News Scan for Nov 10, 2014

Spike in chikungunya cases
Listeriosis from mung sprouts
New Saudi MERS case
C diff underdiagnosis

Chikungunya cases rise steeply, especially in Central America

More than 95,000 new cases of chikungunya have been reported in the Caribbean and Americas since Oct 31, bringing the total to 888,806 cases since the outbreak began in December 2013, according to a Nov 7 update from the Pan American Health Organization (PAHO).

The largest increases were reported in El Salvador, with 76,831 new suspected and confirmed cases since the Oct 31 PAHO update. Chikungunya infections were also reported for the first time in Honduras, with 195 suspected and confirmed cases.

The dramatic spike in cases comes after weeks of increases of well under 10,000 cases per week.

Also, two chikungunya strains have been identified circulating in Brazil, according to a Nov 8 Communicable Disease Threats Report from the European Centre for Disease Prevention and Control (ECDC).

An Asian strain transmitted via the female Aedes aegypti mosquito and responsible for the current outbreak was identified in Brazil, as well as an African strain. The ECDC said that the African strain shows no mutations that would allow it to be transmitted via Aedes albopictus, another potential vector.
Nov 7 PAHO
Nov 8 ECDC
Nov 3
CIDRAP News scan on recent cases


Chicago company's mung sprouts likely tied to summer listeriosis cases

Five listeriosis cases over the summer, two of them fatal, appear to be related to mung bean sprouts from Wholesome Soy Products, Inc, and the Centers for Disease Control and Prevention (CDC) is recommending that consumers not eat any products from the company, according to a Nov 7 outbreak report from the CDC.

The Food and Drug Administration (FDA) detected Listeria monocytogenes in the sprouts and in irrigation water used for growing them at the company, located in Chicago, during routine testing Aug 13. Wholesome Soy issued a voluntary recall of the sprouts and ceased production Aug 28, but production was resumed Sep 15.

FDA did testing again from Oct 7 to 31 and detected the organism in nine environmental swabs and reported unsanitary conditions and poor equipment maintenance. Product and water from the plant were then tested via pulsed-field electrophoresis (PFE) and whole-genome sequencing (WGS) to more accurately characterize the Listeria isolates.

PFGE and WGS were also used to search cases of listeriosis recorded through PulseNet, the national network that performs molecular surveillance of foodborne infections, to find any involving highly related strains, which would likely indicate a common source.

WGS of Listeria from five people who became ill from June through August, four in Illinois and one in Michigan, were found to be highly related to the Listeria strain from Wholesome Soy Products. All had been hospitalized, and two died. Two patients were interviewed and reported eating bean sprouts in the month before their illness.

Wholesome Soy Products stopped production of all products except mung and soy bean sprouts on Oct 14. FDA is working with the company, and Illinois' department of health is working on an embargo of products from the facility and alerting other wholesalers and facilities that may have product to hold or destroy it.
Nov 7 CDC outbreak alert


Saudi Arabia reports MERS case, death

After a 2-day lull, Saudi Arabia's Ministry of Health (MOH) today reported a new MERS-CoV case in Riyadh and the death of a previously reported patient in Taif.

The new MERS-CoV (Middle East respiratory syndrome coronavirus) case is in a 45-year-old female expatriate in Riyadh. She is hospitalized in stable condition, the MOH said. She is not a healthcare worker and had no recent contact with animals or MERS case-patients in the community, but exposure to MERS-CoV patients in a healthcare setting is being investigated.

The MERS-related death is in a 75-year-old expatriate female. The MOH reported her case 5 days ago, at which time it said she was in intensive care and had preexisting disease but no risk factors like contact with animals or other patients.

The new case and death push the Saudi MERS-CoV case count to 799, including 339 fatalities.
Nov 10 Saudi MOH update


Study: C diff diagnosis missed in 23% of European hospital cases

Active Clostridium difficile infections failed to be diagnosed in 23% of hospital patients, according to a study of almost 500 European hospitals published Nov 7 in Lancet Infectious Diseases.

As part of the EUCLID study, a multi-center group of researchers gathered data on 2011-2013 laboratory testing for patients with diarrheal disease from 482 hospitals in 20 European countries. All diarrheal samples obtained from hospitals were re-tested by national laboratories. Researchers found that an average of 74 diagnoses of C difficile per daywere missed by hospital laboratories.

Researchers attributed underdiagnosis to suboptimum hospital testing practices, defining optimum testing as a two-stage process of enzyme immunoassay and toxin culture.

Only two-fifths of European hospitals reported using optimum two-stage testing for C difficile, although the number of hospitals using optimum methods improved from 32% to 48% during the study period.The United Kingdom had the highest percentage of hospitals (79%) using optimum methods.

Aside from the underdiagnosed patients, the study also found a significantly high number of false-positive C difficile cases when culture alone was used for diagnosis. The median age of underdiagnosed patients was significant lower (65.5 years) than that of correctly diagnosed people (76 years), the study said.

In a related commentary, Simon D. Goldenberg, MD, of the Centre for Clinical Infection and Diagnostic Research at King's College in London noted the 48-fold variation across hospitals' laboratory testing practices, especially between hospitals in western Europe and those in southern or eastern Europe.

Goldenberg advocated for greater standardization of testing practices across European countries and enhanced clinical suspicion for C difficile when encountering a patient with diarrheal disease. He also stated the need for more follow-up to understand the effects of underdiagnosis on overall patient health and in-hospital transmission.

EUCLID is the largest-ever European epidemiologic study of C difficile in hospitals.
Nov 7 Lancet Infect Dis
Nov 7 Lancet Infect Dis

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