CDC: 41 more measles cases raise total to 1,022

The Centers for Disease Control and Prevention (CDC) reported 41 more measles cases in the past week, raising 2019's total number of cases to 1,022, a record for the post-elimination era.

"This is the greatest number of cases reported in the U.S. since 1992 and since measles was declared eliminated in 2000," the CDC said today.

Twenty-eight states have recorded cases, with several states reporting outbreaks, defined as three or more related cases. The biggest outbreaks have occurred in New York and New Jersey, with Washington state, California, and Pennsylvania also currently tracking outbreaks.

The CDC said all seven ongoing outbreaks are related to international travel to countries currently experiencing outbreaks, including Israel, Ukraine, and the Philippines. The number of ongoing outbreaks, however, fell from 10 a week ago.

The largest US outbreak is in New York City, which involves at least 566 measles cases since last September, primarily in the city's Orthodox Jewish Brooklyn community. 
Jun 10 CDC update
Jun 3 NYC Health update


MERS-CoV sickens 3 more in Saudi Arabia

Over the last 2 days Saudi Arabia's health ministry reported three more MERS-CoV cases, all of them involving men from three different cities.

One is a 55-year-old from Qusaiba in Al Qassim region in the central part of the country. It's not known if he had contact with camels, and his exposure to MERS-CoV (Middle East respiratory syndrome coronavirus) is listed as secondary, meaning he likely contracted the virus from another patient.

The second patient is a 65-year-old from Qaisoumah in Eastern region who had contact with camels, and the third is a 28-year-old from the city of Unaizah in Al Qassim region who also had contact with camels, a known risk factor for MERS-CoV.

Saudi Arabia has now reported 150 MERS-CoV cases for the year. The World Health Organization said in its most recent global update for the disease as of the end of April it had received reports of 2,428 cases, at least 839 of them fatal, since the virus was first detected in humans in 2012. The vast majority are from Saudi Arabia.
Jun 10 Saudi MOH epidemiological week 24 report


'Blue ribbon' panel issues recommendations on Cyclospora outbreaks

A "blue ribbon" panel of experts commissioned by Fresh Express late last week issued interim recommendations for preventing and addressing Cyclospora outbreaks in the United States, including stepped-up assessment of water sources, personnel training, and data collection.

After several produce suppliers, including Fresh Express, were hit with a Cyclospora cayetanensis outbreak in 2018, the first linked to US-grown produce, the company formed the blue-ribbon panel of 11 experts, headed by food safety expert Michael Osterholm, PhD, MPH director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), which publishes CIDRAP News, and 16 other contributors.

"The goal was to establish a Blue-Ribbon Panel to summarize state-of-the-art advancements regarding this public health challenge and to identify immediate steps that the produce industry and regulators can take to prevent future outbreaks," Osterholm writes in the introduction to the report.

The expert panel first met in November 2018, then formed four working groups to focus on root causes, preventive steps, collaboration, and testing validation. Recommendations developed by the working groups and included in the report are divided in prevention, incident response, and collaboration.

The vast majority of Cyclospora outbreak cases in the United States have involved imported produce.

Prevention advice in the report includes surveying environment water sources for Cyclospora contamination; properly training of farm crews about sanitation, hygiene, and waste management; and developing a fact sheet to raise awareness about the disease, which the experts released with the report. Incidence response steps including assessing farms for unsanitary conditions and probing the role that animals, especially birds, might play in contaminating water bodies. Collaboration improvements include enhanced communication between government and industry, and expanded lab capacity. The report includes 30 recommendations.

"This is an exceptional collaboration by those most knowledgeable about a particular food safety risk," Osterholm said in a Fresh Express news release. "Their value in shedding light on the Cyclospora cayetanensis outbreak problem cannot be overstated and is already providing long-needed assistance toward discovering how best to manage risk and limit future outbreaks."
Jun 5 blue-ribbon panel report
Fresh Express report landing page


Study: Chickenpox vaccine cuts shingles risk in children

Children who received the chickenpox vaccine are significantly less likely to contract shingles, according to large study based on electronic health records that appeared today in Pediatrics.

The varicella vaccine's impact against herpes zoster infection is well known, but researchers weren't sure if the vaccine also had an impact against children's shingles, for which symptoms are generally milder than the adult form of the disease, which is marked by a painful, burning, and blistering skin rash.

For the study, a team led by Kaiser Permanente and funded by the CDC examined data on 6.3 million children from six integrated healthcare organizations between 2003 and 2016. About half of the children were vaccinated for some of all of period covered by the study.

Over the 12-year study period, the shingles rate fell by 72% overall, as the number of vaccinated children rose. Incidence of shingles was 78% lower in vaccinated kids than their unvaccinated counterparts. The team also found that rates for children who were immunosuppressed and weren't able to be vaccinated were 5 to 6 times higher than in kids who weren't immunosuppressed.

Sheila Weinmann, PhD, the study's lead investigator who is with Kaiser Permanente Northwest's Center for Health Research in Portland, Oregon, said in a press release that the highest shingles rates were in the early years of the study when there was a higher proportion of children, especially older ones, who weren't vaccinated against chickenpox.
Jun 10 Pediatrics abstract
Jun 10 Pediatrics commentary
Jun 10 Kaiser Permanente press release


Study: Mid-Atlantic white-tailed deer more susceptible to CWD

According to new research from Penn State University, white-tailed deer from Mid-Atlantic states are more susceptible to chronic wasting disease (CWD) than deer found to the west, likely because of genetic variants that make them more vulnerable to neurologic illnesses. The findings are published in BMC Genetics.

The research is based on tissue samples collected from 720 white-tailed deer from an area encompassing Pennsylvania, Virginia, and Maryland. The samples were tested for 17 microsatellite loci markers. Microsatellite markers are short, repetitive DNA sequence elements, used to identify genetic differences. Eventually, the researchers selected 11 markers most likely to show susceptibility to CWD.

"The genetic variants that would make deer less susceptible to chronic wasting disease are in much lower frequency in the East, likely because they weren't needed," said David Walter, PhD, adjunct assistant professor of wildlife ecology at Penn State and the lead author of the study, in a Penn State news release. "We have seen that deer with the more susceptible genotypes are in the majority."

White-tailed deer populations are larger in the Eastern and Mid-Atlantic parts of the United States, Walter said. In recent years, more states have reported growing numbers of CWD, a fatal prion disease, among deer populations.
Jun 6 BMC Genetics study
Jun 6 Penn State press release

Stewardship / Resistance Scan for Jun 10, 2019

News brief

Stewardship in Scotland tied to lower broad-spectrum prescribing

Researchers in Scotland report in PLOS Medicine that implementation of an antimicrobial stewardship program (ASP) was associated with large, sustained reductions in the prescribing of three broad-spectrum antimicrobials and in a modest reduction of coliform bacteremia resistance rates.

The investigators analyzed data on all patients registered with a general practitioner in the Tayside region of east Scotland from Jan 1, 2005, through December 2015. A primary care ASP was implemented in 2009, and the authors measured prescribing rates for fluoroquinolones, cephalosporins, and co-amoxiclav, as well as resistance to the same three antimicrobials or classes among community-associated coliform bacteremia

Compared with pre-ASP prescribing, the relative reduction for fluoroquinolones was 68.8% and the absolute reduction was 6.3 people exposed per 1,000 population per quarter. For cephalosporins the reduction was 74.0% and 6.1, respectively, and for co-amoxiclav it was 62.3% and 6.8.

The researchers also found reductions in coliform bacteraemia resistance rates associated with the intervention that were significant for fluoroquinolones and cephalosporins 3.5 years after implementation of the ASP but not for co-amoxiclav. They note, "The reductions in resistance took much longer than reductions in prescribing to become evident, and relative reductions were more modest. The overall pattern was of flattening rather than reversal of previously rising resistance rates."
Jun 7 PLOS Med study


Study notes high resistance in Enterococcus in pigs at Thai-Laos border

A new study has found high levels of antimicrobial resistance in Enterococcus faecium and Enterococcus faecalis from pigs, pork products, and humans in Thai-Laos border provinces.

Thai researchers, in the Journal of Global Antimicrobial Resistance, wrote that they analyzed 648 human, pork product, and swine swabs—359 from border provinces in Thailand and 289 from similar provinces in Laos. In all, 75% contained E faecium and 74% E faecalis. All isolates were resistant to all antimicrobials tested except vancomycin.

The occurrence of E faecium in pig, pig carcass, retail pork, and humans in Thailand was 80.6%, 73.8%, 77.6% and 67.0%, respectively. The prevalence of E faecium was higher in Laos (65.7%) than Thailand (47.1%), while E faecalis was more common in Thailand (24.2%) than Laos (12.8%).The scientists first observed high levels of resistance to tetracycline, erythromycin, and streptomycin, followed by gentamicin, ampicillin, and chloramphenicol.

The authors conclude, "These pathogens may serve as potential reservoirs for the maintenance and widespread dissemination of AMR and virulence determinants from animals to humans via the food chain."
Jun 8 J Glob Antimicrob Resist abstract

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