News Scan for Oct 26, 2016

Jack Woodall dies
Saudi MERS case
H7N2 in ostriches
Ebola outcome in kids
Stewardship and antibiotics
Chikungunya drop

Public health pioneer Jack Woodall dies

Jack Payne Woodall, PhD, 81, died Monday at his home in London after a battle with pancreatic cancer. Woodall might be best known for cofounding ProMED (Program for Monitoring Emerging Disease­) in 1994, the online outbreak reporting system run by the International Society for Infectious Diseases, according to a Stat obituary today. The Web platform promoted early surveillance of outbreaks, including the 2003 SARS outbreak and the current yellow fever outbreak in central Africa.

Woodall worked for more than 50 years in the field of public health, for the US Centers for Disease Control and Prevention, the Rockefeller Foundation in New York, and Yale University, among other institutions.

He began his career with a doctorate in entomology and virology from the London School of Hygiene and Tropical Medicine. He was an arbovirologist, and studied Zika virus in Uganda in the 1960s, and as late as this summer was petitioning the World Health Organization to use fractional dosing to stretch the yellow fever vaccine supply. His career saw him living and working in Africa, South America, Europe, and the United States.

Friend and fellow ProMED moderator Margery Pollock, MD, an epidemiologist, told Stat, "He had an inquisitive mind, a brilliant mind, and he would stimulate discussion wherever he was. . . . Jack really believed in emerging infectious diseases and fixing the disease surveillance problems, the challenges to find out about outbreaks sooner."

ProMED cofounder Stephen Morse, PhD, a professor of infectious diseases at Columbia University, said, "Jack had a remarkable life and did so many things, I once jokingly referred to him as our own Indiana Jones."
Oct 26 Stat obituary


Household contact cited in latest Saudi MERS case

Saudi Arabia's Ministry of Health (MOH) today reported one more MERS-CoV case, in a 65-year-old foreign man who contracted the virus from a household contact, according to a daily update from the MOH.

The man from Arar had symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus) and is listed in stable condition. Arar is in northern Saudi Arabia, and on Oct 23 health officials announced a previous case in the same location, involving a 58-year-old foreign man who had primary exposure to the virus, meaning he wasn't thought to have contracted his illness from another patient.

Confirmation of the latest case raises Saudi Arabia's MERS-CoV total to 1,469 cases, 614 of them fatal. Eight people are still being treated for their infections.
Oct 26 Saudi MOH update


South Africa reports low-path H7N2 avian flu in ostriches for first time

For the first time, H7N2 avian flu is being reported in South African ostriches, according to the World Organization for Animal Health (OIE) in a report yesterday.

On Sep 20, South Africa reported 278 cases of low-pathogenic avian flu in a flock of commercial ostriches in Western Cape province near the southern tip of the continent. There were no mortalities. At the time, it was thought the birds suffered from H5N2, but further genetic sequencing has shown H7N2. This is the first time H7N2 is being reported in ostriches.

The ostriches were housed on a farm near George, located in the Western Cape Province. The outbreak, which began on Jul 10, is considered ongoing, and the OIE will post more updates as they develop.
Oct 25 OIE report


Study: Young age, bleeding point to poor Ebola outcome in kids

A study yesterday in Clinical Infectious Diseases shows that children younger than age 5 who present with high viral loads and bleeding are more likely to die from Ebola infection than older children who don't present with those symptoms.

The insights come from a retrospective study performed by a US-based research team using data from five Ebola treatment centers in Liberia and Sierra Leone in 2014 and 2015. The study adds to a growing body of literature about the 2014-16 Ebola outbreak in West Africa, the worst in history.

In the 122 children enrolled in the study, the overall case-fatality rate was 57%. Only 5% presented with bleeding when admitted into the Ebola treatment center, with 59% eventually exhibiting bleeding. (More than half presented with a fever, the most common symptom.) Hemorrhaging was associated with a 5-fold higher increase in mortality. High viremia, or viral load, was also associated with a 5.2-fold high chance of dying from Ebola.

Being younger than 5 was the strongest predictor of death and was associated with a 14.8-fold higher incidence of death. The median age of children enrolled in the study was 7, but the median age for patients who died was 4. The highest case-fatality rate was seen in children younger than 5 (89%), compared with other age-groups (5-9 years, 43%; 10-14 years, 41%; 15-17 years, 25%).

"There is an urgent need to investigate the mechanisms of disease to understand how these risk factors as well as malnutrition, dehydration and electrolyte imbalance contribute to severe outcomes," the authors conclude. "The goal is to identify simple, scalable and relatively inexpensive measures that can improve health outcomes substantially in children in resource-limited settings."
Oct 25 Clin Infect Dis study


Hospital ASP program reduces antibiotic use 17% in children

A new study in the Journal of the Pediatric Infectious Diseases Society showed that a low-cost antibiotic stewardship program (ASP) substantially reduced antibiotic use among pediatric hospital patients.

Previous studied have shown that 33% to 72% of pediatric patients admitted to a hospital receive antimicrobials, but approximately 50% of those are unnecessary. This study followed an ASP at Randall Children's Hospital (RCH) in Portland, Ore. RCH is a nonfreestanding hospital (90% of children in the United States are treated at nonfreestanding hospitals) with 165 tertiary-care beds, including 24 pediatric intensive care unit (ICU) beds and 46 neonatal ICU beds.

The ASP was launched in in April 2013 and consisted of two actions: Engaging physician groups for systematic improvement, and provide 72-hour prospective auditing and feedback to optimize appropriate antibiotic use. RHC had five physicians in a pediatric infectious disease group leading the ASP. The group educated other physicians and created a protocol for antibiotic prophylaxis in pediatric cardiac surgery.

The authors compared antibiotic use in the 1 year prior to ASP implementation with 2 years after. They found that antibiotic use was reduced by 16.8 %, and use of vancomycin decreased by 38%. Cost savings were estimated to be $67,000 per year over the 2-year post-intervention period.

"We found that with limited dedicated resources, a simple ASP can reduce antibiotic use substantially in a nonfreestanding children's hospital," the authors concluded.
Oct 21 J Pediatr Infect Dis Soc abstract


PAHO reports decline in chikungunya outbreak numbers

In its chikungunya update late last week, the Pan American Health Organization (PAHO) reported a decline of 1,667 cases because hundreds of cases in Panama that were formally classified as suspected have been ruled out as chikungunya infections.

The adjustment brings the number of 2016 cases in the Americas to 302,655, PAHO said in its Oct 21 report. Panama recently confirmed that 1,788 previously suspected cases and 347 recently suspected cases (the latter of which were never noted in a PAHO update) were not chikungunya, according to PAHO media and communications specialist Donna Eberwine. Panama's total fell from 1,798 cases on Oct 14 to 11 confirmed and imported cases last week, a decline of 1,787 cases.

Mexico, El Salvador, and Colombia all reported a small number of new cases, but only double-digit increases. Many countries have not reported on chikungunya for several weeks, so PAHO could report a spike at any time. For example, a month ago Brazil—which has experienced by far the most cases this year—reported a 5-week backlog of almost 48,000 cases and hasn't reported to PAHO since.

The region's chikungunya outbreak started in December 2013 in St. Martin in the Caribbean and so far has sickened 2,181,095 people.
Oct 21 PAHO update

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