News Scan for Feb 11, 2019

News brief

DRC sees no let-up in Ebola cases in Katwa

Over the weekend and through today the Democratic Republic of the Congo (DRC) health ministry reported 16 more lab-confirmed Ebola cases, 13 of them from Katwa, the outbreak's current hot spot. Also, in a Feb 9 update, health officials reported 7 more probable cases, all from Katwa involving people who became ill in November and December and died between November and January.

Two of the latest lab-confirmed cases are from Butembo and one is from Vuhovi. The latest developments bring the overall outbreak total to 816 cases, which includes 755 confirmed and 61 probable infections. Outbreak responders are also investigating 178 suspected Ebola cases.

Eleven more people died from their infections. Seven occurred in the community, including six from Katwa and one from Vuhovi. Four people died in Ebola treatment centers, including three from Butembo and one from the Katwa facility. The latest deaths lift the outbreak's fatality total to 513.

In other outbreak developments, the ministry said in its Feb 9 update that immunization of primary care providers has started in Rwampara, a new health zone in Ituri province. It said it took the step, because the health zone is located on a road used by thousands of people from Beni, and that vaccinating health workers is part of plan to limit the spread of the virus to other provinces.

According to today's update, 77,680 people have been vaccinated since the VSV-EBOV campaign began on Aug 8.
Feb 9 DRC update
Feb 10 DRC update
Feb 11 DRC update


Rotavirus symptoms and costs in household contacts

Rotavirus-related acute gastroenteritis in children poses a significant burden on household contacts, especially children younger than 5 years old, according to a study from researchers with the New Vaccine Surveillance Network, which included scientists with the US Centers for Disease Control and Prevention (CDC).

To examine transmission and impact of rotavirus on families, the group enrolled children between the ages of 15 days through age 10 who were seen for acute gastroenteritis at emergency departments at seven different medical centers between December 2011 and June 2016. The team published their findings in the Feb 7 issue Journal of the Pediatric infectious Diseases Society.

Their analysis included 829 kids who were positive for rotavirus and 8,858 who tested negative. They found that households of confirmed rotavirus patients were more likely to report acute gastrointestinal illness and one or more household contact than kids who tested negative for the virus, 35% and 20%, respectively.

Overall, 466 (16%) of the household contacts of rotavirus patients reported illness symptoms. Of that group, 107 (23%) sought medical care, of which 6 (6%) resulted in hospitalization. Household contacts who were younger than 5 were more likely to report illness than those in other age groups (odds ratio, 2.2 [P=.004]). Also, 144 households reported out-of-pocket expenses that ranged from $2 to $640 (median, $20).

Researchers note that traditional cost burden studies haven't adequately direct[O1]  and indirect costs for the household. "Prevention of pediatric rotavirus illness, especially though vaccination, can prevent additional illnesses in HHCs [household contacts]," they wrote.
Feb 7 J Pediatric Infect Dis Soc abstract


Study: Flu vaccination cut hospitalization in Israeli children

Flu vaccination helped prevent hospitalization in fully vaccinated children in Israel, according to new findings based on three flu seasons. A team from Clalit Health Services in Israel and the University of Michigan reported their findings today in Clinical Infectious Diseases.

The team compared flu-positive cases and test-negative controls; 326 and 2,821, respectively, from 2015-16, 36 and 1,069 from 2016-17, and 150 and 781 from 2017-18.

Over the three seasons, vaccine effectiveness (VE) for fully vaccinated children was 53.9% children (95% confidence interval [CI], 38.6% to 68.3%), compared with a statistically not significant 25.6% for partially vaccine kids (95% CI, -3% to 47%). The researchers noted that VE varied depending on the makeup of the seasonal strains that circulated.

For example, for the 2015-16 season, most viruses were 2009 H1N1 and there was a mismatched influenza B lineage, and VE for fully vaccinated kids was statistically significant for influenza A, but not influenza B. For the 2016-17 season when H3N2 was predominant, VE was 70.8% (95% CI, 17.4% to 92.4%). And for the following season when H3N2, 2009 H1N1, and a mismatched B lineage circulated, VE was statistically significant for influenza B but not influenza A.

The authors concluded that flu immunization was effective in preventing hospitalization in fully vaccinated Israeli kids, but not among their partially vaccinated peers. Also, the team observed signs of cross-lineage protection in a season when the vaccine contained B/Victoria and the circulating lineage was B/Yamagata, but not in a season in which the opposite occurred.
Feb 11 Clin Infect Dis abstract


Prior dengue may prime women for severe Zika in pregnancy

A new animal model study published in Immunity suggests that pregnancies in hosts with a prior dengue infection may be more likely to result in severe outcomes from Zika virus illness.

The study was conducted by researchers at Mount Sinai, who transferred dengue virus-specific antibodies into mice before infecting the mice with Zika during pregnancy. Priming the mice with dengue led to increased placental damage, fetal growth, and fetal resorption.

"Our data demonstrate that antibodies generated from a previous dengue virus infection can enhance the severity of Zika virus infection during pregnancy," said Jean Lim, PhD, lead study author and associate professor of microbiology at the Icahn School of Medicine at Mount Sinai in a press release. "Our research may explain the high rate of microcephaly and birth defects observed in the recent Zika virus outbreak in South America."

Both dengue and Zika are flaviviruses, vector-borne diseases that tend to co-circulate in communities. Dengue is antibody-dependent–enhancing, meaning that prior infections with the virus heighten the response to future infections instead of protect against them.
Feb 8 Mount Sinai press release
Feb 8 Immunity study

Stewardship / Resistance Scan for Feb 11, 2019

News brief

CDC: 19 states may have raw milk exposure to drug-resistant Brucella

Today the Centers for Disease Control and Prevention (CDC) announced that health workers are investigating potential exposures to a drug-resistant Brucella strain RB51 in 19 states. The strain comes from raw (unpasteurized) milk from Miller's Biodiversity Farm in Quarryville, Penn.

"One case of RB51 infection (brucellosis) has been confirmed in New York, and an unknown number of people may have been exposed to RB51 from drinking the milk from this farm," the CDC said. "This type of Brucella is resistant to first-line drugs and can be difficult to diagnose because of limited testing options and the fact that early brucellosis symptoms are similar to those of more common illnesses like flu.­"

In November of 2018, a New York resident became the third American to be diagnosed as having brucellosis caused by the RB51 strain. Two cases (unrelated to the Quarryville farm) were also reported in 2017, in New Jersey and Texas.

The 19 states in question are Alabama, California, Connecticut, Florida, Georgia, Iowa, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, and Virginia.

The CDC said anyone who has consumed raw milk from the farm between January of 2016 and January 2019 may have been exposed to the strain.
Feb 8 CDC alert


Study: MDROs prevalent in California nursing homes, long-term acute care

A team of researchers studying nursing homes and long-term acute care facilities in southern California reported today in Clinical Infectious Diseases that a large majority of residents and patients in these facilities harbor multidrug-resistant organisms (MDROs).

The one-day point prevalence study was conducted by researchers with the Shared Health Intervention to Eliminate Life-Threatening Dissemination of MDROs in Orange County (SHIELD OC), a regional public health collaborative to measure the impacts of a coordinated infection prevention initiative on MDRO carriage and infection at 18 nursing homes (NHs), 17 short term acute care hospitals, and 3 long term acute care facilities (LTACs). The aim was to establish baseline MDRO prevalence in the NH and LTACS settings, as patients and residents in these facilities are transferred frequently and are known to serve as a source of MDRO transmission.

From September 2016 to March 2017, a random sampling of 1,050 patients from the 21 facilities were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistance Enterococcus spp. (VRE), extended-spectrum beta-lactamase producing organisms (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE) using nares, axilla/groin, and peri-rectal swabs. In addition, researchers performed multivariate analyses of swab data to evaluate person-level and facility-level characteristics associates with MDRO carriage.

The overall prevalence of MDROs in the 21 facilities was 67%, with at least one MDRO found in 65% of NH residents and 80% of LTAC residents. Twenty-seven percent of NH residents and LTAC patients were found to carry multiple MDRO pathogens. The most common MDROs in NHs were MRSA (42%) and ESBL (34%); in LTACs they were VRE (55%) and ESBL (38%). MDRO status was known for only 18% of NH residents and 49% of LTAC patients. Multivariable models indicated that history of MRSA (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2 to 2.4, P = 0.04), VRE (OR 2.1; 95% CI, 1.2 to 3.8, P = 0.01), ESBL (OR, 1.6; 95% CI, 1.1 to 2.3, P = 0.03) and diabetes (OR, 1.3; 95% CI, 1.0 to 1.7, P = 0.03) were associated with any MDRO carriage.

"In summary, MDRO colonization prevalence is high within the NH and LTAC setting, far exceeding published reports in acute care hospitals. These data demonstrate the importance of NH/LTACs as a dominant MDRO reservoir in the healthcare system," the authors of the study write. "Investment in universal strategies of infection prevention and antimicrobial stewardship that are applicable to nursing homes and long term acute care hospitals are greatly needed and arguably overdue."
Feb 11 Clin Infect Dis abstract

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