News Scan for Oct 17, 2016

Saudi MERS cases
ESBL-E in travelers
Cholera in Haiti
Meningitis at UW-Madison
Afghan polio campaign

Two new MERS cases confirmed in Saudi Arabia

The Saudi Arabia Ministry of Health (MOH) reported two new cases of MERS-CoV in the last 3 days. The cases involve camel and health care workplace exposure, two known risk factors for the respiratory virus. These are the first cases reported by the MOH since Sep 29.

On Oct 15 a 73-year-old Saudi man from Hofuf was listed in stable condition after he presented with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus). The man had direct contact with camels. Today the MOH said a 33-year-old expatriate woman, also in Hofuf, was diagnosed as having MERS. She is in stable condition. The woman was asymptomatic and acquired the disease through her job as a healthcare worker.

The cases raise Saudi Arabia's overall MERS total to 1,460, of which 611 have proved fatal.
Oct 15 MOH update
Oct 17 MOH update


International travelers can spread antibiotic-resistant bacteria, study finds

International travel can contribute to the spread of antimicrobial resistance, according to a new study published in The Lancet Infectious Diseases.

For the large-scale, longitudinal cohort study, Dutch researchers collected fecal samples from 2,001 Dutch travelers and 215 non-travelling household members, along with questionnaires on demographics and illnesses that were filled out before and after travel. The median travel duration was 20 days, and the sub-regions most frequently visited were Southeast Asia, eastern Africa, South America, and southern Asia. Fecal samples were screened for the presence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E), which can be resistant to a range of frequently used antibiotics.

Of the 1,847 participants who were ESBL-E negative before travel and submitted fecal samples after return, 633 were found to have acquired at least one ESBL-E during their journey, for an acquisition rate of 34.3%. The participants most likely to get sick were those who had traveled to Southeast Asia (75% incidence).

Researchers found that antibiotic use during travel was the strongest predictor for ESBL-E acquisition. Other independent predictors included diarrhea during travel, traveler's diarrhea that persisted after return, and pre-existing chronic bowel disease.

While the rate ESBL-E acquisition observed in travelers to Southeast Asia was similar to other studies, the researchers also found that the study participants continued to carry ESBL-E bacteria longer than those in previous studies. While the median duration of colonization after travel was 30 days, more than 11% remained colonized after 12 months. In addition, the possibility of transmitting ESBL-E to a household member was 12%.

"Our findings support the substantial contribution of international travel to the spread of ESBL-E and antimicrobial resistance worldwide," the authors wrote.

An accompanying commentary argues that the findings strengthen the message that the risk of antibiotic-resistant bacteria must be taken into account when evaluating travelers with infections, especially those who have traveled to Southeast Asia.
Oct 14 Lancet Infect Dis study
Oct 14 Lancet Infect Dis


More cholera cases in Haiti after hurricane

In the wake of Hurricane Matthew, Haiti is reporting an uptick of cholera cases. The World Health Organization (WHO) said late last week there has already been 477 suspected cases reported in the Grand Anse and South departments. This is in addition to the approximately 700 cases that occur each week in the country.

The WHO and the Pan American Health Organization (PAHO) issued an appeal to donors for $9 million to carry out emergency responses in Haiti. According to the WHO, "75% of the cholera treatment facilities in Sud and Grand Anse departments have been destroyed, while water distribution systems in the main cities of Jeremie and Les Cayes have almost entirely collapsed."

In response to the new cases, the WHO is also sending 1 million doses of cholera vaccine to Haiti, but many say that's not enough to cover all of those at risk for the illness. In Haiti 2.4 million people have been affected by the hurricane, but a worldwide shortage of the vaccine has the WHO using it conservatively, according to a story in The Verge.

Cholera has been endemic to Haiti since 2010, when United Nations (UN) peacekeepers improperly dumped human waste into the Artibonite River. Since then, there have been 10,000 deaths due to cholera infection. Earlier this summer the UN admitted some culpability for causing the outbreak after a US court said the organization was immune from paying any legal damages to victims.
Oct 14 PAHO/WHO press release
Oct 15 The Verge story


Two cases of type B meningitis at UW-Madison prompt vaccinations

After two students were hospitalized last week due to of meningitis infections, the University of Wisconsin-Madison is recommending all undergraduates get vaccinated against the disease, and is offering free vaccines at campus health centers, according to the Associated Press (AP).

The students were diagnosed as being infected with the rare type B meningococcal strain of meningitis. Most American college students are only vaccinated against the more common strains A, C, Y, and W.

Since 2013, type B meningitis has been linked to six college campus outbreaks, and caused one death that year at UW-Madison.

The two infected students are expected to make a full recovery.
Oct 15 AP story


Afghanistan launching polio vaccine campaign

The Public Health Ministry of Afghanistan announced today it was starting a massive polio vaccination campaign in light of a newly reported case. The drive will target 9.5 million unvaccinated Afghani children under the age of 5.

Last week a case was reported in the Barmal district of the eastern Paktika province, the eighth case of polio this year. Earlier this year, other cases were detected in eastern Kunar and southern Helmand and Kandahar provinces.

Afghanistan, along with its neighbor Pakistan and Nigeria, is one of the three remaining countries where polio is endemic. In all three countries, ongoing political turmoil has prevented access to children during previous vaccination campaigns.

The Health Ministry said Afghanistan was still on track to eradicate polio within the next few years.
Oct 17 Xinhua story

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