NEWS SCAN: Cholera in Africa, C diff in chicken, contaminated hospital uniforms, rural dengue, HFMD hits football team

Aug 31, 2011

Cholera outbreaks take toll on Lake Chad Basin countries
Cross-border efforts are needed to protect African countries that surround the Lake Chad Basin from cholera, which has so far sickened about 38,000 people in the region, at least 1,200 of them fatally, according to a health group working in the area, the Integrated Regional Informational Networks (IRIN), part of the UN Office for the Coordination of Humanitarian Affairs, reported yesterday. Francois Bellet, an environmental health specialist for the United Nations Children's Fund, told IRIN that the basin, vulnerable to the disease due to constant population movement and poor sanitation, is the center of economic activity for the region and that cholera outbreaks threaten economic development. Affected countries include Cameroon, Chad, Niger, and Nigeria. Health ministers signed an agreement in 2010 calling for more coordination to fight cholera outbreaks, but disease fighting and surveillance efforts are still lacking, and people have poor access to clean water, the report said. More rainy season months are ahead, which could intensify cholera outbreaks, which last year showed the biggest spike since 1991.
Aug 30 IRIN report

Sampling turns up C diff in grocery store chicken
A study of Clostridium difficile in retail chicken found the pathogen in 3% to 12.5% of samples, depending on the cultivation procedure used, according to a study by US Department of Agriculture and Texas A&M researchers in Foodborne Pathogens and Disease. In July 2010 they cultivated 32 meat samples from packages they collected from five grocery stores in Bryan and College Station, Tex. Testing included in-house store brands and nationally known brands. After culturing the samples they used polymerase chain reaction (PCR) testing to characterize toxin genes, and they tested each C diff isolate they found for susceptibility to 11 antimicrobial agents. They used pulsed-field gel electrophoresis (PFGE) to compare the genotypes of different isolates. Seven of the 32 meat samples tested positive, and the percent of positive cultures varied by cultivation procedure, ranging from 3.2% (1) to 12.5% (4). Analysis of the isolates identified toxinotype V and PFGE type NAP7 or a NAP7 variant. The authors wrote that they believe their report is the first to document toxinotype V and PFGE NAP7 in poultry meat. Microbial testing suggested that the C diff isolates from poultry meat showed somewhat reduced resistance than for other meat or animal toxinotype V isolates.
Aug 30 Foodborne Pathog Dis abstract

Study: Almost two thirds of hospital uniforms harbor pathogens
Almost two thirds of hospital physicians and nurses tested had potentially pathogenic organisms on their uniforms, even though 59% said they changed their uniforms daily, according to a study by Israeli researchers in the American Journal of Infection Control (AJIC), published by the Association for Professionals in Infection Control and Epidemiology (APIC). The research team used a convenience sample of 135 healthcare workers (HCWs) during a particular shift of a 550-bed university hospital, with less than 5% of available staff not participating. They sampled abdominal, sleeve, and pocket areas of uniforms but did not specify at what time during the shift samples were taken. The team found that 85 workers (63%) had positive samples, with no significant difference between physicians and nurses. Of the 238 samples obtained, 119 (50%) tested positive for at least one pathogen, with 79% of them testing positive for only one pathogen. The most common organisms were Acinetobacter, found in 89 samples, Staphylococcus aureus, in 32 samples, and Enterobacteriaceae, in 18 samples. Twenty-seven cultures contained drug-resistant pathogens, including eight that grew methicillin-resistant S aureus (MRSA). In a press release today from publishing house Elsevier, APIC President Russell Olmsted, MPH, said, "It is important to put these study results into perspective. Any clothing that is worn by humans will become contaminated with microorganisms. The cornerstone of infection prevention remains the use of hand hygiene." The authors also listed some study limitations, such as relying on self-reporting of uniform changes and having a control group of only four laundered uniforms.
September AJIC abstract
Aug 31 Elsevier press release

Rural areas with scarce tap water may bear highest dengue burden
Contrary to conventional wisdom, rural rather than urban areas may bear the highest proportional burden of dengue fever and that access to tap water plays a role, according to a study yesterday in Public Library of Science (PLoS) Medicine. Asian and European researchers conducted an individual-level cohort study of 75,000 households in Kanh-Hoa Province in south-central Vietnam (population 350,000), which was affected by two epidemics of the mosquito-borne disease from January 2005 to June 2008. They found that at low population densities, mostly in rural areas, dengue risk is up to three times higher than in cities, presumably because the ratio of mosquitoes to humans is higher in rural areas. They also found that severe outbreaks occur almost exclusively in areas falling within a narrow range of population densities with low access to tap water, where water storage vessels provide breeding grounds for mosquitoes. However, because the number of people who contract dengue fever in populated areas is high, the team found that urban areas still contribute substantially to dengue epidemics. The authors conclude that improving water supplies and mosquito control in areas with a human population density critical for dengue transmission could enhance control efforts.
Aug 30 PLoS Med study
Aug 30 PLoS news release on the study

HFMD in football players prompts health alert
Four football players on a Pennsylvania high school team were recently diagnosed as having hand, foot, and mouth disease (HFMD), which more commonly causes outbreaks in childcare settings. Administrators at Norwin High School in North Huntingdon sent a letter home to parents on Aug 23 notifying them that a day earlier it learned that four football players had contracted the virus. North Huntingdon is located about 20 miles southeast of Pittsburgh. Officials said they weren't sure how or when the players were exposed. Custodial crews cleaned and disinfected the field, the school's field house, locker rooms, and other areas in the school district. Athletic trainers educated student-athletes on the importance of hand washing and urged them to avoid sharing water bottles and other personal items. Students who had HFMD were not allowed to return to school without a release from a primary care physician. According to the US Centers for Disease Control and Prevention (CDC), HMFD is a common illness in infants in children that is characterized by fever, sores in the mouth, and a rash. It is caused by viruses in the enterovirus group, most commonly coxsackievirus A16. Typically a moderately contagious, mild disease, it usually resolves in 7 to 10 days without treatment.
CDC background on HFMD

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