News Scan for Aug 06, 2015

H5N1 in Ghana, Ivory Coast
Endoscope contamination
Ebola response and research
Legionella in the Bronx
Vaccine exemptions and pertussis

Ghana, Ivory Coast report new H5N1 outbreaks

Animal health officials in Ghana and Ivory Coast yesterday reported more highly pathogenic H5N1 avian flu outbreaks in poultry, signaling a continuation of virus activity that reemerged late last year in Africa.

Ghana's outbreaks began toward the end of July, striking free-range village birds in two locations near Accra, according to a report to the World Organization for Animal Health (OIE). Of 149 susceptible birds, the virus killed 25, with the rest slated for culling.

In Ivory Coast, an outbreak was first detected in early May in village birds in a city in Bouake district, located in the central part of the country, authorities said in a second OIE report. Officials also reported an outbreak in a poultry market in Abidjan that has now been resolved. Between the two events, the virus struck 880 of 1,477 susceptible poultry, with the remaining ones culled to curb disease spread.

Investigation into the source of the outbreaks revealed that the introduction of new live animals and contact with wild species played a role.

The H5N1 virus reemerged in Ghana in June and Ivory Coast in May after an 8-year hiatus. In total, the strain has recently turned up again in five African countries, which in July prompted a warning from the United Nations Food and Agriculture Organization (FAO) that called for more resources to battle the outbreaks.
Aug 5 OIE report on Ghana outbreaks
Aug 5 OIE report on Ivory Coast outbreaks


Tests find residual contamination after endoscope cleaning

Endoscopes commonly used in digestive tract exams can harbor bacteria, even when technicians carefully follow guidance for cleaning the devices, according to a study published in the Aug 1 issue of the American Journal of Infection Control.

Researchers from St Paul and from the Mayo Clinic in Rochester, Minn., tested samples obtained after 60 encounters with 15 colonoscopes and gastroscopes at each cleaning step. They also observed all cleaning steps using a checklist to ensure that protocols were followed according to published guidelines. Cleaning steps included bedside cleaning, automated reprocessing with high-level disinfectant, and storing cleaned devices vertically after drying with isopropyl alcohol and forced air.

When tests showed residual contamination at each step, technicians repeated the cleaning procedures.

Cultures and rapid tests showed that viable organisms and organic residue remained at each cleaning stage, but at different levels. For example, viable organisms were found on 92% of devices after bedside cleaning, 46% after manual cleaning, 64% after high-level disinfection, and 9% after overnight storage. Rapid tests found contamination on high percentages of devices after each cleaning stage.

Researchers concluded that current guidance isn't enough to detect and remove contamination and that more efforts are needed to find processes that can ensure that flexible endoscopes—which have thin tubes, channels, and ports—are free of pathogens before use on the next patient. They also wrote that routine microbial monitoring might be useful.

Earlier this year contaminated duodenoscopes were linked a cluster of drug-resistant infections, some of them fatal, at a Los Angeles hospital.
Jul 30 Am J Infect Control abstract
Aug 5 Elsevier press release on the study


Ebola commentaries tackle final response push, research issues

In separate editorials yesterday in Nature, experts aired two key themes about the battle against Ebola: that international teams need to redouble their efforts to finish off disease in West Africa and that research strategies need to be included early in the outbreak response process, having come too late in the current Ebola epidemic.

In the first editorial, Joanne Liu, MD, international president of Doctors without Borders (MSF), wrote that country health ministries and aid groups must do more to gain the trust of communities in the response, a lesson learned the hard way in the current outbreak. She urged groups not to abandon the fight yet, which will require rebuilding each country's health systems, partly to help identify cases early and reestablish trust in the system.

Liu also warned that some conditions are still in place that could lead to more cases, such as the rainy season and some response gaps. "We need to push through the fatigue and complacency, and put everything we have learned into action to end this epidemic. We must finish the fight against Ebola," she wrote.

In the second editorial, Trudie Lang, PhD, professor of global health at the University of Oxford in the United Kingdom, shared her experience of being part of a team that quickly established clinical trials for treatments in the Ebola outbreak but ran into a 6-week logjam in getting drugs to patients.

Lang said stumbling blocks included lack of skilled workers in African countries to help carry out the trials, contract delays, and competition for getting access to treatment centers. She suggested that a neutral body could help oversee outbreak research and hammer out some of the administrative details. She added that the World Health Organization could help prioritize trials.
Aug 5 Joanne Liu commentary in Nature
Aug 5 Trudie Lang commentary in Nature


Bronx Legionnaire's outbreak reaches 100 cases, 10 deaths

An outbreak of Legionnaire's disease in the Bronx, N.Y., that has been linked to contaminated air conditioning towers has now reached 100 cases and 10 deaths, the Associated Press (AP) reported today.

The outbreak, caused by Legionella bacteria that can become airborne, has primarily affected older people and those with underlying medical conditions, the AP story said. Yesterday the New York City Department of Health and Mental Hygiene (DOHMH) said 92 of the 97 cases reported at the time required hospitalization.

Five of 17 cooling towers in the Bronx tested positive for Legionella, the DOHMH said. The AP said all five towers are in the South Bronx. The DOHMH said in its update, "Health officials are confident that one or more of the five locations that tested positive was the source of the outbreak, and the risk has been removed through disinfection."

So far the nation has had 2,400 Legionnaire's cases this year, the AP story said.
Aug 6 AP story
Aug 5 New York DOHMH update


Study links strict vaccine-exemption laws to low pertussis rates

Lenient state laws regarding childhood vaccinations are associated with increased outbreaks of pertussis (whooping cough), according to a study in the August issue of Health Affairs.

Two University of Georgia scientists measured the association between state kindergarten vaccination exemption laws and vaccination exemption rates from 2002 to 2012, using Centers for Disease Control and Prevention (CDC) annual assessment reports. They then slotted states into quartiles of vaccine-law effectiveness, from high to low, and noted that those with the most effective laws had the lowest rates of pertussis.

The researchers used pertussis data because the disease is fairly common. The United States averages about 45,000 to 50,000 cases, according to CDC data, compared with 60 measles cases a year.

The team identified three policies tied to lower vaccine exemption and pertussis rates: requiring state health department approval for nonmedical vaccine exemptions, allowing exemption from only specific vaccines instead of all vaccines, and mandating criminal or civil punishment for those who don't comply with immunization laws.

They noted that 18 states with the most effective vaccination exemption policies are Alabama, Arkansas, Delaware, Florida, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, South Dakota and Tennessee.

The nine with the least effective laws are Colorado, Idaho, Michigan, Minnesota, Texas, Utah, Vermont, Washington and Wisconsin.

The experts also identified three outliers with the strictest laws: Mississippi, West Virginia, and, as of June, California. The authors found that the first two have the lowest rates of pertussis and allow vaccination exemptions for medical reasons only.
August Health Affairs abstract
Aug 5 University of Georgia news release

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