News Scan for Oct 21, 2016

More MERS in Saudi Arabia
Zika funding offer
Antibiotic de-escalation
Hep A outbreak grows
Chikungunya update

Three new cases of MERS in Saudi Arabia

Today the Saudi Arabia Ministry of Health (MOH) said there were three new cases of MERS-CoV in the country, including two cases acquired in the healthcare settings.

A 72-year-old Saudi woman from Najran is in stable condition after presenting with symptoms of  MERS-CoV (Middle East respiratory syndrome coronavirus). The case is listed as "primary," meaning the patient did not contract the disease from someone else infected with the respiratory virus.

A 61-year-old man from Hofuf is also in stable condition after presenting with symptoms of MERS. This is the third case in that city within the last week, one of which was a healthcare worker, pointing to a possible healthcare cluster of infections. The latest case was listed as having acquired the virus as a patient in a healthcare facility.

Finally a 40-year-old Saudi man from Urayarah was diagnosed as having MERS. He is also in stable condition and presented with symptoms. The man was a healthcare professional and acquired the virus at work.

The new cases brings Saudi Arabia's total to 1,465 cases, including 612 fatalities. Eight patients are still undergoing treatment.
Oct 21 Saudi MOH report


CDC offers $70 million more for Zika funding

The Centers for Disease Control and Prevention (CDC) said today they will be giving an additional $70 million of funding to states, cities, and territories to support Zika prevention, surveillance, and monitoring. The money is made available through the CDC’s Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement.

States have until Nov 20 to apply for the funds, and awards will be determined on factors such as Zika disease burden, current laboratory capacities, and the presence of the mosquitoes that can carry Zika virus.

In other news, the Florida Department of Health (Florida Health) said today that there were three new non-travel related Zika cases in Miami-Dade County today.  One case was linked to the Miami Beach active transmission zone, and the other two cases are currently being investigated. There are now 169 non-travel related cases of Zika in Florida.

Finally today, the World Health Organization’s (WHO) weekly Zika situation report showed little change from last week. Grenada, however, has reported its first case of Zika-related microcephaly.
Oct 21 CDC press release
Oct 21 Florida Health update
Oct 21 WHO Zika situation report


Study finds benefits for antibiotic de-escalation in pneumonia patients

A new study out of Spain has found that antibiotic de-escalation in adult patients with community-acquired pneumonia appears safe and effective and does not adversely affect outcomes.

The study, published yesterday in the Journal of Antimicrobial Chemotherapy, is a retrospective analysis of all adult patients with community-acquired pneumococcal pneumonia (CAPP) admitted to a public hospital in Barcelona, Spain from 1995 to 2014. The aim of the investigation was to determine whether antibiotic de-escalation therapy—in which the initial broad-spectrum antibiotic therapy was narrowed to penicillin, amoxicillin, or amoxicillin/clavulanate within 72 hours of admission—had any impact on clinical outcomes in CAPP patients. The primary outcomes measured were 30-day mortality and length of hospital stay (LOS).

Of the 1,410 episodes of CAPP, antibiotic de-escalation within the first 72 hours after admission was performed on 166 patients. Those patients, it was observed, had a less severe presentation at admission than the non-de-escalation group. After adjustment for confounding factors in multivariate and propensity score analyses, investigators found that antibiotic de-escalation was not associated with an increased risk of 30-day mortality but was associated with a shorter LOS and duration of intravenous (IV) antibiotic therapy. Similar results were observed in a subgroup of patients who had high-risk pneumonia, were clinically unstable within 72 hour of admission, or had bacteremia.

The authors say that the results of their study suggest that de-escalation strategies should be more widely implemented in the management of hospitalized adults with CAPP.
Oct 20 J Antimicrob Chemother study 

More hepatitis A cases linked to frozen strawberries

Yesterday the Centers for Disease Control and Prevention (CDC) updated the case count on a multistate outbreak of hepatitis A linked to frozen strawberries imported from Egypt. Now three more people have gotten sick, bringing the total to 134 cases in 9 states.

The outbreak is tied to smoothies made with the imported strawberries and sold at the chain Tropical Smoothie Café. As of Aug 8, Tropical Smoothie Café removed the frozen strawberries from all their restaurants. Patients report drinking smoothies on or before Aug 8.

Now 107 people in Virginia, 12 people in Maryland, 7 people in West Virginia, 3 people in New York, and 1 person each in Arkansas, California, North Carolina, Oregon, and Wisconsin have been diagnosed as having hepatitis A. Fifty-two people have been hospitalized, and no deaths have been reported.

The CDC said anyone who experiences symptoms of hepatitis A and ate at a Tropical Smoothie Café on or before Aug 8 should report to their doctor.
Oct 20 CDC update


PAHO update reflects further drop in chikungunya cases

In its latest update on chikungunya activity in the Americas region, the Pan American Health Organization (PAHO) reported 174 more suspected or confirmed cases, signaling a continued decline in infections. However, several countries have not reported to PAHO for several weeks.

Last week's increase was much less than the 627 new cases reported the week before, and sharply down from more than 47,000 reported 3 weeks ago. So far this year 304,322 suspected, confirmed, and imported cases have been reported from across the Americas. The number of deaths this year stayed even at 106.

The handful of locations reporting new cases includes Costa Rica, Colombia, El Salvador, Mexico, and Puerto Rico.

The region's chikungunya outbreak started in December 2013 in St. Martin in the Caribbean and so far has sickened 2,182,762 people.
Oct 14 PAHO update

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