drug-resistant bacterial infections."

The phase 2 trial included 80 patients randomized to receive either a dose of ETX2514SUL (ETX2514 1 g plus sulbactam 1 g) or a matching placebo every 6 hours for 7 days. Patients in both arms also received background therapy with 500 mg IV of  imipenem/cilastatin (IMI) every 6 hours.

According to the press release, ETX2514SUL was generally well tolerated. The adverse event profile of ETX2514SUL was similar to placebo with no serious adverse events reported in either arm.
Aug 13 Entasis press release

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