WHO reports Ebola uptick amid DRC security incidents

Ebola transmission intensity increased slightly in the Democratic Republic of the Congo (DRC) outbreak region last week, with 57 new confirmed cases amid minor security flare-ups and major violence in Mandima health zone that suspended response operations, the World Health Organization (WHO) said today in its weekly snapshot of the outbreak.

The major incident, first reported yesterday, was community violence in Lwemba in Mandima health zone that was sparked by the death of a local health worker from Ebola. The WHO said the event has serious impact on response activities and could lead to gaps or delays in reporting in the area, which is one of the Ebola hot spots. The minor incidents affected safe and dignified burials and vaccination in Mambasa and Komanda health zones.

The WHO said most cases over the past 3 weeks are from three hot spots: Kalunguta, Mambasa, and Mandima. It added that cases in Beni have declined.

In other developments, 5 new cases were reported in the DRC, raising the outbreak total to 3,150, according to numbers reflected on the WHO's online Ebola dashboard. Health officials are still investigating 430 suspected cases, and the death toll is at 2,103, reflecting 5 more fatalities.

The DRC's multisector Ebola response committee (CMRE) provided a few more details on the 15 cases reported yesterday. The patients are from Mambasa (5), Beni (4), Kalunguta (4), Komanda (1), and Mandima (1). Of five new deaths noted in the CMRE report, two occurred in community settings, which raises the risk of further spread.
Sep 19 WHO Ebola update
WHO Ebola dashboard
Sep 18 CMRE update


Philippines reports vaccine-derived polio case, environmental positives

The Philippines today announced a circulating vaccine-derived poliovirus type 2 case (cVDPV2) and said the virus has also been detected in sewage in Manila and waterways in Davao, according to a joint statement from the World Health Organization (WHO) and UNICEF.

The illness marks the first polio case of any kind in the Philippines since 2001, the country's health minister said, according to a report today from Agence France-Presse (AFP) and SBS. The WHO said the Philippines and the WHO Western Pacific region were declared polio-free in 2000.

Authorities confirmed on Sep 16 that the case-patient is a 3-year-old girl from Lanao del Sur.

Rabindra Abeyasinghe, MD, the WHO representative in the Philippines, said in the statement that health officials are very concerned cVDPV2 is circulating in Manila, Davao, and Lanao del Sur. "WHO and UNICEF are working closely with the Department of Health to strengthen surveillance and swiftly respond to this outbreak. We urge all parents and caregivers of children under 5 years of age to have them vaccinated so that they are protected against polio for life," he said.

Before the outbreak, the Philippines health department and its partners had launched a polio immunization campaign in Manila. More rounds of vaccination will begin starting in October. Poorly conducted immunization activities—when too few children have received all three doses of polio vaccine—leave children susceptible to vaccine-derived and wild polioviruses.

The WHO said vaccine coverage in the Philippines has been declining over the past few years. It added that at least 95% of children under age 5 need to be vaccinated to stop the spread of polio in the Philippines. The country has also experienced a large measles outbreak, and earlier this year, Philippines health officials said vaccine hesitancy—some of it stemming from controversy surrounding the Dengvaxia vaccine—was fueling the outbreak in some regions of the country.
Sep 19 WHO statement
Sep 19 AFP-SBS story


MERS infects 1 more in Saudi Arabia

Saudi Arabia's health ministry today reported a new MERS-CoV case, the first for September, and the WHO shared more details about six cases the country reported in August.

The new MERS-CoV (Middle East respiratory syndrome coronavirus) case involves a 39-year-old man from Buraidah in the central part of the country in Qassim region. The man's contact with camels isn't known, and health officials said his exposure to the virus is primary, meaning he probably didn't contract MERS-CoV from another known patient.

Meanwhile, the WHO's Eastern Mediterranean regional office in a snapshot of August cases said six were reported for the month, all in Saudi Arabia. One of the infections was fatal. Two patients had July symptom onsets, and one of the patients reported in July died.

Of the six latest cases, two involved a household cluster. Patient ages ranged from 49 to 71, and four were men. None were healthcare workers. The infections lift the global MERS-CoV total as of the end of August to 2,468 cases, at least 850 of them fatal. The vast majority are from Saudi Arabia.
Sep 19 Saudi MOH statement
Sep 19 WHO EMRO monthly MERS-CoV report


Uptick in eastern equine encephalitis activity sickens people in 5 states

Connecticut health officials this week reported the state's first human case of eastern equine encephalitis (EEE) for the year, the fifth state this year to report cases of the rare mosquito-borne disease, according to reports compiled by ProMED Mail, the online reporting system of the International Society for Infectious Diseases.

On Sep 16, the Connecticut Department of Public Health (CDPH) said the patient is an adult resident of East Lyme who got sick during the last week of August with encephalitis and remains hospitalized. It said the virus has been found in mosquitoes in 12 towns and in horses in 2 other towns.

The case marks only the second EEE case in Connecticut and the first since the fall of 2013. The CDPH said two other states in the region had recorded human EEE cases for the season, Massachusetts (8 cases) and Rhode Island (1).

Also, New Jersey on Aug 16 reported its first human EEE case of the year, involving an elderly Somerset County man who was hospitalized and was discharged for rehabilitation care, according to a statement from the New Jersey Department of Health (NJDH).

Outside of the northeast, Michigan is experiencing its worst year for EEE in more than a decade, according to a Sep 17 statement from the Michigan Department of Health and Human Services (MDHHS). So far it has confirmed seven cases, all with July illness-onset dates, five of them fatal. The patients are from five different counties in the southwestern part of the state: Barry, Cass, Van Buren, Kalamazoo, and Berrien.

According to US Centers for Disease Control and Prevention (CDC), about seven human EEE cases are reported each year. It said transmission is most common in and around freshwater hardwood swamps in Atlantic and Gulf Coast states and in the Great Lakes region.
Sep 18 ProMED Mail post

Sep 16 CDPH statement
Aug 16 NJDH statement
Sep 17 MDHHS statement
CDC background information


Gates Foundation awards up to $2 million for universal flu vaccine research

Earlier this week a team of researchers from the University of Chicago, Icahn School of Medicine at Mount Sinai, Fred Hutchinson Cancer Center, and the Scripps Research Institute, received a Grand Challenge for Universal Influenza Vaccine Development grant—part of a $12 million initiative funded by the Bill & Melinda Gates Foundation and Flu Lab.

The team could see as much as $2 million over 2 years to develop MOsaic Natural Selective Targeting of Immune Responses (MONSTIR), a novel approach to creating a universal flu vaccine from a combination of proteins from different segments of multiple virus strains.

"It's like building a Frankenstein's monster of flu proteins, and thus the MONSTIR acronym," said Patrick Wilson, PhD, of the University of Chicago, in a press release. "The goal of the Grand Challenge is to fund novel, higher risk ideas like this that we can now explore with this new collaboration. It's exciting to have the backing of the Gates Foundation and Flu Lab."

MONSTIR will use parts of the influenza virus that do not typically change despite seasonal changes in dominant flu strains, including hemagglutinin and neuraminidase proteins.

The Grand Challenge for Universal Influenza Vaccine Development launched in April 2018 with the goal of funding innovative ideas for flu vaccines.
Sep 16 University of Chicago press release

Stewardship / Resistance Scan for Sep 19, 2019

News brief

USDA study finds resistance levels aren't lower in antibiotic-free pork

A new study by scientists from the US Department of Agriculture (USDA) has found similar levels of antimicrobial resistance (AMR) in pork chops from pigs raised without antibiotics and those raised conventionally.

For the study, published yesterday in the Journal of Food Protection, USDA researchers cultured bacteria from 372 pork chop samples from three food service suppliers that obtained their products from multiple harvesting facilities. Of the 372 samples, 190 came from conventional production systems and 180 came from "raised without antibiotics" (RWA) production systems. They focused on AMR in Escherichia coli, Salmonella enterica, Enterococcus spp, and Staphylococcus aureus. In addition, they evaluated DNA from the samples for the presence of 10 AMR genes.

The results of the analysis showed that levels of eight types of resistant bacteria in the conventional and RWA samples—tetracycline-resistant E coli, Salmonella, and Enterococcus; third-generation cephalosporin-resistant E coli and Salmonella; nalidixic acid-resistant Salmonella; erythromycin-resistant Enterococcus; and methicillin-resistant S aureus—were similar regardless of the antibiotic use claims. The prevalence of AMR genes were also similar. Overall, the populations of AMR bacteria in the samples were a small fraction of the aerobic bacterial population.

The authors of the study, who noted similar findings in conventionally raised and RWA ground beef last year, say that because the samples came from only three suppliers, they can't extrapolate the findings to the entire US retail pork supply. They also note that the findings do not conflict with reports that antibiotic use during swine production increases the presence of AMR bacteria in pig feces.

They conclude, however, that the study provides new evidence that antibiotic use in US swine production does not significantly increase the presence of AMR bacteria in pork products.
Sep 18 J Food Prot abstract
Nov 28, 2018, CIDRAP News story "Study finds resistance levels not lower in antibiotic-free burger meat"


Scientists outline XDR Salmonella Typhimurium in DR Congo

As if the Democratic Republic of the Congo (DRC)—which has been wracked by outbreaks of Ebola, measles, polio, and other diseases—didn't have enough public health crises, researchers today highlighted another serious concern: a strain of highly resistant Salmonella.

Writing in Nature Communications, the team described how they used whole-genome sequencing to analyze 81 blood samples containing Salmonella enterica serovar Typhimurium—a common cause of bloodstream infections in sub-Saharan Africa—that were collected from 2008 to 2016. The scientists found that 54 of these isolates demonstrated resistance to azithromycin and compared them with 27 Salmonella Typhimurium isolates susceptible to the antibiotic.

They found that all 54 resistant isolates were also extended-spectrum beta-lactamase–positive, and 51 were also multidrug-resistant (MDR) and could therefore be classified as extensively drug-resistant (XDR). These XDR isolates belonged to the ST313 sublineage II.1. They also demonstrate resistance to ceftriaxone, which, in addition to azithromycin, is the typical alternative antibiotic used to combat MDR Salmonella, so the only treatment available in the DRC are fluoroquinolones, the authors write.

They also note, "Whole genome sequencing reveals that ST313 II.1 isolates have accumulated genetic signatures potentially associated with altered pathogenicity and host adaptation, related to changes observed in biofilm formation and metabolic capacity." They say the sublineage may have emerged in the country around 2004.
Sep 19 Nat Commun study

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