News Scan for Jul 02, 2013

Hepatitis outbreak grows
Haiti cholera source
Polio in Pakistan
Asia-Pacific lab systems
Drugs for resistant TB

Berry-linked hepatitis A outbreak grows to 131

Four more people have been sickened with hepatitis A after eating a berry mix that contained contaminated pomegranate seeds from Turkey, raising the total the 131, the US Centers for Disease Control and Prevention (CDC) said yesterday in its latest update.

Four more patients have been hospitalized for their infections, raising that total to 59. The latest illness onset is Jun 24.

Federal health officials and their state and local partners have linked the outbreak to Townsend Farms Organic Antioxidant Blend, a frozen mix of berries and pomegranate seeds.

The US Food and Drug Administration recently barred shipments of seeds from a Turkish exporter after linking the product to the outbreak. Townsend used the seeds in a mix sold at Costco stores, as well as a mix sold at Harris Teeter stores, though no infections so far have been linked to the latter.
Jul 1 CDC update


Haiti cholera genome study implicates Nepal as source

The cholera strain that sparked Haiti's epidemic came from a single source, rather than multiple introductions, and is closely related to isolates from Nepal, researchers reported today.

The new findings, in mBio, add to the growing body of evidence that Nepalese peacekeepers unintentionally brought the strain with them when they came to Haiti to assist with earthquake recovery efforts in July 2010, the investigators said.

The team, from the United States, Canada, and Haiti, used high-resolution sequence data and performed evolutionary analyses to compare Vibrio cholerae isolates from Haiti and other parts of the world.

They sequenced genomes of 23 different V cholerae isolates that were obtained from several locations and time points during Haiti's outbreak. The isolates also reflect many different pulsed-field gel electrophoresis (PFGE) patterns.

Haiti's outbreak strain and isolates from Nepal formed a single phylogenetic group that didn't include isolates from anywhere else in the world, even those that had recent outbreaks. Researchers also determined that the PFGE variants from Haiti reflected gradual evolution rather than secondary introductions.

They also found that Haiti's strains have limited ability to acquire new genes, which the team said could influence whether they will adapt or die out when the epidemic winds down.
Jul 2 mBio abstract
Jul 2 American Society for Microbiology press release


Pakistani officials report another polio case, warn of outbreak danger

Pakistani health officials warned of the risk of a major polio outbreak as another case was reported in the Federal Administered Tribal Areas (FATA), according to a report today from the Express Tribune, a newspaper based in Karachi.

The National Institute of Health (NIH) in Islamabad said a 9-month-old baby in North Waziristan Agency has polio, marking the third case there this year, the newspaper reported. Because of a Taliban ban on polio vaccinations, vaccinators have not been able to work in the region since June 2012.

"This is a type-1 polio case—the most dangerous type of polio," the NIH was quoted as saying. "With such a large number of unvaccinated children in South and North Waziristan agencies, there is a serious threat of an explosive outbreak in the region, including southern Khyber-Pakhtunkhwa (K-P) and southeastern Afghanistan (Paktia, Paktika)."

The type-1 virus is associated with the highest rates of paralysis, the story added.

Fourteen of Pakistan's 18 polio cases so far this year have occurred in K-P and the FATA, the newspaper said. The FATA government aims to vaccinate 700,000 children, but it has not been able to include North and South Waziristan in any of the campaigns so far, because of the Taliban's opposition.
Jul 2 Express Tribune story


Asia-Pacific countries agree on need to bolster public health lab systems

Representatives of countries in the Asia-Pacific region agreed at a recent meeting on the need to strengthen their public health laboratory systems so they can better respond to outbreaks of emerging infectious diseases, the World Health Organization's (WHO's) Western Pacific Region office said in a statement today.

The Second Meeting on Laboratory Strengthening on Emerging Infectious Diseases in the Asia Pacific Region took place from Jun 4 to 6 at the WHO Western Pacific Regional Office in Manila.

The nearly 40 delegates present agreed that one of the main avenues for strengthening their national lab systems is to increase inter-sectoral and interdisciplinary cooperation in surveillance and diagnosis of emerging diseases, the WHO said.

The agency said another major topic at the meeting was external quality assurance. The WHO would like to expand its external quality assessment program for dengue to include other pathogens, such as chikungunya.

Delegates promised to improve their national work plans and to exchange ideas and experiences so as to further strengthen their surveillance, diagnosis, and cooperation capacities as called for under the International Health Regulations, the WHO said.
Jul 2 WHO Western Pacific statement


IOM report addresses supply-chain issues with MDR-TB drugs

The Institute of Medicine (IOM) yesterday published a workshop report on strengthening the supply chain of secondary drug options for people who have multidrug-resistant tuberculosis (MDR-TB), with attention to innovative solutions, according to a report summary.

The group defined MDR-TB as resistance to two primary TB drugs: isoniazid and rifampicin. The report points out that, from 2000 to 2009, only 0.2% to 0.5% of an estimated 5 million MDR-TB patients worldwide were treated with drugs of known quality and with appropriate healthcare.

The workshop assessed current delivery mechanisms, explored centralized management of drug delivery, looked at models used for other diseases, and identified possible innovative solutions.
Jul 1 IOM report

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