News Scan for Feb 07, 2014

MERS case in UAE
Canadian H5N1 gene analysis
N95 respirators and bacterial infections
2014 ACIP recommendations

UAE man who owns camels has MERS, WHO says

A 66-year-old United Arab Emirates (UAE) man who owns camels has the latest confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, the World Health Organization (WHO) announced in a statement today.

The man lives in Abu Dhabi and has underlying medical conditions, the WHO said. He became ill on Jan 20 with upper respiratory symptoms and was hospitalized on Jan 24 with pneumonia and renal failure. He tested positive for MERS-CoV on Jan 30 and is now in an intensive care unit in stable condition, the agency said.

Public health authorities are tracing contacts and conducting an epidemiologic investigation.

The WHO said the man owns camels and also had contact with camels Jan 20 during a trip to Oman. Camels have been implicated as a possible source of MERS-CoV in humans, but the link has not been fully established. Few case-patients have reported contact with camels, and person-to-person transmission of the virus has been observed, particularly in hospitals.

In December researchers reported that dromedary camels on a farm in Qatar were infected with a MERS-CoV strain nearly identical to that found in two people associated with the farm, but they couldn't determine whether the camels infected the humans or the other way around. Several studies have also found that camels carried antibodies to MERS-CoV or a closely related virus; one study revealed that camels in the UAE had MERS-CoV-like antibodies in 2003.

With the new case, the WHO has raised its MERS-CoV count to 182 confirmed cases, including 79 deaths. The agency has not yet recognized the case reported Feb 2 by Saudi Arabia, involving a 67-year-old Riyadh man.
Feb 7 WHO statement
Dec 16, 2013, CIDRAP News story "Nearly identical MERS-CoV strains found in camels, humans"


Gene study describes Canadian patient's H5N1 isolate

A research group based in Canada today reported that the H5N1 avian influenza virus isolated from an Alberta woman who recently died of an infection after returning home from a visit to China is a previously undescribed genotype. The patient had meningoencephalitis, an unusual manifestation for a human H5N1 infection.

The woman died on Jan 3, a week after returning from China. How she was exposed to the virus remains unknown.

The researchers based their analysis on an isolate cultured from a bronchoalveolar lavage sample, after conducting tests to ensure that no culture-induced changes were present. Sequencing was done at the Alberta Provincial Laboratory for Public Health and the National Microbiology Laboratory of the Public Health Agency of Canada. The findings were published today in an early-release article from Emerging Infectious Diseases.

The analysis showed that 7 of the 8 genes were 99% or more identical to those of H5N1 viruses of avian origin. However, the PB2 gene showed 99% similarity and 99% identity to H9N2 avian flu viruses from China.

Phylogenetic analysis of the hemagglutinin (HA) gene revealed that the virus belongs to clade, which has been found in many countries, most recently in China, Vietnam, and Indonesia. The team said the HA gene's closest relative was a sequence collected from a tiger that died in 2013 at a zoo in Jiangsu province in China. Those and other findings suggest that the virus is a previously undescribed genotype of H5N1, according to the report.

Genetic tests to gauge the pandemic risk of the virus found no mutations that would confer resistance to adamantanes or neuraminidase inhibitors. The team found some mutations that were linked to increased virulence in mice. Overall the virus is a close antigenic match to the clade candidate vaccine virus of the World Health Organization.

The researchers concluded that because of the patient's unique neurologic manifestations, more studies are needed to understand aspects of virus heterogeneity and the role it played in the fatal case.
Feb 7 Emerg Infect Dis study
Related Jan 14 CIDRAP News story


Study: N95 respirators protect health workers from bacterial pathogens

A study conducted in Beijing hospitals suggests that N95 respirators are better than medical masks for protecting healthcare workers (HCWs) from bacterial pathogens.

The study, published recently in Preventive Medicine, was conducted by researchers from the University of New South Wales in Australia and the Beijing Center for Disease Control, with Raina MacIntyre, MBBS, of the university as lead author.

The research was conducted during the winter of 2008-09. The team randomly assigned 1,441 HCWs in 15 hospitals to wear N95 respirators or medical masks, and they used 481 HCWs from nine hospitals as controls.

HCWs who had respiratory symptoms were tested for Streptococcus pneumoniae, Bordetella pertussis, Chlamydophilia pneumoniae, Mycoplasma pneumoniae, and Haemophilus influenzae type B by polymerase chain reaction (PCR). Tests for common respiratory viruses, including influenza, were also conducted.

The authors found that the rate of bacterial colonization or infection was 2.8% in the N95 group, 5.3% in the mask users, and 7.5% in the control group. They calculated that N95 use reduced the risk of bacterial infection by 46% compared with masks and by 62% versus no protection, with both differences significant. Compared with no protection, medical masks did not significantly lower the risk.

The researchers also report that co-infections with two bacterial species or a virus and bacteria occurred in up to 3.7% of the HCWs and were significantly lower in the N95 group than the other two groups.

In a University of New South Wales press release, MacIntyre said the study makes clear that bacterial infections are common in HCWs with respiratory symptoms, which she said has not been widely recognized.

"N95 respirators were significantly protective against bacterial colonization, co-colonization and viral-bacterial co-infection," the report says. "We showed that dual respiratory virus or bacterial-viral co-infections can be reduced by the use of N95 respirators."

"These findings have important implications for policy and practice," MacIntyre commented in the release. "Currently, the only bacterial respiratory infection for which respirators are considered and recommended for HCWs is tuberculosis."
Jan 25 Preventive Med report


ACIP offers clarifications, new access for 2014 immunization guidelines

The new 2014 summaries of immunization recommendations from the Advisory Committee on Immunization Practices (ACIP) for children and adults, appearing in today's Morbidity and Mortality Weekly Report (MMWR), include few substantive changes but include organizational and formatting changes to improve clarity and ease providers' access to the most current versions.

The immunization tables, figures, and footnotes for both age-groups (0 to 18, 19 and older) will, instead of being published in their entirety in MMWR, be available and maintained on the Centers for Disease Control and Prevention's (CDC's) immunization schedule Web site (see below). Printable versions in several formats are available there.

In addition, the CDC encourages providers to use the content-syndication feature to keep continuously updated schedules accessible on their respective Web sites so that any revisions or additions during the year are immediately incorporated.

Among changes or clarifications in this year's ACIP schedules for children are recent recommendations for use of MenACWY-CRM and MCV4-CRM meningococcal conjugate vaccines as early as 2 months of age, guidance for pneumococcal vaccine in children with high-risk conditions, and guidance for use of hepatitis A vaccine in unvaccinated children at increased risk of infection. Footnotes have been standardized to reflect the number of doses recommended for each vaccine and reorganized to show recommendations for high-risk conditions.

Changes in the recommendations for adults include Haemophilus influenzae type b (Hib) vaccination for certain at-risk persons who have not received the vaccine before and for persons who have received a successful hematopoietic stem cell transplant regardless of previous vaccination. The authors have clarified or simplified some language regarding Td/Tdap (tetanus/diphtheria/pertussis) vaccine, meningococcal vaccine, PCV13 and PPSV23 pneumococcal vaccines, and human papilloma virus (HPV) vaccination timing.

In addition, information has been added on use of certain influenza vaccines in egg-allergic persons.
Feb 7 MMWR ACIP recommendation summary for children 0-18 years
Feb 7 MMWR ACIP recommendation summary for adults 19 and older
CDC's immunization schedule Web site

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