News Scan for May 01, 2015

Nepal diarrheal outbreak prevention
Saudi MERS case
STEC outbreak in Washington
S aureus in swine workers
Neglected diseases in Africa

WHO, other groups take steps to prevent diarrheal diseases in Nepal

The World Health Organization (WHO) said today that it and partner groups working on earthquake response in Nepal are deploying extra medications and equipment to prevent the spread of diarrheal diseases such as cholera, which can spread when disasters damage and contaminate the clean water supply.

Groups estimate that at least 2.8 million people have been displaced, with many living in 16 makeshift camps.

The WHO said health officials are setting up systems to identify the diseases early and government and other groups are providing safe water and sanitation facilities, such as mobile toilets, at the camps. The WHO said it has been supplying chlorine tablets to treat drinking water along with other supplies to improve hygiene. It is also bringing in medical kits that include intravenous fluids, antibiotics, oral rehydration salts, disinfectant, and other supplies to manage possible outbreaks.

Sporadic cases of diarrheal disease have been reported in the camps, but not at higher than expected levels, the WHO said.
May 1 WHO statement


MERS sickens one more in Saudi Arabia

Saudi Arabia's ministry of health (MOH) today reported a MERS-CoV infection in a 35-year-old man, the first case to be reported in 11 days.

The patient is from Khamis Mushayet, in the southwestern Saudi Arabia's Asir region. He isn't a health worker and didn't have known contact with a suspected or confirmed case in the hospital or in the community. He is hospitalized in critical condition.

After a surge of cases over the past few months, illnesses tapered off in April.

The new case-patient's illness lifts Saudi Arabia's MERS-CoV (Middle East respiratory syndrome coronavirus) total to 982 cases, which includes 428 deaths. The MOH said 551 people have recovered from the disease and 3 are still being treated.
May 1 MOH statement


Children attending dairy festival in Washington ill with STEC

Cases are mounting in an outbreak of Shiga toxin–producing Escherichia coli O157:H7 (STEC) in Washington state children who attended a fair in April. The outbreak has grown by 13 cases with two hospitalizations since the first announcement Apr 28, bringing the count to 17, with four hospitalizations.

Fifteen more cases are considered probable, according to a notice today from the Whatcom County Health Department (WCHD). One child has developed hemolytic uremic syndrome, said a story yesterday in the Seattle Times.

The outbreak is associated with the Milk Makers Fest held Apr 21 through 23 at the Northwest Fairground in Lynden, Wash. More than 1,000 primary school children from Whatcom County attended the dairy festival. Most of the illnesses have been in children, says a story in Food Safety News (FSN), but some have been in adults and older children who attended or worked at the festival.

The WCHD is investigating the outbreak to try and determine whether there was a common food or water source or activity.
May 1 WCHD press release
Apr 30 Seattle Times article

Swine exposure sharply increases carriage of multidrug-resistant staph

Farmers who work with swine are about six times more likely to be colonized with multidrug-resistant Staphylococcus aureus (MDRSA) than people with no swine exposure, according to a study published yesterday in Clinical Infectious Diseases.

The authors claim it is "the largest prospective examination of S. aureus infection in a cohort of livestock workers worldwide, and the first such study in the United States."

The researchers, from the University of Iowa, Kent State University, and the National Cancer Institute, followed 1,342 individuals from across Iowa, 1,289 of them adults, for up to 17 months. Nose and throat swabs were collected during the study period and tested for bacteria, and antibiotic susceptibility testing was done on isolates. Questionnaires were completed regarding demographic data and S aureus risk factors.

Of the adults, 596 (46.2%) reported past or current occupational livestock exposure.

Overall, 351 (26%; 95% confidence interval [CI], 23.8%-28.6%) participants carried S aureus in the nose, throat, or both. Of those with colonization, 68 (19.4%) carried MDRSA. Those with current swine exposure were significantly more likely to carry MDRSA (prevalence ratio [PR], 6.1; 95% CI, 3.8-10.0) than those with no exposure, and an upward trend was noted with increasing exposure.

Skin infections, a potential manifestation of S aureus infection, were reported by 67 individuals (103 instances), for an incidence rate of 6.6 (95% CI, 4.9-8.9) per 1,000 person-months. S aureus infection was confirmed in 47 instances for an incidence rate of 2.7 (95% CI, 1.8-3.9) per 1,000 person-months.

"In a rural state like Iowa, which ranks third nationally in overall livestock production and first in swine production, transmission of S. aureus between pigs and farmers and into the broader community could complicate efforts to control S. aureus transmission statewide, and could have effects nationally due to movement of colonized pigs or travel by colonized humans," say the authors.
Apr 29 Clin Infect Dis abstract

In related research, authors of an observational study carried out in Guangdong, China, found that there are dose-response relations between occupational livestock contact and human carriage of methicillin-resistant S aureus (MRSA).

The study involved 682 farm workers, veterinarians, slaughterhouse workers, and butchers as well as 1,178 individuals with no livestock exposure. Overall prevalence of S aureus nasal carriage was 10.8%, with a higher rate among livestock-exposed workers (13.3%) than those unexposed (9.3%) (P = 0.006). The prevalence of MRSA overall was 3.4%, with a significantly higher rate of carriage in those with livestock contact (7.0%) than those without (1.4%) (P < 0.001).
Apr 30 Am J Infect Control abstract


WHO plans call for new agency to address neglected diseases in Africa

The WHO's Regional Office for Africa announced yesterday that African countries and other stakeholders have agreed on the general framework for a new "entity" to combat neglected tropical diseases (NTDs) on the continent.

"Health experts, donors, development partners and affected countries have reached a consensus on the main components of the framework for establishing a new NTD entity," the office said in a statement from Johannesburg. "This entity will support and guide affected countries in the African region to accelerate the implementation of actions required to eliminate NTDs by 2020."

The WHO said the new agency will focus on the five diseases that can be treated with mass drug administration: elephantiasis, river blindness (onchocerciasis), trachoma, bilharzia, and intestinal worms. Its operations will build on experience gained in recent years in tackling NTDs.

The statement noted that the African Programme for Onchocerciasis Control (APOC), established in 1995, will close on Dec 31, 2015. The new NTD group will facilitate the smooth transition of technical support to affected countries as APOC closes, the WHO noted.

The WHO said Africa carries half the global burden of NTDs, which affect millions of impoverished people.
Apr 30 WHO Africa statement


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