News Scan for Oct 13, 2014

MERS in Qatar, Saudi Arabia
Chikungunya spread continues
Fecal transplant for C diff
H5N2 in Germany

Qatar has first MERS case of 2014; Saudi Arabia has 3 more

Qatar has reported its first MERS-CoV case this year, according to media reports, while Saudi Arabia's Ministry of Health (MOH) has confirmed three new cases in as many days, all in men, none of whom are healthcare workers.

Qatar's Supreme Council of Health said the case there involves a 71-year-old Qatari man who fell ill while in Saudi Arabia, according to a report yesterday in The Peninsula, a newspaper in Qatar. He was traveling to Al-Ahsa by road when he got sick. He was hospitalized and was later flown by air ambulance back to Qatar, where he remains hospitalized, the story said.

The new case raises Qatar's MERS-CoV (Middle East respiratory syndrome coronavirus) count to 10, including 5 deaths, according to a case list maintained by FluTrackers. The last case was reported in November 2013.

In Saudi Arabia, the first of the three MERS cases, reported on Oct 11, is in a 50-year-old expatriate in Najran in the southern part of the country. He was symptomatic and is hospitalized, but not in an intensive care unit (ICU). He has no underlying medical conditions, the MOH said.

The second patient, whose case was confirmed yesterday, is a 70-year-old Saudi man from Taif in Mecca province. He is receiving ICU care and has pre-existing disease.

The third patient is a 44-year-old national from Riyadh who also has pre-existing disease and is in an ICU. None of the three men reported recent animal exposure.

The cases bring the country's MERS total for the month so far to 7, 4 of which have been in Taif. The MOH reported 11 MERS cases in September, 5 of which were in Taif. All told, Saudi Arabia has detected 762 MERS cases, including 324 fatal ones.

On Oct 11 the MOH also reported that a previously confirmed case-patient in Taif recovered from his illness. The 65-year-old Saudi man's case matches one confirmed by the MOH on Sep 19.
Oct 12 Peninsula story
Oct 11 MOH update
Oct 12 MOH update
Oct 13 MOH update
Sep 19 CIDRAP News scan on previous case in Taif


Caribbean chikungunya outbreak grows by more than 9,700 cases

Editor's Note: The headline and first paragraph of this scan were revised on Oct 17 to correct misstated PAHO numbers.

Last week's increase in suspected and confirmed chikungunya cases in the ongoing outbreak in the Caribbean and neighboring parts of the Americas numbered 9,711, bringing the total to 759,948, according to an Oct 10 update from the Pan American Health Organization (PAHO).

The areas reporting the greatest increases were Puerto Rico with 2,437 new cases, French Guiana with 1,960, Guadaloupe with 1,690, and Guatemala, reporting its first 424 cases.

Only 11,545 cases have been confirmed.

In the United States, imported cases now number 1,326, according to the Centers for Disease Control and Prevention's (CDC's) Oct 7 update. PAHO puts the US number as of Oct 10 at 1,340. In addition, 11 locally transmitted cases, all of them in Florida, have occurred in the United States.

Puerto Rico and the US Virgin Islands have seen 428 and 45 locally transmitted cases and 25 and 5 travel-associated cases, respectively, says the CDC report.

In related news, the CDC last week announced a new interactive, Web-based tool for predicting where chikungunya-infected travelers are likely to arrive and what geographic areas are at risk for local transmission. Dubbed Nowcast, the model will be updated monthly using the most recent month's data, the CDC said.
Oct 10 PAHO update
Oct 7 CDC update
Oct 7 CDC press release on Nowcast

Fecal microbiota capsules may effectively treat C diff

A small, preliminary study has shown that oral capsules containing frozen fecal microbiota transplant (FMT) material may be as much as 90% effective in treating Clostridium difficile infection (CDI) diarrhea, according to a new report in the Journal of the American Medical Association (JAMA).

The study involved 20 patients with at least three episodes of mild to moderate CDI and failure of a 6- to 8-week taper with oral vancomycin or at least two episodes of CDI requiring hospitalization. They received 15 capsules on 2 consecutive days and were followed up for symptom resolution and adverse events for up to 6 months.

Among the 20 volunteers, 14 (70%) had resolution of diarrhea after the treatment and remained symptom free 8 weeks later. All 6 whose diarrhea did not resolve were re-treated an average of 7 days after the first procedure, and 4 experienced resolution of diarrhea, resulting in an overall 90% success rate.

The researchers, from Massachusetts General Hospital and elsewhere, observed no serious adverse events attributed to FMT. They said that, after larger studies, the treatment may provide an alternative to more invasive administration of FMT.

"Numerous reports have shown that FMT is effective in treating active C difficile infection and preventing recurrences in patients whose infections failed to respond to standard treatments," said lead author Ilan Youngster, MD, of Boston Children's Hospital, in a Massachusetts General Hospital press release. "The procedures that have been used before—colonoscopies, nasogastric tubes, even enemas—all have potential risks and discomforts for patients. The use of capsules simplifies the procedure immensely."
Oct 11 JAMA abstract
Oct 11 Massachusetts General Hospital news release
Oct 11 JAMA press release


Germany reports low-path H5N2 in poultry

Low-pathogenic H5N2 avian influenza struck a farm in Germany last week, according to an Oct 10 report filed with the World Organization for Animal Health (OIE).

The farm, near Laer in North Rhine-Westphalia, housed 1,732 poultry. One of the birds died on Oct 7 and tested positive by polymerase chain reaction for H5N2 on Oct 9. The remainder of the flock was culled to prevent disease spread.

No poultry or poultry meat was moved from the farm, the report said, and disinfection was completed on Oct 9.
Oct 10 OIE report

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