News Scan for Apr 16, 2018

News brief

MERS superspreader study highlights risk in cardiac, renal patients

Difficulty distinguishing pneumonia from volume overload in a patient with renal failure delayed a MERS-CoV diagnosis at a Riyadh hospital last year, which led to a superspreading event that sickened 44 people at three health facilities, Saudi researchers reported in the American Journal of Infection Control.

In their detailed report on the outbreak and its spread, the group said the lessons they learned could help fine-tune protocols for screening for the MERS-CoV (Middle East respiratory syndrome coronavirus) in emergency departments (EDs).

The index patient was a 46-year-old Yemeni man with underlying health conditions including diabetes, hypertension, and asthma, who came into the ED at Riyadh's King Saud Medical City with respiratory symptoms without fever and a recent history of diarrhea. His chest radiograph suggested pulmonary edema, and his blood tests showed evidence of acute kidney failure that required urgent dialysis.

After two dialysis sessions, his pulmonary edema improved, but his respiratory symptoms didn't. He spent 14 hours in the crowded multibed ED before he was admitted to an inpatient room, which he shared with four other patients. Two days later, he experienced respiratory distress, requiring intubation and admission to the intensive care unit, where samples were obtained that tested positive for MERS-CoV. He was taken to another hospital in Riyadh that serves as the MERS-CoV regional reference center, where he died 22 days after admission.

An investigation at the first hospital identified 120 contacts, 109 of them health workers, who had direct unprotected exposure to the man. Sixteen people tested positive for MERS-CoV, including 5 nurses, 3 physicians, 1 paramedic, and 7 patients, 1 of which was a patient at the second hospital. The eventual total for the three simultaneous hospital clusters was 44 cases, 11 of them fatal.

The group concluded that problems identifying pneumonia in people with renal and cardiac failure can delay suspicion for MERS-CoV, along with delays in proper infection control steps. They said the report confirmed the need to rule out the disease in such patients and that a rapid point-of-care test is urgently needed to help ED triage teams identify the disease sooner and prevent major outbreaks.
Apr 13 Am J Infect Control abstract


ECDC reports measles spike in the last month across Europe

The European Centre for Disease Prevention and Control (ECDC) late last week reported a spike in measles activity throughout Europe in the last month. So far, the ECDC has recorded 13 deaths from the disease in 2018.

Romania, with 1,709 cases so far this year, has been hit the hardest, followed by Greece (1,463), France (1,346), and Italy (411). Most concerning are the case counts in France and Italy, which have almost tripled and more than doubled, respectively, in the last month, the ECDC said.

From Mar 1, 2017, to Feb 28, 2018, the ECDC recorded 14,813 measles cases. "Of these cases where age was known, 35% were in children under five and 47% were in those 15 and older. Where vaccination status was known, 86% were unvaccinated," the ECDC said.

According to the most recent health data collected by the World Health Organization in 2016, measles vaccination coverage was below 95% in 22 out of 29 European Union countries surveyed. A 95% population coverage rate with two doses of vaccine is needed to prevent transmission of the measles virus.
Apr 13 ECDC update


H5N1 strikes Bangladeshi poultry; H5N6 hits Hong Kong pet bird store

In the latest highly pathogenic avian flu outbreak developments, Bangladesh reported an H5N1 event involving poultry, and Hong Kong reported evidence of H5N6 at a pet bird shop.

The outbreak in Bangladesh is the country's second to be reported in 2018, according to a recent notification from the World Organization for Animal Health (OIE). The latest detection occurred in layers at a farm at a military boarding school on the outskirts of Jhenaidah in the southwestern part of the country. With a Mar 21 start date, the outbreak killed all 385 of the birds, and authorities destroyed 319 eggs. So far the source of the virus hasn't been determined.

Hong Kong today said in a separate OIE report today that a sample collected Apr 7 from a bird cage holding mynas at a pet bird shop tested positive for the H5N6 virus. The sample was taken as part of routine avian flu surveillance for all poultry farms, poultry markets, and pet bird shops.

A total of 2,834 pet birds were removed from the shop and culled on Apr 13, and the store will be closed for 21 days as part of steps to control the spread of the virus. The source of the virus isn't known, and the report added that no wetlands, nature reserves, or poultry farms are located within 3 kilometers of the store.
Apr 13 OIE report on H5N1 in Bangladesh
Apr 16 OIE report on H5N6 in Hong Kong


Algorithm helps identify antimicrobial peptide with therapeutic potential

An international team of scientists reports today on the use of a computational approach to develop an artificial antimicrobial peptide with the potential to treat gram-negative bacteria.

In a paper published in Nature Communications, researchers from the Massachusetts Institute of Technology (MIT) and the Catholic University of Brasilia describe their approach, which relies on a computer algorithm to generate and evaluate antimicrobial peptide sequences with the greatest potential for antimicrobial activity. Using as a template the plant peptide Pg-AMP1—which is found in the seeds of the guava plant but has only weak antimicrobial activity—the scientists generated 100 candidates and then synthesized them to test against bacteria grown in the lab.

The most promising of these candidates was guavinin 2, which was highly active against Escherichia coli and Acinetobacter baumannii, with limited activity against Klebsiella pneumoniae and modest killing activity toward gram-positive bacteria. When tested in mice with a skin infection caused by Pseudomonas aeruginosa, guavanin 2 significantly reduced the bacterial count.

The scientists say they will continue developing guavanin 2 for use in humans and will use the algorithm to seek out other antimicrobial peptides.

"We can use computers to do a lot of the work for us, as a discovery tool of new antimicrobial peptide sequences," study co-author Cesar de la Fuente-Nunez, PhD, said in an MIT press release. "This computational approach is much more cost-effective and much more time-effective."
Apr 16 Nat Commun study
Apr 16 MIT press release

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Food Outbreak Scan for Apr 16, 2018

News brief

Consumer Reports issues romaine warning; company recalls salads

Consumer Reports today urged the public to avoid all romaine lettuce for now, based on an Escherichia coli O157:H7 outbreak that has sickened 35 people in 11 states, as a Pennsylvania company recalled 8,757 pounds of ready-to-eat salads that may be contaminated.

In another development, a group of five produce grower trade groups issued a joint statement on Apr 14 that said its members are cooperating with government investigators and are working closely to identify the source of the outbreak tied to chopped romaine from the Yuma, Ariz., growing area, adding that nearly all romaine being harvested and shipped now is from California areas not implicated in the outbreak.

The Consumer Reports statement said its advisory is its second warning for romaine since January and that its advice goes beyond the US Centers for Disease Control and Prevention (CDC) advice for the public to buy or order only bagged romaine lettuce that didn't originate from the Yuma growing area. The group said in the statement that it issued the warning out of an abundance of caution and because it may be hard for consumers to tell where the romaine is sourced.

So far, federal officials haven't identified a source, but on Apr 14 Fresh Foods Manufacturing, based in Freedom, Pa., voluntarily recalled ready-to-eat salads after receiving notification that its supplier was recalling romaine lettuce over E coli concerns. No confirmed illnesses have been linked to the company's salads, which were shipped to retail locations in four states: Indiana, Ohio, Pennsylvania, and West Virginia. In a recall notice from the US Department of Agriculture Food Safety and Inspection Service (FSIS), the "Great to Go" by Market District salads, served in clear plastic containers, were produced from Apr 9 to Apr 12 and have a 4-day shelf life.

Meanwhile, the US Food and Drug Administration (FDA) said in an Apr 13 outbreak update that the investigation continues and that it will share more information as it becomes available. It noted that the Yuma growing area implicated in the outbreak generally supplies romaine to the United States during November through March of each year. It said no specific grower, supplier, distributor, or brand has been identified and that it doesn't have information to suggest whole-head romaine or hearts of romaine are involved.

In a separate development, grower groups extended their deepest sympathies to those affected by the outbreak and said they take the responsibility for producing fresh produce very seriously. The groups include the Produce Marketing Association (PMA), the Arizona Leafy Greens Marketing Agreement, the California Leafy Greens Marketing Agreement, United Fresh, and Western Growers.
Apr 16 Consumer Reports statement
Apr 14 FSIS recall notice
Apr 13 FDA update
Apr 16 PMA statement


Single foodborne illness outbreak can cost businesses millions

New research from Johns Hopkins Bloomberg School of Public Health shows that a single foodborne illness outbreak can cost a restaurant millions of dollars in lost revenue, higher insurance premiums, and legal fees. The study is published today in Public Health Reports.

The study used computer models to simulate both small outbreaks and large outbreaks (from 5 to 250 cases) in fast food, fast causal, casual, and fine dining restaurants. The model also took into account 15 different pathogens.

A small outbreak in a fast food restaurant with no lawsuits could cost about $4,000, but that number jumps to $1.9 million when more than 250 people get sick and some decide to sue the establishment. The most costly pathogen was the bacterium Listeria monocytogenes.

"Even a small outbreak involving five to 10 people can have large ramifications for a restaurant," says Sarah M. Bartsch, MPH, lead author of the study, in a Johns Hopkins news release. "Many prevention measures can be simple, like implement adequate food safety staff training for all restaurant employees and apply sufficient sick leave policies, and can potentially avoid substantial costs in the event of an outbreak."

According to the US Centers for Disease Control and Prevention, approximately 48 million Americans are sickened, 128,000 are hospitalized, and 3,000 die each year because of food-related illnesses.
Apr 16 Public Health Rep
Apr 16 John Hopkins
press release  

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