News Scan for Oct 09, 2014

News brief

New estimates put price of US foodborne disease at $15.6 billion per year

Costs associated with foodborne illnesses in the United States total more than $15.6 billion annually, according to a data product released Oct 7 by the US Department of Agriculture's (USDA's) Economic Research Service containing updated estimates.

The pathogen associated with the greatest cost is Salmonella, accounting for $3.7 billion each year. Next in order are Toxopasma gondii at $3.3 billion and Listeria at $2.8 billion.

The total cost is based on estimates for illness caused by the 15 pathogens responsible for more than 95% of foodborne illness in the country, explains a USDA overview. Specifically, the estimates "build on [Centers for Disease Control and Prevention] estimates of the incidence of foodborne disease; peer-reviewed synthesis of data on medical costs, and economic, medical and epidemiological literature; and publicly available data on wages," it says.

Excel files for each of the pathogens contain spreadsheets giving estimated low, mean, and high costs of the illness in question; assumptions used in estimating costs for that pathogen; disease outcomes and associated costs; technical notes and documentation; and relevant research and publications.

A story today in Food Safety News (FSN) says the data help inform food safety policy discussions and provide a foundation for economic analysis of food safety policy. The FSN story also points out that economic costs are only part of the story, with costs to industry and to tax payers also considerable.
Oct 7 USDA overview on the estimates with links to spreadsheets
Oct 9 FSN story

Case-series study: Severe illness common with MERS

Experience gained at one Saudi Arabia institution on the clinical aspects and outcomes of 70 MERS-CoV patients found that severe illness was common, particularly in those with concomitant infections and/or low albumin levels, as were fatalities, with age 65 or over the only independent risk factor for death.

The study was released today in the International Journal of Infectious Disease.

The records of 70 consecutive lab-confirmed MERS-CoV (Middle East respiratory syndrome coronavirus) cases seen at tertiary care center Prince Sultan Military Medical City in Riyadh from Oct 1, 2012, through May 31, 2014, were examined retrospectively. Median age was 62 years, males accounted for 65.7% of the cases, and just over half (55.7%) acquired their illness in the healthcare setting.

Hospital admission was required in 64 cases (91.4%). Fever, dyspnea, and cough were the most common symptoms, occurring in 43 (61.4%), 42 (60%), and 38 (54.3%) case-patients, respectively. Pneumonia developed in 63 (90%), and 49 (70%) were treated in the intensive care unit (ICU).

Forty-nine patients (70%) required ICU admission; associated factors were concomitant infections (odds ratio [OR], 14.13; 95% confidence interval [CI] 1.58-126.09; P = 0.018) and low levels of albumin (OR, 6.31; 95% CI, 1.24-31.90; P = 0.026). Forty-two patients (60%) died in the hospital, with age over 65 years associated with mortality (OR, 4.39; 95% CI, 2.13-9.05; P < 0.0001).

Recent (within 2 weeks of illness onset) exposure to animals, including camels, was present in only 3 cases (4.3%).

The authors noted multiple healthcare-associated clusters in their cohort and note that one patient transmitted the disease to 10 others.

The first case of MERS-CoV was reported in June of 2012 in Saudi Arabia. Since that time it has caused more than 750 cases with more than 320 deaths in multiple countries.
Oct 9 Int J Infect Dis abstract

Lawsuit against UN over Haiti cholera outbreak to proceed

A federal judge in New York has agreed to allow a lawsuit against the United Nations over Haiti's cholera outbreak to proceed, The New York Times reported yesterday.

The lawsuit was filed last year by advocates for Haitian victims of a cholera epidemic that began in 2010, has sickened more than 700,000 people, and has killed more than 8,000. The suit argues that UN peacekeepers were responsible for introducing the disease to Haiti through contaminated sewage in their compound.

Oral arguments are slated to start Oct 23 at the US District Court for the Southern District of New York.
Oct 8 New York Times story

Drug Resistance Scan for Oct 09, 2014

News brief

IDWeek study shows antibiotic stewardship tied to shorter hospital stay

Findings presented at a major infectious disease conference in Philadelphia today suggest that hospital antibiotic stewardship programs can pay unexpected benefits in children.

Researchers at Children's Mercy Hospital–Kansas City (Mo.) found that an antibiotic stewardship program helped children leave the hospital sooner and lowered their chance of being readmitted within 30 days, according to a press release from IDWeek, the annual meeting of four organizations: the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS).

Over 5 years, the hospital's antibiotic stewardship program recommended that the antibiotic be discontinued or the dose or type be changed for 17% of 7,051 children, according to the release. Each child's doctor could accept or reject the recommendation.

The length of stay averaged 68 hours, and there were no 30-day readmissions among children whose doctor followed the recommendation, while the length of stay averaged 82 hours and 3.5% were readmitted within 30 days among those whose doctor did not follow the recommendation, the release said. The most common recommendation was to stop the antibiotic because it was deemed unnecessary.

Jason Newland, MD, lead author of the study, said it is the first to indicate that antibiotic stewardship programs reduce hospitalization time and readmission in children.

Study finds MRSA colonization common in athletes

Another IDWeek study showed that college athletes in contact sports are more likely to carry methicillin-resistant Staphylococcus aureus (MRSA) than non-athletes.

Researchers at Vanderbilt University followed 377 varsity athletes over 2 years, including 224 who played contact sports and 153 in non-contact. They found that colonization with MRSA ranged from 8% to 31% in the contact-sports athletes and 0 to 23% in the non-contact athletes. That compares with 5% to 10% colonization in the general population.

The researchers also found that the contact athletes acquired MRSA sooner and were colonized longer, the release said.

Natalia Jimenez-Truque, PhD, MSCI, a research instructor at Vanderbilt University Medical Center, said the study shows that even when athletes are healthy, a substantial number of them are colonized with MRSA.

"Sports teams can decrease the spread of MRSA by encouraging good hygiene in their athletes, including frequent hand washing and avoiding sharing towels and personal items such as soap and razors," she said.