News Scan for Apr 24, 2014

MERS in Omani camels
New H7N9 cases
Effect of kids' vaccines
Frozen donor stool for C diff
Polio surveillance

Oman camel MERS study supports respiratory spread to humans

Testing of nasal and eye swabs of camels in Oman found 5 of 76 samples positive for Middle East respiratory syndrome coronavirus (MERS-CoV), and genetic sequencing showed that they were closely related to human viruses in the region

The findings, reported today in Eurosurveillance, add more evidence of zoonotic transmission and hint that dromedary camels could be the direct reservoirs, researchers from Austria and Oman said. They also noted high viral loads in the swabs, building a case for respiratory transmission.

The group collected samples from 76 dromedary camels across Oman in December 2013. The animals were different ages, breeds, and genders. The investigators conducted two MERS-CoV reverse transcription quantitative polymerase chain reaction (RT-qPCR) tests on the samples, and retested the ones that were positive. They used gene sequences from the positive samples to perform a phylogenetic analysis.

The five positive samples from the Omani camels were identical to each other and highly similar to those from camel samples from Qatar and Egypt. When the team compared the sequences with other camel samples and 33 human MERS-CoV sequences, they found that the camel sequences clustered independently from each other but with human MERS-CoV sequences from the same geographic area.

For example the Omani camel sequence clustered closely with genes from human samples from the neighboring United Arab Emirates, and researchers saw a similar connection between the animal and human Qatari sequences.

The authors said a high infectious dose through very close contact with a camel might trigger human infections and that the respiratory route might be the most likely route of transmission.
Apr 24 Eurosurveill report


China reports two more H7N9 infections

Two new H7N9 influenza cases were reported today in two of China's provinces, according to health department notices translated and posted by FluTrackers, an infectious disease news message board.

One is in a 51-year-old man from Jiangsu province who is hospitalized in Zhenjiang in critical condition. The other involves a 75-year-old woman with a history of exposure to poultry who is hospitalized in Ganzhou, where her condition is listed as stable.

The cases lift the overall outbreak total to 431. So far 295 of the detections have been reported in the outbreak's second wave, compared with 136 in the first.

In other developments, the World Health Organization (WHO) today provided more details about six H7N9 cases, one of them fatal, reported by China on Apr 17, 20, and 23. They involve three patients from Jiangsu province and one each from Hunan, Guangdong, and Anhui provinces.

One of the patients is a 35-year-old woman who works as a healthcare worker in the Jiangsu province city of Wuxi, where she is hospitalized in critical condition. The report does not say how she was likely exposed to the virus.

Only one of the six patients in today's report was reported to have been exposed to poultry.

Patient ages range from 34 to 60. Among the survivors, four are in critical condition and one is listed in severe condition. Illness onsets range from Mar 21 through Apr 10.
Apr 24 FluTrackers thread
FluTrackers human H7N9 case count
Apr 24 WHO update


CDC: US kids' vaccine program has saved 732,000 lives

The federal Vaccine for Children (VFC) program, which has now been in place for 20 years, has prevented 322 million illnesses, 21 million hospitalizations, and 732,000 deaths, according to a report today from the US Centers for Disease Control and Prevention (CDC).

The assessment of the program, approved by Congress in 1993 and implemented the following year to boost low immunization coverage, appears today in Morbidity and Mortality Weekly Report (MMWR). The CDC's researchers also estimated that the VFC program saved $1.38 trillion.

In a press release today, the CDC said a recent increase in measles cases serves as a reminder of the importance of the VFC program, which has seen five new vaccines added to routine infant immunizations and now provides protection against 14 different diseases.

As of Apr 18, the CDC has received reports of 129 measles cases that were part of 13 outbreaks, according to the statement. It noted that 34 of the patients were infected in other countries and that most of the other infections were linked to those imported cases. Most of the people infected this year were not vaccinated or did not know their vaccination status.

CDC Director Tom Frieden, MD, MPH, said in the release that the nation's health security is only as strong as that of all nations. "Stopping outbreaks where they start is the most effective and least costly way to prevent disease and save lives at home and abroad—and it's the right thing to do."

The CDC released the report ahead of the Apr 26 start of National Infant Immunization Week, an observance designed to raise awareness for childhood vaccinations.
Apr 25 MMWR report
Apr 24 CDC press release


Study: Frozen donor stool via nasogastric tube may cure C diff

The use of frozen stool from healthy donors for fecal microbiota transplantation (FMT) successfully treated 18 of 20 patients (90%) who had serious, relapsing diarrhea caused by Clostridium difficile, according to a study yesterday in Clinical Infectious Diseases.

The treatment was equally effective whether given via colonoscope or a less invasive nasogastric tube.

Massachusetts researchers treated patients who had repeated episodes of C difficile infection using FMT, which helps restore a healthy balance of bacteria in the digestive tract. Fourteen of the patients were cured after one treatment, meaning no disease relapse within 8 weeks. Of the remaining six patients, five received a second administration, and four of them were cured.

The researchers used frozen fecal material from unrelated donors that was screened well ahead of time. Patients who required a second infusion were allowed to choose between the two methods, and all five chose the nasogastric tube.

"We found that delivery of a frozen, stored inoculum through a nasogastric tube is safe, acceptable to patients and as successful as delivery by colonoscopy—which requires a preparatory 'clean out,' sedation or anesthesia, and is quite costly," said senior author Elizabeth Hohmann, MD, of the Massachusetts General Hospital (MGH) Infectious Diseases Division, in an MGH news release.

The researchers are now studying placing the donated material into a frozen capsule, which patients would take orally and would remain undigested until it reaches the small intestine, according to the release.
Apr 23 Clin Infect Dis study
Apr 24 MGH news release


Polio surveillance dropped in Africa, Middle East: CDC

Surveillance for poliovirus (PV) in African and the Middle East declined substantially last year, the US CDC reported today.

Polio cases are detected by monitoring for acute flaccid paralysis (AFP) in children and testing stool specimens using a global lab network, CDC researchers said in MMWR.

The number of African and the Middle Eastern countries meeting national performance targets for polio detection and collection of adequate specimens dropped from 27 of 30 nations (90%) in 2012 to 22 (73%) in 2013, primarily due to deficiencies in Africa.

Environmental surveillance involves testing sewage samples from selected sites for PV and supplements surveillance in humans. The report notes that the proportion of sewage samples in Pakistan that tested positive for wild PV decreased from 67% in 2011 to 20% in 2013.

Pakistan, Afghanistan, and Nigeria are the only three countries in which polio remains endemic.

The authors conclude, "To achieve polio eradication and certify interruption of PV transmission, intensive efforts to strengthen and maintain AFP surveillance are needed at subnational levels, including in field investigation and prompt collection of specimens, particularly in countries with current or recent active PV transmission."
Apr 25 MMWR report

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