Ebola cases drop to 55 as more suspected cases ruled out

After officials received more test results from suspected cases, the Democratic Republic of Congo (DRC) dropped their Ebola case count to 55, including 28 deaths. There are now 38 confirmed cases, 14 probable cases, and 3 suspected cases, the World Health Organization (WHO) said in an update.

The DRC health ministry said there were two new suspicious cases in Iboko. Yesterday, health minister Oly Ilunga Kalenga, MD, traveled to Itipo in Iboko with WHO Director-General Tedros Adhanom Ghebreyesus, PhD. Itipo is the only health area reporting confirmed cases at this time. Parts of Itipo can only be reached by motorcycle, and the area is home to indigenous Pygmy populations, which makes contact tracing challenging.

The DRC also updated information on the ring vaccination campaign, which began on May 21. So far, workers have reached 2,295 people, including 713 in Mbandaka, 498 in Bikoro, 1,054 in Iboko, and 30 in Ingende, according to the DRC health ministry.
Jun 12 WHO update
Jun 11 DRC health ministry update



Study finds high prevalence of colistin-resistant E coli in Vietnamese village

A study examining the prevalence of colistin-resistant bacteria in healthy people from a rural Vietnamese village found that more than 70% were carrying colistin-resistant Escherichia coli, a team of Japanese scientists reported at the annual meeting of the American Society for Microbiology (ASM).

The investigators enrolled 98 healthy participants from 36 households Nguyen Xa village, a representative rural community in Vietnam. Microbiological analysis of stool specimens obtained from each participant detected colistin-resistant bacteria in 70 of 98 residents (71.4%) and 29 of 36 households (80.6%). All of the colistin-resistant isolates were identified as E coli, and 69 of the 70 isolates possessed either MCR1 and/or MCR3, the mobile colistin-resistance genes. In addition, the rate of multidrug-resistance in the MCR-positive E coli isolates was 91.4%.

"It is a remarkable finding from a public health viewpoint that most households that participated in the study had colistin-resistant E. coli carriers," presenting author Yoshimasa Yamamoto, PhD, of Osaka University said in an ASM press release. "Thus, this requires urgent public health attention."

Colistin, considered a last resort antibiotic in human medicine, is one of the most commonly used antimicrobials in food-animal production in Vietnam.
Jun 9 ASM Microbe 2018 abstract
Jun 9 ASM press release


Orthobunyavirus studies reveal novel subtype, first human Keystone virus isolation

In a pair of new orthobunyavirus developments, scientists identified a novel virus in a Ugandan child who had severe encephalopathy, and a Florida team isolated Keystone virus from a human for the first time, according to studies published in a recent issue of Clinical Infectious Diseases.

In the first report, a team from the Netherlands and Uganda looked at genetic sequences from a 3-year-old girl with unexplained encephalitis who was hospitalized in 2016. She died 2 weeks after leaving the hospital.

In a viral sample obtained from the child's cerebrospinal fluid, researchers found several sequences from all segments of a novel orthobunyavirus. Analysis of its S segment revealed 41% amino acid diversity from its closest relative. Researchers named the virus Ntwetwe virus after the child's hometown.

So far the child is the only known case-patient. Scientists said the prevalence of Ntwetwe virus infection isn't known, but phylogenetic analysis shows it clusters with a clade of viruses transmitted only by Anopheles mosquitoes, hinting that the new virus is likely an arbovirus. Given the potential for human exposure and disease severity, assessing the prevalence of Ntwetwe virus infection is an urgent need, the team wrote.
Jun 9 Clin Infect Dis abstract on Ntwetwe virus identification

In the other report, researchers from the University of Florida described the first isolation of Keystone virus in a Florida resident, hinting at the possibility of another endemic arbovirus in the southeastern United States.

They wrote that Keystone virus was first isolated from mosquitoes in Keystone, Fla., in 1964. Seroprevalence studies done five decades ago suggested that about 20% of people from the region had been exposed, but the isolation in a Florida teen who had a rash and fever is a first, though the virus is thought to be endemic in animals and mosquitoes.

The patient is a 16-year-old boy who was seen at a clinic in August 2016 for low-grade fever and diffuse skin rash. He had recently attended a band camp that included evening sessions, during which he was bitten by mosquitos numerous times, despite wearing insect repellent.

Saliva and urine samples were negative for Zika, dengue, and chikungunya viruses. The team isolated Keystone virus after a comprehensive virologic evaluation.

They wrote that the new finding points to the diversity of arboviruses in the region and that an analysis of possible pathogens should include diagnostics for Keystone virus.
Jun 9 Clin Infect Dis abstract on Keystone virus isolation


Study finds broad range of failures in hospital infection prevention practices

An observational study done in hospital clinical units and an emergency department found a broad set of circumstances that led to failures in infection prevention practices, which could lead to self-contamination or transmission during routine medical care.

The study took place in 2016 at a Veterans Affairs hospital and a university hospital. The research team conducted 325 room observations, looking for specific occurrences that they classified as violations, mistakes, or slips. Researchers from Michigan and Utah published their findings yesterday in JAMA Internal Medicine.

Of the observations, 259 (79.7%) occurred outside and 66 (20.3%) took place inside the rooms. Of 283 failures, 102 were violations (deviations from safe operating practices), 144 were procedural mistakes (failures of intention), and 37 were slips (failures of execution). Among the violations were entering rooms without some of all recommended personal protective equipment (PPE), and mistakes were often seen during PPE removal and challenging logistical situations such as badge-enforced computer logins. Common slips were touching one's face or clean areas with contaminated gloves or gowns.

The researchers said their assessment isn't meant to call attention to the failed actions, but rather to spotlight challenges in promoting effective PPE use among healthcare workers. "The broad array of contributing factors in each type of failure suggests that some circumstances may be more modifiable than others and that a range of strategies—behavioral, organizational, and environmental—may be needed to reduce the transmission risk during routine hospital care," they concluded.
Jun 11 JAMA Intern Med abstract


PCV and Hib vaccine cut pediatric mortality dramatically

Two now-common vaccines, the pneumococcal conjugate vaccine (PCV) and Haemophilus influenzae type b (Hib) vaccine, have greatly reduced pediatric mortality from pneumococcus and Hib in the last 15 years, according to a new analysis published in The Lancet Global Health.

In 2000, pneumococcus was estimated to be responsible for 735,000 pediatric deaths worldwide and caused 14.5 million total illnesses. Hib was estimated to have caused 363,000 deaths and 8.1 million total episodes in children in the same year.  By 2015, those numbers were reduced to 294,000 pneumococcal deaths and 29,500 Hib deaths, or by 50% and 90% respectively.

The drastic change is due to the introduction of PCV and Hib vaccines into immunization schedules for most countries in the world, including 54 low-income and middle-income countries eligible for vaccine funding support from Gavi, the Vaccine Alliance.

"By the end of 2015, 129 countries were using PCV. Pneumococcal deaths declined most sharply between 2010 and 2015, when the average annual reduction was 8%, compared with just 3% from 2000 to 2010," the authors wrote. "After 2010, 52 Gavi-eligible countries—many of them countries with the highest pneumococcal disease burden—introduced PCV in their national immunisation programmes."
Jun 11 Lancet Glob Health study


Flu season tails off in Northern Hemisphere

In its latest global flu update, the WHO said flu has returned to inter-seasonal levels for most of the Northern Hemisphere, and is rising but still under seasonal thresholds in the Southern Hemisphere's temperate zone countries.

Influenza activity has increased, however, in recent weeks in Southern Africa with more detections of 2009 H1N1. Brazil, Chile, and Paraguay also had more influenza detections. Australia and New Zealand reported inter-seasonal levels.

Tropical countries in the Caribbean, including Jamaica, reported influenza A activity. Influenza activity remained low throughout southern and eastern Asia.

Worldwide, 69.4% of typed influenza samples were influenza A, and 30.6% were influenza B. Of the subtyped influenza A viruses, 75.1% were 2009 H1N1 and 24.9% were H3N2. The influenza B Yamagata lineage accounted for 76.8% of the influenza B virus samples.
Jun 11 WHO update

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