News Scan for Mar 10, 2016

H7N9 cases in China
Antibiotic resistance in preemies
Angola yellow fever
Guinea's Ebola surveillance

China reports 10 H7N9 cases

Chinese health officials today reported 10 more H7N9 avian flu infections, 4 of which were fatal, in adults from China's mainland, according to the Hong Kong Centre for Health Protection (CHP) and translated updates posted on FluTrackers, an infectious disease news message board.

Six H7N9 cases, 3 of which were fatal, occurred in patients from China's eastern Jiangsu province, according to FluTrackers. The cases were included in Jiangsu's February epidemiological report, which said there have been 13 H7N9 cases and 4 deaths in the province this season.

FluTrackers also reported two cases of H7N9, one of which was fatal, in the city of Wuhu in China's eastern Anhui province. The city recently held an H7N9 prevention and control conference to address risk factors and spread of the disease. A potential third case from Anhui is being reported by provincial news services and awaiting official confirmation, FluTrackers said.

An H7N9 case involving a 69-year-old man with a history of poultry contact in Zhejiang province was confirmed by officials today, though the case was initially reported by Zhejiang news sources on Feb 22, FluTrackers said.

Hong Kong's Centre for Health Protection today reported an H7N9 case in a 37-year-old man in Jieyang, located in China's southern province of Guangdong.

The latest illnesses lift the global total from the disease to 752, according to a case list maintained by FluTrackers.
Mar 10 FluTrackers post on Jiangsu cases
Mar 10 FluTrackers post on Anhui cases
Mar 10 FluTrackers post on Zhejiang case
Mar 10 CHP report on Guangdong case
FluTrackers H7N9 case list


Study: Preterm babies' gut bacteria carry many antibiotic-resistance genes

A study published this week in Nature Microbiology suggests that the gut bacteria of preterm babies—who often are treated with antibiotics because of their higher risk of infections—carry many antibiotic-resistance genes and are less diverse than the gut bacteria of full-term infants.

Researchers at Washington University School of Medicine in St. Louis analyzed 401 stools from 84 preterm infants and sequenced all of the DNA from the samples, according to the study and an accompanying university press release. Using new techniques that they developed, they found that the gut bacteria contained 794 genes that confer resistance to antibiotics. About 80% of the genes had not previously been linked to resistance.

"We find that multidrug-resistant members of the genera Escherichia, Klebsiella and Enterobacter, genera commonly associated with nosocomial infections, dominate the preterm infant gut microbiota," the authors wrote.

"Our study demonstrates that even well-studied bacteria — the ones that we know cause disease or their close relatives — have many genes associated with antibiotic resistance that have not been characterized before," senior author Gautam Dantas, PhD, said in the release. "Now, we know that preterm-infant guts are attracting exactly the wrong kinds of bacteria."

Co-author Barbara B. Warner, MD, commented in the release that preterm infants often have multiple medical problems, including infections. She added, "The conventional wisdom has been antibiotics can’t hurt and they might help. But our new study demonstrates that wide-scale use of antibiotics in this population does not come without cost."

Compared with full-term babies, preterm infants were found to have 10-fold fewer species of bacteria colonizing the gut, and the preterm babies that received the most antibiotics showed the least species diversity, according to the release. Giving breast milk was associated with increased bacterial diversity, as was increased age, perhaps because of longer exposure time. The drugs most associated with low species diversity were meropenem, cefotaxime, and ticarcillin-clavulanate.

The researchers also found that treating a baby with one antibiotic can boost resistance to seemingly unrelated antibiotics. Dantas said this finding makes sense because they found that the majority of these microbes were resistant to multiple drugs, showing that resistance genes tend to cluster together in the same organisms.
Mar 7 Nature Microbiol abstract
Mar 7 Washington University School of Medicine press release


WHO expands yellow fever vaccination campaign in Angola

In an effort to stem an ongoing yellow fever outbreak in Angola, the World Health Organization (WHO) and Angolan health authorities began a massive campaign to vaccinate more than 6 million people in Luanda province, the WHO said yesterday in a statement.

The WHO has procured 7.4 million doses of yellow fever vaccine, which should provide coverage for everyone over the age of 6 months in Luanda, located on Angola's northwestern coast. The yellow fever vaccine coverage rate in Angola was previously below 80%, the WHO said.

Vaccination teams comprising 400 health professionals per municipality are attempting to vaccinate more than 80% of Luanda's population (approximately 6.7 million people) by Mar 18, with reinforcements from the National Army Health Services, the National Police, and the Angolan Red Cross aiding the effort.

One of Angola's largest barriers to vaccinating the majority of Luanda's population by mid-March is the need to ensure safe and orderly vaccination points that can serve thousands of people per day, mitigate panic due to the outbreak, perform vector control activities to stop transmission of the disease by Aedes aegypti mosquitoes, and maintain an adequate supply of vaccines, the WHO said.

In support of the campaign, the WHO has provided $289,000 from the African Public Health Emergency Fund and $500,000 from the Contingency Fund for Emergencies. The WHO has also requested $7.2 million from the United Nations Office for the Coordination of Humanitarian Affairs in support of vaccine costs.

Over the past 8 days, the number of suspected yellow fever cases in Angola has dropped from 157 to 79, and the death rate has decreased by 63%, the WHO said.

Angola's yellow fever outbreak began in December 2015, with most of the cases reported in Luanda's Viana Municipality. Six other provinces reporting yellow fever cases all had links to Luanda and no evidence of local transmission. Since December, Angola has had 65 confirmed and 813 suspected yellow fever cases, 138 of which have been fatal, the WHO said.
Mar 9 WHO update
Mar 12 CIDRAP News item on the outbreak


In Guinea, local call centers beat national system for Ebola surveillance

An analysis of passive surveillance methods used by Guinean officials to detect Ebola cases found that calls to local centers had a much higher sensitivity for case detection than did results from the national call center, according to a report today in Morbidity and Mortality Weekly Report (MMWR).

To compare the sensitivity of the local and national call systems, the Centers for Disease Control and Prevention (CDC) team in Guinea conducted “probabilistic record linkage” of the combined prefecture alerts database, as well as the national call center database, with the national viral hemorrhagic fever (VHF) database, the report says. The VHF database contains records of all known confirmed Ebola cases.

The CDC team evaluated 185,437 calls made to Guinea's national call center between Nov 5, 2014, and Aug 31, 2015, of which 12% (22,660) were alerts about suspected cases and/or deaths. Among 17,309 alert calls that were anlayzed, 71 confirmed cases were matched to 1,838 confirmed cases in the national VHF database, yielding a sensitivity of 3.9%.

In contrast, 113 confirmed cases detected out of 7,038 local-source calls to local call centers were linked to 221 confirmed cases in the VHF database between Apr 1 and Aug 31, 2015, yielding a sensitivity of 51.1%.

In thirteen of Guinea's prefectures where confirmed cases were reported, the sensitivity of the national call center was less than 1%. The CDC said that national call center sensitivity was lower than local call center sensitivity in all prefectures with case detections, although researchers acknowledge limitations to the study, including the potential for mismatched data and late standardization of local call center information.

Sensitive passive surveillance methods are necessary to detect outbreaks before transmission is widespread, the CDC said. Guinea is currently nearing the end of its 90-day enhanced surveillance period after having been declared Ebola-free on Dec 29, 2015.
Mar 11 MMWR report

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