News Scan for Feb 20, 2015

900th Saudi MERS case
New virus, likely tick-borne
Drug-resistant malaria
Smallpox vaccine guidelines
H7N9 death in China
Salmonella in cucumbers

Saudi MERS case raises nation's total to 900

A new case of MERS-CoV and one death in a previously reported case bring totals since June 2012 to 900 and 383, respectively, in Saudi Arabia, according to a report today from the country's Ministry of Health (MOH).

The new case-patient is a 58-year-old Saudi woman from Buraydah in the central part of Saudi Arabia. She is not a healthcare worker but had exposure to MERS-CoV (Middle East respiratory syndrome coronavirus) in a clinical setting. The woman has an underlying medical condition and had no exposure to animals or to MERS cases in the community.

The MOH also reported the death of a 58-year-old man from Khobar in the east central part of the country. He was not a healthcare worker and had an underlying medical condition.

Of the 900 total MERS-CoV cases, 488 people have recovered, 27 cases are still active, and 2 people remain in home isolation.

MERS-CoV cases this year have reached 122 compared with 51 this time last year, according to a Saudi Gazette story today. The MOH today warned that Saudi MERS cases may continue to increase, partly owing to changing weather conditions, the story said.
Feb 20 MOH update
Feb 20 Saudi Gazette


CDC details fatal infection with new, presumably tick-borne virus

A Kansas man whom medical professionals tested for the newly reported Heartland virus was instead infected by another presumably tick-borne virus, a novel member of the genus thogotovirus, according to a report yesterday in Emerging Infectious Diseases.

Researchers from the US Centers for Disease Control and Prevention (CDC) and Kansas reported that the Bourbon County man, who was over 50 and previously healthy, became ill with nausea, weakness, and diarrhea several days after receiving several tick bites and removing an engorged tick from his shoulder.

The following day he developed a fever, loss of appetite, chills, headache, muscle aches, and joint pain. The man received doxycycline from his primary care physician for a presumed tick-borne disease on his third day of illness, but the next day he was hospitalized because of reduced consciousness.

On his eighth day of illness he was transferred to a tertiary care center, where test results were negative for Rocky Mountain spotted fever, Lyme disease, and ehrlichiosis. The patient deteriorated despite intensive care and died 11 days after his first symptoms.

A whole-blood specimen collected 9 days after illness onset was sent to a CDC lab for Heartland virus testing. Scientists were able to isolate a virus that they determined was a novel thogotovirus species and proposed calling it Bourbon virus after the patient's county of residence. They said the virus was likely the cause of the man's illness.

Kansas first reported the case and the new virus in December, but at that time it wasn't clear if the virus was the cause of the man's death, and the virus's genus was not identified.

The only other thogotovirus known to occur in the United States is Aransas Bay virus, which was isolated from Ornithodoros ticks collected off the coast of Texas and reported last year, according to the authors.
Feb 19 Emerg Infect Dis report
CDC Q&A document on Bourbon virus
Related Dec 23, 2014, CIDRAP News item


Malaria survey finds artemisinin resistance widespread in Myanmar

A study of malaria parasites from patients in Myanmar indicates that resistance to artemisinin, a key antimalarial drug, is widespread in the country, according to a report yesterday in The Lancet Infectious Diseases.

Artemisinin combination therapy (ACT) has been the chief tool for treating Plasmodium falciparum malaria in recent years and has been credited for significant progress against it. Resistance to artemisinin was first noted in the Cambodia-Thailand border area in 2009 and has since caused growing concern.

In the survey, researchers from Myanmar, Thailand, and the United Kingdom took P falciparum samples at malaria treatment centers at 55 sites in 10 administrative regions of Myanmar and certain border regions of Thailand and Bangladesh. They analyzed sequences from the "propeller" region of the K13 gene, the site of mutations identified as key determinants of artemisinin resistance.

"Overall, 371 (39%) of 940 samples carried a K13-propeller mutation," the report says. The team found 26 different mutations, including 9 that had not been previously reported in Southeast Asia.

In seven of the 10 administrative regions, the combined K13-mutation prevalence was more than 20%, the team found. The overall prevalence of K13 mutations surpassed 10% in much of the country's eastern and northern regions. In Homalin, a city in the Sagaing Region, 25 kilometers from the Indian border, 21 of 45 parasite samples (47%) had K13-propeller mutations.

"Artemisinin resistance extends across much of Myanmar," the report states. "Appropriate therapeutic regimens should be tested urgently and implemented comprehensively if spread of artemisinin resistance to other regions is to be avoided."
Feb 19 Lancet Infect Dis abstract and full text (pdf)
Related Nov 12, 2013, CIDRAP News story


CDC smallpox vaccination guidance addresses emergency scenario

Smallpox vaccination guidelines just released by the federal government address the use of the nation's three stockpiled vaccines in response to the accidental or intentional release of the deadly virus.

Smallpox was declared eradicated in 1980, but supplies of the virus are maintained for research in the United States and Russia, and there is concern that samples may exist elsewhere and be used for bioterrorism.

The United States built a stockpile of smallpox vaccine after the terrorist attacks of 2001. It now includes three vaccines: ACAM2000, Aventis Pasture Smallpox Vaccine (APSV), and Imvamune, according to the new guidance, published by the CDC today in Morbidity and Mortality Weekly Report (MMWR) Recommendations and Reports.

The vaccines contain live vaccinia virus, a cousin of the smallpox (variola) virus. ACAM2000 and APSV are "replication-competent" vaccines, while Imvamune is an attenuated vaccine intended for those, such as immunocompromised persons, at risk for complications from standard vaccinia strains.

The report says that the CDC in 1991, 2001, and 2003 issued guidance on the use of smallpox vaccines in pre-event vaccination programs, meaning with no cases of smallpox. "However, these recommendations did not fully address the use of smallpox vaccine in a postevent emergency response setting" involving a confirmed case of smallpox anywhere in the world.

Also, ACMA2000 was added to the national stockpile in 2007, later than the previous guidance, and Imvamune was added later still, the report notes. Consequently, "recommendations for the use of these vaccines in a postevent emergency response setting are needed for health-care providers and public health personnel."

The report includes detailed descriptions of the three vaccines, general vaccination recommendations, and guidance on vaccination of groups with vaccine contraindications and various medical conditions.
Feb 20 MMWR Recommendations and Reports article


New Guangdong patient with H7N9 diagnosed and died same day

A 78-year-old resident of Meizhou, a city in the far northeastern part of China's Guangdong province, was diagnosed as having H7N9 avian flu yesterday and died of the disease the same day, according to a press release today from Hong Kong's Centre for Health Protection (CHP).

The CHP release says the case-patient was a man; machine translations regarding the fatal case posted by FluTrackers, an infectious disease news message board, are unclear as to the patient's sex, referring to both a male and a female and in one saying "male" but calling the patient "she."

Guangdong, followed closely by Zhejiang province, has been the site of the most cases of H7N9 in the ongoing outbreak that began in early 2013. FluTrackers puts the total cases at 599.
Feb 20 CHP press release
FluTrackers case listing


CDC evaluates 2014 Salmonella Newport outbreak from cucumbers

A multistate outbreak of cucumber-related Salmonella Newport sickened 275 people in the summer of 2014 and may be related to an unidentified environmental reservoir for the subtype, according to today's MMWR.

Health officials first detected a Salmonella Newport case related to cucumber consumption in August 2014, and the outbreak widened to include 275 people in 29 states and the District of Columbia. Illness onsets ranged from May 20 to Sept 30, and one death from bacteremia was reported in an elderly man.

Among the 141 people with available case information, 48 (34%) were hospitalized. More than half (62%) of the 79 people who provided details ate cucumbers in the week before becoming ill.

Although the source of contamination was never identified, officials traced the illnesses to cucumbers grown in the Delmarva Region of Virginia's Eastern Shore. This was the first time cucumbers have been linked to Salmonella Newport infections; however, previous outbreaks of Salmonella Newport have been linked to tomatoes grown in the Delmarva Region.

The CDC said that, because of Salmonella Newport's transmission via a novel vehicle (cucumbers) in 2014, there is likely an unidentified environmental reservoir for the bacterium in Virginia's Delmarva Region.
Feb 20 MMWR report

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