News Scan for Feb 19, 2015

More Saudi MERS cases
'Superbug' infections in California
TB research initiatives
Neglected tropical diseases

MERS cases rise by 2, deaths by 5, as Saudi uptick continues

The recent rise in MERS-CoV activity continues in Saudi Arabia, with two new cases reported by the country's Ministry of Health (MOH) today, along with five deaths and two recoveries in previously reported cases.

The new cases are in elderly men, neither one a health worker and both with preexisting disease. Their infections bring to 899 the number of MERS-CoV (Middle East respiratory syndrome coronavirus) cases in Saudi Arabia since June 2012.

One case-patient is an 89-year-old Saudi from Riyadh who is in stable condition. He had no known exposure to animals or to confirmed or suspected MERS-CoV patients in the community setting, but exposure to infected patients in the hospital or clinic setting is "under investigation."

The other patient is an 83-year-old Saudi from Khobar who is in critical condition. He had no known exposure to animals or to MERS patients in the community setting but did have exposure in the healthcare setting.

The five deaths occurred in an 85-year-old Saudi man from Riyadh; two Saudi women from Khobar, ages 83 and 70; and two men from Buraydah, one a 23-year-old expatriate and the other a 25-year-old Saudi. All had preexisting disease and none was a health worker. The total number of deaths in Saudi Arabia now stands at 382.

Recoveries in previously reported cases occurred in two men, a 42-year-old expatriate from Buraydah and a 29-year-old Saudi from Riyadh. Neither is a health worker; only the latter case-patient had preexisting disease. Twenty-seven cases of MERS-CoV remain active in the country, plus two listed as "on home isolation." The number of recoveries totals 488, according to the MOH.
Feb 19 MOH update

In related news, the MOH has ordered 3-month suspension of leaves for health personnel in Saudi Arabia whose work involves combating MERS-CoV, according to a story today from Xinhua, China's news agency, and the possibility exists that no leaves will be allowed until after the flu season. The action was taken because of the recent rise in activity.

An MOH statement translated today by the blog Avian Flu Diary suggests that MERS-CoV may have a seasonal pattern of occurrence since its discovery in 2012, given a slight increase in cases in May 2013, followed by a 10-fold increase in spring (April through June) 2014 over spring 2013, and the already fivefold increase this February over the same period last year. The current uptick could indicate an early start to "MERS season," says the MOH.
Feb 19 Xinhua story
Feb 19 Avian Flu Diary post


7 UCLA patients infected, 2 fatally, via contaminated instruments

Seven patients treated at Ronald Reagan UCLA Medical Center, Los Angeles, have been infected with a serious antibiotic-resistant organism during medical procedures, two of them fatally, and 179 more may have been exposed, according to media reports and a UCLA news release.

The infecting organisms are of the carbapenem-resistant Enterobacteriaceae (CRE) group of related bacteria that have an enzyme that protects them from the powerful antibiotic carbapenem. The UCLA infections are thought to have been transmitted through two reusable duodenoscopes that had been cleaned according to the manufacturer's instructions, according to a statement from UCLA yesterday.

UCLA scientists became aware of the exposures in late January, said a Los Angeles Times story yesterday, and removed the involved scopes and started using a higher level of decontamination in other scopes. They are notifying 179 patients who were treated with the potentially contaminated scopes between October 2014 and January of this year to offer testing.

The scopes are inserted down the throat to treat cancer, gallstones, and other problems of the digestive system in a procedure called endoscopic retrograde cholangiopancreatography. It is thought that CRE may have built up in a small area of the duodenoscopes called the elevator channel, said the Times story.

Similar outbreaks have been reported previously, affecting well over 100 patients, the story said. The Food and Drug Administration is working with manufacturers of the scopes as well as with physician groups and hospitals to find a solution and better protect patient safety.

As pointed out in the Times story, the scopes involved "are not the same type used in more routine endoscopies and colonoscopies."
Feb 18 UCLA statement
Feb 18 LA Times story


NIAID expands TB research efforts as new drug enters clinical trials

Two initiatives in tuberculosis (TB) research were announced today: a major expansion of a US government-funded research program and the launch of the first clinical trial of a new TB drug since 2009.

The National Institute of Allergy and Infectious Diseases (NIAID) announced that it is expanding its Tuberculosis Research Units (TBRU) program to four centers in a bid to boost innovation in TB research. The agency said it is awarding up to $15.2 million in fiscal year 2015 and as much as $105.3 million over 7 years to fund the four institutions

The TBRU program was founded in 1994 and has operated for 20 years under a contract with Case Western Reserve University, with several study sites overseas, the NIAID said.

The four institutions receiving the new awards are Boston Medical Center, Brigham and Women's Hospital in Boston, Emory University in Atlanta, and Weill Cornell Medical College in New York City.

"By integrating epidemiology, immunology, and microbiology the four awardee institutions will work together to examine how Mycobacterium tuberculosis interacts with the human host and the immune system to cause disease," the NIAID said. "Through animal studies and clinical research, the TBRU program will focus on TB latency and persistence and their relation to active TB disease in humans."
Feb 19 NIAID press release

Meanwhile, the Global Alliance for TB Drug Development (TB Alliance) announced today the launch of a phase 1 trial of the candidate TB drug TBA-354, hailing it as the first phase 1 trial of a TB drug in 6 years.

TBA-354 is in the nitroimidazole class of chemicals, known for effectiveness against drug-sensitive and drug-resistant TB, the group said in a press release. The class also includes the experimental TB drug pretomanid (formerly PA-824), which is being tested as a component of other novel regimens in multiple clinical trials. In preclinical studies, TBA-354 showed more potent anti-bacterial and sterilizing activity than pretomanid, the release said.

Recruitment is under way to enroll nearly 50 US volunteers for the randomized, double-blind phase 1 trial, which will evaluate the safety, tolerability, pharmacokinetics, and dosing of TBA-354, according to the TB Alliance.
Feb 19 TB Alliance release


WHO notes progress, calls for funding for neglected tropical diseases

The World Health Organization (WHO) today issued a report outlining progress made in combatting 17 neglected tropical diseases and next steps required, and it urged affected countries to ramp up their investments to fight the diseases, which affect more than 1.5 billion people, the agency said in a news release.

The new report, "Investing to Overcome the Impact of Neglected Tropical Diseases," outlines the case for financial support and essential interventions for these diseases, which include dengue, rabies, trachoma, yaws, leprosy, Chagas disease, leishmaniases, and schistosomiases.

"Increased investments by national governments can alleviate human misery, distribute economic gains more evenly, and free masses of people long trapped in poverty," said WHO Director-General Margaret Chan, MD, MPH, in the release.

The report says $34 billion over 16 years is needed, a figure that excludes the cost of donated medicines and other in-kind contributions.

Progress mentioned in the report includes the fact that more than 800 million people were treated for at least one neglected tropical disease in 2012. And in 2014 just 126 cases of dracunculiasis (guinea worm disease) were reported globally, compared with almost 1,800 in 2010 and 3.5 million in the mid-1980s.

In addition, Colombia became the first country for which WHO verified the elimination of river blindness (onchocerciasis) in 2013, followed by Ecuador in 2014. And the number of new cases of sleeping sickness (human African trypanosomiasis) has dropped to fewer than 10,000 annually, with 6,314 cases reported in 2013.
Feb 19 WHO report
Feb 19 WHO news release


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