News Scan for Jan 08, 2015

H7N9 cases in China
Antibiotic discovery
Disney measles outbreak
Omani, Saudi MERS cases
Crimean-Congo fever in HCWs

Two Chinese provinces report 10 H7N9 infections

December disease reports from China's Fujian and Jiangsu provinces revealed 10 more H7N9 avian influenza infections, none of them fatal, according to reports in Chinese identified, translated, and posted by FluTrackers, an infectious disease news message board.

Fujian province reported six of the cases and Jiangsu province reported four. No other details were available about the cases, other than that none were fatal.

Fujian province's previous case-patient was a 27-year-old man from Fuqing City who got sick in late November and had been hospitalized in severe condition. Jiangsu province reported its most recent cases in November—involving three adults, all from different cities.

The new cases that surfaced today lift the global number of H7N9 cases to 488, according to FluTrackers' case list.
FluTrackers thread about six Fujian province H7N9 cases
FluTrackers thread about four Jiangsu province H7N9 cases
FluTrackers H7N9 case list


Study: New, potentially 'irresistible' antibiotic found in Maine dirt

A new antimicrobial, not yet tested in humans, that appears to retain its effectiveness against even what are now drug-resistant pathogens has been discovered in soil through use of a promising new device, a study published yesterday in Nature announced.

The antibiotic, named teixobactin by the researchers, was tested against numerous pathogens in vitro and in mice and found to be effective. Among them were methicillin-resistant Staphylococcus aureus (MRSA) and Mycobacterium tuberculosis.

The agent is thought to attack microbes by binding to fatty lipids that make up the bacterial cell wall, unlike typical antibiotics, which target proteins that easily mutate and become resistant. Even if resistance to teixobactin were to occur, explain the authors, it would take a long time because it is difficult for a bacterium to alter fundamental building blocks of a cell.

The multichannel device used by the authors to isolate and grow the new agent in the laboratory may be as exciting as the organism itself, as it opens the door to discovering environmental microbes that are deadly to other pathogens but are typically not possible to grow outside their natural habitat.

The iChip device sorts bacterial cells from soil samples into chambers and is then buried back into the ground. Diffusion of nutrients and growth factors allow the bacteria in the chambers to reproduce in a more natural setting. The colonies can then be brought into the lab, where they thrive.

According to the authors, 99% of bacteria in the external environment have proved impossible to grow in the lab. This new method allows growth of up to 50% of the uncultured bacteria, they say.

While optimism over teixobactin is reasonable, years of testing are necessary to determine whether it could be used safely and effectively against pathogens in humans. In addition, the agent failed against gram-negative bacteria such as the highly antibiotic-resistant Klebsiella pneumonia. It is hoped that the iChip technology might be used to find new drugs capable of killing even those holdouts.
Jan 7 Nature study abstract
Jan 7 Nature News story on the study
Jan 7 New York Times story


California and Utah measles cases linked to Disney parks

California health officials said yesterday that nine people with confirmed measles cases, two of them Utah residents, were likely exposed to the virus at one of two Disney parks in Orange County between Dec 15 and Dec 20. Three suspected cases have also been identified.

The seven California patients range in age from 8 months to 21 years, according to a statement from the California Department of Public Health (CDPH). Six had not been vaccinated, including two who were too young to be immunized against measles. One had received two doses of measles vaccine. The patients are from five different cities, and several large contact investigations are under way.

All of the confirmed and suspected cases reported visiting either Disneyland or Disney California Adventure Park, and the CDPH added that it's likely that a person infected with measles was at one of the theme parks on the specified days. It said several large measles outbreaks have occurred overseas in recent years and that people from many parts of the world visit Disney and other theme parks in California, including people from countries where the disease is endemic.

Meanwhile, the Utah Department of Health (UDH) said its two patients who were part of the outbreak would have been contagious from Dec 27 through Jan 5, and they attended several events in Utah while they were infected. Locations detailed in a UDH statement yesterday include a grocery store, movie theaters, a church, a department store, and two health facilities. The UDH is identifying contacts and screening people for possible exposure.
Jan 7 CDPH statement
Jan 7 UDH statement


Oman, Saudi Arabia report MERS cases

Officials have announced a case of MERS-CoV in Oman—a fatal one—and in Saudi Arabia.

The case of MERS-CoV (Middle East respiratory syndrome coronavirus) in Oman was its first in almost a year and its third overall, Arab News reported today. All cases have been fatal. The country's health ministry provided no further details.

The case in Saudi Arabia involves an 80-year-old Saudi man in Riyadh, according to an update today from the country's Ministry of Health (MOH). He has preexisting disease, is not a healthcare worker (HCW), and is listed in critical condition. He had no recent contact with animals or other MERS patients.

Saudi Arabia has now confirmed 831 MERS-CoV cases, including 358 deaths. Six of those cases were reported this year.
Jan 8 Arab News story
Jan 8 MOH update


Health worker cluster points to possible airborne CCHF

Russian scientists writing yesterday in the International Journal of Infectious Diseases describe a cluster of nosocomial Crimean-Congo hemorrhagic fever (CCHF) in eight HCWs, two of whom had no contact with the patient's bodily fluids and may have been infected via airborne transmission.

A 23-year-old woman who was 22 weeks pregnant was admitted to a hospital in the Rostov region of southwestern Russia, an area with endemic CCHF, in May 2011. CCHF was lab-confirmed on her 5th day of hospitalization. She was intubated and placed on a ventilator the next day after her condition deteriorated, and she died the day after.

The 8 HCWs—3 physicians, 4 nurses, and 1 attendant— developed CCHF 1 to 4 days after her death, and all cases were lab confirmed by polymerase chain reaction and serology tests. Three of the HCWs performed aerosol-generating procedures. Also, a nurse and an anesthesiologist who did not perform aerosol-generating procedures had no direct or indirect contact with the patient's bodily fluids.

All the HCWs worked in the patient's room during the potential exposure period without goggles and respirators, wearing only gloves, disposable surgical masks, and gowns, which do not protect skin, conjunctiva, and the upper respiratory tract against aerosols, the authors reported. The patient was in an isolation room without negative pressure.

The authors cite three other published accounts of possible airborne CCHF transmission, including one published in Emerging Infectious Diseases last March on a cluster in Turkey. CCHF is caused by a bunyavirus, whereas Ebola and Marburg viruses—which also cause hemorrhagic fevers—are filoviruses.
Jan 7 Int J Infect Dis abstract
March 2014 Emerg Infect Dis
report on Turkey cluster

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