Texas reports rise in Cyclospora cases

The Texas Department of State Health Services said today that clinicians should consider testing patients who complain of lingering diarrhea for Cyclospora, a parasite that can cause severe diarrheal illness.

According to state officials, there have been 68 reported cases of Cyclospora in the last month. Texas health officials are currently conducting investigations to determine if the reported cases share a common exposure source.

In past US outbreaks, the parasite has been linked to salad mix, raspberries, snow peas, and lettuce.  Washing fresh produce does not totally eliminate the risk of Cyclospora, which is transmitted through food and water contaminated with Cyclospora cayetanensis. Infection is not generally transmitted person-to-person.

Symptoms of Cyclospora infection begin 2 days to 2 weeks after ingestion, and severe diarrhea can last for months.

Canada has reported a Cyclospora outbreak that has so far sickened 57 people in British Columbia and Ontario, with most of the illnesses reported from Ontario. The patients were sick between May and June, and an investigation into the source is underway, the Public Health Agency of Canada (PHAC) said in Jul 14 update.
Jul 17 Texas Department of Health alert
Jul 14 PHAC update


Report details non-prescription use of antibiotics in Europe

A report today from the European Commission estimates that 7% of antibiotics taken in the European Union (EU) are taken without a prescription.

The report, which describes the results of the ARNA (antimicrobial resistance and the causes of non-prudent use of antibiotics) project, found that the highest self-reported use of non-prescription oral antibiotics was in Romania (20% of all antibiotic users in 2013, and 16% in 2016) and Greece (16% of all antibiotic users in 2013, and 20% in 2016). High rates of non-prescription antibiotics use were also found in Latvia, Bulgaria, Croatia, and Hungary. The antibiotics were obtained from either a pharmacy or healthcare provider without a prescription, or were left over from a previous prescription.

Patient surveys in seven of the ARNA countries suggested lack of knowledge about antibiotics was a major determinant of non-prudent use, while surveys of pharmacists found that patient pressure played a role in the decision to sell antibiotics over-the-counter (OTC) without a prescription, with some pharmacists saying they feared customers might go to another pharmacy if they refused. A majority of pharmacists and general practitioners (GPs) reported being asked to prescribe an antibiotic even though there was no medical indication.

Dialogue meetings in six of the ARNA countries—Cyprus, Greece, Italy, Hungary, Romania, and Spain—resulted in several policy recommendations to reduce non-prudent use of antibiotics. The recommendations included public health campaigns to educate patients and healthcare providers on appropriate antibiotic use, efforts to strengthen collaboration between GPs and pharmacists, increased use of rapid diagnostic tests that can be performed at the point-of-care, and better enforcement of laws to prevent OTC sales.
July 17 ARNA report


MERS super spreader analysis points to infection control role

A detailed analysis of clinical data and MERS-CoV genetic sequences of the index patient in South Korea's 2015 outbreaks related to hospital settings suggests that the 68-year-old man was a super spreader because of problems with infection control rather than any changes in the virus. South Korean researchers published their findings in a Jul 14 early online edition of BMC Infectious Diseases.

Though MERS-CoV (Middle East respiratory syndrome coronavirus) has been detected in several countries outside of Saudi Arabia, the outbreak in South Korea was unprecedented due to its size (186 cases, 36 of them fatal, over a 2-month span). The event raised suspicions about whether the South Korea strain was more virulent or if there were unique features in South Korea's hospital systems that favored the spread.

Before he got sick, the man had traveled to the Middle East for business, spending most of his time in Bahrain but also making side trips to the United Arab Emirates and Saudi Arabia. Though he didn't encounter any known risk factors in Saudi Arabia, a comparison of his sample with other MERS-CoV viruses revealed that the closest relative was a 2015 Riyadh virus.

Researchers said the man was one of five super spreaders in the outbreak and that he visited four hospitals where 28 related secondary infections were reported. Prolonged duration of exposure before diagnosis and proper isolation may have contributed to the illnesses linked to the man, the group wrote. However, they also said greater pathogen shedding could have played a role, because the man had severe pneumonia and a severe cough during his illness which could have amplified transmission.
Jul 14 BMC Infect Dis abstract

In other MERS-CoV research developments, another South Korean research team reported on serologic responses they saw in 42 patients infected in the country's outbreak. They reported their findings in the Jul 14 edition of Diagnostic Microbiology and Infectious Disease.

The patients included in the study had been treated during an outbreak at Samsung Medical Center. The researchers grouped them into four severity groups.

None of the patients in the asymptomatic group seroconverted, and seroconversion increased along with disease severity. Among patients with pneumonia, 75% of those who died did not seroconvert by the third week, whereas 100% of survivors had done so. The team concluded that case-patients with mild disease showed low seroconversion rates whereas those with fatal infections had impaired responses.
Jul 14 Diagn Microbiol Infect Dis abstract


Emergent BioSolutions to acquire Sanofi's smallpox vaccine

Emergent BioSolutions, a biotechnology company based in Gaithersburg, Md., announced on Jul 14 that it has entered an agreement to buy Sanofi's smallpox vaccine, ACAM2000. In a press release, Emergent said the transaction is worth up to $125 million.

ACAM2000 is the only vaccine licensed by the Food and Drug Administration (FDA) for active immunization of people at high risk for infection. As part of the acquisition, Emergent will take over an existing 10-year contract with the Centers for Disease Control and Prevention for deliveries of ACAM2000 to the strategic national stockpile (SNS). Originally worth $425 million, the contract still has a value of about $160 million for the vaccine to be delivered to the SNS.

The deal includes a bulk manufacturing facility and a lease of a fill-finish facility, both based in the United States.

Daniel Abdun-Nabi, Emergent's president and chief executive officer, said in the press release that the transaction supports the company's growth goals and broadens its countermeasure holdings with a vaccine that is being stockpiled in the United States and internationally. The deal is expected to be finalized this year.

Sanofi is completing the technology transfer from a facility in Austria to the United States, and Emergent expects that an application for FDA licensure will be filed in the second half of 2017 and that product deliveries will resume in 2018 after the FDA licenses the manufacturing facility.
Jul 14 Emergent BioSolutions press release

Vector-borne Disease Scan for Jul 17, 2017

News brief

Infant case series suggests Zika eye problems can occur apart from brain defects

A case series of 112 babies born to Brazilian mothers who had confirmed Zika infections found that 21.4% had eye abnormalities with the potential to impair sight, with the condition sometimes seen on its own without microcephaly or other central nervous system (CNS) problems. Researchers from Brazil reported in JAMA Pediatrics today.

They followed 112 babies who were seen at a referral center for high-risk pregnancies and infectious diseases in Rio de Janeiro until the youngsters were 1 year old. Among the group, 20 had microcephaly and 31 had other CNS abnormalities. Of the mothers, 32 had been sick with Zika virus in the first trimester, 55 in the second, and 25 in the third.

Twenty four (21.4%) of the infants had sight-threatening eye problems; optic nerve and retinal abnormalities were the most common conditions. Ten of the babies who had eye issues did not have microcephaly and eight didn't have any CNS findings.

More than half (58.3%) of the infants who had eye problems were born to women infected in the first trimester, followed by 33.3% in the second, and 8.3% in the third.

The authors acknowledged a referral bias and the lack of a control group, and they wrote that they can't say with certainty that all of the eye problems were linked with Zika infections. However, they said eye abnormalities may be the only initial finding in congenital Zika infection and that all babies possibly exposed to the virus should undergo eye screening, regardless of CNS issues, timing of maternal infection, or lab confirmation.
Jul 17 JAMA press release
Jul 17 JAMA Pediatr


Funding review finds gap that could undermine malaria elimination goals

Global malaria funding is dropping at a time that's crucial for reaching elimination goals, a research team based at the University of California, San Francisco, reported recently in Malaria Journal.

For the study, they looked at both donor funding and government health spending between 1990 and 2013 for 35 countries that are working to eliminate malaria. They also made projections to 2017.

Between 2000 and 2010, donor funding increased from just over $5 million to $176 million, but in 2013, overall funding fell to $62 million. Since 2000, government funding for malaria elimination in the countries has been rising, but it still doesn't fully bridge the gap from the decline in donor funding.

Rima Shretta, MPH, the study's corresponding author, said in a press release from Biomed Central, the journal's publisher, "Our findings demonstrate growing uncertainty about the future availability of donor funding for malaria. The study highlights the need for sustainable financing solutions that bridge the gap between the amount of funding a government can provide based on its economy and the amount donated by external partners, which declines as the country moves closer to becoming malaria-free."

The group also looked at the interventions supported by the malaria elimination funding and found high growth in donor funding for vector-control activities, especially insecticide-treated nets. However, donor money spent on surveillance—considered a key elimination intervention—declined between 2010 and 2012. The researchers said donors will need to assess whether shifting more support to operations such as surveillance and program management will be needed to support progress on malaria elimination goals.
Jul 14 Biomed Central press release
Jul 14 Malar J


Another slight rise noted in Americas chikungunya outbreak

Countries in the Americas reported 317 more chikungunya cases last week, similar to the past several weeks, though not all countries reported their latest numbers, according to an update from the Pan American Health Organization (PAHO).

The weekly total is similar to the 311 cases reported the previous week. Totals can sometimes show large spikes or declines, depending on how frequently countries with high disease burden, such as Brazil, update their cases. For the past few weeks, PAHO's latest report hasn't included new updates from Brazil.

Most of the new illnesses were reported from Central American countries, including Costa Rica, El Salvador, Nicaragua, and Panama. Colombia and Peru also reported a few more chikungunya infections.

Americas countries have now reported 89,563 confirmed, suspected, and imported chikungunya cases this year, most of them from Brazil. The fatality number has held steady at 13.

Since the 2013 start of the outbreak in the Americas and the Caribbean region, the virus has sickened 2,476,274 people.
Jul 17 PAHO update

This week's top reads

Our underwriters