Saudi health ministry details 7-case hospital MERS cluster in Hofuf

Saudi Arabia's Ministry of Health (MOH) has confirmed that a seven-case MERS-CoV cluster in Hofuf involves Almana General Hospital and includes a nurse, according to a machine-translated statement posted today by Avian Flu Diary, a leading infectious disease blog.

The cases involve a patient who was seen in the hospital's emergency department, five patients who contracted MERS-CoV (Middle East respiratory syndrome coronavirus) in the hospital, and another patient who did not contract the disease at the hospital. One of the seven patients is a nurse, the MOH said.

All patients have been transferred to King Fahad Hospital in the city for more specialized care, the statement said. Close contacts of the patients are being monitored.

The MOH had reported in its daily updates seven cases in Hofuf since Oct 19 but has yet to provide many details. In today's update, the agency did not list any new cases but said three previously reported patients in Riyadh have all recovered from the disease.

The patients are a 65-year-old Saudi man who had preexisting disease and two foreign women, ages 29 and 39, who are likely part of a cluster among janitors living together east of Riyadh. All told 716 patients have recovered since the outbreak began in 2012 and 16 are still being treated. The country's MERS total stands at 1,272 cases.
Oct 28 Avian Flu Diary post
Oct 28 MOH update

WHO says two thirds of those under 50 have herpes simplex 1

In its first global estimates of herpes simplex 1 (HSV-1), World Health Organization (WHO) researchers today estimated that 3.7 billion people younger than 50 are infected, about 67% of that population. The team published its estimates in PLoS One.

Aside from documenting the scope of the virus, the report also shows that HSV-1 is an important cause of genital herpes, generally thought be mainly caused by HSV-2. Researchers found that about 140 million people ages 15 to 49 years are infected with genital HSV-1 infection, mainly in the Americas, Europe, and Western Pacific.

In a press release on the study, the WHO said fewer people in developed countries are contracting HSV-1 infections as children because of improvements in hygiene and living conditions. Instead, people are at risk for infection genitally through oral sex.

Marleen Temmerman, MD, director of the WHO's department of reproductive health and research, said in the release, "Access to education and information on both types of herpes and sexually transmitted infections is critical to protect young people's health before they become sexually active."

The HPV-1 prevalence estimates for 2012 varied by region and by gender. The authors also included estimates for new HSV-1 infections that occurred in 2012. The WHO's numbers for HSV-1 follow a study published in January that estimated that 417 million people ages 15 to 49 are infected with HSV-2.

In its statement, the WHO said it is working on a global strategy for addressing sexually transmitted infections, including HSV-1 and HSV-2, which will be considered at the World Health Assembly in May 2016.
Oct 28 PLoS One abstract
Oct 28 WHO press release

Greater drug resistance tied to poorer outcomes in MDR-TB

Greater drug resistance was associated with poorer treatment outcomes among multidrug-resistant tuberculosis (MDR-TB) patients globally, and acquired resistance was worse than initial resistance to the same drugs, according to a study yesterday in Clinical Infectious Diseases.

An international team led by researchers from the US Centers for Disease Control and Prevention analyzed data on 973 MDR-TB patients in 10 countries who had started second-line drugs.

They found that treatment success increased stepwise from 41.6% to 92.3% as the number of proven effective drugs increased from 0 or 1 to 5 or more (P < 0.0001 for trend), while acquired drug resistance decreased from 12% to 16%, depending on the drug, down to 0% to 2% (P < 0.0001 for trend).

The investigators also found, through multivariable analysis and controlling for differences between programs and patients, that the adjusted odds of treatment success decreased 0.62-fold for each increment in drug resistance and increased 2.1-fold for each additional effective drug.

They also noted that treatment succeeded in 85.8% of patients who had straightforward MDR-TB, 69.7% in those with initial resistance to either a fluoroquinolone or second-line injectable (SLI) drug, 37.5% with acquired resistance to a fluoroquinolone or SLI, 29.3% with initial extensively drug-resistant TB (XDR-TB), and 13.0% with acquired XDR-TB (P < 0.0001 for trend).
Oct 27 Clin Infect Dis abstract