News Scan for Jul 23, 2014

More chikungunya in US
MDR-TB treatment resistance risks
Polio vaccination in Syria

CDC: Imported US chikungunya cases surge to 300

The chikungunya epidemic in the Caribbean is continuing to spill over into the United States, with 300 imported cases identified as of yesterday, an increase of 66 from a week earlier, according to the Centers for Disease Control and Prevention (CDC).

Of the 300 cases, 295 were in travelers returning from the Caribbean or South America, the CDC said. The other five were associated with trips to Pacific islands (4 cases) or Asia (1).

Florida has had by far the most cases, 77, followed by New York with 30 and Tennessee with 18. Cases have been reported in 35 states, but most have fewer than 10.

The first two locally acquired chikungunya cases in the continental United States were reported last week in Florida.

The Caribbean epidemic, which began last December and is the first in the Americas, has led to 193 locally acquired cases in Puerto Rico and 2 in the US Virgin Islands, the CDC update noted. Puerto Rican officials declared a chikungunya epidemic on Jul 16.

From 2006 through 2013, the United States averaged just 28 chikungunya cases annually, all of them imported, according to the CDC. The virus does not spread from person to person, but mosquitoes that bite infected people can pass the disease to others.

The Pan American Health Organization put the overall case count in the Caribbean epidemic at 442,310 late last week.
Jul 22 CDC update
Related Jul 17 CIDRAP News story


Study profiles further resistance patterns during MDR-TB treatment

A large, international study to assess the impact of efforts to get second-line treatment to more patients with multidrug-resistant (MDR) tuberculosis (TB) found that treating the condition increases the risk of more resistance, which could be minimized if certain steps are followed.

Researchers from nine different countries, including some from the CDC, published their findings today in Clinical Infectious Diseases.

The team followed 832 patients from 26 clinical sites from Jan 1, 2005, through the end of 2008. Five of the countries participate in the Green Light Committee (GLC), a program designed to increase access to second-line drugs: Estonia, Latvia, Peru, the Philippines, and Russia. Four other non-GLC countries volunteered for the study: South Africa, South Korea, Thailand, and Taiwan. Researchers obtained baseline and monthly sputum cultures. Duplicates of the cultures were sent to the CDC for testing.

Of those without baseline resistance to specific second-line drugs, 8.9% acquired extensively drug-resistant (XDR) TB, 11.2% acquired fluoroquinolone resistance, and 7.8% acquired resistance to second-line injectable drugs. However, the risk of acquiring resistance was lower at GLC-approved sites.

Investigators noted that the findings have important policy implications for programs scaling up services for MDR-TB. For example, they said drug-susceptibility testing should be repeated during treatment and that use of new drugs in regimens without at least two or three other highly effective drugs will contribute to rapidly developing resistance to the new drug.

In an accompany editorial in the same issue, two US experts wrote that there are a number of reasons why MDR-TB patients may develop additional resistance, including variation in drug quality.

They wrote that the study identifies some parameters associated with further drug resistance, though it's difficult to tease out ones that are amenable to intervention. The experts agreed that efforts should be made to ensure that MDR-TB programs embrace GLC features.

However, they disagreed with the study authors' assertion about rapid molecular diagnostics in those who were treated previously. They added that all drug-resistant cases should be diagnosed and started on appropriate treatment as soon as possible.
Jul 23 Clin Infect Dis abstract
Jul 23 Clin Infect Dis editorial


Crucial need cited for continued polio vaccination efforts in Syria

Polio cases in war-torn Syria, which hadn't seen a case since 1999 until the conflict began there 3 years ago, continue to mount and without continued and effective vaccination campaigns will only add to what is already a "humanitarian disaster," says a story from the United Nations (UN) yesterday.

Vaccination coverage in Syria has dropped from an average of 99% to 52% since the war began, says the story, and Syria's health infrastructure has been severely damaged. More than 6.5 million children in the country depend on humanitarian assistance, it notes.

The UN Children's Fund (UNICEF) and the World Health Organization (WHO) have completed the first phase of the largest vaccine campaign in the history of the Middle East, reaching 25 million children under age 5 in seven countries. However, more than 750,000 Syrian children reside in unreachable areas, says the story. More campaigns are planned for October and November.

UNICEF and the WHO have called for "immediate and unhindered access to hard-to-reach children" as well as safe passage for health workers and medical vehicles.

New polio cases have shown up recently in Iraq and Somalia as well as Syria. Estimates say more than half a million children in the latter country live in inaccessible areas.
Jul 22 UN news story
Jun 18 CIDRAP News scan on vaccination campaign

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