Recently identified Ebola Bombali species detected in Kenyan bats

A new Ebola species first identified in bats last year in Sierra Leone—named Bombali virus— has now been found in bats in Kenya, pointing to wide distribution, given that the two countries are on opposite coasts of Africa. Researchers from Finland, Kenya, and Sweden reported their findings in Emerging Infectious Diseases.

The discovery of Bombali ebolavirus last year marked the sixth known species, three of which have been proven to trigger large outbreaks in humans. In Sierra Leone, Bombali ebolavirus was found in the saliva and feces of Angolan free-tailed bats, an insect-eating species, but so far there's no evidence that it can be transmitted to people.

As noted in the new report, the researchers found the virus in the same bat species captured in the Taita Hills in southeast Kenya. No Ebola viruses had ever been found before in wildlife from Kenya or any other east African country. The team found high levels of Bombali ebolavirus in bat tissues, including the virus's full genome, suggesting that active infection occurs. The bats also had antibodies to the virus.

To look for any signs of infection in people, the researchers screened febrile patients who had contact with bats and were seen in Taita Hills clinics. No evidence of Bombali ebolavirus infection or past infection was found.

Bombali ebolavirus is likely to be transmitted across much of sub-Saharan Africa, though Angolan free-tailed bats aren't thought to travel large distances, the group wrote. Tarja Sironen, PhD, study coauthor who is from the University of Helsinki, said in a press release from the school, "This finding increases our understanding about ebolavirus diversity and geography, and highlights the role that insectivorous bat species may play, in addition to fruit bats, for ebolavirus maintenance in nature."
Mar 28 Emerg Infect Dis study
Apr 2 University of Helsinki
press release
Jul 27, 2018, CIDRAP News story "
New Ebola species identified in Sierra Leone"


NIH launches first human trial of universal flu vaccine candidate

Scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), launched the first human trial of H1ssF_3928, an experimental universal flu vaccine.

The trial will test the vaccine's safety and tolerability, as well as its success in eliciting an immune response.

"Seasonal influenza is a perpetual public health challenge, and we continually face the possibility of an influenza pandemic resulting from the emergence and spread of novel influenza viruses," said NIAID Director Anthony S. Fauci, MD. "This Phase 1 clinical trial is a step forward in our efforts to develop a durable and broadly protective universal influenza vaccine."

The trial will include 53 healthy adults ages 18 to 70. A group of 5 participants will receive a single 20-microgram (mcg) intramuscular injection of the experimental vaccine, while the remaining 48 will receive two 60-mcg vaccinations spaced 16 weeks apart.

The vaccine was developed to include the stem of hemagglutinin (HA), an influenza protein. The head of HA is subject to change each year depending on circulating viruses, but the stem remains the same. H1ssF_3928 was created using the stem of the H1N1 virus.
Apr 3 NIH press release


E coli O103 tied to 44 cases in Kentucky, spread to 3 other states

Escherichia coli O103 has infected at least 44 people in Kentucky—24 more than were reported on Mar 29—and has also spread to Tennessee, Ohio, and Georgia, Kentucky officials said today, according to an NPR story.

The possible culprits are beef, chicken, and sliced American cheese, said Mel Bennett, MD, MPH, the manager of the Infectious Disease Branch of the Kentucky Department for Public Health. Six of the 44 patients have required hospitalization. E coli O103 is much less common that the O157:H7 strain, which causes the most foodborne disease illnesses. The 44 Kentucky cases would make it the largest O103 US outbreak since 2000, NPR reported.

Bennett also said the outbreak has spread to the three other states and that Kentucky health officials have been in daily contact with the Centers for Disease Control and Prevention (CDC).

Doug Hogan, spokesperson for the Kentucky Cabinet for Health and Family Services, said cases are spread across several counties, with five confirmed in Fayette County. Some sort of food distribution service may be the root cause, he said. Bennett said some early reports indicated fast food as a primary source of concern.
Apr 3 NPR story


Lassa fever outbreak reaches 500-case milestone in Nigeria

In its latest update on the ongoing Lassa fever outbreak, officials from the Nigerian Centre for Disease Control (NCDC) said today that 15 newly recorded cases raise the outbreak total to 510 cases.

The outbreak began on Jan 1, and so far 119 people have died, resulting in a case-fatality rate of 22.9%. Twenty-one states have at least one confirmed case, with the majority of sicknesses occurring in Edo and Ondo states.

Nigeria has traced case contacts extensively, as some human-to-human transmission has been described in the outbreak.

"A total of 6,320 contacts have been identified from 20 States," the NCDC said. "Of these 1,567 (24.8%) are currently being followed up, 4,690 (74.2%) have completed 21 days follow up, while 8 (0.1%) were lost to follow up. 110 (1.7%) symptomatic contacts have been identified, of which 55 (1.0%) have tested positive," the NCDC said.

Lassa fever is endemic in Nigeria. Most case-patients contract the virus after coming into contact with rodent excreta.
Apr 3 NCDC update


Study: 20% of healthcare-acquired infections are waterborne  

A study today in Infection Control & Hospital Epidemiology examined CDC healthcare infection consultations from 2014 to 2017 and found that 21.6% involved potentially waterborne pathogens.

A total of 1,380 patients (in 134 investigations), with an average of 10.3 affected patients per investigation, were involved in possible water-related healthcare-acquired infections (HAIs).

Nontuberculous mycobacteria were involved in the greatest number of investigations (29.9%). Investigations usually involved medical products (35.8%), and most of these products were medical devices (83.3%), the authors said.

Inpatient facilities represented 70.1% of requested HAI consultations, followed by outpatient (19.4%) and long-term care (14.9%) facilities.

"A large proportion of water-related HAI investigations involved surgery (17.9%) or a medical device (29.9%). In the presence of surgical incisions, injections, and invasive devices, normal surface and mucosal host defenses are breached, potentially leading to invasive infections," the authors concluded.

"As more invasive medical procedures are transitioned from the inpatient to the outpatient setting, patients at risk for becoming infected with water-related organisms are increasingly being exposed in ambulatory settings."
Apr 3 Infect Control Hosp Epidemiol study

Stewardship / Resistance Scan for Apr 03, 2019

News brief

Paper defines metrics for pediatric antimicrobial stewardship programs

A team of Canadian physicians and pharmacists has identified metrics that can be used to measure the impact of pediatric antimicrobial stewardship programs (ASPs), according to a new paper in Pediatrics.

Using a modified Delphi approach, the team developed two surveys that were sent to experts and stakeholders to establish consensus on metrics for evaluating the processes and outcomes of pediatric ASPs. The metrics were subdivided into four ASP domains: antimicrobial consumption, microbiologic outcomes, clinical outcomes, and process measures.

Respondents were asked to rank the scientific merit, impact, feasibility, and accountability of each metric. Consensus was defined as more than 75% of survey respondents agreeing that a metric had scientific merit, and selections were finalized with a face-to-face meeting and a third survey.

Overall, 38 participants from 15 pediatric hospitals across Canada completed all three rounds of the Delphi survey. In the domain of antimicrobial consumption, the two selected metrics were days of therapy per 1,000 patient-days and total antimicrobial days. The clinical and process outcomes chosen were 30-day readmission rate and adherence to ASP recommendations, respectively. A microbiologic outcome was felt to be important and feasible, but consensus could not be obtained on a measure. Several barriers to implementation of the metrics were identified, including information technology limitations at various centers.

"Wide adoption of these pediatric ASP metrics among national and international programs will facilitate international comparative intervention studies," the authors of the paper conclude. "These metrics should be considered when planning the infrastructure necessary to monitor the effectiveness of pediatric ASPs."
Apr 1 Pediatrics article


Report highlights lack of water, sanitation in global healthcare facilities

One in four healthcare facilities around the world lacks consistent access to basic water services, and many lack other services that are crucial to preventing infections and reducing the spread of antimicrobial resistance, according to a report today from the World Health Organization (WHO) and UNICEF.

The report, the first from the WHO/UNICEF on access to water, sanitation, and hygiene (WASH) in healthcare facilities, found that 12% of healthcare facilities globally, used by an estimated 896 million people, had no water service. In addition, 14% had limited water service, meaning they had access to either an improved water source that was off site or did not have water at the time of the survey. A little more than half (55%) of healthcare facilities in least-developed countries (LDCs) had basic water services.

More than one in five healthcare facilities reported having no sanitation service, which translates to more than 1.5 billion people having either no toilets or unimproved toilets (such as pit latrines) at their healthcare facility.

The report also found that one out of six healthcare facilities globally (16%) had no hygiene service, including hand hygiene stations at points of care and soap and water at toilets, and only 27% of facilities in LDCs had basic healthcare waste management.

"Not only does the lack of WASH services in health care facilities compromise patient safety and dignity, it also has the potential to exacerbate the spread of antimicrobial-resistant infections and undermines efforts to improve child and maternal health," WHO Director-General Tedros Adhanom Ghebreyesus, PhD, and UNICEF Executive Director Henrietta Fore, MPA, write in the foreword to the report.

An accompanying "practical steps" report details eight actions governments can take to improve WASH services.
Apr 3 WHO press release
Apr 3 WHO full report
Apr 3 WHO practical steps report

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