News Scan for May 08, 2017

News brief

New case of MERS reported in Riyadh

On May 6 the Saudi Arabian Ministry of Health (MOH) reported a new confirmed case of MERS-CoV in Riyadh.

A 46-year-old Saudi man was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) after showing symptoms of the virus. He is in stable condition, and his infection is listed as "primary," meaning it is unlikely he contracted the disease from another person.

The new case brings Saudi Arabia's total to 1,601 MERS-CoV cases, 662 of them fatal, since the virus was first detected in humans in 2012. Six people are still being treated for their infections, the MOH said.
May 6 MOH report

Special issue focuses on resistance, stewardship in Asia Pacific

The latest issue of Clinical Infectious Diseases includes a supplement on infection prevention and control in the Asia-Pacific region, with a focus on antimicrobial resistance and stewardship.

As a geographic source for emerging infectious diseases, the Asia-Pacific region has become a significant area of concern for global health officials. With high rates of healthcare-associated infections and widespread availability of antimicrobial agents, the steady emergence of multidrug-resistant organisms (MDROs) in Asia-Pacific healthcare settings, and how to slow that emergence, is a particular concern.

The supplement focuses on three key themes of infection prevention and control in healthcare settings across the Asia-Pacific region: (1) epidemiology and evidence to support prevention and control interventions, (2) enhancements to infection prevention and control in healthcare settings, and (3) practices associated with the containment of emerging infectious diseases and outbreaks.

Epidemiologic data and evidence to support prevention and control interventions is covered in two national surveys of best practices and four epidemiology studies, including two studies that look at carbapenem-resistant Enterobacteriaceae and methicillin-resistant Staphylococcus aureus in Singapore. Assessments of efforts to enhance infection prevention and control include a review of antimicrobial stewardship programs in inpatient settings in the region, as well as studies on the innovative use of electronic medical records and molecular diagnostics to identify patients with bacterial infections.

The supplement also includes studies on two outbreaks of bacterial pathogens—a large foodborne outbreak of Streptococcus agalactiae infection in Singapore and a pseudo-outbreak of Bacillus bacteremia in Hong Kong linked to contaminated bed linens.

"The publications in this issue support future work focused on continued generation of evidence and dissemination of data, ongoing microbial surveillance, and implementation, if not adoption, of effective prevention strategies to contain the spread of MDROs and key emerging infectious diseases in the region," the authors of a supplement overview write.
May 2017 Clin Infect Dis supplement

PAHO reports more than 900 new chikungunya cases

Countries in the Americas reported 907 new chikungunya cases, the Pan American Health Organization (PAHO) noted late last week, another week that saw no report from Brazil, which has accounted for the most cases by far this year and last year.

The case count for 2017 has now reached 31,573, according to PAHO's May 5 update. The agency reported 825 cases the week before.

The lion's share of new cases were in Bolivia, which reported 750 for the week and 1,289 for the year. Peru logged 97 new cases and 655 so far in 2017.

Brazil has not reported its most recent 6 weeks of data, and it has accounted for 85% of cases so far this year. Many nations, as well, have not reported on their chikungunya situation for weeks. PAHO reported no new deaths last week, with that number holding at seven, all in Brazil.

The chikungunya outbreak began in late 2013 on the Caribbean island of St. Martin and has now sickened at least 2,418,600 people.
May 5 PAHO update

Study shows rotavirus vaccine is safe, effective

A new study published in The Lancet Infectious Diseases showed that an experimental injected rotavirus vaccine was safe and immunogenic during a small trial in South Africa. These results will help inform phase 1 and 2 trials currently under way that will help assess if the injected vaccine is a useful alternative to oral rotavirus vaccine.

While the oral rotavirus vaccine is regularly used in high- and middle-income countries, it is less successful in low-income countries. This randomized, controlled trial in 162 healthy babies and toddlers measured the safety and adverse effects during three injections of increasing doses of the new parenteral subunit vaccine, called P2-VP8-P[8].

Almost all participants (98%) showed a seroresponse 4 weeks after the third injection. There was no clear dose-response seen between groups given vaccines made with 10, 30, or 60 microgram of antigen.

"The P2-VP8-P[8] vaccine was found to be safe and immunogenic, with evidence that it might provide protection against rotavirus disease in infants," the authors concluded.

Rotavirus is one of the leading causes of severe childhood diarrhea in Africa.
May 5 Lancet Infect Dis study

Flu Scan for May 08, 2017

News brief

H7N9 activity expands in China

Over the weekend, Hong Kong's Centre for Health Protection (CHP) fleshed out more details on 22 recent H7N9 avian flu cases, 8 of them fatal, that were reported Apr 28 to May 4 from China's mainland, signaling continued steady activity in the country's fifth and biggest wave of infections.

The latest illness onsets range from Apr 14 to Apr 29, a sign that the outbreak is ongoing. Fourteen patients were men and 8 were women. Seventeen of the patients had a history of exposure to poultry, poultry markets, or mobile stalls.

One of the unique aspects of the fifth wave has been a much wider geographic spread outside of the typically affected southern and southeastern provinces, and the latest CHP update notes cases in nine provinces, plus the cities of Beijing and Chongqing.

Seven cases are from Hebei province in northern China, a region that had reported only a few previous illnesses. Six are from Sichuan, which has reported several recent infections.

In a related development, Shaanxi province in the northwest, which recently reported its first case, now has four cases, with the announcement of a new case from the city of Xi'an, according to a local government statement translated and posted today by Avian Flu Diary (AFD), an infectious disease news blog.

China has now reported at least 680 cases, with at least 196 of them fatal.
May 6 CHP update
May 8 AFD post

H5N8 avian flu strikes English backyard birds again

The United Kingdom's Department for Environment, Food and Rural Affairs (DEFRA) announced on May 6 that a second highly pathogenic H5N8 avian flu outbreak has been detected near the city of Thornton in Lancashire County in northwestern England.

News of the latest detection came just 2 days after an initial outbreak was reported in backyard birds at a holding near Thornton. The latest outbreak also involves a backyard flock, which contains nine chickens and ducks. A notification today from the World Organization for Animal Health (OIE) said the outbreak began on May 5, killing two of the birds. Authorities said the birds will be culled and an investigation is under way to find the source of the virus.

Officials placed a 3-kilometer (km) protection zone and 10-km surveillance zone around the property.
May 6 DEFRA update
May 8 OIE report

Meta-analysis shows flu vaccine 'herd' benefits in some settings

Vaccinating children against influenza may provide indirect protection for unvaccinated people in some settings, according to a new meta-analysis in Clinical Infectious Diseases.

Australian investigators included 30 studies in their review, including 9 randomized, controlled trials (RCTs), which are considered the "gold standard." Fourteen studies involved the live-attenuated (nasal spray) vaccine, 11 involved the flu shot, and 5 included both.

Of the 30 studies, 20 reported indirect protection effectiveness (IPE) against influenza or influenza-like illness (ILI) ranging from 4% to 66% in unvaccinated people. Of the 6 RCTs with full randomization, 1 study of immunized school-aged children showed IPE of 60% against lab-confirmed flu in the community and 3 household studies involving preschool vaccination showed an aggregate 22% IPE against acute respiratory infections or ILI.

Significant herd protection was also reported in a large-scale RCT that was not fully randomized, and three ecological studies of moderate quality in Japan that involved school-based programs and flu-related mortality in the elderly also showed some IPE.

The authors wrote, however, "Data on IPE in other settings are heterogeneous and lacked power to draw a firm conclusion."

They add, "Robust, large-scaled studies are required to quantify better the indirect protection from vaccinating children for different settings/endpoints."
May 5 Clin Infect Dis review

Study: 2009 H1N1 interventions had impact in camp setting

A large-scale intervention including antiviral prophylaxis helped reduce the impact of a 2009 H1N1 outbreak at a large physical training camp for college freshmen in Beijing in the fall of 2009, Chinese researchers reported May 5 in the International Journal of Infectious Diseases.

China reported its first 2009 H1N1 case in May of 2009, and when the new school began in late August and early September, researchers decided to test how well a combination of measures worked at controlling the spread of the disease at the training camp in a Beijing suburb. In China, college freshmen are required to perform a 2- or 4-week training period either at their school or at a camp.

The countermeasures against 2009 H1N1 included oseltamivir (Tamiflu) treatment for confirmed and possible cases and oseltamivir prophylaxis for all other training participants. The camp staff also isolated patients and possible case-patients and encouraged personal protection, hygiene and social distancing.

In the first 5 days of training, before the countermeasures began, the camp recorded 26 confirmed cases and 405 possible infections. After the intervention began, another 162 possible cases were reported, for a clinical attack rate of 18.2%, which was lower than the 80% that they had predicted in the absence of the interventions for a closed setting.

The researchers also noted that the attack rate they observed was similar to 11.4% seen in an earlier reported Singapore military setting where post-exposure oseltamivir ring prophylaxis was given. The authors said the findings provide additional support for the effectiveness of rapid containment of flu in settings such as schools and hospitals.
May 5 Int J Infect Dis abstract