MERS detected in 2 more Saudi household contacts

Today the Saudi Arabian Ministry of Health (MOH) reported two new MERS-CoV cases in Dumah Al Jandal. At this time, it's not known if the new cases are related to a hospital outbreak in that city first reported at the beginning of August.

The patients are Saudi women, ages 22 and 18, who are listed as secondary household contacts of a MERS-CoV  (Middle East respiratory syndrome coronavirus) patient. Neither patient was symptomatic, and both are in stable condition.

Saudi Arabia's MERS-CoV case count since 2012 has now reached 1,706, including 691 deaths. Twelve patients are still being treated, according to the MOH.
Aug 30 MOH report


FDA approves first drug for Chagas disease

The US Food and Drug Administration (FDA) announced yesterday that it has granted accelerated approval for the nation's first treatment for Chagas disease, a parasitic infection caused by Trypanosoma cruzi spread by kissing bugs that has increasingly been found in the United States, especially in Texas's Rio Grande Valley area.

The drug benznidazole, made by Chemo Research, SL, of Madrid, is approved for use in children ages 2 to 12 years old who have Chagas disease. Its safety and efficacy were shown in two placebo-controlled clinical trials in children 6 to 12 years old. An additional study in kids ages 2 to 12 helped set dosing recommendations. Stomach pain, rash, decreased weight, and headache were among the most common adverse reactions, and the drug was associated with some serious risks, including skin reactions, nervous system effects, and bone marrow depression.

Though the accelerated approval pathway allows the FDA to clear the way for drugs for serious conditions where there are unmet medical but clinical studies show reasonably likely clinical benefits, more studies are needed to verify and spell out benznidazole's clinical benefits.

Edward Cox, MD, who directs the FDA's office of antimicrobial products in its Center for Drug Evaluation and Research, said in the statement, "The FDA is committed to making available safe and therapeutic options to treat tropical diseases."

A recent estimate suggests about 300,000 people in the United States are infected with the parasite. Nearly a third of the people sickened by Chagas can develop potentially fatal cardiomyopathy.
Aug 29 FDA news release


China, Switzerland detail more avian flu outbreaks

China yesterday shared more details about a recent highly pathogenic H5N6 avian flu outbreak in quail, which was first noted in media reports earlier this month.

In a report yesterday from the World Organization for Animal Health (OIE), Chinese officials said the outbreak began on Aug 10 on domestic quail farms in Guizhou province, located in the southwestern part of the country. The virus killed 9,752 of 21,213 susceptible birds, and authorities culled the remaining ones.

China reported its last H5N6 outbreak in January, which struck wild geese at a farm in Hunan province.
Aug 28 OIE report on H5N6 in China

In other avian flu developments, Switzerland today reported two more H5N8 outbreaks, both involving wild ducks, officials said in a separate report from the OIE.

The detections involved mallards found dead on Aug 24 near lakes, one in Vaud canton in the west and the other in Valais canton in the southwest.

Several European countries were hit hard by H5N8 outbreak in the winter and spring, and though activity has slowed in warmer months, a handful of countries continue to report sporadic outbreaks.
Aug 30 OIE report on H5N8 in Switzerland


Animal study finds slower disease course with West Africa Ebola strain

Scientists who experimentally infected macaques with different Ebola virus variants found more evidence that the Makona type responsible for West Africa's 2013-16 outbreak results in slower disease progression, according to a study published yesterday in Scientific Reports.

Also, the research team, based at the Galveston National Laboratory at the University of Texas Medical Branch, Galveston, detailed molecular changes that might be responsible for the different patterns of clinical disease. Though the Makona, Kikwit, and Mayinga Ebola variants are genetically similar, recent reports have suggested that disease from the Makona variant progresses more slowly. The Makona subtype has also been linked to more pronounced gastrointestinal symptoms, such as vomiting and diarrhea.

Using Makona virus grown from the serum of a human who died from Ebola in Guinea in 2014, the researchers experimentally infected 10 healthy macaques, then monitored their clinical signs and analyzed their blood samples. To identify and characterize immune response changes, they analyzed whole blood and peripheral blood mononuclear cells using flow cytometry and RNA sequencing.

Infected macaques had clinical signs typical of Ebola, and blood chemistry patterns were also consistent with the disease, showing damage to multiple organs, especially the kidney, pancreas, and liver.

The researchers saw lymphopenia and thrombocytopenia at later disease stages, along with sharp rises in proinflammatory cytokines and chemokines—both of which are typical for Ebola disease. Also, clinical scores, liver and kidney enzyme changes, cytokine, and chemokine scores appeared later and were less severe than patterns previously reported in Mayinga or Kikwit variants, despite similar viremia levels.
Aug 29 Sci Rep abstract


Yemen's cholera numbers rise again

The World Health Organization (WHO) said cholera cases in Yemen are climbing again after a 6-week decline. There were 30,648 cases and 14 deaths reported in the last week, bringing the total number of cases to 580,206, including 2,028 deaths. The case-fatality ratio remains at 0.35%.

Children under the age of 5 represent 24% of the cases, and the mean age of the cases is 20.5 years. More than one-third, or 32%, of the deaths occurred in children ages 14 and under. All but 1 of Yemen's 23 governorates has reported cholera activity.

Yemen's cholera outbreak is the world's largest, and fueled by civil unrest and a crumpling public health infrastructure.

In other cholera news, Nigeria reported a new outbreak in a displaced persons camp in the north-eastern part of the country. According to the WHO, 69 cases and 5 deaths have been reported at Muna Garage, a home to 44,000 people displaced by conflict and famine. Muna Garage is in Borno state, a troubled region where 60% of health facilities are functioning partially or not at all.
Aug 29 WHO update
Aug 29 WHO Nigeria update


C diff rates in Hong Kong adults more than double in 9 years

The disease burden of Clostridium difficile in Hong Kong adults more than doubled from 2006 to 2014, according to a study yesterday in Emerging Infectious Diseases.

Investigators identified 15,753 C difficile cases in the 9-year study period, 91.4% of them healthcare-related and 5.1% community-associated infections. After adjusting for diagnostic testing, the researchers determined that the incidence increased from 15.41 cases/100,000 persons in 2006 to 36.31 cases/100,000 persons in 2014, for an annual increase of 26%.

The rise was especially driven by infections in elderly patients, who saw a tripling of incidence from 2006 to 2014. Rates of recurrence at 60 days increased from 5.7% in 2006 to 9.1% in 2014.

The authors conclude, "Our data suggest the need for further surveillance, especially in Asia, which contains ≈60% of the world's population."
Aug 29 Emerg Infect Dis study

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