News Scan for Mar 15, 2016

News brief

PulseNet may save $500 million a year in foodborne disease costs

PulseNet, the national lab network that links cases of foodborne disease by tracking genetic fingerprints of pathogens, saves an estimated $500 million and prevents 270,000 disease cases a year, according to an economic evaluation today in the American Journal of Preventive Medicine.

For perspective, PulseNet costs about $7.3 million a year to run, which means an estimated $70 is saved for every dollar spent.

US researchers, including some from the Centers for Disease Control and Prevention (CDC), which operates PulseNet, analyzed data collected from 1994 through 2009. After accounting for underreporting and underdiagnosis, the investigators conservatively reported that each year the system prevents 266,522 illnesses from Salmonella, 9,489 illnesses from Escherichia coli, and 56 illnesses caused by Listeria monocytogenes, or 276,067 total.

They estimate that avoiding those cases reduces medical and productivity costs by $507 million. Additionally, they reported that direct effects from improved recalls reduce illnesses from E coli by 2,819 and Salmonella by 16,994, leading to an additional $37 million saved.

"PulseNet has provided an incredible return on investment with hundreds of thousands of people able to stay healthy as a result of this early warning system," said CDC Director Tom Frieden, MD, MPH, in a CDC news release on the study. "Advanced molecular detection technology, such as whole genome sequencing, is enhancing CDC PulseNet's ability to save lives right now—and promises to save more American lives in the future."
Mar 15 Am J Prev Med study
Mar 15 CDC news release

Study: Flu vaccination poses little risk for surgical patients

A study of surgical patients found that influenza vaccination during a hospital stay did not significantly increase risks for fever or healthcare visits following discharge, according to a report today in Annals of Internal Medicine.

The retrospective cohort study evaluated the health records of 78,392 patients admitted for 81,647 surgeries in southern California's Kaiser Permanente hospitals during the 2011 to 2013 flu seasons. Cases in which perisurgical vaccination would be inappropriate (eg, bone marrow transplants) were excluded from the analysis. About 8% of patients (6,420) received a flu vaccine during their hospital stay, 78% of whom were vaccinated on the day they were discharged.

Investigators found that, when compared with the 34% of patients who had not received a seasonal flu vaccine, patients vaccinated during their surgical stay had only a moderately increased risk of future outpatient visits (a difference of 28.3 more visits per 1,000 vaccinated patients), laboratory tests for infection (10.6 per 1,000), emergency room visits (5.5 per 1,000), and future inpatient care (3.9 per 1,000) in the seven days following discharge.

In an adjusted analysis that included 42,777 surgeries, all increases in risk between vaccinated and unvaccinated patients were found to be nonsignificant. The researchers noted that their study was limited by the fact that they did not distinguish between planned and unplanned hospitalizations or outpatient visits.

The findings may help counter concerns that flu vaccination in hospital patients can lead to fever or muscle pain that may be misinterpreted as a surgical complication. The researchers said that, given the low increase in risk for post-discharge medical visits, the benefits of flu vaccination during a hospital stay outweigh the risks.
Mar 15 Ann Intern Med study

Avian flu outbreaks reported in Nigeria and South Africa

Nigeria continues to battle multiple outbreaks of highly pathogenic avian influenza (HPAI) H5N1, while South Africa confirmed five recent outbreaks of low-pathogenic H5N2, according to reports their governments filed with the World Organization for Animal Health (OIE) yesterday.

Nigeria reported 14 H5N1 outbreaks between Mar 1 and 9. Five occurred on two chicken farms and three backyard flocks in north-central Nigeria's Kano province.

Eight H5N1 outbreaks were reported in Plateau province in central Nigeria, affecting six chicken farms and two backyard flocks. One outbreak on a chicken farm occurred in central Nigeria's Kaduna province.

The farms and flocks housed a total of 13,705 layers and pullets, with mixed poultry species reported in one Kano backyard flock. Of the total number of birds, 893 were sickened by the virus and died, while 12,812 were culled to prevent the spread of infection. Like many previous reports from Nigeria, this one cited poor farm biosecurity as a contributor to the outbreak.

Of South Africa’s five H5N2 outbreaks, four occurred on commercial ostrich farms and one involved domestic ducks. The outbreaks occurred between Dec 1, 2015, and Jan 19 and affected 12,894 birds, 3,720 of which became ill, resulting in 175 deaths. At present, no birds in the South African outbreaks have been destroyed.
Mar 14 OIE report on Nigerian outbreaks
Mar 15 OIE report on South African outbreaks

Coronavirus Scan for Mar 15, 2016

News brief

Study: SARS-like virus in Chinese bats could jump to humans

Researchers at the University of North Carolina at Chapel Hill (UNC) say their research shows that viruses much like the SARS (severe acute respiratory syndrome) coronavirus (CoV) are still lurking in horseshoe bats in China and could jump to humans.

The scientists described their research in a Mar 13 article in the Proceedings of the National Academy of Sciences (PNAS).

Previous studies suggest that SARS-CoV originated in horseshoe bats, and recent metagenomics studies of horseshoe bat viruses identified several SARS-like DNA sequences that are at least 90% identical to the SARS virus, the report says. Further, scientists recently isolated a virus called WIV1-CoV that uses human angiotensin-converting enzyme and could replicate at low levels in human cells.

The authors said they took DNA sequences from SARS-like viruses isolated from horseshoe bats and used them to reconstruct the viruses. They then tested the viruses' ability to infect human cells and mice. The results showed that WIV1-CoV could bind to the same receptors as SARS-CoV and readily replicated in cultured human airway cells, according to a UNC press release.

"The capacity of this group of viruses to jump into humans is greater than we originally thought," Vineet Menachery, PhD, the study's first author, said in the release. "While other adaptations may be required to produce an epidemic, several viral strains circulating in bat populations have already overcome the barrier of replication in human cells and suggest reemergence as a distinct possibility."

The report says it appears that the virus would need additional adaptations, possibly involving components other than its spike protein, before it could easily spread in humans. Also, monoclonal antibodies developed to treat SARS were effective against the virus in human and animal cells, the researchers found. Existing SARS vaccines, however, would not prevent infection with it, they said.
Mar 13 PNAS report
Mar 14 UNC press release

Saudis report 2 MERS cases, 2 deaths, details on Buraydah cluster

Saudi Arabia's Ministry of Health (MOH) today reported 2 new MERS cases in Kharj and Riyadh, along with the deaths of two previously reported patients in Buraydah. The agency also released a weekly report detailing potential risk factors in the recent hospital outbreak in Buraydah.

The first new MERS-CoV (Middle East respiratory syndrome coronavirus) case-patient is a 78-year-old Saudi woman from Kharj who is hospitalized in stable condition. She had contact with camels and is not a healthcare worker, the MOH said.

The second new case involves a 45-year-old Saudi man from Riyadh. He is a healthcare worker, and the source of his exposure is under investigation, the MOH said. He had no contact with camels.

The two deaths in Buraydah involved MERS patients who were not healthcare workers,the MOH reported. The first patient was a 33-year-old foreign man with no preexisting medical conditions, and the second death involved a 60-year-old Saudi man with an underlying disease.

In addition, a 52-year-old Saudi woman from Riyadh has recovered from the disease. She is not a healthcare worker and had an underlying medical condition.

The MOH today also released its weekly MERS-CoV report, which provides details on the ongoing hospital cluster in Buraydah.

In the past three weeks (Feb 22 to Mar 12), 23 MERS-CoV cases have been reported in Saudi Arabia's Qassim region. Twelve infections were the result of secondary transmission, 5 cases are listed as primary, and 6 involve healthcare workers. Eighteen of the infections occurred in one hospital in Buraydah.

The MOH said the virus may be spreading between hospital patients and asymptomatic visitors and that case diagnosis and confirmation in Buraydah occurred later than was ideal. The agency highlights the need for greater infection control and visitor triage in hospitals, better awareness of MERS-CoV signs and symptoms among healthcare workers, and compliance with personal protective equipment guidelines during aerosol-generating procedures.

Today's updates bring Saudi Arabia's MERS-CoV total since 2012 to 1,344 cases and 571 deaths, with 21 cases still active.
Mar 15 MOH update
Mar 15 MOH MERS-CoV Weekly Monitor on Buraydah cluster