NEWS SCAN: AAP ear-infection guidance, novel coronavirus update, more fungal infections, mystery illness in Ghana

Feb 25, 2012

New AAP guidelines offer stricter criteria for ear infections
The American Academy of Pediatrics (AAP) today updated its guidance for acute otitis media (AOM) in children, urging more restricted diagnostic and treatment criteria to reduce unnecessary antibiotic use. The guidance, which was last updated in 2004, was published in Pediatrics. The new version is based on a comprehensive literature review in 2009 by a panel of experts from the AAP, the federal Agency for Healthcare Research and Quality, and the Southern California Evidence-Based Practice Center. For otherwise healthy kids 6 months to 12 years old, the panel recommends diagnosing AOM when there is moderate to severe tympanic membrane (TM) swelling, or for mild TM swelling accompanied by ear pain, as well as for "intense" TM redness. The guidelines also say AOM should not be diagnosed if the child has no middle ear effusion. The panel said that antibiotics should be prescribed for AOM with moderate or severe ear pain, pain that lasts 48 hours or longer, or fever of 39°C (102.2°F) or higher, and also for nonsevere, bilateral AOM in kids younger than 2. The experts recommend amoxicillin as the antibiotic of first choice. Among other recommendations are the inclusion of pain management, reevaluation when symptoms worsen, exclusive breastfeeding for at least 6 months, pneumococcal vaccine, and annual flu vaccine.
Feb 25 AAP updated guidelines
2004 guidelines

Novel coronavirus infection ruled out in Hong Kong case
Hong Kong authorities said over the weekend that they ruled out a novel coronavirus (NCoV) infection in a 40-year-old man who got sick after traveling in the Middle East. The man became ill with a fever, cough, muscle aches, and runny nose on Feb 20 and was hospitalized in Hong Kong, the city's Centre for Health Protection (CHP) said in a Feb 23 statement. The patient tested negative for the novel virus but positive for influenza B. Officials learned that the man had visited Dubai with his family from Jan 24 to Feb 1 and was in Tehran from Feb 1 to 20 before returning home Feb 21. His family members who traveled with him have all stayed healthy, officials said. In other developments, the Saudi Gazette reported on Feb 22 that the 13th confirmed NCoV case involved an "old woman," but the story did not list her age. In announcing the fatal case on Feb 21, the World Health Organization didn't list the patient's age or sex. Seven of the 13 confirmed NCoV cases have been fatal. So far all the case-patients have had links to the Arabian Peninsula by residence, visiting, or contact with others who had been in the region.
Feb 23 Hong Kong CHP statement
Feb 22 Saudi Gazette story
Feb 21 CIDRAP News story on 13th NCoV case

CDC: Fungal infection toll grows to 714, with 48 deaths
The US Centers for Disease Control and Prevention (CDC) today reported 7 more fungal infections over the past week linked to contaminated injectable steroids, pushing the nation's total to 714, according to an update today. One more deaths was reported, raising that number to 48. So far 240 of the illnesses were meningitis only, 138 involved spinal or paraspinal infections with meningitis, 6 involved stroke without lumbar puncture, 296 were paraspinal or spinal infections only, 32 were peripheral joint infections only, and 2 involved a paraspinal or spinal infection along with a peripheral joint injection. The infections have been linked to three lots of methylprednisolone acetate injections from New England Compounding Center that were used to treat back pain and joint problems.
Feb 25 CDC updated case count

Respiratory symptoms at Ghana's coastline spur investigation
Ghana's health ministry is investigating reports of unusual respiratory symptoms in people along the coastline of the town of Aflao near the border with Togo, according to a recent notice from the World Health Organization (WHO) Regional Office for Africa. About 28 people reported acute onset of cough, sneezing, and chest pain that resolved with self-treatment or when they left the coastline area, according to the report. Unconfirmed reports said people along Togo's coast, mostly fishermen, were also reporting symptoms. The first symptoms were reported on Feb 8, but no new cases have been reported since Feb 19. The WHO's office in Ghana, as well as the regional office, are in close contact with the health ministry about the details of its investigation and follow-up. Health officials suspect that the source of the symptoms could be chemical waste dumped into the sea, according to the report. However, a post about Ghana's outbreak on ProMED Mail, the online reporting system of the International Society for Infectious Diseases, noted that the symptoms sound similar to those caused by "red tide." The phenomenon is caused by waterborne algae blooms, which can produce a toxin that can become airborne and cause itchy eyes, scratchy throats, and coughing.
WHO African regional office statement
Feb 23 ProMED Mail post

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