News Scan for Nov 03, 2016

Saudi MERS cases
MDR-TB in West Africa
Antibiotics and sepsis
Kids' infection burden
Fatalities during disasters

Two new MERS patients in critical condition

The Saudi Arabian Ministry of Health (MOH) reported two new cases of MERS-CoV today in men from Buraydah, a city in the central part of the country.

Both men are Saudi nationals and described as having primary exposure to MERS-CoV (Middle East respiratory syndrome coronavirus), meaning they did not contract the virus from someone else. One man is 94 years old, and the other 61. Both remain in critical condition.

On Oct 31, another Saudi man from Buraydah was diagnosed as having MERS. He was also listed in critical condition and described as having primary exposure.

Confirmation of the latest infections raises Saudi Arabia's MERS-CoV total to 1,473 cases, 615 of them fatal. Eight people are still being treated for their infections.
Nov 4 Saudi Arabia MOH report


Study finds high prevalence of drug-resistant TB in West Africa

The prevalence of multidrug-resistant tuberculosis (MDR-TB) in West Africa is much higher than previously thought, according to a study published Tuesday in BMC Medicine.

In the study, investigators from the West African Network of Excellence for TB, AIDS, and Malaria (WANETAM) set out to determine the distribution of MDR-TB in eight West African countries. Although populations in the region are highly susceptible to infectious diseases, the lack of adequate laboratories means data on drug-resistant TB is scarce. To estimate the prevalence of MDR-TB, the investigators collected isolates from new and retreatment patients and tested them for susceptibility to first- and second-line drugs.

In total, the investigators found that 39% of the 974 isolates tested were resistant to one or more front-line drugs, while 22% were considered multi-drug resistant. The prevalence of MDR-TB was 6% in new patients and 35% in retreatment patients, much higher than the World Health Organization's (WHO's) previous estimates of 2% and 17%.

The highest prevalence for MDR-TB was found in retreatment patients in Mali (59%) and two Nigerian sites—Ibadan (39%) and Lagos (66%). Although no extensively drug resistant (XDR) TB isolates were identified, 21% of the isolates were identified as pre-XDR, which means they will develop extensive drug resistance if no effective interventions are instituted.

The authors of the study say their findings suggest MDR-TB could become a serious public health problem in West Africa if control measures aren’t taken.

"We recommend that efforts be put in place for containment of a potential West African TB epidemic at the earliest possible stage," lead investigator Martin Antonio, PhD, said in a news release from BioMed Central, the publisher of the journal. "This is especially important as West Africa with its 245 million inhabitants is one of the poorest regions globally, whose fragile health systems can easily be overwhelmed by infectious disease epidemics, as seen in the recent Ebola outbreak."

Antonio and his colleagues also say their findings should prompt the implementation of continuous surveillance of all retreatment patients in participating countries.
Nov 2 BMC Medicine study
Nov 2 BioMed Central news release


Increased risk of sepsis linked to antibiotic exposure

A study presented at IDWeek 2016 suggests that an increased risk of sepsis following infection-related hospitalization could be linked to antibiotics that disrupt the microbiome.

The study, conducted by researchers with the Centers for Disease Control and Prevention (CDC), used patient records from a hospital drug database to determine how many patients had been re-admitted for sepsis within 90 days of discharge, and how many of those patients had received antibiotics during their initial stay.

In particular, they were looking for antibiotics with a high risk for microbiome disruption, such as third- and fourth-generation cephalosporins, fluoroquinolones, carbapenems, lincosamides, beta-lactam/beta-lactamase inhibitor combinations, and oral vancomycin. Animal studies have shown that giving animals antibiotics that disrupt the balance of good and bad bacteria in the microbiome can have an increased risk of sepsis.

Overall, the data showed that among more than 9 million patients who visited 473 hospitals between 2006 and 2010, 0.6% had sepsis during readmission within 90 days of discharge. When the researchers compared patients who had received antibiotics during the index visit to those who had received no antibiotics, they found that the patients with antibiotic exposure were 50% more likely to be hospitalized with sepsis, and nearly 80% more likely if they had received high-risk antibiotics. Patients who received longer courses of treatment also had a higher risk of sepsis.

"The observed increased risk for subsequent sepsis following receipt of antibiotics that significantly disrupt the microbiome…supports the idea that microbiome disruption confers increased risk for subsequent severe infections, " the study authors concluded.

"It's one more call to really focus our efforts on using antibiotics only when we need them, because the adverse effects are really big," Arjun Srinivasan, MD, told reporters. Srinivasan, who directs CDC programs aimed at preventing healthcare-associated infections, was not involved in the study.
Oct 27 IDWeek abstract


Group recommends 5-step strategy to cut kids' infectious disease burden

More than 3 million children younger than 5 years die from infectious diseases each year, but a simple five-step strategy could reduce the burden, according to a new report commissioned by the Global Hygiene Council (GHC).

The 24-page report, titled "Small Steps for Big Change," was released today and was funded by an educational grant from Reckitt Benckiser, a British maker of health, hygiene, and home products.

According to the report, about 1 million children die of pneumonia each year, and more than 700,000 youngsters die of diarrhea. It also notes complacency in home hygiene practices, with 52% of families saying they don't disinfect household surfaces during cold and flu season. It also said that 31% of foodborne illness outbreaks occur in homes.

John Oxford, PhD, GHC chair and professor emeritus of virology at the University of London, said in a press release that poor personal and home hygiene practices are known as the main cause of infection transmission for colds, diarrhea, and flu. "Hand washing with soap has been shown to reduce diarrheal deaths by 50%, and by developing this 5-step plan, we want to deliver a clear and consistent message about how small changes in hygiene practices could have a big impact on the health and wellbeing of children around the world."

The 5-step program developed by GHC's international experts include reducing the number of infectious diseases in babies, improved hand hygiene, minimizing the risk of contaminated food, cleaning surfaces at home and school, and interrupting disease transmission chains and reducing the need for antibiotics.
Nov 3 GHC report
Nov 3 GHC press release


Experts update field guide for managing dead bodies in disasters

In the first update since 2006, the World Health Organization, its regional office the Pan American Health Organization, and the International Federation of Red Cross and Red Crescent Societies yesterday published a guide for first responders on managing dead bodies after disasters.

In the forward to the 78-page report, the authors said they saw healthy demand for the first edition of the guide, even among more developed nations, but it was time for an update. They note that the document is mainly geared toward natural disasters, but they do cover infectious disease events, while noting that detailed recommendations for highly infectious disease such as Ebola or anthrax are beyond the scope of the document.

The guide covers 10 main steps, from planning and coordination to communicating with families and the media. The information is presented in a streamlined format with passages bulleted whenever possible to allow for easy use and sharing during emergency situations.

In an annex at the end of the guidance , the authors focus on handling bodies of those who die during infectious disease epidemics. They emphasize that untrained first responders shouldn't be involved in managing bodies in epidemics such as Ebola. However, they cover the main principles, such as proper use of personal protective equipment, but warn that the information is not a substitute for proper training by experts.

In October 2014 during West Africa's outbreak the WHO issued a field guide that specifically targets the safe and dignified burial of patients who die from suspected or confirmed Ebola.
Nov 2 field guide

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