NEWS SCAN: Salmonella cucumber outbreak, potential cholera lawsuit, possible malaria test, Lyme-drug shortage

May 9, 2013

Multistate Salmonella outbreak linked to cucumbers grows to 81 cases
Eight more cases of Salmonella Saintpaul infection have been reported in an outbreak linked to imported cucumbers that has now reached 81 cases in 18 states, the US Centers for Disease Control and Prevention (CDC) reported yesterday. Although no deaths have been reported, 29% of patients have required hospitalization, the CDC said in an update. Illness-onset dates range from Jan 12 to Apr 19. Patients range in age from less than 1 to 89 years, with a median of 27, and almost two-thirds are female. On Apr 24 the Food and Drug Administration placed Daniel Cardenas Izabal and Miracle Greenhouse of Culiacan, Mexico, on Import Alert, which means their cucumbers cannot enter the United States unless suppliers verify their lack of contamination. "At this time, there is no indication that contaminated cucumbers supplied by Daniel Cardenas Izabal and Miracle Greenhouse are still on the market," the CDC said. The most-affected states are California, with 28 cases, followed by Arizona with 11 and Minnesota with 9. The number of affected states has not changed since the last CDC update, on Apr 25.
May 8 CDC update
Apr 25 CIDRAP News item on previous update

Litigation against the UN re Haiti cholera may be in store
The United Nations (UN) has been challenged to agree within 60 days to compensate Haitians sickened with cholera since 2010, to apologize to the country for introducing the disease within its borders, and to launch a major sanitation-improvement effort or else face a lawsuit, the Associated Press (AP) reported yesterday. The human rights group Institute for Justice and Democracy in Haiti, based in Boston, announced the action in response to a February letter from the UN saying it was not responsible for the cholera outbreak and asserting its legal immunity. Cholera broke out in Haiti beginning in October 2010 and has affected nearly half a million people, killing about 8,000, according to the AP story. The origin of the cholera-causing bacteria is thought to be contamination of a river from sewage pumped directly into it from a UN-sponsored base housing peacekeeping workers from Nepal. Previously, Haiti had not had a cholera problem since the 1880s, claimed a Haitian doctor interviewed for the story. Lawyers for the institute, who say they have 8,000 people ready to join the suit, plan on suing in New York state court and perhaps in a European venue as well; they are seeking $100,000 for each family who lost a member to cholera and $50,000 for each cholera survivor.
May 7 letter to UN from institute

Study: Malaria protein IDs which children will have severe complication
Levels of a protein produced by the malaria parasite may allow clinicians to identify children with malaria who are likely to go on to have cerebral malaria, a very serious form of the disease that carries a mortality rate of 20%, says a study by Michigan State University (MSU) researchers published in the Journal of Infectious Diseases. Although the cerebral form of malaria occurs in only 1% of children with malaria, it still accounts for an estimated 1 million deaths a year in Africa, where 90% of childhood malaria occurs, according to an MSU press release yesterday. Plasma levels of the protein, HRP2 (histidine-rich protein 2) accurately predicted disease progression in 150 children at Queen Elizabeth Central Hospital in Blantyre, Malawi. "We found that if HRP2 levels are low, clinicians can be more than 90 percent sure the child will not progress to cerebral malaria. . . . That would give them the confidence to merely prescribe oral drugs and send the child home," the senior author said in the release. Workers in rural clinics may see hundreds of children a day and have to decide quickly whether they need hospitalization or not. The HRP2 test currently available is expensive and not suited to rural clinics, but work on a less expensive, portable test is in process.
May 8 MSU press release
J Infect Dis study abstract

Key Lyme drug in short supply in Minnesota
As tick season in Minnesota gears up, shortages of a key antibiotic used to treat tickborne Lyme disease have caused prices to skyrocket, the Minneapolis Star Tribune reported yesterday. Doxycycline, which is also used to treat skin problems, inhalation anthrax, and some sexually transmitted diseases, went on the national drug shortage list in January because of manufacturing delays and increased demand, the story said. One physician said the cost to uninsured patients could increase from $45 per Lyme prescription to $120. Drug shortages have become commonplace in recent years because of industry consolidation, quality issues, and other bottlenecks, the story said. More than 120 drugs are on the federal shortage list.
May 8 Star Tribune article


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