News Scan for Aug 26, 2019

News brief

CIDRAP's CWD Program launches online resource center

After establishing its Chronic Wasting Disease (CWD) Program in March, today the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP) launched a new online CWD Resource Center for educating the public, hunters, medical and public health professionals, wildlife scientists, veterinarians, and policymakers about the disease.

Resources on the site include an in-depth question-and-answer overview, current news, best practices, maps, data, and other information. CWD is a prion-caused spongiform encephalopathy disease of cervids, including deer, elk, and moose. No known human cases exist, but, given the course of other prion diseases, the risk cannot be ruled out.

CWD has been confirmed in at least 26 US states, three Canadian provinces, South Korea, Finland, Norway, and Sweden, with a notable increase in the past 5 years. CIDRAP's CWD Program is guided by an advisory group of 36 global experts.

"Our goal is to make the CIDRAP CWD Resource Center a comprehensive, one-stop resource on CWD," said Michael T. Osterholm, PhD, MPH, University of Minnesota Regents Professor, McKnight Presidential Endowed Chair in Public Health, and director of CIDRAP, publisher of CIDRAP News.

The CIDRAP CWD Program was initiated to respond to the disease in wildlife and prepare for its potential for animal-to-human and human-to-human transmission, according to a University of Minnesota news release emailed to journalists.
CIDRAP CWD Resource Center

DRC Ebola cases continue steady climb as total reaches 2,976

Over the weekend and through today, the Democratic Republic of the Congo (DRC) confirmed 40 more Ebola cases, with no reports of any from the closely watched areas of Goma, South Kivu province, and Pinga, where the virus recently spread, according to the World Health Organization (WHO) online Ebola dashboard and other official sources.

The new cases including a spurt of 18 infections yesterday detailed in a tweet by the WHO's DRC office. Reflecting cases recorded through Aug 24, the WHO said the 18 included 6 in Kalunguta, 4 in Beni, and 2 in Mutwanga. Six more locations each reported 1 case: Mabalako, Mandima, Butembo, Katwa, Kayna, and Komanda.

The new cases this weekend and the eight new ones reported today push the overall outbreak total to 2,976 cases. Health officials are still investigating 397 suspected Ebola cases.

Also over the past few days, 17 more people died from their Ebola infections, pushing the fatality count to 1,986.

In a separate tweet, the WHO's DRC office said the number of people vaccinated since last August has reached 204,772.
Aug 26 WHO online Ebola dashboard
Aug 26 WHO DRC office tweet on cases
Aug 26 WHO DRC office tweet on vaccination

Listeria sickens 24 in the US; connection found to Canadian outbreak

Federal health officials and their state partners are investigating a multistate Listeria monocytogenes outbreak that has sickened 24 people in 13 states, and though a specific food item has not been identified, genetic analysis of the strain making people sick hints at a link to a Canadian outbreak connected to cooked diced chicken.

Of the 24 patients, 22 were hospitalized and 2 people died from their infections, the Centers for Disease Control and Prevention (CDC) said in an Aug 23 statement. States with the most cases are California (4), Illinois (4), Missouri (3), New York (2), Ohio (2), and Oregon (2). Seven states have each reported 1 case: Florida, Iowa, Indiana, Kansas, Kentucky, Michigan, and Texas.

Patients range in age from 35 to 92 years, and 15 of the patients are women. The latest illness onset was Aug 1.

Health officials are interviewing sick people to identify what they ate and other exposures they had. Though a specific food item, grocery store, or restaurant chain hasn't been implicated in the US Listeria infections, the CDC said some foods are more likely to be contaminated, such as lunch meats, cold smoked fish, and unpasteurized dairy products.

The Public Health Agency of Canada (PHAC) said in an Aug 23 update that seven Listeria cases have been confirmed in three provinces: Ontario (5), British Columbia (1), and Manitoba (1). The people first fell ill from November 2017 to June 2019. Six patients were hospitalized, and most of the illnesses were in females.

On Aug 18, the Canadian Food Inspection Agency issued a recall for Rosemount brand cooked diced chicken meat, which was supplied to institutions, including hospitals and nursing homes, where many of the people lived or visited before getting sick. Certain groups are more likely to become infected with Listeria, including pregnant women and their newborns, adults ages 65 and older, those with underlying medical conditions, and people with weakened immune systems.

Canadian officials said the probe is still under way, and it's possible that more products linked to the outbreak will be identified.
Aug 23 CDC outbreak investigation notice
Aug 23 PHAC update

MERS infects 2 more in Saudi Arabia

Saudi Arabia's Ministry of Health (MOH) reported two new MERS-CoV cases, one in Riyadh and the other in Al Qurayyat, located in the northern part of the country.

The patient from Riyadh is a 65-year-old woman whose exposure was secondary, meaning she contracted MERS-CoV (Middle East respiratory syndrome coronavirus) from another sick person, the MOH announced yesterday. The secondary case suggest possible healthcare or household spread. The other case was identified in a 67-year-old man from Al Qurayat who had contact with camels before his symptoms began.

So far, Saudi Arabia has reported five MERS-CoV cases in August.
Aug 25 and 26 Saudi MOH update

In other MERS developments, the World Health Organization (WHO) released more details about nine cases, four of them fatal, reported by Saudi Arabia for July. None of them involved clusters. Only one of the patients was known to have had contact with camels.

Patient are from three different regions: Riyadh (5), Najran (3), and Al Qassim (1). Ages range from 30 to 79, and all but one were male. Seven had underlying medical conditions.

The cases lift the global MERS-CoV global total as of Jul 21 to 2,458 cases, at least 849 of them fatal. The vast majority are from Saudi Arabia.
Aug 26 WHO update

US measles total grows by 12 as case reported in Disney park visitor

The nation's measles total for the year grew by 12 last week, raising the number of confirmed infections to 1,215, the CDC said today in its weekly update. The number of affected states held steady, at 30. The weekly total is down from 21 reported the previous week.

One more person was hospitalized for measles, lifting that total to 125. Complications were reported in one patient, putting that number at 65, the CDC said.

Health officials continue to track six active outbreaks, which are defined as involving three or more cases.

The CDC has said the pace of measles activity this year marks the greatest number of cases reported in the United States since 1992 and since the disease was declared eliminated in 2000.
Aug 26 CDC update

In a related development, California health officials on Aug 23 said a teenage girl from New Zealand who visited Southern California in the middle of August was infected with measles and may have exposed people at Disneyland and a hotel in Anaheim.

The Orange County Health Care Agency (OC HCA) said it is working with the two facilities to reach people who had known close contact with the patient.

In 2015, a measles outbreak linked to two Disney theme parks in California sickened about 131 people and led to related infections in seven US states, Mexico, and Canada.
Aug 23 OC HCA press release

Stewardship / Resistance Scan for Aug 26, 2019

News brief

Study supports multiple-bed room strategy for isolating ESBL patients

A study conducted in Dutch hospitals has found that an isolation strategy of contact precautions in a multiple-bed hospital room was non-inferior to a strategy of contact precautions in a single-bed room for preventing the spread of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, Dutch researchers reported in The Lancet Infectious Diseases.

In the cluster-randomized, crossover study, medical and surgical wards at 16 Dutch hospitals applied, over two study periods, contact precautions in either a single-bed or multiple-bed hospital room as the preferred strategy for isolating patients with ESBL-producing Enterobacteriaceae cultured from a routine clinical sample. Under current European Society for Clinical Microbiology and Infectious Diseases guidelines, contact precautions (i.e., use of gloves and gowns for all direct contact with a patient) are recommended for such patients, preferably in a single room, but studies on the added benefit of a single room have been inconsistent. Compared with other multidrug-resistant pathogens, ESBL-producing Enterobacteriaceae have the highest prevalence in European hospitals and have become an increasing burden.

The hospitals were assigned in a 1:1 ratio to either strategy during the first study period, then switched strategies in the second study period. The primary outcome was transmission of ESBL-producing Enterobacteriaceae to wardmates, which was defined as rectal carriage of an ESBL-producing Enterobacteriaceae isolate that was clonally related to the index patient's isolates. The non-inferiority margin was 10%.

Thirteen hospitals completed both study periods and assessed 1,652 index patients and 12,875 wardmates for eligibility from April 2011 through February 2014. Of those, 693 index patients and 9,527 wardmates were enrolled, with 463 index patients and 7,093 wardmates included in the per-protocol population. For the per-protocol population, transmission of ESBL-producing Enterobacteriaceae to at least one wardmate was identified for 11 of 275 index patients (4%) during the single-bed room strategy period and for 14 of 188 index patients (7%) during the multiple-bed room strategy period (crude risk difference 3.4%; 90% confidence interval [CI], −0.3 to 7.1). For both isolation strategies, the median length of hospital stay was 11 days, and the 30-day mortality was 4%.

"Non-inferiority of the multiple-bed room strategy could change the current single-bed room preference for isolation of patients with ESBL-producing Enterobacteriaceae and, thus, broaden infection-control options for ESBL-producing Enterobacteriaceae in daily clinical practice," the authors of the study conclude.
Aug 23 Lancet Infect Dis study

CDC update shows US Candida auris cases continue to rise

The number of confirmed and probable Candida auris cases in the United States rose to 755 as of June 30, reflecting an increase of 39 cases, according to the most recent case-count update from the Centers for Disease Control and Prevention (CDC).

Of the cases reported to the CDC, 30 are probable and 725 have been lab-confirmed. In its previous update, involving cases through May 31, the CDC reported 716 cases. An additional 1,474 patients have been found to be colonized with the multidrug-resistant yeast, as determined by targeted screening in 10 states with clinical cases.

The number of states affected remains at 12, with New York (359), Illinois (199), and New Jersey (148) reporting the vast majority of C auris cases. Other states reporting cases include Florida (22), Massachusetts (8), California (5), Maryland (5), Texas (4), Oklahoma (2), Connecticut (1), Indiana (1), and Virginia (1).

Since it was identified in 2009 in Japan, C auris has triggered outbreaks in healthcare facilities in 23 countries, and 13 countries have reported single cases. C auris can cause serious invasive infections in immunocompromised patients, and has shown resistance to three major antifungal drug classes. The CDC has estimated that 30% to 60% of patients with infections have died.
Aug 16 CDC update

Resistant Enterobacteriaceae on the rise US hospitals, study finds

An analysis of more than a million Enterobacteriaceae isolates collected from US hospitals has found a rise in ESBL-producing and carbapenem-nonsusceptible Enterobacteriaceae, US researchers reported in BMC Infectious Diseases.

In the study, researchers from Becton, Dickinson and Company and Tetraphase Pharmaceuticals analyzed the antimicrobial susceptibility of non-duplicated isolates from multiple culture sources collected from hospitalized patients at 411 US hospitals from 2013 through 2017. The resistance profiles of interest were ESBL-producing, multidrug-resistant (MDR), and carbapenem-nonsusceptible phenotypes of Enterobacteriaceae, and MDR and carbapenem-nonsusceptible Acinetobacter spp. The outcomes assessed were the rate of bacterial resistance or non-susceptibility per 100 hospital admissions and the proportion of resistant isolates for each year-quarter from Q1 2013 through Q4 2017.

The analysis found that 12.05% of Enterobacteriaceae isolates were identified as ESBL phenotype, 1.21% were carbapenem-nonsusceptible, and 7.08% were MDR, with urine cultures accounting for the majority of resistant isolates. Of the more 19,000 Acinetobacter isolates tested, 37.48% were identified as carbapenem-nonsusceptible and 47.66% as MDR, and the most common source was skin/wound cultures. Trend analyses showed that the rates of ESBL-producing and carbapenem non-susceptible Enterobacteriaceae per 100 hospital admissions increased significantly between 2013 and 2017, with average slopes of 0.0089 and 0.0004 per quarter, respectively. Rates of MDR Enterobacteriaceae and carbapenem-nonsusceptible and MDR Acinetobacter spp., however, decreased during this time period.

The analysis also found that trends in proportions of resistant isolates generally mirrored trends in rates per 100 hospital admissions, and that MDR Enterobacteriaceae and carbapenem-nonsusceptible and MDR Acinetobacter spp. were more common in winter than summer.

The authors of the study say the observed increase in ESBL-producing and carbapenem-nonsusceptible Enterobacteriaceae supports continuing efforts by the CDC and the World Health Organization to combat these pathogens. They conclude, "Continued infection control efforts, together with diagnostic and antimicrobial stewardship and new antibiotics to expand treatment options, will be required to manage these antibiotic-resistant Gram-negative pathogens."
Aug 23 BMC Infect Dis study