News Scan for Jan 06, 2015

H7N9 case in China
MERS in Saudi Arabia, Jordan
ICU infections in elderly
Cold and catching cold

China reports another H7N9 case in Guangdong province

China reported its second H7N9 avian flu case this year, with both cases in Guangdong province near Hong Kong, according to a report today from Xinhua, the country's state-run news agency.

The new case is in a 36-year-old man in the city of Dongguan, which is just north of Shenzhen, the site of an H7N9 infection reported yesterday in a 6-year-old girl. The man is in critical condition in a Dongguan hospital, Xinhua reported, citing provincial health authorities.

Officials in Guangdong and Hong Kong last week culled thousands of chickens after exports to Hong Kong were found to be infected with H7N9, the story said. And Hong Kong raised its response level in hospitals to "serious" from "alert" late last month, after a 68-year-old woman who had traveled from Shenzhen was hospitalized on Dec 25 with H7N9.

The new case raises the global H7N9 total to 477 cases, according to a list kept by FluTrackers, an infectious-disease news message board. Hong Kong health officials yesterday said Guangdong is China's second-most-affected province.
Jan 6 Xinhua story
FluTrackers H7N9 case list


Saudi Arabia reports new MERS case, WHO posts details on recent cases

Saudi Arabia's Ministry of Health (MOH) reported 1 new MERS-CoV case today, bringing the country's total to 829 cases, and the World Health Organization (WHO) posted additional details yesterday on recent MERS cases in Jordan and Saudi Arabia.

The new case-patient is a 61-year-old male expatriate living in Riyadh. He has an underlying medical condition and is currently hospitalized in intensive care. He is not a healthcare worker and had no other risk factors for MERS-CoV (Middle East respiratory syndrome coronavirus), such as exposure to animals or contact with MERS cases in clinical or community settings.

Six MERS cases are still active in Saudi Arabia, 466 people have recovered, and 357 people have died, the MOH said in today's update.

In related news, the World Health Organization (WHO) posted additional details yesterday on recent MERS-CoV cases in Jordan and Saudi Arabia. The patient originally reported in Jordan on Dec 25 is a 70-year-old man from Qurayyat, Saudi Arabia. He has an underlying medical condition and a history of consuming raw camel milk; he had no recent contact with MERS cases.

The man was hospitalized for MERS in Qurayyat on Dec 21, discharged himself against medical advice and traveled to Jordan, where he was hospitalized on Dec 22. He was transferred back to a hospital in Qurayyat on Dec 26, where he is in critical condition and on mechanical ventilation.

The WHO also provided additional details on three Saudi MERS cases, including one death, that involved illness onsets between Dec 19 and 30. The patient who died was an 84-year-old man from Najran with an underlying medical condition. He lived in an area where camels are present and owned goats and sheep but did not come into direct contact with them.

Another patient is a 31-year-old woman from Riyadh with preexisting disease and no history of animal exposure or contact with MERS cases. She is currently hospitalized in critical condition.

The third patient is a 53-year-old man from Al-Kharj with an underlying medical condition. He lives in an area where camels are present and had direct contact with goats and sheep. He is in stable condition in an isolation ward, the agency said.

The WHO said it has been notified of 945 lab-confirmed MERS cases globally and 348 deaths.
Jan 6 MOH report
Jan 5 WHO statement on Jordan
Jan 5 WHO statement on Saudi Arabia


Study: Healthcare-associated infections in elderly raise 5-year death risk

Elderly people who contracted a healthcare-associated infection (HAI) during an intensive care unit (ICU) stay had an increased risk of dying within 5 years, according to a Jan 1 study in the American Journal of Infection Control.

The authors retrospectively analyzed ICU data from 17,537 elderly patients admitted in 2002 to 31 hospitals and an additional 5 years' of Medicare claims data to assess the long-term outcomes and health costs attributed to HAIs. The average age of patients was 77 years.

The study examined long-term risks of central line–associated bloodstream infections (CLABSIs) and ventilator-associated pneumonia (VAP) on 5-year patient quality of life, risk of death, and excess hospital costs. Data from 701 hospitals in 2011 provided further information on HAIs and their related costs.

More than half (57%) of all elderly ICU patients died within 5 years of leaving the hospital. Patients with HAIs, however, were 35% more likely to die in the 5 years following their ICU stay; 75% of patients with a CLABSI and 77% of patients with VAP died within 5 years.

The authors found that preventing CLABSIs led to a gain of 15.55 life years and 9.61 quality-adjusted life years (QALYs). VAP prevention led to a gain of 10.84 life years and 6.55 QALYs.

Prevention of CLABSIs reduced ICU costs by $174,713 per patient, and VAP prevention reduced costs by $163,090 per patient (in today's dollars). The authors estimate that an ongoing ICU infection prevention program costs $145,000 a year.

HAIs kill more than 75,000 Americans each year and lead to $33 billion in excess costs, according to a news release yesterday from Columbia University.
Jan 1 Am J Infect Control study
Jan 5 Columbia University news release


Mouse study supports notion that being cold boosts susceptibility to colds

A mouse experiment suggests that cells in the nose mount a weaker defense against viruses at lower temperatures, thus supporting the popular but debated notion that being cold increases susceptibility to the common cold, according to a Jan 5 report in the Proceedings of the National Academy of Sciences (PNAS).

The researchers say it has long been known that rhinoviruses, the most common cause of colds, grow faster in the relatively cool environment of the nose than in the warmer lungs, but previous studies have focused on the effects of temperature on the virus rather than on the immune response.

Accordingly, the team compared the immune response of cultured mouse airway epithelial cells at 37°C (core body temperature) and 33°C. They found that cells infected with mouse-adapted rhinovirus 1B showed much greater expression of antiviral defense response genes at 37°C than at 33°C, and this correlated with higher expression of interferon genes at 37°C, the report says.

In addition, the team examined viral growth in airway cells from mice with genetic deficiencies in immune-system sensors that detect viruses and in the antiviral response. They found that these immune deficiencies supported much higher levels of viral replication at the higher temperature than occurred in normal cells, according to the report.

"That proves it's not just virus intrinsic, but it's the host's response that's the major contributor" to the difference in viral replication at different temperatures, senior author Akiko Iwasaki, PhD, a Yale professor of immunobiology, said in a Yale press release.

"In general, the lower the temperature, it seems the lower the innate immune response to viruses," Iwasaki said. This may support the view that people should keep warm, and even cover their noses, to avoid catching colds, according to the release.
Jan 5 PNAS abstract
Jan 5 Yale
press release

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