News Scan for Mar 11, 2020

News brief

Four dead in multistate Listeria outbreak tied to mushrooms

The Centers for Disease Control and Prevention (CDC) yesterday announced a deadly Listeria outbreak today linked to enoki mushrooms distributed by Sun Hong Foods, Inc.

So far, 36 people in 17 states have been sickened, including 30 hospitalizations and 4 deaths. Illnesses began from Nov 23, 2016, through Dec 13, 2019, and the four deaths were reported in California, Hawaii, and New Jersey. Six cases are pregnancy-associated, two of which resulted in fetal loss, the CDC said. Patients range in age from less than 1 to 97 years.

"This investigation is ongoing to determine the source of contamination and if additional products are linked to illness," the CDC said, describing the mushrooms as being long, white, and with thin stems. The Sun Hong Food products were sold in a clear and green plastic bag with a "Product of Korea" label.

The Food and Drug Administration (FDA) said the product was recalled by Sun Hong Foods, of Montebello, California, on Mar 9. The mushrooms were distributed in California, Texas, Oregon, Washington, Illinois, and Florida and sold at J&L Supermarket, Jusgo Supermarket, ZTao Market, New Sang Supermarket, and Galleria Market.

"Sun Hong Foods became aware of this issue after notification by FDA that samples of the product tested by the State of Michigan were found to be positive for Listeria monocytogenes," the FDA said.
Mar 9 CDC report
Mar 9 FDA report


Saudi Arabia confirms 3 more MERS cases

Saudi Arabia's Ministry of Health (MOH) is reporting 3 new MERS-CoV cases, 1 today and 2 from yesterday, bringing the country's total for March to 9 infections.

The three new MERS-CoV (Middle Eastern respiratory syndrome coronavirus) cases are in Riyadh, Mecca, and Al Bijadiyah. The case reported yesterday in Riyadh involves a 63-year-old woman who the MOH is classifying as primary, meaning she is unlikely to have contracted the virus from another person. The patient is not a healthcare worker, and her contact with camels—a known risk factor for the disease—is unknown.

The case reported yesterday in Mecca, involving a 54-year-old man who's not a healthcare worker and has unknown contact with camels, is also classified as primary.

The case reported today from Al Bijadiyah, near Al-Kharj, is in a 45-year-old man who had recent contact with camels. His case is listed as primary.

According to the World Health Organization's Jan 31 MERS-CoV situation update, a total of 2,519 confirmed MERS-CoV cases have been reported globally, with 866 associated deaths. The vast majority of these cases occurred in Saudi Arabia.
Mar 11 MOH report


Intervention tied to improved prescribing of pre-op beta-lactams

Implementation of an antibiotic cross-reactivity chart, combined with an enhanced allergy assessment process, at a hospital in Michigan was associated with improved beta-lactam prescribing for surgical prophylaxis (infection prevention), researchers reported yesterday in Clinical Infectious Diseases.

The single-center, quasi-experimental study at St. Joseph Mercy Health System analyzed antibiotic prescribing in all patients who had a documented penicillin allergy and an inpatient surgical procedure in two periods: January 2012 to September 2014 (the historical cohort) and July 2016 to September 2018 (the intervention cohort). The intervention involved adoption of the cross-reactivity chart—which provides recommendations for beta-lactams that do not share the R-group side chain, thought to be primarily responsible for allergic reactions—along with enhanced antibiotic stewardship and institutional processes for allergy assessment. Beta-lactams are recommended as first-line agents for surgical prophylaxis in most surgical procedures.

The primary outcome of the study was use of a beta-lactam alternative for surgical prophylaxis. Secondary outcomes included 30-day readmission, surgical site infections (SSIs), allergic reactions, 30-day mortality, acute kidney injury, and hospital costs.

A total of 2,208 adult surgical patients met the inclusion criteria, with 1,119 in the historical cohort and 1,089 in the intervention cohort. Analysis of the two groups found a significant difference in the number of patients who received an alternative antibiotic (84.9% in the historical cohort vs 15.1% in the intervention cohort, P < 0.001). There was a decrease in 30-day readmissions in the intervention group (7.9% vs 6.3%, P = 0.035), but no difference in the incidence of SSIs in patients readmitted (14.8% vs 13%, P = 0.765). No significant differences were observed in allergic reactions (0.5% vs 0.3%, P = 0.323), SSIs, in-hospital and 30-day mortality, acute kidney injury, or hospital costs.

The authors of the study say the results could have implications beyond surgical prophylaxis.

"While further real-world examples are urgently needed, there are opportunities for this strategy to promote beta-lactam therapy in other infectious diseases," they wrote. "Use of this strategy may present a resource-friendly and easily implemented alternative approach that can work in combination with the suite of existing allergy management strategies."
Mar 10 Clin Infect Dis abstract


Study: White, urban Texans' reluctance to vaccinate raises outbreak risk

A new study shows that white, college-educated, high-income Texans who live in cities or suburbs are less likely than others to vaccinate their children, putting students at 5% of public, 28% of private, and 22% of charter K-8 schools in the state's metro areas at high risk for vaccine-preventable diseases such as measles.

In the study, published yesterday in PLOS Medicine, researchers at the University of Texas at Austin mined public records to evaluate conscientious vaccination exemptions (CVEs) for 318 private, 818 public, and 60 charter schools in Texas from the 2012-13 through 2017-18 school years.

Using regression analysis, the investigators related the exemptions to percentages at the school and county to 115 socioeconomic and demographic factors through the US Census Bureau and the Texas Education Agency.

Over the study period, median CVE percentages rose from 0.38% to 0.79%, resulting in more than 24,000 additional vaccination-exempt students. Suburban school districts saw the largest increases. The median CVE percentage in state school systems more than doubled from 2012 to 2018, with the proportion of schools with CVEs above 3% increasing from 2% to 6% for public schools, 20% to 26% for private schools, and 17% to 22% for charter schools.

The data identified high-risk communities usually obscured in county-level risk assessments and found that public schools, like private schools, are seeing a rise in exemptions. "As public health agencies confront the reemerging threat of measles and other vaccine-preventable diseases, findings such as ours can guide targeted interventions and surveillance within schools, cities, counties, and sociodemographic subgroups," the authors wrote.

Recent population growth and shrinking vaccination rates put Texas at risk for outbreaks of vaccine-preventable diseases, the authors said, noting, "The risk is highly variable, and its socioeconomic and geographic determinants of risk are largely unknown."

All 50 states mandate vaccination for school attendance unless the student is eligible for a medical exemption, but 15 states allow nonmedical exemptions or CVEs. Nonmedical exemptions for vaccination against preventable childhood diseases have been rising in the United States, presumably due to declining health literacy, pervasive misinformation, and increasing distrust of the medical establishment, but recent state laws have sought to curb the trend.
Mar 10 PLOS Med
Nov 19, 2019, CIDRAP News story "Childhood disease outbreaks trigger laws to limit vaccine exemptions"

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