Saudi Arabia reports three new MERS cases

Saudi Arabian health officials have reported three new MERS-CoV (Middle East respiratory syndrome coronavirus) infections in recent days, two of them involving exposure to camels. All three patients have symptoms and are in stable condition, officials said.

One patient is a 78-year-old Saudi man in Riyadh who had indirect contact with camels, the Saudi Ministry of Health (MOH) announced Dec 22. Yesterday the MOH announced a case in another Riyadh man, a 44-year-old Saudi, saying he had no exposure to other MERS-CoV patients and that the source of the virus is under investigation.

The other case, announced Dec 25, is in a 63-year-old Saudi woman in the southern city of Najran who also had indirect contact with camels, according to the MOH. None of the three patients are healthcare workers, officials said.

The three cases raised Saudi Arabia's cumulative MERS count since 2012 to 1,515 cases, including 631 deaths and 12 patients still being treated.
Dec 22 MOH update
Dec 25 MOH update
Dec 26 MOH update


US flu activity continues slow rise; ECDC notes H3N2 threat to seniors

Flu activity in the United States rose slightly again, with one marker—doctor visits for influenza-like illness (ILI)—rising above the national baseline, according to a weekly update posted Dec 23 by the Centers for Disease Control and Prevention (CDC).

At 2.3% for the week ending Dec 17, the proportion of doctor's visits for ILI was slightly above the national baseline of 2.2%. The CDC also said 5 of its 10 regions are above their baselines for that indicator. Oklahoma and Puerto Rico reported high ILI activity, with Arizona and Georgia reporting moderate levels. Puerto Rico is the only area where flu is widespread geographically.

The percentage of respiratory specimens testing positive for flu rose to 7.1%, with H3N2 as the dominant strain, making up 91.2% of subtyped influenza A specimens in the most recent reporting week, the CDC said. Antigenic characterization of 42 H3N2 viruses since Oct 1 shows that 39 are related to the Hong Kong/2014-like viral component included in this season's flu vaccine.

The overall flu hospitalization rate is at 2.4 per 100,000 population, though the level was much higher at 9.8 per 100,000 population in people ages 65 and older. Of patients with subtyped influenza A viruses, 98.9% were H3N2.
Dec 23 CDC FluView

In related flu developments, the World Health Organization (WHO) said yesterday that flu in many parts of the Northern Hemisphere has increased slightly, with activity rising above some national thresholds a little earlier than usual, and the European Centre for Disease Prevention and Control (ECDC) on Dec 24 issued an early-season risk assessment.

The WHO said Europe's hot spots include Norway and Sweden, with activity increasing in Portugal and Spain. Other regions reporting increases are western Asia, Morocco, Iran, Sri Lanka, and Ghana. Globally, the dominant strain is H3N2, which accounts for 98.5% of subtyped influenza A specimens.

Meanwhile, the ECDC said in its annual early season flu risk assessment that H3N2 began circulating early, and though it's too early to gauge intensity and severity, the strain could hit seniors the hardest, based on patterns seen in past flu seasons. Though half of the H3N2 viruses characterized so far are from a new genetic clade, they are genetically similar to the vaccine strain.

The ECDC said preliminary vaccine effectiveness estimates from Scandinavia hint that effectiveness may tilt toward the upper range seen from 2011 to 2015.
Dec 26 WHO global flu update
Dec 24 ECDC
seasonal flu risk assessment


Vet contracts H7N2 virus from cats in New York City

A veterinarian contracted the low-pathogenic H7N2 avian flu virus after helping test cats involved in an H7N2 outbreak at a New York City animal shelter, New York officials announced recently.

The vet had helped obtain respiratory samples from cats at a Manhattan shelter operated by Animal Care Centers of NYC (ACC), the New York Department of Health and Mental Hygiene said in a Dec 22 press release. The person had a brief, mild illness and recovered, the department said. Earlier reports said 45 cats at the shelter were infected.

Two human H7N2 cases have been reported previously in the United States, both mild, one related to a poultry outbreak of H7N2 in 2002 and the other with an unknown source in 2003, the release noted. The vet's case marks the first known human case ascribed to exposure to infected cats, it said.

Health department officials said the vet's case is the only one found among more than 350 people screened for H7N2 because of the cat outbreak, including 160 ACC employees and a number of people who had adopted cats from the Manhattan shelter.

Meanwhile, Pennsylvania officials said recently that "almost a dozen" cats that might have been exposed to the H7N2 virus in New York City animal shelters have been quarantined in a shelter in Chester County on the southwestern outskirts of Philadelphia.

"The cats we're testing and monitoring were transferred last month from an animal shelter in New York before some of the cats developed symptoms similar to a head cold or mild case of the flu," State Veterinarian David Wolfgang, DVM, said in a Dec 23 Pennsylvania Department of Agriculture (PDA) press release.

Officials said there have been no reports of the virus spreading to other animals or infecting humans. They have quarantined three animal shelters in Chester County overall and have recommended postponement of any animal adoptions from those shelters. The sick cats are being treated and are expected to recover fully.
Dec 22 New York City press release
Dec 23 PDA
press release
Related Dec 22
CIDRAP News item


WHO notes first H3N2v flu case reported by Canada

The World Health Organization (WHO) says it has received its first report of a variant influenza A/H3N2 (H3N2v) case in Canada, involving a patient who was exposed to sick swine on a farm.

The patient fell ill with respiratory symptoms on Oct 24 and was hospitalized with pneumonia Nov 8 but has since recovered, the WHO said in its monthly report on "Influenza at the Human-Animal Interface," covering the period of Nov 22 to Dec 19. The report did not list the location of the case.

Partial sequencing of all eight gene segments of the virus isolated from the patient indicates it is closely related to H3N2 viruses circulating in North American swine, the WHO said. Animal health and epidemiologic investigations of the case are continuing.

A number of H3N2v cases have been reported in the United States each summer in recent years, including 18 this past August. Most of them involved people who had contact with pigs at local or state fairs, and most illnesses were mild.
Dec 19 WHO report

Stewardship / Resistance Scan for Dec 27, 2016

News brief

Study: 25% of K pneumonia in long-term care resistant to carbapenems

A new study has found that a quarter of Klebsiella pneumoniae isolates from a nationwide network of hospitals are resistant to carbapenem antibiotics.

According to a Dec 24 study in Clinical Infectious Diseases, 946 of 3,846 K pneumoniae isolates collected at 64 geographically widespread long-term acute care hospitals from January 2014 to March 2015 were carbapenem resistant, for an overall carbapenem resistance rate of 24.6%. While carbapenem-resistant K pneumoniae (CRKP) rates varied widely across 16 states, the highest rates were observed in California (45.5%), South Carolina (35.7%), Kentucky (22.1%), and Indiana (20%).

Of the US census regions, the West had the highest proportion of CRKP isolates (42.2%), followed by the South (12.2%), the Northeast (9.9%), and the Midwest (7.3%).

The 946 CRKP isolates came from 821 patients with a median age of 73 years and several comorbidities, including respiratory failure, advanced stage decubitus ulcers, and severe end-stage kidney disease. More than half of the patients had either a central venous catheter or a urinary catheter. CRKP isolates were primarily from respiratory (58.9%) and urinary (37%) sources.

In addition to being carbapenem resistant, the CRKP isolates were also found to be highly resistant to other commonly used broad-spectrum antibiotic agents, with more than 97% showing resistance to ciprofloxacin, levofloxacin, gentamicin, and tobramycin, and 59.2% demonstrating resistance to amikacin. Of significant concern, 16.1% of 700 tested isolates showed resistance to the last-line antibiotics colistin or polymixin B.

The authors note that the 25% carbapenem resistance rate is substantially higher than the rate of 10.4% reported in a previous study of ICU-associated infections from acute care hospitals, and is likely under-reported because rectal cultures for detection of asymptomatic gastrointestinal colonization were not routinely performed.

"Along these lines, it is clear that the epidemiology of CRKP in the U.S. is rapidly evolving, and enhanced surveillance and reporting is needed across the healthcare continuum," the authors wrote.
Dec 24 Clin Infect Dis study 

Copper oxide-embedded textiles help reduce healthcare-related infections

A study yesterday in the American Journal of Infection Control suggests that using copper oxide-impregnated biocidal textiles in long-term care medical facilities can reduce healthcare-associated infections (HAIs).

The 7-month study involved all patients in two ventilator-dependent wards at a long-term care hospital. In the first intervention period, investigators replaced all the textiles (lines, patients' clothes, and towels) in one ward with copper-oxide impregnated textiles, while the other ward used regular hospital textiles. Previous studies have shown that embedding nonsoluble copper oxide in textiles permanently endows them with potent broad-spectrum antimicrobial properties.

After a 1-month washout period, in which both wards used regular textiles, the investigators then switched the textiles in the two wards for the second intervention period, with the ward that received the treated textiles in period one getting the control textiles, and vice versa. Hospital personnel were blinded to which ward received the treated textiles and which received the control textiles, and all standard infection control measures were observed in both wards. In addition, the characteristics of the patients in the two wards were roughly the same.

At the end of the study, investigators observed significant reductions in HAI indicators in the wards when copper-treated textiles were used, including a 29.3% reduction in antibiotic treatment initiation events, a 55.5% decrease in fever days, a 23% drop in days of antibiotic treatment, and a 27.5% decrease in antibiotic defined daily doses per 1,000 hospitalization days.

"Our study adds an important layer to the in vitro studies and the previous open-label studies supporting the effect of copper oxide–impregnated medical textiles as a possible supplement to other measures aimed at reducing the rate of HAIs," the authors wrote.           
Dec 26 Am J Infect Control study

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