News Scan for Apr 02, 2019

News brief

MERS infects 2 more in Saudi Arabia, 1 fatally

Saudi Arabia today reported two more MERS-CoV cases, one of them fatal, according to a Ministry of Health (MOH) update to its epidemiologic week 14 report.

The fatal MERS-CoV (Middle East respiratory syndrome coronavirus) case involves a 39-year-old man from Jazan in southwestern Saudi Arabia. An investigation found the source of the man's virus to be primary, meaning he wasn't likely exposed to another sick person.

The second patient is a 50-year-old man from the city of Rania in Taif region, located in the west central part of the country. The man's exposure is also listed as primary. Neither man had recent camel contact, the MOH said.

So far this year Saudi Arabia has reported 116 MERS-CoV cases, 57 of them linked to a large outbreak in Wadi ad-Dawasir, including many healthcare-related cases.
Apr 2 MOH report

In other Saudi MERS-CoV developments, the country's agriculture ministry reported an outbreak in camels that began on Mar 11 at a farm in An Nabhaniyah, located in central Saudi Arabia, according to a notification today from the World Organization for Animal Health (OIE). The virus was found in two of five susceptible camels.
Apr 2 OIE report

Survey finds French ICUs short on key stewardship elements

A nationwide survey has found that elements of antibiotic stewardship programs have been implemented in most French intensive care units (ICUs), but to varying degrees, French researchers reported yesterday in the Journal of Antimicrobial Chemotherapy.

The cross-sectional online survey was sent to French ICU specialists in January 2018, and 113 out of 206 (55%) responded. Access to local epidemiology regarding bacterial resistance was reported in 84% of ICUs, but routine access to antibiotic prescribing guidelines and antibiotic consumption data—two essential elements of stewardship programs—were reported in only 54% and 65% of ICUs, respectively. In addition, only 46% reported limiting the duration of antibiotic therapy.

Other notable findings included 94% of ICUs reporting an antibiotic stewardship program leader, 62% and 59% of ICUs reporting the availability of molecular biology and mass spectrometry techniques for rapid identification of bacteria, and 46% reporting therapeutic drug-monitoring of beta-lactams. Only 43% of respondents knew the expression antimicrobial/antibiotic stewardship.

The authors of the study say the findings suggest that antibiotic stewardship measures implemented at the hospital level are not necessarily rolled out in all departments and that monitoring of core elements of stewardship programs might be needed, particularly in key departments such as ICUs.
Apr 1 J Antimicrob Chemother abstract

Flu Scan for Apr 02, 2019

News brief

Flu shows more signs of decline in Northern Hemisphere

Flu activity in most of the Northern Hemisphere is declining, with influenza A viruses still predominanting, the World Health Organization (WHO) said today in an update that covers data to Mar 17.

In North America, the H3N2 strain is dominant, with very few influenza B viruses detected, which is unusual for the latter part of the Northern Hemisphere flu season. In Europe, flu is at baseline or low intensity in 34 countries, with activity still reported as medium in 13 countries.

Flu activity in western Asia saw an overall decrease, but levels are still elevated in Kuwait and Saudi Arabia. In East Asia, flu showed signs of decline but is still above seasonal thresholds in China and Hong Kong. Meanwhile, South Korea is experiencing a second wave of flu activity caused by H3N2 and influenza B, following earlier activity from 2009 H1N1. In Southeast Asia, flu activity is still elevated in Thailand, with influenza B most frequently detected.

In the Southern Hemisphere, flu is still at interseasonal levels, except for some parts of Australia that have been experiencing activity over the past several weeks.
Apr 1 WHO global flu update

Flu vaccine tied to lower mortality in heart failure patients

In a study today in Open Forum Infectious Diseases, researchers combed through published data on all-cause mortality rates among heart failure patients who received the influenza vaccine and found that flu vaccination was associated with a 31% decreased risk of all-cause mortality in those patients. The effect was more prominent (51% lower risk) during influenza season.

The authors drew from eight studies published since 2000, which included a total of 82,354 patients (average age of 65) with heart failure. They found that patients who had received seasonal flu vaccine had a reduced risk of all-cause mortality (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.51 to 0.87), especially during flu season (HR, 0.49; 95% CI, 0.30 to 0.69).

"There was no statistically significant difference in the rate of hospitalization among vaccinated and non-vaccinated patients with heart failure (pooled hazard ratio of 0.62 favoring influenza vaccination), which may be due to the relatively limited number of studies," the authors wrote.

Influenza infection has been associated with an increased risk of myocardial infarction and an exacerbation of chronic cardiovascular conditions. Because of this and the evidence gained from this study, the authors recommend seasonal flu vaccines for eligible heart failure patients.
Apr 2 Open Forum Infect Dis study

High-path avian flu outbreaks strike birds in China, Nepal, Taiwan, Mexico

In the latest highly pathogenic avian flu events, China and Nepal reported H5N1 outbreaks in poultry, Taiwan reported more H5N2 on farms, and Mexico reported an H7N3 outbreak in backyard birds, according to World Organization for Animal Health (OIE) reports and other official notifications.

China's H5N1 outbreak occurred at a poultry farm in Xinmin City in Liaoning province, located in the northeast, according to an agriculture ministry statement translated and posted by Avian Flu Diary (AFD), an infectious disease news blog. The event killed 1,000 of 24,500 birds, and the rest were culled to control the spread of the virus. The H5N1 event marks the second recent avian flu outbreak in Liaoning province, which recently reported highly pathogenic H7N9 in peacocks at a zoo in the city of Jinzhou.

In Nepal, the agriculture ministry reported two more H5N1 outbreaks, both at layer farms in Koshi zone in the southeast. The outbreaks, the second and third reported from Nepal since the middle of March, began on Mar 18 and Mar 21, and between the two locations, the virus killed 3,192 of 5,978 birds. The surviving poultry were destroyed.

Taiwan reported more highly pathogenic H5N2 in poultry and in a wild bird, part of activity involving that strain that began in 2015. Of four new poultry outbreaks, all occurred in Taipei City, three involving dead chickens found discarded in nature parks. The fourth outbreak was at a slaughterhouse. Forty-seven of 108 poultry died in the outbreaks.

Health officials have stepped up surveillance of poultry farms in the area. In a separate report, Taiwan also reported an H5N2 detection in a grey heron found dead on Mar 30 in Taipei City.

In Mexico, animal health officials reported a highly pathogenic H7N3 outbreak in backyard birds in Acolman, located in the greater Mexico City area. The event began on Mar 6, killing all 150 birds at the location. The outbreak is now considered resolved. The country's last H7N3 outbreak occurred in April 2018.
Apr 2 AFD post
Mar 31 OIE report on H5N1 in Nepal
Mar 29 OIE report on H5N2 in Taiwanese poultry
Apr 1 OIE report on H5N2 in Taiwanese wild bird
Apr 2 OIE report on H7N3 in Mexico