News Scan for Jul 17, 2014

MERS-CoV origins
Resistant bacteria in hospitals
Haiti sanitation effort
Pertussis vaccine in pregnancy
Tattoo recall expanded

Bat coronavirus study suggests MERS-CoV 'roots'

Researchers who analyzed the genome of a new coronavirus (CoV) from a South African bat sample demonstrated that it may be the ancestor of MERS-CoV, that a host switch from bats to camels may have taken place in Africa, and that camels are likely infecting humans rather than vice versa, according to a study yesterday in the Journal of Virology.

A German–South African team, including Christian Drosten, MD, of the University of Bonn, sequenced the full genome of a CoV isolated from the feces of a South African Neoromicia capensis, or Cape serotine, bat and named it NeoCoV. They found that 85% of the NeoCoV nucleotide was identical to that of MERS-CoV (Middle East respiratory syndrome coronavirus), and that the two belonged to one viral species.

"The bat virus roots the phylogenetic tree of MERS-CoV, providing evidence for an evolution of MERS-CoV in camels that preceded that in humans," the authors wrote.

The researchers also noted genetic findings that suggest a higher viral diversity of CoV in camels than in humans. "Together with serologic evidence for widespread MERS-CoV infection in camelids sampled up to 20 years back in Africa and the Arabian Peninsula, the genetic data indicates that camels act as sources of virus for humans rather than vice versa," they wrote.

The authors conclude, "The acquisition of MERS-CoV by camels from bats might have taken place in Sub-Saharan Africa. Camelids may represent mixing vessels for MERS-CoV and other mammalian CoVs."
Jul 16 J Virol abstract


Study: Highly resistant bacteria rising in US community hospitals

Infections with the class of highly drug-resistant bacteria known as carbapenem-resistant Enterobacteriaceae (CRE) increased fivefold over a recent 5-year period in 25 community hospitals in the southeastern United States, according to a study in Infection Control and Hospital Epidemiology (ICHE).

CRE are resistant to most commonly used antibiotics and have been called "one of the three greatest threats to human health" by the World Health Organization, according to the Society for Healthcare Epidemiology of America (SHEA), publisher of ICHE. In a press release, the group said at least 48% of CRE infections are fatal.

In the study, researchers from Duke University and other institutions prospectively collected data on CRE isolates at the 25 hospitals from January 2008 through December 2012.

A total of 305 CRE isolates were identified at 16 hospitals. Of the affected patients, 180 (59%) had symptoms and the rest had asymptomatic colonization. Klebsiella pneumoniae was by far the most prevalent CRE species (277 cases, 91%).

The frequency of CRE detection rose more than fivefold from 2008 to 2012: from 0.26 to 1.4 cases per 100,000 patient-days. Only five hospitals had adopted the most recent and more sensitive guidelines for detecting CRE; the detection rate in these hospitals was more than three times higher than in the others.

Given the low adoption rate of the latest surveillance guidelines, the authors say their findings probably underestimate the true level of CRE in the hospitals.

They say factors that are contributing to increased CRE include greater use of broad-spectrum antibiotics, easy transmission of CRE enzymes among bacteria, and increased transmission between long-term acute-care facilities and community hospitals.

"A CRE epidemic is fast approaching," lead author Joshua Thaden, MD, commented in the press release. "We must take immediate and significant action in order to limit the transmission of these dangerous pathogens throughout our hospitals and acute care facilities."
August 2014 ICHE abstract
Accompanying ICHE commentary
Jul 16 SHEA  press release


UNICEF, Haiti launch sanitation campaign

The United Nations Children's Fund (UNICEF) and Haiti's government yesterday announced the launch of a campaign to reduce open defecation, a step designed to reduce the country's cholera burden.

The National Sanitation Campaign combines community outreach to encourage behavior change, an approach that has seen results in three of Haiti's departments, and sanitation infrastructure improvements that include clean drinking water, according to a UNICEF press release. The program targets 55 communities in 10 of Haiti's districts, which are home to 3.8 million people.

Major donors for the campaign include Canada, which will contribute $11 million over the next 3 years, and Japan, which earmarked its $2.5 million donation to cover 2014 through 2015.

Haitian Prime Minister Laurent Lamothe said in the statement, "Until every household has access to safe drinking water and sanitation facilities, cholera and other water-borne diseases will remain a potential threat to vulnerable families throughout the country. We count on the support of the UN and that of international partners to make this a reality."

The program's goal is to stem the spread of cholera and halve the incidence of diarrhea over the next 2 years, UNICEF said. It added that deaths and illnesses from the disease are down 75% for the first quarter of this year compared with the same period in 2013.
Jul 16 UNICEF press release


Study: Pertussis vaccine during pregnancy may protect infants

Immunization with the acellular pertussis vaccine during pregnancy was associated with 91% protection in babies younger than 3 months old, according to an observational study yesterday in The Lancet that wasfunded by Public Health England (PHE).

The UK investigators analyzed PHE data from lab-confirmed cases and hospital admission for pertussis (whooping cough) from Jan 1, 2008, through Sep 30, 2013. They calculated vaccine effectiveness (VE) by comparing vaccination status for mothers in confirmed cases with estimates of vaccine coverage for UK pregnant women based on national data.

Data on 26,684 new moms showed a VE of 91% (95% confidence interval [CI], 84%-95%) for infants younger than 3 months and a VE of 90% (95% CI, 82%-95%) for infants younger than 2 months.

The authors conclude, "This effectiveness probably results from protection of infants by both passive antibodies and reduced maternal exposure."

In an accompanying commentary, Australian and US experts said, "Evidence of the effectiveness of pertussis vaccine in pregnancy from this study is convincing, because of its magnitude, specificity, and the robustness of vaccine effectiveness estimates in sensitivity analysis, against a background of high biological plausibility."
Jul 16 Lancetabstract
Jul 16 Lancet


Company expands recall of tattoo products after contamination

The company that recalled tattoo products over bacterial contamination has expanded the recall and specified which bacteria have contaminated its products, including Clostridium botulinum, which can cause botulism, according to a Jul 15 Food and Drug Administration (FDA) news release.

White & Blue Lion, Inc., of the City of Industry, Calif., is recalling all tubes and ink cups, in addition to the tattoo ink, needles, and kits it recalled on Jul 11. "FDA Laboratory testing has found microbial bacterial contamination in both the inks and needles," the company said in the latest press release.

In the tattoo kits, which contain both inks and needles, the FDA detected Bacilllus species, Sphingomonas paucimobilis, Micrococcus lutes, Corynebacterium, C botulinum, and other Clostridium species. In the ink sets, the agency confirmed Bacillus, Acinetobacter, Staphylococcus haemolyticus, and Sphingomonas paucimobilis.

The news release noted twice in bold print that it did not isolate Mycobacteria, which has been implicated in several tattoo-related outbreaks in recent years.
Jul 15 FDA news release
Jul 14
CIDRAP News scan on initial recall notice
Aug 24, 2012, MMWR
report on Mycobacterium outbreak


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