Cholera vaccination plans dim for Yemen; more needed for South Sudan battle

The World Health Organization (WHO) may reverse a decision it made a month ago to launch a cholera vaccine campaign in Yemen, due to the aggressive spread of the disease and conflict conditions in the country, the New York Times reported today, citing a WHO spokesman who updated reporters at a briefing in Geneva today.

A few weeks ago the WHO and its partners formed a plan to deploy 1 million cholera vaccine doses to help curb Yemen's outbreak, but Christian Lindmeier, the WHO spokesman, said cholera vaccine shipments slated for Yemen might be rerouted to other nations or areas experiencing outbreaks, because insecurity in Yemen makes it difficult to assess where to offer the vaccine and how to roll out the immunization campaign.

According to an update today from the International Committee of the Red Cross, Yemen has now reported more than 313,000 suspected cases, at least 1,700 of them fatal.
Jul 11 Times story
Jul 11 Red Cross

In other cholera outbreak developments, the WHO's African regional office yesterday said South Sudan—where the disease has been endemic since 2014—had reported 17,424 cases, including 320 deaths, since June of 2016. For the week ending Jul 2, 302 new cases were reported.

Ten of the country's counties are reporting active transmission, and suspected cases are being investigated in two more.

So far this year, the WHO has secured about 544,000 oral cholera vaccine doses and has deployed about 380,000 of them. "There are no cholera cases reported from any of the sites where the oral cholera vaccines have been deployed in 2017," the WHO said in its statement. It added that 2 million more vaccine doses are needed to cut disease levels in high-risk areas and to interrupt the spread of the virus in area areas with ongoing transmission.
Jul 10 WHO statement


Saudi Arabia reports fatal MERS case

The Saudi Arabian Ministry of Health (MOH) reported a new case of MERS-CoV in a woman from Al Hawiyah. The patient died from complications of the disease.

The Saudi woman was 76 yearsold and symptomatic when she was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus). Her infection is listed as "primary," meaning it's unlikely she contracted the disease from another person.

This new case raises Saudi Arabia's total number of cases since 2012 to 1,677, 683 of them fatal. Seven people are still being treated for their infections.
Jul 11 Saudi MOH update


Flu on the rise in many Southern Hemisphere countries

As of the latter part of June, flu activity in many Southern Hemisphere countries increased, with H3N2 predominating and circulating alongside influenza B in some of the locations, the World Health Organization (WHO) said yesterday in a global flu update.

In Brazil, flu levels appear to have peaked, but activity is still rising in other South American countries, including Argentina, Chile, Paraguay, and Uruguay. The disease is also on the rise in southern Africa, with circulation dominated by H3N2 followed by the 2009 H1N1 virus.

In Australia and New Zealand, flu has risen from baseline to average levels.

A few countries in Central America have reported some activity increases over recent weeks, including Cuba and El Salvador, where H3N2 is the virus detected most often, and Costa Rica and Nicaragua, where influenza B is predominant.

The WHO noted that a few Asian countries have reported increased flu activity—for example, Thailand, the Philippines, and southern China, including Hong Kong. Only sporadic detections were noted in eastern and western Asia.

Little or no flu was reported in North America, Europe, and northern Africa.

At the global level, specimens tested the third week of June revealed that 80.3% were influenza A and 19.7% were influenza B. Of subtyped A viruses, 85.7% were H3N2. Of subtyped B viruses, about half were the Yamagata lineage and about half belonged to the Victoria lineage.
Jul 10 WHO global flu update


Measles continues European spread in first half of 2017

The World Health Organization (WHO) said today that measles continues to spread across Europe and has claimed 35 lives in the last 12 months.

In Italy alone, there have been 3,300 cases in the last year and two deaths. Thirty-one people have died in Romania, and Germany and Portugal have each reported a death from the disease.

According to new data released by the European Center for Disease Prevention and Control (ECDC), there have been 14,000 diagnosed cases of measles in Europe between January of 2016 and June of 2017. Romania has 42% of the cases (3,922), while Italy has reported 3,508 cases (22%). In the first 5 months of 2017, a total of 6,625 cases were reported, approximately 50% more cases then the total number of cases reported in 2016.

Though 37 European countries have interrupted the spread of measles, the WHO said, "…remaining pockets of low immunization coverage allow the highly contagious virus to spread among those who choose not to vaccinate, do not have equitable access to vaccines or cannot be protected through vaccination due to underlying health conditions." The ECDC said that of all the cases with known vaccination status, 87% have been unvaccinated at the time of diagnosis.

Measles is prevented with the use of the measles, mumps, and rubella (MMR) vaccine, usually administered to infants between ages 12 and 15 months. Some European countries are implementing school-checks of immunization status in light of the recent outbreaks.
Jul 11 WHO press release
Jul 11 ECDC update


Sanofi to acquire Protein Sciences and its recombinant flu vaccine

Paris-based pharmaceutical company Sanofi today announced that it will acquire Protein Sciences, a privately held vaccine company headquartered in Meriden, Conn., according to a press release.

In October 2016, Protein Sciences received US Food and Drug Administration (FDA) approval for Flublok quadrivalent influenza vaccine, the only recombinant protein-based flu vaccine approved by the FDA.

David Loew, Sanofi executive vice president and head of its vaccine division, said, "The acquisition of Protein Sciences will allow us to broaden our flu portfolio with the addition of a non–egg based vaccine."

Manon Cox, PhD, MBA, chief executive officer of Protein Sciences, said the company had been actively looking for an opportunity to grow its business, especially in the United States. "As part of Sanofi Pasteur, we expect our Flublok influenza vaccine to benefit from Sanofi Pasteur's expertise in the field of influenza vaccines," she said in the statement.

The acquisition received unanimous approval from Protein Sciences' board of directors and majority approval from the company's shareholders. The transaction is expected to close in the third quarter of 2017, pending regulatory approval.
Jul 11 Sanofi press release


H5N8 strikes two more South African poultry farms

South African agriculture officials said highly pathogenic H5N8 avian influenza has been detected in two more outbreaks, both affecting commercial layer farms, according to a notification yesterday from the World Organization for Animal Health (OIE).

One of the events began on Jul 6 at a farm in Gauteng province in the north central part of the country, while the other started on Jul 9 in neighboring Mpumalanga province. Between the two locations, the virus killed 1,039 of 377,000 susceptible birds.

So far the source of the virus isn't known. South Africa is the most recent of a handful of African nations to report H5N8 outbreaks. The country has now reported four outbreaks from two provinces, all involving commercial farms.
Jul 10 OIE report on H5N8 in South Africa

Stewardship / Resistance Scan for Jul 11, 2017

News brief

Canada reports first case of Candida auris

Canadian researchers are reporting the first case of the drug-resistant fungal pathogen Candida auris in Canada.

In a case study in Canada Communicable Disease Report, the researchers report that the patient, a 64-year-old individual with a 2-year history of ear complaints, was treated for chronic otitis externa shortly after admission to a tertiary hospital for management of a brain abscess. Previous medical history included a recent hospitalization in India for elective oral surgery. During outpatient follow-up, swabs of the patient's ear discharge revealed the presence of C auris that was resistant to fluconazole and amphotericin B and likely resistant to voriconazole. Case resolution was pending at the time of the report.

The authors of the report say the origin of the infection is unknown but suggest it could be connected to the patient's hospitalization in India, where C auris is endemic.

C auris was originally discovered in 2009 in Japan and since then has emerged as a global health threat owing to its growing resistance to all three major classes of antifungals used to treat Candida infections and its ability to persist on patients and in hospital environments. The US Centers for Disease Control and Prevention (CDC) estimates the mortality rate of C auris infections at approximately 60%. Optimal management for C auris infections is currently unknown.

To help curb the spread of the fungus, the CDC recommends using standard and contact precautions for infected and colonized patients, housing patients in private rooms, cleaning patient rooms daily with a disinfectant active against Clostridium difficile, and informing healthcare facilities when an infected or colonized patient is being transferred in. In the current case, contact precautions had already begun after routine screening had indicated the patient was a carrier of carbapenem-resistant Enterobacteriaceae.

The authors say that since several C auris cases in the United States have been linked to hospitalization abroad, contact precautions and testing may be indicated for anyone who's been hospitalized outside Canada. "This approach may help contain C. auris from nosocomial transmission within and between Canadian healthcare facilities," they write.
Jul 6 Can Commun Dis Rep rapid communication


Study identifies hospital-acquired, MCR-1-carrying isolates in Vietnam

Two colistin-resistant Escherichia coli isolates harboring the MCR-1 gene have been identified in medical settings in Vietnam, researchers reported yesterday in the International Journal of Infectious Diseases.

The two E coli isolates—strains NCGM-EC88 and NCGM-E89—were identified among a total of 18 multidrug-resistant E coli isolates obtained through routine screening for multidrug-resistant pathogens at a Vietnamese hospital in 2014; they were isolated from pus and urine samples from two inpatients.

Susceptibility testing showed that both isolates were resistant to ciprofloxacin and colistin but susceptible to carbapenems, while genomic sequencing revealed that the MCR-1 gene was located on the chromosomes of both isolates. Both isolates also contained a single copy of an insertion element, ISAp11, which can contribute to the insertion of MCR-1 from bacterial plasmids into chromosomes.

Multilocus sequence typing revealed that the two E coli isolates belonged to sequence type (ST) 410 and ST457, both of which have been isolated from food and pet animals in several countries.

Since MCR-1 was first identified in E coli samples from pigs, pork products, and humans in China in November 2015, the colisitin-resistance gene has been identified in bacteria from humans, animals, and the environment in more than 30 countries, and studies have documented the spread of the gene to the clinical setting in China. The authors of the study say they believe this is the first report of hospital-acquired E coli isolates harboring MCR-1 in a medical setting in Vietnam.
Jul 10 Int J Infect Dis abstract

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