News Scan for Jun 10, 2015

Mideast MERS cases
More H7N9 in China
Effect of rotavirus vaccine
Acid suppression and C diff
Vaccine exemptions
Zika virus alert

UAE and Saudi Arabia report one new MERS case each

As MERS continues to spread in South Korea, two more cases have been reported in the Middle East, one in the United Arab Emirates (UAE) and one in Saudi Arabia.

A 77-year-old woman in Abu Dhabi, UAE, is in critical condition with MERS-CoV (Middle East respiratory syndrome coronavirus), the World Health Organization (WHO) reported yesterday. She fell ill May 21 and was hospitalized a week later.

The woman, who has preexisting illnesses, has no history of exposure to known MERS-CoV risk factors in the 2 weeks before she got sick, the WHO said. The UAE informed the agency of the case on Jun 3.

The illness raises the UAE's MERS count to 75 cases, of which 5 have been reported this year, according to a list maintained by FluTrackers, an infectious disease message board. The country is third in cases, behind Saudi Arabia and South Korea.
Jun 9 WHO statement
FluTrackers MERS case list

In Saudi Arabia, the new case involves a 60-year-old Saudi woman in Hofuf, which has accounted for most of the country's cases in May and June. The patient, who is not a healthcare worker, is in stable condition, the Saudi Ministry of Health (MOH) reported. Officials are investigating whether she had any contact with other MERS patients before getting sick.

The MOH also reported the death of a MERS patient in Jeddah whose illness was reported earlier. He was a 55-year-old foreigner who was not a healthcare worker.

Saudi Arabia's MERS tally now stands at 1,029 cases with 452 deaths and 568 recoveries. Eight patients are still in treatment, and one is in home isolation.
Jun 10 MOH statement


China's Zhejiang province reports 4 new H7N9 cases

Health officials in China's Zhejiang province, in their May update of reportable infectious disease, noted four previously unreported cases of H7N9 avian flu, according to a translation of the report posted today by FluTrackers, an infectious disease news message board.

No further information was available about the four cases. Two days ago Jiangsu province posted a similar report involving three cases with a similar lack of detail.

The new cases lift the H7N9 total to 672 infections, according to a case list maintained by FluTrackers.
Jun 10 FluTrackers thread
FluTrackers H7N9 case list


Study: Rotavirus vaccine tied to drops in hospital gastroenteritis

After rotavirus vaccination was implemented in 2006, hospitalizations for acute gastroenteritis among US kids younger than 5 years dropped by 31%, and hospitalizations attributed specifically to rotavirus dropped even steeper, according to a study yesterday in the Journal of the American Medical Association (JAMA).

Researchers from the Centers for Disease Control and Prevention analyzed data on 1,201,458 hospital cases of acute gastroenteritis in that age-group from 2000 to 2012, of which 199,812 involved a rotavirus diagnosis.

Rates of all-cause hospital gastroenteritis dropped by rates ranging from 31% to 55% after introduction of the vaccine. And hospital gastroenteritis rates attributed specifically to rotavirus declined by a low of 63% in 2009 to a high of 94% in 2012. The authors noted that, when vaccination coverage was highest in 2012, the decline was largest for both all-cause disease (55%) and rotavirus disease (94%).

They note that, with rotavirus vaccine coverage only around 73% in 2012, more is needed to increase vaccine uptake.
Jun 9 JAMA study
Jun 9 JAMA press release


AMA advocates limiting vaccine exemptions to medical reasons

The American Medical Association (AMA) jumped into the vaccine-exemption fray yesterday as it passed a resolution against non-medical exemptions for vaccinations, the groups said in a press release.

A policy adopted at the AMA's annual meeting calls for immunization of all US residents—absent a medical reason for not being vaccinated—because disease cases and outbreaks can occur without warning in communities, particularly those with lower rates of immunization. The group added that professionals involved in direct patient care have a particular obligation to get vaccinated to prevent the spread of infectious diseases and ensure the availability of the healthcare workforce.

The AMA reminded the public that US immunization programs have controlled or eliminated diseases such as smallpox, measles, mumps, rubella, diphtheria, and polio. So far only Mississippi and West Virginia bar non-medical exemptions based on personal beliefs; the other 48 states and the District of Columbia offer various types of exemption.

"As evident from the recent measles outbreak at Disneyland, protecting community health in today's mobile society requires that policymakers not permit individuals from opting out of immunization solely as a matter of personal preference or convenience," said AMA Board of Trustees Member Patrice A. Harris, MD.
Jun 9 AMA news release


Study: Acid suppression raises risk of C difficile infection in children

A study published yesterday in Clinical Infectious Diseases suggests that treatment with acid-suppression medications significantly increases the risk of Clostridium difficile infection (CDI) in children.

CDI is an inflammatory colon disease that most often occurs in patients who are on prolonged antibiotic treatment in a healthcare facility. But the authors, from Columbia University and two other institutions, write that the infection has been increasing in children and has recently emerged as a problem in relatively healthy children without traditional risk factors.

They also say that the use of acid-suppression medications, including proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), has increased "dramatically" during the past 10 to 15 years. The medications are a known risk factor for CDI in adults, but there is little information on acid suppression and CDI risk in children, they add.

The team conducted a case-control study using data collected from 1995 to 2014 in The Health Improvement Network (THIN), a collection of electronic medical records maintained by general practitioners in the United Kingdom, with data for more than 13 million people.

The study included patients 0 to 17 years old with records on at least three medical visits or a year of follow-up time. Those who had CDI were matched with up to five controls each by age, sex, THIN practice, time of entry into the dataset, and follow-up time. The main exposure variable was defined as use of PPIs or H2RAs within 90 days of (and starting at least 8 days before) the date of CDI diagnosis.

The authors identified 650 CDI patients and 3,200 controls. They found a more than sevenfold increase in the risk of CDI in children who received the medications, with an adjusted odds ratio (OR) of 7.66 (95% confidence interval, 3.24-18.1). The increase in risk was greater in children 1 to 17 years old than in infants less 1 year. Also, the risk was significantly higher with PPIs than with H2RAs and with shorter intervals between medication use and CDI diagnosis.

"Acid suppression medication was associated with CDI in infants and children in the outpatient setting, with an effect based on medication timing," the authors conclude. "Increased risk for CDI should be factored into the decision to use acid suppression medication in children."
Jun 9 Clin Infect Dis abstract, with link to free full text


Zika virus cases in Brazil prompt CDC travel alert

Travelers to Brazil should take steps to protect themselves from mosquito bites in view of the recent detection of locally transmitted Zika virus infections there, the Centers for Disease Control and Prevention (CDC) said yesterday.

In a Level 1 travel alert, the CDC noted that Brazil on May 14 confirmed 16 locally transmitted cases of the mosquito-borne disease, becoming the first country in the Americas to report the illness. It resembles dengue virus infection but is generally milder and is not known to be fatal.

The CDC said travelers should take standard precautions to prevent mosquito bites, including using repellents and sleeping in screened or air-conditioned rooms or using a bed net if sleeping outside.

Last week the Dominican Republic detected its first Zika virus infection, involving a 12-year-old girl, according to a media report.
Jun 9 CDC notice
Jun 5 CIDRAP News item on Dominican Republic case

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