News Scan for Feb 05, 2016

Finalized USDA poultry standards
Adult vaccine coverage
First MERS autopsy

USDA finalizes new food safety standards for chicken parts, ground poultry

The US Department of Agriculture's (USDA's) Food Safety and Inspection Service (FSIS) announced yesterday that it has finalized new federal standards designed to cut Salmonella and Campylobacter contamination in ground chicken and turkey, as well as in raw chicken breasts, legs, and wings.

In a statement, the USDA said it estimates that implementing the new standards, first proposed in early 2015, will prevent about 50,000 illnesses each year. As part of the efforts, it said the FSIS has updated its microbial testing schedule at poultry facilities and will start posting more information online to help track companies' performance.

The USDA implemented standards for whole chickens in 1996, but it has been concerned about patterns showing that contamination increases further down the production chain when chicken is processed into parts. It said poultry parts make up 80% of chicken that Americans buy. A separate standard for chicken parts and testing done at a point closer to the final product should help reduce exposure to the pathogens, it added.

Al Almanza, the USDA's undersecretary for food safety, said, "This approach to poultry inspection is based on science, supported by strong data, and will truly improve public health." The USDA said the standards fulfill the major steps outlined in a Salmonella Action Plan that it released in 2013.
Feb 4 USDA press release


Adult uptake of Tdap, shingles vaccine rises, but overall coverage low

The US Centers for Disease Control and Prevention (CDC) found that rates of tetanus and diphtheria with acellular pertussis (Tdap) and herpes zoster vaccination increased slightly in adults during 2014, although overall adult vaccination coverage remained similar to 2013 levels, according to today's Morbidity and Mortality Weekly Report (MMWR).

CDC researchers evaluated self-reported immunization statistics from the National Health Interview Survey, focusing on influenza vaccination during the Aug 2013 to June 2014 flu season and during 2014 for all other recommended adult vaccinations.

Tdap vaccination coverage among adults 19 years and older increased by 2.9 percentage points to 20.1%. Herpes zoster uptake in people 60 years and older increased by 3.6 percentage points to 27.9%.

Coverage for other vaccine-preventable diseases remained relatively unchanged compared to 2013 levels, as noted by immunization rates for influenza (43.2% of adults 19 and older), pneumococcal disease (20.3% of high-risk adults ages 19-64; 61.3% of adults 65 and older), tetanus and diphtheria (Td) (62.2% of adults 19 and older), Hepatitis A and B (9% and 24.5%, respectively, of adults 19 and older), and human papillomavirus (HPV) (40.2% in women ages 19-26, 8.2% in men ages 19-26).

Researchers noted that racial and ethnic differences persist, with adult vaccination coverage among whites higher than other groups for all vaccines, with the exception of HPV vaccine uptake, where rates for Caucasian and Black adults were similar, the authors said.

Adults with health insurance, a usual place for receiving health care, and frequent contacts with a physician were more likely to receive recommended immunizations. The authors recommend increased physician assessment of vaccination history and reminder protocols to increase adult vaccine coverage.
Feb 5 MMWR report


First autopsy of MERS patient reveals extensive lung damage

Pathologists have conducted the first autopsy of a MERS-CoV patient, revealing the virus' target cells, involvement outside of the lungs, and potential modes of transmission, according to a case report published today in the American Journal of Pathology.

The report discusses findings from an autopsy performed in 2014 on a 45-year-old male hospital employee in the United Arab Emirates. The patient was part of a MERS-CoV (Middle East respiratory syndrome coronavirus) cluster, although he had no patient care responsibilities or exposure to camels. The authors note that the man shared housing with five paramedic department employees.

Autopsy results showed significant pulmonary damage and cell death, most notable in the alveoli and bronchial submucosal glands. Pathologists confirmed MERS antibodies in pulmonary pneumocytes, epithelial syncytial cells, and bronchial submucosal glands, the latter infection site suggesting a likely route of viral shedding and person-to-person transmission, the authors said.

Aside from evidence of direct viral infection, pathologists also noted that the patient had significant effusion of the pleura, pericardium, and abdomen, along with pulmonary edema and consolidated lungs. No bacterial coinfections were observed.

Researchers found no evidence of direct MERS infection outside of the lungs, though they observed indirect effects to the kidneys likely caused by hypotension or hypoperfusion related to severe illness.

The patient also had multiple comorbidities that became evident on autopsy, including chronic vascular, cardiac, and liver disease.

The autopsy results differ from some observations about MERS that have been made based on animal models of disease, most notably the virus' direct infection only within the pulmonary system. Autopsy results also revealed that the virus primarily targets pneumocytes and epithelial syncytial cells.

Researchers caution that the autopsy results represent only one case report and call for more autopsies on fatal MERS-CoV cases, noting the importance of analyzing all organ systems to understand progression of the infection and adequately test vaccines and treatments.
Feb 5 Am J Pathol case report

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