More suspected cases identified in Uganda's Marburg virus outbreak

The World Health Organization (WHO) said today that it is involved with efforts to curb a Marburg virus outbreak in eastern Uganda near the border with Kenya, where at least one case has been confirmed and several hundred people may have been exposed at health facilities and at a traditional burial ceremony.

The confirmed illness involves a 50-year-old woman from Kween district whose death was originally reported a few days ago. Uganda's health ministry said yesterday that her brother had died after similar symptoms, but no samples were taken for testing before his death. The WHO said one other suspected and one probable case have also been identified, adding that those patients are receiving care and efforts are underway to identify other infected people.

According earlier reports from Uganda, the deceased woman had cared for her brother and took part in his funeral. The WHO said the man was a game hunter who lived near a cave housing Rousettus bats, known as natural hosts of Marburg virus, a close relative of Ebola virus.

WHO staff, along with some from the US Centers for Disease Control and Prevention (CDC) and the African Field Epidemiology Network, are supporting the Ugandan health ministry's rapid response team. Also, the WHO said it is providing medical supplies, safe burial guidance, and $500,000 from its emergency response contingency fund. The health ministry said it has established an isolation ward to handle cases at a hospital and health center in Kween district.
Oct 20 WHO statement
Oct 19 Uganda
health ministry statement


Afghanistan and Syria report more polio cases

Afghanistan has reported another wild poliovirus type 1 (WPV1) infection, and Syria has four more vaccine-derived poliovirus 2 (cVDPV2) infections, plus another detection in a healthy child, the Global Polio Eradication Initiative (GPEI) said in its latest weekly update.

The illness in Afghanistan involves a 15-month-old child from Nangarhar province with a Sep 15 paralysis onset who had previously received one dose of inactivated polio vaccine (IPV).

Afghanistan has reported seven polio cases this year, pushing the global total to 12.

GPEI also noted more positive WPV1 environmental samples in Afghanistan (Hilmand and Kandahar provinces) and Pakistan (Balochistan and Sindh provinces).

Elsewhere, Syria's new cVDPV2 cases are all in Deir ez-Zor governorate, a conflict-ridden part of the country that has already reported several previous cases this year. Illness onsets ranged from Aug 12 to Aug 25. The positive sample from the healthy child was collected on Aug 21. The country has reported 52 cVDPV2 cases this year.

Ongoing violence in Deir ez-Zor led to the destruction of a vaccine cold room where polio and other childhood vaccines were kept, the WHO reported last week. GPEI said that while reports are being verified, plans have been made to provide essential cold-chain equipment to the areas so that vaccination efforts can continue.
Oct 18 GPEI update

CDC reports record number of Salmonella cases tied to backyard poultry

The CDC announced yesterday that an investigation into 10 Salmonella outbreaks linked to live backyard poultry has ended, and this year it recorded a record number of illnesses related to contact with the birds.

While warning that the infection threat remains, the CDC said received 1,120 illness reports, an increase of 159 from its last update in August. Infections were reported in 48 states, and 249 people were hospitalized. One death was reported involving a patient from North Carolina.

Investigations by the CDC and state and local partners involved 10 different outbreaks due to contact with live poultry, such as chicks and ducklings from multiple hatcheries. The outbreak strains included several DNA fingerprints, including Salmonella Braenderup, Enteritidis, Hadar, I 4,[5],12:i, Indiana, Infantis, Litchfield, Mbandaka, Muenchen, and Typhimurium. Illness onsets ranged from Jan 4 to Sep 22.

The CDC said raising backyard birds is becoming more popular, and many people may not be aware of the Salmonella infection risk. It urged people to wash hands with soap and water after touching the birds or anything in their environments and to closely supervise children who handle poultry.
Oct 19 CDC final outbreak investigation report

Tdap coverage in pregnant women rising, but still well below target

The share of pregnant women who receive the tetanus, diphtheria, and pertussis (Tdap) vaccine remains well below the recommended 100%, according to a study published in Morbidity and Mortality Weekly Report. The CDC recommended in 2012 that all women get the vaccine in the third trimester to protect babies too young to be vaccinated against pertussis.

CDC researchers and their colleagues in a pregnancy surveillance system looked at maternal vaccination data collected since 2006 as part of case-control surveillance of birth defects that encompasses study centers in Boston, Philadelphia, and San Diego, plus registries in New York and Massachusetts.

They found that Tdap coverage increased from less than 1% before 2010 to 53% in 2015. For comparison, a recent report for 2013 put coverage at about 42% Most of the women in the latest study were vaccinated at physicians' offices or clinics.

Investigators concluded that though Tdap coverage increased substantially, it remains far below CDC recommendations that all pregnant women be vaccinated.
Oct 20 MMWR report

ASP Scan (Weekly) for Oct 20, 2017

News brief

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

WHO, CDC establish gonococcal antimicrobial surveillance system

Originally published by CIDRAP News Oct 19

Global surveillance of antimicrobial-resistant Neisseria gonorrhoeae is challenging, especially in countries that carry the greatest disease burden, but a new collaboration between the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) may help, representatives of the two agencies reported yesterday in Emerging Infectious Diseases.

The goal of the new Enhanced Gonococcal Antimicrobial Surveillance Program is to keep tabs on trends in antimicrobial susceptibilities in N gonorrhoeae through standard sampling and lab protocols and to improve the timeliness and comparability of data across multiple countries, they wrote. Also, the system is set up to assess resistance patterns in highest-risk populations to help shape country-specific guidance.
Oct 18 Emerg Infect Dis report

In a related development, Danish researchers writing in Eurosurveillance today described a single rare case detected this year of multidrug-resistant N gonorrhoeae infection that involved ceftriaxone resistance and intermediate resistance to azithromycin.

The illness, treated successfully with dual antimicrobial therapy, was reported to national health authorities, but it didn't lead to a wider public health response.
Oct 19 Eurosurveill report


Gonorrhea in Seattle-area MSM increasingly less susceptible to key drug

Originally published by CIDRAP News Oct 16

Seattle researchers report that, among men who have sex with men (MSM) in Seattle and King County, Washington, 5% have gonorrhea with reduced susceptibility to azithromycin, according to a study today in Clinical Infectious Diseases.

The researchers looked at data from a county sexually transmitted disease clinic from 2012 to 2016, with an emphasis on the most recent 3 years. The US Centers for Disease Control and Prevention recommends that gonorrhea be treated with ceftriaxone plus azithromycin, so resistance to azithromycin could affect gonorrhea control efforts.

The analysts found that, in 2012 and 2013, none of the 263 patients from whom N gonorrhoeae was isolated showed reduced susceptibility to azithromycin, and 93% of these cases involved MSM. In 2014, 2015, and 2016, in contrast, the rates of reduced susceptibility among MSM were 5.4%, 4.8%, and 4.6%, respectively, for a 5.0% cumulative rate.

The authors conclude, "The World Health Organization recommends changing treatment guidelines when >5% of isolates are resistant to a recommended drug. The emergence of potentially resistant [azithromycin] gonorrhea should prompt reconsideration of current treatment recommendations, and highlights the need to develop new therapies for gonorrhea."
Oct 16 Clin Infect Dis study


Screening study identifies new antibiotic resistance genes

Originally published by CIDRAP News Oct 16

Swedish researchers who analyzed more than 10,000 bacterial genomes and plasmids from human and environmental samples across the globe found 76 novel resistance genes, which formed 59 previously undescribed gene families of metallo beta-lactamase enzymes. The genes enable resistance to carbapenems, a group of antibiotics reserved for serious infections caused by multidrug-resistant pathogens.

Writing in the Oct 12 edition of Microbiome, the investigators focused on identifying class B1 novel metallo beta-lactamases, which are the most clinically important enzyme subclass. In a press release, from Chalmers University of Technology in Sweden, they said resistance genes are rare, and a lot of DNA data need to be examined before a new gene is identified.

They also noted that identifying a resistance gene is challenging if it hasn't been seen before. So the group developed new computational methods to find DNA patterns associated with antibiotic resistance, and by testing the ones they found in the lab, they could see if their predictions were correct.

Eighteen of 21 genes they tested had the ability to hydrolyze imipenem in an Escherichia coli host. Also, two of the novel genes had atypical zinc-binding motifs in their active sites that hadn't been seen before in metallo beta-lactamases.

As part of their study, the team conducted a phylogenetic analysis, showing that metallo beta-lactamases fell into five evolutionary origin groups. Except for one, all previously characterized mobile metallo beta lactamases probably came from genes in Shewanella, a family of marine bacteria, and other Proteobacterial species.

The experts concluded that the findings more than double the number of known B1 metallo beta-lacamases, and the next step is to look for genes that provide resistance to other types of antibiotics. Erik Kristiansson, PhD, professor of biostatistics at Chalmers and the study's principal investigator, said, "The novel genes we discovered are only the tip of the iceberg."
Oct 12 Microbiome abstract
Oct 16 Chalmers University 
press release

Flu Scan for Oct 20, 2017

News brief

Study: IV zanamivir in kids is safe, yields clinical benefits

A phase 2 study of intravenous (IV) zanamivir in children hospitalized with severe influenza found that treatment was safe, reduced viral load, and was associated with clinical improvement, researchers reported yesterday in an early online edition of Pediatrics.

The drug, a neuraminidase inhibitor, is already approved for flu treatment in its inhaled form (Relenza), but in some instances, antiviral administration by inhaler or pill isn't possible. Researchers have been eyeing zanamivir as an IV drug, especially since it is effective against viruses with some of the most common resistance mutations.

The study took place at 25 hospitals in 5 countries between September 2010 and February 2015, enrolling 73 hospitalized children, of whom 71 were included in the study. Children received a twice-daily age- and weight-adjusted dose comparable to a daily dose given to adults. Kids were treated for 5 days, and as long as 10 days if viral shedding or clinical symptoms persisted.

Safety and efficacy were similar to what studies have found for adults, but in children, fewer serious adverse events were seen, and mortality incidence was lower.

Most children showed clinical improvement over the treatment course, lending support for a dosing schedule adjusted for weight, age, and creatinine clearance.
Oct 19 Pediatrics abstract

H5N8 strikes more poultry and wild birds in Italy

Italy today reported several more highly pathogenic H5N8 avian flu outbreaks in poultry and wild birds, according to two notifications from the World Organization for Animal Health (OIE).

Officials reported eight more outbreaks in poultry, four on commercial farms raising fattening turkeys and four in backyard holdings. Six occurred in Lombardy region, with the virus also hitting two locations in neighboring Veneto region. Both regions are in north-central Italy.

The outbreaks began between Oct 12 and Oct 18, killing 502 of 61,700 susceptible birds. The surviving ones were culled to curb the spread of the virus.

Also, animal health authorities reported two more H5N8 detections in wild birds, both involving a single mute swan found dead on Oct 10 at separate sites in Piemonte region in northwestern Italy.
Oct 20 OIE report on H5N8 in Italian poultry
Oct 20 OIE report on
H5N8 in Italian wild birds

This week's top reads