News Scan for Oct 20, 2016

News brief

Saudi Arabia reports new MERS case in Abha

Saudi Arabia's Ministry of Health (MOH) reported a new MERS-CoV case, the country's fifth in 6 days.

The latest MERS-CoV (Middle East respiratory syndrome coronavirus) case involves a 53-year-old Saudi man in Abha, in the far southwest, the capital of Asir province. His case is listed as "primary," meaning he apparently did not contract the disease from another patient. Officials are investigating whether he had contact with camels or other risk factors.

The man is hospitalized in critical condition. Abha had not reported a MERS case since April.

The new case brings Saudi Arabia's total to 1,462 cases, including 612 fatalities. Five patients are still undergoing treatment.
Oct 20 MOH update


Study shows little evidence of poultry-worker infection early in H7N9

Less than 2% of poultry workers in China early in the epidemic showed evidence of previous infection of H7N9 avian flu in their bloodstreams, according to a serology study today in Influenza and Other Respiratory Viruses.

Chinese health officials and their counterparts from the US Centers for Disease Control and Prevention analyzed sera from 1,480 people in the general population, 1,866 poultry workers, and 178 contacts of confirmed H7N9 cases in nine Chinese provinces. The samples were collected from March 2013 to May 2014. China reported the first human H7N9 cases in March 2013, and since then has confirmed more than 800 cases.

None of the members of the general public tested positive for H7N9 antibodies. The researchers, however, determined that 28 (1.5%) of the poultry workers had hemagglutination inhibition (HI) titers of 20 or higher for H7N9 antibodies, with 2 (0.1%) testing positive by microneutralization (MN) assay. Among 61 healthcare and 117 non-healthcare contacts' sera, 5 (2.8%) had HI titers 20 or greater, but all were negative by MN.

The authors conclude, "There was no evidence of widespread transmission of influenza A (H7N9) virus during March 2013 to May 2014, although A(H7N9) may have caused rare, previously unrecognized infections among poultry workers."
Oct 20 Influenza Other Respir Viruses abstract

Stewardship / Resistance Scan for Oct 20, 2016

News brief

Romanian authorities identify 4 cases of XDR TB

Cases of extensively drug-resistant tuberculosis (XDR-TB) have been identified in three students at a university in Romania and in a family contact, according to a report yesterday from the European Centre for Disease Prevention and Control (ECDC).

The cluster of cases involves three students attending the University of Medicine and Pharmacy in Oradea Municipality, Bihor County, Romania, and a family member of one of the students. The presumed index case is a student from Israel who was diagnosed in 2015, and the other two students are UK citizens. All three students were in contact with each other at the university. The family contact is a brother of one of the UK students.

Romanian authorities have identified 87 contacts who were exposed to the students and are following up to test for XDR-TB as well as latent TB infection. More cases in association with this cluster are expected.

XDR-TB is a rare type of TB that is resistant to first-line antibiotics (isoniazid and rifampicin), any fluoroquinolone, and at least one of three second-line drugs (amikacin, kanamycin, or capreomycin). While it is possible to treat patients diagnosed with XDR-TB, the remaining treatment options are less effective and have more side effects.
Oct 19 ECDC Rapid Risk Assessment

Dutch study finds incidence of pediatric C diff stable

A study by Dutch researchers yesterday finds that the incidence of pediatric Clostridium difficile infection (CDI) has been stable over the previous 6 years.

The surveillance study, published in Clinical Infectious Diseases, included all CDIs reported from May 2009 to May 2015 by 26 Dutch hospitals participating in a national sentinel surveillance study. Infected children were 2 and older. Investigators distinguished between healthcare-onset CDI (in which symptoms began in a hospital or long-term care facility) and community-onset CDI (when symptoms began at home).

Overall, 4,691 CDIs were included in the study, with a total of 135 pediatric CDIs (3%) being reported at 17 hospitals. The investigators did not observe an increase in the monthly number of reported pediatric CDIs during the study period. The median age of the children with CDI was 10 years.

Of the 135 pediatric CDI cases, 55% were community-onset, and 31% met the criteria for severe CDI. Although severe CDI was more likely to occur in children, it resulted in fewer complications than adult CDI. In contrast to adults, there was no CDI-related mortality. Pediatric CDI cases were more likely to occur in university hospitals than non-university hospitals.

The investigators also found that, of the 36 C difficile PCR ribotypes identified, ribotype 265 was most prevalent in children (15%) but rarely found in adults.

The authors note that the findings are in contrast to several studies in recent years that have shown an increase in the incidence of pediatric CDI in community settings and hospitals in the United States.
Oct 19 Clin Infect Dis abstract


Significant overtreatment, undertreatment found in young people's STIs

A study yesterday suggests a significant number of adolescents and young adults are overtreated, and even more are undertreated, for chlamydia and gonorrhea.

The retrospective study, published in the International Journal of Infectious Diseases, looked at 797 patients aged 13 to 24 who were screened for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in the pediatric emergency department of an urban safety-net hospital in Chicago from July 2014 to June 2015. Cook County, where the hospital is located, has the second highest rate of CT and GC infections in the United States, after Los Angeles County.

Overall, the investigators found that 21.6% of the patients tested positive for a sexually transmitted infection (STI), with 19.1% testing positive for CT, 5.5% for GC, and 3.1% testing positive for both. Most of the infected were black and female. Of the 171 patients with an STI, 21.6% were overtreated and 43.4% were undertreated.

When the investigators looked at the factors involved in overtreatment and undertreatment, they found that male and female patients who were overtreated were more likely to present with STI exposure or genitourinary (GU) symptoms. In addition, female patients who were overtreated were likely to be 18 to 19 years old and have a history of STIs. Patients were more likely to be undertreated if they were female and less likely to be undertreated if they presented with STI exposure, had a history of STIs, and had GU symptoms.

Both overtreatment and undertreatment of STIs are problematic. Overtreatment can cause unnecessary emotional trauma, the authors write, and potentially increase the risk of antibiotic resistance, particularly in gonorrhea. Undertreatment, meanwhile, can lead to other conditions and create a pool of young adults and adolescents who are at risk of spreading their infections. The authors suggest that point-of-care testing for CT and GC, as well as use of more modern methods of patient communication to ensure follow-up, could substantially reduce over- and undertreatment.
Oct 19 Int J Infect Dis study

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