News Scan for May 07, 2014

News brief

Researchers find MERS antibodies in Kenyan camels

Camel populations in Kenya have had antibodies to the Middle East respiratory syndrome coronavirus (MERS-CoV) as far back as 1992, according to an international research team that tested stored samples, according to a study yesterday in Emerging Infectious Diseases.

The report is the second recent study to find MERS antibodies in African camels. On Apr 21, another international group found MERS-CoV–like antibodies in camels from widely separated parts of Africa: Nigeria, Tunisia, and Ethiopia. In the latest study, researchers said gauging possible MERS exposure in African camels is important, because most livestock camels slaughtered in the Arabian Peninsula and Egypt are imported from the Greater Horn of Africa, especially Ethiopia, Somalia, Sudan, and Kenya.

In yesterday's study, researchers tested samples from 774 dromedary camels from three of Kenya's regions—Northeastern, Eastern, and Rift Valley—that were collected from 1992 to 2013. Tests included a recombinant MERS-CoV spike protein subunit 1–based ELISA and a highly specific MERS-CoV microneutralization assay.

Samples that tested positive for antibodies reflected all sampling periods and the span of the 20-year period. Seroprevalence was higher in the Northeastern and Eastern regions; however, animals that were isolated at a research center tested negative. The scientists also found a positive correlation between MERS-CoV seropositivity and greater herd density.

The team said their findings might help guide the search for more ancestral MERS-CoV variants that could yield clues to how camels are acquiring the virus and transmitting it to humans. They also said seroprevalence studies in camel handlers could help shed more light on whether silent or unrecognized infections are occurring in humans.
May 6 Emerg Infect Dis study
Apr 22 CIDRAP News story "Antibody study hints at MERS-CoV in African camels"

Haiti confirms 14 chikungunya cases

The 40,000-case chikungunya outbreak afflicting the Caribbean has now spread to Haiti, as officials there have confirmed 14 cases, the Associated Press (AP) reported yesterday.

Haitian Health Minister Florence Guillaume Duperval said in a radio interview that the government would soon air public health advisories on the radio to alert people to symptoms of the mosquito-borne disease, which can include fever, headache, and joint pain.

The story said that the arrival of the disease in Haiti was expected, as the Dominican Republic began reporting cases in March. European health officials said this week that Haiti's neighbor has more than 3,000 suspected or confirmed cases.

The outbreak began on the island of St. Martin in December and is the first chikungunya epidemic to strike the Americas.
May 6 AP story

SHEA, IDSA, others publish guidance for C diff in hospitals

Leading infectious disease organizations have published in the latest issue of Infection Control and Hospital Epidemiology new guidance for preventing Clostridium difficile infections in hospitals.

The guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and was produced by SHEA, the Infectious Diseases Society of America (IDSA), and other groups.

Hospitalizations for C difficile doubled from 2000 to 2009, the guidance states, and the pathogen now rivals methicillin-resistant Staphylococcus aureus (MRSA) as the most common source of healthcare-associated infections. The infection typically doubles the length of hospital stays and costs the US healthcare system from $1 billion to $4.9 billion a year.

Recommended prevent-control steps include appropriate drug use; contact precautions; cleaning and disinfecting equipment and the environment; employing a lab-based alert system; conducting surveillance and report data; educating healthcare personnel, patients, and families, and measuring compliance with federal or international hand hygiene and contact precaution recommendations, among other approaches. The guidance also lists steps to avoid.

The organizations also published similar guidance for preventing surgical-site infections.
SHEA/IDSA C difficile guidance

USDA agencies reach cooperative plan to address food outbreaks

The Food Safety and Inspection Service (FSIS) and the Animal and Plant Health Inspection Service (APHIS)—both US Department of Agriculture agencies—recently signed a Memorandum of Understanding (MOU) that lays out the cooperative roles of each agency during root-cause assessments of foodborne disease outbreaks associated with meat and poultry.

The MOU provides "a comprehensive, multidisciplinary approach" to address such outbreaks, the FSIS said in a May 2 constituent update.

"This MOU will document the procedures and responsibilities under the collaborative effort between APHIS and FSIS in assessing root cause in outbreaks of foodborne illness in humans," the FSIS said in the update. "It will facilitate the sharing of information between agencies and assist in making science-based decisions on mitigation or intervention strategies."

The MOU outlines roles and responsibilities for training personnel and planning interagency assessments. It does not change any existing collaborative work between the two agencies, the MOU states.
May 2 FSIS/APHIS MOU
May 2 FSIS constituent update

Avian Flu Scan for May 07, 2014

News brief

Researchers find possible biomarker for severe H7N9 infection

Researchers who analyzed the blood of Chinese patients infected with H7N9 influenza found markedly elevated levels of angiotensin 2, which be a severity marker for the disease. The team from China reported its findings yesterday in Nature Communications.

They compared plasma from 47 patients infected with H7N9 from Hangzhou, Nanjing, and Shanghai with that of 21 patients from Beijing who were sick with the 2009 H1N1 virus from December 2012 to February 2013. Their comparison also included samples from healthy volunteers and people with coronary heart disease (CHD). For the patients with flu, samples were collected at different times: within the first 7 days of disease onset, 8 to 14 days after disease onset, and from 15 days after disease onset.

The angiotensin 2 plasma levels were much higher in H7N9 patients than in 2009 H1N1 patients, CHD patients, and CHD patients with hypertension.

To focus on disease outcome patterns in H7N9 patients, the group looked at 22 patients who had samples taken from both the first and second week of illness. For those discharged from the hospital in less than 28 days, angiotensin 2 levels decreased significantly during the second week of infection. The level, however, remained high during the second week for those who had longer hospitalizations or who died.

They found that in H7N9 patients, angiotensin 2 levels during the second week of illness highly correlated with severity scores, with levels during the first week showing a weaker but still significant correlation. Similarly, researchers found that patients who have high angiotensin 2 levels during the second week were more likely to die.

Researchers concluded that angiotensin 2 is a biomarker for lethal flu infections and that the findings lend support for potential therapies.
May 6 Nat Commun abstract

Scientists detect H11N2 in Antarctic penguins

Researchers have for the first time identified avian flu viruses in Antarctic penguins, and the H11N2 strain they found differed considerably from existing strains, according to a study yesterday in mBio.

An international team took 301 swabs from windpipes and posterior openings (cloaca) of Adelie penguins in two locations in Antarctica in January and February 2013. They also drew 270 blood samples.

They found that 8 (2.7%) of the swab samples were positive for H11N2 avian flu via polymerase chain reaction. Phylogenetic analysis showed a high degree of similarity among the viruses.

When the researchers compared the full genome sequences of four of the viruses to influenza virus sequences in public databases, they found that they were unique. Lead author Aeron Hurt, PhD, of the World Health Organization's influenza center in Melbourne, said in a news release from the American Society for Microbiology (ASM), "When we drew phylogenetic trees to show the evolutionary relationships of the virus, all of the genes were highly distinct from contemporary [avian flu viruses] circulating in other continents in either the Northern or Southern Hemisphere." The ASM publishes mBio.

Further analysis revealed that the virus diverged from other avian flu viruses between 49 and 80 years ago, with several genes showing similarity and shared ancestry with H3N8 equine influenza viruses.

In addition, 43 of 270 penguins (16%) had influenza A antibodies in their blood. The investigators also found that the cultured H11N2 virus did not replicate well in experimentally inoculated ferrets.
May 6 mBio study
May 6 ASM news release