Recent DRC Ebola cases all involved known transmission chains

All three confirmed Ebola cases reported in the past week in the Democratic Republic of the Congo (DRC) involved known transmission chains, which is a good sign, but volatile situations still plague the outbreak region, the World Health Organization (WHO) said yesterday in its weekly situation report.

The WHO said that, from Feb 3 to Feb 9, all three confirmed Ebola virus disease (EVD) cases were in Beni in North Kivu province. Over the past 21 days, officials confirmed 13 new cases, 12 in Beni and 1 in Mabalako, which is also in North Kivu province. Three of those patients died, all in the community, which raised the risk of disease spread.

"Although recent trends of this outbreak, including the small number of weekly cases and limited geographic area affected by EVD are encouraging," the WHO said, "continued vigilance is crucial, particularly for contact identification and follow up, in order to interrupt possible nosocomial transmission linked to traditional practitioner facilities."

"The security situation in several EVD-affected health areas remain unstable and unpredictable," the WHO added. "On 8 February, a health centre was attacked in Butembo, destroying equipment and infrastructure. On 8 February 2020, an attack on civilians in Mabalako Health Zone led to a suspension of response activities for 48 hours."

Since Feb 9, the WHO has logged 2 new cases, 1 on Feb 10 and 1 yesterday. The DRC's Ebola technical committee (CMRE) said the case reported yesterday was in Beni. No new cases were reported today, according to the WHO's online dashboard, keeping the outbreak total at 3,432 cases, including 2,249 deaths. Authorities are tracking 461 suspected cases.
Feb 12 WHO situation report
Feb 12 CMRE update
WHO Ebola dashboard


MCR-1 colistin resistance gene identified in Wyoming hospital patient

A urinary tract infection (UTI) caused by multidrug-resistant bacteria carrying the MCR-1 colistin resistance gene was identified in a Wyoming hospital patient in early 2019, researchers from the Centers for Disease Control and Prevention (CDC) and the Wyoming Department of Health (WDH) reported today in Morbidity and Mortality Weekly Report (MMWR). It's the first MCR-1-carrying isolate identified in Wyoming or surrounding states.

The patient, who had a history of recurrent UTIs, was admitted to the hospital in mid-December 2018, and admission urine culture and antimicrobial susceptibility testing identified the infecting pathogen as carbapenem-resistant Klebsiella pneumoniae with extended-spectrum beta-lactamase production. Further testing identified resistance to 16 antibiotics. In early January 2019, the Texas Antimicrobial Resistance Laboratory Network found additional resistance to colistin and identified a plasmid-mediated MCR-1 gene.

WDH subsequently began in investigation to determine where the patient might have acquired the organism, but was not able to identify the route of acquisition. The patient had not traveled internationally or been exposed to livestock, but had experience repeated UTIs caused by K pneumoniae and Escherichia coli in the previous 2 years and had been treated with antibiotics. The authors of the case report suggest this could have increased the risk for acquiring antibiotic-resistant bacteria.

A point-prevalence survey conducted to identify possible transmission of the MCR-1 gene to other patients found six patients who were in the same hospital unit at the same time as the index patient; rectal screening of four of those patients was negative. The patient recovered after receiving appropriate antibiotics and was discharged from the hospital in January 2019.

The first US patient carrying MCR-1 was identified in Pennsylvania in July 2016, and since then MCR-1-carrying isolates have been identified in 20 more states. Colistin is considered a last-resort antibiotic.
Feb 14 MMWR case report


Study: 3-dose pneumococcal vaccine tops 2-dose regimen in infants

A study today in Pediatrics suggests that children under 1 year old are less likely to suffer pneumococcal disease if they receive three doses of pneumococcal conjugate vaccine (PCV) than if they get only two doses, but the difference in infection rates has dropped in recent years as pneumococcal strains targeted by vaccines have become less common.

Researchers from the CDC, state health departments, and other institutions looked at the rates of invasive pneumococcal disease in children under 5 years from 2001 through 2016, using the CDC's Active Bacterial Core Surveillance data.

They note that most countries use a 3-dose PCV schedule, but a 4-dose schedule—3 primary doses and 1 booster—is licensed for infants in the United States. The team compared breakthrough disease rates in children receiving 2 or 3 doses, both with and without booster doses (2+1 versus 3+1; 2+0 versus 3+0). Children who received 7-valent and 13-valent PCV (PCV7 and PCV13) doses were included.

The researchers found 71 PCV7 and 49 PCV13 breakthrough infections among children who received the schedules studied. PCV13 breakthrough infections were higher in children under 1 year old who received 2 doses (2+0) than in the 3-dose (3+0) group: incidence rates (IRs) per 100,000 were 7.8 versus 0.6. The IR ratio was 12.9, with a 95% confidence interval of 4.1 to 40.4. The results for PCV7 cases were similar.

In addition, the study revealed that differences in case numbers between the 2-dose and 3-dose regimens in children under age 1 were greater in 2010 and 2011 (IR for 2+0 group, 18.6; IR for 3+0 group, 1.4) than in 2012 through 2016 (IR for 2+0 group, 3.6; IR for 3+0 group, 0.2).

"Fewer PCV breakthrough infections occurred in the first year of life with 3 primary doses," the team concluded. "Differences in breakthrough infection rates by schedule decreased as vaccine serotypes decreased in circulation."
Feb 13 Pediatrics abstract


Vietnam reports two more H5N6 avian flu outbreaks in poultry

Vietnam reported two more outbreaks of H5N6 highly pathogenic avian flu yesterday, a day after four other outbreaks were reported in the northern part of the country, according to the World Organization for Animal Health (OIE).

A total of 1,000 birds were infected and died out of 8,731 susceptible birds on the two affected farms, the OIE said. The rest of the birds were killed and disposed of. The farms are in Bac Ninh province in the country's northeast. Bac Ninh adjoins Ha Noi province, site of one of the earlier outbreaks.
Feb 12 OIE report

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