News Scan for Feb 12, 2019

News brief

MERS infects 9 more in Saudi Arabia

In an ongoing surge of MERS-CoV activity, Saudi Arabia's health ministry today announced nine new cases, including seven that are possibly linked to a hospital outbreak in Wadi ad-Dawasir, according to an update to its epidemiological week 7 report.

Of patients from Wadi ad-Dawasir, ages range from 37 to 80 years old, and four are women and three are men. Regarding MERS-CoV (Middle East respiratory syndrome coronavirus) exposures, 2 people had contact with camels before they became ill, 2 are classified as secondary healthcare cases, 1 is listed as primary exposure, and sources are still under investigation for 2.

Four patients are in home isolation, meaning their illnesses are likely asymptomatic, and the other three are hospitalized.

The other two illnesses announced today involve a 33-year-old man from Najran who had primary exposure, meaning he isn't thought to have contracted the virus from another patient, and is hospitalized, and a 16-year-old girl from Riyadh who is listed as a secondary household contact and is in home isolation.

The latest cases raise Saudi Arabia's number of MERS-CoV cases since the first of the year to 59, which includes 36 from Wadi ad-Dawasir.
Feb 12 MOH update


WHO: Expect southward movement of yellow fever in Brazil

In December and January, Brazil recorded 36 cases of yellow fever, including 8 deaths.  Today the World Health Organization (WHO) published an update on the outbreak and warned that given recent trends in human and animal cases, the virus could spread across parts of the country with low population immunity.

The WHO said recent human cases in Parana state could be the beginning of a third wave of virus activity in that country. Parana state, located in southeast Brazil, had not seen a yellow fever case since 2015. The other cases recorded in the last 2 months were from Sao Paulo state.

"While too early to determine if this year will show the high numbers of human cases observed in the last two large seasonal peaks, there is indication that the virus transmission is continuing to spread in a southerly direction and in areas with low population immunity," the WHO said.

Since 2016, Brazil has battled two distinct waves of yellow fever outbreaks. In 2016 and 2017 there were 778 human cases, including 262 deaths, and during the 2017–2018 seasonal period, there were 1,376 human cases, including 483 deaths.
Feb 11 WHO release


Lassa fever outbreak declared in Guinea as Nigeria outbreak grows

Guinea has confirmed its first locally acquired Lassa fever case in two decades, which involves a 35-year-old man from Kissidougou prefecture, located in the southern part of the country, who died from his illness, according to a weekly emergencies and outbreak report from the WHO African regional office.

The man's symptoms began on Jan 7, and he sought care at a private clinic before he was hospitalized twice, one for suspected severe malaria. His condition worsened, and he died on Jan 29 after experiencing hemorrhagic symptoms. Initial tests were negative for Ebola and yellow fever, and subsequent testing was positive for Lassa fever.

The man was buried according to local customs against medical advice. As of Feb 7, 108 contacts are being monitored, and so far, no other illnesses have been detected.

Last week, two suspected viral hemorrhagic fever cases were detected in Conakry, and one has tested negative and results on the second are pending.

Guinea's health ministry has declared a Lassa fever outbreak and has held a public emergency meeting to plan and begin response steps. According to the WHO report, Guinea is considered part of Africa's Lassa fever belt, though infections are rare in the country. It added that rat species that spread the virus is present in the country and seroprevalence studies suggest Lassa fever might be more widespread than though in parts of Guinea.
Feb 12 WHO African regional office report

In other Lassa fever developments, Nigerian officials have confirmed 275 cases so far this year, up from 213 reported by the WHO earlier this month, according to a Feb 3 update from the Nigeria Centre for Disease Control (NCDC). To date, 19 of Nigeria's 36 states have reported Lassa cases this year.

Four more illnesses were reported in healthcare workers, raising that total to nine, 1 of them fatal. The outbreak has led to 57 deaths, up from 16 in the WHO's recent report.
Feb 3 NCDC update


Data from Mexico show Zika more widespread than thought

Using surveillance data from the Mexican Institute of Social Security (IMSS), researchers show that Zika prevalence was higher than previously thought in 2016. The analysis was published yesterday in PLoS One.

According to the authors, a total of 43,725 suspected cases of Zika virus disease (ZVD) were reported to the IMSS in 2016, of which 1,700 (3.9%) were confirmed by lab testing. The overall incidence of suspected Zika cases was 82.0 cases per 100,000 inhabitants, and the overall positive case estimate rate was 25.3 per 100,000.

Those findings put the Mexican incidence of Zika on par with Colombia, which had 4% of cases confirmed in the same year and are much higher than previously reported (5.9 per 100,000) prevalence estimates.

Women were more likely to have symptomatic Zika infections than men. The incidence of suspected Zika in pregnant women nationwide was 717 per 100,000 pregnant women, and the incidence of Zika-positive pregnant women was 186.1 per 100,000.

"Among pregnant women, the cumulative positive ZVD incidence rates were the highest in Guerrero, Chiapas and Yucatán, with considerable geographical variation, and we found higher incidence levels than have been reported by previous estimates," the authors said.
Feb 11 PLoS One study


Controversial H5N1 studies set to resume after panel review

Following the December 2017 lifting of a moratorium on funding gain-of-function (GOF) research on potential pandemic viruses such as avian flu, a government review panel tasked with reviewing proposed projects last year approved experiments by two labs, ScienceInsider reported on Feb 8.

The National Institute of Allergy and Infectious Diseases has funded one of the projects, led by Yoshihiro Kawaoka, DVM, PhD, from the University of Wisconsin at Madison and the University of Tokyo. According to ScienceInsider, the grant funding approved in January will cover work to identify mutations in H5N1 that allow transmission by respiratory droplets in ferrets.

The other proposed project cleared for work is still awaiting funding and will be led by Ron Fouchier, PhD, from Erasmus University Medical Center in the Netherlands. It will focus on identifying molecular changes that enhance the virulence of flu viruses and mutations that occur when H5N1 is passaged through ferrets.

Both scientists were lead authors of two controversial H5N1 papers published in 2012 that touched off the GOF controversy that led to a pause in federally funded work in 2014 and intensive efforts to reevaluate government GOF funding policies and forge recommendations to help federal officials make their decisions.

According to the report, a US Department of Health and Human Services (HHS) panel reviewed the projects last summer and made recommendations about the risks and benefits, safety, and communication plans. However, HHS said it can't make the panel's reviews public because of proprietary and grant competition considerations.

Some experts told ScienceInsider that the panel's deliberations should be transparent.
Feb 8 ScienceInsider report
Dec 19, 2017, CIDRAP News story "Feds lift gain-of-function research pause, offer guidance"

Stewardship / Resistance Scan for Feb 12, 2019

News brief

Study: Hospital readmission for Staph bacteremia patients common, costly

New research by scientists with the University of Mississippi Medical Center indicates that 30-day hospital readmission among patients who survived initial hospitalization with Staphylococcus aureus bloodstream infections is common and costly. The findings appeared yesterday in Clinical Infectious Diseases.

Using the 2014 Nationwide Readmissions Database, the researchers examined 30-day readmission, mortality, length of stay, and costs associated with initial hospitalization for methicillin-susceptible and methicillin-resistant S aureus (MSSA and MRSA) bacteremia. Although research on mortality from S aureus bacteremia is extensive, less is known about hospital readmission, and greater understanding of readmission, and its risk factors, could result in improved patient care.

From January 2014 through November 2014, the researchers identified 92,089 patients with S aureus bacteremia, 48.5% of whom had MRSA bacteremia. The all-cause 30-day readmission rate was 22% overall, with no significant difference between MRSA and MSSA cases. But patients with MRSA bacteremia were 17% more likely to have 30-day readmission with S aureus bacteremia recurrence (hazard ratio, 1.17; 95% confidence interval [CI], 1.02 to 1.35). In addition, patients with MRSA bacteremia had higher in-hospital mortality (odds ratio,1.15; 95% CI, 1.07 to 1.22), and longer hospital stays (incidence rate ratio, 1.08; 95% CI, 1.06 to 1.11).

Readmission with bacteremia recurrence was particularly associated with endocarditis, congestive heart failure, end stage renal failure, underlying immunocompromising comorbidities, and drug abuse. The mean overall cost of readmission was $12,425 per patient, and $19,186 per patient in those with bacteremia recurrence.

The authors of the study conclude, "Efforts should continue to optimize patient care, particularly for those with risk factors for readmission, to decrease readmissions and associated morbidity and mortality in the context of S aureus bacteremia."
Feb 11 Clin Infect Dis abstract


Review of hospital stewardship programs finds economic impacts

A systematic review of previous research suggests that hospital antimicrobial stewardship programs (ASPs) help save costs by decreasing length of stay and antibiotic expenditures.

The review, published today in Antimicrobial Resistance and Infection Control, looked at studies published from 2000 through 2017 that evaluated patient and/or economic outcomes after implementation of hospital ASPs. Key economic outcomes were costs associated with antibiotics, length of stay, and total costs (including operation and implementation). A total of 146 primary research studies were included on the final analysis, the majority of which were conducted in 500-1,000 bed hospitals in North America (49%), Europe (25%), and Asia (14%).

Of the studies that evaluated length of stay and antibiotic expenditure, 85% (58 of 68 studies) showed a reduction in length of stay and 92% (80 of 87 studies) showed a decrease in antimicrobial costs following ASP implementation. Average cost savings were $732 per patient in US studies and €198 per patient ($224 US) in European studies, with length of stay being a key driver of cost savings. Savings were higher among hospitals with ASPs that included therapy review and antibiotic restrictions.

"Overall, this systematic review demonstrates that ASPs can offset or reduce costs while improving some patient outcomes, thereby suggesting high value for certain healthcare systems," the authors of the review write. "However, for the findings to be globally relevant, more studies, particularly in real world settings across a diverse range of geographies and resource settings are required, so that a full critical appraisal of the true value of these programs can be made."
Feb 12 Antimicrob Resist Infect Control study


Fleming Fund selects UK partners for African stewardship program

The Fleming Fund, a UK government aid program to help low- and middle-income countries fight antimicrobial resistance (AMR), today announced the 12 hospitals and research institutions that will work with partners in four African countries to promote antimicrobial stewardship.

Through the Commonwealth Partnerships for Antimicrobial Stewardship program, clinicians, nurses and pharmacists from 12 National Health Service (NHS) trusts and UK academic institutions will work with partner teams in hospitals in Ghana, Tanzania, Uganda, and Zambia to improve stewardship practices and protocols and develop tools that help reduce the spread of AMR. The winners were chosen for their strong records in antimicrobial stewardship.

"The quality of all the proposals received was extremely high and the selected NHS teams will make a great impact working in partnership with teams on stewardship practices across Africa," Keith Ridge, England's Chief Pharmaceutical Officer, said in a press release.

The Fleming Fund will provide £1.3 million ($1.68 million US) to support the projects, which will last up to 15 months.
Feb 12 Fleming Fund press release

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