Study: Ebola survivors can safely have cataract surgery

Survivors of Ebola virus disease (EVD) often suffer long-term vision complications that can now safely be corrected with cataract surgery, according to new research from Emory Eye Center ophthalmologists published in EBioMedicine.

From 13% to 34% of Ebola survivors will have post-infection vision impairment due to uveitis, an eye inflammation caused by cataracts. But because the Ebola virus is known to remain in ocular fluid even after clearing the rest of the body, doctors are hesitant to perform cataract or other ocular surgeries on survivors because of the risk of infection.

The EVICT (Ebola Virus Persistence in Ocular Tissues and Fluids) study tracked 50 survivors (46 with vision impairment) in Sierra Leone after the 2014-2016 Ebola outbreak. Researchers tested ocular fluid for Ebola virus at an average of 19 months after patients' initial diagnosis with Ebola virus disease in the first phase of the study, and at an average of 34 months after diagnosis of Ebola in the second phase of the study. All samples were negative, and 34 patients elected to have cataract surgery. All patients who had surgery saw restoration of 20/30 vision.

"The step-wise approach involving ocular screening, ocular fluid sampling, and subsequent cataract surgery was safe, feasible, and vision restorative in this cohort of EVD survivors," the researchers concluded.

In other Ebola news, research published yesterday in The Lancet Infectious Diseases showed that African and European participants in a phase 1 trial of the recombinant vesicular stomatitis virus (rVSV) vaccine had an antibody response up to 2 years after initial inoculation. The vaccine expresses the Zaire Ebola virus glycoprotein (rVSV-ZEBOV), and participants who received a single dose of both low and high doses of the vaccine showed similar antibody responses.

Authors of the study said the single dose protection offered by rVSV-ZEBOV makes it a good candidate for outbreak response and prevention in remote areas, where booster dosing might prove difficult.
Apr 4 EbioMedicine study
Apr 4 Lancet Infect Dis


Yellow fever slows in Brazil but reaches northern coast of Sao Paulo

Brazilian news media reported that yellow fever has reached the northern coast of Sao Paulo state, near the city of Ubatuba. Officials confirmed yellow fever in two dead monkeys (one a household pet), and the flavivirus is suspected as the cause of death in one person, whose case is still under investigation.

Local officials said only 47% of the Ubatuba population is vaccinated against yellow fever, but an immunization program is under way.

Citizens of Brazil's northern and eastern states have not been routinely vaccinated against yellow fever. Last month, however, Brazil extended the yellow fever vaccine recommendation throughout the country, and the government aims to vaccinate 77.5 million people by April 2019.

The news comes as the country's Ministry of Health released its latest yellow fever numbers, showing a reduction of confirmed cases since Jul 1, 2017, from a total of 1,131 on Mar 28 to 1,127 as of Apr 3. There are still 328 deaths reported. The Ministry of Health explained that cases were removed from the totals after state health secretariats reclassified previously recorded cases.
Apr 4 Folha de S. Paulo story
Apr 4 Ministry of Health


Universal flu vaccine work gets $11.3 million in funding

The Open Philanthropy Project awarded $11.3 million to the Institute for Protein Design (IPD) at the University of Washington School of Medicine in Seattle to support the institute's development of a universal flu vaccine.

This is the largest Open Philanthropy gift in the sciences, and the first investment at UW Medicine. The gift will be administered in two parts, with $5.6 million used to refine Rosetta, the software platform developed at UW for protein design, and $5.7 million for the institute's program to develop a universal flu vaccine.

IPD began in 2012 and creates custom-designed proteins to improve human health in medicine, energy, industry, and technology. Researchers at IPD and UW Medicine are working on a nanoparticle vaccine that will trigger a protective immune response to multiple existing flu strains as well as new strains that might appear in the future, according to an IPD press release.

A universal vaccine would eliminate the current model of seasonal vaccine production, and ideally would require immunization just once every 5 years.
Apr 5 IPD press release


H5N8 avian flu strikes more poultry in Bulgaria, Iraq

In highly pathogenic avian flu outbreak developments, Bulgaria and Iraq reported more H5N8 outbreaks and the United Kingdom reported another H5N6 detection in wild birds, according to the latest official announcements.

Bulgaria's outbreak, its second involving H5N8 in the past month, was detailed in a government report translated and posted today by Avian Flu Diary (AFD), an infectious disease news blog. The event occurred at a duck farm housing 6,000 birds in Yambol province in the country's southeast. All of the ducks were slated for culling.

In Iraq, which has reported several H5N8 outbreaks since early January, the virus struck two more commercial poultry farms in Diyala and Baghdad provinces, according to a report today from the World Organization for Animal Health (OIE). The outbreaks began on Mar 28 and Apr 2, respectively, killing 10,000 of 13,500 susceptible birds. The remaining ones were destroyed to curb the spread of the virus.

Elsewhere, UK officials reported two more H5N6 detections in two wild buzzards found dead on Mar 28 in Suffolk, the OIE said in an Apr 3 notification. The virus is the new reassortant of H5N8 and a European N6 virus. Officials said the source of the virus was contact with wild species.
Apr 5 AFD post
Apr 5 OIE report on H5N8 in Iraq
Apr 3 OIE report on H5N6 in the UK

Stewardship / Resistance Scan for Apr 05, 2018

News brief

Study finds racial disparities in invasive MRSA incidence remain

A study today in Clinical Infectious Diseases shows that while rates of healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) have decreased in the United States, racial disparities in MRSA rates have not changed.

In the study, researchers from the Centers for Disease Control and Prevention (CDC) and elsewhere analyzed 2005-2014 surveillance data from nine states collected by the CDC's Emerging Infections Program to determine whether reductions in invasive MRSA incidence affected racial disparities in rates. Previous research has consistently documented higher rates of MRSA infections among blacks compared to whites across age groups, but the reasons for this disparity remain unclear.

Case classification included hospital-onset (HO), healthcare-associated hospital-onset (HACO), or community-associated MRSA. Negative binomial regression models evaluated the adjusted rate ratio (aRR) of MRSA in black patients (versus white patients), controlling for age, sex, and temporal trends.

The analysis found that despite substantial decreases in HO and HACO (but not CA) MRSA incidence from 2005 through 2014, the racial disparities did not decline. When adjusted for age, sex, and year, blacks had higher rates for HO MRSA (aRR: 3.20), HACO MRSA (aRR: 3.84), and CA MRSA (aRR: 2.78) incidence, with no significant change in the aRR over time.

"In summary, blacks continue to have a 2-3 times higher incidence rate of healthcare-associated invasive MRSA despite significant decreases in overall disease rates from 2005-2014," the authors write. "Eliminating racial disparities will require improved understanding of the determinants underlying these disparities, as well as prevention strategies to address those determinants."
Apr 5 Clin Infect Dis study


ESBL Klebsiella found more harmful than ESBL E coli

A study today in Infection Control & Hospital Epidemiology found that bloodstream infections caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) lead to more severe clinical symptoms and higher death rates than bloodstream infections caused by ESBL-producing Escherichia coli (ESBL-EC).

A large international group of researchers analyzed data on 687 patients with ESBL-EC bloodstream infections and 222 with ESBL-KP bloodstream infections. ESBL-KP was associated with intensive care unit stay, cardiovascular and neurologic comorbidities, length of hospital stay greater than14 days, and a nonurinary source, while ESBL-EC was not.

The investigators also discovered a 33.7% 30-day mortality rate in the ESBL-KP patients, compared with 17.4% in ESBL-EC patients. They noted that CTX-M was the most common ESBL subtype—occurring in 76% of isolates tested—but it was not tied to differences in clinical outcome or death.

The authors concluded, "All ESBL-producing Enterobacteriaceae should not be considered a homogeneous group."
Apr 5 Infect Control Hosp Epidemiol abstract

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